Association of milk and dairy product consumption with the incidence of cardio-cerebrovascular disease incidence in middle-aged and older Korean adults: a 16-year follow-up of the Korean Genome and Epidemiology Study.

BACKGROUND/OBJECTIVES: Unhealthy dietary behaviors constitute one of risk the factors for chronic and cardiovascular diseases, which are prevalent in middle-aged and older populations. Milk and dairy products are high-quality foods and important sources of calcium. Calcium protects against osteoporosis and cardiovascular disease. Therefore, this study investigated the association of milk and dairy product consumption with cardio-cerebrovascular disease incidence in middle-aged and older Korean adults. SUBJECTS/METHODS: Data were derived from the Ansan-Anseong cohort study, and a total of 8,009 individuals aged 40-69 years were selected and followed up biennially. Cox proportional hazard models were used to examine the association of milk and dairy product consumption with cardio-cerebrovascular disease incidence. RESULTS: During a mean follow-up period of 96.5 person-months, 552 new cases of cardio-cerebrovascular disease were documented. Milk consumers (< 1 serving/day) exhibited a 23% lower risk of cardio-cerebrovascular disease incidence than non-milk consumers (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.61-0.97; P for trend = 0.842). High yogurt consumption was associated with a 29% lower incidence risk (≥ 0.5 servings/day vs. none: HR, 0.71; 95% CI, 0.53-0.96; P for trend = 0.049), whereas high ice cream consumption was associated with a 70% higher risk of cardio-cerebrovascular disease incidence (≥ 0.5 servings/day vs. none: HR, 1.70; 95% CI, 1.01-2.88; P for trend = 0.070). CONCLUSIONS: This study indicates that less than one serving of milk and high yogurt consumption are associated with a lower cardio-cerebrovascular disease risk in the middle-aged and older populations.

Early childhood eating behaviors associated with risk of overweight and its socio-ecological determinants in Korean preschool children.

BACKGROUND/OBJECTIVES: This study aimed to identify preschool children's eating behaviors associated with early childhood obesity and its multi-level, socio-ecological determinants. SUBJECTS/METHODS: In a cross-sectional study of 364 mothers of preschool children aged 3-5 years, these children's healthy eating behaviors were assessed using a validated preschool nutrition quotient (NQ-P) questionnaire. The children's overweight or obesity statuses were determined based on body mass index percentiles from the 2017 Korean National Growth Chart. The associations between the NQ-P score and risk of overweight or obesity were examined using multivariable logistic regression. The associations of individual, maternal, physical, and media environmental factors with the NQ-P score were also examined using multivariable linear regression. RESULTS: Preschool children with greater NQ-P scores were at a significantly lower risk of overweight or obesity (P < 0.01). The NQ-P score had a significantly positive association with maternal body mass index and an inverse association with household income (all P < 0.05). Maternal parenting and feeding practices exhibited associations with the NQ-P score. Positive associations were observed with "warm," "structured," and "autonomy-supportive" parenting as well as monitoring feeding practices (all P < 0.05). In addition, the NQ-P score had a significantly positive association with the childcare center's anti-obesogenic environment, such as the provision of nutritional and physical-activity support and vicinity of the built food environment to the home, including access to good-quality food, fruits and vegetables, and low-fat foods (all P < 0.05). Regarding media environments, the NQ-P score demonstrated more significant associations with viewing and eating and/or cooking content displayed on online video platforms (all P < 0.05) than with that on television. CONCLUSIONS: Our findings confirm the significance of healthy eating behaviors in early-childhood-obesity prevention and underscore the importance of multilevel maternal, physical, and media environmental interventions that effectively guide eating behaviors in preschool children.

Association of Dietary Sodium-to-Potassium Ratio with Cardiometabolic Risk Factors in Korean Adults: Findings from the Korean National Health and Nutrition Examination Survey.

