Trends in commonly used and potentially inappropriate medications in older Korean patients with polypharmacy.

BACKGROUND: Polypharmacy is a global public health concern. This study aimed to determine the prevalence of polypharmacy and trends in the use of commonly used and potentially inappropriate medications among older Korean patients. METHODS: Individuals aged ≥ 65 years who were prescribed any medication between 2014 and 2018 were selected from the Korean National Health Information Database. Joinpoint regression analyses were used to determine trends in the age-adjusted polypharmacy rates by age group. The prescription rates of the most commonly used medications and the most commonly used potentially inappropriate medications were analysed by year or age group for patients with polypharmacy using the chi-square and proportion difference tests. RESULTS: This study included 1,849,968 patients, 661,206 (35.7%) of whom had polypharmacy. Age-adjusted polypharmacy rates increased significantly between 2014 and 2018 (P = 0.046). Among patients with polypharmacy, the most commonly prescribed medications were aspirin (100 mg), atorvastatin, metformin, glimepiride, and rosuvastatin. The most commonly prescribed and potentially inappropriate medications were alprazolam, diazepam, amitriptyline, zolpidem, and dimenhydrinate. There was a significant decrease in the prescription rates for each of these drugs in 2018 compared with 2014 among patients with polypharmacy (all P < 0.001), whereas there was a significant increase in alprazolam prescription among patients aged ≥ 85 years when analysed by age group (P < 0.001). CONCLUSIONS: This study revealed an increasing prevalence of polypharmacy among older adults. Additionally, it highlighted that the utilisation of commonly prescribed potentially inappropriate medications, such as benzodiazepines and tricyclic antidepressants, has remained persistent, particularly among patients aged ≥ 85 years who practiced polypharmacy. These findings provide evidence-based guidance for the development of robust polypharmacy management strategies to ensure medication safety among older adults.

Effects of Post-COVID-19 Syndrome on Quality of Life Among Airline Crew.

Background: Interest in post-coronavirus disease 2019 (COVID-19) syndrome following COVID-19 infection has been increasing. Maintaining quality of life (QoL) is vital for airline crews because they work in a special environment, where they are responsible for the passengers' safety. This study aims to closely investigate factors affecting the QoL of airline crews, including post-COVID-19 syndrome. Methods: This study was designed as a cross-sectional survey, comprising 167 crews. Findings: Age-specific significant differences were observed in social, overall, and total QoL scores. The physical domain QoL was significantly higher in the cockpit crews than that in the cabin crews. Significant differences were found in psychological and overall QoL depending on years of continuous service. Social domain and environmental QoL were lower in those who had no symptoms after being diagnosed with COVID-19 than in those who were symptomatic. Among the participants, 4.2% had post-COVID-19 syndrome, indicating significant differences in the physical domain, depending on whether they exhibit post-COVID-19 syndrome. Conclusion: It is urgent to develop measures to increase the QoL of airline crews, investigate post-COVID-19 syndrome before returning to work, and develop strategies to manage it. Application to practice: The QoL among airline crews differed not only by the demographic characteristics of the participants but also by the presence of symptoms during COVID-19 diagnosis and post-COVID-19 syndrome. Higher QoL among airline crews is associated with the safety of both airline crews and passengers. Therefore, it is necessary to establish a systematic management protocol for airline crews returning to work after following COVID-19 infection.

Cardioprotection via mitochondrial transplantation supports fatty acid metabolism in ischemia-reperfusion injured rat heart.

In addition to cellular damage, ischemia-reperfusion (IR) injury induces substantial damage to the mitochondria and endoplasmic reticulum. In this study, we sought to determine whether impaired mitochondrial function owing to IR could be restored by transplanting mitochondria into the heart under ex vivo IR states. Additionally, we aimed to provide preliminary results to inform therapeutic options for ischemic heart disease (IHD). Healthy mitochondria isolated from autologous gluteus maximus muscle were transplanted into the hearts of Sprague-Dawley rats damaged by IR using the Langendorff system, and the heart rate and oxygen consumption capacity of the mitochondria were measured to confirm whether heart function was restored. In addition, relative expression levels were measured to identify the genes related to IR injury. Mitochondrial oxygen consumption capacity was found to be lower in the IR group than in the group that underwent mitochondrial transplantation after IR injury (p < 0.05), and the control group showed a tendency toward increased oxygen consumption capacity compared with the IR group. Among the genes related to fatty acid metabolism, Cpt1b (p < 0.05) and Fads1 (p < 0.01) showed significant expression in the following order: IR group, IR + transplantation group, and control group. These results suggest that mitochondrial transplantation protects the heart from IR damage and may be feasible as a therapeutic option for IHD.

