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Purpose@#This study aimed to provide the clinical characteristics, prognostic factors, and 5-year relative survival rates of lung cancer diagnosed in 2015. @*Materials and Methods@#The demographic risk factors of lung cancer were calculated using the KALC-R (Korean Association of Lung Cancer Registry) cohort in 2015, with survival follow-up until December 31, 2020. The 5-year relative survival rates were estimated using Ederer II methods, and the general population data used the death rate adjusted for sex and age published by the Korea Statistical Information Service from 2015 to 2020. @*Results@#We enrolled 2,657 patients with lung cancer who were diagnosed in South Korea in 2015. Of all patients, 2,098 (79.0%) were diagnosed with non–small cell lung cancer (NSCLC) and 345 (13.0%) were diagnosed with small cell lung cancer (SCLC), respectively. Old age, poor performance status, and advanced clinical stage were independent risk factors for both NSCLC and SCLC. In addition, the 5-year relative survival rate declined with advanced stage in both NSCLC (82%, 59%, 16%, 10% as the stage progressed) and SCLC (16%, 4% as the stage progressed). In patients with stage IV adenocarcinoma, the 5-year relative survival rate was higher in the presence of epidermal growth factor receptor (EGFR) mutation (19% vs. 11%) or anaplastic lymphoma kinase (ALK) translocation (38% vs. 11%). @*Conclusion@#In this Korean nationwide survey, the 5-year relative survival rates of NSCLC were 82% at stage I, 59% at stage II, 16% at stage III, and 10% at stage IV, and the 5-year relative survival rates of SCLC were 16% in cases with limited disease, and 4% in cases with extensive disease.
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Purpose@#The awareness time interval (ATI), the time from the witnessed event to emergency medical service (EMS) activation, is an important factor influencing out-of-hospital cardiac arrest (OHCA) outcomes. Since bystander cardiopulmonary resuscitation (BCPR) is provided after cardiac arrest is recognized, the effect of BCPR may vary depending on ATI delay. We aimed to investigate whether ATI modifies the effect of BCPR on OHCA outcomes. @*Materials and Methods@#A population-based observational study was conducted with EMS-treated witnessed adult (≥18 years) OHCAs between 2013 and 2018. The exposure variable was provision of BCPR. The primary outcome was a good neurological outcome defined as cerebral performance category scale 1or 2 (good CPC). Multivariable logistic regression analysis was conducted using the ATI group (–1, 1–5, 5– min) as the interaction term. @*Results@#Of 34366 eligible OHCAs, 65.5% received BCPR. EMS was activated within 1 min in 45.9%, within 1–5 min in 29.2%, and after 5 min in 24.9% cases. In the adjusted interaction model, compared with no BCPR, a longer ATI resulted in smaller adjusted odds ratios for good CPC in the BCPR group [5.33 (4.17–6.82) for ATI ≤1 min, 5.14 (4.00–6.60) for 1–5 min, and 2.14 (1.63–2.81) for ATI >5 min]. @*Conclusion@#The effect of BCPR on improving the chances for a good neurological outcome decreased as time from collapse to EMS activation increased. The importance of early recognition of OHCA and EMS activation should be emphasized in BCPR training.
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Objectives@#Korea and Japan have managed the spread of coronavirus disease 2019 (COVID-19) using markedly different policies, referred to as the “3T” and “3C” strategies, respectively. This study examined these differences to assess the roles of active testing and contact tracing as non-pharmaceutical interventions (NPIs). We compared the proportion of unlinked cases (UCs) and test positivity rate (TPR) as indicators of tracing and testing capacities. @*Methods@#We outlined the evolution of NPI policies and investigated temporal trends in their correlations with UCs, confirmed cases, and TPR prior to the Omicron peak. Spearman correlation coefficients were reported between the proportion of UCs, confirmed cases, and TPR. The Fisher r-to-z transformation was employed to examine the significance of differences between correlation coefficients. @*Results@#The proportion of UCs was significantly correlated with confirmed cases (r=0.995, p<0.001) and TPR (r=0.659, p<0.001) in Korea and with confirmed cases (r=0.437, p<0.001) and TPR (r=0.429, p<0.001) in Japan. The Fisher r-to-z test revealed significant differences in correlation coefficients between the proportion of UCs and confirmed cases (z=16.07, p<0.001) and between the proportion of UCs and TPR (z=2.12, p=0.034) in Korea and Japan. @*Conclusions@#Higher UCs were associated with increases in confirmed cases and TPR, indicating the importance of combining testing and contact tracing in controlling COVID-19. The implementation of stricter policies led to stronger correlations between these indicators. The proportion of UCs and TPR effectively indicated the effectiveness of NPIs. If the proportion of UCs shows an upward trend, more testing and contact tracing may be required.
