Purpose: Sepsis-related deaths occur during both the early proinflammatory and the late immunosuppressive phases of the condition. The balance of pro- and anti-inflammatory responses is influenced by damaged cells that die via either proinflammatory necroptosis or anti-inflammatory apoptosis. Both forms of cell death may be mediated by reactive oxygen species (ROS) generated during the proinflammatory response. Recent evidence suggests that exercise training boosts antioxidative capacity and could offer protection against sepsis. Given these findings, we aimed to examine the impact of exercise training on neural cell death in the context of sepsis. Methods: We assessed the effectiveness of exercise in reducing ROS production and the inflammatory response using a cecal ligation and puncture (CLP)-induced sepsis model. Forty C57BL/6N male mice were randomly divided into 2 groups: control (CLP-Con; n=20) and experimental (CLP-Ex; n=20). Before the induction of sepsis by CLP, the CLP-Ex mice underwent interval training on a treadmill 3 days per week for 8 weeks. Each day involved 10 cycles of 2 minutes at 8 m/min and 2 minutes at 15 m/min. After the CLP procedure, we monitored the survival of 10 mice from each group over a 30-hour period. Results: The findings indicated that exercise training increased the survival rate among mice with CLP-induced sepsis by enhancing antioxidative capacity and delaying the transition from a hyperdynamic to an immunosuppressive state. Conclusions Exercise training may delay the progression from the hyperdynamic state to the hypodynamic phase of sepsis by increasing antioxidant capacity and reducing apoptotic cell death.

BACKGROUND/OBJECTIVES: The recent coronavirus disease 2019 pandemic has brought to light issues regarding personal and environmental cleanliness. Individuals may have concerns about cleanliness at food service establishments when they consume food prepared at a restaurant. In Korea, a new restaurant hygienic certificate system was implemented in 2017. The effect of this new system has not been evaluated. SUBJECTS/METHODS: This study investigated consumers' perceptions of these new certificates using the protection motivation theory (PMT). An online survey was conducted to collect data and then exploratory factor analysis, analysis of variance, and multiple regression tests were run. RESULTS: The results of this study indicate that 3 different certificates had significant differences in threat (P < 0.001) and benefit (P < 0.001) perception. However, experience with a foodborne illness from a restaurant did not effect on the PMT variables. In addition, the 3-tier certificate did not motivate consumers to protect themselves against foodborne illnesses, while previous experiences of foodborne illness (P < 0.05), coping (P < 0.001), and benefits (P < 0.01) affected this protection motivation. CONCLUSIONS This study suggests that consumers were not influenced by different certificate levels regarding their motivation to protect themselves from foodborne illnesses. Therefore, an improved plan should be initiated to clarify the meaning of these certificates. The results of this study can help the application and development of a new system for future adaptations.

This study investigated the cumulative effects of depressive symptoms on cognitive function over time in community-dwelling older adults. Methods: Data were investigated from 2,533 community-dwelling older adults who participated in the Korean Longitudinal Study of Aging (KLoSA) from the 5th (2014) to the 8th wave (2020). The association between cumulative depressive symptoms and cognitive function was identified through multiple regression analysis. Results: When the multiple regression analysis was conducted from each wave, the current depressive symptoms scores and cognitive function scores were negatively associated, regardless of the waves (B5th = - 0.26, B6th = - 0.26, B7th = - 0.26, and B8th = - 0.27; all p < .001). Further, when all the previous depressive symptoms scores were added as explanatory variables in the 8th wave, the current one (B8th = - 0.09, p < .001) and the previous ones (B5th = - 0.11, B6th = - 0.09, and B7th = - 0.13; all p < .001) were also negatively associated with the cognitive function score. The delta R2 , which indicates the difference between the model’s R2 with and without the depressive symptoms scores, was greater in the model with all the previous and current depressive symptoms scores (6.4%) than in the model with only the current depressive symptoms score (3.6%). Conclusion: Depressive symptoms in older adults have a long-term impact. This results in an accumulated adverse effect on the cognitive function. Therefore, to prevent cognitive decline in older adults, we suggest detecting their depressive symptoms early and providing continuous intervention to reduce exposure to long-term depressive symptoms.

