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Background: Depression is a prevalent mental health disorder that presents substantial public health challenges. Emerging evidence underscores the role of dietary patterns in mitigating depressive symptoms. This study investigated the association between diet quality, assessed using the Recommended Food Score (RFS), and depressive symptoms, evaluated with the Patient Health Questionnaire-9 (PHQ-9), in a sample of Korean adults., Methods: This cross-sectional study analyzed data from 19,786 participants recruited from a general hospital in Korea, all of whom completed the RFS and PHQ-9 assessments. General characteristics and anthropometric indices were recorded. Statistical analyses included chi-square tests and binary logistic regression to calculate odds ratios (ORs) and 95% confidence intervals for depressive symptoms according to RFS scores, adjusting for potential confounders., Results: Higher RFS scores were associated with reduced odds of depression in univariate (OR, 0.59; P<0.001) and multivariate (OR, 0.72; P<0.001) analyses. Sociodemographic factors, including older age, higher education, marital status, higher income, professional occupation, and regular exercise, were linked to decreased odds of depression. Conversely, female sex, current smoking, and alcohol consumption were associated with increased odds., Conclusion: The findings reveal an inverse relationship between diet quality and depressive symptoms among Korean adults, emphasizing the potential of dietary improvements in mental health promotion. Sociodemographic factors significantly influence depression risk. Future studies should adopt longitudinal designs incorporating a wider range of variables to elucidate these complex interactions.

Background: To analyze the anthropometric changes in women who had participated in a combined resistance and aerobic training program for more than a year and to determine the effect of the exercise on weight loss., Methods: A total of 9,128 women aged between 20 and 60 years who registered in the Curves program, which employs a combination of resistance and aerobic training exercises, and who participated for more than 1 year were included in our analysis. The women were divided into groups according to exercise frequency: <1, 1, 2, and ≥3 days/week. Weight and waist circumference were measured at the beginning and end of the follow-up period., Results: The average follow-up duration was 625.3±151.2 days. Waist circumference and body weight decreased more on average in those who participated more frequently in exercise. The achievement of more than 5% weight reduction became more likely with increasing frequency of exercise participation. The odds ratios of more than 5% weight reduction between the exercise groups were 1.47, 1.58, and 2.05 for the 1, 2, and ≥3 days/week exercise groups, respectively., Conclusion: Women who participated in a combined resistance and aerobic training program for more than a year lost weight in a dose-dependent manner.

Background: Health-related quality of life (HRQoL) reflects an individual's perception of their physical and mental health over time. Despite numerous studies linking physical activity to improved HRQoL, most rely on self-reported data, limiting the accuracy and generalizability of findings. This study leverages objective accelerometer data to explore the association between physical activity and HRQoL in Korean adults., Objective: The objective of this study is to analyze the relationship between objectively measured physical activity using accelerometers and HRQoL among Korean adults, aiming to inform targeted interventions for enhancing HRQoL through physical activity., Methods: This observational study included 1298 participants aged 19-64 years from the Korea National Health and Nutrition Examination Survey (KNHANES) VI, who wore an accelerometer for 7 consecutive days. HRQoL was assessed using the EQ-5D questionnaire, and physical activity was quantified as moderate-to-vigorous physical activity accelerometer-total (MVPA-AT) and accelerometer-bout (MVPA-AB). Data were analyzed using logistic regression to determine the odds ratio (ORs) for low HRQoL, adjusting for socioeconomic variables and mental health factors., Results: Participants with higher HRQoL were younger, more likely to be male, single, highly educated, employed in white-collar jobs, and had higher household incomes. They also reported less stress and better subjective health status. The high HRQoL group had significantly more participants meeting MVPA-AB ≥600 metabolic equivalents (P<.01). Logistic regression showed that participants meeting MVPA-AB ≥600 metabolic equivalents had higher odds of high HRQoL (OR 1.55, 95% CI 1.11-2.17). Adjusted models showed consistent results, although the association weakened when adjusting for mental health factors (OR 1.45, 95% CI 1.01-2.09)., Conclusions: The study demonstrates a significant association between HRQoL and moderate to vigorous physical activity sustained for at least 10 minutes, as measured by accelerometer. These findings support promoting physical activity, particularly sustained moderate to vigorous activity, to enhance HRQoL. Further interventional studies focusing on specific physical activity domains such as occupational, leisure-time, and commuting activities are warranted., (©Sujeong Han, Bumjo Oh, Ho Jun Kim, Seo Eun Hwang, Jong Seung Kim. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 03.09.2024.)

Background: The coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare services, including chronic disease management, for vulnerable groups, such as older individuals with hypertension. This study aimed to evaluate hypertension management in South Korea's elderly population during the pandemic using treatment consistency indices such as the continuity of care (COC), modified, modified continuity index (MMCI), and most frequent provider continuity (MFPC)., Methods: This study used the Korea Disease Control and Prevention Agency-COVID-19-National Health Insurance Service cohort (K-COV-N cohort) from the National Health Insurance Service between 2017 and 2021. The research included a total of 4,097,299 hypertensive patients aged 65 years or older. We defined 2018 and 2019 as the baseline period before the COVID-19 pandemic and 2020 and 2021 as the COVID-19 period and calculated the indices of medical continuity (number of visits, COC, MMCI, and MFPC) on a yearly basis., Results: The number of visits decreased during the COVID-19 period compared to the baseline period (59.64±52.75 vs. 50.49±50.33, P<0.001). However, COC, MMCI, and MFPC were not decreased in the baseline period compared to the COVID-19 period (0.71±0.21 vs. 0.71±0.22, P<0.001; 0.97±0.05 vs. 0.96±0.05, P<0.001; 0.8±0.17 vs. 0.8±0.17, P<0.001, respectively)., Conclusion: COVID-19 had no significant impact on the continuity of care but affected the frequency of outpatient visits for older patients with hypertension. However, this study highlights the importance of addressing healthcare inequalities, especially in older patients with hypertension, during pandemics and advocates for policy changes to ensure continued care for vulnerable populations.

Background: Prolonged improper posture can lead to forward head posture (FHP), causing headaches, impaired respiratory function, and fatigue. This is especially relevant in sedentary scenarios, where individuals often maintain static postures for extended periods-a significant part of daily life for many. The development of a system capable of detecting FHP is crucial, as it would not only alert users to correct their posture but also serve the broader goal of contributing to public health by preventing the progression of chronic injuries associated with this condition. However, despite significant advancements in estimating human poses from standard 2D images, most computational pose models do not include measurements of the craniovertebral angle, which involves the C7 vertebra, crucial for diagnosing FHP., Objective: Accurate diagnosis of FHP typically requires dedicated devices, such as clinical postural assessments or specialized imaging equipment, but their use is impractical for continuous, real-time monitoring in everyday settings. Therefore, developing an accessible, efficient method for regular posture assessment that can be easily integrated into daily activities, providing real-time feedback, and promoting corrective action, is necessary., Methods: The system sequentially estimates 2D and 3D human anatomical key points from a provided 2D image, using the Detectron2D and VideoPose3D algorithms, respectively. It then uses a graph convolutional network (GCN), explicitly crafted to analyze the spatial configuration and alignment of the upper body's anatomical key points in 3D space. This GCN aims to implicitly learn the intricate relationship between the estimated 3D key points and the correct posture, specifically to identify FHP., Results: The test accuracy was 78.27% when inputs included all joints corresponding to the upper body key points. The GCN model demonstrated slightly superior balanced performance across classes with an F 1 -score (macro) of 77.54%, compared to the baseline feedforward neural network (FFNN) model's 75.88%. Specifically, the GCN model showed a more balanced precision and recall between the classes, suggesting its potential for better generalization in FHP detection across diverse postures. Meanwhile, the baseline FFNN model demonstrates a higher precision for FHP cases but at the cost of lower recall, indicating that while it is more accurate in confirming FHP when detected, it misses a significant number of actual FHP instances. This assertion is further substantiated by the examination of the latent feature space using t-distributed stochastic neighbor embedding, where the GCN model presented an isotropic distribution, unlike the FFNN model, which showed an anisotropic distribution., Conclusions: Based on 2D image input using 3D human pose estimation joint inputs, it was found that it is possible to learn FHP-related features using the proposed GCN-based network to develop a posture correction system. We conclude the paper by addressing the limitations of our current system and proposing potential avenues for future work in this area., (©Haedeun Lee, Bumjo Oh, Seung-Chan Kim. Originally published in JMIR Formative Research (https://formative.jmir.org), 26.08.2024.)