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Background@#We conducted a comprehensive meta-analysis of prospective cohort studies to analyze the effect of circulating vitamin D level on the risk of sudden cardiac death (SCD) and cardiovascular disease (CVD) mortality. @*Methods@#Prospective cohort studies evaluating the association between circulating vitamin D and risk of SCD and CVD mortality were systematically searched in the PubMed and Embase. Extracted data were analyzed using a random effects model and results were expressed in terms of hazard ratio (HR) and 95% confidence interval (CI). Restricted cubic spline analysis was used to estimate the dose-response relationships. @*Results@#Of the 1,321 records identified using the search strategy, a total of 19 cohort studies were included in the final meta-analysis. The pooled estimate of HR (95% CI) for low vs. high circulating vitamin D level was 1.75 (1.49–2.06) with I 2 value of 30.4%. In subgroup analysis, strong effects of circulating vitamin D were observed in healthy general population (pooled HR, 1.84; 95% CI, 1.43–2.38) and the clinical endpoint of SCD (pooled HRs, 2.68; 95% CI, 1.48– 4.83). The dose-response analysis at the reference level of < 50 nmol/L showed a significant negative association between circulating vitamin D and risk of SCD and CVD mortality. @*Conclusion@#Our meta-analysis of prospective cohort studies showed that lower circulating vitamin D level significantly increased the risk of SCD and CVD mortality.
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Objectives@#Although it is difficult to define the quality of stroke care, acute ischemic stroke (AIS) patients with moderate-to-severe neurological deficits may benefit from thrombectomy-capable hospitals (TCHs) that have a stroke unit, stroke specialists, and a substantial endovascular thrombectomy (EVT) case volume. @*Methods@#From national audit data collected between 2013 and 2016, potential EVT candidates arriving within 24 hours with a baseline National Institutes of Health Stroke Scale score ≥6 were identified. Hospitals were classified as TCHs (≥15 EVT case/y, stroke unit, and stroke specialists), primary stroke hospitals (PSHs) without EVT (PSHs-without-EVT, 0 case/y), and PSHs-with-EVT. Thirty-day and 1-year case-fatality rates (CFRs) were analyzed using random intercept multilevel logistic regression. @*Results@#Out of 35 004 AIS patients, 7954 (22.7%) EVT candidates were included in this study. The average 30-day CFR was 16.3% in PSHs-without-EVT, 14.8% in PSHs-with-EVT, and 11.0% in TCHs. The average 1-year CFR was 37.5% in PSHs-without-EVT, 31.3% in PSHs-with-EVT, and 26.2% in TCHs. In TCHs, a significant reduction was not found in the 30-day CFR (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.76 to 1.12), but was found in the 1-year CFR (OR, 0.84; 95% CI, 0.73 to 0.96). @*Conclusions@#The 1-year CFR was significantly reduced when EVT candidates were treated at TCHs. TCHs are not defined based solely on the number of EVTs, but also based on the presence of a stroke unit and stroke specialists. This supports the need for TCH certification in Korea and suggests that annual EVT case volume could be used to qualify TCHs.
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Objectives@#This study aimed to explore the status of regional variations in acute ischemic stroke (AIS) treatment and investigate the association between the presence of a thrombectomy-capable stroke center (TSC) and the case fatality rate (CFR) of AIS within hospital service areas (HSAs). @*Methods@#This observational cross-sectional study analyzed acute stroke quality assessment program data from 262 hospitals between 2013 and 2016. TSCs were defined according to the criteria of the Joint Commission. In total, 64 HSAs were identified based on the addresses of hospitals. We analyzed the effects of structure factors, process factors, and the presence of a TSC on the CFR of AIS using multivariate logistic regression. @*Results@#Among 262 hospitals, 31 hospitals met the definition of a TSC. Of the 64 HSAs, only 20 had a TSC. At hospitals, the presence of a stroke unit, the presence of stroke specialists, and the rate of endovascular thrombectomy (EVT) treatment were associated with reductions in the CFR. In HSAs, the rate of EVT treatment (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.97 to 0.99) and the presence of a TSC (OR, 0.93; 95% CI, 0.88 to 0.99) significantly reduced the CFR of AIS. @*Conclusions@#The presence of a TSC within an HSA, corresponding to structure and process factors related to the quality of care, contributed significantly to lowering the CFR of AIS. The CFR also declined as the rate of treatment increased. This study highlights the importance of TSCs in the development of an acute stroke care system in Korea.
