Strange attractor can be constructed from time series data such as heart sound. In the areas of the recognition and diagnosis of abnormal heart sounds, signal presentation method is very useful because good features can be detected from good presentation. This paper examines efficiency in diagnosing abnormal heart sounds of the two different methods for constructing attractor. Nine different heart sounds from typical clinical conditions were used for this study. The first method was constructing attractors using original heart sounds, and the second was modifying the original sounds by autocorrelation and they were then applied to the orignal sounds as to cross correlation checks. Attractors could be constructed using signals generated by these methods, and values of fractal dimensions would then be calculated which has been a well known method to measure characteristics of attractors. The results showed that the second method appeared to provide more efficient way to correctly classify abnormal heart sounds.
Diagnosis ; Fractals* ; Heart Sounds* ; Heart*

PURPOSE: The purpose of this study was to evaluate the quality of meta-analysis regarding exercise using Assessment of Multiple Systematic Reviews (AMSTAR) as well as to compare effect size according to outcomes. METHODS: Electronic databases including the Korean Studies Information Service System (KISS), the National Assembly Library and the DBpia, HAKJISAand RISS4U for the dates 1990 to January 2014 were searched for 'meta-analysis' and 'exercise' in the fields of medical, nursing, physical therapy and physical exercise in Korea. AMSTAR was scored for quality assessment of the 33 articles included in the study. Data were analyzed using descriptive statistics, t-test, ANOVA and chi2-test. RESULTS: The mean score for AMSTAR evaluations was 4.18 (SD=1.78) and about 67% were classified at the low-quality level and 30% at the moderate-quality level. The scores of quality were statistically different by field of research, number of participants, number of databases, financial support and approval by IRB. The effect size that presented in individual studies were different by type of exercise in the applied intervention. CONCLUSION: This critical appraisal of meta-analysis published in various field that focused on exercise indicates that a guideline such as the PRISMA checklist should be strongly recommended for optimum reporting of meta-analysis across research fields.
Databases, Factual ; *Exercise ; Humans ; Publishing/*standards ; Republic of Korea ; Research

OBJECTIVE: Attention Deficit/Hyperactivity Disorder(ADHD) and tic disorders are relatively common childhood onset neuropsychiatric disorders, and these two disorders frequently cooccur in some individual. Although the efficacy of psychostimulants is well established in ADHD, as many as 25% of children fail to respond to psychostimulant treatment due either to a lack of efficacy or to intolerable side effects including exacerbations of tics. Guanfacine, a selective alpha2A-adrenergic agonist, was recently introduced for the treatment of children with ADHD. This study is to evaluate the efficacy and safety of guanfacine in children with ADHD and comorbid habit disorders and to identify subgroups of children who may have a more favorable response to guanfacine. METHODS: Twenty five children who were 6 to 16 years old were enrolled in an open trial of guanfacine for two months. Primary outcome measures were DuPaul Parent and Teacher Rating Scales, Conners Parent and Teacher Rating Scales and Yale Global Tic Severity Scale. Paired t-test and multiple logistic regression were performed to evaluate symptom improvement and to examine predictor variables for positive drug response. RESULTS: Severity of ADHD symptoms and tics after guanfacine administration was significantly reduced at each follow-up point in the ratings completed by both parents and teachers and in clinical evaluation, compared to their pre-medication status. Children with moderate ADHD symptoms responded more favorably to guanfacine than children with mild or severe symptoms. CONCLUSION: These findings suggest that guanfacine may be a safe and an effective medication for ADHD children who cannot benefit from psychostimulants, but more definitive research strategies are needed for future investigation.
Adolescent ; Child ; Comorbidity ; Follow-Up Studies ; Guanfacine* ; Humans ; Logistic Models ; Outcome Assessment (Health Care) ; Parents ; Tic Disorders ; Tics ; Weights and Measures

