The Trend of Psychiatric Visits and Psychiatric Medication Prescription Among People Tested for SARS-CoV-2 During the Initial Phase of COVID-19 Pandemic in South Korea

Objective@#The objective of this study was to monitor the trend of psychiatric visits and medication prescriptions among people tested for SARS-CoV-2 during the initial phase of coronavirus disease 2019 (COVID-19) pandemic in South Korea. @*Methods@#We conducted a population-based cohort study using data from the National Health Insurance Service (NHIS) linked to the Korea Disease Control and Prevention Agency (KDCA) data. The overall trend of psychiatric visits during COVID-19 for each month was compared to the month prior to COVID-19. The number of psychiatric medication prescription records was monitored from January 2019 to May 2020. @*Results@#A total of 212,678 individuals were tested for SARS-CoV-2 between January 2020 and May 2020. Among these individuals, 72.1% (n=153,309) did not have pre-existing mental illness, and 27.9% (n=59,369) had pre-existing mental illness. We found that most psychiatric visits were made in March, and patients without pre-existing mental illness significantly increased in psychiatric outpatients during the COVID-19 pandemic (p trend<0.001). In addition, psychiatric medication prescriptions were the most prescribed between March and April 2020. @*Conclusion@#We identified a rising trend in psychiatric visits and medication prescriptions among people who were tested for SARSCoV-2 during the initial phase of COVID-19 pandemic in South Korea.

Low serum cholesterol level as a risk factor for out-of-hospital cardiac arrest: a case-control study

Objective@#We aimed to identify the association between low serum total cholesterol levels and the risk of out-of-hospital cardiac arrest (OHCA). @*Methods@#This case-control study was performed using datasets from the Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance (CAPTURES) project and the Korea National Health and Nutrition Examination Survey (KNHANES). Cases were defined as emergency medical service-treated adult patients who experienced OHCA with a presumed cardiac etiology from the CAPTURES project dataset. Four controls from the KNHANES dataset were matched to each case based on age, sex, and county. Multivariable conditional logistic regression analysis was conducted to evaluate the effect of total cholesterol levels on OHCA. @*Results@#A total of 607 matched case-control pairs were analyzed. We classified total cholesterol levels into six categories (<148, 148-166.9, 167-189.9, 190-215.9, 216.237.9, and ≥238 mg/dL) according to the distribution of total cholesterol levels in the KNHANES dataset. Subjects with a total cholesterol level of 167-189.9 mg/dL (25th.49th percentile of the KNHANES dataset) were used as the reference group. In both the adjusted models and sensitivity analysis, a total cholesterol level of <148 mg/dL was significantly associated with OHCA (adjusted odds ratio [95% confidence interval], 6.53 [4.47.9.56]). @*Conclusion@#We identified an association between very-low total cholesterol levels and an increased risk of OHCA in a large, community-based population. Future prospective studies are needed to better understand how a low lipid profile is associated with OHCA.

A female patient with Xp21 gene deletion syndrome

Xp21 contiguous gene deletion syndrome is associated with complex glycerol kinase deficiency, congenital adrenal hypoplasia, Duchene muscular dystrophy, and intellectual disability. Xp21 gene deletion syndrome is X-linked recessive, so most symptomatic patients are male, and only a few female symptomatic patients have been reported. We report the first female Korean case of an Xp21 deletion. NGS data were analyzed for copy number variation, and the Xp21 deletion (chr X:29301056-31838200) was confirmed using real-time PCR.

