• Child Health Nursing Research
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• 제29권3호
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• pp.166-181
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• 2023

Purpose: This study examined the literature concerning the burdens of parents of preschool-aged children diagnosed with type 1 diabetes mellitus. Methods: We employed an integrative review methodology based on Whittemore and Knafl's framework. The literature search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across four electronic databases: PubMed, Web of Science, the Cumulative Index to Nursing Allied Health Literature (CINAHL), and PsycINFO. Ultimately, 18 articles were included in the review. Results: The review yielded four themes: (1) parental burdens, (2) factors related to the burdens, (3) coping strategies, and (4) implications for clinical practice. Parents experienced psychological, physical, and social burdens due to the diabetes care of their children. Several factors influenced burdens, including child-related characteristics such as age, severity of diabetes, and hospitalization experience, as well as parental factors like family income, race, and residential area. Parents initially felt burdened when their child was diagnosed with type 1 diabetes, but over time, they often adapted to the situation through support and sharing of responsibilities. Parents desired education and interventions reflecting the unique characteristics of preschoolers. Conclusion: This integrative literature review revealed that parents experience numerous burdens when their child is diagnosed with diabetes. Future research should focus on developing interventions to address parents' psychological difficulties, including tracking parental psychological changes over time. Tailored nursing interventions should also be provided to parents of preschool-aged children, as opposed to the more generic nursing interventions traditionally applied across all age groups of children in clinical settings.

• Child Health Nursing Research
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• 제25권4호
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• pp.449-457
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• 2019

Purpose: The purpose of this study was to identify predictors of eating disorders in adolescents with type 1 diabetes, with the goal of providing data in support of nursing interventions to improve their health. Methods: A total of 136 adolescents aged 13-18 years with type 1 diabetes completed the Diabetes Eating Problem Survey-Revised, Rosenberg Self-Esteem Scale, and the Beck Depression Inventory-II, using structured self-reported questionnaires. The collected data were analyzed using the t-test, $x^2$ test, and binominal logistic regression with SPSS version 23.0 for Windows. Results: The prevalence of eating disorders in adolescents with type 1 diabetes was 39%. Four significant predictors of eating disorders were identified; absence of body satisfaction (odds ratio [OR]=3.87, 95% confidence interval [CI]=1.55~9.65), depression (OR=2.87, 95% CI=1.13~7.28), female gender (OR=2.67, 95% CI=1.09~6.54), and glycosylated hemoglobin type A1c levels (OR=1.47, 95% CI=1.10~1.97). Conclusion: In order to prevent eating disorders among adolescents with type 1 diabetes, programs for managing adolescents' depression and improving their body satisfaction should be developed. Futhermore, more attention should be directed towards programs aiming to prevent eating disorders in female adolescents.

• Child Health Nursing Research
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• 제30권1호
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• pp.17-30
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• 2024

Purpose: This pilot study aimed to assess the feasibility, preliminary efficacy, and effects of a mobile app healthcare coaching program developed based on self-regulation theory among youths with type 1 diabetes. Methods: A mixed-method design was utilized. Participants were randomly assigned into intervention (n=23, 12-week coaching program) or control groups (n=16, usual care). Pre- and post-intervention assessments included self-efficacy, diabetes management behavior, and health outcomes (quality of life, depression, and HbA1c). Quantitative data were analyzed with SPSS/WIN ver. 26.0. The narrative information from the participants in the healthcare coaching program underwent content analyzed. Results: The intervention group had significantly lower depression scores (t=2.57, p=.014) than the control group. No significant differences were observed in self-efficacy, diabetes management behavior, and health outcomes between the two groups. The average frequency of health behavior monitoring per week among the participants was 1.86±1.60. The qualitative findings indicated that participants perceived improved diabetes self-management with the intervention; however, challenges during vacations, dietary control difficulties, and a lack of disease awareness were identified. Conclusion: The healthcare coaching program improved psychological aspects for youth with type 1 diabetes. Further research is needed to develop and implement mobile app interventions aimed at enhancing compliance with diabetes management in pediatric and adolescent populations.

