Publications by authors named "Jung-Ah Lee"

126 Publications

Personalized Risk Prediction for 30-Day Readmissions With Venous Thromboembolism Using Machine Learning.

J Nurs Scholarsh 2021 Feb 22. Epub 2021 Feb 22.

Professor, School of Medicine, University of California, Irvine, CA.

Purpose: The aim of the study was to develop and validate machine learning models to predict the personalized risk for 30-day readmission with venous thromboembolism (VTE).

Design: This study was a retrospective, observational study.

Methods: We extracted and preprocessed the structured electronic health records (EHRs) from a single academic hospital. Then we developed and evaluated three prediction models using logistic regression, the balanced random forest model, and the multilayer perceptron.

Results: The study sample included 158,804 total admissions; VTE-positive cases accounted for 2,080 admissions from among 1,695 patients (1.31%). Based on the evaluation results, the balanced random forest model outperformed the other two risk prediction models.

Conclusions: This study delivered a high-performing, validated risk prediction tool using machine learning and EHRs to identify patients at high risk for VTE after discharge.

Clinical Relevance: The risk prediction model developed in this study can potentially guide treatment decisions for discharged patients for better patient outcomes.
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http://dx.doi.org/10.1111/jnu.12637DOI Listing
February 2021

Discordance Between Apolipoprotein B and Low-Density Lipoprotein Cholesterol and Progression of Coronary Artery Calcification in Middle Age.

Circ J 2020 Dec 11. Epub 2020 Dec 11.

Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine.

Background: A high level of apolipoprotein B (apoB) is associated with incident coronary artery disease (CAD) when low-density lipoprotein cholesterol (LDL-C) level is discordantly low or concordantly high. However, data on the relationship of apoB with subclinical measure of CAD are limited.Methods and Results:A total of 14,205 men (mean age 41.0 years) who were free of cardiovascular disease at baseline and who underwent a health checkup exam, including measurement of coronary artery calcium (CAC), were studied. Of the study group, 2,773 participants (19.5%) had CAC at baseline, and CAC progression was observed in 2,550 (18.0%). The multivariate-adjusted CAC score ratios (95% confidence interval) comparing discordantly high apoB/low LDL-C and concordantly high apoB/high LDL-C with concordantly low apoB/low LDL-C were 1.51 (0.98-2.32) and 2.70 (2.19-3.33), respectively. The corresponding relative risks for CAC progression were 1.26 (1.02-1.56) and 1.49 (1.34-1.66), respectively. These associations did not change appreciably after adjustment for insulin resistance and subclinical inflammation.

Conclusions: Discordant analysis showed that a high apoB level was strongly associated with prevalence and progression of CAC independent of LDL-C in a large cohort of healthy adults. The present study results highlighted the importance of an apoB measure as a potential target for primary prevention of coronary atherosclerosis in healthy adults.
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http://dx.doi.org/10.1253/circj.CJ-20-0692DOI Listing
December 2020

Spousal Concordance regarding Lifestyle Factors and Chronic Diseases among Couples Visiting Primary Care Providers in Korea.

Korean J Fam Med 2020 May 20;41(3):183-188. Epub 2020 May 20.

Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Background: Few studies have been conducted in Korea on concordance regarding chronic diseases and lifestyle factors among couples. We, therefore, evaluated spousal concordance regarding lifestyle factors and chronic diseases among Korean couples.

Methods: A total 1,040 participants (520 couples) who visited family physicians were recruited from 22 hospitals. All participants were aged ≥40 years. Participants completed questionnaires on smoking, drinking, physical activity, and irregular eating habits, including skipping breakfast. We estimated the spousal concordance regarding lifestyle factors and chronic diseases using McNemar tests and logistic regression analysis.

Results: The concordance rate was high among couples who shared unhealthy behaviors, such as low physical activity, irregular diet, and skipping breakfast (P<0.05). When cardiovascular risk factors such as overweight (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.14-2.63), hypertension (OR, 1.88; 95% CI, 1.23-2.86), or hyperlipidemia (OR, 2.41; 95% CI, 1.60-3.64) were prevalent among husbands, the odds that their wives also had the same risk factors at the same time was significantly high. The odds of being depressed when the spouse was depressed were also significantly high in both men (OR, 5.54; 95% CI, 2.19-13.96) and women (OR, 4.52; 95% CI, 1.77-11.53).

Conclusion: There was a high level of concordance regarding lifestyle factors among couples, which could lead to an increase in the prevalence of chronic diseases among couples. In addition, if a spouse has depression, the odds of their partner also having depression was high.
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http://dx.doi.org/10.4082/kjfm.18.0104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272367PMC
May 2020

Correction to: "I was Confused About How to Take Care of Mom Because this Disease Is Different Everyday": Vietnamese American Caregivers' Understanding of Alzheimer's Disease.

J Cross Cult Gerontol 2020 06;35(2):235

Sue and Bill Gross School of Nursing, University of California, 100A Berk Hall, Irvine, CA, 92697-3959, USA.

The original version of this article unfortunately contained a mistake.
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http://dx.doi.org/10.1007/s10823-020-09400-0DOI Listing
June 2020

Energy Efficiency and Patient Satisfaction of Gait With Knee-Ankle-Foot Orthosis and Robot (ReWalk)-Assisted Gait in Patients With Spinal Cord Injury.

Ann Rehabil Med 2020 Apr 29;44(2):131-141. Epub 2020 Apr 29.

Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea.

Objective: To compare the energy efficiency of gait with knee-ankle-foot orthosis (KAFO) and robot-assisted gait and to develop a usability questionnaire to evaluate the satisfaction of walking devices in paraplegic patients with spinal cord injuries.

