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Background: The dissemination of Klebsiella spp. producing multiple carbapenemases has been increasingly recognized. Between July 2019 and August 2021, ten patients were found to carry Klebsiella spp. co-harboring bla KPC-4 and bla VIM-1 across multiple wards at a Korean hospital, and one isolate was recovered from a hand-washing sink, more than a year after the outbreak. This study aimed to investigate the outbreak and conduct a genomic study of these isolates., Methods: Whole-genome sequencing, including long-read sequencing, was performed to analyze plasmid structures and mobile genetic elements (MGEs). Bioinformatics analyses were performed to trace clonal transmission chains and horizontal gene transfer., Results: The findings suggested that the inter-ward spread of Klebsiella spp. seemed to be facilitated by healthcare worker contact or patient movement. Of the nine isolates collected (eight clinical and one environmental), seven (including the environmental isolate) were identified as K. pneumoniae (ST3680) and two were K. variicola (single-locus variant of ST5252). These isolates showed high genetic relatedness within their species and harbored the IncHI5B plasmid carrying both bla KPC-4 and bla VIM-1 (pKPCVIM.1). On this plasmid, bla VIM-1 was located in the Class 1 integron associated with IS1326::IS1353 (In2), and Tn4401b carrying bla KPC-4 was inserted into IS1326::IS1353, creating a novel MGE construct (In2_bla VIM-1 -Tn4401b_bla KPC-4 )., Conclusion: The hospital-wide spread of bla KPC-4 and bla VIM-1 was facilitated by clonal spread and horizontal plasmid transfer. The persistence of this strain in the hospital sink suggests a potential reservoir of the strain. Understanding the transmission mechanisms of persistent pathogens is important for improving infection control strategies in hospitals., (© 2024. The Author(s).)

Epidemiological studies frequently use indices of adiposity related to mortality. However, no studies have validated prediction equations for body composition in adult cancer survivors. We aimed to develop and cross-validate prediction equations for body fat mass (BFM), lean body mass (LBM), trunk fat mass (TFM), and appendicular lean mass (ALM) in adult cancer survivors using sociodemographic, anthropometric, and laboratory test data. This study included adult cancer survivors from the Korean National Health and Nutrition Examination Survey 2008-2011 with complete data on Dual-energy X-ray absorptiometry (DXA) measurements. A total of 310 participants were randomly divided into development and cross-validation groups (5:5 ratio). Age, height, weight, waist circumference, serum creatinine levels, and lifestyle factors were included as independent variables The predictive equations were developed using a multiple linear regression and their predictive performances were primarily evaluated with R2 and Concordance Correlation Coefficient (CCC). The initial equations, which included age, height, weight, and waist circumference, showed different predictive abilities based on sex for BFM (total: R2 = 0.810, standard error of estimate [SEE] = 3.072 kg, CCC = 0.897; men: R2 = 0.848, SEE = 2.217 kg CCC = 0.855; women: R2 = 0.791, SEE = 2.194 kg, CCC = 0.840), LBM (total: R2 = 0.736, SEE = 3.321 kg, CCC = 0.838; men: R2 = 0.703, SEE = 2.450 kg, CCC = 0.774; women: R2 = 0.854, SEE = 2.234 kg, CCC = 0.902), TFM (total: R2 = 0.758, SEE = 1.932 kg, CCC = 0.844; men: R2 = 0.650, SEE = 1.745 kg, CCC = 0.794; women: R2 = 0.852, SEE = 1.504 kg, CCC = 0.890), and ALM (total: R2 = 0.775, SEE = 1.726 kg, CCC = 0.876; men: R2 = 0.805, SEE = 1.320 kg, CCC = 0.817; women: R2 = 0.726, SEE = 1.198 kg, CCC = 0.802). When additional factors, such as creatinine, smoking, alcohol consumption, and physically inactive were included in the initial equations the predictive performance of the equations were generally improved. The prediction equations for body composition derived from this study suggest a potential application in epidemiological investigations on adult cancer survivors., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Park et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Both bisphosphonates and denosumab are the mainstays of treatment for osteoporosis to prevent fractures. However, there are still few trials directly comparing the prevention of fractures and the safety of 2 drugs in the treatment of osteoporosis. We aimed to compare the efficacy and safety between denosumab and bisphosphonates using a nationwide claims database. The database was covered with 10 million, 20% of the whole Korean population sampled by age and sex stratification of the Health Insurance Review and Assessment Service in South Korea. Among 228 367 subjects who were over 50 yr of age and taking denosumab or bisphosphonate from January 2018 to April 2022, the analysis was performed on 91 460 subjects after 1:1 propensity score matching. The primary outcome was treatment effectiveness; total fracture, major osteoporotic fracture, femur fracture, pelvic fracture, vertebral fracture, adverse drug reactions; acute kidney injury, chronic kidney disease, and atypical femoral fracture. Total fracture and osteoporotic major fracture, as the main outcomes of efficacy, were comparable in the denosumab and bisphosphonate group (HR 1.06, 95% CI, 0.98-1.15, P = .14; HR 1.13, 95% CI, 0.97-1.32, P = .12, respectively). Safety for acute kidney injury, chronic kidney disease, and atypical femoral fracture also did not show any differences between the 2 groups. In subgroup analysis according to ages, the denosumab group under 70 yr of age had a significantly lower risk for occurrences of acute kidney injury compared to the bisphosphonate group under 70 yr of age (HR 0.53, 95% CI, 0.29-0.93, P = .03). In real-world data reflecting clinical practice, denosumab and bisphosphonate showed comparable effectiveness for total fractures and major osteoporosis fractures, as well as safety regarding acute kidney injury, chronic kidney disease, and atypical femoral fracture., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Society for Bone and Mineral Research. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Despite previous efforts to build statistical models for predicting the risk of suicidal behavior using machine-learning analysis, a high-accuracy model can lead to overfitting. Furthermore, internal validation cannot completely address this problem. In this study, we created models for predicting the occurrence of suicide attempts among Koreans at high risk of suicide, and we verified these models in an independent cohort. We performed logistic and penalized regression for suicide attempts within 6 months among suicidal ideators and attempters in The Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior (K-COMPASS). We then validated the models in a test cohort. Our findings indicated that several factors significantly predicted suicide attempts in the models, including young age, suicidal ideation, previous suicidal attempts, anxiety, alcohol abuse, stress, and impulsivity. The area under the curve and positive predictive values were 0.941 and 0.484 after variable selection and 0.751 and 0.084 in the test cohort. The corresponding values for the penalized regression model were 0.943 and 0.524 in the original training cohort and 0.794 and 0.115 in the test cohort. The prediction model constructed through a prospective cohort study of the suicide high-risk group showed satisfactory accuracy even in the test cohort. The accuracy with penalized regression was greater than that with the "classical" logistic model., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To improve the current recommendations for the diagnosis of canine heartworm (Dirofilaria immitis) disease., Animals: Blood samples collected from 35 shelter dogs in the Republic of Korea., Methods: Samples were tested for the presence of microfilaria using the modified Knott (MK) test and D immitis DNA using species-specific loop-mediated isothermal amplification (LAMP) PCR. The blood samples were additionally assessed for the presence of heartworm antigens using the Antigen Rapid Canine Heartworm AG Test Kit 2.0 (Bionote Co). The performance of the MK test and LAMP PCR was assessed through statistical analysis, with a paired McNemar test utilized for comparison., Results: The heartworm antigen was detected in 28.5% of the subjects. Of the 10 positive animals, the MK test detected microfilaria in 4 of 35 (11.4%) animals, and LAMP PCR detected D immitis DNA in 6 of 35 (17.1%). The results of this study indicate that the LAMP PCR showed more positive results in samples compared to the conventional MK test., Clinical Relevance: The D immitis-specific LAMP PCR assay has the potential to function as an alternative to current detection methods. It could complement the existing antigen detection tests in diagnosing canine heartworm infections.

The present study firstly reports surface sediment from the subsea depth of 200 m as a potential natural peloid. The fine-silt sediment exhibited a consistent clay mineral composition dominated by illite, chlorite, kaolinite, and diatomite. The most abundant clay mineral was illite/mica, with other minerals loosely packed in a face-to-face orientation. The thermal conductivity, specific heat capacity, and cation-exchange capacity of the sediment were in the range 0.855-0.885 W/m K, 2.718-2.821 J/g °C, and 23.06-32.96 cmol/kg, respectively. The concentrations of most toxic elements in the sediment were considerably lower than the limits set by domestic cosmetic regulations and other international standards. The analyzed samples exhibited similar properties to those of previously reported peloids, thus making them suitable for use in the field of pelotherapy; furthermore, the consistency in data across a wide peloid-distribution area is expected to enable economically viable mining. Future investigations should aim to to evaluate the long-term effects on the skin, the bioavailability of potentially hazardous substances, and the therapeutic efficacy for various skin conditions., (© 2024. The Author(s).)

