A Case-Control Study Exploring the Relationship between Risk Factors of Detrusor Underactivity and Bladder Outlet Obstruction and Incomplete Bladder Emptying in Community-Dwelling Women Aged 65 or Older Who have Overactive Bladder Symptoms

Overactive bladder (OAB) is a common health problem in women and tends to increase with age. Although OAB symptoms can occur due to involuntary detruosr contractions and incomplete bladder emptying, incomplete bladder emptying in older women who have OAB symptoms has been given little attention by researchers. Detrusor underactivity (DUA) and bladder outlet obstruction (BOO) have been proposed as causes of incomplete bladder emptying but research about the risk factors related to incomplete bladder emptying in exclusively older women is still scant. Therefore, the purpose of this study was to examine the relationship between risk factors of DUA and BOO and incomplete bladder emptying in women aged 65 or older who have OAB symptoms. A total of 203 medical records were reviewed and 170 met the inclusion criteria. Model selection was conducted to determine the best model for analyzing the data. Logistic regression and a receiver operator characteristics (ROC) curve were performed to answer the research questions. Sixty-six (39%) of the women had incomplete bladder emptying. The result revealed a significant relationship between the presence of diabetes mellitus and increased bladder capacity ([greater than or equal to]500ml) and incomplete bladder emptying. Another significant but unexpected relationship was found between anterior vaginal prolapse and incomplete bladder emptying: an increase in the degree of anterior vaginal prolapse decreased the risk of incomplete bladder emptying. However, the relationship between incomplete bladder emptying and urinary frequency was not significant. Among urodynamic parameters, a maximal urine flow rate (Qmax) and voiding patterns were significantly related to incomplete bladder emptying: a greater maximal urine flow rate (Qmax) and interrupted voiding pattern were associated with an increased risk of incomplete bladder emptying. The current study raises awareness of incomplete bladder emptying in older women with OAB symptoms. In addition, the findings may help nurse researchers and health care professionals understand what risk factors are related to incomplete bladder emptying in older women who have OAB symptoms

Psychobehavioral factors, arterial stiffness, and blood pressure in Korean Americans

High levels of psychological stress and a high prevalence of hypertension (HTN) have been reported in Korean Americans (KAs). Immigration may be one source of stress which contributes to HTN in KAs. Arterial stiffness is another cardiovascular condition which is also related to both stress and hypertension. Traditionally, arterial stiffness was viewed as the result of HTN, but longitudinal studies have shown that arterial stiffness may itself predict progression of HTN in non-hypertensive people. Thus, this study explored the associations among stressors (acculturation and time in the U.S.), psychobehavioral responses (psychological stress, chronic active coping, and stress emotions of anger, anxiety, and depression), and physiological responses (blood pressure and arterial stiffness) in KAs. In this study, a convenient sample of 102 KAs (aged 21-60 years, 60% women) was recruited. Subjects were asked to complete the seven psychobehavioral scales and a demographic questionnaire. Physiological data including weight, height, blood pressure (BP), and arterial stiffness were also measured. The collected data were analyzed using SAS (version 9.2). Descriptive analysis, Pearson correlation, and multiple regressions were used to analyze the data. Age and mean arterial pressure (MAP) were the major determinants of arterial stiffness as measured by carotid-femoral pulse wave velocity (cfPWV) and augmentation index adjusted at heart rate 75 (AI_75). When age and MAP were controlled, state anger and state & trait anxiety significantly and independently predicted levels of cfPWV. Women had a significantly higher AI_75 than men. Perceived stress significantly predicted AI_75 after controlling age, MAP, and gender. Anger, anxiety, and perceived stress were related to arterial stiffness but not BP. Age was an independent predictor of cfPWV but not of BP; thus, age-associated increases in BP reported in previous studies may actually be the effect of age-associated increases and related effects of PWV on BP. More studies are needed to compare psychobehavioral factors and arterial stiffness in KAs and other racial groups, and to explore specific mechanisms by which psychobehavioral factors are implicated in the pathological process of arterial stiffness

