PURPOSE: The purpose of the present study was to identify prevalence of excessive daytime sleepiness(EDS) and its associations with sleep habits, sleep problems, depression, subjective health status and obesity in community dwelling adults. METHOD: Data was collected from adults aged 20-59 years by random sampling. Subjects completed a questionnaire which was composed of the Epworth Sleepiness Scale, Center for Epidemiologic Studies Depression Scale, and questions that included items about sleep habits, sleep problems, subjective health status and sociodemographic characteristics. Height and weight were measured for calculation of body mass index. The statistical analyses was based on 3,302 adults (51.5% males and 48.5% females). Descriptive statistics, univariate logistic regression and multiple logistic regression were used. RESULT: The prevalence of EDS was 17.1%. Multiple logistic regression showed that the associated factors of EDS were depression, obesity, dissatisfaction with sleep time, irregular sleep, and habitual snoring. Depression was the most significant associated factor(adjusted odds ratio for severe depression=2.27, 95% Confidence Interval=1.73-2.96). CONCLUSION: EDS is a common symptom in adults. Our finding suggested that persons with a complaint of EDS should be completely assessed for depression and obesity as well as sleep problems.
Activities of Daily Living ; Adult ; Cross-Sectional Studies ; Demography ; Depression ; Disorders of Excessive Somnolence/*diagnosis/*epidemiology ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Prevalence ; Questionnaires ; Sleep Initiation and Maintenance Disorders/epidemiology

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation that is usually progressive. It is a major cause of morbidity and mortality worldwide, leading to substantial and increasing economic and social burden. Palliative care for COPD patients aims to reduce symptoms and exacerbations and improve exercise tolerance and quality of life. It is difficult to make a prognosis for COPD patients due to the variable illness trajectory and advanced care of patients. However, severity of breathlessness, assessment of lung function impairment, and frequency of exacerbations can help to identify palliative care needs and determine effective methods to mitigate symptoms, which is discussed in this paper. In these patients, it is recommended to provide individualized palliative care along with curative/restorative care at the onset of COPD symptoms. Before launching a palliative care system in Korea, it is necessary to prepare pulmonary rehabilitation resources, patient-centered communication, timely palliative responsiveness, and a program for effective advanced care planning. A multidisciplinary approach involving collaboration with not only the respiratory and palliative care teams but also primary care offers a new model of care for these patients and should be considered with a priority.
Cooperative Behavior ; Dyspnea ; Exercise Tolerance ; Hospice Care ; Hospices* ; Humans ; Korea ; Lung ; Mortality ; Palliative Care* ; Primary Health Care ; Prognosis ; Pulmonary Disease, Chronic Obstructive* ; Quality of Life ; Rehabilitation ; Respiratory Therapy

Depression is a commonly encountered condition in the primary care that indicates low mood, loss of energy, sadness, loss of pleasure, sleep disorders or poor appetite, fatigue, and poor concentration. Of all the patients visiting the primary care, screening tests should be considered for the high-risk group and diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The purpose of treatment should be to assess and prevent the risk of suicides and administer medications, psychotherapy, and counseling to alleviate depression and restore daily life. Antidepressants are selected based on the comorbidities, side effects, and preferences of patients. These should be administered for a sufficient duration, followed by gradual reduction of the dosage and subsequent discontinuation of the drug. Counseling or psychotherapy may be considered for the treatment of depression. Primary care physicians should be skilled for screening, diagnosis, treatment, and counseling. Efficient treatment of depression in the primary care requires collaboration with the caregivers, psychiatrists, and nurse practitioners for assistance in its management.

Purpose: D-dimer levels are known to be associated with poor outcomes in patients with various cancers, but their significance at the end of life remains unclear. This study investigated D-dimer levels as a prognostic indicator for terminal cancer patients in the last hours of life. Methods: The retrospective study was conducted at a palliative care unit of a tertiary cancer center, using a database to analyze the records of patients treated from January 1, 2010 to December 31, 2018. In total, 67 terminal cancer patients with available data on Ddimer levels were included. Patients’ demographic data, clinical information, and laboratory values, including D-dimer levels, were collected. Survival was analyzed using the Kaplan– Meier method and the log-rank test. A Cox proportional-hazards model was used to identify prognostic factors of poor survival. Results: The most common site of cancer was the lung (32.8%) and the median survival time was 5 days. Most laboratory results, particularly D-dimer levels, deviated from the normal range. Patients with high D-dimer levels had a significantly shorter survival time than those with low D-dimer levels (4 days vs. 7 days; P=0.012). In the Cox regression analysis, only a high D-dimer level was identified as a predictor of a poor prognosis (hazard ratio, 1.83; 95% confidence interval, 1.09~3.07). Conclusion Our results suggest that at the very end of life, D-dimer levels may serve as a prognostic factor for survival in cancer patients.

