Area-level deprivation and handwashing behavior during the COVID-19 pandemic: A multilevel analysis on a nationwide survey in Korea

This study investigated the association between area deprivation level and performance of handwashing behavior during the COVID-19 pandemic in Korean adults. This study used data from the 2015 Population and Housing Census data to measure area deprivation level. The 2020 Korea Community Health Survey was used for all other variables, including hand hygiene behavior (August through November 2020). The association between area deprivation level and practice of handwashing behavior was examined using multilevel logistic regression analysis. The study population comprised 215,676 adults aged 19 years or above. Compared to the least area deprived group, the most deprived group was more likely to not wash hands after using the restroom (OR 1.43, 95% CI 1.13-1.82), after coming home (OR 1.85, 95% CI 1.43-2.39), and using soap (OR 1.55, 95% CI 1.29-1.84). The findings suggest the importance of considering area deprivation in implementing policies that promote handwashing, particularly during a pandemic.

Satisfaction with local healthcare services and medical need among hypertensive patients: a nationwide study

BACKGROUND

Investigating the factors associated with unmet medical needs is important since it can reflect access to healthcare. This study examined the relationship between the unmet medical needs of patients with hypertension and their satisfaction with the healthcare services available in their neighborhoods.

METHODS

Data were from the 2021 Korean Community Health Survey. The sample included individuals aged 19 years who were diagnosed with hypertension. The main outcome measure was unmet medical need. The relationship between the outcome measure and independent variables were analyzed using multivariate logistic regressions, along with a subgroup analysis based on whether patients were currently receiving treatment for hypertension.

RESULTS

Unmet medical needs were found in 4.3% of the study participants. A higher likelihood of unmet medical needs was found in individuals not satisfied with the healthcare services at proximity (adjusted OR = 1.69, 95% CI: 1.49-1.92) compared to those satisfied with services nearby. Similar tendencies were found regardless of whether individuals were currently receiving treatment for hypertension, although larger differences were found between groups in participants who were currently not receiving treatment.

CONCLUSIONS

The findings infer the need to consider patient satisfaction with nearby healthcare services in implementing public health policies that address unmet medical need in patients with hypertension.

Five-year Trajectory about Screening for Complication of Diabetes Kidney Disease and Cardiovascular Disease Mortality : Focusing on Regional Difference

BACKGROUNDS

The overall screening rate for complication of diabetes kidney disease is improving; however, regional variations are increasing. It is necessary to select regions vulnerable to change and understand their characteristics.

METHODS

Group-based trajectory analysis was performed to derive change patterns in the complication of diabetes kidney disease screening rate in 244 regions using Community Health Survey data between 2015 and 2019. ANOVA test was conducted to examine the differences in regional characteristics and CVD in each change pattern.

RESULTS

The change patterns in complication of diabetes kidney disease screening rate were classified into four groups: high and rapidly increasing (Group 1, 5.2%), steady high (Group 2, 8.2%), moderate and increasing (Group 3, 52.9%), and low and slightly increasing (Group 4, 23.8%). Group 4 had many rural areas and worse socioeconomic status, healthcare systems, health behaviors, and diabetes management, and these regions had higher CVD mortality rates.

CONCLUSIONS

Regions where the screening for complication of diabetes kidney disease rate did not improve compared to other regions were vulnerable not only in socioeconomic status, healthcare system, and health behavior, but also in disease management. This suggests the need for local and environmental support, as well as aggressive health service interventions in relatively vulnerable areas.

Effect of motivated physicians and elderly patients with hypertension or type 2 diabetes mellitus in prepared communities on health behaviours and outcomes: A population-based PS matched retrospective cohort study during five-year follow-up period

Effective chronic disease management requires the active participation of patients, communities, and physicians. The objective of this study was to estimate the effectiveness of the Community-based Registration and Management for elderly patients with Hypertension or Type 2 Diabetes mellitus Project (CRMHDP) by using motivated primary care physicians and patients supported by prepared communities, to utilise healthcare and health outcomes in four cities in South Korea. We conducted a propensity score-matched retrospective cohort study using 2010-2011 as the baseline years, alongside a follow-up period until 2015/2016, based on the Korean National Health Insurance database. Both a CRMHDP group (n = 46,865) and a control group (n = 93,730) were applied against healthcare utilisation and difference-in-differences estimations were performed. For the health outcome analysis, the intervention group (n = 27,242) and control group (n = 54,484) were analysed using the Kaplan-Meier method and Cox proportional hazard regression. Results: The difference-in-differences estimation of the average annual clinic visits per person and the average annual days covered were 1.26 (95% confidence interval, 1.13-1.39) and 22.97 (95% CI, 20.91-25.03), respectively, between the intervention and control groups. The adjusted hazard ratio for death in the intervention group, compared to the control group, was 0.90 (95% CI, 0.86-0.93). For stroke and chronic renal failure, the adjusted hazard ratios for the intervention group compared to the control group were 0.94 (95% CI, 0.88-0.99) and 0.80 (95% CI 0.73-0.89), respectively. Our study suggests that for effective chronic disease management both elderly patients and physicians need to be motivated by community support.

Patients with diabetes in regions with population decline and likelihood of receiving diabetes management education and screenings for related complications in Korea

OBJECTIVE

Many municipal districts in Korea face population decline owing to overall population decreases and aging. We investigated the association between geographic rurality and likelihood of receiving diabetes management education and diabetic retinopathy and diabetes-related kidney disease screenings among adults with diabetes.

METHODS

Patient data were obtained from the 2021 Korea Community Health Survey (27,391 individuals; aged ≥19 years and physician-diagnosed with diabetes mellitus). Geographic rurality was categorized based on population decline as follows: with, at risk of, or without population decline. The association between geographic rurality and likelihood of receiving diabetes management education and diabetic retinopathy and diabetes-related kidney disease screenings was examined using multilevel logistic regression analyses.

RESULTS

Among 27,391 patients with diabetes, 31.1% received diabetes education; 40.0% and 46.4% were screened for diabetic retinopathy and diabetes-related kidney disease, respectively. Individuals residing in regions with population decline were less likely to receive diabetes education (odds ratio [OR] 0.62, 95% CI 0.50-0.75) and diabetic retinopathy (OR 0.79, 95% CI 0.70-0.90) and diabetes-related kidney disease (OR 0.64, 95% CI 0.55-0.75) screenings, as compared with their counterparts.

CONCLUSIONS

Our findings highlight the importance of increased monitoring and providing diabetes education and screenings for patients with diabetes living in rural areas.

Cancer risk based on alcohol consumption levels: a comprehensive systematic review and meta-analysis

OBJECTIVES

Alcohol consumption is a well-established risk factor for cancer. Despite extensive research into the relationship between alcohol consumption and cancer risk, the effect of light alcohol consumption on cancer risk remains a topic of debate. To contribute to this discourse, we conducted a comprehensive systematic review and meta-analysis.

METHODS

Our systematic review aimed to investigate the associations between different levels of alcohol consumption and the risk of several cancer types. We focused on analyzing prospective associations using data from 139 cohort studies. Among them, 106 studies were included in the meta-analysis after a quantitative synthesis.

RESULTS

Our analysis did not find a significant association between light alcohol consumption and all-cause cancer risk (relative risk, 1.02; 95% confidence interval, 0.99 to 1.04), but we observed a dose-response relationship. Light alcohol consumption was significantly associated with higher risks of esophageal, colorectal, and breast cancers. Light to moderate drinking was associated with elevated risks of esophageal, colorectal, laryngeal, and breast cancers. Heavy drinking was also found to contribute to the risk of stomach, liver, pancreas, and prostate cancers, thereby increasing the risk of almost all types of cancer. Additionally, females generally had lower cancer risks compared to males.

CONCLUSIONS

Our findings highlight that cancer risks extend beyond heavy alcohol consumption to include light alcohol consumption as well. These findings suggest that there is no safe level of alcohol consumption associated with cancer risk. Our results underscore the importance of public health interventions addressing alcohol consumption to mitigate cancer risks.

Beneficial Role of Multi-Disciplinary Treatment for Anaplastic Thyroid Cancer with Initial Distant Metastasis

PURPOSE/OBJECTIVE(S)

Anaplastic thyroid cancer (ATC) is a rare, highly aggressive tumor, with median survival around 5 months. Approximately half of the ATC patients presents with distant metastases at diagnosis, showing even more devastating prognosis, yet no outcome analysis had been reported. In this study, we aim to evaluate the clinical outcome of M1 ATC patients, and to define the group of patients who would benefit from local treatment based on multi-disciplinary approach.

