Factors Affecting Adherence to National Colorectal Cancer Screening: A 12-Year Longitudinal Study Using Multi-Institutional Pooled Data in Korea.

BACKGROUND: Consistent uptake of colorectal cancer (CRC) screening is important to reduce the incidence and mortality from advanced-stage CRC and increase the survival rate of the patients. We conducted a longitudinal study to determine the factors affecting CRC screening compliance in Korean adults using individual-level linked data from the Korean National Health and Nutrition Examination Survey, Korean National Health Insurance Service, and Korean Health Insurance Review and Assessment Service. METHODS: We selected 3,464 adults aged 50-79 years as the study population and followed them for 12 years (January 2007-December 2018). The outcome variable was the level of adherence to CRC screening, categorized as nonadherent, intermittently adherent, and consistently adherent. An ordinal logistic regression model was designed to determine the socioeconomic factors, family history of CRC, and medical conditions that could facilitate the consistent uptake of CRC screening. RESULTS: The results showed a significant and positive association between consistent uptake of CRC screening and the 100-150% income category (odds ratio [OR], 1.710; 95% confidence interval [CI], 1.401-2.088); clerical, sales and service job category (OR, 1.962; 95% CI, 1.582-2.433); residency at medium-sized cities (OR, 1.295; 95% CI, 1.094-1.532); high-school graduation (OR, 1.440; 95% CI, 1.210-1.713); married status (OR, 2.281; 95% CI, 1.946-2.674); use of employment-based national health insurance (OR, 1.820; 95% CI, 1.261-2.626); use of private insurance (OR, 2.259; 95% CI, 1.970-2.589); no disability (OR, 1.428; 95% CI, 1.175-1.737); family history of CRC (OR, 2.027; 95% CI, 1.514-2.714); and history of colorectal neoplasm (OR, 1.216; 95% CI; 1.039-1.422). CONCLUSION: The lack of regular participation in CRC screening programs in the Republic of Korea was found to be an issue that requires attention. Policies on CRC screening must place increased emphasis on strengthening educational and public relations initiatives.

Regularity of cervical cancer screening in Korea: analysis using national public data for 12 years.

OBJECTIVE: To assess the frequency of regular uptake of national cervical cancer screening (CCS) program and identify associated factors among Korean women. METHODS: This study is a fundamental investigation that employs openly accessible public data of Korea through secondary data analysis. A cohort of 4,663 women from the 2007-2012 Korean National Health and Nutrition Examination Survey, was followed up for up to 12 years (2007-2018) to obtain the frequency of national CCS. Compliance level with CCS was categorized, and an ordinal logistic regression model was employed to investigate the contributing factors. RESULTS: The regular uptake of CCS in South Korea was low at 18.9%. The trend of regular screening showed significant association with various factors, including age (40-59 years), household income (100%-150% bracket), occupation (service workers), place of residence (small to medium sized cities), education level (middle school graduates), marital status (married), and possession of private insurance. Moreover, individuals with a history of non-cervical cancer or carcinoma in situ of the cervix, a family history of cervical cancer, or a higher frequency of general check-ups demonstrated a stronger adherence to regular CCS uptake. CONCLUSION: Our findings revealed that regular participation in CCS in Korea was lower than anticipated, with factors such as socioeconomic status, personal history of gynecologic issue, and frequency of general health check-ups playing influential roles. However, further research, including an exploration of unexamined psychological barriers to screening, is necessary to gain a better understanding the reasons behind the reduced rates of regular CCS among Korean women.

Digital Therapeutic Exercises Using Augmented Reality Glasses for Frailty Prevention among Older Adults.

OBJECTIVES: The objective of this study was to investigate the effects of a digital therapeutic exercise platform for pre-frail or frail elderly individuals using augmented reality (AR) technology accessed through glasses. A tablet-based exercise program was utilized for the control group, and a non-inferiority assessment was employed. METHODS: The participants included older adult women aged 65 years and older residing in Incheon, South Korea. A digital therapeutic exercise program involving AR glasses or tablet-based exercise was administered twice a week for 12 weeks, with gradually increasing exercise duration. Statistical analysis was conducted using the t-test and Wilcoxon rank sum test for non-inferiority assessment. RESULTS: In the primary efficacy assessment, regarding the change in lower limb strength, a non-inferior result was observed for the intervention group (mean change, 5.46) relative to the control group (mean change, 4.83), with a mean difference of 0.63 between groups (95% confidence interval, -2.33 to 3.58). Changes in body composition and physical fitness-related variables differed non-significantly between the groups. However, the intervention group demonstrated a significantly greater increase in cardiorespiratory endurance (p < 0.005) and a significantly larger decrease in the frailty index (p < 0.001). CONCLUSIONS: An AR-based digital therapeutic program significantly and positively contributed to the improvement of cardiovascular endurance and the reduction of indicators of aging among older adults. These findings underscore the value of digital therapeutics in mitigating the effects of aging.

