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Despite the high risk of cancer to the population, Korean Americans are known to have lower knowledge about cancer related information and a lower level of adherence to cancer prevention guidelines. This indicates the necessity of cancer interventions targeting the Korean American population. To reach this population effectively, it is imperative to understand Korean Americans cancer information seeking behaviors. This study (a) identified cancer information sources that are trusted and used by Korean American women and (b) examined how general media exposure and trust in cancer information sources are related to the use of these sources. It also (c) explored perceived usefulness and limitations of cancer information sources. A mixed methods study using seven focus group interviews with 34 Korean American women and surveys with 152 Korean American women was conducted in the Washington, DC, metropolitan area from 2011 to 2012. The results indicate that Korean American women viewed health care professionals as the most trusted cancer information source but used the Internet and Korean ethnic media more often for cancer information seeking because of language, cultural, and economic barriers. Korean American women were most likely to obtain cancer information from media they used frequently for general purposes. Correlations between usage frequency and trust in doctor/health providers and the Internet as cancer information sources were negligible. When seeking cancer information, important factors for Korean American women were accessibility, affordability, and language proficiency, cultural sensitivity, meeting immediate needs, understandability, convenience, and reliability of cancer information sources. Findings from this study support developing interventions using Korean language media, including print, television and the Internet for health promotion and cancer prevention targeting Korean American women.

This paper draws on data collected as part of a comprehensive evaluation of a nurse-led rapid response service (RRS) in South Yorkshire. It reviews the assessments of the service by the RRS team themselves and by other care professionals, drawing on their views about which older people (as differentiated by their health problems) it was appropriate to refer to the RRS, and more generally about the strengths and limitations of the service. The views were collected by administering a postal semi-structured questionnaire to 120 care professionals involved in and with the RRS. The findings indicate that the service's rapid response to the patient's needs and its follow-up care were seen by all groups as positive achievements. However, referrers and service providers had contrasting interpretations about the patient eligibility criteria and disagreed strongly about the problems to which the RRS could effectively respond. These differences were a major factor in the conflicts that developed around referrals and service delivery. The findings strongly suggest that it is essential for innovative services to develop clear and consensual patient eligibility criteria and for these to be widely understood by all the professionals that are involved. [ABSTRACT FROM AUTHOR]

AimMany innovative community-based intermediate care services have been initiated to address the care needs of older people with chronic health conditions, but there is little evidence about their outcomes or how they are best configured and delivered. This study aimed to evaluate one practice innovation, a rapid response service (RRS).MethodThis study focused on the RRS's clinical and therapeutic achievements, and patients' satisfaction with its care. A mixed design of quantitative and qualitative methods was used.ResultsPatients were satisfied with staff attitudes; being treated at home or in a home-like environment; and receiving a quick response to their needs and access to services/ help. Aspects of care that they were dissatisfied with were inconvenient facilities and insufficient equipment or material supplies; arrangements for their care and recovery; lack of communication; inappropriate medical care; and insufficient or limited duration of care.ConclusionThe RRS provided holistic assessments for a previously under-served group of older people with chronic health problems and disabilities, and identified and responded to several unmet needs, partly through its own treatment and partly by referring patients to other health and social services. [ABSTRACT FROM AUTHOR]

Background: Increasing numbers of underserved people with chronic diseases and decreasing providers in rural areas have contributed to the care shortage in the United States. Nurse-led telehealth/mobile care models have potential benefits for this population. However, there is a substantial gap in the literature regarding this topic., Purpose: To examine the available literature on nurse-led telehealth/mobile health care models with a particular focus on care model settings, nursing roles, care components, achieved outcomes, and the identification of both facilitative factors and encountered challenges. The ultimate goal is to offer recommendations based on these findings, thereby aiding the development or refinement of evidence-based care models that meet to the unique needs of low-income populations., Methodology: Literature published from 2010 to 2023 was searched in six electronic databases (Cumulative Index to Nursing and Allied Health Literature, Communication and Mass Media Complete, Medline, APA PsycINFO, Social Sciences Index, and Web of Science databases)., Results: Commonalities identified among included studies with significant improvements were the provision of home monitors and education to participants, multiple engagements, and extensive community and/or family involvement., Conclusions: Nurse-led telehealth/mobile health care models for chronic diseases are an emerging approach. Nurse educators must ensure that future nurses are adept in diverse telehealth modes, collaborating across disciplines. Leveraging advanced practice registered nurses and interdisciplinary teams provides holistic care., Implications: Our review outlined recent research findings that suggest enhanced patient outcomes through technology, communication, and community support. In addition, we offered suggestions for future research and practice, emphasizing the importance of exploring the requirements of diverse and underserved communities., Competing Interests: Competing interests: The authors report no conflicts of interest., (Copyright © 2024 American Association of Nurse Practitioners.)

Purpose: Research suggests immigrants are at a greater risk of mental health disorders compared to native-born populations. Thus, the current study investigated factors associated with professional mental help-seeking intention among American immigrants., Method: A cross-sectional study was conducted with 207 first-generation Iranian Americans, and data were collected using survey questionnaires., Results: Younger Iranians living in western states in the United States and those with positive attitudes toward professional mental health services had greater intention to seek these services. Unexpectedly, those with better mental health literacy (MHL) held more mental health stigma (MHS)., Conclusion: Findings elucidated valuable insights into the complex dynamics among sociodemographic factors, acculturation, MHL, MHS, attitudes, and intentions toward professional mental health help-seeking. We also highlighted the intricate relationship between MHL and MHS, suggesting that strategies to improve MHL may not necessarily mitigate MHS within this community. Therefore, integrating anti-stigma, contact-based approaches to MHL programs could effectively reduce stigma while facilitating mental health help-seeking. [ Journal of Psychosocial Nursing and Mental Health Services, xx (xx), xx-xx.].