MATERIALS/METHODS

A total of 133 histology-confirmed ATC patients underwent protocol-based multidisciplinary treatment including surgery and chemoradiotherapy (CRT) between May 2016 and January 2022. Patients received intensity-modulated radiotherapy of 30 fractions concurrently with paclitaxel on days 1, 8 and 15 every 4 weeks, and lenvatinib was added upon progression. After 18 fractions of CRT, interim response analysis using modified RECIST was conducted for adaptive treatment planning. We reviewed 58 patients with distant metastasis at diagnosis (stage IVC). Overall survival (OS) and progression-free survival (PFS) were measured from the day of diagnosis.

RESULTS

Most common metastatic site was lung (91.4%), followed by bone (31.0%) and brain (5.2%). Lenvatinib was added for 35 patients after any sign of progression. Fourteen patients received upfront surgery (16 debulking and 5 total) followed by adjuvant CRT in 16 patients. Thirty-one patients received upfront CRT with 2 patients receiving total resection after sufficient down-staging. Six (10%) patients could not complete radiotherapy but continued receiving systemic treatment. The median follow-up was 5.9 months. The median and 1-year OS were 6.2 months and 20.5%, and PFS were 3.7 months and 3.5%. Total RT dose over 60 Gy significantly improved median OS (7.5 vs 4.1 months, p = 0.012) and median PFS (4.4 vs 3.0, p = 0.010). Patients with less than 10 initial metastatic tumors showed better median OS (9.1 vs 4.6 months, p = 0.002) but not PFS (5.1 vs 3.6, p = 0.485). At interim analysis, early response (CR, PR and SD) of primary tumor was not associated with survival, while progression of distant metastases showed significantly worse median OS (9.8 vs 4.6 months, p = 0.001). More than 10 metastatic tumors (HR 2.73, 95% CI 1.32-5.66) and stable metastasis at interim analysis (HR 2.39, 95% CI 1.04-5.48) remained as significant factor in the multivariable cox regression analysis. Median OS and PFS of patients with less than 10 metastases showing no progression at interim analysis were 9.1 months, and 5.1 months.

CONCLUSION

Local treatment combined with chemotherapy for M1 ATC patients showed outcome comparable to those of non-metastatic ATC results. Active local treatment should be considered especially for patients with less than 10 metastases, and patients without distant progression in early response evaluation.

Korea Seroprevalence Study of Monitoring of SARS-COV-2 Antibody Retention and Transmission (K-SEROSMART): findings from national representative sample

OBJECTIVES

We estimated the population prevalence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including unreported infections, through a Korea Seroprevalence Study of Monitoring of SARS-CoV-2 Antibody Retention and Transmission (K-SEROSMART) in 258 communities throughout Korea.

METHODS

In August 2022, a survey was conducted among 10,000 household members aged 5 years and older, in households selected through two stage probability random sampling. During face-to-face household interviews, participants self-reported their health status, COVID-19 diagnosis and vaccination history, and general characteristics. Subsequently, participants visited a community health center or medical clinic for blood sampling. Blood samples were analyzed for the presence of antibodies to spike proteins (anti-S) and antibodies to nucleocapsid proteins (anti-N) SARS-CoV-2 proteins using an electrochemiluminescence immunoassay. To estimate the population prevalence, the PROC SURVEYMEANS statistical procedure was employed, with weighting to reflect demographic data from July 2022.

RESULTS

In total, 9,945 individuals from 5,041 households were surveyed across 258 communities, representing all basic local governments in Korea. The overall population-adjusted prevalence rates of anti-S and anti-N were 97.6% and 57.1%, respectively. Since the Korea Disease Control and Prevention Agency has reported a cumulative incidence of confirmed cases of 37.8% through July 31, 2022, the proportion of unreported infections among all COVID-19 infection was suggested to be 33.9%.

CONCLUSIONS

The K-SEROSMART represents the first nationwide, community-based seroepidemiologic survey of COVID-19, confirming that most individuals possess antibodies to SARS-CoV-2 and that a significant number of unreported cases existed. Furthermore, this study lays the foundation for a surveillance system to continuously monitor transmission at the community level and the response to COVID-19.

Public perception of the appropriateness of COVID-19 management strategies and level of disturbances in daily activities: A focus on educational level

BACKGROUND

This study investigated the association between public perception of the appropriateness of management strategies implemented during the COVID-19 pandemic and the level of disturbances in daily activities reported by the general population.

METHODS

This cross-sectional study used Korea Community Health Survey conducted from August to November 2020. Public perception of COVID-19 management strategies included those implemented by the government (central, city or provincial, and administrative districts), the mass media, regional medical institutions, and neighbors. The subjective level of disturbances in daily activities was measured using a 0-100 numeric rating scale developed by Korea Disease Control and Prevention Agency. Multivariable linear regression analysis was used. A subgroup analysis was conducted based on education level.

RESULTS

The present study analyzed 211,353 participants. Compared to individuals who perceived that the management strategies implemented during the pandemic was 'highly appropriate,' those who reported 'mediocre appropriateness' (β: -1.96, p-value: <0.001) or 'low appropriateness' (β: -3.60, p-value: 0.010) reported higher levels of subjective disturbances. The appropriateness of measures implemented by the mass media was associated with levels of subjective disturbances felt by individuals of lower education with statistical significance, whereas that applied by the mass media and the government were important in those with higher education.

CONCLUSIONS

The findings suggest the importance of public perception of management strategies when implementing containment policies and minimizing its disturbances on daily lives is essential.

Is COVID-19 induced reductions in the level of physical activity associated with increased depressive symptoms in patients with hypertension?

BACKGROUND

Studies have reported that the coronavirus 2019 (COVID-19) outbreak led to reduced levels of physical activity, but this has been rarely studied in patients with hypertension. This study investigated the association between depressive symptoms and changes in physical activity of patients with hypertension during the COVID-19 outbreak.

METHODS

Data were from the Korea Community Health Survey (KCHS), conducted between August to November 2020. The KCHS is a nationwide cross-sectional survey that evaluates information on various sociodemographic, economic, and health related variables. Depressive symptoms were measured using the Patient Health Questionnaire-9. Physical activity was measured using a questionnaire inquiring whether participants experienced any changes in physical activity after the pandemic. The association between depressive symptoms and changes in physical activity level were analyzed using a multivariable logistic regression analysis.

RESULTS

Out of 55,203 patients, 39.6% responded that they had experienced lower levels of physical activity due to the pandemic and showed increased likelihoods of depressive symptoms (OR 1.33, 95% CI 1.14-1.54) than individuals who responded that they had performed similar levels of physical activity. This tendency was stronger in patients that did not receive treatment for hypertension (OR 2.07, 95% CI 1.02-4.23) than those who did receive treatment with marginal significance (p-value of interaction term: 0.1241).

CONCLUSIONS

Decreased levels of physical activity due to the outbreak was experienced by a noticeable proportion of patients with hypertension and was associated with increased likelihoods of depressive symptoms.

Physical activity, sedentary behavior, and cardiovascular disease risk in Korea: a trajectory analysis

OBJECTIVES

To identify the distinct trajectories of sedentary behavior (SB) and explore whether reduced cardiovascular disease (CVD) risk was associated with a distinct trajectory of physical activity (PA).

METHODS

We analyzed data from 6,425 people who participated in the Korean Health Panel Survey over a period of 10 years. The participants' self-reported SB and PA were assessed annually, and trajectory groups were identified using a group-based trajectory model for longitudinal data analysis. Logistic regression analysis was performed to assess the association between CVD risk (10-year cumulative incidence) and the trajectories of SB and PA. The adjusted variables included socio-demographic factors, the predisposing diseases of CVD, and baseline health behaviors.

RESULTS

Trajectory analysis identified 4 SB trajectory groups: SB group 1 (low and slightly increasing trend, 53.1%), SB group 2 (high and rapidly decreasing trend, 14.7%), SB group 3 (high and slightly decreasing trend, 9.9%), and SB group 4 (low and rapidly increasing trend, 22.2%). The 3 PA trajectory groups were PA group 1 (moderate and slightly decreasing trend, 32.1%), PA group 2 (low and slightly decreasing trend, 57.3%), and PA group 3 (maintained inactivity, 10.7%). By the 10-year follow-up, 577 cases of incident CVD had occurred. We also noted a 50% reduction in the risk of CVD when SB group 4 was accompanied by PA group 1 (odds ratio, 0.50; 95% confidence interval, 0.28 to 0.90).

CONCLUSIONS

Despite increased time spent in SB, maintaining PA about 2 days to 3 days per week reduced the occurrence of CVD.

