Climate-related variabilities in the Styx-M ice core record from northern Victoria Land, East Antarctica, during 1979-2014.

The historical climate variability in East Antarctica inferred from ice cores remains under debate owing to the vastness and complexity of the region. This study evaluates the potential climate variabilities in the Styx-M ice core records (δ18O, d-excess, and snow accumulation) from northern Victoria Land adjacent to the Ross Sea sector of East Antarctica during 1979-2014. Results show that the primary moisture source in this area is the Pacific Ocean sector. Although the annual mean δ18O values was limited to directly indicate the temperature changes, a weak relevance between the average δ18O values and the temperature signal during the austral summer season is detectable. δ18O, d-excess, and snow accumulation correlate with sea surface temperature and sea ice extent in the Ross Sea sector. A coupled influence of the SAM, ASL, and ENSO climate indices is expected, because the oceanic environment in this region is influenced by them. The pronounced intrusion of oceanic moisture coupled with atmospheric circulation patterns over the Ross Sea region makes the Styx-M ice core a promising record of the local oceanic conditions, with the snow accumulation rate being a direct proxy. Additionally, the analysis of trace elements from 1979 to 1999 revealed the presence of crustal dust sourced from the Transantarctic Mountains, as well as non-crustal sources, both intricately linked with atmospheric transport. These results demonstrate that the contributions of-and variations in-oceanic conditions associated with atmospheric circulation changes are detectable and dominant in the Styx-M ice core. This study serves as a basis for interpreting longer parts of the Styx-M ice core.

Advanced one-pot deconstruction and valorization of lignocellulosic biomass into triacetic acid lactone using Rhodosporidium toruloides.

BACKGROUND: Rhodosporidium toruloides is capable of co-utilization of complex carbon sources and robust growth from lignocellulosic hydrolysates. This oleaginous yeast is therefore an attractive host for heterologous production of valuable bioproducts at high titers from low-cost, deconstructed biomass in an economically and environmentally sustainable manner. Here we demonstrate this by engineering R. toruloides to produce the polyketide triacetic acid lactone (TAL) directly from unfiltered hydrolysate deconstructed from biomass with minimal unit process operations. RESULTS: Introduction of the 2-pyrone synthase gene into R. toruloides enabled the organism to produce 2.4 g/L TAL from simple media or 2.0 g/L from hydrolysate produced from sorghum biomass. Both of these titers are on par with titers from other better-studied microbial hosts after they had been heavily engineered. We next demonstrate that filtered hydrolysates produced from ensiled sorghum are superior to those derived from dried sorghum for TAL production, likely due to the substantial organic acids produced during ensiling. We also demonstrate that the organic acids found in ensiled biomass can be used for direct synthesis of ionic liquids within the biomass pretreatment process, enabling consolidation of unit operations of in-situ ionic liquid synthesis, pretreatment, saccharification, and fermentation into a one-pot, separations-free process. Finally, we demonstrate this consolidation in a 2 L bioreactor using unfiltered hydrolysate, producing 3.9 g/L TAL. CONCLUSION: Many steps involved in deconstructing biomass into fermentable substrate can be combined into a distinct operation, and directly fed to cultures of engineered R. toruloides cultures for subsequent valorization into gram per liter titers of TAL in a cost-effective manner.

Potentially inappropriate prescribing of cardiovascular system and antiplatelet/anticoagulant drugs among elderly patients: a Korean population-based national study.