Methods: Thirteen patients with complete paraplegia participated and 10 completed the evaluation. They were trained to walk with KAFO (KAFO-gait) or a ReWalk robot (ReWalk-gait) for 4 weeks (20 sessions). After a 2-week wash-out period, they switched walking devices and underwent 4 additional weeks of training. Two evaluations were performed (after 2 and 4 weeks) following the training periods for each walking device, using the 6-minute walking test (6MWT) and 30-minute walking test (30MWT). The spatiotemporal variables (walking distance, velocity, and cadence) and energy expenditure (heart rate, maximal heart rate, the physiologic cost index, oxygen consumption, metabolic equivalents, and energy efficiency) were evaluated duringthe 6MWT and 30MWT. A usability evaluation questionnaire for walking devices was developed based on the International Organization for Standardization/International Electrotechnical Commission guidelines through expert consultation.

Results: The ReWalk-gait presented significant advantages in energy efficiency compared to KAFO-gait in the 6MWT and 30MWT; however, there were no differences in walking distance or speed in the 30MWT between ReWalk-gait and KAFOgait. The usability test demonstrated that ReWalk-gait was not superior to KAFO-gait in terms of safety, efficacy, efficiency, or patient satisfaction.

Conclusion: The robot (ReWalk) enabled patients with paraplegia to walk with lower energy consumption compared to KAFO, but the ReWalk-gait was not superior to KAFO-gaitin terms of patient satisfaction.
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http://dx.doi.org/10.5535/arm.2020.44.2.131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7214138PMC
April 2020

"I was Confused About How to Take Care of Mom Because this Disease is Different Everyday": Vietnamese American Caregivers' Understanding of Alzheimer's Disease.

J Cross Cult Gerontol 2020 Jun;35(2):217-234

Sue and Bill Gross School of Nursing, University of California, 100A Berk Hall, Irvine, CA, 92697-3959, USA.

Family members provide the majority of caregiving to individuals living with Alzheimer's disease (AD) and related dementias. Asian American families are disproportionately impacted by the burden of caregiving due to limited knowledge about the disease in this community. This study explored how Vietnamese American caregivers understand AD and provide care to family members with AD. Twenty caregivers who have provided care to a family member with AD participated in a semi-structured qualitative interview. Data were analyzed using thematic analysis. Several themes were identified in the caregivers' understanding of AD: (a) "Now I know:" the disruptions, shocks and surprises leading up to the initial diagnosis; (b) The frustrations of managing family members' cognitive impairments; (c)"Going with the flow:" challenges in managing personality and behavioral changes; (d) The exhaustion of around-the-clock caregiving; (e)"Taking it day by day" in the face of progressively worsening symptoms. Underlining the participants' descriptions of AD was a shared understanding of the progressively worsening, complex and unpredictable nature of the disease that makes it challenging for family caregivers on a daily basis. Findings provide important implications for healthcare workers' outreach to Vietnamese American families to ease the caregiving experience through culturally-responsive education, thereby enhancing the families' ability to recognize the early symptoms and seek appropriate help.
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http://dx.doi.org/10.1007/s10823-020-09396-7DOI Listing
June 2020

"Things Are Different Now But": Older LGBT Adults' Experiences and Unmet Needs in Health Care.

J Transcult Nurs 2020 09 19;31(5):492-501. Epub 2019 Dec 19.

School of Medicine, University of California Irvine, Irvine, CA, USA.

Approximately 2.7 million U.S. older adults self-identify as lesbian, gay, bisexual, and transgender (LGBT). Many felt unsafe revealing their sexual orientation until relatively recently, and may still not be "out" to medical providers. The aim of this study was to increase understanding of the experiences and needs of older LGBT adults when accessing care. Individual semistructured interviews were conducted with 10 individuals aged 65 years or older from a local LGBT community. Interviews were audio taped and transcribed verbatim. Transcripts were analyzed via thematic analysis. Major themes were "Outness," "Things are Different Now," and "Additional Resources." These describe participant comfort with being "out"; how treatment they received changed over time, and needed services or other options from the community. While many older LGBT adults are accustomed to navigating social mores to avoid negative experiences, nurses as well as other health care providers must be prepared to create trusting relationships with these individuals to provide truly comprehensive care.
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http://dx.doi.org/10.1177/1043659619895099DOI Listing
September 2020

Relationships within MOMS Orange County care coordinated home visitation perinatal program.

Public Health Nurs 2020 03 2;37(2):215-221. Epub 2019 Dec 2.

Department of Nursing, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA.

Purpose: The study aimed to examine how registered nurses (RNs) and paraprofessional home visitors (PHVs) work together as a team to care for underserved perinatal women in a coordinated home visitation program.

Design And Methods: Qualitative methods were used to understand the perspectives of three RNs and twenty PHVs who worked at MOMS Orange County, a community-based perinatal health program. Individual one-on-one interviews were administered with the RNs and focus groups with the PHVs. Qualitative content analysis was conducted to synthesize themes.

Results: RNs perceived themselves as educators, mentors, and supervisors. PHVs thought of themselves as supporters, coaches, and advocates. Interdependence and proactive communication were favorable characteristics of the relationship in which RNs trained PHVs to provide health education. The positive interactions between RNs and PHVs appeared to enhance the client-healthcare provider connection.

Conclusions: Our study is one of the first to describe relationships and communication patterns among the healthcare team in a coordinated home visitation program in the United States. Future studies should examine how additional members of the team, including clients and healthcare providers, view their experiences with a home visitation program.
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http://dx.doi.org/10.1111/phn.12689DOI Listing
March 2020

Correlates of life-support treatment preferences among low-income home-based cancer management recipients.

Eur J Oncol Nurs 2019 Dec 12;43:101665. Epub 2019 Sep 12.

University of California, Irvine, Sue and Bill Gross School of Nursing, Irvine, CA, 92697, USA. Electronic address:

Purpose: To examine the correlates of life-support treatment (LST) preferences from attitudes toward advance directives (ADs), perceived susceptibility, symptom frequency, symptom burden, and global health among low-income community-dwelling cancer management recipients, controlling for age, sex, education, and duration after cancer diagnosis.

Methods: A cross-sectional, correlational study design was used to assess LST preferences and correlates. Data were collected from low-income cancer survivors during nurses' home visits.

