Relationships between social determinants of health and health-related quality of life of elderly in a community

간호학과/석사본 연구는 일 지역 노인의 사회적 건강결정인자 수준을 파악하고, 건강관련 삶의 질 영향요인을 규명하기 위한 서술적 상관관계 연구이다. 자료 수집은 임의 표출로 선정된 일 지역에 거주하는 65세 이상 노인 인구를 대상으로 일대일 면담을 통해 구조화된 설문지를 이용하였고, 총 199부가 통계분석에 사용되었다. 자료 분석은 SPSS WIN 20.0 패키지를 이용하여 기술통계, T-test, ANOVA, 상관분석, 위계적 다변수 회귀분석을 실시하였다. 본 연구 결과를 요약하면 다음과 같다. 대상자의 성별은 여성이 77.4%, 평균 연령은 73.6세였고, 결혼 상태는 무배우자에 속하는 비율이 51.8%로 높게 나타났다. 동거인 형태에서는 가족과 거주하는 노인이 54.3%로 가장 많았으며, 최종학력은 초등학교 졸업이 30.7%, 월 평균 소득수준은 50만원 미만이 36.2%로 가장 많았다. 만성질환은 고혈압을 가지고 있는 노인이 59.8%로 가장 많았고, 관절염, 고지혈증, 골다공증, 당뇨 순이었다. 공공 보건기관 서비스 만족도는 64.3%가 지역 보건기관에 만족하고 있었다. 대상자의 건강관련 삶의 질 평균은 0.83±0.13점이었고, 건강관련 삶의 질 각 차원에서 통증/불편의 ‘다소 문제 있음’이 122명(61.3%)으로 가장 많이 나타났다. 이어서 불안/우울의 ‘다소 문제 있음’ 85명(42.7%)로 나타났으며, 운동능력 ‘다소 문제 있음’이 66명(33.2%), 일상활동의 ‘다소 문제 있음’이 56명(28.1%), 자가관리의 ‘다소 문제 있음’이 24명(12.1%)으로 나타났다. 대상자의 사회적 건강결정인자 중 물리적 상황에서 주거형태는 주택 거주 53.8%, 빌라 거주 24.1%, 아파트 거주 20.1%순이었다. 거주지역은 가좌지역이 40.7%로 가장 많았고, 홍제·홍은지역 40.2%였으며, 평균 거주기간은 약 19.6년이었다. 사회 심리적 요인인 사회적 지지의 평균평점은 최대 4점에 2.71점이었고, 사회적 응집력에 해당되는 지역사회 공동체의식의 평균평점은 최대 5점에 3.16점이었으며, 사회적 관계망의 평균평점은 최대 5점에 2.15점이었다. 행동생물학적 요인인 건강증진행위의 평균평점은 최대 4점에 2.83점이었다. 건강관련 삶의 질에 영향을 미치는 사회적 건강결정인자는 거주지역, 지역사회 공동체의식, 건강증진행위로 나타났으며, 일반적 특성에서는 연령, 월평균 소득으로 나타났다. 연희·신촌지역에서 거주하는 노인들이 다른 지역에 거주하는 노인들보다 건강관련 삶의 질이 높았고(β=.147, p=.046), 지역사회 공동체의식이 높을수록(β=.186, p=.030), 건강증진행위가 증가할수록 건강관련 삶의 질이 높았다(β=.262, p=.003). 또한 65-75세 미만(β=.290, p=.043) 노인이 85세 이상 노인보다, 월평균 소득 150만원 이상(β=.324, p=.015) 노인이 무 소득자에 비해 건강관련 삶의 질이 높았고, 18.2%의 설명력을 보였다. 이상의 결과에서 노인의 건강관련 삶의 질 향상을 위하여 사회적 건강결정인자 중 물리적 상황과 사회적 응집력, 행동 심리학적 요인의 건강증진행위별 사회 환경적 접근이 필요함을 확인할 수 있다. 본 연구는 노인의 사회적 건강결정인자 수준을 확인하고 건강관련 삶의 질과의 관계를 파악한 주요 결과를 통해, 향후 지역사회 노인건강증진을 위한 효율적인 프로그램 구축과 사회적 환경의 개선 및 발전을 위한 정책수립의 기초자료로 활용될 수 있을 것이다.ope

