PURPOSE: We aimed to examine if past and more recent body mass index (BMI) changes are associated with eating behavior (EB) traits and whether these associations are due to non-genetic factors. MATERIALS AND METHODS: In 1321 Korean twins and family members, recent and past BMI change groups were defined using quartiles of BMI change between first and second visits over 2.4+/-0.9 years and BMI change between 20 years old and second visit, respectively. We applied linear mixed analysis for relationships of past or recent BMI change groups and each EB (restrained, external, and emotional EB using the Dutch Eating Behavior Questionnaire) assessed at second visit after adjusting for household effect and covariates (age, gender, education, medical history of diabetes, hypertension, and dyslipidemia, alcohol use, physical activity, smoking habit, and calorie intake). In monozygotic twin pairs, paired t-test for within-pair comparison and conditional logistic regression analysis were conducted regarding EB. RESULTS: Greater past BMI change was associated with higher restrained eating scores (P for trend=0.031), whereas greater recent BMI change was associated with higher external eating scores (P for trend=0.046). In co-twin-control analysis, twins with greater past BMI change were more likely to have higher restrained eating scores as compared with their co-twins with lower past BMI change (odds ratio 1.80; 95% confidence interval 1.13-2.87), whereas there were no associations between recent BMI change and external eating scores. CONCLUSION: Greater BMI change since 20 years old is associated with higher dietary restraint, and non-genetic factors explain this relationship.
Adult ; Aged ; Body Composition/physiology ; *Body Mass Index ; Body Weight/physiology ; Feeding Behavior/*physiology ; Female ; Humans ; Male ; Middle Aged ; Questionnaires ; Twins, Monozygotic

Objective: The aim of this study was to explore whether psychological inflexibility in the elderly population is related to social-distancing phobia, and examine whether their viral anxiety, preoccupation with sleep, or intolerance of uncertainty may mediate the relationship. Methods: Among the elderly population aged ≥65 in Korea, we conducted an anonymous online survey during January and February 2023. We collected the responses of 300 participants, collected demographic information, and symptoms using rating scales such as the Social-Distancing Phobia scale, Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), Intolerance of Uncertainty Scale-12 (IUS-12), Acceptance and Action Questionnaire-II (AAQ-II), and Glasgow Sleep Effort Scale (GSES). Results: Social-distancing phobia was expected by the SAVE-6 (β=0.34, p<0.001), IUS-12 (β=0.18, p=0.003), and GSES (β=0.18, p= 0.001) in the linear regression analysis. In the mediation analysis, psychological inflexibility did not directly influence social-distancing phobia. However, viral anxiety, intolerance of uncertainty, or preoccupation with sleep completely mediated the influence of psychological inflexibility on social-distancing phobia among elderly population. Conclusion The management of psychological inflexibility, intolerance of uncertainty, or preoccupation with sleep needs to be considered when designing interventions to address social-distancing phobia in elderly populations in future pandemics.

PUROPOSE: Surgical critically ill patients require adequate nutrition support and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) guidelines recommend low non-protein calorie:nitrogen ratio (NPC:N ratio, 70~100) for critically ill pateints. In this study, we assess the current use of early parenteral nutrition of surgical critically ill patients and analyze the clinical significance of NPC:N. METHODS: This is a retrospective study of critically ill adult patients who remained in the intensive care unit (ICU) for over 3 days and could not receive enteral nutrition for the first 7 days. Data on parenteral intake of patients were collected from electronic medical records. Association of NPC:N scores with clinical outcome (length of ICU stay, length; of hospital stay, duration of ventilation, and mortality) were analyzed using Pearson correlation and multiple regression. RESULTS: The study included 72 cases, average parenteral calorie intake was 14.6 kcal/kg/day and protein intake was 0.5 g/kg/day. We assessed the NPC:N scores to determine the patients' NPC:N for the first 7 days in ICU close to the A.S.P.E.N guidelines. NPC:N scores showed weak negative correlation with length of hospital stay and duration of mechanical ventilation (r=-0.259, P=0.028; r=-0.495, P=0.001). Multiple regression adjusted with APACHE (Acute Physiology and Chronic Health Evaluation) II score, age, and body mass index showed correlation of higher NPC:N score with decreased length of hospital stay and shorter duration of ventilation (P=0.0001, P=0.035, respectively). However, length of ICU stay and mortality within 60 days showed no significant correlation with NPC:N scores. CONCLUSION: Parenteral calories and protein intakes of critically ill patients in ICU were lower in comparison to A.S.P.E.N. recommendation in this study. Low NPC:N scores might be related to shorter length of hospital stay, duration of mechanical ventilation. Consultation of a nutritional support team could have a positive effect in providing appropriate nutrition support.
Adult ; APACHE ; Body Mass Index ; Critical Illness* ; Electronic Health Records ; Enteral Nutrition ; Humans ; Intensive Care Units ; Length of Stay ; Mortality ; Nitrogen* ; Nutritional Support ; Parenteral Nutrition* ; Physiology ; Protein-Energy Malnutrition ; Respiration, Artificial ; Retrospective Studies ; Ventilation