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Objectives@#Despite its advantages, it is not yet common practice in Korea for researchers to investigate disease associations using spatio-temporal analyses. In this study, we aimed to review health-related epidemiological research using spatio-temporal analyses and to observe methodological trends. @*Methods@#Health-related studies that applied spatial or spatio-temporal methods were identified using 2 international databases (PubMed and Embase) and 4 Korean academic databases (KoreaMed, NDSL, DBpia, and RISS). Two reviewers extracted data to review the included studies. A search for relevant keywords yielded 5919 studies. @*Results@#Of the studies that were initially found, 150 were ultimately included based on the eligibility criteria. In terms of the research topic, 5 categories with 11 subcategories were identified: chronic diseases (n=31, 20.7%), infectious diseases (n=27, 18.0%), health-related topics (including service utilization, equity, and behavior) (n=47, 31.3%), mental health (n=15, 10.0%), and cancer (n=7, 4.7%). Compared to the period between 2000 and 2010, more studies published between 2011 and 2020 were found to use 2 or more spatial analysis techniques (35.6% of included studies), and the number of studies on mapping increased 6-fold. @*Conclusions@#Further spatio-temporal analysis-related studies with point data are needed to provide insights and evidence to support policy decision-making for the prevention and control of infectious and chronic diseases using advances in spatial techniques.
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Objectives@#Despite its advantages, it is not yet common practice in Korea for researchers to investigate disease associations using spatio-temporal analyses. In this study, we aimed to review health-related epidemiological research using spatio-temporal analyses and to observe methodological trends. @*Methods@#Health-related studies that applied spatial or spatio-temporal methods were identified using 2 international databases (PubMed and Embase) and 4 Korean academic databases (KoreaMed, NDSL, DBpia, and RISS). Two reviewers extracted data to review the included studies. A search for relevant keywords yielded 5919 studies. @*Results@#Of the studies that were initially found, 150 were ultimately included based on the eligibility criteria. In terms of the research topic, 5 categories with 11 subcategories were identified: chronic diseases (n=31, 20.7%), infectious diseases (n=27, 18.0%), health-related topics (including service utilization, equity, and behavior) (n=47, 31.3%), mental health (n=15, 10.0%), and cancer (n=7, 4.7%). Compared to the period between 2000 and 2010, more studies published between 2011 and 2020 were found to use 2 or more spatial analysis techniques (35.6% of included studies), and the number of studies on mapping increased 6-fold. @*Conclusions@#Further spatio-temporal analysis-related studies with point data are needed to provide insights and evidence to support policy decision-making for the prevention and control of infectious and chronic diseases using advances in spatial techniques.
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BACKGROUND/OBJECTIVES@#The measurement of body composition, including muscle and fat mass, remains challenging in large epidemiological studies due to time constraint and cost when using accurate modalities. Therefore, this study aimed to develop and validate prediction equations according to sex to measure lean body mass (LBM), appendicular skeletal muscle mass (ASM), and body fat mass (BFM) using anthropometric measurement, serum creatinine level, and lifestyle factors as independent variables and dual-energy X-ray absorptiometry as the reference method. @*SUBJECTS/METHODS@#A sample of the Korean general adult population (men:7,599; women:10,009) from the Korean National Health and Nutrition Examination Survey 2008–2011 was included in this study. The participants were divided into the derivation and validation groups via a random number generator (with a ratio of 70:30). The prediction equations were developed using a series of multivariable linear regressions and validated using the Bland– Altman plot and intraclass correlation coefficient (ICC). @*RESULTS@#The initial and practical equations that included age, height, weight, and waist circumference had a different predictive ability for LBM (men: R2 = 0.85, standard error of estimate [SEE] = 2.7 kg; women: R2 = 0.78, SEE = 2.2 kg), ASM (men: R2= 0.81, SEE = 1.6 kg; women: R2 = 0.71, SEE = 1.2 kg), and BFM (men: R2 = 0.74, SEE = 2.7 kg; women: R2 = 0.83, SEE = 2.2 kg) according to sex. Compared with the first prediction equation, the addition of other factors, including serum creatinine level, physical activity, smoking status, and alcohol use, resulted in an R2 that is higher by 0.01 and SEE that is lower by 0.1. @*CONCLUSIONS@#All equations had low bias, moderate agreement based on the Bland–Altman plot, and high ICC, and this result showed that these equations can be further applied to other epidemiologic studies.
