Search

Background This study aimed to examine the impact of marital transitions on the incidence of frailty among older adults in South Korea. Methods Data for this longitudinal study were extracted from the first to seventh wave (2006–2018) of the Korean Longitudinal Study of Aging, which included 5,133 participants. Frailty was assessed using the Frailty Instrument scale. Marital transition was categorized into four groups (spouse to spouse [SS], spouse to no spouse [SN], no spouse to spouse [NS] and no spouse to no spouse [NN]). Transitions in marital status and their relationship with frailty were investigated using lagged generalized estimation equations. Results The SN group (OR 1.65 CI 1.26 − 2.15) and NN groups (OR 1.64 CI 1.40 − 1.93) had increased likelihood of frailty than the SS group. Furthermore, males in the NN group (OR 2.10 CI 1.53 − 2.88) had the highest odds of frailty among all groups, whereas females in the SN group (OR 1.58 CI 1.17 − 2.14) had higher odds of frailty than those in other groups. Conclusion Spousal status may affect frailty among middle-aged and older adults in South Korea. The likelihood of frailty increased for those who lived alone or had been divorced or widowed. Single/unmarried men had a higher likelihood of frailty than widowed or divorced men, while widowed or divorced women had a higher likelihood of frailty than unmarried women.Spousal status is a potential factor that influences frailty, which can be affected differently by sex.

Housing is an important social determinant of health. We investigated effects of changes in housing tenure and affordability on depressive symptoms.Data of 9,956 individuals aged20 years from the Korea Welfare Panel Study (2015-2020) were analyzed. Housing tenure was categorized as homeowners or tenants. Individuals with housing-related expenditures exceeding 30% of household income were defined as having housing unaffordability. Analyses using generalized estimating equations were conducted to evaluate the relationship between changes in housing tenure and affordability on depressive symptoms measured with the Center for Epidemiologic Studies Depression Scale.Individuals who became tenants (β = 0.326, p = 0.027) or were persistent tenants (β = 0.542, p0.001) demonstrated significantly more severe depressive symptoms than persistent homeowners. Individuals with new (β = 0.562, p0.001) or consistent housing unaffordability (β = 1.032, p = 0.036) showed increased depressive symptoms compared with those with persistent housing affordability. Depressive symptoms were reduced in new homeowners and those who left housing unaffordability status (β = -0.807, p = 0.031). The interaction between housing tenure and affordability on depressive symptoms differed by age and household composition. Housing tenure at post-retirement age and single-person households were associated with a decrease in depressive symptoms, respectively.All housing-related factors, especially different domains of housing insecurity including unstable neighborhoods or reasons for moving, have not been identified.Changes in housing tenure, affordability, and the two combined were significantly associated with depressive symptoms. Furthermore, the degree of interactive effect varied among age groups and household composition. Housing welfare policies that can stabilize housing tenure and affordability might help prevent depression.

Context Despite previous studies regarding the association between smoking and diabetes, the effects of electronic cigarettes and secondhand smoke (SHS) on glucose metabolism and insulin sensitivity have not been fully elucidated. Objective To examine the association of mixed electronic and conventional cigarette use and exposure to SHS with prediabetes. Design Data from the 2014-2018 Korean National Health and Nutrition Examination Survey were analyzed. Setting Nationwide population-based. Participants Of 39 199 participants, 22 385 participants (9490 men, 12 895 women) without diabetes were included. The main independent variables were smoking behaviors, including exposure to SHS. Interventions None. Main Outcome Measures Prediabetes (hemoglobin A1C of 5.7-6.4%). Results Of 22 385 participants without diabetes, 6735 had prediabetes. Mixed cigarette use was associated with a 1.57-fold increase in the odds of prediabetes when compared with never-smoking [odds ratio (OR) = 1.57, 95% CI = 1.29-1.92] and a 1.27-fold increase when compared with conventional cigarette use only (OR = 1.27, 95% CI = 1.07-1.52). Participants who were current nonsmokers, but mixed users in the past had an increased risk of prediabetes (OR = 1.54, 95% CI = 1.04-2.13). There was no significant association between prediabetes and current nonsmoking in individuals with previous conventional cigarette use only. Among never-smokers, exposure to SHS significantly increased the risk of prediabetes (OR = 1.16, 95% CI = 1.04-1.30). Conclusions Mixed use of electronic and conventional cigarettes and exposure to SHS increased the risk of prediabetes. Further studies are required to comprehensively investigate the molecular biology underlying the effects of previous and current mixed use of electronic cigarettes and SHS on glucose metabolism.

