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Yaelim Lee,1 Jong-Min Baek,2 Ye-Won Jeon,3 Eun-Ok Im4 1Department of Nursing, Red Cross College of Nursing, Chung-Ang University, Dongjak-gu, Seoul, Republic of Korea; 2Department of Surgery, Yeouido St. Mary’s Hospital, Seoul, Republic of Korea; 3Department of Surgery, St. Vincent’s Hospital, Gyeonggi-do, Republic of Korea; 4Department of Nursing, School of Nursing, Duke University, Durham, NC, USACorrespondence: Yaelim LeeDepartment of Nursing, Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 06974, Republic of KoreaTel +82 10 9950 2731Email ylcaregiver@gmail.comPurpose: The objective of the study was to explore breast cancer patients’ illness perception, its relationship to perceived sense of well-being, and the role of perceived social support.Methods: Women with diagnosed breast cancer were recruited from the two university hospitals in South Korea between January and April 2018. The questionnaires included the Illness Perception Questionnaire-Revised (IPQ-R) and the Functional Assessment of Cancer Therapy for Breast cancer (FACT-B). A total of 321 participants’ data was analyzed using descriptive analyses, multiple regression, and structural equation modeling.Results: Negative illness perception was greater in participants currently receiving chemotherapy (p=0.044) or had received chemotherapy in the past (p=0.006). Positive illness perception was lower in older participants (p=0.001) or those who had received chemotherapy (p=0.018). Negative illness perception had a direct effect on a low sense of well-being (p

Cobalt is a substance that has been abused for athletic performance enhancement and has thus been prohibited by human and animal sports doping control authorities. However, because cobalt is present in humans and animals as a trace element, a certain level of cobalt is naturally present in their excretions. In the racing industry, cobalt is a controlled substance with a threshold concentration specified by the International Agreement on Breeding, Racing and Wagering (IABRW) for international harmonization. Due to environmental and feed consumption differences among countries, regional cobalt concentration trends should be evaluated before cobalt testing is introduced. In this study, we conducted a preliminary evaluation of the urinary concentration of cobalt among a population of racehorses in Korea using inductively coupled plasma mass spectrometry (ICP‐MS) analysis, followed by analysis of the urinary release of cobalt after the administration of cobalt chloride in various situations. The normal distribution for the Korea‐based racehorses was used to determine a urine concentration limit (96.5 ng/ml, risk factor of 1 in 10,000). After the intravenous (IV) administration of CoCl2, the initial elimination of cobalt was rapid. A high concentration (over 2,000 ng/ml) and a slow excretion pattern were observed during the final 2 weeks of the 3‐week observation period. When CoCl2 was administered orally, maximum concentration (Cmax, 92–992 ng/ml) was observed at 6–8 h. [ABSTRACT FROM AUTHOR]

The purpose of the study was to explore Korean women's attitudes toward breast cancer screening tests from a feminist perspective. Twenty Korean women working in Dong-Dae-Moon Market in Seoul, South Korea were recruited using a convenience sampling method. Semi-structured in-depth interviews were conducted using an interview guideline that was developed for the study. The data were analyzed using a thematic analysis. The themes emerged from the analysis process included: 'importance of breasts to women', 'fearful, but not related to me', 'bad previous experience', and 'no need for a breast exam.' Based on the findings, implications for nursing practice are proposed. [ABSTRACT FROM AUTHOR]

Background: The development of nursing leaders is an important topic in changing healthcare environments. Successful nursing leadership is critical to the reconstruction, implementation, and evaluation of healthcare systems worldwide. However, the characteristics of successful nursing leadership remain unclear, especially in a global context. Furthermore, despite the growing importance of cultural intelligence, cross-cultural concepts of successful nursing leadership have been inadequately addressed in the literature., Purpose: This study was designed to identify the characteristics of successful leadership in nursing from the perspective of Asian leaders in four countries (United States, Taiwan, Korea, and Japan) and to make recommendations for successful leadership in nursing in the future., Methods: A qualitative approach employing five strategies, including in-depth discussions through face-to-face and email discussions, an integrated literature review using multiple databases, responses to 10 topics related to nursing leadership, and written note summaries of the characteristics of successful leadership, was used in this study. A total of 10 nursing leaders from four countries were recruited as participants using snowball sampling. The collected qualitative data were analyzed using line-by-line coding and simple content analysis to extract the characteristics of successful leadership in nursing., Results: The final sample included seven nursing leaders aged between 55 and 70 years. All of the participants were in nursing leadership positions at schools/colleges of nursing or professional organizations for at least two decades and had extensive leadership experience through their schools/colleges, professional organizations, and/or governments. Five key themes related to the characteristics of successful leadership were identified from the participants: (a) culturally and historically prescribed, (b) overcoming gendered experience, (c) equipped with good character, (d) guiding with a vision, and (e) with contextualized leadership., Conclusions/implications for Practice: Five characteristics of successful leadership were identified from the perspective of Asian nursing leaders. All of the participants recommended that successful nursing leadership be based on contextual leadership and that successful nursing leadership help meet rapidly changing needs, enable mutual trust, and actively commit and complete necessary risks. Moreover, future successful leadership should have a clear vision and strongly guide the implementation of changes as well as be equipped with cultural intelligence. Finally, successful nursing leadership should be based on ethical, trustable, and humane behaviors while promptly and adequately responding to the changing needs of their institutions/organizations. Cross-regional research on successful nursing leadership is essential to enrich the global evidence and knowledge on developing the next generation of nursing leaders., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc.)

Background: Despite an increasing number of culturally tailored technology-based interventions for racial/ethnic minorities, little is known about practical issues in conducting a culturally tailored technology-based intervention study among racial/ethnic minority groups, especially among Asian American colorectal cancer survivors., Objective: The aim of this study was to describe the practical issues in conducting a study using a culturally tailored technology-based intervention among Asian American colorectal cancer survivors., Methods: In a technology-based colorectal cancer intervention study, research team members wrote memos on issues in conducting a culturally tailored technology-based intervention study among the specific population and plausible reasons for the issues. Then, a content analysis was used to analyze the research diaries and written records of the research team., Results: The practical issues found in the research process included ( a ) unauthentic cases, ( b ) a low response rate, ( c ) high dropout rates, ( d ) technological literacy, ( e ) language issues, ( f ) cultural tailoring issues, and ( g ) time and geographical limitations., Conclusions: These practical issues need to be considered in planning and implementing culturally tailored technology-based interventions among Asian American colorectal cancer survivors., Implications for Practice: Multiple implications such as detailed information sheets, flexibility in languages, open attitudes toward cultural differences and variances, and continuous training of interventionists are proposed for culturally tailored technology-based interventions among this specific population., Competing Interests: The authors have no conflicts of interests to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