• Child Health Nursing Research
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• 제25권2호
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• pp.234-243
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• 2019

Purpose: The purpose of this study was to investigate associations between self-management and diabetes knowledge, diabetes-related attitudes, family support, and self-efficacy in adolescents with type 1 diabetes mellitus based on the information-motivation-behavior skills model. Methods: Data collection was conducted between March 18 and September 30, 2018. Patients (N=87) aged 12 to 19 years were recruited from the outpatient clinic of S children's hospital and an online community for patient with type 1 diabetes mellitus. Data were analyzed using descriptive statistics, the independent t-test, one-way ANOVA, Pearsons correlation, and hierarchical multiple linear regression with SPSS IBM 23.0, with the two-tailed level of significance set at 0.05. Results: The mean score of self-management in adolescents with type 1 diabetes mellitus was $61.23{\pm}10.00$ out of 80. The regression analysis showed that self-efficacy and family support significantly explained 56.9% of the variance in self-management (F=21.38, p<.001). Self-efficacy (${\beta}=.504$, p<.001) and family support (${\beta}=.188$, p<.001) were significant predictors of self-management. Conclusion: It is necessary to develop individual interventions to improve self-efficacy and family support for adolescents with type 1 diabetes mellitus to help them enhance their self-management.

• Child Health Nursing Research
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• 제29권1호
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• pp.7-23
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• 2023

Purpose: The purpose of this study was to investigate the effect of family-centered interventions on improving health outcomes in children and adolescents with type 1 diabetes mellitus (T1DM). Methods: A literature search was conducted according to the PRISMA guidelines, using six electronic databases: EMBASE, CINAHL, Medline, CENTRAL, Scopus, and Web of Science. The inclusion criteria encompassed studies with populations of children and adolescents (age <18 years) and at least one parent/caregiver, or only parents/caregivers if the children were very young, and studies that investigated the health outcomes of children and parents/caregivers diagnosed with T1DM. Results: From 2,746 published studies, only nine studies met the inclusion criteria. The key interventions were non-technology-based interventions (n=4), technology-based interventions (n=2), and combined technology- and non-technology-based interventions (n=3). The interventions had effects on glycated hemoglobin, adherence to diabetes management, diabetes self-management behaviors, and parent-child teamwork in diabetes management. Other essential effects were children's quality of life, children's problem-solving skills, parents' quality of life, and parents' coping and depression. Conclusion: Family-centered interventions can effectively improve health outcomes in children and adolescents with T1DM. In the future, family-centered interventions integrated with other approaches, theories, and models should be developed to achieve the best possible outcomes.

• Nutrition Research and Practice
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• 제17권4호
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• pp.780-788
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• 2023

BACKGROUND/OBJECTIVES: This study examined the relationship between famine exposure in early life and the risk of type 2 diabetes in adulthood during the 1959-1961 Chinese Famine. SUBJECTS/METHODS: A total of 3,418 individuals aged 35-74 years free of diabetes from two studies in 2006 and 2009 were followed up prospectively in 2009 and 2012, respectively. Famine exposure was classified as unexposed (individuals born in 1962-1978), fetal exposed (individuals born in 1959-1961), child exposed (individuals born in 1949-1958), and adolescent/adult exposed (born in 1931-1948). A logistic regression model was used to assess the relationship between famine exposure and diabetes after adjustment for potential covariates. RESULTS: During a three-year follow-up, the age-adjusted incidence rates of type 2 diabetes were 5.7%, 14.5%, 12.7%, and 17.8% in unexposed, fetal-exposed, child-exposed, and adolescent/adult-exposed groups, respectively (P < 0.01). Relative to the unexposed group, the relative risks (95% confidence interval) for diabetes were 2.15 (1.29-3.60), 1.53 (0.93-2.51), and 1.65 (0.75-3.63) in the fetal-exposed, child-exposed, and adolescent/adult-exposed groups, after controlling for potential covariates. The interactions between famine exposure and obesity, education level, and family history of diabetes were not observed, except for the urbanization type. Individuals living in rural areas with fetal and childhood famine exposure were at a higher risk of type 2 diabetes, with relative risks of 8.79 (1.82-42.54) and 2.33 (1.17-4.65), respectively. CONCLUSIONS: These findings indicate that famine exposure in early life is an independent predictor of type 2 diabetes, particularly in women. Early identification and intervention may help prevent diabetes in later life.

• Clinical and Experimental Pediatrics
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• 제54권2호
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• pp.45-50
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• 2011

Compared to that in the Caucasian population, type 1 diabetes mellitus (T1DM) incidence rates are very low in Koreans. Therefore, compared to the recent development of pharmacological therapy applicable to Korean children with T1DM, interest in nonpharmacological therapy and psychosocial support systems remains low, as is the development of Korean-style T1DM education programs for therapeutic application. Children who have been newly diagnosed with diabetes are placed in completely new environments for treatment. For appropriate control of diabetes, patients have to self-monitor blood glucose levels and inject insulin several times a day and must use extreme self-control when they eat foods to avoid increases in blood glucose levels. Blood glucose excursions resulting from impaired pancreatic ${\beta}$ cell functions cause mental stress due to vague fears of chronic complications of diabetes. In addition, children with diabetes cannot be excluded from the substantial amount of studies required of Korean adolescents, and the absolute shortage of time for ideal control of diabetes adds to their mental stress. Many of these patients are psychologically isolated in school where they spend most of their time, and they are not appropriately considered or supported with respect to blood glucose control in many cases. In this respect, this author will introduce some of the newest views on nonpharmacological therapy and psychosocial support systems that account for important parts of T1DM management and seek measures to apply them in conformity with the social characteristics of Korea.

