OBJECTIVES: The purpose of this study is to assess the effects of smoking and drinking on blood lead and cadmium levels based on a dose-response relationship in the general Korean adult population. METHODS: The study population consisted of 1,901 Koreans, who took part in the 2008 Korean National Health and Nutrition Examination Survey, in which blood lead and cadmium levels were measured. Geometric mean concentrations and their 95% confidence intervals of metals in blood were estimated by analysis of covariance (ANCOVA) adjusting for demographic and lifestyle factors. RESULTS: We observed a statistically significant dose-response relationship with daily smoking amount/alcohol intake and blood lead/cadmium levels. While daily smoking amount was more consistent with blood cadmium level (0.1-0.2 microg/L per 5 cigarettes), blood lead concentrations were higher as daily alcohol intake increased (0.1-0.2 microg/dL per 10 gram of alcohol). CONCLUSIONS: Our findings clearly support a relationship between daily smoking amount/alcohol intake and blood lead/cadmium levels, suggesting an additional reason towards efforts to reduce smoking and drinking habits.
Adult ; Cadmium ; Drinking ; Humans ; Korea ; Life Style ; Metals ; Nutrition Surveys ; Smoke ; Smoking

OBJECTIVE: Depressive symptoms among university students are a major mental-health issue worldwide, and university students are particularly vulnerable to various stressors that can produce depression. Therefore, accurate and sustainable assessment of depressive symptoms among university students is of special importance. The Patient Health Questionnaire-9 (PHQ-9) is one such measure. The objective of the current study was to evaluate the psychometric properties of the PHQ-9 among Korean university students.METHODS: A total sample of 582 university students attending a four-year private university in South Korea was recruited for the study. Confirmatory factor analyses (CFAs) were performed to compare the goodness-of-fit of four competing models suggested by extant literature on the PHQ-9. Convergent validity was assessed using a correlation analysis between the PHQ-9 and other psychiatric instruments, including the Depression, Anxiety, and Stress Scale-21 (DASS-21) and the Generalized Anxiety Disorder Scale (GAD-7).RESULTS: A one-factor structure of the PHQ-9 provided the best fit to the data. Internal consistency was adequate. The PHQ-9 demonstrated good convergent validity with related constructs.CONCLUSION: The psychometric properties of the PHQ-9 proved to be adequate, with a robust and interpretable factor structure and good internal consistency. The PHQ-9’s validity, reliability, brevity and ease of administration make it a useful screening instrument for depression among university students in Korea.
Anxiety ; Anxiety Disorders ; Depression ; Humans ; Korea ; Mass Screening ; Psychometrics

The costliness index (CI) is an index that is used in various ways to improve the quality of medical care and the management of appropriate treatment in medical institutions. However, the current calculation method for CI has a limitation in reflecting the actual medical cost of the patient unit because the outpatient and inpatient costs are evaluated separately. It is desirable to calculate the CI by integrating the medical cost into the episode unit. We developed an episode-based CI method using the episode classification system of the Centers for Medicare and Medicaid Services to the National Inpatient Sample data in Korea, which can integrate the admission and ambulatory care cost to episode unit. Additionally, we compared our new method with the previous method. In some episodes, the correlation between previous and episode-based CI was low, and the proportion of outpatient treatment costs in total cost and readmission rates are high. As a result of regression analysis, it is possible that the level of total medical costs of the patient unit in low volume medical institute and rural area has been underestimated. High proportion of outpatient treatment cost in total medical cost means that some medical institutions may have provided medical services in the ambulatory care that are ancillary to inpatient treatment. In addition, a high readmission rate indicates insufficient treatment service for inpatients, which means that previous CI may not accurately reflect actual patient-based treatment costs. Therefore, an integrated patient-unit classification system which can be used as a more effective CI indicator is needed.