Development of a multidisciplinary medication management program in nursing homes: protocol for a randomized controlled trial : Multidisciplinary medication management in nursing homes.

BACKGROUND: Polypharmacy and the use of potentially inappropriate medications are common among nursing home residents and are associated with negative outcomes. Although deprescribing has been proposed as a way to curtail these problems, the best way to implement multidisciplinary comprehensive medication review and deprescribing and its real impact in specific high-risk populations, such as nursing home residents, is still unclear. This multicenter randomized controlled clinical trial aims to assess the effects of a multidisciplinary mediation management program on medication use and health problems. METHODS: A total of 1,672 residents aged ≥ 65 years from 22 nursing homes in South Korea who meet the targeted criteria, such as the use of ≥ 10 medications, are eligible to participate. The experimental group will receive a comprehensive medication review, deprescription, and multidisciplinary case conference with the help of platform. Outcomes will be measured at baseline, at the end of the intervention, as well as at 3, 6, 9, and 12 months after the end of the intervention. The primary endpoints will be the rate of adverse drug events, number of potentially inappropriate medications/potentially inappropriate medication users/two or more central nervous system drug/ central nervous system drug users, delirium, emergency department visits, hospitalization, and falls. The secondary endpoint will be the number of medications taken and polypharmacy users. DISCUSSION: Our trial design is unique in that it aims to introduce a structured operationalized clinical program focused on reducing polypharmacy and potentially inappropriate medications in a nursing home setting with large samples. TRIAL REGISTRATION: Ethical approval was granted by the public institutional review board of the Ministry of Health and Welfare (2022-1092-009). The study is also registered with the Clinical Research Information Service (Identifier: KCT0008157, Development and evaluation of a multidisciplinary medication management program in long-term care facility residents Status: Approved First Submitted Date: 2023/01/18 Registered Date: 2023/02/03 Last Updated Date: 2023/01/18 (nih.go.kr) https://cris.nih.go.kr/ ), which includes all items from the World Health Organization Trial Registration Dataset.

Real-World Safety and Effectiveness of Controlled-Release Cilostazol in Patients with Symptomatic Peripheral Artery Disease.

BACKGROUND: Cilostazol is the only first-line medication for treating intermittent claudication, and the controlled-release (CR) formulation is associated with a lower prevalence of adverse events (AEs). OBJECTIVE: The objective of the study was to assess the safety and effectiveness of cilostazol CR in patients with symptomatic peripheral artery disease (PAD). METHODS: In this multicentre (113 sites), open-label, prospective observational study, we evaluated the real-world safety and effectiveness of cilostazol CR 200 mg once daily in patients with symptomatic PAD treated in routine clinical settings. The primary endpoint was the incidence and severity of AEs, and their causal relationship with cilostazol CR. The secondary endpoint was the effectiveness of the drug, as assessed by each patient's physician, for improving intermittent claudication. RESULTS: Among 2063 participants who received cilostazol CR for a mean duration of 88.6 days, 99 (4.80 %) experienced adverse drug reactions (ADRs), although no unexpected adverse reactions were observed. There was no significant difference in the incidence of ADRs according to patient demographics and comorbidities (all p > 0.05). The treatment was 'effective' in 1600 patients (78.93 %), although effectiveness significantly differed according to the patients' sex and the presence of comorbidities, including diabetes mellitus, hypertension, and coronary artery disease (all p < 0.01). CONCLUSIONS: This study demonstrated the tolerability and effectiveness of cilostazol CR treatment in patients with symptomatic PAD.

Oral microbiome correlates with selected clinical biomarkers in individuals with no significant systemic disease.