Results: Survivors who had mostly solid cancer participated (N = 107, mean age = 67.39 ± 11.57 years, 32.7% males). Hospice care was the most desired (66.4%), while aggressive treatments were less preferred: cardiopulmonary resuscitation (15.9%), ventilation support (15.0%), hemodialysis (18.7%), or chemotherapy (12.1%). Higher symptom frequency was associated with a greater likelihood of preferring all aggressive treatments (odds ratios = 1.44-1.75). In addition, longer cancer duration was associated with a greater likelihood of preferring ventilation support; females had a lesser likelihood of preferring hemodialysis and chemotherapy. Higher education was associated with a lesser likelihood of preferring chemotherapy. More positive attitudes (B = 0.15, p = .001) were associated with a greater likelihood of preferring hospice care, and greater symptom burden of pain (B = -0.03, p = .047) was associated with a lesser likelihood.

Conclusion: Results support the feasibility of incorporating ADs into cancer management among community-dwelling cancer survivors, with consideration of AD attitudes and symptom monitoring. An integration of AD discussion into the home visiting service could be a liaison for the quality and continuity of cancer survivorship care that guides and manages patients' survivorship issues.
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http://dx.doi.org/10.1016/j.ejon.2019.09.006DOI Listing
December 2019

Effect of diabetes self-management education on glycemic control in Latino adults with type 2 diabetes: A systematic review and meta-analysis.

Patient Educ Couns 2020 02 9;103(2):266-275. Epub 2019 Sep 9.

University of Texas Medical Branch School of Nursing.

Purpose: This systematic review and meta-analysis evaluated the effectiveness of diabetes self-management education (DSME) in reducing glycosylated hemoglobin (A1C) levels in adult Latinos with type 2 diabetes (T2DM).

Methods: Five databases were searched for DSME randomized controlled trials or quasi-experimental trials published between January 1997 and March 2019. A random effects model was utilized to calculate combined effect sizes. Subgroup analyses were performed to explore possible sources of heterogeneity between studies.

Results: Twenty-three unique studies met criteria for this systematic review and of these, 18 were included in the meta-analysis. Pooled estimate effect of DSME on A1C from the random effect model was -0.240 (95% confidence interval = -0.345, -0.135, p <  0.001). There was moderate heterogeneity (Cochrane Q=30.977, P=0.020, I^2 = 45.121) between the studies. Subgroup analyses demonstrated greater A1C reductions in studies with intervention duration ≤6 months, initial A1C baseline values >8.0 [69 mmol/mol], and team-based approach.

Conclusions: Meta-analysis results showed that culturally tailored DSME interventions significantly reduce AIC in Latinos with T2DM despite the heterogeneity across the studies.

Implications: The heterogeneity in the study methodologies reinforce the need for additional studies to better understand DSME interventions to reduce disparities in Latino adults with T2DM.
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http://dx.doi.org/10.1016/j.pec.2019.09.009DOI Listing
February 2020

Can Liking, Commenting, and Sharing Enhance Persuasion? The Interaction Effect between Modality Interactivity and Agency Affordances on Smokers' Quitting Intentions.

Health Commun 2020 Nov 16;35(13):1593-1604. Epub 2019 Aug 16.

The Stan Richards School of Advertising & Public Relations, The University of Texas at Austin.

This article examines whether the persuasive potential of modality interactivity on anti-smoking websites can be harnessed by adding agency affordances, such as the like, comment, and share features. Using a 2 × 2 factorial experiment with a current smoker sample (N = 154), we investigated the interaction effects between modality interactivity (low vs. high) and agency affordances (absence vs. presence) on persuasion outcomes. The results showed that the effects of modality interactivity on telepresence, systematic processing, and change in quitting intentions varied depending on the existence of agency affordances on the website. Agency affordances on the anti-smoking website led to a greater sense of agency and systematic processing on the website content. Only in the presence of agency affordances did modality interactivity enhance the feeling of telepresence, which led to greater quitting intentions than in the control condition. Without agency affordances, modality interactivity diminished systematic processing, leading to lower quitting intentions.
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http://dx.doi.org/10.1080/10410236.2019.1654172DOI Listing
November 2020

"Living happily despite having an illness": Perceptions of healthy aging among Korean American, Vietnamese American, and Latino older adults.

Appl Nurs Res 2019 08 10;48:30-36. Epub 2019 May 10.

University of California, Irvine, Division of Geriatric Medicine & Gerontology, Department of Family Medicine, School of Medicine, 200 Manchester, Suite 835, Orange, CA 92865, United States of America. Electronic address:

Background/objective: The growingly diverse aging population presents a challenge for the geriatric workforce, particularly its capacity to effectively respond to the sociocultural and linguistic needs of ethnic minority older adults. Informed by research on the importance of culturally-competent care in reducing racial and ethnic health disparities, this study sought to understand the meaning of healthy aging from the perspectives of Korean American, Vietnamese American, and Latino older adults.

Methods: Interviews were conducted with 30 participants recruited from community-based organizations in Southern California.

Results: Several dimensions emerged in the participants' understanding of healthy aging: (1) having good physical and mental health (2) optimism and acceptance; (3) social connectedness; (4) taking charge of one's health; and (5) independence and self-worth.

Conclusions: Results could inform the development of a culturally-responsive geriatric healthcare system that takes into account older adults' beliefs, preferences, and needs to promote successful aging.
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http://dx.doi.org/10.1016/j.apnr.2019.04.002DOI Listing
August 2019

Short report: depressive mood moderates the association between family communication and self-rated health in married couples.

Psychol Health Med 2020 01 24;25(1):102-109. Epub 2019 May 24.

Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, South Korea.