OBJECTIVES: The aim of this study was to develop a Korean version of a mood chart application on an Android platform. METHODS: This application is based on the traditional mood chart. Eighteen adults with DSM-5 bipolar disorder were enrolled from November 2016 to March 2017. They were asked to rate their daily mood scores and severity of irritability and impulsivity for six months. Their clinicians rated their symptom severity monthly using the Clinical Global Impression-7 (CGI-7) scale. After six months, the participants completed an anonymous questionnaire regarding their satisfaction with the application. RESULTS: Of the 18 patients, one withdrew their consent from this study and six were males (35.3%) ; their mean age was 31.71±8.56 years. The mean follow-up duration was 159.12±49.45 days and the period of application use was 143.65±52.11 days. The mean total response rate was 59.45% and the mean response rate on the same day was 43.06%. The adherence to using the application decreased significantly declined over the duration since enrollment [odds ratio (OR)=1.008, p=0.008] but tended to increase according to age (OR=0.958, p=0.002). The application mood scores were correlated significantly with the manic (β=0.307, p=0.004) and depressive (β=−0.701, p < 0.001) subscale, and the total (β=1.026, p=0.002) of the CGI-7 (linear mixed models). The majority of subjects agreed that the application helped them manage their symptoms (92.86%), stating that the application was easy to use (78.57%). CONCLUSION: This application could be a valid and useful tool to monitor the mood symptoms of patients with bipolar disorder in Korea.
Adult ; Anonyms and Pseudonyms ; Bipolar Disorder* ; Follow-Up Studies ; Humans ; Impulsive Behavior ; Korea ; Male ; Methyltestosterone ; Mood Disorders ; Self Care ; Smartphone* ; Telemedicine

Urinary incontinence (UI), affecting 3%-11% of males and 25%-45% of females globally, is expected to rise with an aging population. It significantly impacts mental health, causing depression, stress, and reduced quality of life. UI can exacerbate psychiatric conditions, affecting treatment compliance and effectiveness. Itis categorized into transient and chronic types. Transient UI, often reversible, is caused by factors summarized in the acronym DIAPPERS: Delirium, Infection, Atrophic urethritis/vaginitis, Psychological disorders, Pharmaceuticals, Excess urine output, Restricted mobility, Stool impaction. Chronic UI includes stress, urge, mixed, overflow, functional, and persistent incontinence. Drug-induced UI, a transient form, is frequently seen in psychiatric treatment. Antipsychotics, antidepressants, and other psychiatric medications can cause UI through various mechanisms like affecting bladder muscle tone, altering nerve reflexes, and inducing other conditions like diabetes or epilepsy. Specific drugs like lithium and valproic acid have also been linked to UI, though mechanisms are not al-ways clear. Managing UI in psychiatric patients requires careful monitoring of urinary symptoms and judiciousmedication management. If a drug is identified as the cause, options include discontinuing, reducing, or adjusting the dosage. In cases where medication continuation is necessary, additional treatments like desmopressin, oxybutynin, trihexyphenidyl, or amitriptyline may be considered.