Nutrition education is essential for the health of people with disabilities. This paper presents nutrition education topics and operational directions for people with disabilities living in social welfare facilities for people with disabilities. This study was conducted through one-on-one, in-depth interviews with 11 operators and workers at social welfare facilities where people with disabilities reside. They were asked about the current status of nutrition education at the social welfare facility for people with disabilities where the interviewee works, major diseases of residents, topics of nutrition education needed, and preferred education methods to determine the type of nutrition education for people with disabilities needed in the field. As a topic of nutrition education, dietary education for obesity prevention and management was most requested, and education on basic nutritional ingredients was also desired. It was mentioned that the educational level would be appropriate for children aged 6∼9, and using materials that would attract interest was recommended. Activity-based face-to-face education was preferred for the operation of the program, and it was mentioned that education would be possible in a short period. In addition, it was mentioned that nutrition education is necessary for people with disabilities and workers at social welfare facilities for people with disabilities. Confirming the topic and operation direction of the nutrition education program required by social welfare facilities for people with disabilities will make it possible to contribute to providing nutrition education tailored to social welfare facilities for people with disabilities in Korea.

In 2000, Korea enacted a controversial law prohibiting doctors from dispensing drugs. Doctors have opposed this law, and in theory, the law inconveniences patients. We assessed the relationship between patients' satisfaction with drug dispensation and their overall support for the law by using a logit model to determine the effects of the law on patients and which patients are likely to support the law. We employed random digit dialing and obtained a sample of 540 adults who had used drugs since the law was enacted. We collected the data through phone interviews. The results indicate that the respondents were generally dissatisfied with the law regardless of sociodemographic or regional characteristics. However, with other factors controlled for, those respondents from the same region as the ruling political party were significantly more likely to support the law. This implies that regional politics influenced the policymaking process through which the law was crafted and enacted.
Adult ; Health Policy ; Humans ; Jurisprudence ; Korea ; Logistic Models ; Patient Satisfaction ; Politics ; Surveys and Questionnaires

PURPOSE: The purpose of the study was to examine the recording accuracy of faculty observers and standardized patients (SPs) on a clinical performance examination (CPX). METHODS: This was a cross-sectional study of a fourth-year medical students' CPX that was held at a medical school in Seoul, Korea. The CPX consisted of 4 cases and was administered to 118 examinees, with the participation of 52 SP and 45 faculty observers. For the study we chose 15 examinees per case, and analyzed 60 student-SP encounters in total. To determine the recording accuracy level, 2 SP trainers developed an answer key for each encounter. First, we computed agreement rates (P) and kappa coefficient (K) values between the answer key-SPs and the answer key-faculty observers. Secondly, we analyzed variance (ANOVA) with repeated measures to determine whether the mean percentage of the correct checklist score differed as a function of the rater, the case, or the interaction between both factors. RESULTS: Mean P rates ranged from 0.72 to 0.86, while mean K values varied from 0.39 to 0.59. The SP checklist accuracy was higher than that of faculty observersat the level of item comparison. Results from ANOVA showed that there was no significant difference between the percentage of correct scores by the answer key, faculty observers and SPs. There was no significant interaction between rater and case factors. CONCLUSION: Acceptable levels of recording accuracy were obtained in both rater groups. SP raters can replace faculty raters in a large-scale CPX with thorough preparation.
Checklist ; Clinical Competence ; Cross-Sectional Studies ; Education, Medical, Undergraduate ; Educational Measurement ; Humans ; Korea ; Observer Variation ; Schools, Medical

Objectives: This study investigated the need for nutrition education aimed at improving the health of residents and users of social welfare facilities for persons with disability and aimed to provide basic information for developing a nutrition education program that meets the needs of the field. Methods: Altogether, 249 employees working in social welfare facilities for people with disabilities were included in the study. Data on the health status of residents/users, meal management, nutritional education, nutritional education needs, and awareness of nutritional education were obtained through online surveys. A descriptive analysis was conducted to analyze the demographic characteristics, needs, and perceptions of the respondents, and independent t-tests and χ2 tests were performed to analyze and compare the differences between residential and daycare facilities. Results: The majority of residents/users of social welfare facilities for persons with disabilities have developmental disabilities. When educating residents with residents/users of social welfare facilities, ‘personal hygiene’ was the most necessary topic, followed by ‘obesity management’ education. Regarding the methods of providing education, face-toface lectures demonstrated a high demand. They responded that when nutrition education experts provide nutrition education to people with disabilities, they must understand ‘the physical characteristics of persons with disabilities’ and have the ability to determine appropriate nutrition for such people. The most appropriate nutrition program training would be twice a year, lasting 30 min to 1 h per training session. Conclusions It will present a direction for operating a nutrition education program for persons with disabilities that meets their needs of social welfare facilities and ultimately contribute to the establishment and activation of nutrition education tailored to welfare facilities for such individuals in Korea.