Background: Although microbiota in prostatic tissues of patients with prostate cancer have been studied, results of different studies have been inconsistent. Different ethnicity of study subjects, different study designs, and potential contaminations during sample collection and experiments might have influenced microbiome results of prostatic tissues. In this study, we analyzed microbiota and their potential functions in benign and malignant tissues of prostate cancer considering possible contaminants and host variables., Materials and Methods: A total of 118 tissue samples (59 benign tissues and 59 malignant tissues) obtained by robot-assisted laparoscopic radical prostatectomy were analyzed and 64 negative controls (from sampling to sequencing processes) were included to reduce potential contaminants., Results: Alteration of the microbiome in prostate tissues was detected only in patients with diabetes. Furthermore, the influence of diabetes on microbiome was significant in malignant tissues. The microbiome in malignant tissues of patients with diabetes was influenced by pathologic stages. The relative abundance of Cutibacterium was reduced in the high pathologic group compared to that in the intermediate group. This reduction was related to microbial pathways increased in the high pathologic group., Conclusion: Results of this study indicate that diabetes can influence the progression of prostate cancer with microbiome alteration in prostate tissues. Although further studies are necessary to confirm findings of this study, this study can help us understand tissue microbiome in prostate cancer and improve clinical therapy strategies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Lee, Kim, Oh, Hong and Kim.)

East Asian populations exhibit a genetic predisposition to obesity, yet comprehensive research on these traits is limited. We conducted a genome-wide association study (GWAS) with 93,673 Korean subjects to uncover novel genetic loci linked to obesity, examining metrics such as body mass index, waist circumference, body fat ratio, and abdominal fat ratio. Participants were categorized into non-obese, metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO) groups. Using advanced computational methods, we developed a multifaceted polygenic risk scores (PRS) model to predict obesity. Our GWAS identified significant genetic effects with distinct sizes and directions within the MHO and MUO groups compared with the non-obese group. Gene-based and gene-set analyses, along with cluster analysis, revealed heterogeneous patterns of significant genes on chromosomes 3 (MUO group) and 11 (MHO group). In analyses targeting genetic predisposition differences based on metabolic health, odds ratios of high PRS compared with medium PRS showed significant differences between non-obese and MUO, and non-obese and MHO. Similar patterns were seen for low PRS compared with medium PRS. These findings were supported by the estimated genetic correlation (0.89 from bivariate GREML). Regional analyses highlighted significant local genetic correlations on chromosome 11, while single variant approaches suggested widespread pleiotropic effects, especially on chromosome 11. In conclusion, our study identifies specific genetic loci and risks associated with obesity in the Korean population, emphasizing the heterogeneous genetic factors contributing to MHO and MUO., (© The Author(s) 2024. Published by Oxford University Press.)

Objective: Depression among non-smokers at risk of second-hand smoke (SHS) exposure has been a neglected public health concern despite their vulnerability. The objective of this study was to develop high-performance machine-learning (ML) models for the prediction of depression in non-smokers and to identify important predictors of depression for second-hand smokers., Methods: ML algorithms were created using demographic and clinical data from the Korea National Health and Nutrition Examination Survey (KNHANES) participants from 2014, 2016, and 2018 ( N  = 11,463). The Patient Health Questionnaire was used to diagnose depression with a total score of 10 or higher. The final model was selected according to the area under the curve (AUC) or sensitivity. Shapley additive explanations (SHAP) were used to identify influential features., Results: The light gradient boosting machine (LGBM) with the highest positive predictive value (PPV; 0.646) was selected as the best model among the ML algorithms, whereas the support vector machine (SVM) had the highest AUC (0.900). The most influential factors identified using the LGBM were stress perception, followed by subjective health status and quality of life. Among the smoking-related features, urine cotinine levels were the most important, and no linear relationship existed between the smoking-related features and the values of SHAP., Conclusions: Compared with the previously developed ML models, our LGBM models achieved excellent and even superior performance in predicting depression among non-smokers at risk of SHS exposure, suggesting potential goals for depression-preventive interventions for non-smokers during public health crises., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

The oral cavity connects the external environment and the respiratory and digestive systems, and the oral microbial ecosystem is complex and plays a crucial role in overall health and immune defense against external threats. Recently, the potential use of probiotics for disease prevention and treatment has gained attention. This study aimed to assess the effect of Weissella cibaria CMS1 ( W. cibaria CMS1) consumption on the oral microbiome and immune function in healthy individuals through a 12-week clinical trial. This randomized, double-blind, placebo-controlled, parallel trial enrolled 90 healthy subjects. The consumption of W. cibaria CMS1 significantly increased salivary immunoglobulin A ( p = 0.046) and decreased tumor necrosis factor-α (TNF-α) levels ( p = 0.008). Analysis of the oral microbiota revealed changes in beta diversity, increased abundance of Firmicutes and Actinobacteria, and decreased abundance of Bacteroidetes and Fusobacteria after 12 weeks of consuming W. cibaria CMS1. Significant increases in various strains, including Lactobacillales, Bacilli, Streptococcaceae, Streptococcus, and Firmicutes, were observed in the W. cibaria CMS1 group after 12 weeks of intake. Additionally, Fusobacteriia Fusobacteriales Fusobacteriaceae and Fusobacteriia Fusobacteriales Fusobacteriaceae Fusobacterium exhibited a positive correlation with TNF-α. These findings demonstrate the positive effect of W. cibaria CMS1 on the oral environment and immune function.

Background: Understanding the clinical course and pivotal time points of COVID-19 aggravation is critical for enhancing patient monitoring. This retrospective, multi-center cohort study aims to identify these significant time points and associate them with potential risk factors, leveraging data from a sizable cohort with mild-to-moderate symptoms upon admission., Methods: This study included data from 1,696 COVID-19 patients with mild-to-moderate clinical severity upon admission across multiple hospitals in Daegu-Kyungpook Province (Daegu dataset) between February 18 and early March 2020 and 321 COVID-19 patients at Seoul Boramae Hospital (Boramae dataset) collected from February to July 2020. The approach involved: (1) identifying the optimal time point for aggravation using survival analyses with maximally selected rank statistics; (2) investigating the relationship between comorbidities and time to aggravation; and (3) developing prediction models through machine learning techniques. The models were validated internally among patients from the Daegu dataset and externally among patients from the Boramae dataset., Results: The Daegu dataset showed a mean age of 51.0 ± 19.6 years, with 8 days for aggravation and day 5 being identified as the pivotal point for survival. Contrary to previous findings, specific comorbidities had no notable impact on aggravation patterns. Prediction models utilizing factors including age and chest X-ray infiltration demonstrated promising performance, with the top model achieving an AUC of 0.827 in external validation for 5 days aggravation prediction., Conclusion: Our study highlights the crucial significance of the initial 5 days period post-admission in managing COVID-19 patients. The identification of this pivotal time frame, combined with our robust predictive models, provides valuable insights for early intervention strategies. This research underscores the potential of proactive monitoring and timely interventions in enhancing patient outcomes, particularly for those at risk of rapid aggravation. Our findings offer a meaningful contribution to understanding the COVID-19 clinical course and supporting healthcare providers in optimizing patient care and resource allocation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Moon, Ham, Song, Lee, Goo, Oh, Lee, Kim and Park.)