Association between Cigarette Smoking and Sarcopenia according to Obesity in the Middle-Aged and Elderly Korean Population: The Korea National Health and Nutrition Examination Survey (2008–2011) / 가정의학회지

BACKGROUND: The definition of sarcopenia focuses on muscle mass and function. Sarcopenic obesity is the relative excess of fat tissue with decreased muscle mass. We examined the association between cigarette smoking and sarcopenia according to obesity in middle-aged and elderly Koreans. METHODS: We conducted a cross-sectional study of 9,385 subjects (age ≥50 years) based on data from the fourth and fifth Korea National Health and Nutrition Examination Surveys (2008–2011). Smoking groups were categorized by smoking status and the number of cigarettes smoked daily. Sarcopenia was defined as weight-adjusted appendicular skeletal muscle mass of 2 standard deviations below the sex-specific mean for young adults. Obesity was defined as fat mass ≥30% for men and ≥40% for women. Subjects were categorized into three groups: sarcopenic obese (SO), sarcopenic non-obese (SNO), and normal. Multiple logistic regression analysis was performed to assess the association between smoking and SNO and SO. RESULTS: Among men, current smokers were more associated with SNO than never-smokers (adjusted odds ratio [OR], 3.34; 95% confidence interval [CI], 1.09–10.26). However, there was no significant association between smoking status and SNO in women or SO in either sex. Among current smokers, moderate smokers (11–20 cigarettes/d) were more likely to be SNO (adjusted OR, 5.81; 95% CI, 1.12–30.31) and heavy smokers (>20 cigarettes/d) were more likely to be SO (adjusted OR, 9.53; 95% CI, 1.65–55.01) than light smokers (<11 cigarettes/d). CONCLUSION: In men, smoking was positively associated with SNO, and heavy smokers were more likely to be SO than light smokers.

Association between C-Reactive Protein and Metabolic Syndrome in Korean Adults / 가정의학회지

BACKGROUND: The prevalence of metabolic syndrome (MetS) is increasing, and obesity, insulin resistance, and inflammation are the known risk factors. However, results of previous studies regarding the relationship between MetS and inflammation have not been consistent. This study aimed to identify the associations between C-reactive protein (CRP) and MetS and its components in obese and non-obese men and women. METHODS: This was a cross-sectional study based on the 6th Korea National Health and Nutrition Examination Survey (2015), and a nationally representative sample of 3,013 Korean adults aged 40–78 years were included. Those with cardiovascular disease, cancer, CRP level >10 mg/L, white blood cell count >10,000/mm3, chronic kidney disease, and lung/liver disease were excluded. RESULTS: Approximately 11.0%, 50.0%, 8.4%, and 48.8% of non-obese men, obese men, non-obese women, and obese women presented with MetS (P<0.001), respectively. In all four groups, those who presented with MetS or its components showed a higher high-sensitivity (hs-CRP) average than those without. Multivariate regression analysis showed the increased risk of developing MetS with higher quartiles of hs-CRP level in obese (3rd and 4th quartiles: odds ratios [ORs], 3.87 and 2.57, respectively) and non-obese women (4th quartile: OR, 2.63). The different components also showed increased ORs in the four groups. However, no statistically significant trend in the relationship was found in men. CONCLUSION: Low-grade inflammation may increase the risk of MetS in Korean women independent of adiposity. However, due to the cross-sectional design of the present study, further studies must be conducted to identify the causal relationship between inflammation and metabolic disorders.

Development of Web-Based Cognitive Training Program : Preliminary Study

Correlation between Smoking and Depression in Korean Adult Group: The Korean National Health and Nutrition Examination Survey (2014)

BACKGROUND: Though several factors have been found to be associated with depression, yet many others remain uncovered. A few studies have focused on the correlation between smoking and depression. This study was designed to explore whether there was a relationship between smoking and depression in a Korean adult group.METHODS: This study was based on the 2014 data of 17,780 Koreans obtained from the sixth Korea National Health and Nutrition Examination Survey (KNHNES, 2013–2015). The participants' depression status was evaluated based on their responses to survey. The correlation between smoking and depression was examined using multiple linear regression analysis after adjusting confounders. The result was represented as correlation factors, and a P-value of less than 0.05 was considered statistically significant.RESULTS: Our study revealed higher depression prevalence in the current smoker group as compared to non-smokers and ex-smokers and this difference was statistically significant.CONCLUSION: Smoking status was statistically significantly related to depression. Among the three smoking status groups, the current smoker group had the highest prevalence of depression. Hence s stopping smoking was considered to be effective and important to prevent depression.