Background: Alloantibodies against red blood cells (RBC) found in pregnant women can cause hemolytic disease in the fetus and newborn (HDFN). Therefore, checking and carefully observing the mother’s unexpected alloantibodies is essential during pregnancy. This study examined the frequency of unexpected antibodies according to the department. Methods: For patients who visited the authors’ hospital from December 31, 2020 to May 1, 2023 the results of RBC antibody screening and unexpected antibody identification tests were collected and classified according to the department. The antibody screening test was detected with Qwalys-3 DIAGAST, Loos Cedex, France) equipment using ABS HEMASCREEN (DIAGAST), and the antibody identification test was performed using the Resolve panel (Ortho-Clinical Diagnostics, San Diego, USA). The difference in frequency of each antibody according to the patient group was tested using Pearson’s chi-square test and Fisher’s exact test according to the relative frequency. Results: Among 46,193 patients who underwent unexpected antibody screening, 9,531 were obstetrics, and 18,313 were infertility centers. One hundred and seventy-seven patients underwent the unexpected antibody identification test: 57 obstetrics patients, 42 infertility center patients, and 78 positive patients who visited other departments.One hundred and ninety-three antibodies were identified, and there was no significant difference in the positive rate of unexpected antibodies by department. The antibody identified with the highest frequency was anti-M (18.1%) followed by anti-E (13.5%). Conclusion In the East Asian population, anti-M is frequently reported, causing clinical problems. Anti-M was also commonly observed in this study; so, the clinical features should be carefully observed if anti-M is identified.

Background: The factors associated with sleep disorder are controversial. This study aimed to evaluate the prevalence of sleep disorder and the factors associated with sleep disorder among Korean adult cancer survivors. Methods: In this cross-sectional study, we collected data on sleep problems as outcome variables, and sociodemographic and clinical information as predictor variables from cancer survivors at two university-affiliated hospitals. Sleep disorder was defined as “a difficulty in sleep initiation or sleep maintenance at least 3 times a week that started after a cancer diagnosis.” Multiple logistic regression analysis was performed with odds ratios (OR) and 95% confidence intervals (95% CI) to evaluate the factors associated with sleep disorder. Results: The participants were 1,893 Korean cancer survivors (mean age, 58.1 years; females 68.0%). The prevalence of sleep disorder among male and female cancer survivors were 16.5% and 20.3%, respectively. An increase of age by 1-year was associated with a 1.04 (95% CI, 1.01–1.07; P=0.011) times higher risk of sleep disorder in males, while an inverse association was found in females. In female survivors, high fear of cancer recurrence (FCR), high anxiety, menopause, and high EuroQol Visual Analog Scale were associated with 1.45 (95% CI, 1.06–1.98; P=0.020), 1.78 (95% CI, 1.25–2.55; P=0.002), 1.70 (95% CI, 1.08–2.67; P=0.022), and 0.59 (95% CI, 0.43–0.82; P=0.002) times higher risk of sleep disorder, respectively. In male survivors, living with a spouse/or partner was associated with 57% (95% CI, 0.20–0.95; P=0.036) lower risk of sleep disorder. Analyses of cancer sites showed that the factors associated with sleep disorder varied across cancer sites. Conclusion One-fifth of adult cancer survivors had sleep disorder. Age, menopausal status, FCR, anxiety, living with a spouse or partner, and quality of life were independently associated with sleep disorder in Korean cancer survivors.

Lung cancer survivors need to undergo continuous care by primary care physicians after acute treatment. The health problems of lung cancer survivors are associated with their treatment: for example, severe pain, respiratory difficulty, poor quality of life, or pneumonitis. They also have various comorbidities, such as stroke, myocardial infarction, arrhythmia, chronic obstructive pulmonary disease, or psychological problems. Surveillance of lung cancer survivors is based on an annual chest CT with routine physical examination. Incidence of second primary cancer in lung cancer survivors is reported to increase in the remnant lung, head and neck, kidney, bladder, thyroid, stomach, and breast. Therefore, lung cancer survivors need to undergo regular health examination for early detection of cancer. Smoking status, weight change, drinking behavior, and vaccination, especially influenza and pneumococcal vaccination, should be assessed whenever the patient meets a clinician. The primary care physician would be expected to take on the role of managing the health problems of Korean lung cancer survivors comprehensively, including physical and psychosocial problems, from screening to survivorship care.
Arrhythmias, Cardiac ; Breast ; Comorbidity ; Drinking Behavior ; Early Detection of Cancer ; Head ; Humans ; Incidence ; Influenza, Human ; Kidney ; Korea* ; Long-Term Care ; Lung Neoplasms* ; Lung* ; Mass Screening ; Myocardial Infarction ; Neck ; Neoplasms, Second Primary ; Physical Examination ; Physicians, Primary Care ; Pneumonia ; Primary Health Care ; Pulmonary Disease, Chronic Obstructive ; Quality of Life ; Smoke ; Smoking ; Stomach ; Stroke ; Survival Rate ; Survivors* ; Thyroid Gland ; Tomography, X-Ray Computed ; Urinary Bladder ; Vaccination

