Psychotropic Medications Promote Time-Dependent Reduction of Suicidal Ideation in Mood Disorder: A Prospective Cohort Study.

BACKGROUND: Despite a plethora of research on the topic, there is still no solid evidence that pharmacological treatment actually reduces the risk of suicide in patients with mental illness. In this study, we aimed to assess the effect of psychotropic medications on suicidal ideation in patients with major depressive disorder (MDD) and bipolar disorder (BPD) in two age groups: less than 25 years and 25 years and older. METHODS: We analyzed 312 patients with mood disorders with current suicidal thoughts or recent suicide attempts. We followed the participants from baseline for 6 months and assessed changes in suicidal ideation with Columbia-Suicide Severity Rating Scale (C-SSRS). The effect of psychotropic drug administration on suicidal ideation over time was analyzed using a linear mixed model. RESULTS: In patients aged 25 years and older with mood disorders, suicidal ideation was more severe when using psychotropic drugs than when not using them. However, suicidal ideation decreased rapidly over time. The time-dependent reduction in suicidal ideation was accelerated when using antidepressants and sedatives/hypnotics in adult MDD, and when using mood stabilizers in adult BPD. However, this effect was not observed in participants aged less than 25 years. CONCLUSION: Adequate psychotropic medication may reduce suicidal ideation in patients with mood disorders aged 25 years and older. Additional research on psychotropic drugs is needed to effectively reduce the risk of suicide among children and adolescents with mood disorders.

Healthcare Utilization and Discrepancies by Income Level among Patients with Newly Diagnosed Type 2 Diabetes: An Analysis of National Health Insurance Sample Cohort Data.

Objectives: : The use of qualitative healthcare services or its discrepancy between different income levels of the type 2 diabetes(T2D) patients has seldom been studied concurrently. The present study is unique that regarding T2D patients of early stages of diagnosis. Aimed to assess the utilization of qualitative healthcare services and influence of income levels on the inequality of care among newly diagnosed patients with T2D. Methods: A retrospective cohort study of 7590 patients was conducted by the NHIS-NSC2 from 2002 to 2015. Insured employee in 2013 with no history of T2D between 2002 and 2012 were included. The standard of diabetes care includes HbA1c (4 times/year), eyes (once /year) and lipid abnormalities (once/year). Multivariate logistic regression analysis was performed to examine the difference between income levels and inequality of care. Results: From years 1 to 3, rates of appropriate screening fell from 16.9% to 14.1% (HbA1c), 15.8% to 14.5% (eye), and 59.2% to 33.2% (lipid abnormalities). Relative to income class 5 (the highest-income group), HbA1 screening was significantly less common in class 2 (year 2: OR, 0.785; 95% CI, 0.61-0.99; year 3: OR, 0.793; 95% CI, 0.69-0.91). In year 1, lipid screening was less common in class 1 (OR, 0.843; 95% CI, 0.73-0.98) than in class 5, a trend that continued in year 2. Eye screening rates were consistently lower in class 1 than in class 5 (year 1: OR, 0.734; 95% CI, 0.604-0.890; year 2: OR, 0.628; 95% CI, 0.503-0.779; year 3: OR, 0.814; 95% CI, 0.668-0.989). Conclusions: Newly diagnosed T2D patients have shown low rate of HbA1c and screening for diabetic-related complications and experienced inequality in relation to receiving qualitative diabetes care by income levels.

Mental health effects associated with COVID-19 financial assistance in South Korea: a comparison of employment status.

