PURPOSE: The purpose of the study was to compare salivary cortisol levels, self-reported occupational stress, and anxiety before duty to those after duty in the shift and regular work nurses, and the relationships among them. METHODS: Thirty nurses working in a tertiary hospital participated in the study. Salivary specimens were collected before and after daytime duty for 2 days. The occupational stress and state anxiety were also evaluated using self-report questionnaires. RESULTS: The average level of salivary cortisol was 0.40 µg/dL before duty and 0.20 µg/dL after duty in Korean nurses. Overall levels of salivary cortisol, self-reported occupational stress, and anxiety were higher in shift working nurses than regular working nurses. In shift working nurses, the salivary cortisol gap between before and after duty was attenuated on the first day of daytime duty. Significant positive correlation was found between the level of cortisol before duty and anxiety after duty. CONCLUSION: Strategies to alleviate occupational stress and anxiety are needed for shift working nurses, especially for those with elevated levels of cortisol. It seems to require 3days to recover from attenuated cortisol rhythm during nighttime duty in shift working nurses.
Anxiety* ; Hydrocortisone* ; Tertiary Care Centers

Purpose: This study aimed to investigate objectively measured physical activity (PA) in institutionalized older adults with mild cognitive impairment (MCI) and to elucidate the influence of autonomic nervous function, salivary cortisol, and PA on cognitive functions based on neurovisceral integration model. Methods: Overall cognitive function was evaluated using the mini-mental state examination (MMSE) and executive function was evaluated using semantic verbal fluency test and clock drawing test. Actigraph for PA, HRV and sAA for autonomous function, and the geriatric depression scale for depression were used. Saliva specimens were collected in the morning for sAA and cortisol. Results: Ninety-eight older adults from four regional geriatric hospitals participated in the study. They took 4,499 steps per day on average. They spent 753.93 minutes and 23.12 minutes on average in sedentary and moderate-to-vigorous activity, respectively. In the multiple regression analysis, lower salivary cortisol level (β = - .33, p = .041) and greater step counts (β = .37, p = .029) significantly improved MMSE score. Greater step count (β = .27, p = .016) also exerted a significant influence on verbal fluency, and greater sAA (β = .35, p = .026) was significantly associated with a better clock drawing test result. Conclusion Salivary cortisol, sAA and physical activity were significantly associated with cognitive functions. To prevent older adults from developing dementia, strategies are needed to increase their overall PA amount by decreasing sedentary time and to decrease salivary cortisol for cognitive function, and to maintain their sympathetic nervous activity for executive function.

Purpose: This study aimed to investigate objectively measured physical activity (PA) in institutionalized older adults with mild cognitive impairment (MCI) and to elucidate the influence of autonomic nervous function, salivary cortisol, and PA on cognitive functions based on neurovisceral integration model. Methods: Overall cognitive function was evaluated using the mini-mental state examination (MMSE) and executive function was evaluated using semantic verbal fluency test and clock drawing test. Actigraph for PA, HRV and sAA for autonomous function, and the geriatric depression scale for depression were used. Saliva specimens were collected in the morning for sAA and cortisol. Results: Ninety-eight older adults from four regional geriatric hospitals participated in the study. They took 4,499 steps per day on average. They spent 753.93 minutes and 23.12 minutes on average in sedentary and moderate-to-vigorous activity, respectively. In the multiple regression analysis, lower salivary cortisol level (β = - .33, p = .041) and greater step counts (β = .37, p = .029) significantly improved MMSE score. Greater step count (β = .27, p = .016) also exerted a significant influence on verbal fluency, and greater sAA (β = .35, p = .026) was significantly associated with a better clock drawing test result. Conclusion Salivary cortisol, sAA and physical activity were significantly associated with cognitive functions. To prevent older adults from developing dementia, strategies are needed to increase their overall PA amount by decreasing sedentary time and to decrease salivary cortisol for cognitive function, and to maintain their sympathetic nervous activity for executive function.

