Association between diet quality and untreated dental caries: results from the Korea National Health and Nutrition Examination Survey

BACKGROUND/OBJECTIVES@#Few studies have provided evidence of the association between diet quality and dental caries. This study aimed to examine the association between diet quality and untreated dental caries in a Korean representative population. @*SUBJECTS/METHODS@#The study population included a sample of 13,815 participants, aged ≥ 19 from the Korea National Health and Nutrition Examination Survey during 2013–2015. The explanatory variable was diet quality and the outcome variable was untreated dental caries.Untreated dental caries were defined by the number of decayed teeth recorded according to the criteria established by the World Health Organization. Diet quality was defined by using the Korean Healthy Eating Index (KHEI) through the 24-h recall methods. We assessed the association between diet quality and untreated dental caries while adjusting for age, sex, education, income, smoking status, dental visits, toothbrushing frequencies, obesity, and diabetes mellitus. @*RESULTS@#The mean overall KHEI scores in the untreated dental caries group were significantly lower than those in the group without untreated dental caries. Significant differences were observed in the untreated dental caries group based on the KHEI quartiles (P < 0.001). After adjusting for potential confounders, the quartiles of KHEI scores showed an association with untreated dental caries, demonstrating a dose-effect trend (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.35–1.84 for 1st quartile; OR, 1.38; 95% CI, 1.19–1.59 for 2nd quartile; OR, 1.32; 95% CI, 1.14–1.53 for 3rd quartile; reference quartile highest]). @*CONCLUSIONS@#The findings indicated an inverse association between diet quality and untreated dental caries in Korean adults. Healthcare providers should take into account the significant role of diet quality in preventing and managing oral health.

Socioeconomic status, food security, and chewing discomfort of Korean elders: results from the Korea National Health and Nutrition Examination Survey

BACKGROUND/OBJECTIVES@#The purpose of this study was to investigate the association between socioeconomic status and chewing discomfort and identify the role of food insecurity in the association's causal pathway in a representative sample of Korean elders.MATERIALS/METHODS: We conducted cross-sectional analyses of the Korea National Health and Nutrition Examination Survey (2013–2015) data for elders aged ≥ 65 years.Socioeconomic status indicators used included household income and education level.Chewing discomfort was assessed according to the self-reported presence of chewing problems. Food security was surveyed using a questionnaire based on the US Household Food Security Survey Module. @*RESULTS@#The odds ratios of chewing discomfort in the 1st and 2nd income quartiles were 1.55 (95% confidence interval [CI], 1.15–2.10) and 1.40 (95% CI, 1.03–1.90), respectively, compared to participants in the highest income quartile. Participants with the lowest education level were 1.89 (95% CI, 1.30–2.75) times more likely to have chewing discomfort than those without chewing discomfort. After including food security in the final model, the logistic coefficients were attenuated in the income and education quartiles. @*CONCLUSIONS@#Low socioeconomic status was associated with chewing discomfort. In addition, the results confirm that food insecurity can mediate the association between socioeconomic inequalities and chewing discomfort among the elderly.

Relationship between Complementary Feeding Introduction and Early Childhood Caries: Results from the Korea National Health and Nutrition Examination Survey 2008–2015 / 대한지역사회영양학회지

OBJECTIVES: This study examined whether the infant feeding type and duration are related to the introduction of complementary feeding, and whether the appropriate introduction of complementary feeding in infancy is related to tooth decay in toddlers. METHODS: The subjects were 1,521 toddlers among 2~3 year old children in the Korea National Health and Nutrition Examination Survey from 2008 to 2015. The toddlers were divided into the appropriate group (4~6 months) and delayed group (>6 months) according to the timing of complementary feeding introduction. RESULTS: The delayed group were 26.5% of subjects and the formula feeding period in the appropriate group and delayed group was 8.4 and 10.3 months, respectively (P=0.002). On the other hand, there was no difference in the breastfeeding period between the appropriate group and delayed group (P=0.6955). Early childhood caries was more common in the delayed group (P=0.0065). The delayed introduction of complementary feeding was associated with a risk of early childhood caries according to the logistic models (OR 1.81, 95% CI 1.27–2.57). CONCLUSIONS: The introduction of complementary feeding is associated with early childhood caries. Therefore, the importance of the proper introduction of complementary feeding in infancy should be emphasized, and public relations and education for maternal care and breastfeeding should be provided through health care institutions.

