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Objectives: Estimating the risk of diabetes mellitus (DM) is important for the proper management of patients with spinal cord injury (SCI). We investigated the short-term and long-term risks of DM among patients with SCI, according to the presence or severity of post-SCI disability and the level of injury. Methods: We conducted a retrospective cohort study using the Korean National Health Insurance Service (2010–2018) database. After matching by age and sex, 6129 SCI patients and 22,979 controls were included. The primary outcome was incident DM, and risk was evaluated for both the short term (within 1 year after SCI) and the long term (after 1 year of SCI diagnosis). Results: The risk of DM was higher among patients with cervical- and thoracic-level SCI accompanied by disability compared to the controls during follow-up (4.6 ± 2.6 years). The short-term risk of DM was higher among patients with SCI (odds ratio [OR] 2.51, 95% confidence interval [CI] 1.91–3.27) than among the controls and it was even higher among patients with severe disability (OR 5.38, 95% CI 2.91–9.27). According to the level of injury, patients with cervical SCI had the highest short-term risk of DM (with disability, OR 4.93, 95% CI 3.07–7.63). There was no significant increase of DM risk in the long term, after 1 year of SCI diagnosis. Conclusions: Patients with SCI accompanied by severe disability and cervical-level injury had higher risks of pronounced DM in the short term. The findings of this study emphasize the need for active surveillance of DM among patients with high-level SCI and disability, especially in the short term, in addition to continuous monitoring and proper management of DM in the long term. [ABSTRACT FROM AUTHOR]

Background and purpose: Previous studies have examined the risk of stroke in patients with Parkinson disease (PD), but the incidence of PD onset among stroke patients and its risk according to severity of poststroke disabilities have scarcely been investigated. This study aims to determine whether the risk of PD is increased among stroke patients using a retrospective cohort with a large population‐based database. Methods: We used data collected by the Korean National Health Insurance Service from 2010 to 2018 and examined 307,361 stroke patients and 380,917 sex‐ and age‐matched individuals without stroke to uncover the incidence of PD. Cox proportional hazards regression was used to calculate the hazard ratio (HR) and 95% confidence interval (CI), and the risk of PD was compared according to presence and severity of disability. Results: During 4.31 years of follow‐up, stroke patients had a 1.67 times higher risk of PD compared to individuals without stroke (adjusted HR = 1.67, 95% CI = 1.57–1.78). The risk of PD was greater among stroke patients with disabilities than among those without disabilities, even after adjustment for multiple covariates (adjusted HR = 1.72, 95% CI = 1.55–1.91; and adjusted HR = 1.66, 95% CI = 1.56–1.77, respectively). Conclusions: Our study demonstrated an increased risk of PD among stroke patients. Health professionals need to pay careful attention to detecting movement disorders as clues for diagnosing PD. [ABSTRACT FROM AUTHOR]

To compare the frequency of Ureaplasma-positive gastric fluid (GF) cultures based on the cause and mode of delivery in preterm newborns. This retrospective cohort study included women with a singleton pregnancy who delivered prematurely (between 23+0 and 32+0 weeks of gestation, n=464) at a single university hospital in South Korea. The newborns' GF was obtained on the day of birth via nasogastric intubation. The frequency of Ureaplasma spp. in GF cultures was measured and compared according to the cause and mode of delivery. Ureaplasma spp. was detected in 20.3 % of the GF samples. The presence of Ureaplasma spp. was significantly higher in the spontaneous preterm birth group than in the indicated preterm birth group (30.2 vs. 3.0 %; p<0.001). Additionally, Ureaplasma spp. was more frequently found in the vaginal delivery group than in the cesarean delivery group, irrespective of the cause of preterm delivery [indicated preterm birth group (22.2 vs. 1.9 %, p=0.023); spontaneous preterm birth group (37.7 vs. 24.2 %, p=0.015)]. Ureaplasma spp. were found in 20.3 % of the GFs. However, only 1.9 % of newborns in the indicated preterm birth group with cesarean delivery had a Ureaplasma-positive GF culture. [ABSTRACT FROM AUTHOR]

Previous studies have reported that low levels of physical activity result in sarcopenic obesity (SO). However, the effects of specific intensities of physical activity on SO and the optimal amount of physical activity for lowering the prevalence of SO have not been well studied. This study aimed to identify the effects of physical activity levels and intensity on SO and the optimal amount of physical activity related to a lower prevalence of SO. This cross-sectional study used data from the nationwide Korean Frailty and Aging Cohort Study (KFACS), which included 2071 older adults (1030 men, 1041 women). SO was defined according to the criteria of the European Society for Clinical Nutrition Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO). Multivariate logistic regression analysis was performed to investigate the association between the physical activity level and SO. The high activity group had a significantly lower prevalence of SO than the non-high activity (low and moderate activity) group. On the other hand, moderate-intensity physical activity was associated with a lower prevalence of SO. A total physical activity energy expenditure of > 3032 kcal/week (433 kcal/day) for men and 2730 kcal/week (390 kcal/day) for women was associated with a reduced prevalence of SO. The high physical activity and total physical energy expenditure described above may be beneficial for reducing the prevalence of SO. [ABSTRACT FROM AUTHOR]

Aim: As life expectancy increases worldwide, the prevalence and the disease burden of diabetes in older adults are also increasing. This study aimed to examine sex differences in the reciprocal relationship between glycemic control and depressive symptoms among older adults with diabetes by using longitudinal data at two timepoints. Methods: Wave 1 (W1, 2016–2017) and wave 2 (W2, 2018–2019) data from the Korean Frailty and Aging Cohort Study were used. Finally, 416 older adults with diabetes who satisfied the inclusion criteria were analyzed (215 males, 201 females). The reciprocal relationship between depressive symptoms and glycosylated hemoglobin A1c (HbA1c) levels was examined using a cross‐lagged panel model. Results: HbA1c levels and depressive symptoms at earlier time points were the most significant factors contributing to HbA1c levels and depressive symptoms at later timepoints. The relationship between HbA1c level and depressive symptoms differed according to sex. The cross‐path from depressive symptoms (W1) to HbA1c levels (W2) was positively statistically significant in males (β = 0.18, SD = 0.05, P = 0.001). The path from HbA1c levels (W1) to depressive symptoms (W2) was positively statistically significant in females (β = 0.12, SD = 0.06, P = 0.032). Conclusions: Early management of blood glucose levels and depressive symptoms is important in older adults with diabetes. Moreover, glycemic control through social activities in the community could be effective in relieving depressive symptoms in older females with diabetes, and managing depressive symptoms and glucose levels together could be effective in glycemic control in older males with diabetes. Geriatr Gerontol Int 2024; 24: 32–39. [ABSTRACT FROM AUTHOR]

Construction supervision is a key task that can confirm and inspect the project execution and support the creation of successful results. For the efficient performance of construction supervision, collecting various information necessary for the supervisor's decision-making is a prerequisite, and the use of digital technology has recently been proposed as an alternative. Accordingly, the purpose of this study is to present a roadmap for the step-by-step use of digital technology to improve the efficiency of construction supervision. This study was limited to the supervision of construction projects, which have a high proportion of contract volumes in the Korean construction industry and can directly affect people's lives. This study reclassified Korea's construction supervision works, collected data on the urgency and effectiveness of detailed works from various stakeholders, and derived a final roadmap using importance–performance analysis. The results of this study are expected to serve as basic guidelines that can be used when reviewing digital technologies that can be applied step by step to improve the efficiency of construction supervision work. [ABSTRACT FROM AUTHOR]

Background: This study aimed to identify the risk factors associated with coronavirus disease 2019 (COVID-19) infection and mortality among older adults in South Korea. Methods: Using Korean National Health Insurance data from January 1, 2020, to March 31, 2022, we analyzed the impact of various factors, including age, comorbidity burden, and insurance type, on COVID-19 infection and mortality rates. Results: Age was the most significant risk factor for mortality in older adults. A higher comorbidity burden was also associated with increased infection (odds ratio [OR]=1.33 for Charlson Comorbidity Index [CCI] ≥2, 95% confidence interval [CI] 1.321-1.339) and mortality (OR=1.537 for CCI ≥2, 95% CI 1.459-1.618) rates. While Medical Aid recipients exhibited lower infection rates (OR=0.898, 95% CI 0.89-0.906) than National Health Insurance beneficiaries, they had higher mortality rates (OR=1.692, 95% CI 1.623-1.763). Conclusion: These results emphasized the need to prioritize vaccination and allocate healthcare resources for older adults, particularly those with multiple comorbidities. Addressing socioeconomic disparities and ensuring equitable access to testing and healthcare services are crucial for mitigating the impact of COVID-19 on older adults. [ABSTRACT FROM AUTHOR]