Exploring the Category and Use Cases on Digital Therapeutic Methodologies.

OBJECTIVES: As the Fourth Industrial Revolution advances, there is a growing interest in digital technology. In particular, the use of digital therapeutics (DTx) in healthcare is anticipated to reduce medical expenses. However, analytical research on DTx is still insufficient to fuel momentum for future DTx development. The purpose of this article is to analyze representative cases of different types of DTx from around the world and to propose a classification system. METHODS: In this exploratory study examining DTx interaction types and representative cases, we conducted a literature review and selected seven interaction types that were utilized in a large number of cases. Then, we evaluated the specific characteristics of each DTx mechanism by reviewing the relevant literature, analyzing their indications and treatment components. A representative case for each mechanism was provided. RESULTS: Cognitive behavioral therapy, distraction therapy, graded exposure therapy, reminiscence therapy, art therapy, therapeutic exercise, and gamification are the seven categories of DTx interaction types. Illustrative examples of each variety are provided. CONCLUSIONS: Efforts from both the government and private sector are crucial for success, as standardization can decrease both the expense and the time required for government-led DTx development. The private sector should partner with medical facilities to stimulate potential demand, carry out clinical research, and produce scholarly evidence.

User Experience of Augmented Reality Glasses-based Tele-Exercise in Elderly Women.

OBJECTIVES: The purpose of this study was to identify any difference in user experience between tablet- and augmented reality (AR) glasses-based tele-exercise programs in elderly women. METHODS: Participants in the AR group (n = 14) connected Nreal glasses with smartphones to display a pre-recorded exercise program, while each member of the tablet group (n = 13) participated in the same exercise program using an all-in-one personal computer. The program included sitting or standing on a chair, bare-handed calisthenics, and muscle strengthening using an elastic band. The exercise movements were presented first for the upper and then the lower extremities, and the total exercise time was 40 minutes (5 minutes of warm-up exercises, 30 minutes of main exercises, and 5 minutes of cool-down exercises). To evaluate the user experience, a questionnaire consisting of a 7-point Likert scale was used as a measurement tool. In addition, the Wilcoxon rank-sum test was used to assess differences between the two groups. RESULTS: Of the six user experience scales, attractiveness (p = 0.114), stimulation (p = 0.534), and novelty (p = 0.916) did not differ significantly between the groups. However, efficiency (p = 0.006), perspicuity (p = 0.008), and dependability (p = 0.049) did vary significantly between groups. CONCLUSIONS: When developing an AR glasses-based exercise program for the elderly, the efficiency, clarity, and stability of the program must be considered to meet the participants' needs.

Impact of biologic agents on body weight and obesity-related disorders in patients with psoriasis: A nationwide population-based cohort study.

OBJECTIVE: This large-scale population-based study aimed to analyze the effects of biologic agents on body weight and obesity-related disorders in patients with psoriasis for 10 years (January 2010 to December 2019), using the customized database provided by the Korean National Health Insurance Service. METHODS: The demographic data and health charts of 620,885 psoriasis patients, divided into three groups according to their treatment modalities (biologics, non-biologic systemic agents, and other agents), were analyzed. RESULTS: Patients with severe psoriasis who were prescribed biologic agents had a higher rate of comorbidities, such as diabetes, dyslipidemia, fatty liver, increased body weight, body mass index, and waist circumference than those in the other treatment groups. We found that the use of biologic agents was a significant independent risk factor for gaining weight after correcting for age, sex, initial weight, total prescription period, duration between the weight measurements before and after psoriasis treatment, exercise, smoking, drinking and presence of comorbidities. In contrast, the use of non-biologic systemic agents was not a significant independent risk factor for weight change. Gender-stratified regression analysis found that biologics were an independent variable affecting weight change for men, but not for women. CONCLUSIONS: Patients with severe psoriasis who are prescribed biologic agents tend to have a higher body weight and a higher prevalence of obesity-related disorders than those in other treatment groups. Caution must be exercised when using biologics, as they may cause additional weight gain, especially in men.