BACKGROUND. Coronary artery calcification (CAC) on lung cancer screening low-dose chest CT (LDCT) is a cardiovascular risk marker. South Korea was the first Asian country to initiate a national LDCT lung cancer screening program, although CAC-related outcomes are poorly explored. OBJECTIVE. The purpose of this article is to evaluate CAC prevalence and severity using visual analysis and artificial intelligence (AI) methods and to characterize CAC's association with major adverse cardiovascular events (MACEs) in patients undergoing LDCT in Korea's national lung cancer screening program. METHODS. This retrospective study included 1002 patients (mean age, 62.4 ± 5.4 [SD] years; 994 men, eight women) who underwent LDCT at two Korean medical centers between April 2017 and May 2023 as part of Korea's national lung cancer screening program. Two radiologists independently assessed CAC presence and severity using visual analysis, consulting a third radiologist to resolve differences. Two AI software applications were also used to assess CAC presence and severity. MACE occurrences were identified by EMR review. RESULTS. Interreader agreement for CAC presence and severity, expressed as kappa, was 0.793 and 0.671, respectively. CAC prevalence was 53.4% by consensus visual assessment, 60.1% by AI software I, and 56.6% by AI software II. CAC severity was mild, moderate, and severe by consensus visual analysis in 28.0%, 10.3%, and 15.1%; by AI software I in 39.9%, 14.0%, and 6.2%; and by AI software II in 34.9%, 14.3%, and 7.3%. MACEs occurred in 36 of 625 (5.6%) patients with follow-up after LDCT (median, 1108 days). MACE incidence in patients with no, mild, moderate, and severe CAC for consensus visual analysis was 1.1%, 5.0%, 2.9%, and 8.6%, respectively ( p < .001); for AI software I, it was 1.3%, 3.0%, 7.9%, and 11.3% ( p < .001); and for AI software II, it was 1.2%, 3.4%, 7.7%, and 9.6% ( p < .001). CONCLUSION. For Korea's national lung cancer screening program, MACE occurrence increased significantly with increasing CAC severity, whether assessed by visual analysis or AI software. The study is limited by the large sex imbalance for Korea's national lung cancer screening program. CLINICAL IMPACT. The findings provide reference data for health care practitioners engaged in developing and overseeing national lung cancer screening programs, highlighting the importance of routine CAC evaluation.

As global air pollution, particularly fine particulate matter (PM 2.5 ), has become a major environmental problem, various PM 2.5 mitigation technologies including green infrastructure have received significant attention. However, owing to spatial constraints on urban greening, there is a lack of management plans for urban forests to efficiently mitigate PM 2.5 . In this study, we assessed the PM 2.5 reduction capabilities of Pinus densiflora (Korean red pine) and Quercus acutissima (sawtooth oak) by measuring the changes of PM 2.5 concentrations using an experimental chamber system. In addition, the PM 2.5 reduction efficiency in 90 min (PMRE 90 ) and the amount of PM 2.5 reduction per leaf area (PMR LA ) were compared based on arrangement structures and density levels. The results showed that the PM 2.5 reduction by plants was significantly greater than that of the control experiment without any plants, and an additional reduction effect of approximately 1.38 times was induced by a 1.5 m s -1 air flow. The PMRE 90 of Korean red pine was the highest at medium density. In contrast, the PMRE 90 of sawtooth oak was the highest at high density. The PMR LA of both species was highest at low densities. The different responses of the species to total reduction were well explained by total leaf area (TLA). The PMRE 90 of both species was positively correlated with TLA. The PMR LA of sawtooth oak was approximately 2.3 times greater than that of Korean red pine. However, there were no significant differences in both PMRE 90 and PMR LA between the arrangement structures. Our findings reveal the potential mechanisms of vegetation in reducing PM 2.5 according to arrangement structure and density. This highlights the importance of efficiently using urban green spaces with spatial constraints on PM 2.5 mitigation in the future., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: In California, preventive dental care is covered by Medi-Cal (California's Medicaid program). However, many beneficiaries do not use their dental benefits. Given that a lack of knowledge about oral health and insurance coverage contributes to this underutilization, promoting the use of dental benefits among eligible individuals via an educational program is imperative. Responding to the particular needs of older immigrants with limited English proficiency, we developed a digital oral health intervention for older Korean-American Medi-Cal enrollees in Los Angeles. This educational intervention is designed to be delivered via computers and the Internet. It consists of a 15-min self-running PowerPoint presentation narrated in Korean with links to additional information on the Internet. The slides contain information about the basic etiology of oral diseases, oral hygiene, common myths about oral health and dental care, Medi-Cal coverage of preventive dental care, and how to find a dental clinic., Methods: We pilot tested the intervention with 12 participants to examine its feasibility and acceptability. We also obtained participants' qualitative feedback about the intervention., Results: A post-intervention quantitative assessment yielded high participant satisfaction and improved oral health and dental care knowledge. Participant responses to the intervention yielded four themes: (1) content and structure, (2) linguistic and cultural aspects, (3) delivery mode, and (4) additional concerns and suggestions., Conclusions: Our findings confirm the intervention's feasibility and acceptability and suggest further refinement., (© 2024. The Author(s).)

Background: Evidence of the relationship between greenness and sleep is limited, and, given the worsening sleep insufficiency worldwide, this relationship needs elucidation. In this study, we investigated the association of greenness with sleep deprivation using nationwide survey data., Methods: This study included 1,727,273 participants in the Korea Community Health Survey who resided in all 229 districts of South Korea from 2011 to 2018. Sleep deprivation variables were defined as strong deprivation or mild deprivation, based on average daily sleep duration of <5 or 5-6 h, respectively. District-specific annual average of satellite-derived enhanced vegetation index (EVI) was used as a green space exposure. A logistic regression with complex survey weights was used to estimate the association between greenness and sleep deprivation, and it was further examined by sex, age group, educational status, income level, and population density. The regression analysis was performed annually, and the annual estimates were pooled by a combined data analysis., Results: A higher level of greenness was associated (odds ratio [95 % confidence interval]) with strong and mild sleep deprivation (0.96 [0.93-0.99] and 0.96 [0.95-0.97]), respectively, and males and the younger age group (<65 years) showed a more prominent association with greenness than in females and the elderly group (65 years or older). In addition, only high-population-density areas showed evident associations of greenness with both strong and mild sleep deprivation., Conclusions: This large population-based study provides important epidemiological evidence for improving sleep quantity through an increase in greenness exposure and supports policymakers in establishing strategies for urban planning., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Presenteeism, which refers to going to work despite being ill, has been associated with loss of work productivity, decreased quality of care, and an increased risk of health problems. The prevalence of presenteeism is particularly high among nurses; therefore, a reliable and valid tool is needed to assess presenteeism. This study aimed to translate the Stanford Presenteeism Scale (SPS) and to examine its psychometric properties in a Korean nurse population. A methodological study was performed in January 2023. The original SPS-6 (English-language) was translated and adapted to the Korean language using a committee approach translation, cognitive interviews, and content validation with a review panel of experts. An online survey was completed by 608 Korean nurses. The internal consistency, item-to-total correlation, construct validity, concurrent validity, and discriminant validity were examined as psychometric properties of the Korean version of the SPS. The final version of the K-SPS consists of four items shortened from the original six items. Cronbach's alpha of the K-SPS-4 was 0.74, indicating adequate reliability. Confirmatory factor analysis showed a one-factor solution with a good fit. There was a positive correlation between the K-SPS-4 and the Work Limitations Questionnaire. Discriminant validity was evidenced by the positive correlation of the K-SPS-4 with job satisfaction and the negative correlation with job stress. The K-SPS-4 has acceptable psychometric properties, supporting the feasibility of its use in assessing the level of presenteeism among Korean nurses. The validated K-SPS-4 can provide a basis for developing intervention programs to enhance productivity and promote health among nurses in clinical settings., (© 2023 Wiley Periodicals LLC.)

