Change of Femoral Anteversion Angle in Children With Intoeing Gait Measured by Three-Dimensional Computed Tomography Reconstruction: 3-Year Follow-Up Study

Objective@#To investigate long-term changes in femoral anteversion angle (FAA) in children with intoeing gait and to identify factors that affect FAA changes. @*Methods@#We retrospectively analyzed three-dimensional computed tomography data from 2006 to 2022 of children with intoeing gait with ≥3 years of follow-up without active treatment. The study examined the mean changes in FAA, the effects of sex, age, and initial FAA on FAA change, and mean FAAs by age. Changes in FAA severity up to eight years of age were also observed and analyzed by sex. @*Results@#A total of 126 lower limbs of 63 children (30 males, 33 females) with intoeing gait were included, with a mean age of 5.11±1.05 years and a mean follow-up period of 43.59±7.74 months. The initial FAA was 41.42°±8.29° and the follow-up FAA was 33.25°±9.19°, indicating a significant decrease (p<0.001). Significant correlations were observed between age and changes in FAA, as well as between initial FAA and changes in FAA (r=0.248, p=0.005; r=-0.333, p<0.001). At age 8 years, only 22 limbs were classified as having mild FAA severity. @*Conclusion@#During the follow-up period, children with intoeing gait had a significant decreased in FAA. No significant difference in FAA change was found between sex, but younger children and those with greater initial FAA were more likely to have decreased FAA. However, most children retained moderate to severe severity of increased FAA. Further studies are required to validate these findings.

Associations between Frailty in Older Adults and Malnutrition in Rural Areas: 2019 Updated Version of the Asian Working Group for Sarcopenia

Purpose@#The purpose of this study was to evaluate the prevalence of frailty among an older adult population living in rural communities and to determine if frailty is associated with nutritional status after adjusting for sarcopenia and depression. @*Materials and Methods@#This research used baseline data from the Namgaram-2 study. Frailty was evaluated using the Kaigo-Yobo checklist in an older Korean population. The nutritional statuses of older people were measured using the Korean version of the mini nutritional assessment (MNA). The recent criteria of the Asian Working Group for Sarcopenia were applied for diagnosis of sarcopenia, and depression was assessed using the Geriatric Depression Scale-Short Form. @*Results@#The prevalence of frailty was 18.8% (male: 9.6%; female: 23.4%) and was significantly higher in individuals in their 80s [male, 35.3% (p<0.001); female, 42.3% (p<0.001)], those of poor economic status [male, 18.2% (p=0.012); female, 34.9% (p<0.001)], those with hypertension [female, 27.7% (p=0.008)], those with sarcopenia [male, 34.1% (p<0.001); female, 37.2% (p<0.001)], those with depression [male, 46.4% (p<0.001); female, 51.7% (p<0.001)], and those at high risk of malnutrition [male, 44.4% (p<0.001); female, 51.7% (p<0.001)]. After adjusting for demographic variables, including hypertension, diabetes, sarcopenia and depression, frailty was significantly associated with nutritional status [male: odds ratio (OR)=6.73, 95% confidence interval (CI), 1.84–24.65; female: OR=4.83, 95% CI, 2.88–8.11]. @*Conclusion@#For older adults, MNA is a suitable tool of use in assessing both nutritional status and frailty. Moreover, the nutritional status of older adults appears to be associated with frailty, even after corrections for physical and psychological function.

Cohort Profile: Firefighter Research on the Enhancement of Safety and Health (FRESH), a Prospective Cohort Study on Korean Firefighters

40 years or new hires with less than 1 year of service.

Barriers related to Walking Activity according to the Age Group of Rural residents / 農村醫學 地域保健

Objective@#This study aimed to report the relationship between walking activity and perceived physical activity barriers after classifying the age group(≤64, 65-74, ≥75). @*Methods@#The subjects were conducted on 1500 residents of two areas, and the walking activity was defined as five or more times a week, 10 minutes or more at a time, and 30 minutes or more per day. Perceived physical activity barriers were lack of time, lack of social support, lack of energy, lack of willpower, and fear of falling. @*Results@#In the group under 64 year, the lack of time (exp(B)=0.819, p=0.002) and the lack of willpower (exp(B)=0.656, p<0.001) were significantly associated. In the 65-74 year old group, the lack of willpower (exp(B)=0.714, p<0.001) and fear of falling (exp(B)=0.787, p=0.003) were a significant association. In the group aged 75 years and over, lack ofwill power (exp(B)=0.734, p<0.001) and fear of falling (exp(B)=0.807, p=0.003) were significantly associated. @*Conclusion@#In order to solve the lack of willpower and lack of time, a walking activity should be performed together at a certain time in the village, and the elderly in the late ages should reduce the fear of falling by performing a fall prevention exercise in parallel.