OBJECTIVES: This study was aimed to investigate the neurocognitive functioning of patients with remitted bipolar disorder and compare with schizophrenic patients' neurocognitive functioning. METHODS: This issue was addressed by comparing remitted DSM-IV diagnosed bipolar, schizophrenics patients and controls on several clinical and neurocognitive measures. Clinical state was assessed using the Positive and Negative Syndrome Scale (PANSS), Young Mania Rating Scale (YMRS), and Montgomery-Asberg Depression Rating Scale (MADRS). Neurocognitive measures included the KWIS, WMS-III, Korean California Verbal Learning Test (K-CVLT), Wisconsin Card Sorting Test (WCST), Rey-Osterrieth Complex Test (RCFT), and Color Trails Test (CTT). Thirty-two subjects with remitted bipolar disorder, twenty-four remitted schizophrenia and twelve normal controls were studied. RESULTS: Analysis of variance (ANOVA) revealed no differences across groups on age, education and IQ. With respect to neurocognitive test performance, bipolar disorder patients and schizophrenic patients were similar and both groups were impaired compared to normal controls. Two diagnosed groups have persistent impairments in neurocognitive function, particularly in the domains of declarative memory. CONCLUSION: The results provide support for the view that remitted patients with bipolar disorder suffer cognitive impairment.
Bipolar Disorder ; California ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Schizophrenia ; Sensitivity and Specificity ; Verbal Learning ; Wisconsin

BACKGROUND: An increase in bone mineral density during adolescence increases resistance to fractures in older age. The Korean Society for Bone and Mineral Research and the Korean Society of Exercise Physiology developed exercise guidelines to increase the peak bone mass (PBM) in adolescents based on evidence through a systematic review of previous research.METHODS: Articles were selected using the systematic method, and the exercise guidelines were established by selecting key questions (KQs) and defining the effects of exercises based on evidence through a literature review for selecting the final exercise method. There were 9 KQs. An online search was conducted on articles published since 2000, and 93 articles were identified.RESULTS: An increase in PBM in adolescence was effective for preventing osteoporosis and fractures in older age. Exercise programs as part of vigorous physical activity (VPA) including resistance and impact exercise at least 5 to 6 months were effective for improving PBM in adolescents. It is recommended that resistance exercise is performed 10 to 12 rep·set⁻¹ 1-2 set·region⁻¹ and 3 days·week⁻¹ using the large muscles. For impact exercises such as jumping, it is recommended that the exercise is performed at least 50 jumps·min⁻¹, 10 min·day⁻¹ and 2 days·week⁻¹.CONCLUSIONS: Exercise guidelines were successfully developed, and they recommend at least 5 to 6 months of VPA, which includes both resistance and impact exercises. With the development of exercise guidelines, the incidence of osteoporosis and fractures in the aging society can be reduced in the future, thus contributing to improved public health.
Adolescent ; Aging ; Bone Density ; Exercise ; Humans ; Incidence ; Methods ; Miners ; Motor Activity ; Muscles ; Osteoporosis ; Physiology ; Public Health

BACKGROUND: Hospital admissions for ambulatory care sensitive conditions (ACSCs), which are widely used as an indicator of poor access to primary care, can be used as an efficiency indicator of healthcare use in countries providing good access to health care. Korea, which has a national health insurance (NHI) system and a good supply of health care resources, is one such country. To quantify admission rates of ACSC and identify characteristics influencing variation in Korean health care institutions. METHODS: By using NHI claims data, we computed the mean ACSC admission rate for all institutions with ACSC admissions. RESULTS: The average ACSC admission rate for 4,461 institutions was 1.45%. Hospitals and clinics with inpatient beds showed larger variations in the ACSC admission rate (0%-87.9% and 0-99.6%, respectively) and a higher coefficient of variation (7.96 and 2.29) than general/tertiary care hospitals (0%-19.1%, 0.85). The regression analysis results indicate that the ACSC admission rate was significantly higher for hospitals than for clinics (β=0.986, p<0.05), and for private corporate institutions than public institutions (β=0.271, p<0.05). CONCLUSION: Substantial variations in ACSC admission rates could suggest the potential problem of inefficient use of healthcare resources. Since hospitals and private corporate institutions tend to increase ACSC admission rates, future health policy should focus on these types of institutions.
Ambulatory Care* ; Delivery of Health Care* ; Health Policy ; Health Services Accessibility ; Humans ; Inpatients ; Korea* ; National Health Programs ; Primary Health Care