Sharks are known to contain high levels of mercury in their meat. However, few studies have directly assessed the changes in mercury concentration in the human body according to shark meat intake. One hundred and ninety-seven participants that traditionally consume shark meat during the Chuseok holiday were recruited from two areas of Gyeongsangbuk-do, South Korea to examine their blood mercury level before and after the holiday season. Blood mercury levels were measured before and after the holiday season. Characteristics such as the consumption of shark meat, intake amount, and the effect on mercury concentration were assessed during the survey. Univariable and multivariable analysis (Linear Mixed Model) were done for assessing the association between shark meat consumption of holiday season and blood mercury level. Among the total participants, 83 consumed shark meat during holiday. In the univariable analysis, a significant increase in blood mercury levels before and after Chuseok was observed only for the group that consumed shark meat during holiday. The multivariable analysis (adjusted for identified confounders that affect both exposure and outcome considering repeated measurements) showed that consuming shark meat was significantly associated with increased blood mercury levels by 3.56 μg/L (95% confidence interval [CI], 2.64-4.67 μg/L). In the model considering the amount consumed as two group, the level of increase was 2.61 μg/L (95% CI, 1.63-3.58 μg/L) for those consuming <100 g, and 6.20 μg/L (95% CI, 4.77-7.62 μg/L) for those consuming ≥100 g compared to group without consuming shark meat. Considering amount consumed as continuous value, 0.02 μg/L (95% CI, 0.01-0.02 μg/L) of blood mercury increase was significantly associated with consuming 1 g. Consumption of shark meat significantly elevated blood mercury levels, exceeding commonly suggested reference concentrations in less than 2 weeks. These findings suggest the need for public health warnings and regulations regarding shark meat consumption., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Given that the obesity rate among school-age children is increasing, school nurses can play a vital role in managing obesity and encouraging healthy living in school settings. Obese children from low-income backgrounds are more vulnerable than other students and require more careful attention and intervention. This qualitative study aimed to explore and understand the barriers recognized by school nurses in managing obesity in low-income household children. A focus group interview was conducted with 17 school nurses working at an elementary school. Children, home, school, political and structural, and social areas were revealed as intricate factors in obesity management. This study can help understand school nurses' obstacles in managing obese children from low-income families and can help them prepare practical measures to overcome these obstacles., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Owing to industrialization and urbanization in recent decades, fine particulate matter (PM 2.5 ) in the atmosphere has become a major environmental problem worldwide. This environmental issue pushed the use of forests as air filtering tools. However, there is a lack of continuous and long-term forest management to efficiently mitigate PM 2.5 . In this study, we assessed the potential of different forest types to control air pollution by measuring the seasonal PM 2.5 concentrations inside and outside the forest for one year. In addition, the PM 2.5 reduction efficiencies (PMREs) of two forest types were compared, and their relationship with stand characteristics was analyzed. The results showed that the average PMRE inside the forests was approximately 18.2%; the seasonal PMRE was highest in winter (approximately 28.1%) and lowest in summer (approximately 9.6%). The average PMRE of the Taehwa deciduous broad-leaved forest (TDF) (approximately 18.8%) was significantly higher than that of the Taehwa coniferous forest (TCF) (approximately 17.5%) (P < 0.001); differences were also observed seasonally. The PMRE in the TCF was higher in spring and summer (P < 0.001), while that in the TDF was higher in autumn and winter (P < 0.001). Furthermore, the PMRE in the TDF was negatively correlated with stand density (P = 0.003) and positively correlated with the average diameter at breast height (DBH) (P = 0.028). However, the PMRE in the TCF did not significantly correlate with stand characteristics. As such, the results of this study revealed the differences in PM 2.5 mitigation according to stand characteristics, which should be considered in urban forest management., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Recent reports have suggested that pneumonitis is a rare complication following vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, its clinical features and outcomes are not well known. The aim of this study was to identify the clinical characteristics and outcomes of patients with vaccine-associated pneumonitis following vaccination against SARS-CoV-2., Methods: In this nationwide multicenter survey study, questionnaires were distributed to pulmonary physicians in referral hospitals. They were asked to report cases of development or exacerbation of interstitial lung disease (ILD) associated with the coronavirus disease 2019 vaccine. Vaccine-associated pneumonitis was defined as new pulmonary infiltrates documented on chest computed tomography within 4 weeks of vaccination and exclusion of other possible etiologies., Results: From the survey, 49 cases of vaccine-associated pneumonitis were identified between February 27 and October 30, 2021. After multidisciplinary discussion, 46 cases were analyzed. The median age was 66 years and 28 (61%) were male. The median interval between vaccination and respiratory symptoms was 5 days. There were 20 (43%), 17 (37%), and nine (19%) patients with newly identified pneumonitis, exacerbation of pre-diagnosed ILD, and undetermined pre-existing ILD, respectively. The administered vaccines were BNT162b2 and ChAdOx1 nCov-19/AZD1222 each in 21 patients followed by mRNA-1273 in three, and Ad26.COV2.S in one patient. Except for five patients with mild disease, 41 (89%) patients were treated with corticosteroid. Significant improvement was observed in 26 (57%) patients including four patients who did not receive treatment. However, ILD aggravated in 9 (20%) patients despite treatment. Mortality was observed in eight (17%) patients., Conclusion: These results suggest pneumonitis as a potentially significant safety concern for vaccines against SARS-CoV-2. Clinical awareness and patient education are necessary for early recognition and prompt management. Additional research is warranted to identify the epidemiology and characterize the pathophysiology of vaccine-associated pneumonitis., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2023 The Korean Academy of Medical Sciences.)

Background: This study evaluated the effects of chronic exposure to aircraft noise on the cognitive functions of Korean elementary school students attending an elementary school around a military airfield and clarified the relationship between noise exposure and cognitive functions., Methods: Five schools with average weight equivalent continuous perceived noise levels (WECPNL) of ≥75 dB were selected from four regions in Korea. Each of these schools was matched with a non-exposed school. The Korean Intelligence Test Primary (KIT-P) was used to measure the scores of four subcategories and the intelligence quotient (IQ). The noise exposure groups were divided into high-exposure (WECPNL ≥ 80 dB) and medium-exposure (75 ≤ WECPNL < 80) groups. The period of exposure during the school year was collected. A linear mixed model, with matched pairs of schools, was used for statistical analysis., Results: In the multivariable linear mixed model adjusted by possible confounders, the reasoning score was significantly lower in the high-exposure group of students than in the no-exposure group. Other scores and IQ were lower in the noise exposure groups, although these were not statistically significant. The duration of exposure did not show a significant relationship with cognitive functions., Conclusion: Chronic exposure to noise from military airfields may influence the cognitive functions, thereby reducing the learning performance of Korean children., Competing Interests: None

This study aims to explore the impact of distributional changes in coronavirus disease 2019 (COVID-19) infection fear with sex differences. A quota sampling strategy was followed and 483 Korean adults were surveyed in a community sample. Self-report questionnaires were used to assess COVID-19 infection fear, depressive symptoms, and general characteristics. Quantile regression was used to explore the regression relationship of COVID-19 infection fear and an individual's sex. There was a significant difference in COVID-19 infection fear ( P = 0.001) and depression ( P = 0.008) between the sexes - male and female. The differences between sexes at the 20th and 30th percentiles were significant (β = 2.04, P = 0.006; β = 1.5, P = 0.004, respectively). The results demonstrate that sex significantly predicts COVID-19 infection fear and women had significantly greater fear than men in the mild-level of COVID-19 infection fear., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2023 The Korean Academy of Medical Sciences.)

Background: The COVID-19 pandemic has created devastating health, social, economic, and political effects that will have long-lasting impacts. Public health efforts to reduce the spread of COVID-19 are the priority of national policies for responding to the pandemic globally. Public health and social measures (PHSMs) have been shown to be effective when used alone or in combination with other measures, reducing the risk of spreading COVID-19. However, there is insufficient evidence on the status of compliance with PHSMs in the general population for the prevention of COVID-19 in public areas, including Korea., Objective: The aim of this study was to assess levels of compliance with the recommended PHSMs against SARS-CoV-2 infection and their predictors among the general population by using national data., Methods: This study was a secondary data analysis of the National Survey of Infectious Disease Preventive Behaviors in Community, which was conducted by the Korea Centers for Disease Control and Prevention Agency (KDCA) between October 12 and October 30, 2020. The primary study was cross-sectional, using stratified sampling via an adjusted proportional allocation method to select representative samples and ensure the stability of samples. The data were collected through phone interviews conducted by trained enumerators using a structured questionnaire. PHSM adherence was measured using a 10-item comprehensive infectious disease prevention behavior (CIDPB) scale, and each sociocognitive factor, including perceived susceptibility to SARS-CoV-2 infection, perceived severity of SARS-CoV-2 infection, perceived confidence in performing preventive behaviors related to COVID-19, information comprehension ability, and trust in information from the KDCA, was measured. A total of 4003 participants were included in the final analysis. Tobit regression and a decision tree analysis were performed to identify the predictors of preventive measures and the target groups for intervention., Results: We discovered that women scored 1.34 points higher on the CIDPB scale than men (P<.001). Compared to the group aged 19 to 29 years, those aged 50 to 59 years and those older than 60 years scored 1.89 and 2.48 points higher on the CIDPB scale (P<.001), respectively. The perceived severity of infection, confidence in preventive behaviors, information comprehension ability, and trust in information from the KDCA were significant positive determinants of CIDPBs (P<.001). The perceived susceptibility to infection showed a significant negative relationship with CIDPBs (P<.001)., Conclusions: Female sex, older age, lower income, and sociocognitive factors were found to be significant determinants of adhering to PHSMs. The findings suggest the need for tailored interventions for target groups; specifically, the age group that was the most active at work indicated the highest potential to spread infection. Adequate public health education and health communication for promoting adherence to PHSMs should be emphasized, and behavior change strategies for those with low perceived confidence in performing PHSMs should be prioritized., (©Hye Chong Hong, Hyeonkyeong Lee, Suk Jeong Lee, Chang Park, Mikyung Lee. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 17.01.2023.)