Relationship between Complementary Feeding Introduction and Early Childhood Caries: Results from the Korea National Health and Nutrition Examination Survey 2008–2015 / 대한지역사회영양학회지

OBJECTIVES: This study examined whether the infant feeding type and duration are related to the introduction of complementary feeding, and whether the appropriate introduction of complementary feeding in infancy is related to tooth decay in toddlers. METHODS: The subjects were 1,521 toddlers among 2~3 year old children in the Korea National Health and Nutrition Examination Survey from 2008 to 2015. The toddlers were divided into the appropriate group (4~6 months) and delayed group (>6 months) according to the timing of complementary feeding introduction. RESULTS: The delayed group were 26.5% of subjects and the formula feeding period in the appropriate group and delayed group was 8.4 and 10.3 months, respectively (P=0.002). On the other hand, there was no difference in the breastfeeding period between the appropriate group and delayed group (P=0.6955). Early childhood caries was more common in the delayed group (P=0.0065). The delayed introduction of complementary feeding was associated with a risk of early childhood caries according to the logistic models (OR 1.81, 95% CI 1.27–2.57). CONCLUSIONS: The introduction of complementary feeding is associated with early childhood caries. Therefore, the importance of the proper introduction of complementary feeding in infancy should be emphasized, and public relations and education for maternal care and breastfeeding should be provided through health care institutions.

Number of existing permanent teeth is associated with chronic kidney disease in the elderly Korean population

BACKGROUND/AIMS: The aim of this study was to assess the association between the number of existing permanent teeth and chronic kidney disease (CKD) in a representative sample of the elderly Korean population. METHODS: A total of 2,519 subjects who participated in the Korean National Health and Nutrition Examination Survey were cross-sectionally examined. The number of existing permanent teeth was evaluated by clinical oral examination. CKD was defined based on definition and classification by Kidney Disease: Improving Global Outcomes (KDIGO) 2012 guidelines. Multivariable logistic regression analyses were performed controlling for age, gender, income, education, tooth-brushing frequency, periodontitis, state of dentition, smoking, alcohol consumption, hypertension, obesity, diabetes mellitus, and hypercholesterolemia. Subgroup analyses by age and gender were also performed. RESULTS: The number of teeth was significantly associated with CKD after controlling for all potential confounders (adjusted odds ratio [AOR], 1.67; 95% confidence interval [CI], 1.04 to 2.70 for lower number of teeth; AOR, 1.59; 95% CI, 1.14 to 2.23 for moderate number of teeth). In the subgroup analyses, the association was highlighted in females aged 75 years over (AOR, 2.55; 95% CI, 1.05 to 6.20 for lower number of teeth; AOR, 1.95; 95% CI, 1.01 to 3.80 for moderate number of teeth). CONCLUSIONS: Our findings suggest that the number of existing permanent teeth may be associated with CKD among Korean elderly.

Comparing Chewable and Manual Toothbrushes for Reducing Dental Plaque: A Pilot Study / 치위생과학회지

This study aimed to compare the effectiveness of chewable toothbrush and manual toothbrush and provide basic data for recommendation of the chewable toothbrush in specific groups and situations. A total of 20 subjects participated in this study (rolling method, 10; non-rolling method, 10). After professional prophylaxis, participants used the manual toothbrush to brush their teeth for 3 minutes. After a 7-day wash-out period, participants used the chewable toothbrush according to the manufacturer's instructions. Pre- and post-plaque indexing of the teeth was performed. The dental plaque index was assessed using the Turesky Modification of the Quigley-Hein Plaque Index (TMQHPI) for amount of plaque and Silness-Löe Plaque Index (SLPI) for plaque thickness. The difference between pre- and post-dental plaque index was analyzed using a paired t-test and the Wilcoxon signed-rank test. The Mann-Whitney U test was also used to compare the dental plaque index reduction rates. The dental plaque index differed significantly between the chewable toothbrush and the manual toothbrush. The TMQHPI reduction rate was significantly different between the rolling and non-rolling method groups for the manual toothbrush but not the chewable toothbrush. The difference in SLPI reduction rate between the rolling and non-rolling method groups was significant for the manual toothbrush but not for the chewable toothbrush. Differences in the dental plaque index reduction rates between the chewable and manual toothbrushes were not significant in the non-rolling method group. The results of this study showed higher reduction rates in dental plaque with manual toothbrush use than with chewable toothbrush use. However, the non-rolling method group did not show statistically significant differences according to toothbrush type. The present study showed that a chewable toothbrush can be an alternative to a manual toothbrush for individuals who have difficulty using the generally recommended rolling method.

