Most patients with COPD are unaware of their health threats and are not diagnosed: a national-level study using pulmonary function test.

This study aimed to investigate national-level prevalence of COPD, proportion of patients diagnosed with and without COPD. We performed pulmonary function test (PFT) in 24,454 adults aged > 40 years for 8 years (2010-2017). The annual COPD prevalence increased from 13.1% in 2010 to 14.6% in 2012, followed by 13.3% in 2017. However, patients diagnosed with COPD ranged between 0.5 and 1.0% in the last 8 years, which means that only 5% of all COPD patients were diagnosed with COPD by doctors. We defined potential high-risk individuals as those with a FEV1/FVC ratio of < 0.70, who have not been diagnosed with COPD and other respiratory diseases tuberculosis, asthma, lung cancer. The proportion of this group was 80.8% in 2010 and 78.1% in 2017. The older age group, women, low-educated group, and current smokers who have been smoking for a long time are more likely to be in the high-risk group having a higher possibility to develop COPD but are not diagnosed with COPD appropriately. Although COPD prevalence was high in the ever, current, and heavy smokers, only the diagnosis rate of COPD in ever smokers was 2.38 times higher than never smokers, indicating that a system is needed to screen and intervention for these groups.

Association between Lower-to-Upper Ratio of Appendicular Skeletal Muscle and Metabolic Syndrome.

(1) Background: Metabolic syndrome (MetS) is a cluster-based disorder comprising several pre-disease or pre-clinical statuses for diabetes, hypertension, dyslipidemia, cardiovascular risk, and mortality. Appendicular skeletal muscle (ASM), or lean mass, is considered the main site of insulin-mediated glucose utilization. Therefore, we aimed to reveal the association between lower appendicular skeletal muscle mass to upper appendicular skeletal muscle mass ratio (LUR) and risk for MetS. (2) Methods: We analyzed the 2008-2011 Korean National Health Examination and Nutrition Survey (KNHANES) data. Quintiles of lower ASM to upper ASM ratio (LUR) were categorized as follows: Q1: ≤2.65, Q2: 2.66-2.80, Q3: 2.81-2.94, Q4: 2.95-3.11, and Q5: ≥3.12 in men and Q1: ≤3.00, Q2: 3.01-3.18, Q3: 3.19-3.36, Q4: 3.37-3.60, and Q5: ≥3.61 in women. Multivariate logistic regression models were used after setting MetS and the LUR quintiles as the independent and dependent variables and adjusting for covariates. (3) Result: In men, MetS in accordance with the LUR quintiles exhibits a reverse J-curve. All groups from Q2 to Q5 had a lower odds ratio (OR) (95% CI) for MetS compared to the Q1 group. The lowest OR (95% CI) of 0.85 (0.80-0.91) was observed in Q4. However, in women, the figure shows a sine curve. Compared to the Q1 group, the Q2 and Q3 groups had a higher OR, while the Q4 and Q5 groups presented a lower OR. Among them, the OR (95% CI) in the Q4 group was lowest, at 0.83 (0.76-0.91). (4) Conclusions: While total appendicular skeletal muscle mass is important to prevent MetS, it is necessary to maintain an optimal ratio of muscle mass between the upper and lower appendicular skeletal muscle mass.

Gestational age-specific serum creatinine can predict adverse pregnancy outcomes.

Serum creatinine level (SCr) typically decreases during pregnancy due to physiologic glomerular hyperfiltration. Therefore, the clinical practice of estimated glomerular filtration rate (eGFR) based on SCr concentrations might be inapplicable to pregnant women with kidney disease since it does not take into account of the pregnancy-related biological changes. We integrated the Wonju Severance Christian Hospital (WSCH)-based findings and prior knowledge from big data to reveal the relationship between the abnormal but hidden SCr level and adverse pregnancy outcomes. We analyzed 4004 pregnant women who visited in WSCH. Adverse pregnancy outcomes included preterm birth, preeclampsia, fetal growth retardation, and intrauterine fetal demise. We categorized the pregnant women into four groups based on the gestational age (GA)-unadjusted raw distribution (Q1-4raw), and then GA-specific (Q1-4adj) SCr distribution. Linear regression analysis revealed that Q1-4adj groups had better predictive outcomes than the Q1-4raw groups. In logistic regression model, the Q1-4adj groups exhibited a robust non-linear U-shaped relationship with the risk of adverse pregnancy outcomes, compared to the Q1-4raw groups. The integrative analysis on SCr with respect to GA-specific distribution could be used to screen out pregnant women with a normal SCr coupled with a decreased renal function.