OBJECTIVES: To investigate the prevalence of potentially inappropriate prescribing (PIP) for cardiovascular system (CVS) and antiplatelet/anticoagulant (AP/AC) drugs among Korean elderly patients, using the Screening Tool of Older Persons' Prescriptions (STOPP) criteria version 2 and to identify the risk factors related to PIP. METHODS: The 2016 National Aged Patient Sample data, comprising National Health Insurance claim records for a random sample of 20% of patients aged ≥ 65 years, were used to calculate PIP prevalence of outpatient prescriptions. For criteria including drug-disease interactions, PIP prevalence per indication was estimated. RESULTS: Among 1,274,148 elderly patients and 27,062,307 outpatient prescription claims, 100,085 patients (7.85%) and 341,664 claims (1.27%) had one or more PIP. The most frequent PIP was "non-steroidal anti-inflammatory drug with concurrent antiplatelet agent (s) without proton-pump inhibitor prophylaxis" in the claim-level (0.97%) and patient-level (6.33%) analyses. "Beta-blocker with bradycardia" (16.47% of claims) and "angiotensin receptor blockers in patients with hyperkalaemia" (23.89% of claims) showed the highest PIP prevalence per indication. Logistic regression analysis revealed that, among the patient and health care provider characteristics, female, older age, more severe comorbidities, polypharmacy, higher level of healthcare organization, and specialty of prescriber were significantly associated with a higher risk of PIP. CONCLUSIONS: Our findings of a high prevalence of PIP for CVS and AP/AC drugs among the elderly suggest that an effective strategy is urgently needed to improve the prescription practices of these drugs.

Record of North American boreal forest fires in northwest Greenland snow.

We present boreal forest fire proxies in a northwest Greenland snowpit spanning a period of six years, from spring 2003 to summer 2009. Levoglucosan (C6H10O5) is a specific organic molecular marker of biomass burning caused by boreal forest fires. In this study, levoglucosan was determined via liquid chromatography/negative ion electrospray ionization-tandem mass spectrometry, wherein isotope-dilution and multiple reaction monitoring methods are employed. Ammonium (NH4+) and oxalate (C2O42-), traditional biomass burning proxies, were determined using two-channel ion chromatography. In the northwest Greenland snowpit, peaks in levoglucosan, ammonium, and oxalate were observed in snow layers corresponding to the summer-fall seasons of 2004 and 2005. Considered together, these spikes are a marker for large boreal forest fires. The levoglucosan deposited in the Greenland snow was strongly dependent on long-range atmospheric transportation. A 10-day backward air mass trajectory analysis supports that the major contributors were air masses from North America. In addition, satellite-derived carbon monoxide (CO) and ammonia (NH3) concentrations suggest that chemicals from North American boreal forest fires during the summer-fall of 2004 and 2005 were transported to Greenland. However, large boreal fires in Siberia in 2003 and 2008 were not recorded in the snowpit. The sub-annual resolution measurements of levoglucosan and ammonium can distinguish between the contributions of past boreal forest fires and soil emissions from anthropogenic activity to Greenland snow and ice.

Core educational components of interprofessional education in pediatric emergencies: An integrated review.

PURPOSE: This study was conducted to explore the core educational components of interprofessional education (IPE) for pediatric emergencies to establish a basis for interprofessional simulation education. METHODS: Using Whittemore and Knafl's integrative review method, we searched for studies in PubMed, Embase, Cochrane Library, CINAHL, and four South Korean databases (RISS, NDSL, DBpia, and KISS). RESULTS: We identified 21 studies on the general characteristics of IPE in pediatric emergency situations and integrated the core components of IPE according to a PRISMA flowchart. Three core components were identified (individual-competent professionals, team-cooperative professions, and outcome-optimal achievement), with the subthemes of role and responsibility, clinical judgment, performance, leadership, communication, teamwork, patient safety, and quality improvement. CONCLUSION: We recommend that IPE pediatric emergencies should contain the three dimensions of these core components to enhance individual and team performance and to promote optimal achievement in terms of patient outcomes. IPE programs should consider these characteristics and include a valid tool for evaluating the programs' effectiveness.

Reliable Ultra Trace Analysis of Cd, U and Zn Concentrations in Greenland Snow and Ice by Using Ultraclean Methods for Contamination Control.

This study presents ultraclean procedures used in the challenging task of determining trace elements at or below the pg/g concentration level encountered in Greenland snow and ice. In order to validate these ultraclean procedures, recent snowfall and Holocene ice from northwest Greenland were analyzed for Cd, U, and Zn concentrations. The total procedural blanks brought through the entire measurement procedure proved to be negligible, compared to trace element concentrations, measured in snow and ice samples. This validates the overall practicality of the proposed ultraclean procedures, thereby ensuring the reliable measurements of ultra-trace analysis. A comparison between our study and published data shows that improper procedures employed throughout all stages, from field sampling to analysis to elevate the concentrations by several orders of magnitude, relative to the reliable concentration ranges. The risk of contamination exposure for selected trace elements appears to increase in the order of U < As ≤ Pb < Cd < Zn. Reliable measurements of Cd, U, and Zn concentrations in snow and ice allowed us to interpret the data in terms of seasonal variations in the inputs of crustal and anthropogenic sources to Greenland ice sheet.

