Prevalence and Premature Mortality Statistics of Autism Spectrum Disorder Among Children in Korea: A Nationwide Population-Based Birth Cohort Study

Background@#The aim of this study was to estimate the 8-year prevalence and mortality statistics of autism spectrum disorder (ASD) according to birth year (2002–2012). @*Methods@#We used the National Health Insurance Service database with 4,989,351 children born from 2002 to 2012 including 35,529 children diagnosed with ASD until 8 years of age.The 8-year cumulative prevalence of ASD was calculated annually (2010–2020) with 8 years of follow-up. The 8-year mortality was estimated using Cox models adjusted for sex, household income, area of residence, and year of birth. @*Results@#Of the 473,494 children born in 2002, 2,467 (5.2 per 1,000 births) were diagnosed with ASD until 2010. The ASD prevalence was 2.6 times higher among boys (1,839; 7.4 per 1,000 boy births) than girls (628; 2.8 per 1,000 girl births). Of the 467,360 children born in 2012, 4,378 (9.4 per 1,000 births) were diagnosed with ASD until 2020. The ASD prevalence was 2.7 times higher among boys (3,246; 13.5 per 1,000 boy births) than girls (1,132; 5.0 per 1,000 girl births). The risk of all-cause mortality was higher among children with ASD than those without (hazard ratio [HR], 2.340; 95% confidence interval [CI], 2.063–2.654), which is substantially higher among girls (HR, 4.223; 95% CI, 3.472–5.135) than boys (HR, 1.774; 95% CI, 1.505–2.090). @*Conclusion@#The present study demonstrated that national-level prevalence and mortality statistics of ASD can be estimated effectively using claims data comprising newborns born each year and followed up for to the age of interest. Because this information is essential to establish evidence-based policies, health authorities need to consider producing epidemiological information of ASD continuously using the same methodology.

Nationwide Survey for Current Status of Laboratory Diagnosis of Clostridioides difficile Infection in Korea

Background@#The interest in Clostridioides difficile infection (CDI) has increased, and the choice of assays became wider since the first national survey in Korea on CDI diagnosis in 2015. We conducted a survey of the domestic CDI assays with more varied questions to understand the current situation in Korea. @*Methods@#In April 2018, about 50 questions on the current status of CDI assays and details on implementation and perceptions were written, and a survey questionnaire was administered to laboratory medicine specialists in 200 institutions. @*Results@#One-hundred and fifty institutions responded to the questionnaire, of which 90 (60.0%) including one commercial laboratory, performed CDI assays. The toxin AB enzyme immunoassay (toxin AB EIA), nucleic acid amplification test (NAAT), and C. difficile culture, glutamate dehydrogenase assay, alone or in combination with other assays, were used in 75 (84.3%), 52 (58.4%), 35 (36.0%), and 23 (25.8%), respectively, and 65 (73.0%) institutions performed a combination of two or more assays. The sensitivity of toxin AB EIA was more negatively perceived, and that on specificity was more positively perceived. The perception of sensitivity and specificity of NAAT was mostly positive. Perception on the algorithm test projected it as useful but in need of countermeasures. Sixty-three (73.3%) institutions responded that they performed surveillance on CDI. @*Conclusion@#This study provides useful evidence on the current status of CDI laboratory diagnosis in Korea as well as on items that require improvement and is thought to aid in standardizing and improving the CDI laboratory diagnosis in Korea.

New Obligations of Health Insurance Review and Assessment Service: Taking Full-fledged Action Against the COVID-19 Pandemic / 예방의학회지

In 2020, the coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented disruptions to global health systems. The Korea has taken full-fledged actions against this novel infectious disease, swiftly implementing a testing-tracing-treatment strategy. New obligations have therefore been given to the Health Insurance Review and Assessment Service (HIRA) to devote the utmost effort towards tackling this global health crisis. Thanks to the universal national health insurance and state-of-the-art information communications technology (ICT) of the Korea, HIRA has conducted far-reaching countermeasures to detect and treat cases early, prevent the spread of COVID-19, respond quickly to surging demand for the healthcare services, and translate evidence into policy. Three main factors have enabled HIRA to undertake pandemic control preemptively and systematically: nationwide data aggregated from all healthcare providers and patients, pre-existing ICT network systems, and real-time data exchanges. HIRA has maximized the use of data and pre-existing network systems to conduct rapid and responsive measures in a centralized way, both of which have been the most critical tactics and strategies used by the Korean healthcare system. In the face of new obligations, our promise is to strive for a more responsive and resilient health system during this prolonged crisis.

