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Background: Sleep has been known to affect childhood development. Sleep disturbance is likely more common in children with developmental delay (DD) than in typical development. There are few studies on the correlation between sleep disturbance and developmental features in children with DD. Therefore, this study aimed to evaluate the associations between the two in children with DD. Methods: A total of 45 children (age range 27.0 ± 11.1) with DD were recruited and evaluated using the Sleep Disturbance Scale for Children (SDSC) and Bayley Scales of Infant and Toddler Development (BSID-III). The outcomes are expressed as means and standard deviations. The correlation between SDSC and BSID-III was assessed using Spearman's rank correlation test. Multiple regression analysis was performed to investigate the relationship between BSID-III domains and SDSC questionnaire subscales. Statistical significance was set at p < 0.05. Results: Based on the correlation analysis and subsequent hierarchical regression analysis, cognition and socio-emotional domains of BSID-III were significantly associated with the DOES subscale of the SDSC questionnaire. In addition, the expressive language domain of the BSID-III was found to be associated with the DA subscale of the SDSC questionnaire. It seems that excessive daytime sleepiness might negatively affect emotional and behavioral problems and cognitive function. Also, arousal disorders seem to be related to memory consolidation process, which is thought to affect language expression. Conclusion: This study demonstrated that DA and DOES subscales of the SDSC questionnaire were correlated with developmental aspects in preschool-aged children with DD. Sleep problems in children with DD can negatively affect their development, thereby interfering with the effectiveness of rehabilitation. Identifying and properly managing the modifiable factors of sleep problems is also crucial as a part of comprehensive rehabilitation treatment. Therefore, we should pay more attention to sleep problems, even in preschool-aged children with DD. [ABSTRACT FROM AUTHOR]

Introduction: We developed a convolutional neural network (CNN) model to predict treatment outcomes of transforaminal epidural steroid injection (TFESI) for controlling cervical radicular pain due to cervical foraminal stenosis. Methods: We retrospectively recruited 293 patients with cervical TFESI due to cervical radicular pain caused by cervical foraminal stenosis. We obtained a single oblique cervical radiograph from each patient. We cut each oblique cervical radiograph image into a square shape, including the foramen that was targeted for TFESI, the intervertebral disc, the facet joint of the corresponding level with the targeted foramen, and the pedicles of the vertebral bodies just above and below the targeted foramen. Therefore, images including the targeted foramen and structures around the targeted foramen were used as input data. A favorable outcome was defined as a ≥ 50% reduction in the numeric rating scale (NRS) score at 2 months post TFESI compared to the pretreatment NRS score. A poor outcome was defined as a < 50% reduction in the NRS score at 2 months post TFESI vs. the pretreatment score. Results: The area under the curve of our developed model for predicting the treatment outcome of cervical TFESI in patients with cervical foraminal stenosis was 0.823. Conclusion: A CNN model trained using oblique cervical radiographs can be helpful in predicting treatment outcomes after cervical TFESI in patients with cervical foraminal stenosis. If the predictive accuracy is increased, we believe that the deep learning model using cervical radiographs as input data can be easily and widely used in clinics or hospitals. [ABSTRACT FROM AUTHOR]

Applications of machine learning in the healthcare field have become increasingly diverse. In this review, we investigated the integration of artificial intelligence (AI) in predicting the prognosis of patients with central nervous system disorders such as stroke, traumatic brain injury, and spinal cord injury. AI algorithms have shown promise in prognostic assessment, but challenges remain in achieving a higher prediction accuracy for practical clinical use. We suggest that accumulating more diverse data, including medical imaging and collaborative efforts among hospitals, can enhance the predictive capabilities of AI. As healthcare professionals become more familiar with AI, its role in central nervous system rehabilitation is expected to advance significantly, revolutionizing patient care. [ABSTRACT FROM AUTHOR]

