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Abstract Background Owing to the rapid growth in the popularity of Large Language Models (LLMs), various performance evaluation studies have been conducted to confirm their applicability in the medical field. However, there is still no clear framework for evaluating LLMs. Objective This study reviews studies on LLM evaluations in the medical field and analyzes the research methods used in these studies. It aims to provide a reference for future researchers designing LLM studies. Methods & materials We conducted a scoping review of three databases (PubMed, Embase, and MEDLINE) to identify LLM-related articles published between January 1, 2023, and September 30, 2023. We analyzed the types of methods, number of questions (queries), evaluators, repeat measurements, additional analysis methods, use of prompt engineering, and metrics other than accuracy. Results A total of 142 articles met the inclusion criteria. LLM evaluation was primarily categorized as either providing test examinations (n = 53, 37.3%) or being evaluated by a medical professional (n = 80, 56.3%), with some hybrid cases (n = 5, 3.5%) or a combination of the two (n = 4, 2.8%). Most studies had 100 or fewer questions (n = 18, 29.0%), 15 (24.2%) performed repeated measurements, 18 (29.0%) performed additional analyses, and 8 (12.9%) used prompt engineering. For medical assessment, most studies used 50 or fewer queries (n = 54, 64.3%), had two evaluators (n = 43, 48.3%), and 14 (14.7%) used prompt engineering. Conclusions More research is required regarding the application of LLMs in healthcare. Although previous studies have evaluated performance, future studies will likely focus on improving performance. A well-structured methodology is required for these studies to be conducted systematically.

Abstract Obesity in adolescents is a global health concern associated with several diseases and complications in adulthood. Obesity has been reported to be strongly associated with oral habits. To investigate the association between tooth brushing during lunchtime and the prevalence of obesity among adolescents in a nationally representative sample of South Korean adolescents. Data from the 2018–2021 Korea Youth Risk Behavior Web-Based Survey were used in this cross-sectional study. Obesity was measured based on the body mass index. The chi-square test was used to investigate and compare tooth brushing habits during lunchtime in the study population, and multivariate logistic regression analysis was performed to analyze the relationship between tooth brushing during lunchtime and the prevalence of obesity. The odds of obesity were lower in the group that brushed their teeth during lunchtime (adjusted odd ratio: 0.90, 95% confidence interval: 0.88–0.93). Furthermore, the odds of obesity were significantly higher in high school students; boys; those with a low household income, low subjective health status awareness, medical history (asthma or atrophy), and history of sealant use; and those who responded after the coronavirus disease 2019 pandemic. A significant inverse relationship was found between tooth brushing habits during lunchtime and the prevalence of obesity. This relationship was consistent regardless of socioeconomic and lifestyle factors.

Abstract Background Recent studies have attempted to analyze the changes in self-rated health (SRH) during the coronavirus disease 2019 (COVID-19) pandemic. However, the results have been inconsistent. Notably, SRH is subjective, and responses may vary across and within countries because of sociocultural differences. Thus, we aimed to examine whether the interaction effects between the COVID-19 pandemic and regional deprivation influenced SRH in South Korea. Methods The study population comprised 877,778 participants from the Korea Community Health Survey. The data were collected from 2018 to 2021. Multiple regression analysis was employed to determine the relationship between SRH and the interaction between the COVID-19 pandemic status and the socioeconomic level of residential areas. Results The post-pandemic groups (odds ratio [OR] = 2.25, P

Abstract Background Digital therapeutics (DTx) is a treatment option that uses computer software to provide evidence-based interventions for medical disorders. DTx platforms are digital services that facilitate interactions among stakeholders of DTx treatment within a standardized structure. However, there is still a lack of overall awareness regarding the effectiveness and usage of DTx and DTx platforms. This study aimed to investigate insomnia patients’ recognition, thoughts, feelings, and demands for conventional treatments versus DTx for insomnia. Methods Nine participants, aged 19–50 years, who had experience with professional medical interventions for insomnia, were recruited through purposive sampling. Two online focus group interviews, each lasting 1.5 h, were conducted. The interview questions focused on difficulties encountered during conventional treatment, inadequate recognition of DTx, and concerns and demands regarding DTx and its platform. The data were analyzed using thematic analysis. Results The participants reported subjective difficulties associated with receiving conventional treatment, including concerns about drug side effects and dependence, social stigma, and lack of perceived necessity for treatment. They expressed concerns about DTx, such as cost-effectiveness, evidence on efficacy, and concerns about breach of personal information. Additionally, their demands included convenience of use, reduction in social stigma related to the use of DTx, compatibility of DTx with other healthcare systems, and enhanced communication with healthcare providers when using DTx platforms. Conclusions The focus group highlighted the need for increased awareness, demonstrated efficacy, cost-effectiveness, cybersecurity measures, and accessibility of insomnia DTx and its platforms. Tailored approaches considering patient characteristics are crucial for widespread adoption of insomnia DTx and its platforms.

ObjectiveTo investigate the association among smoking cessation, weight or waist circumference change post-cessation, and cardiovascular disease (CVD) or all-cause death among patients with type 2 Diabetes (T2D).Materials and methodsThis retrospective cohort study included 32,142 patients with T2D classified according to changes in smoking status, post-cessation weight, and waist circumference. Especially for recent or long-term quitters, participants who changed from current to none/former smoker or from non-smoker to former smoker were defined as recent quitters, and those who changed from former to none/former smoker were defined as long-term quitters. CVD or all-cause death risk was evaluated.ResultsA total of 5,845 participants were newly diagnosed with CVD, and 3,723 died during follow-up. After adjusting for potential confounding factors, compared with current smokers, the hazard ratios (HRs) for CVD were 0.94 (95% confidence interval [CI]: 0.85–1.03), 0.82 (95% CI: 0.74–0.90), and 0.82 (95% CI: 0.75–0.90) for recent quitters, long-term quitters, non-smokers, respectively; 0.88 (95% CI: 0.78–0.99), 0.68 (95% CI: 0.57–0.81), and 0.82 (95% CI: 0.67–1.00) for long-term quitters with no waist circumference gain, long-term quitters with waist circumference gain of 0.1–5.0 cm, and long-term quitters with waist circumference gain ≥5.0 cm, respectively; and 0.79 (95% CI: 0.71–0.89), 0.85 (95% CI: 0.74–0.98), and 0.84 (95% CI: 0.60–1.17) for long-term quitters with no weight gain, long-term quitters with weight gain of 2–5 kg, and long-term quitters with weight gain ≥5 kg, respectively. Similar associations were observed for all-cause death.ConclusionsPatients with T2D should maintain their weight and waist circumference after long-term smoking cessation to prevent CVD. It is more important for them to maintain weight rather than waist circumference to prevent all-cause death.

Abstract Background Eating habits formed during adolescence greatly influence the maintenance of health in adulthood. With the recent development of social media and easy access to the Internet, adolescents watch plenty of food videos, particularly Mukbang and Cookbnag(eating show)content. This media genre’s impact on food choices has been covered in several studies; however, studies on unhealthy eating habits directly related to adolescents’ exposure to eating shows are insufficient. Methods For this study, we used data from the 18th Korea Youth Risk Behavior Survey conducted in 2022 and finalized 50,451 participants. The extent of exposure to eating show media over the course of a week, as well as the consumption of fast food, sugar-sweetened beverages (SSBs), and high caffeinated beverages within that week were measured through self-reporting questionnaires. We classified the participants into two groups based on their frequency of watching eating shows. A multiple logistic regression analysis was performed to investigate the association between eating show and unhealthy food consumption. Results For both males and females, eating show exposure was strongly associated with the consumption of fast food (male: OR:1.37, 95% CI:1.26–1.49; female: OR:1.46, 95% CI:1.36–1.57), SSB (male: OR:1.42, 95% CI:1.26–1.60; female: OR:1.51, 95% CI:1.35–1.70), and high caffeinated beverage (male: OR:1.30, 95% CI:1.23–1.37; female: OR:1.24, 95% CI:1.18–1.31). It was observed that both sexes were more likely to frequently eat unhealthy food than students who did not watch eating shows. Conclusion Among Korean adolescents, students exposed to eating shows, which primarily aim to entertain, were more likely to consume fast food, SSBs, and high caffeinated beverages. Therefore, this study's findings suggest that eating show could influence adolescents' food choices, highlighting the need for interest in emerging cultures and corresponding health policies.

