OBJECTIVES: Humidifier disinfectants (HDs) were sold in Korea from 1994 until their recall in 2011. We examined the incidence patterns of 8 respiratory diseases before and after the HD recall and estimated the attributable risk in the Korean population. METHODS: Using National Health Insurance data from 2002 to 2019, we performed age–cohort–period and differences-in-diffference analyses (comparing periods before vs. after the recall) to estimate the population-attributable fraction and the excess number of episodes. The database comprised 51 million individuals (99% of the Korean population). The incidence of 8 diseases—acute upper respiratory infection (AURI), acute lower respiratory infection (ALRI), asthma, pneumonia, chronic sinusitis (CS), interstitial lung disease (ILD), bronchiectasis, and chronic obstructive pulmonary disease (COPD)—was defined by constructing episodes of care based on patterns of medical care and the clinical characteristics of each disease. RESULTS: The relative risks (RRs) for AURI, ALRI, asthma, pneumonia, CS, and ILD were elevated among younger individuals (with an RR as high as 82.18 for AURI in males), whereas chronic conditions such as bronchiectasis, COPD, and ILD showed higher RRs in older individuals. During the HD exposure period, the population-attributable risk percentage ranged from 4.6% for bronchiectasis to 25.1% for pneumonia, with the excess number of episodes ranging from 6,218 for ILD to 3,058,861 for CS. Notably, females of reproductive age (19-44 years) experienced 1.1-9.2 times more excess episodes than males. CONCLUSIONS This study provides epidemiological evidence that inhalation exposure to HDs affects the entire respiratory tract and identifies vulnerable groups.

OBJECTIVES: Humidifier disinfectants (HDs) were sold in Korea from 1994 until their recall in 2011. We examined the incidence patterns of 8 respiratory diseases before and after the HD recall and estimated the attributable risk in the Korean population. METHODS: Using National Health Insurance data from 2002 to 2019, we performed age–cohort–period and differences-in-diffference analyses (comparing periods before vs. after the recall) to estimate the population-attributable fraction and the excess number of episodes. The database comprised 51 million individuals (99% of the Korean population). The incidence of 8 diseases—acute upper respiratory infection (AURI), acute lower respiratory infection (ALRI), asthma, pneumonia, chronic sinusitis (CS), interstitial lung disease (ILD), bronchiectasis, and chronic obstructive pulmonary disease (COPD)—was defined by constructing episodes of care based on patterns of medical care and the clinical characteristics of each disease. RESULTS: The relative risks (RRs) for AURI, ALRI, asthma, pneumonia, CS, and ILD were elevated among younger individuals (with an RR as high as 82.18 for AURI in males), whereas chronic conditions such as bronchiectasis, COPD, and ILD showed higher RRs in older individuals. During the HD exposure period, the population-attributable risk percentage ranged from 4.6% for bronchiectasis to 25.1% for pneumonia, with the excess number of episodes ranging from 6,218 for ILD to 3,058,861 for CS. Notably, females of reproductive age (19-44 years) experienced 1.1-9.2 times more excess episodes than males. CONCLUSIONS This study provides epidemiological evidence that inhalation exposure to HDs affects the entire respiratory tract and identifies vulnerable groups.

OBJECTIVES: Humidifier disinfectants (HDs) were sold in Korea from 1994 until their recall in 2011. We examined the incidence patterns of 8 respiratory diseases before and after the HD recall and estimated the attributable risk in the Korean population. METHODS: Using National Health Insurance data from 2002 to 2019, we performed age–cohort–period and differences-in-diffference analyses (comparing periods before vs. after the recall) to estimate the population-attributable fraction and the excess number of episodes. The database comprised 51 million individuals (99% of the Korean population). The incidence of 8 diseases—acute upper respiratory infection (AURI), acute lower respiratory infection (ALRI), asthma, pneumonia, chronic sinusitis (CS), interstitial lung disease (ILD), bronchiectasis, and chronic obstructive pulmonary disease (COPD)—was defined by constructing episodes of care based on patterns of medical care and the clinical characteristics of each disease. RESULTS: The relative risks (RRs) for AURI, ALRI, asthma, pneumonia, CS, and ILD were elevated among younger individuals (with an RR as high as 82.18 for AURI in males), whereas chronic conditions such as bronchiectasis, COPD, and ILD showed higher RRs in older individuals. During the HD exposure period, the population-attributable risk percentage ranged from 4.6% for bronchiectasis to 25.1% for pneumonia, with the excess number of episodes ranging from 6,218 for ILD to 3,058,861 for CS. Notably, females of reproductive age (19-44 years) experienced 1.1-9.2 times more excess episodes than males. CONCLUSIONS This study provides epidemiological evidence that inhalation exposure to HDs affects the entire respiratory tract and identifies vulnerable groups.