Trend in Prevalence of Smoking and Motivation to Quit among Korean Adult Male Cancer Survivors over the Last 8 Years: The Korea National Health and Nutrition Examination Survey V–VII (2010–2017) / 가정의학회지

Background@#This study aimed to investigate trends in the prevalence of current smokers and motivation to quit among Korean male cancer survivors. @*Methods@#Out of 20,012 men who participated in the Korea National Health and Nutrition Examination Survey V (2010–2012), VI (2013–2015), and VII (2016–2017), 742 cancer survivors were included. A cancer survivor was defined as a person who concurred to the item, “The cancer has been diagnosed by a doctor” in the health questionnaire. Smoking status was classified as current, former, and never smokers. Regarding motivation to quit smoking, we defined those who had a willingness to quit within 6 months as the willing group. Logistic regression analysis was conducted to examine trends in the prevalence of current smokers and the proportion of the willing group among current smokers. @*Results@#Overall, 3.7% of Korean men who participated in the study were cancer survivors. Current smokers constituted 19.5%, 19.1%, and 15.3% of cancer survivors in phases V, VI, and VII respectively which did not show significant changes (P for trend=0.33). However, the proportion of current smokers in the non-cancer group was significantly reduced to 46.6%, 41.2%, and 38.9% in phases V, VI, and VII, respectively (P for trend <0.001). The proportion of those with a motivation to quit smoking did not show a significant trend in the cancer survivors (P for trend=0.964) and non-cancer group (P for trend=0.884). @*Conclusion@#Prevalence of current smokers and motivation to quit in Korean male cancer survivors did not show significant trends.

Preliminary Results of Teleconsultations Temporarily Allowed during the COVID-19 Pandemic

Purpose@#During the COVID-19 pandemic, Korea has temporarily expanded coverage of teleconsultation to ensure access to essential health services. As a preliminary study, we investigated service utilization patterns and the characteristics of doctors and patients involved in these temporary teleconsultation services. @*Materials and Methods@#Using national health insurance claims data from February 23, 2020 to June 30, 2020 from the Health Insurance Review and Assessment Service, 228269875 cases were identified. Among them, 567390 cases that received teleconsultation services were included in our study. We performed descriptive analyses according to the types of healthcare institutions. @*Results@#In total, 6193 healthcare institutions provided teleconsultation. Of these, 5466 (88.3%) were clinics. Physicians providing teleconsultations were most likely to be doctors of internal medicine (34.0%) or pediatricians (7.0%) and based in the Seoul Metropolitan area (30.4%). In terms of patients undergoing teleconsultation, the most common major disease categories treated were circulatory system diseases (I00–I99). In a detailed analysis, hypertensive diseases (I10–I15) were the most common diagnoses, with a total of 88726 cases (15.6%), followed by diabetes mellitus at 60298 cases (10.6%). The proportion of Medical Aid recipients receiving teleconsultations was higher (9.5%) than other socioeconomic groups. Among all participants, 356622 cases (84.6%) were from a return visit, and 108838 cases (19.2%) received teleconsultation services without being prescribed drugs. @*Conclusion@#Temporarily allowed teleconsultation services were provided mostly to the following patients: 1) those scheduled for revisitation, 2) those with chronic diseases, and 3) those living in pandemic hotspots.

