PURPOSE: The purpose of this descriptive study was to identify the impact of workplace bullying and LMX (Leader-Member Exchange) on turnover intention among nurses. METHODS: The participants were 364 nurses from the Seoul metropolitan area who were attending a continuing education program. A structured questionnaire was used for data collection and data were analyzed using the SPSS/Window program. Hierarchical multiple regression analysis was performed to verify the effect of variables on turnover intention. RESULTS: Higher workplace bullying was associated with higher turnover intention. Workplace bullying was negatively correlated with leader-member exchange. The most influential factors for turnover intention were LMX (beta=-7.22, p<.001), work load (beta=2.96, p=.003), and workplace bullying (beta=2.64, p=.009). These factors accounted for 28% of the variance in turnover intention. CONCLUSION: The study results indicate that there is need to develop strategies to prevent workplace bullying and cultivate a good relationship between nursing managers and nurses to lower nurses' turnover intention.
Bullying* ; Data Collection ; Education, Continuing ; Intention* ; Leadership ; Nursing ; Surveys and Questionnaires ; Regression Analysis ; Seoul

OBJECTIVES: Autism is a complex neurodevelopmental spectrum disorder with a strong genetic component. Previous neurochemical and genetic studies have suggested the possible involvement of the serotonin system in autism. Tryptophan 2,3-dioxygenase(TDO2) is the rate-limiting enzyme in the catabolism of tryptophan, which is the precursor of serotonin synthesis. The aim of this study was to investigate the association between the TDO2 gene and autism spectrum disorders(ASD) in a Korean population. METHODS: The patients were diagnosed with ASD on the basis of the DSM-IV diagnostic classification outlined in the Korean version of the Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule. The present study included the detection of four single nucleotide polymorphisms(SNPs) in the TDO2 gene(rs2292536, rs6856558, rs6830072, rs6830800) and the family-based association analysis of the single nucleotide polymorphisms in Korean ASD trios using a transmission disequilibrium test(TDT) and haplotype analysis. The family trios of 136 probands were included in analysis. 87.5% were male and 86.0% were diagnosed with autism. The mean age of the probands was 78.5+/-35.8 months(range: 26-264 months). RESULTS: Two SNPs showed no polymorphism, and there was no significant difference in transmission in the other two SNPs. We also could not find any significant transmission in the haplotype analysis(p>.05). CONCLUSION: We could not find any significant statistical association between the transmission of SNPs in the TDO2 gene and ASD in a Korean population. This result may not support the possible involvement of the TDO2 gene in the development of ASD, and further exploration might be needed to investigate other plausible SNP sites.
Appointments and Schedules ; Autistic Disorder* ; Child ; Autism Spectrum Disorder* ; Classification ; Diagnostic and Statistical Manual of Mental Disorders ; Haplotypes ; Humans ; Male ; Metabolism ; Polymorphism, Single Nucleotide ; Serotonin ; Tryptophan

Purpose: We have developed and operated a portfolio-based course aimed at strengthening pre-medical students’ capabilities for self-management and self-improvement. In order to determine the effectiveness of the course and to establish future operational strategies, we evaluated the course and the students’ learning experience. Methods: The subjects of this study were 97 students of a pre-medical course “Self-development and portfolio I” in 2019. Their learning experience was evaluated through the professor’s assessment of portfolios they had submitted, and the program was evaluated based on the responses of 68 students who completed a survey. The survey questionnaire included 32 items. Descriptive statistics were reported for quantitative data, including the mean and standard deviation. Opinions collected from the open-ended question were grouped into categories. Results: The evaluation of students’ portfolios showed that only 6.2% of the students’ portfolios were well-organized, with specific goals, strategies, processes, and self-reflections, while most lacked the basic components of a portfolio (46.4%) or contained insufficient content (47.4%). Students’ responses to the survey showed that regular portfolio personality assessments (72.1%), team (64.7%), and individual (60.3%) activities were felt to be more appropriate as educational methods for this course, rather than lectures. Turning to the portfolio creation experience, the forms and components of the portfolios (68.2%) and the materials provided (62.2%) were felt to be appropriate. However, students felt that individual autonomy needed to be reflected more (66.7%) and that this course interfered with other studies (42.5%). Conclusion The findings of this study suggest that standardized samples, guidelines, and sufficient time for autonomous portfolio creation should be provided. In addition, education on portfolio utilization should be conducted in small groups in the future.