Purpose: This study aimed to investigate autonomic nervous function during the orthostatic challenge and its relationship with depression and fall, and to elucidate fall-associated factors, including autonomic function, executive function, and depression among institutionalized older adults with mild cognitive impairment (MCI). Methods: This study employed a descriptive cross-sectional design. Fall experiences in the current institutions were researched. Heart rate variability (HRV) during the orthostatic challenge was measured. Executive function was evaluated using the semantic verbal fluency test and clock drawing test. Depression was assessed using the Geriatric Depression Scale. Results: Of the 115 older adults, 17 (14.8%) experienced falls in the current institution. None of the HRV indices during the orthostatic challenge showed any significant changes except for the standard deviation of normal RR intervals (p = .037) in the institutionalized older adults with MCI. None of the HRV indices was significantly related to the depressive symptoms. Multivariate logistic regression analysis showed that normalized high frequency on lying was independently associated with falls (OR = 1.027, p = .049) after adjusting for other conventional fall risk factors although executive function and depressive symptoms were not significant factors for falls. Conclusions Institutionalized older adults with MCI were vulnerable to autonomic nervous modulation, especially to sympathetic modulation, during the orthostatic challenge, which was not associated with depressive symptoms. As increased resting parasympathetic activity seemed to play a key role in association with falls, autonomic nervous function assessment should be considered for fall risk evaluation.

Purpose: This study aimed to evaluate the rest-activity circadian rhythm (RAR) using data obtained from wearable actigraph devices in hospitalized older adults with mild cognitive impairment (MCI), and to investigate its relationship with salivary alpha amylase (sAA). Methods: This secondary data analysis used data from the Hospitalized Older Adults’ Cognition and Physical Activity Study. Actigraph data for 3-4 days were analyzed for RAR. RAR indices such as interdaily stability (IS), intradaily variability (IV), activity level during the most active 10-hour period and during the most least active 5-hour period, and relative amplitude (RA) were calculated. Data on sAA collected in the morning and general characteristics, including body mass index (BMI), were analyzed. Results: Data from 92 hospitalized older adults with MCI were analyzed. The IS, IV, RA were 0.23, 0.73, 0.88, respectively. The average level of sAA was 77.02 U/mL, and a higher level of sAA was significantly associated with better IS and RA in the regression analysis, while age, BMI, and cognitive level were not. BMI showed positive correlations with IS and RA. Conclusion RAR in the hospitalized older adults with MCI was attenuated, showing especially low IS, which implies they failed to maintain regular and repetitive 24-hour RAR. Increased sAA and BMI were associated with robust RAR. Nurses need to pay attention to maintain robust RAR in hospitalized older adults with MCI, and strategies should be developed to improve their RAR.

Purpose: The purpose of this study was to investigate nutritional intake, body mass index (BMI) and depression, and to elucidate depression in relation to nutritional intake and BMI among Chinese college students studying in South Korea. Methods: A descriptive study design was adopted. Data were collected from 170 Chinese college students in South Korea June-August, 2019. In this study, 24-hour dietary records were obtained and BMI was measured. Nutrient intakes were calculated from the dietary records using the CAN-PRO software. Depression was assessed using the Center for Epidemiological Studies Depression Scale (CES-D). Results: Of 170 participants, 19 (11.2%) were underweight and 42 (24.7%) were overweight. Female, single, and non-smoking participants were underweight. There were 97 (57.1%) participants experiencing depression, and 99 (58.2%) consuming lower protein than the recommended nutrient intake resulting in insufficient nutrients. The intake of vitamin A, vitamin C, vitamin D, pantothenic acid, calcium, iron, and selenium was much lower than the standard. Depressive participants were significantly greater among the underweight participants and those consuming insufficient nutrients in terms of protein, pantothenic acid, and selenium. Conclusion An intervention program is required to improve nutritional status, which should be a part of the strategies to manage depression for Chinese college students in South Korea.

PURPOSE: This study investigates patterns of small group interaction and examines the influence among graduate nursing students of online collaborative learning strategies on small group interaction patterns, task performance and learning attitude in web-based team learning environments. METHODS: To analyze patterns of small group interaction, group discussion dialogues were reviewed by two instructors. Groups were divided into two categories depending on the type of feedback given (passive or active). For task performance, evaluation of learning processes and numbers of postings were examined. Learning attitude toward group study and coursework were measured via scales. RESULTS: Explorative interactions were still low among graduate nursing students. Among the students given active feedback, considerable individual variability in interaction frequency was revealed and some students did not show any specific type of interaction pattern. Whether given active or passive feedback, groups exhibited no significant differences in terms of task performance and learning attitude. Also, frequent group interaction was significantly related to greater task performance. CONCLUSION: Active feedback strategies should be modified to improve task performance and learning attitude among graduate nursing students.
Education, Distance ; Education, Nursing ; Group Processes ; Humans ; Learning* ; Students, Nursing* ; Task Performance and Analysis* ; Weights and Measures