Mortality of Children with Autism Spectrum Disorder Using Data from a Large-Scale Korean National Cohort

Purpose@#This study aimed to investigate the association between autism spectrum disorder (ASD) diagnosis and mortality among children using the data from a large-scale national cohort of Korean infants and children. We also explored the association between hearing impairment detected during early infancy and mortality. @*Materials and Methods@#We performed a retrospective cohort study using the nationwide claims data of the Republic of Korea.Children born between 2007 and 2014 (n=3598904) were followed up until 2020. Cox proportional hazard models were used to examine the association between ASD diagnosis and mortality among children. Then, in order to evaluate the association between hearing impairment and mortality, Cox proportional hazard models were built using the responses related to hearing impairment asked during the first health screening (at age 4–6 months). @*Results@#Of the 3598904 children born between 2007 and 2014, 32878 children (0.9%) were diagnosed with ASD until the end of 2020. We identified that ASD diagnosis was associated with higher mortality among children [hazard ratio (HR)=2.5, 95% confidence interval (CI): 2.2–2.9]. This association was stronger among girls (HR=4.8, 95% CI: 3.9–5.8) compared to boys (HR=1.9, 95% CI: 1.6–2.2). We found that hearing impairment detected during infancy was associated with higher mortality among children with ASD diagnosis. @*Conclusion@#ASD diagnosis was associated with higher mortality among Korean children. This association was stronger in girls than in boys. Hearing impairment detected during infancy was also associated with higher mortality among children diagnosed with ASD.

Preliminary Results of Teleconsultations Temporarily Allowed during the COVID-19 Pandemic

Purpose@#During the COVID-19 pandemic, Korea has temporarily expanded coverage of teleconsultation to ensure access to essential health services. As a preliminary study, we investigated service utilization patterns and the characteristics of doctors and patients involved in these temporary teleconsultation services. @*Materials and Methods@#Using national health insurance claims data from February 23, 2020 to June 30, 2020 from the Health Insurance Review and Assessment Service, 228269875 cases were identified. Among them, 567390 cases that received teleconsultation services were included in our study. We performed descriptive analyses according to the types of healthcare institutions. @*Results@#In total, 6193 healthcare institutions provided teleconsultation. Of these, 5466 (88.3%) were clinics. Physicians providing teleconsultations were most likely to be doctors of internal medicine (34.0%) or pediatricians (7.0%) and based in the Seoul Metropolitan area (30.4%). In terms of patients undergoing teleconsultation, the most common major disease categories treated were circulatory system diseases (I00–I99). In a detailed analysis, hypertensive diseases (I10–I15) were the most common diagnoses, with a total of 88726 cases (15.6%), followed by diabetes mellitus at 60298 cases (10.6%). The proportion of Medical Aid recipients receiving teleconsultations was higher (9.5%) than other socioeconomic groups. Among all participants, 356622 cases (84.6%) were from a return visit, and 108838 cases (19.2%) received teleconsultation services without being prescribed drugs. @*Conclusion@#Temporarily allowed teleconsultation services were provided mostly to the following patients: 1) those scheduled for revisitation, 2) those with chronic diseases, and 3) those living in pandemic hotspots.

Mortality of Children with Autism Spectrum Disorder Using Data from a Large-Scale Korean National Cohort

Purpose@#This study aimed to investigate the association between autism spectrum disorder (ASD) diagnosis and mortality among children using the data from a large-scale national cohort of Korean infants and children. We also explored the association between hearing impairment detected during early infancy and mortality. @*Materials and Methods@#We performed a retrospective cohort study using the nationwide claims data of the Republic of Korea.Children born between 2007 and 2014 (n=3598904) were followed up until 2020. Cox proportional hazard models were used to examine the association between ASD diagnosis and mortality among children. Then, in order to evaluate the association between hearing impairment and mortality, Cox proportional hazard models were built using the responses related to hearing impairment asked during the first health screening (at age 4–6 months). @*Results@#Of the 3598904 children born between 2007 and 2014, 32878 children (0.9%) were diagnosed with ASD until the end of 2020. We identified that ASD diagnosis was associated with higher mortality among children [hazard ratio (HR)=2.5, 95% confidence interval (CI): 2.2–2.9]. This association was stronger among girls (HR=4.8, 95% CI: 3.9–5.8) compared to boys (HR=1.9, 95% CI: 1.6–2.2). We found that hearing impairment detected during infancy was associated with higher mortality among children with ASD diagnosis. @*Conclusion@#ASD diagnosis was associated with higher mortality among Korean children. This association was stronger in girls than in boys. Hearing impairment detected during infancy was also associated with higher mortality among children diagnosed with ASD.