Various X-ray techniques are employed to investigate specimens in diverse fields. Generally, scattering and absorption/emission processes occur due to the interaction of X-rays with matter. The output signals from these processes contain structural information and the electronic structure of specimens, respectively. The combination of complementary X-ray techniques improves the understanding of complex systems holistically. In this context, we introduce a multiplex imaging instrument that can collect small-/wide-angle X-ray diffraction and X-ray emission spectra simultaneously to investigate morphological information with nanoscale resolution, crystal arrangement at the atomic scale and the electronic structure of specimens.

Abstract Background In response to the rapid aging population and increasing number of cancer patients, discussions on dignified end-of-life (EoL) decisions are active around the world. Therefore, this study aimed to identify the differences in EoL care patterns between types of hospice used for cancer patients. Methods In this population-based cohort study, the Korean National Health Insurance Service cohort data containing all registered cancer patients who died between 2017 and 2021 were used. A total of 408,964 individuals were eligible for analysis. The variable of interest, the type of hospice used in the 6 months before death, was classified as follows: (1) Non-hospice users; (2) Hospital-based hospice single users; (3) Home-based hospice single users; (4) Combined hospice users. The outcomes were set as patterns of care, including intense care and supportive care. To identify differences in care patterns between hospice types, a generalized linear model with zero-inflated negative binomial distribution was applied. Results Hospice enrollment was associated with less intense care and more supportive care near death. Notably, those who used combined hospice care had the lowest probability and frequency of receiving intense care (aOR: 0.18, 95% CI: 0.17–0.19, aRR: 0.47, 95% CI: 0.44–0.49), while home-based hospice single users had the highest probability and frequency of receiving supportive care (Prescription for narcotic analgesics, aOR: 2.95, 95% CI: 2.69–3.23, aRR: 1.45, 95% CI: 1.41–1.49; Mental health care, aOR: 3.40, 95% CI: 3.13–3.69, aRR: 1.35, 95% CI: 1.31–1.39). Conclusion Our findings suggest that although intense care for life-sustaining decreases with hospice enrollment, QoL at the EoL actually improves with appropriate supportive care. This study is meaningful in that it not only offers valuable insight into hospice care for terminally ill patients, but also provides policy implications for the introduction of patient-centered community-based hospice services.

Abstract Background Unmet health needs are particularly important to people with disabilities; however, these unmet needs owing to limitations in daily life have been under-researched thus far. This study examined the effects of disability-related limitations in daily life on unmet needs. Methods This study included 5,074 adults with disabilities from the 2018–2020 Korea Disability and Life Dynamics Panel. We analyzed the effects of disability-related limitations in daily life on unmet needs using logistic regression with a generalized estimating equation model. Results Overall, 4.8% men and 4.6% women with disabilities had unmet needs. For men, unmet needs were 1.46 times (95% confidence interval [CI] 1.09–1.96) higher for those with moderate limitations in daily life. For women, unmet needs were 1.79 times (95% CI 1.22–2.39) higher when there were moderate limitations in daily life. The prominent factors causing this effect were physical or brain lesion disability for men and internal or facial disability and burden of medical expenses for women. Conclusions Limitations in daily life due to disability increase the risk of having unmet needs, an effect that is significantly more pronounced in men. These unmet needs differ depending on an individual’s sex, disability type, limited body parts, and other specific causes. Efforts are required to reduce the unmet needs of people with disabilities by considering the type of disability, impaired body parts, and causes of unmet needs in daily life.

Abstract Background Smoking is a major risk factor that significantly affects public health. Although the South Korean government spends significant money on smoking cessation services, the smoking rate remains stagnant. Families influence health-conscious decisions, and family meals can positively affect smoking suppression and health behaviors. Therefore, this study investigated whether family meals are correlated with adults’ smoking behaviors. Methods This study used data from the 2019–2021 Korean National Health and Nutrition Examination Survey. Having a meal together with family was defined as “yes” for those who have at least one meal with their family each day and “no” for those who do not. Current smoking status was classified as having smoked at least 5 packs of cigarettes (100 cigarettes) in one’s lifetime and having used either conventional cigarettes or e-cigarettes in the last 30 days. Multiple logistic regression analyses were used to examine the association between eating together, smoking, and weight application. Results When comparing the group that ate with their family compared to the group that did not, the odds ratio for current smoking status was 1.27 (95% confidence interval [CI]: 1.05–1.54) for male participants and 1.90 (95% CI: 1.33–2.71) for female participants. This showed a dose-dependent effect according to the frequency of family meals. Those who smoked conventional cigarettes had a strong association (men: OR 1.28, 95% CI 1.00–1.67; women: OR 2.22, 95% CI 1.42–3.46). However, those who only vaped e-cigarettes or used both conventional cigarettes and e-cigarettes had no statistically significant correlations. Conclusion This study provides evidence suggesting that eating meals as a family is related to smoking behavior and can positively affect smoking cessation intentions in adults. Consequently, a smoking cessation program can be developed that uses social support, such as encouraging family meals.

Photoinduced nonequilibrium phase transitions have stimulated interest in the dynamic interactions between electrons and crystalline ions, which have long been overlooked within the Born–Oppenheimer approximation. Ultrafast melting before lattice thermalization prompted researchers to revisit this issue to understand ultrafast photoinduced weakening of the crystal bonding. However, the absence of direct evidence demonstrating the role of orbital dynamics in lattice disorder leaves it elusive. By performing time-resolved resonant X-ray scattering with an X-ray free-electron laser, we directly monitored the ultrafast dynamics of bonding orbitals of Ge to drive photoinduced melting. Increased photoexcitation of bonding electrons amplifies the orbital disturbance to expedite the lattice disorder approaching the sub-picosecond scale of the nonthermal regime. The lattice disorder time shows strong nonlinear dependence on the laser fluence with a crossover behavior from thermal-driven to nonthermal-dominant kinetics, which is also verified by ab initio and two-temperature molecular dynamics simulations. This study elucidates the impact of bonding orbitals on lattice stability with a unifying interpretation on photoinduced melting.

Background: The coronavirus disease 2019 (COVID-19) pandemic has been one of the most serious global threats to public health recently. The present study examined whether area deprivation is associated with concerns related to COVID-19 using large nationwide data across South Korea. Methods: We used nationwide 2020 Korea Community Health Survey and official government database. Of the 225,680 included participants, 123,324 (54.6%) were women, and the mean age was 54.9 [17.8] years old. We classified the Area deprivation index (ADI) into Quartile 1 (Least deprived); Quartile 2; Quartile 3; and Quartile 4 (Most deprived). Our primary outcome was the concerns related to COVID-19 (0–16 scores). Multilevel regression analysis was conducted. Results: The mean score of concerns related to COVID-19 was 11.3 [3.2] in the total population. 13.5% of the variability in the scores of concerns related to COVID-19 was accounted for by district areas. Area with Q4 of ADI were associated with an increased score of concerns related to COVID-19 (Q1: reference; Q2: β = 0.218, SE = 0.119, FDR adj.p-value = 0.085; Q3: β = 0.235, SE = 0.133, FDR adj.p-value = 0.094; Q4: β = 0.252, SE = 0.109, FDR adj.p-value = 0.029). 19–49 groups in area with Q4 of ADI were associated with an increase in scores of concerns related to COVID-19 than other age groups in area with Q4 of ADI. Area with Q4 of ADI were associated with a score of concern of being criticized if getting infected compared to area with Q1 of ADI. Conclusion: We found that the highest quartile ADI was associated with greater concerns related to COVID-19. By identifying vulnerable population to concerns related to COVID-19, health systems may consider preventive intervention to mitigate mental health issues.