Background: Although many studies about survival rates and functional outcomes after stroke have been published, studies on gender differences have reported conflicting results. Aims: To determine whether there are differences in mortality and functional outcomes during the first 5 years after a first-ever ischemic stroke in Korean males and females. Method: This is an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation, a prospective multicenter cohort study. Multifaceted functional assessments were performed repeatedly from 7 days to 60 months after stroke onset to test motor, ambulatory, cognitive, language, and swallowing functions as well as activities of daily living (ADLs) in patients with first-ever stroke. Of 10,636 first-ever-stroke patients admitted to nine representative hospitals in Korea, 8210 were ischemic stroke patients included in the mortality analysis. Among them, 6258 patients provided informed consent and 3508 completed functional assessments for 60 months. Gender-related differences in 5-year mortality and functional recovery were analyzed. Result: Women showed a significantly higher 5-year mortality rate than men after correction for possible covariates (p < 0.05). In terms of functional outcomes, women showed worse ambulatory, cognitive, language, and ADL outcomes than men after adjusting for covariates (all p < 0.05). The 5-year recovery pattern differed significantly between genders only for ADL function (β-coefficient estimate = 0.34; p = 0.03). Conclusion: Five-year mortality rate, functional outcomes, and recovery patterns after first-ever ischemic stroke differed significantly by gender. These results suggest the need for gender-specific stroke care and long-term management strategies. [ABSTRACT FROM AUTHOR]

Drawing on the theory of planned behavior (TPB), the present study examined the relative importance of informal social control and social cohesion/trust in the behavioral intention to post online race-related hate speech. A conceptual framework of a mediation model was validated on data from 809 survey respondents, and age, gender, Internet usage, and the number of posts representing racist hate speech on online platforms in a 1-year period were controlled for as demographic data. Twenty-six measurement items were designed to measure the four TPB constructs of attitude, subjective norm, perceived behavioral control (PBC), and behavioral intention, as well as the two action-oriented variables of social cohesion/trust and informal social control. Partial least-squares structural equation modeling analysis was conducted to test a series of research hypotheses, and the findings were as follows: (a) informal social control partially mediated the relationships between behavioral intention to post online race-related hate speech and both attitude and subjective norm; (b) informal social control fully mediated the influence of PBC on behavioral intention; and (c) social cohesion/trust did not significantly mediate any of the relationships between behavioral intention and attitude, subjective norm, or PBC. The results indicate that the willingness to intervene in informal social control plays an important role in preventing unwelcome online activity. [ABSTRACT FROM AUTHOR]

Purpose: Endoscopic resection (ER) is a reliable treatment for early colorectal cancer without lymph node metastasis. We aimed to examine the effects of ER performed prior to T1 colorectal cancer (T1 CRC) surgery by comparing long-term survival after radical surgery with prior ER to that after radical surgery alone. Methods: This retrospective study included patients who underwent surgical resection of T1 CRC at the National Cancer Center, Korea, between 2003 and 2017. All eligible patients (n = 543) were divided into primary and secondary surgery groups. To ensure similar characteristics between the groups, 1:1 propensity score matching was used. Baseline characteristics, gross and histological features, along with postoperative recurrence-free survival (RFS) between the two groups were compared. Cox proportional hazard model was used to identify the risk factors affecting recurrence after surgery. Cost analysis was performed to examine the cost-effectiveness of ER and radical surgeries. Results: No significant differences were observed in 5-year RFS between the two groups in matched data (96.9% vs. 95.5%, p = 0.596) and in the unadjusted model (97.2% vs. 96.8%, p = 0.930). This difference was also similar in subgroup analyses based on node status and high-risk histologic features. ER before surgery did not increase the medical costs of radical surgery. Conclusion: ER prior to radical surgery did not affect the long-term oncologic outcomes of T1 CRC or significantly increased the medical costs. Attempting ER first for suspected T1 CRC would be a good strategy to avoid unnecessary surgery without concerns of worsening cancer-related prognosis. [ABSTRACT FROM AUTHOR]

Automatic age estimation using panoramic dental radiographic images is an important procedure for forensics and personal oral healthcare. The accuracies of the age estimation have increased recently with the advances in deep neural networks (DNN), but DNN requires large sizes of the labeled dataset which is not always available. This study examined whether a deep neural network is able to estimate tooth ages when precise age information is not given. A deep neural network model was developed and applied to age estimation using an image augmentation technique. A total of 10,023 original images were classified according to age groups (in decades, from the 10s to the 70s). The proposed model was validated using a 10-fold cross-validation technique for precise evaluation, and the accuracies of the predicted tooth ages were calculated by varying the tolerance. The accuracies were 53.846% with a tolerance of ±5 years, 95.121% with ±15 years, and 99.581% with ±25 years, which means the probability for the estimation error to be larger than one age group is 0.419%. The results indicate that artificial intelligence has potential not only in the forensic aspect but also in the clinical aspect of oral care. [ABSTRACT FROM AUTHOR]

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Background: South Korea has no official geriatric specialties or subspecialties. Moreover, studies on the unmet needs related to geriatric health problems in older Korean adults are scarce. Therefore, we investigated the unmet needs regarding geriatric health problems among older Korean adults. Methods: This cross-sectional study included 411 Korean adults aged =70 years. We constructed a questionnaire for a field survey that comprised 21 items to understand the geriatric challenges related to the participants' physicians and the necessity for geriatric physicians to resolve participants' health problems. We used unweighted numbers (weighted percentages) or mean±standard deviation to describe the characteristics of the study participants for categorical and continuous variables, respectively. Results: This study included a total of 411 men and women. The mean age was 77.6±5.9 years. Among the participants, 88.6% had one or more chronic diseases (mean number of chronic diseases, 2.0±1.3). Of the participants, 32.8% said that their physicians did not spend enough time addressing their problems and only 24.3% felt that their physicians understood geriatric problems well. Of these, 76.2% (n=313) said that geriatricians were required to fulfill their unmet healthcare needs. Conclusions: The participants reported the need for help from a geriatrician, although most of the participants consulted regular physicians about their health problems. The study results support that geriatricians are needed to improve health services for older adults. [ABSTRACT FROM AUTHOR]

Background. Predicting the course of depression is necessary for personalized treatment. Impaired glucose metabolism (IGM) was introduced as a promising depression biomarker, but no consensus was made. This study aimed to predict IGM at the time of depression diagnosis and examine the relationship between long-term prognosis and predicted results. Methods. Clinical data were extracted from four electronic health records in South Korea. The study population included patients with depression, and the outcome was IGM within 1 year. One database was used to develop the model using three algorithms. External validation was performed using the best algorithm across the three databases. The area under the curve (AUC) was calculated to determine the model’s performance. Kaplan–Meier and Cox survival analyses of the risk of hospitalization for depression as the long-term outcome were performed. A metaanalysis of the long-term outcome was performed across the four databases. Results. A prediction model was developed using the data of 3,668 people, with an AUC of 0.781 with least absolute shrinkage and selection operator (LASSO) logistic regression. In the external validation, the AUCs were 0.643, 0.610, and 0.515. Through the predicted results, survival analysis and meta-analysis were performed; the hazard ratios of risk of hospitalization for depression in patients predicted to have IGM was 1.20 (95% confidence interval [CI] 1.02–1.41, p = 0.027) at a 3-year follow-up. Conclusions. We developed prediction models for IGM occurrence within a year. The predicted results were related to the long-term prognosis of depression, presenting as a promising IGM biomarker related to the prognosis of depression. [ABSTRACT FROM AUTHOR]

Lethal neonatal rigidity and multifocal seizure syndrome (RMFSL) is a severe autosomal recessive epileptic encephalopathy characterized by rigidity, intractable multifocal seizures, microcephaly, apnea, and bradycardia immediately after birth. RMFSL is related to a mutation in breast cancer 1-associated ataxia telangiectasia mutated activation-1 protein (BRAT1). We report a case of a female infant born to non-consanguineous Korean parents who developed hypertonia, dysmorphic features, progressive encephalopathy with refractory seizures at birth, and worsening intermittent apnea, leading to intubation and death at 137 days of age. The initial repeated electroencephalographic findings were normal; however, a pattern of focal seizures emerged at 35 days of life. Rapid trio whole-exome sequencing revealed heterozygous mutations c.1313_1314delAG p.(Gln438Argfs*51) and c.1276C>T p. (Gln426*) in BRAT1. After genetic counseling for pregnancy planning, a preimplantation genetic diagnosis for targeted BRAT1 mutations was successfully performed, and a healthy baby was born. To our knowledge, this is the first reported case of a Korean patient with compound heterozygous mutations in BRAT1. An early and accurate genetic diagnosis can help provide timely treatment to patients and indicate the need for reproductive counseling for parents for family planning. [ABSTRACT FROM AUTHOR]