Sleep is being emphasized as a factor that improves mental health and quality of life. Here, we aimed to investigate the association between the quality and duration of sleep and subjective cognitive decline in the Korean population. We used the 2018 Korean Community Health Survey data that are nationwide representative data collected by the Korea Centers for Disease Control and Prevention. Sleep quality was measured using the Korean version of Pittsburgh Sleep Quality Index. The study population comprised 206,719 individuals aged 19 years and over. We used multiple logistic regression for the analysis. Individuals of both sexes with poor sleep quality were more likely to experience subjective cognitive decline compared with the reference group (good sleep quality) (men, odds ratio (OR) = 1.97 [95% confidence interval (CI) 1.86–2.09]; women, OR = 1.75 [95% CI 1.67–1.84]). U-shape associations were found between sleep duration and subjective cognitive decline. Additionally, the presence of depressive symptom or stress and health-related behaviors, including smoking, drinking, and not walking, were high-risk factors for subjective cognitive decline. Our results indicate that poor sleep quality might contribute to subjective cognitive decline in the Korean population. We suggest the implementation of intervention measures for poor sleep behaviors to prevent cognitive decline.

Context Insulin resistance is a determinant of diabetes. With the increasing popularity of electronic smoking, the number of dual smokers (smoking both cigarettes and electronic cigarettes [e-cigarettes]) is increasing. However, few studies have assessed the association between insulin resistance and smoking behavior, including dual smoking. Objective This work aims to investigate the association between smoking behaviors and insulin resistance. Methods This prospective, cross-sectional study took place among the general community. A total of 11 653 participants (4721 male and 6932 female) aged 19 years or older from the 2016 to 2018 Korea National Health and Nutrition Examination Survey were divided based on their smoking behaviors: dual smokers (both cigarettes and e-cigarettes), single smokers (cigarette smokers), previous smokers, and nonsmokers. Insulin resistance was determined based on the triglyceride-glucose index. Multiple logistic regression analysis was performed to investigate the association between smoking behavior and insulin resistance. Results Among the participants, 164 males (3.5%) and 33 females (0.5%) were dual-smokers, and 1,428 males (30.2%) and 308 females (4.4%) were single-smokers. Male and female smokers (dual and single) both had higher odds of being in a group with higher insulin resistance than nonsmokers (male, dual: OR = 2.19; 95% CI, 1.39-3.44; single: OR = 1.78; 95% CI, 1.43-2.22; female, dual: OR = 2.32; 95% CI, 1.01-5.34; single: OR = 1.76; 95% CI, 1.28-2.42). Conclusion This study suggests that single and dual smoking both may increase the risk of insulin resistance in the general population. Education on the adverse effects of smoking behaviors may be an important strategy to improve the health of the population.

The purpose of this study is to suggest priority tasks necessary for building a sustainable healthcare system in Korea based on the Delphi consensus among healthcare professionals.Twenty-five items covering the three categories that make up healthcare policy (healthcare demand, supply, and environment) were selected based on a literature evaluation. Email surveys were also analyzed using a two-round modified Delphi method. Of 59 experts, 21 completed the first and second rounds. Each item asked about the degree of importance and urgency, and the answers were rated on a 9-point Likert scale. A coefficient of variation less than 50% for each item in the Delphi survey meant that consensus was reached. Only items that meet a predetermined threshold are prioritized (agreement ≥ 90%, average importance score and urgency score ≥ 6.5).Eight items that satisfy all three criteria were set as priorities for a sustainable healthcare system. These tasks are "Securing the financial soundness of the National Health Insurance (NHI)," "Solving the problem of low fertility," "Strengthening response to public health crises such as infectious or environmental diseases," "Bio-health technology innovation using D.N.A (Data, Network, AI)," "Intensive management of dementia patients," "Mental healthcare and suicide prevention," "Reform of the operation structure of the NHI Service," and "Reform the healthcare delivery system and payment system."The eight items for which consensus was reached in this study should be prioritized for Korea's sustainable healthcare system. Health policy makers will need to put considerable effort into researching and establishing these priorities.