High-sodium and low-potassium intakes are interdependently linked to hypertension and cardiovascular diseases. We investigated the associations of dietary sodium-to-potassium (Na/K) ratio with cardiometabolic risk factors in 12,996 Korean adults (≥30 years) from the Korean National Health and Nutrition Examination Survey Ⅶ (2016-2018). Food intake was assessed through 24 h dietary recall data. Participants were divided into thirds based on their dietary Na/K ratio, with mean molar Na/K ratios of 1.11 (low), 1.92 (medium), and 3.21 (high). Although no significant associations were found between the dietary Na/K level and the risk of hypertension, obesity, and diabetes in all participants, the high Na/K ratio group had a higher risk of hypertension compared to the low Na/K ratio group in older adults (≥65 years) after adjusting for confounding factors (odds ratio = 1.38, 95% confidence interval: 1.10-1.72). Moreover, a higher Na/K ratio was associated with an increased risk of metabolic syndrome (MetS) in all participants (p for trend = 0.0020). Within MetS components, abdominal obesity, elevated triglycerides, and elevated blood pressure were positively associated with the Na/K level. The food groups positively associated with a lower Na/K ratio were fruits, unsalted vegetables, nuts, potatoes, and dairy products. These findings suggest that a high dietary Na/K ratio may be an important risk factor for hypertension in older adults and MetS in all adults.

Development of a Nurse Turnover Prediction Model in Korea Using Machine Learning.

Nurse turnover is a critical issue in Korea, as it affects the quality of patient care and increases the financial burden on healthcare systems. To address this problem, this study aimed to develop and evaluate a machine learning-based prediction model for nurse turnover in Korea and analyze factors influencing nurse turnover. The study was conducted in two phases: building the prediction model and evaluating its performance. Three models, namely, decision tree, logistic regression, and random forest were evaluated and compared to build the nurse turnover prediction model. The importance of turnover decision factors was also analyzed. The random forest model showed the highest accuracy of 0.97. The accuracy of turnover prediction within one year was improved to 98.9% with the optimized random forest. Salary was the most important decision factor for nurse turnover. The nurse turnover prediction model developed in this study can efficiently predict nurse turnover in Korea with minimal personnel and cost through machine learning. The model can effectively manage nurse turnover in a cost-effective manner if utilized in hospitals or nursing units.

7,8-Dihydroxyflavone Attenuates Inflammatory Response and Insulin Resistance Induced by the Paracrine Interaction between Adipocytes and Macrophages.

Obesity-induced inflammation and insulin resistance are mediated by macrophage infiltration into adipose tissue. We investigated the effects of 7,8-dihydroxyflavone (7,8-DHF), a flavone found in plants, on the inflammatory response and insulin resistance induced by the interaction between adipocytes and macrophages. Hypertrophied 3T3-L1 adipocytes were cocultured with RAW 264.7 macrophages and treated with 7,8-DHF (3.12, 12.5, and 50 µM). The inflammatory cytokines and free fatty acid (FFA) release were evaluated by assay kits, and signaling pathways were determined by immunoblotting. Coculture of adipocytes and macrophages increased inflammatory mediators, such as nitric oxide (NO), monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) and FFA secretion but suppressed the production of anti-inflammatory adiponectin. 7,8-DHF counteracted the coculture-induced changes (p < 0.001). 7,8-DHF also inhibited c-Jun N-terminal kinase (JNK) activation and blocked nuclear factor kappa B (NF-κB) nuclear translocation in the coculture system (p < 0.01). In addition, adipocytes cocultured with macrophages did not increase glucose uptake and Akt phosphorylation in response to insulin. However, 7,8-DHF treatment recovered the impaired responsiveness to insulin (p < 0.01). These findings show that 7,8-DHF alleviates inflammation and adipocyte dysfunction in the coculture of hypertrophied 3T3-L1 adipocytes and RAW 264.7 macrophages, indicating its potential as a therapeutic agent for obesity-induced insulin resistance.

Awareness and Needs of Smoking Cessation Services for Female Emotional Laborers, Parcel Delivery Workers, Transportation Workers, and Construction Workers in South Korea.

