Trajectories of Depressive Symptoms in Community-Dwelling Korean Older Adults

Objectives This study aimed to identify trajectories of depressive symptoms and investigate predictive variables of latent class in Korean community-dwelling older adults. Methods Study participants comprised 2,016 community-dwelling Korean adults aged over 65 years, using data from the Korean Longitudinal Study of Aging (KLoSA) from 2006–2016. The KLoSA, a nationally representative panel survey, has been conducted biannually since 2006. We used latent class growth analysis to identify depressive symptom trajectories. Multinomial logistic regression analysis was conducted to identify predictors of each class of depressive symptoms. Results Five depressive symptom trajectory groups were identified: Class 1, no depressive symptom (13.8%); Class 2, low depressive symptom (32.8%); Class 3, decreasing depressive symptom (10.6%); Class 4, increasing depressive symptoms (24.0%); and Class 5, persistent depressive symptoms (18.8%). We found that older adults followed five distinct depressive symptom trajectories over 10 years. Mini-Mental State Examination scores, number of chronic diseases, educational level, gender, current employment, contact with children, and social activity were associated with a higher risk of these trajectories. Conclusions Depressive symptoms are associated with social networks as cognitive function scores increase and number of chronic diseases decrease. Interventions to strengthening existing social networks and developing relationships should be tailored to target specific needs for each trajectory, and chronic disease management, including cognitive function, may be beneficial in preventing depressive symptoms among older adults. KEYWORDS Older adults, Depressive symptom, Trajectory, Latent class growth analysis, Korean

Behavioral Patterns of Care Providers and Resistiveness to Care of Persons With Dementia

Resistiveness to care in persons with dementia is a distinct obstacle for care providers to provide oral care. It is necessary to find out specific behaviors of care providers that affect resistiveness to care. This is a secondary data analysis to identify behaviors of care providers related to resistiveness to care using 70 videos that were taken when 23 persons with dementia received oral care in long-term care facilities at baseline, month 3 and month 6. The behavior patterns of care providers and resistiveness to care of persons with dementia were extracted in the form of the frequency of each behavior using a coding scheme for behavioral observation. The coding scheme for behavior patterns of care providers consists of 2 dimensions: person-centered behaviors including 18 items and task-centered behaviors including 4 items. In addition, the coding scheme for resistiveness to care of persons with dementia includes 13 items. The data were analyzed using a linear mixed model analysis considering the repeated measured data. Among person-centered behaviors, ‘assessing the comfort of resident,’ and ‘cooperatively negotiating’ were less likely to occur resistiveness to care. However, ‘physically controlling’ was the most significant to increase the occurrence of resistiveness to care of persons with dementia. Therefore, it is recommended that care providers try to understand the causes of discomfort for persons with dementia and meet his/her needs rather than to physically control when providing oral care.

Compartmentalizing Cell-Free Systems: Toward Creating Life-Like Artificial Cells and Beyond

Building an artificial cell is a research area that is rigorously studied in the field of synthetic biology. It has brought about much attention with the aim of ultimately constructing a natural cell-like structure. In particular, with the more mature cell-free platforms and various compartmentalization methods becoming available, achieving this aim seems not far away. In this review, we discuss the various types of artificial cells capable of hosting several cellular functions. Different compartmental boundaries and the mature and evolving technologies that are used for compartmentalization are examined, and exciting recent advances that overcome or have the potential to address current challenges are discussed. Ultimately, we show how compartmentalization and cell-free systems have, and will, come together to fulfill the goal to assemble a fully synthetic cell that displays functionality and complexity as advanced as that in nature. The development of such artificial cell systems will offer insight into the fundamental study of evolutionary biology and the sea of applications as a result. Although several challenges remain, emerging technologies such as artificial intelligence also appear to help pave the way to address them and achieve the ultimate goal.

Factors Affecting the Timing of a Central Line Associated Bloodstream Infection Onset in Children with Cancer

PURPOSE

The purpose of this study is to identify controllable treatment-environment-related factors affecting the timing of a central line-associated bloodstream infection (CLABSI) onset in children with cancer with central venous catheters (CVC).