Summary: Background: Owing to the aging population, the prevalence of dementia is increasing worldwide and has become an important public health problem. In 2018, Korea implemented the National Dementia Care Policy to strengthen the management of dementia and reduce its related burden on medical expenses. This study investigated the effect this policy on total and out-of-pocket costs in elderly patients with dementia. Methods: Data were from the National Health Insurance System. The study population included 10,549,863 individuals aged 65 years or older, recorded between January 1, 2015, and December 31, 2020. The treatment group comprised of dementia patients and the control group those diagnosed with the five most common diseases found in individuals aged 65 years or above. The difference-in-difference was used to explore changes in total and out-of-pocket healthcare costs per diagnosed case between the treatment and control group before and after the intervention period. Findings: Policy implementation was associated with a significant decrease in patient out-of-pocket cost. In the covariate-controlled model, no statistically significant changes were found for total mean healthcare cost. However, patient out-of-pocket cost decreased by 0.05 per diagnosed case. Interpretation: The National Dementia Care Policy led to a reduction in patient out-of-pocket cost in elderly patients with dementia. National policies need to be monitored to reduce the economic burden of patients with dementia while maintaining the financial sustainability of the healthcare system. Funding: This research was financially supported by the Ministry of Trade, Industry and Energy (MOTIE) and Korea Planning & Evaluation Institute of Industrial Technology (Project No. 20024263).

BackgroundUser engagement is crucial for digital therapeutics (DTx) effectiveness; due to variations in the conceptualization of engagement and intervention design, assessment and retention of engagement remain challenging. ObjectiveWe investigated the influence of the perceived acceptability of experimental intervention components and satisfaction with core intervention components in DTx on user engagement, while also identifying potential barriers and facilitators to user engagement. MethodsWe conducted a mixed methods study with a 2 × 2 factorial design, involving 12 outpatients with atopic dermatitis. Participants were randomized into 4 experimental groups based on push notification (“basic” or “advanced”) and human coach (“on” or “off”) experimental intervention components. All participants engaged in self-monitoring and learning courses as core intervention components within an app-based intervention over 8 weeks. Data were collected through in-app behavioral data, physician- and self-reported questionnaires, and semistructured interviews assessed at baseline, 4 weeks, and 8 weeks. Descriptive statistics and thematic analysis were used to evaluate user engagement, perceived acceptability of experimental intervention components (ie, push notification and human coach), satisfaction with core intervention components (ie, self-monitoring and learning courses), and intervention effectiveness through clinical outcomes. ResultsThe primary outcome indicated that group 4, provided with “advanced-level push notifications” and a “human coach,” showed higher completion rates for self-monitoring forms and learning courses compared to the predetermined threshold of clinical significance. Qualitative data analysis revealed three key themes: (1) perceived acceptability of the experimental intervention components, (2) satisfaction with the core intervention components, and (3) suggestions for improvement in the overall intervention program. Regarding clinical outcomes, the Perceived Stress Scale and Dermatology Life Quality Index scores presented the highest improvement in group 4. ConclusionsThese findings will help refine the intervention and inform the design of a subsequent randomized trial to test its effectiveness. Furthermore, this design may serve as a model for broadly examining and optimizing overall engagement in DTx and for future investigation into the complex relationship between engagement and clinical outcomes. Trial RegistrationClinical Research Information Service KCT0007675; http://tinyurl.com/2m8rjrmv

Abstract Background We aimed to demonstrate the associations between social interactions within social distancing norms during the coronavirus disease 2019 (COVID-19) pandemic and cognitive function among South Korean older adults. Methods Data from the 2017 and 2020 Survey of Living Conditions and Welfare Needs of Korean Older Persons were used. There were 18,813 participants (7,539 males; 11,274 females). T-test and multiple logistic regression analyses verified whether the mean difference in older adults’ cognitive function before and during the COVID-19 pandemic was statistically significant. We also examined the associations between social interactions and cognitive function. The key results were presented as odds ratios (ORs) and 95% confidence intervals (CI). Results All participants were more likely to experience cognitive impairment during the COVID-19 pandemic than before (males: OR 1.56, 95% CI 1.3–1.78; females: OR 1.26, 95% CI: 1.14–1.40). Cognitive impairment increased linearly with the decreased frequency of face-to-face contact with non-cohabiting children. Possible cognitive impairment was greater for females who had not visited senior welfare centers for the past year (OR 1.43, 95% CI 1.21–1.69). Conclusion Korean older adults’ cognitive function declined during the COVID-19 pandemic and was associated with reduced social interactions because of social distancing measures. Alternative interventions should be promoted for safely restoring social networks, considering the adverse effects of long-term social distancing on older adults’ mental health and cognitive function.

Abstract Smoking is a risk factor for respiratory diseases, and it worsens sleep quality due to nicotine stimulation and sudden nicotine withdrawal during sleep. This can increase the severity of OSA through alterations upper airway inflammation and neuromuscular function, arousal mechanisms, and sleep architecture. Therefore, it may lead to sleep-disrupted breathing, particularly obstructive sleep apnea (OSA). Herein, this study aims to research the association between smoking and OSA through the STOP-Bang index. In this study, total sample of 3442 participants (1465 men and 1977 women) were analyzed. We used data from the Korea National Health and Nutrition Examination Survey in 2020 by classifying adults into current, ex-, and non-smokers. A multiple logistic regression analysis was used to investigate the association between smoking and OSA. Furthermore, multinomial regression analysis was used to investigate the effect of smoking cessation. For males, compared to the non-smokers, the odds ratios (OR) for the OSA were significantly higher in the ex-smokers (OR: 1.53, 95% confidence interval(CI) 1.01–2.32) and current smokers (OR: 1.79, 95% CI 1.10–2.89). In females, higher ORs were observed for OSA risk, similar to the non-smokers, smoking cessation, and pack-years. Among men, OSA was significantly associated with a moderate risk for ex-smokers (OR: 1.61, 95% CI 1.05–2.48) and a severe risk for current smokers (OR: 1.88, 95% CI 1.07–3.29). This study observed that smoking might contribute to OSA risk among adults. Smoking cessation can help to manage sleep quality properly.

Abstract BackgroundDigital health technologies are widely used for disease management, with their computing platforms, software, and sensors being used for health care. These technologies are developed to manage chronic diseases and infectious bacterial diseases, including tuberculosis (TB). ObjectiveThis study aims to comprehensively review the literature on the use of digital health interventions (DHIs) for enhancing TB treatment adherence and identify major strategies for their adoption. MethodsWe conducted a literature search in the PubMed, Cochrane Library, Ovid Embase, and Scopus databases for relevant studies published between January 2012 and March 2022. Studies that focused on web-based or mobile phone–based interventions, medication adherence, digital health, randomized controlled trials, digital interventions, or mobile health and ubiquitous health technology for TB treatment and related health outcomes were included. ResultsWe identified 27 relevant studies and classified them according to the intervention method, a significant difference in treatment success, and health outcomes. The following interventions were emphasized: SMS text messaging interventions (8/27, 30%), medicine reminders (6/27, 22%), and web-based direct observation therapy (9/27, 33%). Digital health technology significantly promoted disease management among individuals and health care professionals. However, only a few studies addressed 2-way communication therapies, such as interactive SMS text messaging and feedback systems. ConclusionsThis scoping review classified studies on DHIs for patients with TB and demonstrated their potential for the self-management of TB. DHIs are still being developed, and evidence on the impact of digital technologies on enhancing TB treatment adherence remains limited. However, it is necessary to encourage patients’ participation in TB treatment and self-management through bidirectional communication. We emphasize the importance of developing a communication system.

Abstract Background Frailty is recognized as a geriatric syndrome associated with depression. The consequences and mechanism of frailty transitions are still understudied. This study assessed the influence of frailty transitions on new-onset depressive symptomology using longitudinal, nationwide data of Korean community-dwelling older adults. Methods Longitudinal population-based study conducted in every even-numbered year starting from 2006 to 2020 (eight waves) with a sample of older adults aged ≥ 60 years old. After the application of exclusion criteria, a total of 2,256 participants were included in the 2008 baseline year. Frailty transition was determined through the biennial assessment of change in frailty status using the frailty instrument (FI); depression was measured using the Center for Epidemiological Studies Depression 10 Scale. We employed the lagged general estimating equations to assess the temporal effect of frailty transition on obtaining depressive symptoms. Results Compared to non-frail individuals, the risk of depression was higher in transitioned into frailty and constantly frail participants over a 2-year interval: men (odds ratio (OR) 1.26, 95% confidence interval (CI) 1.21–1.32; OR 1.29, 95% CI 1.21–1.38), women (OR 1.34, 95% CI 1.28–1.40; OR 1.51, 95% CI 1.41–1.62), respectively. Conclusions Frailty transition is found to be associated with new-onset depressive symptoms. Frail individuals and those who transitioned into frailty were associated with a higher risk of depression. Particular attention should be paid to these frailty transitioned groups. Early intervention and implementation of prevention strategies at physical, nutritional, and social levels are warranted to ameliorate frailty and depression in late life.

