Korea In January Research Articles

Job Characteristic Profiles and Presenteeism Among Shift Nurses: A Latent Profile Analysis Based on the Job Demands–Resources Model

ABSTRACTAim(s)To investigate job characteristic profiles based on the job demands–resources (JD‐R) model and the association between job characteristic profiles and presenteeism.DesignCross‐sectional study.MethodsData were collected from shift nurses in South Korea in January 2023 using an online survey. This study included 544 nurses working in tertiary and general hospitals in South Korea. The participants were classified into four job characteristic profiles based on the JD‐R model using latent profile analysis. Multiple logistic and linear regression analyses were performed to examine the association between job characteristic profiles and presenteeism.ResultsFour profiles were derived from the latent profile analysis: low strain–low motivation, high strain–low motivation, low strain–high motivation and high strain–high motivation. The high strain–low motivation, low strain–high motivation and high strain–high motivation groups were 1.74, 1.37 and 3.51 times more likely to experience presenteeism than the low strain–low motivation group respectively. The number of days worked while sick and the level of reduced job productivity was also the highest in the high strain–high motivation group. In addition, general health, multimorbidities and insomnia were significant factors affecting presenteeism, number of days worked while sick and productivity loss among shift nurses.ConclusionsThis study found that even with higher levels of job resources, work environments with high levels of job demands were associated with higher rates of presenteeism.ImpactStudy findings suggest that various strategies are needed to improve the physical and mental health of shift nurses, and create a healthy organisational environment by reducing excessive job demands to reduce presenteeism and increase productivity.Reporting MethodSTROBE guidelines.Patient or Public ContributionNo patient or public contribution.

교육컨설팅의 학문적 정립에 관한 연구

The purpose of this study was to suggest the direction of development of education consulting through the establishment of education consulting as a discipline. This study examined the origins and current status of education consulting and the challenges for establishing education consulting as a discipline. The Korean graduate schools, domestic academic institutions, were the starting point of education consulting in the world. In March 2012, the first master's program in education consulting was opened at Dongduk Women's University Graduate School of Education. The Department of Education Consulting and the Major in Education Consulting have been established in the master's and doctoral programs of three Korean graduate schools and in the master's programs of nine Korean graduate schools of education. The Korea Association of Education Consulting and Coaching, a professional society of education consulting, was founded in June 2017, and its professional journal, the Journal of Education Consulting and Coaching, was selected as a KCI accredited journal of the National Research Foundation of Korea in January 2022. In order to establish education consulting as an academic discipline, this study proposed to establish research objects and research areas of education consulting, establish theories and research methods, expand the establishment of education consulting departments and education consulting majors in Korean universities and graduate schools, and expand professional societies and professional journals related to education consulting. This study is the first paper to study the academic establishment of education consulting through the research objects, theories, and research methods of education consulting, the establishment of master's and doctoral programs in graduate schools, the establishment of professional societies, and the publication of professional journals, and has significance as a basic study for the academic establishment of education consulting.

A multifaceted approach to explain short- and long-term PM2.5 concentration changes in Northeast Asia in the month of January during 2016–2021

Changes in PM2.5 concentrations are influenced by interwoven impacts of key drivers (e.g., meteorology, local emissions, and regional emissions). However, it is challenging to quantitatively disentangle their impacts individually at once. Therefore, we introduced a multifaceted approach (i.e., meteorology vs. emissions and self-contribution vs. long-range transport) to analyze the effects of major drivers for long- and short-term PM2.5 concentration changes based on observation and simulation in the month of January during 2016–2021 in Northeast Asia. For the simulations, we conducted modeling with the WRF-CMAQ system. The observed PM2.5 concentrations in China and South Korea in January 2021 decreased by 13.7 and 9.8 μg/m3, respectively, compared to those in January 2016. Emission change was the dominant factor to reduce PM2.5 concentrations in China (−115%) and South Korea (−74%) for the 6 years. However, the short-term changes in PM2.5 concentrations between January of 2020–2021 were mainly driven by meteorological conditions in China (−73%) and South Korea (−68%). At the same time, in South Korea located in downwind area, the impact of long-range transport from upwind area (LTI) decreased by 55% (9.6 μg/m3) over the 6 years whereas the impact of local emissions increased (+2.9 μg/m3/year) during 2016–2019 but decreased (−4.5 μg/m3/year) during 2019–2021. Additionally, PM2.5 concentrations in the upwind area showed a positive relationship with LTIs. However, for the days when westerly winds became weak in the downwind area, high PM2.5 concentrations in upwind area did not lead to high LTIs. These results imply that the decline of PM2.5 concentrations in South Korea was significantly affected by a combination of emission reduction in upwind area and meteorological conditions that hinder long-range transport. The proposed multifaceted approach can identify the main drivers of PM2.5 concentration change in a region by considering the regional characteristics.