Depression is a common mental health disorder. Despite sleep disturbance being associated with depression, limited data regarding the association of sleep quality with depression exists. We aimed to investigate the association between sleep quality and depressive symptoms in the South Korean population.This cross-sectional study used data from the 2018 Korean Community Health Survey, a nationwide representative survey conducted annually at national public health centers since 2008. The study population comprised 176,794 individuals (78,356 male and 98,438 female) aged 19 years and over. Sleep quality was measured using the Korean version of Pittsburgh Sleep Quality Index and depressive symptoms with the Patient Health Questionnaire-9. Data were analyzed using multiple logistic regression.The average PSQI score was 5.03 for men and 5.98 for women. Individuals of both sexes with poor sleep quality were more likely to be depressed (men: odds ratio (OR) = 7.02 [95% confidence interval (CI) = 6.17-7.99]). In subgroup analysis stratified by independent variables, participants with the following characteristics had greater association between poor sleep quality and depressive symptoms: unmarried, college or higher education, white-collar occupation, current smoker, frequent drinker, walking physical activity, and no-stress.Limitations included the cross-sectional nature of the study, use of only secondary data and a self-rated questionnaire for evaluating depressive symptoms, and inherent limitations in the PSQI.Poor sleep quality may contribute to depressive symptoms among Korean adults. Screening for poor sleep quality and implementing measures to improve sleep behaviors may prevent the onset of depression.

This study explored the association between Coronavirus disease (COVID-19) and depression by comparing Patient Health Questionnaire-9 (PHQ-9) results pre-pandemic (2019) and after the start of the pandemic (2020). Data of 444,051 participants (200,206 male (45.1%); 243,845 female (54.9%)) were obtained from the Korean Community Health Survey conducted from 2019 to 2020. The independent variable of interest in this study was the year, divided into binary categories, 2019 and 2020. The dependent variable was depression, measured by the PHQ-9 scale. This dependent variable was also binary, dividing those who are considered depressed or not by a cut-off score of 10. A logistic regression model was employed to examine the association. Our results reveal that compared to participants in 2019, patients from the study sample of 2020 were marginally more likely to be depressed, especially female patients (male OR: 1.092, 95% CI [0.998 to 1.195], female OR: 1.066, 95% CI [1.002 to 1.134]). Moreover, using the participants from the year 2019 as a reference group, those who appeared anxious in response to the COVID-19-related questions in the survey showed more tendency to have a PHQ-9 score of 10 or more. Compared to participants from the 2019 group, those from 2020 more likely to be depressed were those with no-one to contact in case of emergency due to COVID-19 (male OR: 1.45, 95% CI [1.26 to 1.66], female OR: 1.46, 95% CI [1.33 to 1.60]), and individuals with concerns regarding economic loss (male OR: 1.18, 95% CI [1.07 to 1.30], female OR: 1.11, 95% CI [1.04 to 1.18]) and infection of a vulnerable family member at home due to COVID-19 (male OR: 1.16, 95% CI [1.05 to 1.28], female OR: 1.09, 95% CI [ 1.02 to 1.16]).

Graphic health warning labels on cigarette packs inform smokers about the health risks associated with tobacco smoking. Adolescents are generally the main targets to influence by graphic health warning labels. This study investigated the association between graphic health warning labels on cigarette packs and attempts to quit smoking in South Korean adolescents. This cross-sectional study used data from the 2017 to 2019 Korea Youth Risk Behavior Web-based Survey, using multiple logistic regression for the analysis. The study population comprised 11,142 adolescents aged 12–18 years. The outcome variable was attempts to quit smoking among adolescent smokers who had seen graphic health warning labels. Attempts to quit smoking were higher among adolescent smokers who had seen graphic health warning labels compared to those who had not {boys, odds ratio (OR) = 1.72 [95% confidence interval (CI), 1.48–2.00]; girls, OR = 1.74 (95% CI, 1.33–2.28)}. The correlation was greater for adolescents who thought about the harm of smoking [boys, OR = 1.86 (95% CI, 1.60–2.16); girls, OR = 1.85 (95% CI, 1.41–2.43)] and the willingness to quit [boys, OR = 2.03 (95% CI, 1.74–2.36); girls, OR = 2.04 (95% CI, 1.55–2.68)] after seeing graphic health warning labels. Our findings indicate that graphic health warning labels on cigarette packs have the potential to lower smoking intentions of adolescents. We suggest that the use of graphic health warning labels is an effective policy-related intervention to reduce smoking in South Korean adolescents.

