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Purpose: This study aimed to identify high-risk groups for Long-Term Care Insurance (LTCI) in older people not approved for LTCI and to examine the characteristics of each high-risk group.Methods: This study was a retrospective study using the National Health Insurance Service database and included 7,724,101 older A decision- tree model was used to predict the high-risk groups for LTCI. The dependent variable was defined as LTCI eligibility. As independent variables, 78 variables consisting of personal factors, environmental factors, health status, and physical and cognitive abilities were used.Results: The prediction model to identify high-risk groups for LTCI was developed as the decision-tree model consisting of 19 end nodes with 10 risk factors. Eleven groups were identified as high-risk groups. The results showed the model could predict about 72% of the older people at high risk for LTCI needs using the NHIS database without the assessment of LTCI eligibility.Conclusion: The findings might be useful for the development of evidence-based preventative services and can contribute to preemptively discovering those who need preventive services in older adults.

Parasite infection rates estimated by examining ancient coprolites can provide insights into parasitism in Joseon society. Using newly discovered Joseon period cases is essential to regularly update the parasite infection rates and reinforce the reliability of our previous estimations. In the present study, we investigated parasite infections in Joseon coprolites newly isolated from the cities of Euijeongbu, Gumi, and Wonju. We then updated the overall parasite infection rates of Joseon period samples (n= 30) as follows: 86.7% (26/30) for Trichuris trichiura, 56.7% (17/30) for Ascaris lumbricoides, 30.0% (9/30) for Clonorchis sinensis, and 30.0% (9/30) for Paragonimus westermani. The parasite infection rates in the Joseon society, estimated through coprolite examination, were very similar to those determined previously despite the addition of new cases to the existing data pool.

Purpose: The purpose of this study is to identify the progress of transition from the non-graded to the approved for Long-term Care Insurance (LTCI) and analyze the factors affecting becoming beneficiaries. Methods: This study was designed as a prospective cohort study. Study population was the non-graded for LTCI in 2018. We tracked and observed study population until December 2020 by using big data. Variables in the analysis consisted of the individual (socioeconomic characteristics, health status, medical service usage) and community-related (physical environment, local infrastructure, local older population, local social capacity, health policy) factors. Competing risks regression analysis was used to identify determinants of transition from the non-graded to beneficiaries for LTCI. Results: We analyzed 52,308 non-graded for LTC insurance. The average period of transition from the non-graded to beneficiaries was about 15.61 months, the cumulative transition rate for 6 months was 4.8%, and the cumulative transition rate for 36 months was 49.6%. The individual factors (higher age, female, low income, lower daily living ability, lower cognitive-behavioral score, dementia, low back pain, and lower medical expenses), as well as the community factors (rural areas) were determinants for the transition to beneficiaries. Conclusion: To prevent non-graded from being persons with LTC needs, we suggested that it is necessary to develop a policy that can establish an integrated community-based support system by selecting vulnerable groups such as rural residents and low-income groups. In addition, additional research is needed to evaluate the effect of preventive programs for the non-graded on maintaining and improving their health and functional status.

Although parents with cancer report that talking with their children about cancer and dying is distressing, accessible support is rare. We assessed the feasibility, acceptability, and preliminary effects of Families Addressing Cancer Together (FACT), a web-based, tailored psychosocial intervention to help parents talk about their cancer with their children.This pilot study used a pre-posttest design. Eligible participants were parents with new or metastatic solid tumors who had minor (ages 3-18) children. Participants who completed baseline assessments received online access to FACT. We assessed feasibility through enrollment and retention rates and reasons for study refusal. Acceptability was evaluated by satisfaction ratings. We examined participants' selection of intervention content and preliminary effects on communication self-efficacy and other psychosocial outcomes (depression and anxiety symptoms, health-related quality of life, family functioning) at 2- and 12-week post-intervention.Of 68 parents we approached, 53 (78%) agreed to participate. Forty-six parents completed baseline assessments and received the FACT intervention. Of the 46 participants, 35 (76%) completed 2-week assessments, and 25 (54%) completed 12-week assessments. Parents reported that FACT was helpful (90%), relevant (95%), and easy to understand (100%). Parents' psychosocial outcomes did not significantly improve post-intervention, but parents endorsed less worry about talking with their child (46% vs. 37%) and reductions in the number of communication concerns (3.4 to 1.8).The FACT intervention was feasible, acceptable, and has potential to address communication concerns of parents with cancer. A randomized trial is needed to test its efficacy in improving psychological and parenting outcomes.This study was IRB-approved and registered with clinicaltrials.gov (NCT04342871).