Aim: The aim of this study was to explore communication apprehension and communication self-efficacy in undergraduate nursing students and identify factors that contribute to communication apprehension and communication self-efficacy., Background: Communication education and skills training is often incorporated into undergraduate nursing curricula; however, communication competence continues to be a problem for novice nurses. Communication apprehension is a concept that has been only minimally researched in nursing education and can have a negative impact on student communication readiness., Design: This study employed a cross-sectional design and surveyed a national sample of undergraduate nursing students between October 2022 and March 2023., Methods: An online survey was sent out to undergraduate nursing student members of the National Student Nurses Association as well as nursing education programs in 8 states and the District of Columbia. The survey was comprised of demographic questions, the Personal Report of Communication Apprehension, and the communication subscale of the Nursing Student Self-Efficacy Survey., Results: Approximately 22.1 % of the students had high communication apprehension, with the highest communication apprehension in public speaking and classroom communication. Communication self-efficacy scores ranged from 12 to 40, with a mean of 31.65 (SD = 6.28). Communication apprehension and communication self-efficacy were significantly negatively correlated. Positive and negative affect were significant predictors of communication apprehension. Affect, as well as current healthcare employment were significant predictors of communication self-efficacy. When controlling for all demographic, educational, and psychological variables, communication apprehension was a significant predictor of communication self-efficacy., Conclusions: This study is one of the few to explore communication apprehension in undergraduate nursing students. Data demonstrated that communication apprehension is a prevalent problem for many nursing students. Communication apprehension was also found to be a significant predictor of communication self-efficacy after controlling for all other variables. Progression through nursing education did not show a correlation with a decrease in the students' communication apprehension or increase in communication self-efficacy. Given these findings, educational efforts aimed at reducing communication apprehension and enhancing students' school-related affect could contribute to an improvement in communication self-efficacy., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This study aimed to investigate both chronic health conditions and the utilization of patient portals, focusing particularly on caregivers responsible for individuals with Alzheimer's disease and related dementias (ADRD). Data from the Health Information National Trends Survey 2018-2020 were analyzed, involving a sample of 304 family and unpaid caregivers of individuals with ADRD. Among caregivers of individuals with ADRD, 77.6% had at least one chronic disease. A significant proportion (46.6%) of ADRD caregivers had never accessed their patient portals. The limited utilization of patient portals among caregivers responsible for individuals with ADRD, particularly those with lower education, advanced age, and few chronic conditions, becomes apparent due to challenges associated with digital literacy and discomfort with computers. Recognizing the crucial role caregivers play for individuals with ADRD and their health risks, there's a need for tailored training to enhance their health management skills and caregiving capabilities., 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.

Communication among healthcare professionals is critical to optimizing patient outcomes, and communication education is incorporated into the educational programs of healthcare professions students. Communication can be a source of stress for new healthcare professionals, however, there is a lack of research on communication apprehension (CA) in healthcare students, especially in nursing education. This scoping review sought to explore CA and factors associated with CA among healthcare professions students. This scoping review report was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (Tricco et al., Annals of Internal Medicine, 2018, 169, 467-473). Twenty studies of healthcare professions students were included for analysis. The percentage of health professions students with high CA ranged from 0.7% to 27%. Five out of seven intervention studies demonstrated a significant decrease in CA after the intervention. This review identified inconsistent associations between CA and various individual and educational factors. More research is needed utilizing rigorous research designs, designs employing qualitative methodology, and studies to investigate the impact of language on CA in health professions students who speak English as a second language., (© 2023 The Authors. Nursing & Health Sciences published by John Wiley & Sons Australia, Ltd.)

Objective: To identify facilitators and barriers to human papillomavirus (HPV) vaccination among college students. Methods: A cross-sectional survey with college students ( N  = 306) between the ages of 18 and 26 was conducted using a computer-delivered survey via iPad. A survey was designed to assess HPV/HPV vaccine-related knowledge, beliefs, and vaccination practices. Results: Low completion rates for the HPV vaccination series (females: 28.9%; males: 11.5%) were observed among college students. The compliance was lower among students who were black American and did not speak English at home. In contrast, the compliance was higher among those who had received any recommendation for HPV vaccination, those with higher knowledge about HPV and HPV vaccine, and higher perceived benefits of vaccination. Conclusions: Increasing knowledge of HPV infection, including the benefits of HPV vaccination and health care providers recommending the HPV vaccine, may increase HPV vaccination among college students and reduce the incidence of the disease.

Structural and cultural barriers have led to limited access to and use of mental health services among immigrants in the United States (U.S.). This study provided a systematic review of factors associated with help-seeking attitudes, intentions, and behaviors among immigrants who are living in the U.S. This systematic review was performed using Medline, CINAHL, APA PsycInfo, Global Health, and Web of Science. Qualitative and quantitative studies examining mental help-seeking among immigrants in the U.S. were included. 954 records were identified through a search of databases. After removing duplicates and screening by title and abstract, a total of 104 articles were eligible for full-text review and a total of 19 studies were included. Immigrants are more reluctant to seek help from professional mental health services due to barriers such as stigma, cultural beliefs, lack of English language proficiency, and lack of trust in health care providers., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: We examined the role of patient-provider communication (PPC) during in-person visits and via electronic communication and social media use on colorectal cancer (CRC) screening among Asian Americans (AAs) and Non-Hispanic Whites (NHWs) aged 50 and older., Methods: Health Information National Trends Survey 2017-2020 data were analyzed., Results: AAs tended to evaluate the quality of PPC during their in-person visits to a health care provider lower than NHWs. AAs' CRC screening rate was lower than the rate of NHWs (78.8% vs. 84.4%). After adjusting for sociodemographics, healthcare access, and health status, the quality of PPC was the only significant predictor associated with a lower probability of CRC screening among AAs (Adjusted OR 0.74; 95% CI 0.56, 0.96); while the Internet to communicate with a health care provider was the only significant predictor of CRC screening among NHWs (Adjusted OR 1.76; CI 1.11, 2.79). AAs were more likely to use YouTube to watch a health-related video than NHWs (43.5% vs, 24%). However, social media use was not associated with CRC screening in both AAs and NHWs., Conclusion: Use of electronic communication technology may contribute to improve health information literacy and reduce the disparity. On-line communication may empower the culturally and linguistically diverse AAs by improving their confidence in communication with health care providers. Thus, communication technologies need to be strategically utilized and tailored to better meet the communication needs of racial/ethnic minorities. Online communication technologies may reduce the disparities in PPC related to cancer screening and cancer burden experienced by AAs., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Abstract: This study reports our experience in implementing and evaluating medication-assisted treatment (MAT) training. MAT training includes immersion into practice and integration of treatment for opioid use disorder (OUD). During 2019-2021, MAT training was offered to students in Master of Science in Nursing and Doctor of Nursing Practice programs. Feedback on our training program was obtained through required Substance Abuse and Mental Health Services surveys and focus groups after training sessions to assess the quality of training, materials, instruction, and impact and usefulness of training. In addition, after completion of training, surveys were emailed to those who graduated in 2020 and 2021. Surveys included demographic questions and qualitative responses to assess MAT training quality, clinical application time, and how comfortable graduates felt regarding their knowledge, skills, and attitude toward treatment. Integrating training modules from the beginning of the nursing program over several semesters facilitating students with multiple exposures to training materials and offering clinical experiences solidified students' knowledge into practice. Most students were satisfied with the training and felt the training was effective in integrating new knowledge related to MAT. More importantly, it improved students' negative attitudes toward people with OUD and students' desire to pursue being an OUD MAT provider after graduation. The continued assessment and curriculum development of MAT training in nursing programs is crucial in fighting the opioid overdose epidemic. This expansion in interested MAT providers may contribute to improving access for underserved patients seeking MAT treatment with an increase in available providers., Competing Interests: Competing interests: The authors report no conflicts of interest., (Copyright © 2023 American Association of Nurse Practitioners.)