BACKGROUND: COVID-19 has created tensions across different sectors of the society, but the impact has been unequal. Vulnerable people have been most affected, especially those with insecure employment and who have experienced economic hardships due to unemployment and lost wages. The combination of social change and economic hardships due to the pandemic increases the risk of poor mental health. Some countries have utilized financial assistance to alleviate economic hardships caused by COVID-19, and in South Korea, the central and local governments have implemented COVID-19 financial assistance. This study analysed the impact of financial assistance on mental health associated with working status during the COVID-19 pandemic in South Korea. METHODS: The participants of this study were randomly selected from residents of Gyeonggi-do after being proportionally allocated by resident registration population status. A total of 1,000 adult males and females aged 19 years or older in Gyeonggi-do who received financial assistance from the central and local governments were selected. A retrospective pre-post-study design was applied, and mental health surveys including the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-item scale (GAD-7) were applied. RESULTS: The results show that depression scores averaged 5.5 and anxiety scores averaged 4.4 before COVID-19 Financial Assistance. It is similar to the national average of 5.1 and 4.5 respectively at that time. After the assistance, depression scores dropped to 4.5, and anxiety scores dropped to 3.2. Before the assistance, depression and anxiety were higher among temporary day labourers with less job security, and they showed the most significant improvement in mental health. For full-time workers, there was no significant change in anxiety or depression after receiving the assistance. CONCLUSIONS: Financial assistance can provide material resources and also positively affect mental health. In particular, it had a greater impact on the relatively vulnerable groups, such as those in unstable employment.

Effect of motivated physicians and elderly patients with hypertension or type 2 diabetes mellitus in prepared communities on health behaviours and outcomes: A population-based PS matched retrospective cohort study during five-year follow-up period.

Effective chronic disease management requires the active participation of patients, communities, and physicians. The objective of this study was to estimate the effectiveness of the Community-based Registration and Management for elderly patients with Hypertension or Type 2 Diabetes mellitus Project (CRMHDP) by using motivated primary care physicians and patients supported by prepared communities, to utilise healthcare and health outcomes in four cities in South Korea. We conducted a propensity score-matched retrospective cohort study using 2010-2011 as the baseline years, alongside a follow-up period until 2015/2016, based on the Korean National Health Insurance database. Both a CRMHDP group (n = 46,865) and a control group (n = 93,730) were applied against healthcare utilisation and difference-in-differences estimations were performed. For the health outcome analysis, the intervention group (n = 27,242) and control group (n = 54,484) were analysed using the Kaplan-Meier method and Cox proportional hazard regression. Results: The difference-in-differences estimation of the average annual clinic visits per person and the average annual days covered were 1.26 (95% confidence interval, 1.13-1.39) and 22.97 (95% CI, 20.91-25.03), respectively, between the intervention and control groups. The adjusted hazard ratio for death in the intervention group, compared to the control group, was 0.90 (95% CI, 0.86-0.93). For stroke and chronic renal failure, the adjusted hazard ratios for the intervention group compared to the control group were 0.94 (95% CI, 0.88-0.99) and 0.80 (95% CI 0.73-0.89), respectively. Our study suggests that for effective chronic disease management both elderly patients and physicians need to be motivated by community support.

Suicide risk of chronic diseases and comorbidities: A Korean case-control study.

OBJECTIVES: Chronic diseases including mental disorders have been associated with suicide. This study broadens the approach by incorporating a comprehensive list of chronic diseases and a context of comorbidities and explored their associations with suicide. METHODS: Data-linkage between death registry and Korean National Health Insurance data was conducted. Suicide cases (n = 64,099) between 2009 and 2013 were 1:4 matched for gender and age to an alive control (n = 256,396). A total of 92 individual diseases of 9 broad categories were identified from insurance claims data. Conditional logistic regression was applied to assess the associations, adjusting for mental and behavioral disorders and socioeconomic status. RESULTS: Suicide cases frequently experienced chronic diseases (90.0 %) and comorbidities (74.6 %). Chronic diseases greatly increased suicide risk and, among these, mental and behavioral disorders showed the highest suicide risk (OR = 7.53, 95 % CI = 7.32-7.74) followed by cardiovascular (OR = 3.36, 95 % CI = 3.26-3.47). For individual diseases, gastritis and duodenitis were most prevalent (68.1 %) among suicide cases but depressive disorder showed the highest risk (OR = 4.95, 95 % CI = 4.79-5.12). Suicide risk was strong in comorbid status sometimes comparable to odds for mental and behavioral disorder alone (e.g., OR for cardiovascular and eye vision-related diseases = 4.01, 95 % CI = 3.86-4.17). LIMITATIONS: Differentiation of comorbidity was limited to pairs between major disease categories, neglecting the heterogeneity within categories. CONCLUSION: Chronic diseases, in particular comorbidity, showed strong associations with suicide. This suggests that those with comorbidities feel that they are pushed to the extreme line, supporting comprehensive interventions for them to address wider reasons including psychological and social problems, besides medical problems.