Objectives: We aimed to evaluate the severity of suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection according to variants of concern in Gyeongsangbuk-do and Daegu, Korea., Methods: The database of coronavirus disease 2019 (COVID-19) cases reported from epidemiological investigations through the integrated system operated by the Korea Disease Control and Prevention Agency, from January 20, 2020 to May 7, 2022 was combined with data from the Health Insurance Review and Assessment Service system. The severity odds ratio (SOR) in secondary infection episodes compared with primary infection was estimated using a generalized linear model with a binomial distribution., Results: In all patients, the SOR of SARS-CoV-2 reinfection was 0.89 (95% confidence interval [CI], 0.82 to 0.95), and the severity was lower than in the first infection. Patients who had been vaccinated within 91 days showed a more attenuated SOR (0.85; 95% CI, 0.74 to 0.98). However, despite vaccination, in patients with both primary and secondary infections caused by the Omicron variant, the severity was reduced to a lesser extent than in patients primarily infected with other variants., Conclusions: We could make efforts to relieve the severity of COVID-19 in vulnerable populations, in which death is more likely, by recommending booster vaccinations in case of a resurgence.

Background: Reemergent local outbreaks of classical swine fever (CSF) occurred simultaneously in multiple pig farms on CSF-free Jeju Island, South Korea, in 2014 because of inadvertent injection of a commercial CSF (LOM) vaccine into pregnant sows. The LOM virus has since spread across the island and has become endemic in Jeju herds, raising concern about possible reversion to the virulence of the LOM vaccine. We previously isolated LOM-derived field CSF virus (CSFV) strains with unique insertion-deletion (INDEL) mutations in the 3'-untranslated region (UTR), designated LOM-derived Jeju 3'-UTR INDEL variants, from CSF-recurrent swine farms on Jeju Island in 2019., Methods: The present study conducted animal experiments to investigate whether a 2019 emergent LOM 3'-UTR INDEL variant, KNU-1905, has reverted to a pathogenic form in conventional pigs (n = 10)., Results: Experimental animal infection showed that pigs inoculated with the commercial LOM vaccine strain developed no adverse effects compared to the sham-infected pigs. However, KNU-1905 displayed pathogenic characteristics in pigs, including clinical symptoms (e.g., lethargy, conjunctivitis, nasal discharge, and diarrhoea), weight loss, and gross lesions. Moreover, viremia, virus shedding in faeces and nasal fluids, and viral loads in various tissues of all the KNU-1905-infected pigs were highly significant, in contrast to those of the LOM-infected group in which CSFV RNA was detected only in the serum, nasal, and tonsil samples of one identical pig., Conclusions: Overall, the LOM-derived field isolate with molecular variations induced clinical adverse events in pigs, which commonly shed considerable amounts of CSFV. This study provides evidence that the genetic evolution of the LOM-derived CSFV circulating on Jeju Island might have allowed the LOM vaccine to recover its primary prototype and that these variants might have induced chronic or persistent infection in pigs that can shed CSFV in field farms leading to a risk of transmission among pigs or farms in this former CSF-free region., (© 2022 The Authors. Veterinary Medicine and Science published by John Wiley & Sons Ltd.)

Understanding the CO 2 flux over agricultural crop fields is critical because the temporal cycle is driven by both ecological environment and anthropogenic change. We analyzed the net ecosystem exchange of CO 2 measured over a barley-rice double-cropping field using the eddy covariance method for 5 years. We conducted gap-filling based on u * -threshold criteria and partitioned the net ecosystem exchange into gross primary production and respiration. The relative importance analysis of solar radiation, temperature, soil heat flux, soil water content, and vapor deficit revealed that solar radiation and temperature were the dominant contributors to net ecosystem exchange. The annual variation in the net ecosystem exchange followed a bimodal pattern driven by CO 2 uptake by both barley and rice, displaying two negative peaks in late April and mid-August. The elongation stages of the crops exhibited the highest flux. Gross primary production and respiration were closely related to solar radiation and nighttime temperature, respectively. The relative importance of the other environmental variables was affected by the cultivation season and irrigation water. In the period of rice cultivation, respiration was approximately 3 µmol m -2  s -1 higher during rice drainage than during the flooded period. The accumulated net ecosystem production was estimated to be 315 gC m -2 and 349 gC m -2 for the barley and rice growing periods, respectively, and 649 gC m -2 for the annual total. These values are comparable with the results of other studies on barley-rice double-cropping fields., (© 2022. The Author(s) under exclusive licence to International Society of Biometeorology.)

Background: Health space (HS) is a statistical way of visualizing individual's health status in multi-dimensional space. In this study, we propose a novel HS in two-dimensional space based on scores of metabolic stress and of oxidative stress., Methods: These scores were derived from three statistical models: logistic regression model, logistic mixed effect model, and proportional odds model. HSs were developed using Korea National Health And Nutrition Examination Survey data with 32,140 samples. To evaluate and compare the performance of the HSs, we also developed the Health Space Index (HSI) which is a quantitative performance measure based on the approximate 95% confidence ellipses of HS., Results: Through simulation studies, we confirmed that HS from the proportional odds model showed highest power in discriminating health status of individual (subject). Further validation studies were conducted using two independent cohort datasets: a health examination dataset from Ewha-Boramae cohort with 862 samples and a population-based cohort from the Korea association resource project with 3,199 samples., Conclusions: These validation studies using two independent datasets successfully demonstrated the usefulness of the proposed HS., (© 2022. The Author(s).)

Out-of-hospital cardiac arrest (OHCA) is a notable public health issue with negative outcomes, such as high mortality and aftereffects. Additionally, the adverse effects of extreme temperatures on health have become more important under climate change; however, few studies have investigated the relationship between temperature and OHCA. In this study, we examined the association between temperature and OHCA and its underlying risk factors. We conducted a two-stage time-series analysis using a Poisson regression model with a distributed lag non-linear model (DLNM) and meta-analysis, based on a nationwide dataset from South Korea (2008-2018). We found that 17.4% of excess OHCA was attributed to cold, while 0.9% was attributed to heat. Based on central estimates, excess OHCA attributed to cold were more prominent in the population with hypertension comorbidity (31.0%) than the populations with diabetes (24.3%) and heart disease (17.4%). Excess OHCA attributed to heat were larger in the populations with diabetes (2.7%) and heart disease comorbidity (2.7%) than the population with hypertension (1.2%) based on central estimates. Furthermore, the time-varying excess OHCA attributed to cold have decreased over time, and although those of heat did not show a certain pattern during the study period, there was a weak increasing tendency since 2011. In conclusion, we found that OHCAs were associated with temperature, and cold temperatures showed a greater impact than that of hot temperatures. The effects of cold and hot temperatures on OHCA were more evident in the populations with hypertension, diabetes, and heart diseases, compared to the general population. In addition, the impacts of heat on OHCA increased in recent years, while those of cold temperatures decreased. Our results provide scientific evidence for policymakers to mitigate the OHCA burden attributed to temperature., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction/aims: The current status of antidepressant use in patients with amyotrophic lateral sclerosis (ALS), such as the prevalence and factors associated with it, has not been systematically investigated. We aimed to analyze the prevalence and patterns of antidepressant prescriptions in patients with ALS and depression, and to identify factors associated with antidepressant prescriptions after the diagnosis of ALS., Methods: The data of patients with ALS and the prescription of antidepressants were retrieved from the Korean National Health Insurance claims data. A multivariate logistic regression model was used to identify factors associated with antidepressant prescriptions., Results: In total, 533 of 2955 patients had depressive disorders, and 426 were prescribed antidepressants. Selective serotonin reuptake inhibitors and tricyclic antidepressants were the most frequently prescribed drugs. Adjusted odds ratios (ORs) were 1.379 for the prescription of antidepressants in females. For various age groups, compared with those aged 80 years and older, adjusted ORs were 1.889 for those in their 70s, 2.319 for those in their 60s, 2.872 for those in their 50s, 2.854 for those in their 40s, and 3.363 for those under 40 years of age. Adjusted ORs were 1.662 for patients with a history of a psychiatric disorder and 1.861 for those with a history of psychiatric pharmacotherapy (all P < .05)., Discussion: Most patients with ALS who had depression received antidepressant prescriptions. In young females with a previous psychiatric disorder or pharmacotherapy, an in-depth evaluation for a depressive disorder should be performed., (© 2022 Wiley Periodicals LLC.)