Effect of Epidural Block in the Incidence of Postherpetic Neuralgia: A Population-Based Matched-Cohort Study.

BACKGROUND: Incidence of postherpetic neuralgia (PHN) increases with age. Epidural block in patients with herpes zoster (HZ) is expected to decrease the risk of PHN. The purpose of this study was to evaluate the effectiveness of epidural block on PHN incidence in a population-based study. METHODS: This was a retrospective matched cohort study and data were sourced from the Korean National Health Insurance Service. The study cohort comprised 427 patients diagnosed with HZ who received epidural block within 30 days after a diagnosis of HZ. The matched control cohort included 427 patients without epidural block and were randomly matched to the study cohort at a 1:1 ratio based on covariates such as sociodemographic factors. The log-rank test was used to assess differences in the incidence of PHN. Cox proportional hazards regression models were used to estimate the hazard ratio (HR) for subsequent PHN, while controlling for potential comorbidities. RESULTS: Among the 854 sampled patients, 30 (7.03%) from the study cohort and 18 (4.22%) from the match-control developed PHN during follow-up. There were no significant differences in the incidence of PHN between the two cohorts (p=0.08). Cox proportional hazard regressions showed that the HR for PHN in patients with epidural block was 1.66 (95% confidence interval, 0.91-3.02; p=0.10). CONCLUSION: Our study indicates that epidural block did not effectively prevent PHN. However, further studies are needed to determine the effect of epidural block in patients with HZ for the prevention of PHN.

Usage of the Internet of Things in Medical Institutions and its Implications.

OBJECTIVES: The purpose of this study was to explore new ways of creating value in the medical field and to derive recommendations for the role of medical institutions and the government. METHODS: In this paper, based on expert discussion, we classified Internet of Things (IoT) technologies into four categories according to the type of information they collect (location, environmental parameters, energy consumption, and biometrics), and investigated examples of application. RESULTS: Biometric IoT diagnoses diseases accurately and offers appropriate and effective treatment. Environmental parameter measurement plays an important role in accurately identifying and controlling environmental factors that could be harmful to patients. The use of energy measurement and location tracking technology enabled optimal allocation of limited hospital resources and increased the efficiency of energy consumption. The resulting economic value has returned to patients, improving hospitals' cost-effectiveness. CONCLUSIONS: Introducing IoT-based technology to clinical sites, including medical institutions, will enhance the quality of medical services, increase patient safety, improve management efficiency, and promote patient-centered medical services. Moreover, the IoT is expected to play an active role in the five major tasks of facility hygiene in medical fields, which are all required to deal with the COVID-19 pandemic: social distancing, contact tracking, bed occupancy control, and air quality management. Ultimately, the IoT is expected to serve as a key element for hospitals to perform their original functions more effectively. Continuing investments, deregulation policies, information protection, and IT standardization activities should be carried out more actively for the IoT to fulfill its expectations.

Effects of smartphone mirroring-based telepresence exercise on body composition and physical function in obese older women.

AIMS: This study aimed to develop a smartphone mirroring-based telepresence exercise program that can be performed at home while allowing for real-time feedback by instructors. METHODS: For this randomized controlled trial, 29 obese older women aged 66-87 years with ≥ 30% body fat were recruited at a senior citizen center. The intervention group was provided with the smartphone mirroring-based telepresence exercise program, in which participants exercised in their homes for 20-40 min three times a week for 12 weeks. Participants in the control group performed the same exercise program at the senior citizen center. Body composition and functional abilities were measured before and after the program. RESULTS: Women in the intervention group showed a decrease in their body fat percentage (P = 0.026) and an increase in grip strength (P = 0.008). In the control group, women demonstrated a decrease in their weight (P = 0.006) and body fat percentage (P = 0.001) and an increase in skeletal muscle (P = 0.044) and grip strength (P = 0.006). CONCLUSION: Smartphone mirroring-based telepresence exercises at home lower body fat percentage and increase muscle strength similar to traditional group exercises. They present an innovative way for obese older women to improve and maintain their health. TRIAL REGISTRATION: Clinical Research Information Service KCT0006147.

Association of nasal septal deviation with the incidence of anxiety, depression, and migraine: A national population-based study.