Background:A disproportionate amount of family caregiving can negatively impact married women's mental health. This study aims to examine the relationship between depressive symptoms in South Korean women and the satisfaction with their husband's participation in family caregiving.MethodsRaw data from 1,515 of the participants in the 2014, 2016, and 2018 Korean Longitudinal Survey of Women and Families were analyzed. Satisfaction with husbands' participation in family caregiving was classified as satisfied, less satisfied, and not satisfied. The survey used the Center for Epidemiologic Studies Depression Scale to measure depressive symptoms. The association was examined using a generalized estimating equations model.ResultsResults indicated 22.2% of the participating women reported depressive symptoms. Women who reported dissatisfaction with their husband's participation in caregiving were 2.54 times more likely to report depressive symptoms than the women who were satisfied. Subgroup analysis indicated that women with higher levels of education, were more likely to have depressive symptoms when they were not satisfied with their husbands' participation in caregiving.ConclusionMarried women who reported being dissatisfied with their husbands' participation in caregiving were more likely to report depressive symptoms. These results suggest the need to create environments with fair distribution of caregiving duties to minimize depressive symptoms in women.

Recent studies suggest that sensory impairment is related to cognitive function at older ages. Therefore, we aimed to investigate the impact of sensory impairment on cognitive function in the Korean population. We used the Korean Longitudinal Study of Aging data from 2006 to 2018. Cognitive function was measured by the Korean version of the Mini-Mental State Examination scale. A score

Background: Evaluating whether the cigarette type used in the past and present and exposure to secondhand smoke are associated with prediabetes is important for future research and public health interventions. This study aimed to examine the association of mixed electronic and conventional cigarette use and exposure to secondhand smoke with prediabetes. Methods: Data from the 2014-2018 Korean National Health and Nutrition Examination Survey were analyzed. Prediabetes was defined as an HbA1C of 5·7–6·4%. Participants were categorized according to type of cigarette used and secondhand smoke exposure. Multiple logistic regression analysis was performed. Findings: Of the 22,385 participants without diabetes, 6,735 had prediabetes. Mixed cigarette use was associated with prediabetes when compared with only conventional cigarette use (odds ratio [OR]=1·27, 95% confidence interval [CI]=1·09–1·49). Participants who were current non-smokers but mixed users in the past had an increased risk of prediabetes (OR=1·54, 95% CI=1·06–2·23). However, there was no significant association between current non-smoking but only conventional cigarette use in the past and prediabetes. Among never-smokers, exposure to secondhand smoke significantly increased the risk of prediabetes (OR=1·15, 95% CI=1·03–1·28). Interpretation: Mixed use of electronic and conventional cigarettes and exposure to secondhand smoke was associated with prediabetes. Furthermore, the mixed use in the past was associated with prediabetes even if the cigarette was not used currently. In future research on the determining the effect of smoking on prediabetes and interventions to prevent diabetes, the cigarette type used should be considered. Funding Information: None. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study used data obtained from the 2014 and 2018 Korean National Health and Nutrition Examination Survey (KNHANES). The KNHANES is a nationwide population-based survey designed to acquire information regarding the health and nutrition of people in South Korea. The survey is performed by the Korean Centers for Disease Control and Prevention (KCDC) and combines a health interview with a physical examination and nutrition survey. The KNHANES protocols were approved by the Institutional Review Board of the KCDC (IRB No. 2018-01-03-P-A), and the research complied with the tenets of the Declaration of Helsinki for medical research involving human subjects. Informed consent was obtained from all participants.