Korea Seroprevalence Study of Monitoring of SARS-COV-2 Antibody Retention and Transmission (K-SEROSMART): findings from national representative sample.

OBJECTIVES: We estimated the population prevalence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including unreported infections, through a Korea Seroprevalence Study of Monitoring of SARS-CoV-2 Antibody Retention and Transmission (K-SEROSMART) in 258 communities throughout Korea. METHODS: In August 2022, a survey was conducted among 10,000 household members aged 5 years and older, in households selected through two stage probability random sampling. During face-to-face household interviews, participants self-reported their health status, COVID-19 diagnosis and vaccination history, and general characteristics. Subsequently, participants visited a community health center or medical clinic for blood sampling. Blood samples were analyzed for the presence of antibodies to spike proteins (anti-S) and antibodies to nucleocapsid proteins (anti-N) SARS-CoV-2 proteins using an electrochemiluminescence immunoassay. To estimate the population prevalence, the PROC SURVEYMEANS statistical procedure was employed, with weighting to reflect demographic data from July 2022. RESULTS: In total, 9,945 individuals from 5,041 households were surveyed across 258 communities, representing all basic local governments in Korea. The overall population-adjusted prevalence rates of anti-S and anti-N were 97.6% and 57.1%, respectively. Since the Korea Disease Control and Prevention Agency has reported a cumulative incidence of confirmed cases of 37.8% through July 31, 2022, the proportion of unreported infections among all COVID-19 infection was suggested to be 33.9%. CONCLUSIONS: The K-SEROSMART represents the first nationwide, community-based seroepidemiologic survey of COVID-19, confirming that most individuals possess antibodies to SARS-CoV-2 and that a significant number of unreported cases existed. Furthermore, this study lays the foundation for a surveillance system to continuously monitor transmission at the community level and the response to COVID-19.

Impact of the COVID-19 Pandemic on Admission and Mortality Among Patients With Severe Emergency Diseases at Emergency Departments in Korea in 2020: Registry Data From the National Emergency Department Information System.

We aimed to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on admissions of patients with acute myocardial infarction, stroke, and severe trauma, and their excess mortality in emergency departments (EDs) in South Korea using registry data from the National Emergency Department Information System (NEDIS) for patients attending EDs of regional and local emergency medical centers. During the outbreak period of 2020, there were 350,698 ED visits, which was lower than the total in 2019 (392,627 visits). Multiple logistic regression revealed that, compared with 2019, there was significantly higher ED mortality rate during the COVID-19 outbreak in 2020 (adjusted odds ratio, 1.10; 95% confidence interval, 1.07-1.13). This finding implies that during the early outbreak period, people might have avoided seeking medical care even for acute and life-threatening conditions, or transfer times at the scene to the hospital arrival were delayed, or treatment for the patients in EDs were delayed.

Unemployment risk of all employed working-age cancer survivors after cancer diagnosis in South Korea: a retrospective cohort analysis of population-based administrative data.

PURPOSE: As the cancer survival rate increases, discussions on the employment status of cancer survivors should be actively carried out worldwide. This study examined patients' working status changes after cancer diagnosis to provide the basis for cancer survivors' return to work. METHODS: We established a nationwide cohort to determine long-term work changes after cancer diagnosis. All patients aged 19 to 50 years who were newly diagnosed with cancer while working for the previous 3 years were considered as the case group in 2010. Using propensity score matching (PSM), the cases were matched by sex and age at a ratio of 1:3 with the control group. Kaplan-Meier curve and Cox hazard model analyses were performed to determine the occurrence of unemployment and return to work in the case and control groups on a yearly basis. RESULTS: According to the 6-year follow-up after cancer diagnosis, 26.5% of cancer patients and 23.2% of controls had lost their jobs by the end of the follow-up (P < .0001). Meanwhile, 50.5% of cancer patients and 57.4% of controls had returned to work after unemployment (P < .0001). Subsequently, based on the Cox hazard model, the unemployment risk of cancer patients was 1.42 times higher than that of the general population, while the proportion of those who returned to work was 1.15 times lower. CONCLUSION: Employment is very closely related to the quality of life of cancer survivors. These results highlight the need for a system that can support cancer survivors' work maintenance and return to work after unemployment during the treatment period and the fact that awareness of this must be improved.