Association between the Number of Existing Permanent Teeth and Chronic Obstructive Pulmonary Disease / 치위생과학회지

The aim of this study was to evaluate whether the number of existing permanent teeth is associated with chronic obstructive pulmonary disease (COPD) in a representative sample of Korean adults. Data from 3,107 subjects who participated in the 2009 Korea National Health and Nutrition Examination Survey were examined. The dependent variable was COPD and the independent variable was the number of existing permanent teeth. Spirometry results were classified into three groups (normal pattern, restrictive pattern, and obstructive pattern) by trained technicians. We used dichotomized COPD variables (no vs. yes). The number of existing permanent teeth was evaluated by oral examination and divided into 3 groups (0∼19, 20∼27, and 28). Demographic factors (age group and sex group), socioeconomic status (education and income), health behaviors (smoking and drinking), oral health and behavior (frequency of toothbrushing; periodontitis; decayed, missing, filled, permanent teeth index; and denture status), and general health status (body mass index, diabetes mellitus, and hypertension) were included as confounders in the analysis. Bivariate analysis and multivariate logistic regression analyses including confounders were applied, and all analyses considered a complex sampling design. Stratified analysis was performed by smoking status. After controlling for various confounders, there was a significant association between the number of existing permanent teeth and COPD (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.20∼3.00 for the 20∼27 group; OR, 3.93; 95% CI, 1.75∼8.84 for the 0∼19 group). The association was more significant in current smokers (OR, 8.90; 95% CI, 2.53∼31.33). Our data indicate that the number of existing permanent teeth was independently associated with COPD, especially in current smokers. Further longitudinal research is needed to determine whether oral health promotion plays a role in the improvement of lung function and prevention of COPD.

Association between the number of existing permanent teeth and health-related quality of life (EuroQol-5 Dimension) among adults: findings from the fifth Korea National Health and Nutrition Examination Surveys, 2012 / 대한구강보건학회지

OBJECTIVES: The aim of this study was to evaluate whether the number of existing permanent teeth is associated with health-related quality of life by using EuroQol-5 Dimension (EuroQol-5D) in a representative sample of Korean adults. METHODS: A total of 5349 subjects who participated in the 2012 fifth Korea National Health and Nutrition Examination Survey (KNHANES) were examined. The dependent variable was EQ-5D index and independent variable was the number of existing permanent teeth. The health-related quality of life was assessed by using EQ-5D index. The number of existing permanent teeth was evaluated by dentists using World Health Organization Index. Demographic factors (age and gender), socioeconomic status (education, income), oral health behaviors (frequency of daily toothbrushing, and regular dental visit), health behaviors (cigarette smoking, drinking, regular physical activity), general health status (depression, stress, body mass index, hypertension, diabetes mellitus) were included as confounder in analysis. Multivariable linear regression model, stratified analysis and analysis of covariance were applied. RESULTS: After adjustment for various confounders, the number of existing permanent teeth was positively associated with EQ-5D index (P<0.001). This association was highlighted among 40-59 year-old males and over 60 year-old females. CONCLUSIONS: Our data indicate that the number of existing permanent teeth was independently associated with EQ-5D index. Our results provided the substantially important evidence on the health and oral health promotion for Korean adults.