BACKGROUND & AIMS: Nasal obstruction caused by nasal septal deviation is very bothersome and, therefore, can affect the patient's emotional state. However, little is known about the effect of nasal septal deviation (NSD) on the neuropsychiatric aspects of patients. Therefore, this study aims to verify the higher incidence of anxiety, depression, and migraine in patients diagnosed with NSD compared to general populations using big data. METHODS: This retrospective cohort study collected subjects from the Korean National Health Insurance Service (NHIS) database. Adjustments were made to minimize the confounding of variables for age, sex, residence type, income levels, hypertension, diabetes, dyslipidemia, rhinitis, and chronic rhinosinusitis between the two groups. The primary endpoint of this study was newly diagnosed anxiety, depression, and migraine between January 2009 and December 2018. Kaplan-Meier survival curves, logarithmic rank test, and Cox proportional regression test were used for statistical analysis. RESULTS: Among a total of 135,769 subjects in the NHIS database, 48,495 patients with NSD (NSD group) and 54,475 control subjects (control group) were selected. Patients with NSD had an increased risk of anxiety, depression, and migraine compared to the control group. In the NSD group, the adjusted hazard ratios (HR) were 1.236 (95% CI, 1.198-1.276) for anxiety, 1.289 (95% CI, 1.238-1.343) for depression, and 1.251 (95% CI, 1.214-1.290) for migraine. CONCLUSION: NSD is associated with a higher incidence of anxiety, depression, and migraine. Therefore, it is suggested that physicians carefully consider psychoneurological distress and employ therapeutic strategies to minimize these conditions.

Effect of Ranitidine Intake on the Risk of Gastric Cancer Development.

Gastric cancer is one of the most prevalent cancers globally, with high mortality, particularly in East Asia. Certain ranitidine products contain potentially carcinogenic N-nitrosodimethylamine. We investigated the potential association between gastric cancer risk and ranitidine intake using a nationwide cohort, extracted from the Korean National Health Insurance Service. In this longitudinal study, we employed a 1:1 propensity score matching according to sociodemographic factors. A total of 40,887 subjects were enrolled, of which 906 developed gastric cancer during the follow-up period. We investigated gastric cancer events during the follow-up period using the survival analysis, log-rank test, and Cox proportional hazards regression models to estimate incidence, survival rate, and hazard ratio. The incidence of gastric cancer was 67,422; 67,470; and 67,444 person-years in the control, other histamine-2 blockers, and ranitidine groups, respectively. Because the adjusted hazard ratio of gastric cancer was 0.98 and 1.01 in the other histamine-2 blockers and ranitidine groups, respectively, we could not calculate the likelihood of gastric cancer development in the ranitidine group. Ranitidine intake did not significantly increase the incidence of gastric cancer. Therefore, the relative risk of gastric cancer may be low in patients taking ranitidine products in South Korea.

Risk of cerebro- and cardiovascular disease in patients with scrub typhus.

We analyzed the National Health Insurance Service-National Sample Cohort (NHIS-NSC) data to evaluate whether scrub typhus infection is associated with increased risk of subsequent cardio- and cerebrovascular disease. Compared with the control group, the scrub typhus group showed a greater incidence rate of cardiovascular disease (14.5 vs. 9.0 cases per 1000 person-years). In contrast, the scrub typhus group showed no difference in incidence rate of cerebrovascular disease (12.0 vs. 13.3 cases per 1000 person-years). Based on the NHIS-NSC data, patients with scrub typhus are at greater risk of developing cardiovascular disease long term compared with that of the general population.

Estimating Maximal Oxygen Uptake From Daily Activity Data Measured by a Watch-Type Fitness Tracker: Cross-Sectional Study.