The oral microbiome is an important component of the microbiome in the human body. Although the association of the oral microbiome with various diseases, including periodontitis and cancer, has been reported, information on how the oral microbiome is related to health-related indicators in healthy populations is still insufficient. In this study, we examined the associations of the oral microbiome with 15 metabolic and 19 complete blood count (CBC)-based markers in 692 healthy Korean individuals. The richness of the oral microbiome was associated with four CBC markers and one metabolic marker. Compositional variation in the oral microbiome was significantly explained by four markers: fasting glucose, fasting insulin, white blood cell count, and total leukocyte count. Furthermore, we found that these biomarkers were associated with the relative abundances of numerous microbial genera, such as Treponema, TG5, and Tannerella. By identifying the relationship between the oral microbiome and clinical biomarkers in a healthy population, our study presents a direction for future studies on oral microbiome-based diagnosis and interventions.

Factors Associated With Airline Cabin Crews' Influenza Vaccination Intention in the Workplace-based Setting.

BACKGROUND: Yearly influenza vaccination is the best way to prevent influenza. Workplace vaccination program for airline cabin crews is an important countermeasure in the management of infectious diseases. Understanding the influenza vaccination behavior of cabin crews is essential to establishing strategies to promote vaccine uptake. This study aimed to examine factors associated with airline cabin crews' influenza vaccination intention in a workplace-based setting. We applied the theory of planned behavior (TPB) to explain the vaccination behavior of employees. METHODS: A cross-sectional study was performed in April 2021. Participants self-reported the structured questionnaires that consisted of TPB variables, and reasons for influenza vaccination/nonvaccination in 2020. A total of 253 crew members participated, and 242 were included in the analysis. FINDINGS: The influenza vaccination rate was 70.7% in 2020, and vaccination intention was 5.92 of 7 points in 2021. Multiple linear regression showed that influenza vaccination intention was associated with subjective norms (ß = .394, p < .001), positive attitude (ß = .145, p = .007), perceived behavioral control (ß = .170, p = .004), actual behavioral control (ß = .145, p = .010), and the previous year's vaccination (ß = .163, p < .001). The model accounted for 57% of the variance in influenza vaccination intention (F = 40.959, p < .001). CONCLUSIONS/APPLICATION TO PRACTICE: Our findings indicate that TPB is useful in explaining employees' influenza vaccination intention and influencing factors. Focusing on positive messages that emphasize the social effects of vaccination and providing free vaccination on specific dates are potential strategies to increase intention. It can be applied to help design on-site workplace vaccination programs for essential frontline workers.

Association of metabolic syndrome and its components with the risk of depressive symptoms: A systematic review and meta-analysis of cohort studies.

BACKGROUND: The purpose of this meta-analysis was to quantitatively analyze the association between metabolic syndrome (MetS) and the risk of depressive symptoms. METHODS: Three electronic databases (PubMed, Embase, and PsycINFO) were searched for articles published through February 15, 2022. Cohort studies evaluating the association between MetS and depressive symptoms were selected for inclusion in this study. A random-effects model was used to evaluate the pooled estimates of MetS, including each of its components, associated with depressive symptoms. RESULTS: A total of 11 cohort studies were selected including >2.65 million participants. There was a significant association between MetS and depressive symptoms risk, albeit with a high degree of heterogeneity (relative risk = 1.29, 95 % confidence interval: 1.12-1.48; I2 = 79.3 %). This association was consistently significant in Western countries, but it was not significant in Asian countries. When stratified by sex, age, and geographical region, MetS and its components exhibited varying degrees of association with depressive symptoms. CONCLUSIONS: MetS is a risk factor for depressive symptoms. Further large-scale prospective cohort studies are required to confirm our findings.

A Benchmark Comparison of Four Off-the-Shelf Proprietary Visual-Inertial Odometry Systems.