DESIGN

This study is a secondary data analysis with the data extracted from electronic medical records in a tertiary hospital in South Korea. This study was conducted by reviewing electronic medical records of 470 pediatric cancer patients younger than the age of 18 years from 2010 to 2016.

METHOD

The timing of a CLABSI onset was identified through the onset of CLABSI and the duration of catheterization. Cox proportional hazards regression analysis was used to estimate the impact of variables on the timing of CLABSI onset. The duration of catheterization was estimated using the Kaplan-Meier method.

FINDING

Multivariable analysis by Cox proportional model analysis showed that there are six independent variables affecting the timing of a CLABSI onset: length of stay in hospital, catheter insertion location, use of antibiotics on day of catheter insertion, catheter function, number of blood transfusions per 100 days, and number of blood tests per 100 days.

CONCLUSIONS

The findings of this study provide a foundation for the development of EBP-based CVC guidelines to effectively reduce CLABSIs and maintain a long-term CVC without a CLABSI.

Bringing Light into Cell-Free Expression

Cell-free systems, as part of the synthetic biology field, have become a critical platform in biological studies. However, there is a lack of research into developing a switch for a dynamical control of the transcriptional and translational process. The optogenetic tool has been widely proven as an ideal control switch for protein synthesis due to its nontoxicity and excellent time-space conversion. Hence, in this study, a blue light-regulated two-component system named YF1/FixJ was incorporated into an Escherichia coli-based cell-free system to control protein synthesis. The corresponding cell-free system successfully achieved a 5-fold dynamic protein expression by blue light repression and 3-fold dynamic expression by blue light activation. With the aim of expanding the applications of cell-free synthetic biology, the cell-free blue light-sensing system was used to perform imaging, light-controlled antibody synthesis, and light-triggered artificial cell assembly. This study can provide a guide for further research into the field of cell-free optical sensing. Moreover, it will also promote the development of cell-free synthetic biology and optogenetics through applying the cell-free optical sensing system to synthetic biology education, biopharmaceutical research, and artificial cell construction.

Genetic variants in the folate metabolic pathway genes predict cutaneous melanoma-specific survival

BACKGROUND

Folate metabolism plays an important role in DNA methylation and nucleic acid synthesis and thus may function as a regulatory factor in cancer development. Genome-wide association studies (GWASs) have identified some single-nucleotide polymorphisms (SNPs) associated with cutaneous melanoma-specific survival (CMSS), but no SNPs were found in genes involved in the folate metabolic pathway.

OBJECTIVES

To examine associations between SNPs in folate metabolic pathway genes and CMSS.

METHODS

We comprehensively evaluated 2645 (422 genotyped and 2223 imputed) common SNPs in folate metabolic pathway genes from a published GWAS of 858 patients from The University of Texas MD Anderson Cancer Center and performed the validation in another GWAS of 409 patients from the Nurses' Health Study and Health Professionals Follow-up Study, in which 95/858 (11·1%) and 48/409 (11·7%) patients died of cutaneous melanoma, respectively.

RESULTS

We identified two independent SNPs (MTHFD1 rs1950902 G>A and ALPL rs10917006 C>T) to be associated with CMSS in both datasets, and their meta-analysis yielded an allelic hazards ratio of 1·75 (95% confidence interval 1·32-2·32, P = 9·96 × 10^-5 ) and 2·05 (1·39-3·01, P = 2·84 × 10^-4 ), respectively. The genotype-phenotype correlation analyses provided additional support for the biological plausibility of these two variants' roles in tumour progression, suggesting that variation in SNP-related mRNA expression levels is likely to be the mechanism underlying the observed associations with CMSS.

