Timely accessibility to healthcare resources and heatwave-related mortality in 7 major cities of South Korea: a two-stage approach with principal component analysis.

Background: Due to the ongoing effects of climate change, the incidence of heatwave-related mortality is rising globally. Improved allocation and utilization of healthcare resources could help alleviate this issue. This study aimed to identify healthcare resource factors associated with heatwave-related mortality in seven major cities of South Korea. Methods: We analyzed daily time-series data on mean temperature and all-cause mortality from 2011 to 2019. Using principal component analysis (PCA), we clustered district-level healthcare resource indicators into three principal components (PCs). To estimate district-specific heatwave-mortality risk, we used a distributed lag model with a quasi-Poisson distribution. Furthermore, a meta-regression was performed to examine the association between healthcare resources and heatwave-mortality risk. Findings: A total of 310,363 deaths were analyzed in 74 districts. The lag-cumulative heatwave-related mortality (RRs) ranged from 1.12 (95% confidence interval [CI]: 1.07, 1.17) to 1.21 (95% CI 1.05, 1.38), depending on the definitions used for heatwaves. Of the three PCs for healthcare resources (PC1: pre-hospital emergency medical service, PC2: hospital resources, PC3: timely access), timely access was associated with reduced risk of heatwave-related mortality, particularly among the elderly. Specifically, timely access to any emergency room (ER) exhibited the strongest association with lower heatwave-related mortality. Interpretation: Our findings suggest that timely access to any ER is more effective in reducing heatwave-related mortality risk than access to higher-level healthcare facilities, especially among the elderly. Therefore, healthcare resource factors and ER accessibility should be prioritized when identifying vulnerable populations for heatwaves, along with known individual and socio-demographic factors. Funding: This work was supported by the Research Program funded by the Korea Disease Control and Prevention Agency (2022-12-303), the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (No. 2022R1A2C2092353) and the MD-PhD/Medical Scientist Training Program through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea.

Comparison of microalgal hydrochar and pyrochar: production, physicochemical properties, and environmental application.

Microalgal biomass has been considered the third-generation biofuel production feedstock, but microalgae-derived biochar still needs to be thoroughly understood. This study aims to evaluate the production and physicochemical properties of microalgae-derived hydrochar produced by hydrothermal carbonization (HTC) process by comparison with pyrochar produced by dry thermal carbonization (DTC) process for environmental applications. Microalgal biochar was produced with commercially available Chlorella vulgaris microalgae using HTC and DTC processes under various temperature conditions. Pyrochar presented higher pH, ash contents, porosity, and surface area than hydrochar. Hydrochar gave more oxygen-containing functional groups on the surface and higher lead adsorption than pyrochar, making the microalgal hydrochar applicable in soil amendment and various environmental remediations. HTC could be an economically feasible thermochemical process for microalgal biochar production. It can produce hydrochar with high production yield from wet microalgae at low temperatures without a drying process.

Beneficial impacts of residential greenness on sleep deprivation in adults aged 19 or older living in South Korea: A nationwide community health survey in 2011-2018.

BACKGROUND: Evidence of the relationship between greenness and sleep is limited, and, given the worsening sleep insufficiency worldwide, this relationship needs elucidation. In this study, we investigated the association of greenness with sleep deprivation using nationwide survey data. METHODS: This study included 1,727,273 participants in the Korea Community Health Survey who resided in all 229 districts of South Korea from 2011 to 2018. Sleep deprivation variables were defined as strong deprivation or mild deprivation, based on average daily sleep duration of <5 or 5-6 h, respectively. District-specific annual average of satellite-derived enhanced vegetation index (EVI) was used as a green space exposure. A logistic regression with complex survey weights was used to estimate the association between greenness and sleep deprivation, and it was further examined by sex, age group, educational status, income level, and population density. The regression analysis was performed annually, and the annual estimates were pooled by a combined data analysis. RESULTS: A higher level of greenness was associated (odds ratio [95 % confidence interval]) with strong and mild sleep deprivation (0.96 [0.93-0.99] and 0.96 [0.95-0.97]), respectively, and males and the younger age group (<65 years) showed a more prominent association with greenness than in females and the elderly group (65 years or older). In addition, only high-population-density areas showed evident associations of greenness with both strong and mild sleep deprivation. CONCLUSIONS: This large population-based study provides important epidemiological evidence for improving sleep quantity through an increase in greenness exposure and supports policymakers in establishing strategies for urban planning.

Machine learning based estimation of urban on-road CO2 concentration in Seoul.