The number of health technology-based intervention studies has grown significantly. However, issues in the recruitment and retention for such studies, especially of Asian Americans, have rarely been discussed. The purpose of this paper was to discuss issues in the recruitment and retention of a specific group of Asian Americans-Korean American midlife women with depressive symptoms-into a technology-based intervention study using computers and mobile devices with a measurement device and to provide directions for future participant recruitment and retention in technology-based intervention studies. The written memos of research team members and the written records of research team meetings were analyzed using a content analysis. The issues in the recruitment and retention process included (1) low recruitment and retention rates; (2) the perceived long intervention period; (3) strict inclusion/exclusion criteria; (4) concerns related to the use of a measurement device; and (5) the perceived adequacy of monetary incentives. Based on the issues identified in the study, several suggestions are made for future recruitment and retention of racial/ethnic minorities in technology-based intervention studies (eg, appropriate intervention period, innovative and creative motivation strategies, acceptable measurement scales and devices, and adequate monetary reimbursement)., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The raison d'être of nursing is caring for human beings. Mainly due to its close link to the nursing discipline's raison d'être, "caring," translational science is recently getting more attention from nursing scientists across the globe. This paper is to discuss the current status of translational science in nursing across four countries (the USA, Taiwan, South Korea, and Japan). The data used in this discussion paper included: (a) written notes on issues related translational research/science in individual countries; (b) written memos on exemplars/cases from their own experiences; and (c) summaries of literature reviews. The data analysis was conducted using a simple content analysis. Four themes reflecting the current status of translational science across the countries were identified: (a) "contextualized in unique culture and history of nursing"; (b) "connecting basic science to clinical practice"; (c) "an extension of evidence-based practice"; and (d) "highly promoted, but still minimal translation of nursing knowledge.", (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

To supply proper and sufficient information and coaching through cancer education, it is important to decide who are risk groups among a target population. A decision tree analysis could help decide the characteristics of the risk groups. This study aimed to identify the combined characteristics of Asian American breast cancer survivors that were closely linked to high needs for help during their breast cancer survivorship process. The data on the needs for help among 185 Asian American breast cancer survivors from a parent clinical trial were included in this analysis. The instruments included the Supportive Care Needs Survey-Short Form 34 (SCNS-SF34) and multiple scales to measure the factors influencing the women's needs for help. The data were analyzed using latent profile analyses and decision tree analyses. The characteristics of the group with the highest needs for help were different depending on the types of needs. For instance, the group with the highest patient care/support needs for help score had high global symptom distress scores (cut point = 2.25) and high physical symptom distress (cut point = 1.57) and did not have regular access to health care (mean = 95.00; node 10). The findings suggest several risk groups to target in future interventions for cancer education to reduce the needs for help among this specific population. Multiple factors that could influence the needs for help among Asian American breast cancer survivors need to be considered in future intervention development for cancer education., (© 2024. The Author(s) under exclusive licence to American Association for Cancer Education.)

Cancer survivors including Asian American breast cancer survivors have reported their high needs for help during their survivorship process. With the COVID-19 pandemic, the necessity of technology-based programs to address their needs for help without face-to-face interactions has been highlighted. The purpose of this randomized intervention study was to determine the efficacy of a technology-based program in reducing various types of needs for help among this specific population. This was a randomized clinical trial with repeated measures. A total of 199 participants were included in the data analysis. The recruitment settings included both online and offline communities/groups for Asian Americans. The needs for help were assessed using the Support Care Needs Survey-34 Short Form (SCNS) subscales measuring psychological, information, physical, support, and communication needs. Data analysis was conducted through an intent-to-treat approach. In the mixed effect models, psychological needs, information needs, physical needs, and communication needs decreased over time (P < .001). However, there were no significant group * time effects. Social support significantly mediated the effects of a technology-based intervention on psychological, information, and support needs at the pre-test and the post-1 month. This study supported significant decreases in the needs for help of Asian American breast cancer survivors by a technology-based intervention. Further studies are needed with other racial/ethnic groups of cancer survivors to confirm the efficacy of a technology-based intervention in reducing cancer survivors' needs for help during their survivorship process., (© 2024. The Author(s) under exclusive licence to American Association for Cancer Education.)

Background: To determine the potential influence of a home-based virtual group exercise on people's long-term overall health consequences in global Asian population., Methods: We recruited 1021 participants from more than 7 regions across the globe including Taiwan, Malaysia, Singapore, Hong Kong, United States, Canada, Europe, and other regions. All the participants attended the virtual group Qigong exercise 60-minute bi-weekly with instructors for 6 months from June 2022 to December 2022. The physical, mental, and social well-being and other variables were measured via online questionnaires., Results: The majority were 51 to 65 (50.6%) years old, female (90.2%), married (68.5%), and came from Taiwan (48.9%). Older adults had higher scores on measures of overall health and exercise adherence, and lower scores on measures of sleep quality and depressive symptoms compared with younger counterparts (P < .05). Most of them (95.3%) acknowledged that the improvement of health status was their motivating factor for exercise. Eighty nine percent of the participants believed that social media played an important role in this exercise program., Conclusion: This study will suggest such approach has great potential to reduce health disparities and can be implemented to underserved population who has limited recourses to join in-person exercise program., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Despite increased research on breast cancer survivors, little is known about how socio-behavioral factors influence the symptoms among racial/ethnic minority breast cancer survivors, particularly Asian American breast cancer survivors (AABCS)., Objective: This study examined the relationship between multiple socio-behavioral factors in AABCS, including attitudes, perceived barriers, and social influences, and their symptom experiences, with an emphasis on the mediating effect of self-efficacy., Methods: This secondary analysis used data collected from 195 AABCS women recruited through online and offline communities from January 2017 to June 2020. Study variables were measured using validated instruments such as the Questions on Attitudes, Self-Efficacy, Perceived Barriers, and Social Influences; the Cancer Behavior Inventory; and the Memorial Symptom Assessment Scale-Short Form. For structural equation modeling based on Bandura's self-efficacy theory, mediation analysis was performed using SPSS version 26.0 and AMOS 28., Results: The overall fitness of the hypothetical model to the data is acceptable (χ2 = 51.36, P < .001; goodness-of-fit index = 0.95, adjusted goodness-of-fit index = 0.89, comparative fit index = 0.96, Tucker-Lewis index = 0.94, normed fit index = 0.94, and root-mean-square error of approximation index = 0.08). Both attitudes and social influences indirectly influenced symptom distress through self-efficacy (β = -0.054, P = .019, and β = -0.053, P = .017, respectively). Perceived barriers had indirect effects through self-efficacy (β = 0.121, P = .024) and significant direct effects (β = 0.605, P = .003) on symptom distress., Conclusions: Our findings supported that the self-efficacy for coping mediated their symptom experience among AABCS. In addition, there were significant relationships among attitudes, perceived barriers, social influences, and symptom experience., Implications for Practice: Future theory-driven interventions need to consider self-efficacy and socio-behavioral factors in symptom management among AABCS., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Lower socioeconomic status (SES) is related to increased incidence and mortality due to chronic diseases in adults. Association between SES variables and gut microbiome variation has been observed in adults at the population level, suggesting that biological mechanisms may underlie the SES associations; however, there is a need for larger studies that consider individual- and neighborhood-level measures of SES in racially diverse populations. In 825 participants from a multi-ethnic cohort, we investigated how SES shapes the gut microbiome. We determined the relationship of a range of individual- and neighborhood-level SES indicators with the gut microbiome. Individual education level and occupation were self-reported by questionnaire. Geocoding was applied to link participants' addresses with neighborhood census tract socioeconomic indicators, including average income and social deprivation in the census tract. Gut microbiome was measured using 16SV4 region rRNA gene sequencing of stool samples. We compared α-diversity, β-diversity, and taxonomic and functional pathway abundance by SES. Lower SES was significantly associated with greater α-diversity and compositional differences among groups, as measured by β-diversity. Several taxa related to low SES were identified, especially an increasing abundance of Prevotella copri and Catenibacterium sp000437715, and decreasing abundance of Dysosmobacter welbionis in terms of their high log-fold change differences. In addition, nativity and race/ethnicity have emerged as ecosocial factors that also influence the gut microbiota. Together, these results showed that lower SES was strongly associated with compositional and taxonomic measures of the gut microbiome, and may contribute to shaping the gut microbiota., (© 2024. The Author(s).)