BACKGROUND: Cardiorespiratory fitness (CRF), an important index of physical fitness, is the ability to inhale and provide oxygen to the exercising muscle. However, despite its importance, the current gold standard for measuring CRF is impractical, requiring maximal exercise from the participants. OBJECTIVE: This study aimed to develop a convenient and practical estimation model for CRF using data collected from daily life with a wristwatch-type device. METHODS: A total of 191 subjects, aged 20 to 65 years, participated in this study. Maximal oxygen uptake (VO2 max), a standard measure of CRF, was measured with a maximal exercise test. Heart rate (HR) and physical activity data were collected using a commercial wristwatch-type fitness tracker (Fitbit; Fitbit Charge; Fitbit) for 3 consecutive days. Maximal activity energy expenditure (aEEmax) and slope between HR and physical activity were calculated using a linear regression. A VO2 max estimation model was built using multiple linear regression with data on age, sex, height, percent body fat, aEEmax, and the slope. The result was validated with 2 different cross-validation methods. RESULTS: aEEmax showed a moderate correlation with VO2 max (r=0.50). The correlation coefficient for the multiple linear regression model was 0.81, and the SE of estimate (SEE) was 3.518 mL/kg/min. The regression model was cross-validated through the predicted residual error sum of square (PRESS). The PRESS correlation coefficient was 0.79, and the PRESS SEE was 3.667 mL/kg/min. The model was further validated by dividing it into different subgroups and calculating the constant error (CE) where a low CE showed that the model does not significantly overestimate or underestimate VO2 max. CONCLUSIONS: This study proposes a CRF estimation method using data collected by a wristwatch-type fitness tracker without any specific protocol for a wide range of the population.

Augmented Reality to Localize Individual Organ in Surgical Procedure.

OBJECTIVES: Augmented reality (AR) technology has become rapidly available and is suitable for various medical applications since it can provide effective visualization of intricate anatomical structures inside the human body. This paper describes the procedure to develop an AR app with Unity3D and Vuforia software development kit and publish it to a smartphone for the localization of critical tissues or organs that cannot be seen easily by the naked eye during surgery. METHODS: In this study, Vuforia version 6.5 integrated with the Unity Editor was installed on a desktop computer and configured to develop the Android AR app for the visualization of internal organs. Three-dimensional segmented human organs were extracted from a computerized tomography file using Seg3D software, and overlaid on a target body surface through the developed app with an artificial marker. RESULTS: To aid beginners in using the AR technology for medical applications, a 3D model of the thyroid and surrounding structures was created from a thyroid cancer patient's DICOM file, and was visualized on the neck of a medical training mannequin through the developed AR app. The individual organs, including the thyroid, trachea, carotid artery, jugular vein, and esophagus were localized by the surgeon's Android smartphone. CONCLUSIONS: Vuforia software can help even researchers, students, or surgeons who do not possess computer vision expertise to easily develop an AR app in a user-friendly manner and use it to visualize and localize critical internal organs without incision. It could allow AR technology to be extensively utilized for various medical applications.

Web-Based Telepresence Exercise Program for Community-Dwelling Elderly Women With a High Risk of Falling: Randomized Controlled Trial.

BACKGROUND: While physical exercise is known to help prevent falls in the elderly, bad weather and long distance between the home and place of exercise represent substantial deterrents for the elderly to join or continue attending exercise programs outside their residence. Conventional modalities for home exercise can be helpful but do not offer direct and prompt feedback to the participant, which minimizes the benefit. OBJECTIVE: We aimed to develop an elderly-friendly telepresence exercise platform and to evaluate the effects of a 12-week telepresence exercise program on fall-related risk factors in community-dwelling elderly women with a high risk of falling. METHODS: In total, 34 women aged 68-91 years with Fall Risk Assessment scores >14 and no medical contraindication to physical training-based therapy were recruited in person from a senior citizen center. The telepresence exercise platform included a 15-inch tablet computer, custom-made peer-to-peer video conferencing server system, and broadband Internet connectivity. The Web-based program included supervised resistance exercises performed using elastic resistance bands and balance exercise for 20-40 minutes a day, three times a week, for 12 weeks. During the telepresence exercise session, each participant in the intervention group was supervised remotely by a specialized instructor who provided feedback in real time. The women in the control group maintained their lifestyle without any intervention. Fall-related physical factors (body composition and physical function parameters) and psychological factors (Korean Falls Efficacy Scale score, Fear of Falling Questionnaire score) before and after the 12-week interventional period were examined in person by an exercise specialist blinded to the group allocation scheme. RESULTS: Of the 30 women enrolled, 23 completed the study. Compared to women in the control group (n=13), those in the intervention group (n=10) showed significant improvements on the scores for the chair stand test (95% confidence interval -10.45 to -5.94, P<.001), Berg Balance Scale (95% confidence interval -2.31 to -0.28, P=.02), and Fear of Falling Questionnaire (95% confidence interval 0.69-3.5, P=.01). CONCLUSIONS: The telepresence exercise program had positive effects on fall-related risk factors in community-dwelling elderly women with a high risk of falling. Elderly-friendly telepresence technology for home-based exercises can serve as an effective intervention to improve fall-related physical and psychological factors. TRIAL REGISTRATION: Clinical Research Information Service KCT0002710; https://cris.nih.go.kr/cris/en/search/ search_result_st01.jsp?seq=11246 (Archived by WebCite at http://www.webcitation.org/6zdSUEsmb).