Background and Objectives Caregiving is a social process and commonly involves more than a single caregiver, especially for older adults with multimorbidity, including dementia. This study was to characterize informal caregiving networks of older adults with dementia superimposed on multimorbidity (e.g., end-stage kidney disease) and to examine the relationships of network properties to outcomes of caregivers and older adults. Research Design and Methods An egocentric social network survey was conducted. Up to 3 family caregivers of older adults on dialysis who had moderate-to-severe irreversible cognitive impairment with or without a documented diagnosis of dementia were recruited from 11 dialysis centers in 2 states. Caregivers completed a social network survey about individuals providing caregiving to the older adult and measures of caregiving burden and rewards, depression, and financial hardship. Older adults’ emergency department visits and hospital admissions during the past 12 months were abstracted from the medical records. Results A total of 76 caregiver informants of 46 older adults (78% Black) participated in the study. Of the 46 older adults, 65% had a multimember network (median size of 4). As the network density (the proportion of ties between members among all possible ties) increased, primary caregivers’ financial hardship decreased whereas nonprimary caregivers’ financial hardship increased. Further, for every 1-unit increase in mean degree (the average number of connections among members), there was a nearly fourfold increase in the odds of no hospital admission during the prior year for the older adult. Discussion and Implications The network dynamics of informal caregiving networks may have an impact on the well-being of caregivers and older adults with dementia, but confirmatory longitudinal studies are needed.

Despite a humidifier disinfectant (HD) product containing chloromethylisothiazolinone (CMIT) and methylisothiazolinone (MIT) with approximately 22% magnesium nitrate as a stabilizer, no report on the effects of magnesium nitrate on the respiratory toxicity of CMIT/MIT is available. In this study, Kathon CG and Proclin 200, containing approximately 1.5% CMIT/MIT with different magnesium nitrate concentrations (22.6% and 3%, respectively), were used to compare respiratory effects after intratracheal instillation (ITI) in C57BL/6 mice. C57BL/6 mice were randomized into groups of saline control, magnesium nitrate, Kathon CG, and Proclin 200 with 1.14 mg/kg of CMIT/MIT as the active ingredient, and administration was performed 6 times in a 2–3 day-interval in 2 weeks in all groups. Differential cell count analysis, cytokine analysis, and histological analysis of lung tissue were performed to characterize the injury features. Both Kathon and Proclin 200 induced an increase in inflammatory cell levels in the bronchoalveolar lavage (BAL) fluid, in particular, eosinophils and type 2 T helper cell (Th2)-secreted cytokines. All histopathological changes including granulomatous inflammation, mixed inflammatory cell infiltration, mucous cell hyperplasia, eosinophil infiltration, and pulmonary fibrosis were induced with similar frequency and severity in Kathon CG and Proclin 200 groups. Our results suggested that magnesium nitrate did not affect CMIT/MIT-induced lung injury in the intratracheally instilled model. Further inhalation studies are needed to determine the distribution and toxicity differences of CMIT/MIT in the lungs according to the magnesium nitrate concentration.