Background: Self-harm is an important public health problem with increasing incidences among adolescents for over a decade. This study aimed to identify factors associated with self-harm in adolescent psychiatric inpatients in Korea. We also investigated clinical characteristics associated with nonsuicidal self-injury disorder (NSSI-D) and suicidal behavior disorder (SBD) according to the Diagnostic and Statistical Manual of Mental Disorders 5 criteria. Methods: This retrospective study included 215 adolescents aged between 12 to 18 years, who were admitted to the psychiatric ward of Samsung Medical Center, Seoul, Korea, from January 2014 to February 2021. Participants were divided into three groups according to NSSI-D and SBD diagnostic criteria. Collected data were analyzed using chi-square test and analysis of variance test. Results: Overall, 57.7% of the participants (n=124) reported self-harm at least once in their lives. Patients with self-harm were more likely to have experienced parental conflict, parent-child relational problems, and verbal, physical, or sexual abuse. Among the three groups divided according to NSSI-D and SBD diagnostic criteria, patients with both NSSI-D and SBD were more likely to have experienced parent-child relational problems than those with either NSSI-D only or SBD only. Conclusion: This study shows that parent-child relational problem is associated with high incidences of self-harm. Especially, the parent-child relational problem seemed to be a risk factor for SBD among patients with NSSI-D. These are important findings that provide an understanding of the self-harm characteristics and therefore improve prevention and treatment strategies in psychiatric adolescent patients. [ABSTRACT FROM AUTHOR]

Background: The 5-times chair stand test (5CST) is a proxy tool for measuring physical performance and muscle strength in diagnosing sarcopenia. The Asian Working Group for Sarcopenia 2019 guidelines recommends the 5CST for evaluating gait speed, whereas the European Working Group on Sarcopenia in Older People guidelines recommend the chair stand test as a proxy for muscle strength. Aims: This study sought to determine whether the chair stand test correlates with handgrip strength and gait speed, and investigate sex differences in these relationships. Methods: We used data collected from 1416 participants (678 men and 738 women) in the 2017 Korean Frailty and Aging Cohort Study (KFACS). Results: The 5CST time had a higher correlation with gait speed (r = − 0.470) than handgrip strength (r = − 0.309). In addition, 5CST time predicted low gait speed (area under the curve [AUC] 0.727) better than low handgrip strength (AUC 0.641). The optimal cutoff values of the 5CST to estimate low gait speed were 10 s for men (sensitivity 62%, specificity 64%) and 11 s for women (sensitivity 68%, specificity 67%). The optimal cutoff values of the 5CST for low handgrip strength were the same as those for low gait speed (10 s for men and 11 s for women). Conclusions: The 5-times chair stand test fits with gait speed and handgrip strength but seems to be a better proxy of gait speed than handgrip strength. The optimal cutoff values of the 5CST to estimate low gait speed and low handgrip strength were lower in men than women. Although none of the AWGS 2019 or EWGSOP guidelines present sex-specific cutoffs for the 5CST, it needs to be considered in the next guidelines. [ABSTRACT FROM AUTHOR]

Background: Cardiac rehabilitation (CR) is a prognostic management strategy to help patients with CVD achieve a good quality of life and lower the rates of recurrence, readmission, and premature death from disease. Globally, cardiac rehabilitation is poorly established in hospitals and communities. Hence, this study aimed to investigate the discrepancies in the perceptions of the need for CR programs and relevant health policies between directors of hospitals and health policy personnel in South Korea to shed light on the status and to establish practically superior and effective strategies to promote CR in South Korea.Methods: We sent a questionnaire to 592 public health policy managers and directors of selected hospitals, 132 of whom returned a completed questionnaire (response rate: 22.3%). The participants were categorized into five types of organizations depending on their practice of PCI (Percutaneous Coronary Intervention), establishment of cardiac rehabilitation, director of hospital, and government's policy makers. Differences in the opinions between directors of hospitals that perform/do not perform PCI, directors of hospitals with/without cardiac rehabilitation, and between hospital directors and health policy makers were analyzed.Results: Responses about targeting diseases for cardiac rehabilitation, patients' roles in cardiac rehabilitation, hospitals' roles in cardiac rehabilitation, and governmental health policies' roles in cardiac rehabilitation were more positive among hospitals that perform PCI than those that do not. Responses to questions about the effectiveness of cardiac rehabilitation and hospitals' roles in cardiac rehabilitation tended to be more positive in hospitals with cardiac rehabilitation than in those without. Hospital directors responded more positively to questions about targeting diseases for cardiac rehabilitation and governmental health policies' roles in cardiac rehabilitation than policy makers, and both hospitals and public organizations provided negative responses to the question about patients' roles in cardiac rehabilitation. Responses to questions about targeting diseases for cardiac rehabilitation, patients' roles in cardiac rehabilitation, and governmental health policies' roles in cardiac rehabilitation were more positive in hospitals that perform PCI than those that do not and public organizations.Conclusions: Hospitals must ensure timely referral, provide education, and promote the need for cardiac rehabilitation. In addition, governmental socioeconomic support is needed in a varity of aspects. [ABSTRACT FROM AUTHOR]

Background: This study investigated the impact of physical frailty on the development of disabilities in mobility, activities of daily living (ADL), and instrumental activities of daily living (IADL) according to sex among community-dwelling Korean older adults.Methods: We used data of 2,905 older adults aged 70-84 years from the Korean Frailty and Aging Cohort Study (KFACS) at baseline (2016-2017) and Wave 2 (2018-2019). Fried's physical frailty phenotype was used to identify frailty.Results: After adjustment, frailty showed a higher impact for women than men on developing mobility disability (odds ratio [OR]=14.00, 95% confidence interval [CI]=4.8-40.78 vs. OR=9.89, 95% CI=4.28-22.86) and IADL disability after two years (OR=7.22, 95% CI=2.67-19.56 vs. OR=3.19, 95% CI=1.17-8.70). Pre-frailty led to mobility disability for women and men (OR=2.77, 95% CI=1.93-3.98 vs. OR=2.49, 95% CI=1.66-3.72, respectively), and IADL disability only for women (OR=3.01, 95% CI=1.28-7.09). Among the IADL components, both men and women who were prefrail or frail showed increased disability in 'using transportation'. Among men, pre-frailty was significantly associated with disability in "going out" and "shopping". In women, frailty was significantly associated with disability in "doing laundry," "performing household chores," "shopping," and "managing money".Conclusions: Physical frailty increased disability over 2 years for women more than men. Physical frailty increased disability in outdoor activity-related IADL components in men and household work-related IADL components in women. This study highlights the need for gender-specific policies and preventative programs for frailty, particularly restorative interventions that focus on women who are physically frail. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the prevalence and management of diabetes mellitus, risk-factor control, and comorbidities among Korean adults. Methods: We conducted a cross-sectional analysis of data from the Korea National Health and Nutrition Examination Survey to assess the prevalence, treatment, risk factors, comorbidities, and self-management behaviors of diabetes mellitus from 2019 to 2020. We also analyzed data from the Korean National Health Insurance Service to evaluate the use of antidiabetic medications in people with diabetes mellitus from 2002 through 2018. Results: Among Korean adults aged 30 years or older, the estimated prevalence of diabetes mellitus was 16.7% in 2020. From 2019 through 2020, 65.8% of adults with diabetes mellitus were aware of the disease and treated with antidiabetic medications. The percentage of adults with diabetes mellitus who achieved glycosylated hemoglobin (HbA1c) <6.5% was 24.5% despite the increased use of new antidiabetic medications. We found that adults with diabetes mellitus who achieved all three goals of HbA1c <6.5%, blood pressure (BP) <140/85 mm Hg, and low-density lipoprotein cholesterol <100 mg/dL were 9.7%. The percentage of self-management behaviors was lower in men than women. Excess energy intake was observed in 16.7% of adults with diabetes mellitus. Conclusion: The prevalence of diabetes mellitus among Korean adults remained high. Only 9.7% of adults with diabetes mellitus achieved all glycemic, BP, and lipid controls from 2019 to 2020. Continuous evaluation of national diabetes statistics and a national effort to increase awareness of diabetes mellitus and improve comprehensive diabetes care are needed. [ABSTRACT FROM AUTHOR]