Workers' depression is an important issue, with the prevalence higher in women than in men. This study aimed to identify the effects of workplace violence exposure and psychosocial working conditions on depressive symptoms in female workers in South Korea. This study included 15 605 female wageworkers who participated in the fifth Korean Working Conditions Survey. Logistic regression analyses were implemented to identify the factors that affected their depression. The female workers reported increased frequency of symptoms of depression when there was humiliating behavior from co-workers (adjusted odds ratio [aOR] = 1.999) or physical violence from clients (aOR = 1.609). In psychosocial working environments, they reported a greater frequency of depressive symptoms with high quantitative demands (aOR = 1.498), high emotional demands (aOR = 1.085), lower colleague's support (aOR = 1.566), or lack of support from supervisors at the workplace (aOR = 1.707). An emphasis should be put on preventing humiliating behaviors from co-workers as well as violence from clients in the workplace., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Limited research studies have focused on examining the impact of technology-based interventions in changing symptom clusters among Asian American breast cancer survivors., Objective: The aim of this study was to understand the longitudinal impact of a technology-based program on the symptom cluster experience of Asian American breast cancer survivors., Methods: This is a secondary data analysis that used exploratory factor analysis at each time point (baseline, post-1 month, post-3 months) for the control and intervention groups (N = 199)., Results: The number of symptom clusters remained the same, and the same symptoms remained in similar clusters across the 2 groups. The control group experienced psychological cluster, fatigue cluster, and neck/skin cluster at baseline; psychological cluster, fatigue/dizzy cluster, and neck/skin cluster at post-1 month; and psychological cluster, fatigue/dizzy cluster, and somatic cluster at post-3 months. The intervention group experienced psychological cluster, neck cluster, and appetite/itching cluster at baseline; somatic/anticholinergic cluster, psychological/sexual cluster, and appetite cluster at post-1 month; and psychological cluster, neck cluster, and itching cluster at post-3 months. The psychological and neck clusters shared similar core symptoms of feeling nervous, dry mouth, and cough between the control and intervention groups., Conclusion: The different symptom cluster experiences may be due to the technology-based intervention where the intervention group receives individual/group coaching/support that may have changed symptom clusters over time. Yet, the true efficacy of the intervention on symptom clusters warrants further investigation., Implications for Practice: Clinicians should understand the changes in symptom clusters as well as the presence of core symptoms and take a targeted symptom cluster approach in clinical settings., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Mainly due to their cultural attitudes toward symptoms and breast cancer, Asian American breast cancer survivors tend to suffer from symptoms and often delay in getting treatments, information, and support. To improve their symptom management, it would be important to determine risk groups among them. Decision tree analyses reportedly help determine risk groups by identifying the characteristics that are directly associated with target health outcomes., Objective: Using a decision tree analysis, this study aimed at identifying the characteristics that were closely linked to the symptom experience of Asian American breast cancer survivors., Methods: This was a part of a parent randomized controlled trial among Asian American breast cancer survivors. Only the data from 135 women at the pre-test were included. Multiple instruments were used to collect the data: the Memorial Symptom Assessment Scale-Short Form, the Cancer Behavior Inventory, the PRQ-2000, the Perceived Isolation Scale, and the Supportive Care Needs Survey-Short Form 34. The data were analyzed using latent profile analysis and decision tree analyses., Results: Two most frequently found profiles included the low symptom experience profile (72.6%) and the high symptom experience profile (27.4%). The high symptom experience profile was predicted by 2 combined characteristics; (a) high psychological needs for help (over 60.00 points), and (b) low psychological needs for help (cut point = 60.00), high perceived barriers (cut point = 1.62), and high social isolation (social support) (cut point = 2.33)., Conclusions: These characteristics linked to Asian American breast cancer survivors with high symptom experience need to be considered in future intervention development., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

A culturally tailored virtual program could meet the survivorship needs of Asian American women breast cancer survivors (AABC). This study aims to determine the efficacy of a culturally tailored virtual information and coaching/support program (TICAA) in improving AABC's survivorship experience. A randomized clinical trial (NCT02803593) was conducted from January 2017 to June 2020 among 199 AABC. The intervention group utilized TICAA and the American Cancer Society [ACS] website while the control group used only ACS website for 12 weeks. The outcomes were measured using the SCNS-34SF (needs; primary), the MSAS-SF (symptoms; secondary), and the FACT-B (quality of life; secondary). The data were analyzed using an intent-to-treat approach. The intervention group showed significant reductions in their needs from the baseline (T0) to post 4 weeks (T1) and to post 12 weeks (T2). Although the changes were not statistically significant, the intervention group had decreased symptoms from T0 to T2 while the control group had an increase in their symptoms. The intervention group had a significant increase in their quality of life from T0 to T2. A culturally tailored virtual program could therefore improve quality of life in AABC patients. Trial Registration: To Enhance Breast Cancer Survivorship of Asian Americans (TICAA), NCT02803593, https://clinicaltrials.gov/ct2/show/NCT02803593?titles=TICAA&draw=2&rank=1., (© 2023. Springer Nature Limited.)