CONCLUSIONS

Two possibly functional genetic variants, MTHFD1 rs1950902 and ALPL rs10917006, were likely to be independently or jointly associated with CMSS, which may add to personalized treatment in the future, once further validated. What is already known about this topic? Existing data show that survival rates vary among patients with melanoma with similar clinical characteristics; therefore, it is necessary to identify additional complementary biomarkers for melanoma-specific prognosis. A hypothesis-driven approach, by pooling the effects of single-nucleotide polymorphisms (SNPs) in a specific biological pathway as genetic risk scores, may provide a prognostic utility, and genetic variants of genes in folate metabolism have been reported to be associated with cancer risk. What does this study add? Two genetic variants in the folate metabolic pathway genes, MTHFD1 rs1950902 and ALPL rs10917006, are significantly associated with cutaneous melanoma-specific survival (CMSS). What is the translational message? The identification of genetic variants will make a risk-prediction model possible for CMSS. The SNPs in the folate metabolic pathway genes, once validated in larger studies, may be useful in the personalized management and treatment of patients with cutaneous melanoma.

Association of blood mercury levels with nonmelanoma skin cancer in the U.S.A. using National Health and Nutrition Examination Survey data (2003-2016)

BACKGROUND

Some studies have reported increased incidence or mortality of lung and brain cancers associated with occupations involving potential mercury exposure. Epidemiological evidence related to skin cancer is also limited.

OBJECTIVES

To investigate the association between blood mercury (Hg) levels and nonmelanoma skin cancer (NMSC).

METHODS

We used National Health and Nutrition Examination Survey data from 2003 to 2016. The exposures were blood total (tHg), inorganic (iHg) and methylmercury (MeHg). The outcome was a self-reported diagnosis of NMSC. We included participants aged ≥ 20 years who had information on blood mercury and sociodemographic factors. We conducted a logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of NMSC associated with quartiles of blood Hg, after adjusting for the sociodemographic factors and survey year.

RESULTS

The number of participants was 29 413; mean age was 49 years and 52% were female. Compared with those with a tHg ≤ 0·47 μg L^-1 (Q1), those with a tHg > 1·74 μg L^-1 (Q4) had nearly double the odds of NMSC (OR 1·79, 95% CI 1·19-2·71; P_trend = 0·004). Similarly, those in the highest quartile of MeHg (> 1·44 μg L^-1 ) had 1·7 times greater odds of NMSC (OR 1·74, 95% CI 1·13-2·70; P_trend = 0·01) than those in the lowest quartile (≤ 0·21 μg L^-1 ). iHg levels were nonsignificantly positively associated with NMSC (P_trend = 0·08).

CONCLUSIONS

We found that higher blood tHg and MeHg levels were associated with a higher prevalence of NMSC. Linked Comment: Taylor. Br J Dermatol 2020; 183:413-414.

Multilevel Effects of Community Capacity on Active Aging in Community-Dwelling Older Adults in South Korea

PURPOSE

This study aimed at identifying the level of active aging in older adults and the influence of the individual and community levels of community capacity on active aging.

METHODS

A cross-sectional survey was conducted on a stratified sample of 380 older adults living in 35 neighborhoods of five regions in Seoul, the capital of South Korea. The structured questionnaire included the Korean version of instruments that measure active aging and community capacity at the individual level. Secondary data including metropolitan statistical information, a public data portal, and a city plan were used to acquire community-capacity factors at the community level. Data were analyzed with multilevel models.

RESULTS

The overall active aging mean score was 3.00 ± 0.55 out of 5; the highest mean score was in the security domain (3.46 ± 0.65) and the lowest one was in the participation domain (2.71 ± 0.66). Individual factors associated with active aging included age, education, income, and community capacity at the individual level. At the community level, two community-capacity factors (senior leisure welfare facilities and cooperative unions) were significantly associated with active aging. In active aging, 6.4% and 4.1% of total variance could be explained by 35 neighborhoods, after considering individual and community level variables, respectively.

CONCLUSION

This study showed that community capacity is important for active aging among older adults. Appropriate strategies that consider both individual and community factors, such as contextual indicators of community capacity, are necessary to improve active aging.

Interprofessional global health competencies of South Korean health professional students: educational needs and strategies

BACKGROUND

There is growing recognition of the importance of educating health professional students to enhance their competence in collaborating with individuals from other health professions in the area of global health. This study aimed to identify the performance levels in interprofessional global health competencies (IGHC) of health professional students, their educational needs, and the strategies for successfully developing IGHC.