Abstract Introduction Since adolescent with obesity is closely linked with the incidence of cardiovascular disease, it is important to identify the factors that increase the prevalence of adolescent with obesity and prevent it early. This study aimed to examine which of the demographic and lifestyle factors including sitting hours per week for purposes other than study had the greatest influence on Korean adolescents with obesity during the coronavirus disease 2019 (COVID-19) pandemic. Methods We used the Korean Youth Risk Behavior Web-based Survey (KYRBWS) data. The primary outcome was the relationship between sitting hours and obesity during and after the COVID-19 pandemic. Multiple logistic regression analysis was performed to examine which of the demographic and lifestyle factors including sitting hours per week for purposes other than study had the greatest influence on Korean adolescents’ obesity status. Results The prevalence of obesity was significantly higher during the COVID-19 than before the COVID-19 (OR, 1.268, CI:1.232–1.305). There was a significant increase in the OR for sitting hours per week for purposes other than study (OR, 1.021, 95% CI, 1.019–1.024). Compared to low household income, the OR decreased for middle (OR = 0.798, 95% CI:0.77, 0.826) and high-income household students (OR, 0.833, 95% CI: 0.803–0.865). Discussion/Conclusion The results of this study confirmed the relationship between sit-ting hours and obesity in adolescents during the pandemic. To prevent adolescent with obesity, further studies are needed to focus on the importance of promoting health policy in adolescents to avoid the continuous rising of its prevalence and needed to understand whether the increase in obesity rates during the pandemic is a temporary trend.

Abstract Background Marital status has been suggested as an associated factor for cognitive impairment. The consequences of marital transitions are still understudied. This study evaluated the influence of marital transitions on cognitive function using longitudinal, nationwide data of Korean older adults. Methods This research comprised a longitudinal sample of older adults aged ≥ 45 years old, drawn from the Korean Longitudinal Study of Aging (2006–2020). Marital transition was determined through the biennial assessment of change in marital status; cognitive function was measured using the Korean version of the Mini-Mental State Examination. We employed general estimating equations to assess the temporal effect of marital transition on cognitive function. Results Compared to married individuals, the odds ratios (ORs) of cognitive decline were higher in not married and transitioned out of marriage participants: men (OR 1.32, 95% confidence interval (CI) 0.96–1.82; OR 1.42, 95% CI 0.90–2.24), women (OR 1.21, 95% CI 1.03–1.42; OR 1.20, 95% CI 1.01–1.52), respectively, despite the findings being not statistically significant in men. The participants who transitioned out of marriage over time also showed greater ORs for mild cognitive impairment: men (OR 1.39, 95% CI 0.79–1.87), women (OR 1.33, 95% CI 1.05–1.80), and dementia: men (OR 1.60, 95% CI 0.85–1.99), women: (OR 1.49, 95% CI 1.20–2.19). Conclusion Marital transition is found to be associated with cognitive function decline. Not-married individuals and those who became divorced or widowed were associated with the risk of cognitive function decline. Particular attention should be paid to these marital transitioned groups.

Abstract Although many studies have been conducted on machine learning (ML) models for Parkinson’s disease (PD) prediction using neuroimaging and movement analyses, studies with large population-based datasets are limited. We aimed to propose PD prediction models using ML algorithms based on the National Health Insurance Service-Health Screening datasets. We selected individuals who participated in national health-screening programs > 5 times between 2002 and 2015. PD was defined based on the ICD-code (G20), and a matched cohort of individuals without PD was selected using a 1:1 random sampling method. Various ML algorithms were applied for PD prediction, and the performance of the prediction models was compared. Neural networks, gradient boosting machines, and random forest algorithms exhibited the best average prediction accuracy (average area under the receiver operating characteristic curve (AUC): 0.779, 0.766, and 0.731, respectively) among the algorithms validated in this study. The overall model performance metrics were higher in men than in women (AUC: 0.742 and 0.729, respectively). The most important factor for predicting PD occurrence was body mass index, followed by total cholesterol, glucose, hemoglobin, and blood pressure levels. Smoking and alcohol consumption (in men) and socioeconomic status, physical activity, and diabetes mellitus (in women) were highly correlated with the occurrence of PD. The proposed health-screening dataset-based PD prediction model using ML algorithms is readily applicable, produces validated results, and could be a useful option for PD prediction models.

BackgroundDigital health technologies are becoming increasingly available to children and young people and their families. However, there are no scoping reviews that provide both an overview of the characteristics of digital interventions for children and young people and potential challenges to be considered when developing and implementing them. ObjectiveThis study aimed to systematically review scientific publications to identify the current characteristics and potential complications of digital interventions for children and young people. MethodsThis scoping review was conducted using the framework of Arksey and O’Malley and adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. A search of 5 databases (PubMed, Scopus, Embase, MEDLINE, and CINAHL) and Google Scholar was performed for eligible clinical trials published between January 1, 2018, and August 19, 2022. ResultsThe initial search of the 5 databases yielded 3775 citations; duplicates and those not meeting the inclusion criteria were eliminated. In total, 34 articles were included in the final review and relevant information, such as the descriptive characteristics and potential challenges, were classified. Mental health (26/34, 76%) was the most common target for the digital intervention for children and young people, exceeding physical health (8/34, 24%) by more than 3 times. In addition, a substantial number of digital interventions were dedicated solely to children and young people. Digital interventions for children and young people were more likely to be delivered via computers (17/34, 50%) rather than smartphones (13/34, 38%). More than one-third of the studies (13/34, 38%) applied cognitive behavioral theory as the theory of digital interventions. The duration of the digital intervention for children and young people was more likely to vary depending on the target user rather than the target disease. Intervention components were classified into 5 categories: guidance, task and activity, reminder and monitoring, supportive feedback, and reward system. Potential challenges were subcategorized into ethical, interpersonal, and societal challenges. For ethical challenges, the consent of children and young people or caregivers, potential risk of adverse events, and data privacy issues were considered. For interpersonal challenges, the engagement of children and young people was affected by the preference or barrier of caregivers to participate in studies. For societal challenges, restricted ethnicity in recruitment, limited availability of digital technology, differences in internet use patterns between girls and boys, unified clinical settings, and language barriers were described. ConclusionsWe identified potential challenges and provided suggestions about ethical, interpersonal, and societal aspects to consider when developing and deploying digital-based interventions for children and young people. Our findings provide a thorough overview of the published literature and may serve as a comprehensive, informative foundation for the development and implementation of digital-based interventions for children and young people.

Abstract Background Textbook outcome (TO) has been introduced as a novel composite measure for lung cancer surgery. We investigated TO after lobectomy for early‐stage non‐small cell lung cancer (NSCLC) in a Korean tertiary hospital and its prognostic implications for overall survival and recurrence. Methods Between January 2012 and December 2017, 418 consecutive patients who underwent lobectomy for clinical stages I and II NSCLC were identified and retrospectively reviewed. TO was defined as complete resection (negative resection margins and sufficient lymph node dissection), no 30‐day or in‐hospital mortality, no reintervention within 30 days, no readmission to the intensive care unit, no prolonged hospital stay (

Abstract Insulin resistance can be affected directly or indirectly by smoking. This cross-sectional study aimed at examining the association between smoking patterns and insulin resistance using objective biomarkers. Data from 4043 participants sourced from the Korea National Health and Nutrition Examination Survey, conducted from 2016 to 2018, were examined. Short-term smoking patterns were used to classify participants according to urine levels of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and cotinine as continuous-smokers, past-smokers, current-smokers, and non-smokers. Insulin resistance was calculated using the triglyceride-glucose index from blood samples and was defined as either high or low. Multiple logistic regression analysis was performed to investigate the association between smoking behavior and insulin resistance. Men and women who were continuous-smokers (men: odds ratio [OR] = 1.74, p = 0.001; women: OR = 2.01, p = 0.001) and past-smokers (men: OR = 1.47, p = 0.033; women: OR = 1.37, p = 0.050) were more likely to have high insulin resistance than their non-smoking counterparts. Long-term smokers (≥ 40 days) are at an increased risk of insulin resistance in short-term smoking patterns. Smoking cessation may protect against insulin resistance. Therefore, first-time smokers should be educated about the health benefits of quitting smoking.

