Identification of Mutations in the Thyroxine-Binding Globulin (TBG) Gene in Patients with TBG Deficiency in Korea

Background@#Thyroxine-binding globulin (TBG) is a major transporter protein for thyroid hormones. The serpin family A member 7 (SERPINA7) gene codes for TBG, and mutations of the SERPINA7 gene result in TBG deficiency. Although more than 40 mutations have been reported in several countries, only a few studies of TBG deficiency and SERPINA7 gene mutation have been performed in Korea. The aim of this study is to review the clinical presentations and laboratory findings of patients with TBG deficiency and to investigate the types of SERPINA7 gene mutation. @*Methods@#Five unrelated Korean adults with TBG deficiency attending endocrinology clinic underwent SERPINA7 gene sequencing. Four patients harbored a SERPINA7 gene mutation. Serum thyroid hormones, anti-microsomal antibodies, and TBG were measured. Genomic DNA was extracted from whole blood. All exons and intron-exon boundaries of the TBG gene were amplified and sequencing was performed. @*Results@#Two patients were heterozygous females, and the other two were hemizygous males. One heterozygous female had coexisting hypothyroidism. The other heterozygous female was erroneously prescribed levothyroxine at a local clinic. One hemizygous male harbored a novel mutation, p.Phe269Cysfs*18, which caused TBG partial deficiency. Three patients had the p.Leu372Phefs*23 mutation, which is known as TBG-complete deficiency Japan (TBG-CDJ) and was also presented in previous mutation analyses in Korea. @*Conclusion@#This study presents four patients diagnosed with TBG deficiency and provides the results of SERPINA7 gene sequencing. One novel mutation, p.Phe269Cysfs*18, causing TBD-partial deficiency and three cases of TBG-CDJ were demonstrated. It is necessary to identify TBG deficiency to prevent improper treatment. Also, sequencing of the SERPINA7 gene would provide valuable information about the TBG variants in Korea.

Bone Mineral Density Screening Interval and Transition to Osteoporosis in Asian Women

Background@#Bone mineral density (BMD) testing is indicated for women aged 65 years, but screening strategies for osteoporosis are controversial. Currently, there is no study focusing on the BMD testing interval in Asian populations. The current study aimed to evaluate the estimated time interval for screening osteoporosis. @*Methods@#We conducted a study of 6,385 subjects aged 50 years and older who underwent dual-energy X-ray absorptiometry screening more than twice at Samsung Medical Center as participants in a routine health checkup. Subjects were divided based on baseline T-score into mild osteopenia (T-score, –1.5), moderate osteopenia (T-score, ≤–1.5 to >–2.0), and severe osteopenia (T-score, ≤–2.0 to >–2.5). Information about personal medical and social history was collected by a structured questionnaire. @*Results@#The adjusted estimated BMD testing interval for 10% of the subjects to develop osteoporosis was 13.2 years in mild osteopenia, 5.0 years in moderate osteopenia, and 1.5 years in severe osteopenia. @*Conclusion@#Our study provides extended information about BMD screening intervals in Asian female population. Baseline T-score was important for predicting BMD screening interval, and repeat BMD testing within 5 years might not be necessary in mild osteopenia subjects.

Changes in the Long-term Prognosis of Crohn’s Disease between 1986 and 2015: The Population-Based Songpa-Kangdong Inflammatory Bowel Disease Cohort Study