Although South Korea has implemented various smoking cessation services, women who are emotional laborers, as well as parcel delivery, transportation, and construction workers, have poor access to these services. This study evaluated the smoking-related characteristics of workers in these four occupations as well as the awareness of and need for smoking cessation services. In total 808 workers in these four occupations aged 19 years and above were recruited nationwide and had their data analyzed. The participants' age, marital status, number of work hours per week, job-related stress, age when they started smoking, average number of cigarettes a day, types of tobacco products, close relationships to others who smoke, number of attempts to quit smoking, plans to quit smoking, awareness of cessation services, prior utilization of cessation services, and need for cessation services were surveyed. Compared with parcel delivery workers, female emotional laborers and transportation and construction workers had more attempts to quit smoking, plans to quit smoking, and prior utilization of smoking cessation services, moreover, construction workers had a significantly lower awareness of smoking cessation services. Parcel delivery workers need smoking cessation programs, mobile applications to help them quit smoking, and improvements in their work environments. Cessation services and education should be promoted at workplaces and among managers.

Health and economic impact of a smoking cessation program in Korean workplaces.

Smoking is a leading cause of diseases and death, with significant socioeconomic consequences. The purpose of this study was to evaluate the health and economic effectiveness of a workplace smoking cessation program. A total of 89 smokers from seven workplaces in Korea were the participants of the program. For 4 months, individual counseling based on the transtheoretical model (TTM) was conducted and interpersonal and organizational components were applied to encourage entire workplaces to encourage employee smoking cessation. The primary outcome was whether participants quit smoking or not. We also evaluated the changes in attitude and perceptions related to smoking cessation before and after the program and estimated the program's economic effects. Economic effects were defined as reductions in productivity losses and medical expenses. We calculated the return on investment (ROI) values representing the averted cost through the program compared to program cost. At the end of the program, 40.4% of participants quit smoking. Improvements were observed in TTM-based attitudes and perceptions. The mean reduction in productivity losses was estimated to be $187,609.94 for 2 yr and the mean reduction in medical expenses was $3,136.49 at 20 yr among seven workplaces. When accounting for these reductions, the ROI was 15.39 (ranging from -1.00 to 44.53). These effects were robust under various scenarios. The smoking cessation program should be expanded to a wider variety of workplaces. In the future, more sophisticated economic assessment methods should be developed and applied to facilitate workplace recruitment and attract management support.

Smoking is a major cause of disease and death with large socioeconomic costs. This study examined the effect of a workplace smoking cessation program on health perspective, and on productivity and profit. A total of 40.4% of participants quit smoking, and the perceptions on smoking were improved. Also, the program was revealed to have an average return on investment (ROI) of 15.39. This can be deemed as the program's economic effect is 15.39 times the program cost. We believe this kind of evaluation may help with the dissemination of workplace health promotion programs.

Burden of dust storms on years of life lost in Seoul, South Korea: A distributed lag analysis.

Although dust storms have been associated with adverse health outcomes, studies on the burden of dust storms on deaths are limited. As global warming has induced significant climate changes in recent decades, which have accelerated desertification worldwide, it is necessary to evaluate the burden of dust storm-induced premature mortality using a critical measure of disease burden, such as the years of life lost (YLL). The YLL attributable to dust storms have not been examined to date. This study investigated the association between Asian dust storms (ADS) and the YLL in Seoul, South Korea, during 2002-2013. We conducted a time-series study using a generalized additive model assuming a Gaussian distribution and applied a distributed lag model with a maximum lag of 5 days to investigate the delayed and cumulative effects of ADS on the YLL. We also conducted stratified analyses using the cause of death (respiratory and cardiovascular diseases) and sociodemographic status (sex, age, education level, occupation, and marital status). During the study period, 108 ADS events occurred, and the average daily YLL was 1511 years due to non-accidental causes. The cumulative ADS exposure over the 6-day lag period was associated with a significant increase of 104.7 (95% CI, 31.0-178.5 years) and 34.4 years (4.0-64.7 years) in the YLL due to non-accidental causes and cardiovascular mortality, respectively. Sociodemographic analyses revealed associations between ADS exposure and the YLL in males, both <65 and ≥ 65 years old, those with middle-level education, and the unemployed, unmarried, and widowed (26.5-83.8 years). This study provides new evidence suggesting that exposure to dust storms significantly increases the YLL. Our findings suggest that dust storms are a critical environmental risk affecting premature mortality. These results could contribute to the establishment of public health policies aimed at managing dust storm exposure and reducing premature deaths.