COVID-19 has become the first modern-day pandemic of historic proportion, affecting >600 million individuals worldwide and causing >6.5 million deaths. While acute infection has had devastating consequences, postacute sequelae of SARS-CoV-2 infection appears to be a pandemic of its own, impacting up to one-third of survivors and often causing symptoms suggestive of cardiovascular phenomena. This review will highlight the suspected pathophysiology of postacute sequelae of SARS-CoV-2, its influence on the cardiovascular system, and potential treatment strategies., Competing Interests: Disclosures K.B. Highland reports VielaBio, clinical trial for acute COVID. The other authors report no conflicts.

Introduction: Medication for addiction treatment (MAT) for opioid use disorder (OUD) in pregnant women is known to improve neonatal health outcomes. Despite the benefits of this evidence-based treatment for OUD, MAT has been underutilized during pregnancy among certain racial/ethnic groups of women in the United States. The purpose of this study was to examine racial/ethnic differences and factors that affect MAT administration among pregnant women with OUD seeking treatment at publicly funded facilities., Methods: We used data from the 2010-2019 Treatment Episode Data Set system. The analytic sample included 15,777 pregnant women with OUD. We built logistic regression models to examine associations between race/ethnicity and MAT and determine differences and similarities in factors that may influence the use of MAT across racial/ethnic groups of pregnant women with OUD., Results: Although in this sample only 31.6 % received MAT, an increasing trend of MAT receipt has been observed during 2010-2019. Approximately 44 % of the Hispanic pregnant women received MAT, and this was significantly higher than non-Hispanic Black (27.1 %) and White (31.3 %) women. Even after adjusting for potential confounders, the adjusted odds of receiving MAT during pregnancy were lower for Black (AOR = 0.57, 95 % CI 0.44, 0.75) and White (AOR = 0.75, 95 % CI 0.61, 0.91) women compared to Hispanic women. Not being in the labor force increased the odds of receiving MAT in Hispanic women relative to their employed counterparts while homelessness or dependent living decreased the odds of MAT for White women compared to those living independently. Regardless of their racial/ethnic background, pregnant women younger than 29 years old were less likely to receive MAT relative to older women; however, if they were arrested once prior to admission to treatment, they had significantly higher odds of receiving MAT than those with no arrests. Treatment of at least 7 months was associated with a higher likelihood of MAT across all racial/ethnic groups., Conclusions: This study highlights the underutilization of MAT, particularly among pregnant Black and White women who seek treatment for OUD in publicly funded treatment facilities. A multi-dimensional approach to MAT intervention programs is needed to increase MAT for all pregnant women and reduce racial/ethnic inequities., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Oxiracetam may have a modest effect on preventing cognitive decline. Exercise can also enhance cognitive function. This trial aims to investigate the effect of oxiracetam on post-stroke cognitive impairment and explore whether this effect is modified by exercise. Furthermore, the mechanisms that mediate this effect will be investigated through a neural network analysis., Methods: This is a multicenter, randomized, double-blind, placebo-controlled phase IV trial. Patients who complained of cognitive decline 3 months after stroke and had a high risk of cognitive decline were eligible. Patients were randomly assigned to receive either 800 mg of oxiracetam or placebo twice daily for 36 weeks. After randomization, a predetermined exercise protocol was provided to each participant, and the degree of physical activity was assessed using wrist actigraphy at 4, 12, 24, and 36 weeks. Resting-state functional MRI was obtained in baseline and 36-week follow-up. Co-primary endpoints are changes in the Mini-Mental State Examination and Clinical Dementia Rating-Sum of Boxes. Secondary endpoints include changes in the NINDS-CSN VCIHS-Neuropsychology Protocol, Euro QoL, patient's global assessment, and functional network connectivity. If there is a significant difference in physical activity between the two groups, the interaction effect between physical activity and the treatment group will be examined. A total of 500 patients were enrolled from February 2018, and the last patient's final follow-up was completed in September 2022., Conclusion: This trial is meaningful not only to prove the efficacy of oxiracetam, but also evaluate whether exercise can modify the effects of medication and how cognitive function can be restored. Trial registrationhttp://cris.nih.go.kr (KCT0005137)., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this study., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Aim: This study examined the relationships between patient-centred care, diabetes self-management and selected health outcomes for Omani patients with type-2 diabetes., Methods: Cross-sectional surveys were administered for 237 patients with type-2 diabetes. Hierarchical regression analyses examined the relationships between the selected study variables., Results: The sample was middle-aged (M = 48, SD = 11.0 years) with nearly a decade (M = 9.68, SD = 6.11) since being diagnosed with type-2 diabetes, with higher than ideal glycaemic control measures (M = 8.8%, SD = 2.4%). In bivariate analyses, patient-centred care was positively associated with diabetes self-management but not with glycaemic control or quality of life. However, after controlling demographic and clinical characteristics, patient-centred care was positively associated with both physical and mental aspects of health-related quality of life. In the final regression model, controlling for demographic and clinical characteristics and patient-centred care, diabetes self-management significantly predicted both glycaemic control and both physical and mental aspects of health-related quality of life., Conclusions: The findings support that providing individualized care may contribute to the self-management of chronic conditions. For achieving optimal outcomes, it may be necessary for providers to effectively assess patients' unique challenges and motivations. Increasing diabetes self-management may improve quality of life and reduce diabetes complications., (© 2022 John Wiley & Sons Australia, Ltd.)

Using a single-group, pre-posttest design, we evaluated feasibility and acceptability of a technology-enhanced physical activity intervention in 43 midlife (aged 35-64) first-generation Korean American adults who were physically inactive. The intervention consisted of bi-weekly education sessions for 4 weeks, monthly small group walks for the following 8 weeks, and weekly reminder text messages during the entire intervention period. A 100% retention rate, 93% adherence, and 88.4% satisfaction supported the feasibility and acceptability of the intervention. Paired t -tests revealed the intervention was successful and effective as demonstrating a significant increase in self-efficacy and moderate physical activity and improved cardiometabolic health. This easy and motivation enhancing intervention has a wide potential applicability for other ethnic groups. Further intervention research is suggested in a large sample, multisite, for a longer-term with a randomized controlled trial design, which may lead us to narrow the gap in physical activity engagement and cardiometabolic health disparities.