Background: Although the epidemiology of Huntington's disease (HD) in Korea differs notably from that in Western countries, the genetic disparities between these regions remain unclear., Objective: To investigate the characteristics and clinical significance of cytosine-adenine-guanine (CAG) repeat size associated with HD in the Korean population., Methods: We analyzed the CAG repeat lengths of the HTT gene in 941 healthy individuals (1,882 alleles) and 954 patients with chorea (1,908 alleles) from two referral hospitals in Korea. We presented normative CAG repeat length data for the Korean population and computed the reduced penetrance (36-39 CAG) and intermediate allele (27-35 CAG) frequencies in the two groups. Furthermore, we investigated the relationship between intermediate alleles and chorea development using logistic regression models in individuals aged ≥55 years., Results: The mean (±standard deviation) CAG repeat length in healthy individuals was 17.5 ± 2.0, with a reduced penetrance allele frequency of 0.05 % (1/1882) and intermediate allele frequency of 0.69 % (13/1882). We identified 213 patients with genetically confirmed HD whose CAG repeat length ranged from 39 to 140, with a mean of 45.2 ± 7.9 in the longer allele. Compared with normal CAG repeat alleles, intermediate CAG repeat alleles were significantly related to a higher risk of developing chorea (age of onset range, 63-84 years) in individuals aged ≥55 years., Conclusions: This study provides insights into the specific characteristics of CAG repeat lengths in the HTT gene in the Korean population. The reduced penetrance and intermediate allele frequencies in the Korean general population seem to be lower than those reported in Western populations. The presence of intermediate alleles may increase the risk of chorea in the Korean elderly population, which requires further large-scale investigations., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jee-Young Lee reports financial support was provided by SMG-SNU Boramae Medical Center focused clinical research grant-in-aid (04-2022-0014)., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Glaceum Inc. has proposed HSG4112, a structural analogue of glabridin, as a novel anti-obesity compound. Animal studies and phase I human trials have shown that HSG4112 improves energy consumption, normalises weight, and is safe and drug-resistant. Based on these results, the company plans to conduct a phase 2a clinical trial to determine the safety and efficacy of HSG4112 in overweight and obese patients., Methods: A 16-week randomised, double-blind, placebo-controlled, parallel-group trial will be conducted at five large hospitals in South Korea to assess the safety and efficacy of HSG4112 in overweight and obese patients. Participants who meet the inclusion/exclusion criteria will be assigned a subject number and randomly assigned to one of the four treatment groups (one group receiving a placebo) in a 1:1:1:1 ratio. The study's primary outcome will be to monitor the change in body weight (kg) from baseline to the end of treatment while monitoring safety and tolerability., Discussion: This trial will evaluate the efficacy and safety of HSG4112 in overweight and obese adults. Upon proving the safety and effectiveness of the newly developed mechanism, it might significantly improve the perception of the product among medical personnel and obese patients. Furthermore, it may aid in managing chronic conditions that require long-term treatment. Trial registration: ClinicalTrials.gov, identifier [NCT05197556]., Competing Interests: SL and YK are current/former employees of Glaceum Inc. and own stock in the company. Glaceum Inc. provided funding for the research and holds Patent US9783551B2, which grants intellectual properties (IPs) for synthesising and using the compounds in the article. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Min, Oh, Koo, Kim, Lee, Lee, Kim and Kwon.)

Background: The timeliness of raising vaccine acceptance and uptake among the public is essential to overcoming COVID-19; however, the decision-making process among patients with underlying medical conditions is complex, leading individuals to vaccine hesitancy because of their health status. Although vaccine implementation is more effective when deployed as soon as possible, vaccine hesitancy is a significant threat to the success of vaccination programs., Objective: This study aims to evaluate the effectiveness of a communication tool for patients with underlying medical conditions who should decide whether to receive a COVID-19 vaccine., Methods: This 3-arm prospective randomized controlled trial will test the effect of the developed communication intervention, which is fully automated, patient decision aid (SMART-DA), and user-centered information (SMART-DA-α). The web-based intervention was developed to help decision-making regarding COVID-19 vaccination among patients with underlying medical conditions. Over 450 patients will be enrolled on the web from a closed panel access website and randomly assigned to 1 of 3 equal groups stratified by their underlying disease, sex, age, and willingness to receive a COVID-19 vaccine. SMART-DA-α provides additional information targeted at helping patients' decision-making regarding COVID-19 vaccination. Implementation outcomes are COVID-19 vaccination intention, vaccine knowledge, decisional conflict, stress related to decision-making, and attitudes toward vaccination, and was self-assessed through questionnaires., Results: This study was funded in 2020 and approved by the Clinical Research Information Service, Republic of Korea. Data were collected from December 2021 to January 2022. This paper was initially submitted before data analysis. The results are expected to be published in the winter of 2023., Conclusions: We believe that the outcomes of this study will provide valuable new insights into the potential of decision aids for supporting informed decision-making regarding COVID-19 vaccination and discovering the barriers to making informed decisions regarding COVID-19 vaccination, especially among patients with underlying medical conditions. This study will provide knowledge about the common needs, fears, and perceptions concerning vaccines among patients, which can help tailor information for individuals and develop policies to support them., Trial Registration: Korea Clinical Information Service KCT0006945; https://cris.nih.go.kr/cris/search/detailSearch.do/20965., International Registered Report Identifier (irrid): DERR1-10.2196/42837., (©Minjung Lee, Bumjo Oh, Nan-He Yoon, Shinkyeong Kim, Young-Il Jung. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 19.01.2023.)

Background: As the worldwide spread of coronavirus disease 2019 (COVID-19) continues for a long time, early prediction of the maximum severity is required for effective treatment of each patient., Objective: This study aimed to develop predictive models for the maximum severity of hospitalized COVID-19 patients using artificial intelligence (AI)/machine learning (ML) algorithms., Methods: The medical records of 2,263 COVID-19 patients admitted to 10 hospitals in Daegu, Korea, from February 18, 2020, to May 19, 2020, were comprehensively reviewed. The maximum severity during hospitalization was divided into four groups according to the severity level: mild, moderate, severe, and critical. The patient's initial hospitalization records were used as predictors. The total dataset was randomly split into a training set and a testing set in a 2:1 ratio, taking into account the four maximum severity groups. Predictive models were developed using the training set and were evaluated using the testing set. Two approaches were performed: using four groups based on original severity levels groups (i.e., 4-group classification) and using two groups after regrouping the four severity level into two (i.e., binary classification). Three variable selection methods including randomForestSRC were performed. As AI/ML algorithms for 4-group classification, GUIDE and proportional odds model were used. For binary classification, we used five AI/ML algorithms, including deep neural network and GUIDE., Results: Of the four maximum severity groups, the moderate group had the highest percentage (1,115 patients; 49.5%). As factors contributing to exacerbation of maximum severity, there were 25 statistically significant predictors through simple analysis of linear trends. As a result of model development, the following three models based on binary classification showed high predictive performance: (1) Mild vs. Above Moderate, (2) Below Moderate vs. Above Severe, and (3) Below Severe vs. Critical. The performance of these three binary models was evaluated using AUC values 0.883, 0.879, and, 0.887, respectively. Based on results for each of the three predictive models, we developed web-based nomograms for clinical use (http://statgen.snu.ac.kr/software/nomogramDaeguCovid/)., Conclusions: We successfully developed web-based nomograms predicting the maximum severity. These nomograms are expected to help plan an effective treatment for each patient in the clinical field., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Hwangbo, Kim, Lee, Lee, Oh, Moon, Kim and Park.)

Determining whether weekend catch-up sleep (CUS) is related to high risk of depression in the general middle-aged population in Korea. This study is a cross-sectional study analyzing data from 2016 to 2017 collected in the Korea National Health and Nutrition Examination Survey VII-1, 2; less than 35 years, and more than 65 years were excluded. Interviews on sociodemographic characteristics, mood and sleep-related profiles, and comorbid medical conditions were conducted. Participants were divided into three groups according to weekday sleeping time (< 6 h, 6 to ≤ 8 h, and ≥ 8 h). Weekend CUS was identified when nocturnal sleep extension occurred over the weekend. The risk of depression was evaluated using the PHQ-9. The PHQ-9 score differed among the three groups. The prevalence of moderate to severe depressive symptom and PHQ-9 score ≥ 10 was the highest in the group sleep over 8 h and the next highest in the group sleep less than 6 h. In the group sleep less than 6 h, PHQ-9 score ≥ 10 was significantly higher in the without CUS group than the with CUS group. The risk of depression in middle-aged individuals was associated with both short and long sleep duration, and the severity and prevalence of depression were lower in the group with CUS when a shortened sleep pattern was observed., Supplementary Information: The online version contains supplementary material available at 10.1007/s41105-022-00415-3., Competing Interests: Conflict of interestThe authors have no potential conflicts of interest to disclose., (© The Author(s), under exclusive licence to Japanese Society of Sleep Research 2022. Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Burning mouth syndrome (BMS) is a chronic pain condition accompanied by unpleasant burning sensations of the oral mucosa. While multiple factors were proposed for the etiology, evidence suggested a neuropathic pain origin while others suspected the use of antibiotics as the underlying cause. Interestingly, several reports demonstrated the intimate interaction of the nervous system and the microbiome. The current study aims to elucidate the correlation of the oral microbiome with the pathophysiology of the primary BMS. Microbiome samples obtained from the unstimulated whole saliva of 19 primary BMS patients and 22 healthy controls were sequenced and analyzed of the V3-V4 region of 16S rRNA gene. There was a distinct difference in the microbial composition between the BMS and the control groups at all taxonomic levels. Alpha diversity indexes of the oral microbiome were significantly lower in the BMS group. The samples were readily distinguished by multidimensional scaling analysis and linear discriminant analysis effect size. Streptococcus , Rothia , Bergeyella , and Granulicatella genus were dominant in the BMS group, while Prevotella , Haemophilus , Fusobacterium , Campylobacter , and Allorevotella genus were more abundant in the healthy group. Distinct microbiome signatures of BMS patients suggested a diagnostic value and a potential role in the pathogenesis of BMS., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Introduction: Every year, at least half of the smokers in South Korea attempt to quit smoking. However, the Korean smoking rate remains still high among OECD countries. This study aimed to identify the factors that influence the success of smoking cessation efforts., Methods: The study included 1395 smokers, who participated in a 12-week program comprising doctor counseling and pharmacological treatment (i.e. varenicline), conducted at smoking cessation clinics in two general hospitals from 2015 to 2019. The participants responded to a survey questionnaire inquiring about their smoking behaviors at the first visit to the clinic. After completing the program, they were asked whether they succeeded in smoking cessation. Based on participants' reported success or failure, multivariable logistic regression analyses were conducted to obtain adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for factors related to smoking cessation success., Results: Following the 12-week program, 39.6% of the participants (n=553) succeeded in smoking cessation. Lower rates of nicotine dependence (AOR=0.73; 95% Cl: 0.54-0.98) and lower total amounts of smoking (AOR=0.67; 95% Cl: 0.47-0.95) were significantly associated with higher success rates in smoking cessation. In addition, smokers who participated in the program for at least 8 weeks (AOR=7.16; 95% Cl: 5.57-9.20) and smokers who had hypertension (AOR=1.40; 95% Cl: 1.07-1.85) or a cardiovascular disease (AOR=1.68; 95% Cl: 1.03-2.75) achieved higher success rates., Conclusions: Smokers' success in smoking cessation was influenced by the period of visits to the smoking cessation clinic, the severity of nicotine dependence, and the presence of a cardiovascular disease including hypertension. Using these factors, smoking cessation strategy may be improved and personalized for individuals., Competing Interests: The authors have each completed and submitted an ICMJE form for disclosure of potential conflicts of interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. All the authors report that since the initial planning of the work, the study was funded by Pfizer Korea Pharmaceutics Ltd., (© 2022 Eum Y.H. et al.)