The association between night eating syndrome and health-related quality of life in Korean adults: a nationwide study

PURPOSE

Quality of life may be influenced by the presence of eating disorders. This study investigated the association between night eating syndrome (NES) and health-related quality of life in the general population.

METHODS

Data were from the 2019 Korea Community Health Survey. The presence of NES was determined using the Night Eating Questionnaire. Health-related quality of life was measured using the 3-level EuroQoL-5 Dimension Index. Multivariable linear regression analyses assessed the association between NES and health-related quality of life. Subgroup analyses were performed based on daily sleep duration.

RESULTS

A total of 34,434 individuals aged 19 years or older were included in the study population. Participants with NES (β = - 4.85, p < 0.001) reported poorer health-related quality of life scores than those without NES. Decreases in health-related quality of life scores among those with NES were greatest in those who slept over 8 h daily (β = - 12.03, p = 0.004), followed by those who slept less than 6 h (β = - 5.90, p = 0.006) and participants who slept between 6 and 8 h (β = - 3.40, p = 0.026) daily.

CONCLUSION

Individuals with NES were more likely to have a lower health-related quality of life than those without NES. These findings highlight the potential importance of considering NES in investigating the health-related quality of life.

LEVEL OF EVIDENCE

Level III, well-designed case-control analytic studies.

Perceived social support and depressive symptoms during the COVID-19 pandemic: A nationally-representative study

BACKGROUND

The COVID-19 pandemic and the associated containment policies have led to negative mental health consequences in the general population.

AIMS

This study investigated the association between perceived social support and depressive symptoms in Korea.

METHODS

Data from the Korea Community Health Survey conducted from August to November 2020 was used for this cross-sectional study. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9) and perceived social support was assessed based on the number of contacts that participants had identified as being available in case participants needed isolation due to COVID-19 exposure. This study included the general adult populations aged 19 years and older. The relationship between the perceived social support and depressive symptoms was analyzed using multivariable liner regression analysis. Subgroup analysis was conducted based on income.

RESULTS

Analysis of the data obtained from 225,453 participants indicated that PHQ-9 scores were highest in the group with 'no' perceived social support, followed by 'low', 'middle', and 'high' perceived levels of social support. Compared to individuals with 'high' perceived social support, those with 'middle' (β: .10, p-value <.001), 'low (β: .07, p-value .010), and 'no' (β: .34, p-value <.001) perceived levels of social support showed poorer depression scores. The magnitude of the relationship found was particularly strong in the low-income group.

CONCLUSIONS

During the COVID-19 pandemic, individuals' depression scores varied according to their perceived level of social support. Strategies that address the need of vulnerable individuals are required to reduce the potentially negative mental health consequences of the pandemic.

Efficacy of Silkworm Pupae Extract on Muscle Strength and Mass in Middle-Aged and Older Individuals: A Randomized, Double-Blind, Placebo-Controlled Trial

OBJECTIVES

We investigated the efficacy and safety of silkworm pupae extract (SWP) consumption for 12 weeks on muscle mass and strength in middle-aged and older individuals with relatively low skeletal muscle mass who do regular low-intensity exercise.

DESIGN

A randomized double-blinded placebo-controlled trial.

PARTICIPANTS

The study was conducted with 54 participants with relatively low skeletal muscle mass (SMM) (64.4 ± 6.1 years; body mass index, 23.8 ± 2.4 kg/m2).

INTERVENTION AND MEASUREMENTS

Participants were randomly assigned to one of two groups: 1000 mg of SWP/day plus regular exercise (SWP group, n=27) or placebo plus regular exercise (placebo group, n=27). All participants were required to engage in 30-60 minutes/day of walking for ≥3 days/week for 12 weeks. The primary outcome was knee extension/flexion strength (Nm), measured at the velocity of 60°/s. Secondary outcomes included body composition, biomarkers (creatine kinase and creatinine), handgrip strength, and quality of life questionnaire.

RESULTS

Both the intention-to-treat (ITT) and per-protocol (PP) analyses revealed no significant impact of SWP on knee strength compared to the placebo group over 12 weeks. On the other hand, the SWP group had significantly greater increases in right-handgrip strength by 1.94 kg (95% CI: 0.08-3.79; p = 0.041) and left-handgrip strength by 1.83 kg (0.25-3.41; p = 0.024) compared to the placebo group in the ITT population, after 12 weeks. Moreover, in the PP population, the SWP group revealed an even greater increase in right-handgrip strength by 2.07 kg (0.15-3. 98; p = 0.035) and left-handgrip strength by 2.21 kg (0.60-3.83; p = 0.008) for the 12-week period. However, this study resulted in a failure to detect significant differences in the body composition, biomarkers, quality of life questionnaire, physical activity, and caloric intake between the groups. None of the participants in the SWP group experienced any significant adverse events. In the placebo group, two participants experienced urticaria and allergic side effects, leading to their withdrawal from the study and two exhibited elevated levels of liver enzyme and increased diastolic blood pressure, respectively at 12 weeks.

CONCLUSION

SWP, in addition to low-intensity exercise, may enhance handgrip strengths in middle-aged and older adults with relatively lower SMM. Future studies need to use a large sample size over longer periods to validate our findings. This trial was registered at clinicaltrials.gov as NCT04994054.

Viral shedding patterns of symptomatic SARS-CoV-2 infections by periods of variant predominance and vaccination status in Gyeonggi Province, Korea

OBJECTIVES

We compared the viral cycle threshold (Ct) values of infected patients to better understand viral kinetics by vaccination status during different periods of variant predominance in Gyeonggi Province, Korea.

METHODS

We obtained case-specific data from the coronavirus disease 2019 (COVID-19) surveillance system, Gyeonggi in-depth epidemiological report system, and Health Insurance Review & Assessment Service from January 2020 to January 2022. We defined periods of variant predominance and explored Ct values by analyzing viral sequencing test results. Using a generalized additive model, we performed a nonlinear regression analysis to determine viral kinetics over time.

RESULTS

Cases in the Delta variant's period of predominance had higher viral shedding patterns than cases in other periods. The temporal change of viral shedding did not vary by vaccination status in the Omicron-predominant period, but viral shedding decreased in patients who had completed their third vaccination in the Delta-predominant period. During the Delta-predominant and Omicron-predominant periods, the time from symptom onset to peak viral shedding based on the E gene was approximately 2.4 days (95% confidence interval [CI], 2.2 to 2.5) and 2.1 days (95% CI, 2.0 to 2.1), respectively.

CONCLUSIONS

In one-time tests conducted to diagnose COVID-19 in a large population, although no adjustment for individual characteristics was conducted, it was confirmed that viral shedding differed by the predominant strain and vaccination history. These results show the value of utilizing hundreds of thousands of test data produced at COVID-19 screening test centers.

Epidemiological characteristics of diabetes mellitus in Korea

Background: The estimated prevalence of diabetes mellitus has increased and become a burden among non-communicable diseases due to the accelerated aging population worldwide and the increased prevalence in low-income countries. In Korea, diabetes has become a serious public health concern.Current Concepts: There are four major concerns in diabetes epidemiology. First, the increased obesity rate is associated with increased diabetes prevalence. Second, a more than 40% increase in men and women with prediabetes has been observed. Prediabetes is not only a risk factor for diabetes but can also have pathophysiological effects. Third, one in three patients did not know that they had the disease. Three in four persons with diabetes experienced uncontrolled blood glucose even with treatment. Moreover, the treatment and awareness rates among people with diabetes in their 30s and 40s were lower than 50%. Unhealthy habits such as smoking, alcohol drinking, and inadequate physical activity persist in patients undergoing treatment. Finally, it has recently been found that the risk of developing diabetes is high among cancer survivors and patients recovering from coronavirus disease 2019.Discussion and Conclusion: A strategy should be developed to improve early detection and treatment rate in young people. We need to emphasize the seriousness of the increasing number of people with prediabetes and examine the effects of drug intervention for prediabetes, on the basis of academic research. We should also pay attention to patients who recovered from the newly emerging coronavirus disease 2019 and cancer survivors at risk of developing diabetes.

Seroprevalence of severe acute respiratory syndrome coronavirus 2 antibodies during the third wave of coronavirus disease in the Seoul metropolitan area of Korea

Objectives

After the third wave of coronavirus disease (COVID-19), by mid-February 2021, approximately 0.16% of the population was confirmed positive, which appeared to be one of the lowest rates worldwide at that time. However, asymptomatic transmission poses a challenge for COVID-19 surveillance. Therefore, a community-based serosurvey of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was conducted to understand the effectiveness of Korea's strong containment strategy.