Influence of self efficacy, social support and sense of community on health-related quality of life for middle-aged and elderly residents living in a rural community

PURPOSE: The purpose of this study was to examine the relationship between self-efficacy, social support, sense of community and health-related quality of life (HRQoL), including the direct and indirect effects of the variables on HRQoL. METHODS: A cross-sectional survey was conducted with a convenience sample of 249 middle-aged and elderly residents living in a rural community in A-County, K Province. The structured questionnaire included 4 scales from the Euro Quality of life-5 Dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression), and measures of General Self-Efficacy, Social Support, and Sense of Community. Data were analyzed using SPSS WIN 20.0 and AMOS 21.0 program. RESULTS: The mean HRQoL score for the participants was 0.87±0.13. Self-efficacy (β=.13, p=.039) and age (β= -.38, p<.001) were significantly associated with HRQoL, explaining 21% of the variance. In the path analysis, self-efficacy showed a significant direct effect on HRQoL (β=.14, p=.040) and significantly mediating relationships between both social support (β=.05, p=.030) and sense of community (β=.02, p=.025) and HRQoL. CONCLUSION: Although self-efficacy was found to be the main predictor for HRQoL, the findings imply that social environmental factors such as social support and sense of community need to be considered when developing interventions to increase HRQoL in middle-aged and elderly residents in rural communities.ope

PERSONAL AND INTERPERSONAL FACTORS RELATED TO SUICIDAL IDEATION AMONG RURAL VIETNAMESE ADOLESCENTS

The purpose of this study was to explore the level of suicidal ideation and its personal, peer- and family-related factors among rural Vietnamese adolescents. A self-administered survey was conducted with 171 students from two middle schools in two communes of Quang-Tri Province in Vietnam. Suicidal ideation and risk factors were measured using the Vietnamese version of the World Health Organization (WHO) Global School-based Student Health Survey (GSHS). The data were analyzed by chi-square test and logistic regression analysis. The prevalence of suicidal ideation was 14.2%, and no gender differences were found. The major risk factors associated with suicidal ideation were feelings of loneliness, having no close friends, and parental drinking. The findings suggest that student interpersonal skills, and family and community involvement are key considerations for the development of a suicide prevention program for this population. Further research is suggested to develop and evaluate a school-based culturally adaptive suicide prevention program.ope

Interprofessional global health competencies of South Korean health professional students: educational needs and strategies

BACKGROUND: There is growing recognition of the importance of educating health professional students to enhance their competence in collaborating with individuals from other health professions in the area of global health. This study aimed to identify the performance levels in interprofessional global health competencies (IGHC) of health professional students, their educational needs, and the strategies for successfully developing IGHC. METHODS: This study used a mixed methods design involving an online survey followed by focus group interviews. A sample of 325 fourth-year undergraduate students from 14 health-related majors completed a self-report online survey (38.8% response rate). The performance of IGHC was measured on a five-point Likert scale using the IGHC items developed by the Consortium of Universities for Global Health. Additionally, 12 senior students and five professors in global health-related majors participated in focus group interviews. The students' educational needs and priorities were analysed using the Borich needs assessment and the Locus for Focus model. RESULTS: The participants' IGHC mean score was 3.11 (SD = 0.55) and differed by previous global health activity experiences (t = - 2.10, p = .037). Nine competencies in six domains using the Locus for Focus model were identified as a priority for global health education. Suggested strategies to enhance IGHC included establishing IGHC education in formal curricula, developing value-based content and outcomes, and engaging students in learning activities. CONCLUSIONS: It is necessary to design an interprofessional pre-departure course to achieve the priority IGHC and to organise learning activities where there is cooperation in problem solving while applying the expertise of each major within resource-limited settings. This study supports future health professional education that should foster enhanced roles and scopes of practice as changing agents to assure the achievement of sustainable development goals.ope