Scope: Aspergillus terreus is an industrial microorganism used in the brewing and sauce industries. It produces monacolin K, a natural statin. The study conducted an 8-week randomized controlled trial with hypercholesterolemic subjects to examine the hypocholesterolemic effects and mechanisms of supplementation with yellow yeast rice (YYR) prepared by growing Aspergillus fungi on steamed rice., Methods and Results: YYR supplementation markedly reduced total cholesterol, LDL, and apolipoprotein B100 levels in plasma compared with the placebo. In addition, YYR induced a significantly increased ATP binding cassette subfamily B member 11 (ABCB11) gene expression compared with the placebo, indicating the role of YYR in lowering intrahepatic cholesterol availability by stimulating the bile salt export pump. Upregulation of LDL receptor (LDLR) and 3-methylglutaryl-CoA reductase (HMGCR) gene expressions provided additional evidence to support the role of YYR in reducing hepatic cholesterol availability. Plasma metabolomic profiling revealed the possibility of diminishing bile acid absorption. Finally, Spearman rank analysis showed correlations of plasma cholesterol profiles with HMGCR and LDLR gene expressions (negative) and plasma bile acids (positive). Plasma bile acids also correlated with ABCB11 (negative) and LDLR (positive) gene expressions., Conclusion: These findings suggest that daily YYR supplementation exerted hypocholesterolemic effects in mild-to-moderate hypercholesterolemic subjects by reducing intrahepatic cholesterol availability through stimulating bile salt export pumps and inhibiting cholesterol biosynthesis., (© 2021 Wiley-VCH GmbH.)

Recent studies have reported dysbiosis of the microbiome in breast tissue collected from patients with breast cancer and the association between the microbiota and disease progression. However, the role of the microbiota in breast tissue remains unclear, possibly due to the complexity of breast cancer and various factors, including racial and geographical differences, influencing microbiota in breast tissue. Here, to determine the potential role of microbiota in breast tumor tissue, we analyzed 141 tissue samples based on three different tissue types (tumor, adjacent normal, and lymph node tissues) from the same patients with breast cancer in Korea. The microbiota was not simply distinguishable based on tissue types. However, the microbiota could be divided into two cluster types, even within the same tissue type, and the clinicopathologic factors were differently correlated in the two cluster types. Risk of regional recurrence was also significantly different between the microbiota cluster types ( p = 0.014). In predicted function analysis, the pentose and glucuronate interconversions were significantly different between the cluster types ( q < 0.001), and Enterococcus was the main genus contributing to these differences ( q < 0.01). Results showed that the microbiota of breast tissue could interact with the host and influence the risk of regional recurrence. Although further studies would be recommended to validate our results, this study could expand our understanding on the breast tissue microbiota, and the results might be applied to develop novel prediction methods and treatments for patients with breast cancer.

Aging has become a global problem, and the interest in healthy aging is growing. Healthy aging involves a focus on the maintenance of the function and well-being of elderly adults, rather than a specific disease. Thus, the management of frailty, which is an accumulated decline in function, is important for healthy aging. The adaptation method was used to develop clinical practice guidelines on frailty management that are applicable in primary care settings. The guidelines were developed in three phases: preparation (organization of committees and establishment of the scope of development), literature screening and evaluation (selection of the clinical practice guidelines to be adapted and evaluation of the guidelines using the Korean Appraisal of Guidelines for Research and Evaluation II tool), and confirmation of recommendations (three rounds of Delphi consensus and internal and external reviews). A total of 16 recommendations (five recommendations for diagnosis and assessment, 11 recommendations for intervention of frailty) were made through the guideline development process. These clinical practice guidelines provide overall guidance on the identification, evaluation, intervention, and monitoring of frailty, making them applicable in primary care settings. As aging and "healthy aging" become more and more important, these guidelines are also expected to increase in clinical usefulness.

Short sleep duration or poor sleep quality has been associated with an increased risk of obesity. Although the underlying mechanism remains unclear, one proposed pathway is poor diet quality. This cross-sectional study investigated whether diet quality modifies the association between sleep status and obesity in Korean adults. We used the baseline data and samples of 737 men and 428 women ( n = 1165) aged 19-64, who participated in the prospective Ewha-Boramae cohort study. Sleep duration was dichotomized into ≥7 h (adequate) and <7 h (insufficient). Pittsburgh Sleep Quality Index (PSQI) values, reflecting sleep quality, were dichotomized into >5 (poor quality) and ≤5 (good quality). Diet quality was evaluated by the Recommended Food Score (RFS). Obesity was associated with higher rates of insufficient sleep and poor sleep quality in women, but not in men. After adjustment for covariates, women with poor sleep quality had a higher risk of obesity than women with good sleep quality (OR = 2.198; 95% CI = 1.027-4.704); this association occurred only in the group with RFS ≤ median score. Our findings support a significant association between sleep quality and obesity, and this association has been potentially modified by dietary quality in women.

Introduction: Young adults receive health screenings at lower rates than other age groups, and it may be difficult to detect diseases in the early stages for this group. We examined differences in health status relative to smoking in a young age group using the results of health screenings conducted in engaged and newly married couples in a cross-sectional database., Methods: The participants in this study were 808 young adults who visited a municipal hospital health screening center from July 2017 to March 2019. They completed a self-administered questionnaire, and physical measurements and a blood test were taken. They were classified into non-cigarette smokers, past cigarette smokers, and current cigarette smokers according to smoking behavior. In this study, we compared metabolic syndrome, the main components of which include obesity, high blood pressure, high blood triglycerides, low levels of HDL cholesterol and insulin resistance, with smoking behavior., Results: The mean age of the participants was 30.9±3.3 years (males 32.0±3.2, females 29.8±3.1), and 13.9% were current cigarette smokers (males 22.8%, females 5.1%). The proportion of men in their 30s was 76.6% for male group and 50.0% for female group, indicating that the male group had a relatively higher proportion of older and current smokers. Significant differences were found in age, sex, blood pressure, metabolic abnormalities, and drinking status according to smoking status. Cigarette smokers had a 2.4-fold greater risk of metabolic syndrome (95% confidence interval [CI], 1.43-3.96) than non-cigarette smokers; in particular, they had a 2.6-fold (95% CI, 1.44-4.55) greater risk of hypertriglyceridemia and a three-fold (95% CI, 1.45-6.35) greater risk of low HDL cholesterol., Conclusions: In comparison with non-single, young and generally healthy city dwellers, the risk of metabolic syndrome was significantly higher in smokers than in non-smokers, and in particular, it was confirmed that the risk of hypertriglyceridemia and low HDL cholesterolemia was higher. Smoking cessation is necessary, even for the young, because smoking may cause changes in blood lipids even if the smoking duration is short., Competing Interests: The authors have declared that no competing interests exist.

