Over- and under-supply of inpatient rehabilitation after stroke without a post-acute rehabilitation system: a nationwide retrospective cohort study.

Introduction: This study aimed to investigate the utilization of post-ischemic stroke rehabilitation prior to the introduction of the post-acute rehabilitation system in South Korea in 2017. Methods: Medical resources utilized for patients with cerebral infarction hospitalized at Regional Cardio-Cerebrovascular Centers (RCCVCs) of 11 tertiary hospitals were tracked until 2019. Stroke severity was classified according to the National Institutes of Health Stroke Scale (NIHSS), and multivariate regression analysis was performed to analyze factors influencing the length of hospital stay (LOS). Results: This study included 3,520 patients. Among 939 patients with stroke with moderate or greater severity, 209 (22.3%) returned home after RCCVC discharge without inpatient rehabilitation. Furthermore, 1,455 (56.4%) out of 2,581 patients with minor strokes with NIHSS scores ≤4 were readmitted to another hospital for rehabilitation. The median LOS of patients who received inpatient rehabilitation after RCCVC discharge was 47 days. During the inpatient rehabilitation period, the patients were admitted to 2.7 hospitals on average. The LOS was longer in the lowest-income group, high-severity group, and women. Conclusion: Before the introduction of the post-acute rehabilitation system, treatment after stroke was both over- and under-supplied, thus delaying home discharge. These results support the development of a post-acute rehabilitation system that defines the patients, duration, and intensity of rehabilitation.

The impact of self-reported sensory impairment on cognitive function using the Korean longitudinal study of aging survey data.

Recent studies suggest that sensory impairment is related to cognitive function at older ages. Therefore, we aimed to investigate the impact of sensory impairment on cognitive function in the Korean population. We used the Korean Longitudinal Study of Aging data from 2006 to 2018. Cognitive function was measured by the Korean version of the Mini-Mental State Examination scale. A score < 24 at the time of assessment was defined as cognitive impairment. Sensory impairment was assessed according to the self-reported levels of hearing or vision, and the development of sensory impairment was investigated using records of prior survey. We used the generalized estimating equation model to determine association between cognitive function and sensory impairment. A total of 4844 participants (age range: 47-95 years; mean age: 58) were included in the study. Compared to people without sensory impairment, people with a single sensory impairment of hearing or vision had a higher risk of cognitive impairment (odds ratio (OR) = 1.65 [95% confidence interval (CI), 1.49-1.82]). People with dual sensory impairment had the greatest risk of cognitive impairment (OR = 3.23 [95% CI, 2.52-4.12]). The findings suggested the need for timely assessment of sensory function in older persons, which may be useful in identifying individuals at risk for cognitive impairment.

A nationwide cohort study of the association of benzodiazepines with SARS-CoV-2 infection and clinical outcomes.

The evidence for the impact of benzodiazepine (BZD) use on infection or clinical outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is limited. We evaluated the association of BZD use with SARS-CoV-2 infection and the clinical outcomes of coronavirus disease 2019 (COVID-19) using a nationwide COVID-19 database from South Korea. This nationwide cohort study was performed using the COVID-19 database from the Health Insurance Review and Assessment Service of Korea, and SARS-CoV-2 positivity was investigated according to BZD use. SARS-CoV-2-positive adult patients were assessed in three groups, those who needed hospitalization, those with severe symptoms requiring intensive care, and those who died. A multivariate logistic regression model was used for all the analyses. After adjusting for potential confounding factors, there was no association between BZD use and SARS-CoV-2 positivity. SARS-CoV-2-positive patients with BZD use showed an increased risk of need for hospitalization from COVID-19 compared to those without BZD use (odds ratio [OR]: 1.33, 95% confidence interval [CI] 1.07-1.65). In addition, there was a higher risk for long-term users (OR: 2.64, 95% CI 1.08-6.47). Chronic BZD use contributed to a higher risk of the need for hospitalization among COVID-19 patients, whereas BZD use did not increase the risk of SARS-CoV-2 test positivity, severe outcomes, or mortality.