Objectives: Despite the high prevalence of depression among older Korean Americans (KAs), there has been very little research on depression literacy among older KAs. This study identified specific areas of improvement in depression literacy to address mental health promotion among KAs. Twenty-two items on the depression literacy scale were grouped under five key themes: incidence and prognosis, differential symptoms, symptom recognition, non-pharmacological effectiveness, and pharmacological knowledge. This study aimed to assess the level of understanding depression literacy based on five domains and identify factors associated with depression literacy and its domains among older KAs., Methods: A cross-sectional study with 178 KAs aged 60 years and older was conducted in the Washington DC Metro area. Interviewer and self-administered questionnaires were used to collect data. Multiple linear regression analyses were conducted to identify factors associated with depression literacy and its domains. Statistical significance was set at p < .05 for analyses., Results: Knowledge pertaining to all 5 depression literacy domains was low, particularly on pharmacological treatment and differential symptoms were noticeably low. The majority of participants had misconceptions about antidepressants. 86% believed that antidepressants can have a rapid effect on symptoms, 82.6% believed people with depression should stop taking antidepressants as soon as they feel better, and 66.3% believed antidepressants were addictive., Conclusion: Misperception about depression and antidepressants may be associated with poor mental health outcomes among older KAs. Culturally-tailored education for older KAs with limited English proficiency could be beneficial in promoting depression literacy and reducing stigma or misconceptions regarding depression and treatments., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Evidence-based practice (EBP) is crucial in keeping nurses aware of the current knowledge and improving clinical decision-making. The integration of nurses’ EBP competencies and organizational support has been suggested to create an effective arena in implementing EBP. The purpose of the study was to examine organizational factors influencing nurses’ EBP knowledge, attitudes, and implementation and identify staff nurses’ perceptions of EBP nursing leadership and hospital supports in Saudi Arabia. Data were collected from a convenience sample of staff nurses (N = 227) working in four hospitals using a cross-sectional, correlational descriptive design. Level of education (p < 0.05), EBP training (p < 0.05), unit type (ICU (p < 0.001) and ER (p < 0.01)), perceived nursing leadership (p < 0.001), and work environment (p < 0.05) supports were found significantly associated with nurses’ knowledge. Magnet recognition (p < 0.01) and knowledge (p < 0.001) had significant influence on nurses’ attitudes. Unit type (ER) (p < 0.05), knowledge (p < 0.001), and attitudes (p < 0.001) were associated with implementation. Encouragement to attend EBP trainings from nursing leadership was perceived by most nurses (51.1%). Nurses reported their hospitals support EBP through training (68.2%). Findings support the need for healthcare systems to create a culture that facilitates EBP implementation to enhance nurses’ EBP competencies and improve patients’ outcomes. Nursing managers may consider preparing nurses through education.

Patient-centered care enhances diabetes self-management; however, the primary care nurse's role in promoting diabetes self-management within a patient-centered care model is unexplored. This study investigated the perceptions of Omani patients with type-2 diabetes and their clinic nurses on the nurses' role in promoting diabetes self-management within a patient-centered care approach. The thematic analysis of the data from individual interviews with patients (n = 24) revealed two themes: patients experienced "missteps on an unclear path" and "nurses doing their best." Patients struggled to identify treatment goals and faltered in their attempts to adopt diabetes self-management behaviors. The nurses' role was perceived as task-oriented. Nurse narratives (n = 21) revealed that very few nurses were aware of the patient-centered care philosophy. A theme emerged of nurses "needing a new perspective" to transition their care delivery to align with the patient-centered care model. Nurses expected patients to comply with their instructions and missed opportunities for assessment, engagement, and collaborative problem-solving during patient encounters. The shift from a physician-based medical model to a patient-centered primary care delivery system may necessitate that nurses engage more effectively with patients, collaborate on an individual treatment plan, and motivate them to adopt self-management behaviors.

Background: Health care providers' stigmatizing attitudes are obstacles to patients' well- being and quality of life. Dealing with HIV-related stigma and understanding the impact of feasible interventions on reducing stigmatizing attitudes among health care providers are considered important strategies to improve the quality of HIV care, patient-provider relationships, and provide supportive and safe care services., Objective: The aim of this study was to systematically review interventions to reduce HIV-related stigma among health care providers., Methods: This systematic review was performed using Medline, CINAHL, ERIC, and APA PsycInfo, Health Source: Nursing/Academic Edition to search for quasi-experimental studies and randomized controlled trials (RCTs) designed to reduce HIV stigma among health care providers. The quality of eligible research studies was independently appraised by two reviewers., Results: A total of 774 studies were screened, 100 articles were assessed for eligibility, and 10 studies met the inclusion criteria. All interventions effectively reduced HIV-related stigma. Elements of successful interventions included knowledge modules, peer education, patients' testimonials, Photovoice-informed stigma reduction training, stigma-free space intervention, and popular opinion leaders. Interventions were assessed and compared in terms of contents, delivery modes, HIV stigma measurements, follow-up, and limitations., Conclusion: This systematic review supports the effectiveness of in-person educational interventions at reducing HIV-related stigma among health care providers across countries. Comparisons of delivery modes of interventions indicated that educational interventions delivered by patients' testimonials and peer education strategies are more promising than lecture-based teaching methods. Further studies are needed to assess the long-term effects of interventions on clinical behaviors and practices., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Klebsiella pneumoniae is one of the important clinical organisms that causes various infectious diseases, including urinary tract infections, necrotizing pneumonia, and surgical wound infections. The increase in the incidence of multidrug-resistance K. pneumoniae is a major problem in public healthcare. Therefore, a novel antibacterial agent is needed to treat this pathogen. Here, we studied the in vitro and in vivo activities of a novel antibiotic LCB10-0200, a siderophore-conjugated cephalosporin, against clinical isolates of K. pneumoniae . In vitro susceptibility study found that LCB10-0200 showed potent antibacterial activity against K. pneumoniae , including the beta-lactamase producing strains. The in vivo efficacy of LCB10-0200 was examined in three different mouse infection models, including systemic, thigh, and urinary tract infections. LCB10-0200 showed more potent in vivo activity than ceftazidime in the three in vivo models against the drug-susceptible and drug-resistant K. pneumoniae strains. Taken together, these results show that LCB10-0200 is a potential antibacterial agent to treat infection caused by K. pneumoniae .