The spore-forming Bacillus coagulans has attracted attention for their therapeutic action in the colon. However, the mechanism of this action remains unclear. In this study, healthy subjects with mild intermittent constipation were supplemented with B. coagulans SNZ 1969 (BC) or the placebo for 8 weeks (n = 80). Then, we assessed colonic transit time (CTT), weekly complete spontaneous bowel movement (CSBM) scores, bowel discomfort symptom (BDS) scores, and 16S rRNA fecal microbiome profiles. The association between the critically altered gut microbiome and clinical outcomes was analyzed using redundancy analysis (RDA) and validated by receiver operating characteristic (ROC) curves. BC supplementation significantly improved CTT (p = 0.031), CSBM at weeks 2 (p = 0.045) and 9 (p = 0.038), and BDS at weeks 3 (p = 0.019) and 6 (p = 0.029) compared with the placebo, while altering the community composition of the gut microbiota. We also confirmed that BC was effectively delivered to the gut. Finally, the multivariate redundancy analysis concluded that BC-induced enrichment of Lactobacillales and diminishment of Synergistales were related to CTT improvements. This study provides important new data on how spore-forming B. coagulans SNZ 1969 contributes to improving gut motility and presents evidence supporting the use of B. coagulans SNZ 1969 in adults with mild intermittent constipation and habitual low intake of fruit and vegetables., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Oxidative stress aggravates the progression of lifestyle-related chronic diseases. However, knowledge and practices that enable quantifying oxidative stress are still lacking. Here, we performed a proof-of-concept study to predict the oxidative stress status in a healthy population using retrospective cohort data from Boramae medical center in Korea ( n = 1328). To obtain binary performance measures, we selected healthy controls versus oxidative disease cases based on the "health space" statistical methodology. We then developed a machine learning algorithm for discrimination of oxidative stress status using least absolute shrinkage and selection operator (LASSO)/elastic net regression with 10-fold cross-validation. A proposed fine-tune model included 16 features out of the full spectrum of diverse and complex data. The predictive performance was externally evaluated by generating receiver operating characteristic curves with area under the curve of 0.949 (CI 0.925 to 0.974), sensitivity of 0.923 (CI 0.879 to 0.967), and specificity of 0.855 (CI 0.795 to 0.915). Moreover, the discrimination power was confirmed by applying the proposed diagnostic model to the full dataset consisting of subjects with various degrees of oxidative stress. The results provide a feasible approach for stratifying the oxidative stress risks in the healthy population and selecting appropriate strategies for individual subjects toward implementing data-driven precision nutrition.

Background: Limited information is available about the present characteristics and dynamic clinical changes that occur in patients with COVID-19 during the early phase of the illness., Objective: This study aimed to develop and validate machine learning models based on clinical features to assess the risk of severe disease and triage for COVID-19 patients upon hospital admission., Methods: This retrospective multicenter cohort study included patients with COVID-19 who were released from quarantine until April 30, 2020, in Korea. A total of 5628 patients were included in the training and testing cohorts to train and validate the models that predict clinical severity and the duration of hospitalization, and the clinical severity score was defined at four levels: mild, moderate, severe, and critical., Results: Out of a total of 5601 patients, 4455 (79.5%), 330 (5.9%), 512 (9.1%), and 301 (5.4%) were included in the mild, moderate, severe, and critical levels, respectively. As risk factors for predicting critical patients, we selected older age, shortness of breath, a high white blood cell count, low hemoglobin levels, a low lymphocyte count, and a low platelet count. We developed 3 prediction models to classify clinical severity levels. For example, the prediction model with 6 variables yielded a predictive power of >0.93 for the area under the receiver operating characteristic curve. We developed a web-based nomogram, using these models., Conclusions: Our prediction models, along with the web-based nomogram, are expected to be useful for the assessment of the onset of severe and critical illness among patients with COVID-19 and triage patients upon hospital admission., (©Bumjo Oh, Suhyun Hwangbo, Taeyeong Jung, Kyungha Min, Chanhee Lee, Catherine Apio, Hyejin Lee, Seungyeoun Lee, Min Kyong Moon, Shin-Woo Kim, Taesung Park. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 16.04.2021.)

Background: Scientists have strongly implied that aerosols could be the plausible cause of coronavirus disease-2019 (COVID-19) transmission; however, aerosol transmission remains controversial., The Study: We investigated the epidemiological relationship among infected cases on a recent cluster infection of COVID-19 in an apartment building in Seoul, South Korea. All infected cases were found along two vertical lines of the building, and each line was connected through a single air duct in the bathroom for natural ventilation. Our investigation found no other possible contact between the cases than the airborne infection through a single air duct in the bathroom. The virus from the first infected case can be spread to upstairs and downstairs through the air duct by the (reverse) stack effect, which explains the air movement in a vertical shaft., Conclusions: This study suggests aerosol transmission, particularly indoors with insufficient ventilation, which is underappreciated., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Immunoglobulin A nephropathy (IgAN) involves repeated events of gross haematuria with concurrent upper airway infections. The mucosal immune system, especially the tonsil, is considered the initial site of inflammation, although the role of the tonsillar microbiota has not been established in IgAN. In this study, we compared the tonsillar microbiota of patients with IgAN (n = 21) and other glomerular diseases (n = 36) as well as, healthy controls (n = 23) from three medical centres in Korea. The microbiota was analysed from tonsil swabs using the Illumina MiSeq system based on 16S rRNA gene. Tonsillar bacterial diversity was higher in IgAN than in other glomerular diseases, although it did not differ from that of healthy controls. Principal coordinates analysis revealed differences between the tonsillar microbiota of IgAN and both healthy and disease controls. The proportions of Rahnella, Ruminococcus&#95;g2, and Clostridium&#95;g21 were significantly higher in patients with IgAN than in healthy controls (corrected p < 0.05). The relative abundances of several taxa were correlated with the estimated glomerular filtration rate, blood urea nitrogen, haemoglobin, and serum albumin levels. Based on our findings, tonsillar microbiota may be associated with clinical features and possible immunologic pathogenesis of IgAN.

Background: Happiness has traditionally been thought to comprise two parts - pleasure (hedonia) and meaning (eudaimonia). Even though the two types of happiness are correlated, genomics studies have found distinct transcriptional correlates of hedonia and eudaimonia, particularly in the Conserved Transcriptional Response to Adversity (CTRA) marked by up-regulation of proinflammatory genes and down-regulation of interferon-related genes. Eudaimonia has been associated with reduced CTRA gene expression in several studies, whereas hedonia shows no consistent association with the CTRA. However, most of these social genomics studies have been conducted in Western cultures with Caucasian samples, so it is unclear if these findings extended to non-Western cultures with other ethnic groups. Moreover, it is unknown whether age might modify the association between CTRA gene expression and eudaimonia. To this end, we examined in a sample of Koreans the relationship between CTRA profiles and measures of hedonia and eudaimonia, as well as the role of age in modulating the strength of those relationships., Methods: Blood samples were collected from 152 healthy Korean adults (mean age = 44.64; 50 % female). Well-being was measured using the Mental Health Continuum short form (MHC-SF), Ryff Scales of Psychological Well-being (PWB), and subjective well-being (SWB) scales. RNA transcriptome profiles were obtained by RNA sequencing. Mixed effect linear model analyses examined the association between CTRA gene expression and measures of MHC-SF, SWB, PWB (total scores and six subscales) and additional analyses examined a possible moderating role of age., Results: CTRA gene expression was significantly downregulated in association with the MHC-SF eudaimonic scores as well as the PWB total scores. Among the six domains of PWB, autonomy showed the strongest inverse correlation with CTRA profiles. Moreover, the inverse association between CTRA and PWB was stronger for older participants., Conclusion: Eudaimonia is associated with reduced CTRA gene expression in a Korean population, with particularly marked relationships for autonomy. Findings also suggest that aging with meaning may bring biological advantage in later life., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: HX110-A and HX110-B are compound extracts based on radix adenophorae and rhizoma dioscoreae, respectively, which have anti-inflammatory activity. There are limited data on whether they may help improve respiratory conditions including lung function. Therefore, in this trial, we will evaluate the effectiveness and safety of the use of HX110-A and HX110-B for the treatment of respiratory health in adults with mild respiratory symptoms., Methods: This will be an 8-week, randomized, double-blind, parallel group, placebo-controlled trial with three arms. Adults more than 40 years old with persistent respiratory symptoms will be enrolled. Patients with definite respiratory disease or with a history of recent intake of antioxidants or anti-inflammatory agents will be excluded. Study subjects will be assigned at a 1:1:1 ratio into the following three arms: controls, experimental group 1 (HX110-A), and experimental group 2 (HX110-B). Control or experimental foods will be administered for 8 weeks, and follow-up will be up to 12 weeks. The primary outcome will be total antioxidant capacity. Secondary outcomes will be inflammatory indexes, respiratory symptoms, lung function, quality of life, and fatigue level. Safety outcomes will be assessed by monitoring adverse events and vital signs, and through clinical pathology tests., Results: This trial will reveal the effectiveness and safety of HX110-A and/or HX110-B for medical purposes in adults with respiratory symptoms. The results should clarify if active intake of specific foods with these functional compounds may promote respiratory health in adults without definite respiratory disease., Trial Registration: Clinical Research Information Service, KCT0003614. Registered 12 May 2019 (Respectively registered, https://cris.nih.go.kr/cris/en/search/search&#95;result&#95;st01.jsp?seq=13364).