Prognostic Indicators for Acute Liver Failure Development and Mortality in Patients with Hepatitis A: Consecutive Case Analysis

PURPOSE: Due to the seroepidemiological shift in hepatitis A (HA), its severity, mortality, and complications have increased in recent years. Thus, the aim of this study was to identify predictive factors associated with poor prognosis among patients with HA. MATERIALS AND METHODS: A total of 304 patients with HA admitted to our institution between July 2009 and June 2011 were enrolled consecutively. Patients with complications defined as acute liver failure (ALF) were evaluated, and mortality was defined as death or liver transplantation. RESULTS: The mean age of patients (204 males, 100 females) was 32 years. Eighteen (5.9%) patients had progressed to ALF. Of the patients with ALF, 10 patients (3.3%) showed spontaneous survival while 8 (2.6%) died or underwent liver transplantation. Multivariate regression analysis showed that Model for End-Stage Liver Disease (MELD) and systemic inflammatory response syndrome (SIRS) scores were significant predictive factors of ALF. Based on receiver operating characteristics (ROC) analysis, a MELD > or =23.5 was significantly more predictive than a SIRS score > or =3 (area under the ROC: 0.940 vs. 0.742, respectively). In addition, of patients with a MELD score > or =23.5, King's College Hospital criteria (KCC) and SIRS scores were predictive factors associated with death/transplantation in multivariate analysis. CONCLUSION: MELD and SIRS scores > or =23.5 and > or =3, respectively, appeared to be related to ALF development. In addition, KCC and SIRS scores > or =3 were valuable in predicting mortality of patients with a MELD > or =23.5.

Correlation between Soluble Triggering Receptor Expressed on Myeloid Cells-1 and Endoscopic Activity in Intestinal Behcet's Disease

PURPOSE: The serum levels of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) have recently been shown to be correlated highly with disease activity in patients with intestinal Behcet's disease (BD). However, it remains unclear whether sTREM-1 levels reflect endoscopic activity in intestinal BD. This study aimed to evaluate the correlation of sTREM-1 levels with endoscopic activity in intestinal BD. MATERIALS AND METHODS: A total of 84 patients with intestinal BD were enrolled. Endoscopic activity was compared with sTREM-1 levels as well as other laboratory findings, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). RESULTS: sTREM-1 levels were significantly increased in intestinal BD patients compared with controls (37.98+/-27.09 pg/mL vs. 16.65+/-7.76 pg/mL, p=0.002), however, there was no difference between endoscopically quiescent and active diseases (43.53+/-24.95 pg/mL vs. 42.22+/-32.68 pg/mL, p=0.819). Moreover, serum sTREM-1 levels did not differ in terms of number, shape, depth, size, margin, or type of ulcer in patients with intestinal BD. However, mean ESR and CRP levels in patients with active disease were significantly higher than those in patients with quiescent disease (p=0.001, p<0.001, respectively). In addition, endoscopic activity scores for intestinal BD were correlated significantly with both CRP levels (gamma=0.329) and ESR (gamma=0.298), but not with sTREM-1 levels (gamma=0.166). CONCLUSION: Unlike CRP levels and ESR, serum sTREM-1 levels were not correlated with endoscopic activity in patients with intestinal BD.

Recurrent Esophageal Stricture Caused by Candidiasis in an HIV-Infected Patient / 대한내과학회지

Esophageal candidiasis is a common opportunistic infection that develops in human immunodeficiency virus (HIV)-infected patients. It is usually effectively treated with fluconazole, and the occurrence of an esophageal stricture in association with esophageal candidiasis has rarely been reported in HIV-infected patients. In the case presented here, a 49-year-old man was diagnosed with severe esophageal candidiasis with HIV infection. At the time of the HIV diagnosis, he had immunodeficient status with a CD4+ T lymphocyte count of 150 cells/mm3. He received antifungal treatment with fluconazole and combined antiretroviral therapy. Although the esophageal candidiasis improved with rapid recovery of the CD4+ T lymphocyte count, a recurrent esophageal stricture developed. To treat the recurrent esophageal stricture, the patient received repeated balloon dilatation and stent insertion. We report this rare case of severe esophageal stricture complication of esophageal candidiasis in an HIV-infected patient.