Exploring radiation therapist education and training.

Radiation therapy has become increasingly complex over time and is rapidly evolving. Radiation therapists play a key role within the interdisciplinary team and their education must prepare them to function effectively in the future in order to ensure a safe, high quality radiation therapy service. The aim of this research was to evaluate the current status of radiation therapist education to establish the duration of education programs, the percentage of radiation therapy-specific content and the professional title on graduation. A survey was developed, based on the questionnaire used for the ESTRO 3rd Revision of the Core Curriculum for Radiation Therapists. This was piloted by colleagues to verify the validity of the survey and also its use outside of the European context. The final survey was distributed purposively through Survey Monkey via a local gatekeeper to key radiation therapy personnel covering all of Europe and Australia, New Zealand, USA and South Korea in January 2021 who distributed it to educational institutes and clinical departments in their respective countries. 101 responses were received of which 58 were fully complete and available for analysis representing 30 countries, 26 European and 4 beyond Europe. The duration and radiation therapy-specific content of education programs varied considerably with dedicated radiation therapy programs from the respondents offered only in Ireland, Australia, New Zealand, and the U.S.A. 17 countries in the survey offer 'combined' programs with the majority dedicating less than 20% of their content to radiation therapy. Of note is that several respondents were unable to state the percentage of content related to radiation therapy and there was a variation in content and duration of programs, even within a single country. This survey has demonstrated that there remains a significant deficit in the educational programs of radiation therapists in many regions.

Changes in the Epidemiology and Causative Pathogens of Meningitis in Children After the Outbreak of the Coronavirus Disease 2019: A Multicenter Database Study.

BackgroundWith the outbreak of the COVID-19 pandemic, non-pharmaceutical interventions such as social distancing have been implemented worldwide, and a decrease in other infectious diseases has been reported as an unexpected benefit. However, to date, studies are lacking regarding the effects of the COVID-19 pandemic on neuroinfectious diseases; therefore, we aimed to determine the effects of the COVID-19 pandemic on the incidence of meningitis, which is the most common infectious disease in children.MethodsThis retrospective study used electronic medical record data from five university hospitals located in the metropolitan cities in Korea. This study included patients aged <18 years who were diagnosed with meningitis between January 2017 and December 2020. We analyzed the clinical characteristics of patients with meningitis and changes in the incidence and causative pathogens of meningitis before and after the COVID-19 outbreak.ResultsThe study included 677 patients with meningitis. Following the outbreak of COVID-19 in Korea in January 2020, the incidence of childhood meningitis significantly decreased and seasonal changes noted yearly disappeared. There was a difference in the age distribution of patients with meningitis. The incidence of meningitis decreased significantly in children aged >5 years, and the incidence in children <5 years of age relatively increased (p < 0.001). In addition, there was a notable decrease in the cases of suspected meningitis (p < 0.001). The incidence of enteroviral meningitis, the most common cause of meningitis, significantly decreased.ConclusionAfter the COVID-19 outbreak, the incidence of childhood meningitis significantly decreased with the implementation of non-pharmaceutical interventions. Absence of enteroviral meningitis and decrease in the proportion of patients aged ≥5 years with meningitis having mild symptoms were noted. Consequently, it can be concluded that the non-pharmaceutical interventions (NPIs) instituted to prevent the spread of COVID-19 had some effect on reducing the incidence of meningitis.