Perceptions and Feasibility of Actions Related to Sodium Reduction among Restaurant Owners and Cooks in Seongnam, South Korea: Comparison According to Stages of Behavioral Change.

With the increase in meals eaten outside the home, sodium reduction in restaurant foods is essential for reducing sodium intake. This study aimed to assess the stages of behavioral change for reducing sodium and the differences in perceptions among restaurant staff by stage. Restaurant owners and cooks (n = 313) in Seongnam, South Korea were surveyed on their stage of behavioral change, practices, and perceptive factors related to sodium reduction in restaurant meals using a questionnaire. The proportion of behavioral change by stage was 20.4% in the maintenance and action (MA) stage, 32.3% in the preparation (P) stage, and 47.3% in the pre-preparation (PP) stage, which included contemplation and pre-contemplation stages. The items that represent differences among the groups were recognition of social environment for sodium reduction, practice of weighing condiments and measuring salinity, and feasibility of actions related to low-sodium cooking. Logistic regression analysis was used to estimate odds ratios for practice and perceptive factors by using stage of behavioral change as the independent variable. Factors associated with being in the MA stage were weighing condiments, measuring salinity, and high feasibility of actions related to low-sodium cooking. Recognition of sodium labeling and anticipation of better taste by reducing sodium increased the odds of being in the P stage rather than the PP stage. These results suggest that customized stepwise education and support are needed for the efficacy of restaurant-based sodium reduction programs.

Psidium guajava L. leaf extract inhibits adipocyte differentiation and improves insulin sensitivity in 3T3-L1 cells.

BACKGROUND/OBJECTIVES: Psidium guajava L. (guava) leaves have been shown to exhibit hypoglycemic and antidiabetic effects in rodents. This study investigated the effects of guava leaf extract on adipogenesis, glucose uptake, and lipolysis of adipocytes to examine whether the antidiabetic properties are mediated through direct effects on adipocytes. MATERIALS/METHODS: 3T3-L1 cells were treated with 25, 50, 100 µg/mL of methanol extract from guava leaf extract (GLE) or 0.1% dimethyl sulfoxide as a control. Lipid accumulation was evaluated with Oil Red O Staining and AdipoRed assay. Immunoblotting was performed to measure the expression of adipogenic transcription factors, fatty acid synthase (FAS), and AMP-activated protein kinase (AMPK). Glucose uptake under basal or insulin-stimulated condition was measured using a glucose analog 2-[N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl)amino]-2-deoxy-D-glucose. Lipolysis from fully differentiated adipocytes was measured by free fatty acids release into the culture medium in the presence or absence of epinephrine. RESULTS: Oil Red O staining and AdipoRed assay have shown that GLE treatment reduced lipid accumulation during adipocyte differentiation. Mitotic clonal expansion, an early essential event for adipocyte differentiation, was inhibited by GLE treatment. GLE inhibited the expression of transcription factors involved in adipocyte differentiation, such as peroxisome proliferator-activated receptor γ (PPARγ), CCAAT/enhancer-binding protein α (C/EBPα), and sterol regulatory element-binding protein-1c (SREBP-1c). FAS expression was also decreased while the phosphorylation of AMPK was increased by GLE treatment. In addition, GLE increased insulin-induced glucose uptake into adipocytes. In lipid-filled mature adipocytes, GLE enhanced epinephrine-induced lipolysis but reduced basal lipolysis dose-dependently. CONCLUSIONS: The results show that GLE inhibits adipogenesis and improves adipocyte function by reducing basal lipolysis and increasing insulin-stimulated glucose uptake in adipocytes, which can be partly associated with antidiabetic effects of guava leaves.