Validation of the Western Ontario and McMaster Universities Arthritis Index Short Form (WOMAC-SF) and Its Relevance to Disability and Frailty

PURPOSE: This study aimed to evaluate the validity of the Western Ontario and McMaster Universities Arthritis Index Short Form (WOMAC-SF) for the assessment of musculoskeletal disorders. We evaluated whether WOMAC-SF correlated with the World Health Organization Disability Assessment Schedule 12 (WHODAS-12) and Kaigo-Yobo questionnaires for assessing health-outcomes in Korea.MATERIALS AND METHODS: This cross-sectional study used data from the Namgaram-2 cohort. WOMAC, WOMAC-SF, WHODAS-12, and Kaigo-Yobo questionnaires were administered to patients with musculoskeletal disorders, including radiology-confirmed knee osteoarthritis (RKOA), sarcopenia, and osteoporosis. The relationships among WOMAC-SF, WHODAS-12, and Kaigo-Yobo scores were analyzed by stepwise multiple regression analysis.RESULTS: WOMAC-SF was associated with the WOMAC questionnaire. The results of confirmatory factor analysis for the hypothesized model with two latent factors, pain and function, provided satisfactory fit indices. WOMAC-SF pain and function were associated with RKOA. Kaigo-Yobo was associated with WOMAC-SF pain (B=0.140, p=0.001) and WOMAC-SF function (B=0.042, p=0.004). WHODAS-12 was associated with WOMAC-SF pain (B=0.679, p=0.003) and WOMAC-SF function (B=0.804, p<0.001).CONCLUSION: WOMAC-SF was validated for the evaluation of low extremity musculoskeletal disorders and health-related quality of life in a community-based population. Furthermore, we confirmed that WOMAC-SF were reflective of disability and frailty, which affect health outcomes.

Prevalence of Upper Extremity Musculoskeletal Diseases and Disability among Fruit Tree Farmers in Korea: Cross-Sectional Study

PURPOSE: The aim of this study was to examine the prevalence of upper extremity musculoskeletal (MSK) diseases and to identify factors influencing disability among fruit tree farmers in Korea. MATERIALS AND METHODS: Of the 1150 subjects of the Namgaram study, 460 fruit tree farmers completed a questionnaire and underwent clinical evaluations, including physical assessments, laboratory tests, simple radiographic examinations, and magnetic resonance imaging studies of the upper extremities. Disability was assessed using the Disabilities of the Arm, Shoulder, and Hand outcome measure. Data were analyzed with descriptive statistics and regression analyses using SPSS Win 24.0. RESULTS: The prevalences of upper extremity MSK diseases were 60.4% for rotator cuff tear, 20.9% for golf elbow, 40.9% for tennis elbow, and 58.0% for hand osteoarthritis. Disability in fruit farmers was associated with female sex (B=−4.47, p<0.001), smoking (B=−4.00, p=0.026), depression (B=2.83, p<0.001), working hours (B=0.96, p=0.001), injuries of the arms (B=10.78, p<0.001) and shoulders (B=6.75, p<0.001), and numbers of upper extremity MSK diseases (B=2.02, p=0.001), with 26.5% of the variance explained (R2=0.265, Durbin-Watson test=1.81, p<0.001). CONCLUSION: Fruit tree farmers remain at risk for MSK diseases of the upper extremities. Disability tended to worsen with more MSK diseases. It is necessary to not only educate farmers about prevention strategies, but also to develop an effective management system for agricultural work-related MSK diseases and a surveillance system at the government level for the health problems of farmers.