Introduction: Gait disturbance in central nervous system (CNS) demyelinating disorders, including multiple sclerosis (MS) and neuromyelitis optica (NMO) is one of the most troublesome problems that has a direct impact on the quality of life. However, the associations between gait disturbance and other clinical variables of these two diseases have not been fully elucidated. Objective: This study aimed to evaluate gait disturbance using a computerized gait analysis system and its association with various clinical variables in patients with MS and NMO. Methods: A total of 33 patients (14 with MS and 19 with NMO) with minor disabilities, who were able to walk independently and had passed their acute phase, were enrolled in the study. Gait analysis were performed using a computer-based instrumented walkway system. (Walk-way MG-1000, Anima, Japan) Clinical variables, such as disease duration, medication, body mass index (BMI), hand grip power, and muscle mass were recorded. The Montreal Cognitive Assessment (MOCA), Beck Depression Inventory score-II (BDI), and fatigue scale were measured using the Functional Assessment of Chronic Illness Therapy-fatigue scale (FACIT-fatigue) scale. A trained neurologist scored the Expanded Disability Status Scale (EDSS). Results: Gait speed was the single parameter that showed a significant positive correlation with MOCA (p < 0.001). The stance phase time was the single parameter that showed a significant negative correlation with EDSS (p < 0.001). Hand grip strength showed a significant positive correlation with skeletal muscle mass as assessed by bioimpedance analysis (p < 0.05). The FACIT-fatigue scale score showed a significant negative correlation with the BDI (p < 0.001). Conclusion: In our patients with MS/NMO with mild disability, cognitive impairment was significantly correlated with gait speed, and the degree of disability was significantly correlated with stance phase time. Our findings may imply that early detection of a decrease in gait speed and an increase in stance phase time can predict the progression of cognitive impairment in patients with MS/NMO with mild disability. [ABSTRACT FROM AUTHOR]

Background: Cardiac rehabilitation (CR) is an essential component in secondary prevention of cardiovascular diseases. Current guidelines recommend that the program should be comprehensive including multidisciplinary behavioral intervention, not only exercise training. While the utilization of CR is gradually increasing, the comprehensiveness of the program has not been systemically evaluated in Korea. Methods: During the year 2020, nation-wide survey was done to evaluate the current status of CR in Korea. Survey was done by web-based structured questionnaire. Survey was requested to 164 hospitals performing percutaneous coronary intervention. Results: Among 164 hospitals, 47 (28.7%) hospitals had CR programs. In hospitals with CR, multidisciplinary intervention other than exercise-based program was provided only partially: nutritional counseling (63%), vocational counseling for return to work (39%), stress management (31%), psychological evaluation (18%). Personnel for CR was commonly not dedicated to the program or even absent: (percentage of dedicated, concurrent with other work, absent) physical therapist (59, 41, 0%), nurse (31, 69, 0%), dietician (6, 65, 29%), clinical psychologist (0, 37, 63%). Conclusion: Comprehensiveness of CR in Korea is suboptimal and human resource for it is poorly disposed. More awareness of current status by both clinicians and health policy makers is needed and insurance reimbursement for educational program should be improved. [ABSTRACT FROM AUTHOR]

Background: Cardiac rehabilitation (CR) is a prognostic management strategy to help patients with CVD achieve a good quality of life and lower the rates of recurrence, readmission, and premature death from disease. Globally, cardiac rehabilitation is poorly established in hospitals and communities. Hence, this study aimed to investigate the discrepancies in the perceptions of the need for CR programs and relevant health policies between directors of hospitals and health policy personnel in South Korea to shed light on the status and to establish practically superior and effective strategies to promote CR in South Korea.Methods: We sent a questionnaire to 592 public health policy managers and directors of selected hospitals, 132 of whom returned a completed questionnaire (response rate: 22.3%). The participants were categorized into five types of organizations depending on their practice of PCI (Percutaneous Coronary Intervention), establishment of cardiac rehabilitation, director of hospital, and government's policy makers. Differences in the opinions between directors of hospitals that perform/do not perform PCI, directors of hospitals with/without cardiac rehabilitation, and between hospital directors and health policy makers were analyzed.Results: Responses about targeting diseases for cardiac rehabilitation, patients' roles in cardiac rehabilitation, hospitals' roles in cardiac rehabilitation, and governmental health policies' roles in cardiac rehabilitation were more positive among hospitals that perform PCI than those that do not. Responses to questions about the effectiveness of cardiac rehabilitation and hospitals' roles in cardiac rehabilitation tended to be more positive in hospitals with cardiac rehabilitation than in those without. Hospital directors responded more positively to questions about targeting diseases for cardiac rehabilitation and governmental health policies' roles in cardiac rehabilitation than policy makers, and both hospitals and public organizations provided negative responses to the question about patients' roles in cardiac rehabilitation. Responses to questions about targeting diseases for cardiac rehabilitation, patients' roles in cardiac rehabilitation, and governmental health policies' roles in cardiac rehabilitation were more positive in hospitals that perform PCI than those that do not and public organizations.Conclusions: Hospitals must ensure timely referral, provide education, and promote the need for cardiac rehabilitation. In addition, governmental socioeconomic support is needed in a varity of aspects. [ABSTRACT FROM AUTHOR]