Binge Drinking and Obesity-Related Eating: The Moderating Roles of the Eating Broadcast Viewing Experience among Korean Adults.

Recently, there has been a notable rise in binge drinking and in the popularity of eating broadcasts via TV and online platforms, especially in Korea. This study analyzed the moderating effect of the eating broadcast viewing experience on the relationship between binge drinking and obesity-related eating behaviors. Cross-sectional self-reported online survey data were collected from 1125 Korean adults. Moderation models for restrained, emotional, and external eating behaviors were tested using moderation analyses with Hayes's PROCESS version 3.5 compatible with SPSS. As a result, the eating broadcast viewing experience moderated the relationship between binge drinking frequency and external eating (Fchange = 2.686, p = 0.045). More frequent binge drinking was associated with a higher level of external eating in participants who only watched online eating broadcasts, especially among women. Participants in their twenties showed the same above association; additionally, those who only watched TV eating broadcasts showed an inverse association, indicating that more frequent binge drinking was associated with a lower level of external eating. Consequently, an eating broadcast viewing experience was one of the environmental factors associated with binge drinking that influences obesity-related eating behaviors.

Successful Smoking Cessation among Women Smokers Based on Utilizing National Smoking Cessation Service Type in Korea.

BACKGROUND: This study aimed to evaluate the successful smoking cessation across different national smoking cessation services. METHODS: This study included data that had been previously entered into the integrated information system for smoking cessation services and comprised 144,688 participants after excluding missing data. These clinics provide face-to-face counseling, phone calls, text messages, and e-mail services for six months and nine sessions. RESULTS: The women-only program had the lowest success rate (11.3%). Compared with the women-only program, the six-month success rate of smoking cessation clinic at public health centers (OR = 3.72, CI = [3.52, 3.92]), visiting-type smoking cessation clinics (OR = 2.97, CI = [2.79, 3.16]), the residential 4 -night 5-day program (OR = 7.79, CI = [6.49, 9.35]), and a program for inpatients (OR = 2.36, CI = [1.89, 2.94]) showed a significant increase. CONCLUSIONS: Emotional labor workers who participated in the women-only program had low smoking cessation success rates, while those who participated in the residential 4-night 5-day program had high success rates.

Anti-Inflammatory and Anti-Diabetic Effect of Black Soybean Anthocyanins: Data from a Dual Cooperative Cellular System.

Obesity is characterized by elevated infiltration of macrophages into adipose tissue, leading to the development of insulin resistance. The black soybean seed coat is a rich source of anthocyanins with antioxidative and anti-inflammatory activities. This study investigated the effects of black soybean anthocyanin extract (BSAn) on obesity-induced oxidative stress, the inflammatory response, and insulin resistance in a coculture system of hypertrophied 3T3-L1 adipocytes and RAW264 macrophages. Coculture of adipocytes with macrophages increased the production of reactive oxygen species and inflammatory mediators and cytokines (NO, MCP-1, PGE2, TNFα, and IL-6) and the release of free fatty acids but reduced anti-inflammatory adiponectin secretion. BSAn treatment (12.5, 25, 50, and 100 µg/mL) alleviated the coculture-induced changes (p < 0.001) and inhibited coculture-induced activation of JNK and ERK signaling (p < 0.01). BSAn also blocked the migration of RAW264.7 macrophages toward 3T3-L1 adipocytes. In addition, treatment with BSAn increased PPARγ expression and glucose uptake in response to insulin in hypertrophied 3T3-L1 adipocyte and RAW264.7 macrophage coculture (p < 0.01). These results demonstrate that BSAn attenuates inflammatory responses and improves adipocyte metabolic function in the coculture of hypertrophied 3T3-L1 adipocytes and RAW264.7 macrophages, suggesting the effectiveness of BSAn for obesity-induced insulin resistance.

