Objectives: This study aimed to investigate the prevalence of unhealthy dietary habits by maternal educational level and how the effect of maternal education changed between 2009 and 2019. Methods: Using data from the Korea Youth Risk Behavior Survey conducted between 2009 and 2019, we assessed the prevalence of each unhealthy dietary habit (insufficient consumption of milk and fruit/vegetable, breakfast-skipping, and frequent consumption of fast food, soft drinks, and instant noodles) and the prevalence difference between maternal middle/high school and college graduate groups in four periods. The models included maternal educational level, four periods and the interaction between them, sex, and grade. In addition, we estimated the ORs of unhealthy dietary habits between the two maternal educational groups at each period. Results: Throughout the study period, unhealthy dietary habits were consistently more prevalent among mothers with lower education levels. Between 2009–2010 and 2017– 2019, the prevalence of unhealthy dietary habits increased, with a particular increase in that of frequent consumption of fast food and soft drink. The prevalence differentials between the middle school and college graduate group decreased or did not differ, while those between the high school and college graduate groups increased over time.A similar trend was observed in the relative scale. Conclusion Considering the increase in the prevalence of unhealthy dietary habits and the prevalence differentials by maternal educational level, targeted efforts are needed not only for all adolescents and their parents but also for those with low socioeconomic status to improve the dietary habits of adolescents.

Objective: We examined the performance of attention tests related to suicidal ideation in mood disorder patients and to explain the differenceof attention test performance in relation to suicidal ideation after controlling clinical and psychological variables of mood disorderpatients. Methods: Seventy-three in- and outpatients with major depressive disorder (n=41) or bipolar disorder (n=32) completed a self-ratingquestionnaire assessing socio-demographic characteristics, and clinical and psychological variables. Comprehensive Attention Test(CAT) also was conducted. Results: Thirty-three patients were the high-suicidal ideation (SI) group, and forty patients were the low-SI group. The errors of commission(CEs) of visual sustained attention in the high-SI group was 6.3 times higher on average than that of the low-SI group. Aftercontrolling for sex, age, and diagnosis, a higher number of CEs on visual sustained attention tasks predicted higher SI score. However,after controlling for sex, age, diagnosis, and depressive mood, this predictive ability was no longer observed. Conclusion This study showed that CE on the visual sustained attention task seems to influence suicidal ideation as a result of interactionwith depressive symptoms. Psychiatry Investig 2020;17(4):374-381

OBJECTIVE: Several abbreviated versions of the Alcohol Use Disorder Identification Test (AUDIT) have been developed and used widely in clinical settings. This paper provides evidence supporting the use of abbreviated versions of AUDIT by comparing the utility of various abbreviated versions and determining the cut-off values for the population of South Korea. METHODS: Data were obtained from the 4th to 6th Korean National Health and Nutrition Examination Surveys. After calculating the whole AUDIT score, the cut-off value of at-risk drinking proposed by the World Health Organization was applied and the study sample was divided into normal and at-risk drinking groups. Receiver operating characteristic curves were drawn for the AUDIT-3rd question (Q3) alone, AUDIT-quantity and frequency (QF), AUDIT-consumption (C), AUDIT-4, and AUDIT-primary clinic (PC), and the optimal cut-off values were obtained for each group. RESULTS: A total of 46,450 subjects were analyzed. The at-risk drinking group comprised 29.2% of all subjects. The area under the receiver operating characteristic curve (AUROC) of the abbreviated versions of AUDIT increased from 0.954 to 0.991 as the number of questions was increased from one to four. The differences in the AUROC between the abbreviated versions of AUDIT were statistically significant. The most appropriate cut-off values for AUDIT-Q3 alone, AUDIT-QF, AUDIT-C, AUDIT-4, and AUDIT-PC for adults over age 19 were 2, 4, 5, 6, and 4 points, respectively. CONCLUSION: As the number of items analyzed increased from one to four, the AUROC increased to a statistically significant level. The cut-off values for the abbreviated versions of AUDIT were similar in South Korea to other countries.
Adult ; Alcohol-Related Disorders ; Alcoholism ; Drinking ; Humans ; Korea ; Nutrition Surveys* ; ROC Curve ; World Health Organization

OBJECTIVE: Several abbreviated versions of the Alcohol Use Disorder Identification Test (AUDIT) have been developed and are widely used in clinical settings. In this study, we provide evidence supporting the use of abbreviated versions of AUDIT by comparing the utility of various abbreviated versions and determining cut-off values for the population of South Korea. METHODS: Data were obtained from the 4th to 6th Korean National Health and Nutrition Examination Surveys. After calculating the whole AUDIT score, we applied the cut-off value of at-risk drinking proposed by the World Health Organization and divided the study sample into normal and at-risk drinking groups. Receiver operating characteristic curves were drawn for AUDIT-3rd question (Q3) alone, AUDIT-quantity and frequency (QF), AUDIT-consumption (C), AUDIT-4, and AUDIT-primary clinic (PC), and optimal cut-off values were obtained for each group. RESULTS: A total of 46,450 subjects were analyzed. The at-risk drinking group comprised 29.2% of all subjects. The area under receiver operating characteristic curve (AUROC) of the abbreviated versions of AUDIT increased from 0.954 to 0.991 as the number of questions increased from one to four. The differences in AUROC between the abbreviated versions of AUDIT were statistically significant. The most appropriate cut-off values for AUDIT-Q3 alone, AUDIT-QF, AUDIT-C, AUDIT-4, and AUDIT-PC for adults over age 19 were 2, 4, 5, 6, and 4 points, respectively. CONCLUSION: As the number of items analyzed increased from one to four items, the AUROC increased to a statistically significant level. Cut-off values for abbreviated versions of AUDIT are similar in South Korea to other countries.
Adult ; Alcohol-Related Disorders ; Alcoholism ; Drinking ; Humans ; Korea ; Nutrition Surveys* ; ROC Curve ; World Health Organization