Due to prolonged survival and the relatively young median age of patients, the quality of life (QOL) of breast cancer survivors is an important issue in Korea. We conducted an educational program for breast cancer survivors, and evaluated its impact on knowledge, QOL, and lifestyle changes. This study utilized a single-arm pretest-posttest design. Participants were tested before and after an educational program to measure changes in knowledge. To measure QOL change, we conducted a QOL survey at the time of enrollment and again 6 months later. Regarding the knowledge test, mean scores increased from 9.62 to 14.74 points following education (p < 0.001). After 6 months, 97 patients completed the QOL survey and the data were analyzed, showing significant improvements in anxiety (p = 0.021), depression (p = 0.003), functional well-being (p = 0.005), and breast cancer subscales of the Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B) (p < 0.001). Additionally, the rates of adequate exercise significantly improved (p < 0.001), while rates of alcohol consumption and second cancer screening did not significantly change. One educational program session can improve patient knowledge, QOL, and psychosocial well-being, but is insufficient to achieve significant changes in health behavior. [ABSTRACT FROM AUTHOR]

The percentage of patients undergoing cardiac rehabilitation programs (CRP) is very low (30–40%), and hospitals providing CRP are either insufficient or lacking, even in countries with advanced medical care; therefore, this study aims to investigate the barriers, as well as compare the differences between hospitals, with or without CRP. We conducted a survey, in which the questionnaire was distributed through post or email to 607 specialists who work at 164 hospitals performing percutaneous coronary interventions (PCI). The results were as follows: (1) of the 164 hospitals, 132 responded (response rate: 80.5%). While all 47 hospitals with CRP responded (100%), from among the 117 hospitals without CRP, 85 responded (72.7%). (2) Of the 607 specialists, 227 responded (response rate: 36.9%). The response rates according to specialties were as follows: cardiologists (28.9%), cardiac surgeons (24.5%), and physiatrists (64.1%). (3) While the specialists at hospitals with CRP identified patient referral, transportation, and cost as the major barriers, for those at hospitals without CRP, all items were considered barriers, especially the items related to equipment, space, workforce, and budget as being more serious barriers. Therefore, in order to actively promote CRP, it is suggested that governments consider the customized support system according to the performance of CRPs. [ABSTRACT FROM AUTHOR]

This study aimed to compare gait analysis and balance function measurements, such as the Berg balance scale (BBS) score to seek specific measurements that can represent the balance functions of patients with brain lesions. Additionally, we also compared other different gait function scale scores with gait analysis measurements. This study included 77 patients with brain lesions admitted to our institution between January 2017 and August 2020. Their gait analysis parameters and clinical data, including personal data; clinical diagnosis; duration of the disease; cognition, ambulation, and stair-climbing sub-scores of the modified Barthel index (MBI); manual muscle test (MMT) findings of both lower extremities; functional ambulation category (FAC); and BBS score, were retrospectively analyzed. A multiple linear regression analysis was performed to identify the gait analysis parameters that would significantly correlate with the balance function and other physical performances. In the results, the BBS scores were significantly correlated with the gait speed and step width/height2. However, the other gait function measurements, such as the FAC and ambulation and stair-climbing sub-scores of the MBI, were correlated only with the gait speed. Additionally, both the summations of the lower extremity MMT findings and anti-gravity lower extremity MMT findings were correlated with the average swing phase time. Therefore, in the gait analysis, the gait speed may be an important factor in determining the balance and gait functions of the patients with brain lesions. Moreover, the step width/height2 may be a significant factor in determining their balance function. However, further studies with larger sample sizes should be performed to confirm this relationship. [ABSTRACT FROM AUTHOR]

Hand grip strength (HGS) is a means to assess health status and physical abilities indirectly. Various factors are known to be related to HGS, but data on the factors influencing HGS in the Korean population are lacking. Recently, the Korea National Health and Nutrition Examination Survey (KNHANES) conducted by the Korea Centers for Disease Control and Prevention surveyed social status, nutrition, physical status, and other medical history including HGS. This study aimed to investigate the social, physical, and individual health behavior factors associated with low HGS in the elderly Korean population. This population-based cross-sectional study was based on the 2014–2016 KNHANES. Community-dwelling Korean elderly (aged ≥65 years) were included in this survey. The relationship between HGS and socioeconomic status, nutrition, exercise, and other clinical characteristics were analyzed using multivariate logistic regression. The sample size was 3,634 (weighted: 6,006,406). Elderly men and women with low HGS showed lower body mass index, reduced physical activity and lower education level. Among elderly men, excessive carbohydrate and inadequate protein intake were observed in the low HGS group. Meanwhile, older women who did not drink alcohol and had diabetes were at higher risk of low HGS. In conclusion, various physical, nutritional, socioeconomic and comorbidity statuses were seemed to be the factors associated with HGS in Korean elderly. However, further cohort or case-control study will be necessary to determine the causal relationship of those factors and HGS. [ABSTRACT FROM AUTHOR]