Objectives Unrepresented adults are individuals who lack decision-making capacity and have neither an available surrogate decision maker nor an applicable advance directive. Currently, the prevalence of unrepresented nursing home (NH) residents and how medical decisions are made is unknown. We examined (1) the prevalence of unrepresented NH residents, (2) NH policies and procedures to address medical decision making for those residents, and (3) NH staff's perceptions of medical decision making for unrepresented residents. Design We reviewed resident medical records and NH policy and procedure documents. We also conducted a survey of NH staff using an investigator-developed questionnaire. Setting and Participants Sixty-six staff members recruited from 3 NHs (433 residents total) in 1 metropolitan area of Georgia, USA. Methods Medical records and policy and procedure documents were reviewed using preset criteria. The survey included 31 structured and open-ended questions regarding medical decision-making practices for unrepresented residents (eg, awareness of medical decision-making processes, experiences in medical decision making, and suggestions to improve practice). We used descriptive statistics and conventional content analysis. Results Four residents (1%) met the criteria of being unrepresented. We found no written statements that specifically addressed medical decision making for unrepresented residents in the participating NHs. Of 66 survey participants, 11 had been involved in medical decision making for unrepresented residents. The most common decisions involved do-not-resuscitate orders, major medical and surgical treatments, and life-sustaining treatments. These decisions were made primarily by relying on the resident's physician or through discussions within the facility's interdisciplinary team. Suggestions included adopting explicit mechanisms or protocols related to decision making for unrepresented residents, education/training, and resources for group-based decision making. Conclusions and Implications Although prevalence in the 3 NHs was low, NH care providers, ethical and legal professionals, and other key stakeholders should discuss practical approaches and policies to systematically identify unrepresented residents and to improve NHs’ medical decision-making practices for them.

Metagonimiasis, commonly seen in East Asian countries, is a parasitic disorder caused by definitive hosts’ ingestion of undercooked freshwater fishes. Recently, genetic analysis has proved 28S rRNA and cytochrome c oxidase subunit I (COI) mtDNA gene to be a successful marker differentiating species of the genus Metagonimus. In the present study, using specimens from the newly discovered Joseon Dynasty human remains of Goryeong, we obtained updated genetic data on genus Metagonimus, which was also prevalent during the Joseon period. The ancient DNA (aDNA) was retrieved from the coprolite sample of the seventeenth century, half-mummified individual discovered at Goryeong Country, South Korea. Cloning and sequencing were performed on PCR-amplified amplicons for M. yokogawai 28S rRNA and COI mtDNA gene. The consensus sequences were used for species identification and phylogenetic analysis using NCBI/BLAST and MEGA X software. Based on the COI mtDNA gene region, the Goryeong sequence was confirmed as belonging to M. yokogawai, as it was shown to form a separate cluster with other M. yokogawai taxa that are distinct also from M. takahashii and M. miyatai. In a series of our genetic analyses on genus Metagonimus using samples retrieved from Joseon-period cases, aDNA sequences of genus Metagonimus revealed in South Korea thus far are those of M. yokogawai, but not of M. miyatai or M. takahashii yet.

Purpose: When patients with advanced cancer have minor children (age < 18), their health-related quality of life is closely linked to their concerns about the impact of progressive illness and death on their children. The Parenting Concerns Questionnaire (PCQ), a validated measure for parents with cancer, does not capture the full range of concerns in advanced cancer. The aim of this was study was to adapt and establish psychometrics for the PCQ for advanced disease (PCQ-AD). Methods: After generating an initial item-bank, we conducted concept elicitation interviews with clinicians (n = 8) and cognitive interviews with patients (n = 23) for face validity. New items addressed concerns about impact of parental death, making every moment count, communication, and financial impact of cancer on children. We administered 21 candidate items to 151 parents with advanced cancer. We conducted confirmatory factor analysis (CFA), calculated internal consistency, and assessed convergent and known-groups validity. Results: We removed 8 redundant items due to residual covariation between items. CFA of the 13-item PCQ-AD demonstrated satisfactory fit (CFI = 0.971, TLI = 0.966, RMSEA = 0.081) and high internal consistency (Cronbach’s alpha = 0.94, composite reliability = 0.95). The PCQ-AD demonstrated convergent validity and known-groups validity; patients with poor functional status reported higher scores than patients with better functional status (Cohen’s d = 0.56, p = 0.002). Conclusion: Adaptation of the PCQ yielded the addition of constructs important in advanced cancer. The PCQ-AD appears to be a reliable and valid measure of parenting concerns in advanced cancer, but future studies are needed to examine measure performance in diverse populations and responsiveness of the PCQ-AD to interventions.