METHODS

This study used a mixed methods design involving an online survey followed by focus group interviews. A sample of 325 fourth-year undergraduate students from 14 health-related majors completed a self-report online survey (38.8% response rate). The performance of IGHC was measured on a five-point Likert scale using the IGHC items developed by the Consortium of Universities for Global Health. Additionally, 12 senior students and five professors in global health-related majors participated in focus group interviews. The students' educational needs and priorities were analysed using the Borich needs assessment and the Locus for Focus model.

RESULTS

The participants' IGHC mean score was 3.11 (SD = 0.55) and differed by previous global health activity experiences (t = - 2.10, p = .037). Nine competencies in six domains using the Locus for Focus model were identified as a priority for global health education. Suggested strategies to enhance IGHC included establishing IGHC education in formal curricula, developing value-based content and outcomes, and engaging students in learning activities.

CONCLUSIONS

It is necessary to design an interprofessional pre-departure course to achieve the priority IGHC and to organise learning activities where there is cooperation in problem solving while applying the expertise of each major within resource-limited settings. This study supports future health professional education that should foster enhanced roles and scopes of practice as changing agents to assure the achievement of sustainable development goals.

PREDICTORS OF LONGITUDINAL COGNITIVE DECLINE AMONG COMMUNITY-DWELLING KOREAN OLDER ADULTS

Objective This study aims to explore predictors to longitudinal decline of cognitive function in old adults in Korean. Methods The data were derived from the information system of the Korean Longitudinal Study of Aging (KLoSA) which performed nationwide aging panel survey for adults aged over 45 years between 2006 and 2016. The sample consisted of 1,262 older adults who completed K-MMSE. Of the total 1,262 participants, 752 had normal cognition, 243 had mild cognitive impairment, and the rest 267 had dementia. Variables from diverse dimensions were derived from the KLoSA. The linear mixed models were used to predict and explain predictors affecting cognitive function decline over time. Results The ADL and IADL, depression, exercise, and social activity were time-varying variables significantly related to the cognitive function of the older adults. Over time, difference in change of the K-MMSE score between three groups was significant. Conclusions This study identified predictors influencing decrease of cognitive function over time in older adults in Korea. Tailored intervention needs to be developed and implemented in order to delay the cognitive function decline. Improving physical function through regular exercise, increasing social activity, and managing depression by early detection and treatment are recommended according to the cognitive function status. Keywords: old adults, cognitive function, K-MMSE, predictor

FACTORS AFFECTING BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS IN OLDER ADULTS WITH DEMENTIA

The purpose of this study was to identify factors predicting behavioral and psychological symptoms of dementia(BPSD) in older adults with Dementia. This is a cross-sectional study, recruiting 157 participants from neurology general hospital as study subjects. Data collection was performed from June 2018 to May 2019. BPSD were classified using a modified version of the Cohen-Mansfield agitation inventory(CMAI), which are physically non-aggressive behaviors(PNAB), physically aggressive behaviors(PGAB), verbally non-aggressive behaviors(VNAB), verbally aggressive behaviors(VAGB). The Cornell scale for depression in dementia(CSDD), korea activity of daily living scale(K-ADL), korean mini-mental state examination(K-MMSE), activity and sleep time through using actigraphy for 2weeks, salivary melatonin and cortisol level at 4 times a day done after waking up, after breakfast, before and after dinner, and medication were measured as influencing factors. The generalized linear mixed model analyses indicated that VNAB and VAGB were associated with severe depression(p<0.01, respectively), low melatonin level at the after waking up (p<0.05, respectively), and high melatonin level before dinner(p<0.05, respectively). On the PNAB and PGAB, severe depression(p<0.05, respectively) and high activity(p<0.05, respectively) showed great influences. These findings suggest that developing of intervention of BPSD must be started with detecting depression, ADL. Considering the factors of each type of symptom, tailoring an individual approach is recommended. In addition, this study identified that the activity through actigraphy and salivary melatonin measurement are useful tools to examine BPSD. It can be helpful in the objective evaluation of BPSD.