Self-rated health, a valid measure of general health, is influenced by family dynamics and depression. In this study, using data from the Family Cohort Study in Primary Care, we investigated whether depressive mood moderated the association between family communication and self-rated health in married couples. Among the 520 couples in the cohort, we cross-sectionally analyzed the responses of 420 couples (840 participants) who provided answers to the Center for Epidemiologic Studies Depression Scale, the Family Communication Scale of the Family Adaptation and Cohesion Evaluation Scale-IV, and a self-rated health question. Hierarchical regression analyses were performed to evaluate the interactions between depressive mood and family communication on self-rated health. High levels of family communication were associated with better self-rated health (r = -.16, p < .01), and that depressive mood moderated the association between family communication and self-rated health (β = .10, p = .008). Specifically, the association between family communication and self-rated health was significant only when levels of depressive mood were low (β = -.175, p = < .001), and the association was lost when levels of depressive mood were high (β = -.031, p = .446). High levels of depressive mood weakened the positive association between family communication and self-rated health. Our findings highlight the significant influence of depressive symptoms on family dynamics and health among patients in primary care.
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http://dx.doi.org/10.1080/13548506.2019.1622747DOI Listing
January 2020

Impact of family communication on self-rated health of couples who visited primary care physicians: A cross-sectional analysis of Family Cohort Study in Primary Care.

PLoS One 2019 13;14(3):e0213427. Epub 2019 Mar 13.

Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Introduction: Self-rated health (SRH) is a subjective health measurement that predicts mortality and morbidity and reflects mental health and socioeconomic status. Since a couple's relationship can influence the health status of the individuals involved, poor family communication can negatively influence the health status of its members. The aim of this study was to investigate the factors affecting SRH among married couples in primary care and evaluated the effect of family communication on SRH.

Material And Methods: In this cross-sectional analysis of Family Cohort Study in Primary Care, 469 couples (938 participants) were analyzed to evaluate the relationship between SRH and family communication. Participants answered questionnaires on demographic characteristics and lifestyle factors. The Korean version of the Family Communication Scale of Family Adaptation and Cohesion Evaluation Scale-IV was used to assess family communication, and a 5-point scale of SRH questions was used to assess the SRH status. Multivariate logistic regression analyses were performed in order to evaluate the relationship between family communication and SRH and identify associated factors for good SRH.

Results: Wives with a high family communication level had higher OR for good SRH. When the husband and wife both reported high family communication levels, the OR for good SRH increased in wives; however, the relationship between family communication and SRH was not significant in husbands. In the multi-adjusted model, the OR for good SRH of husbands increased in those with >12 years of education, moderate drinkers and decreased in current smokers. The OR for good SRH of wives increased in those with age of 60 to 69, those with >12 years of education, and those who participated in vigorous physical activity, and decreased in those with diabetes and depressive mood.

Conclusions: Our results indicate that improvement in family communication may contribute to better SRH.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0213427PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6415836PMC
December 2019

Effect of exergaming on health-related quality of life in older adults: A systematic review.

Int J Nurs Stud 2019 May 10;93:30-40. Epub 2019 Feb 10.

Sue and Bill Gross School of Nursing, University of California, Irvine, CA, 92697, USA.

Introduction: Exercise through video or virtual reality games (i.e. exergames) has grown in popularity among older adults; however, there is limited evidence on efficacy of exergaming on well-being related to health in this population. This systematic review examined the effectiveness of exergaming on health-related quality of life in older adults.

Methods: PRISMA guidelines for this systematic review. Several databases were searched using keywords to identify peer-reviewed journal articles in English. Randomized control trials that evaluated the effect of exergaming on health-related quality of life in older adults when compared to a control group and published between January 2007 to May 2017 were included.

Results: Nine articles that in total included 614 older adults with varying levels of disability, mean age 73.6 + 7.9 years old, and 67% female were analyzed. Significant improvements in health-related quality of life of older adults engaged in exergaming were reported in three studies. Sample sizes were small in 7 of the studies (N < 60). The study participants, exergaming platforms, health-related quality of life instruments, study settings and length, duration and frequency of exergaming varied across studies.

Conclusion: Exergaming is a new emerging form of exercise that is popular among older adults. However, findings from this analysis were not strong enough to warrant recommendation due to the small sample sizes and heterogeneity in the study participants, exergaming platforms, health-related quality of life instruments, length, duration and frequency of the intervention and study settings. Further research is needed with larger sample sizes and less heterogeneity to adequately explore the true effects of exergaming on health-related quality of life of older adults.
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http://dx.doi.org/10.1016/j.ijnurstu.2019.01.010DOI Listing
May 2019

Multiple relationships between Tardieu, Kinematic data, and Wolf Motor Function Test with children with cerebral palsy.

NeuroRehabilitation 2019 ;44(2):191-197

Department of Physical Therapy, Sports Movement Artificial Robotics Technology (SMART) Institute, The Graduate School, Yonsei University, Wonju, Republic of Korea.

Background: The World Health Organization (WHO) has developed the International Classification of Functioning, Disability and Health (ICF) model in order to provide a theoretical foundation of physical therapy diagnosis and intervention. However, the multidirectional relationships between the body structure/function domain variables (spasticity and movement kinematics) and the activity domain variables (e.g. reaching, grasping, folding, and lifting abilities) using the Wolf Motor Function Test (WMFT) remain unknown.

Objective: The purpose of the present study was to examine the directional relationships between the body function and structure domain variables and the activity domain variables using the WMFT.

Methods: Nineteen children with cerebral palsy (CP) were recruited from a major rehabilitation center. Standardized clinical tests included Tardieu scale and WMFT, which were used to measure the body function and structure domain (spasticity) and activity domain (reaching, grasping, folding, and lifting abilities). An eight infrared motion capture system (VICON, Oxford, UK) was used to collect kinematics data during reaching, which represent the body function and structure domain variables. Correlational analysis was performed at P < 0.05.

Results: Our results revealed a fair to strong relationship between the body function and structure domain variables (11 out of 18 kinematic data) and activity domain variables (WMFT). However, no significant correlation was observed between the Tardieu score and the kinematics data or between the Tardieu score and the WMFT variables.