OBJECTIVES: Humidifier disinfectants (HDs) were sold in Korea from 1994 until their recall in 2011. We examined the incidence patterns of 8 respiratory diseases before and after the HD recall and estimated the attributable risk in the Korean population. METHODS: Using National Health Insurance data from 2002 to 2019, we performed age–cohort–period and differences-in-diffference analyses (comparing periods before vs. after the recall) to estimate the population-attributable fraction and the excess number of episodes. The database comprised 51 million individuals (99% of the Korean population). The incidence of 8 diseases—acute upper respiratory infection (AURI), acute lower respiratory infection (ALRI), asthma, pneumonia, chronic sinusitis (CS), interstitial lung disease (ILD), bronchiectasis, and chronic obstructive pulmonary disease (COPD)—was defined by constructing episodes of care based on patterns of medical care and the clinical characteristics of each disease. RESULTS: The relative risks (RRs) for AURI, ALRI, asthma, pneumonia, CS, and ILD were elevated among younger individuals (with an RR as high as 82.18 for AURI in males), whereas chronic conditions such as bronchiectasis, COPD, and ILD showed higher RRs in older individuals. During the HD exposure period, the population-attributable risk percentage ranged from 4.6% for bronchiectasis to 25.1% for pneumonia, with the excess number of episodes ranging from 6,218 for ILD to 3,058,861 for CS. Notably, females of reproductive age (19-44 years) experienced 1.1-9.2 times more excess episodes than males. CONCLUSIONS This study provides epidemiological evidence that inhalation exposure to HDs affects the entire respiratory tract and identifies vulnerable groups.

Purpose: Cuscuta australis R. Brown (CA) is a parasitic plant that attaches to host plants and disrupts the growth, nutrient absorption, and overall development of leguminous plants.However, CA is known to contain various bioactive components, including vitamin A, β-carotene, lutein, and kaempferol, which have demonstrated pharmacological effects in immune responses. This study aims to investigate the potential benefits of CA extracts obtained using different extraction methods to explore its potential as a novel natural resource for applications in the food and pharmaceutical industries. Methods: In this study, water (CAW), ethanol (CAE), and hot water (CAHW) extracts of CA were prepared to investigate their antioxidant and anti-inflammatory effects in RAW264.7 cells. Results: The CAHW group exhibited the highest levels of antioxidant compounds, such as total polyphenols and flavonoids, resulting in a significantly higher ferric reducing antioxidant power compared to the other groups. The 1,1-diphenyl-2-picrylhydrazyl and 2,2-azino-bis-3-ethylen-benzothiazoline-6-sulfonate radical scavenging activities were also high in the CAHW and CAE groups but were lower compared to the positive control, ascorbic acid. In RAW264.7 cells, CA extracts at concentrations of 50, 100, and 200 μg/mL showed no cytotoxicity, and nitric oxide (NO) production was reduced in a dose-dependent manner.At a concentration of 200 μg/mL, all the CA extracts exhibited significant anti-inflammatory activity by modulating the nuclear factor kappa B signaling pathway, effectively resulting in the down-regulation of inflammation-related genes such as cyclooxygenase-2, inducible NO synthase, tumor necrosis factor-alpha, and interleukin-6 in RAW264.7 cells, with the CAHW extract demonstrating the most potent inhibitory effect among all the CA extract groups. Conclusion Overall, CA extraction is effective for both antioxidant and anti-inflammatory activities, with the hot water extraction method proving to be the most effective.

Purpose: Cuscuta australis R. Brown (CA) is a parasitic plant that attaches to host plants and disrupts the growth, nutrient absorption, and overall development of leguminous plants.However, CA is known to contain various bioactive components, including vitamin A, β-carotene, lutein, and kaempferol, which have demonstrated pharmacological effects in immune responses. This study aims to investigate the potential benefits of CA extracts obtained using different extraction methods to explore its potential as a novel natural resource for applications in the food and pharmaceutical industries. Methods: In this study, water (CAW), ethanol (CAE), and hot water (CAHW) extracts of CA were prepared to investigate their antioxidant and anti-inflammatory effects in RAW264.7 cells. Results: The CAHW group exhibited the highest levels of antioxidant compounds, such as total polyphenols and flavonoids, resulting in a significantly higher ferric reducing antioxidant power compared to the other groups. The 1,1-diphenyl-2-picrylhydrazyl and 2,2-azino-bis-3-ethylen-benzothiazoline-6-sulfonate radical scavenging activities were also high in the CAHW and CAE groups but were lower compared to the positive control, ascorbic acid. In RAW264.7 cells, CA extracts at concentrations of 50, 100, and 200 μg/mL showed no cytotoxicity, and nitric oxide (NO) production was reduced in a dose-dependent manner.At a concentration of 200 μg/mL, all the CA extracts exhibited significant anti-inflammatory activity by modulating the nuclear factor kappa B signaling pathway, effectively resulting in the down-regulation of inflammation-related genes such as cyclooxygenase-2, inducible NO synthase, tumor necrosis factor-alpha, and interleukin-6 in RAW264.7 cells, with the CAHW extract demonstrating the most potent inhibitory effect among all the CA extract groups. Conclusion Overall, CA extraction is effective for both antioxidant and anti-inflammatory activities, with the hot water extraction method proving to be the most effective.

