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Background Self-employed business owners in Korea make up one-quarter of the working population, and half of those who are self-employed are in micro and small businesses. Compared to the significant research interest in business management and economics, to date, there has been little interest in the health of small business owners. We investigated the health status of self-employed small business owners compared to standard workers. Methods The third Korean Working Conditions Survey, which included a total of 32 630 adults aged 20 to 59 years, was analyzed. A small business was defined as an enterprise with between 0 and 4 workers. Standard employment included full-time employment with a permanent or 1-year contract. Health outcomes included eight types of physical health and mental health problems assessed using the WHO-5 Wellbeing Index. Results Small business groups were found to have an increased prevalence of depression after controlling for all potential covariates (odds ratio [OR] = 1.37; 95% confidence interval [CI] 1.29-1.47). In addition, the prevalence of work-related physical health problems was significantly higher among self-employed small business owners in a full adjusted model: backache (OR = 1.16; 95% CI, 1.06-1.26), muscular pains in upper limbs (OR = 1.19; 95% CI, 1.12-1.27), and muscular pains in lower limbs (OR = 1.14; 95% CI, 1.07-1.22). Conclusion We found a positive association between small business entrepreneurs and increased prevalence of mental and physical illness in adults in the Republic of Korea.

Background and purpose As an osteoclast differentiation factor, receptor activator of NF-κB ligand (RANKL) is produced by various immune cells and may be involved in the pathogenesis of osteoporosis and inflammation. Although RANKL is expressed in most immune cells and tissues, it is not clear how this might affect allergic inflammation. Experimental approach The roles of RANKL in allergic rhinitis (AR) were analysed in an ovalbumin (OVA)-induced animal model, human subjects, and a human mast cell line (HMC-1). Small interfering RNA experiments were performed in an OVA-induced AR model. Key results RANKL and RANKL receptor (RANK) were up-regulated in serum or nasal mucosal tissues of AR patients and AR mice. RANKL and RANK were colocalised in mast cells of nasal mucosa tissue. Depletion of RANKL by RANKL siRNA ameliorated AR symptoms and reduced AR-related biomarkers, including thymic stromal lymphopoietin (TSLP), IgE, histamine, and inflammatory cell infiltration, whereas recombinant RANKL increased AR responses and TSLP levels. In addition, functional deficiency of TSLP decreased AR responses induced by RANKL. In human mast cells, interaction of RANKL with RANK increased production of TSLP and inflammatory cytokines. Production of TSLP by RANKL stimulation was mediated through activation of the PI3K, MAPK, caspase-1, and NF-κB pathways. Furthermore, dexamethasone alleviated RANKL-induced inflammatory reactions in AR models. Conclusion and implications Collectively, these data suggest that RANKL may induce development of AR through up-regulation of TSLP.

Objective Over 24% of older American adults (approximately 14 million) are estimated to have reduced olfactory sensitivity. Previous studies have provided evidence that patients with diabetes mellitus (DM) or its complications are at increased risk of olfactory dysfunction. We therefore investigated whether smell dysfunction was associated with DM-related biomarkers, including fasting blood glucose, glycohemoglobin, serum insulin, and homeostasis model assessment of insulin sensitivity (HOMA-IR), in older US adults. Methods Data from 9,678 older adults who had participated in the 2013 to 2014 National Health and Nutrition Examination Survey were available for this study. We used the eight-item, self-administered scratch-and-sniff smell test (Sensonics, Inc., Haddon Heights, NJ) for assessing smell. Smell dysfunction was defined as the condition with an odor identification score of ≤ 5. Results Of the 978 participants, 20% of older adults (n = 193) were defined as having smell dysfunction. After adjustment for potential confounding variables, participants in the highest HOMA-IR quintile had approximately two-fold increased odds (odds ratio = 2.25; 95% confidence interval: 1.25-4.05) of smell dysfunction compared with those in the lowest HOMA-IR quintile. In contrast, the odds of smell dysfunction were not associated with the quintiles for fasting blood glucose, glycohemoglobin (HbA1c), or serum insulin levels. Conclusion We found a significant association between smell dysfunction and severe insulin resistance in older US adults. Our data suggests that insulin resistance may be mechanistically linked to loss of smell function. Level of evidence 4. Laryngoscope, 128:1992-1996, 2018.