PURPOSE: Chest physiotherapy (CPT) is commonly used for mechanically ventilated patients, but little is known about its physiological effects, particularly in patients with acute lung injury (ALI). The aim of the study was to determine the benefits and risks of delivering multimodal respiratory physiotherapy to mechanically ventilated patients with ALI receiving paralytic agents. METHODS: A repeated measure-experimental design using a counterbalancing method was employed. Fifteen patients received CPT (vibration, percussion, or palm-cup percussion) in addition to the routine CPT in a randomized order. Another 15 patients, contraindicated for the percussion technique, received routine CPT including manual hyperinflation and position change, and were observed as a comparative group. The effects of CPT were evaluated by measuring the volume of aspirated secretions and the dynamic lung compliance (Cd) over time. For the adverse effects, peripheral oxygen saturation (SpO2) was recorded. Cd and SpO2 were recorded at the baseline period, immediately after the physiotherapy treatment, and at 10, 20, 30 and 60 minutes posttreatment. RESULTS: The volume of collected secretions did not differ significantly when compared between the groups (p = .838). Cd increased significantly over time in the manual percussion (p = .042) and palm-cup percussion (p = .046) group, where Cd in the latter remained elevated twice longer than in the former. None of the CPT techniques exerted major detrimental effects on SpO2. CONCLUSIONS: We found that the palm-cup percussion technique was the most effective in increasing Cd without any accompanying detrimental effects on SpO2. However, additional CPT did not affect the volume of aspirated secretions.
Acute Lung Injury ; Critical Care ; Humans ; Lung ; Lung Compliance ; Oxygen ; Percussion ; Pilot Projects ; Respiratory Mechanics ; Risk Assessment ; Sputum ; Thorax ; Vibration

PURPOSE: This study was designed to test structural equation modeling of the quality of life of stroke survivors in order to provide guidelines for development of interventions and strategies to improve their quality of life. METHODS: The participants in the study were patients who visited the neurology outpatient department of a tertiary hospital in Seoul between June 25 and October 15, 2009. Data collection was carried out through one-on-one interviews. Demographic factors, functional independence, social support, nutritional status, post-stroke biobehavioral changes and quality of life were investigated. RESULTS: The final analysis included 215 patients. Fitness of the hypothetical model was appropriate (chi-square=111.5, p=.000, GFI=.926, AGFI=.880, RMSA=.068, NFI=.911, CFI=.953). Functional dependency, social support and post-stroke biobehavioral changes were found to be significant explaining variance in quality of life. Post-stroke biobehavioral changes had the strongest direct influence on quality of life. Nutritional status had an indirect effect on the quality of life. CONCLUSION: To improve the quality of life of stroke survivors, comprehensive interventions are necessary to manage post-stroke biobehavioral changes, and strengthening social support networks that can contribute to enhancing the quality of life of stroke survivors.
Aged ; Demography ; Depression ; Fatigue ; Female ; Humans ; Interviews as Topic ; Male ; Middle Aged ; *Models, Psychological ; Nutritional Status ; Pain ; *Quality of Life ; Sleep Deprivation ; Social Support ; Stroke/*psychology ; *Survivors

PURPOSE: The purpose of this exploratory study was to find a specific time of day with a stable cortisol level and to investigate the relationship between salivary cortisol and sleep. METHODS: A total of 36 Korean female college students participated in the study. Salivary specimens were collected 6 times a day for 2 days in different stressful situations. Sleep characteristics were measured using an actigraph while salivary specimens were collected. Perceived stress was evaluated using the Global Assessment of Recent Stress. RESULTS: Depending on whether there were morning peak and/or afternoon elevations in the cortisol levels, the type of diurnal cortisol pattern was classified into 4 types. None of the cortisol levels in different times of the day showed significant relationships to perceived stress levels. Cortisol levels in the morning, levels of peak cortisol and diurnal differences of cortisol were significantly correlated with sleep duration. The time with most stable cortisol level was 9-10 pm. CONCLUSION: It is recommended that measurements of salivary cortisol are taken from 9-10 pm since it showed a stable value regardless of diurnal cortisol rhythm and sleep. Sleep duration should be considered as an important confounding factor in measuring cortisol levels in the morning and the diurnal differences of cortisol.
Adult* ; Female* ; Humans ; Hydrocortisone*