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Objective: To examine the clinical characteristics of atypical femoral fracture (AFF) and to determine the risk factors for and clinical outcomes of AFFs in rheumatoid arthritis (RA) patients treated with bisphosphonates (BPs)., Methods: A nested case-control study was conducted using data derived from the medical records of all RA patients treated with BPs at Seoul St. Mary's Hospital, a tertiary rheumatology center, from January 1, 2008 to December 31, 2014. All of the patients with RA and had been treated with BPs for at least 1 year. Ten RA patients with AFF were identified, and each of these patients (cases) was age- and sex-matched with 4 RA patients without AFF (controls)., Results: Five hundred fifty-two RA patients had BP exposure. Of the 10 with AFF, all were female (mean ± SD age 66.3 ± 8.7 years), and 90% of cases involved fracture of the proximal femur. The mean ± SD length of BP exposure in patients with AFF was 7.4 ± 3.2 years. Compared with controls, patients with AFF had a longer exposure to BPs and more often had a femorotibial angle of <175 degrees (both P < 0.001). There were no differences in RA duration, medications taken during the previous 6 months, and bone mineral density in the femur and lumbar spine between patients with and those without AFF. Multivariate logistic analyses identified longer BP exposure (odds ratio 2.386 [95% confidence interval 1.066-5.343]) as being associated with an increased risk of AFF., Conclusion: RA patients who have a valgus deformity and are receiving long-term BP treatment are at higher risk of AFF compared with matched control patients with RA. These patients should be carefully followed up with hip radiography or dual x-ray absorptiometry., (© 2016, American College of Rheumatology.)

Objectives: The present study was designed to investigate the smoking and heavy smoking trends and identify possible related factors among Korean male workers from 2007 to 2012 by occupational groups., Methods: The data were derived from the fourth (2007-2009) and fifth (2010-2012) waves of the Korean National Health and Nutrition Examination Survey (KNHANES). Occupational groups were categorised into three groups, which were non-manual, manual and service and sales groups. Age-adjusted prevalence rates of smoking and heavy smoking (>20 cigarettes/day) in men aged 25-64 years were calculated. Factors associated with heavy smoking were investigated using logistic regression analyses., Results: Smoking rate in manual workers decreased gradually over time (p for trend <0.0001). Smoking rate was higher in manual than non-manual workers, but the difference reduced over time (p for trend <0.0001). Heavy smoking rate decreased from 2007 to 2012 (p for trend <0.0001). Heavy smoking rate was higher in manual than non-manual workers; however, this difference increased over time. Stress, depressive mood and long working hours (≥60 h/week) were associated with heavy smoking., Conclusions: Antismoking policy should focus on current and heavy smokers. Workplace antismoking programmes should consider working hours and stress, especially in manual workers., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Background: Lateral lymph node metastasis is an important prognostic factor and is predictive of tumor recurrence and cause-specific survival in patients with papillary thyroid cancer (PTC). However, the factors predicting recurrence and clinical outcomes after therapeutic lateral neck dissection are not well established. The aims of this study were to evaluate the incidence, pattern, and factors predictive of PTC recurrence after therapeutic lateral neck dissection., Materials and Methods: The records of 126 consecutive patients who underwent total thyroidectomy with therapeutic lateral neck dissection for primary PTC at the National Cancer Center were retrospectively reviewed. The factors predictive of recurrence were determined using both univariate and multivariate analyses considering several clinicopathologic variables., Results: The median follow-up period was 61.2 months, during which 22 patients (17.5 %) experienced recurrence with 1 death (0.8 %) due to disease. Locoregional recurrence and distant metastasis were found in 20 cases (15.9 %) and 2 cases (1.6 %), respectively. Male gender, aggressive histology, number of lymph node metastases, initial level of T4-off Tg per ng/mL, and ATA risk categories (high risk) were independent risk factors for recurrence. Of note, initial T4-off Tg levels greater than 4.2 ng/mL showed highest sensitivity and specificity in predicting recurrence., Conclusions: These results provide useful information regarding the clinical outcomes after therapeutic lateral neck dissection for primary PTC and can be used to identify at-risk patients who need aggressive treatment and intensive surveillance for postoperative recurrence.

Objectives: The present study was designed to identify the association between work hours and obesity in Korean adult manual and nonmanual workers, and to determine whether there is a gender difference in this association., Methods: The study was conducted using Korean National Health and Nutrition Examination Survey data collected between 2007 and 2010. Individuals aged below 25 or over 64 years, pregnant women, part-time workers, soldiers, housewives and students were excluded. The total number of individuals included in the analysis was 8,889 (5,241 male and 3,648 female subjects). The outcome variable was obesity, defined as body mass index ≥25 kg/m(2). Variables considered in the model were age, education, income, marital status, alcohol drinking, smoking, daily energy intake, physical activity, sleep hours per day, the type of job, work hours, and work schedule. Work hours were categorized as <40, 40-48 (reference), 49-60, and >60 hours per week., Results: In the multiple SURVEYLOGISTIC regression analyses, the adjusted odds ratio of obesity for long work hours (>60 hours per week) in male manual workers was 1.647 (95% confidence interval 1.262-2.151). Long work hours did not significantly increase the odds ratio for obesity in male nonmanual workers and female manual and nonmanual workers., Conclusions: More than 60 work hours per week increased the risk of obesity in Korean male manual workers. This result might be helpful in preventing obesity in Korean adult workers, especially male manual workers.