Background/Aims@#The long-term course of Crohn’s disease (CD) has never been evaluated in non-Caucasian population-based cohorts. The aim of the present study was to evaluate the longterm prognosis of Korean CD patients in the well-defined population-based Songpa-Kangdong inflammatory bowel disease cohort. @*Methods@#Outcomes of disease and their predictors were evaluated for 418 patients diagnosed with CD between 1986 and 2015. @*Results@#During a median of 123 months, systemic corticosteroids, thiopurines, and anti-tumor necrosis factor (TNF) agents were administered to 58.6%, 81.3%, and 37.1% of patients, respectively. Over time, the cumulative probability of starting corticosteroids significantly decreased (p=0.001), whereas that of starting thiopurines and anti-TNFs significantly increased (both p<0.001). The cumulative probability of behavioral progression was 54.5% at 20 years, and it significantly decreased during the anti-TNF era. Intestinal resection was required for 113 patients (27.0%). The cumulative probabilities of intestinal resection at 1, 5, 10, 20, and 25 years after CD diagnosis were 12.7%, 16.5%, 23.8%, 45.1%, and 51.2%, respectively. Multivariable Cox regression analysis identified stricturing behavior at diagnosis (adjusted hazard ratio [aHR], 2.70; 95% confidence interval [CI], 1.55 to 4.71), penetrating behavior at diagnosis (aHR, 11.15; 95% CI, 6.91 to 17.97), and diagnosis of CD during the anti-TNF era (aHR, 0.51; 95% CI, 0.35 to 0.76) as independently associated with intestinal resection. The standardized mortality ratio among CD patients was 1.36 (95% CI, 0.59 to 2.68). @*Conclusions@#The long-term prognosis of Korean patients with CD is at least as good as that of Western CD patients, as indicated by the low intestinal resection rate. Moreover, behavioral progression and intestinal resection rates have decreased over the past 3 decades.

Serum Carcinoembryonic Antigen as a Biomarker for Medullary Thyroid Cancer

Background and Objectives@#The lack of known elevated biomarkers in cancer surveillance is a challenge for diagnostics. However, few studies have assessed the proportion of patients with medullary thyroid cancer (MTC) that presented with elevated serum carcinoembryonic antigen (CEA) level. @*Materials and Methods@#This was a retrospective study of 115 patients treated for MTC at Samsung Medical Center between 1995 and 2017. Serum calcitonin and CEA levels that were available at one of the following time points were included: (a) within 3 months before the initial surgery, (b) when a structural recurrence was confined to the neck, or (c) when a distant metastasis was identified during follow-up. Considering the high false-positive rate of serum CEA testing, 5 ng/mL was selected as the cut-off threshold. @*Results@#The sensitivity of CEA at the time of diagnosis was 54%, but it significantly increased with anatomical stage, from 20% in stage I to 88% in stage IV (p for trend ＜0.001). At the time of diagnosis, larger tumor size, more frequent gross extra-thyroidal extension, more frequent N1b, and a higher number of metastatic lymph nodes were significantly observed in CEA-positive patients compared with CEA-negative patients (p＜0.05). The sensitivity of CEA at the time of recurrence was 56% for local recurrence and 80% for distant recurrence. @*Conclusion@#The CEA value was associated with anatomical stage as a biomarker for MTC and could be used to predict poor prognosis. However, serum CEA testing plays a limited role in diagnosis and follow-up of MTC because it can show normal values even in advanced disease.

An exploratory study of the patients for the consultation and use of preventive dental service / 대한구강보건학회지

Objectives@#This study aims to identify the factors related to the consultation and use of preventive dental services among patients visiting dental clinics. @*Methods@#The self-reporting questionnaire survey was conducted among patients in Busan, South Korea, and overall, 319 patients participated in this study, with a response rate of 83.9%. @*Results@#Among the study participants, 74.6% stated that preventive service was necessary and 193 patients (60.5%) agreed to undergo consultation for preventive dental service. Consequently, 66.3% of patients who underwent consultation agreed to participate in preventive dental service.The most popular reason provided to receive this service was “to maintain teeth longer” (72.9%), whereas the common factor for declining was “lack of time” (49.3%). Most people who did not attend the consultation of preventive dental service mentioned that the dental staff “did not recommend the consultation” (43.9%). Logistic regression analysis for the consultation and service use for preventive dental service showed that dental clinics, age, and satisfaction were the most influential factors. @*Conclusions@#Both the characteristics of patients and dental clinics were important factors for people to agree to the consultation and use of preventive dental services. If dental staff launch efforts to improve the quality of service for the satisfaction of patients, it will increase participation in preventive dental services, which could help promote oral health and patients’ quality of life.