The Integrated Memory Care Clinic is a patient-centered medical home led by advanced practice RNs (APRNs) who provide dementia care and primary care simultaneously and continuously. We explored the experiences of 12 informal caregivers of persons living with dementia during their first year at the Clinic. Data were analyzed via directed content analysis. Caregivers described the Clinic as “the only place you should go to for dementia [care].” Caregivers felt a sense of belonging to the Clinic, valued APRNs' competence and staff's dedication, and round-the-clock telephone access to APRNs. Caregivers also acknowledged that “we're all out here swimming on our own.” They expressed their sense of being overwhelmed and needing more services and medical and non-medical resources, and more prognostic information on dementia. Although the Clinic is beneficial for caregivers, caregiving demands exceed the supply of services and resources at the Clinic. [ Research in Gerontological Nursing, 14 (2), 69–78.]

Informal caregiving research has focused on the primary caregiver and caregiver-patient dyad. Thus, we know little about caregiving beyond the dyadic relationship. This study was to gain a comprehensive understanding of informal caregiving networks for individuals with dementia superimposed on complex multimorbidity. We used egocentric social network analysis to obtain caregiving information of 46 patients with moderate to severe cognitive impairment, 5 chronic conditions on average, and undergoing hemodialysis (4.3 mean years). Most patients (n=35, 77.8%) were Black, 22 (47.8%) male, and mean age of 73.9 years. Starting with the primary family caregiver (FCG), up to 2 additional FCGs were recruited for each patient, totaling 76 FCGs (46 primary, 30 non-primary). Most were a child of the patient (n=39, 51.3%), female (n=57, 75%), and 54.2 years of age. Of the 46 networks, 16 (35%) included only one FCG (singletons). Multimember networks (n=30, 65%) provided longer caregiving than singletons (7.7 vs 3.8 years, p=0.008). Average network size was 2.8, and 26 (54.5%) networks had at least one male caregiver. Among the 30 multimember networks, average size was 3.8, density (proportion of possible ties) was 0.9, and mean degree and maximum degree (number of ties per member to other network members) were 2.5 and 2.8, respectively. Higher mean and maximum degrees were associated with fewer 12-month patient hospitalizations (r=-0.47, p=0.01; r=-0.43, p=0.02, respectively). Including additional caregiver informants significantly increased network size, ties and maximum degree centrality compared to those based on primary caregiver only, allowing for fuller network description.

This study aimed to identify trajectories of multimorbidity in older adults prior to receiving long-term care benefits and to demonstrate their value in predicting mortality.This study included 1,004,924 Korean beneficiaries who completed the National Long-Term Care Insurance (NLTCI) eligibility assessment between 2010 and 2016. Multimorbidity was defined as the coexistence of 2 or more out of 23 chronic diseases related to disability in the 10 years before transitioning to long-term care. Mortality was defined as all-cause deaths after the date of the NLTCI needs assessment. Latent class growth modeling was performed to identify groups that exhibited similar trajectory patterns over time. Sex, age, and long-term care grade were used as covariates. Cox proportional hazards models were used to analyze the mortality rates by trajectories.Three patterns emerged in the multimorbidity trajectory in the 10 years prior to entering the long-term care system: consistently low morbidity ("consistently low"), an abrupt increase in morbidity in less than one year ("catastrophic"), and an increment in morbidity over a longer period ("progressive"). In multiple Cox regression adjusting for covariates, the hazard ratios (95% confidence interval) of 1-year mortality for the catastrophic and progressive groups were 1.38 (1.36-1.39) and 1.43 (1.41-1.45), respectively, compared to the consistently low group.This study identified distinct trajectories of multimorbidity in older people accessing the long-term care system and demonstrated their prognostic value for the survival of those with long-term care needs. Treatment and management strategies targeting individuals with a high-risk trajectory are warranted.