Objective To evaluate if molecular markers of eosinophilia in olfactory-enriched mucosa are associated with olfactory dysfunction. Study Design Cross-sectional study of tissue biopsies from 99 patients, and an additional 30 patients who underwent prospective olfactory testing prior to sinonasal procedures. Methods Tissue biopsies were processed for analysis of inflammatory markers using quantitative real time polymerase chain reaction (qRT-PCR). Ipsilateral olfactory performance was assessed using the Sniffin' Sticks (Burghart, Wedel, Germany) threshold component and the University of Pennsylvania Smell Identification Test (Sensonics, Haddon Heights, NJ). Age-adjusted data was correlated with inflammatory marker expression and clinical measures of obstruction from computed tomography and endoscopy. Results Gene expression of the eosinophil marker CLC (Charcot Leyden crystal protein) was elevated in superior turbinate (ST) tissue in chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) compared to ST and inferior turbinate tissue in CRS without nasal polyps (CRSsNP) and control patients (all P < 0.001, respectively). CLC in ST tissue was correlated with IL-5 and eotaxin-1 expression (all P < 0.001; P = 0.65, and 0.49, respectively). CLC expression was strongly correlated with eosinophilic cationic protein levels (P < 0.001; r = −0.76), and ST CLC expression was inversely related to olfactory threshold (P = 0.002, r = −0.57) and discrimination scores (P = 0.05, r = −0.42). In multiple linear regression of CLC gene expression, polyp status, and radiographic and endoscopic findings with olfactory threshold, CLC was the only significantly correlated variable (P < 0.05). Conclusion Markers of eosinophils are elevated in the ST of patients with CRSwNP and correlate with olfactory loss. These findings support the hypothesis that olfactory dysfunction in CRS correlates local eosinophil influx into the olfactory cleft. Level of Evidence NA. Laryngoscope, 2017

Background This study explored whether precarious workers have difficulties in health care access as compared with non-precarious workers. Methods The 2008 Korean Community Health Survey data were used for this study. Information was obtained on 51,322 participants (40,514 non-precarious workers and 10,808 precarious workers). Precarious workers were defined as part-time or contingent workers. Results Precarious workers had significantly higher risk of limited access to hospitals (OR = 1.14; 95% CI: 1.06–1.22) and dentists (OR = 1.28; 95% CI: 1.21–1.36) than non-precarious workers; disparities in doctor contacts among precarious workers were mostly linked to not having enough money. The risk of not receiving preventive care—medical checkups (OR = 0.52; 95% CI: 0.49–0.55) or cancer screenings (OR = 0.82; 95% CI: 0.77–0.86)—was also significantly elevated among precarious workers. Conclusion We found that precarious workers had more difficulty accessing health care or receiving health checkups or cancer screenings than their non-precarious counterparts. Am. J. Ind. Med. © 2016 Wiley Periodicals, Inc.