Commercial visual-inertial odometry (VIO) systems have been gaining attention as cost-effective, off-the-shelf, six-degree-of-freedom (6-DoF) ego-motion-tracking sensors for estimating accurate and consistent camera pose data, in addition to their ability to operate without external localization from motion capture or global positioning systems. It is unclear from existing results, however, which commercial VIO platforms are the most stable, consistent, and accurate in terms of state estimation for indoor and outdoor robotic applications. We assessed four popular proprietary VIO systems (Apple ARKit, Google ARCore, Intel RealSense T265, and Stereolabs ZED 2) through a series of both indoor and outdoor experiments in which we showed their positioning stability, consistency, and accuracy. After evaluating four popular VIO sensors in challenging real-world indoor and outdoor scenarios, Apple ARKit showed the most stable and high accuracy/consistency, and the relative pose error was a drift error of about 0.02 m per second. We present our complete results as a benchmark comparison for the research community.

Depression, Anxiety, Stress and Anger of the Cabin Crew during the COVID-19 Pandemic in South Korea.

This study examines the levels of depression, anxiety, stress, and state and trait anger of cabin crews, as well as the differences in the main variables and general characteristics between the depression and anxiety groups, during the COVID-19 pandemic. This descriptive cross-sectional study used data from 161 Korean cabin crew members. Data were analyzed using descriptive analysis, independent t-tests, and chi-square tests. Of the participants, 62.7% were women, and 52.2% and 46.6% were classified into the depression and anxiety groups, respectively. No differences in the general characteristics between the non-depression and depression groups were found. However, in the anxiety group, there were significant differences in age, marital status, position, and work type during the COVID-19 pandemic. Additionally, the anxiety group showed a higher anger state (approximately 6.76 times higher than the normal group) than the depression group (approximately 4.90 times higher than the normal group). In a pandemic, airlines should screen cabin crews for depression and anxiety. The development and applications of mental health education for high-risk groups should include anger intervention.

Patterns of patients with polypharmacy in adult population from Korea.

Polypharmacy and its rising global prevalence is a growing public health burden. Using a large representative nationwide Korean cohort (N = 761,145), we conducted a retrospective cross-sectional study aiming to identify subpopulations of patients with polypharmacy and characterize their unique patterns through cluster analysis. Patients aged ≥ 30 years who were prescribed at least one medication between 2014 and 2018 were included in our study. Six clusters were identified: cluster 1 mostly included patients who were hospitalized for a long time (4.3 ± 5.3 days); cluster 2 consisted of patients with disabilities (100.0%) and had the highest mean number of prescription drugs (7.7 ± 2.8 medications); cluster 3 was a group of low-income patients (99.9%); cluster 4 was a group of high-income patients (80.2%) who frequently (46.4 ± 25.9 days) visited hospitals/clinics (7.3 ± 2.7 places); cluster 5 was mostly elderly (74.9 ± 9.8 years) females (80.3%); and cluster 6 comprised mostly middle-aged (56.4 ± 1.5 years) males (88.6%) (all P < 0.001). Patients in clusters 1-5 had more prescribed medications and outpatient visit days than those in cluster 6 (all P < 0.001). Given limited health care resources, individuals with any of the identified phenotypes may be preferential candidates for participation in intervention programs for optimal medication use.

Workplace foodservice meals are associated with higher nutritional quality among adult Korean workers: a nationwide cross-sectional study.

BACKGROUND/OBJECTIVES: Adequate nutritional intake is essential for good health and well-being. We aimed to compare the nutrient intake from homemade meals, meals sourced externally ("eating out"), and meals from workplace foodservices, as well as the potential association between foodservices used and nutritional quality among adult Korean workers. SUBJECTS/METHODS: We used data from the Korea National Health and Nutrition Examination Survey, a nationwide cross-sectional survey on the health and nutritional status of the Korean population. Data from 6,845 workers aged 20-64 years were included. A survey on dietary behavior and nutrition was conducted using the 24-h dietary recall method. Nutritional quality was examined using the index of nutritional quality (INQ) score. Higher INQ scores reflected poorer nutritional quality, with insufficient intake of a higher number of nutrients. Multivariate linear regression was used to identify the association between the foodservices used and INQ scores after adjusting for other covariates. RESULTS: We found that foodservice users exhibited a higher 1-day intake of total energy and macronutrients (all P < 0.05) and lower INQ scores (P < 0.01) than non-users. The INQ scores for total daily meals decreased with the frequency of foodservice use (P < 0.01). A significant association was observed between the non-use of foodservices and INQ scores (ß = 0.29, P < 0.01) after adjusting for other covariates. CONCLUSIONS: The use of workplace foodservices contributed to higher dietary nutritional quality among workers. This study highlights the importance of expanding the scope of workplace foodservices to promote higher nutritional quality and healthy dietary habits among workers.