Mental health has been a major public health concerns during the COVID-19 pandemic. This study investigated the effects of COVID-19 on mental health and whether individual and regional characteristics are associated with the changes in mental health. We estimated district-specific changes in the prevalence of moderate stress, extreme stress, and depression before and during the COVID-19 pandemic after adjusting for the time trend of mental health outcomes. Then, a meta-regression was conducted to examine the associations between district-level characteristics and changes in mental health due to the pandemic. The prevalence of moderate stress, extreme stress, and depression increased during the pandemic and the increases were more prominent in districts with high population density and in individuals aged 19-59 years, with a high education level, and with high household income. The % with reduced physical activity due to the pandemic were positively associated with increases in stress; while, the % that have mutual trust among neighbors and the number of sports facilities were negatively associated with increases in stress. Local tax per person had a positive association with increase in depression. Our study provides epidemiological evidence into the mental health consequences of the pandemic, which can inform the priority of resource allocation for managing mental health., (© 2022. The Author(s).)

Copy number polymorphisms (CNPs) of antimicrobial peptides (AMPs) in livestock can influence the innate immune response of individuals. We conducted a high-resolution analysis of the genomic variations of porcine cathelicidin PR39 using cloned PR39 amplicons corresponding to the 5' untranslated region (UTR) to 3' UTR from four individuals of three different pig breeds. We identified 15 different sequences corresponding to 9 different coding domain sequences (CDSs), encoding 7 different protein sequences consisting of 3 functional and 4 non-functional forms. Subsequently, we developed a PR39 CNP typing method using real-time polymerase chain reaction (PCR) and analyzed the PR39 copy numbers from 44 pigs of six breeds. Significant variations in PR39 copies ranging from 2 to 10 copies, with a mean copy number of 5, were observed among all commercial breeds, except the wild boar. Among the different breeds, the PR39 copy number was highest (10) in Korean native pigs. Gene expression analysis showed that PR39 expression was correlated with the copy number. Moreover, the comparative analysis of the cathelicidin cluster-containing region among eight mammalian species showed the complete evolutionary conservation of the region, except for differences in the degree of cathelicidin expansion in each species. Therefore, characterization of CNPs in AMP genes could aid in improving the genetic potential of innate immune responses in livestock animals., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Phthalates, bisphenols and parabens have been widely used in household and personal-care products. Their endocrine disrupting, sensitizing and antimicrobial properties might play a role in the occurrence of allergic diseases. However, the effects of these chemicals, particularly on humans, are relatively underexplored., Objectives: This study aimed to report the concentrations of phthalate, bisphenol and paraben in urine of Korean children, and assess their relationship with allergic outcomes., Methods: Data obtained from nationally representative Korean children, a total of 1458 children between 3 and 11 years of age recruited in the Korean National Environmental Health Survey (3 rd round of KoNEHS 2015-2017), were analyzed. Associations of urinary phthalate metabolites, bisphenols, and parabens levels with atopic dermatitis and allergic rhinitis was examined by grouped into preschool (aged 3-5 years) and school children (aged 6-11 years). Allergic outcomes were obtained through questionnaires answered by their caregivers., Results: Atopic dermatitis was associated with urinary metabolites of DEHP, BzBP, DINP, and DIDP, and MeP and PrP in preschool children, BPA and PrP in school children. Allergic rhinitis was associated with MeP and PrP in preschool children, and metabolites of DEHP, MeP and PrP in school children. The association of urinary chemicals with atopic dermatitis and allergic rhinitis were different by gender, especially in preschool children., Conclusion: Urinary phthalates, BPA and parabens levels in the Korean children were related with atopic dermatitis and allergic rhinitis. Considering the importance of allergic diseases in children, the public health implications of exposure to these chemicals warrant further studies. Given the cross-sectional design and confounding variables, the results of this study should be interpreted with caution., Competing Interests: Declaration of competing interest All authors declare they have no actual or potential competing financial interest., (Copyright © 2021 Elsevier B.V. All rights reserved.)

In South Korea, self-employed workers comprise 24.6% of the working population-among which 99.7% were found to operate with less than 50 employees. However, few studies have investigated the effects of an involuntary choice of self-employment. In this study, based on the fifth Korean Working Conditions Survey, the factors affecting subjective well-being and mental health in small business owners with less than 50 employees among service/sales workers, who account for more than half of the self-employed population in Korea, were analyzed by the World Health Organization-Five Well-Being Index, using the Student's t -test, ANOVA and logistic regression analysis. Results showed that the well-being level for those who opted for self-employment involuntarily was lower than those who chose it voluntarily. Then, participants were separated into two groups according to sex; the degree corresponding to the poor well-being score group was compared, and that of the group who chose self-employment because they could not find any other work was significantly higher than that of the group who chose it voluntarily, in both men and women, and this was similar even after correcting for covariance. As the number of people being forced to choose self-employment is expected to further increase after the outbreak of COVID-19, future studies should be conducted to improve subjective well-being of such workers.

Medical aid (MA) in South Korea, a national public assistance scheme, provides minimum medical security for low-income families. The Korean government has adopted a case management (CM) programme to control MA beneficiaries' inappropriate medical use and enhance beneficiaries' quality of life. This study aimed to explore case managers' experiences of implementing CM for MA beneficiaries' potential barriers. This study employed a qualitative phenomenological tradition using focus-group interviews. Three focus groups with 19 MA case managers were conducted (July to August 2018) using semistructured interview questions. Data were analysed through qualitative content analysis using the NVivo software programme, followed by consensus meetings between researchers. Participants perceived the structural barriers to CM implementation as a contradictory MA system, lack of communication among government departments and CM guidelines not reflecting reality. Five themes were derived as the personal barriers: burnout, the conflict between private values and CM goals, role confusion, beneficiaries' blame, and lack of acknowledgement from coworkers. To improve case managers' experiences concerning MA beneficiaries, policy solutions and a collaborative environment with beneficiaries, public nurses and social service providers are needed to ensure the workforce's sustainability. Also, it is required to develop practical guidelines that reflect the reality of implementing CM., (© 2021 John Wiley & Sons Ltd.)

Objectives: Despite high rates of cardiometabolic diseases in Korean immigrants (KIs), little is known about cultural and environmental factors contributing to lifestyle behaviors. The purpose of this cross-sectional study was to examine the relationships among acculturation, environment, and lifestyle behaviors (dietary behavior, physical activity, and sedentary behavior) through culturally sensitive psychological mediators, body image discrepancy and acculturative stress in middle-aged KIs., Design: A cross-sectional study was conducted. KIs aged 30-65 years were recruited online and at Korean community centers and churches in the Northeastern US Participants completed validated measures of dietary behavior (the Nutrition Subscale of the Health Promoting Lifestyle Profile (HPLP) II), physical activity (the International Physical Activity Questionnaire (IPAQ) - short form), and sedentary behavior (the Sedentary Behavior Questionnaire). Acculturative stress was measured by the Acculturative Stress Index and body image discrepancy was measured by the Stunkard Figure Rating Scale. Acculturation was defined as a latent variable measured by Korean and American orientation (Vancouver Index of Acculturation), age of immigration to the US, length of residency in the US, and English proficiency. Data were analyzed with structural equation modeling (SEM)., Results: The sample included 361 KIs (mean age = 41.77 ±   10.28 years, 48.1% female, and 46.4% overweight or obese). In the SEM model, acculturation had significant indirect effects on dietary behavior, physical activity, and sedentary behavior through body image discrepancy. Acculturative stress mediated the relationship between acculturation and sedentary behavior. Greater environmental support for physical activity and better healthy food accessibility were related to higher levels of physical activity and healthier dietary behavior, respectively., Conclusion: In our study, acculturation and environmental support for physical activity and healthy food simultaneously influenced KIs' lifestyle behaviors. Addressing an unhealthy body image and acculturative stress may be additional strategies for lifestyle intervention programs to prevent cardiometabolic diseases in KIs.

Chronic kidney disease-mineral bone disorder (CKD-MBD) is the most common complication in CKD patients. Although there is a consensus on treatment guidelines for CKD-MBD, it remains uncertain whether these treatment recommendations reflect actual practice. Therefore, the aim of this study was to investigate the CKD-MBD medication trend in real-world practice. This was a retrospective and observational study using a 12-year period database transformed into a common data model from three tertiary university hospitals. Study populations were subjects initially diagnosed as CKD. The date of diagnosis was designated as the index date. New patients were categorized year to year from 2008 to 2019 with a fixed observation period of 365 days to check the prescription of CKD-MBD medications including calcium-containing phosphate binder, noncalcium-containing phosphate binder, aluminium hydroxide, vitamin D receptor activator (VDRA), and cinacalcet. The numbers of CKD patients in the three hospitals were 7555, 2424, and 5351, respectively. The proportion for patients with CKD-MBD medication prescription decreased yearly regardless of hospital and CKD stage ( p for trend < 0.05). The use of aluminium hydroxide disappeared steadily while the use of VDRA increased annually in all settings. Despite these changes in prescription patterns, the mean value for CKD-MBD-related serologic markers was almost within target range. The proportion of the population within the target value was not significantly changed. Irrespective of hospital and CKD stage, similar trends of prescription for CKD-MBD medications were observed in real-world practice. Further research with a distributed network study may be helpful to understand medication trends in CKD-MBD treatment., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2021 Sungdam Han et al.)