Effect of Burnout on Post-traumatic Stress Disorder Symptoms Among Firefighters in Korea: Data From the Firefighter Research on Enhancement of Safety & Health (FRESH) / 예방의학회지

OBJECTIVES@#It is well-known that post-traumatic stress disorder (PTSD) among firefighters contributes to their job-related stress. However, the relationship between burnout and PTSD in firefighters has rarely been studied. This study therefore explored the association between burnout and its related factors, such as trauma and violence, and PTSD symptoms among firefighters in Korea.@*METHODS@#A total of 535 firefighters participated in the Firefighter Research on Enhancement of Safety & Health study at 3 university hospitals from 2016 to 2017. The 535 participants received a baseline health examination, including questionnaires assessing their mental health. A Web-based survey was also conducted to collect data on job-related stress, history of exposure to violence, burnout, and trauma experience. The associations among burnout, its related factors, and PTSD symptoms were investigated using structural equation modeling.@*RESULTS@#Job demands (β=0.411, p<0.001) and effort-reward balance (β=-0.290, p<0.001) were significantly related to burnout. Burnout (β=0.237, p<0.001) and violence (β=0.123, p=0.014) were significantly related to PTSD risk. Trauma (β=0.131, p=0.001) was significantly related to burnout; however, trauma was not directly associated with PTSD scores (β=0.085, p=0.081).@*CONCLUSIONS@#Our results show that burnout and psychological, sexual, and physical violence at the hands of clients directly affected participants’ PTSD symptoms. Burnout mediated the relationship between trauma experience and PTSD.

The Association of Perceived Neighborhood Walkability and Environmental Pollution With Frailty Among Community-dwelling Older Adults in Korean Rural Areas: A Cross-sectional Study / 예방의학회지

OBJECTIVES@#The aim of this study was to evaluate the associations of frailty with perceived neighborhood walkability and environmental pollution among community-dwelling older adults in rural areas.@*METHODS@#The participants were 808 community-dwelling men and women aged 65 years and older in 2 rural towns. Comprehensive information, including demographics, socioeconomic status, grip strength, polypharmacy, perceived neighborhood environment (specifically, walkability and environmental pollution), and frailty, was collected from participants using face-to-face interviews conducted between June and August 2018. Perceived neighborhood walkability was measured using 20 items that were selected and revised from the Neighborhood Environment Walkability Scale, the Neighborhood Walkability Checklist from the National Heart Foundation of Australia, and the Physical Activity Neighborhood Environment Survey. The Kaigo-Yobo Checklist was used to assess participants’ frailty.@*RESULTS@#The overall prevalence of frailty in this community-dwelling population was 35.5%. Sex, age, cohabitation status, educational attainment, employment status, grip strength, and polypharmacy were significantly associated with frailty. In the logistic regression analysis, frailty was associated with low perceived neighborhood walkability (adjusted odds ratio [aOR], 0.881; 95% confidence interval [CI], 0.833 to 0.932; p<0.001) and severe perceived neighborhood environmental pollution (aOR, 1.052; 95% CI, 1.017 to 1.087; p=0.003) after adjusting for sex, age, cohabitation status, educational attainment, employment status, monthly income, grip strength, and polypharmacy.@*CONCLUSIONS@#More studies are warranted to establish causal relationships between walkability and environmental pollution and frailty.

Common Upper Extremity Disorders and Function Affect Upper Extremity-Related Quality of Life: A Community-Based Sample from Rural Areas

PURPOSE: Upper extremity musculoskeletal disorders (UEMDs), such as rotator cuff tear, epicondylitis, and hand osteoarthritis, have a negative impact on quality of life (QOL). In this study, we evaluated the prevalence of rotator cuff tear, lateral and medial epicondylitis, and hand osteoarthritis in the dominant side and the impact of these UEMDs on the disabilities of the arm, shoulder, and hand (DASH) outcome measure, which assesses upper extremity-related QOL. MATERIALS AND METHODS: In 2013–2015, 987 participants from rural areas completed a questionnaire and underwent physical examinations, laboratory tests, simple radiographic evaluations of bilateral upper extremities, and magnetic resonance imaging studies of bilateral shoulders. Based on data from these participants, researchers evaluated DASH and performed a functional assessment of each region of the dominant side and related UEMDs. RESULTS: The prevalences of epicondylitis, rotator cuff tear, and hand osteoarthritis were 33.7%, 53.4%, and 44.6%, respectively. Univariate regression analysis results revealed that epicondylitis, epicondylitis+rotator cuff tear, epicondylitis+hand osteoarthritis, and epicondylitis+rotator cuff tear+hand osteoarthritis were significantly associated with DASH score. Multiple regression analysis, including DASH, UEMD, and regional functional assessments, showed that only epicondylitis and epicondylitis+rotator cuff tear were associated with DASH score. CONCLUSION: Epicondylitis significantly affected QOL, while other UEMDs, such as hand osteoarthritis and rotator cuff tear, had no significant impact. When a patient's QOL is affected by a UEMD, there is an increased possibility of the simultaneous presence of other UEMDs.