Conclusions: The present findings suggest that the body structure/function domain variables (Kinematic data) are closely associated with activity domain variables (WMFT). However, the body function and structure domain variables within Tardieu spasticity and kinematic data variables were not associated each other, nor between Tardieu spasticity and activity domain variables (WMFT), indicating that Tardieu spasticity test does not seem to account for or reflect active kinematic movement or WFMT variables. This finding provides an important clinical insight when developing a comprehensive assessment and intervention for children with CP.
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http://dx.doi.org/10.3233/NRE-182610DOI Listing
June 2019

Correlates of advance directive treatment preferences among community-dwelling older people with chronic diseases.

Int J Older People Nurs 2019 Jun 1;14(2):e12229. Epub 2019 Mar 1.

Sue and Bill Gross School of Nursing, University of California, Irvine, Irvine, California.

Background: Concerns over the creation of advance directives (ADs) and the factors associated with treatment directive decisions among Korean community-dwelling older people with chronic diseases have rarely been addressed.

Objectives: This study aimed to examine knowledge, attitudes and barriers/benefits regarding ADs and their associations with AD treatment preferences among chronically ill, low-income, community-dwelling older people.

Methods: Using a descriptive, correlational design, older people who were recipients of home visiting service for chronic disease management participated in this study. Home visiting nurses collected data on knowledge, attitudes and perceived barriers/benefits and treatment directives using questionnaires during home visits.

Results: Older people (N = 112, mean age = 74.9 years, women = 83.9%) who had chronic diseases such as hypertension (56.3%), diabetes mellitus (40.2%) and cardiovascular disease/stroke (22.3%) participated. Approximately half of the participants preferred hospice care (54.5%), while a few of them preferred aggressive treatments: cardiopulmonary resuscitation (CPR) (14.3%), ventilation support (9.8%) and haemodialysis (8.9%). Being married was associated with the likelihood of preferring CPR (odds ratio [OR] = 11.79) and ventilation support (OR = 9.99), higher education with CPR (OR = 1.23) and haemodialysis (OR = 1.16), and having a cardiovascular disease (CVD)/stroke with CPR (OR = 6.46) and hospice care (OR = 3.06). Among the modifiable factors, greater perceived barriers increased the likelihood of CPR preference (OR = 1.12) but decreased the likelihood of hospice care preference (OR = 0.96). Greater perceived benefits decreased the likelihood of CPR preference (OR = 0.81) and ventilation support (OR = 0.89), and AD knowledge decreased the likelihood of haemodialysis preference (OR = 0.23).

Conclusion: The multidimensional factors were differently associated with each of the AD treatment preferences. Modifiable factors, including perceived barriers and benefits and knowledge, should be improved to help low-income, community-dwelling older people select adequate AD treatment preferences.

Implications For Practice: Additional information regarding AD treatments and some modifiable and non-modifiable correlates can be integrated into primary and palliative/supportive care in public health. The current home visitation service may also benefit from incorporating AD discussions while extending the service to embrace AD issues in addition to disease management.
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http://dx.doi.org/10.1111/opn.12229DOI Listing
June 2019

A Program Model Describing a Community-Based Mother and Infant Health Program.

Res Theory Nurs Pract 2019 02;33(1):39-57

Department of Nursing, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California.

Background And Purpose: The objective of this study was to formulate a MOMS Orange County program model to describe the components and function of a successful community-based maternal and infant health program.

Methods: A logic framework was used to guide the development of the MOMS program model. Twenty-five MOMS staff members were interviewed; MOMS documents and existing research literature were reviewed. Content analyses were used to identify themes of interviews and the review guide was used to summarize the documents.

Results: The key components of the MOMS program were identified to formulate a narrative and graphic model. The main elements of this model included: target population (underserved women who have low socioeconomic status and have limited access to healthcare in Orange County); theoretical assumptions (social determinants of health, human ecology, self-efficacy); goals (empower women, enhance health of infants, strengthen families); inputs (funded by public and private sources; 50 staff members); activities (care-coordination home visitation community-center group health education); outputs (the number of home visitations, referrals to medical and/or psychological services, and group health education classes); and outcomes (short-term: healthy pregnancy, birth outcomes, family support; medium-term: postpartum well-being, infant development, family functioning; long-term: women's well-being, children's development, family relationships. Future research should test how this model functions to empirically improve maternal, newborn, child, and family health.

Implications For Practice: The MOMS program provides a new approach to community-based maternal and infant health interventions focusing on health promotion and disease prevention for underserved families in socioeconomically disadvantaged communities.
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http://dx.doi.org/10.1891/1541-6577.33.1.39DOI Listing
February 2019

Caregiving Experience of Dementia among Korean American Family Caregivers.

Issues Ment Health Nurs 2019 Feb 8;40(2):158-165. Epub 2019 Jan 8.

b Sue and Bill Gross School of Nursing , University of California, Irvine , Irvine, California , USA.

Dementia is a major public health problem affecting 5.5 million people in USA. This qualitative study explored the caregiving experience of Korean American (KA) families of persons with dementia (PWD). Adult KA caregivers of PWD (n = 18) were recruited for semi-structured interviews. Thematic analysis yielded four themes: challenges in finding resources, struggling with mental health issues, traveling the path of acceptance, and finding ways to survive. Due to the language barrier, most KA caregivers reported using Korean Internet for information on dementia and caregiving. Some traveled to South Korea seeking medical assistance for dementia (medical tourism). Importantly, some KA caregivers expressed suicidal thoughts and depression. Unexpectedly, familism prevented help seeking and possible relief from their difficulties. There is an urgent need to improve access to dementia care services and education for the KA community. Building a trusting relationship with healthcare providers is even more important for KA caregivers to address their mental health concerns.
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http://dx.doi.org/10.1080/01612840.2018.1534909DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6445682PMC
February 2019

Trends in the ease of cigarette purchase among Korean adolescents: evidence from the Korea youth risk behavior web-based survey 2005-2016.