Altered subcallosal and posterior cingulate cortex-based functional connectivity during smoking cue and mental simulation processing in smokers.

BACKGROUND: Long-term cigarette smoking induces sensitization of incentive salience and conditioning of contextual cues which involves brain function alteration across multiple regions. Understanding how nicotine affects hub-based functional connectivities involved in affective and cognitive function can help us determine the treatment strategy for nicotine dependence. METHOD: Functional MRI was conducted on 30 smokers and 30 non-smokers while mentally simulating neutral and smoking hand movements. Smoking cue and mental simulation processing-related changes in functional connectivity strengths of the subcallosal and posterior cingulate cortex (SCC and PCC) with major brain network nodes were examined. RESULTS: Compared to non-smokers, smokers showed cue-induced SCC functional connectivities which were enhanced with the intraparietal sulcus and reduced with the medial prefrontal cortex. The PCC activation and functional connectivity enhancements with the anterior insula cortex and rostro-lateral prefrontal cortex was found during smoking mental simulation. The PCC-lateral prefrontal cortex functional connectivity correlated with nicotine dependence severity. CONCLUSION: The present results demonstrate that smokers can be identified by cue-induced SCC functional connectivity strength decline and increment in the default mode and dorsal attention network nodes. However, nicotine dependence was associated with smoking mental simulation-related PCC-lateral prefrontal cortex functional connectivity strength, suggesting that the development of nicotine dependence may depend on the strength of coupling between the default mode network and the central executive network at the cognitive level.

Plutonium fallout reconstructed from an Antarctic Plateau snowpack using inductively coupled plasma sector field mass spectrometry.

Anthropogenic plutonium (Pu) in the environment is a result of atmospheric nuclear testing during the second half of the 20th century. In this work, we analyzed a 4-meter deep Antarctic Plateau snowpack characterized by a low snow accumulation rate and negligible snow impurities. These sample conditions enabled us to measure the snowpack Pu fallout by applying inductively coupled plasma sector field mass spectrometry to a few mL of snow melt without purification or preconcentration. Pu concentrations in the reconstructed Pu fallout record for the period after 1956 CE increased and decreased in agreement with past atmospheric nuclear testing. Two peaks and two dips associable with historical events were observed, and the highest peak in 1964(±1) CE approximately coincided with the maximum concentration of non-sea-salt sulfate caused by the Mt. Agung eruption in 1963 CE. Enhanced Pu fallout in the 1970s was attributed the geographical proximity of the Southern Hemispheric nuclear test sites. Our results suggest that by improving the instrumental sensitivity and precision, the potential of the Antarctic ice sheet as an archive of Pu fallout can be further explored and utilized for understanding atmospheric dispersion and for dating ice cores.

Prevalence and predictors of potentially inappropriate prescribing of central nervous system and psychotropic drugs among elderly patients: A national population study in Korea.

OBJECTIVES: To investigate the prevalence of potentially inappropriate prescribing (PIP) of central nervous system and psychotropic (CNS-PS) drugs to the Korean elderly population, and to identify PIP-associated factors. METHODS: Ambulatory care visits were identified from the 2013 National Aged Patient Sample (HIRA-APS-2013) data, composed of 20% random samples of all enrollees in the universal health security program aged ≥65 years. The CNS-PS section of Screening Tool of Older Person's potentially inappropriate Prescriptions (STOPP) criteria version 2 was used to identify PIP at these visits. RESULTS: A total of 24,427,069 prescription claims records and 1,122,080 patients were included in the study; 10.73% of the claims and 53.64% of the patients satisfied at least one STOPP criterion in the prescription of CNS-PS drugs. The highest prevalence of PIP was observed for the criteria of "first-generation antihistamines" (FGAH), followed by tricyclic antidepressants (TCA) in patients with prostatism and TCA in patients with dementia. The generalized estimating equation logistic regression analysis showed that the PIP of FGAH was significantly associated with polypharmacy (5-9 drugs: odds ratio (OR) 4.965, 95% confidence interval (CI) 4.936-4.994; ≥10 drugs: OR 5.704, 95% CI 5.604-5.807), less severe health conditions (Charlson Comorbidity Index (CCI)=2: OR 0.852, 95% CI 0.842-0.862; CCI=1: OR 0.975, 95% CI 0.964-0.986), prescriptions from clinics (OR>1.0), and outpatient care by general practitioners (OR>1.0). CONCLUSIONS: Appropriate interventions to reduce PIP should be made, especially for the criteria that indicate a high PIP prevalence. Targeted strategies are necessary to modify the risk factors of PIP identified from this study.

