Purpose: The purpose of this study was to derive contextual indicators of medical provider quality and assess their relative importance along with the individual utilization of antenatal care (ANC) and institutional births with a skilled birth attendant (SBA) in India using a multilevel framework. Methods: The 2015~2016 Demographic and Health Survey (DHS) from India was used to assess the outcomes of neonatal, infant, and under-five child mortality. The final analytic sample included 182,980 children across 28,283 communities, 640 districts, and 36 states and union territories. The contextual indicators of medical provider quality for districts and states were derived from the individual-level number of ANC visits (<4 or ${\geq}4$) and institutional delivery with SBA. A series of random effects logistic regression models were estimated with a stepwise addition of predictor variables. Results: About half of the mothers (47.3%) had attended ${\geq}4$ ANC visits and 75.8% delivered in institutional settings with SBAs. Based on ANC visits, 276~281 districts (43.1~43.9%) and 13~16 states (36.5~44.4%) were classified as "low" quality areas, whereas 268~285 districts (41.9~44.5%) and 8~9 states (22.2~25.0%) were classified as "low" quality areas based on institutional delivery with SBAs. Conditional on a comprehensive set of covariates, the individual use of both ANC and SBA were significantly associated with all mortality outcomes (OR: 1.17, 95% CI: 1.08, 1.26, and OR: 1.10, 95% CI: 1.02, 1.19, respectively, for under-five child mortality) and remained robust even after adjusting for contextual indicators of medical provider quality. Districts and states with low quality were associated with 57~61% and 27~43% higher odds of under-five child mortality, respectively. Conclusion: When simultaneously considered, district- and state-level provider quality mattered more than individual access to care for all mortality outcomes in India. Further investigations are needed to assess the importance of improving the quality of health service delivery at higher levels to prevent unnecessary child deaths in developing countries.

Purpose: The aim of this study was to investigate the characteristics of intervention programs for internet/smartphone addiction among adolescents through an integrative literature review. Methods: We searched MEDLINE(PubMed), CINAHL, Embase, DBpia, RISS, and KISS using a combination of "Internet or $phone^*$," "$addicti^*$," "adolescent," and "intervention or program or therapy." The searched studies were reviewed according to the criteria and an integrative literature review was conducted on the 14 selected papers published from January 1, 2013 to November 14, 2017. Results: Through the integrative review and analysis, a total of four attributes of interventions and their effects were derived. First, the number of group-focused interventions was significantly higher than that of individual-focused ones. Second, the interventions addressed various aspects of adolescents' problems while considering the complex nature of addiction problems. Third, there was a bias for region and sexual ratio. Lastly, most studies were actively conducted in community-based counseling or psychology settings. Conclusion: It is necessary to find more effective methods for addressing internet/smartphone addiction among adolescents through multidisciplinary approaches, including the consideration of various cultural and gender characteristics. This study provides a basis for developing future programs addressing addiction problems among adolescents.

Purpose: This study aimed to suggest strategies for advancing local-government-based accreditation systems and surveyor training in long-term care facilities in Korea. Methods: A comprehensive review of the literature including research papers and official reports issued by governments from the United States, Australia, and Japan was conducted to explore domestic and international policies related to long-term care facility certification and accreditation systems. Results: The USA has two types of care quality assurance systems including mandatory certification (5-star rating system) by the Centers for Medicare and Medicaid Services and voluntary accreditation by the Joint Commission on Accreditation of Healthcare Organizations. Australia operates a government-based mandatory accreditation system for all long-term care facilities through the Australian Aged Care Quality Agency. Japan, particularly the Tokyo district, operates a third-party evaluation system that involves the voluntary participation of long-term care facilities. Conclusion: This study provides several strategies to enhance accreditation processes and surveyors'expertise. For instance, motivating facilities to voluntarily participate in accreditation is necessary by 1) providing sufficient and continuous consultations and feedback about how to improve care quality, 2) differentiating accreditation domains and indicators from the national health insurance certification system, and 3) actively utilizing accreditation results and providing incentives.

Purpose: The purpose of this study was to review health-related interventions in nursing studies for low-income school-age children and adolescents. Methods: Searches among CINAHL, MEDLINE, PubMed, EMBASE, DBpia, and RISS identified 27 intervention studies published from January 2000 to April 2018. Results: Twenty-seven intervention studies were identified: 12 included psychosocial adaptations and 15 included the healthy lifestyle promotion and disease prevention. The settings were mainly schools and community welfare centers. Many studies were based on social cognitive theory and interventions were provided in a group format. Depression, self-esteem, resilience, self-efficacy for vegetable and fruit consumption, physical activity, and health-related knowledge improved significantly after the health-related interventions. However, the findings were inconsistent with regard to anxiety, peer relationships, body mass index (BMI), blood pressure, cholesterol, and glucose. Conclusion: There is potential for enhancing outcomes for psychosocial, physical health, and health-related knowledge among low-income school-age children and adolescents. Integrated interventions addressing the physical as well as psychological health of low-income children and adolescents should be conducted. It would be prudent to consider the ethnicity and family background of the child or adolescent. However, rigorous study designs and scientific validation are needed for further evidence.

Purpose: The purpose of this study was to observe the effects of biofeedback training on the perceived stress, stress response, and academic resilience of nursing students. Methods: The research used a randomly assigned control group pretest-posttest design. The study participants were 34 senior students from the College of Nursing of S University. The study was conducted from March to April 2012. The biofeedback training conducted in this study consisted of eight sessions, each divided into two stages: 15 minutes each for breathing biofeedback training and electromyography (EMG) biofeedback training. The collected data were analyzed using SPSS version 19.0. Results: We found statistically significant decreases in perceived stress and EMG levels and an increase in academic resilience in the experimental group. Conclusion: The results showed that the biofeedback training for the nursing students was extremely effective in reducing their levels of perceived stress and EMG while increasing academic resilience. To clarify the effects of biofeedback training on the biological stress response, participants with a higher level of stress response should be recruited in future studies.