Development and Validation of Digital Health Technology Literacy Assessment Questionnaire

In clinical practice, assessing digital health literacy is important to identify patients who may encounter difficulties adapting to digital health using digital technology and service. We developed the Digital Health Technology Literacy Assessment Questionnaire (DHTL-AQ) to assess the ability to use digital health technology, services, and data. The DHTL-AQ was developed in three phases. In the first phase, the conceptual framework and domains and items were generated from a systematic literature review using relevant theory and surveys. In the second phase, a cross-sectional survey with 590 adults age ≥ 18 years was conducted at an academic hospital in Seoul, Korea in January and February 2020 to test face validity of the items. Then, psychometric validation was conducted to determine the final items and cut-off scores of the DHTL-AQ. The eHealth literacy scale, the Newest Vital Sign, and 10 mobile app task ability assessments were examined to test validity. The final DHTL-AQ includes 34 items in two domains (digital functional and digital critical literacy) and 4 categories (Information and Communications Technology terms, Information and Communications Technology icons, use of an app, evaluating reliability and relevance of health information). The DHTL-AQ had excellent internal consistency (overall Cronbach’s α = 0.95; 0.87–0.94 for subtotals) and acceptable model fit (CFI = 0.821, TLI = 0.807, SRMR = 0.065, RMSEA = 0.090). The DHTL-AQ was highly correlated with task ability assessment (r = 0.7591), and moderately correlated with the eHealth literacy scale (r = 0.5265) and the Newest Vital Sign (r = 0.5929). The DHTL-AQ is a reliable and valid instrument to measure digital health technology literacy.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10916-022-01800-8.

Perceptions of Generational Conflict Among Three Age Groups in South Korea

After rapid industrialization during the past few decades, the gap between generations in South Korea has widened and the issue of generational conflict is being discussed as a social problem (Chung & Lim, 2018). The purpose of this study is to find out how each generation perceives generational conflict in the areas of family, politics, economy and social welfare, and culture. An online survey of 1,000 adults aged 20 and over was conducted nationwide in South Korea in January, 2021 with three age groups: the youngest group aged 20-39, mid-age group of 40- 64 and the oldest group of 65 and over. The questionnaire was created using the items developed by a previous research that used a Delphi technique (Chung, 2020). Participants answered how serious they perceive generational conflict in the dyadic relationship on 5-point Likert scales. Descriptive statistics were calculated, and t-tests have been performed to see the generational differences. Results show that the youngest group and the oldest group perceive the highest level of generational conflict each other in the areas of culture and politics. In cultural aspects, ‘use of slang among the same group’, ‘Ability to utilize digital devices’ were the items that had the highest level of conflict. In the political realm, progressive vs. conservative ideology was the area of the highest conflict. In addition, t-test results showed that the oldest group perceived generational conflict even deeper than the youngest group in the ‘economy and social welfare’ and cultural areas. Implications of these findings are discussed.

A case study of heavy PM2.5 secondary formation by N2O5 nocturnal chemistry in Seoul, Korea in January 2018: Model performance and error analysis

Heterogeneous hydrolysis of dinitrogen pentoxide (N2O5) plays an important role in nighttime nitrate (NO3−) formation in urban areas, and sometimes influences the occurrence of heavy PM2.5 pollution the next day in the Seoul Metropolitan Area (SMA), Korea. Here, we discuss the heavy PM2.5 wintertime episode of January 13–15, 2018, which was mainly induced by nighttime N2O5 heterogeneous reaction in the SMA. In our case, we confirmed that nighttime N2O5 hydrolysis is the most critical factor in the rapid formation of aerosol nitrate at high levels during the night, which prevailed in the morning of the next day. Our Integrated Process Rate (IPR) analysis showed that nighttime nitrate production in the episode was almost solely attributable to N2O5 chemistry, with hourly mean production rates of 0.8 ± 0.4 μg/m3 per hour in SMA, which is comparable to the daytime nitrate photochemical production rates of 0.9 ± 0.5 μg/m3 per hour. We also carried out a series of assessment of N2O5–driven nitrate formation sensitivity, and relevant errors were quantified by applying different N2O5 uptake coefficients in the WRF-CMAQ model. The potential errors of nighttime-average nitrate concentrations induced by N2O5 uptake process were assessed from a linear perspective for the planetary boundary layer (PBL) variances caused by four different PBL parameterization schemes: YSU, ACM2, MYJ, and QNSE. The potential error ranges by N2O5 uptake process were analyzed to be 2.3 to 3.5 μg/m3 (~10% relative to the nighttime-average), while biases of PBL simulations from 4 parameterization schemes were 2.3 ± 1.0 μg/m3, showing similar ranges in our episode. Although N2O5–driven heavy PM2.5 episodes do not occur often in SMA, our findings suggest the importance of N2O5 chemistry in vigorous wintertime nitrate formation and operational prediction errors of such PM2.5 episodes, under the premise of enhanced PBL simulation capabilities.