BACKGROUND: Smoking effects are relatively well-documented, especially on cancers and cardiovascular diseases. However, the direction and magnitude of association between smoking and obesity remain unclear. Conflicting results so far are thought to stem from the multiple confounding structure of smoking and other obesogenic life style characteristics. METHODS: Cotwin control study is a genomic epidemiology design, in which the other twin (=cotwin) serves as a control of the twin. Cotwin control study, discordant for smoking habits can provide powerful evidence of association between smoking and obesity by completely matching genomic information, intrauterine environment, and almost all environmental factors. We selected 3,697 like-sex twin pairs (2,762 male and 935 female pairs) out of 63,666 pairs of adult twins in the existing Korea Twin and Family Register, whose smoking habits are discordant. We used the information of obesity as body mass index (BMI, kg/m2), blood pressure, and blood cholesterol level at the time or later than the smoking information. Paired t-test was done to compare the smoking effects. RESULTS: Lifetime smoking rate was 80.1% (47.9 current smoker) for men and 10% (1.7% current smoker) for women. Among 2,762 and 935 male and female like-sex twin pairs, 363 male pairs and 20 female pairs correspond to the definition of smoker-nonsmoker pair. The male smokers demonstrated increase in BMI by 0.47, while female smokers show slight decrease (by 0.13), which were not statistically significant. Diastolic and systolic blood pressure, and cholesterol level were slightly increased among smokers by 1.85 mmHg,0.62 mmHg, and 1.28 mg/dl for men. For women, the results show increase in diastolic blood pressure (3.42mmHg) and cholesterol level (1.25 mg/dl), and systolic pressure (8.17 mmHg). CONCLUSION: The results refute the possibility that smoking can reduce BMI. Considering the direct adverse effect of smoking, it should be emphasized that smoking do not decrease obesity and thus increase overall metabolic syndrome.
Adult ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Cholesterol ; Epidemiology ; Female ; Humans ; Korea ; Life Style ; Male ; Obesity ; Risk Factors* ; Smoke* ; Smoking* ; Twins

Bone mineral density (BMD) has been suggested to be associated with atherosclerosis. In the present study, we evaluated the association between lumbar BMD and the segments of carotid intima-media thickness (CIMT), a surrogate marker of subclinical atherosclerosis, in Korean adults, with consideration of sex and menopause status. Among 1,679 Korean adults who enrolled in a Healthy Twin Study, 723 men, 690 premenopausal women, and 266 postmenopausal women measured the CIMT at the common carotid artery intima-media thickness (CCA-IMT), carotid bifurcation intima-media thickness (BIF-IMT), internal carotid artery intima-media thickness (ICA-IMT) using B-mode ultrasound and lumbar BMD using dual-energy X-ray absorptiometry. The composite CIMT was calculated as the mean value of three CIMTs. The association was evaluated using linear mixed models. In premenopausal women, lumbar BMD was positively associated with composite CIMT and with CCA-IMT (P = 0.008 and 0.002, respectively). However, no association was observed between BMD and CIMT in men or in postmenopausal women. Stratified analysis revealed the effect of body mass index (BMI) on the association between BMD and CIME. The positive association in premenopausal women persisted only in low BMI (< 25 kg/m²) group, whereas a positive association appeared at high BMI (≥ 25 kg/m²) group in men. A high lumbar BMD may indicate an elevated risk of subclinical atherosclerosis in premenopausal women and men with high BMI.
Absorptiometry, Photon ; Adult* ; Atherosclerosis ; Biomarkers ; Body Mass Index ; Bone Density* ; Carotid Arteries ; Carotid Artery, Common ; Carotid Artery, Internal ; Carotid Intima-Media Thickness* ; Cross-Sectional Studies* ; Female ; Humans ; Male ; Menopause ; Osteoporosis ; Twins* ; Ultrasonography

Objective: This study assessed the reliability and validity of the Stress and Anxiety to Viral Epidemics–9 items (SAVE-9) and Stress and Anxiety to Viral Epidemics–6 items (SAVE-6) scales for measuring viral anxiety among firefighters during the coronavirus disease-2019 pandemic. Methods: An online survey was conducted among 304 firefighters assigned in Gyeonggi-do. The SAVE-9 scale, initially developed for healthcare workers, was adapted for firefighters. We compared it with the SAVE-6 scale designed for the general population among the firefighters sample. The confirmatory factor analysis (CFA) was conducted to explore the factor structure of both scales. Internal consistency reliability was checked using Cronbach’s alpha and McDonald’s omega. Convergent validity was assessed in accordance with the Patient Health Questionnaire–9 and Generalized Anxiety Disorder–7 scales. Results: The SAVE-9 scale demonstrated a Cronbach alpha of 0.880, while the SAVE-6 scale yielded an alpha of 0.874. CFA indicated good model fits for both SAVE-9 and SAVE-6 scales among firefighters sample. The SAVE-9 and SAVE-6 comparably measures viral anxiety of firefighters. Conclusion Both of the SAVE-9 and SAVE-6 scales are reliable and valid instruments for assessing viral anxiety among firefighters during the pandemic.