Association between depression and the risk of Alzheimer's disease using the Korean National Health Insurance Service-Elderly Cohort.

In this cohort study, we assessed the association between depression and the risk of Alzheimer's disease from data obtained from the 2002 to 2013 Korean National Health Insurance Service-Elderly Cohort Database, which accounts for 10% of the South Korean population aged > 60 years. A total 518,466 patients were included in the analysis and followed up, unless they were excluded due to death or migration. Patients who sought treatment for depression or dementia within 1 year of the washout period and who were diagnosed with dementia within the 1-year period of the diagnosis of depression were excluded from the study. The risk of dementia was analysed using Cox proportional hazards models. Patients with a history of depression during the follow-up period were at a higher risk of Alzheimer's disease than those without a history of depression (HR 3.35, CI 3.27-3.42). The severe-depression group exhibited the highest risk of Alzheimer's disease (HR 4.41, CI 4.04-4.81), while the mild-depression group exhibited a relatively lower risk of Alzheimer's disease (HR 3.31, CI 3.16-3.47). The risk of Alzheimer's disease was associated with depression history and an increased severity of depression increased the risk of Alzheimer's disease.

Arthritis status changes and depressive symptoms among middle-aged and older Koreans: Analysis of data from the Korean Longitudinal Study of Aging survey.

OBJECTIVE: Arthritis can negatively affect physical and mental health, especially among middle-aged and older people. This study investigated the longitudinal association between changes in arthritis status and depressive symptoms among Korean adults aged ≥45 years. METHODS: We analyzed data from the Korean Longitudinal Study of Aging 2008-2018, using a generalized estimating equation model to investigate associations between arthritis status change and depressive symptoms, which were assessed using five categories according to measurements based on the Center for Epidemiological Studies Depression Scale (CES-D-10). RESULTS: Both men and women whose arthritis status changed to "worse" or remained "same" scored higher for depressive symptoms than those who reported "no symptoms of arthritis" (men, worse = ß: 1.07, P ≤ .001, same = ß: 0.25 P = .031; women, worse = ß: 0.99, P ≤ .001, same = ß: 0.13, P = .049). Conversely, men with a "better" arthritis status (ß: -0.71, P ≤ .001) and women with a "recovered" arthritis status (ß: -0.56, P = .031) scored lower for depressive symptoms than those who reported "no symptoms of arthritis." CONCLUSIONS: Arthritis status changes are associated with depressive symptoms in middle-aged and older Koreans. Therefore, mental health evaluation and management interventions are recommended for patients with arthritis and changes in disease status.

Association between quality and duration of sleep and subjective cognitive decline: a cross-sectional study in South Korea.

Sleep is being emphasized as a factor that improves mental health and quality of life. Here, we aimed to investigate the association between the quality and duration of sleep and subjective cognitive decline in the Korean population. We used the 2018 Korean Community Health Survey data that are nationwide representative data collected by the Korea Centers for Disease Control and Prevention. Sleep quality was measured using the Korean version of Pittsburgh Sleep Quality Index. The study population comprised 206,719 individuals aged 19 years and over. We used multiple logistic regression for the analysis. Individuals of both sexes with poor sleep quality were more likely to experience subjective cognitive decline compared with the reference group (good sleep quality) (men, odds ratio (OR) = 1.97 [95% confidence interval (CI) 1.86-2.09]; women, OR = 1.75 [95% CI 1.67-1.84]). U-shape associations were found between sleep duration and subjective cognitive decline. Additionally, the presence of depressive symptom or stress and health-related behaviors, including smoking, drinking, and not walking, were high-risk factors for subjective cognitive decline. Our results indicate that poor sleep quality might contribute to subjective cognitive decline in the Korean population. We suggest the implementation of intervention measures for poor sleep behaviors to prevent cognitive decline.

Association Between Smoking Behavior and Insulin Resistance Using Triglyceride-Glucose Index Among South Korean Adults.