Clinicopathological Features of Patients Diagnosed with Both Primary Thyroid Cancer and Primary Renal Cell Cancer and Its Comparison with Patients with Thyroid Cancer or Renal Cell Cancer Alone

Background and Objectives@#Thyroid cancer (TC) and renal cell carcinoma (RCC) display more frequent co-occurrence than would be expected by chance. We investigated clinicopathological features of patients with both primary TC and primary RCC (TC/RCC) group to facilitate a greater understanding of the relationship between two cancers. @*Materials and Methods@#A total of 53 patients who diagnosed with TC/RCC were enrolled. 13,663 TC-alone and 3279 RCC-alone patients who had undergone surgery at Samsung Medical Center between 1994 and 2014 were included as control groups. The clinicopathological characteristics of these patients were retrospectively reviewed. @*Results@#The median age at the time of TC or RCC diagnosis was 54 years in TC/RCC group and the RCC-alone group, while the patients in TC-alone group were significantly younger (47 years). The TC/RCC group showed a nearly equal sex prevalence (49% male), significantly different than the results of the TC-alone group (80% female) and RCC-alone group (71% male). A higher grade of pathologic stage (56.6% in stage 3) and greater number of patients with multifocality of thyroid tumors (45 vs. 32%), and more family history of cancer (32 vs. 0.4%) were revealed in TC/RCC group than in TC-alone group. In addition, 15.1% of patients in TC/RCC group presented with additional primary cancers such as prostate, colon, stomach, breast, and lung cancers. Conclusion: Patients in the TC/RCC group have a high rate of cancer family history, multifocality of thyroid tumors, and additional cancers. To understand this unique subset group, additional studies for environmental and genetic factors would be helpful for earlier diagnosis of combined cancers.

Clinical Characteristics and Long-term Prognosis of Elderly-Onset Ulcerative Colitis in a Population-Based Cohort in the SongpaKangdong District of Seoul, Korea

Background/Aims@#We aimed to evaluate the clinical characteristics and long-term prognosis of elderly-onset ulcerative colitis (EOUC) in Korean patients over a 30-year period using a wellestablished population-based cohort in the Songpa-Kangdong district of Seoul, Korea. @*Methods@#Clinical characteristics and prognosis were compared between two groups: EOUC,defined as UC diagnosed in individuals aged ≥60 years and non-EOUC (N-EOUC), defined asUC diagnosed in individuals aged 18 to 59 years. @*Results@#We identified 99 patients with EOUC (10.3%) and 866 patients with N-EOUC (89.7%) between 1986 and 2015. During the median follow-up of 104.5 months, the overall exposure tomedications was comparable between patients with EOUC and N-EOUC (p=0.091 for corticosteroids, p=0.794 for thiopurines, and p=0.095 for anti-tumor necrosis factor agents). The cumula-tive risks of disease outcomes were also comparable between patients with EOUC and N-EOUC (22.4% vs 30.4% for proximal disease extension [p=0.351], 11.9% vs 18.1% for hospitalization [p=0.240], and 2.3% vs 1.8% for colectomy [p=0.977]) at 10 years after diagnosis. Multivariate Cox regression analysis revealed that corticosteroid use at diagnosis was an independent predic-tor of proximal disease extension (hazard ratio [HR], 6.216; 95% confidence interval [CI], 1.314 to 28.826) and hospitalization (HR, 11.241; 95% CI, 3.027 to 41.742) in patients with EOUC. @*Conclusions@#In this population-based study from Korea, the pattern of medication use seemed comparable between the EOUC and N-EOUC groups. Moreover, patients with EOUC and those with N-EOUC have a similar disease course in terms of proximal disease extension, hospitaliza-tion, and colectomy.