Background: A variety of sociodemographic factors, such as gender, age, household income, and educational level, influence individuals' likelihood of smoking. Work-related factors may also be linked to smoking behavior. We sought to investigate the relationship between smoking and work environment in South Korea., Methods: We analyzed data from the Fifth Korean National Health and Nutrition Examination Survey to determine whether there was an association between smoking and occupation type (e.g., manual, nonmanual, or service work), night-shift work, and hours worked/week (e.g., <40, 40-48, 49-60, or >60 hours) for 4,685 workers. Regression models were adjusted for sociodemographic variables such as age, recent alcohol consumption, hours slept, educational level, and household income., Results: The prevalence of smoking was 50.1% in men and 7.2% in women. For women, manual workers had 2.34 times [95% confidence interval (CI): 1.02-5.36] greater odds of smoking compared with nonmanual workers, whereas service workers had 2.37 times greater odds (95% CI: 1.28-4.40). Furthermore, women who worked 49-60 hours had 2.21 times greater odds of smoking (95% CI: 1.10-3.75) as compared with women who worked 40-48 hours., Conclusion: Women who work long hours or who are employed in service or manual positions are more likely to smoke. These results indicate a need in South Korea to target these specific groups when creating nonsmoking policies.

Purpose: We investigated the role of individual and community level factors on diabetes screening test behavior., Methods: We used individual-level data from 170,193 adults aged 30 years or older who were not diagnosed with diabetes and participated in the 2009 community health survey. Community-level data includes 253 communities and were collected from various national statistics. Multilevel logistic regression analysis was conducted., Results: The rate of diabetes screening within the year prior to this study was 53.2%. Community variance of Model I, Model II and Model III was 0.236, 0.252 and 0.238, respectively. The proportional change in variance of Model II and Model III was -6.8% and -1.2%. The odds ratio for participation of diabetic screening of areas with bottom financial independence compared to areas with top was 0.84 (95% confidence interval, 0.74-0.96); the odds ratio of areas with top internist compared to areas with bottom was 1.15 (95% confidence interval, 1.01-1.31)., Conclusion: This study identified a contextual effect influencing the participation of Korean adults in diabetes screening. It is necessary to develop specific policies that consider not only individual factors, but also community factors relating to individual behaviors to increase the likelihood of diabetes screening., (Copyright © 2013. Published by Elsevier B.V.)

Purpose: Longitudinal changes in the prevalence of self-reported physician-diagnosed allergic rhinitis (AR) in Korea and the association between the prevalence of AR and type of residence area among Korean males and females in 1998, 2001, 2005 and 2007-2009 were evaluated., Methods: Age-standardized prevalence was calculated using the Korea National Health and Nutrition Examination Survey (KNHANES) I-IV. Stratified factors of sex, age, and socioeconomic status were adjusted to compare the prevalence of AR in relation to residential area by multiple logistic analysis., Results: The prevalence of AR increased by tenfolds from 1.2 % in 1998 to 12.0 % in 2007-2009. The trends for prevalence of AR were also statistically significant (p < .05). The age-standardized prevalence of AR among urban females was higher (13.9%) than that in rural females (11.5%). After adjustment for survey years, age, socioeconomic levels and asthma, the odds of AR were higher in urban than rural residents, except for males in 1998., Conclusion: The prevalence of AR in Korea has increased over the past decade, and living in an urban area may be a susceptible factor. For prevention and management of AR, further evaluations of contributing factors and mechanisms underlying differences in AR are needed., (Copyright © 2012. Published by Elsevier B.V.)

Occupation can influence the prevalence of metabolic syndrome. Age and gender could interact with the association between occupation and metabolic syndrome. This study aimed to investigate the prevalence of metabolic syndrome among the Korean working population and determine whether the prevalence differed according to occupation, age and gender. We conducted a cross-sectional study in Korean adults using the Third Korean National Health and Nutrition Examination Survey (KNHANES III). The analysis included 3,288 workers over 19 yr old. The prevalence odds ratios (PORs) of metabolic syndrome among representative types of occupations were estimated after stratification for age and gender by logistic regression. Female manual workers had a higher prevalence of metabolic syndrome than female non-manual workers among those younger than age 50 (POR=1.95, 95%CI=1.12-3.40). However, female manual workers aged 50 and older had a lower prevalence of metabolic syndrome than female non-manual workers (POR=0.36, 95%CI=0.22-0.59). Manual occupations can be a risk factor for metabolic syndrome, but this correlation is limited to younger female workers. The effects of occupation on the prevalence of metabolic syndrome were different between older and younger workers, which could be due to longitudinal transition of socio-cultural structure.

Background: There is concern that endoscopic/robotic thyroidectomy could impair anterior chest skin sensation. Here, this possibility was assessed., Patients and Methods: Fifty-one patients who underwent bilateral axillo-breast approach endoscopic/robotic thyroidectomy were asked 8 to 115 days (median: 29 d) later to undergo Semmes-Weinstein pressure threshold testing and to complete a questionnaire. Patient clinicopathological details were extracted., Results: Twenty-one patients (41.2%) showed sensory impairment (sum of sensory changes ≥ 1). The average sum of sensory change (scale of 0 to 95) was 1.4 (range, 0 to 8). Impaired patients did not differ from unimpaired patients in any clinicopathological parameter except for time from operation. Compared with 1 month postsurgery, there was significantly less sensory impairment 3 months postsurgery (P=0.0083). The questionnaires yielded similar observations., Conclusions: The temporary and mild nature of the sensory change in the anterior chest area will relieve surgeons and patients from concerns that bilateral axillo-breast approach endoscopic/robotic thyroidectomy could permanently impair chest sensation.