• Child Health Nursing Research
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• 제21권2호
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• pp.176-182
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• 2015

Purpose: The study purposes were to explore school nurses' experience, perceived barriers, and education needs in diabetes management at school. Methods: This study was a cross sectional study and the study participants were recruited conveniently at continuing education seminars for school nurses at Incheon Metropolitan City. Results: Data for 101 school nurses were analyzed. The nurses were all women and their mean age was $46.9{\pm}9.3$ years. About 66% of them had experience with children with diabetes at school. The school nurses reported that 74.6% of the students tested their blood glucose by themselves, the school clinic was the most common place for blood glucose tests (47.8%) and insulin injections (50.8%) and the nurses knew students' diagnosis through the student health survey (58.2%). About half of the nurses (53.7%) reported that glucagon should be available at school and 49.2% were willing to inject glucagon when necessary. The most frequently reported barrier in diabetes management was role confusion ($6.0{\pm}1.3$) and the most common educational need was emergency responses ($5.9{\pm}1.4$). Conclusions: School health policy for diabetes management and diabetes resources are necessary to minimize role confusion of school nurses, improve emergency response, and facilitate health promotion activities in diabetes management.

• Child Health Nursing Research
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• 제21권2호
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• pp.83-90
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• 2015

Purpose: The purpose of this study was to describe the subjective happiness and satisfaction with life of children with type 1 diabetes and explore related factors. Methods: A descriptive cross-sectional study design was used and the study was conducted with children at a diabetes camp. Data were collected using a self-report questionnaire to explore positive and negative psychological factors. The questionnaire included Subjective Happiness Scale, Satisfaction with Life Scale, Perceived Stress Scale and the Center for Epidemiological Studies Depression Scale for Children (CES-DC), Multidimensional Scale of Perceived Social Support, and General Self-Efficacy Scale. Results: Data from 15 children were used for data analysis. The correlational analysis results showed that subjective happiness was positively correlated satisfaction with life, social support, and self-efficacy, and was negatively correlated with perceived stress. Satisfaction with life was positively correlated social support, and was negatively correlated with perceived stress. Conclusion: Results indicate that the positive psychology factors were closely related with social support and self-efficacy and may alleviate perceived stress and depressive feelings. Therefore, researchers and clinicians should include positive psychological factors in their health management model for children with chronic illness.

• 한국산학기술학회논문지
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• 제18권7호
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• pp.257-268
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• 2017

본 연구의 목적은 1형 당뇨병 자녀를 둔 부모의 불안, 당뇨관련 스트레스 및 외상 후 성장의 정도에 대해 알아보고, 일반적 특성 및 질병관련 특성에 따른 차이와 각 변수의 관련성을 알아보고자 하였다. 서술적 조사 연구로 자료수집은 2016년 1월 4일부터 29일까지 1형 당뇨 인터넷 카페에서 온라인 설문으로 이루어졌고 77명이 최종 분석에 포함되었다. 측정변수는 불안, 당뇨관련 스트레스, 외상 후 성장이었다. 통계분석은 t-test, Mann-Whitney U test, Kruskal-Wallis test와 Pearson correlation coefficient로 분석하였다. 연구결과 부모가 종교가 있는 경우 외상 후 성장이 유의하게 높았고(p<.05), 자녀의 연령이 6세 미만인 경우(p<.05), 저혈당 경험이 있는 경우(p<.05)와 당화혈색소가 높은 경우(p<.05) 부모의 불안과 스트레스가 높았다. 그 외의 변수에 따라서는 유의한 차이가 없었다. 상관관계에서는 불안과 스트레스가 정적 상관관계(r=.684, p<.001), 불안과 스트레스와 외상 후 성장은 부적 상관관계(r=-.401, p<.001; r=-.327, p<.05)를 보였다. 본 연구의 결과를 통해 외상후 성장은 부정적인 정서를 감소시키는 역할을 할 수 있을 것으로 생각되며, 외상 후 성장을 도모할 수 있는 중재와 불안과 스트레스를 낮출 수 있는 중재가 필요한 것으로 판단된다.