An exploratory study of the patients for the consultation and use of preventive dental service / 대한구강보건학회지

Objectives@#This study aims to identify the factors related to the consultation and use of preventive dental services among patients visiting dental clinics. @*Methods@#The self-reporting questionnaire survey was conducted among patients in Busan, South Korea, and overall, 319 patients participated in this study, with a response rate of 83.9%. @*Results@#Among the study participants, 74.6% stated that preventive service was necessary and 193 patients (60.5%) agreed to undergo consultation for preventive dental service. Consequently, 66.3% of patients who underwent consultation agreed to participate in preventive dental service.The most popular reason provided to receive this service was “to maintain teeth longer” (72.9%), whereas the common factor for declining was “lack of time” (49.3%). Most people who did not attend the consultation of preventive dental service mentioned that the dental staff “did not recommend the consultation” (43.9%). Logistic regression analysis for the consultation and service use for preventive dental service showed that dental clinics, age, and satisfaction were the most influential factors. @*Conclusions@#Both the characteristics of patients and dental clinics were important factors for people to agree to the consultation and use of preventive dental services. If dental staff launch efforts to improve the quality of service for the satisfaction of patients, it will increase participation in preventive dental services, which could help promote oral health and patients’ quality of life.

Clinicopathological Features of Patients Diagnosed with Both Primary Thyroid Cancer and Primary Renal Cell Cancer and Its Comparison with Patients with Thyroid Cancer or Renal Cell Cancer Alone

Background and Objectives@#Thyroid cancer (TC) and renal cell carcinoma (RCC) display more frequent co-occurrence than would be expected by chance. We investigated clinicopathological features of patients with both primary TC and primary RCC (TC/RCC) group to facilitate a greater understanding of the relationship between two cancers. @*Materials and Methods@#A total of 53 patients who diagnosed with TC/RCC were enrolled. 13,663 TC-alone and 3279 RCC-alone patients who had undergone surgery at Samsung Medical Center between 1994 and 2014 were included as control groups. The clinicopathological characteristics of these patients were retrospectively reviewed. @*Results@#The median age at the time of TC or RCC diagnosis was 54 years in TC/RCC group and the RCC-alone group, while the patients in TC-alone group were significantly younger (47 years). The TC/RCC group showed a nearly equal sex prevalence (49% male), significantly different than the results of the TC-alone group (80% female) and RCC-alone group (71% male). A higher grade of pathologic stage (56.6% in stage 3) and greater number of patients with multifocality of thyroid tumors (45 vs. 32%), and more family history of cancer (32 vs. 0.4%) were revealed in TC/RCC group than in TC-alone group. In addition, 15.1% of patients in TC/RCC group presented with additional primary cancers such as prostate, colon, stomach, breast, and lung cancers. Conclusion: Patients in the TC/RCC group have a high rate of cancer family history, multifocality of thyroid tumors, and additional cancers. To understand this unique subset group, additional studies for environmental and genetic factors would be helpful for earlier diagnosis of combined cancers.

Clinical Characteristics and Long-term Prognosis of Elderly-Onset Ulcerative Colitis in a Population-Based Cohort in the SongpaKangdong District of Seoul, Korea