Trend in Prevalence of Smoking and Motivation to Quit among Korean Adult Male Cancer Survivors over the Last 8 Years: The Korea National Health and Nutrition Examination Survey V–VII (2010–2017) / 가정의학회지

Background@#This study aimed to investigate trends in the prevalence of current smokers and motivation to quit among Korean male cancer survivors. @*Methods@#Out of 20,012 men who participated in the Korea National Health and Nutrition Examination Survey V (2010–2012), VI (2013–2015), and VII (2016–2017), 742 cancer survivors were included. A cancer survivor was defined as a person who concurred to the item, “The cancer has been diagnosed by a doctor” in the health questionnaire. Smoking status was classified as current, former, and never smokers. Regarding motivation to quit smoking, we defined those who had a willingness to quit within 6 months as the willing group. Logistic regression analysis was conducted to examine trends in the prevalence of current smokers and the proportion of the willing group among current smokers. @*Results@#Overall, 3.7% of Korean men who participated in the study were cancer survivors. Current smokers constituted 19.5%, 19.1%, and 15.3% of cancer survivors in phases V, VI, and VII respectively which did not show significant changes (P for trend=0.33). However, the proportion of current smokers in the non-cancer group was significantly reduced to 46.6%, 41.2%, and 38.9% in phases V, VI, and VII, respectively (P for trend <0.001). The proportion of those with a motivation to quit smoking did not show a significant trend in the cancer survivors (P for trend=0.964) and non-cancer group (P for trend=0.884). @*Conclusion@#Prevalence of current smokers and motivation to quit in Korean male cancer survivors did not show significant trends.

Comparison of the Seroprevalence of Measles Antibodies among Healthcare Workers in Two Korean Hospitals in 2019 / 감염과화학요법

We performed a point seroprevalence survey of measles among healthcare workers (HCWs) at two Korean teaching hospitals in 2019. A total of 2,830 HCWs underwent an antibody test.The overall seropositivity of measles was 93.1%. The seroprevalence of measles was lowest in HCWs aged 20 - 24 years (81.2%), followed by those aged 25 - 29 years (90.1%). The rates of anti-measles IgG positivity were significantly different between the two hospitals (97.0% vs.89.4%, P <0.001). These results suggest that the seropositivity of measles in HCWs may differ depending on the hospital's vaccination policy.

Development and validation of a portfolio assessment system for medical schools in Korea / 보건의료교육평가

Purpose@#Consistent evaluation procedures based on objective and rational standards are essential for the sustainability of portfolio-based education, which has been widely introduced in medical education. We aimed to develop and implement a portfolio assessment system, and to assess its validity and reliability. @*Methods@#We developed a portfolio assessment system from March 2019 to August 2019 and confirmed its content validity through expert assessment by an expert group comprising 2 medical education specialists, 2 professors involved in education at medical school, and a professor of basic medical science. Six trained assessors conducted 2 rounds of evaluation of 7 randomly selected portfolios for the “Self-Development and Portfolio II” course from January 2020 to July 2020. These data are used inter-rater reliability was evaluated using intra-class correlation coefficients (ICCs) in September 2020. @*Results@#The portfolio assessment system is based on the following process; assessor selection, training, analytical/comprehensive evaluation, and consensus. Appropriately trained assessors evaluated portfolios based on specific assessment criteria and a rubric for assigning points. In the analysis of inter-rater reliability, the first round of evaluation grades was submitted, and all assessment areas except “goal-setting” showed a high ICC of 0.81 or higher. After the first round of assessment, we attempted to standardize objective assessment procedures. As a result, all components of the assessments showed close correlations, with ICCs of 0.81 or higher. @*Conclusion@#We confirmed that when assessors with an appropriate training conduct portfolio assessment based on specified standards through a systematic procedure, the results are reliable.