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Objectives@#The purpose of this study was to investigate the health effects of air conditioning use during the 2018 heat wave in Korea, included the highest temperature ever recorded in the nation. @*Methods@#The participants in this study were 1000 adults aged 19 years and older recruited from across Korea. The participants were asked about their experience of symptoms of various diseases, disruptions of their daily lives, and use of air conditioning during the heat wave. The associations between air conditioning use during the heat wave and health outcomes were analyzed using the chi-square test and multiple logistic regression models. @*Results@#Among participants who lacked air conditioning in the main space where they spent time outside the home, 33.9%, 8.1%, 43.5%, and 19.4% experienced symptoms of heat-related, cardiovascular, nervous system diseases, and air-conditioningitis, respectively. In comparison, participants who did have air conditioning outside the home experienced the same symptoms at proportions of 21.0%, 1.9%, 26.8%, and 34.2%, respectively (p=0.027, 0.007, 0.007, and 0.023, respectively). Among participants who had no air conditioner at home, 10.0% were absent from school or work due to the heat wave. In contrast, among participants who had an air conditioner at home, only 3.7% were absent as a result of the heat wave (p=0.007). @*Conclusions@#When air conditioning was not used at home or in the main space where participants spent time outside the home during the 2018 heat wave, adverse health effects were more prevalent, but the risk of air-conditioningitis was reduced.
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OBJECTIVES: The purpose of this study was to estimate the mediating effect of subjective unmet healthcare needs on poor health. The mediating effect of unmet needs on health outcomes was estimated. METHODS: Cross-sectional research method was used to analyze Korea Health Panel data from 2011 to 2015, investigating the mediating effect for each annual dataset and lagged dependent variables. RESULTS: The magnitude of the effect of low income on poor health and the mediating effect of unmet needs were estimated using age, sex, education level, employment status, healthcare insurance status, disability, and chronic disease as control variables and self-rated health as the dependent variable. The mediating effect of unmet needs due to financial reasons was between 14.7% to 32.9% of the total marginal effect, and 7.2% to 18.7% in lagged model. CONCLUSIONS: The fixed-effect logit model demonstrated that the existence of unmet needs raised the likelihood of poor self-rated health. However, only a small proportion of the effects of low income on health was mediated by unmet needs, and the results varied annually. Further studies are necessary to search for ways to explain the varying results in the Korea Health Panel data, as well as to consider a time series analysis of the mediating effect. The results of this study present the clear implication that even though it is crucial to address the unmet needs, but it is not enough to tackle the income related health inequalities.
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Chronic Disease , Dataset , Delivery of Health Care , Education , Employment , Healthcare Disparities , Insurance Coverage , Korea , Logistic Models , Methods , Needs Assessment , Negotiating , Socioeconomic FactorsABSTRACT
OBJECTIVES@#The purpose of this study was to estimate the mediating effect of subjective unmet healthcare needs on poor health. The mediating effect of unmet needs on health outcomes was estimated.@*METHODS@#Cross-sectional research method was used to analyze Korea Health Panel data from 2011 to 2015, investigating the mediating effect for each annual dataset and lagged dependent variables.@*RESULTS@#The magnitude of the effect of low income on poor health and the mediating effect of unmet needs were estimated using age, sex, education level, employment status, healthcare insurance status, disability, and chronic disease as control variables and self-rated health as the dependent variable. The mediating effect of unmet needs due to financial reasons was between 14.7% to 32.9% of the total marginal effect, and 7.2% to 18.7% in lagged model.@*CONCLUSIONS@#The fixed-effect logit model demonstrated that the existence of unmet needs raised the likelihood of poor self-rated health. However, only a small proportion of the effects of low income on health was mediated by unmet needs, and the results varied annually. Further studies are necessary to search for ways to explain the varying results in the Korea Health Panel data, as well as to consider a time series analysis of the mediating effect. The results of this study present the clear implication that even though it is crucial to address the unmet needs, but it is not enough to tackle the income related health inequalities.