Acid suppressant use in association with incidence and severe outcomes of COVID-19: a systematic review and meta-analysis.

PURPOSE: Several observational studies have presented conflicting results on the association between the use of proton pump inhibitors (PPIs) or histamine H2 receptor antagonist (H2RA) and the risk of coronavirus disease 2019 (COVID-19). This systematic review and meta-analysis aimed to examine this association. METHODS: In July 2021, PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were searched for articles investigating the relationship between the two main acid suppressants and COVID-19. Studies showing the effect estimates as hazard ratio (HR) for severe outcomes or incidence of COVID-19 were evaluated using a random-effects model. RESULTS: A total of 15 retrospective cohort studies with 18,109 COVID-19 cases were included in the current meta-analysis. PPI use was significantly associated with severe outcomes of COVID-19 (hazard ratio [HR] = 1.53; 95% confidence interval [CI]: 1.20-1.95) but not with the incidence of COVID-19, whereas H2RA use was significantly associated with decreased incidence (HR = 0.86, 95% CI: 0.76-0.97). For subgroup analyses of PPIs, increased severe outcomes of COVID-19 were observed in < 60 years, active use, in-hospital use, and Asians. For subgroup analyses of H2RAs, decreased severe outcomes of COVID-19 were observed in > 60 years, while in-hospital use and use in Asia were associated with higher disease severity. CONCLUSIONS: Close observation can be considered for COVID-19 patients who use PPIs to prevent severe outcomes. However, caution should be taken because of substantial heterogeneity and plausible protopathic bias.

Potentially inappropriate medication use and associated factors in residents of long-term care facilities: A nationwide cohort study.

Background: Residents in long-term care (LTC) facilities (LTCFs) may have multimorbidity and be unable to self-administer medication. Thus, due to the risk of potentially inappropriate medications (PIMs), epidemiological studies on PIM use and its associated factors should be conducted to ensure safe medication use for residents in LTCFs. Objective: We evaluated PIM use among residents of LTCF and the associated factors in residents of LTCFs in Korea using a nationwide database. Methods: This cross-sectional study used the Korea National Health Insurance Service Senior Cohort (KNHIS-SC) database 2.0 of the National Health Insurance Service (NHIS), a single public insurer in Korea. We analyzed older adults aged ≥65 years who were residents of LTCFs in 2018, using the KNHIS-SC database. The 2019 American Geriatrics Society (AGS) Beers criteria was used for PIM identification. The prevalence of PIM use was defined as the proportion of LTCF residents who received PIM prescriptions at least once. We evaluated the frequency of prescriptions, including PIMs, and determined the most frequently used PIMs. We also conducted a multivariable logistic regression analysis to identify the factors associated with PIM use. Results: The prevalence of PIM among the LTCF residents was 81.6%. The prevalence of PIM was 74.9% for LTC grades 1 or 2 (high dependence) and 85.2% for LTC grades 3-5 (low dependence). Quetiapine was the most frequently prescribed PIM, followed by chlorpheniramine. The low dependence level was significantly associated with PIM use (odds ratio of LTC grades 3-5: 1.49, 95% confidence interval 1.32-1.68, reference: LTC grades 1 or 2); moreover, the number of medical institutions visited, and medications emerged as primary influencing factors. Conclusion: Most LTCF residents were vulnerable to PIM exposure. Furthermore, exposure to PIMs is associated with LTC grade. This result highlights the need for comprehensive medication management of LTCF residents.

Age-Specific Association Between Handgrip Strength and Nutritional Quality in Korean Men: A Nationwide Cross-Sectional Study.