Development and validation of a portfolio assessment system for medical schools in Korea / 보건의료교육평가

Purpose@#Consistent evaluation procedures based on objective and rational standards are essential for the sustainability of portfolio-based education, which has been widely introduced in medical education. We aimed to develop and implement a portfolio assessment system, and to assess its validity and reliability. @*Methods@#We developed a portfolio assessment system from March 2019 to August 2019 and confirmed its content validity through expert assessment by an expert group comprising 2 medical education specialists, 2 professors involved in education at medical school, and a professor of basic medical science. Six trained assessors conducted 2 rounds of evaluation of 7 randomly selected portfolios for the “Self-Development and Portfolio II” course from January 2020 to July 2020. These data are used inter-rater reliability was evaluated using intra-class correlation coefficients (ICCs) in September 2020. @*Results@#The portfolio assessment system is based on the following process; assessor selection, training, analytical/comprehensive evaluation, and consensus. Appropriately trained assessors evaluated portfolios based on specific assessment criteria and a rubric for assigning points. In the analysis of inter-rater reliability, the first round of evaluation grades was submitted, and all assessment areas except “goal-setting” showed a high ICC of 0.81 or higher. After the first round of assessment, we attempted to standardize objective assessment procedures. As a result, all components of the assessments showed close correlations, with ICCs of 0.81 or higher. @*Conclusion@#We confirmed that when assessors with an appropriate training conduct portfolio assessment based on specified standards through a systematic procedure, the results are reliable.

Satisfaction with and suitability of the problem-based learning program at the Catholic University of Korea College of Medicine / 보건의료교육평가

Purpose@#This study was conducted to identify suggestions for improving the effectiveness and promoting the success of the current problem-based learning (PBL) program at the Catholic University of Korea College of Medicine through a professor and student awareness survey. @*Methods@#A survey was carried out by sending out mobile Naver Form survey pages via text messages 3 times in December 2018, to 44 medical students and 74 professors. In addition, relevant official documents from the school administration were reviewed. The collected data were analyzed to identify the achievement of educational goals, overall satisfaction with, and operational suitability of the PBL program. @*Results@#The overall satisfaction scores for the PBL program were neutral (students, 3.27±0.95 vs. professors, 3.58±1.07; P=0.118). Regarding the achievement of educational goals, the integration of basic and clinical medicine and encouragement of learning motivation were ranked lowest. Many respondents expressed negative opinions about the modules (students, 25.0%; professors, 39.2%) and tutors (students, 54.5%; professors, 24.3%). The students and professors agreed that the offering timing of the program in medical school and the length of each phase were suitable, while opinions expressed in greater detail pointed to issues such as the classes being held too close to exams and their alignment with regular course units. @*Conclusion@#Issues with modules and tutors were the most pressing. Detailed and appropriate modules should be developed on the basis of advice from professors with experience in PBL tutoring. Inconsistencies in tutoring should be reduced by standardization and retraining.

Evaluation of a portfolio-based course on self-development for pre-medical students in Korea / 보건의료교육평가