To provide appropriate and adequate information and support for Asian American breast cancer survivors, it would be essential to identify risk groups among them to target in future cancer education interventions. In this secondary analysis, the characteristics of risk groups within Asian American breast cancer survivors who had low quality of life were identified using a decision tree analysis. For this analysis, only the pre-test data of 185 women from a parent study were selected. Multiple instruments including the Functional Assessment of Cancer Therapy Scale-Breast Cancer (FACT-B) were used in the parent study. The data were analyzed using descriptive and inferential statistics and decision tree analyses. The decision tree analyses showed six combined characteristics associated with lower quality of life scores than the total mean quality of life scores. For instance, the women with lower quality of life scores (than the total mean quality of life scores) had high perceived barriers (cut point = 1.84), low self-efficacy for coping (cut point = 81.50), and high global symptom distress (cut point = 2.27). Also, the characteristics linked to the lowest quality life scores were different depending on the dimensions of the quality of life. The characteristics associated with the quality of life of Asian American breast cancer survivors need to be considered in future education programs for this specific population., (© 2023. The Author(s) under exclusive licence to American Association for Cancer Education.)

Background: The prevalence of depression is higher among midlife women, and they have less control over their diabetes during the menopausal transition. However, there is limited evidence on the association between type 2 diabetes mellitus and depression among Korean women in their midlife. This study aimed to examine the association between type 2 diabetes mellitus and depression and explore the levels of awareness and treatment of depression among Korean midlife women with T2DM., Methods: This is a cross-sectional analysis study conducted using data from the Korea National Health and Nutrition Examination Surveys of 2014, 2016, and 2018. Korean women aged 40-64 years who randomly participated in the surveys were included, and 4,063 midlife women were selected as study participants. The diabetes progression status of the participants was classified into diabetes, pre-diabetes, and non-diabetes. Furthermore, the Patient Health Questionnaire-9 was used for screening depression. Participants' awareness rate, treatment rate among incident cases of depression, and treatment rate among awareness cases of depression were also analyzed. For data analysis, the Rao-Scott χ2 test, multiple logistic regression, and linear regression were conducted using SAS 9.4 software program., Results: The prevalence of depression significantly differed between diabetes, pre-diabetes, and non-diabetes groups. However, depression awareness, treatment/incident, and treatment/awareness rates did not differ statistically between the diabetes progression status groups. Compared to the non-diabetes group, diabetes group had a higher odds ratio of depression after adjusting for general and health-related factors. Thus, the diabetes group had significantly higher PHQ-9 scores than the non-diabetes group after adjusting for covariates., Conclusions: Women in their midlife who have type 2 diabetes mellitus tend to have higher levels of depressive symptoms and are at risk of depression. However, we found no significant differences between diabetes and non-diabetes regarding the awareness and treatment rates of depression in South Korea. We recommend that future studies focus on developing clinical practice guidelines aimed at additional screening and intervention for depression in midlife women with type 2 diabetes mellitus to ensure prompt treatment and improved outcomes., (© 2023. The Author(s).)

The purpose of this article is to discuss the current status of research mentoring in nursing across 4 countries (the United States, Taiwan, South Korea, and Japan) and to make suggestions for future research mentoring. Seven leaders reflected on the current status of research mentoring in nursing, provided exemplars/cases from their own experiences, and their reviews of the literature. Six themes were discussed: ( a ) "culturally defined"; ( b ) "professionally contextualized"; ( c ) "teaching research integrity and research practice"; ( d ) "with mutual respect and care"; ( e ) "based on effective communication"; and ( f ) "supported by institutional and governmental commitment and infrastructure.", (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Technology-based programs using computers and mobile devices are known to be effective in providing information and support to marginalized populations including immigrants. Yet, little is still known on the factors that may influence the effectiveness of technology-based programs in improving symptom experience, including immigration transition, especially among Asian American breast cancer survivors. This study aimed to identify the characteristics related to immigration transition that significantly affected the symptom distress changes by a technology-based information and coaching/support program among Asian American breast cancer survivors. This secondary analysis was conducted with the data from 102 Asian American breast cancer survivors from a randomized clinical trial in progress. Multiple instruments were used: the questions on background characteristics and immigration transition and the Memorial Symptom Assessment Scale-Short Form. The data were analyzed using repeated-measurement analyses and decision tree analyses. The mean changes in the symptoms distress scores were as follows: -0.12 (SD, 0.47) in the Global Distress Index scores; -0.08 (SD, 0.43) in the physical symptom distress scores; and -0.15 (SD, 0.65) in the psychological symptom distress scores. The characteristics with the highest impact on the symptom distress score changes included the immigration age for Global Distress Index and physical symptom distress score and the level of acculturation for psychological symptom distress score., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

The purpose of this secondary analysis was to determine the clusters of midlife women by gastrointestinal (GI) symptoms and to explore differences in the clusters by race/ethnicity. This analysis used the data from two internet-based studies among 1,054 midlife women. The analysis was conducted with the data on background characteristics, health and menopausal status, and GI symptoms (collected using the GI Symptom Index for Midlife Women). The data were analyzed using factor analyses, hierarchical cluster analyses, chi-square tests, multinomial logistic regression analyses, and analyses of covariance. Three clusters were adopted: Cluster 1 (with low total numbers and severity scores of symptoms; 46.0%), Cluster 2 (with moderate total numbers and severity scores of symptoms; 44.0%), and Cluster 3 (with high total numbers and severity scores of symptoms; 10.0%). Only in Cluster 2, there were significant racial/ethnic differences in individual GI symptoms. These results provide directions for future GI symptom management among midlife women.

Purpose: A culturally tailored technology-based cancer support program was recently developed and tested among Asian American breast cancer survivors. To explore future opportunities to sustain the program, the research team participated in the SPeeding Research-tested INTervention (SPRINT) program sponsored by the National Cancer Institute. The purpose of this discussion paper is to share the lessons that the research team gained from a customer discovery study through the SPRINT program., Methods: During the SPRINT program, a total of 73 stakeholders were recruited through a snowball sampling across the globe. Semi-structured interviews were conducted for customer discovery through WebEX, phone calls, and in-person visits (50 in-person interviews, 4 phone interviews, and 19 WebEx interviews). All the interviews were recorded using audio-taping or writing memos. Also, the research team wrote memos on the issues/concerns related to the project during the interview process. Then, the transcripts and memos were analyzed using a content analysis to provide evidence for the lessons., Results: The themes reflecting the lessons from the customer discovery study included (a) "who are the stakeholders"; (b) "depending on stakeholders"; (c) "what works or not"; (d) "personal versus family responsibilities"; and (e) "depending on countries' situations.", Conclusion: These lessons could provide directions for future development and implementation of technology-based cancer support programs for Asian American breast cancer survivors., (© 2021. The Author(s) under exclusive licence to American Association for Cancer Education.)