Purpose: Adjuvant chemotherapy after D2 gastrectomy is standard for resectable locally advanced gastric cancer (LAGC) in Asia. Based on positive findings for perioperative chemotherapy in European phase III studies, the phase III PRODIGY study (ClinicalTrials.gov identifier: NCT01515748) investigated whether neoadjuvant docetaxel, oxaliplatin, and S-1 (DOS) followed by surgery and adjuvant S-1 could improve outcomes versus standard treatment in Korean patients with resectable LAGC., Patients and Methods: Patients 20-75 years of age, with Eastern Cooperative Oncology Group performance status 0-1, and with histologically confirmed primary gastric or gastroesophageal junction adenocarcinoma (clinical TNM staging: T2-3N+ or T4Nany) were randomly assigned to D2 surgery followed by adjuvant S-1 (40-60 mg orally twice a day, days 1-28 every 6 weeks for eight cycles; SC group) or neoadjuvant DOS (docetaxel 50 mg/m 2 , oxaliplatin 100 mg/m 2 intravenously day 1, S-1 40 mg/m 2 orally twice a day, days 1-14 every 3 weeks for three cycles) before D2 surgery, followed by adjuvant S-1 (CSC group). The primary objective was progression-free survival (PFS) with CSC versus SC. Two sensitivity analyses were performed: intent-to-treat and landmark PFS analysis., Results: Between January 18, 2012, and January 2, 2017, 266 patients were randomly assigned to CSC and 264 to SC at 18 Korean study sites; 238 and 246 patients, respectively, were treated (full analysis set). Follow-up was ongoing in 176 patients at data cutoff (January 21, 2019; median follow-up 38.6 months [interquartile range, 23.5-62.1]). CSC improved PFS versus SC (adjusted hazard ratio, 0.70; 95% CI, 0.52 to 0.95; stratified log-rank P = .023). Sensitivity analyses confirmed these findings. Treatments were well tolerated. Two grade 5 adverse events (febrile neutropenia and dyspnea) occurred during neoadjuvant treatment., Conclusion: PRODIGY showed that neoadjuvant DOS chemotherapy, as part of perioperative chemotherapy, is effective and tolerable in Korean patients with LAGC., Competing Interests: Yoon-Koo KangConsulting or Advisory Role: DAEHWA Pharmaceutical, Bristol-Myers Squibb, Zymeworks, ALX Oncology, Amgen, Novartis, MacroGenics, Surface Oncology Min-Hee RyuHonoraria: DAEHWA Pharmaceutical, Bristol-Myers Squibb, Lilly, Ono Pharmaceutical, MSD, Taiho Pharmaceutical, Novartis, Daiichi Sankyo, AstraZenecaConsulting or Advisory Role: DAEHWA Pharmaceutical, Bristol-Myers Squibb, Lilly, Ono Pharmaceutical, MSD, Taiho Pharmaceutical, Novartis, Daiichi Sankyo, AstraZeneca Sun Young RhaConsulting or Advisory Role: MSD Oncology, Ipsen, Daiichi Sankyo, Eisai, Amgen, IndivumedSpeakers' Bureau: Lilly, EisaiResearch Funding: MSD Oncology, Bristol-Myers Squibb, Eisai, Roche/Genentech, MedPacto, ASLAN Pharmaceuticals, SillaJen, Bayer, Immunomet Gyunji KimEmployment: Sanofi, NovartisStock and Other Ownership Interests: Sanofi YeonJu LeeEmployment: SanofiStock and Other Ownership Interests: Sanofi Jee Hyun LeeEmployment: SanofiNo other potential conflicts of interest were reported.

Recent genomic studies of methicillin-resistant Staphylococcus aureus (MRSA) have revealed genetic diversity in the various clonal lineages. Along with clinical concerns of MRSA infection, infection with heterogeneous vancomycin-intermediate S. aureus (hVISA) is closely associated with treatment failure. In this study, we investigated the magnitude of genetic variation and features at the genomic level of hVISA strains isolated in South Korea. Four hVISA strains were analyzed by molecular epidemiology, antimicrobial susceptibility, and whole-genome sequencing methods, and they were compared with the reference VISA and vancomycin-susceptible S. aureus strains in the same clonal lineage. The epidemiologic features of hVISA strains were closely related to the ST5 and ST239 clones. Comparative analysis of the whole genome showed genetic mutations, particularly in two-component systems (TCSs) and transcriptional regulators. Genetic mutations in walK were commonly found in both ST5- (F545L, E378K, T500K) and ST239-related (E424D, T492R) hVISA strains. hVISA strains in the ST5 clonal lineage contained mutations in TCS genes, including the walK , vraR , and agr loci, whereas ST239-related strains harbored different genetic variations in walK , lytR , and saeR . This study suggests that the diverse genetic variation of TCSs and transcriptional regulators are involved in reduced vancomycin susceptibility through different mechanisms in each clonal lineage.

Fisheries activities for supplying marine productions were excessively overwhelming. Furthermore in the competitive industrialization, the impact on marine ecosystems and fisheries resources are severe due to the increase of various seabed litter such as plastic materials, styrofoam and plastic bottles and the deterioration of the marine environment. Despite these seriously situation, very few studies of some sea of Korea have been carried out on sedimentary waste fishing. Also some fisheries and there are few reports on plastics present on the seabed of around Korea. This study investigated the distribution of seabed litter collected from the seabed and characteristics of each area by using the trawl gear of the survey vessel from February to November 2018. The weight of all seabed litter collected during the investigation was 62,541.5 kg km -2 , with a range of 0.2-15,019.7 kg km -2 . The most amount of seabed litter was collected from sea block 106 in the South Sea, followed by sea blocks 76 and 82 in the East Sea. Through this study, which was conducted for the first time in all sea in around Korea, it can be used as basic data to understand the current status of seabed litter in the seabed and to establish effective policies at the led by the government., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Postoperative nausea and vomiting (PONV) is an undesirable complication in patients undergoing general anesthesia. Combination therapy via different mechanisms of action for antiemetic prophylaxis has been warranted for effective treatment of PONV. This study was designed to compare the prophylactic antiemetic effect between midazolam combined with palonosetron (group MP) and palonosetron alone (group P) after laparoscopic cholecystectomy surgeries., Methods: A prospective randomized controlled trial was investigated in non-smoking female. Eighty-eight patients were randomly divided into 2 groups with 44 patients each. Group MP received 0.05 mg/kg of midazolam intravenously before induction of anesthesia whereas group P received the same volume of normal saline. Immediately after anesthetic induction, 0.075 mg of palonosetron was administered to both the groups. The incidence and severity of PONV were assessed during 2 time intervals (0-2 hours, 2-24 hours), postoperatively., Results: The incidence of PONV during 24 hours after surgery was lower in group MP as compared to group P. There was also a significant difference in the use of rescue antiemetics. The severity of nausea was significantly lower in group MP as compared to group P, in the initial 2 hours after surgery. The incidence of side effects was similar between the 2 groups., Conclusion: In the prevention of PONV, midazolam combined with palonosetron, administered during induction of anesthesia was more effective as compared to palonosetron alone., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Previous studies report that income inequality is an important risk factor for depression and suicide, and an increasing income gap appears inevitable. However, little study to date has investigated associations between the attribution of poverty and suicide. Though we previously reported associations between socio-cultural factors, including income, and suicide, we tried to explore more focused associations between income, attribution of poverty (individualistic, societal), permissive attitude toward suicide, and suicidal thought using a structural equation model., Methods: A total of 2213 participants from each of three nations (South Korea, Japan, and the United States) completed an online survey. Participants without a history of psychological disorders or suicide attempts completed scales measuring attributions of poverty, attitudes toward suicide, and severity of suicidal thoughts., Results: We established a structural equation model, which exhibited a good fit for all nations, and compared significant path coefficients by country. South Korea had the highest severity of suicidal thought and societal attribution of poverty, followed by Japan and America. In all nations, a permissive attitude was positively related to the severity of suicidal thought and individualistic attribution of poverty was positively related to a permissive attitude toward suicide. Societal attribution of poverty was positively associated with a permissive attitude in Japan and the United States. Income was negatively associated with the severity of suicide in South Korea and the United States., Conclusion: Through an established structural equation model, we found the influence of poverty on suicide and identify the common and distinctive factors associated with suicide in each country., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Although the number of cancer patients admitted to the intensive care unit is increasing, the data on the use of extracorporeal membrane oxygenation in patients with malignancy are limited. We applied extracorporeal membrane oxygenation to carefully selected patients with active hematologic malignancy or nonhematologic malignancy who experienced respiratory or cardiac failure despite maximal conventional therapy. Patients with active malignancy who underwent extracorporeal membrane oxygenation in our institution between January 2012 and December 2016 were included in this study. The primary outcome of this study was defined as survival to hospital discharge. We also investigated the factors associated with survival to hospital discharge. There were 30 (30.6%) and 68 (69.4%) patients in the hematologic malignancy group and the nonhematologic malignancy group, respectively. Patients in the hematologic malignancy group were younger, more neutropenic, more hypotensive, had a lower Charlson Comorbidity Index, higher sequential organ failure assessment score, and lower platelet count than those in the nonhematologic malignancy group. Forty-six (46.9%) patients were successfully weaned off extracorporeal membrane oxygenation, and 30 (30.6%) patients survived until hospital discharge. Hospital survival rate and survival status 6 months after hospital discharge were significantly lower in patients with hematologic malignancy than in those with nonhematologic malignancy (13.3% vs. 38.2%, P = .026 and 3.3% vs. 26.5%, P = .017, respectively). Multivariate analysis identified an active hematologic malignancy, older age, acidosis, thrombocytopenia, high vasoactive-inotrope score, and respiratory failure as the risk factors for in-hospital death. Patients with hematologic malignancy requiring extracorporeal membrane oxygenation support had significantly lower rates of hospital survival and 6-month survival after discharge than patients with nonhematologic malignancy. Therefore, extracorporeal membrane oxygenation for treating cardiac or respiratory failure should only be considered in highly selected patients with hematologic malignancy., (© 2021 International Center for Artificial Organs and Transplantation and Wiley Periodicals LLC.)