Impact of Health-related Quality of Life in Firefighters: Focused on Posttraumatic Stress, Health-related Work Limitations, and Family Support / 한국직업건강간호학회지

PURPOSE: The purpose of this descriptive, cross-sectional study was to identify the factors affecting health-related quality of life by examining the relationships among posttraumatic stress, health-related work limitations, and family support in firefighters. METHODS: The data were collected from 390 firefighters working in four fire stations located in the G district using self-report questionnaires. The collected data were analyzed using descriptive statistics, t-test, one-way ANOVA along with the Scheffé test, and multiple regression. RESULTS: As per the results of multiple regression analysis, the factors affecting health-related quality of life in firefighters were posttraumatic stress, health-related work limitations, and family support. This model explained 31% of the variance in health-related quality of life (F=30.03, p<.001). CONCLUSION: Considering the findings of this study, there is a need to reduce posttraumatic stress and health-related work limitations and develop family support toward firefighters.

Habitual exercise and falls among community-dwelling older Japanese adults / 体力科学

The purpose of this study was to retrospectively examine the association of habitual exercise with “single fall (= 1)”, “multiple falls (≥ 2)”, and “injurious falls (≥ 1)” among community-dwelling older adults. A total of 1,683 community-dwelling older adults, aged 60-97 years (72.6 +/- 6.6 yr, 512 men and 1,171 women) were included in this study. Habitual exercises continued one year or longer (6.4 +/- 9.5 yr) were classified into twelve types. Exercise components (time, quantity, period of continuity, and number of exercises) were divided with median or tertiles. To assess the association between habitual exercises and fall status, multivariable logistic regression analyses with stepwise selection method, were applied. The multivariable logistic regression analyses showed that dance (odds ratio (OR): 0.30, 95% confidence interval (CI): 0.09-0.96) was negatively associated with “single fall”. Bicycling (OR: 3.72, 95% CI: 1.32-10.77) was positively associated with “multiple falls”, and the period of continuity (OR: 0.74, 95% CI: 0.60-0.91) was negatively associated with “multiple falls”. None of the exercise components were selected with regard to “injurious falls”. Results indicate that dance may be an effective type of exercise for fall prevention among community-dwelling older adults. However, caution about falling is warranted toward bicycling as an exercise. Moreover, a longer period of continuity (≥ 4 years) appears to be a positive factor of habitual exercise for fall prevention.

Cross-sectional analysis of hierarchy of higher-level functional capacity and quantity/intensity of physical activity in older women / 体力科学

The purpose of this study was to examine the association between the hierarchy of higher-level functional capacity (instrumental self-competence, intellectual activity, social role) and the quantity of physical activity in older women (n = 175, 72.1 ± 5.8 years). Physical activity was estimated with a uniaxial accelerometer that calculated light-intensity physical activity (LPA), and moderate-to vigorous-intensity physical activity (MVPA). Higher-level functional capacity was assessed with the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence. According to the three subscales (instrumental self-competence, intellectual activity, and social role) of the TMIG index, participants who reported a score of 1 or more below the respective full marks were categorized as a group with reduced status. Logistic regression analysis was conducted to examine association between the hierarchy of higher-level functional capacity and the quantity of physical activity divided by intensity of activity, adjusted by covariance. Only low MVPA showed a significantly lower odds ratio than high MVPA in reduced status of instrumental self-competence. Since instrumental self-competence was significantly related with only the quantity of MVPA, it may be more important to focus on “quantity” of physical activity to prevent reductions in higher-level functional capacity in advanced stages of declining functional capacity.