The urban on-road CO2 emissions will continue to increase, it is therefore essential to manage urban on-road CO2 concentrations for effective urban CO2 mitigation. However, limited observations of on-road CO2 concentrations prevents a full understanding of its variation. Therefore, in this study, a machine learning-based model that predicts on-road CO2 concentration (CO2traffic) was developed for Seoul, South Korea. This model predicts hourly CO2traffic with high precision (R2 = 0.8 and RMSE = 22.9 ppm) by utilizing CO2 observations, traffic volume, traffic speed, and wind speed as the main factors. High spatiotemporal inhomogeneity of hourly CO2traffic over Seoul, with 14.3 ppm by time-of-day and 345.1 ppm by road, was apparent in the CO2traffic data predicted by the model. The large spatiotemporal variability of CO2traffic was related to different road types (major arterial roads, minor arterial roads, and urban highways) and land-use types (residential, commercial, bare ground, and urban vegetation). The cause of the increase in CO2traffic differed by road type, and the diurnal variation of CO2traffic differed according to land-use type. Our results demonstrate that high spatiotemporal on-road CO2 monitoring is required to manage urban on-road CO2 concentrations with high variability. In addition, this study demonstrated that a model using machine learning techniques can be an alternative for monitoring CO2 concentrations on all roads without conducting observations. Applying the machine learning techniques developed in this study to cities around the world with limited observation infrastructure will enable effective urban on-road CO2 emissions management.

Individual and regional characteristics associated with changes in mental health before and during the COVID-19 pandemic in South Korea.

Mental health has been a major public health concerns during the COVID-19 pandemic. This study investigated the effects of COVID-19 on mental health and whether individual and regional characteristics are associated with the changes in mental health. We estimated district-specific changes in the prevalence of moderate stress, extreme stress, and depression before and during the COVID-19 pandemic after adjusting for the time trend of mental health outcomes. Then, a meta-regression was conducted to examine the associations between district-level characteristics and changes in mental health due to the pandemic. The prevalence of moderate stress, extreme stress, and depression increased during the pandemic and the increases were more prominent in districts with high population density and in individuals aged 19-59 years, with a high education level, and with high household income. The % with reduced physical activity due to the pandemic were positively associated with increases in stress; while, the % that have mutual trust among neighbors and the number of sports facilities were negatively associated with increases in stress. Local tax per person had a positive association with increase in depression. Our study provides epidemiological evidence into the mental health consequences of the pandemic, which can inform the priority of resource allocation for managing mental health.

Spatiotemporal variations in urban CO2 flux with land-use types in Seoul.

BACKGROUND: Cities are a major source of atmospheric CO2; however, understanding the surface CO2 exchange processes that determine the net CO2 flux emitted from each city is challenging owing to the high heterogeneity of urban land use. Therefore, this study investigates the spatiotemporal variations of urban CO2 flux over the Seoul Capital Area, South Korea from 2017 to 2018, using CO2 flux measurements at nine sites with different urban land-use types (baseline, residential, old town residential, commercial, and vegetation areas). RESULTS: Annual CO2 flux significantly varied from 1.09 kg C m- 2 year- 1 at the baseline site to 16.28 kg C m- 2 year- 1 at the old town residential site in the Seoul Capital Area. Monthly CO2 flux variations were closely correlated with the vegetation activity (r = - 0.61) at all sites; however, its correlation with building energy usage differed for each land-use type (r = 0.72 at residential sites and r = 0.34 at commercial sites). Diurnal CO2 flux variations were mostly correlated with traffic volume at all sites (r = 0.8); however, its correlation with the floating population was the opposite at residential (r = - 0.44) and commercial (r = 0.80) sites. Additionally, the hourly CO2 flux was highly related to temperature. At the vegetation site, as the temperature exceeded 24 ℃, the sensitivity of CO2 absorption to temperature increased 7.44-fold than that at the previous temperature. Conversely, the CO2 flux of non-vegetation sites increased when the temperature was less than or exceeded the 18 ℃ baseline, being three-times more sensitive to cold temperatures than hot ones. On average, non-vegetation urban sites emitted 0.45 g C m- 2 h- 1 of CO2 throughout the year, regardless of the temperature. CONCLUSIONS: Our results demonstrated that most urban areas acted as CO2 emission sources in all time zones; however, the CO2 flux characteristics varied extensively based on urban land-use types, even within cities. Therefore, multiple observations from various land-use types are essential for identifying the comprehensive CO2 cycle of each city to develop effective urban CO2 reduction policies.

Excess out-of-hospital cardiac arrests due to ambient temperatures in South Korea from 2008 to 2018.

Out-of-hospital cardiac arrest (OHCA) is a notable public health issue with negative outcomes, such as high mortality and aftereffects. Additionally, the adverse effects of extreme temperatures on health have become more important under climate change; however, few studies have investigated the relationship between temperature and OHCA. In this study, we examined the association between temperature and OHCA and its underlying risk factors. We conducted a two-stage time-series analysis using a Poisson regression model with a distributed lag non-linear model (DLNM) and meta-analysis, based on a nationwide dataset from South Korea (2008-2018). We found that 17.4% of excess OHCA was attributed to cold, while 0.9% was attributed to heat. Based on central estimates, excess OHCA attributed to cold were more prominent in the population with hypertension comorbidity (31.0%) than the populations with diabetes (24.3%) and heart disease (17.4%). Excess OHCA attributed to heat were larger in the populations with diabetes (2.7%) and heart disease comorbidity (2.7%) than the population with hypertension (1.2%) based on central estimates. Furthermore, the time-varying excess OHCA attributed to cold have decreased over time, and although those of heat did not show a certain pattern during the study period, there was a weak increasing tendency since 2011. In conclusion, we found that OHCAs were associated with temperature, and cold temperatures showed a greater impact than that of hot temperatures. The effects of cold and hot temperatures on OHCA were more evident in the populations with hypertension, diabetes, and heart diseases, compared to the general population. In addition, the impacts of heat on OHCA increased in recent years, while those of cold temperatures decreased. Our results provide scientific evidence for policymakers to mitigate the OHCA burden attributed to temperature.