PURPOSE: This study aimed to validate the psychometric properties of the CRAFFT (Car, Relax, Alone, Forget, Family/Friends, Trouble) by using item response theory (IRT) and further examine gender differences in item-level responses.METHODS: This study used the 13(th) (2017) Korea Youth Risk Behavior Survey data conducted by the Korean Centers for Disease and Prevention and analyzed data of 8,568 students who reported drinking alcohol in the previous 30 days. IRT assumptions including unidimensionality, local independence, and monotonicity were tested. A one-factor two-parameter IRT model was fitted for item parameterization (M₂ = 76.92, 20 df, p < .001, root mean square error of approximation = 0.02). Graphics for item characteristic curves and item and test information curves were provided. Differential item functioning (DIF) analysis was evaluated to measure item equivalence between boys and girls.RESULTS: Unidimensionality and local independence were satisfied, and the dominant factor eigenvalue and variance were 2.48 and 41.3% in boys and 2.08 and 34.7% in girls, respectively, and residual correlations in paired items were less than .2. The discrimination parameters were estimated as 1.32–3.59 for boys and 1.30–3.64 for girls. The severity parameters estimated verity as −0.23 to 1.67 for boys and −0.32 to 2.17 for girls. DIF was detected for four of six items, “Car,” “Relax,” “Forget,” and “Family/friends.” However, its impact on the total score was negligible.CONCLUSION: The CRAFFT is a valid and reliable screening tool to identify alcohol use problems for both boys and girls, exhibiting good discrimination, good coverage of severity, and negligible DIF.
Adolescent ; Alcohols ; Discrimination (Psychology) ; Drinking ; Female ; Humans ; Korea ; Mass Screening ; Psychometrics ; Risk-Taking

Purpose: The purposes of this study were to analyze and compare the textbooks of fundamentals of nursing and practice in order to standardize them for medication administration, infection control, and pressure injury. Methods: The current study is a literature review of the ten textbooks published after 2013. Ten textbooks were the ones selected by the Korea Health Personnel Licensing Examination Institute as major textbooks. Three items were reviewed: medication administration, infection control, and pressure injury, with a focus on differences in numbers, range, direction, and others. Results: For medication administration, there were some discrepancies in the size of needle and syringe, maximum dosage depending on injection methods, replacement period of catheter and infusion set, depth of insertion for vaginal medication administration. For infection control, items with discrepancies included length of time for hand washing, concentration of chemical sterilant, frequency of ventilation to prevent airborne disease, distance to prevent droplet-borne infection, the latent period of infectious disease, and methods to treat medical wastes. For pressure injury, the discrepancies were exhibited in the degree and duration of pressure for pressure injuries, range of scores for risks in pressure injury assessment tools, and temperature of the solution to irrigate pressure injuries. Conclusion Standardized textbooks for these three parts will be useful teaching aide for students and nurses to carry out consistent and professional nursing for patients’ safety.

Purpose: The aims of this systematic review were to identify the study protocol of Virtual Reality Therapy (VRT) and review the effect of VRT among patients with Post-Traumatic Stress Disorder (PTSD). Methods: This review followed the guideline of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic literature search was conducted using 12 electronic databases including gray literature with no limit of publication year. Search terms included relevant terms regarding “PTSD”, “trauma”, and “VRT”. Among 265 studies extracted through PRISMA, 20 studies were selected and evaluated for quality assessment using the Risk of Bias tool of Cochrane’s collaboration. Results: The majority of the literature focused on combat veterans and war situations (95%).Usually, each session usually took 60~120 minutes of VRT in 10~20 sessions for 5~10 weeks. The VRT equipment and contents were individually designed considering patients’ traumatic experiences. Most of the studies reported the positive effects associated to reduced levels of PTSD (80%) and related symptoms, such as, depression (45%) and anxiety (25%). Conclusion Based on our findings, further studies are required to evaluate VRT in people with PTSD, after improving study design and standardizing protocols.

Purpose: The aims of this systematic review were to identify the study protocol of Virtual Reality Therapy (VRT) and review the effect of VRT among patients with Post-Traumatic Stress Disorder (PTSD). Methods: This review followed the guideline of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic literature search was conducted using 12 electronic databases including gray literature with no limit of publication year. Search terms included relevant terms regarding “PTSD”, “trauma”, and “VRT”. Among 265 studies extracted through PRISMA, 20 studies were selected and evaluated for quality assessment using the Risk of Bias tool of Cochrane’s collaboration. Results: The majority of the literature focused on combat veterans and war situations (95%).Usually, each session usually took 60~120 minutes of VRT in 10~20 sessions for 5~10 weeks. The VRT equipment and contents were individually designed considering patients’ traumatic experiences. Most of the studies reported the positive effects associated to reduced levels of PTSD (80%) and related symptoms, such as, depression (45%) and anxiety (25%). Conclusion Based on our findings, further studies are required to evaluate VRT in people with PTSD, after improving study design and standardizing protocols.