Background/Aims@#We aimed to evaluate the clinical characteristics and long-term prognosis of elderly-onset ulcerative colitis (EOUC) in Korean patients over a 30-year period using a wellestablished population-based cohort in the Songpa-Kangdong district of Seoul, Korea. @*Methods@#Clinical characteristics and prognosis were compared between two groups: EOUC,defined as UC diagnosed in individuals aged ≥60 years and non-EOUC (N-EOUC), defined asUC diagnosed in individuals aged 18 to 59 years. @*Results@#We identified 99 patients with EOUC (10.3%) and 866 patients with N-EOUC (89.7%) between 1986 and 2015. During the median follow-up of 104.5 months, the overall exposure tomedications was comparable between patients with EOUC and N-EOUC (p=0.091 for corticosteroids, p=0.794 for thiopurines, and p=0.095 for anti-tumor necrosis factor agents). The cumula-tive risks of disease outcomes were also comparable between patients with EOUC and N-EOUC (22.4% vs 30.4% for proximal disease extension [p=0.351], 11.9% vs 18.1% for hospitalization [p=0.240], and 2.3% vs 1.8% for colectomy [p=0.977]) at 10 years after diagnosis. Multivariate Cox regression analysis revealed that corticosteroid use at diagnosis was an independent predic-tor of proximal disease extension (hazard ratio [HR], 6.216; 95% confidence interval [CI], 1.314 to 28.826) and hospitalization (HR, 11.241; 95% CI, 3.027 to 41.742) in patients with EOUC. @*Conclusions@#In this population-based study from Korea, the pattern of medication use seemed comparable between the EOUC and N-EOUC groups. Moreover, patients with EOUC and those with N-EOUC have a similar disease course in terms of proximal disease extension, hospitaliza-tion, and colectomy.

Influences of Sarcopenic and Non-sarcopenic Obesity on the Components of Metabolic Syndrome in Adolescents

PURPOSE: The purpose of this study was to investigate the influences of sarcopenic and non-sarcopenic obesity on the components of Metabolic Syndrome (MetS) in adolescents. METHODS: This study used the fifth Korean National Health and Nutrition Examination Survey data from 2010 to 2011. The study included 859 adolescents aged 12 to 18 years. Descriptive statistics and simple and multiple logistic regression analyses were conducted using SAS 9.2. RESULTS: Based on the results, adolescents with sarcopenic obesity had a higher risk of central obesity (AOR: 23.41, 95% CI: 12.76–43.97), high triglyceride (OR: 4.58, 95% CI: 2.69–7.79), low HDL-cholesterol (AOR: 2.66, 95% CI: 1.74–4.05), high blood pressure (AOR: 3.44, 95% CI: 1.37–8.68), and high fasting glucose (AOR: 2.37, 95% CI: 1.13–4.96) than their normal counterparts. Adolescents with non-sarcopenic obesity had a higher risk of central obesity (AOR: 19.75, 95% CI: 9.73–44.67), high triglyceride (OR: 3.09, 95% CI: 1.22–7.81), and low HDL-cholesterol (AOR: 2.73, 95% CI: 1.37–5.45) than normal youths, and these were not significantly related to high blood pressure and fasting glucose. CONCLUSION: Sarcopenic obesity was more related to the components of MetS than non-sarcopenic obesity. Since adolescents with sarcopenic obesity are a more vulnerable population, a prevention and management program for MetS and cardiovascular risk should be implemented in this population.

Effect of Palmitoyl-Pentapeptide (Pal-KTTKS) on Wound Contractile Process in Relation with Connective Tissue Growth Factor and α-Smooth Muscle Actin Expression

To evaluate whether Palmitoyl-pentapeptide (Pal-KTTKS), a lipidated subfragment of type 1 pro-collagen (residues 212–216), plays a role in fibroblast contractility, the effect of Pal-KTTKS on the expression of pro-fibrotic mediators in hypertropic scarring were investigated in relation with trans-differentiation of fibroblast to myofibroblast, an icon of scar formation. α-SMA was visualized by immunofluorescence confocal microscopy with a Cy-3-conjugated monoclonal antibody. The extent of α-SMA-positive fibroblasts was determined in collagen lattices and in cell culture study. Pal-KTTKS (0–0.5 µM) induced CTGF and α-SMA protein levels were determined by western blot analysis and fibroblast contractility was assessed in three-dimensional collagen lattice contraction assay. In confocal analysis, fibroblasts were observed as elongated and spindle shapes while myofibroblast observed as squamous, enlarged cells with pronounced stress fibers. Without Pal-KTTKS treatment, three quarters of the fibroblasts differentiates into the myofibroblast; α-SMA-positive stress fibers per field decreased twofold with 0.1 µM Pal-KTTKS treatment (75 ± 7.1 vs 38.6 ± 16.1%, n = 3, p<0.05). The inhibitory effect was not significant in 0.5 µM Pal-KTTKS treatment. Stress fiber level and collagen contractility correlates with α-SMA expression level. In conclusion, Pal-KTTKS (0.1 µM) reduces α-SMA expression and trans-differentiation of fibroblasts to myofibroblast. The degree of reduction is dose-dependent. An abundance of myofibroblast and fibrotic scarring is correlated with excessive levels of α-SMA and collagen contractility. Delicate balance between the wound healing properties and pro-fibrotic abilities of pentapeptide KTTKS should be considered for selecting therapeutic dose for scar prevention.