Methods

We collected 5,002 residual sera samples from January 30 to March 3, 2021 from 265 medical facilities in Seoul, 346 in Kyunggi-do' and 57 in Incheon. Among them, 60 samples from tertiary institutions were excluded. We defined the sub-regions according to the addresses of the medical facilities where the specimens were collected. Elecsys Anti-SARS-CoV-2 was used for the screening test, and positivity was confirmed using the SARS-CoV-2 sVNT Kit. Prevalence was estimated using sampling weight and the Wilson score interval for a binomial proportion with a 95% confidence interval.

Results

Among the 4,942 specimens, 32 and 25 tested positive for COVID-19 in the screening and confirmatory tests, respectively. The overall crude prevalence of SARS-CoV-2 antibody was 0.51%. The population-adjusted overall prevalence was 0.55% in women and 0.38% in men. The region-specific estimation was 0.67% and 0.30% in Gyeonggi-do and Seoul, respectively. No positive cases were detected in Incheon.

Conclusion

The proportion of undetected cases in South Korea remains low. Therefore, an infection control strategy with exhaustive tracing and widespread pre-emptive testing appears to be effective in containing the spread of the virus in the community.

What types of burden experienced by family caregivers of dementia patients are related to their life satisfaction?

BACKGROUND

As the burdens related to dementia caregiving are vast, this study aimed to examine the relationship between life satisfaction and different types of burden reported by family caregivers of patients with dementia.

METHODS

Data from the 2019 Korea Community Health Survey were used. The association between life satisfaction and caregiving burden reported by family caregivers of patients with dementia was investigated using multivariable regression analysis. These burdens resulted from social prejudice and temporal, physical, psychological, or economic reasons. Life Satisfaction was measured using the Organization for Economic Cooperation and Development Better Life Index. Subgroup analysis was performed based on the residing status of patients with dementia and the region of residence of the caregiver.

RESULTS

Data of 12,617 participants were analyzed. Compared to individuals with no burden, those who reported a burden due to temporal (β -0.23, p = 0.003), psychological (β -0.18, p <0.001), and economic (β -0.27, p <0.001) demands showed poorer levels of life satisfaction. These tendencies were maintained in caregivers residing with patients and those providing care for institutionalized patients. Regarding the region where the caregiver lived, for those living in rural regions, burdens related to social prejudice or economical demands were associated with poor life satisfaction.

CONCLUSION

Family caregivers reporting caregiving-related burdens for temporal, psychological, or economic reasons had lower life satisfaction. These findings suggest the importance of considering caregiver's different needs and conditions when implementing coping strategies when caring for individuals with dementia.

Is fear of COVID-19 higher in individuals residing in more deprived areas? A nationwide study

Background

This study investigated the association between various types of coronavirus disease 2019 (COVID-19)-related fear and the level of area deprivation in Korea.

Methods

Different types of COVID-19-related fear were examined, namely fear of infection, fear of dying from infection, fear of public criticism, fear of a family member getting infected and fear of economic loss. The level of area deprivation was measured based on the Area Deprivation Index, which was calculated based on population census data. The association between various types of COVID-19-related fear and the level of area deprivation was analyzed using multivariable logistic regression analysis.

Results

This study included 199 859 individuals from the 253 administrative divisions in South Korea. Findings indicated that fear was most common in individuals residing in the most deprived areas, followed by those in the mediocre and least deprived areas (fear of infection: odds ratio (OR) 1.05, 95% confidence interval (CI) 1.01–1.09; fear of dying from infection: OR 1.23, 95% CI 1.19–1.28; fear of public criticism: OR 1.20, 95% CI 1.15–1.24; fear of a family member getting infected: OR 1.12, 95% CI 1.07–1.18).

Conclusions

The findings suggest the need to monitor and account for area deprivation in managing the psychological health effects of the COVID-19 crisis.

The Ability to Rest at Home During COVID-19 Symptom Manifestation and Depressive Symptoms: Evidence From Korea

OBJECTIVE

This study investigated the association between ability to rest at home in times of coronavirus disease 2019 (COVID-19) symptom manifestation and depressive symptoms.

METHODS

The 2020 Korea Community Health Survey data were used. The presence of depressive symptoms was determined using the Patient Health Questionnaire-9. The relationship between depressive symptoms and ability to rest at home was examined using logistic regression analysis. Additional analysis was performed on the reasons for the inability to stay at home.

RESULTS

Depressive symptoms were more common in participants who could not rest at home if symptoms manifested (4.1%) than those who could rest at home (2.7%). Participants who could not rest at home (OR 1.53, 95% CI 1.34-1.74) were more likely to have depressive symptoms, particularly when they had to report to work (OR 1.50, 95% CI 1.30-1.74) or purchase daily necessities (OR 2.40, 95% CI 1.15-5.03).

CONCLUSION

Inability to rest at home in the case of COVID-19 symptom manifestation was associated with depressive symptoms. The findings suggest the need to address the identified vulnerable groups to mitigate the mental health consequences of the pandemic.

The association between episodes of night eating and levels of depression in the general population

OBJECTIVE

Research has suggested that a correlation may exist between depressive mood and episodes of night eating. This study aimed to examine whether having episodes of night eating was associated with increased levels of depression.

METHOD

This study used data from the 2019 Korea Community Health Survey and the study population consisted of adults aged ≥19 years. Depression levels were measured using the Patient Health Questionnaire-9. We investigated the patients' general characteristics using t-tests and analysis of variance. The association between depression levels and episodes of night eating was analyzed using a multivariable linear regression analysis. Subgroup analysis was conducted based on daily sleep duration.

RESULTS

We analyzed 34,358 individuals and found higher average depression scores (β: 4.99, p < .001) in those with episodes of night eating than those without. Large effect sizes were found for differences in depression scores between participants with and without episodes of night eating. The magnitude of this increase was particularly pronounced in individuals who reported 9 or more hours of sleep per day.

DISCUSSION

An association was found between levels of depression and episodes of night eating as individuals with episodes of night eating were more likely to have higher depression scores. Our findings suggest the potential need to consider night eating when addressing the mental health of the general population.

Does having various types of fear related to the COVID-19 disrupt the daily life of individuals?

OBJECTIVES

Unexpected changes in daily routines caused by the coronavirus disease 2019 (COVID-19) pandemic may affect psychological health. This study investigated the association between various types of COVID-19-related fear and the subjective level of disturbance in daily activities experienced by individuals.

METHODS

This cross-sectional study used the Korea Community Health Survey conducted from August through November 2020. COVID-19-related fear included fear of infection, death, public criticism, family members getting infected, and economic loss. The subjective level of disruption in daily activities was measured using a 0-100 numeric rating scale developed by the Korea Disease Control and Prevention Agency. Multivariable linear regression was used to analyze the associations between the independent and dependent variables. A subgroup analysis was performed based on income level.

RESULTS

Participants who reported fear of infection (β=-3.37, p<0.001), death (β=-0.33, p=0.030), public criticism (β=-1.63, p<0.001), a family member getting infected (β=-1.03, p<0.001), and economic loss (β=-3.52, p<0.001) experienced more disturbances in daily activities. The magnitude of this association was most significant in the lowest-income group.

CONCLUSIONS

Individuals reporting COVID-19-related fear experienced higher levels of subjective disruption in daily activities.

A comprehensive study of deaths due to exposure to humidifier disinfectant in Korea: focusing on medical records, assessment of exposure to humidifier disinfectants, and causes of death

OBJECTIVES

We aimed to determine the characteristics of the deceased victims of deaths caused by exposure to humidifier disinfectants, and present the distribution of the victims’ data submitted for damage application, demographic characteristics, imaging findings, characteristics of humidifier disinfectant exposure, and distribution of the causes of death.

METHODS

An integrated database of victims was established using the medical records data of 1,413 victims submitted during the application for death damage caused by exposure to humidifier disinfectants, and the demographic characteristics, medical records, imaging findings, exposure characteristics, and cause of death were examined.

RESULTS

The average numbers of data submissions of each applicant for death damage were 3.0 medical use records. A total of 608 (43.0%) victims had more than one finding of acute, subacute, or chronic interstitial lung diseases. The average daily and cumulative use times of the victims were 14.40 and 24,645.81 hours, respectively, indicating greater exposure in this group than in the survivors. The humidifier disinfectants’ components comprised polyhexamethylene guanidine (72.8%), chloromethylisothiazolinone/methylisothiazolinone (10.5%), other components (15.0%), and oligo-[2-(2-ethoxy)-ethoxyethyl] guanidine chloride (1.5%). The components’ distribution was 67.8% for single-component use, which was higher than that in the survivors (59.8%). The distribution of the causes of death were: respiratory diseases (54.4%), neoplasms (16.8%), and circulatory diseases (6.3%). Other interstitial lung diseases (65.5%) were the most common cause of death among those who died due to respiratory diseases.