BMC Public Health 2018 Nov 7;18(1):1242. Epub 2018 Nov 7.

Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro-43-gil, Songpa-gu, Seoul, 05505, South Korea.

Background: According to the Juvenile Protection Act in Korea, no one is allowed to sell, rent, or distribute tobacco products to adolescents. Furthermore, the Framework Convention on Tobacco Control Article 16 prohibits the sale of tobacco products to minors. In this study, we investigated the trends in and associated factors of the ease of cigarette purchase among Korean adolescents from 2005 to 2016.

Methods: The analyses were based on the data of the Korea Youth Risk Behavior Web-based Survey. We estimated the trends in the ease of cigarette purchase from 2005 to 2016 and evaluated associated factors. Ease of cigarette purchase was defined as the proportion of adolescents who were able to purchase cigarettes from among those who had tried to purchase cigarettes in the past 30 days.

Results: The ease of cigarette purchase began decreasing since 2008 (81.3%) compared to 2005 (83.9%). It decreased to 76.5% in 2013 and further decreased to 71.4% in 2016. The ease of cigarette purchase increased for adolescents who were in higher grades, smoked larger amounts of cigarettes per day, lived in metropolitan cities, had problematic drinking in the past year, and had close friends who smoked. It decreased in adolescents who had current smokers among their family members.

Conclusions: Although the proportion of adolescents who were able to purchase cigarettes significantly decreased starting in 2008, more than 70% of Korean adolescents can still purchase cigarettes. Enforcement of the Juvenile Protection Act must be strengthened in order to prevent cigarette use among adolescents.
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http://dx.doi.org/10.1186/s12889-018-6151-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6222989PMC
November 2018

Factors Affecting Adherence to Antihypertensive Medication.

Korean J Fam Med 2018 Nov 2;39(6):325-332. Epub 2018 Nov 2.

Departments of Family Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.

Background: Hypertension is a major contributor to the global disease burden of cardiovascular and cerebrovascular disease. The aim of this study was to determine demographic and clinical factors associated with adherence to antihypertensive medication.

Methods: From August 2012 to February 2015, we recruited 1,523 Korean patients with hypertension who visited family physicians. The study was conducted in 24 facilities located in urban and metropolitan areas. Of these facilities, two were primary care clinics and 22 were level 2 or 3 hospitals. Adherence was assessed using the pill count method; a cut-off value of 80% was used as the criterion for good adherence. Sociodemographic and lifestyle factors were compared between the adherent and nonadherent groups using the chi-square test for categorical variables and t-test for continuous variables. Binary logistic regression analysis was performed with medication adherence as the outcome variable.

Results: Of the 1,523 patients, 1,245 (81.7%) showed good adherence to antihypertensive medication. In the multivariate logistic analysis, age ≥65 years, exercise, treatment in a metropolitan-located hospital, being on ≥2 classes of antihypertensive medication and concomitant medication for diabetes, and a family history of hypertension or cardiovascular diseases were associated with good adherence. Patients who had a habit of high salt intake were less adherent to medication.

Conclusion: Multiple classes of antihypertensive medications, concomitant medication, and exercise were associated with good adherence to antihypertensive medication, and high salt intake was associated with poor adherence to antihypertensive medication. These factors should be considered to improve hypertension control.
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http://dx.doi.org/10.4082/kjfm.17.0041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6250947PMC
November 2018

Enhanced neutralizing antibody response induced by inactivated enterovirus 71 in cynomolgus monkeys.

PLoS One 2018 2;13(10):e0202552. Epub 2018 Oct 2.

Division of Vaccine Research, National Research Institute of Health, Centers for Disease Control and Prevention, Osong-eup, CheongJu, Chungcheongbuk-do, Republic of Korea.

Enterovirus 71 (EV71) is a major etiological agent of various public health issues, particularly in the Asia-Pacific region. EV71 causes hand-foot-and-mouth disease (HFMD) and is associated with serious neurological disorders in young children. A formalin-inactivated EV71 candidate vaccine (KCDC-HFMDV1-EV71) based on the C4 subgenotype was previously developed and confirmed to be a potential candidate vaccine for prevention of EV71 infection in mice. In this study, an inactivated EV71 vaccine was used for analysis of long-term immunogenicity and efficacy in cynomolgus monkeys, a common nonhuman primate model. The vaccine was immunized three times at 0, 4, and 8 weeks with either 20-μg doses of EV71 candidate vaccine formulated with aluminum hydroxide gel adjuvant or phosphate-buffered saline as a control. The group immunized with the inactivated EV71 showed significantly increased EV71-specific antibody and serum neutralizing antibody titers at 3 weeks after vaccination and maintained these elevated titers until the end of the experiment (54 weeks after vaccination). The sera from vaccinated cynomolgus monkeys showed a crossreactive neutralizing antibody response to the heterologous subtype of EV71 (B1-4, C1, and C2). These findings suggest that the inactivated EV71 candidate vaccine may be a potential vaccine candidate and valuable tool for the control of HFMD.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202552PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6168120PMC
March 2019

Health behaviors and illness according to marital status in middle-aged Koreans.

J Public Health (Oxf) 2018 06;40(2):e99-e106

Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olymphic-Ro 43-Gil, Songpa-gu, Seoul, South Korea.

Background: Marital status influences health and this association might differ by time and/or country. Divorce rates have increased abruptly in Korea. We investigated relationships between marital status and health behaviors and illness among middle-aged Koreans.

Methods: Data from the fifth Korean National Health and Nutrition Examination Survey 2010-12 was used. Participants were middle-aged (40-65 years) Koreans (3015 male and 4498 female) who had been married. Health behaviors and physical and mental health status were evaluated separately for each gender according to marital status (currently married versus separated, divorced or widowed) using logistic regression analyses adjusted for age, income level and region.