Recurrent Esophageal Stricture Caused by Candidiasis in an HIV-Infected Patient / 대한내과학회지

Esophageal candidiasis is a common opportunistic infection that develops in human immunodeficiency virus (HIV)-infected patients. It is usually effectively treated with fluconazole, and the occurrence of an esophageal stricture in association with esophageal candidiasis has rarely been reported in HIV-infected patients. In the case presented here, a 49-year-old man was diagnosed with severe esophageal candidiasis with HIV infection. At the time of the HIV diagnosis, he had immunodeficient status with a CD4+ T lymphocyte count of 150 cells/mm3. He received antifungal treatment with fluconazole and combined antiretroviral therapy. Although the esophageal candidiasis improved with rapid recovery of the CD4+ T lymphocyte count, a recurrent esophageal stricture developed. To treat the recurrent esophageal stricture, the patient received repeated balloon dilatation and stent insertion. We report this rare case of severe esophageal stricture complication of esophageal candidiasis in an HIV-infected patient.

Recurrent Acute Pericarditis Induced by 5-aminosalicylates in a Patient with Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is an idiopathic chronic inflammation of the intestines. IBD treatment may require anti-inflammatory agents such as sulfasalazine or 5-aminosalicylate (5-ASA) and immunomodulators to control the symptoms. However, these agents have a variety of common adverse effects such as nausea, vomiting, skin rash, leukopenia, thrombocytopenia, and infections. Moreover, rare side effects such as nephrotic syndrome, pneumonitis, and pericarditis can occur. A 21-year-old male was admitted to the hospital due to acute chest pain, fever, and sweating. The patient had a history of Crohn's disease and had been taking mesalazine for 3 weeks. Chest x-ray, echocardiography, and clinical manifestations revealed that the patient had acute pericarditis. However, we did not recognize the relationship between these findings and 5-ASA at that time. Two years later, the patient took 5-ASA again, and similar symptoms occurred, which led us to confirm that he suffered from pericarditis induced by this drug. We report a case of acute recurrent pericarditis that developed after taking 5-ASA for IBD treatment with a review of the literature.

The Rebleeding Risk and Prognostic Factors of Acute Hemorrhagic Rectal Ulcer

BACKGROUND/AIMS: Acute hemorrhagic rectal ulcer (AHRU) is an important etiology of lower gastrointestinal bleeding in intensive care unit patients and hospital inpatients. Moreover, with increasing elderly populations, and improved survival in critically ill patients, the incidence of AHRU has increased. The aim of this study is to determine rebleeding risk and prognostic factors of AHRU patients. METHODS: We retrospectively reviewed 32 patients with AHRU in Severance Hospital from February 2006 to October 2010, collected clinical data, and analyzed their association with the recurrence of bleeding and mortality of patients. RESULTS: The mean age of patients was 65.5 years, and 27 patients (84.4%) showed Eastern Cooperative Oncology Group performance status 3-4. Nineteen patients (59.4%) had recurrent bleeding. Hypoalbuminemia (2 mg/dL) and thrombocytopenia (40 seconds) increased mortality (P=0.028, P=0.008 and P=0.027, respectively) and the patients with rebleeding showed a tendency toward higher mortality, compared to those without (57.9% vs. 23.1%, P=0.051). CONCLUSIONS: In AHRU patients, hypoalbuminemia was a risk factor of rebleeding, and chronic liver disease, hypoalbuminemia, renal dysfunction, thrombocytopenia and no endoscopic treatment at the first bleeding event was correlated with relatively earlier rebleeding.

Two Cases of Wernicke's Encephalopathy in Young Age Patients Receiving Allogeneic Hematopoietic Stem Cell Transplantation

Wernicke's encephalopathy is an acute neurolopsychiatric syndrome caused by thiamine deficiency, and classically presents with the triad of opthalmopathy, ataxia and altered mentality. Both prolonged total parenteral nutrition and reduced oral intake can induce Wernicke's encephalopathy during hematopoietic stem cell transplantation (HSCT). Although early treatment is important for recovery from Wernicke's encephalopathy, the vague symptoms and characteristics hinder early diagnosis. Furthermore, Wernicke's encephalopathy is not infrequent and can develop at any age during HSCT. Herein, we present two young patients developing Wernicke's encephalopathy during HSCT.