Background: Midlife peri-menopausal and post-menopausal women with metabolic syndrome experience multiple co-occurring symptoms or symptom clusters, which often result in significant symptom cluster burden. While they are a high-risk symptom burden group, there are no studies that have focused on identifying symptom cluster trajectories in midlife peri-menopausal and post-menopausal women with metabolic syndrome., Objectives: The objectives were to identify meaningful subgroups of midlife peri-menopausal and post-menopausal women with metabolic syndrome based on their distinct symptom cluster burden trajectories, and to describe the demographic, social, and clinical characteristics of different symptom cluster burden subgroups., Design: This is a secondary data analysis using the longitudinal data from Study of Women's Health Across the Nation., Methods: Multi-trajectory analysis using latent class growth analysis was conducted to join the different developmental trajectories of symptom clusters to identify meaningful subgroups and high-risk subgroup for greater symptom cluster burden over time. Then, descriptive statistics were used to explain the demographic characteristics of each symptom cluster trajectory subgroup, and bivariate analysis to examine the association between each symptom cluster trajectory subgroup and demographic characteristics., Results: A total of four classes were identified: Class 1 (low symptom cluster burden), Classes 2 and 3 (moderate symptom cluster burden), and Class 4 (high symptom cluster burden). Social support was a significant predictor of high symptom cluster burden subgroup and highlights the need to provide routine assessment., Conclusion: An understanding and appreciation for the different symptom cluster trajectory subgroups and their dynamic nature will assist clinicians to offer targeted and routine symptom cluster assessment and management in clinical settings.

Through a decision tree analysis, this study aimed to determine the characteristics of Asian American breast cancer survivors who had higher decreases in their need for information by a technology-based information and coaching/support program compared with their counterparts. This is a part of a larger randomized controlled trial; only the data from 99 Asian American breast cancer survivors were used for this analysis. The measurement scales included the Memorial Symptom Assessment Scale-Short Form, the Cancer Behavior Inventory, the Questions on Attitudes, Subjective Norm, Perceived Behavioral Control and Behavioral Intention, and the Supportive Care Needs Survey-Short Form 34. The data analysis was done using t-tests, chi-square tests, repeated measurement analyses, and a decision tree analysis. The information needs scores of all the participants decreased during the 3-month intervention period (p < .005). However, only the intervention group had statistically significant decreases in the information needs scores during the 3 months (dif. =  - 8.545; p < .005). Those with low social influence scores and high self-efficacy scores had significantly larger decreases in their information needs scores compared with the average change scores (100%, p < 01). Asian American breast cancer survivors with low social influences and high self-efficacy would highly benefit from a technology-based intervention for their need for information., (© 2021. American Association for Cancer Education.)

The purpose of the study was to explore the associations of sub-ethnicity to the survivorship experience of Asian American breast cancer survivors and identify the multiple factors that influenced their survivorship experience. This was a secondary analysis of the data among 94 Asian American breast cancer survivors from a larger ongoing study. Instruments included: questions on background characteristics, the perceived isolation scale, the Personal Resource Questionnaire, the Memorial Symptom Assessment Scale-Short Form, and the Functional Assessment of Cancer Therapy-Breast Cancer. Data were analyzed using hierarchical logistic and multiple regression analyses. After controlling for other factors, being a Japanese American (ref. = being a Chinese American) was significantly associated with pain scores (odds ratio [OR] = -0.32, p  < .01), symptom distress scores ( β = -0.27, p  < .01), and the quality of life scores ( β  = 0.22, p  = .03). Sub-ethnic variations in cultural attitudes, values, and beliefs need to be considered in future research/practice with Asian American breast cancer survivors.

This study aimed to explore racial/ethnic differences in the attitudes toward Alzheimer's Disease (AD) and dementia caregiving among midlife women who were family caregivers of persons living with AD (MWPLAD) in the U.S. and examine the associations of the attitudes to their health outcomes. This was a cross-sectional online survey study among 172 MWPLAD. The instruments included: the Attitude toward AD and Related Dementias Scale, the Questions on Attitudes toward AD Caregiving, the Social Readjustment Rating Scale, the EQ-5D-5L and the Midlife Women's Symptom Index. Multiple linear regression analyses were conducted. There were significant racial/ethnic differences in caregivers' attitudes toward dementia caregiving, health-related quality of life, and total severity scores of symptoms (p < .01). Controlling for covariates including race/ethnicity, caregivers' positive attitudes toward dementia caregiving were significantly associated with their health outcomes (p ≤ .05). Interventions for MWPLAD need to consider racial/ethnical differences in their attitudes toward dementia caregiving., Competing Interests: Declaration of Conflicting Interests The authors have no conflicts of interests to report., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The purpose of this secondary analysis was to determine the clusters of Asian American breast cancer survivors by the severity scores of menopausal symptoms and to explore the characteristics associated with the identified clusters. The data from an ongoing study among 94 survivors were used. The instruments included the Perceived Isolation Scale, the Personal Resource Questionnaire, and the Memorial Symptom Assessment Scale-Short Form. The data analysis was conducted using hierarchical cluster analyses and multinomial logistic analyses. Three clusters were identified: "the cluster with high severity scores of total, psychological, physical, and psychosomatic symptoms (Cluster 1)," "the cluster with moderate severity scores of total, psychological, physical, and psychosomatic symptoms (Cluster 2)," and "the cluster with low severity scores of total, psychological, physical, and psychosomatic symptoms (Cluster 3)." The clusters had significant differences in the level of acculturation, perceived social isolation, and perceived social support ( p  < 0.05).

The aim of this study was to identify and compare symptom clusters in midlife menopausal women with and without metabolic syndrome based on symptom occurrence and severity dimension through secondary data analysis of the Study of Women's Health Across the Nation. Exploratory factor analysis was used to group symptoms that are highly correlated with each other and verified by confirmatory factor analysis. Midlife menopausal women with metabolic syndrome (n = 424) experienced mental health, vasomotor, and somatic cluster across both symptom dimensions. In contrast, midlife menopausal women without metabolic syndrome (n = 1022) experienced mental health/sleep/urinary, vasomotor, and somatic cluster for symptom occurrence dimension and mental health/sleep, vasomotor/genital, and somatic cluster for symptom severity dimension. This is the first study to identify symptom clusters in midlife menopausal women with metabolic syndrome, who are at risk for experiencing complex symptoms associated with menopause transition and metabolic syndrome, and to compare symptom clusters to those without metabolic syndrome.