BackgroundSmartphones and their associated technology have evolved to an extent where these devices can be used to provide digital health interventions. However, few studies have been conducted on the willingness to use (WTU) and willingness to pay (WTP) for digital health interventions. ObjectiveThe purpose of this study was to investigate how previous service experience, the content of the services, and individuals’ health status affect WTU and WTP. MethodsWe conducted a nationwide web-based survey in 3 groups: nonusers (n=506), public service users (n=368), and private service users (n=266). Participants read scenarios about an imagined health status (such as having a chronic illness) and the use of digital health intervention models (self-management, expert management, and medical management). They were then asked to respond to questions on WTU and WTP. ResultsPublic service users had a greater intention to use digital health intervention services than nonusers and private service users: scenario A (health-risk situation and self-management), nonusers=odd ratio [OR] .239 (SE .076; P

The objective was to determine the association between health-related behaviour with overweight and obesity in South Korean adults by using the Korean National Health and Nutritional Examination Survey (KNHANES) 2018-2020. The study participants were 16,784 aged ≥ 20years. The variables were socio-demographic, lifestyle, food habits and metabolic conditions. The logistic regression analysis performed to find the association by the odds ratio (OR, 95% CI). MCA performed to identify risk factors were computed for overweight and obesity. Overweight and obesity were significantly associated with health behaviour, high income (OR = 1.26; 95% CI: 1.15-1.39), smoking(OR = 1.29; 95% CI: 1.08-1.53), low physical activity(OR = 3.23; 95% CI: 1.79-4.69), diabetes(OR = 2.70; 95% CI: 1.62-4.50), high cholesterol and low HDL(OR = 3.98; 95%CI:2.65-5.97). The high discriminant variables of MCA were aged over 60years, lower education, high income, diabetes, lack of physical activity, and high cholesterol. The findings confirm that the OR of obesity and overweight was likely associated with health behaviour patterns. Besides, it indicates the MCA would be very effective to identify the population-based data context than individual data and it may suggest that more research on association between health behaviours and obesity prevention interventions should be developed for each age group for better health outcomes.

This study aimed to clarify the association between hypertension and conventional cigarette and electronic cigarette (e-cigarette) use, together or individually. A total of 275,762 participants were included, of which 120,766 were men and 154,996 were women. The data were drawn from the Korea Community Health Survey conducted in 2019. A multiple logistic regression model was used to examine the association between hypertension and types of smoking. Hypertension was defined as systolic blood pressure higher than 140 mmHg or diastolic blood pressure higher than 90 mmHg. Based on the types of smoking, participants were grouped as dual smokers of conventional and e-cigarettes, e-cigarette only smokers, conventional cigarette only smokers, past-smokers, and non-smokers. Compared to non-smokers, dual smokers presented the highest odds ratio for hypertension in the male [odds ratio (OR): 1.24, confidence interval (CI): 1.10 to 1.39] and female groups (OR: 1.44 CI: 0.96 to 2.15). According to the Cochran-Mantel-Haenszel test, the two-sided p-value of < 0.001 indicated an overall statistically significant association between types of smoking and hypertension. Use of both cigarette types was statistically significant in the male group, but only the use of conventional cigarettes and past smoking were statistically significant in the female group. Among smokers of the two cigarette types, those who were dual smokers of e-cigarettes and conventional cigarettes were the most likely to have the highest prevalence of hypertension.

PurposeThe purpose of this study was to develop prioritized cancer indicators and measure the population-based monitoring of the entire life cycle of cancer care, guiding the improvement of care delivery systems.MethodsScoping review was performed based on the Joanna Briggs Institute's methodology. Electronic databases were searched in PubMed, Cochrane Library, EMBASE, Ovid Medline, RISS, KISS, and KoreaMed. The searches were limited to articles published in English between 2010 and 2020. No restrictions were applied regarding the publication status or country of origin, and all study designs were included. Gray literature was used to broaden the search's scope, identify new recommendations, need to be in connect with subject experts, and explore pertinent websites. The process and selected indicators were analyzed based on their frequency distribution and percentage.ResultsThe literature search yielded 6,202 works. In addition, national and international cancer guidelines were obtained from official database reports. A total of 35 articles and 20 reports regarding cancer indicators were finally selected for data synthesis. Based on them, 254 core sets of cancer indicators were identified. The selected indicators were classified into six domains based on the continuum of cancer care and survivor's life cycle, namely, primary prevention (61, 24.0%), secondary prevention (46, 18.1%), treatment (85, 33.5%), quality of care (33, 13.0%), survivor management (33, 13.0%), and end-of-life care (14, 5.5%).ConclusionThere is a growing interest in developing specific areas of cancer care. Cancer indicators can help organizations, care providers, and patients strive for optimal care outcomes. The identified indicators could guide future innovations by identifying weaknesses in cancer prevention and management.

Abstract The objective of this study was to evaluate the effects of diabetes mellitus (DM) on the rate of carpal tunnel release (CTR) using a large nationwide cohort in Korea and to identify risk factors, including comorbidities and socioeconomic status (SES), associated with CTR. Patients with a primary or secondary diagnosis of carpal tunnel syndrome (CTS; ICD-10 code: G560) were selected and divided into two groups according to the presence of DM. A Cox proportional hazard model was used to assess the rate of CTR between the two groups. To evaluate the influence of demographic factors, comorbidities, and SES on CTR, multivariate Cox proportional hazard regression models were used to adjust for confounding variables. In total, 12,419 patients with CTS were included in the study: 2487 in DM cohort and 9932 in non-DM cohort. DM duration was negatively related with the rate of CTR (HR = 0.89, 95% CI 0.87–0.91) in CTS patients with DM. The rate of CTR was decreased in patients with DM compared to those without DM in the unadjusted model; however, after adjusting for comorbidities, DM had no significant effect on the rate of CTR. Female sex (HR = 1.50, 95% CI 1.36–1.67) correlated with the rate of CTR, and an inverse relationship between the number of comorbidities and CTR was found (p

ObjectiveThis study examined whether pandemic related family economic hardships influenced adolescents' mental health during the COVID-19 pandemic in Korea.MethodsData were collected from 54,948 adolescents who participated in the 2020 Korea Youth Risk Behavior Web-Based Survey. We performed a multiple logistic regression analysis to examine the association between family economic hardship and mental health (anxiety, depressive symptoms, and suicidal ideation).ResultsAmong the adolescents, 39.7, 24.7, and 5.9% reported slight, moderate, and severe economic hardship, respectively. COVID-19 related family economic hardship was significantly associated with higher odds of adolescents reporting anxiety, depressive symptoms, and suicidal ideation. This association was stronger among adolescents with low to middle family economic status.ConclusionsThis study suggests that adolescents from more economically vulnerable families are likely to be at a higher risk for long-term mental health effects due to the financial consequences of the COVID-19 pandemic.

Pemphigus is an autoimmune mucocutaneous blistering disease caused by autoantibodies against desmogleins. Rituximab effectively treats pemphigus by inducing remission and rapidly reducing corticosteroid dosage. In Korea, the high cost of rituximab had been a burden until the National Health Insurance began to cover 90% of rituximab costs via reimbursement for severe pemphigus patients. We analyzed 214 patients with pemphigus who were treated with their first round of rituximab. The time to initiate rituximab and the time to partial remission under minimal therapy (PRMT) were both significantly shorter after the rituximab reimbursement policy. The total steroid intake for PRMT and complete remission (CR) was less in patients who were diagnosed after the reimbursement. The interrupted time series (ITS) model, a novel analysis method to evaluate the effects of an intervention, showed a decrease in total systemic corticosteroid intake until PRMT after reimbursement began. In peripheral blood mononuclear cells from patients with pemphigus vulgaris, the relative frequencies of desmoglein 3-specific CD11c+CD27−IgD− atypical memory B cells positively correlated with the periods from disease onset to rituximab treatment and to PRMT and the total systemic corticosteroid intake until PRMT. We found that early rituximab therapy, induced by the reimbursement policy, shortened the disease course and reduced the total corticosteroid use by pemphigus patients. The decreased frequency of circulating desmoglein-specific atypical memory B cells can be used as a surrogate marker for a good prognosis after rituximab.