Results: About 5.4% of men and 13.0% of women lived without their spouses. Odd ratios (ORs) for smoking, binge drinking, inadequate sleep, hypertriglyceridemia and depression were significantly higher in participants not living with their spouses. ORs for non-participation in regular health examinations and cancer screenings, anemia, elevated alanine aminotransferase and suicidal ideation were significantly higher in men not living with their spouses.

Conclusions: Health behaviors and illness were significantly worse in middle-aged Koreans not living with their spouses. Men were more susceptible to poor health screening, nutritional deficiencies and mental illness. Preventive services are necessary to improve their health status.
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http://dx.doi.org/10.1093/pubmed/fdx071DOI Listing
June 2018

Facilitators and barriers to research participation: perspectives of Latinos with type 2 diabetes.

Eur J Cardiovasc Nurs 2018 12 11;17(8):737-741. Epub 2018 Jun 11.

1 Sue and Bill Gross School of Nursing, University of California Irvine, USA.

Background: Latinos constitute 17% of the US population and are one of the largest ethnic groups; however, only 7.6% participate in research studies. There is a disproportionately high number of Latinos living with type 2 diabetes mellitus and are at increased risk for cardiovascular events. Research to elicit facilitators and barriers for participation in research and effective recruitment strategies is limited.

Aims: This article reports the qualitative findings of a mixed-methods study examining perceived facilitators and barriers for research participation, and explores decision-making processes and ascertains ethnic values that influenced their decisions among Spanish-speaking Latinos with type 2 diabetes mellitus.

Methods: Semi-structured interviews were conducted with 25 participants (mean age 50.8 ± 9.4 years, 76% women and 28% employed). Participants were asked to elaborate on perceived facilitators and barriers to research participation. All interviews were conducted in Spanish. Transcribed interviews were analyzed through conventional content analysis.

Results: Three themes emerged from transcribed interviews: (a) lowering barriers to access health-related expertise; (b) language concordance; and (c) trusting relationships. Perceived barriers to research participation included work schedule, childcare, transportation and ethnic beliefs.

Conclusion: Strategies to support learning, language concordance and establishing trusting relationships among Spanish-speaking Latinos may be key to increasing Latinos in research studies.
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http://dx.doi.org/10.1177/1474515118780895DOI Listing
December 2018

The immunogenicity and protection effect of an inactivated coxsackievirus A6, A10, and A16 vaccine against hand, foot, and mouth disease.

Vaccine 2018 06 5;36(24):3445-3452. Epub 2018 May 5.

Division of Vaccine Research, National Institute of Health, Centers for Disease Control and Prevention, Osong, CheongJu, Chungcheongbuk-do, South Korea. Electronic address:

Coxsackievirus belongs to the Enterovirus genus of the Picornaviridae family and is one of the major pathogens associated with human hand, foot, and mouth disease (HFMD). Historically, outbreaks of HFMD have mainly been caused by enterovirus 71 and coxsackievirus A16. Recently, coxsackieviruses A6 and A10 have been associated with increased occurrences of sporadic HFMD cases and outbreak events globally. In this study, the immunogenicity of coxsackieviruses A6, A10, and A16 (CA6, CA10, and CA16), which were inactivated by formalin or β-propiolactone (BPL) under different conditions, was evaluated as multivalent vaccine candidates. CA6 induced similar immune responses with both inactivation methods, and the immune efficacy of CA10 and CA16 was better following inactivation with BPL than with formalin. There was no sufficient cross-reactivity or cross-protectivity against heterologous strains in groups vaccinated with the BPL-inactivated (BI) monovalent vaccine. Sufficient neutralizing antibody and cell-mediated immune responses were induced in the BI-trivalent vaccinated group. These findings suggest that BI-CA6, CA10, and CA16 are potential multivalent vaccine candidates and that a multivalent vaccine is needed to control HFMD. The coxsackievirus multivalent vaccine could be useful for the development of effective HFMD vaccines.
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http://dx.doi.org/10.1016/j.vaccine.2018.05.005DOI Listing
June 2018

Reduction of mycoplasmal lesions and clinical signs by vaccination against Mycoplasma hyorhinis.

Vet Immunol Immunopathol 2018 Feb 5;196:14-17. Epub 2017 Dec 5.

College of Veterinary Medicine, Konkuk University, Seoul 143-701, Republic of Korea. Electronic address:

Porcine mycoplasmal pneumonia is a significant disease problem in the swine industry. The causative agents include Mycoplasma hyopneumoniae and Mycoplasma hyorhinis. M. hyopneumoniae is the major pathogen contributing to the porcine respiratory disease complex, but is difficult to isolate from the respiratory tract and tonsils, whereas M. hyorhinis is not. Although M. hyorhinis is commonly detected in the lungs, the role of M. hyorhinis as a cause of pneumonia remains unclear. Current vaccines for porcine mycoplasmal pneumonia only include M. hyopneumoniae, not M. hyorhinis. M. hyopneumoniae vaccines are widely used, but disease still occurs because of poor vaccine efficacy and possibly the presence of M. hyorhinis. In this study, an inactivated vaccine containing a mixture of M. hyorhinis and M. hyopneumoniae was generated and evaluated for safety, immunogenicity, and protective efficacy against challenge with M. hyorhinis in pigs. The inactivated vaccine induced an antibody response and reduced pneumonic lesions in the lungs and tracheas compared with the non-vaccinated group.
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http://dx.doi.org/10.1016/j.vetimm.2017.12.001DOI Listing
February 2018

Strain Mapping and Raman Spectroscopy of Bent GaP and GaAs Nanowires.

ACS Omega 2018 Mar 15;3(3):3129-3135. Epub 2018 Mar 15.

Korea Advanced Analysis Center, Korea Institute of Science and Technology, Seoul 136-791, Korea.