Objective: To establish reference values for hand grip strength (HGS) in a healthy Korean population and to identify the dependent anthropometric variables that affect HGS. Methods: Based on the sixth Korea National Health and Nutrition Examination Survey from 2014 to 2015, we analyzed the HGS data of 7,969 South Koreans. Individuals with specific chronic diseases and who reported poor subjective health status were excluded to ensure a healthy population sample. Means with standard deviations (SDs) and 95% confidence intervals were calculated for each 5-year interval starting from 10 years of age. To determine the relationship between HGS and anthropometric variables, we performed correlation analyses between HGS and height, weight, and body mass index (BMI). Additionally, based on these findings, the cut-off value for low HGS was presented by deriving -2SD values of healthy young adults as recommended by the European Working Group on Sarcopenia in Older People. Results: The mean age and BMI of men and women were 38.3 and 38.2 years and 23.8 and 22.4 kg/m2, respectively. Mean HGS of the dominant hand in men and women was 39.5 and 24.2 kg, respectively. The peak in HGS was at 35–39 years of age, after which HGS decreased in both sexes. HGS was significantly correlated with height, weight, and BMI. The cut-off values for weak HGS were < 28.9 and < 16.8 kg in men and women, respectively. Conclusion: These results provide useful reference values to assess HGS in patients who undergo hand surgery or who have various diseases that affect HGS. Moreover, a cut-off value for low HGS may help in defining sarcopenia among the Korean population. [ABSTRACT FROM AUTHOR]

Background: Lumbar stabilization exercises are effective for the treatment of patients with low back pain. However, personalized exercise programs are required to facilitate more efficient treatment, as each individual exhibits the different characteristics of the trunk muscles and pain.Objective: To determine the effects of graded lumbar stabilization exercises on the trunk muscles in healthy individuals, using surface electromyography.Design: A cross-sectional prospective study.Setting: Outpatient pain clinic.Participants: Ten healthy male participants without low back pain were recruited on a volunteer basis.Methods: Four common lumbar stabilization exercises were selected, including the curl up, dead bug, Superman, and bird dog exercises. Each exercise was divided into 5 intensity levels, with participants performing all exercises at each intensity level, to a total of 20 exercises. Electromyographic changes in the trunk muscles according to intensity level were analyzed.Main Outcome Measurements: Using superficial electromyography, the peak amplitude and area under the curve for each of the rectus abdominis (RA), external oblique abdominis (EO), multifidus (MF), and erector spinae (ES) muscles were measured.Results: In general, as the level of intensity increased, the activity of the related lumbar stabilizing muscles also increased significantly (P < .05). Specifically, the peak amplitudes of the RA (P = .008) and EO (P < .001) were increased during the curl up exercise, whereas the peak amplitudes of the MF (P < .001) and ES (P = .002) were increased during the bird dog exercise. The prolonged exercise duration of the Superman exercise increased the mean area under the curve of MF, ES, and RA (P < .001).Conclusions: Using a graded exercise program, an appropriate level of exercise intensity can be prescribed and modulated according to patient tolerance and physical ability. Therefore, a graded lumbar stabilization exercise program may represent an effective way to strengthen the lumbar stabilizing muscles in patients with low back pain. [ABSTRACT FROM AUTHOR]