Trend in Disability-Adjusted Life Years (DALYs) for Injuries in Korea: 2004–2012

BACKGROUND: Injury is a major public health problem and accounts for 10% of the global burden of disease. This study intends to present the temporal trend in the injury burden in Korea and to compare the burden size by injury mechanism and age group. METHODS: This study was a nationwide population-based observational study. We used two data sets, the death certificates statistics and the Korean National Hospital Discharge Survey data (2004–2012). We calculated age-standardized disability-adjusted life year (DALY) from years of life lost (YLL) and years lived with disability (YLD) and trend analysis. RESULTS: The DALYs of road injury decreased (P = 0.002), falls did not exhibit a trend (P = 0.108), and self-harm increased overall (P = 0.045). In the road injury, the YLLs decreased across all 4 age groups (0–14, 15–49, 50–79, ≥ 80) and the YLDs decreased in the 0–14-year-old group. In total, the DALYs of road injuries decreased in the 0–14-year-old group. In the fall injury, although the YLLs decreased in the over 80-year-old group, the YLDs increased in the 50–79-year-old group and the over 80-year-old group. The burden of self-harm injury was high in the age group 15 years and over, especially in the 15–49-year-old group. CONCLUSION: The leading causes of the injury burden were road injuries, falls, and self-harm. The burden of road injury and self-harm have recently shown a gradual decreasing tendency. On the other hands, that of fall injuries are continually high in the age group over 50 years of age.

Epidemiologic Characteristics of Injured School-age Patients Transported via Emergency Medical Services in Korea

BACKGROUND: The purpose of this study was to identify the characteristics of injuries of school-aged children transported via emergency medical services (EMS) that occurred in schools by comparing with injuries that occurred outside of school. METHODS: Data from the 119 EMS from 2012 to 2014 were analyzed. School and non-school injuries were analyzed in children 6 to 17 years of age. The epidemiologic characteristics were assessed according to school-age groups; low-grade primary (6–8 years), high-grade primary (9–13 years), middle (13–15 years) and high (15–17 years) school. Gender-stratified multivariable logistic regression analysis was conducted to estimate the risks of school injury in each age group. RESULTS: During the study period, a total of 167,104 children with injury were transported via 119 ambulances. Of these injuries, 13.3% occurred at schools. Boys accounted for 76.9% of school injuries and middle school children accounted for a significantly greater proportion (39.6%) of school injuries (P < 0.001). The most frequent mechanisms of injury at school were falls (43.8%). The peak times for school injury occurrence were lunch time (13:00–13:59) in all age groups. Multivariate regression identified the risky age groups as high-grade primary (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.09–1.20) and middle school-aged boys (OR, 1.82; 95% CI, 1.74–1.90) and middle school-aged girls (OR, 1.30; 95% CI, 1.21–1.40). CONCLUSION: Notable epidemiologic differences exist between in- and out-of-school injuries. The age groups at risk for school injuries differ by gender.

Study on Recognition and Menu Development Direction of Medicated Diet Gruel: Focusing on Elders in Daejoen Area