Purpose: Cuscuta australis R. Brown (CA) is a parasitic plant that attaches to host plants and disrupts the growth, nutrient absorption, and overall development of leguminous plants.However, CA is known to contain various bioactive components, including vitamin A, β-carotene, lutein, and kaempferol, which have demonstrated pharmacological effects in immune responses. This study aims to investigate the potential benefits of CA extracts obtained using different extraction methods to explore its potential as a novel natural resource for applications in the food and pharmaceutical industries. Methods: In this study, water (CAW), ethanol (CAE), and hot water (CAHW) extracts of CA were prepared to investigate their antioxidant and anti-inflammatory effects in RAW264.7 cells. Results: The CAHW group exhibited the highest levels of antioxidant compounds, such as total polyphenols and flavonoids, resulting in a significantly higher ferric reducing antioxidant power compared to the other groups. The 1,1-diphenyl-2-picrylhydrazyl and 2,2-azino-bis-3-ethylen-benzothiazoline-6-sulfonate radical scavenging activities were also high in the CAHW and CAE groups but were lower compared to the positive control, ascorbic acid. In RAW264.7 cells, CA extracts at concentrations of 50, 100, and 200 μg/mL showed no cytotoxicity, and nitric oxide (NO) production was reduced in a dose-dependent manner.At a concentration of 200 μg/mL, all the CA extracts exhibited significant anti-inflammatory activity by modulating the nuclear factor kappa B signaling pathway, effectively resulting in the down-regulation of inflammation-related genes such as cyclooxygenase-2, inducible NO synthase, tumor necrosis factor-alpha, and interleukin-6 in RAW264.7 cells, with the CAHW extract demonstrating the most potent inhibitory effect among all the CA extract groups. Conclusion Overall, CA extraction is effective for both antioxidant and anti-inflammatory activities, with the hot water extraction method proving to be the most effective.

OBJECTIVES: Inhalation exposure to humidifier disinfectants has resulted to various types of health damages in Korea. To determine the epidemiological correlation necessary for presuming the legal causation, we aimed to develop a method to synthesize the entire evidence. METHODS: Epidemiological and toxicological studies are systematically reviewed. Target health problems are selected by criteria such as frequent complaints of claimants. Relevant epidemiologic studies are reviewed and the risk of bias and confidence level of the total evidence are evaluated. Toxicological literature reviews are conducted on three lines of evidence including hazard information, animal studies, and mechanistic studies, considering the source-to-exposure-to-outcome continuum. The confidence level of the body of evidence is then translated into the toxicological evidence levels for the causality between humidifier disinfectant exposure and health effects. Finally, the levels of epidemiological and toxicological evidence are synthesized. RESULTS: Under the Special Act revised in 2020, if the history of exposure and the disease occurred/worsened after exposure were approved, and the epidemiological correlation between the exposure and disease was verified, the legal causation is presumed unless the company proves the evidence against it. The epidemiological correlation can be verified through epidemiological investigations, health monitoring, cohort investigations and/or toxicological studies. It is not simply as statistical association as understood in judicial precedents, but a general causation established by the evidence as a whole, i.e., through weight-of-the-evidence approach. CONCLUSIONS The weight-of-the-evidence approach differs from the conclusive single study approach and this systematic evidence integration can be used in presumption of causation.

Objectives: ：The turnover rate of mental health workers in community mental health institutes is remarkably high.We explored the mediating effects of perceived work value on the relationship between burnout and turnover intention among mental health professionals working for community mental health centers and addiction centers. Methods: ：A total of 161 mental health workers completed this survey. We administered the Maslach Burnout Inventory-General Survey (MBI-GS) and the Michigan Organizational Assessment Questionnaire (MOAQ) (which explores turnover intention). Perceived work value was assessed using two items of the Scale of Resilience to Burnout.Associations were sought using the t-test, analysis of variance, correlation analyses, and hierarchical regression analyses. Results: ：The burnout level was significantly negatively correlated with perceived work value. Burnout was significantly positively correlated with turnover intention, and perceived work value significantly negatively correlated. Bootstrapping showed that perceived work value partially mediated the relationship between burnout and turnover intention. Conclusion ：Perceived work value may buffer turnover intention caused by burnout. Creation of an environment in which mental health workers feel that their work is valuable is important to prevent resignations.

Purpose: This study evaluated the surgical volumes and types of specific surgical procedures in a single trauma center for 3 consecutive years. Methods: From January 2014 to December 2016 there were 9,530 injury cases in the trauma registry that were reviewed. Results: There were 1,502 patients (15.8%) with an injury severity score over 15, of which 426 (28.4%) underwent an emergency operation or had an interventional radiology procedure. There were 186 craniotomies, 87 laparotomies, and 74 interventional radiology procedures performed. Conclusion The number of emergency operations by each dedicated trauma surgeon was very low therefore implementation of an acute-care surgery model is appropriate to consider together with changes to the training program for trauma surgeons.