Purpose@#We have developed and operated a portfolio-based course aimed at strengthening pre-medical students’ capabilities for self-management and self-improvement. In order to determine the effectiveness of the course and to establish future operational strategies, we evaluated the course and the students’ learning experience. @*Methods@#The subjects of this study were 97 students of a pre-medical course “Self-development and portfolio I” in 2019. Their learning experience was evaluated through the professor’s assessment of portfolios they had submitted, and the program was evaluated based on the responses of 68 students who completed a survey. The survey questionnaire included 32 items. Descriptive statistics were reported for quantitative data, including the mean and standard deviation. Opinions collected from the open-ended question were grouped into categories. @*Results@#The evaluation of students’ portfolios showed that only 6.2% of the students’ portfolios were well-organized, with specific goals, strategies, processes, and self-reflections, while most lacked the basic components of a portfolio (46.4%) or contained insufficient content (47.4%). Students’ responses to the survey showed that regular portfolio personality assessments (72.1%), team (64.7%), and individual (60.3%) activities were felt to be more appropriate as educational methods for this course, rather than lectures. Turning to the portfolio creation experience, the forms and components of the portfolios (68.2%) and the materials provided (62.2%) were felt to be appropriate. However, students felt that individual autonomy needed to be reflected more (66.7%) and that this course interfered with other studies (42.5%). @*Conclusion@#The findings of this study suggest that standardized samples, guidelines, and sufficient time for autonomous portfolio creation should be provided. In addition, education on portfolio utilization should be conducted in small groups in the future.

Erratum: Authorship & Funding Acknowledgment Correction. The relationship of nutrition of rice and positive evaluation of the rice-based meal on the physical and emotional self-diagnosis and learning efficiency of the middle and highschool students in the Jeonju area / 한국영양학회지

The original version of this article contained errors in authorship and funding acknowledgment.

The relationship of nutrition of rice and positive evaluation of the rice-based meal on the physical and emotional self-diagnosis and learning efficiency of the middle and highschool students in the Jeonju area / 한국영양학회지

PURPOSE: This study examined the relationship of the nutrition of rice and the positive evaluation of the rice-based meal with the food consumption habits, physical and emotional health status, and learning efficacy of 601 middle and high school students in Jeonju area. METHODS: The participants were divided into two groups using cluster analysis in that the participants belonging to the upper groups had a center score of 46.86 (n = 348), while the people belonging to the lower group had a center score of 36.89 (n = 253). Statistical differences were tested for all the relationships between the physical and emotional healths symptoms and learning efficacy between the groups at the α = 0.05 level. RESULTS: Significant differences in the physical self-evaluated symptoms were observed in all five items in each cluster (p < 0.05). In the case of the emotional health status, nine out of 10 items showed significant differences between the groups. Similarly, significant differences in all five items in learning efficacy questionnaire were noted (p < 0.05). Positive attitudes of the parents toward having breakfast also showed significant differences among the groups. CONCLUSION: The nutrition of rice and a positive evaluation of the rice-based meals significantly affect the physical and emotional health status and learning efficacy of juveniles. These findings can be used as baseline information for promoting nutrition education, particularly rice-based breakfast.

Relationship between Perceived Health Status andPatient Satisfaction in Outpatient Settings - Korean National Health and Nutrition Examination Survey 2015 / 의료커뮤니케이션

BACKGROUND: It is important to investigate patient satisfaction to improve the quality of healthcare. Among the many factors that affect patient satisfaction, perceived health status has been considered as one of the major factors. Therefore, we investigated patient satisfaction through patient experience in outpatient settings according to perceived health status.METHODS: This cross-sectional study using questionnaires of patient experience and perceived health status from the Korean National Health and Nutrition Examination Survey 2015 included 4267 people aged over 19 years who met the inclusion criteria. Perceived health status was classified into three: good, fair, and poor. Questions about patient experience consisted of four items: doctor spending enough time with patients, doctor providing easy-to-understand explanation, doctor giving opportunity to ask questions or raise concerns, and doctor involving patient in decisions about care or treatment. Patient experience was classified into two: satisfied and non-satisfied. A multivariate regression model was used to analyze the data.RESULTS: In the good perceived health status group, level of satisfaction was 79.2%, 88.5%, 83.3% and 87.2%, respectively for the four items targeting patient experience. In the poor group, level of satisfaction was 76%, 84.9%, 79.5%, and 83.1%, respectively for the four items. In multivariate logistic regression analyses, the odds ratios of good perceived health status group were 1.775 (1.347–2.338), 1.946 (1.356–2.793), 1.652 (1.218–2.240), and 1.665 (1.193–2.323) compared with the poor group.CONCLUSION: Perceived health status is associated with patient satisfaction. In particular, the better the perceived health status, the better the patient satisfaction through patient experience.