Background: The prevalence of obesity is increasing in South Korea. We aimed to identify the perceptions, attitudes, behaviors, and barriers to effective obesity care in South Korea., Methods: The Awareness, Care, and Treatment In Obesity maNagement-an International Observation (ACTION-IO) study was a cross-sectional survey conducted in 11 countries. Respondents were people with obesity (PwO; body mass index ≥25 kg/m 2 in South Korea from self-reported height/weight) and healthcare professionals (HCPs) primarily involved in direct care with PwO., Results: The survey was completed by 1,500 PwO and 200 HCPs in South Korea. PwO (78%) and HCPs (81%) agreed that obesity is a chronic disease, but more PwO (84%) believed that obesity has an extreme impact on their overall health compared with HCPs (65%). Most PwO felt completely responsible for their own weight loss (81%), and 78% reported at least one serious weight loss attempt in the past. In contrast, HCPs reported that, on average, only 35% of their patients with obesity had made a serious attempt at losing weight. Only 31% of PwO had discussed weight with their HCP in the past 5 years; of those, 78% appreciated that HCPs initiated these conversations. Short appointment times restricted weight loss discussions for 70% of HCPs, and 29% of HCPs expressed complete comfort with such conversations., Conclusion: South Korean PwO are motivated to lose weight and have expressed interest in HCPs being more active in their weight management. Further nationwide efforts may be required to lower the barriers to education about obesity and effective weight loss discussion and management.

Currently, a few of studies revealed that there is an association between mastication and cognitive impairment. There is no study of Korean adult representative samples in relation to mastication and cognitive decline. This study was to investigate the relationship between mastication and mild cognitive impairment in Korean adults.A population-based cross-sectional study was conducted in which a total of 7029 subjects (2987 men and 4042 women) over 45 years old were surveyed from the Korea Longitudinal Study on Aging (KLoSA), Round 5th survey. Logistic regression analysis was performed for the study data controlling for confounding factors such as age, gender, education, income, smoking, drinking, exercise, wearing denture, and the number of chronic diseases.Decreased chewing function is associated with mild cognitive impairment (odds ratio [OR] = 3.24, 95% confidence interval [CI] = 2.67-3.93) after controlling for confounding variables. In the participants who did not wear dentures, the reduction of chewing function was strongly correlated with mild cognitive impairment (OR = 3.97, 95% CI = 3.11-5.08).Mastication was associated with mild cognitive impairment. To prevent cognitive decline, health specialists should pay more attention to the decline of the mastication in people without dentures.

Objective: Suicidal ideation (SI) precedes actual suicidal event. Thus, it is important for the prevention of suicide to screen the individuals with SI. This study aimed to identify the factors associated with SI and to build prediction models in Korean adults using machine learning methods., Methods: The 2010-2013 dataset of the Korea National Health and Nutritional Examination Survey was used as the training dataset (n=16,437), and the subset collected in 2015 was used as the testing dataset (n=3,788). Various machine learning algorithms were applied and compared to the conventional logistic regression (LR)-based model., Results: Common risk factors for SI included stress awareness, experience of continuous depressive mood, EQ-5D score, depressive disorder, household income, educational status, alcohol abuse, and unmet medical service needs. The prediction performances of the machine learning models, as measured by the area under receiver-operating curve, ranged from 0.794 to 0.877, some of which were better than that of the conventional LR model (0.867). The Bayesian network, LogitBoost with LR, and ANN models outperformed the conventional LR model., Conclusion: A machine learning-based approach could provide better SI prediction performance compared to a conventional LR-based model. These may help primary care physicians to identify patients at risk of SI and will facilitate the early prevention of suicide.

Background: While health-related quality of life (HRQoL) has clinical value, its determinants, particularly objective health-related measurements, have not been fully explored. This study seeks to identify the biological indicators that relate to HRQoL among a group of older Korean adults using a machine-learning approach., Methods: We used physical and mental scores from the 36-item Short Form Health Survey (SF-36) to measure HRQoL among older Korean adults who participated in the Korean Longitudinal Study of Aging (KLoSA) biomarker pilot study (N = 385). The variables for the multivariate penalized regression analysis included demographic factors, medical measurements, physical performance, and health-related behaviors., Results: The multivariate profiles identified several significant biomarkers that relate to quality of life. Among the 20 variables, handgrip strength was the most powerful indicator in both men and women for the SF-36 physical scores, followed by walking speed. Age and total sleep duration exclusively were significantly associated with the SF-36 physical scores only in women, whereas body mass index, blood pressure, and sit-to-stand times were unique elements in men., Conclusions: The present study suggests significant physical indicators that explain quality of life in elderly populations, using a data-driven approach. Based on these findings, maintaining a good level of physical performance is considered a key element of successful aging., Competing Interests: Declaration of Competing Interest The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Weight loss interventions using mobile phone apps have recently shown promising results., Objective: This study aimed to analyze the short-term weight loss effect of a mobile coaching intervention when it is integrated with a local public health care center and a regional hospital's antiobesity clinic as a multidisciplinary model., Methods: A total of 150 overweight or obese adults signed up to complete an 8-week antiobesity intervention program with human coaching through a mobile platform. Paired t tests and multiple linear regression analysis were used to identify the intervention factors related to weight change., Results: Among the 150 participants enrolled in this study, 112 completed the 8-week weight loss intervention. Weight (baseline: mean 77.5 kg, SD 12.9; after intervention: mean 74.8 kg, SD 12.6; mean difference -2.73 kg), body mass index, waist circumference, fat mass (baseline: mean 28.3 kg, SD 6.6; after intervention: mean 25.7 kg, SD 6.3; mean difference -2.65 kg), and fat percentage all showed a statistically significant decrease, and metabolic equivalent of task (MET) showed a statistically significant increase after intervention. In multiple linear regression analysis, age (beta=.07; P=.06), △MET (beta=-.0009; P=.10), number of articles read (beta=-.01; P=.04), and frequency of weight records (beta=-.05; P=.10; R 2 =0.4843) were identified as significant factors of weight change. Moreover, age (beta=.06; P=.03), sex (female; beta=1.16; P=.08), △MET (beta=-.0009; P<.001), and number of articles read (beta=-.02; P<.001; R 2 =0.3728) were identified as significant variables of fat mass change., Conclusions: The multidisciplinary approach, combining a mobile health (mHealth) care app by health care providers, was effective for short-term weight loss. Additional studies are needed to evaluate the efficacy of mHealth care apps in obesity treatment., (©Youngin Kim, Bumjo Oh, Hyun-Young Shin. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 21.01.2020.)