This study aimed to determine the potential association between handgrip strength and nutritional quality in Korean men aged ≥20 years using data from the Korea National Health and Nutrition Examination Survey 2016 to 2018. This population-based cross-sectional study included 5,748 men aged ≥20 years. A dietary intake survey was performed using the 24-hr dietary recall method. Nutritional quality was examined using the Index of Nutritional Quality (INQ) score. A high INQ score reflected poor nutritional quality, with insufficient intake of many nutrients. Multivariate linear regression was used to determine the association between handgrip strength and INQ scores after adjusting for other covariates. The intake of carbohydrates, fiber, calcium, and vitamins B2 and C was significantly positively associated with a higher quartile for handgrip strength for those aged ≥65 years (all p < .01). A significant inverse association was found between the quartiles of handgrip strength and INQ scores among men aged ≥65 years after adjusting for all covariates (ß = -0.26, p < .01). This association was not found among those aged <65 years (p = .25). The age-specific association between handgrip strength and nutritional quality underscores the importance of public policies that promote sufficient and comprehensive nutrient intake among older adults. Handgrip strength may be useful in clinical practice as a simple and cost-effective tool for screening for nutritional quality in older adults.

Preclinical Evaluation of a Novel Polymer-free Everolimus-eluting Stent in a Mid-term Porcine Coronary Restenosis Model.

BACKGROUND: Titanium dioxide films exhibit good biocompatibility and may be effective as drug-binding matrices for drug-eluting stents. We conducted a mid-term evaluation of a novel polymer-free everolimus-eluting stent using nitrogen-doped titanium dioxide film deposition (TIGEREVOLUTION®) in comparison with a commercial durable polymer everolimus-eluting stent (XIENCE Alpine®) in a porcine coronary restenosis model. METHODS: Twenty-eight coronary arteries from 14 mini-pigs were randomly allocated to TIGEREVOLUTION® stent and XIENCE Alpine® stent groups. The stents were implanted in the coronary artery at a 1.1-1.2:1 stent-to-artery ratio. Eleven stented coronary arteries in each group were finally analyzed using coronary angiography, optical coherence tomography, and histopathologic evaluation 6 months after stenting. RESULTS: Quantitative coronary analysis showed no significant differences in the pre-procedural, post-procedural, and 6-month lumen diameters between the groups. In the volumetric analysis of optical coherence tomography at 6 months, no significant differences were observed in stent volume, lumen volume, and percent area stenosis between the groups. There were no significant differences in injury score, inflammation score, or fibrin score between the groups, although the fibrin score was zero in the TIGEREVOLUTION® stent group (0 vs. 0.07 ± 0.11, P = 0.180). CONCLUSION: Preclinical evaluation, including optical coherence tomographic findings 6 months after stenting, demonstrated that the TIGEREVOLUTION® stent exhibited efficacy and safety comparable with the XIENCE Alpine® stent, supporting the need for further clinical studies on the TIGEREVOLUTION® stent.

Gut Microbiome Structure and Association with Host Factors in a Korean Population.

Characterizing the gut microbiome in the healthy population is the first step in elucidating its associations with host health conditions. Populations with different diet patterns, lifestyles, and genetic backgrounds harbor different gut microbes. In this study, we characterized the gut microbiome of 890 healthy Koreans using 16S rRNA sequencing. The Korean population harbored a relatively large fraction of the Prevotella enterotype and presented a distinctive gut microbiome, compared to that in the populations of other countries. Additionally, we determined the clusters of cooccurring microbes that were quantitatively correlated with each other. We found that microbe composition of the gut was strongly associated with age. We identified that the abundance of members of Bacteroidia and Clostridia differed with the host dietary patterns, body mass index, and stool frequency. The gut microbiome data obtained in this study would be an important resource for future studies addressing microbial contributions in health and disease. IMPORTANCE Comparing the gut microbiomes of healthy controls and disease patients showed that the composition of the gut microbiome is associated with various host health conditions. The gut microbiome in healthy Western populations is well characterized, while that of non-Western populations, with different diet patterns, lifestyles, and genetic backgrounds, is not clearly defined. In this study, we characterized the microbiome of 890 healthy Korean individuals using 16S rRNA sequencing and found that Koreans have a gut microbiome different from that in the individuals of neighboring countries. The members of Bacteroidetes and Firmicutes cooccurred and were quantitatively associated with each other. Additionally, we found that the gut microbial composition is strongly associated with the host's age. The microbiome data presented here represent the gut microbiome of a healthy Korean population and could be used to unveil gut microbiome-associated host conditions in this population.