Objectives: To assess price reductions of anticancer drugs in South Korea over 12 years and analyze the association between price reduction, drug characteristics, and repricing mechanisms., Methods: We constructed a dataset based on the Health Insurance Review and Assessment Service (HIRA) price log of anticancer drugs from January 2007 to June 2019. We investigated each mechanism that resulted in a price reduction, including actual transaction price (ATP), voluntary reduction by a manufacturer, price-volume agreement, expansion of indication or reimbursement scope, price cut at generic entry, lump price cut in April 2012, and re-evaluation. The price reduction rate per year was estimated by dividing the total number of price reduction events by the total period for which the products were on the market. A Poisson regression model was used to estimate the characteristics-adjusted incidence rate ratio of the price reduction. Price reduction per event was also determined across originator and generic products. Data analysis was performed using R (version 3.5.1)., Results: Five hundred price reductions occurred in 439 new anticancer drugs, with a reduction rate per 100 product-years of 23. ATP was the most frequent cause (39.2%) but had minimal impact (average reduction per event of 3%), followed by lump price cut (19.2%) and voluntary reduction (10.2%). Generic entries and lump price cut had the greatest impact (16-29% reduction per event). ATP was the most frequently occurring mechanism, followed by generic entry, voluntary reduction, and the lump price-cut in April 2012., Conclusions: The incidence of price reduction of anticancer drugs increased gradually due to various repricing mechanisms. Although these mechanisms are effective, improvements can be made. Well-designed mechanisms that actively regulate price adjustment are needed to establish repricing policies that adequately reflect changes in the value of drugs over their entire life cycle.

Background: The number of deaths from COVID-19 continues to surge worldwide. In particular, if a patient's condition is sufficiently severe to require invasive ventilation, it is more likely to lead to death than to recovery., Objective: The goal of our study was to analyze the factors related to COVID-19 severity in patients and to develop an artificial intelligence (AI) model to predict the severity of COVID-19 at an early stage., Methods: We developed an AI model that predicts severity based on data from 5601 COVID-19 patients from all national and regional hospitals across South Korea as of April 2020. The clinical severity of COVID-19 was divided into two categories: low and high severity. The condition of patients in the low-severity group corresponded to no limit of activity, oxygen support with nasal prong or facial mask, and noninvasive ventilation. The condition of patients in the high-severity group corresponded to invasive ventilation, multi-organ failure with extracorporeal membrane oxygenation required, and death. For the AI model input, we used 37 variables from the medical records, including basic patient information, a physical index, initial examination findings, clinical findings, comorbid diseases, and general blood test results at an early stage. Feature importance analysis was performed with AdaBoost, random forest, and eXtreme Gradient Boosting (XGBoost); the AI model for predicting COVID-19 severity among patients was developed with a 5-layer deep neural network (DNN) with the 20 most important features, which were selected based on ranked feature importance analysis of 37 features from the comprehensive data set. The selection procedure was performed using sensitivity, specificity, accuracy, balanced accuracy, and area under the curve (AUC)., Results: We found that age was the most important factor for predicting disease severity, followed by lymphocyte level, platelet count, and shortness of breath or dyspnea. Our proposed 5-layer DNN with the 20 most important features provided high sensitivity (90.2%), specificity (90.4%), accuracy (90.4%), balanced accuracy (90.3%), and AUC (0.96)., Conclusions: Our proposed AI model with the selected features was able to predict the severity of COVID-19 accurately. We also made a web application so that anyone can access the model. We believe that sharing the AI model with the public will be helpful in validating and improving its performance., (©Heewon Chung, Hoon Ko, Wu Seong Kang, Kyung Won Kim, Hooseok Lee, Chul Park, Hyun-Ok Song, Tae-Young Choi, Jae Ho Seo, Jinseok Lee. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 19.04.2021.)

Background: Evidence continues to accumulate that the presence or absence of early trauma (ET) implies unique characteristics in the relationships between suicidal ideation and its risk factors. We examined the relationships among recent stress, depressive symptoms, anxiety symptoms, and suicidal ideation in Korean suicidal women with or without such a history., Methods: Using data on suicidal adult females, 217 victims and 134 non-victims of ET, from the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior, we performed structural equation modeling to investigate the contribution of recent stress, depressive symptoms, and anxiety symptoms on suicidal ideation within each group according to the presence or absence of a history of ET., Results: Structural equation modeling with anxiety and depressive symptoms as potential mediators showed a good fit. Recent stress had a direct effect on both depressive symptoms and anxiety symptoms in both groups. Only anxiety symptoms for victims of ET (standardized regression weight, 0.281; P = 0.005) and depressive symptoms for non-victims of ET (standardized regression weight, 0.326; P = 0.003) were full mediators that increased suicidal ideation. Thus, stress contributed to suicidal ideation by increasing the level of anxiety and depressive symptoms for victims and non-victims, respectively., Conclusion: Tailored strategies to reduce suicidal ideation should be implemented according to group type, victims or non-victims of ET. Beyond educating suicidal women in stress-management techniques, it would be effective to decrease anxiety symptoms for those with a history of ET and decrease depressive symptoms for those without such a history., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2021 The Korean Academy of Medical Sciences.)

Religious belief and participation may facilitate well-being and the transition to living in the United States for Korean immigrants. However, there is little known about how Korean immigrant young adults obtain social/emotional support from church involvement and benefit from spiritual networks. A qualitative study was conducted through in-depth interviews with 22 members of one Protestant church in the Washington, DC metropolitan area. According to our findings, all respondents were supported in their transition to living in the United States through the social support and well-being effects of religious belief/affiliation. They manifested their belief mainly in two different ways, either engaging in spiritual networks as a church leader or by focusing on their education and livelihoods with their religious belief as a powerful motivator. It is hoped that further study will elucidate more of the mechanisms linking religious belief to the living transition for Korean and other immigrants to the United States.

We examined the localization of olfactory marker protein (OMP), protein gene product9.5 (PGP9.5), and glycan diversity in the vomeronasal organ (VNO) of the Korean black goat (Capra hircus coreanae) during the prenatal and postnatal periods using immunohistochemistry and lectin histochemistry. In fetal and 1-day-old goats, OMP was occasionally identified in receptor cells of the VNO sensory epithelium, and PGP9.5 was localized in both the sensory and non-sensory epithelia. In VNO from adult goats, OMP was abundant in the sensory epithelium and scarce in single cells of the non-sensory epithelium. These results suggest that OMP production is initiated in the VNO sensory epithelium (VNE) during the fetal stage, and that its activity is increased in adult VNO receptor cells and solitary cells in the non-sensory epithelium (VNSE). Furthermore, the free borders of the sensory epithelia were positive for 7 lectins, and 6 lectins were moderately and/or highly abundant in receptor cells. Supporting and basal cells, and nerve bundles had similar expression patterns. In VNE, 7 lectins were observed in the free border, and 6 in ciliated, goblet, and basal cells, and in gland acini. The intensities of WGA, LCA, and PNA were high in VSE receptor cells, and the intensity of PNA was high in ciliated cells of the VNSE. The other 3 lectins showed similar patterns throughout development. Collectively, these results confirm that the Korean black goat VNO starts developing during the late fetal stages and differentiates further after birth., (Copyright © 2021 Elsevier GmbH. All rights reserved.)