BACKGROUND AND PURPOSE: Visual assessment of medial temporal-lobe atrophy (MTA) has been quick, reliable, and easy to apply in routine clinical practice. However, one of the limitations in visual assessments of MTA is the lack of widely accepted age-adjusted norms and cutoff scores for MTA for a diagnosis of Alzheimer's disease (AD). This study aimed to determine the optimal cutoff score on a T1-weighted axial MTA Visual Rating Scale (VRS) for differentiating patients with AD from cognitively normal elderly people. METHODS: The 3,430 recruited subjects comprising 1,427 with no cognitive impairment (NC) and 2003 AD patients were divided into age ranges of 50–59, 60–69, 70–79, and 80–89 years. Of these, 446 participants (218 in the NC group and 228 in the AD group) were chosen by random sampling for inclusion in this study. Each decade age group included 57 individuals, with the exception of 47 subjects being included in the 80- to 89-year NC group. The scores on the T1-weighted axial MTA VRS were graded by two neurologists. The cutoff values were evaluated from the area under the receiver operating characteristic curve. RESULTS: The optimal axial MTA VRS cutoff score from discriminating AD from NC increased with age: it was ≥as ≥1, ≥2, and ≥3 in subjects aged 50–59, 60–69, 70–79, and 80–89 years, respectively (all p < 0.001). CONCLUSIONS: These results show that the optimal cutoff score on the axial MTA VRS for diagnosing of AD differed according to the decade age group. This information could be of practical usefulness in the clinical setting.
Aged ; Alzheimer Disease* ; Atrophy* ; Cognition Disorders ; Dementia* ; Diagnosis ; Humans ; Korea* ; Pemetrexed ; ROC Curve

PURPOSE: Serum level of 25-hydroxyvitamin D (25-OHD) is considered as the most appropriate marker of vitamin D status. However, only a few studies have investigated the relationship between 25-OHD and parathyroid hormone (PTH) in children. To this end, this study was aimed at evaluating the lowest 25-OHD level that suppresses the production of parathyroid hormone in children. METHODS: A retrospective record review was performed for children aged 0.2 to 18 years (n=193; 106 boys and 87 girls) who underwent simultaneous measurements of serum 25-OHD and PTH levels between January 2010 and June 2014. RESULTS: The inflection point of serum 25-OHD level for maximal suppression of PTH was at 18.0 ng/mL (95% confidence interval, 14.3–21.7 ng/mL). The median PTH level of the children with 25-OHD levels of <18.0 ng/mL was higher than that of children with 25-OHD levels ≥ 18.0 ng/mL (P<0.0001). The median calcium level of children with 25-OHD levels<18.0 ng/mL was lower than that of children with 25-OHD levels≥18.0 ng/mL (P=0.0001). The frequency of hyperparathyroidism was higher in the children with 25-OHD levels<18.0 ng/mL than in the children with 25-OHD levels≥18.0 ng/mL (P<0.0001). Hypocalcemia was more prevalent in the children with 25-OHD levels<18.0 ng/mL than in the children with 25-OHD levels≥18.0 ng/mL (P<0.0001). CONCLUSION: These data suggest that a vitamin D level of 18.0 ng/mL could be the criterion for 25-OHD deficiency in children at the inflection point of the maximal suppression of PTH.
Calcium ; Child* ; Humans ; Hyperparathyroidism ; Hypocalcemia ; Parathyroid Hormone* ; Retrospective Studies ; Vitamin D ; Vitamin D Deficiency

The reliability of clinical measurements is critical to medical research and clinical practice. Newly proposed methods are assessed in terms of their reliability, which includes their repeatability, intra- and interobserver reproducibility. In general, new methods that provide repeatable and reproducible results are compared with established methods used clinically. This paper describes common statistical methods for assessing reliability and agreement between methods, including the intraclass correlation coefficient, coefficient of variation, Bland-Altman plot, limits of agreement, percent agreement, and the kappa statistic. These methods are more appropriate for estimating reliability than hypothesis testing or simple correlation methods. However, some methods of reliability, especially unscaled ones, do not clearly define the acceptable level of error in real size and unit. The Bland-Altman plot is more useful for method comparison studies as it assesses the relationship between the differences and the magnitude of paired measurements, bias (as mean difference), and degree of agreement (as limits of agreement) between two methods or conditions (e.g., observers). Caution should be used when handling heteroscedasticity of difference between two measurements, employing the means of repeated measurements by method in methods comparison studies, and comparing reliability between different studies. Additionally, independence in the measuring processes, the combined use of different forms of estimating, clear descriptions of the calculations used to produce indices, and clinical acceptability should be emphasized when assessing reliability and method comparison studies.
Bias (Epidemiology) ; Methods* ; Reproducibility of Results