The purpose of this study was to provide basic data for the development of medicinal herbs, which are useful for the treatment of chronic diseases and physical characteristics of the elderly. A total of 151 adult women aged 65 years or older currently living in Daejeon were enrolled. The contents of this study were parents' health status, recognition of the necessity for a dietary therapy, awareness of medicinal herbs, requirements for medicinal herbs, physician of medicinal herbs and obstacles to medicinal herbs. Based on these results, the differences in the perception of medicinal herbs according to the dietary needs group as well as differences in the perception of medicinal herbs according to medicinal herbicidal groups were analyzed. Of the 151 subjects, 90.7% were married, and 44.4% of them were aged between 40 and 49. Most of the patients were aged in their 70s (68.9%), and 79.5% of had chronic illnesses such as high blood pressure, hyperlipidemia, arteriosclerosis, and heart disease. It is recognized that dietary therapy is necessary for the treatment of diseases, and awareness of medicinal herbs is low but necessary. As for the requirements for medicinal herbs, the most favored was ‘porridge for the prevention and treatment of diseases’, and 72.2% of medicinal herbs were physicians. However, problems cited were availabitity of ingredients, cooking technique, price of ingredients, and others. In addition, both groups requiring dietary therapy and having high awareness of medicinal herbs felt that medicinal herbs would be helpful in treating diseases. Therefore, it is necessary to provide a simple medicinal herb recipe for each disease and to develop anti cooked medicinal herbs.

Epidemiology of Emergency Medical Services-Assessed Mass Casualty Incidents according to Causes

To effectively mitigate and reduce the burden of mass casualty incidents (MCIs), preparedness measures should be based on MCIs' epidemiological characteristics. This study aimed to describe the epidemiological characteristics and outcomes of emergency medical services (EMS)-assessed MCIs from multiple areas according to cause. Therefore, we extracted the records of all MCIs that involved > or = 6 patients from an EMS database. All patients involved in EMS-assessed MCIs from six areas were eligible for this study, and their prehospital and hospital records were reviewed for a 1-year period. The EMS-assessed MCIs were categorized as being caused by fire accidents (FAs), road traffic accidents (RTAs), chemical and biological agents (CBs), and other mechanical causes (MECHs). A total of 362 EMS-assessed MCIs were identified, with a crude incidence rate of 0.6-5.0/100,000 population. Among these MCIs, 322 were caused by RTAs. The MCIs involved 2,578 patients, and 54.3% of these patients were women. We observed that the most common mechanism of injury varied according to MCI cause, and that a higher number of patients per incident was associated with a longer prehospital time. The highest hospital admission rate was observed for CBs (16 patients, 55.2%), and most patients in RTAs and MECHs experienced non-severe injuries. The total number of deaths was 32 (1.2%). An EMS-assessed MCI database was established using the EMS database and medical records review. Our findings indicate that RTA MCIs create a burden on EMS and emergency department resources, although CB MCIs create a burden on hospitals' resources.

Reliability and Validity of the Short Form of the Literacy-Independent Cognitive Assessment in the Elderly

BACKGROUND AND PURPOSE: The Literacy-Independent Cognitive Assessment (LICA) has been developed for a diagnosis of dementia and is a useful neuropsychological test battery for illiterate populations as well as literate populations. The objective of this study was to develop the short form of the LICA (S-LICA) and to evaluate the reliability and validity of the S-LICA. METHODS: The subtests of the S-LICA were selected based on the factor analysis and validation study results of the LICA. Patients with dementia (n=101) and normal elderly controls (n=185) participated in this study. RESULTS: Cronbach's coefficient alpha of the S-LICA was 0.92 for illiterate subjects and 0.94 for literate subjects, and the item-total correlation ranged from 0.63 to 0.81 (p<.01).The test-retest reliability of the S-LICA total score was high (r=0.94, p<.001), and the subtests had high test-retest reliabilities (r=0.68-0.87, p<.01). The correlation between the K-MMSE and S-LICA total scores were substantial in both the illiterate subjects (r=0.837, p<.001) and the literate subjects(r=0.802, p<.001). The correlation between the S-LICA and LICA was very high (r=0.989, p<.001). The area under the curve of the receiver operating characteristic was 0.999 for the literate subjects and 0.985 for the illiterate subjects. The sensitivity and specificity of the S-LICA for a diagnosis of dementia were 97% and 96% at the cutoff point of 72 for the literate subjects, and 96% and 93% at the cutoff point of 68 for the illiterate subjects, respectively. CONCLUSIONS: Our results indicate that the S-LICA is a reliable and valid instrument for quick evaluation of patients with dementia in both illiterate and literate elderly populations.