Evaluation of the Detection Ability of New Infrasound Networks Installed by Korea Meteorological Administration

The Korea Meteorological Administration (KMA) installed infrasound networks in Cheorwon and Yanggu. These networks have been operated for detecting infrasound generated from artificial explosions, such as those due to North Korea's nuclear tests, and from natural phenomena such as the volcanic eruption of Mt. Baekdu. Currently, the KMA is simultaneously performing infrasound analysis and seismic wave analysis to discriminate between natural and artificial earthquakes. To efficiently perform the discrimination and analysis of artificial earthquakes, three infrasound networks were expanded in the West Sea and northern Gyeonggi-do Gyodong-do, Paju, and Yeoncheon. In this study, 22 cases of artificial earthquake events that occurred in North Korea in January 2020 were analyzed to test the analysis capabilities of the three newly installed infrasound networks. The results of the analysis confirmed that the newly installed infrasound networks exhibited a higher infrasound detection rate than the existing Cheorwon and Yanggu infrasound networks. The Cheorwon and Yanggu observation networks are being planned for relocation and installation due to aging and poor site conditions. The use of the new infrasound network is expected to improve the detection rate and analysis accuracy with respect to artificial earthquakes. Furthermore, it is expected to enhance the detection capability of infrasound generated from various physical phenomena such as nuclear tests performed by North Korea and volcanic eruption of Mt. Baekdu.

Recent Evidence and Initial Experiences of Transcatheter Edge-to-Edge Repair of the Mitral Valve in South Korea.

As a percutaneous technique for the reduction of mitral regurgitation, the MitraClip system (Abbott Vascular, Abbott Park, IL, USA) for transcatheter edge-to-edge repair of the mitral valve was developed in 1998 and first used in 2003. Its main advantage is being less invasive than surgery, because it can be performed through a transcatheter approach without any hemodynamic compromise. Recent studies have shown that this procedure reduces symptoms and improves functional capacity with low complication rates. Two randomized clinical trials have investigated the use of this technique for functional mitral regurgitation. The Korean Ministry of Food and Drug Safety approved its use for degenerative mitral regurgitation in 2019, and this procedure started to be performed in Korea in January 2020. Its use for functional mitral regurgitation was also approved in Korea in 2020. In this article, recent evidence on transcatheter edge-to-edge repair of the mitral valve and our initial experiences in Korea will be reviewed.

Detection and phylogenetic analysis of norovirus from individual septic tanks in the drainage basin of the coastal area located in the Jaran Bay of Korea

Norovirus (NoV) prevalence was investigated in 100 sewage samples collected from 35 individual septic tanks around the drainage basin of Jaran Bay, Korea in January, May, and July of 2017. Genotypes and diversity of NoV strains detected in sewage samples were also assessed using the conventional RT-PCR and phylogenetic analysis. NoV GI or GII were detected in 22 (22.0%) and 24 (24.0%) samples, respectively. Thirteen genotypes were identified with three dominant genotypes (GI.9, GII.5 and GII.17) and GII.17 showed relatively higher prevalence during the survey period. GII.17 strains were clustered into recombinant type variant or NoV GII.17 Kawasaki variant. NoV GII.17 strains were considered emergent epidemic variants with widespread circulation. NoV surveillance strategy should include both environmental (sewage) and clinical data to reveal minor NoV genotypes likely cause of asymptomatic or underreported infections in the local population.

Investigating the Capability to Extract Impulse Response Functions From Ambient Seismic Noise Using a Mine Collapse Event

AbstractUsing recordings of a mine collapse event (Mw 4.2) in South Korea in January 2015, we demonstrated that the phase and amplitude information of impulse response functions (IRFs) can be effectively retrieved using seismic interferometry. This event is equivalent to a single downward force at shallow depth. Using quantitative metrics, we compared three different seismic interferometry techniques—deconvolution, coherency, and cross correlation—to extract the IRFs between two distant stations with ambient seismic noise data. The azimuthal dependency of the source distribution of the ambient noise was also evaluated. We found that deconvolution is the best method for extracting IRFs from ambient seismic noise within the period band of 2–10 s. The coherency method is also effective if appropriate spectral normalization or whitening schemes are applied during the data processing.