Introduction There is an increased demand for services for hospitalised older patients with acute medical conditions due to rapidly ageing population. The COMPrehensive geriatric AsseSSment and multidisciplinary team intervention for hospitalised older adults (COMPASS) study will test the effectiveness of comprehensive geriatric assessment (CGA) and multidisciplinary intervention by comparing it with conventional care among acute hospitalised older adults in Korea.Methods and analysis A multicentre trial within a cohort comprising three substudies (randomised controlled trials) will be conducted. The intervention includes CGA and CGA-based multidisciplinary interventions by physicians (geriatricians, oncologists), nurses, nutritionists and pharmacists. The multidisciplinary intervention includes nutritional support, medication review and adjustment, rehabilitation, early discharge planning and prevention of geriatric syndromes (falls, delirium, pressure sore and urinary retention). The analysis will be based on an intention-to-treat principle. The primary outcome is living at home 3 months after discharge. In addition to assessing the economic effects of the intervention, a cost-utility analysis will be conducted.Ethics and dissemination The study protocol was reviewed and approved by the ethics committees of Seoul National University Bundang Hospital and each study site. The study findings will be published in peer-reviewed journals. Subgroup and further in-depth analyses will subsequently be published.Trial registration number KCT0006270.

BackgroundThe LACE index (length of stay, acuity of admission, comorbidity index, and emergency room visit in the past 6 months) has been used to predict the risk of 30-day readmission after hospital discharge in both medical and surgical patients. This study aimed to utilize the LACE index to predict the risk of 30-day readmission in hospitalized patients with acute myocardial infraction (AMI).MethodsThis was a retrospective study. Data were extracted from the hospital's electronic medical records of patients admitted with AMI between 2015 and 2019. LACE index was built on admission patient demographic data, and clinical and laboratory findings during the index of admission. The multivariate logistic regression was performed to determine the association and the risk prediction ability of the LACE index, and 30-day readmission were analyzed by receiver operator characteristic curves with C-statistic.ResultsOf the 3,607 patients included in the study, 5.7% (205) were readmitted within 30 days of discharge from the hospital. The adjusted odds ratio based on logistic regression of all baseline variables showed a statistically significant association with the LACE score and revealed an increased risk of readmission within 30 days of hospital discharge. However, patients with high LACE scores (≥10) had a significantly higher rate of emergency revisits within 30 days from the index discharge than those with low LACE scores. Despite this, analysis of the receiver operating characteristic curve indicated that the LACE index had favorable discrimination ability C-statistic 0.78 (95%CI; 0.75–0.81). The Hosmer–Lemeshow goodness- of-fit test P value was p = 0.920, indicating that the model was well-calibrated to predict risk of the 30-day readmission.ConclusionThe LACE index demonstrated the good discrimination power to predict the risk of 30-day readmissions for hospitalized patients with AMI. These results can help clinicians to predict the risk of 30-day readmission at the early stage of hospitalization and pay attention during the care of high-risk patients. Future work is to be focused on additional factors to predict the risk of 30-day readmissions; they should be considered to improve the model performance of the LACE index with other acute conditions by using administrative data.

PurposeEnd-stage lung diseases result in anatomical changes of the thoracic cavity. However, very few studies have assessed changes in the thoracic cavity after lung transplantation (LTx). This study aimed to evaluate the relationships between thoracic cavity volume (TCV) changes after LTx and underlying lung disease.MethodsWe reviewed 89 patients who underwent a pre-LTx pulmonary function test (PFT), chest computed tomography (CT) scan, and 1-year follow-up CT after LTx. These patients were classified into two groups according to pre-LTx PFT as follows: obstructive group [forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio < 70%] and restrictive group (FEV1/FVC ratio > 70%). We measured TCV using CT scan before and at 1 year after LTx and compared the TCV change in the two groups.ResultsIn the restrictive group, TCV increased after LTx (preop: 2,347.8 ± 709.5 mL, 1-year postop: 3,224.4 ± 919.0 mL, p < 0.001). In contrast, in the obstructive group, it decreased after LTx (preop: 4,662.9 ± 1,296.3 mL, 1-year postop: 3,711.1 ± 891.7 mL, p < 0.001). We observed that restrictive lung disease, taller stature, lower body mass index, and larger donor lung were independently associated with increased TCV after LTx.ConclusionThe disease-specific chest remodeling caused by restriction and hyperinflation is at least, in part, reversible. After LTx, the chest remodeling appears to occur in the opposite direction to the disease-specific remodeling caused by the underlying lung disease in recipients.

BackgroundCancer is one of the leading chronic diseases, which causes premature mortality in Korea. Early detection has been reported to be associated with reduced mortality and morbidity. Consistent evidence reports that lower screening rates are associated with socioeconomic-based disparities. This study aimed to examine income-related disparities in cancer screening services and to analyze the association between utilization of cancer screening and individual characteristics, including income levels.MethodsThis study utilized the data from the Korea National Health and Nutrition Examination Survey (KNHANES), a population-based survey from 2013 to 2019. The study population included individuals aged 40 years or over. The variables were socioeconomic characteristics and perceived health status. Household income was categorized into quartiles from Q1 (the lowest income group) to Q4 (the highest income group). Multivariate logistic regression analysis was performed to analyze the association between cancer screening and individual characteristics and household income levels.ResultsThere were 20,347 individuals included in this study. Among these, 14,741 (72.4%) had undergone cancer screening. There existed a gap in the utilization of cancer screening between the lowest (Q1) and highest (Q4) income quintiles owing to evident income disparities; Q4 thus had a significantly higher likelihood of undergoing cancer screening than other quintiles. Female sex, university and over education, number of chronic diseases, and private insurance coverage were positively associated with cancer screening (p < 0.001).ConclusionOur findings suggest that policymakers should develop and design strategies to increase awareness and efforts to improve the education and promotion of cancer screening among lower-income target groups.

Objective: This study aimed to evaluate the longitudinal association between changes in depressive symptoms and hazardous drinking among South Korean adults.Participants/Methods: This study was conducted using a sample drawn from participants enrolled in the Korea Welfare Panel Study (KoWePS) from 2013 to 2018. Hazardous drinking was defined as a score of 11 points for men and seven points for women on the Korean version of the Alcohol Use Disorders Identification Test. Depressive symptoms were evaluated using an 11-item version of the Center for Epidemiologic Studies Depression Scale. A generalized estimating equation model was used to analyze the association between changes in depressive symptoms and hazardous drinking.Results: Of the 12,878 people registered with KoWePS and without follow-up losses from 2013 to 2018, a total of 2,341 were included in this study, excluding those under the age of 19 and those with missing data. Persistent depressive symptoms (men, odds ratio [OR]: 2.20, 95% confidence interval [CI]: 1.48–3.21; women, OR: 2.64, 95% CI: 1.66–4.22) and the changes from non-depressive symptoms to depressive symptoms (men, adjusted OR: 2.18, 95% CI: 1.80–2.64; women, OR: 1.71, 95% CI: 1.27–2.29) increased the likelihood of hazardous drinking.Conclusions: Persistent depressive symptoms and changes from non-depressive to depressive symptoms are associated with increased prevalence of hazardous drinking. This suggests that an evaluation of the underlying mental illness or emotion should be made when counseling for abstaining from alcohol for chronic drinkers or the general public.