Risk Factors of Catheter Loss Following Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis / 대한신장학회지

PURPOSE: Peritoneal dialysis (PD) catheter removal is regarded as an important index of patient morbidity. The aim of this study was to evaluate factors influencing catheter loss following peritonitis in PD patients. METHODS: We retrospectively reviewed 917 episodes of peritonitis in 621 new CAPD patients from Jan 2001 to Feb. 2009 in Dongsan Medical center. Episodes requiring PD catheter removal were compared by both univariate and multivariate analyses with those in which PD catheters were preserved. RESULTS: When peritonitis episodes requiring PD catheter removal (n=80) were compared to catheter preserved peritonitis episodes (n=837), the incidence of PD catheter loss increased as the duration on PD preceding the peritonitis were longer (p<0.000). Also, PD catheter removal was more likely to occur after peritonitis episodes with low serum albumin level (p=0.009) and high serum CRP level (p<0.000), those with long duration of PD effluent leukocyte count remaining above 100/mm3 (p<0.000), those with concomitant exit site/tunnel infection (p=0.043), and those with presence of abdominal pathology (p<0.000). The microbiological determinants of PD catheter loss included two or more bacteria cultured (p=0.002) and fungi (p<0.000). In multivariate analysis, the duration of PD effluent leukocyte count remaining above 100/mL and the number of organism cultured were independent risk factors of PD catheter removal in peritonitis episodes. CONCLUSION: Duration of PD effluent leukocyte count remaining above 100/mm3, and the number of organisms cultured were independent risk factors for catheter removal following peritonitis.

IL-12 p40-Expressing Immune Cells Revealed by Cytokine Reporter Mouse System / 체질인류학회지

Interleukin-12 (IL-12), consisting of p35 and p40, plays important roles in linking innate and adaptive immunity. While p35 is constitutively expressed, IL-12 p40 gene expression is induced upon activation by Toll-like receptor ligands. Recently, with gene targeting technology, the cytokine IL-12 p40 reporter mouse has been developed to express the p40 gene linked via a viral IRES element with yellow fluorescence protein (YFP) fluorescent reporter. We investigated whether this novel system would be useful to reveal IL-12 p40-producing immune cells. We first investigated whether macrophages and dendritic cells from these mice faithfully reported p40 induction. Next, we tested if microglial cells, macrophages in the brain, could induce IL-12 p40. Finally we tested whether B cells could produce IL-12 p40 because there were very few reports for IL-12 production by B cells. Our results confirmed that macrophages and dendritic cells are main producer of IL-12 p40. Then, we found that microglial cells could produce IL-12 p40 upon stimulation with various TLR ligands. Finally we found that a subset of B cells could produce IL-12 p40 in TLR9-dependent manner. Taken all together, our system will be a valuable tool to identify the type of immune cells that produce IL-12 p40.

Screening of Interleukin-12/interleukin-23 p40 Inducers in Rheumatoid Synovial Fluids by Fluorescence Reporter Mouse System / 체질인류학회지

Although rheumatoid arthritis has been known to be a common autoimmune disease characterized by chronic inflammation mainly evident in diarthrodial joints, its pathogenesis remains to be clarified. In the present study, to investigate the pathogenic signaling system taken place in the rheumatoid joints, we assessed whether synovial fluid obtained from patients with rheumatoid arthritis contains inducers for proinflammatory cytokines such as interleukin (IL)-12 and IL-23. Peritoneal macrophages isolated from IL-12/IL-23 p40-YFP reporter mice were stimulated with synovial fluid, followed by flow cytometry to screen CD11b+ and YFP-expressing cells, reflective of IL-12/IL-23 p40-producing macrophages. The expression levels of Toll-like receptor (TLR)-2 and -4, which have a potential to mediate IL-12/IL- 23 p40 induction, were determined in synovial cells obtained from a patient with rheumatoid arthritis by RT-PCR analyses. One out of 10 synovial fluid from rheumatoid arthritis patients induced IL-12/IL-23 p40 expression, while all of 10 synovial fluid from osteoarthritis patients did not. Synoviocytes constitutively expressed Toll-like receptor (TLR)-2 and -4 which are candidate receptors for IL-12/IL-23 inducers. Upon LPS stimulation, the levels of TLR-2 and -4 were downregulated and upregulated, respectively. Taken together, these results suggest that some patients with rheumatoid arthritis elicit synovitis through TLR-2- and -4-mediated induction of proinflammatory cytokines IL-12 and IL-23.