This study aimed to identify the association between physical exercise and glycated hemoglobin (HbA1c) levels in Korean patients diagnosed with diabetes. Data from the 2015–2019 Korea National Health and Nutrition Examination Survey were used. In total, 2559 participants were included (1286 males and 1273 females). Multiple logistic regression analysis was conducted to examine the effect of physical exercise on controlled HbA1c levels among diabetic patients. In Korean male patients with diabetes, performance of physical exercise, including walking and resistance exercises, was associated with controlled HbA1c levels < 6.5% (odds ratio (OR), 1.85; 95% confidence interval (CI), 1.17–2.92). In males, performing resistance exercise for ≥5 days a week, without walking exercise, had a significant association with HbA1c levels (OR, 1.75; 95% CI, 1.15–2.65). HbA1c levels were more likely to be controlled when both walking and resistance exercises were performed for ≥5 days a week in both sexes (males: OR, 1.74; 95% CI, 1.04–2.93 and females: OR, 2.59; 95% CI, 1.09–6.15). This study found that resistance exercise may contribute to the management of HbA1c levels among Korean patients with diabetes. Promoting resistance exercise performance can be beneficial for improving the condition of patients with diabetes.

Diabetes mellitus is an important chronic disease causing economic and social burden. Insulin resistance is a determinant of diabetes, and regular eating patterns are an important factor in blood sugar control. This study investigated the association between breakfast frequency and the risk of increased insulin resistance in Koreans. Data for 12,856 participants without diabetes in the 2016&ndash, 2018 Korea National Health and Nutrition Examination Survey were analyzed. Insulin resistance was assessed using the triglyceride-glucose (TyG) index, while the median TyG index value was used to define higher (&ge, 8.5) vs. lower (&lt, 8.5) insulin resistance. Association between breakfast frequency and risk of increased insulin resistance was investigated using multiple logistic regression. Compared with those who had regular breakfast 5&ndash, 7 times per week, the odds ratios (95% confidence intervals) of individuals who did not eat breakfast were the highest at 1.42 (95% CI = 1.24&ndash, 1.64, p &le, 0.0001). Those who had breakfast 1&ndash, 4 times per week had an odds ratio of 1.17 (95% CI = 1.03&ndash, 1.32, p = 0.0153). We found that a lower weekly breakfast consumption was associated with a higher risk of insulin resistance in Koreans. Promoting the benefits of breakfast can be an important message to improve the health of the population.

Government Geothermal Cooling-Heating Projects has made efforts to reduce GHG(Greenhouse Gas) emissions and to manage cost of greenhouse farm households. This study evaluated the economic benefits of heating load rate of change by comparing Geothermal Cooling-Heating System with the existing system(greenhouse diesel heating) in the Government Geothermal Cooling-Heating Projects. Economic analysis results shows that, 1) When installing the Cooling-Heating system according to the ratio of 70% heating load in policy standards, the geothermal cooling-heating system has economic efficiency with greenhouse type or scale independent because the investment cost is recovered within 7 years. And It was more economic efficiency the ratio of 50% heating load than70% heating load. 2) When installing the Cooling-Heating system according to the glass greenhouse of the ratio of 90% heating load, pay period of investment cost is recovered within 5 years. Therefore it is necessary to apply flexible heating sharing according to greenhouse type or scale.

We report a rare case of a 74-year-old man with metachronous gallbladder cancer and bile duct cancer who underwent curative resection twice, with the operations nine years apart. At the age of 65 years, the patient underwent a cholecystectomy and resection of the liver bed for gallbladder cancer. This was a well-differentiated adenocarcinoma, with negative resection margins (T2N0M0, stage IB). Nine years later, during a follow-up examination, abdominal computed tomography and MRCP showed an enhanced 1.7 cm mass in the hilum that extended to the second branch of the right intrahepatic bile duct. We diagnosed this lesion as a perihilar bile duct cancer, Bismuth type IIIa, and performed bile duct excision, right hepatic lobectomy and Roux-en-Y hepaticojejunostomy. The histological diagnosis was a well-differentiated adenocarcinoma with one regional lymph node metastasis (T1N1M0, stage IIB). Twelve months after the second operation, the patient is well, with no signs of recurrence. This case is compared with 11 other cases of metachronous biliary tract cancer published in the world medical literature.