Purpose: This study was conducted to identify suggestions for improving the effectiveness and promoting the success of the current problem-based learning (PBL) program at the Catholic University of Korea College of Medicine through a professor and student awareness survey. Methods: A survey was carried out by sending out mobile Naver Form survey pages via text messages 3 times in December 2018, to 44 medical students and 74 professors. In addition, relevant official documents from the school administration were reviewed. The collected data were analyzed to identify the achievement of educational goals, overall satisfaction with, and operational suitability of the PBL program. Results: The overall satisfaction scores for the PBL program were neutral (students, 3.27±0.95 vs. professors, 3.58±1.07; P=0.118). Regarding the achievement of educational goals, the integration of basic and clinical medicine and encouragement of learning motivation were ranked lowest. Many respondents expressed negative opinions about the modules (students, 25.0%; professors, 39.2%) and tutors (students, 54.5%; professors, 24.3%). The students and professors agreed that the offering timing of the program in medical school and the length of each phase were suitable, while opinions expressed in greater detail pointed to issues such as the classes being held too close to exams and their alignment with regular course units. Conclusion Issues with modules and tutors were the most pressing. Detailed and appropriate modules should be developed on the basis of advice from professors with experience in PBL tutoring. Inconsistencies in tutoring should be reduced by standardization and retraining.

Purpose: Overweight (OW)/obese girls tend to have an earlier pubertal onset than girls with normal weight. However, only a few studies have reported the progression of puberty in these girls. This study aimed to identify risk factors for rapid pubertal progression in OW/obese girls presenting with precocious breast development. Methods: This retrospective cohort study reviewed the medical records of 110 OW (body mass index [BMI] ≥85th percentile for age and sex) and 213 nonoverweight (NW, BMI <85th percentile for age and sex) girls who presented with breast budding before 8 years of age. OW girls were divided into 2 subgroups: girls with central puberty progression before 9 years of age (OW-RP) and those without (OW-SP). Results: Progression to central puberty before the age of 9 was more common in NW girls than in OW girls (83.8 % vs. 65.2 % in NW vs. OW group, p<0.001), and progression-free survival for 1, 2, and 3 years was higher in the OW group (p<0.001). In a subgroup analysis of OW girls, the OW-RP subgroup had more advanced bone age (BA) at the first visit (p=0.047) and higher initial luteinizing hormone (LH, p=0.010) levels than the OW-SP subgroup. Being NW (p=0.001) and having more advanced BA (p=0.023) at the initial workup were the risk factors for pubertal progression before age 9. Conclusion Pubertal progression seems to be slower in OW girls than in NW girls presenting with precocious breast development. However, it can progress rapidly in OW girls with particularly pronounced BA advancement and high LH levels at the initial workup.

Purpose: Consistent evaluation procedures based on objective and rational standards are essential for the sustainability of portfolio-based education, which has been widely introduced in medical education. We aimed to develop and implement a portfolio assessment system, and to assess its validity and reliability. Methods: We developed a portfolio assessment system from March 2019 to August 2019 and confirmed its content validity through expert assessment by an expert group comprising 2 medical education specialists, 2 professors involved in education at medical school, and a professor of basic medical science. Six trained assessors conducted 2 rounds of evaluation of 7 randomly selected portfolios for the “Self-Development and Portfolio II” course from January 2020 to July 2020. These data are used inter-rater reliability was evaluated using intra-class correlation coefficients (ICCs) in September 2020. Results: The portfolio assessment system is based on the following process; assessor selection, training, analytical/comprehensive evaluation, and consensus. Appropriately trained assessors evaluated portfolios based on specific assessment criteria and a rubric for assigning points. In the analysis of inter-rater reliability, the first round of evaluation grades was submitted, and all assessment areas except “goal-setting” showed a high ICC of 0.81 or higher. After the first round of assessment, we attempted to standardize objective assessment procedures. As a result, all components of the assessments showed close correlations, with ICCs of 0.81 or higher. Conclusion We confirmed that when assessors with an appropriate training conduct portfolio assessment based on specified standards through a systematic procedure, the results are reliable.

The present study was aimed at investigating the regulation of atrial natriuretic peptide (ANP) system in association with either enhanced or attenuated activity of the renin-angiotensin system (RAS). The cardiac tissue mRNA and peptide levels of ANP were measured in rats with two-kidney, one clip (2K1C) or deoxycorticosterone acetate (DOCA)-salt hypertension. Plasma renin concentration was increased in 2K1C hypertension along with increases of renin mRNA and protein contents in the clipped kidney. On the contrary, it was suppressed in DOCA-salt hypertension along with decreases of renin mRNA and protein contents in the remaining kidney. The plasma ANP concentration was similarly increased in both models of hypertension. The cardiac tissue ANP contents were not significantly changed, but the tissue ANP mRNA levels were upregulated in the hypertrophied heart in these two models of hypertension. It is suggested that the cardiac ANP system is transcriptionally enhanced by cardiac hypertrophy associated with hypertension, independent of the systemic RAS.
Animal ; Atrial Natriuretic Factor/metabolism* ; Desoxycorticosterone ; Gene Expression Regulation ; Hypertension/metabolism* ; Hypertension/chemically induced ; Male ; Myocardium/pathology ; Organ Weight ; Peptides ; RNA, Messenger/analysis ; Rats ; Rats, Sprague-Dawley ; Renin/genetics* ; Renin/blood* ; Renin-Angiotensin System/physiology