Stroke is one of the leading causes of mortality and disability in Korea. Patients who experience stroke require adequate management throughout the acute to subacute and chronic stages. Many patients with long-term functional issues require rehabilitative management even in the chronic stage. A comprehensive rehabilitation and care model for patients who experience stroke is necessary to effectively manage their needs during rehabilitation and allocate medical resources throughout the stages, thus ensuring reduced unmet needs and improved post-stroke quality of life. In Korea, the government and medical specialists are working on re-organizing the rehabilitation care model, including standardized triage and discharge planning after acute stroke treatment, and establishing systematic transitional and long-term rehabilitation care plans. This review briefly introduces the general rehabilitation triage after acute stroke and describes the current transitional and continuous care systems available for these patients in Korea. We also present the issues faced in transitional and long-term care plans of the current system and the efforts invested in resolving them and promoting long-term care in stroke cases. [ABSTRACT FROM AUTHOR]

This study examined whether online video ads in the U.S. and South Korea reflect their cultural values in the same way as traditional advertising has shown. A content analysis was conducted on popular YouTube video ads in both countries. Surprisingly, the results from the current research were somewhat inconsistent with the previous research results in mass media advertising. Most of the frequencies of advertising appeals of popular online video ads on YouTube in South Korea were not significantly different from those in the U.S., despite cultural differences between the two countries. Popular online video advertising might be more likely to reflect the individual and emotional characteristics of online video advertising rather than cultural values. Implications for international research on online video advertising were discussed. [ABSTRACT FROM AUTHOR]

Background: Falls are one of the most serious health problems among older adults. Sarcopenia is characterized by a decrease in muscle mass, strength, and physical function. Due to potentially age-related conditions, both falls and sarcopenia have common risk factors. However, the association between sarcopenia and falls is controversial. Moreover, the sex differences in the impact of sarcopenia on falls is not yet clear. This study aimed to investigate the sex differences in the impact of sarcopenia, defined by the Asian Working Group for Sarcopenia (AWGS), on falls in Korean older adults.Methods: In this cross-sectional study, we used data from the Korean Frailty and Aging Cohort Study; 2323 community-dwelling older adults (1111 males and 1212 females) aged 70-84 years were recruited in this cross-sectional study. To evaluate sarcopenia, the AWGS diagnostic algorithm was used. We compared the faller and non-faller groups. We performed unadjusted and fully adjusted logistic regression analyses to evaluate the relationship between sarcopenia, falls, and fall-related fractures.Results: A total of 239 (24.1%) females in the faller group had a history of falls in the past year, which was statistically higher than that in males (176, 15.8%). In the fully adjusted model, handgrip strength (odds ratio [OR] = 1.508, 95% confidence interval [CI] = 1.028-2.211), and short physical performance battery (OR = 2.068, 95% CI = 1.308-3.271) were significantly lower in the male faller group. However, in the fully adjusted model, the female faller group only showed a significantly low appendicular skeletal muscle mass index (OR = 1.419, 95% CI = 1.058-1.903).Conclusions: This large cohort study aimed to identify the sex differences in the incidence of sarcopenia in the older Korean population, using the AWGS diagnostic algorithm, and its correlation with falls and fall-related fractures. The incidence of falls did not increase in the sarcopenia group. Among the sarcopenia components, sex differences affect the history of falls. Therefore, when studying the risk of falls in old age, sex differences should be considered. [ABSTRACT FROM AUTHOR]

Background: Focused ultrasound (FUS)-mediated blood–brain barrier (BBB) opening has shown efficacy in removal of amyloid plaque and improvement of cognitive functions in preclinical studies, but this is rarely reported in clinical studies. This study was conducted to evaluate the safety, feasibility and potential benefits of repeated extensive BBB opening. Methods: In this open-label, prospective study, six patients with Alzheimer's disease (AD) were enrolled at Severance Hospital in Korea between August 2020 and September 2020. Five of them completed the study. FUS-mediated BBB opening, targeting the bilateral frontal lobe regions over 20 cm3, was performed twice at three-month intervals. Magnetic resonance imaging, 18F-Florbetaben (FBB) positron emission tomography, Caregiver-Administered Neuropsychiatric Inventory (CGA-NPI) and comprehensive neuropsychological tests were performed before and after the procedures. Results: FUS targeted a mean volume of 21.1 ± 2.7 cm3 and BBB opening was confirmed at 95.7% ± 9.4% of the targeted volume. The frontal-to-other cortical region FBB standardized uptake value ratio at 3 months after the procedure showed a slight decrease, which was statistically significant, compared to the pre-procedure value (− 1.6%, 0.986 vs1.002, P = 0.043). The CGA-NPI score at 2 weeks after the second procedure significantly decreased compared to baseline (2.2 ± 3.0 vs 8.6 ± 6.0, P = 0.042), but recovered after 3 months (5.2 ± 5.8 vs 8.6 ± 6.0, P = 0.89). No adverse effects were observed. Conclusions: The repeated and extensive BBB opening in the frontal lobe is safe and feasible for patients with AD. In addition, the BBB opening is potentially beneficial for amyloid removal in AD patients. [ABSTRACT FROM AUTHOR]

Background despite of the beneficial effects of fibroblast growth factor (FGF) 21 in several metabolic diseases, the association of plasma FGF21 with muscle mass and muscle strength is still unclear. Methods a total of 386 community-dwelling older adults aged 70–84 years were analysed. Appendicular skeletal muscle mass was measured using dual-energy X-ray absorptiometry and normalised to the square of height (ASM/ht2). Muscle strength was assessed using the hand grip strength (HGS) test. The definitions of low muscle mass (LMM) and low muscle strength (LMS) were based on the Asian Working Group for Sarcopenia. Results plasma FGF21 was significantly lower in participants with LMM than in those with normal muscle mass (289.7 [192.4–448.3] vs. 345.6 [238.6–503.2] pg/ml, P  = 0.008). In contrast, the LMS group had a significantly higher plasma FGF21 level than the normal muscle strength group (369.7 [244.4–591.1] vs. 309.7 [205.3–444.8] pg/ml, P  = 0.006). In the partial correlation analysis, following adjustment for age, sex and body mass index, FGF21 levels had no significant association with ASM/ht2, but were negatively associated with HGS (r  = −0.112, P  = 0.029). Furthermore, after multivariate adjustment for confounding variables, the odds ratio for the risk of LMS was 2.32 (95% confidence interval 1.20–4.46) when comparing the highest with the lowest FGF21 quartile. Conclusions circulating FGF21 levels are negatively associated with muscle strength but are not independently correlated with muscle mass. [ABSTRACT FROM AUTHOR]

Introduction: Early supported discharge (ESD) is a transitional care model aimed at facilitating post-acute stroke patients' discharge to home. Previous studies have demonstrated that ESD provides equivalent patient and caregiver outcomes with superior cost-effectiveness compared to conventional rehabilitation (CR). This study intends to examine the feasibility of ESD in Korea. Methods and Analysis: This study is designed as a multicenter assessor-blinded, randomized controlled trial. Ninety post-acute stroke patients with mild to moderate disability (modified Rankin Scale 1–3) will be recruited from three university hospitals (30 patients per hospital) in Korea and allocated to either the ESD group or the CR group in a 1:1 ratio. Patients in the ESD group will receive individualized discharge planning and goal setting, a 4-week home-based rehabilitation program, and liaison service to community-based resources by a multidisciplinary team. Patients in the CR group will receive rehabilitation practices according to their current hospital policy. Outcomes: The primary outcome is the Korean version of the modified Barthel Index, and the primary endpoint was post-onset 3 months. Clinical outcomes, patient/caregiver reported outcomes, and socioeconomic outcomes will be measured at baseline, 1 month after discharge, 2 months after discharge, and 3 months after onset. Discussion: The efficacy and cost-effectiveness of ESD can vary according to the healthcare system and sociocultural aspects. To establish ESD as an alternative transitional care model for post-acute stroke patients in Korea, its feasibility needs to be examined in prior. This study will add evidence on the applicability of ESD in Korea. Ethical Considerations: The study protocol was reviewed and approved by the Institutional Review Board of Seoul National University Bundang Hospital (IRB number B-2012/654-308). The study protocol was registered at ClinicalTrials.gov (Identifier NCT04720820). Disseminations will include submission to peer-reviewed journals and presentations at conferences. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to identify social factors predicting improvement of frailty in community‐dwelling older adults after 2 years using a population‐based cohort study. Methods: We analyzed data from the 2016 and 2018 Korean Frailty and Aging Cohort Study. The participants of this study were 1428 community‐dwelling older adults aged 70–84 years who were recruited from 10 medical centers across different regions. Frailty was measured using the five‐item FRAIL scale, which evaluates fatigue, resistance, ambulation, illness and weight loss. Multilevel logistic regression analysis was used to examine baseline social factors that predict frailty improvement after 2 years by frailty status. Results: In frail older adults, higher participation in social activities (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.02–1.34) was significantly associated with frailty improvement. In pre‐frail older adults, there were no significant social factors predicting the improvement of frailty status; however, other modifiable factors such as high and moderate levels of physical activity (OR 1.17, 95% CI 1.07–1.28, OR 1.13, 95% CI 1.03–1.25, respectively) and low depressive symptoms (OR 0.88, 95% CI 0.84–0.91) were associated with pre‐frail improvements. High levels of physical activity (OR 1.16, 95% CI 1.02–1.33) were also associated with improvements of frailty. Conclusions: Different strategies depending on the level of frailty are necessary to improve frailty status. Timely and appropriate interventions can promote frailty improvement and prevent negative health outcomes in community‐dwelling older adults. Geriatr Gerontol Int 2021; 21: 465–471. [ABSTRACT FROM AUTHOR]