Mediating effect of deviant peers on the relationship between sensation seeking and lifetime smoking among high school students.

BACKGROUND: Despite the greater risk of lifetime smoking among high sensation seekers, it is difficult to change a sensation seeking tendency through interventions. Therefore, it is important to identify a modifiable factor mediating the link between these two conditions in order to weaken or disconnect the association. OBJECTIVES: Based on the literature, deviant peers may play a pivotal role in explaining this association. Thus, we aimed to investigate the mediating effect of deviant peers on the association between sensation seeking and lifetime smoking among Korean adolescents. METHODS: We analyzed secondary data obtained from 876 high school students. Approximately 51% of the participants were male. In order to investigate the mediating effect of deviant peers after controlling for 16 factors, we tested an indirect effect in a simple mediation model using the PROCESS macro, which is a regression-based approach. RESULTS: We found a significant total effect of sensation seeking on lifetime smoking: greater risk of lifetime smoking among high sensation seekers. In addition, we found a significant mediating effect of deviant peers on the association between the two conditions. Specifically, higher sensation seeking successfully predicted a greater number of deviant peers, which, in turn, successfully predicted greater risk of lifetime smoking. CONCLUSION: Given difficulties in directly changing levels of sensation seeking and the significant mediating effect of deviant peers on the association between the two conditions, prevention strategies focusing on peers may be advantageous for high sensation seekers in reducing their risk of lifetime smoking in adolescence.

Factors influencing on influenza vaccination and its trends of coverage in patients with diabetes in Korea: A population-based cross-sectional study.

BACKGROUND: Influenza infection is a contagious disease and annual influenza vaccination is recommended to the patients with chronic diseases. Although diabetes is an indication for influenza vaccination, the global rate of influenza vaccination is insufficient. Therefore, our study aimed to elucidate influenza vaccination statuses among patients with diabetes and the related factors in Korea. METHODS: A total of 32,268 subjects (4,540 with and 27,728 without diabetes) from the Korea National Health and Nutrition Examination Survey III-VI (2005-2015) were included. Socioeconomic factors and health-related factors were analyses for the relation of influenza vaccination by Student's t-test, the chi-squared test and a multivariate logistic regression analysis. RESULTS: The influenza vaccination coverage rates were 50.0% in the diabetes mellitus (DM) group and 38.2% in the non-DM group. The trends in influenza vaccination rates during KNHANES III-VI were not significant in each group (P trend  =  0.24 in the DM group, 0.30 in the non-DM group). Socioeconomic (older age, female sex, higher family income, and medical aid insurance) and health-related factors (lack of risky alcohol consumption, obesity, and recent health check-ups) were associated with influenza vaccination among patients with DM. CONCLUSIONS: The rate of influenza vaccination among patients with diabetes is insufficient in Korea. More efforts are needed to increase the influenza vaccination rates among vulnerable at-risk populations.

Factors Influencing Influenza Vaccination Among Patients With Chronic Obstructive Pulmonary Disease: A Population-Based Cross-sectional Study.