CONTEXT: Insulin resistance is a determinant of diabetes. With the increasing popularity of electronic smoking, the number of dual smokers (smoking both cigarettes and electronic cigarettes [e-cigarettes]) is increasing. However, few studies have assessed the association between insulin resistance and smoking behavior, including dual smoking. OBJECTIVE: This work aims to investigate the association between smoking behaviors and insulin resistance. METHODS: This prospective, cross-sectional study took place among the general community. A total of 11 653 participants (4721 male and 6932 female) aged 19 years or older from the 2016 to 2018 Korea National Health and Nutrition Examination Survey were divided based on their smoking behaviors: dual smokers (both cigarettes and e-cigarettes), single smokers (cigarette smokers), previous smokers, and nonsmokers. Insulin resistance was determined based on the triglyceride-glucose index. Multiple logistic regression analysis was performed to investigate the association between smoking behavior and insulin resistance. RESULTS: Among the participants, 205 males (3.9%) and 40 females (0.5%) were dual smokers, and 1581 males (29.9%) and 350 females (4.5%) were single smokers. Male and female smokers (dual and single) both had higher odds of being in a group with higher insulin resistance than nonsmokers (male, dual: OR = 2.19; 95% CI, 1.39-3.44; single: OR = 1.78; 95% CI, 1.43-2.22; female, dual: OR = 2.32; 95% CI, 1.01-5.34; single: OR = 1.76; 95% CI, 1.28-2.42). CONCLUSION: This study suggests that single and dual smoking both may increase the risk of insulin resistance in the general population. Education on the adverse effects of smoking behaviors may be an important strategy to improve the health of the population.

Urinary incontinence status changes and depressive symptoms among middle-aged and older women: Using data from a survey of the Korean Longitudinal Study of Aging.

BACKGROUND: Urinary incontinence (UI) affects 200 million people worldwide and is a common problem in middle-aged and older women. The symptoms of UI in women are known to have a variety of effects on their health. Therefore, this study aimed to identify the effects of changes in UI status on depressive symptoms and identify determinants of the progression of UI among South Korean women 45 years old and above. METHODS: Data were collected from the Korean Longitudinal Study of Aging from 2012 to 2016. Participants were categorized into five groups by the results of a prior panel survey on UI status: "Recovered," "Better," "Same," "Worse," and "No symptoms of urinary incontinence." We used the generalized estimating equation model and performed subgroup analyses based on age, working status, household income, perceived health status, and the number of chronic medical conditions. RESULTS: A total of 3,957 middle-aged and older women were included in the analysis. Those with a change to "worse" UI status (ß: 0.408, P=0.005) had higher depressive symptom scores than those who reported "no symptoms of UI." Conversely, those with a "better" (ß: -0.271, P=0.0131) or "recovered" (ß: -0.518, P=0.0020) UI status had lower depressive symptom scores than those with "no symptom of UI". Younger women and those with a "better" or "recovered" status showed a tendency of having fewer depressive symptoms. Older women and those with a "worse" status showed a tendency of having more depressive symptoms. LIMITATIONS: The cause of UI could not be evaluated. Changes in UI status were evaluated based on self-reported data. CONCLUSION: This study showed that a change in UI status is associated with depression in middle-aged and older Korean women. It is important to consider UI management to relieve depressive symptoms.

Sex differences in type of exercise associated with depression in South Korean adults.

Exercise has been considered as treatment and a preventive modality to alleviate depressive symptoms, but sex differences regarding specific types of exercise in association with depression have not been clearly elucidated. Here, we investigated sex differences in the association between exercise type and depression in Korean adults. Data from the Korea National Health and Nutrition Examination Survey (KNHANES) were used for this study. A total of 13,914 participants who had filled in a Patient Health Questionnaire-9 (PHQ-9) were included. The subjects' exercise status had been evaluated with questions on strength exercise and walking, and answers were analysed in the current study using multivariate logistic regression. Male participants who reported having done strength exercise more than once in a week were less likely to be depressed after adjusting for covariates assumed to affect depression levels [adjusted odds ratio (OR) 0.60, 95% CI 0.40-0.92]. In women, walking more than once during the previous week was associated with lower depression levels after covariate adjustments (adjusted OR 0.54, CI 0.34-0.87). This study identifies the relationship between exercise and the presence of depressive symptoms and finds sex differences in the types of exercise that correlate with depression in Korean adults.