Background: We evaluated the validity of the Timed Up and Go test (TUG) to screen for physical frailty and low physical performance in a nationwide community-dwelling Korean older population. Methods: We used baseline records of 3,010 ambulatory participants with TUG data from the Korean Frailty Aging Cohort Study from 2016 to 2017. The population-specific distribution of TUG was assessed. Physical frailty was defined as =3 positive items in the 5-item Cardiovascular Health Study (CHS) frailty scale, and low physical performance was assessed as Short Physical Performance Battery (SPPB) scores =9 (ranging from 0 to 12). Results: In men (n=1,429) and women (n=1,581), the mean TUG times were 10.3±2.7 seconds and 10.2±3.0 seconds, respectively. The cut-off TUG times for the worst quintile were 11.8 seconds in men and 12.5 seconds in women. The TUG time was correlated with both the CHS frailty scale score (standardized beta [B]=0.36, p<0.001) and SPPB total score (B=-0.22, p<0.001) in the linear regression analysis adjusted for age and sex. In the receiver operating characteristic analysis, the performance of TUG in identifying physical frailty, calculated as the area under the curve (AUC), was 0.87, while the AUC of TUG in identifying low physical performance according to SPPB was 0.86. Conclusion: In the Korean older population, TUG can be a simple measure to identify physical frailty and low physical performance so as to identify populations that may benefit from in-depth geriatric assessments. [ABSTRACT FROM AUTHOR]

Previous studies have investigated the predictors for home discharge without considering stroke severity. To develop a practical assessment tool that predicts home discharge for moderate stroke patients after subacute rehabilitation therapy in the tertiary hospitals. Stroke patients with National Institutes of Health Stroke Scale scores of 6 to 13 were included in this prospective cohort study. Various demographic, clinical, and functional factors were analyzed as potential predictive factors. A weighted scoring model was developed through the following three-step process: 1) selection of the factors by logistic regression analyses, 2) development of a weighted scoring model, and 3) validation of the generalizability of the model. The home discharge rate was 51% (n = 372), and the overall mean length of stay of hospitalization was 32.5 days. 1) The Cognitive Functional Independence Measure, 2) the Functional Ambulation Categories, 3) the modified Charlson Comorbidity Index, and 4) marital status were independent predictors of home discharge. The coefficient value for marital status was adjusted to 1 in the scoring system, and the values of the other parameters were proportionally converted to the nearest integer. Possible total scores ranged from 0 to 13 in the model, with a higher score indicating a higher probability of home discharge. With a cutoff point of 7, this model showed 87.0% sensitivity and 86.2% specificity (area under the curve = 0.90). This novel assessment tool can be useful in predicting home discharge after subacute rehabilitation of moderate stroke patients. [ABSTRACT FROM AUTHOR]

To describe the prevalence of sarcopenia in a large group of community-dwelling older adults using the Asian Working Group for Sarcopenia (AWGS) 2019 definition and algorithm. Cross-sectional data analysis of a cohort study. The Nationwide Korean Frailty and Aging Cohort Study (KFACS). A total of 2123 ambulatory community-dwelling older adults, aged 70 to 84 years (mean, 75.9 ± 3.9 years; 49.5% women) were enrolled in the KFACS. Appendicular skeletal muscle mass was measured by dual-energy x-ray absorptiometry. Physical function was assessed by handgrip strength, usual gait speed, the 5-times-sit-to-stand test, the timed up-and-go test, and the Short Physical Performance Battery. In a case-finding assessment, screening for sarcopenia was performed using the calf circumference (CC), SARC-F questionnaire, and SARC-F combined with CC (SARC-CalF). According to the AWGS 2019 algorithm, 43.5%, 7.5%, and 26.0% of the subjects in the whole study sample were classified as those at risk for sarcopenia according to CC, SARC-F, and SARC-CalF, respectively. The prevalence rates of possible sarcopenia using 3 screening tools for case-finding and muscle strength or physical performance tests according to the AWGS 2019 diagnostic algorithm were 20.1% in men and 29.2% in women. The prevalence rates of sarcopenia, when defined as low muscle mass plus low handgrip strength and/or slow gait speed, were significantly higher according to the AWGS 2019 (21.3% in men and 13.8% in women) than the AWGS 2014 (10.3% in men and 8.1% in women) definitions. The prevalence of severe sarcopenia was 6.4% in men and 3.2% in women. The results of our study suggest that the use of CC and SARC-CalF to screen for possible sarcopenia may be more suited than using the SARC-F questionnaire alone according to the AWGS 2019 diagnostic algorithm in community-dwelling adults aged 70 to 84 years. The prevalence of sarcopenia was significantly higher according to the AWGS 2019 than AWGS 2014 criteria. [ABSTRACT FROM AUTHOR]

The design of an external antenna for digital television (TV) has become more challenging because its relatively large size is not conformal to and esthetically preferred for commercial use. This article presents a feasibility study on external transparent antennas for ultrahigh definition (UHD) TV applications in Korea (470–771 MHz). The proposed antennas are patch and dipole types, representing directional and omnidirectional radiation, respectively. Both antennas use a metal mesh film with an optical transparency above 70% and a low sheet resistance of $0.04~\Omega $ /sq. The transparent patch using a capacitive feed has an average efficiency of 83.8% and a peak gain of 6.2 dBi, and the transparent dipole with widen arms has an average efficiency of 72.1% and a peak gain of 2.4 dBi. To emphasize the potential application to UHD TV, the average Rx peak gain of the patch and dipole antennas, which are 4.8 and 2.0 dBi, respectively, in practical conditions are investigated. The measured results of the proposed antennas offer the feasibility of implementing transparent antennas with performances identical to the nontransparent ones and a soft visual impact as an advantage, thus making them become good candidates as external antennas for UHD TV applications. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) is the most common chronic metabolic disorder with an increasing prevalence worldwide. According to a previous study, physicians' treatment patterns or patients' behaviors change when they become aware of the risk for cardiovascular (CV) disease in patients with DM. However, there exist controversial reports from previous studies in the impact of physicians' behaviors on the patients' quality of life (QoL) improvements. So we investigate the changes in QoL according to physicians and patients' behavioral changes after the awareness of CV risks in patients with type 2 DM. Methods: Data were obtained from a prospective, observational study where 799 patients aged =40 years with type 2 DM were recruited at 24 tertiary hospitals in Korea. Changes in physicians' behaviors were defined as changes in the dose/type of antihypertensive, lipid-lowering, and anti-platelet therapies within 6-month after the awareness of CV risks in patients. Changes in patients' behaviors were based on lifestyle modifications. Audit of Diabetes Dependent Quality of Life comprising 19-life-domains was used. Results: The weighted impact score change for local or long-distance journey (P=0.0049), holidays (P=0.0364), and physical health (P=0.0451) domains significantly differed between the two groups; patients whose physician's behaviors changed showed greater improvement than those whose physician's behaviors did not change. Conclusion: This study demonstrates that changes in physicians' behaviors, as a result of perceiving CV risks, improve QoL in some domains of life in DM patients. Physicians should recognize the importance of understanding CV risks and implement appropriate management. [ABSTRACT FROM AUTHOR]