Crohn's disease (CD) is a chronic inflammatory bowel disease with multifactorial causes including environmental and genetic factors. Several studies have demonstrated that the organic cation/carnitine transporter 1 (OCTN1) non-synonymous variant L503F is associated with susceptibility to CD. However, it was reported that L503F is absent in Asian populations. Previously, we identified and functionally characterized genetic variants of the OCTN1 promoter region in Koreans. In that study, four variants demonstrated significant changes in promoter activity. In the present study, we determined whether four functional variants of the OCTN1 promoter play a role in the susceptibility to or clinical course of CD in Koreans. To examine it, the frequencies of the four variants of the OCTN1 promoter were determined by genotyping using DNA samples from 194 patients with CD and 287 healthy controls. Then, associations between genetic variants and the susceptibility to CD or clinical course of CD were evaluated. We found that susceptibility to CD was not associated with OCTN1 functional promoter variants or haplotypes showing altered promoter activities in in vitro assays. However, OCTN1 functional promoter haplotypes showing decreased promoter activities were significantly associated with a penetrating behavior in CD patients (HR=2.428, p=0.009). Our results suggest that the OCTN1 functional promoter haplotypes can influence the CD phenotype, although these might not be associated with susceptibility to this disease.
Asian Continental Ancestry Group ; Crohn Disease* ; DNA ; Haplotypes* ; Humans ; In Vitro Techniques ; Inflammatory Bowel Diseases ; Phenotype ; Promoter Regions, Genetic

Although the overall incidence of hepatitis A in Korea has been decreasing, adolescents remain highly vulnerable to its outbreaks. This study was conducted to compare the immunogenicity and safety of three hepatitis A vaccines in Korean adolescents. Healthy anti-hepatitis A virus seronegative subjects aged 13 to 19 yr were randomized in three equal groups to receive two doses of Avaxim(TM), Epaxal(R), or Havrix(R), 6 to 12 months apart. Seroconversion rates one month after the first dose were 98%, 95%, and 93% for Avaxim(TM), Epaxal(R), and Havrix(R), respectively. Seroconversion rates reached 100% for all vaccine groups one month after the second dose. Anti-HAV geometric mean concentrations (GMCs) were 7,207.7 mIU/mL (95% CI, 6023.1-8684.7), 1,750.5 mIU/mL (95% CI, 1362.9-2248.3), and 1,953.5 mIU/mL (95% CI, 1459.4-2614.7) after two doses of Avaxim(TM), Epaxal(R), and Havrix(R) respectively. Avaxim(TM) was significantly more immunogenic than Epaxal(R) and Havrix(R), whereas there were no significant differences in antibody responses between Epaxal(R) and Havrix(R). Local and systemic solicited adverse events (AEs) were mostly of mild-to-moderate intensity and resolved within 5 days. No serious AEs were reported. In conclusion, all three vaccines are highly immunogenic and well-tolerated in Korean adolescents. (Clinical Trial Registry NCT00483470)
Adolescent ; Antibody Formation ; Female ; Hepatitis A/immunology/*prevention & control ; Hepatitis A Antibodies/blood ; Hepatitis A Vaccines/adverse effects/*immunology ; Humans ; Male ; Republic of Korea ; Vaccines, Inactivated/adverse effects/immunology ; Young Adult

Richter's syndrome refers to the development of aggressive lymphoma in a patient with chronic lymphocytic leukemia (CLL). It occurs in about 2% to 10% of patients with CLL. The most frequent manifestation of Richter's syndrome is diffuse large B cell lymphoma (DLBCL). Extranodal involvement is rare but can occur. The prognosis of Richter's syndrome is very poor. We herein report a case of a rare presentation of Richter's syndrome. A 42-year-old man diagnosed with CLL 2 years previously developed nodules on the bilateral thighs and buttocks. A positron emission tomography (PET)-CT scan revealed high fluorodeoxyglucose uptake in multiple lymph nodes, skeletal muscles, and the myocardium. An ultrasonography-guided biopsy confirmed Richter's syndrome from CLL to DLBCL. The patient was treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy. After six cycles of chemotherapy, we performed a PET-CT scan that revealed a complete response. However, 3 months later, the syndrome recurred. The patient was undergoing salvage chemotherapy at the time of this writing.
Adult ; Biopsy ; Buttocks ; Cyclophosphamide ; Doxorubicin ; Drug Therapy ; Humans ; Leukemia, Lymphocytic, Chronic, B-Cell ; Lymph Nodes ; Lymphoma ; Lymphoma, B-Cell* ; Muscle, Skeletal ; Myocardium ; Positron-Emission Tomography ; Prednisone ; Prognosis ; Thigh ; Vincristine ; Writing ; Rituximab