Inhibition of Fibrotic Contraction by C-Phycocyanin through Modulation of Connective Tissue Growth Factor and α-Smooth Muscle Actin Expression

The effects of C-phycocyanin (C-pc), a phycobiliprotein, on the expression of pro-fibrotic mediators in hyper-tropic scarring such as connective tissue growth factor (CTGF) and α-smooth muscle actins (α-SMA) were investigated in relation to trans-differentiation of fibroblast to myo-fibroblast, an icon of scar formation. C-pc was isolated from Spirulina Platensis extract using sonication method and C-pc concentration was determined by Bennet and Bogorad equation. α-SMA and CTGF levels in wounded primary human dermal fibroblasts were determined by western blot analysis and immuno-fluorescence confocal microscope was employed. Fibroblast contractility was examined by three-dimensional collagen lattice contraction assay. There was an elevation of α-SMA (121%) and CTGF (143%) levels in wound cells as compared with non-wound cells. The does-response profiles of down regulation demonstrated that the maximum inhibitions of α-SMA by 63% (p<0.05) and CTGF by 50% (p<0.1) were achieved by C-pc (6 nM) treated cells. In confocal assay, non-wound fibroblasts exhibited basal level of α-SMA staining, while wounded cells without C-pc treatment showed strong up-regulation of α-SMA by 147% (p<0.05). C-pc (6 nM) inhibited α-SMA expression by 70% (p<0.05) and reduced collagen contraction by 29% (p<0.05). C-pc seemed to lessen the over expression of CTGF, α-SMA, subsequently alleviating the fibrotic contracture. This study suggests the potential application of C-pc to regulation of the expression of pro-fibrotic mediators in scarring process and its potential usage as an efficient means for anti-fibrosis therapy.

Troglitazone Enhances the Apoptotic Response of DLD-1 Colon Cancer Cells to Photodynamic Therapy

PURPOSE: The aim of this study was to investigate whether the peroxisomal proliferator-activated receptor gamma (PPARγ) ligand troglitazone in combination with photodynamic therapy (PDT) enhances the apoptotic response of DLD-1 colon cancer cells. MATERIALS AND METHODS: The effects of troglitazone, PDT, and troglitazone in combination with PDT on cell viability and apoptosis were assessed in DLD-1 cells. Cell viability and proliferation were evaluated using the tetrazolium-based MTT assay, and apoptosis was evaluated via cell staining with propidium iodide (PI) and annexin V-FITC. The levels of pro-caspase-3 were measured via Western blot analyses. RESULTS: Treatment of troglitazone and PDT induced the growth retardation and cell death of DLD-1 cells in a dose-dependent manner, respectively. The combination treatment significantly suppressed cell growth and increased the apoptotic response of DLD-1 and resulted in apoptosis rather than necrosis, as shown by PI/annexin V staining and degradation of procaspase-3. CONCLUSION: Conclusion: These results document the anti-proliferative and apoptotic activities of PDT in combination with the PPARγ ligand troglitazone and provide a strong rationale for testing the therapeutic potential of combination treatment in colon cancer.