DEMENTED OLDER ADULT’S SALIVARY CORTISOL LEVELS AND PHYSICAL STRESS INDEX AS STRESS INDICATOR

Demented older adults experience many internal and external stress inducers that are thought to be a source of behavioral and psychological symptoms of dementia(BPSD). The purpose of this study was to compare the stress index among older adults through salivary cortisol levels and physical stress index. This study was cross-sectional design, including 139 participants who recruited until May of this year(104 demented older adults who visited hospital outpatient neurology and 35 non-demented older adults as control group). The physical stress index was measured by heart rate variability and salivary cortisol levels(4 samples/day, 1 days). Salivary cortisol levels were measured at four times after wake up, after breakfast, before dinner and after dinner. The data were analyzed using independent t-test and generalized estimating equations. In salivary cortisol levels measured after wake up, the demented older adults reported about 1.5 times higher than non-demented older adults(p=.042). And the salivary cortisol levels measured after breakfast were about 2.3 times higher in the demented older adults than in control groups(p=.002). Accordingly, the results can be concluded that demented older adults have higher stress levels than control groups in the morning. Also the physical stress index through heart rate variability(HRV) in the demented older adults(6.30±0.65) had higher than control groups(6.00±0.55, t=2.45, p=.016). There are significant differences in salivary cortisol levels and physical stress index between demented older adults and control groups. As stress inducers affects BPSD for the demented older adults, nursing intervention should be tailored to proper way based on their stress inducers.

A STUDY ON THE COMPARISON OF STRESS INDEX OF DEMENTED OLDER ADULTS AND THE PAIN OF THE MAIN CAREGIVER

The purpose of this study was to compare the stress and fatigue index between the demented older adults and the non-demented older adults and to identify the correlation between the behavioral psychological symptoms of the demented older adults and the pain of the main caregiver. A total of 100 participants(80 demented older adults and 20 non-demented older adults) were selected. The demented older adults, who visited hospital neurology as an outpatient, were paired up with the caregivers who provided the care for the demented older adults. The non-demented older adults who had normal cognitive function without limitation in a daily life and scored MMSE of 24 or higher were selected. The stress and fatigue index were measured by using an autonomic nervous system analyzer that measures heart rate variability(HRV), and structured questionnaires were used to examine behavioral psychological symptoms. The collected data were analyzed by using Independent t-test and Pearson’s correlations analysis. The result of the analysis showed that average score of the demented older adults had higher stress index than the control group(non-demented older adults), which was statistically significant(t=3.350, p=.001). In addition, the result indicated the statistically significant positive correlation between the behavioral psychological symptoms of demented older adults and the level of pain of main caregivers (r=0.89, p=<.001). The results of this study suggest that managing both the physical and psychological aspects of the stress in the main caregivers is necessary, as well as the development of stress management program for the demented older adults.

Do severe maternal morbidity and adequate prenatal care affect the delivery cost? A nationwide cohort study for 11 years with follow up

OBJECTIVE

To explore whether severe maternal morbidity (SMM) and adequate prenatal care (PNC) affect delivery cost.

DESIGN

Population-based retrospective cohort study.

SETTING

National Health Insurance Service National Sample Cohort in Korea.

POPULATION

A total of 90 035 deliveries in 2003 and 2013.

METHODS

Severe maternal morbidity was determined using the Centers for Disease Control and Prevention's algorithm. Delivery medical costs were calculated by estimating claimed total medical costs using year-specific inflation adjustment factors. Adequate PNC was estimated by the Kessner Adequacy of Prenatal Care Index. To estimate adjusted mean delivery medical costs related to SMM, we applied a generalised estimating equation model with log link and γ distribution, by adjusting for all covariates.

MAIN OUTCOME MEASURES

Delivery cost was calculated by estimating claimed total medical cost during delivery hospitalisation using year-specific inflation.

RESULTS

Of the 90 035 deliveries, 2041 (2.27%) involved SMM. Women with SMM had a greater adjusted mean cost of delivery (US$ 1,263, 95% CI US$ 1,196-1,334) than those without (US$ 740, 95% CI US$ 729-750). Interestingly, women who had inadequate PNC had higher delivery medical costs than those with adequate PNC, adjusted for all covariates.