Moment Tensor Inversion for Nuclear Explosions: What Can We Learn from the 6 January and 9 September 2016 Nuclear Tests, North Korea?

ABSTRACT Two nuclear explosions were carried out by the Democratic People’s Republic of North Korea in January and September 2016. Epicenters were located close to those of the 2006, 2009, and 2013 previous explosions. We perform a seismological analysis of the 2016 events combining the analysis of full waveforms at regional distances and seismic array beams at teleseismic distances. We estimate the most relevant source parameters, such as source depth, moment release, and full moment tensor (MT). The best MT solution can be decomposed into an isotropic source, directly related with the explosion and an additional deviatoric term, likely due to near‐source interactions with topographic and/or underground facilities features. We additionally perform an accurate resolution test to assess source parameters uncertainties and trade‐offs. This analysis sheds light on source parameters inconsistencies among studies on previous shallow explosive sources. The resolution of the true MT is hindered by strong source parameters trade‐offs, so that a broad range of well‐fitting MT solutions can be found, spanning from a dominant positive isotropic term to a dominant negative vertical compensated linear vector dipole. The true mechanism can be discriminated by additionally modeling first‐motion polarities at seismic arrays at teleseismic distances. A comparative assessment of the 2016 explosion with earlier nuclear tests documents similar vertical waveforms but a significant increase of amplitude for the 2016 explosions, which proves that the 9 September 2016 was the largest nuclear explosion ever performed in North Korea with a magnitude M w 4.9 and a shallow depth of less than 2 km, although there are no proofs of a fusion explosion. Modeling transversal component waveforms suggests variable size and orientation of the double‐couple components of the 2009, 2013, and 2016 sources.

Experimental infection of mandarin duck with highly pathogenic avian influenza A (H5N8 and H5N1) viruses

A highly pathogenic avian influenza (HPAI) H5N8 virus was first detected in poultry and wild birds in South Korea in January 2014. Here, we determined the pathogenicity and transmissibility of three different clades of H5 viruses in mandarin ducks to examine the potential for wild bird infection. H5N8 (clade 2.3.4.4) replicated more efficiently in the upper and lower respiratory tract of mandarin ducks than two previously identified H5N1 virus clades (clades 2.2 and 2.3.2.1). However, none of the mandarin ducks infected with H5N8 and H5N1 viruses showed severe clinical signs or mortality, and gross lesions were only observed in a few tissues. Viral replication and shedding were greater in H5N8-infected ducks than in H5N1-infected ducks. Recovery of all viruses from control duck in contact with infected ducks indicated that the highly pathogenic H5 viruses spread horizontally through contact. Taken together, these results suggest that H5N8 viruses spread efficiently in mandarin ducks. Further studies of pathogenicity in wild birds are required to examine possible long-distance dissemination via migration routes.

Role for migratory wild birds in the global spread of avian influenza H5N8.

Avian influenza viruses affect both poultry production and public health. A subtype H5N8 (clade 2.3.4.4) virus, following an outbreak in poultry in South Korea in January 2014, rapidly spread worldwide in 2014-2015. Our analysis of H5N8 viral sequences, epidemiological investigations, waterfowl migration, and poultry trade showed that long-distance migratory birds can play a major role in the global spread of avian influenza viruses. Further, we found that the hemagglutinin of clade 2.3.4.4 virus was remarkably promiscuous, creating reassortants with multiple neuraminidase subtypes. Improving our understanding of the circumpolar circulation of avian influenza viruses in migratory waterfowl will help to provide early warning of threats from avian influenza to poultry, and potentially human, health.

Novel Avian Influenza A(H5N8) Viruses in Migratory Birds, China, 2013-2014.

Novel Avian Influenza A(H5N8) Viruses in Migratory Birds, China, 2013-2014.

Characterization of an H5N8 influenza A virus isolated from chickens during an outbreak of severe avian influenza in Japan in April 2014.