Minimal Change Nephrotic Syndrome Developed after Thymectomy in a Patient with Thymoma / 대한신장학회지

We report a case of patient with malignant thymoma, who developed nephrotic syndrome several years after thymectomy. This 38-year-old man was diagnosed as myasthenia gravis and malignant thymoma and underwent thymectomy in 2004. Tumor resection and systemic chemotherapy were performed after recurrence in pleura in 2006. He also took pyridostigmine to control his symptoms of myasthenia gravis after thymectomy. Four years later, even though there was no evidence of recurrence of thymoma, he developed a nephrotic syndrome and was diagnosed as a minimal change disease on renal biopsy. After pulse therapy with methylprednisolone followed by oral administration of prednisolone therapy, nephrotic syndrome was improved.

Cutaneous Metastasis from Cholangiocarcinoma as the First Clinical Sign: A Report of Two Cases

Cutaneous metastases from internal malignancies are uncommon. Furthermore, cutaneous metastases from cholangiocarcinoma are extremely rare. Here we report a case of two patients with distant cutaneous metastases of cholangiocarcinoma: 1) a 66-year-old man who presented with a solitary, erythematous nodule on the scalp and 2) a 44-year-old man who presented with multiple, erythematous nodules on the scalp, the chest wall, and the back. In both cases, the erythematous nodules were the first clinical signs of cholangiocarcinoma. Histopathological analyses of skin biopsy specimens of the two patients revealed adenocarcinomas with features similar to the original cholangiocarcinoma. Two cases of cholangiocarcinoma in which metastatic skin nodules appeared as the first sign of the disease are reported here, with a review of the relevant literature.

Hepatocellular Carcinoma with Bile Duct Tumor Thrombi / 영남의대학술지

Obstruction of the bile duct owing to the direct extension of a tumor is occasionally found in patients with a hepatic neoplasm, but bile duct tumor thrombus caused by the intrabiliary transplantation of a free-floating tumor is a rare complication of hepatocellular carcinoma. A 50-year-old woman was diagnosed with HCC with bile duct tumor thrombi. She received transarterial chemoembolization (TACE) because her liver function was not suitable for surgery at the time of diagnosis. After TACE, infected biloma occurred recurrently. Thus, resection of the HCC, including the bile duct tumor thrombi, was performed. Six months after the surgery, recurred HCC in the distal common bile duct as drop metastasis was noted. The patient was treated with tomotherapy and has been alive for three years as of this writing, without recurrence. The prognosis of HCC with bile duct tumor thrombi is considered dismal, but if appropriate procedures are selected and are actively carried out, long-term survival can occasionally be achieved.

PCR-Based Sensitive Detection of Wood-Decaying Fungus Phellinus linteus by Specific Primer from rDNA ITS Regions

Based on the rDNA ITS sequences data, specific primer set for PCR detection of wood-decaying fungus Phellinus linteus was designed. The length of PCR products using designed primer set(SHF and SHR) was about 540 bp. Among 11 species, 17 isolates of Phellinus spp. including Phellinus linteus, P. pomaceus, P. spiculosus, P. baumi, P. pini, P. igniarius, P. gilvus, P. biscuspidatus, P. weirii, P. johnsonianus, P. robutus, and P. igniarius, seven isolates of Phellinus linteus showed about 540 bp-sized single band. This molecular technique could offer a useful tool for detecting and identifying Phellinus linteus.

Development of a Home Health Care Nursing Intervention List through Analysis of Home Health Care Nursing Records / 기본간호학회지

The purpose of this study was to identify nursing diagnoses and nursing interventions that are found in the home health care patients, and to establish a basis for a standardized Nursing Intervention List that would help nurses doing home health care nursing. For this study, the records of 150 home health care clients who were discharged, from the Home Health Care Center at Yonsei Medical Center, between January to July, 2001 were analyzed. Of the 43 nursing diagnoses recorded for these clients are 43, the most frequent diagnoses were in the area of Exchanging. There were 2,814 nursing interventions which is a mean of 4.73 nursing interventions per diagnosis. We confirmed that most of the interventions were related to 'education' and 'advice'. We present a Home Health Care Nursing Intervention List that was developed based on the results of this study. It has the five 5 criteria of the ICNP classification, Observing, Management, Performance, Caring, and Informing.