Colorectal cancer (CRC) is the second most-commonly diagnosed cancer among Korean Americans after breast cancer, with incidence rates exceeding that of lung, prostate, and stomach cancers. However, CRC screening rates are lower among Korean Americans than the general U.S. population. To understand barriers to screening in this population, we conducted 11 focus groups with 51 Korean Americans ages 40+ in the Washington, DC, metropolitan area between 2011 and 2016. Our analysis used the Health Belief Model as a framework. Motivators to seek screening include a family or personal history of cancer or gastrointestinal disease (high perceived susceptibility), knowing people with CRC (high severity), favorable test results reducing worry (high benefits), and physician recommendations (cues to action). Barriers to screening include the common misperception that Korean lifestyles prevent CRC (low susceptibility), the belief that cancer is normal for older adults (low severity), the assumption that screening only benefits symptomatic people (low benefits), the costs and potential risks of testing along with a preference for traditional Korean approaches to wellness (high barriers), and lack of health insurance (low self-efficacy). Interventions seeking to increase the rate of cancer screening in the Korean American community will benefit from emphasizing the burden from CRC among Korean Americans (increasing perceived susceptibility to CRC), explaining that colonoscopies can prevent CRC rather than just diagnosing it (increasing perceived benefits of screening), reducing anxieties about test procedures and embarrassment (reducing perceived barriers to screening), and improving clinical communication (improving cues to action and self-efficacy).

Abstract: The performance of scoring systems for risk stratification in patients with atrial fibrillation (AF) was not validated well in patients with stroke. The purpose of this study was to evaluate whether the risk scoring systems predict vascular outcomes in stroke patients with AF.Data were obtained from a nationwide multicenter registry for acute stroke with AF from January 1, 2013, to December 31, 2015. We investigated the predictive power of the CHADS2, CHA2DS2-VASc, ATRIA, and Essen stroke scores in stroke patients with AF. The subjects were further stratified into groups according to treatment with or without oral anticoagulants (OACs).A total of 3112 stroke with AF subjects were included. The rate of recurrent ischemic stroke and any stroke were not associated with the CHADS2, CHA2DS2-VASc, ATRIA, and Essen stroke risk scores. The risks of death and major adverse cerebrovascular and cardiovascular events (MACEs) increased sequentially with the increase of each risk score in OAC group. (the range of C-index 0.544-0.558 for recurrent ischemic stroke; 0.523-0.537 for any stroke; 0.580-0.597 for death; 0.564-0.583 for MACEs). However, in the group treated with OACs, all risk scores were significantly associated with the risk of MACEs. The C-statistics of the 4 scoring systems were 0.544 to 0.558, 0.523 to 0.537, 0.580 to 0.597, 0.564 to 0.583, respectively, for recurrent ischemic stroke, any stroke, death, and MACEs.The performance of the CHADS2, CHA2DS2-VASc, ATRIA, and Essen stroke risk scores for the prediction of recurrent stroke was unsatisfactory in stroke patients with AF whereas the performance for the prediction of recurrent stroke was not MACEs or death was good. A new risk stratification scheme that is specific for secondary stroke prevention in the AF population is needed., Competing Interests: The other authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background and Purpose: We analyzed the incidence and causes of oral anticoagulant (OAC) cessation and subsequent stroke after OAC withdrawal in a cohort of Korean stroke patients with atrial fibrillation., Methods: The Korean Atrial Fibrillation Evaluation Registry in Ischemic Stroke patients (K-ATTENTION) is a multicenter cohort study, merging stroke registries from 11 tertiary centers in Korea. The number of OAC interruption episodes and the reasons were reviewed from hospital records. Stroke after OAC withdrawal was defined when a patient experienced ischaemic stroke within 31 days after OAC withdrawal. Clinical variables were compared between patients who experienced stroke recurrence during OAC interruption and those who did not experience recurrence., Results: Among 3213 stroke patients with atrial fibrillation, a total of 329 episodes of OAC interruption were detected in 229 patients after index stroke (mean age 72.9 ± 8.3 years, 113 female patients). The most frequent reason for OAC withdrawal was poor compliance [103 episodes (31.3%)] followed by extracranial bleeding [96 episodes (29.2%)]. Stroke after OAC withdrawal was noted in 13 patients. Mean age, vascular risk factor profile and mean CHA 2 DS 2 -VASc score were not significantly different between patients with and without recurrent stroke., Conclusions: A considerable number of stroke patients with atrial fibrillation experienced temporary interruption of OAC after index stroke, which was associated with stroke recurrence of 4.0 cases per 100 interruption episodes., (© 2020 European Academy of Neurology.)

Aims: To examine prevalence of bullying among nurses and explore associations of organizational betrayal and support with well-being among nurses exposed to bullying., Background: Bullying is a problem in many nursing workplaces, and organizations have an obligation to support nurses who are bullied. Support or betrayal after bullying could affect nurse well-being, including burnout., Methods: In this cross-sectional study among U.S. nurses, data were collected in a survey using the Negative Acts Questionnaire-Revised for Nursing, the Institutional Betrayal Questionnaire for Health, the Well-Being Index, a job satisfaction scale and demographic questions., Results: Prevalence of weekly/daily bullying was 31% (N = 242). Among nurses exposed to any bullying (N = 173), organizational betrayal increased odds of burnout (OR 2.62, p = .02), job dissatisfaction (OR 2.97, p = .04) and absenteeism (OR 6.11, p < .001). Organizational support decreased odds of job dissatisfaction (OR 0.30, p = .001) and absenteeism (OR 0.50, p = .04)., Conclusion: Analysis of study findings suggests organizational betrayal increases likelihood of burnout, job dissatisfaction and absenteeism, and support decreases likelihood of dissatisfaction and absenteeism., Implications for Nursing Management: Nurse leaders should be aware of the issue of organizational betrayal and support in relation to well-being. Future studies can further explore the concepts of betrayal and support to provide additional evidence., (© 2019 John Wiley & Sons Ltd.)

Aim and Objectives: To examine the influence of staff nurses' individual factors on knowledge, attitudes and implementation of evidence-based practice in Saudi Arabia and to identify facilitators and barriers to evidence-based practice implementation., Background: Evidence-based practice has been considered as a key for healthcare quality measure. The literature, however, shows that nurses worldwide are not implementing evidence-based practice as expected and recommended by governing agencies. In Saudi Arabia, evidence-based practice implementation has not been addressed sufficiently., Design: A cross-sectional, correlational design was used. We have complied with the guidelines of STROBE Checklist in presenting this research. A convenience sample of staff nurses (n = 227) was selected from four hospitals in Riyadh, Saudi Arabia. The survey questions included the Evidence-based Practice Questionnaire and individual factors. Data were analysed using multiple linear regression models., Results: Attitudes towards evidence-based practice had the highest mean followed by evidence-based practice knowledge and implementation means. Evidence-based practice training and research involvement were associated with knowledge in the bivariate and multivariate analyses. None of the individual factors were associated with attitudes. However, knowledge was associated with attitudes. Knowledge and attitudes influenced evidence-based practice implementation positively. Unexpectedly, receiving evidence-based practice training made it more difficult for nurses to participate in evidence-based practice implementation process. We found that attitudes partially mediated the relationship between knowledge and evidence-based practice implementation., Conclusion: Nurses in Saudi Arabia are willing to be involved in the evidence-based practice process. However, nurses identified that they need to improve their knowledge and skills in order to be active participants in the process., Relevance to Clinical Practice: Organisations and nursing leadership may benefit from developing a comprehensive strategy to promote staff nurses' involvement in the evidence-based practice process through providing continuing education and mentoring programmes about evidence-based practice., (© 2019 John Wiley & Sons Ltd.)