Background Chronic rhinosinusitis (CRS) is likely a biologically heterogeneous disease process. Current guidelines propose subclassification using polyp status while others propose using mucosal eosinophilia. We hypothesized that appropriate CRS subclassification would increase homogeneity of baseline symptoms, and identify characteristic symptoms of each subtype. Methods A total of 57 CRS patients undergoing surgery prospectively completed a preoperative battery of 73 questions relating to symptoms including the 22-item Sino-Nasal Outcome Test (SNOT-22) and 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29) general quality of life (QOL) measures. Eosinophilic cationic protein (ECP) levels were determined from ethmoid, uncinate, and polyp tissue homogenates using enzyme-linked immunosorbent assay (ELISA) and normalized to total protein. Patients were classified as eosinophilic (eCRS) or non-eosinophilic (neCRS) using a 95th percentile threshold established from control tissue from 82 patients without CRS. Separate pairwise comparisons were performed on patient-reported symptoms using polyp and eosinophilic status. Results Of the 57 patients, 28 had CRS with nasal polyps (CRSwNP); 27 of 57 patients had eCRS (CRSwNP, n = 21; CRS without nasal polyps [CRSsNP], n = 6). CRSwNP patients had increased need to blow nose, frequency of nasal congestion, more severe difficulty breathing through nose, more severe nasal discharge, but less cough (p < 0.05). eCRS patients had more bothersome loss of taste/smell, ear pain, sneezing, severe difficulty breathing through nose, and severe nasal congestion compared to neCRS patients (p < 0.05). Conclusion Subclassifying CRS with symptoms alone is difficult with neither polyp status nor eosinophilia giving a distinctive clinical symptom profile. However, certain symptoms may help otolaryngologists identify CRS subtypes, which may help guide future treatments. Further validation and evaluation of prognosis following treatment is required to evaluate appropriate means of subclassifying CRS.

Background Chronic rhinosinusitis (CRS) is a common condition encountered in primary care medicine and is estimated to affect 12.5% of the United States population. This study aims to compare methods of assessing health utility in CRS. Methods A cross-sectional sample of CRS patients (n = 137) were interviewed using direct health utility assessment measures: the visual analogue scale (VAS), time trade-off (TTO), and standard gamble (SG). General quality of life (QOL) scores were obtained via the 36-item Short Form Health Survey (SF-36) and converted to SF-6D health utility values using a Bayesian algorithm. Disease-specific QOL was measured with the 22-item Sino-Nasal Outcome Test (SNOT-22). A selected subgroup of patients (n = 51) not initiating surgery or new treatment for CRS were re-interviewed within 3 weeks. Results The mean ± SD health utilities were VAS 0.69 ± 0.19; TTO 0.80 ± 0.27; SG 0.93 ± 0.11; and SF-6D 0.72 ± 0.12; they differed significantly (p < 0.001). Only VAS scores differed based on disease state classification or the presence of nasal polyposis. Correlations between methods of determining health utility were weak, but significant. VAS, TTO, and SF-6D scores were significantly associated with SNOT-22 (p < 0.001 for all); however, SG and SNOT-22 were poorly correlated (Spearman correlation = −0.33). The test-retest reliability of TTO (Spearman correlation = 0.71) and SG (0.73) was strong. Conclusion CRS patients show significant impairment in QOL, with health utility values similar to those of patients with acquired immune deficiency syndrome (AIDS) or intermittent claudication using similar methods. The method of ascertainment significantly affects measured health utility, but the degree of impairment warrants improved recognition and appropriate treatment of the condition.

Background This study investigated whether experience of workplace injustice was associated with self-reported occupational health using a nationally representative sample of Korean workers. Methods We used the first wave of the Korean Working Conditions Survey (KWCS) and included 7,007 wage employees as the study population. Workplace injustice included the experience of discrimination, violence, or harassment, and occupational health was measured as self-reported health problems and absenteeism. Personal, occupational, and job-related characteristics were included as covariates. Results An average of 7.2% of workers reported experiencing at least one workplace injustice over the past 12 months. Female workers were significantly more likely to experience age and gender discrimination, and unwanted sexual attention than male workers. Both male and female workers who experienced any workplace injustice (i.e., discrimination, harassment, or violence) reported approximately two- to threefold increased risk for physical and mental health problems (i.e., backaches, muscular pain, stomach pain, overall fatigue, headaches, anxiety/depression, sleeping problems, and injury) and absenteeism due to accidents or due to health problems. Conclusion Perceived injustice at work was significantly associated with an increased risk of occupational disease and absenteeism for Korean wage employees. Am. J. Ind. Med. 57:87–96, 2014. © 2013 Wiley Periodicals, Inc.