This study aimed to investigate the factors associated with vaccination coverage among chronic obstructive pulmonary disease (COPD) patients in Korea using the fourth to the sixth Korean National Health and Nutrition Examination Surveys (KNHANES IV, V, VI). A total of 16 812 subjects aged 40 years and older who underwent spirometry and had an "influenza vaccination history" were analyzed. The vaccination rate of middle-aged (40-64 years) COPD patients was only 31.9%; whereas, the vaccination rate of elderly (65 years and older) COPD patients was 80.0%. The results of a multiple regression analysis indicated that older age (odds ratio [OR], 1.12; 95% confidence interval [95% CI], 1.09-1.14), poor self-rated health status (OR, 1.45; 95% CI, 1.14-1.95), regular health check-up (OR, 2.61; 95% CI, 1.93-3.51), married marital status (OR, 0.64; 95% CI, 0.42-0.96), and household income below average (OR, 0.72; 95% CI, 0.53-0.98) were associated with influenza vaccination. More attention and targeted interventions are required to improve the influenza vaccination rate of COPD patients.

Body Misperception and Its Associated Factors among Cancer Survivors in Korea

Background: As the number of cancer survivors is increasing, the importance of their healthcare management is becoming emphasized. For this purpose, appropriate recognition of the importance of body weight is necessary. This study concerned misconceptions about body weight and related factors among cancer patients. Methods: This cross-sectional study involved 1,159 participants who participated in the 2007-2012 Korean National Health and Nutrition Examination Survey. Self-reported questionnaires were used to assess cancer information, socioeconomic status, health behavior, and psychological factors. Results: Men had a higher rate of underestimation and a lower rate of overestimation of body weight than women (34.7% vs. 22.9%; 10.9% vs. 15.5%, respectively). Underestimation of body weight was positively associated with a self-assessment of being in poor health in men (OR 2.44, 95% CI 1.58- 3.75) and in elderly women (OR 3.70, 95% CI 2.44-5.23). Overestimation of body weight was positively associated with depression in men (OR 2.17, 95% CI 1.01-4.63) and a high educational level/high-income level and having tried to control weight in women (OR 1.92, 95% CI 1.16-3.18; OR 1.57, 95% CI 1.00-2.47; OR 3.24, 95% CI 1.82-5.77, respectively). Conclusions: Higher socioeconomic status (SES), depression, self-rated health status, age, and weight control trials were found to be associated with underestimation and overestimation of body weight in cancer survivors. From this study, it is evident that more efforts are needed to remove misperceptions and to develop healthy behavior for cancer survivors by various means.

Gamma-glutamyltransferase and cardiovascular mortality in Korean adults: A cohort study.

BACKGROUND AND AIMS: Insufficient evidence has been reported on the associations between gamma-glutamyltransferase (GGT) and cardiovascular disease (CVD) mortality from studies with an adequate number of participants. METHODS: 512,990 Korean adults who participated in routine health examinations during the period 2002-2003 were followed up until 2013. Hazard ratios (HRs) were calculated after adjusting for potential confounders. RESULTS: Each 1-unit higher natural-log-transformed GGT (LogeGGT) level was associated with approximately 30-50% higher mortality risk of CVD (HR = 1.31): hypertensive diseases (HR = 1.31), ischemic heart diseases (IHD, HR = 1.29), total stroke (HR = 1.29), acute myocardial infarction (HR = 1.30), chronic IHD (HR = 1.27), heart failure (HR = 1.48), hemorrhagic stroke (HR = 1.42), and ischemic stroke (HR = 1.27). The associations with CVD mortality did not vary by sex, or alcohol use, whereas they were stronger in younger (<60 years), non-hypertensive (systolic blood pressure [SBP] <140 mmHg), physically more active, normal-weight (body mass index<25 kg/m2), and normocholesterolemic (total cholesterol <200 mg/dL) adults than in their respective counterparts. Adding LogeGGT to prediction models for CVD mortality increased AUC value (0.0020, p < 0.001), especially in persons aged <60 years (0.0055), with SBP <140 mmHg (0.0030), and with both age <60 years and SBP <140 mmHg (0.0086). CONCLUSIONS: Higher GGT significantly increased the risk of mortality due to CVD and its subtypes. The relative risks were greater in subjects with younger age, no hypertension, more physical activity, normal weight, and normocholesterolemia than in their respective counterparts. In the general population, adding GGT to conventional CVD risk factors may improve the prediction of CVD mortality, especially in subjects younger than 60 years and in those without hypertension.

Pb concentrations and isotopic record preserved in northwest Greenland snow.