Purpose: The purpose of this study was to evaluate the psychometric properties and factor structure of the Korean version of the Penn State Worry Questionnaire (PSWQ) for use with the Korean university student population. Methods: A sample of 504 undergraduate students enrolled at a four-year university in South Korea were recruited for the study. Confirmatory factor analysis (CFA) was conducted, based on pre-existing models, to compare the model fit indices of three previously proposed factor structures for the PSWQ. Internal consistency was measured using Cronbach’s ⍺ while test-retest reliability was assessed using Pearson correlation coefficients. To assess the convergent validity of the PSWQ, Pearson correlations were conducted to examine the association between the PSWQ and the State-Trait Anxiety Inventory-T. Results: CFA results indicated that the one-factor model with method effect fit the data well in the sample. The PSWQ evidenced high internal consistency and adequate to good test-retest reliability over four weeks. The PSWQ also demonstrated substantial convergent validity with trait anxiety. Conclusion The Korean version of the PSWQ was found to be sufficiently coherent and robust to be used with the university student populations and its reliability and validity has also been supported. The PSWQ measures a facet of worry as a general, unidimensional construct but different response patterns emerged between positively or negatively worded questions.

Objective: We aimed to classify subgroups of suicidality among adolescents and identify the influencing factors of the classification of these latent classes. Methods: Suicidal thought, plans, and attempts as well as the feelings of sadness/hopelessness and loneliness were utilized as indicators to derive the suicidality classes. Additionally, health behaviors, such as dietary habits, physical activity, experiences of violence victimization, sexual activity, and deviant behavior, along with demographic factors, such as sex, school year, grades, and household income, were considered as influencing factors. The analysis utilized data from the 18th Youth Health Behavior Survey (2022) conducted by the Korea Disease Control and Prevention Agency, involving 51,850 middle and high school students. Results: The findings revealed three latent classes of suicidality among adolescents: “active suicidality,” “passive suicidality,” and “non-suicidality.” The influencing factor analysis indicated that all factors, with the exception of high-intensity physical activities, significantly influenced the classification of latent classes of suicidality. Notably, walking exercise and the frequency of exercise during physical education class were found to be factors that differentiated between active and passive suicidality within the suicidality classes. Conclusion This study employed nationwide data to identify the exhibited suicidality classes among adolescents and tested the influencing factors necessary for predicting such classes. The study’s findings offer valuable insights for policy development in suicide prevention and suggest the need for developing customized interventions tailored to each identified class.

Digital health is rapidly growing worldwide and its area is expanding from wellness to treatment due to digital therapeutics (DTx). This study compared DTx in the Korean context with other countries to better understand its political and practical implications. DTx is generally the same internationally, often categorized as software as a medical device. It provides evidence-based therapeutic interventions for medical disabilities and diseases.Abroad, DTx support entailed state subsidies and fundraising and national health insurance coverage. In the case of national health insurance coverage, most cases were applied to mental diseases. Moreover, in Japan, DTx related to hypertension will possibly be under discussion for national health insurance coverage in 2022. In overseas countries, coverage was decided only when the clinical effects were equivalent to those provided by existing technology, and in the UK, real usage data for DTx and associated evaluations were reflected by national health coverage determination. Prices were either determined through closed negotiations with health insurance operating agencies and manufacturers or established based on existing technology. Concerning the current situation, DTx dealing with various diseases including hypertension are expected to be developed near in the future, and the demand for use and compensation will likely increase. Therefore, it is urgent to define and prepare for DTx, relevant support systems, and health insurance coverage listings. Several support systems must be considered, including government subsidies, science/technology funds, and health insurance.

BACKGROUND: Clear cell renal cell carcinoma (CCRCC) is presumed to be associated with adipogenic differentiation. Histone modification is known to be important for adipogenesis, and the function of histone demethylase plant homeodomain finger 2 (PHF2) has been noted. In addition, PHF2 may act as a tumor suppressor via epigenetic regulation of p53 and is reported to be reduced in colon cancer and stomach cancer tissues. In this study, we examined PHF2 expression in CCRCC specimens by immunohistochemistry. METHODS: We studied 254 CCRCCs and 56 non-neoplastic renal tissues from patients who underwent radical or partial nephrectomy between 2000 and 2003 at the Seoul National University Hospital. Tissue microarray blocks were prepared, and immunohistochemical staining for PHF2 was performed. RESULTS: Among 254 CCRCC cases, 150 cases (59.1%) showed high expression and 104 cases (40.1%) showed low expression. High expression of PHF2 was significantly correlated with a low Fuhrman nuclear grade (p < .001), smaller tumor size (p < .001), low overall stage (p = .003), longer cancer-specific survival (p = .002), and progression-free survival (p < .001) of the patients. However, it was not an independent prognostic factor in multivariate analysis adjusted for Fuhrman nuclear grade and overall stage. CONCLUSIONS: Our study showed that low expression of PHF2 is associated with aggressiveness and poor prognosis of CCRCC.
Adipogenesis ; Carcinoma, Renal Cell* ; Colonic Neoplasms ; Disease-Free Survival ; Epigenomics ; Fingers ; Histones ; Humans ; Immunohistochemistry ; Multivariate Analysis ; Nephrectomy ; Plants ; Prognosis ; Seoul ; Stomach Neoplasms