Association between changes in economic activity and catastrophic health expenditure: findings from the Korea Health Panel Survey, 2014-2016.

BACKGROUND: The rate of catastrophic health expenditure (CHE) continues to rise in South Korea. This study examined the association between changes in economic activity and CHE experiences in South Korea. METHODS: This study analyzed the Korea Health Panel Survey data using a logistic regression analysis to study the association between changes in economic activity in 2014-2015 and the participants' CHE experiences in 2015. The study included a total of 12,454 individuals over the age of 19. The subgroup analyses were organized by sex, age, health-related variables, and household level variables, and the reasons for leaving economic activity. RESULTS: Those who quit economic activities were more likely to experience CHE than those who continued to engage in economic activities (OR [odds ratio] = 2.10; 95% CI [confidence interval]: 1.31-3.36). The subgroup analysis results, according to health-related variables, showed that there is a tendency to a higher Charlson comorbidity index, a higher OR, and, in groups that quit their economic activities, people with disabilities were more likely to experience CHE than people without disabilities (OR = 5.63; 95% CI 1.71-18.59, OR = 1.82; 95% CI 1.08-3.08, respectively). Another subgroup analysis found that if the reason for not participating in economic activity was a health-related issue, the participant was more likely to experience CHE (active → inactive: OR = 2.40; 95% CI 0.61-9.43, inactive → inactive OR = 1.65; 95% CI 1.01-2.68). CONCLUSIONS: Those individuals who became unemployed were more likely to experience CHE, especially if health problems precipitated the job loss. Therefore, efforts are needed to expand coverage for those people who suffer from high medical expenses.

Association between Blood Heavy Metal Levels and Predicted 10-Year Risk for A First Atherosclerosis Cardiovascular Disease in the General Korean Population.

BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is a preventable type of disease, thus, specifying factors that increase the occurrence of this type of disease is needed. Heavy metals such as cadmium (Cd), lead (Pb), and mercury (Hg) have been suggested as possible factors influencing the development of cardiovascular disease. We aimed to link blood heavy metal levels (Cd, Pb, Hg) with 10-year ASCVD risk scores. METHODS: A population of 993 men and 1431 women who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) were included. The 2013 American College of Cardiology/American Heart Association (ACC/AHA) pooled cohort equations risk prediction model and Korean Risk Prediction Model (KRPM) were used as means for risk prediction. Following multivariate adjustment; blood Cd; Pb; and Hg levels were divided into quartiles for analysis using linear trends estimation and multiple regression models. RESULTS: There was an overall positive trend between blood Cd, Pb, and Hg levels and 10-year ASCVD risk scores; KRPM risk score increasing by quartile for blood Cd (men p < 0.0001, women p = 0.0024), Pb (men p = 0.0097, women p = 0.0330), Hg (men p = 0.0096, women p = 0.0030) rates and pooled cohort equations risk score increasing by quartile for Cd (men p < 0.0001, women p = 0.0034) and Hg (men p = 0.0099, women p = 0.0010) with linear trends. Urban population showed a stronger relationship between blood Cd, Pb, and Hg levels and 10-year ASCVD risk score especially among men with multiple regression analysis. CONCLUSION: Blood Cd, Pb, and Hg levels are associated with ASCVD risk. Thus, they should be considered while developing preventive measures for ASCVD.

Association between continuity of care and type 2 diabetes development among patients with thyroid disorder.