Strain engineering of nanowires (NWs) has been recognized as a powerful strategy for tuning the optical and electronic properties of nanoscale semiconductors. Therefore, the characterization of the strains with nanometer-scale spatial resolution is of great importance for various promising applications. In the present work, we synthesized single-crystalline zinc blende phase GaP and GaAs NWs using the chemical vapor transport method and visualized their bending strains (up to 3%) with high precision using the nanobeam electron diffraction technique. The strain mapping at all crystallographic axes revealed that (i) maximum strain exists along the growth direction ([111]) with the tensile and compressive strains at the outer and inner parts, respectively; (ii) the opposite strains appeared along the perpendicular direction ([2̅11]); and (iii) the tensile strain was larger than the coexisting compressive strain at all axes. The Raman spectrum collected for individual bent NWs showed the peak broadening and red shift of the transverse optical modes that were well-correlated with the strain maps. These results are consistent with the larger mechanical modulus of GaP than that of GaAs. Our work provides new insight into the bending strain of III-V semiconductors, which is of paramount importance in the performance of flexible or bendable electronics.
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http://dx.doi.org/10.1021/acsomega.8b00063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6641494PMC
March 2018

Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review.

BMC Med Inform Decis Mak 2018 02 20;18(1):12. Epub 2018 Feb 20.

Program in Public Health, University of California Irvine, Irvine, CA, USA.

Background: Mobile health (mHealth) has continuously been used as a method in behavioral research to improve self-management in patients with chronic diseases. However, the evidence of its effectiveness in chronic disease management in the adult population is still lacking. We conducted a systematic review to examine the effectiveness of mHealth interventions on process measures as well as health outcomes in randomized controlled trials (RCTs) to improve chronic disease management.

Methods: Relevant randomized controlled studies that were published between January 2005 and March 2016 were searched in six databases: PubMed, CINAHL, EMBASE, the Cochrane Library, PsycINFO, and Web of Science. The inclusion criteria were RCTs that conducted an intervention using mobile devices such as smartphones or tablets for adult patients with chronic diseases to examine disease management or health promotion.

Results: Of the 12 RCTs reviewed, 10 of the mHealth interventions demonstrated statistically significant improvement in some health outcomes. The most common features of mHealth systems used in the reviewed RCTs were real-time or regular basis symptom assessments, pre-programed reminders, or feedbacks tailored specifically to the data provided by participants via mHealth devices. Most studies developed their own mHealth systems including mobile apps. Training of mHealth systems was provided to participants in person or through paper-based instructions. None of the studies reported the relationship between health outcomes and patient engagement levels on the mHealth system.

Conclusions: Findings from mHealth intervention studies for chronic disease management have shown promising aspects, particularly in improving self-management and some health outcomes.
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http://dx.doi.org/10.1186/s12911-018-0591-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5819153PMC
February 2018

Usages of Computers and Smartphones to Develop Dementia Care Education Program for Asian American Family Caregivers.

Healthc Inform Res 2017 Oct 31;23(4):338-342. Epub 2017 Oct 31.

The Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, CA, USA.

Objectives: Families of ethnic minority persons with dementia often seek help at later stages of the disease. Little is known about the effectiveness of various methods in supporting ethnic minority dementia patients' caregivers. The objective of the study was to identify smartphone and computer usage among family caregivers of dementia patients (i.e., Korean and Vietnamese Americans) to develop dementia-care education programs for them.

Methods: Participants were asked various questions related to their computer or smartphone usage in conjunction with needs-assessment interviews. Flyers were distributed at two ethnic minority community centers in Southern California. Snowball recruitment was also utilized to reach out to the families of dementia patients dwelling in the community.

Results: Thirty-five family caregivers, including 20 Vietnamese and 15 Korean individuals, participated in this survey. Thirty participants (30 of 35, 85.7%) were computer users. Among those, 76.7% (23 of 30) reported daily usage and 53% (16 of 30) claimed to use social media. A majority of the participants (31 of 35, 88.6%) reported that they owned smartphones. More than half of smartphone users (18 of 29, 62%) claimed to use social media applications. Many participants claimed that they could not attend in-class education due to caregiving and/or transportation issues.

Conclusions: Most family caregivers of dementia patients use smartphones more often than computers, and more than half of those caregivers communicate with others through social media apps. A smartphone-app-based caregiver intervention may serve as a more effective approach compared to the conventional in-class method. Multiple modalities for the development of caregiver interventions should be considered.
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http://dx.doi.org/10.4258/hir.2017.23.4.338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688035PMC
October 2017

Risk of osteoporosis after gastrectomy in long-term gastric cancer survivors.

Gastric Cancer 2018 07 21;21(4):720-727. Epub 2017 Nov 21.

Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

Introduction: Although early detection and successful gastrectomy have improved the survival of patients with gastric cancer, long-term health problems remain troubling. We evaluated the prevalence of osteoporosis and its risk factors in long-term survivors of gastric cancer after gastrectomy.

Methods: We reviewed the medical records of a tertiary hospital between 2007 and 2014 to identify survivors of gastric cancer who had visited our center at around 5 years after gastrectomy. We evaluated their health status, including bone mineral density (BMD). Dual-energy X-ray absorptiometry was used to measure the BMD of the lumbar spine and femur (total and neck area). The prevalence of osteoporosis, defined by a BMD T score <-2.5, was investigated, and clinical variables associated with the presence of osteoporosis were identified.

Results: A total of 250 survivors were included. The mean age was 54.6 years old, and the median follow-up was 6.0 years. The prevalence of osteoporosis was 34.0% (27.4% for men and 43.6% for women). Older age [odds ratio (OR) 5.50, 95% CI 2.33-13.00], higher alkaline phosphatase levels before gastrectomy (OR 5.67, 95% CI 1.36-23.64), and marked weight loss (≥20%) after gastrectomy (OR 3.59, 95% CI 1.32-9.77) were independently associated with the presence of osteoporosis.

Conclusions: In our cohort, osteoporosis was commonly observed in long-term survivors of gastric cancer, and several risk factors for it were identified. To reduce the risk of osteoporosis after gastrectomy, maintaining adequate body weight may be necessary.
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http://dx.doi.org/10.1007/s10120-017-0777-7DOI Listing
July 2018