Development and Evaluation of Cardiovascular Disease Prevention Education Materials for Middle-aged Korean-Chinese Female Workers: Applying Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P)

Purpose : The purpose of this study was to develop and evaluate the quality (understandability and actionability) of health education materials for Korean-Chinese (KC) female migrant workers, using Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P). Methods : Educational needs assessment was conducted with 3 focus groups with 20 KC women and a focus group with 4 community stakeholders. The quality of the educational materials was evaluated by 3 experts and a community stakeholder, followed by a survey with 15 KC women using 17 items for understandability and 7 items for actionability by means of a Korean version PEMAT-P. Results : The health educational calendar consists of 12 subjects out of 9 topics related to healthy lifestyles for preventing cardiovascular diseases. The overall mean understandability score was 98.8% and the overall mean actionability was 100%. Conclusion : Involvement of KC women and community stakeholders in the development of educational materials was found to be an effective strategy for increasing understandability and actionability of educational materials for KC female migrant workers. This study also demonstrates the PEMAT-P is a useful evaluation tool, emphasizing the actionability of educational materials.ope

Mobile App-Based Health Promotion Programs: A Systematic Review of the Literature

This study investigated the features and usefulness of mobile app-based health promotion programs for the general population. A comprehensive bibliographic search of studies on health promotion programs using mobile apps in peer-reviewed journals published in English up to November 2017 was performed using the PubMed, Embase, and CINAHL databases. The inclusion criteria were (1) randomized control trial designs; (2) assessed mobile app-based interventions to promote adult health conditions; 12 studies were ultimately included. The most common topics were diet and physical activity (n = 8) and overall healthy lifestyle improvement (n = 4). The purpose of the apps included providing feedback on one's health status (n = 9) and monitoring individual health status or behavior change (n = 9). Across all studies, health outcomes were shown to be better for mobile app users compared to non-users. Mobile app-based health interventions may be an effective strategy for improving health promotion behaviors in the general population without diseases. This study suggests that mobile app use is becoming commonplace for a variety of health-promoting behaviors in addition to physical activity and weight control. Future research should address the feasibility and effectiveness of using mobile apps for health promotion in developing countries.ope

Factors related to Professional Quality of Life among Community Health Practitioners in Korea

Purpose: The aims of this study were to examine the work, client, and personal environments of community health practitioners, including the level of their professional quality of life (ProQOL), and identify the factors affecting their ProQOL. Methods: Data were collected using a web-survey questionnaire, which was completed by a sample of 308 community health practitioners currently working in Korea. The questionnaire included items on ProQOL; three dimensions labeled compassion satisfaction, burn out, and secondary traumatic stress; job stress; job satisfaction; sense of community; and general characteristics. Results: The mean scores for the three dimensions were 39.2±6.44 (compassion satisfaction), 31.9±3.59 (burn out), and 26.4±5.05 (secondary traumatic stress). A multiple linear regression revealed that compassion satisfaction varied significantly according to the satisfaction with job choice, sense of community, job stress, and job satisfaction. The factors affecting burn out were sense of community and work load, while the factors affecting secondary traumatic stress were education, job stress, and job satisfaction. Conclusion: The findings of this study suggest that comprehensive intervention focusing on improving the sense of community and job satisfaction and reducing job stress is essential to promote community health practitioners’ ProQOL.ope

The Relationships between Social Determinants of Health and Health-related Quality of Life among the Community-dwelling Elderly

Purpose: The purpose of this study was to examine the social determinants of health (SDH) associated with health-related quality of life (HQOL) among the community-dwelling elderly, based on the conceptual framework of the Commission on Social Determinants of Health (CSDH). Methods: A survey was conducted with 199 elders aged 65 years or older sampled through convenient sampling. Data were collected through face to face interviews by trained interviewers using a structured questionnaire, which included scales of the residential area, social support, sense of community, social network, health behaviors, and HQOL. Data were analyzed by ANOVA and stepwise multivariate regression. Results: Major SDH affecting HQOL included the participants’ residential area, sense of community, and health behavior. The HQOL of the elderly residing in the B area with a low rate of basic livelihood security recipients was higher than that of those residing in other areas. Conclusion: CSDH framework was useful to determine the factors associated with HQOL among the community-dwelling elderly. In addition to their health behavior, their sense of community was found to be a SDH of HQOL, indicating the need of health promotion programs tailored to the characteristics of residential areas and strategies to enhance involvement in community activities.ope