Pulse Wave Velocity in Korean American Men and Women

Arterial stiffness is an important clinical marker of cardiovascular diseases. Although many studies have been conducted on different racial groups, less is known about arterial stiffness in Asian Americans. Korean Americans constitute the fifth largest subgroup in the Asian American population and reportedly have a noticeably high prevalence of hypertension. The aims of this study were to assess arterial stiffness and blood pressure and to examine the effect of age and gender on arterial stiffness and blood pressure in 102 Korean American men and women aged 21 to 60 years. The values of arterial stiffness for Korean Americans in this study were compared to published reference values for other racial and ethnic groups. Arterial stiffness was measured by carotid-femoral pulse wave velocity, which is the gold standard for determining arterial stiffness. Findings indicated that aging was an important determinant of arterial stiffness, which increased linearly with age. Although there was no gender difference observed in arterial stiffness, the effect of age on arterial stiffness was greater in women than in men. After adjusting for covariates including age, body mass index, and smoking, multiple regression models showed that arterial stiffness and gender were significant predictors of systolic and diastolic blood pressure. The comparisons of these findings to those from several other studies that used the same method to measure arterial stiffness showed that Korean Americans may have levels of arterial stiffness that are similar to or slightly higher than those of other racial groups. Considering that arterial stiffness is an independent predictor of future development of hypertension, more studies are required to examine cardiovascular risk of this understudied group

Visit-to-Visit Blood Pressure Variability and Sleep Architecture

Visit‐to‐visit blood pressure (BP) variability (BPV) is an independent risk factor of cardiovascular disease (CVD). Sleep architecture characterizes the distribution of different stages of sleep and may be important in CVD development. We examined the association between visit‐to‐visit BPV and sleep architecture using in‐lab polysomnographic data from 3,565 patients referred to an academic sleep center. BPV was calculated using the intra‐individual coefficient of variation of BP measures collected 12 months before the sleep study. We conducted multiple linear regression analyses to assess the association of systolic and diastolic BPV with sleep architecture—rapid eye movement (REM) and non‐rapid eye movement (NREM) sleep duration. Our results show that systolic BPV was inversely associated with REM sleep duration (p = .058). When patients were divided into tertile groups based on their BPV, those in the third tertile (highest variability) spent 2.7 fewer minutes in REM sleep than those in the first tertile (lowest variability, p = .032), after adjusting for covariates. We did not find an association of systolic BPV with other measures of sleep architecture. Diastolic BPV was not associated with sleep architecture either. In summary, our study showed that greater systolic BPV was associated with lower REM sleep duration. Future investigation is warranted to clarify the directionality, mechanism, and therapeutic implications

Utilization of Work-Family Balance Support Policy and Factors Associated with Retention Intention among Married Female Officers with Preschool Children

PURPOSE: This study aimed to identify utilization of the work-family support policy (WFSP) and factors affecting retention intention among Korean female military officers. METHODS: This cross-sectional survey recruited 103 married female officers from the Korean Army, Navy, and Air force with preschool-aged children through convenience and snowball sampling. Via online surveys from June to November, 2018, the participants self-reported retention intention, work-family conflict, job satisfaction, and utilization of the WFSP. The data were analyzed using descriptive statistics, independent t-tests, one-way analysis of variance, Pearson's correlation coefficient, and multiple linear regression. RESULTS: Retention intention (22.29±5.98) was reported at the mid-level, lower than scores reported in the literature for female workers. Work-family conflict (32.51±5.29) and job satisfaction (63.10±7.45) were above the midpoint levels. Use of maternity leave (100.0%) and parental leave (92.2%) was high, especially compared to the rates of child-care day off (20.4%) and parenting time (20.4%). ‘Noticeable increases in childcare services within the army’ (22.8%) was reported as the supportive measure needed the most by female military officers. Job satisfaction (β=.43, p≤.001), the use of parenting time (β=−0.29, p=.002), living type (β=−.18, p=.043), and service type (β=−.16, p=.035) significantly influenced retention intention. CONCLUSIONS: The findings highlight the priority areas of importance within the WFSP and suggest that a family-friendly culture can improve female officers' retention intention. Accordingly, policy changes at the Ministry of National Defense improving the system to enhance a family-friendly culture in the military is expected to strengthen the retention intention of female officers and contribute to excellence in the military workforce

Psychosocial support interventions for women with gestational diabetes mellitus: a systematic review

Purpose This study aimed to analyze the content and effectiveness of psychosocial support interventions for women with gestational diabetes mellitus (GDM). Methods The following databases were searched with no limitation of the time period: Ovid-MEDLINE, Cochrane Library, Ovid-Embase, CINAHL, PsycINFO, NDSL, KoreaMed, RISS, and KISS. Two investigators independently reviewed and selected articles according to the predefined inclusion/exclusion criteria. ROB 2.0 and the RoBANS 2.0 checklist were used to evaluate study quality. Results Based on the 14 selected studies, psychosocial support interventions were provided for the purpose of (1) informational support (including GDM and diabetes mellitus information; how to manage diet, exercise, stress, blood glucose, and weight; postpartum management; and prevention of type 2 diabetes mellitus); (2) self-management motivation (setting goals for diet and exercise management, glucose monitoring, and enhancing positive health behaviors); (3) relaxation (practicing breathing and/or meditation); and (4) emotional support (sharing opinions and support). Psychosocial supportive interventions to women with GDM lead to behavioral change, mostly in the form of self-care behavior; they also reduce depression, anxiety and stress, and have an impact on improving self-efficacy. These interventions contribute to lowering physiological parameters such as fasting plasma glucose, glycated hemoglobin, and 2-hour postprandial glucose levels. Conclusion Psychosocial supportive interventions can indeed positively affect self-care behaviors, lifestyle changes, and physiological parameters in women with GDM. Nurses can play a pivotal role in integrative management and can streamline the care for women with GDM during pregnancy and following birth, especially through psychosocial support interventions