Concludes that while the North Korean press gives more space to stories concerning the unification of the two Koreas than does the South, it is also more hostile and less varied in its coverage of the issue. (FL)

Objectives: Cognitive frailty — the coexistence of physical frailty and cognitive impairment—is a phenotype of frailty in the elderly. The coexistence of physical frailty and cognitive impairment, known as cognitive frailty, is one of the phenotypes of frailty in the elderly. Cognitive frailty predicts adverse health outcome more accurately than does physical frailty. In this study, we aim to determine whether the polypharmacy common among the elderly is linked with cognitive frailty. Design, Setting, and Participants: The elderly, aged between 70 and 84 years, who participated in the cross-sectional Korean Frailty and Aging Cohort Study were included in the present study. Measurements: Polypharmacy and hyperpolypharmacy were defined as the use of at least five and ten medications, respectively. Physical frailty was assessed by the Korean version of the FRAIL scale, and cognitive status was measured by the Trail Making Test part A, word list recall test, the Korean version of the Frontal Assessment Battery, and the Digit Span Backward test. Results: Among the 2,392 participants, 26.8% and 4.1% took more than five and ten prescribed medications, respectively. Polypharmacy and hyperpolypharmacy participants tend to have more cognitive impairment and physical frailty. Participants with cognitive frailty had the highest polypharmacy rate regardless of medication type. After controlling for the potential confounders including severity of comorbidities, frailty was found to be significantly related to polypharmacy, as defined by prescribed as well as total medications, including non-prescribed medications. However, cognitive impairment only showed a linkage to polypharmacy of prescribed medications, which—according to the results of multivariable analysis— could increase cognitive frailty, with an odds ratio of 2.70. Conclusion: Although the elderly tend to depend on various medications, they should seriously consider the risk of polypharmacy for better health outcomes. [ABSTRACT FROM AUTHOR]

This study aimed to clarify the association between calorie intake and cognitive function in community-dwelling older adults. A cross-sectional analysis was performed on the first-year baseline data of 1559 adults aged 70–84 years using population data from the Korean Frailty and Aging Cohort Study. We included 543 participants who participated in nutritional surveys and accurately responded regarding their daily calorie intake. Daily ingestion was measured using the 24-hour dietary recall method, and neuropsychological tests evaluated cognitive characteristics. Logistic regression models were utilized to calculate odds ratios (ORs) with 95% confidence intervals (CIs). The prevalence rate of cognitive impairment was 8%. Subjects with cognitive impairment mainly showed memory loss. After adjusting the confounding factors, participants who had less than the recommended intake were susceptible to cognitive impairment compared to those who that had the proposed intake (adjusted OR: 7.70, 95% CI: 1.01–58.45). We showed that lesser calorie intake than the recommended intake increases the ORs of cognitive impairment. We suggest that an adequate calorie intake protects against cognitive decline, and further studies are essential to investigate the influence of calorie intake reduction on the elderly before widespread application. [ABSTRACT FROM AUTHOR]

Background in October 2018, the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) updated their original definition of sarcopenia to reflect the scientific and clinical evidence that has accumulated over the last decade. Objective to determine the prevalence of sarcopenia in a large group of community-dwelling older adults using the EWGSOP2 definition and algorithm. Design a cross-sectional study. Setting the nationwide Korean Frailty and Aging Cohort Study (KFACS). Subjects a total of 2,099 ambulatory community-dwelling older adults, aged 70–84 years (mean age, 75.9 ± 4.0 years; 49.8% women) who were enrolled in the KFACS. Methods physical function was assessed by handgrip strength, usual gait speed, the five-times-sit-to-stand test, the timed up-and-go test, and the Short Physical Performance Battery. Appendicular skeletal muscle mass (ASM) was measured by dual-energy X-ray absorptiometry. Results according to the criteria of the EWGSOP2, the sarcopenia indicators of combined low muscle strength and low muscle quantity were present in 4.6–14.5% of men and 6.7–14.4% of women. The severe sarcopenia indicators of combined low muscle strength, low muscle quantity and low physical performance were present in 0.3–2.2% of men and 0.2–6.2% of women. Using the clinical algorithm with SARC-F as a screening tool, the prevalence of probable sarcopenia (2.2%), confirmed sarcopenia (1.4%) and severe sarcopenia (0.8%) was low. Conclusions the prevalence of sarcopenia among community-dwelling older individuals varied depending on which components of the revised EWGSOP2 definition were used, such as the tools used to measure muscle strength and the ASM indicators for low muscle mass. [ABSTRACT FROM AUTHOR]

Field collected populations of two mosquito species, Culex pipiens pallens and Aedes albopictus, were tested for susceptibility to five pyrethroid insecticides using a topical application bioassay. The laboratory strain of Cx. pipiens pallens (KS‐CP) demonstrated the most and the lowest susceptibility to deltamethrin and d‐cis/trans prallethrine with LD50 values of 0.00022 μg/♀ and 0.00178 μg/♀, respectively, while Ae. albopictus (KS‐AL) showed the greatest and the lowest susceptibility to phthalethrin and deltamethrin with LD50 values of 0.00015 μg/♀ and 0.00085 μg/♀, respectively. Cx. pipiens pallens (JF‐CP) collected at a nearby rice field in Jeonju showed the greatest susceptibility to deltamethrin (LD50 value of 0.0473 μg/♀) and the resistance ratios (RRs) and compared to the laboratory strain were 215 fold greater. JF‐CP demonstrated the lowest susceptibility to d‐cis/trans phenothrin (0.7697 μg/♀) with RRs 711.0 fold greater than the KS‐CP. An Ae. albopictus (JF‐AL) collected at a nearby forest in Jeonju showed the highest susceptibility to deltamethrin (0.00203 μg/♀) with RRs 2.4 fold greater than the KS‐AL. JF‐AL demonstrated the lowest susceptibility to d‐cis/trans prallethrine (LD50 value 0.00646 μg/♀) with RRs 9.4 fold greater than the KS‐AL. JF‐AL demonstrated the greatest resistance to phthalethrin with RRs 39.3 fold greater than the KS‐AL. Resistance ratios of Cx. pipiens pallens between field and laboratory strains ranged from 215.0 to 711.0 and Ae. albopictus ranged from 2.4 to 39.3. These results indicate that the choice of effective insecticides to selected species of mosquito populations will result in more effective control against field strains of mosquito vectors and decrease environmental pollution. [ABSTRACT FROM AUTHOR]

Pierre Robin sequence (PRS), also called Robin sequence, is a congenital anomaly characterized by a triad of micrognathia, glossoptosis, and upper airway obstruction. Infants with PRS can present with varying degrees of respiratory difficulty secondary to upper airway obstruction. There has been no consensus for the treatment of upper airway obstruction in infants with PRS, but recent studies recommend attempting non-surgical interventions before surgical treatment. In this case report, we present 3 cases of infants diagnosed with PRS who showed persistent respiratory difficulties after birth. Before considering surgical intervention, insertion of a nasopharyngeal airway was attempted in these infants. Following this procedure, symptoms of upper airway obstruction were relieved, and all infants were discharged without surgical interventions; the nasopharyngeal airway was removed 1 to 2 months later. To date, no infant has shown signs of upper airway obstruction. Nasopharyngeal airway insertion is a highly effective and less invasive treatment option for infants with PRS. However, it is not widely known and used in Korea. Nasopharyngeal airway insertion can be preferentially considered before surgical intervention for upper airway obstruction in such infants. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to investigate the prevalence, management, and comorbidities of diabetes among Korean adults aged 30 years and older. Methods: This study used 2013 to 2016 data from the Korea National Health and Nutrition Examination Survey, a nationallyrepresentative survey of the Korean population. Diabetes was defined as fasting glucose =126 mg/dL, current use of antidiabetic medication, a previous history of diabetes, or glycosylated hemoglobin (HbA1c) =6.5%. Results: In 2016, 14.4% (approximately 5.02 million) of Korean adults had diabetes. The prevalence of impaired fasting glucose was 25.3% (8.71 million). From 2013 to 2016, the awareness, control, and treatment rates for diabetes were 62.6%, 56.7%, and 25.1%, respectively. People with diabetes had the following comorbidities: obesity (50.4%), abdominal obesity (47.8%), hypertension (55.3%), and hypercholesterolemia (34.9%). The 25.1%, 68.4%, and 44.2% of people with diabetes achieved HbA1c <6.5%, blood pressure <140/85 mm Hg, and low density lipoprotein cholesterol <100 mg/dL. Only 8.4% of people with diabetes had good control of all three targets. Conclusion: This study confirms that diabetes is as an important public health problem. Efforts should be made to increase awareness, detection, and comprehensive management of diabetes to reduce diabetes-related morbidity and mortality. [ABSTRACT FROM AUTHOR]