The effect of initial antidepressant type on treatment adherence in outpatients with new onset depression.

BACKGROUND: Continuous use of antidepressants can relieve depressive symptoms and prevent recurrence in people with depression; however, many studies have reported low drug compliance rates. This study aimed to investigate the relationship between the type of initial antidepressants and treatment adherence in outpatients with new onset depression. METHODS: This was a retrospective cohort study using National Health Insurance claim data for services provided in 2012. We examined data from 142,336 individuals aged 18 years or older, who were continuously enrolled in treatment after a new episode of depression, and had initiated antidepressant treatment. A new diagnosis of depression, is defined as a first reported diagnosis of depression in the preceding five years. Adherence was operationally defined as the antidepressant being dispensed to the patient at least 80% of the time during the first three- and six-month treatment periods. To investigate the relationship between the initial type of antidepressants and treatment adherence, we estimated adjusted odds ratios and 95% confidence intervals using logistic regression analysis, adjusting for socio-demographic and health care utilization characteristics. RESULTS: A statistically significant association was found between initial antidepressant type and adherence in the first three- and six-month treatment periods for employed and self-employed patients newly diagnosed with major depression. In addition, patients with starting prescriptions for tricyclic antidepressants had significantly lower adherence compared to selective serotonin reuptake inhibitors. LIMITATIONS: This study used national insurance data; therefore, only variables on the claim form were available, and psychological and environmental factors were not considered. CONCLUSIONS: This was the first study to demonstrate the relationship between initial antidepressant type and treatment adherence among Korean outpatients with new onset depression.

Prevalence of Insomnia in Various Industries and Associated Demographic Factors in Night-Shift Workers Using Workers' Specific Health Examination Data.

This study aimed to investigate the prevalence of insomnia in various industries and the associated demographic factors. We searched the nationwide night-shift Workers' Specific Health Examination (nsWSHE) data extracted in 2015 information on factors associated with insomnia, including sex, age, and the number of workers in the workplace. The prevalence of moderate insomnia in the total industry was 4.6%. Industries with a high prevalence of insomnia included the arts, sports, and recreation-related services industry, followed by the activities of household as employers industry, financial and insurance activities industry, human health and social welfare industry, and accommodation and food services activities industry. The prevalence of insomnia was higher in women. Age was a significant factor. In general, insomnia was highest among those aged ≥60 years. Insomnia was highest in small-sized companies with fewer than five employees compared to large enterprises with more than 1000 employees. This study is the first to analyze the prevalence of insomnia among night-shift workers who participated in the WSHEs. The findings of this study can be used to prioritize intervention policies for insomnia among night-shift workers.

Effects of Community-Based Interventions on Medication Adherence and Hospitalization for Elderly Patients with Type 2 Diabetes at Primary Care Clinics in South Korea.

Korean Disease Control and Prevention Agency launched Control and Prevention Community-based Registration and Management for Hypertension and Diabetes mellitus Project (CRMHDP) in Gwangmyeong city, 2009. This project has provided incentives on both patient and physician and has made private clinics and Public Health Center (PHC) in a community collaborate for effective chronic disease management among elderly people. This study aimed to evaluate the effects of CRMHDP on medication compliance and hospitalization due to diabetes-specific complications. The retrospective cohort study design was based on data of Korean National Health Insurance (KNHI) with 2 control areas (A & B) with usual primary care service similar to Gwangmyeong city regarding community health resources. The data on the study subjects were examined for the following 5 years since the baseline point. Medication adherence rates of CRMHDP-enrollees after the project was significantly higher than two control groups. For the hospitalization due to any complications, adjusted hazard ratio in the intervention group, compared to the control group A and B, were 0.76 (95% Confidence Interval: 0.65-0.78) and 0.52 (95% Confidence Interval 0.41-0.78), respectively. CRMHDP could successful in improving the management of type 2 diabetes mellitus among elderly people in South Korean primary care settings.