Background: Metabolic syndrome is known as a lifestyle disease that results from poor health behaviors. Yet, little is known about the subgroups of midlife women with distinct health behavior profiles who are at risk for developing metabolic syndrome., Purpose: This study aims to identify latent subgroups of midlife women with distinct health behavior profiles (physical activity, alcohol, diet, and smoking), to describe the characteristics of latent subgroups, and to examine the association between latent class membership and future development of metabolic syndrome., Method: This is a secondary data analysis using baseline and follow-up data from years 1, 3, 5, and 7 (N = 3,100) from the Study of Women's Health Across the Nation (SWAN). Latent class analysis was used to identify latent subgroups of midlife women based on their distinct health behavior profiles. Bivariate and multiple logistic regression was conducted to examine the individual characteristics of each latent subgroup and its association with the future development of metabolic syndrome., Result: A 4-class model was selected: Class 1 (Healthy), Class 2 (Healthy except alcohol), Class 3 (Healthy except diet), and Class 4 (Unhealthy). Significant differences in individual characteristics were found among the four latent classes (p < .001). The regression analysis found that Class 2 had lower odds of developing metabolic syndrome at all future visits with statistical significance reached at visit 3 (p < .05) while Class 4 had higher odds of developing metabolic syndrome at all visits except visit 3 when both compared to Class 1., Conclusion: Clinicians should use the study findings to offer personalized approach to promote healthy behaviors and to guide future development of health promotion programs for midlife women., (© Society of Behavioral Medicine 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Using a decision tree analysis, this study aimed to identify the characteristics of the groups within Asian American breast cancer survivors whose symptom distress scores were effectively improved by a technology-based program. This was a secondary analysis of the data from an ongoing randomized controlled trial among 115 Asian American breast cancer survivors. The instruments were questions on background factors; the Memorial Symptom Assessment Scale-Short Form; the Cancer Behavior Inventory; the Questions on Attitudes, Subjective Norm, Perceived Behavioral Control, and Behavioral Intention; and the Supportive Care Needs Survey-Short Form 34. The data were analyzed using chi-square tests, t tests, repeated measurement analyses, and decision tree analyses. The decrease in the global distress index scores was the largest (1.253 points) among those with high psychological support needs. The decrease in the physical symptom distress scale scores was the largest (1.133 points) among those with high physical and daily living support needs who had a short US residence period and who were young. The decrease in the psychological symptom distress scores was the largest (1.511) among those with high psychological support needs. The findings suggest several characteristics of the groups within Asian American breast cancer survivors whose symptom distress could be highly improved by a technology-based intervention., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Technology-based intervention programs are known to be effective in approaching socially excluded groups or racial/ethnic minorities, including this specific population. However, the retention of participants in technology-based intervention studies is far more complicated and challenging compared with conventional studies targeting racial/ethnic minorities., Objective: This study aimed to identify the complex characteristics of the groups within Asian American breast cancer survivors who were successfully retained in a 3-month technology-based intervention study., Methods: This secondary analysis of the data from a larger ongoing intervention study included 155 Asian American breast cancer survivors. Major variables were measured using multiple instruments including the questions on characteristics of the participants, the Personal Resource Questionnaire, perceived isolation, Memorial Symptom Assessment Scale-Short Form, Cancer Behavior Inventory, 34-item Supportive Care Needs Survey Short Form, and Functional Assessment of Cancer Therapy Scale-Breast Cancer. Data analyses were done through χ2 tests, t tests, and decision tree analyses., Results: The retention rates differed by subethnicity (P = .025), immigration age (P < .001), and stage of breast cancer (P = .003). The decision tree indicated four groups with the highest probability of retention: (a) those who were diagnosed with stage II, III, or IV breast cancer, (b) those who immigrated to the United States after turning 31 years old, and (c) those who had high perceived barriers., Conclusion: This study provides directions for future retention strategies for technology-based interventions among Asian American breast cancer survivors., Implications for Practice: Participants' characteristics need to be considered in developing retain strategies for technology-based interventions among Asian American breast cancer survivors., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Midlife perimenopausal and postmenopausal women with metabolic syndrome experience multiple symptoms concurrently., Objective: The study objectives were to examine the relationship among symptoms through network visualization and identify and compare symptom clusters and key symptoms across symptom occurrence and symptom severity dimensions in midlife perimenopausal and postmenopausal women with and without metabolic syndrome., Methods: Cross-sectional data from the Study of Women's Health Across the Nation (Visit 5) were used for analysis. A machine-learning-based network analysis and the Walktrap algorithm were used to fulfill the study objectives., Results: The number and types of symptom clusters differed between the groups. Midlife perimenopausal and postmenopausal women with metabolic syndrome experienced the psychological/somatic/genital cluster (key symptom: frequent mood change), the sleep/urinary cluster (sleep disturbance), and the vasomotor cluster (cold sweat) in the symptom occurrence dimension and the psychological/somatic/sexual cluster (anxiety), the sleep/urinary cluster (sleep disturbance), and the vasomotor/genital cluster (night sweat) in the symptom severity dimension. In contrast, midlife perimenopausal and postmenopausal women without metabolic syndrome experienced the psychological cluster (anxiety), the sleep/somatic/genitourinary cluster (sleep disturbance), and the vasomotor cluster (night sweat) in the symptom occurrence dimension and the psychological/somatic cluster (anxiety), the sleep/urinary cluster (sleep disturbance), the vasomotor cluster (night sweat), and the sexual/genital cluster (vaginal dryness) in the symptom severity dimension., Discussion: The study findings may serve as a knowledge basis for effective assessment and management of symptom clusters and key symptoms in clinical settings and provide directions for future development of targeted symptom management interventions., Competing Interests: The authors have no conflicts of interest to report., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: This study aimed to explore the associations of immigration transition to gastrointestinal (GI) symptoms experienced during the menopausal transition among 974 midlife women in the US., Methods: The data from 974 midlife women from 2 national Internet survey studies were used for this secondary analysis. Only the data related to background characteristics and, health/menopausal status, immigration transition, and the Gastrointestinal Symptom Index for Midlife Women were included. The data were analyzed using descriptive and inferential statistics including analyses of covariance, logistic regression analyses, and hierarchical multiple regression analyses., Results: There were statistical differences in total numbers and total severity scores of total GI symptoms between immigrants and nonimmigrants (F = 7.08 and 6.20, respectively; both P < 0.05); Immigrants had fewer total numbers and lower total severity scores of GI symptoms than nonimmigrants. All immigration transition variables including immigration status, the length of stay in the US, and the acculturation level accounted for 11.8% of the total numbers (F = 32.79, P < 0.001) and 12.5% of the total severity scores of GI symptoms (F = 35.10, P < 0.001). However, only immigration status (being nonimmigrant) was a significant factor that was associated with greater total numbers and higher total severity scores of GI symptoms (β = 0.62, P < 0.001 and β = 0.65, P < 0.001, respectively)., Conclusions: This study supports that immigration status is a significant factor that influences GI symptoms during the menopausal transition., Competing Interests: Financial disclosure/conflicts of interest: None reported., (Copyright © 2022 by The North American Menopause Society.)