Objectives: This study was conducted to find an optimal questionnaire to evaluate the slow gait speed seen in community dwelling elderly. Design: Four questions asking about difficulty in walking were compared against the measured usual gait speed. The questions were: 1) Is it difficult to walk 100 m without help? 2) Is it difficult to walk 300 m without help? 3) Is it difficult to walk around one lap of a 400-meter track without help? 4) Can you cross a crosswalk before the green on the crosswalk light turns red? Participants: The subjects were 1479 older adults aged 70 to 84 years who had responded to the four questions and completed gait speed measuring in the first baseline year (2016) of the Korean Frailty and Aging Cohort Study. Results: Of the four questions, "Is it difficult to walk around one lap of track (400 m) without help?" showed the highest kappa coefficient (0.357), sensitivity (0.61), and negative predictive value (0.82). Conclusion: Based on the results of this study, the authors suggest that "Difficulty in walking around one lap of a 400-m track without help" may be the best question to use when evaluating slow gait speed. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine how sodium intake can affect frailty, but not anorexia, in community-dwelling older adults in Korea. Design: This was a cross-sectional study. Setting: The study used data from the Korean Frailty and Aging Cohort Survey (KFACS), a multi-center longitudinal study addressing 10 centers across urban, rural, and suburban communities in Korea, between 2016 and 2017. Participants: A total of 954 older adults who underwent both 24-hour dietary recall assessment and physical function test during the first-year baseline investigation of the KFACS. Measurements: Frailty was determined according to the Fried frailty index (FFI). Results: Of the 954 participants, 461 (48.3%) were male and the mean age was 76.3 years old. The average daily sodium intake was 3857 mg. The frailty prevalence in first to third quartiles was 21.8%, 7.5%, and 5.4%, respectively, and increased in the fourth quartile of sodium intake to 8.9%. Using the second quartile of sodium intake (2504–3575 mg) as reference, the odds ratios of frailty were 1.64 (95% confidence interval: 0.84–3.22), 1.33 (0.57–3.06), and 4.00 (1.72–9.27) for the first (<2504 mg), third (3575–4873 mg), and fourth (≥4873 mg) quartiles, respectively, in a multivariate-adjusted analysis. Conclusion: Low sodium intake (<2504 mg) is related to frailty in older people, but it seems to be a less important factor than other nutritional factors. The prevalence of frailty did not increase up to a daily sodium intake of 3575 mg, but it increased upon a daily sodium intake higher than 3575 mg. [ABSTRACT FROM AUTHOR]

Highlights • The manual timer systematically underestimated usual gait speed in community settings. • The static start protocol showed a higher prevalence of slowness than the dynamic start protocol. • The automatic timer may be useful for measuring gait speed in healthy older adults. Abstract Aim This study aimed to compare 4-m usual gait speed obtained with different protocols and to determine the prevalence of slowness using different diagnostic criteria in a large cohort of community-dwelling older adults. Methods A total of 1177 non-disabled community-dwelling older adults aged 70–84 years were assessed for 4-m usual gait speed using four different testing protocols: (1) automatic timer (ultrasonic sensor), dynamic start; (2) manual timer (stopwatch), dynamic start; (3) automatic timer, static start; and (4) manual timer, static start. To assess agreement between usual gait speed and the testing protocols, linear regression and Bland-Altman analyses were performed. Results There was systematic bias (i.e., difference between automatic timer and manual timer methods), with underestimation of usual gait speed (bias 0.0695 m/s for dynamic start; bias 0.0702 m/s for static start) by the manual timer. There was systematic bias in start conditions, with underestimation of usual gait speed with a static start using both timer methods, compared with that in dynamic start assessment (P < 0.001). The prevalence of slowness ranged from 2.3 to 4.7% in men and 5.9–11.1% in women for <0.80 m/s, and from 17.1 to 30.5% in men and 26.3–45.9% in women for <1.00 m/s. Conclusions The findings of this study indicated that 4-m usual gait speed measured under different testing protocols was able to determine different prevalence rates of slowness among non-disabled community-dwelling older adults. An automatic timer may be useful for measuring gait speed changes in individuals likely to have faster gait speed in community-based research settings. [ABSTRACT FROM AUTHOR]

Objectives: To test whether sleep disturbances are associated with frailty in older men and women.Design: Cross-sectional analysis of cohort study data. The participants were 1168 community-dwelling older adults aged 70 to 84 years who took part in the Korean Frailty and Aging Cohort Study and completed both self-reported sleep parameters and assessment of frailty. Univariate and multivariate survey logistic regression models were used to calculate odds ratios (OR) with 95% confidence intervals (CI) for frailty. Frailty was defined using the Fried's criteria.Results: Frailty was associated with sleep latency in men. The odds ratio for this association was 3.39 (95% CI 1.31-8.76) after adjusting for age, body mass index (BMI), physical activity, and select comorbidities, and 2.16 (95% CI 0.75-6.23) after further adjusting for depression. Frailty was associated with long sleep duration of more than 8 hours a night in women. The odds ratio for this association was 3.95 (95% CI, 1.27-12.33) after adjusting for age, BMI, physical activity, select comorbidities, and the number of medications.Conclusion: Prolonged sleep latency (≥60 minutes) in men and long sleep duration (>8hr per night) in women were each independently associated with higher odds of frailty. Long sleep latency in elderly men and long sleep duration in elderly women may suggest they have a high chance of frailty. [ABSTRACT FROM AUTHOR]

Sarcopenia, a common clinical syndrome in older adults, is defined as decreased muscle mass, strength, and physical performance. Since sarcopenia is associated with the incidence of functional decline, falls, and even mortality in older adults, researchers and health care providers have been keen to accumulate clinical evidence to advocate the screening and prevention of sarcopenia progression in older adults. The factors that may accelerate the loss of muscle mass and function include chronic diseases, inactivity, and deficiency in appropriate nutritional support. Among these, nutritional support is considered an initial step to delay the progression of muscle wasting and improve physical performance in community-dwelling older adults. However, a nationwide study suggested that most Korean older adults do not consume sufficient dietary protein to maintain their muscle mass. Furthermore, considering age-associated anabolic resistance to dietary protein, higher protein intake should be emphasized in older adults than in younger people. To develop a dietary protein recommendation for older adults in Korea, we reviewed the relevant literature, including interventional studies from Korea. From these, we recommend that older adults consume at least 1.2 g of protein per kg of body weight per day (g/ kg/day) to delay the progression of muscle wasting. The amount we recommend (1.2 g/ kg/day) is 31.4% higher than the previously suggested recommended daily allowance (i.e., 0.91 g/kg/day) for the general population of Korea. Also, evidence to date suggests that the combination of exercise and nutritional support may enhance the beneficial effects of protein intake in older adults in Korea. We found that the current studies are insufficient to build population-based guidelines for older adults, and we call for further researches in Korea. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to examine the correlation between the number of remaining natural teeth (NRT) and the appendicular skeletal muscle mass index (SMI) in older adults. Methods: This study was based on data from the 2008-2010 Korea National Health and Nutritional Examination Surveys. The participants were 2,378 older participants (984 men and 1,394 women) aged over 65 years. Survey dentists conducted oral health examinations, and ASM was measured using dual-energy X-ray absorptiometry. Results: The participants with NRT≥20 had more ASM and SMI than those with NRT<20 in both sexes. SMI was correlated with NRT in men (r=0.018, p<0.001) and in women (r=- 0.007, p<0.001). The positive correlation between the NRT and SMI remained significant in men even after adjusting for age, marital status, income, smoking, drinking, physical activity, protein intake, energy intake, calcium intake, body mass index, fasting blood glucose level, medications, and prostheses (β=0.011, p=0.001). In women, the correlation disappeared after adjustment for smoking, alcohol, physical activity, protein intake, energy intake, calcium intake, marital status, income, fasting basal glucose, medication administration, and prostheses. Conclusion: This study showed a correlation between NRT and SMI in those ≥65 years of age in Korea. The relationship persisted in men, but not in women, even after adjusting for confounders. [ABSTRACT FROM AUTHOR]