The purpose of this longitudinal cohort study was to explore the outcomes of persons living with dementia (PLWD) and their caregivers during their first 9 months at the Integrated Memory Care Clinic (IMCC). IMCC advanced practice registered nurses provide dementia care and primary care simultaneously and continuously to PLWD until institutionalization. Changes were examined in caregivers' psychological well-being (perceived stress, depressive symptoms, caregiver burden, and anxiety) and health status and in PLWDs' quality of life and neuropsychiatric symptoms. Data were collected at baseline, then 3 and 6 months post-baseline. Forty-two caregivers completed all 3 assessments. Most variables remained unchanged. Statistically significant improvements in 5 sub-scales of the Neuropsychiatric Inventory were observed: caregivers' distress regarding their PLWDs' delusions and anxiety, and PLWDs' severity of delusions, depression, and total symptom severity. Further testing of the IMCC is required, including in quasi-experimental studies, to determine its efficacy.

In this study, we investigated the effects of Formaldehyde (FA) exposure on splenic immune responses wherein helper T cells become activated and differentiate into effector T and regulatory T cells. BALB/c mice were exposed to two FA concentrations (1.38 mg/m3 and 5.36 mg/m3) for 4 h/day and 5 days/week for 2 weeks. FA-induced immune responses were examined by the production of cytokines, expression of mRNAs, and distributions of helper T cells and regulatory T cells. Moreover, expression of calcineurin and NFATs, regulatory T cell-related signalling proteins, were evaluated. FA exposure suppressed Th2-, Th1-, and Th17-related splenic cytokines in a dose-dependent manner. mRNA expression of splenic cytokines was also decreased by FA exposure, which correlated with decreased cytokine expression. In parallel, FA exposure promoted T cell differentiation into regulatory T cells in a dose-dependent manner supported by the expression of calcineurin and NFAT1. Taken together, our results indicated that FA exposure increases the number of regulatory T cells via calcineurin-NFAT signalling, thereby leading to effector T cell activity suppression with decreased T cell-related cytokine secretion and mRNA expression. These findings provide insight into the mechanisms underlying the adverse effects of FA and accordingly have general implications for human health, particularly in occupational settings.

Introduction: Both solid organ transplant candidates and recipients and their family caregivers have complex care needs and may benefit from palliative care. But palliative care is not often considered as part of transplant care despite palliative care being promoted as an important component of transplant care both before and after solid organ transplantation. Further, the current state of the science of palliative care in solid organ transplantation has not been well-documented. Objective: To describe the state of the science of palliative care in solid organ transplant and identify gaps in the literature. Methods: Four electronic databases were searched using controlled vocabulary words and synonymous free text to find articles on palliative care and solid organ transplant. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist were also used. Results: Twenty articles were included in the final review for synthesis, 18 of which involved transplants for adults only. Twelve articles described palliative care for patients before transplant, four articles examined palliative care for patients after transplant, primarily at the end-of-life, and four articles described transplant provider perspectives on palliative care. The reviewed evidence suggested that patients could be benefited by palliative care both pre and posttransplant, particularly for symptom management and advance care planning and that transplant providers faced many barriers to implementing palliative care in practice. Discussion: There is limited research on palliative care following solid organ transplantation, particularly outside of hospice care. Much of the prior research on this topic has described adult patients.