The Utilization of National Tobacco Cessation Services among Female Smokers and the Need for a Gender-Responsive Approach.

Despite the steadily increasing prevalence of female smoking, gender-responsive tobacco cessation services have not been widely provided worldwide. The purpose of this study is to identify factors associated with the use of tobacco cessation services among female tobacco product users in Korea from a national perspective. We performed a logistic regression analysis using data from 663 female smokers; 11.0% of female smokers had used government-supported smoking cessation services. A logistic regression model showed a statistically significant association between the utilization of smoking cessation services and a history of pregnancy and childbirth, depression, current use of heated tobacco products and multiple tobacco products, parental smoking status and receiving advice to quit. With regard to the motivation ruler, those in their 50s reported a higher importance than those in their 20s. Weight gain concerns when quitting smoking were the lowest among the participants aged 19-29. The need to develop gender-specific smoking cessation programs is the highest among the participants aged 39-49 and the lowest among those aged 19-29. This study suggests several factors related to the utilization of national health services among female smokers. Further studies considering gender-specific needs for the development of gender-responsive tobacco cessation support are needed.

Eating control and eating behavior modification to reduce abdominal obesity: a 12-month randomized controlled trial.

BACKGROUND/OBJECTIVES: Abdominal obesity is associated with metabolic disorders, and, in recent years, its prevalence in Korea has continuously increased. The change of lifestyle, particularly diet, is critical for the reduction of abdominal obesity. This study evaluated the effectiveness of an intervention focused on dietary self-efficacy and behaviors on the improvement of abdominal obesity. SUBJECTS/METHODS: Abdominally obese adults with additional cardiovascular risk factors were recruited through 16 medical facilities in South Korea from the year 2013 to 2014. The participants were randomly divided into 2 groups: an intensive intervention group (IG) that received a multi-component intervention to reduce abdominal obesity, by mainly focusing on dietary attitude and dietary behavior change, and a minimal information intervention group (MG) that received a brief explanation of health status and a simple recommendation for a lifestyle change. The interventions were provided for 6 mon, and health examinations were conducted at baseline, 3-, 6-, and 12-mon follow-ups. A path analysis was conducted to identify the process governing the changes in abdominal obesity. RESULTS: The IG showed an improvement in self-efficacy for eating control and diet quality at 6-mon follow-up. Abdominal obesity improved in both groups. Waist circumference was observed to be decreased through the path of "improved self-efficacy for eating control in food availability-eating restriction-improved dietary quality" in IG. Most changes in follow-ups were not significantly different between two groups. CONCLUSIONS: The intensive program targeting the modification of dietary behavior influenced management of abdominal obesity, and the effect occurred through a step-by-step process of change in attitude and behavior. Generally, improvements were also seen in the MG, which supports the necessity of regular health check-ups and brief consultation. The results can be used for further development and implementation of more successful interventions. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0000762.

Atypical Antipsychotics Augmentation in Patients with Depressive Disorder and Risk of Subsequent Dementia: A Nationwide Population-Based Cohort Study.