Background: This study investigated whether the prevalence, awareness, treatment, and control of hypertension and diabetes differed by residential areas. In addition, the rate of good hypertension or diabetes control was examined separately in men and women, and in urban and rural areas.Methods: This study used Korea National Health and Nutrition Examination V (2010-2012) data, a nationwide cross-sectional survey of general South Korean population. Residential areas were categorized into urban and rural areas. To examine differences between the residential areas in terms of prevalence, awareness, treatment, and control of hypertension and diabetes we performed a multivariate logistic regression adjusting for age, body mass index, physical activity, alcohol use, smoking, marital status, monthly income, and educational level. To investigate control of hypertension or diabetes within each residential area, we performed a subgroup analysis in both urban and rural areas.Results: The prevalence of hypertension is higher among men in urban areas than among those in rural areas (OR = 0.80; 95 % CI = 0.67-0.96, reference group = urban areas). However, the subgroups did not differ in terms of diabetes prevalence, awareness, treatment, and control. Regardless of both sex and residential area, participants in good control of their hypertension and diabetes were younger. Inequality in good control of hypertension was observed in men who lived in urban (≤Elementary school, OR 0.74, 95 % CI 0.60-0.92) and rural areas (≤Elementary school, OR 0.67, 95 % CI 0.46-0.99). Inequality in health status was found in women who resided in urban areas (≤Elementary school, OR 0.53, 95 % CI 0.37-0.75). Good control of diabetes also showed inequalities in health status for both men (≤Elementary school, OR 0.61, 95 % CI 0.40-0.94; Middle/High school, OR 0.69, 95 % CI 0.49-0.96) and women in urban areas (≤1 million won, OR 0.56, 95 % CI 0.33-0.93) (Reference group = '≥College' for education and '>3 million' Korean won for income).Conclusions: After correction for individual socioeconomic status, differences by residential area were not observed. However, when the participants with good disease control were divided by region, inequality was confirmed in urban residents. Therefore, differentiated health policies to resolve individual and regional health inequalities are necessary. [ABSTRACT FROM AUTHOR]

Regional Cardiocerebrovascular Centers (RCCs)—a Korean government initiative—seek to reduce medical gaps across regions, and their cardiac rehabilitation (CR) programs are expected to model post-acute care for the Korean CR program. Accordingly, this study aimed to evaluate the current status of CR programs in the RCCs. We distributed surveys on the CR condition, activity, and barriers to 12 RCCs in different provinces. The results revealed significant gaps in the annual number of acute myocardial infarction admissions, and CR candidates, capacity, and density across the 12 RCCs. The CR capacity (50–500) and density (0.42–7.36) indicated particularly large gaps. Twelve RCCs had the necessary facilities, equipment and personnel for CR assessments and management, with high CR referral (97%) and patient education (78%) rates. However, the inpatient CR exercise training (56%) participation rate was inadequate, with much lower enrollment (47%) and adherence (17%) rates to the outpatient CR program and large differences across centers. Therefore, this study's results will provide the evidence required to establish special national health strategies to overcome the CR barriers of patient, doctor/hospital, and policy factors for activating Korean CR programs. [ABSTRACT FROM AUTHOR]

Computed tomography (CT) is a reference method for measuring skeletal muscle mass, and the amount of fat in the skeletal muscle can be calculated based on CT attenuation. This study aimed to comprehensively investigate the effect of muscle quality and quantity on metabolic syndrome (MetS) according to sex. This retrospective cross-sectional study enrolled 8081 individuals aged ≥20 years who underwent self-referral abdominopelvic CT at our hospital. The total abdominal muscle area (TAMA), low-attenuation abdominal muscle area (LAMA), normal-attenuation abdominal muscle area (NAMA), and extramyocellular lipid area (EMCLA) were measured using cross-sectional CT data of the L3 lumbar vertebrae. The TAMA and NAMA showed negative correlations with risk factors for MetS and a positive correlation with high-density lipoprotein cholesterol, whereas the LAMA and EMCLA showed an inverse trend in both the sexes (p < 0.001). After adjusting for various factors, a higher LAMA index and the ratio of LAMA to TAMA were associated with a higher prevalence of MetS. High TAMA indices were associated with a lower prevalence of MetS. Furthermore, muscle quality and quantity were associated with the prevalence of MetS in both males and females. However, the LAMA showed a stronger association with MetS in males than in females. [ABSTRACT FROM AUTHOR]

The development of technology-based home fitness has emerged from the booming digital healthcare market and recent demands for at-home fitness and health equipment due to the COVID-19 pandemic. Digital healthcare company Alyce Healthcare recently developed Weelo, which is a web-based online fitness program. Weelo recommends an exercise protocol through machine-learning-enabled recognition of the user's motion and provides visual and auditory feedback. We evaluated whether Weelo improves physical and mental well-being to assess its capabilities and effectiveness. Thirty-two participants performed a total of 20 exercise sessions following the Weelo guide on a laptop. The participants were evaluated using a before and after exercise program, body composition, handgrip strength, six-minute walk test, modified star excursion balance test, short form 36, fatigue severity scale, Beck depression index, and a satisfaction survey. Overall, there was a significant improvement in muscle strength, endurance, and balance ability, as well as an improved quality of life and significant reduction in fatigue and depression. Participants showed high motivation to continue following the Weelo exercise program. In conclusion, utilizing Weelo improved physical and mental well-being and is considered to be an individual-use indoor exercise program that serves as an alternative to traditional face-to-face exercise. [ABSTRACT FROM AUTHOR]