Relationship between Dry Eye Syndrome and Frequency of Coffee Consumption in Korean Adults: Korea National Health and Nutrition Examination Survey V, 2010–2012 / 가정의학회지

BACKGROUND: Dry eye syndrome is a common health problem in the adult population. Many risk factors including age, sex, prior eye surgery, various chronic diseases, and lifestyle factors can affect its development. We have evaluated the risk of dry eye syndrome based on the frequency of coffee consumption among Korean adult population. METHODS: A total of 9,752 adults with age 19 years and older were randomly selected between 2010 and 2012. They have all participated in the National Health and Nutrition Examination Survey V of Korea. Dry eye syndrome was being diagnosed by the physicians at some points in the participant’s lifetime. The average daily coffee intake was divided into the following: less than 1 cup, 1 to 2 cups, and 3 cups or more. Various physio-environmental factors and medical conditions were used as correction variables to assess the risk of dry eye syndrome in relation to the frequency of coffee consumption. RESULTS: The prevalence of dry eye syndrome decreased to 9.2%, 8.8%, and 6.3% as coffee consumption increased from less than 1 cup to 1–2 cups and more than 3 cups, respectively. However, there was no significant relationship between the frequency of coffee consumption and the risk of dry eye syndrome after adjusting various risk factors. CONCLUSION: There is no relationship between the frequency of coffee consumption and risk of dry eye syndrome.

Relationship between Age at Menarche and Metabolic Syndrome in Premenopausal Women: Korea National Health and Nutrition Examination Survey 2013–2014 / 가정의학회지

BACKGROUND: Early menarche may be associated with increased risk of cardiovascular disease. The aim of this study was to evaluate the relationship between age at menarche and metabolic syndrome (MetS) in Korean premenopausal women. METHODS: We used nationally representative data from the Korea National Health and Nutrition Examination Survey from 2013 to 2014, and 3,023 premenopausal women aged 20–55 years were our subjects. We defined early menarche as age at first menstrual period less than 12 years. Multivariable logistic regression analysis was used to evaluate the relationship between age at menarche and MetS after adjusting for current age, and socioeconomic, lifestyle, and reproductive variables. RESULTS: MetS was much more common in women aged 40–55 years than in women aged 20–39 years (4.1% vs. 15.1%). Compared with women who experienced menarche at age 12–15 years, the risk of MetS in the early menarche group was not higher in either age group, after adjusting for current age, and socioeconomic, lifestyle, and reproductive variables (odds ratio [OR], 1.767; 95% confidence interval [CI], 0.718–4.351 in those aged 20–39 years; OR, 1.780; 95% CI, 0.775–4.085 in those aged 40–55 years). The risk of MetS in women with menarche at age ≥16 years was not higher than in women with menarche at age 12–15 years. CONCLUSION: Early or late menarche was not associated with an increased risk of MetS in premenopausal Korean women. Even before menopause, current age has a major influence on the development of MetS.

Therapeutic Effects of Leuprorelin (Leuprolide Acetate) in Sexual Offenders with Paraphilia

BACKGROUND: This study examined the clinical effects of leuprolide acetate in sexual offenders with paraphilic disorders evaluated by means of objective psychiatric assessment. METHODS: The subjects of this study were seven sexual offenders who were being treated by means of an injection for sexual impulse control by a court order. They had been diagnosed with paraphilia by a psychiatrist based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and had been put on probation by the Ministry of Justice between January 2016 and December 2016. RESULTS: After twelve months, we observed significant improvement in symptoms, as decrease of abnormal sexual interest and activity, sexual fantasy, Clinical Global Impression-Severity (CGI-S), and Clinical Global Impression-Impulsivity (GCI-I). There were a mild feminization of the body shape, feelings of fatigue, and mild hot flushes. No other adverse effect was reported. CONCLUSION: These results suggested that the clinical effects of leuprolide acetate in sexual offenders might be an effective treatment and safety strategy.