ObjectiveThe purpose of this study was to investigate the association between grip strength and hypertension in the Korean population aged 65 years or older. Furthermore, individual differences in BMI were taken into account to examine whether grip strength or a relative grip strength predicted hypertension better.MethodsData from the Korean Longitudinal Study of Ageing from 2006 to 2016 were assessed, and a total of 3,383 participants were analyzed in our study (Male: 1,527, Female: 1,856). Using the generalized estimating equation model, the association between grip strength and hypertension, assessed by the response to the question 'have you ever been diagnosed with hypertension from your doctor?', over the follow-up period was analyzed. The relative grip strength, calculated by dividing the mean grip strength by BMI, was also analyzed in association of hypertension.ResultsBoth grip strength and relative grip strength were significantly associated with hypertension in our sample. However, the results were more significant in the total sample when relative grip strength was used. In terms of grip strength, as the High group as reference: Low (Odds Ratio (OR): 1.238, 95% Confidence Interval (CI): 1.096, 1.397), Middle Low (OR: 1.104, 95% CI: 0.990, 1.231), and Middle high (OR: 1.024, 95% CI: 0.934, 1.122). In the analysis using relative grip strength, as High group as reference: Low (OR: 1.393, 95% CI: 1.234, 1.573), Middle low (OR: 1.232, 95% CI: 1.104, 1.374), and Middle high (OR:1.104, 95% CI: 1.009, 1.209). Furthermore, the lower QIC measure in the model with relative grip strength (QIC: 25,251) compared with the one using grip strength (QIC: 25,266) indicated a better model fit in the former.ConclusionsThe results of the current study strengthen the previous findings in regards to hand grip strength and health. Furthermore, the results of our study shines light on the necessity of considering individual differences in BMI, when using a physical measure as a study variable.

Abstract Background To discover the association between eating alone and diet quality among Korean adults who eat alone measured by the mean adequacy ratio (MAR), Methods The cross-sectional study in diet quality which was measured by nutrient intakes, indicated as MAR and nutrient adequacy ratio (NAR) with the Korean National Health and Nutrition Examination Survey (KNHANES) VI 2013–2015 data. Study population was 8523 Korean adults. Multiple linear regression was performed to identify the association between eating behaviour and MAR and further study analysed how socioeconomic factors influence the diet quality of those who eat alone. Results We found that the diet quality of people who eat alone was lower than that of people who eat together in both male (β: − 0.110, p = 0.002) and female participants (β: − 0.069, p = 0.005). Among who eats alone, the socioeconomic factors that negatively influenced MAR with the living arrangement, education level, income levels, and various occupation classifications. Conclusions People who eat alone have nutrition intake below the recommended amount. This could lead to serious health problems not only to those who are socially disadvantaged but also those who are in a higher social stratum. Policy-makers should develop strategies to enhance diet quality to prevent potential risk factors.

Abstract Background Thyroid hormones are known to have direct and indirect effects on metabolism. Individuals with metabolic syndrome, a disease that is growing in incidence at a rapid rate, are at higher risk for cardiovascular disease, diabetes, and cancer. The aim of this study was to identify whether significant correlations exist between thyroid hormone levels and components of the metabolic syndrome in the general population of Korea. Methods The data were collected from the sixth Korea National Health and Nutrition Examination Surveys from 2013 to 2015. A total of 1423 participants were tested for thyroid function. The analysis of variance and multiple linear regression were performed to analyze the relationship between thyroid hormone level and components of the metabolic syndrome. Results A positive association between free thyroxine and fasting glucose level was observed in patients with high free thyroxine levels (≥1.70 ng/dL, β = 15.992, p =

Objectives Albuminuria has emerged as a biomarker for several medical conditions, and vitamin D has received attention due to its associations with various disorders. We evaluated the association between low serum vitamin D levels and prevalent albuminuria by sex in the Korean general population. Methods We analyzed 9823 participants (4401 males, 5422 females) from the Korea National Health and Nutrition Examination Survey 2011-2012 (KNHANES V-2), and categorized them as having a normal range of vitamin D levels, vitamin D insufficiency, or vitamin D deficiency. A multivariable logistic regression model was used to compare the risk of albuminuria across these groups. Stratified analyses were conducted by smoking status, obesity, and renal function. Results Albuminuria was found in 325 of the 4401 male participants (7.4%) and in 455 of the 5422 female participants (8.4%). Among the males, vitamin D deficiency was associated with an odds ratio (OR) for albuminuria of 1.78 (95% confidence interval [CI], 1.07 to 2.97, p

Introduction: The literature on stroke mortality and neighborhood effect is characterized by studies that are often Western society-oriented, with a lack of racial and cultural diversity. We estimated the effect of cross-level interaction between individual and regional socioeconomic status on the survival after onset of ischemic stroke. Methods: We selected newly diagnosed ischemic stroke patients from 2002 to 2013 using stratified representative sampling data of 1,025,340 subjects. A total of 37,044 patients over the 10 years from 2004 to 2013 had newly diagnosed stroke. We calculated hazard ratios (HR) of 12- and 36-month mortality using the Cox proportional hazard model, with the reference group as stroke patients with high income in advantaged regions. Results: For the middle income level, the patients in advantaged regions showed low HRs for overall mortality (12-month HR 1.27; 95% confidence interval [CI], 1.13–1.44; 36-month HR 1.25; 95% CI, 1.14–1.37) compared to the others in disadvantaged regions (12-month HR 1.36; 95% CI, 1.19–1.56; 36-month HR 1.30; 95% CI, 1.17–1.44). Interestingly, for the low income level, the patients in advantaged regions showed high HRs for overall mortality (12-month HR 1.27; 95% CI, 1.13–1.44; 36-month HR 1.33; 95% CI, 1.22–1.46) compared to the others in disadvantaged regions (12-month HR 1.25; 95% CI, 1.09–1.43; 36-month HR 1.30; 95% CI, 1.18–1.44). Conclusion: Although we need to perform further investigations to determine the exact mechanisms, regional deprivation, as well as medical factors, might be associated with survival after onset of ischemic stroke in low-income patients.

Abstract Background Previous studies have examined associations between sitting time and negative health outcomes and mental health. However, the relationship between overall sitting time and major depressive disorder (MDD) in South Korea has not been studied. This study examined the association between MDD and overall sitting time and physical activity in South Koreans. Methods Data from the sixth Korean National Health and Nutrition Examination Survey (KNHANES), a cross-sectional, nationally representative survey, were analyzed. Total participants were 4145 in 2014. MDD was assessed using the Patient Health Questionnaire (PHQ-9). Participants’ data regarding self-reported sitting time and physical activity were analyzed via multiple logistic regression. Results Results showed that people who sat for 8–10 h (OR: 1.56, 95% CI: 1.15–2.11) or more than 10 h (OR: 1.71, 95% CI: 1.23–2.39) had increased risk of MDD compared to those who sat for less than 5 h a day. Subgroup analysis showed that the strongest effect of reported sitting time on risk of MDD was found in men with lower levels of physical activity who sat for 8 to 10 h (OR: 3.04, 95% CI: 1.15–8.01) or more than 10 h (OR: 3.43, 95% CI: 1.26–9.35). Level of physical activity was not an independent predictor for MDD. Conclusions Sitting for long periods was associated with greater risk of MDD in South Korean adults. Reducing sitting time in people with MDD could help to prevent associated physical health problems and may improve mental health.

Abstract Background Previous evidence suggests that there is a correlation between prolonged sitting time and cardio-metabolic disease, such as metabolic syndrome (MS). Cardiovascular disease is the second-leading cause of mortality in South Korea, a country with the longest working hours among all member states of the Organization for Economic Co-operation and Development. However, no previous study has investigated the relationships of overall sitting-time and occupation with MS in South Korea. Accordingly, the present study examined these relationships in a South Korean population. Methods Data from the sixth Korean National Health and Nutrition Examination Survey (KNHANES), a nationally representative survey with a cross-sectional design, were used in the present study. MS diagnoses were evaluated using the International Diabetes Foundation (IDF) criteria. Participants self-reported their overall sitting times, and occupations were classified using the Korean version of the Standard Classification of Occupations (KSCO). A multiple logistic regression analysis was conducted to evaluate the associations of sitting time and occupation with MS. Results The risk of MS was 1.21-fold higher among participants who sat for >7 h/day than among those who sat for ≤7 h/day (odds ratio [OR]: 1.21, 95 % confidence interval [CI]: 1.00–1.46). Regarding occupation, office workers had a two-fold higher risk of MS than did agriculture, forestry, and fishery (AFF) workers (OR: 2.01, 95 % CI: 1.26–3.22). In a combined analysis of sitting time and occupation, male participants who sat for >7 h/day and reported an occupation that involves office work (OW) or machine fitting (MF) were significantly more likely to have MS when compared to those who sat for ≤7 h/day and were employed as AFF workers (>7 h/day × OW, OR: 2.41, 95 % CI: 1.05–5.51; >7 h/day × MF, OR: 2.92, 95 % CI: 1.43–5.93). Conclusions Excessive sitting time and a sedentary occupation correlated positively with MS in South Korean adults. Accordingly, a reduction in the overall sitting time or inclusion of energy-expending activities in the workplace might improve the rate of MS.