Thyroid disorders are associated with blood glucose abnormalities. For rendering the patients euthyroid, routine screening and care are essential. Therefore, the aim of this study was to investigate the association between continuity of care (COC) and type 2 diabetes onset among patients with thyroid disorders.We used the national claim data. Our study population was 4099 patients with hyperthyroidism or hypothyroidism. For calculating COC, the Most Frequent Provider Continuity Index (MFPCI), Modified Modified Continuity Index (MMCI), and COC Index (COCI) were used. The dependent variable was type 2 diabetes onset. The Cox proportional hazard regression model was used.Among 4099 patients with thyroid disorders, 25.3% experienced onset of type 2 diabetes. Thyroid patients who had MFPCI and COCI below the median were more likely to experience onset of type 2 diabetes than who had these indices above the median (MFPCI: hazard ratio [HR] = 1.26, 95% confidence interval [CI] = 1.09-1.46; COCI: HR = 1.22, 95% CI = 1.06-1.41). Our subgroup analysis showed that female patients and those 20 to 34 years of age showed a significant association between COC and onset of type 2 diabetes.Patients with thyroid disorders with low COC showed an increased risk of developing type 2 diabetes. Therefore, efforts to enhance COC among patients with thyroid disorders needs to be encouraged.

Association between Changes in Depressive State and Cognitive Function.

Dementia is defined as a severe form of cognitive impairment. Research concerning the two-way relationship between depression and cognitive impairment has been conducted; however, there has been little analysis of cognitive function following changes in depressive status. This study describes the association between changes in depressive state and cognitive function in a Korean geriatric population sample. Using the Korean Longitudinal Study of Aging (KLoSA) database, Mini-Mental State Examination (MMSE) scores and Center for Epidemiologic Studies Depression Scale (CESD-10) indexes were used for measuring cognitive function and depression, respectively. The survey population was divided into four case categories by change in depressive status: normal to normal (Group A), normal to depressive (Group B), depressive to normal (Group C), and depressive to depressive (Group D). Analysis of variance, multiple regression analysis, and subgroup analysis were used for statistical examination. In the multiple regression analysis between MMSE values and depressive status change groups, with Group A as the reference, ß in all other groups was negative, and its absolute value was large in the order of D, B, and C in both men (B: -0.717, C: -0.416, D: -1.539) and women (B: -0.629, C: -0.430, D: -1.143). There were also significant results in the subgroup analysis in terms of age, working status, participation in social activities, regular physical activities, and number of chronic medical conditions. In conclusion, both cases-those suffering from depression and those having suffered from it before-experience cognitive impairment. The degree of cognitive function being impaired is greater in the case of depression-onset than that of depression-remission. Age, stimulating activities, and chronic conditions are also strongly relevant to cognitive decline accompanied by changes in depressive state.

Correction to: Depressive symptoms in individuals with family members requiring ADL assistance.

Following publication of the original article [1], the authors reported an error in Table 2 in their paper. The table entry "Men's P value" was mistakenly included under the table heading "Women". The original article [1] has been updated.

Depressive symptoms in individuals with family members requiring ADL assistance.

BACKGROUND: The number of patients with depressive symptoms worldwide is increasing steadily, and the prevalence of depression among caregivers is high. Therefore, the present study aimed to identify the effects of individuals' caregiving status with respect to their family members requiring activities of daily living (ADLs) assistance on depressive symptoms among those aged 45 or over. METHODS: Data were collected from the 2006-2016 using the Korean Longitudinal Study of Aging surveys. Participants were categorized into three groups based on their caregiving status with respect to family members requiring ADL assistance: whether they provided the assistance themselves, whether the assistance was provided by other caregivers, or whether no assistance was required. We analyzed the generalized estimating equation model and subgroups. RESULTS: A total of 3744 men and 4386 women were included for the analysis. Men who cared for family members requiring ADL assistance had higher depressive symptoms than those with family members who did not require ADL assistance. Among women, participants who had family members requiring ADL assistance that they themselves or others were providing had higher depressive symptoms than those without family members requiring ADL assistance. Subgroup analysis was conducted based on age, job status, regular physical activities, participation status in social activities, and the number of cohabiting generations. CONCLUSIONS: The study results indicated higher depressive symptoms among those with family members requiring ADL assistance and those who care for such family members themselves. This suggests that an alternative to family caregiving is necessary, especially for the elderly, regardless of caregiver sex.