Effect of the Period From COVID-19 Symptom Onset to Confirmation on Disease Duration: Quantitative Analysis of Publicly Available Patient Data.

BACKGROUND: In general, early intervention in disease based on early diagnosis is considered to be very important for improving health outcomes. However, there is still insufficient evidence regarding how medical care that is based on the early diagnosis of confirmed cases can affect the outcome of COVID-19 treatment. OBJECTIVE: We aimed to investigate the effect of the duration from the onset of clinical symptoms to confirmation of COVID-19 on the duration from the onset of symptoms to the resolution of COVID-19 (release from quarantine). METHODS: For preliminary data collection, we performed data crawling to extract data from social networks, blogs, and official websites operated by local governments. We collected data from the 4002 confirmed cases in 33 cities reported up to May 31, 2020, for whom sex and age information could be verified. Subsequently, 2494 patients with unclear symptom onset dates and 1349 patients who had not been released or had no data about their release dates were excluded. Thus, 159 patients were finally included in this study. To investigate whether rapid confirmation reduces the prevalence period, we divided the duration from symptom onset to confirmation into quartiles of ≤1, ≤3, ≤6, and ≥7 days, respectively. We investigated the duration from symptom onset to release and that from confirmation to release according to these quartiles. Furthermore, we performed multiple regression analysis to investigate the effects of rapid confirmation after symptom onset on the treatment period, duration of prevalence, and duration until release from isolation. RESULTS: We performed multiple regression analysis to investigate the association between rapid confirmation after symptom onset and the total prevalence period (faster release from isolation). The time from symptom onset to confirmation showed a negative association with the time from confirmation to release (t1=-3.58; P<.001) and a positive association with the time from symptom onset to release (t1=5.86; P<.001); these associations were statistically significant. CONCLUSIONS: The duration from COVID-19 symptom onset to confirmation date is an important variable for predicting disease prevalence, and these results support the hypothesis that a short duration of symptom onset to confirmation can reduce the time from symptom onset to release.

Does the implementation of smoke-free laws and smoking culture affect exposure to tobacco smoking? Results from 3 hospitality settings in South Korea.

OBJECTIVES: It is especially difficult for hospitality workers to avoid secondhand smoke (SHS), meaning that they are likely particularly vulnerable to the effects of SHS. The authors aimed to determine the degree to which smoke-free laws protect hospitality workers from SHS exposure, by examining biochemical markers of such exposure. MATERIAL AND METHODS: This was a cross-sectional study examining SHS exposure in non-smoking employees working in hospitality settings where smoking is prohibited or permitted. The following biomarkers were selected: cotinine and tobaccospecific nitrosamines, which are known to measure SHS exposure, and 2 representative carcinogens: 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK). The authors compared these biomarkers between 3 hospitality settings. A descriptive analysis was performed. In addition, they conducted 1-way and 2-way analysis of covariance (ANCOVA) to compare the biochemical markers. RESULTS: Smoking substances were identified by smoking ban levels. In the case of hair nicotine and urine cotinine, their concentrations were lower in areas with a complete smoking ban than in both areas with a separate smoking room and no smoking ban; however, there was no statistically significant difference between these. In the case of dust NNK, its level was the lowest in areas with a complete smoking ban. To confirm the smoking ban effect by hospitality settings, the authors checked the results of the 2-way ANCOVA. In karaoke and billiard halls, the dust NNK concentrations were significantly higher in areas with no smoking ban than in areas with a separate smoking room. CONCLUSIONS: Exposure to SHS is more prevalent in places that are more lenient when it comes to smoking (e.g., Internet cafés) than in places that are not (e.g., restaurants and cafés), even when smoking is similarly prohibited in both types of places. Int J Occup Med Environ Health. 2021;34(1):53-67.

Association between the symptoms of benign prostatic hyperplasia and social disparities: Does social capital promote prostate health?

This cross-sectional study investigated the relationships between socioeconomic factors and social capital and benign prostatic hyperplasia symptoms. The participants were 100,000 adult men who participated in the Korea Community Health Survey. The surveyors used the International Prostate Symptom Score. As regards occupation, the prevalence of benign prostatic hyperplasia was higher in men with blue-collar occupations or those who were unemployed than in those with white-collar jobs. In terms of marital status, the prevalence of benign prostatic hyperplasia was 1.319 times higher among divorced men than married men. As regards social capital, the prevalence of benign prostatic hyperplasia in men with positive attitudes towards one's community scores that reflected good, poor and very poor community scores was 1.228, 1.246 and 1.447 times higher than that of men who had very good scores respectively. The groups with good, poor, and very poor community participation scores had 1.115, 1.202 and 1.364 times higher prevalence of benign prostatic hyperplasia than the group with very good scores. Social disparities and social capital of a community were associated with the prevalence of benign prostatic hyperplasia. Thus, the use of social capital in the community setting will be effective in the management of the condition.