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BACKGROUND: Cut-off values for visceral fat area (VFA) measured by computed tomography (CT) for identifying individuals at risk of metabolic syndrome (MetS) have not been clearly established in Korean adults, particularly for large populations. We aimed to identify optimal VFA and waist circumference (WC) cut-off values and compare the ability of VFA and WC to predict the presence of ≥2 metabolic risk factors. METHODS: We included 36,783 subjects aged 19–79 years undergoing abdominal fat CT during regular health checkups between January 2007 and February 2015 in Seoul. The risk factors for MetS except WC were based on the International Diabetes Federation criteria. Receiver operating characteristic curve analyses were used to determine the appropriate VFA and WC cut-off values for MetS. RESULTS: VFA was a more significant predictor of metabolic risk factors than WC and body mass index (BMI). The optimal cut-off values for VFA and WC were 134.6 cm2 and 88 cm for men and 91.1 cm2 and 81 cm for women, respectively. We estimated age-specific cut-off values for VFA, WC, and BMI. VFA cut-off values increased with age, particularly among women. CONCLUSION: This large population study proposed the cut-off values for VFA and WC for identifying subjects at risk of MetS among Korean adults. For more accurate diagnosis, different age-specific cut-off values for VFA and WC may be considered.
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Adult , Female , Humans , Male , Abdominal Fat , Body Mass Index , Diagnosis , Intra-Abdominal Fat , Obesity, Abdominal , Risk Factors , ROC Curve , Seoul , Waist CircumferenceABSTRACT
BACKGROUND: In cardiac arrest, the survival rate increases with the provision of bystander cardiopulmonary resuscitation (CPR), of which the initial response and treatment are critical. Telephone CPR is among the effective methods that might increase the provision of bystander CPR. This study aimed to describe and examine the improvement of neurological outcomes in individuals with out-of-hospital acute cardiac arrest by implementing the nationwide, standardized telephone CPR program. METHODS: Data from the emergency medical service-based cardiac arrest registry that were collected between 2009 and 2014 were used. The effectiveness of the intervention in the interrupted time-series study was determined via a segmented regression analysis, which showed the risk ratio and risk difference in good neurological outcomes before and after the intervention. RESULTS: Of 164,221 patients, 148,403 were analyzed. However, patients with unknown sex and limited data on treatment outcomes were excluded. Approximately 64.3% patients were men, with an average age of 63.7 years. The number of bystander CPR increased by 3.3 times (95% confidence interval [CI], 3.1–3.5) after the intervention, whereas the rate of good neurological outcomes increased by 2.6 times (95% CI, 2.3–2.9 [1.6%]; 1.4–1.7). The excess number was identified based on the differences between the observed and predicted trends. In total, 2,127 cases of out-of-hospital cardiac arrest (OHCA) after the intervention period received additional bystander CPR, and 339 cases of OHCA had good neurological outcomes. CONCLUSION: The nationwide implementation of the standardized telephone CPR program increased the number of bystander CPR and improved good neurological outcomes.
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Humans , Male , Cardiopulmonary Resuscitation , Emergencies , Heart Arrest , Odds Ratio , Out-of-Hospital Cardiac Arrest , Survival Rate , TelephoneABSTRACT
OBJECTIVE: This study aimed to describe the conceptualization, development, and implementation processes of the newly established Korean Cardiac Arrest Resuscitation Consortium (KoCARC) to improve out-of-hospital cardiac arrest (OHCA) outcomes. METHODS: The KoCARC was established in 2014 by recruiting hospitals willing to participate voluntarily. To enhance professionalism in research, seven research committees, the Epidemiology and Preventive Research Committee, Community Resuscitation Research Committee, Emergency Medical System Resuscitation Research Committee, Hospital Resuscitation Research Committee, Hypothermia and Postresuscitation Care Research Committee, Cardiac Care Resuscitation Committee, and Pediatric Resuscitation Research Committee, were organized under a steering committee. The KoCARC registry was developed with variables incorporated in the currently existing regional OHCA registries and Utstein templates and were collected via a web-based electronic database system. The KoCARC study population comprises patients visiting the participating hospitals who had been treated by the emergency medical system for OHCA presumed to have a cardiac etiology. RESULTS: A total of 62 hospitals volunteered to participate in the KoCARC, which captures 33.0% of the study population in Korea. Web-based data collection started in October 2015, and to date (December 2016), there were 3,187 cases compiled in the registry collected from 32 hospitals. CONCLUSION: The KoCARC is a self-funded, voluntary, hospital-based collaborative research network providing high level evidence in the field of OHCA and resuscitation. This paper will serve as a reference for subsequent KoCARC manuscripts and for data elements collected in the study.