BACKGROUND: While atypical antipsychotic medications are widely used for treating depressive disorders, their long-term effects on the risk of subsequent dementia have not been studied adequately. OBJECTIVE: To investigate whether the risk of dementia differs according to the use of atypical antipsychotic drugs, and compare the effects of antipsychotic agents on dementia risk in individuals with late-life depressive disorders. METHODS: A nationwide population-based retrospective cohort study was conducted using data from the National Health Insurance Service-Senior Cohort of South Korea. Atypical antipsychotic dosages were standardized using a defined daily dose, and the cumulative dosage was calculated. Participants were observed from January 2008 to December 2015. Cox proportional hazard regression analysis was used to estimate the hazard ratios. RESULTS: The cohort included 43,788 elderly adults with depressive disorders: 9,901 participants (22.6%) were diagnosed with dementia. Findings showed that atypical antipsychotics were prescribed to 1,967 participants (4.5%). Compared with non-users, users of atypical antipsychotics experienced a significantly higher risk for dementia with an adjusted hazard ratio (aHR) of 1.541 (95% confidence interval [CI], 1.415-1.678). A cumulative dose-response relationship was observed (test for trend, p < 0.0001). Among atypical antipsychotics, risperidone displayed the highest risk for dementia (aHR 1.767, [95% CI, 1.555-2.009]). CONCLUSION: In this study of elderly individuals with depressive disorders, atypical antipsychotic use was associated with a significantly higher risk of subsequent dementia. Healthcare professionals should be aware of this potential long-term risk. A limitation that should be mentioned is that we could not exclude patients with bipolar depression.

Mortality and Prognostic Factors of Nontuberculous Mycobacterial Infection in Korea: A Population-based Comparative Study.

BACKGROUND: Population-based studies on the mortality burden of nontuberculous mycobacteria (NTM) infection are lacking. We compared the long-term mortality of NTM-infected patients with tuberculosis (TB)-patients and the general population, and investigated mortality-associated factors. METHODS: We analyzed nationwide-data from the Korean National Health Insurance and Korea-Statistical Office between 2002 and 2017. NTM infection was identified using the International Classification of Disease, Tenth Revision code, with one-to-one matching to TB patients and general population controls. RESULTS: A total of 530 401 individuals were analyzed, including 183 267 with NTM infections; 166 666 with TB; and 180 468 controls. The overall 6-, 10-, and 14-year cumulative survival probabilities in the NTM group were 86.3%, 80.8%, and 77.1%, respectively, which were significantly lower than those of the TB or control groups (log-rank P < .0001). In cases of NTM and TB coinfection, the overall 6-, 10-, and 14-year cumulative survival probabilities were 75.1%, 65.4%, and 57.0%, respectively. Multivariable analysis indicated that old age, male gender, province, and various respiratory or nonrespiratory comorbidities were significantly associated with mortality of NTM infection. The use of a macrolide (more than 1 year) negatively correlated with mortality of NTM infection (adjusted hazard ratio [aHR] 0.61, 95% confidence interval [CI] .53-.71), regardless of azithromycin (aHR 0.60, 95% CI .43-.85) or clarithromycin use (aHR 0.63, 95% CI .53-.75). CONCLUSIONS: NTM-infected patients had poor prognosis when compared to TB patients or the general population, especially for NTM and TB coinfection. NTM mortality was associated with certain demographic characteristics, but long-term use of macrolides may provide survival benefits.

Regional disparities in the associations of cardiometabolic risk factors and healthy dietary factors in Korean adults.

BACKGROUND/OBJECTIVES: Regional disparities in dietary factors might be related to regional disparities in cardiometabolic health. Therefore, this study investigated the associations of cardiometabolic risk factors and dietary factors with regional types in Korean adults. SUBJECTS/METHODS: Based on data from the 2007-2017 Korea National Health and Nutrition Examination Survey, the study included 39,781 adults aged ≥ 19 years who completed the dietary survey and a health examination. Healthy and unhealthy dietary factors (fat, sodium, fruit, and vegetable intakes) were evaluated using 1-day 24-h dietary recall method, as well as the use of nutrition labels with a questionnaire. RESULTS: Of the participants, 48.7%, 36.0%, and 15.2% lived in metropolitan, urban, and rural areas, respectively. Adults living in urban and rural had higher odds ratios (ORs) for obesity (OR for urban, 1.07; 95% confidence interval (CI), 1.01-1.14; OR for rural, 1.14; 95% CI, 1.05-1.24) than adults living in metropolitan areas; these associations were significantly observed in middle-aged adults. Compared to metropolitan residents, rural residents had lower ORs for hypertension in middle-aged (OR, 0.86; 95% CI, 0.76-0.96) and metabolic syndrome in older adults (OR, 0.78; 95% CI, 0.67-0.91). Regarding urban residents, a lower OR for diabetes in middle-aged adults (OR, 0.85; 95% CI, 0.74-0.97) and a higher OR for hypertension in older adults (OR, 1.19; 95% CI, 1.02-1.39) were observed. Overall rural residents had higher ORs of excessive carbohydrate, low fruit, and high salted-vegetable intakes than metropolitan residents. Low fruit intake was positively associated with obesity, metabolic syndrome, and hypertension, after adjustment for regional type and other confounders in total participants. CONCLUSIONS: These findings indicate that cardiometabolic risk and unhealthy dietary factors differ among regional types and age groups within Korea. Nutritional policy and interventions should consider regional types for prevention and management of cardiometabolic risk factors.