Association Between Duration of Reproductive Years and Metabolic Syndrome.

BACKGROUND: The incidence of metabolic syndrome (MetS) has gradually increased in recent years. MetS has been associated with age at menarche and menopause; however, the association between MetS and the reproductive span remains unclear. MATERIALS AND METHODS: This study examined MetS and the reproductive span among 1,214 participants of the 2014 Korea National Health and Nutrition Examination Surveys, a stratified, complex, multistage, probability cluster survey conducted by the Division of Chronic Disease Surveillance of the Korea Center for Disease Control and Prevention since 1998. MetS was defined by using the joint interim statement of the International Diabetes Federation; National Heart, Lung, and Blood Institute; and American Heart Association. The reproductive span or duration of reproductive years was calculated from age at menarche to age at menopause for postmenopausal women. RESULTS: The prevalence of MetS in this study was 36% (437 of 1,214). In multivariate analysis adjusted for age, longer reproductive years were associated with a higher prevalence of MetS (odds ratio [OR] 1.059, 95% confidence interval [CI] 1.055-1.063). However, after adjusting for covariates (age, residential area, income, dyslipidemia medication, education, current smoking, regular exercise, alcohol consumption, body mass index, years after menopause, aspartate aminotransferase, alanine aminotransferase, and white and red blood cell counts), longer reproductive years were associated with a lower prevalence of MetS (OR 0.751, 95% CI 0.745-0.747). CONCLUSION: Longer reproductive years were significantly associated with a decreased prevalence of MetS.

Correction Equation for Estimation of Actual Potassium Concentration in Hemolyzed Specimen.

BACKGROUND: A spuriously elevated serum potassium value could possibly cause medical decision errors because it leads to masked hypokalemia or pseudohyperkalemia. The aim of this study was to develop a correction equation for falsely elevated potassium level caused by hemolysis. METHODS: A total of 988 samples with a hemolysis index (HI) value greater than the potassium alert HI value were recollected within two hours from initial collection. We divided 988 paired samples into 3 groups: hypokalemia, normal, and hyperkalemia. When samples were checked after recollection within 2 hours, 525 cases showed HI of 1. We analyzed the relationship between the delta of initial and recollected samples' HI values and the delta of initial and recollected samples' potassium levels, resulting in 5 different delta groups. RESULTS: The proportion of masked hypokalemia and pseudohyperkalemia was 17.6% (125/710) and 64.1% (139/217), respectively. The trend and distribution of potassium concentration for each of the 5 delta HI groups according to delta HI level showed an exponential curve. From this exponential curve function, a correction equation for estimation of true potassium concentration in hemolyzed specimens was calculated: measured potassium (-0.0561e 0.6578* delta HI + 0.0804). CONCLUSIONS: The clinical application of the correction equation for adjusting the hemolysis effect on potassium concentration could be useful for the detection of masked hypokalemia or pseudohyperkalemia.

Habit of Eating Breakfast Is Associated with a Lower Risk of Hypertension.

BACKGROUND: The association between skipping breakfast and cardio-metabolic syndrome is well known. However, there are very few Korean studies about the habit of eating breakfast and hypertension. The present study aimed to investigate the relationship between the habit of eating breakfast and hypertension in a healthy Korean population. METHODS: Participants in the 2014 Korea National Health and Nutrition Examination Surveys (KNHANES) were enrolled for this study. Medical history, including hypertension, was measured using a 24-hour recall method. The habit of eating breakfast was estimated from self-reported questionnaires and was classified into two groups: the eating breakfast group, defined as those who ate breakfast more than 5 times per week, and the not eating breakfast group, defined as those who did not eat any breakfast for a week. RESULTS: The crude odds ratio of skipping breakfast for the prevalence of hypertension was 0.366. However, after adjusting for all considerable confounding factors (age, sex, regular exercise, current smoking, systolic blood pressure, diastolic blood pressure, body mass index, waist circumference, and red blood cell counts), not eating breakfast was associated with a higher risk of HTN (OR = 1.065; 95% CI = 1.057-1.073; p-value < 0.001). CONCLUSION: The habit of eating breakfast was associated with a lower risk of hypertension among healthy Korean adults.