Backgrounds: Triglyceride (TG) is known to be regulated by multiple lifestyle factors rather than genetic factors. This cross-sectional and community-based study (Healthy Twin study in Korea) aimed to estimate the "modifiable TG level" by identifying non-genetic risk factors of TG., Methods: Participants were recruited between 2006 and 2011 who fulfilled health examinations and detail surveys: 3079 Korean adults including 949 monozygotic twins and 222 dizygotic twins. In order to investigate conventional risk factors, a mixed model accounting for family as a random effect was performed. In addition, we conducted a co-twin control analysis for 452 monozygotic twin (MZ) pairs, to examine non-genetic risk factors and potentially modifiable serum triglyceride levels., Results: After excluding patients on dyslipidemia or diabetes medication, 2672 individuals (1029 men, with mean age of 43.9; and 1643 women with mean age of 43.3; 949 MZ pairs, 222 dizygotic twin pairs, and 1501sibling pairs) were analyzed. Fasting blood sugar (FBS), lipid panel, height, weight, waist (WC) and hip circumference, body mass index (BMI), amount of dietary intake and amount of physical activity was examined after adjusting for age and sex. For conventional analysis, WC, fat %, and BMI were identified as significant factors influencing serum triglyceride levels. Examination of non-genetic factors from the Co-twin control study revealed BMI (beta coefficient 9.94 with C.I. 3.42 to 16.46) and amount of alcohol intake (beta coefficient 0.08 with C.I. 0.02 to 0.14) as significant factors., Conclusion: Our findings suggest that controlling body weight and alcohol intake might be effective to control TG; moderate weight control (BMI 1 reduction) and reducing alcohol consumption by 50 g/week (about two glassed of beer) might reduce TG level by 9.94 and 4.0 mg/dL.

This study tried to investigate the effects of number of medications and age on antihypertensive medication adherence in a real-world setting using a nationwide representative cohort.We obtained data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) of Korea, which is a sample of 2.2% (N = 1,048,061) of total population (N = 46,605,433). Patients aged 20 years or older (N = 150,550) who took antihypertensive medications for at least 1 year were selected. Medication possession ratio (MPR) was used for measuring adherence. The subjects were divided into 5 subgroups according to total number of medications: 1-2, 3-4, 5-6, 7-8, and 9 or more. The mean age and the mean number of medications were 60.3 ± 12.6 years and 4.1 ± 2.2, respectively. The mean MPR was 80.4 ± 23.9%, and 66.9% (N = 100,645) of total subjects were adherent (MPR ≥ 80%). The overall tendency of antihypertensive medication adherence according to the total number of medications displayed an inverted U-shape with a peak at 3-4 drugs. Adherence consistently increased as the age increased until age 69 and started to decrease from age 70. The proportion of adherent patients (MPR ≥ 80%) according to the total number of medications also showed an inverted U-shape with a peak at 3-4 drugs. When the same number of drugs was taken, the proportion of adherent patients according to age featured an inverted U- shape with a peak at 60 to 69 years. Patients taking 9 or more total drugs had the overall odds ratio (95% CI) of non-adherence (MPR < 80%) with 1.17 (1.11-1.24) compared with those taking 1 to 8 total drugs and the odds ratios in the age subgroups of 40 to 49, 50 to 59, 60 to 69 years were 1.57 (1.31-1.87), 1.21 (1.08-1.36), and 1.14 (1.04-1.25), respectively (P < .05).Association between age, total number of medications, and antihypertensive adherence displayed an inverted U-shape with a peak at 3 to 4 total medications and at age 60 to 69 years. When the total number of drugs was 9 or more, adherence decreased prominently, regardless of age.

Diabetic foot ulcer (DFU) is a complication experienced by diabetic patients and does not heal well in an altered wound environment. Although diverse microbes in DFU were detected, little is known about their influences on diabetic foot wound (DFW) and the association with the skin microbiota in normal tissue from the same patients according to clinical features. We aimed to analyze the microbiota in normal skin and DFW tissue from the same subject and predict their roles based on clinical features. We analyzed the microbiota in normal skin and DFW tissue from the same subject and compared the associated members of microbiota with clinical parameters. The diversity of skin microbiota was higher than that of DFW tissues, along with compositional differences. In addition, different microbes were associated with clinical features. The proportions of Bacteroidetes, Prevotella , Peptoniphilus , Porphyromonas , and Dialister were higher in the severe groups than of the mild groups, whereas that of Firmicutes was lower in the severe groups. According to wound severity, the microbiota could be related to inflammation, damaging host cell membrane, and pathogenicity through lipopolysaccharide biosynthesis, cellular antigens, and protein digestion metabolism. The predicted DFW microbiota functions according to systemic diabetic status defined by ESRD and HbA1c, differed from those presented by wound severity. Results indicate that the microbiota in normal skin is related to the colonizing microbes in DFW tissue according to clinical features and the different microbes can play important roles in DFW prognosis. This information can be applied to prevent and manage DFW by modulating the microbiota., Competing Interests: The authors declare that they have no conflicts of interest.

Background: Electronic cigarette (EC) consumption ('vaping') is rapidly increasing, not only in adults but also in adolescents. Little is known about the association between vaping and problem behaviors such as drinking., Methods: We used data from the 11th Korea Youth Risk Behavior Web-based Survey, which was conducted in 2015 and included 68,043 participants who were Korean middle and high school students. The survey assessed EC, cigarette, and alcohol use. Multiple regression analysis was used to examine risk of current drinking and problem drinking across the following categories of users: never user (never used either product), former user (use of EC or cigarettes in the past, but not currently), vaping only, smoking only, and dual user (current use of both products)., Results: EC only users were 1.2% in males, and 0.3% in females. Dual user of both conventional cigarettes and ECs were 5.1% in males, and 1.2% in females. Drinking frequency, drinking quantity per once, and problem drinking were higher among vapers than non-vapers and former-vapers, moreover, were higher among daily vapers than intermittent vapers. Compared to never users, EC only users were higher on risk of current drink and problem drink. The dual users were highest on risk of current drink., Conclusion: Vaping is independently associated with alcohol use problems in Korean students, even those not currently smoking. Moreover, dual use of cigarettes and ECs is strongly associated with alcohol use problems. Therefore, vaping students should be concerned about their hidden alcohol use problems.

Sleep debt is known to have harmful effects on health. Weekend catch-up sleep (CUS) is a behavior to cope with weekday sleep debt. However, it is unclear whether weekend CUS has advantageous effects on health because sleep hygiene guidelines recommend regularizing bed time and arousal time. The aim of this study was to identify whether weekend CUS behavior has an association with better health-related quality of life (HRQoL)According to the inclusion criteria, 4871 participants were selected from the 2016 Korea National Health and Nutrition Examination Survey. Sleep questionnaires and European quality of life scale-5 dimensions (EQ-5D) questionnaire were used to collect data about the participants' sleep patterns and HRQoL. Odds ratios (ORs) with 95% confidence intervals (95% CIs) for each dimensional problem of EQ-5D were derived by logistic regression. Mean EQ-5D index scores were compared between weekend CUS and non-CUS groups based on their weekday sleep durations and quintile of chronotype.The ORs of dimensional problems of HRQoL of non-CUS group versus weekend CUS group were 1.63 (95% CI 1.07, 2.47) for usual activities, and 1.45 (95% CI 1.11, 1.90) for anxiety/depression. Mean EQ-5D scores of the weekend CUS group were significantly higher than those of the non-CUS group for sleeping less than 6 hours (0.953 ± 0.004 vs 0.936 ± 0.007, P = .036) and sleeping 6 to 7 hours (0.965 ± 0.003 vs 0.955 ± .0.004, P = .045). These findings were similar in the fourth quintile (Q4) of chronotype (0.965 ± 0.007 vs 0.951 ± 0.008, P = .008) and fifth quintile (Q5) (0.952 ± 0.006 vs 0.941 ± 0.007, P = .022).Weekend CUS behavior was associated with better HRQoL than non-CUS among Korean adults. Especially, it was significant in participants who slept for less than 7 hours or participants whose chronotype was the fourth or fifth quintile. Attention may be needed for subjects with sleep short time and later chronotype who do not have weekend-CUS behaviors, because there is a risk that their HRQoL might be compromised.

Background/objective: South Korea's 2018 Report Card on Physical Activity for Children and Youth is the second comprehensive evaluation of physical activity and the sources of influence based on the 10 core indicators provided by the Active Healthy Kids Global Alliance. It will serve as an advocacy tool to promote physical activity among children and youth., Methods: Three national surveillance data (i.e., 2017 Korea Youth Risk Behavior Web-based Survey, 2016 Korea National Health and Nutrition Examination Survey, 2016 Physical Activity Promotion System) were used as main sources to evaluate the indicators. Descriptive statistics were performed to obtain prevalence estimates of physical activity-related indicators. In addition, expert opinions as well as the most recently available published or unpublished relevant sources were synthesized., Results: South Korea's 2018 Report Card, compared to the 2016 Report Card, showed favourable changes in the Active Transportation (B+), Organized Sports Participation (C), Sedentary Behaviours (D), and School (D+) indicators, while unfavourable changes were shown in Overall Physical Activity (F) and Government (D). Physical Fitness was graded as D+. In parallel with the 2016 Report Card, Active Play, Family and Peers, and Community and Environment remain ungraded due to insufficient data., Conclusions: Successes as well as gaps and research needs were identified in the 2018 Report Card. Though some indicators have shown improvement, most children and youth continue to be insufficiently physically active with overall poor grades (Average of D+). To achieve substantial improvement in all grades in future Report Cards, more institutional and governmental support and investment is needed to promote physical activity. Furthermore, effort should be made to generate data pertaining to the indicators that were ungraded.