Spectrum of pleuropulmonary paragonimiasis: An analysis of 685 cases diagnosed over 22 years.

OBJECTIVES: Paragonimiasis is a global foodborne zoonosis. Overlapping clinical and imaging features with other lung pathologies hamper correct diagnosis and require differential diagnosis. METHODS: During 1982-2003, 49,012 samples were referred for immunodiagnosis of helminthiases. We detected paragonimiasis cases by enzyme-linked immunosorbent assay (ELISA). We assessed clinical, radiographical and laboratory characteristics, and diagnostic dilemmas associated with delayed diagnosis. RESULTS: We analyzed 685 pleuropulmonary paragonimiasis cases. ELISA-positive was 665. Eggs were detected in 50. Symptom duration correlated well with the appearance of chest radiographs; 359 pleural, 33 pleuroparenchymal, and 264 parenchymal lesions (P < 0.001). Twenty-nine had normal chest images. Eosinophilia, seen in 304, was common in pleural and pleuroparenchymal patients (P < 0.05). Chest pain and dyspnea were characteristic for pleurisy patients. Sputum (odds ratios [OR]: 6.79; 95% CI: 4.41-10.47), blood-tinged sputum (OR: 5.62; 95% CI: 3.75-8.42), and foul-odor (OR: 2.70; 95% CI: 1.42-5.16) were significant in parenchymal patients. Delayed diagnosis (119) for ≥ 25 weeks was attributed mainly to misdiagnosis as tuberculosis, malignancy, or chronic obstructive pulmonary disease (COPD) (OR: 111.75; 95% CI: 43.25-288.74). CONCLUSIONS: Variable symptoms and radiographs of pleuropulmonary paragonimiasis depended on the stage of infection. Suspicion of tuberculosis, malignancy, or COPD was major cause of delayed diagnosis.

Gender Differences in the Relationship between Type 2 Diabetes Mellitus and Employment: Evidence from the Korea Health Panel Study.

Previous studies have analyzed the impact of diabetes mellitus on labor market participation by men and women, but gender difference between type 2 diabetes mellitus (T2DM) and employment has not been the focus. This study aims to explore gender differences between T2DM and employment status. Data from the Korea Health Panel Study, 2013-2015 were analyzed by distinguishingT2DM and non-diabetes (N = 11,216). The empirical model was established and the generalized two-stage least squares (2SLS) was estimated, controlling for endogeneity. A family history of diabetes, as an instrumental variable, was related to an individual's genetic predisposition to develop diabetes. The estimated results for the 2SLS showed the interaction effects between T2DM and employment. T2DM had a statistically significant and negative effect on employment for women only. The comparison with non-diabetes showed that women with T2DM had a lower probability of employment by 51.9% (p < 0.05). Exposing gender bias in employment suggests that healthcare policies and disease management programs for diabetic patients should adopt gender-specific remedies.

Comparisons in the attitudes toward suicide among urban residents, lawmakers and community mental health workers in South Korea.

The attitudes of the general public and lawmakers toward suicide can influence the degree to which suicide prevention is prioritized in public policymaking. In this study, we compared the attitudes of urban residents, lawmakers, and community mental health workers toward suicide. Urban residents (N = 501) were surveyed through a telephone interview, while self-reported questionnaire was administered by lawmakers (N = 156) and community mental health workers (N = 121) through office visit and post, respectively. We used the Suicide Opinion Questionnaire to measure attitudes toward suicide in all three samples. Both the general public and legislators had insufficient knowledge and more permissive and uncaring attitudes toward suicide, whereas community mental health workers were more inclined to have sufficient knowledge of suicide and more intolerant and caring attitudes towards suicide. Therefore, lawmakers and the general public require education on suicide and suicide prevention, which may help lower South Korea's high suicide rate ranking among the Organization for Economic Co-operation and Development member states.