CONCLUSIONS

Careful discussions of appropriate remedies should be conducted based on a comprehensive understanding of the characteristics of the deceased victims, considering their specificities and limitations.

Perceived environmental pollution and subjective cognitive decline (SCD) or SCD-related functional difficulties among the general population

This study aimed to determine whether perceived environmental pollution is associated with subjective cognitive decline (SCD) or SCD-related functional difficulties. We conducted a cross-sectional study using data from a nationwide sample of 191,054 individuals aged ≥19 years from the 2018 Korea Community Health Survey. Perceived air, water, soil, noise, and green space pollution was assessed. To investigate the dose-response effect of the amount of perceived environmental pollution, we determined whether an increasing number of types of perceived environmental pollution also increased the odds of having SCD or SCD-related functional difficulties. Among the 191,054 individuals, the prevalence of SCD and SCD-related functional difficulties was 17.7% (N = 33,853) and 2.2% (N = 4139), respectively. Perception of air, soil, or noise pollution was significantly associated with SCD. However, the perception of any type of environmental pollution was not significantly associated with SCD-related functional difficulties. With regard to a dose-response effect, individuals perceiving a greater number of types of environmental pollution had significantly higher odds of SCD or SCD-related functional difficulties. This association was notably more evident in the younger age group.

A lysosomal enigma CLN5 and its significance in understanding neuronal ceroid lipofuscinosis

Neuronal Ceroid Lipofuscinosis (NCL), also known as Batten disease, is an incurable childhood brain disease. The thirteen forms of NCL are caused by mutations in thirteen CLN genes. Mutations in one CLN gene, CLN5, cause variant late-infantile NCL, with an age of onset between 4 and 7 years. The CLN5 protein is ubiquitously expressed in the majority of tissues studied and in the brain, CLN5 shows both neuronal and glial cell expression. Mutations in CLN5 are associated with the accumulation of autofluorescent storage material in lysosomes, the recycling units of the cell, in the brain and peripheral tissues. CLN5 resides in the lysosome and its function is still elusive. Initial studies suggested CLN5 was a transmembrane protein, which was later revealed to be processed into a soluble form. Multiple glycosylation sites have been reported, which may dictate its localisation and function. CLN5 interacts with several CLN proteins, and other lysosomal proteins, making it an important candidate to understand lysosomal biology. The existing knowledge on CLN5 biology stems from studies using several model organisms, including mice, sheep, cattle, dogs, social amoeba and cell cultures. Each model organism has its advantages and limitations, making it crucial to adopt a combinatorial approach, using both human cells and model organisms, to understand CLN5 pathologies and design drug therapies. In this comprehensive review, we have summarised and critiqued existing literature on CLN5 and have discussed the missing pieces of the puzzle that need to be addressed to develop an efficient therapy for CLN5 Batten disease.

A Network Model of Positive Resources, Temperament, Childhood Trauma, and Comorbid Symptoms for Patient with Depressive Disorders

OBJECTIVE

Temperament, positive resources, childhood trauma, and other clinical comorbid symptoms are related to depressive symptom severity. Here, we used network analysis to examine the interrelations between these clinical factors in patients with depressive disorders.

METHODS

Patients with depressive disorders (n=454) completed self-report questionnaires evaluating clinical symptoms, childhood trauma, temperament, and positive resources. To identify network pattern and the most central aspect, we performed network analysis and centrality analyses. First, we analyzed the network pattern in total participants. Second, we established two groups of those with severe depressive symptoms and those with mild depressive symptoms and compared their network patterns.

RESULTS

Deficient optimism and depression were the central factors in the network of total participants. In the group with severe depressive symptoms, lack of social support and childhood emotional trauma showed high centrality. Deficient social support and other positive resources played central roles in the group with mild depressive symptoms.

CONCLUSION

Network pattern of psychological factors was different between those with mild or severe depression. Lack of positive resources is an important factor in psychological processes in both mild and severe depression. However, childhood emotional trauma may play a relatively important role in patients with severe depressive symptoms.

Seed dormancy and germination of Asarum sieboldii, a disjunct relict species in East Asia

Disjunct species in the same genus are a common feature of the flora in the temperate forests of East Asia and eastern North America. This study aimed to evaluate whether the kind of seed dormancy was maintained after species in the genus Asarum (Aristolochiaceae) were separated from their common ancestor. We classified the seed dormancy of Asarum sieboldii, an East Asian species, based on a phenology study and experiments in controlled temperature conditions, and then compared it to that of the previously studied A. canadense, an eastern North American species. The underdeveloped embryo of A. sieboldii grew and germinated (radicle emergence) in autumn but shoot emergence did not occur until the following spring. The seeds of A. sieboldii had deep simple epicotyl morphophysiological dormancy because the seeds with emerged radicle required a relatively long period of cold stratification to break epicotyl dormancy and produce a shoot. Although the seed of A. sieboldii had weaker radicle dormancy and stronger epicotyl dormancy compared to A. canadense, the kind of seed dormancy was the same for the two species. The trait of seed dormancy was inherited from a shared common ancestor and maintained in populations well after the two species (or their ancestors) separated. However, quantitative differences in temperature requirements for radicle and shoot emergence suggest the possibility of adaptation to the environment.

Association between perceived environmental pollution and poor sleep quality: results from nationwide general population sample of 162,797 people

OBJECTIVE/BACKGROUND

Perceived environmental pollution may play a significant role in understanding environmentally induced health-related symptoms. This study aimed to determine whether perceived environmental pollution is associated with poor sleep quality.

METHODS

We conducted a cross-sectional study using data from a nationwide sample of 162,797 individuals aged ≥19 years from the 2018 Korea Community Health Survey. The Pittsburgh Sleep Quality Index was used for assessing sleep quality. Five types of perceived environmental pollutants involving air, water, soil, noise, and green space were assessed. We investigate the association between perceived environmental pollution and poor sleep quality. We also investigated whether an increasing number of perceived environmental pollutants magnified the odds of poor sleep quality.

RESULTS

The prevalence of poor sleep quality was 42.7% (n = 69,554), and 15.6%, 10.1%, 11.9%, 23.0%, and 11.5% reported perceived environmental pollution concerning air, water, soil, noise, and green space, respectively. A perception of air, soil, or noise pollution was significantly associated with poor sleep quality. In addition, those perceiving a greater number of environmental pollutants had significantly higher odds of poor sleep quality. Notably, this association was magnified in individuals living in rural areas.

CONCLUSIONS

Perceived environmental pollution was significantly associated with poor sleep quality. Our results suggest that a more comprehensive exposure to environmental pollution may not only have a worse effect on health outcomes including sleep quality.

Associations between Chewing Difficulty, Subjective Cognitive Decline, and Related Functional Difficulties among Older People without Dementia: Focus on Body Mass Index

OBJECTIVE

This study aimed to determine whether chewing difficulty is associated with subjective cognitive decline (SCD) and related functional difficulties by body mass index.

DESIGN

A population-based cross-sectional study.

SETTING AND PARTICIPANTS

A nationwide sample of 54,004 individuals aged ≥65 years from the 2018 Korea Community Health Survey.

MEASUREMENTS

SCD and SCD-related functional difficulties were measured using the cognitive decline module of the Behavioral Risk Factor Surveillance System. Chewing difficulty was assessed based on a self-report questionnaire from an oral health-related behaviors interview survey. BMI was calculated from objective values by measuring height and weight through a physical meter.

RESULTS

Among the 54,004 individuals, the prevalence of SCD in underweight, overweight, and obesity group was 33.6% (n = 806), 30.3% (n = 9,691), and 28.7% (n=5,632) respectively. Chewing difficulty was associated with SCD and SCD-related functional difficulties. This association was more pronounced in underweight (BMI: <18.5 kg/m2) people [underweight: (odds ratio [OR] = 1.68, 95% confidence interval [CI] 1.48-1.92); normal weight: OR = 1.13, 95% CI 1.04-1.22; obese: OR = 1.15, 95% CI 1.05-1.27]. Similar trends were demonstrated for SCD-related functional difficulties (underweight: OR = 1.53, 95% CI 1.17-2.01; normal weight: OR = 1.36, 95% CI 1.15-1.63; obese: OR = 1.50, 95% CI 1.22-1.86).

CONCLUSIONS

Chewing difficulty was associated with SCD and SCD-related functional difficulties in older people. Our results suggest that underweight status may play roles in the associations between chewing difficulty and SCD and SCD-related functional difficulties.