Association between ambient temperature and injury by intentions and mechanisms: A case-crossover design with a distributed lag nonlinear model.

Although injury is a leading cause of death worldwide, the association between ambient temperature and injury has received little research attention compared to the association of temperature with mortality and morbidity from non-external causes. With current climate change and increases in weather extremes, assessing the association between temperature and injury is important for determining public health priorities. Therefore, the present study examined the association between ambient temperature and injury risk with a focus on the intentions and mechanisms of injury. Using the national emergency database, we identified a total of 703,503 injured patients who had visited emergency departments in Seoul, South Korea from 2008 to 2016. We conducted a time-stratified case-crossover study using a conditional Poisson regression model, and applied a distributed lag nonlinear model to explore possible nonlinear and delayed effects of daily mean temperature on injury risk. Injury risk was significantly associated with ambient temperature, and temperature-injury association curves markedly differed with respect to intentions and mechanisms of injury. Although unintentional injuries increased significantly at both high and low temperatures, intentional injuries - including self-harm and assault - significantly increased only at high temperatures. The mechanism-specific analyses showed that injuries caused by traffic accidents and burns significantly increased at both high and low temperatures. However, injuries caused by all other mechanisms (i.e., fall, blunt object, machinery, penetration, and poisoning) significantly increased only at high temperatures, while injury due to slipping increased at low temperatures. Our study provides evidence that ambient temperature is associated with risk of injury, and this association differs depending on the intentions and mechanisms of injury. Overall, our findings help foster a more comprehensive understanding of the association between temperature and injury that can be used to establish appropriate public health policies and targeted interventions.

Gender-differences in predictors for time to metabolic syndrome resolution: A secondary analysis of a randomized controlled trial study.

Understanding gender differences in health-related behaviors and their impacts is a crucial aspect of effective primary care. We studied gender-based differences in predictors of metabolic syndrome (MetS) resolution among newly diagnosed MetS patients. This study was a secondary analysis of a prospective clinical trial study comprising of 637 middle-aged and older adults (226 men and 411 women) who underwent a regular health checkup and were newly diagnosed with MetS at 16 different health clinics of 14 metropolitan cities and provinces. We conducted Cox proportional hazard analysis to estimate cumulative probability of MetS resolution within a 12-month observation period. Among the 637 patients, 47.6% of participants achieved MetS resolution. The resolution rate was similar among men and women (44.7% and 49.1%, respectively, P = 0.320). Low household income (Hazard ratio = 2.62, 95% confidence interval: 1.13-6.08) and current employment (2.29, 1.26-4.13) were associated with a higher cumulative probability of MetS resolution in men than in women. For women, however, longer sleeping hours (1.18, 1.04-1.34) and living with a partner (1.58, 1.06-2.35) were positive predictors of MetS resolution. Being overweight (0.63, 0.44-0.89) was associated with lower cumulative probability of MetS resolution in women than in men. The factors associated with cumulative probability of MetS resolution within the 12-month follow-up were different between men and women. These findings facilitate further exploration on gender-based differences in risk factors for less optimal improvements in MetS.