Alteration of Innate Immune T and B Cells in the NC/Nga Mouse

BACKGROUND: Millions of people in the world are suffering from atopic dermatitis (AD), which is a chronic inflammatory skin disease triggered by Th2 immune responses. The NC/Nga mouse is the most extensively studied animal model of AD. Like human AD, NC/Nga mice demonstrate increased levels of IgE, a hallmark of Th2 immune responses. Adaptive immunity cannot be generated without help of innate immunity. Especially natural killer T (NKT) cells and marginal zone B (MZB) cells have been known to play important roles in linking innate immunity to adaptive immunity. METHODS: Through flow cytometric analysis and ELISA assay, we investigated whether these lymphocytes might be altered in number in NC/Nga mice. RESULTS: Our data demonstrated that the number of NKT cells was reduced in NC/Nga mice and IFNgamma production by NKT cells upon alpha-GalCer stimulation decreased to the levels of CD1d KO mice lacking in NKT cells. However, reduction of NKT cells in NC/Nga mice was not due to CD1d expression, which was normal in the thymus. Interestingly, there was a significant increase of CD1d(high)B220+ cells in the spleen of NC/Nga mice. Further, we confirmed that CD1d(high)B220+ cells are B cells, not dendritic cells. These CD1d(high)B220+ B cells show IgM(high)CD21(high)CD23low, a characteristic phenotype of MZB cells. CONCLUSION: We provide the evidence that there are decreased activities of NKT cells and increased number of MZB cells in the NC/Nga mice. Our findings may thus explain why NC/Nga mice are susceptible to AD.

A Study on the Appropriate Normal Range of Serum Creatinine Level for Koreans / 대한신장학회잡지

BACKGROUND: Early identification and appropriate management of mild chronic renal failure has been increasingly recognized as an important opportunity to delay the progression of renal disease. Many physicians rely on serum creatinine (Scr) as a screening test for renal impairment; however, Scr levels can remain within the normal range even when renal function is significantly impaired in certain group of patients. METHODS: The subjects were 20, 245 persons who were enrolled a regular health check up program, Jan. 1997 to Jun. 2001, at Ajou University Hospital, Korea. We identified GFR below 60 mL/min/1.73 m2 as abnormal and found the percentage of patients with Scr value from 1.1 mg/dL to 1.4 mg/dL and their sex and age distribution, using GFRs calculated by Cockroft-Gault Equation, MDRD Equation, and Kang's Equation. RESULTS: Average Scr was 1.07+-0.13 mg/dL in male and 0.82+-0.11 mg/dL in female. Among 34 University hospital in metro Seoul area, 11 hospital used 1.4 mg/dL as normal upper limit of Scr and 7 hospital used 1.3 mg/dL. Taking normal Scr upper limit as 1.3 or 1.4 mg/dL, the frequency of GFR below 60 mL/min/1.73 m2 was 3.9-50% in males and 75-100% in females, although some differences existed according to the equation used. CONCLUSION: Currently used normal Scr upper limit 1.3, 1.4 mL/dL was found to be much too high and we concluded a downward adjustment is needed and one-time test is not adequate to conclude renal impairment but several regular tests are required.