Objectives: This study was conducted to determine the cutoff value and efficacy of the EuroQol Visual Analogue Scale (EQ-VAS) for predicting frailty.Design: The EQ-VAS medians (Interquartile Range) were compared and analyzed against the FFI.Participants: The subjects were 1471 older adults aged 70 to 84 years who had completed both EQ-VAS and Fried Frailty index (FFI) in the first baseline year (2016) of the Korean Frailty and Aging Cohort Study.Results: Of the 1471 subjects,600 were classified as robust, 716 as pre-frail, and 155 as frail. The median EQ-VAS scores were 80.00 (20.00) for robust, 75.00 (25.00) for pre-frail, and 60.00 (25.00) for frail subjects.The medians of all five components of the FFI, weight loss (70.00 vs. 80.00), grip strength (70.00 vs. 80.00), exhaustion (70.00 vs. 80.00), walking velocity (70.00 vs. 80.00), and physical activity (70.00 vs. 80.00), were lower in the abnormal groups. We tested the efficacy of EQ-VAS as a diagnostic tool to predict frailty, and the area under the curve of EQ-VAS was 0.71 withthe optimal cut-off value of 72.Conclusion: EQ-VAS presented negative correlation with FFI, and the optimal cut off value for frailty was 72. These results suggest that EQ-VAS is a valuable tool for assessing frailty andmay be a good predictor of frailty in Korean elderly population. [ABSTRACT FROM AUTHOR]

ABSTRACT Kim, Y.H.; Sugarman, D.E.; Kim, H.C.; Son, S.; Ha, H.K.; Chang, W.K.; Han, K.W., and Ryu, J., 2018. Implementation of a Numerical Model of Metals for Total Maximum Daily Loads (TMDLs) in Onsan Harbor, Korea. In: Shim, J.-S.; Chun, I., and Lim, H.S. (eds.), Proceedings from the International Coastal Symposium (ICS) 2018 (Busan, Republic of Korea). Journal of Coastal Research, Special Issue No. 85, pp. 1506–1510. Coconut Creek (Florida), ISSN 0749-0208. Accumulation of heavy metals has been one of fundamental environmental concerns for many coastal and estuarine systems, which can be directly influenced by contaminants loading from land. Onsan Harbor, Korea, surrounded by Onsan National Industrial Complex, shows high concentration of heavy metals in the seabed sediments. In order to establish proper environmental management plan for Onsan Harbor, the implementation of a Total Maximum Daily Loads (TMDL) was proposed. As a part of TMDL for metals, numerical model has been developed to evaluate metal fluxes into the Onsan harbor. A bathtub model for four different metals, including Copper, Zinc, Lead, and Mercury, was implemented in Onsan harbor. To supply data for boundary conditions and model calibration, extensive monitoring programs were conducted in the study area for past three years, between 2014 and 2016. The data from the monitoring programs includes freshwater discharge rate, load of metals from streams and tributaries, concentration of dissolved and particulate metals in water and sediments, sedimentation rates, and current velocities. The model was calibrated and validated with these monitoring data and other public data sets, and the results confirm high performance of the metal TMDL model in Onsan Harbor system. To evaluate numeric targets of the TMDL for metals, more than 100 scenarios were simulated with the well-calibrated model. The results show that (1) after the reduction of 10% loading from the present level, the copper concentration in sediments will be lower than Probable Effects Level (PEL) within 12 years, and (2) after the reduction of 10% zinc loading, the zinc concentration in sediments will be lower than PEL in 17 years. [ABSTRACT FROM AUTHOR]

ABSTRACT Kim, H.-C.; Song, Y.-S.; Kim, Y.H.; Son, S.; Cho, J.-G.; Chang, W.K.; Lee, C.-H.; Nam, J., and Ryu, J., 2018. Implications of esuarine and coastal management in the growth of Porphyra sp. in the Geum River Estuary, South Korea: A modeling study. In: Shim, J.-S.; Chun, I., and Lim, H.S. (eds.), Proceedings from the International Coastal Symposium (ICS) 2018 (Busan, Republic of Korea). Journal of Coastal Research, Special Issue No. 85, pp. 396–400. Coconut Creek (Florida), ISSN 0749-0208. Laver (Porphyra sp.) is one of macroalgae species that has been cultivated for the purpose of food consumption in the coastal areas of Korean Peninsula. In specific, Porphyra tenera Kjellman and Porphyra yezonensis Ueda are two major commercial species for aquaculture in the west coast of Korea. In this study authors employed an ecosystem modeling approach (Hadley et al., 2014) to simulate the nutrient physiology and growth of the laver in aquaculture facilities located in the vicinities of Geum River Estuary. Some of model coefficients and parameterizations were modified from the original version based on laboratory experiments, if necessary. In addition, authors calibrated and validated the Delft3D (https://oss.deltares.nl/web/delft3d) with long-term time series data from the area. The Delft3D is an open source modeling suite that can simulate hydrodynamics (temperature, salinity, flow fields), sediment transport and water quality variables (inorganic nutrients). As one of the end-point goals of the present study is to develop decision supporting tools that can be used by coastal managers, the macroalgae growth model was coupled with the Delft3D in order to predict effects of episodic climatic events and/or upstream water management decisions on the estuarine ecosystem. Temperature, salinity and nitrogen loadings estimated from the Delft3D were used as input to the ecosystem model, and subsequent responses from Porphyra sp. were numerically simulated. Given thirteen scenario-based simulations, it is found that model simulated dissolved inorganic nitrogen concentrations do not change significantly for the same climatic condition. However, the maximum potential annual production of macroalgae is found to be more dependent on ammonium ion concentration. [ABSTRACT FROM AUTHOR]

Discrepant incidence has been reported regarding the incidence of herb-induced liver injury (HILI). To address the growing worldwide concern of HILI, we evaluated the risk of HILI in a nationwide prospective study. Between April 2013 and January 2016, 1001 inpatients (360 males and 641 females) from 10 tertiary hospitals throughout South Korea were treated with herbal drugs and had their liver enzymes periodically measured. A total of six patients met the criteria for HILI with RUCAM scores ranging from 4 to 7. All these participants were women and developed the hepatocellular type of HILI. One HILI participant met the criteria for Hy's law; however, none of six cases presented clinical symptoms related to liver injury. This is the first nationwide prospective study that estimated the extent of the incidence of HILI [total: 0.60%, 95% confidence interval (CI) 0.12-1.08; women: 0.95%, 95% CI 0.19-1.68] and described its features in hospitalized participants. [ABSTRACT FROM AUTHOR]

Objective: To compare non-invasive ventilation neurally adjusted ventilatory assist (NIV-NAVA) and non-invasive pressure support (NIV-PS) in preterm infants on patient-ventilator synchrony.Design: A randomised phase II crossover trial.Setting: Neonatal intensive care units of two tertiary university hospitals in Korea.Patients: Preterm infants born <32 weeks.Intervention: NIV-NAVA and NIV-PS were applied in random order after ventilator weaning. Data were recorded for sequential 5 min periods after 10 min applications of each mode.Main Outcome Measures: The electrical activity of the diaphragm (Edi), ventilator flow and pressure curves were compared to examine the trigger delay (primary outcome) and other parameters of patient-ventilator interaction (secondary outcomes) for each period.Results: Fifteen infants completed the protocol. Trigger delay (35.2±8.3 vs 294.6±101.9 ms, p<0.001), ventilator inspiratory time (423.3±87.1 vs 534.0±165.5 ms, p=0.009) and inspiratory time in excess (32.3±8.3% vs 294.6±101.9%, p=0.001) were lower during NIV-NAVA compared with NIV-PS. Maximum Edi (12.6±6.3 vs 16.6±8.7 μV, p=0.003), swing Edi (8.8±4.8 vs 12.2±8.7 μV, p=0.012) and peak inspiratory pressure (12.3±1.5 vs 14.7±2.7 cm H2O, p=0.003) were also lower during NIV-NAVA. The main asynchrony events during NIV-PS were ineffective efforts and autotriggering. All types of asynchronies except double triggering were reduced with NIV-NAVA. Asynchrony index was significantly lower during NIV-NAVA compared with NIV-PS (p<0.001). No significant differences in leakage, expiratory tidal volume or minute ventilation were observed, but the respiratory rate was lower during NIV-PS than during NIV-NAVA.Conclusions: NAVA improved patient-ventilator synchrony and diaphragmatic unloading in preterm infants during non-invasive nasal ventilation even in the presence of large air leaks.Trial Registration Number: Registered with http://www.clinicaltrials.gov (NCT01877720). [ABSTRACT FROM AUTHOR]