Preservation of peritoneal membrane function is important in the success of long-term peritoneal dialysis (PD). During PD, human peritoneal mesothelial cells (HPMC) are continuously exposed to unphysiological peritoneal dialysis solution(PDS) charaterized by high glucose and lactate concentrations, low pH, and hyperosmolality. Since few studies have examined the effects of lactate and pH on HPMC biology, the present study investigated the effects of lactate and pH on the viability and proliferation of cultured HPMC and on the production of TGF-beta1, a fibrogenic cytokine, and fibronectin by cultured HPMC. HPMC were obtained from the omental tissue of pregnant women who were undergoing Cesarean section. Cells at confluence were utilized to determine the viability(LDH release), proliferation([3H]-thymidine incorporation), and the production of fibronectin and TGF-beta1(ELISA) after synchronizing the cell growth by incubating with serum free media for 24 hours. After exposure to the media containing lactate and pH, LDH release increased in dose- and time-dependent manner. Both 1.5% and 4.25% commercial PD solutions were cytotoxic and induced more than 80% LDH release within 24 hours. LDH release decreased with increasing dilution of commercial peritoneal dialysate, but there was no significant difference in LDH release between 1.5% and 4.25% PDS. LDH release increased in response to pH 5.5. Thymidine incorporation assay revealed that lactate and low pH significantly inhibited proliferation of HPMC. ELISA revealed that exposure of HPMC to lactate and low pH decreased fibronectin protein synthesis, when compared to cell exposed to bicarbonate containing M199 media. Our results clearly show that lactate and low pH lead to dose- and time-dependent cell death and reduce proliferation of cultured HPMC. Lactate and low pH per se appear to decrease fibronectin production by HPMC but may set a stage for other factors to promote progressive fibrosis during the healing stage in long-term PD.
Biology ; Cell Death ; Cesarean Section ; Culture Media, Serum-Free ; Enzyme-Linked Immunosorbent Assay ; Female ; Fibronectins ; Fibrosis ; Glucose ; Humans* ; Hydrogen-Ion Concentration* ; Lactic Acid* ; Membranes ; Peritoneal Dialysis ; Pregnancy ; Pregnant Women ; Thymidine ; Transforming Growth Factor beta1

PURPOSE: We report a case of systemic cystinosis who showed cystine crystal depositions within cornea. METHODS: A 13-year-old boy with systemic cystinosis who had chronic renal failure, growth retardation, rickets for 9 years was consulted for ophthalmic examination for photophobia. We performed complete ophthalmic examinations including slit lamp examination, corneal pachymetry, corneal sensitivity test, specular microscopy, corneal topography, and fundoscopic examination. RESULTS: There were needle-like cystine crystal depositions within the entire corneal stroma. Other findings were within normal. CONCLUSIONS: We report a case of sytemic cystinosis that had cystine crystal depositions within cornea. It is the first case report in Korea.
Adolescent ; Cornea* ; Corneal Pachymetry ; Corneal Stroma ; Corneal Topography ; Cystine* ; Cystinosis* ; Humans ; Kidney Failure, Chronic ; Korea ; Male ; Microscopy ; Photophobia ; Rickets

PURPOSE: The purpose of this study were to identify the influential factors of bullying of intensive care nurses and to suggest a final structural model based on identified relationships between nursing organizational culture, authentic leadership, self-esteem, and bullying in the workplace. METHODS: Data were collected from 221 nurses at intensive care units in eight general hospitals using structured questionnaires and analyzed by structural equation modeling. RESULTS: In this study, the average of bullying in the workplace was 1.34±0.40, nursing organizational culture was 3.31±0.47, self-esteem was 2.79±0.44, and authentic leadership was 3.61±0.60. The factors affecting nursing organizational culture were authentic leadership (β=.54, p<.001) and self-esteem (β=.24, p=.002) that had direct positive effects on the nursing organizational culture. The nursing organizational culture had also a direct effect on reducing workplace bullying (β=−.45, p<.001). Authentic leadership (β=−.24, p=.004) and self-esteem (β=−.11, p=.004) had indirect effects on workplace bullying, which was mediated by the nursing organizational culture. CONCLUSION To understand and reduce workplace bullying, evaluating a nursing organizational culture should be preceded. Based on the finding of this study, an intervention for increasing authentic leadership and self-esteem of nurses can positively help to create the nursing organizational culture and then reduce workplace bullying.