IDENTIFICATION OF THE PHYSICAL FUNCTION OF FRAIL OLDER ADULTS AND EFFECTIVITY OF THE HEALTH CHECK-UP QUESTIONNAIRE (KIHON CHECK-LIST) / 体力科学

The purposes of this study were (i) to determine the characteristics of physical function for frail older adults, compared with those for the independent and the dependent, (ii) to examine validity of the “health check-up questionnaire” (Kihon Check-list: CL) for finding frail older adults. Five hundred thirty-nine older Japanese people (75.5 ± 7.0 years) were assigned to each one of the three categories: the independent, the frail and the dependent according to the classification criteria of long-term care insurance system. Physical function score (PFS) was estimated by principal components analysis. Logistic regression analysis was conducted to assess validity of the CL and to examine the screening tool for detecting frail older adults who have a higher risk for becoming the dependent. Significant differences were observed among the three groups in PFS (the independent, 0.580 ± 0.467; the frail, -0.309 ± 0.733; the dependent -1.347 ± 0.949). The Odds ratio (OR) of the dependent for older adults to whom the CL was applied was 2.4 (95% confidence interval (CI): 1.3 - 4.5), and the OR for those to whom both the CL and the hand-grip strength test were applied was 5.4 (2.6 - 11.5). These data suggest that the comprehensive status of physical function of frail older adults, which varied widely, was intermediate between the independent and the dependent. It is useful to add the hand-grip strength test to the CL as a screening tool to subdivide frail older adults.

DISCRIMINATION OF MOBILITY LIMITATION BY HAND-GRIP STRENGTH AMONG COMMUNITY-DWELLING OLDER ADULTS / 体力科学

The purpose of this study was to determine whether hand-grip strength (HGS) can be a significant discrimination factor of mobility limitation (ML) among older adults. Cross-sectional analysis was conducted on data from 939 community-dwelling older adults, aged 65-96 years (74.4 ± 6.4 yr, 266 men, 673 women). ML was defined as self-reported difficulty in walking 400 m, climbing 10 steps, and rising from a chair. Trained testers assessed standardized measurements of HGS and lower extremity performance score (LEPS) calculated by four tests (i.e., tandem stance, 5-chair sit-to-stand, alternate step, and timed up & go). Receiver operating characteristic (ROC) analysis was conducted to identify discrimination power of HGS and LEPS for ML. The areas under the ROC curves (AUCs) of HGS and LEPS for ML were 0.82 and 0.87 in men; 0.70 and 0.85 in women, respectively. No significant difference was detected between the AUCs of HGS and LEPS (<i>P</i> = 0.12) in men, whereas in women, the AUC was significantly lower in HGS than LEPS (<i>P</i> < 0.001). The optimal HGS cut-off values for ML were 31.0 kg (sensitivity 75%, specificity 81%) for men and 19.6 kg (sensitivity 73%, specificity 57%) for women. In men, the HGS test could be as useful as LEPS for identifying ML. In women, discrimination power for ML by HGS alone was considered acceptable; however, a combination of HGS and lower extremity performance tests could be more useful for monitoring the hierarchical levels of physical frailty.

ASSOCIATION BETWEEN HABITUAL WALKING AND MULTIPLE OR INJURIOUS FALLS AMONG COMMUNITY-DWELLING OLDER ADULTS ∼ DIFFERENCE BY RISK OF FALLING ∼ / 体力科学

<b>BACKGROUND:</b> The purpose of this study was to examine the association between habitual walking and multiple or injurious falls among community-dwelling older adults. <b>METHODS:</b> Cross-sectional analysis was conducted on the data from 708 community-dwelling older adults, aged 60-91 years (72.3 +/- 6.6 yr, 233 men and 475 women). Prevalence of falls between walkers and non-walkers was compared separately by the number of risk factors (Groups R0, R1, R2, R3 and R4+). Logistic regression analysis was used to assess the association between habitual walking and falls separately by lower (R<3) and higher (R3+) risk groups. An interaction between habitual walking and risk of falling was examined in logistic regression analysis among all participants. <b>RESULTS:</b> In Groups R0, R1 and R2, prevalence of falls was lower in walkers than non-walkers; however, in Groups R3 and R4+, prevalence of falls was higher in walkers. Logistic regression analysis showed that habitual walking was significantly associated with fewer falls (Odds ratio (OR): 0.44, 95% confidence interval (CI): 0.20-0.97) among the lower risk group, but significantly associated with greater falls (OR: 4.61, 95% CI: 1.32-16.09) among the higher risk group. The interaction between habitual walking and higher risk of falling was significant (<i>P</i> < 0.05). <b>CONCLUSION:</b> Habitual walking seems to positively affect the prevention of multiple or injurious falls but only in community-dwelling older adults who have less than three risk factors.