Background There is insufficient evidence on the effect of statins, particularly high-intensity statins, in patients with acute ischemic stroke and atrial fibrillation. We investigated the impact of statins on the outcomes in these patients, including those who might be vulnerable to statin therapy and those without clinical atherosclerotic cardiovascular diseases. Methods and Results A total of 2153 patients with acute ischemic stroke and atrial fibrillation were enrolled in the present nationwide, multicenter, cohort study. The primary composite end point was the occurrence of net adverse clinical and cerebral events (NACCE; death from any cause, stroke, acute coronary syndrome, or major bleeding) over a 3-year period based on statin intensity. NACCE rates were lower in patients receiving low- to moderate-intensity (adjusted hazard ratio 0.64; 95% CI: 0.52-0.78) and high-intensity statins (hazard ratio 0.51; 95% CI 0.40-0.66) than in those not receiving statin therapy. High-intensity statins were associated with a lower risk for NACCE than low- to moderate-intensity statins (hazard ratio 0.76; 95% CI 0.59-0.96). Subgroup analyses showed that the differences in hazard ratio for 3-year NACCE favored statin use across all subgroups, including older patients, those with low cholesterol levels, patients receiving anticoagulants, and patients without clinical atherosclerotic cardiovascular diseases. Magnified benefits of high-intensity statins compared with low- to moderate-intensity statins were observed in patients who underwent revascularization therapy and those under 75 years of age. Conclusions Statins, particularly high-intensity statins, could reduce the risk for NACCE in patients with acute ischemic stroke and atrial fibrillation; this needs to be further explored in randomized controlled trials.

High prevalence rates of both Vitamin B12 insufficiency and depressive symptoms exist in pregnant women. Although the association between depressive symptoms and certain nutrient deficiencies like iron, folate, or Vitamin B12 has been established, the specific relationship between low-normal serum Vitamin B12 levels and depressive symptoms in pregnant women in the United States has not been studied closely. Using 2005-2006 National Health and Nutrition Examination Survey data, a secondary analysis was conducted to examine the association between low-normal serum Vitamin B12 level and depression, as measured by a score of 10 or higher on the Patient Health Questionnaire-9, in pregnant women (N = 174). In bivariate regression models, Vitamin B12 level, experiencing poverty, and pre-pregnancy body mass index (BMI) were significant predictors of depression. In multivariate logistic regression models, pregnant women with low-normal serum Vitamin B12 levels (OR = 3.82, 95% CI [1.10-13.31], p < 0.04) were 3.82 times more likely to experience depression, controlling for sociodemographic characteristics, pre-pregnancy BMI, and the biomarkers hemoglobin and folate. Identifying and treating pregnant women with low-normal Vitamin B12 levels may enhance prenatal depression management., (© 2019 Wiley Periodicals, Inc.)

Background and Objectives: The 30-min rule has been used to maintain a core temperature (CT) of red-blood-cell (RBC) units below 10°C during transportation. We evaluated the utility of temperature-sensitive indicators (TIs) to monitor the surface temperature (ST) of RBC units and to explore whether TIs can help with compliance with the 30-min rule by extrapolating or correlating temperature change with time., Materials and Methods: Two US FDA-approved TIs, Safe-T-Vue 10 (STV10; Temptime Corporation, Morris Plains, NJ, USA) and Timestrip Blood Temp 10 (BT10; Timestrip UK Ltd, Cambridge, UK), were attached to 50 RBC units. After issue, their colour change indicating 10°C was monitored, and temperature excursions were measured by standard reading. In additional 18 RBC units, both ST and CT were monitored simultaneously., Results: In 50 RBC units, 94% of STV10 and 100% of BT10 showed colour change indicating 10°C within 30 min; 4% of STV10 and 18% of BT10 showed it during transportation. The time for colour change indicating 10°C differed significantly between STV10 and BT10 (19·0 vs. 5·6 min, P < 0·001). In additional 18 RBC units, 83·3% of STV10, 100% of BT10 and 88·9% of CT reached 10°C within 30 min, and the time for colour change indicating 10°C was 24·4 min in STV10, 14·6 min in BT 10 and 24·2 min in CT (P < 0·001)., Conclusion: In two TIs, the time for colour change indicating 10°C varied considerably. To enhance the utility of TIs, further improvement and standardization would be needed., (© 2019 International Society of Blood Transfusion.)

Aims: The aim of this study is to compare the frequency and correlates of undiagnosed diabetes between Hispanic and white American adults ages 20 and older with known diabetes or elevated HbA 1c ., Methods: Using 2007 to 2012 National Health and Nutrition Survey data, 1792 white and Hispanic Americans age 20 and older with known diabetes or elevated HbA 1c (≥6.5%) were included in the analysis. Undiagnosed diabetes was defined as elevated HbA 1c more than or equal to 6.5% without prior diabetes diagnosis. Covariates included demographics, health care access, and survey language., Results: Hispanics were younger (54.92 vs 61.45 y, p < .001) and had a higher rate of undiagnosed diabetes (28.2% vs 18.0%, p < .001) than their white counterparts. For Hispanics, those with undiagnosed diabetes had higher mean HbA 1c than those with known diabetes (p = .03), but no significant difference was found between diagnosed and undiagnosed diabetes among whites. Covariates that decreased the odds of undiagnosed diabetes among Hispanic Americans included having a routine place to receive health care. For whites, covariates that decreased the odds of undiagnosed diabetes were a higher ratio of income to poverty level, having health insurance and having a routine place for health care., Conclusion: The high proportion of unknown diabetes among Hispanic Americans suggests the need for a culturally competent health campaign to improve community diabetes awareness. Emphasizing the importance of having a routine place of health care for regular health check-ups and expanded community resources for diabetes early detection and prevention among this population could decrease the burden of diabetes., (© 2019 John Wiley & Sons, Ltd.)