Prevalence of Anemia and Its Association with Frailty, Physical Function and Cognition in Community-Dwelling Older Adults: Findings from the HOPE Study

OBJECTIVES

The prevalence of anemia and its impact on frailty and physical function amongst the multiethnic older populations in the Southeast Asian (SEA) countries are often not well studied. Singapore, a nation comprised of multiethnic communities, is one of the most rapidly aging population globally. We aim to evaluate the prevalence of anemia and its impact on frailty, and physical function in Healthy Older People Everyday (HOPE)- an epidemiologic population-based study on community-dwelling older adults in Singapore.

DESIGN

Cross-sectional study.

SETTING

Community.

PARTICIPANTS

480 adults ≥ 65 years old.

MEASUREMENTS

Data were collected from interviewers-administered questionnaires on socio-demographics, FRAIL scale, Mini-Mental State Examination, EQ-5D, Barthel Index, and Lawton index. Hemoglobin concentration and physical assessments, including anthropometry, grip strength, timed up-and-go (TUG) were measured.

RESULTS

The overall prevalence of anemia was 15.2% (73 out of 480). The Indian ethnic group had the highest prevalence of anemia (32%, OR=3.02; 95%CI= 1.23-7.41) with the lowest hemoglobin concentration compared to the overall population (13.0±1.3g/L and 13.5±1.4g/L, p=0.02). Hemoglobin levels and anemia were significantly associated with frailty (OR=2.28; 95% CI=1.02-5.10), low grip strength (OR=1.79; 95% CI=1.01-3.03), ≥ one IADL impairment (OR=2.35; 95% CI=1.39-3.97). Each 1 g/dL increase in hemoglobin was associated with a 6% decrease in frailty odds after adjusting for potential covariates (OR = 0.94, 95% CI: 0.90-0.99). There was a significant difference in the mean TUG between the non-anemic (11.0±3.4 seconds) and anemic (12.3±6.0 seconds, p=0.01) counterparts, but no difference in the number of falls.

CONCLUSION

In our multiethnic Asian population, anemia was adversely associated with frailty, decreased muscle strength, and IADL impairment. Health policies on anemia screening should be employed to avoid or potentially delay or reverse these adverse outcomes associated with anemia. Recognition, evaluation, and treatment of anemia amongst this vulnerable population is warranted.

Association Between Recent Experience of Childbirth and Sleep Quality in South Korean Women: Results from a Nationwide Study

INTRODUCTION

Although women commonly report deterioration of sleep quality postpartum, this relationship has been less studied in East Asian countries. This study investigated the association between recent experience of childbirth and sleep quality in South Korean women and additionally examined how healthy practice behavior interplays in the stated relationship.

METHODS

Data from the 2018 Community Health Survey were used. Sleep quality was measured using the Pittsburgh sleep quality index (PSQI). Women who responded to have given birth in the past year were categorized as having a recent experience of childbirth. The general characteristics of the study population were investigated using chi-square test. The association between the dependent and independent variables was analyzed using multivariate logistic regression analysis.

RESULTS

Of a total of 41,708 study participants, 16,877 (40.5%) individuals reported poor sleep quality. Poor sleep quality was more common in women with a recent experience of childbirth (48.4%) than those without (40.0%). Compared to individuals without a recent experience of childbirth, those with such an experience were more likely to show poor sleep quality (OR 1.50, 95% CI 1.34-1.68). Such differences were reduced in individuals with a healthy lifestyle.

CONCLUSION

Recent experience of childbirth was associated with higher likelihoods of poor sleep quality in women. The degree of risks found was reduced in individuals practicing a healthy lifestyle habit. The findings infer the need to monitor and address sleep-related disturbances commonly reported among postpartum women.

Factors associated with poor sleep quality in the Korean general population: Providing information from the Korean version of the Pittsburgh Sleep Quality Index

BACKGROUND

Recently, studies have been conducted to address the research gap in the understanding of poor-quality sleep and its relationship to health outcomes, through the evaluation of sleep quality. The aim of this study was to provide information regarding poor sleep quality based on a nationwide general population sample in Korea.

METHODS

We conducted a cross-sectional study using data from a nationwide sample of 165,193 individuals (males: 44%) aged 19 years or older from the 2018 Korea Community Health Survey. The age range of the participants was 19-107 years (mean: 55.3 ± 17.5). The Korean version of the Pittsburgh Sleep Quality Index (PSQI) was used for assessing sleep quality. Poor sleep quality was defined as a total PSQI score of >5.

RESULTS

The overall prevalence of poor sleepers was 41.0% (males: 35.6%; females: 46.2%). Poor sociodemographic status (illiteracy, low income, and unemployment), poor health behaviors (smoking, high-risk drinking, diabetes, hypertension, non-participation in walking, and obesity), and poor mental health (perceived poor health status, stress, depressive symptoms, and subjective cognitive decline) were all associated with poor sleep quality in both males and females.

LIMITATIONS

As this study relies on self-reported and cross-sectional data, causal inferences cannot be made.

CONCLUSIONS

Poor sleep quality is highly prevalent in females. In addition, poor socio-demographic status, poor health behaviors, and poor mental health were associated with poor sleep quality. The mechanisms underlying sex differences in sleep quality remain to be elucidated, and further studies are required to address this.

Risk of nosocomial transmission of coronavirus disease 2019: an experience in a general ward setting in Hong Kong

BACKGROUND

Coronavirus disease 2019 (COVID-19) was first reported in Wuhan in December 2019 and has rapidly spread across different cities within and outside China. Hong Kong started to prepare for COVID-19 on 31st December 2019 and infection control measures in public hospitals were tightened to limit nosocomial transmission within healthcare facilities. However, the recommendations on the transmission-based precautions required for COVID-19 in hospital settings vary from droplet and contact precautions, to contact and airborne precautions with placement of patients in airborne infection isolation rooms.

AIM

To describe an outbreak investigation of a patient with COVID-19 who was nursed in an open cubicle of a general ward before the diagnosis was made.

METHOD

Contacts were identified and risk categorized as 'close' or 'casual' for decisions on quarantine and/or medical surveillance. Respiratory specimens were collected from contacts who developed fever, and/or respiratory symptoms during the surveillance period and were tested for SARS-CoV-2.

FINDINGS

A total of 71 staff and 49 patients were identified from contact tracing, seven staff and 10 patients fulfilled the criteria of 'close contact'. At the end of 28-day surveillance, 76 tests were performed on 52 contacts and all were negative, including all patient close contacts and six of the seven staff close contacts. The remaining contacts were asymptomatic throughout the surveillance period.

CONCLUSION

Our findings suggest that SARS-CoV-2 is not spread by an airborne route, and nosocomial transmissions can be prevented through vigilant basic infection control measures, including wearing of surgical masks, hand and environmental hygiene.

A new aortoiliac calcification scoring system to predict grade C anastomotic leak following rectal cancer surgery

BACKGROUND

Aortoiliac calcification may be a surrogate marker of decreased visceral perfusion causing anastomotic leak (AL). The aim of this study was to evaluate the predictive role of aortoiliac calcification for AL after rectal cancer surgery.

METHODS

We enrolled patients with primary rectal cancer who had restorative resection at our institution between January 2013 and December 2015. An aortoiliac calcification score was calculated as the sum of calcification scores at the infrarenal aorta (0: no, 1: ≤ 3 cm, 2: > 3 cm) and the common iliac arteries (0: no, 1: unilateral, 2: bilateral). AL was classified into three grades: grade A, requiring no intervention; grade B, requiring therapeutic intervention without re-laparotomy; and grade C, requiring re-laparotomy. Clinicopathological characteristics were analyzed to identify risk factors for AL.

RESULTS

There were 583 patients. Three-hundred forty-five (59.2%) had an aortoiliac calcification score ≥ 3, and 37 (6.3%) patients experienced AL, in 30 cases (5.1%) grade C AL. Patients with an aortoiliac calcification score ≥ 3 had a higher incidence of grade C AL (6.7% vs. 2.9%, p = 0.045). Multivariate logistic regression analysis revealed that an aortoiliac calcification score ≥ 3 was an independent risk factor for grade C AL (odds ratio = 2.669, 95% confidence interval 1.066-6.686, p = 0.036).

CONCLUSIONS

Aortoiliac calcification may be considered a risk factor for grade C AL after rectal cancer surgery.

Effect of virtual reality meditation on sleep quality of intensive care unit patients: A randomised controlled trial

OBJECTIVE

This study aimed to investigate the effect of virtual reality meditation on sleep quality of intensive care unit patients.