PURPOSE: The Lee Jong-Wook Seoul Project, which began in 2011, is a training program that aims to educate faculty members of Lao University of Health Sciences in medical knowledge and skills. The project has tremendous significance, attempting to apply the Korean health care developmental model to developing countries. Precise evaluation of the project outcome must be performed to enhance the effectiveness, improve the shortcomings, and adjust the future direction of the program. METHODS: Trainers and exchange professors were asked to fill out questionnaires in the middle and at the end of the program. Eight months after its completion, an evaluation team visited Lao and interviewed each exchange professor individually. Also, 360-degree feedback was obtained from their colleagues. We analyzed the answers to the questionnaires, based on Kirkpatrick's 4-level model. RESULTS: The trainers and exchange professors had positive reactions to the program. All participants felt that their knowledge and skills improved (in their respective fields), although the actual improvement was not extensive, according to their trainers' assessments. The 360-degree feedback demonstrated that the participants actively passed on their experience, knowledge, and skills to their colleagues on returning to work. CONCLUSION: Although a 4-level evaluation was not conducted and despite the limitations in examining academic achievement, interviewing Lao professors, and acquiring quantitative data at Lao University of Health Sciences, this project has demonstrated its value in the development of individual professors and their colleagues.
Delivery of Health Care ; Developing Countries ; Education ; Seoul* ; Surveys and Questionnaires

BACKGROUND: We examined the association between salivary mitochondrial DNA (mtDNA) copy number and chronic fatigue combined with depression and insomnia. METHODS: This cross-sectional study included 58 healthy adults with moderate to severe fatigue (Brief Fatigue Inventory [BFI] ≥4) for longer than 6 months. Subjects were classified as those without combined symptoms, with either depression (Beck Depression Inventory [BDI] ≥13) or insomnia (Pittsburgh Sleep Quality Index [PSQI] ≥5), or with both depression and insomnia. Salivary mtDNA copy number was measured by real-time quantitative polymerase chain reaction. The association was evaluated using a general linear model. RESULTS: About 76% of participants had either depression or insomnia as additional symptoms. These subjects were predominately female, drank more alcohol, and exercised less than those without combined symptoms (P<0.05). The group with both depression and insomnia exhibited significantly higher BFI and lower mtDNA copy number than those without combined symptoms (P<0.05). After adjusting for confounding factors, significant negative associations between mtDNA copy number and usual fatigue were found in the group without combined symptoms, whereas the negative associations in the group with combined symptoms were attenuated. BDI and PSQI were not associated with mtDNA copy number. CONCLUSION: Chronic fatigue is negatively associated with salivary mtDNA copy number. Salivary mtDNA copy number may be a biological marker of fatigue with or without combined symptoms, indicating that a separate approach is necessary.
Adult* ; Biomarkers ; Cross-Sectional Studies ; Depression ; Depressive Disorder ; DNA, Mitochondrial* ; Fatigue* ; Female ; Humans ; Linear Models ; Mental Fatigue ; Polymerase Chain Reaction ; Sleep Initiation and Maintenance Disorders ; Sleep Wake Disorders

BACKGROUND: Our objectives in this study were to (1) evaluate the possible role of p53, c-kit and CD34 proteins in sarcomas and to determine their potential relationship; (2) use a tissue microarray to compare the immunohistochemical staining results on both the tissue microarrays and the corresponding whole tissue sections. METHODS: Whole sections from 85 sarcomas were studied for the immunohistochemical expression of p53, c-kit and CD34. Tissue microarrays consisting of triplicate 2 mm cores from the corresponding blocks were constructed and stained according to the same protocols as those used for the whole sections. RESULTS: On whole section analysis, p53 protein was expressed in 25 cases (29.4%). Expression of c-kit was observed in 31 specimens (36.5%), whereas CD34 expression was noted in 11 tumors (12.9%). The overall concordance between triplicates was 96% (217/226). The consensus score from the combined triplicates agreed with the results on the whole sections at 91.4% (233/255). The correlations between p53 and CD34, and between c-kit and CD34, were statistically significant (p=.028 and p=.010 respectively). CONCLUSIONS: p53 and c-kit express relatively frequently in sarcomas. Tissue microarrays are an effective alternative to whole sections; however, the presence of triplicate punches seems to improve the yield but not the concordance of data.
Consensus ; Sarcoma* ; Tissue Array Analysis*