OBJECTIVE: To analyze cognitive functions of post-stroke aphasia patients compared to patients having right hemispheric stroke and left hemispheric lesions without aphasia, and to look for a relationship between cognitive deficits and aphasia severity. METHODS: Thirty-six patients with right hemispheric stroke (group 1), 32 with left hemispheric lesion without aphasia (group 2), and 26 left hemispheric stroke patients with aphasia (group 3) completed a set of tests in the computerized neurocognitive function batteries for attention, executive function and intelligence and Korean version of Western Aphasia Battery. Data analyses explored cognitive characteristics among the three groups and the correlation between cognitive deficits and aphasia severity. RESULTS: Right hemispheric and left hemispheric stroke patients without aphasia showed similar findings except for digit span forward test. Cognitive tests for working memory and sustained attention were significantly impaired in the aphasic patients, but intelligence was shown to be similar in the three groups. Significant correlation between cognitive deficit and aphasia severity was only shown in some attention tests. CONCLUSION: Cognitive deficits may be accompanied with post-stroke aphasia and there are possible associations between language and cognitive measures. Therefore, detection and treatment towards coexisting cognitive impairment may be necessary for efficient aphasia treatment.
Aphasia* ; Cognition ; Executive Function ; Humans ; Intelligence ; Memory, Short-Term ; Statistics as Topic ; Stroke

OBJECTIVE: The aim of this study was to examine the change in the hippocampal volume and shape in early-onset mild cognitive impairment (EO-MCI) associated with the APOE ε4 carrier state. METHODS: This study had 50 subjects aged 55–63 years, all of whom were diagnosed with MCI at baseline via the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet. The EO-MCI patients were divided into the MCI continued (MCIcont) and Alzheimer's disease (AD) converted (ADconv) groups 2 years later. The hippocampal volume and shape were measured for all the subjects. The local shape analysis (LSA) was used to conduct based on the 2-year-interval magnetic resonance imaging scans. RESULTS: There was a significant correlation between APOE ε4 allele and hippocampal volume atrophy. Over two years, the volume reduction in the left hippocampus was found to be faster than that in the right hippocampus, especially in the APOE ε4 carriers. LSA showed that the 2 subfields were significantly affected in the left hippocampus. CONCLUSION: These results suggest that the possession of APOE ε4 allele may lead to greater predilection for left hippocampal atrophy in EO-MCI, and some specific subfields of the hippocampus may be more prominently involved.
Alleles ; Alzheimer Disease ; Apolipoproteins E ; Atrophy ; Carrier State ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Mild Cognitive Impairment*

This study was undertaken to provide basic data for revitalizing the school meal support centers and improvingschool meals, by analyzing the purchase conditions and satisfaction of food according to an adoptionof a school meal service support center. Comparing the purchasing efficiency, convenience to purchase, andhigher overall satisfaction was achieved when a school meal service support center was adopted by the localgovernment, as compared to non-adopted school meal service support centers. Therefore, it is considered thatthe adaption of a school meal service support center is urgently required by non-adoption local governments.Moreover, the stability of food material supplies was also higher in the adopted rather than the non-adoptedcenters. Satisfaction with the quality of food ingredients was also found to be significantly higher in theadopted centers. These results indicate that if the local government adopts and introduces the school mealsupport center, inconsistencies observed in the return and exchange processes experienced by the non-adoptedcenters can be resolved, and food quality satisfaction can be improved. We, therefore, propose the necessityto implement a system for determining reasonable pricing by establishing systematic cooperation amongschools, manufacturing entities (suppliers), and the School Meal Service Support Center.