We present high-resolution lead (Pb) concentrations and isotopic ratios from a northwest Greenland snow pit covering a six-year period between 2003 and 2009. Pb concentrations ranged widely from 2.7 pg g-1 to 97.3 pg g-1, with a mean concentration of 21.6 pg g-1. These values are higher than those recorded for the pre-industrial period. Pb concentrations exhibit seasonal spikes in winter-spring layers. Crustal Pb enrichment factors (EF) suggest that the northwest Greenland snow pit is highly enriched with Pb of predominantly anthropogenic origin. The 206Pb/207Pb ratios ranged from 1.144 to 1.169 with a mean value of 1.156, which fall between less radiogenic Eurasian-type and more radiogenic Canadian-type signatures. This result suggests that several potential source areas of Pb impact on northwest Greenland. Abrupt changes in Pb concentrations and Pb isotope ratios were observed and related to seasonal shifts in source regions of aerosol transport. The 206Pb/207Pb isotope ratio increased gradually between 2003 and 2009. The similarity of the three-isotope plot (206Pb/207Pb versus 208Pb/207Pb) between some of our samples and Chinese urban aerosols suggests a steadily increasing contribution of Chinese Pb to northwest Greenland snow.

Mental Health of the People with Hearing Impairment in Korea: A Population-Based Cross-Sectional Study.

BACKGROUND: The prevalence of hearing impairment is increasing and an association between hearing impairment and mental health has been reported. Our study aimed to determine the association between hearing impairment and mental health in Korea. METHODS: This was a cross-sectional study of data from the Korean National Health and Nutrition Examination Survey 2010-2013, with a sample size of 18,563 individuals (6,395 with hearing impairment and 12,168 without hearing impairment), aged ≥20 years. RESULTS: The female group with hearing impairment tended to have a higher rate of stress (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.11 to 1.56). The association between hearing impairment and depressive symptoms was higher in elderly males (OR, 1.60; 95% CI, 1.10 to 2.32), while the association of hearing impairment with suicide ideation was higher in elderly females (OR, 1.32; 95% CI, 1.00 to 1.75). CONCLUSION: Elderly individuals with hearing impairment are easily susceptible to poor mental health status. Early targeted intervention to address mental health problems is recommended for people with hearing impairment.

White blood cell counts, insulin resistance, vitamin D levels and sarcopenia in Korean elderly men.

Sarcopenia is a major determinant of frailty, disability and mortality in the elderly. Whether low-grade inflammation, insulin resistance and vitamin D are independently associated with sarcopenia remains unclear. In our study, sarcopenia was defined as an appendicular skeletal muscle mass divided by height squared (ASM/Ht2) that was <2 SD below the normal means for young adults. Insulin resistance was estimated using the homeostasis model assessment of insulin resistance (HOMA-IR) index [(insulin (IU/mL) × fasting glucose (mg/dL)/18)/22.5]. Data of white blood cell counts and serum 25-hydroxyvitamin D (25-(OH)D) levels were collected in the second and third year (2008-2009) of Fourth Korean National Health and Nutrition Examination Survey (KNHANES IV). The results showed that the prevalence of sarcopenia in Korean elderly men aged more than 65 years was 11.2%. ASM/Ht2 were positively associated with vitamin D levels, but negatively associated with white blood cell counts and HOMA-IR by multiple regression analysis. After adjustment for covariables, sarcopenia was associated with the highest quartile of WBC counts (OR = 2.93, 95% CI = 1.21-7.14) and the highest quartile of serum vitamin D levels (OR = 0.38, 95% CI = 0.15-0.95). In conclusion, the study findings suggest that higher WBC counts and lower vitamin D levels are independently associated with the presence of sarcopenia in community-dwelling elderly men. They also provide a basis for further studies of the complex immune-endocrine network in sarcopenia.

Facility characteristics as independent prognostic factors of nursing home-acquired pneumonia.