CONCLUSION

Delivery involving SMM was associated with nearly doubled medical costs. Additionally, inadequate PNC increased the medical costs of delivery. The current study confirmed the burden of SMM and found that adequate PNC might be a useful preventive factor in reducing medical costs.

TWEETABLE ABSTRACT

We found that women with severe maternal morbidity and inadequate prenatal care had increased medical costs during delivery hospitalisation.

Risk Factors for Underdiagnosis of Diabetes Based on the Korean National Health and Nutrition Examination Survey 2013-2015

We included 11 298 subjects aged 30 years or older without diagnosis of diabetes by doctors who had undergone A1C screening. The diagnostic criterion for diabetes was A1C ≥6.5% (48 µmol/mol). This cross-sectional study was performed by reflecting weight of the sample in Korean National Health and Nutrition Examination Survey to represent South Korea. Risk factors were age (odds ratio [OR] = 1.06, 95% confidence interval [CI] = 1.04-1.08), Medicaid beneficiary (OR = 2.77, 95% CI = 1.25-6.14), presence of family history of diabetes (OR = 1.97, 95% CI = 1.36-2.84), serum triglyceride level (OR = 1.01, 95% CI = 1.01-1.03), serum high-density lipoprotein level (OR = 0.96, 95% CI = 0.95-0.98), currently smoking (OR = 1.85, 95% CI = 1.20-2.85), and the presence of regular checkup (OR = 1.41, 95% CI = 1.01-2.00). To prevent diabetes with a healthy life, it is necessary to establish a diabetes prevention program for vulnerable people and implement health-related policies such as smoking cessation and regular checkups.

Development and Validation of the Nursing Home Care-related Quality of Life Scale

OBJECTIVES

We developed an instrument to assess nursing home residents' quality of life (QOL), with a focus on QOL-related factors modifiable through nursing home care, within the South Korean context; then, we tested its validity and reliability.

DESIGN

The scale was constructed through a literature review, qualitative interviews, expert panel review, and a focus group interview; then, it was validated through survey research.

SETTING AND PARTICIPANTS

Residents (N = 667) from 42 nursing homes in South Korea participated in scale validation.

METHODS

Ninety-nine items across 5 dimensions were initially drafted through a literature review and qualitative interview data. The expert panel review and a focus group interview yielded a scale with 31 items across 3 dimensions. Next, using survey data from nursing home residents, we examined the construct and concurrent validity and reliability (using Kuder-Richardson 20) of the 31-item QOL scale.

RESULTS

Through a series of factor analyses, the 31 items were reduced to 17 items across 2 dimensions: Environment and Services (13 items) and Social Interaction (4 items). This 17-item scale was further examined for model fitness and reliability. The scale had acceptable to good fit (root mean square error of approximation = 0.07 and 0.07; comparative fit index = 0.83 and 0.98 for Environment and Services and Social Interaction, respectively), and good concurrent validity and internal consistency (Kuder-Richardson 20 = 0.72).

CONCLUSIONS AND IMPLICATIONS

This 17-item scale is a valid and reliable tool to assess nursing home residents' QOL in South Korea, with a focus on factors modifiable through nursing home care. Through more research to test its usefulness, validity, and reliability, the scale can be used as an index of nursing home care quality and contribute to the development of strategies to improve nursing home residents' QOL.

Advances and Challenges in Cell-Free Incorporation of Unnatural Amino Acids Into Proteins

Incorporation of unnatural amino acids (UNAAs) into proteins currently is an active biological research area for various fundamental and applied science. In this context, cell-free synthetic biology (CFSB) has been developed and recognized as a robust testing and biomanufacturing platform for highly efficient UNAA incorporation. It enables the orchestration of unnatural biological machinery toward an exclusive user-defined objective of unnatural protein synthesis. This review aims to overview the principles of cell-free unnatural protein synthesis (CFUPS) systems, their advantages, different UNAA incorporation approaches, and recent achievements. These have catalyzed cutting-edge research and diverse emerging applications. Especially, present challenges and future trends are focused and discussed. With the development of CFSB and the fusion with other advanced next-generation technologies, CFUPS systems would explicitly deliver their values for biopharmaceutical applications.