Introduction: Midlife climacteric women with metabolic syndrome are at high risk for experiencing a complex array of symptoms. The aim of this scoping review was to identify the prevalence, types, and clustering of symptoms in midlife climacteric women with metabolic syndrome and to compare them to symptoms of midlife climacteric women without metabolic syndrome., Methods: A three-step search method was used according to Joanna Briggs Institute methodology. Eligibility criteria of participants, concept, context, and types of evidence were selected in alignment with the review questions. Seven databases (PubMed, Embase, Web of Science, CINAHL, PsycINFO, ProQuest Dissertation & Theses, OpenGrey) were searched using search terms with no language or date restrictions. Title and abstract screening, full-text review, data charting, and data synthesis were conducted by two independent researchers based on the eligibility criteria., Results: The search yielded 3813 studies after removing duplicates with 48 full-text papers assessed for eligibility. A total of eight studies were reviewed and analyzed which reported the prevalence and types of symptoms individually or grouped based on each body system. Midlife climacteric women with metabolic syndrome experience a wide prevalence of individual and grouped urogenital, vasomotor, psychological, sleep, and somatic symptoms. Mental exhaustion had the highest prevalence (84.4%) among the individual symptoms, and urogenital symptoms had the highest prevalence (81.3%) among the grouped symptoms. There were mixed findings on symptoms between midlife climacteric women with metabolic syndrome and without metabolic syndrome. No studies focused on symptom clusters., Conclusion: Our findings will serve as a knowledge basis for understanding symptoms experienced by midlife climacteric women with metabolic syndrome. This new knowledge can assist clinicians in effectively assessing and managing their symptoms in clinical settings and inform future development of targeted symptom management interventions.

Objective: The purpose of this study was to explore the associations of race/ethnicity and menopausal status to gastrointestinal (GI) symptoms experienced during the menopausal transition while considering multiple factors that could influence the symptoms., Methods: This secondary analysis was conducted with the data from 1,051 women from 2 Internet-based studies on midlife women's health issues. In the original studies, the data were collected using a dozen questions on sociodemographic and health/menopausal factors and the GI Index for Midlife Women. The data were analyzed utilizing ANOVA, multiple logistic regression, and hierarchical linear regression analyses., Results: When covariates were controlled, being Non-Hispanic (N-H) Asian was a significant factor that influenced the total numbers of GI symptoms (β = -0.26) and total severity scores of GI symptoms (β = -0.26). When covariates were controlled, premenopausal status was the strongest factor that influenced the total numbers of GI symptoms in all participants, Hispanics, N-H Whites, N-H African Americans, and N-H Asians (β = 53, -0.40, -0.77, -0.76, -0.26, respectively) and the total severity scores of GI symptoms in all participants, Hispanics, N-H Whites, N-H African Americans, and N-H Asians (β = -0.50, -0.38, -0.72, -0.75, -0.25, respectively)., Conclusions: This study supports the association of race/ethnicity and menopausal status to GI symptoms experienced during the menopausal transition., Competing Interests: Financial disclosure/conflicts of interest: None reported., (Copyright © 2021 by The North American Menopause Society.)

The purpose of this article is to discuss whether the properties of existing situation-specific theories are congruent with the philosophical stance of neo-pragmatism. A literature review was conducted using PubMed, CINAHL, and PsycInfo with keywords of "situation-specific theory" and "nursing." Fifteen situation-specific theories were included in the analysis. The properties of existing situation-specific theories included "high specificity and low level of abstraction," "context understanding," "direct linkages to research and practice," and "reflecting diversities and complexities with limited generalizability." Finally, the findings are discussed in terms of their linkages to the major tenets of neo-pragmatism., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

With the recent impact by the COVID-19 pandemic, nursing research has gone through unexpected changes across the globe. The purpose of this special report is to present the commonalities in the impact of the COVID-19 pandemic on nursing research across four countries, including the United States, South Korea, Japan, and Taiwan, and one region, that is, Hong Kong, and to make recommendations for future nursing research during the immediate postpandemic period and future pandemic situations. To identify the commonalities, seven researchers/leaders from the five countries/regions had discussions through 3 days of an international workshop. The content for this discussion paper derived from: (a) the exemplars/cases of the COVID-19 impact on the research process, (b) researchers/leaders' presentations on the COVID-19 impact, and (c) memos from the workshop. The materials were analyzed using a simple content analysis. The commonalities included: (a) "a heavy emphasis on teaching and fluctuating productivity," (b) "increased funding opportunities and governmental support," (c) "gendered experience complicated by professional differences," (d) "delays and changes/modifications in research process," (e) "limited research settings and difficulties in getting access," and (f) "increased online dissemination activities with positive changes in the image of nursing." With all collective wisdom that nurse researchers have obtained during the COVID-19 pandemic, nursing research will evolve again for the successful future of the nursing discipline., (© 2021 Wiley Periodicals LLC.)

Purpose: To explore the environmental characteristics of young breast cancer survivors (YBCSs) in China., Participants & Setting: 17 participants aged 18-45 years were recruited from hospitals and through participant referral in Shanghai, China., Methodologic Approach: Semistructured interviews were conducted to explore the environmental characteristics of YBCSs. Content analysis was performed to analyze the data., Findings: The following four domains emerged from the analysis., Implications for Nursing: The study provides insights into the specific issues of YBCSs at different environmental levels. Nurses should collaborate with the healthcare team, family members, and other stakeholders in addressing these issues to support YBCSs. Culturally tailored support should be developed to release the burden of socially desired roles and other cultural issues for Chinese YBCSs.

Despite the increasing usages of technology-based programs, few technology-based support programs are currently available for racial/ethnic minority cancer survivors including Korean-American cancer survivors. The purpose of this study was to explore the attitudes toward technology-based cancer support programs among Korean-American cancer survivors from a feminist perspective. In-person focus group interviews were held with 17 Korean-American cancer survivors. All the interviews were recorded by writing memos. Then, the written memos were analyzed using a content analysis. Four major themes reflecting their attitudes toward technology-based cancer-support programs were identified: (a) "easy to access"; (b) "good for peer and family support," (c) "overcoming language barriers," and (d) "providing Korean-specific and personalized trustable information." Future technology-based cancer support groups for this specific population need to incorporate peer support, support for family members, Korean language, and Korea-specific information and intervention components.