OBJECTIVES: The presence of psychiatric disorders including depression and anxiety disorders is considered to be the most important risk factor of suicide. Also, suicidal risk is known to be increased in patients who have serious medical illnesses. Like in patients with other medical illness, some authors reported that suicidal risk is increased in patients with stroke. But there have been no reports with Korean patients. The aim of this study is to investigate the frequency of suicidal ideation of patients in the acute stage of stroke, and to examine the demographic characteristics, and psychiatric and neurological symptoms between the patients with and without suicidal ideation. METHODS: Seventy seven hospitalized stroke patients at the Hallym Stroke Center from July of 1999 to June of 2000 were included in this study. Beck Suicidal Ideation Scale(BSIS) was used to evaluate suicidal ideation. Beck Depression Inventory(BDI) and Beck Anxiety Inventory(BAI) for depression and anxiety, and Social Support Scale(SSS) for social support system of the stroke patients were used. Neurologic disabilities were rated with National Institutes of Health Stroke Scale(NIHSS) and Barthel's Index. RESULTS: Thirty five percent(N=27) of the stroke patients reported severe suicidal ideation. Scores of BDI, BAI and SSS were higher in the patients with severe suicidal ideation than their counterpart. There were no differences in Barthel's index score and NIHSS between two groups. Most patients with severe suicidal ideation had depressive or anxiety symptoms. But patients without depressive or anxiety symptoms also reported severe suicidal ideation. CONCLUSIONS: Thirty five percent of stroke patients in acute stage of their illness have severe suicidal ideation that requires careful psychiatric evaluation and intervention. Inclusion of routine assessment of suicidal ideation in these patients is recommended.
Anxiety ; Anxiety Disorders ; Depression ; Humans ; National Institutes of Health (U.S.) ; Risk Factors ; Stroke* ; Suicidal Ideation* ; Suicide

OBJECTIVES: This study was conducted to develop and validate Eating Behaviors Test form (EBT) for infants and young children, including eating behaviors of their parents and parental feeding practices. METHODS: Draft version of EBT form was developed after a pretest on 83 mothers. It was consisted of 42 questions including 3 components; eating behavior of children, eating behavior of parents, and parental feeding practices. Using these questionnaires, the first survey was conducted on 320 infants and children, 1 to 6 year old, for exploratory factor analysis, and the second survey was collected on 731 infants and children for confirmatory factor analysis. RESULTS: Exploratory factor analysis on 42 questions of EBT form resulted in 3 factor model for children's eating behavior, 3 factor model for parents' eating behavior, and 1 factor model for parental feeding practices. Three factors for children's eating behavior could be explained as follows; factor 1, pickiness (reliability alpha=0.89; explanation of variance=27.79), factor 2, over activity (alpha=0.80, explanation of variance=16.51), and factor 3, irregularity (alpha=0.59, explanation of variance=10.01). Three factors for mother's eating behavior could be explained as follows; factor 1,irregularities (alpha=0.73, explanation of variance=21.73), factor 2, pickiness (alpha=0.65, explanation of variance= 20.16), and factor 3, permissiveness (alpha=0.60, explanation of variance=19.13). Confirmatory factor analysis confirmed an acceptance fit for these models. Internal consistencies for these factors were above 0.6. CONCLUSIONS: Our results indicated that EBT form is a valid tool to measure comprehensive eating and feeding behaviors for infants and young children.
Child* ; Eating ; Factor Analysis, Statistical ; Feeding Behavior* ; Humans ; Infant* ; Mothers ; Parents ; Permissiveness ; Surveys and Questionnaires

Food allergy is an important public health problem affecting 5% of infants and children in Korea. Food allergy is defined as an immune response triggered by food proteins. Food allergy is highly associated with atopic dermatitis and is one of the most common triggers of potentially fatal anaphylaxis in the community. Sensitization to food allergens can occur in the gastrointestinal tract (class 1 food allergy) or as a consequence of cross reactivity to structurally homologous inhalant allergens (class 2 food allergy). Allergenicity of food is largely determined by structural aspects, including cross-reactivity and reduced or enhanced allergenicity with cooking that convey allergenic characteristics to food. Management of food allergy currently focuses on dietary avoidance of the offending foods, prompt recognition and treatment of allergic reactions, and nutritional support. This review includes definitions and examines the prevalence and management of food allergies and the characteristics of food allergens.
Allergens ; Anaphylaxis ; Child ; Cooking ; Cross Reactions ; Dermatitis, Atopic ; Disease Management ; Food Hypersensitivity ; Gastrointestinal Tract ; Humans ; Hypersensitivity ; Infant ; Korea ; Nutritional Support ; Prevalence ; Proteins ; Public Health