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Humans , Cardiopulmonary Resuscitation , Data Collection , Emergencies , Epidemiology , Heart Arrest , Hypothermia , Korea , Out-of-Hospital Cardiac Arrest , Professionalism , Registries , ResuscitationABSTRACT
Growth charts are curves or tables that facilitate the visualization of anthropometric parameters, and are widely used as an important indicator when evaluating the growth status of children and adolescents. The latest version of the Korean National Growth Charts released in 2007 has raised concerns regarding the inclusion of data from both breastfed and formula-fed infants, higher body mass index (BMI) values in boys, and smaller 3rd percentile values in height-for-age charts. Thus, new growth charts have been developed to improve the previous version. The 2006 World Health Organization Child Growth Standards, regarded as the standard for breastfed infants and children, were introduced for children aged 0–35 months. For children and adolescents aged 3–18 years, these new growth charts include height-for-age, weight-for-age, BMI-for-age, weight-for-height, and head circumference-for-age charts, and were developed using data obtained in 1997 and 2005. Data sets and exclusion criteria were applied differently for the development of the different growth charts. BMI-for-age charts were adjusted to decrease the 95th percentile values of BMI. Criteria for obesity were simplified and defined as a BMI of ≥95th percentile for age and sex. The 3rd percentile values for height-for-age charts were also increased. Additional percentile lines (1st and 99th) and growth charts with standard deviation lines were introduced. 2017 Korean National Growth Charts are recommended for the evaluation of body size and growth of Korean children and adolescents for use in clinics and the public health sector in Korea.
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Adolescent , Child , Humans , Infant , Body Mass Index , Body Size , Dataset , Growth Charts , Head , Korea , Obesity , Public Health , World Health OrganizationABSTRACT
BACKGROUND: We investigated the association between body composition, especially truncal or non-truncal fat mass (FM), and bone mineral density (BMD) in premenopausal women in Korea. METHODS: A cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey IV and V (2008–2011). Total lean mass (LM), total FM (TFM), truncal FM, and non-truncal FM, and BMD of the total femur, femoral neck (FN), and lumbar spine were measured using dual-energy X-ray absorptiometry. The association between body composition and BMD was analyzed using multiple linear regression. The risk of low BMD according to quartiles of TFM, truncal FM, and non-truncal FM was calculated using logistic regression. Subgroup analysis according to body mass index was also performed. RESULTS: In 4,343 premenopausal women, total LM was positively associated with BMD regardless of weight adjustment. TFM, truncal FM, and non-truncal FM were inversely associated with BMD after adjusting for weight. Odds ratios (ORs) for low BMD and 95% confidence intervals (CIs) of the highest quartile of TFM, truncal FM, and non-truncal FM compared with the lowest quartile were calculated. The risk of low BMD of the FN was higher in the highest quartile of TFM (OR, 4.48; 95% CI, 1.11–18.01) and truncal FM (OR, 5.48; 95% CI, 1.75–17.20). Truncal FM and not-truncal FM had an inverse association with BMD in the non-obese and obese subgroups of women. CONCLUSION: Total LM has a protective effect on BMD and FM can have a detrimental effect on BMD besides its skeletal loading effect.
Subject(s)
Female , Humans , Absorptiometry, Photon , Body Composition , Body Mass Index , Bone Density , Cross-Sectional Studies , Femur , Femur Neck , Korea , Linear Models , Logistic Models , Nutrition Surveys , Odds Ratio , Osteoporosis , Premenopause , SpineABSTRACT
BACKGROUND: In 2011, two roads in a residential area in Seoul were found to be contaminated with the radionuclide cesium-137 (137Cs). In response to public concerns, an epidemiological study was conducted. METHODS: The standardized cancer incidence ratios in the affected and neighboring regions were calculated based on the central cancer registry. Households in the region were sampled using the random stratified sampling technique, and questionnaires were administered to family members, via home visit and via students in elementary to high schools. Information on duration of residency and frequency of use of the roads was applied to calculate cumulative radiation exposure dose from the roads, alongside with the reported 137Cs contamination amounts. Information on past medical history, perceived risk, anxiety and psychological stress was also obtained. Of the 31,053 residents, 8,875 were analyzed. To examine possible associations between radiation exposure and health problems, logistic regression adjusted for covariates were performed with consideration of the sampling design, population weight and stratification. RESULTS: No significant association was found between self-informed diseases, including cancers, and estimated radiation exposure dose. According to an increase of radiation level, a significant increase in anxiety in all and a decline in the psychosocial wellbeing of the adults was noted. The risk perception level was higher in the elderly, females, the less educated, and the highest exposed individuals. CONCLUSION: This study provides a basis for risk communication with residents and community environmental health policy.