Tip surgery remains the most difficult part of rhinoplasty in Asian patients because of the lower lateral cartilage characteristics and thick skin. The objective of this study was to evaluate the multilayer cartilaginous tip-grafting technique used for tip refinement in Korean patients undergoing rhinoplasty.Case series with chart review.Academic tertiary care medical center.A retrospective study of 99 Korean patients who underwent open rhinoplasty involving multilayer cartilaginous tip-grafting for tip refinement was performed. Autologous septal, conchal, costal, or homologous costal cartilage, or a combination of these materials was used as grafting materials. Preoperative and postoperative photographs were reviewed for objective and subjective assessment of aesthetic outcomes.Among patients, 7 had undergone previous rhinoplasty (7.1%), and removal of the previously placed silicone graft was required in 5 patients (5.1%). Two (6.7%), 3 (61.5%), 4 (28.8%), and 5 (3.0%) layers of cartilaginous graft were used. Postoperative aesthetic outcomes were graded as excellent in 63.6%, fair in 28.3%, and no change/worse in 8.1% of cases. Preoperative and postoperative objective measurements showed that the procedure resulted in increased nasal tip projection (0.52 ± 0.06 vs 0.57 ± 0.05; P.05) and improved nasolabial angle (92.98° ± 9.95° vs 95.34° ± 8.20°; P.05). The overall complication rate was 12.1%, and 8 patients required revision surgery (8.1%). Complications included infection (5.1%), visible graft contour (1.0%), nostril deformity (1.0%), overprojection (2.0%), and visible hypertrophic scar at the marginal incision site (3.0%).The multilayer cartilaginous tip-grafting technique was found to be effective for aesthetic refinement of the nasal tip when used in rhinoplasty for Korean patients.

We assessed the relationship between particle air pollution and changes in lung function in children as measured by spirometry over time. Data were collected from air pollution and family health examinations of 181 subjects, aged 9–19 years, in a Korean community. The children performed lung function tests, and their height and weight were measured. Their parents responded to an interview regarding the children's history of disease. Data on air pollution were obtained from the Environmental Management Corporation, which is part of the Korean Ministry of the Environment. We found evidence that the declines in forced vital capacity (FVC) and forced expiratory volume in 1 sec (FEV1) were significantly associated with the PM10 concentration for 37–60 hr preceding the lung function tests. The associations were consistent in the two-pollutant models. Our findings suggest that exposure to PM10 may increase the risk of adverse health effects in children with respiratory symptoms or diseases. Pediatr Pulmonol. 2008; 43:476–480. © 2008 Wiley-Liss, Inc.

Background. The aim of this study was to investigate the correlation between lymphatic vessel density in squamous cell carcinoma of the tongue and regional metastasis. Methods. Intratumoral and peritumoral lymphatic densities (ILDs and PLDs, respectively) were determined by immunohistochemical staining of lymphatic endothelial cells with podoplanin in 62 patients surgically treated for tongue cancer. Clinicopathological variables were quantified, and their correlations with regional metastasis were assessed. Results. The rate of regional metastasis was significantly higher in patients with high ILD than that in those with low ILD (21/33, 63.6% vs 8/29, 27.5%; p = .006). Perineural invasion and lymphovascular invasion were also significantly correlated with regional metastasis. By multivariate analyses, ILD was the only variable identified to be significantly correlated with regional metastasis (p = .009). On the other hand, PLD showed no correlation with regional metastasis. Conclusions. ILD showed a strong correlation with regional metastasis in patients with squamous cell carcinoma of the tongue. © 2009 Wiley Periodicals, Inc. Head Neck, 2010

ObjectivesThe aim of this study was to evaluate the pathognomic findings of magnetic resonance image(MRI) and determine the benefit of MRI in early diagnosis of invasive fungal sinusitis(IFS).Metho...