The Effects of Intense Physical Activity on Stress in Adolescents: Findings from Korea Youth Risk Behavior Web-Based Survey (2015-2017).

The purpose of this study was to investigate the association between intense physical activity and stress in Korean adolescents. The study used data from the Korea Youth Risk Behavior Web-Based Survey (KYRBWS), 2015-2017, that included 170,359 responses from Korean adolescents. Intense activity and stress were measured by self-diagnosis. Additionally, the chi-square test and multiple logistic regression analyses were used. It was revealed that 78.9% of Korean adolescents were exposed to stress. Students who engaged in physical activity more than five times per week were less likely to be stressed than those who did not (boys odds ratio (OR): 0.79, confidence interval (CI): 0.78-0.80, p for trend: <0.0001; girls OR: 0.77, CI: 0.75-0.79, p for trend: <0.0001). The results indicated the same tendency among both boys and girls. The results of subgroup analysis revealed that students living with relatives or in childcare facilities were more likely to experience stress if they had insufficient exercise. In addition, the results confirmed that the probability of suicidal ideation increased as the frequency of exercise decreased. This study suggests that intense physical activity in Korean adolescents has a positive effect on stress management in both boys and girls. Hence, physical activity should be encouraged and implemented for managing stress.

Effects of different types and frequencies of physical activity on the homeostatic model assessment of insulin resistance.

This study analyzed the type and frequency of physical activity that most effectively reduces the homeostatic model assessment of insulin resistance (HOMA2-IR) among adults (≥19 years) in Asia. We used national representative data from 1645 men and 2272 women who participated in the Korea National Health and Nutrition Examination Survey in 2015 were included in the analysis. The effects of different types and frequencies of physical activity on HOMA2-IR were investigated using a multiple regression analysis. Compared with no activity, moderate-to-vigorous physical activity (MVPA) ≥5 times per week (ß: -0.214, p≤0.0198) and walking and MVPA ≥5 times per week (ß: -0.183, p≤0.0049) were negatively associated with HOMA2-IR. In the subgroup analysis, the strongest effect was observed among overweight men. Additionally, walking plus MVPA ≥5 times per week had the strongest effect on men with a higher-than-recommended daily calorie intake (ß: -0.350, p≤0.0030). Therefore, in conclusion, the appropriate type and frequency of physical activity can help reduce HOMA2-IR in South Korean men, especially those who are overweight and/or have a higher-than-recommended daily calorie intake.

Fabrication of a TEM sample of ion-irradiated material using focused ion beam microprocessing and low-energy Ar ion milling.

Cross-section-view TEM samples of ion-irradiated material are successfully fabricated using a focused ion beam (FIB) system and low-energy Ar ion milling. Ga ion-induced damages in FIB processing are reduced remarkably by the means of low-energy Ar ion milling. There are optimized ion milling conditions for the reduction and removal of the secondary artifacts such as defects and ripples. Incident angles and accelerated voltages are especially more important factors on the preservation of a clean surface far from secondary defects and surface roughing due to Ga and Ar ion bombardment.

Effect of a sintering process on the electrical properties of SnO2 gas sensors.

SnO2 is a widely used sensor material that exhibits high sensitivity. It is known for its complex sensing characteristics, and its microstructure is an important parameter related to electrical properties and mechanical rigidity. Understanding of its microstructural effects is therefore essential to examine sensing mechanisms that may apply to industrial devices. In this work, the effect of a sintering process on the electrical properties is investigated. The sintering temperature and the relative density were chosen as process variables. The grain size of the specimen increased as the sintering temperature increased, whereas the relative density did not change. The apparent activation energy for conduction varied as the compacting pressure and the sintering conditions changed. Samples with a high density and large particle size showed low activation energy for conduction and low sensitivity at 375 degrees C. In an attempt to improve the properties, the powder was heat-treated at 1000 degrees C for 10 hours before compacting and sintering. The samples with heat-treated powder showed a slight decrease in the activation energy depending on the density and comparable sensitivity compared to non-treated powder at a high density. Pre-treatment of powder can be a simple means of thermal stability under high operating temperatures.