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Adult , Aged , Female , Humans , Anxiety , Environmental Health , Epidemiologic Studies , Family Characteristics , House Calls , Incidence , Internship and Residency , Logistic Models , Radiation Exposure , Seoul , Stress, PsychologicalABSTRACT
BACKGROUND: The Korea Radiation Effect & Epidemiology Cohort METHODS: Using the KREEC-R raw data, we calculated age standardized rates (ASRs) of female thyroid cancer and re-analyzed the results of survey on the use of medical services. We also marked the administrative districts of residents who received the Radiation Health Research Institute (RHRI) health examinations and those in which thyroid cancer case occurred as per the Chonnam National University Research Institute of Medical Sciences (RIMS) final report on maps where the locations of NPPs and 5 km-radii around them were also indicated. And we compared the incidence rates of Radiation-induced cancer measured between the first period when RHRI health examinations were not yet implemented, and the second period when the RHRI health examinations were implemented. RESULTS: The ASR for the far-distance group, which comprised residents living in areas outside the 30 km radius of the NPPs, increased rapidly after 2000; however, that of the exposed group, which comprised residents living within a 5 km radius of the NPPs, started to increase rapidly even before 1995. The frequencies of the use of medical services were significantly higher in the intermediate proximate group, which comprised residents living within a 5–30 km radius of the NPPs, than in the exposed group in women. In case of female thyroid cancer, the second period ASR was higher than the first period ASR, but in case of female liver cancer and female stomach cancer no significant difference were observed between the periods. On map, many administrative districts of residents who received RHRI health examinations and most administrative districts in which thyroid cancer case occurred on RIMS final report were outside 5 km-radii around NPPs. CONCLUSIONS: We could not find any evidence supporting the assertion that detection bias influenced the increased risks of female thyroid cancer observed in the exposed group of the KREEC-R study, as opposed to the control group.
Subject(s)
Female , Humans , Academies and Institutes , Bias , Cohort Studies , Epidemiology , Incidence , Korea , Liver Neoplasms , Neoplasms, Radiation-Induced , Nuclear Power Plants , Radiation Effects , Radius , Stomach Neoplasms , Thyroid Gland , Thyroid NeoplasmsABSTRACT
OBJECTIVE: Chest pain is one of the most common complaints in the emergency department (ED). Cardiac computed tomography angiography (CCTA) is a frequently used tool for the early triage of patients with low- to intermediate-risk acute chest pain. We present a study protocol for a multicenter prospective randomized controlled clinical trial testing the hypothesis that a low-dose CCTA protocol using prospective electrocardiogram (ECG)-triggering and limited-scan range can provide sufficient diagnostic safety for early triage of patients with acute chest pain. METHODS: The trial will include 681 younger adult (aged 20 to 55) patients visiting EDs of three academic hospitals for acute chest pain or equivalent symptoms who require further evaluation to rule out acute coronary syndrome. Participants will be randomly allocated to either low-dose or conventional CCTA protocol at a 2:1 ratio. The low-dose group will undergo CCTA with prospective ECG-triggering and restricted scan range from sub-carina to heart base. The conventional protocol group will undergo CCTA with retrospective ECG-gating covering the entire chest. Patient disposition is determined based on computed tomography findings and clinical progression and all patients are followed for a month. The primary objective is to prove that the chance of experiencing any hard event within 30 days after a negative low-dose CCTA is less than 1%. The secondary objectives are comparisons of the amount of radiation exposure, ED length of stay and overall cost. RESULTS AND CONCLUSION: Our low-dose protocol is readily applicable to current multi-detector computed tomography devices. If this study proves its safety and efficacy, dose-reduction without purchasing of expensive newer devices would be possible.