METHODS

This randomised controlled trial included 48 cardiac intensive care unit patients in a university hospital in Korea randomly allocated to the experimental (24) and the control group (24). For the experimental group, meditation was provided for 30 minutes using a head-mounted display for virtual reality, on the evening of the admission day.

MAIN OUTCOME MEASURES

The sleep quality of both groups was measured by self-report using Sleep Scale A and the activity tracker FitBit Charge 2.

RESULTS

The experimental group reported significantly higher subjective sleep quality than did the control group. Activity tracker assessment indicated that total sleep time and light sleep time did not differ between the groups. However, the awake time was shorter, deep sleep time was longer and sleep efficiency was significantly higher in the experimental group than in the control group.

CONCLUSION

Virtual reality meditation positively affected the sleep quality of intensive care unit patients. Critical care nurses should consider using virtual reality meditation as a nursing intervention to improve the patient's sleep quality.

Stacking Fault Energy Analyses of Additively Manufactured Stainless Steel 316L and CrCoNi Medium Entropy Alloy Using In Situ Neutron Diffraction

Stacking fault energies (SFE) were determined in additively manufactured (AM) stainless steel (SS 316 L) and equiatomic CrCoNi medium-entropy alloys. AM specimens were fabricated via directed energy deposition and tensile loaded at room temperature. In situ neutron diffraction was performed to obtain a number of faulting-embedded diffraction peaks simultaneously from a set of (hkl) grains during deformation. The peak profiles diffracted from imperfect crystal structures were analyzed to correlate stacking fault probabilities and mean-square lattice strains to the SFE. The result shows that averaged SFEs are 32.8 mJ/m2 for the AM SS 316 L and 15.1 mJ/m2 for the AM CrCoNi alloys. Meanwhile, during deformation, the SFE varies from 46 to 21 mJ/m2 (AM SS 316 L) and 24 to 11 mJ/m2 (AM CrCoNi) from initial to stabilized stages, respectively. The transient SFEs are attributed to the deformation activity changes from dislocation slip to twinning as straining. The twinning deformation substructure and atomic stacking faults were confirmed by electron backscatter diffraction (EBSD) and transmission electron microscopy (TEM). The significant variance of the SFE suggests the critical twinning stress as 830 ± 25 MPa for the AM SS 316 L and 790 ± 40 MPa for AM CrCoNi, respectively.

P799 The echocardiographic and clinical characteristics of Fabry patients without overt left ventricular hypertrophy but progressing despite on enzyme replacement therapy

Background

Fabry disease (FD) is X-linked genetic disorder caused by the deficiency or absent activity of lysosomal α- galactosidase. When the heart is involved, progressive left ventricular hypertrophy (LVH) is the key feature. Although, LVH is not present in all subjects, some of them progress with LVH despite enzyme replacement therapy (ERT). The present study aimed to evaluate the characteristics of patient of FD without overt LVH, but progresses with their left ventricular mass index (LVMI).

Method : This study includes subjects carrying genetic mutations for FD without LVH (n = 12) in a single tertiary center. ‘Decreasing LVMI group (Group1)’ was defined when pre-ERT LVMI minus last LVMI value obtained by echocardiography was positive, and when negative, defined as ‘Increasing LVMI group (Group 2)’. The baseline characteristics and echocardiographic parameters including global strain was analyzed.

Result : Total 6 patients were classified as Group 1 and 2 each. The median age at diagnosis for male was 21 vs 27 for each group, and 21 vs 31 for female. The median follow-up duration was 4.0 vs 5.7 yr. The antibody formation for replaced enzyme was 3 for Group 2 and any family member who developed overt LVH was much 1 vs 3 for group 1 vs 2. Initial 3 plane GLS was worse and showed trend to drop in Group 2.

Conclusion : In the Fabry patients get worse with their LVMI but still not developed overt LVH despite enzyme replacement therapy, there are some clinical and echo-parameter difference. These findings could suggest insufficient enzyme replacement therapy.

Group 1 (n = 6) Group 2 (n = 6) Female/Male 4/2 3/3 Age of at Dx (Female) (median) 21 28 Age of at Dx (Male) (median) 21 31 F/U duration (median) 4.0 yrs 5.7 yrs Antibody formation 0 3 Any Overt LVH family Genotype c.56T &gt; C c.40-11T &gt; A, 782_delG, c.658C &gt; T Initial LVMI (Median) 98.2g/m2 70.9g/m2 Initial GLS (3P) -19 -17.8 Continuously elevated LysoGb3 2 4 Proteinuria &gt;300mg 1 3 (1 preparing HD)

The Frequency of Sleep Medication Use and the Risk of Subjective Cognitive Decline (SCD) or SCD With Functional Difficulties in Elderly Individuals Without Dementia

Background

The present study investigated whether the frequency of sleep medication use affects subjective cognitive decline (SCD) or SCD with functional difficulties in elderly individuals.

Methods

The 2018 Korea Community Health Survey data, which consists of national representative and community-based data, was used in this study. A total of 57,050 individuals aged 65 years or older were included in this study. SCD was measured using the Behavioral Risk Factor Surveillance System. A logistic regression analysis was used to analyze the data.

Results

In total, 16,966 (29.7%) participants had SCD and 3,487 (6.1%) had SCD with functional difficulties. The elderly individuals who took sleep medication more than once a week had higher risks of both SCD and SCD with functional difficulties than those who did not take any sleep medication in a month (SCD: odds ratio [OR] = 1.329, 95% confidence interval [CI] = 1.194–1.480; SCD with functional difficulties: OR = 1.752, 95% CI = 1.491–2.058).

Conclusions

Frequent sleep medication use was associated with both SCD and SCD with functional difficulties. This study suggests that early detection of cognitive impairment and efforts to reduce the frequent use of sleeping pills in patients with insomnia might be helpful to reduce the burden of SCD and SCD with functional difficulties in the elderly population.

Developing Children's Oral Health Assessment Toolkits Using Machine Learning Algorithm

OBJECTIVES

Evaluating children's oral health status and treatment needs is challenging. We aim to build oral health assessment toolkits to predict Children's Oral Health Status Index (COHSI) score and referral for treatment needs (RFTN) of oral health. Parent and Child toolkits consist of short-form survey items (12 for children and 8 for parents) with and without children's demographic information (7 questions) to predict the child's oral health status and need for treatment.

METHODS

Data were collected from 12 dental practices in Los Angeles County from 2015 to 2016. We predicted COHSI score and RFTN using random Bootstrap samples with manually introduced Gaussian noise together with machine learning algorithms, such as Extreme Gradient Boosting and Naive Bayesian algorithms (using R). The toolkits predicted the probability of treatment needs and the COHSI score with percentile (ranking). The performance of the toolkits was evaluated internally and externally by residual mean square error (RMSE), correlation, sensitivity and specificity.

RESULTS

The toolkits were developed based on survey responses from 545 families with children aged 2 to 17 y. The sensitivity and specificity for predicting RFTN were 93% and 49% respectively with the external data. The correlation(s) between predicted and clinically determined COHSI was 0.88 (and 0.91 for its percentile). The RMSEs of the COHSI toolkit were 4.2 for COHSI (and 1.3 for its percentile).

CONCLUSIONS

Survey responses from children and their parents/guardians are predictive for clinical outcomes. The toolkits can be used by oral health programs at baseline among school populations. The toolkits can also be used to quantify differences between pre- and post-dental care program implementation. The toolkits' predicted oral health scores can be used to stratify samples in oral health research.

KNOWLEDGE TRANSFER STATEMENT

This study creates the oral health toolkits that combine self- and proxy- reported short forms with children's demographic characteristics to predict children's oral health and treatment needs using Machine Learning algorithms. The toolkits can be used by oral health programs at baseline among school populations to quantify differences between pre and post dental care program implementation. The toolkits can also be used to stratify samples according to the treatment needs and oral health status.

Feasibility of a guided participation discharge program for very preterm infants in a neonatal intensive care unit: a randomized controlled trial

Background

Previous studies showed that parents of very preterm infants expressed feelings of incompetence and experienced high levels of stress upon the discharge of their infants. We conducted a systematic review of seven studies and observed potential benefits for parental outcomes when using discharge interventions that adopted guided participation (GP). More evidence is needed on the effective doses of discharge interventions underpinned by the principles of GP.

Aim

To investigate the feasibility and preliminarily estimate the effects on parental competence and stress outcomes of a newly developed, nurse-led, GP discharge program for mothers of very preterm infants.