A highly pathogenic avian influenza virus (HPAIV) of subtype H5N8, A/chicken/Kumamoto/1-7/2014, was isolated from a Japanese chicken farm during an outbreak in April 2014. Phylogenetic analysis revealed that this virus belonged to HA clade 2.3.4.4. All eight genomic segments showed high sequence similarity to those of the H5N8 subtype HPAIVs A/broiler duck/Korea/Buan2/2014 and A/baikal teal/Korea/Donglim3/2014, which were isolated in Korea in January 2014. Intranasal experimental infection of chickens and ducks with A/chicken/Kumamoto/1-7/2014 was performed to assess the pathogenicity of the virus in chickens and the potential for waterfowl to act as a virus reservoir and carrier. A high-titer virus challenge (10(6) EID50 per animal) was lethal in chickens, but they were unaffected by lower virus doses (10(2) EID50 or 10(4) EID50 per animal). Virus challenge at all doses examined was found to result in asymptomatic infection of ducks. An HI assay revealed that A/chicken/Kumamoto/1-7/2014 possessed relatively low cross-reactivity with H5 viruses belonging to clades other than clade 2.3.4.4. These results suggest that waterfowl may be able to spread the virus even if they possess antibodies resulting from a previous infection with H5 HPAIV that was antigenically distinguishable from viruses belonging to clade 2.3.4.4.

Reassortant highly pathogenic influenza A H5N2 virus containing gene segments related to Eurasian H5N8 in British Columbia, Canada, 2014.

In late November 2014 higher than normal death losses in a meat turkey and chicken broiler breeder farm in the Fraser Valley of British Columbia initiated a diagnostic investigation that led to the discovery of a novel reassortant highly pathogenic avian influenza (HPAI) H5N2 virus. This virus, composed of 5 gene segments (PB2, PA, HA, M and NS) related to Eurasian HPAI H5N8 and the remaining gene segments (PB1, NP and NA) related to North American lineage waterfowl viruses, represents the first HPAI outbreak in North American poultry due to a virus with Eurasian lineage genes. Since its first appearance in Korea in January 2014, HPAI H5N8 spread to Western Europe in November 2014. These European outbreaks happened to temporally coincide with migratory waterfowl movements. The fact that the British Columbia outbreaks also occurred at a time associated with increased migratory waterfowl activity along with reports by the USA of a wholly Eurasian H5N8 virus detected in wild birds in Washington State, strongly suggest that migratory waterfowl were responsible for bringing Eurasian H5N8 to North America where it subsequently reassorted with indigenous viruses.

Study on sensitive information leakage vulnerability modeling

Purpose – The purpose of this paper is to provide a model for quantitatively analyzing the security profile of an organization’s IT environment. The model considers the security risks associated with stored data, as well as services and devices that can act as channels for data leakages. The authors propose a sensitive information (SI) leakage vulnerability model. Design/methodology/approach – Factors identified as having an impact on the security profile are identified, and scores are assigned based on detailed criteria. These scores are utilized by mathematical models that produce a vulnerability index, which indicates the overall security vulnerability of the organization. In this chapter, the authors verify the model result extracted from SI leakage vulnerability weak index by applying the proposed model to an actual incident that occurred in South Korea in January 2014. Findings – The paper provides vulnerability result and vulnerability index. They are depends on SI state in information systems. Originality/value – The authors identify and define four core variables related to SI leakage: SI, security policy, and leakage channel and value of SI. The authors simplify the SI leakage problem. The authors propose a SI leakage vulnerability model.

Older adults' perception of chronic illness management in South Korea.

Objectives:Despite the recent emphasis on a patient-centered chronic care model, few studies have investigated its use in older adults in South Korea. We explored how older Korean adults perceive and cope with their chronic illness.Methods:We conducted focus group interviews in Seoul, Korea in January 2010. Focus groups were formed by disease type (hypertension and type 2 diabetes) and gender using purposive sampling. Inclusion criteria were patients aged 60 and over who had been diagnosed with diabetes or hypertension and received care at a community health center for at least six months prior to participation. Interview data were analyzed through descriptive content analysis.Results:Among personal factors, most participants felt overwhelmed when they received their diagnosis. However, with time and control of their acute symptoms using medication, their worry diminished and participants tended to denying being identified as a patient or sick person. Among socio-familial factors, participants reported experiencing stigma with their chronic illness and feeling it was a symbol of weakness. Instead of modifying their lifestyles, which might interfere with their social relationships, they resorted to only following their medicine regime prescribed by their doctor. Participants also reported feeling that their doctor only prescribed medications and acted in an authoritative and threatening manner to induce and reinforce participants’ compliance with treatment.Conclusions:For successful patient-centered management of chronic illnesses, supportive environments that include family, friends, and healthcare providers should be established.