FALL-RELATED FACTORS TO TARGET IN COMMUNITY-BASED INTERVENTIONS FOR PREVENTION OF FALLS / 体力科学

Fall-related factors (FRFs) are classified into intrinsic factors and extrinsic factors. Intervention programs, which focused on modifiable factors (MFs) among FRFs have been designed to prevent falls. The purpose of this study was to identify easily-measurable intrinsic MFs for falls and recurrent falls. Cross-sectional analysis was carried out on the data from 483 community-dwelling older adults, aged 65-92 years (73.7 ± 5.9 yr, 138 men, 345 women). We measured history of falls in the past year and 7 domains of FRFs. Of these, 20 items were selected as MFs. Analyses of FRFs and MFs were conducted by comparing (separated by sex) those who did not report a fall with those who reported any number of falls, and those who reported no falls or one fall with those who reported recurrent falls. Using the significant items as independent variables, multiple logistic regression analysis with forward selection method was performed. The prevalence of falls and recurrent falls was: in men, 24.6% and 14.5%; in women, 26.7% and 12.5%. There were no significant differences in prevalence of falls or recurrent falls between genders. The following items were selected as the MFs most strongly associated with falls: climbing 10 steps with difficulty and tandem walk; and associated with recurrent falls: climbing 10 steps with difficulty, sit and reach, and tandem walk. These results are useful in determining the focus of fall prevention programs to be used in future community-based interventions.

Mitochondrial DNA Aberrations of Bone Marrow Cells from Patients with Aplastic Anemia

This study was undertaken primarily to test the hypothesis that mitochondrial DNA (mtDNA) mutations may be associated with aplastic anemia. Complete mtDNA nucleotide sequence was analyzed in nine and eight bone marrow specimens from Korean patients with aplastic anemia and healthy individuals, respectively. We found a large number of polymorphisms as well as apparent new mutations in both patients and controls throughout the entire mtDNA genome; 12 mutations harbored amino acid changes in patients and none of the mutations in controls produced amino acid changes. There were heteroplasmic mutations and more nonsynonymous mtDNA changes observed in patients, so the mean number of mtDNA aberrations of bone marrow cells showed statistically significant difference overall between patients (mean=25.6) and controls (mean=12.8) (p=0.019). Our data may support an association of mtDNA aberrations with aplastic anemia.

Effect of Vitamin E on Cadmium Accumulation and Excretion in Chronic Cadmium Poisoned Rats

The purpose of this study was to investigate the effect of vitamin E on the cadmium accumulation in body, cadmium excretion and detoxification functions in chronic cadmium poisoned rats. Sprague-Dawley male rats weighing 100+/-10 g were randomly assigned to one normal group and three cadmium poisoned groups. Cadmium poisoned groups were classified to vitamin E free diet (Cd-0E group), vitamin E 40 mg/kg diet (Cd-400E group) and 400 mg/kg diet (Cd-400E group) according to the levels of vitamin E supplement. Animals were maintained on 0, 40 mg and 400 mg vitamin E/kg diets for 20 weeks and simultaneously administered 50 ppm Cd2+ dissolved in the drinking water. Body weight, food intakes and food efficiency ratio were significantly decreased in all cadmium groups, compared with those of normal group. The accumulation of cadmium in rat liver, kidney and blood was reduced by sufficient vitamin E supplementation. The metallothionein (MT) content in liver and kidney were increased in all cadmium groups compared with that of normal group. The ratio of cadmium absorption and retention were significantly decreased in vitamin E supplementation groups. Accordingly, vitamin E supplementation resulted in an excretion of cadmium in urine and feces and a lowered accumulation of cadmium in liver and kidney. It can be suggested that increased MT synthesis lead to the significant decrease in cadmium absorption and retention rations.