Background and Objectives: This study aimed to group diseases classified by the International Classification of Diseases using principal component analysis, and discuss a systematic approach to reducing the preventable death rate from a perspective of public health. Materials and Methods: Using a 10-year follow-up analysis of the Korean Longitudinal Study of Aging (KLoSA) data, this study obtained de-identified data including participants’ data of community-dwelling individuals aged ≥45 years from 2006 to 2016. Participants were randomly selected using a multistage, stratified probability sampling based on geographical area and housing type. We excluded 37 participants with missing information at baseline and included 10,217 study participants. This study used the principal component analysis to extract comorbidity patterns, and chi-square test and Cox proportional hazards models for analyzing the association between the factors of interest. Results: Principal component 1 (diabetes, heart disease, and hypertension) was associated with an increased hazard ratio (HR) of 1.079 (95% confidence interval (CI) 1.031–1.129, p = 0.001). Principal component 3 (psychiatric and cerebrovascular diseases) was related to an increased HR of 1.134 (95% CI 1.094–1.175, p < 0.0001). Moreover, principal component 4 was associated with a high HR of 1.172 (95% CI 1.130–1.215, p < 0.0001). However, among participants aged between 45 and 64 years, principal component 4 showed a meaningfully increased HR of 1.262 (95% CI 1.184–1.346, p < 0.001). In this study, among the four principal components, three were statistically associated with increased mortality. Conclusions: The principal component analysis for predicting mortality may become a useful tool, and artificial intelligence (AI) will improve a value-based healthcare strategy, along with developing a clinical decision support model.

BACKGROUND:To investigate relationships among neonatal hypothyroidism, family income, and intellectual disability, as well as the combined effects of neonatal hypothyroidism and low family income on intellectual disability. METHODS:Data were extracted from the National Health Insurance Service-National Sample Cohort from 2002 to 2011. This retrospective study included 91,247 infants. The presence of intellectual disability was based on the disability evaluation system in Korea. Newborn hypothyroidism was identified from diagnosis and prescription codes. Family income was determined from average monthly insurance premiums. Cox proportional hazards models were used to calculate adjusted hazard ratios. RESULTS:Of the 91,247 infants, 208 were considered to have intellectual disability (29.18 cases per 100,000 person-year). The risk of intellectual disability was higher in infants with hypothyroidism than in those without hypothyroidism (hazard ratio = 5.28, P: < .0001). The risk of intellectual disability was higher in infants with low family income than in those with high family income (hazard ratio = 2.32, P: < .0001). The risk of intellectual disability was higher in infants with hypothyroidism and low family income than in those without hypothyroidism and with high family income (hazard ratio = 36.05, P: < .0001). CONCLUSIONS:Neonatal hypothyroidism and low family income were associated with the risk of intellectual disability in Korea. Additionally, neonatal hypothyroidism and low family income significantly increased the risk of intellectual disability. Public health policymakers should consider providing additional resources for alleviating neonatal hypothyroidism among low-income families.

OBJECTIVES: Considering the effect of sex and head of household responsibilities, this study was designed to evaluate whether precarious employment is associated with the development of new-onset severe depressive symptoms. METHODS: We followed 2214 male and 1276 female waged workers, ≤59 years of age and without moderate depressive symptom, from the Korean Welfare Panel Study 2007–2013. Their employment status was classified as full-time permanent, precarious, self-employed, or unemployed after baseline. Except for occupation and company size, all variables were treated as time-dependent. Severe depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression Scale (CES-D-11). A generalized estimating equation was used to evaluate the effect of employment status on the development of new-onset severe depressive symptoms. RESULTS: After adjusting for initial baseline CES-D-11 score, chronic disease, and other socioeconomic covariates, precarious employment was associated with the development of new-onset severe depressive symptoms among male heads of household [odds ratio (OR) 1.52, 95% confidence interval (95% CI) 1.02–2.25] and female heads of household (OR 4.19, 95% CI 1.70–10.32). In addition, the transition from full-time permanent employment to another employment status was associated with the development of new-onset severe depressive symptoms among both sexes, with an especially strong association among females. CONCLUSION: The present study suggests that, depending on head of household status and sex, precarious employment is associated with the development of new-onset severe depressive symptoms.

Objectives: To examine the sex-specific factors associated with being unaware of one’s hepatitis B virus surface antigen (HBsAg) seropositivity status in a large, HBsAg-positive population of Koreans. Methods: In total, 1197 subjects aged 19 years or older who were HBsAg-positive according to data from the 2007-2012 Korea National Health and Nutrition Examination Survey were included. Subjects were considered unaware of their HBsAg seropositivity status if they answered that they had no knowledge of being previously infected by the hepatitis B virus (HBV) or diagnosed with HBV hepatitis. Multivariate Poisson regression models with robust variance estimate were used to assess the significance of the variables using weighted frequencies. Results: The majority (77.8%) of HbsAg-positive Korean adults (females, 81.9%; males, 74.6%) were unaware of their HBsAg seropositivity status. We found that sex (female: prevalence ratio [PR] 1.19), household income (low: PR, 1.15), marital status (never married: PR, 1.18), self-rated health (moderate: PR, 1.14; good: PR, 1.12), and alcohol use (at least 2-3 times/wk: PR, 1.21) were associated with being unaware. In females, age (50 to 59 years: PR, 1.29; ≥70 years: PR, 1.30), household income (low: PR, 1.37; middle–low: PR, 1.24), and marital status (never married: PR, 1.33) were associated with being unaware. In males, self-rated health (moderate: PR, 1.14; good: PR, 1.21) and alcohol use (at least 2–3 times/wk: PR, 1.21) were associated with being unaware. Conclusions: Factors related to the socioeconomic status of females and the health-related behaviors of males were found to be associated with being unaware of one’s HBsAg seropositivity status.

Objectives: Mental health disorders and suicide are an important and growing public health concern in Korea. Evidence has shown that both globally and in Korea, obesity is associated with an increased risk of developing some psychiatric disorders. Therefore, we examined the association between distorted body weight perception (BWP) and suicidal ideation. Methods: Data were obtained from the 2007-2012 Korea National Health and Nutritional Evaluation Survey (KNHANES), an annual cross-sectional nationwide survey that included 14 276 men and 19 428 women. Multiple logistic regression analyses were conducted to investigate the associations between nine BWP categories, which combined body image (BI) and body mass index (BMI) categories, and suicidal ideation. Moreover, the fitness of our models was verified using the Akaike information criterion. Results: Consistent with previous studies, suicidal ideation was associated with marital status, household income, education level, and perceived health status in both genders. Only women were significantly more likely to have distorted BWP; there was no relationship among men. In category B1 (low BMI and normal BI), women (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.48 to 3.42) were more likely to express suicidal ideation than women in category B2 (normal BMI and normal BI) were. Women in overweight BWP category C2 (normal BMI and fat BI) also had an increased OR for suicidal ideation (OR, 2.25; 95% CI, 1.48 to 3.42). Those in normal BWP categories were not likely to have suicidal ideation. Among women in the underweight BWP categories, only the OR for those in category A2 (normal BMI and thin BI) was significant (OR, 1.34; 95% CI, 1.13 to 1.59). Conclusions: Distorted BWP should be considered an important factor in the prevention of suicide and for the improvement of mental health among Korean adults, especially Korean women with distorted BWPs.