First-generation Chinese and Korean male immigrants in the United States are at high risk for tobacco use. This study pilot-tested a graphic, native-language text-messaging intervention to promote smoking cessation among these groups. First-generation Chinese and Korean male immigrant smokers (N = 71) were recruited from the Washington DC area. Participants were randomly assigned to one of four conditions based on a between-subjects 2 (graphic plus text or text-only messages) � 2 (quitline information or quitting tips) design. The text-messaging intervention included 30 text messages in total and lasted one month. Participants completed an expired air carbon monoxide (CO) assessment and self-reported measures at both baseline and follow-up. Results show that, from baseline to follow-up, participants' expired air CO levels decreased significantly (P = 0.001). Attitude toward quitting also became more positive (P = 0.028). Compared with text-only messages, graphic text messages produced greater positive changes in quitting attitudes (P = 0.039) and elicited greater fear response (P = 0.005). Compared with quitting tip messages, quitline information resulted in greater regret (P = 0.016) and fear (P = 0.051). These findings suggest that graphic text-messaging can be an effective method to promote smoking cessation among first-generation Chinese and Korean male immigrants., (� The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: In patients with unilateral posterior inferior cerebellar artery (PICA) territory infarction, the absence of relevant vessel stenosis may make it difficult to determine the etiology of the infarction. The incidence of cardioembolic (CE) infarction and the factors associated with infarction in such patients remains largely unknown. We hypothesized that the PICA angle would affect the flow direction of embolic sources. Thus, we analyzed the association between high-risk CE sources and the PICA angle., Methods: Patients with an isolated unilateral PICA territory infarction without relevant vessel stenosis who were admitted between 2014 and 2017 were included from the Korea University Stroke Registry, which includes data from 3 university hospitals. We classified patients according to the presence of CE sources. For each case, we measured the angle between the vertebral artery (VA) and the proximal PICA., Results: In all, 71 patients met the final study entry criteria. Multivariable analysis showed that the PICA angle was independently associated with the risk of a CE source. The optimal cut-off value using Youden's index was 89°. We classified the PICA shape based on the optimal cut-off value. A CE source was identified in 83.3% of cases in which the PICA angle exceeded 89°., Conclusions: The angle between the PICA and VA was an independent predictor of unilateral PICA stroke with high-risk CE sources without relevant artery stenosis, suggesting that an angle greater than 89° could be a new image marker for determining the stroke subtype., (Copyright © 2018. Published by Elsevier Inc.)

The purpose of this study was to explore depression and its relationship with background characteristics, health literacy, and depression literacy among Korean Americans (KAs). A cross-sectional survey was conducted among 178 older KAs (age 60≥) in the Washington D.C. metro area in 2016. Three open-ended questions were included to obtain narrative responses for thoughts about depression and its symptoms, and the living situation that might be related to depression. Depression was measured on the Patient Health Questionnaire-9 translated into Korean. The rate of depression was 22.5% among older KAs. No relationship between health literacy and depression was shown. In the regression analysis with covariates, limited English proficiency, less family support, shorter length of U.S. residency, male, and higher depression literacy were significantly associated with higher odds of depression. On narrative questions, only 35% among respondents believed that depression was a mental status. The others described it as environmental or attitude problems such as stress or goals being set too high. Education about depression engaging older KAs immigrants with limited English, and their families are the important health issue in the Korean community.

Ursolic acid (UA) supplementation was previously shown to improve skeletal muscle function in resistance-trained men. This study aimed to determine, using the same experimental paradigm, whether UA also has beneficial effects on exercise-induced skeletal muscle damage markers including the levels of cortisol, B-type natriuretic peptide (BNP), myoglobin, creatine kinase (CK), creatine kinase-myocardial band (CK-MB), and lactate dehydrogenase (LDH) in resistance-trained men. Sixteen healthy participants were randomly assigned to resistance training (RT) or RT+UA groups (n=8 per group). Participants were trained according to the RT program (60~80% of 1 repetition, 6 times/week), and the UA group was additionally given UA supplementation (450 mg/day) for 8 weeks. Blood samples were obtained before and after intervention, and cortisol, BNP, myoglobin, CK, CK-MB, and LDH levels were analyzed. Subjects who underwent RT alone showed no significant change in body composition and markers of skeletal muscle damage, whereas RT+UA group showed slightly decreased body weight and body fat percentage and slightly increased lean body mass, but without statistical significance. In addition, UA supplementation significantly decreased the BNP, CK, CK-MB, and LDH levels (p<0.05). In conclusion, UA supplementation alleviates increased skeletal muscle damage markers after RT. This finding provides evidence for a potential new therapy for resistance-trained men., Competing Interests: CONFLICTS OF INTEREST: The authors declare no conflicts of interest.

Web-based culture-specific interventions for Korean American (KA) women to improve mammography utilization are not available. An established intervention developed to improve mammography utilizations for Korean American (KA) women was tested via the Web for its efficacy, feasibility, and acceptability. A randomized controlled trial, with a pretest-posttest control group design, was conducted with 136 KA women and their spouses. Intention to have a mammogram within the next 12 months increased significantly in the intervention group compare to controls. Among women whose mammograms had not been updated, 22 % of women in the intervention and 13 % of women in the control group obtained a mammogram at 2-month post-baseline, even though the difference was not statistically significant. The Web-based study educating couples was feasible and could improve KA women's breast cancer screening intention and behaviors. Combining off-line contact for recruitment/data collection with online intervention material could decrease the attrition rate in the future study because the attrition rate in this study was higher than the original study.

Cancer is the leading cause of death for Korean Americans (KAs). Breast cancer (BC) is the most commonly occurring cancer among KA women, and its rate has been rapidly increasing. Low BC screening rates for KAs puts them at greater risk for late-stage breast cancer. We conducted a systematic review of the published literature on cancer screening among KAs, and identified 38 eligible studies. Despite significant increases in mammogram utilization over the past two decades, KAs have consistently lower rates of mammogram screening than other American populations. KA women also report lower rates of clinical breast examination and breast self-examination. Screening rates are higher among adults with higher socioeconomic status, greater acculturation to the United States, more cancer knowledge, higher perceived susceptibility to BC, more social support, and better access to health services. However, fear of finding something wrong, fear of embarrassment or lack of modesty, not knowing where to go for screening, believing that mammography is only necessary when symptoms are present, and perceived time and cost difficulties in accessing mammography were reported as barriers to mammogram screening. Coordinated efforts from clinicians, public health workers, KA cultural and religious organizations, and the broader breast cancer advocacy and awareness community are necessary for improving BC screening among KAs.

Follicular lymphoma (FL) is the second most common lymphoid malignancy, representing 20% to 25% of all cases of non-Hodgkin's lymphoma (NHL), and the most common of the indolent NHLs. FL is considered incurable in the majority of patients with the current standard therapeutic approaches, although outcomes have improved in the last few decades with our current therapies, with a median overall survival that now exceeds 18 years. While the majority of patients with FL have improved outcomes with our current therapeutic approaches, there are patients with high-risk disease features that have inferior outcomes to these therapies. There is an urgent need to integrate novel therapeutic agents into the treatment regimens for these patients to improve outcomes with continued evaluation of biomarkers indicative of prognosis and effects of these regimens on quality of life., (Published by Oxford University Press 2016. This work is written by US Government employees and is in the public domain in the US.)