Customer Discovery as the First Essential Step for Successful Health Information Technology System Development.

OBJECTIVES: Customer discovery (CD) is a method to determine if there are actual customers for a product/service and what they would want before actually developing the product/service. This concept, however, is rather new to health information technology (IT) systems. Therefore, the aim of this paper was to demonstrate how to use the CD method in developing a comprehensive health IT service for patients with knee/leg pain. METHODS: We participated in a 6-week I-Corps program to perform CD, in which we interviewed 55 people in person, by phone, or by video conference within 6 weeks: 4 weeks in the United States and 2 weeks in Korea. The interviewees included orthopedic doctors, physical therapists, physical trainers, physicians, researchers, pharmacists, vendors, and patients. By analyzing the interview data, the aim was to revise our business model accordingly. RESULTS: Using the CD approach enabled us to understand the customer segments and identify value propositions. We concluded that a facilitating tele-rehabilitation system is needed the most and that the most suitable customer segment is early stage arthritis patients. We identified a new design concept for the customer segment. Furthermore, CD is required to identify value propositions in detail. CONCLUSIONS: CD is crucial to determine a more desirable direction in developing health IT systems, and it can be a powerful tool to increase the potential for successful commercialization in the health IT field.

Fitness as a determinant of arterial stiffness in healthy adult men: a cross-sectional study.

BACKGROUND: Fitness is known to influence arterial stiffness. This study aimed to assess differences in cardiorespiratory endurance, muscular strength, and flexibility according to arterial stiffness, based on sex and age. METHODS: We enrolled 1590 healthy adults (men: 1242, women: 348) who were free of metabolic syndrome. We measured cardiorespiratory endurance in an exercise stress test on a treadmill, muscular strength by a grip test, and flexibility by upper body forward-bends from a standing position. The brachial-ankle pulse wave velocity test was performed to measure arterial stiffness before the fitness test. Cluster analysis was performed to divide the patients into groups with low (Cluster 1) and high (Cluster 2) arterial stiffness. According to the k-cluster analysis results, Cluster 1 included 624 men and 180 women, and Cluster 2 included 618 men and 168 women. RESULTS: Men in the middle-aged group with low arterial stiffness demonstrated higher cardiorespiratory endurance, muscular strength, and flexibility than those with high arterial stiffness. Similarly, among men in the old-aged group, the cardiorespiratory endurance and muscular strength, but not flexibility, differed significantly according to arterial stiffness. Women in both clusters showed similar cardiorespiratory endurance, muscular strength, and flexibility regardless of their arterial stiffness. CONCLUSIONS: Among healthy adults, arterial stiffness was inversely associated with fitness in men but not in women. Therefore, fitness seems to be a determinant for arterial stiffness in men. Additionally, regular exercise should be recommended for middle-aged men to prevent arterial stiffness.

Healthcare worker infected with Middle East Respiratory Syndrome during cardiopulmonary resuscitation in Korea, 2015.

OBJECTIVES: During the outbreak of the Middle East Respiratory Syndrome (MERS) in Korea in 2015, the Korea Centers for Disease Control and Prevention (KCDC) confirmed a case of MERS in a healthcare worker in Daejeon, South Korea. To verify the precise route of infection for the case, we conducted an in-depth epidemiological investigation in cooperation with the KCDC. METHODS: We reviewed the MERS outbreak investigation report of the KCDC, and interviewed the healthcare worker who had recovered from MERS. Using the media interview data, we reaffirmed and supplemented the nature of the exposure. RESULTS: The healthcare worker, a nurse, was infected while performing cardiopulmonary resuscitation (CPR) for a MERS patient in an isolation room. During the CPR which lasted for an hour, a large amount of body fluid was splashed. The nurse was presumed to have touched the mask to adjust its position during the CPR. She suggested that she was contaminated with the MERS patient's body fluids by wiping away the sweat from her face during the CPR. CONCLUSIONS: The possible routes of infection may include the following: respiratory invasion of aerosols contaminated with MERS-coronavirus (MERS-CoV) through a gap between the face and mask; mucosal exposure to sweat contaminated with MERS-CoV; and contamination during doffing of personal protective equipment. The MERS guidelines should reflect this case to decrease the risk of infection during CPR.