Methods

A two-arm randomized controlled trial was conducted in a neonatal intensive care unit (NICU). Mothers of infants with gestational ages of ≤32 weeks who had no congenital malformations and did not need to undergo major surgeries were recruited. All mothers were the primary caregivers to their infants. The intervention group received a nurse-led GP discharge intervention (three structured 30- to 60-min GP sessions and one follow-up phone call). The control group received usual care. The parental outcomes were measured using the Parenting Sense of Competence Scale (C-PSOC) and Perceived Stress Scale (C-PSS) at baseline (T0), on the day of discharge (T1), after the follow-up phone call (within 72 h after discharge) (T2), and 1 month after discharge (T3). The outcomes were analyzed using generalized estimating equations based on intention-to-treat principles.

Results

Thirty infant–mother dyads were recruited. Greater improvements in the C-PSOC score were observed in the intervention group than in the control group at T1 and T2, although these differences were statistically insignificant. The intervention group exhibited greater improvements than the control group in the C-PSS scores at T1, T2, and T3, although these differences were also not statistically significant.

Conclusions

The findings suggest that a GP discharge intervention could improve parenting competence and stress among mothers with very preterm infants. The absence of adverse events suggests that the GP discharge intervention could be feasibly implemented in NICU settings. This feasibility study was not powered to determine the effectiveness of the intervention but is anticipated to lay the foundation for a future full-scale study.

Trial registration

ClinicalTrials.gov Identifier: NCT03668912. Date of registration: 13 September 2018 (retrospectively registered).

P1711The association of multidisciplinary team approach with clinical outcomes in patients with acute myocardial infarction underwent veno-arterial extracorporeal membrane oxygenation

Background

Multidisciplinary team approach is necessary for the management of critically-ill patients. However, limited data are available on the impact of specialized extracorporeal membrane oxygenation (ECMO) team on clinical outcomes in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock.

Objectives

This study aimed to identify whether specialized ECMO team is associated with improved in-hospital mortality in AMI patients underwent venoarterial ECMO.

Methods

A total of 255 AMI patients underwent venoarterial ECMO from May 2004 to July 2018 were enrolled. In January 2014, multidisciplinary ECMO team was founded at our institution. Eligible patients were classified into pre-ECMO team group (n=131) and post-ECMO team group (n=124). The primary outcome was in-hospital mortality.

Results

In-hospital mortality (54.2% vs. 33.9%, p=0.002) and cardiac intensive care unit mortality (45.0% vs. 25.0%, p=0.001) were significantly lower after the implantation of multidisciplinary ECMO team (pre ECMO team vs. post-ECMO team). On binary logistic regression model, the multidisciplinary ECMO team approach was associated with lower risk of in-hospital mortality (odds ratio 0.36, 95% confidence interval 0.19–0.67, p=0.001). Incidence of all-cause mortality (58.3% vs. 35.2%, p<0.001) and rehospitalization due to heart failure (28.2% vs. 6.4%, p=0.001) at 6-months follow-up were also significantly lower in the post-ECMO team group than in the pre-ECMO team group.

Clinical outcomes Variables Total (N=255) Pre-ECMO team (N=131) Post-ECMO team (N=124) P value In-hospital mortality 113 (44.3) 71 (54.2) 42 (33.9) 0.002 Cardiovascular death 90 (35.3) 59 (45.0) 31 (25.0) 0.001 Noncardiovascular death 23 (9.0) 12 (9.2) 11 (8.9) >0.99 Cardiac intensive care unit mortality 106 (41.6) 68 (51.9) 38 (30.6) 0.001 Successful weaning of ECMO 169 (66.3) 75 (57.3) 94 (75.8) 0.002 Data are presented as n (%). Abbreviations: ECMO, extracorporeal membrane oxygenation.

Incidence of death, readmission for HF

Conclusions

The multidisciplinary ECMO team approach was associated with improved clinical outcomes in AMI patients complicated by cardiogenic shock. Our data support that specialized ECMO team is indispensable to improve outcomes in patients with AMI with refractory cardiogenic shock.

P800Proposal of an algorithm for the diagnosis of hypertension by using out-of-office blood pressure measurements

Background and purpose

Based on the data of patients who measured office BP (OBP) in controlled condition, home BP (HBP), and 24-hour ambulatory BP (24hABP) for diagnosis of hypertension, we developed and validated a diagnostic algorithm for hypertension.

Methods

Patients who have high BP (≥140/90 mmHg) at the outpatient clinic were referred to measure OBP in controlled condition, HBP and 24hABP. The OBP was measured three times at each visit for 3 days in controlled condition by using a validated oscillometric device. HBP was measured for 7 days in triplicates every morning and evening. The 24hABP was measured on the 8th day. Same study protocol was used for development and validation population.

Results

In the development of algorithm, 319 patients were recruited and data of 256 patients (51.8±9.7 years, 119 men) with valid HBP and 24hABP measurements were analyzed. In the validation of algorithm, 300 patients were recruited and data of 257 patients (52.4±9.8 years, 126 men) with valid HBP and 24hABP measurements were analyzed. In the development population, the prevalence of masked hypertension was 19.5% (n=50) and most of them (n=47, 94%) was in the range of 130–139/80–89 mmHg. The BP in the range of 130–144/80–94 mmHg was defined as the grey zone of OBP, because prevalence of white-coat hypertension was lowered to 1.6% from 4.3% with threshold of 145/95 mmHg. The diagnostic sensitivity, specificity, positive and negative predictive value of OBP was improved to 97.4%, 76.5, 96.5% and 81.3% after excluding the grey zone of OBP (n=125). The diagnostic agreement between 24hABP and HBP in the grey zone of OBP was 64%. The diagnostic sensitivity, specificity, positive and negative predictive value of HBP were 88.8%, 74.7, 93.5% and 61.5% after excluding the grey zone of HBP (130–134/80–84 mmHg, n=28). Based upon these results, we developed a diagnostic algorithm for hypertension by using on out-of-office BP measurements to improved diagnostic accuracy of hypertension (Figure). In the validation population, the developed algorithm showed similar diagnostic accuracy.

Diagnostic algorithm for hypertension

Conclusion

For accurate diagnosis of hypertension, OBP measurement according to guidelines and 24hABP measurement to grey zone of OBP is preferred. To improve diagnostic accuracy of HBP measurement, 24hABP measurement to grey zone of HBP is required.

Acknowledgement/Funding

Part of this study was supported by a grand from Dong-A ST Co. Ltd., Seoul, Korea.

1423Adherence to triple component antihypertensive regimen is higher in single-pill combination than two-pill regimen: data from a randomized controlled trial using medication event monitoring system

Background

Simplicity of regimen is known to be an important determinant of medication adherence and using single-pill combination (SPC) in hypertension treatment resulted in better adherence and persistence than free-equivalent combination. However, this finding has been studied only in dual-component antihypertensive treatments and in observational studies using medication possession ratio as an index of adherence. Medication event monitoring system (MEMS) is considered to be the gold standard in estimating medication adherence.

Purpose

To investigate the superiority in adherence of triple-component SPC compared to equivalent two-pill regimen using MEMS

Methods

This is a multi-center open-label randomized controlled trial. Inclusion criteria were hypertensive patients whose clinic blood pressure is not adequately controlled (systolic >140 mmHg or diastolic >90 mmHg) with combination antihypertensive regimen comprising two of three classes (angiotensin receptor blocker, calcium channel blocker and thiazide diuretics) for at least 4 weeks. Eligible patients were randomized either to single-pill (triple-component SPC, olmesartan/amlodipine/ hydrochlorothiazide 20/5/12.5 mg) or two-pill (dual-component SPC + one free pill, olmesartan/hydrochlorothiazide 20/12.5 mg + amlodipine 5 mg) groups and maintained for 12 weeks. Medications were dispensed in MEMS. Primary outcomes were the difference of percentage of dose taken (PDT) and percentage of days with prescribed dose taken correctly (PDTc) between single- and two-pill therapy, calculated from MEMS data.

Results

From 8 hospitals, 146 hypertensive patients were randomized into single- and two-pill groups. Final analysis was done in 65 and 66 patients in each group from which adherence index could be obtained. Baseline clinical characteristics of the two groups were not different. The single-pill group had significantly higher PDT and PDTc compared to the two-pill group. (median (25–75 percentile) (%), PDT 95.1 (87.9 - 100.0) vs 91.2 (79.8 - 96.5); PDTc 93.1 (79.8 - 96.5) vs 91.3 (70.7 - 96.4), p = both 0.04, by Wilcoxon rank sum test)

Percent dose taken

Conclusion

Single-pill combination of triple-component antihypertensive regimen showed superior adherence compared to equivalent two-pill therapy. Reducing pill burden by using SPC is a relevant strategy to enhance the adherence to multi-drug antihypertensive therapy.

Acknowledgement/Funding

Daiichi-Sankyo