It is important to understand the association between oxidative stress-related parameters and to evaluate their status in advance of chronic disease development. Further development towards disease can then be prevented by dietary antioxidants. The present study was aimed at assessing the relationship between diet quality, blood antioxidants, and oxidative damage to determine whether the association between these markers differs by oxidative stress status. For a cross-sectional analysis, we used data and samples of baseline information from a prospective cohort study. A total of 1229 eligible adults were classified into apparently healthy subjects (66.5%) and those with oxidative stress conditions (35.5%). Diet quality was assessed using the recommended food score (RFS). Plasma carotenoids (blood antioxidants) and blood/urinary malondialdehyde (MDA; oxidative damage) were determined by high-performance liquid chromatography. We found that the healthy group was younger, and they had a lower RFS and plasma MDA level and higher plasma carotenoids compared to the oxidative stress condition group. This result is probably due to the quenching of the oxidative response in the tissues of those people. A positive association of RFS with plasma carotenoids (total and β -carotene) was found in both groups, suggesting that carotenoids are a robust reflection of diet quality. Negative associations were observed between plasma MDA and RFS in the oxidative stress condition group and between urinary MDA and plasma zeaxanthin in the healthy group. Erythrocyte MDA was positively associated with plasma carotenoids (total, lutein, zeaxanthin, β -cryptoxanthin, and α - and β -carotene), regardless of health condition, probably also as a result of the use of carotenoids as antioxidants. In conclusion, these results indicate that the above three factors may be associated with the oxidative stress response and depend on the oxidative status. Furthermore, it was also suggested that erythrocytes are important in the oxidative stress response and the quenching of this response is represented in plasma carotenoids.

Both extremely long and short sleep durations have been associated with increased risk of numerous health problems. This study examined the association between self-reported sleep duration and reporting of musculoskeletal pain in the adult Korean population.This study included data from 17,108 adults aged ≥50 years, obtained from the Korea National Health and Nutrition Examination Survey 2010-2012 and 2013-2015. Self-reported daily hours slept and the presence of musculoskeletal pain in knee joint, hip joint, or low back were examined. Patients were stratified into 5 groups by their sleep duration: ≤5, 6, 7, 8, or ≥9 h. Multivariate logistic regression analysis was performed, adjusting for covariates including age, sex, marital status, smoking, alcohol use, family income level, education, physical exercise, body mass index (BMI), and stress level.A U-shaped relationship was observed between the length of sleep duration and the presence of musculoskeletal pain. After adjusting for covariates, sleep duration of ≤5 h or ≥9 h was significantly associated with musculoskeletal pain experienced for more than 30 days over a 3-month period. We also found that the presence of multi-site musculoskeletal pain was significantly higher among those who slept for ≤5 h or ≥9 h than in those who slept for 7 h.These findings suggest that either short or long sleep duration is associated with musculoskeletal pain among Korean adults.

We aimed to investigate the potential of preoperative mammographic breast density (MBD) as a prognostic factor in breast cancer. Data of 969 patients with primary breast cancer were analyzed. We defined low MBD as fatty or fibroglandular breast, and high MBD as heterogeneously dense or extremely dense breast, respectively. The high MBD group demonstrated a superior overall survival rate compared to the low MBD group (p < 0.001). Favorable prognostic effects of high MBD were observed in subgroups aged >50 years (p < 0.001) and with positive hormone receptor (HRc) and negative human epidermal growth factor receptor 2 (HER2) (p < 0.001). The high MBD group had a higher proportion of patients aged ≤50 years (p < 0.001) and patients with body mass index (BMI) ≤25 kg/m 2 (p < 0.001), and a higher proportion of patients who received chemotherapy (p < 0.001). MBD was a significant independent prognostic factor by multivariable analysis (hazard ratio, 0.382; 95% confidence interval, 0.206-0.708). The high MBD group was associated with superior overall survival rates. Preoperative MBD was a strong independent prognostic factor in operable primary invasive female breast cancer, especially in patients with age >50 years and the HRc(+)/HER2(-) subtype. Favorable clinicopathologic features, active treatments, and other factors could contribute to this causality.

Background: The aim of the present study is to evaluate the association between BMD and type 2 DM status in middle-aged and elderly men. To investigate a possible correlation, the present study used the BMD dataset of the Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011., Methods: In total, 37,753 individuals participated in health examination surveys between 2008 and 2011. A total of 3383 males aged ≥50 years were eligible. They underwent BMD measurement through dual-energy X-ray absorptiometry (DXA). The fasting plasma glucose and insulin levels of participants were also measured., Results: Men with prediabetes and diabetes had significantly higher mean BMD at all measured sites than control men did, irrespective of DM status. This was confirmed by multivariable linear regression analyses. DM duration was an important factor affecting BMD. Patients with DM for > 5 years had lower mean BMD in the total hip and femoral neck than those with DM for ≤5 years. Per multivariable linear regression analyses, patients with DM for > 5 years had significantly lower mean BMD at the femoral neck than those with DM ≤5 years., Conclusions: DM duration was significantly associated with reduced femoral neck BMD.

Background: Recent studies on physical activity were analyzed by randomizing participants into either the intervention or control group. It is necessary to classify each intervention and control groups according to physical activity using the International Physical Activity Questionnaire (IPAQ)., Methods: This was a pilot project for SmartCare Services. The intervention group received obesity management services using a smartphone for 24 weeks, while the control group did not receive the interventions. Six anthropometric indices were analyzed: weight, body mass index (BMI), waist circumference, body fat, systolic blood pressure (SBP), and diastolic blood pressure (DBP). Five laboratory tests, including fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglycerides (TGs), were also assessed. The final 324 participants were categorized using the IPAQ questionnaire, and anthropometric indices and laboratory tests were analyzed for within-group and between-group changes from baseline to final visit., Results: Statistically significant decreases in the intervention group compared with the control group were observed in terms of insufficient activity (IA) (-1.6 ± 3.03 vs -0.1 ± 1.94 kg) and moderate activity (MA) (-2.5 ± 3.81 vs -0.3 ± 2.24 kg) for weight, IA (-0.7 ± 1.14 vs -0.2 ± 0.93 kg/m) and MA (-0.9 ± 1.30 vs -0.2 ± 0.86 kg/m) for BMI, and health-enhancing physical activity (HEPA) (-1.6 ± 3.69% vs -0.1 ± 3.15%) for body fat. For HbA1c, HEPA in the intervention group showed significant decreases (-0.2 ± 0.67 vs 0.0 ± 0.34 mg/dL) compared with the control group., Conclusion: Anthropometric indices and laboratory test results were improved in the smartphone-based intervention group. Especially, improvement of metabolic components in the group with more active physical activity was remarkable.

Purpose: To investigate risk factors for high myopia in the general Korean population., Methods: In this nationwide population study, the dataset of the Korea National Health and Nutrition Examination Survey 2008-2012 was analyzed. The study cohort included 11 703 participants, aged 25-49 years, who underwent neither refractive nor cataract surgery. The association between demographic, socioeconomic, behavioral, and systemic variables and high myopia was investigated., Results: The mean participant age was 37.9 ± 6.8 years, and the prevalence of high myopia ≤-6.0D was 7.0 ± 0.3% in the study population. The right eyes (-1.76 ± 0.03 D) were more myopic than the left eyes (-1.70 ± 0.03 D; P < 0.001). In multivariate logistic regression analysis, high myopia was associated with age (odds ratio [OR], 0.97 per 1 year-increase) and female sex (OR, 1.24). Other identified risk factors included education level ≥ university graduation (OR, 1.91), the presence of hypertension (OR, 1.69), and serum glucose level (OR, 1.01 per 1 mg/dL). Sunlight exposure of ≥5 h/day (OR, 0.67) and serum 25-hydroxyvitamin D level (OR, 0.97 per 1 ng/mL) showed protective effect against high myopia., Conclusion: High myopia is associated with younger age, female sex, high education level, longer sunlight exposure, and some other systemic conditions.