Correction: Accuracy of a screening tool for medication adherence: A systematic review and meta-analysis of the Morisky Medication Adherence Scale-8.

[This corrects the article DOI: 10.1371/journal.pone.0187139.].

Accuracy of a screening tool for medication adherence: A systematic review and meta-analysis of the Morisky Medication Adherence Scale-8.

BACKGROUND: This systematic review examined the reliability and validity of the Morisky Medication Adherence Scale-8 (MMAS-8), which has been widely used to assess patient medication adherence in clinical research and medical practice. METHODS: Of 418 studies identified through searching 4 electronic databases, we finally analyzed 28 studies meeting the selection criteria of this study regarding the reliability and validity of MMAS-8 including sensitivity and specificity. Meta-analysis for Cronbach's α, intraclass correlation coefficient (ICC), sensitivity and specificity to detect a patient with nonadherence to medication were performed. The pooled estimates for Cronbach's α and ICC were calculated using the random-effects weighted T transformation. A bivariate random-effects model was used to estimate pooled sensitivity and specificity. FINDINGS: The pooled Cronbach's α estimate for type 2 diabetes group in 7 studies and osteoporosis group in 3 studies were 0.67 (95% Confidence Interval(CI), 0.65 to 0.69) and 0.77 (95% CI, 0.72 to 0.83), respectively. With regard to test-retest, the pooled ICC for type 2 diabetes group in 3 studies and osteoporosis group in 2 studies were 0.81 (95% CI, 0.75 to 0.85) and 0.80 (95% CI, 0.74 to 0.85). For a cut-off value of 6, the pooled sensitivity and specificity in 12 studies were 0.43 (95% CI, 0.33 to 0.53) and 0.73 (95% CI, 0.68 to 0.78), respectively. CONCLUSIONS: The MMAS-8 had acceptable internal consistency and reproducibility in a few diseases like type 2 diabetes. Using the cut-off value of 6, criterion validity was not enough good to validly screen a patient with nonadherence to medication. However, this study did not calculated a pooled estimate for criterion validity using the higher values than 6 as a cut-off value since most of included individual studies did not report criterion validity based on those values.

The prevalence of suicidal ideation and depression among primary care patients and current management in South Korea.

BACKGROUND: Primary care in South Korea has no effective screening system to identify high-risk suicide patients despite to the possibility of hidden patients. The present study examined the prevalence of suicidal ideation and depression among primary care patients and investigated rates of recognition and management strategies of physicians as they encountering patients with suicidal ideation and depression in primary care settings. METHODS: This study was conducted as a two-part survey of patients visiting primary care clinics and their physicians. (1) The survey for patients was administered over 17 days in two areas and assessed socio-demographic characteristics, health behavior and the prevalence of suicidal ideation and depression. The participants were 1363 outpatients; 848 lived in urban area, and 515 were from rural area. (2) We surveyed the physicians' recognition of patients with suicidal ideations and depression as well as their current management. Eighteen doctors at 15 local clinics (8 in urban area and 7 in rural area) participated in this survey. RESULTS: The prevalence rates of suicidal ideation and depression (Patient Health Questionnaire-9 ≥ 10) were 18.3% (95% confidence interval: 16.2-20.3) and 13.9% (95% CI 12.6-15.7), respectively in primary care settings. The rates of suicidal ideation and depression were approximately 2.4 times and 1.4 times higher, respectively than those in community dwelling people. Ten (69.7%) and 4 (26.7%) of the 15 clinics staffed physicians who did not recognize suicidal ideation and depression, respectively. Five (83.3%) of 6 and 4 (38.6%) of 14 physicians who recognized suicidal ideation and depression among their patients respectively, only recommended psychiatry without any arrangements for a referral. CONCLUSION: Our findings imply that many patients with suicidal ideations and depression in primary care settings are under-diagnosed and under-treated. As a result, education and training of the identification and management of suicidal ideation and depression should be made available to physicians in primary care settings.

Associations of Sarcopenia and Sarcopenic Obesity With Metabolic Syndrome Considering Both Muscle Mass and Muscle Strength.