Background: Although many studies have identified the risk factors for suicide, the absence of a statistical model that integrates several risk areas makes it difficult to understand the abnormally high suicide rate in South Korea. Therefore, we aimed to establish a multidimensional structural equation model of suicide incorporating socio-cultural and psychiatric factors. We performed cross-national comparisons to identify the unique factors influencing South Korea's suicide rate., Methods: We conducted a web survey inviting adults aged 20- to 59-years from South Korea, Japan, and the United States to respond to questionnaires. A total of 2,213 subjects were included. We then developed a structural equation model, exhibiting a good fit in all countries., Results: A permissive attitude was the factor that most strongly predicted the intensity of suicidal ideation in all countries. In South Korea, a low income was directly associated with both permissive attitude and the intensity of suicidal ideation. South Korea's highly fatalistic attitude related to more receptive attitudes toward suicide. Individual's resilience to stress provided significant protection against suicidal ideation in the United States and Japan, but not in South Korea., Limitations: Since our sample excluded adults over 60 years, thus reducing the generalizability of our results. Furthermore, we employed a cross-sectional design; a longitudinal study is needed to draw causal inferences about suicidal death CONCLUSIONS: This study developed the first multidimensional, integrated statistical model of suicidal ideation. Our findings explain the causes of South Korea's high suicide rate and can be used to develop new interventions., (Copyright © 2020. Published by Elsevier B.V.)

Background Low muscle mass has been associated with poor prognosis in certain chronic diseases, but its clinical significance in patients with coronary artery disease is unclear. We assessed the clinical significance of 2 easily measured surrogate markers of low muscle mass: the ratio of serum creatinine to serum cystatin C (Scr/Scys), and the ratio of estimated glomerular filtration rate by Scys to Scr (eGFRcys/eGFRcr). Methods and Results Patients with coronary artery disease undergoing percutaneous coronary intervention were prospectively enrolled from a single tertiary center, and Scr and Scys levels were simultaneously measured at admission. Best cut-off values for Scr/Scys and eGFRcys/eGFRcr to discriminate 3-year mortality were determined; 1.0 for men and 0.8 for women in Scr/Scys, and 1.1 for men and 1.0 for women in eGFRcys/eGFRcr. The prognostic values on 3-year mortality and the additive values of 2 markers on the predictive model were compared. In 1928 patients enrolled (mean age 65.2±9.9 years, 70.8% men), the risk of 3-year mortality increased proportionally according to the decrease of the surrogate markers. Both Scr/Scys- and eGFRcys/eGFRcr-based low muscle mass groups showed significantly higher risk of death, after adjusting for possible confounders. They also increased predictive power of the mortality prediction model. Low Scr/Scys values were associated with high mortality rate in patients who were ≥65 years, nonobese, male, had renal dysfunction at baseline, and presented with acute myocardial infarction. Conclusions Serum surrogate markers of muscle mass, Scr/Scys, and eGFRcys/eGFRcr may have clinical significance for detecting patients with coronary artery disease at high risk for long-term mortality.

Background: COVID-19, which is accompanied by acute respiratory distress, multiple organ failure, and death, has spread worldwide much faster than previously thought. However, at present, it has limited treatments., Objective: To overcome this issue, we developed an artificial intelligence (AI) model of COVID-19, named EDRnet (ensemble learning model based on deep neural network and random forest models), to predict in-hospital mortality using a routine blood sample at the time of hospital admission., Methods: We selected 28 blood biomarkers and used the age and gender information of patients as model inputs. To improve the mortality prediction, we adopted an ensemble approach combining deep neural network and random forest models. We trained our model with a database of blood samples from 361 COVID-19 patients in Wuhan, China, and applied it to 106 COVID-19 patients in three Korean medical institutions., Results: In the testing data sets, EDRnet provided high sensitivity (100%), specificity (91%), and accuracy (92%). To extend the number of patient data points, we developed a web application (BeatCOVID19) where anyone can access the model to predict mortality and can register his or her own blood laboratory results., Conclusions: Our new AI model, EDRnet, accurately predicts the mortality rate for COVID-19. It is publicly available and aims to help health care providers fight COVID-19 and improve patients' outcomes., (©Hoon Ko, Heewon Chung, Wu Seong Kang, Chul Park, Do Wan Kim, Seong Eun Kim, Chi Ryang Chung, Ryoung Eun Ko, Hooseok Lee, Jae Ho Seo, Tae-Young Choi, Rafael Jaimes, Kyung Won Kim, Jinseok Lee. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 23.12.2020.)

The novel bacterial strain C33 T was isolated from a freshwater sample collected from the Hapcheon-Changnyeong barrage. The Gram-negative, motile, yellow-pigmented strain C33 T was characterized as a rod-shaped and strictly aerobic bacterium. A 16S-rRNA phylogenetic analysis revealed that this strain was most closely related to Sphingomonas changbaiensis V2M44 T , Sphingomonas tabacisoli X1-8 T , and Sphingomonas flavalba ZLT-5 T with 97.1, 97.0, and 95.0 % 16S-rRNA sequence similarities, respectively. The genomic DNA GC content of strain C33 T was estimated at 65.0 mol%. The average nucleotide identity of strain C33 T relative to S. changbaiensis V2M44 T and S. flavalba ZLT-5 T was found to be 77.0 and 75.6%, with average amino-acid identities of 69.9, and 66.7%, and the digital DNA-DNA hybridization values of 21.3 and 17.7 %, respectively. The cells grew at 19-37 °C and pH 6-9 with 0-0.5 % (w/v) NaCl (optimum: 28 °C, pH 6.5, and 0 % NaCl). The major component identified in the polyamine pattern was sym -homospermidine, and the main ubiquinone was Q-10. The predominant polar lipids characterized were diphophatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, phosphatidylmonomethylethanolamine, phosphatidyldimethylethanolamine, and sphingoglycolipid. Iso-C 15 : 0 , C 15 : 0 anteiso, and summed feature 3 (C 16 : 1 ω and/or C c and/or C 16 : 1 ω 7 c ) were found to be the primary cellular fatty acids in strain C33 T . Based on these genotypic and phenotypic characteristics, strain C33 T was classified as a novel species of the genus Sphingomonas ; and the name Sphingomonas changnyeongensis sp. nov. is proposed (=KACC 21511 T =JCM 33880 T ).

Safety surveillance, using appropriately consistent review criteria, could improve human participants' well-being in clinical trials. To establish a globally consistent framework, the quality of the current content for review by institutional review boards (IRBs), as mandatory oversight entities, requires evaluation. This study collected and analyzed forms reporting serious adverse events (SAEs) to IRBs/ Research Ethics Committees(RECs) to compare them with the well-structured form presented in the literature using completeness and accuracy scores. We found sub-optimal completeness and accuracy scores when compared with perfect scores ( p < .05). Less than half of the retrieved forms had queries on causality assessment (≤43.1%). Thus, contents of SAE forms require improvement for IRB oversight and, further, there is a need to develop a well-structured form that could improve international consistency.

It is necessary to determine an environmentally friendly method of reusing the vast amount of coal waste that is generated during coal preparation. This study evaluates the applicability of using weathered coal waste in a permeable reactive barrier to prevent groundwater contamination. Coal waste, with different weathering degrees, was obtained from two coal mining sites in South Jeolla Province, Korea. The reactivities of the coal waste with inorganic contaminants, such as copper, cadmium, and arsenic, were examined in batch and column experiments. The batch experiment results indicate that the coal waste removal efficiencies of copper (99.8%) and cadmium (95.4%) were higher than those of arsenic (71.0%). The maximum adsorption capacities of coal waste for copper, cadmium, and arsenic calculated from the Langmuir isotherm model were 4.440 mg/g, 3.660 mg/g, and 0.718 mg/g, respectively. The equilibrium of adsorption was attained within 8 h. The column experiment results reveal that the coal waste effectively removed inorganic contaminants under flow-through conditions. Faster breakthrough times were observed in single solute system (As(V) = 19.3 PV, Cu(II) = 47.6 PV) compared with binary solute system (As(V) = 27.8 PV, Cu(II) = 65.4 PV). To confirm the applicability of using coal waste in a groundwater environment, its decontamination ability was analyzed at low concentrations and under various pH conditions. To examine the potential ecological risks in the subsurface environment, a test to determine acute toxicity to Daphnia magna and a toxic characteristic leaching procedure (TCLP) test were conducted. The coal waste was found to satisfy appropriate standards. The acute toxicity test also confirmed the ecological safety of using coal waste in a groundwater environment. The acceptably high capacity and fast kinetics of inorganic contaminant sorption by the coal waste indicate it could potentially be employed as a reactive material. The recycling and application of this abundant waste material will contribute to solving both coal waste disposal and water pollution problems.