Long term magnetic Resonance Angiography follow-up in moyamoya disease

OBJECTIVE: Revascularization is an effective treatment for the ischemic symptom of moyamoya disease. Indirect revascularization is also effective. Magnetic resonance angiography (MRA) has the ability for collateral formation that is equivalent to conventional angiography. This study analyzed the results of indirect revascularization by MRA.0aMETHODS: A total of 25 patients underwent bilateral EDAS for the management of moyamoya disease. All patients underwent MRA after surgery more than 24 months later. The collateral formation was graded as Good, Fair, and Poor. The clinical outcome was assessed as Excellent, Good, Fair, and Poor.0aRESULTS: Good collateral formation was 32 sides of the EDAS, and fair was 18. An excellent clinical outcome was obtained in 15 patients, Good in 8, Fair in 1, and Poor in 1. There was a significant correlation between the preoperative symptom, gender, and the clinical outcome.0aCONCLUSION: In the management of ischemic moyamoya disease, indirect revascularization has been the golden standard with remarkably low morbidity and mortality. Moreover, and MRA can replace conventional angiography in the follow-up of moyamoya patients.ope

The Ability of the Gliadel® Wafer to Control the Malignant Brain Tumor；Preliminary Report

Introduction：Adjuvant systemic chemotherapy increases survival for malignant glioma patients. However, it is unable to effectively cross the blood-brain barrier and have unacceptable systemic toxicities, and the short exposure time of tumor tissue to chemotherapeutic agents. Consequently, many researchers have tried to develop innovative local treatments that bypass the blood-brain barrier and allow for direct treatment in the central nervous system(interstitial chemotherapy). Recently, Gliadel® wafer containing carmustine(BCNU) was approved for the interstitial chemotherapy. We present our initial experience in using interstitial chemotherapy as a strategy to treat malignant brain tumors. Materials and Methods：We analyzed the clinical feature, MRI figures, KPS score, and progression-free survival in 13 malignant brain tumor patients treated with interstitial chemotherapy using Gliadel® wafer from Sep 2004 to Dec 2006. There were 6 glioblastomas, 4 anaplastic astrocytomas, and 3 poorly differentiated carcinomas. Each patient has different treatment histories before and after insertion of Gliadel® wafer. Out of 3 metastatic brain tumors, 2 were recurred after gamma knife surgery. Old patient with huge cystic metastatic tumor refused other kind of chemotherapy. So we inserted Gliadel® wafer after grossly total removal of tumor without any other treatment. Three anaplastic astrocytomas and three glioblastomas recurred after surgery or biopsy, followed by concomitant radiation and Temodal chemotherapy. Three glioblastomas and one anaplastic astrocytoma were treated with interstitial chemotherapy using Gliadel® wafer at the first surgery followed by concomitant radiation and Temodal® chemotherapy. Results：There was not any complication related to interstitial chemotherapy using Gliadel® wafer during follow-up (follow up duration：mean - 10 months, range -3~20 months). Three patients were dead 8, 11 and 12 months after after insertion of Gliadel® wafer(2 anaplastic astrocytomas and 1 glioblastoma). Follow-up MRI of 2 glioblastoma patients revealed tumor regrowth 3 and 19 months after insertion of Gliadel® wafer. The others are alive. The survivals showed the good performance status. Conclusion：This would be the brief preliminary report about the local control of the highly infiltrative brain tumor. Because the local progression or recurrence is still problematic combination of interstitial chemotherapy using Gliadel® wafer and systemic chemotherapy with Temodal® or other anticancer agents could improve patient's survival without increasing additional systemic toxicity.ope