Though ventricular assist devices (VADs) are an important treatment option for acute heart failure, an extracorporeal membrane oxygenator (ECMO) is usually used in pediatric patients for several reasons. However, a temporary centrifugal pump-based Bi-VAD might have clinical advantages versus ECMO or implantable VADs. From January 2000 to July 2018, we retrospectively reviewed 36 pediatric patients who required mechanical circulatory support (MCS) for acute heart failure. Cases with postoperative MCS were excluded. Since 2016, we have tried to immediately add a right VAD rather than ECMO, when the patients begin to present features of right heart failure after left VAD support started in cases that the patients’ respiratory function did not require an oxygenator. Original diagnoses included dilated cardiomyopathy (n = 18), myocarditis (n = 11), and others (n = 7). Eleven patients were supported by Bi-VAD, and 25 patients were supported by ECMO; of these. Four patients were successfully weaned from VAD, and 10 patients were weaned from ECMO. Eleven patients underwent heart transplantation. Overall, we have 15 (41.7%) early mortalities. There were no significant differences in early mortality, morbidity, and weaning rate between the Bi-VAD group and the ECMO group. During the support, patients with Bi-VADs significantly required fewer platelets and showed less hemolysis than ECMO patients. Patients with myocarditis were successfully weaned from Bi-VAD support and bridged to transplantation thereafter. A temporary centrifugal pump-based Bi-VAD was clinically comparable to ECMO for pediatric patients with acceptable pulmonary function.

To evaluate the efficacy of selective lateral lymph node dissection (LLND) and the effect of preoperative chemoradiotherapy (PCRT) in patients with LLN ≥ 5 mm. Patients who underwent PCRT for rectal cancer were classified: (A) total mesorectal excision (TME)-only with LLN

INTRODUCTION: Historically, stillbirth risk factors are more prevalent among non-Hispanic Black women than non-Hispanic White women, including age < 20, lower formal educational attainment, prepregnancy obesity, smoking, hypertension, diabetes, short interpregnancy interval, small for gestational age newborn, late prenatal care, and previous cesarean birth. We examined whether these disparities have changed since 2011 and identified a group of risk factors that differed between Black women and White women when accounting for correlations among variables. METHODS: In a random sample of 315 stillbirths from the National Center for Health Statistics’ 2016 fetal death data, Black women and White women were compared for each risk factor using t-tests or chi-square tests. Variables with p ≤ .20 were analyzed using multivariate analysis of variance. RESULTS: In this sample, Black women experiencing stillbirth were less likely to have a Bachelor’s degree (12.94% vs. 28.49%, p = .04), and more likely to be obese (44.5% vs. 29.1%, p = .01) than White women. Multivariate analysis accounting for correlations among variables showed a group of risk factors that differed between Black women and White women: age < 20, lower education, prepregnancy obesity, hypertension (chronic and pregnancy-associated), nulliparity before stillbirth, and earlier gestation. CLINICAL IMPLICATIONS: Less formal education, obesity, age

Background Upper urinary tract urothelial carcinomas are relatively rare and have a cancer-specific survival rate of 20%–30%. The current gold standard treatment for nonmetastatic high-grade urinary tract urothelial carcinoma is radical nephroureterectomy with bladder cuff resection. Objective This study aimed to compare conditional cancer-specific survival between open radical nephroureterectomy and laparoscopic radical nephroureterectomy in patients with nonmetastatic stage pT3-4 or TxN(+) locally advanced urinary tract urothelial carcinoma from five tertiary centers. Methods The medical records of 723 patients were retrospectively reviewed. The patients had locally advanced and nodal staged tumors and had undergone open radical nephroureterectomy (n = 388) or laparoscopic radical nephroureterectomy (n = 260) at five tertiary Korean institutions from January 2000 and December 2012. To control for heterogenic baseline differences between the two modalities, propensity score matching and subgroup analysis were conducted. Conditional survival analysis was also conducted to determine survival outcome and to overcome differences in follow-up duration between the groups. Results During the median 50.8-month follow up, 255 deaths occurred. In univariate analysis, significant factors affecting cancer-specific survival (e.g., age, history of bladder cancer, American Society of Anesthesiologists score, pathological N stage, and presence of lymphovascular invasion and carcinoma in situ) differed in each subsequent year. The cancer-specific survival between patients treated with open radical nephroureterectomy and laparoscopic radical nephroureterectomy was not different between patients with and without a history of bladder cancer. After adjusting baseline differences between the two groups by using propensity score matching, both groups still had no significant differences in cancer-specific survival. Conclusion The two surgical modalities showed no significant differences in the 5-year cancer-specific survival in patients with locally advanced urinary tract urothelial carcinoma.