Troglitazone Enhances the Apoptotic Response of DLD-1 Colon Cancer Cells to Photodynamic Therapy

PURPOSE: The aim of this study was to investigate whether the peroxisomal proliferator-activated receptor gamma (PPARγ) ligand troglitazone in combination with photodynamic therapy (PDT) enhances the apoptotic response of DLD-1 colon cancer cells. MATERIALS AND METHODS: The effects of troglitazone, PDT, and troglitazone in combination with PDT on cell viability and apoptosis were assessed in DLD-1 cells. Cell viability and proliferation were evaluated using the tetrazolium-based MTT assay, and apoptosis was evaluated via cell staining with propidium iodide (PI) and annexin V-FITC. The levels of pro-caspase-3 were measured via Western blot analyses. RESULTS: Treatment of troglitazone and PDT induced the growth retardation and cell death of DLD-1 cells in a dose-dependent manner, respectively. The combination treatment significantly suppressed cell growth and increased the apoptotic response of DLD-1 and resulted in apoptosis rather than necrosis, as shown by PI/annexin V staining and degradation of procaspase-3. CONCLUSION: Conclusion: These results document the anti-proliferative and apoptotic activities of PDT in combination with the PPARγ ligand troglitazone and provide a strong rationale for testing the therapeutic potential of combination treatment in colon cancer.

The Effects of Shift Work and Hours of Sleep on Metabolic Syndrome in Korean Workers / 한국직업건강간호학회지

PURPOSE: The purpose of this study was to investigate the effects of shift work and hours of sleep on metabolic syndrome in Korean workers. METHODS: This study used the Korean National Health and Nutrition Examination Survey data of 2014. The study included 1,579 Korean workers aged over 20. χ2 test, t-test, and hierarchical multiple logistic regression were used for statistical analysis of data. RESULTS: From the univariate analysis, hours of sleep, regular work, occupational group, sex, age, marital status, education, smoking, and self-rated health were significantly related to metabolic syndrome. After adjusting demographic, occupational, and health-related variables, workers with under 6 hours/day of sleep showed higher risk for metabolic syndrome (AOR: 1.56, 95% CI: 1.01~2.44), and shift work was not significantly related to metabolic syndrome. Male laborers and workers aged 40 or older also showed higher risk for metabolic syndrome. CONCLUSION: Results of this study suggest that workers with under 6 hours of sleep, male laborers and workers aged 40 or older are the risk groups of metabolic syndrome. Therefore, prevention and management program for metabolic syndrome should be implemented for this population.

Effect of Job Insecurity on Job related Depression and Anxiety: Large- and Small-sized Company Employees / 한국직업건강간호학회지

PURPOSE: The purpose of this study was to investigate the influences of job insecurity on job related depression and anxiety in large- and small-sized company employees. METHODS: Data of the third Korean Working Condition Survey in 2011 were used. Subjects were 2,050 large-sized company employees and 18,924 small-sized company workers. χ² test and multiple logistic regression using SAS 9.2 were conducted. RESULTS: Large- and small-sized company employees showed significant differences in terms of demographic, health-related, and job-related characteristics. From the bivariate analysis, gender, income, self-rated health, occupation, working hours per week, job-related stress, workplace violence, and job insecurity were significantly related to job-related depression/anxiety in large-sized company employees. From the multivariate analysis, higher income (AOR: 0.22, 95%CI: 0.07~0.71), better health perception (AOR: 0.05, 95%CL: 0.01~0.18), 40 or more working hours per week (AOR: 0.20, 95%CI: 0.05~0.79) showed lower risk for job-related depression/anxiety. From the bivariate and multivariate analysis, better health perception (AOR: 0.32, 95%CI: 0.20~0.53), higher job-related stress (AOR: 2.57, 95%CI: 1.68~3.93, workplace violence experience (AOR: 4.26; 95%CI: 2.88~6.30), and job insecurity experience (AOR: 1.90, 95%CI: 1.18~3.05) were significantly related to job-related depression/anxiety in small-sized company employees. CONCLUSION: Results of this study suggest that job insecurity experience was significantly related to job-related depression/anxiety in small-sized company employees but not in large-sized company employees. Therefore, small-sized company workers who have experienced feeling of job insecurity are vulnerable population in terms of job-related depression/anxiety.