A high percentage of Korean American (KA) women have never had a mammogram, which puts them at greater risk for late-stage breast cancer. The aim of this study was to compare health beliefs and spousal support about breast cancer and screening between KA women with and without a history of mammogram completion. Cross-sectional data were obtained from 428 non-adherent married KA women. KA women who never had a mammogram were younger, had less access to health care, had less knowledge, and had lower perceived self-efficacy, benefits, and spousal support, and higher perceived barriers to breast cancer screening compared to women who had had a mammogram. Assessing differing characteristics between the two groups of KA women may lead to a better understanding of the variables influencing mammography screening in this population and possibly increase early screening.

Introduction: The Sysmex XN modular system (Sysmex, Kobe, Japan) uses a novel technology for white blood cell (WBC) count and differential, using separate channels: white cell nucleated (WNR), WBC differential (WDF), and white progenitor cell (WPC) channels. We questioned how concordant WBC counts would be between them., Methods: In a total of 6327 consecutive specimens, WBC counts were compared between WNR and WDF channels. They were also compared in three groups of WBC counts and two groups of chemotherapy status. In 508 specimens from the 4361 specimens that were run on the XN-20 module, the WPC channel was used for reflex test. Data were compared using Pearson's correlation, absolute difference, and percent difference (%D)., Results: WBC counts between WNR and WDF channels showed very high correlations in total specimens (r = 0.9976) and in the groups of WBC counts and chemotherapy. As WBC count increased, absolute difference increased, while %D decreased (P < 0.0001, both). Percent difference was 1.55% in total specimens and showed the highest value in the severe leukopenia group (<1.0 × 10(9)/L, 6.18%)., Conclusions: This is the first large-scale study on novel channel technology for WBC counts in the Sysmex XN. WBC counts by WNR, WDF, and WPC channels are highly correlated, and they are overall interchangeable and reliable., (© 2015 John Wiley & Sons Ltd.)

Serious medication errors continue to exist in hospitals, even though there is technology that could potentially eliminate them such as bar code medication administration. Little is known about the degree to which the culture of patient safety is associated with behavioral intention to use bar code medication administration. Based on the Technology Acceptance Model, this study evaluated the relationships among patient safety culture and perceived usefulness and perceived ease of use, and behavioral intention to use bar code medication administration technology among nurses in hospitals. Cross-sectional surveys with a convenience sample of 163 nurses using bar code medication administration were conducted. Feedback and communication about errors had a positive impact in predicting perceived usefulness (β=.26, P<.01) and perceived ease of use (β=.22, P<.05). In a multiple regression model predicting for behavioral intention, age had a negative impact (β=-.17, P<.05); however, teamwork within hospital units (β=.20, P<.05) and perceived usefulness (β=.35, P<.01) both had a positive impact on behavioral intention. The overall bar code medication administration behavioral intention model explained 24% (P<.001) of the variance. Identified factors influencing bar code medication administration behavioral intention can help inform hospitals to develop tailored interventions for RNs to reduce medication administration errors and increase patient safety by using this technology.

This study examines Korean American community newspapers' representation of risks and benefits involved with medical tourism offered in Korea. Using framing theory, this research attempts to explain Korean Americans' highly positive perceptions and high willingness to use health and medical services in Korea through medical tourism rather than using such services in the United States. The result of content analyses indicated that Korean American community newspapers are rarely engaged in risk communication and lack sufficient information about potential risks of medical tourism while emphasizing diverse benefits. Korean ethnic media, as the primary source of health communication for Korean Americans, should provide more reliable health and medical information for the population's appropriate health management.

Background: The purpose of this study is to determine whether microRNA for pluripotent stem cells are also expressed in breast cancer and are associated with metastasis and outcome., Methods: We studied global microRNA profiles during differentiation of human embryonic stem cells (n =26) and in breast cancer patients (n = 33) and human cell lines (n = 35). Using in situ hybridization, we then investigated MIR302 expression in 318 untreated breast cancer patients (test cohort, n = 22 and validation cohort, n = 296). In parallel, using next-generation sequencing data from breast cancer patients (n = 684), we assessed microRNA association with stem cell markers. All statistical tests were two-sided., Results: In healthy tissues, the MIR302 (high)/MIR203 (low) asymmetry was exclusive for pluripotent stem cells. MIR302 was expressed in a small population of cancer cells within invasive ductal carcinoma, but not in normal breast (P < .001). Furthermore, MIR302 was expressed in the tumor cells together with stem cell markers, such as CD44 and BMI1. Conversely, MIR203 expression in 684 breast tumors negatively correlated with CD44 (Spearman correlation, Rho = -0.08, P = .04) and BMI1 (Rho = -0.11, P = .004), but positively correlated with differentiation marker CD24 (Rho = 0.15, P < .001). Primary tumors with lymph node metastasis had cancer cells showing scattered expression of MIR302 and widespread repression of MIR203. Finally, overall survival was statistically significantly shorter in patients with MIR302-positive cancer cells (P = .03)., Conclusions: In healthy tissues the MIR302(high)/MIR203(low) asymmetry was characteristic of embryonic and induced pluripotency. In invasive ductal carcinoma, the MIR302/MIR203 asymmetry was associated with stem cell markers, metastasis, and shorter survival., (© The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Ursolic acid (UA), a type of pentacyclic triterpenoid carboxylic acid purified from natural plants, can promote skeletal muscle development. We measured the effect of resistance training (RT) with/without UA on skeletal muscle development and related factors in men. Sixteen healthy male participants (age, 29.37±5.14 years; body mass index=27.13±2.16 kg/m(2)) were randomly assigned to RT (n=7) or RT with UA (RT+UA, n=9) groups. Both groups completed 8 weeks of intervention consisting of 5 sets of 26 exercises, with 10~15 repetitions at 60~80% of 1 repetition maximum and a 60~90-s rest interval between sets, performed 6 times/week. UA or placebo was orally ingested as 1 capsule 3 times/day for 8 weeks. The following factors were measured pre-and post-intervention: body composition, insulin, insulin-like growth factor-1 (IGF-1), irisin, and skeletal muscle strength. Body fat percentage was significantly decreased (p<0.001) in the RT+UA group, despite body weight, body mass index, lean body mass, glucose, and insulin levels remaining unchanged. IGF-1 and irisin were significantly increased compared with baseline levels in the RT+UA group (p<0.05). Maximal right and left extension (p<0.01), right flexion (p<0.05), and left flexion (p<0.001) were significantly increased compared with baseline levels in the RT+UA group. These findings suggest that UA-induced elevation of serum irisin may be useful as an agent for the enhancement of skeletal muscle strength during RT.