The aqueous extract of European mistletoe (Viscum album, L.) has been used in cancer therapy. The purified mistletoe lectins, main components of mistletoe, have demonstrated cytotoxic and immune-system-stimulating activities. Korean mistletoe (Viscum album L. coloratum), a subspecies of European mistletoe, has also been reported to possess anticancer and immunological activities. A galactose- and N-acetyl-D-galactosamine-specific lectin (Viscum album L. coloratum agglutinin, VCA) with Mr 60 kDa was isolated from Korean mistletoe. Mistletoe preparations have been given subcutaneously due to the low stability of lectin in the gastrointestinal (GI) tract. In the present study, we investigated the possibility of alginate/chitosan microcapsules as a tool for oral delivery of mistletoe lectin. In addition, our strategy has been to develop a system composed of stabilizing cores (granules), which contain mistletoe lectin, extract or powder, coated by a biodegradable polymer wall. Our results indicated that successful incorporation of VCA into alginate/chitosan microcapsules has been achieved and that the alginate/chitosan microcapsule protected the VCA from degradation at acidic pH values. And coating the VCA with polyacrylic polymers, Eudragit, produced outstanding results with ideal release profiles and only minimal losses of cytotoxicity after manufacturing step. The granules prepared with extract or whole plant produced the best results due to the stability in the extract or whole plant during manufacturing process.

Background: In mediastinal lymph node sampling in non-small cell lung cancer (NSCLC) it is important to determine the appropriate treatment as well as to predict an outcome. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a recently developed, accurate, safe technique in patients with NSCLC for sampling mediastinal lymph nodes. We sought to determine the usefulness of EBUS-TBNA in mediastinal staging with NSCLC considered to be operable. Methods: We retrospectively reviewed the records of 142 patients who underwent EBUS-TBNA for mediastinal staging in the Asan Medical Center, Korea from July 2008 to July 2010. If patients were in an operable state, they underwent subsequent surgical staging. Diagnoses based on biopsy results were compared with those based on surgical results. Results: We performed EBUS-TBNA in 184 mediastinal lymph nodes in 142 NSCLC patients. Almost all of the EBUS-TBNA samples were from the lower paratracheal (112, 60.9%) and subcarinal (57, 31.0%) lymph nodes. In 142 patients, 51 patients (35.9%) were confirmed with malignant invasion of the mediastinal lymph node by EBUS-TBNA and 91 (64.1%) patients were not confirmed. Among the 91 patients, 64 patients (70.3%) underwent surgical staging. 3 patients (4.7%) who were misdiagnosed by the EBUS-TBNA were confirmed by surgery. After Diagnostic sensitivity of EBUS-TBNA, the prediction of mediastinal metastatsis was 94.4% and specificity was 100%. The procedures were performed safely and no serious complications were observed. Conclusion: We demonstrated the high diagnostic value of EBUS-TBNA for mediastinal staging.

Acute cholangitis usually develops in congenital hepatic fibrosis (CHF), accompanied by cystic dilated bile ducts. However, it can also develop in simple CHF and may lead to critical course. A 30-year old man presented with recurrent acute cholangitis without bile duct dilatation. He visited the hospital for febrile sense and abdominal pain in the right upper quadrant. He had been admitted several times for hepatosplenomegaly and cholangitis since childhood and received a liver biopsy 15 years ago. Abdominal computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) revealed hepatosplenomegaly and a mildly dilated bile duct without stones or biliary cysts. His condition improved after conservative treatment. However, during a two-month follow up period, the patient experienced three episodes of acute cholangitis. A liver biopsy was performed and showed periportal fibrosis and intrahepatic ductular dysplasia, characteristics of congenital hepatic fibrosis. The periportal fibrosis and the infiltration of inflammatory cells were aggravated compared to 15 years ago. There was no evidence of hepatic cirrhosis. He was diagnosed with congenital hepatic fibrosis with recurrent acute cholangitis without intrahepatic duct dilatation, and conservatively treated with antibiotics.