A Retrospective Mid- and Long-term Follow-up Study on the Changes in Hematologic Parameters in the Highly Exposed Residents of the Hebei Spirit Oil Spill in Taean, South Korea.

OBJECTIVES: This study aimed to analyze changes in hematologic parameters in the residents of the areas highly contaminated by the Hebei Spirit Oil Spill in 2007 and those who participated in the clean-up activities. METHODS: According to demographic characteristics, health status and behavior, and level of exposure to oil, we compared the hematologic results in 2009 and 2012 among 701 residents. The hematologic parameters were composed of white blood cell (WBC) count, and levels of hemoglobin, hematocrit (Hct), aspartate aminotransferase (AST), alanine aminotransferase (ALT), glucose, glycosylated hemoglobin (HbA1c), blood urea nitrogen (BUN), creatinine (Cr), total cholesterol (T-chol), high-density lipoprotein (HDL), and triglyceride (TG). RESULTS: Paired t-test revealed that the WBC count and levels of Hct, AST, ALT, glucose, and HbA1c significantly increased, whereas the BUN, Cr, HDL, and TG levels significantly decreased. Multiple linear regression modelling showed a relationship between the level of exposure to oil and temporal changes in Hct, glucose, HbA1c, and BUN levels. CONCLUSION: Our results suggest a relationship between level of exposure to oil and changes in hematologic parameters over 3 years. Further studies should be conducted to determine the impact of oil spill on health such as the occurrence of diseases.

Effects of prolonged exercise versus multiple short exercise sessions on risk for metabolic syndrome and the atherogenic index in middle-aged obese women: a randomised controlled trial.

BACKGROUND: Many people, although they may recognise the positive effects of exercise, do not exercise regularly owing to lack of time. This study aimed to investigate the effects of prolonged single-session exercise and multiple short sessions of exercise on the risk of metabolic syndrome and the atherogenic index in middle-aged obese women. METHODS: Thirty-six participants were divided into the single-session group, multiple-session group, and control group. The single-session group engaged in one session of treadmill exercise for 30 min a day; the multiple-session group had three sessions of 10 min a day. Both groups exercised 3 days/week for 12 weeks. The control group did not perform any exercise. RESULTS: The single-session group showed decreases in weight (0.97 kg [95% C.I. = 0.09-1.83], p < .05), body mass index (0.43 kg/m2 [95% C.I. = 0.03-0.81], p < .05), and fat mass (1.65 kg, [95% C.I. = 0.78-2.51], p < .01). Systolic blood pressure dropped in the single-session group (6.66 mmHg, [95% C.I. = 1.44-11.88], p < .05), and diastolic blood pressure dropped in the multiple-session group (3.38 mmHg, [95% C.I. = 1.44-5.88], p < .01). High-density lipoprotein cholesterol rose in the single-session group (4.08 mg/dL, [95% C.I. = -8.08-(-)0.07], p < .05) and dropped in the control group (10.75 mg/dL [95% C.I. = 1.95-19.54], p < .01). According to post hoc analysis, high-density lipoprotein cholesterol increased more in the single-session group than the control group (95% C.I. = 0.61-21.88, p < .05). Glucose levels decreased in both the single-session group (16 mg/dL [95% C.I. = 5.64-26.35], p < .01) and the multiple-session group (12.16 mg/dL, [95% C.I. = 2.18-22.14], p < .05). Waist circumference decreased in the single-session group (2.65 cm [95% C.I. = 1.46-3.83], p < .001) and multiple-session group (2.04 cm, [95% C.I. = 1.51-2.73], p < .001). Low-density lipoprotein cholesterol levels rose in both the multiple-session group (-15.79 mg/dL [95% C.I. = -34.24-(-)3.78], p < .05) and the control group (-22.94 mg/dL [95% C.I. = -44.63-(-)1.24], p < .05). The atherogenic index increased in the control group (-1.06 [95% C.I. = -1.69-(-)0.41], p < .01). CONCLUSIONS: The findings indicate that prolonged exercise is superior to multiple short sessions for improving the risk of metabolic syndrome and the atherogenic index in middle-aged obese women. However, multiple short sessions can be recommended as an alternative to prolonged exercise when the goal is to decrease blood glucose or waist circumference.