OBJECTIVES: We investigated the associations of sarcopenia-defined both in terms of muscle mass and muscle strength-and sarcopenic obesity with metabolic syndrome. METHODS: Secondary data pertaining to 309 subjects (85 men and 224 women) were collected from participants in exercise programs at a health center in a suburban area. Muscle mass was measured using bioelectrical impedance analysis, and muscle strength was measured via handgrip strength. Sarcopenia based on muscle mass alone was defined as a weight-adjusted skeletal muscle mass index more than two standard deviations below the mean of a sex-specific young reference group (class II sarcopenia). Two cut-off values for low handgrip strength were used: the first criteria were <26 kg for men and <18 kg for women, and the second criteria were the lowest quintile of handgrip strength among the study subjects. Sarcopenic obesity was defined as the combination of class II sarcopenia and being in the two highest quintiles of total body fat percentage among the subjects. The associations of sarcopenia and sarcopenic obesity with metabolic syndrome were evaluated using logistic regression models. RESULTS: The age-adjusted risk ratios (RRs) of metabolic syndrome being compared in people with or without sarcopenia defined in terms of muscle mass were 1.25 (95% confidence interval [CI], 1.06 to 1.47, p=0.008) in men and 1.12 (95% CI, 1.06 to 1.19, p<0.001) in women, which were found to be statistically significant relationships. The RRs of metabolic syndrome being compared in people with or without sarcopenic obesity were 1.31 in men (95% CI, 1.10 to 1.56, p=0.003) and 1.17 in women (95% CI, 1.10 to 1.25, p<0.001), which were likewise found to be statistically significant relationships. CONCLUSIONS: The associations of sarcopenia defined in terms of muscle mass and sarcopenic obesity with metabolic syndrome were statistically significant in both men and women. Therefore, sarcopenia and sarcopenic obesity must be considered as part of the community-based management of non-communicable diseases.

Comprehensive psychometric examination of the attitudes towards suicide (ATTS) in South Korea.

BACKGROUND: The aim of this study is to examine the validity and reliability of the Korean version of attitudes towards suicide (ATTS) on a group of university students, which would contribute to the evaluation of the ATTS as a useful tool of measuring attitudes toward suicide in South Korea with very high suicide rates. METHODS: The subjects of the study were 195 undergraduates at Chung-Ang University, South Korea in 2013. The measure for assessing public attitudes towards suicide was ATTS made up of 34 items in English and the Korean version of it was produced by forward and backward translation procedure. To identify any factors unique to South Koreans' attitudes towards suicide, we applied exploratory factor analysis (EFA) to the data from 195 university students and was followed by confirmatory factor analysis (CFA) to assess construct validity of the Korean version. The internal consistency of the scale was assessed using Cronbach's α and the assessment of the test-retest reliability was performed by intraclass correlation coefficients. RESULTS: On the EFA analysis, were excluded, the tool had 11 factors (32 items), accounting for 62.99 % of the total variance in participants' responses. CFA failed to support 11-factor model of the scale. Six out of 11 factors were acceptable in terms of both internal consistency and test-retest reliability. CONCLUSIONS: Six factors of the Korean version of the ATTS had acceptable content validity and reliability. However, on the whole, it did not have good construct validity and thus further investigations are needed to develop a scale measuring true public attitudes toward suicide in South Korea.

Trends and risk factors of the epidemic of charcoal burning suicide in a recent decade among Korean people.

The aims of this study were to analyze annual trends of charcoal burning (CB) suicide, 2000 to 2011, and to examine the risk factors of CB suicide in Korea. Data on suicides (n=138,938) were obtained from the Statistics Korea. The proportion of CB suicides among all suicide deaths reported was 0.7% (84 cases) in 2007, and since 2008 it has rapidly increased to 7.9% (1,251 cases) in 2011. Of significant risk factors of CB suicide, the presence of the media report of Ahn's suicide was the greatest risk factor (adjusted odds ratio, 11.69; 95% CI, 10.30-13.23) of the initial phase of the continuing CB suicides since 2008. Korean Government should urgently consider effective measures against CB suicide, including enforced media regulations on reporting such suicides.