BACKGROUND/AIMS: Recently, the incidence of nursing home-acquired pneumonia (NHAP) has been increasing and is now the leading cause of death among nursing home residents. This study was performed to identify risk factors associated with NHAP mortality, focusing on facility characteristics. METHODS: Data on all patients ≥ 70 years of age admitted with newly diagnosed pneumonia were reviewed. To compare the quality of care in nursing facilities, the following three groups were defined: patients who acquired pneumonia in the community, care homes, and care hospitals. In these patients, 90-day mortality was compared. RESULTS: Survival analyses were performed in 282 patients with pneumonia. In the analyses, 90-day mortality was higher in patients in care homes (12.2%, 40.3%, and 19.6% in community, care homes, and care hospitals, respectively). Among the 118 NHAP patients, residence in a care home, structural lung diseases, treatment with inappropriate antimicrobial agents for accompanying infections, and a high pneumonia severity index score were risk factors associated with higher 90-day mortality. However, infection by potentially drug-resistant pathogens was not important. CONCLUSIONS: Unfavorable institutional factors in care homes are important prognostic factors for NHAP.

Associations Between Periodontitis and Chronic Obstructive Pulmonary Disease: The 2010 to 2012 Korean National Health and Nutrition Examination Survey.

BACKGROUND: The aim of this study is to examine whether oral hygiene and self-care, particularly in periodontal health, are associated with chronic obstructive pulmonary disease (COPD) in the Korean population. METHODS: Data from the Korean National Health and Nutrition Examination Survey from 2010 to 2012 were used to assess the community periodontal index (CPI) of 5,878 participants (normal lung function: n = 5,181; obstructive spirometric pattern: n = 697) aged ≥40 years, who underwent spirometry. RESULTS: Participants with COPD brushed their teeth less frequently and used the following less frequently: 1) dental floss and/or interdental brush; 2) mouthwash; and 3) electric toothbrush (P <0.001). Prevalence of periodontitis in patients with COPD (58.1%) was significantly higher than in those without COPD (34.0%, P <0.001). Number of teeth was significantly lower in patients with COPD compared with controls. Decayed-missing-filled tooth index was significantly lower in patients with COPD. This study shows risk of COPD by periodontal severity. Periodontitis (CPI 3 and 4) was associated in males with COPD after adjustment for: 1) age; 2) income; 3) education; 4) smoking; 5) alcohol consumption; 6) exercise; 7) body mass index; 8) toothbrushing frequency; 9) diabetes mellitus; and 10) number of teeth (CPI 3: relative risk [RR] = 1.38, 95% confidence interval [CI] = 1.12 to 2.05; CPI 4: RR = 1.23, 95% CI = 1.06 to 1.56). CONCLUSION: Findings of this cross-sectional study suggest that COPD in males may be associated with severe periodontitis and indicates the importance of promoting dental care in patients with COPD.

The association among three aspects of physical fitness and metabolic syndrome in a Korean elderly population.

BACKGROUND: The purpose of current study is to evaluate the association between physical fitness level and the prevalence of metabolic syndrome (MS) in a Korean elderly population. METHODS: A cross-sectional study measuring physical fitness and components of MS in a health promotion center of a general hospital for routine health check-ups. A total of 227 subjects >60 years old agreed to participate. A lifestyle questionnaire that included cigarette smoking, alcohol consumption, and physical activity was checked. Body weight, height, blood pressure, fasting glucose, total cholesterol, triglycerides, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, C-reactive protein, and glycated hemoglobin were measured. Muscular strength was assessed by measuring grasping power. Muscular endurance was evaluated using a sit-up test. Cardiopulmonary fitness was assessed via the Tecumseh step test (measuring hear rates at 1 min post-exercise). RESULTS: The highest tertile muscular endurance group (sit-ups >15 in men, >10 in women) was 0.37 times less likely to have MS [95 % confidence interval (CI) 0.17-0.84; p = 0.036] compared to that in the lowest tertile group (<11 in men, 0 in women), and the highest tertile in the cardiopulmonary fitness group (heart rate at rest >91/min in men, >92/min in women) was 2.81 times more likely to have MS (95 % CI 1.27-6.18; p = 0.038) compared to that in the lowest tertile group (<81/min in men, <80/min in women). CONCLUSIONS: Cardiopulmonary fitness and muscular endurance were related to MS in a Korean elderly population after adjusting for age, sex, current smoker, current alcohol drinking, and physical activity. Older adults should be encouraged to increase their cardiopulmonary fitness and muscular endurance.