Factors Influencing Physical Activity among Community-dwelling Older Adults with Type 2 Diabetes: A Path Analysis

PURPOSE: The purpose of the study was to identify factors influencing physical activity among community-dwelling older adults with type 2 diabetes. The study design was based on the Theory of Triadic Influence. METHODS: A total of 242 older adults with type 2 diabetes participated in this study. Six variables related to physical activity in older adults, including self-efficacy, social normative belief, attitudes, intention, experience, and level of physical activity, were measured using reliable instruments. Data were analyzed using descriptive statistics, Pearson's correlation analyses, and a path analysis. RESULTS: The mean physical activity score was 104.2, range from zero to 381.21. The path analysis showed that self-efficacy had the greatest total effect on physical activity. Also, experience had direct and total effects on physical activity as well as mediated the paths of social normative beliefs to attitudes and intention to physical activity. These factors accounted for 10% of the total variance, and the fit indices of the model satisfied the criteria of fitness. CONCLUSION: The findings of the study reveal the important role of self-efficacy and past experience in physical activity in older adults with type 2 diabetes.

Construction of a Structural Model Incorporating Nurse Image, Image Determinants, and Self-esteem for Evaluation of Cambodian Nursing Students / 한국간호교육학회지

PURPOSE: This study, on the basis of a structural model that includes nurse image, image determinants, and self-esteem of Cambodian nursing students influenced by the Korean nursing education system, demonstrates distinctions between senior and junior according to experience in clinical practice. METHODS: Data were collected via a questionnaire from 194 nursing students in Cambodia and subsequently analyzed using the STATA IC 12 program. RESULTS: First, image determinants and their sub-factors-subjective, institutional, and media-effect both the nurse image and self-esteem of nursing students. Second, the study confirms that nurse image has no significant effect on self-esteem. Also, the individual factor, a sub-factor of nurse image, possesses a weak relationship with nurse image. Third, the structural model mediating between senior and junior reveals differences resulting from experiences derived from clinical practice. CONCLUSION: The study has significance in that Cambodian nursing students, who are rarely studied in terms of nurse image, have been systemically analyzed via a structural model incorporating image determinants and self-esteem.

Factors Affecting Job-Seeking Stress in Nursing Students / 한국직업건강간호학회지

PURPOSE: The purpose of this study was to investigate what factors are affecting job-seeking stress in nursing students. METHODS: Subjects were 463 students from two 3-year and two 4-year colleges of nursing in K-Province in Korea. Data was collected from self-administered questionnaires. t-test, ANOVA, Pearson's and Spearman's correlation coefficients, and hierarchical multiple regression with dummy variables were used for statistical analysis of data. RESULTS: Job-seeking stress was significantly different by school system (t=2.76, p=.006), family economic status (F=3.40, p=.005), characteristics (t=1.99, p=.047), academic achievement (F=6.54, p=.002), current weight control status (t=2.23, p=.026), times of cosmetic surgery (r=.11, p=.022), self-esteem (r=-.47, p<.001) and appearance stress (r=.40, p<.001). However, after controlling for general characteristics, self-esteem, and perceived appearance stress, job-seeking stress was significantly different by grade (1st vs 3rd, beta=0.163, p<.001), academic achievement (low vs. high, beta=-0.121, p=.0321), self-esteem (beta=-0.224, p<.001), and appearance stress (beta=0.099, p<.001). The explanation power of self-esteem on job-seeking stress was greater compared with that of appearance stress. CONCLUSION: Results of this study suggest that it is necessary for nursing students to develop intervention program aimed at reducing job-seeking stress, and it would be effective to focus on improving self-esteem for them.