Sex Differences in Lower Urinary Tract Symptoms in Older Korean Adults Living in Rural Areas: Prevalence, Quality of Life, and Associated Factors

Purpose Urinary incontinence (UI) is associated with nursing home admission, functional decline, and risk of death among community-dwelling older adults. Little information, however, is available on sex differences in lower urinary tract symptoms (LUTS) in older Korean adults exclusively living in rural areas. This study examined sex-related differences in LUTS, factors associated with UI in older adults living in rural areas, and health-related quality of life (HRQoL) in incontinent older adults. Methods This was a cross-sectional study in which face-to-face interviews were conducted at 15 rural community-health centres. A total of 323 older adults aged ≥65 years from rural areas of Korea participated. LUTS prevalence was evaluated and HRQoL was measured using the King’s Health Questionnaire. The chi-square test and t -test were used to examine sex differences in characteristics, LUTS, and HRQoL. Multivariable logistic regression was used to identify risk factors associated with UI. Results Nocturia was the most prevalent symptom, affecting 87% of men and 86% of women. Women (53%) had significantly more UI of any kind than did men (35%) (P=0.007). Urgency UI was the most frequent type of UI in men, whereas stress UI was the most frequent in women. Regarding HRQoL, men had significantly higher scores in the domains of sleep/energy disturbances (P=0.032) than did women, and women reported greater effects from the severity of incontinence (P=0.001) than did men. Arthritis was the only factor associated with UI in men (odds ratio [OR], 6.88; 95% confidence interval [CI], 1.46–32.36). However, women with diabetes mellitus were less likely to have UI than those without (OR, 0.43; 95% CI, 0.23–0.82). Conclusions LUTS were found to be highly prevalent in community-dwelling older Korean adults in rural areas. Interventions to improve sleep and to reduce UI severity are needed for incontinent men and women, respectively

Psychological stress and arterial stiffness in Korean Americans

Arterial stiffness is identified as a causative factor for hypertension. The purpose of this study was to explore the relationship between psychological stress and arterial stiffness in Korean Americans

Does a nurse-led postpartum self-care program for first-time mothers in Bangladesh improve postpartum fatigue, depressive mood, and maternal functioning?: a non-synchronized quasi-experimental study

Purpose This study aimed to test the efficacy of a nurse-led postpartum self-care (NLPPSC) intervention at reducing postpartum fatigue (PPF) and depressive mood and promoting maternal functioning among first-time mothers in Bangladesh. Methods A non-synchronized quasi-experimental design was used. First-time mothers were recruited during postpartum and assigned to the experimental or control group (34 each). The experimental group received the NLPPSC in the hospital, a 1-day intervention that focused on increasing self-efficacy. The control group received usual care. Data on PPF, depressive mood, maternal functioning, self-care behaviors, postpartum self-efficacy, and self-care knowledge were collected at postpartum 2 weeks (attrition 23.5%) and 6 weeks (attrition 16.1%). Data were analyzed using descriptive statistics, bivariate statistics, and linear mixed model analysis. Results One-third (33.3%) of new mothers experienced depressive mood (Edinburgh Postnatal Depression Scale scores of ≥13 points). The NLPPSC intervention was statistically significant in decreasing PPF (β=–6.17, SE=1.81, t=–3.39, p<.01) and increased maternal functioning at postpartum 6 weeks in the experimental group (β=13.72, t=3.73, p<.01) compared to the control. Knowledge was also statistically significant for increased maternal functioning over time (β=.37, SE=.18, t=2.03, p<.05). However, there were no statistically significant differences in depressive mood over time. Conclusion The NLPPSC intervention was feasible and effective in improving fatigue and maternal functioning in Bangladeshi mothers by postpartum 6 weeks. Postpartum care knowledge was effective in improved maternal functioning and thus supports implementing the NLPPSC intervention for new mothers after childbirth