The purpose of this article is to identify the commonalities in nursing perspectives among 6 countries/regions (United States, South Korea, Taiwan, Japan, Hong Kong, and Thailand). Nine leaders from the 6 countries/regions reflected on what nursing perspectives were in their own countries/regions and provided exemplars/cases from their own experiences and literature reviews. The data were analyzed using a content analysis. Seven themes were extracted: (a) "embedded in cultural and historical contexts"; (b) "based on philosophical pluralism"; (c) "women-centered perspectives"; (d) "care-oriented holistic views"; (e) "ethical and humane views"; (f) "respecting and advocating"; and (g) "considering diversities.", (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: The purpose of this study was to examine the specific characteristics that were directly linked to menopausal symptoms of midlife women from four major racial/ethnic groups in the United States using a decision tree analysis., Methods: This was a secondary analysis of the data from 1,027 midlife women from 2 larger Internet-based studies. The parent studies used the Midlife Women's Symptom Index with multiple questions on background characteristics and health and menopausal status. The data were analyzed using ANOVA and decision tree analyses., Results: Across all the racial/ethnic groups, menopausal stage and country of birth were significantly related to the total number and total severity scores of menopausal symptoms (P < 0.001). In each racial/ethnic group, different combined characteristics of the participants were closely linked to the total number and total severity scores of menopausal symptoms (P < 0.05). For instance, in African Americans, the total severity scores of menopausal symptoms increased among those who were postmenopausal (P < 0.001), US born (P < 0.001), and with low family income (P = 0.030)., Conclusions: Specific risk groups by the combined characteristics need to be considered in future practice with midlife women., Competing Interests: Financial disclosure/conflicts of interest: None reported., (Copyright © 2021 by The North American Menopause Society.)

Background: Understanding the factors underlying health disparities is vital to developing strategies to improve health equity in old age. Such efforts should be encouraged in Korea., Objective: This study explored how material, behavioral, psychological, and social-relational factors contribute to income-related disparities in cardiovascular risk among Korean adults 65 years and older., Methods: This was a secondary analysis of Korean National Health and Nutrition Examination Survey data (2013-2017), targeting 7347 older adults (≥65 years). Socioeconomic position, defined as income, was the primary indicator. The outcome was binary for predicted cardiovascular risk (<90 vs ≥90 percentile). Disparities were measured using relative index of inequality (RII). The contributions of material, behavioral, psychological, and social-relational factors were estimated by calculating percentage reduction in RII when adjusted for these factors., Results: Among men aged 65 to 74 years and women 75 years or older, the largest reductions in RII were achieved after adjusting for social-relational factors. Among men 75 years or older and women aged 65 to 74 years, adjusting for material factors resulted in the largest reductions in RII. Adjustments for behavioral factors also reduced RII for both genders aged 65 to 74 years., Conclusions: Improving the social, material, and behavioral circumstances of lower-income older adults may help address income-related disparities in cardiovascular risk in old age., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc.)

Background: Contraceptive methods have rapidly evolved over the past several decades, but little research has explored how women interact with contraception over time. Exploring contraceptive beliefs, perceptions, and attitudes of women in midlife can reveal much about how lived experience affects contraceptive decisions and reproductive health choices., Methods: Individual, semi-structured interviews were conducted with 20 women between the ages of 40 and 55 who had not reached menopause and did not have a permanent method of sterilization. Data were coded using qualitative descriptive methods., Results: Three major themes were identified: 1) journey toward empowerment; 2) finding the right fit: evolution over time; and 3) anticipating a transition. Past experiences with or fear of side effects and hormones were common reasons to change or avoid certain contraceptive methods. Most participants were happy with their contraceptive method; however, those who were unhappy were more likely to vocalize fatigue at continuing to need contraception as menopause approached., Conclusion: Approaching contraceptive counseling from a place that considers the journey with contraception over a reproductive life span will help identify how beliefs, perceptions, and attitudes of women affect their contraceptive practices and choices.

The purpose of this article is to propose essential components of culturally tailored interventions through analyzing practical issues in 3 studies that tested culturally tailored interventions among Asian American women. Practical issues in the studies were analyzed using a content analysis according to the evaluation criteria for rigor in cross-cultural research. Seven essential components of culturally tailored interventions were identified through the analysis: (a) respecting cultural uniqueness; (b) understanding cultural contexts; (c) using cultural examples; (d) having flexibility; (e) adopting multiple languages; (f) having bilingual and/or culturally matched research team members; and (g) engaging community consultants and research participants. Key words: Asian, culture, intervention, issue, rigor., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: A decision tree analysis helps determine the complex characteristics of the groups that are closely connected with specific outcomes. Using a decision tree analysis, the purpose of this secondary analysis was to examine the associations of type II diabetes mellitus (DM) to depressive symptoms among midlife women from four major racial/ethnic groups in the US. while identifying the complex characteristics of the women that were closely linked to depressive symptoms., Methods: The data from two larger Internet survey studies were used for this analysis. The data from a total of 164 women (62 with type II diabetes and 102 without diabetes) were included. The data were collected using several instruments to measure background characteristics, health and menopausal status, and depressive symptoms (the Depression Index for Midlife Women). The data analysis was conducted using independent t tests, Mann-Whitney U tests, and decision tree analyses., Results: The total numbers and total severity scores of depressive symptoms were significantly higher in those with DM compared with those without DM (P < 0.05). There were significant differences in the total numbers and total severity scores of depressive symptoms by menopausal status and race/ethnicity (P < 0.05). DM was a significant factor that influenced the total severity scores of depressive symptoms among midlife women in peri- or postmenopausal stages who were born outside the US and among midlife women in their premenopausal stage (P < 0.05)., Conclusions: This study indicated several combined characteristics of midlife women at high risk for depressive symptoms that could provide directions for future interventions., Competing Interests: Financial disclosure/conflicts of interest: None reported., (Copyright © 2021 by The North American Menopause Society.)

Reproductive health research rarely involves the inclusion of women over 40, creating a large knowledge gap regarding women in midlife. Women continue to have reproductive health needs, concerns, and priorities up to the point of menopause that should be examined to improve reproductive health outcomes and provide individualized care. In-depth, individual, semi-structured interviews were conducted with 20 women between the ages of 40 and 55 who had not reached menopause and did not have a permanent method of sterilization. Using the feminist poststructuralist tenets, three major themes were identified: (a) knowledge acquisition during the perimenopause, (b) subjectivity regarding family planning, and (c) the agency of aging. Participants spoke to a need for reproductive health that listens to their lived experience, addresses menopause clinically and positively, and encourages autonomously driven health priorities. Further research on effective nonhormonal contraception, education on perimenopausal symptoms, and healthy aging is necessary.