Anti-Biofilm Effects of Torilis japonica Ethanol Extracts against Staphylococcus aureus.

The spread of antibiotic-resistant strains of Staphylococcus aureus, a gram-positive opportunistic pathogen, has increased due to the frequent use of antibiotics. Inhibition of the quorum-sensing systems of biofilm-producing strains using plant extracts represents an efficient approach for controlling infections. Torilis japonica is a medicinal herb showing various bioactivities; however, no studies have reported the anti-biofilm effects of T. japonica extracts against drug-resistant S. aureus. In this study, we evaluated the inhibitory effects of T. japonica ethanol extract (TJE) on biofilm production in methicillin-sensitive S. aureus (MSSA) KCTC 1927, methicillin-resistant S. aureus (MRSA) KCCM 40510, and MRSA KCCM 40511. Biofilm assays showed that TJE could inhibit biofilm formation in all strains. Furthermore, the hemolysis of sheep blood was found to be reduced when the strains were treated with TJE. The mRNA expression of agrA, sarA, icaA, hla, and RNAIII was evaluated using reverse transcription-polymerase chain reaction to determine the effect of TJE on the regulation of genes encoding quorum sensing-related virulence factors in MSSA and MRSA. The expression of hla reduced in a concentration-dependent manner upon treatment with TJE. Moreover, the expression levels of other genes were significantly reduced compared to those in the control group. In conclusion, TJE can suppress biofilm formation and virulence factor-related gene expression in MSSA and MRSA strains. The extract may therefore be used to develop treatments for infections caused by antibiotic-resistant S. aureus.

Reduction in urban atmospheric CO2 enhancement in Seoul, South Korea, resulting from social distancing policies during the COVID-19 pandemic.

With the spread of the COVID-19 virus globally, cities worldwide have implemented unprecedented social distancing policies to mitigate infection rates. Many studies have demonstrated that improved air quality and reduced carbon emissions have resulted from the COVID-19 pandemic. Yet, questions remain regarding changes in atmospheric CO2 concentrations because of the complex cycles involving the interaction of CO2 with the natural environment. In this study, we compared the changes in urban CO2 enhancement (△CO2) reflecting the contribution of local CO2 emissions to the atmospheric CO2 in urban areas, according to the intensity of social distancing policies implemented during the COVID-19 pandemic in Seoul, South Korea. We used data from three CO2 ground observation sites in the central area of Seoul and outside the urban area of Seoul. By comparing the urban CO2 concentration in Seoul with that of the background area using two different methods, considering both vertical and horizontal differences in CO2 concentration, we quantified the △CO2 of the pre-COVID-19 period and two COVID-19 periods, during which intensive social distancing policies with different intensities were implemented (Level 1, Level 2.5). During the pre-COVID-19 period, the average △CO2 calculated using the two methods was 24.82 ppm, and it decreased significantly to 16.42 and 14.36 ppm during the Level 1 and Level 2.5 periods, respectively. In addition, the urban contribution of Seoul to atmospheric CO2 concentration decreased from 5.27% during the pre-COVID-19 period to 3.54% and 3.19% during the Level 1 and Level 2.5 periods, respectively. The results indicate that the social distancing policies implemented in Seoul resulted in reduced local CO2 emissions, leading to a reduction in atmospheric CO2 concentration. Interestingly, it also shows that the extent of atmospheric CO2 concentration reduction can be greatly affected by the intensity of policies. Our study suggests that changes in human activity could reduce the urban direct contribution to the background CO2 concentration helping to further mitigate climate change.

Urban environments and COVID-19 in three Eastern states of the United States.

The United States has the highest numbers of confirmed cases and deaths during the novel coronavirus disease 2019 (COVID-19) pandemic. Previous studies reported that urban residents are more vulnerable to the spread and mortality of COVID-19 than rural residents. However, the pathways through which urban environments affect COVID-19 spread and mortality are unclear. We collected daily data on the number of confirmed cases and deaths of COVID-19 from Mar. 01 to Nov. 16, 2020 for all 91 counties in New York, New Jersey, and Connecticut in the United States. We calculated the COVID-19 incidence %, daily reproduction number, and mortality %, then estimated the associations with urban environment indicators using regression models. COVID-19 outcomes were generally highest in areas with high population density, and this pattern was evident in the early period of epidemic. Among the area-level demographic variables, the percentage of Black or Hispanic residents showed the strongest positive association with COVID-19 outcomes. Higher risk of COVID-19 outcomes was also associated with higher percentage of overcrowded households, uninsured people, and income inequality. The percent elderly, sex ratio (the ratio of males to females), and greenness were negatively associated with risk of COVID-19 outcomes. The results of this study could indicate where resources are most needed.

Heatwave-Related Mortality Risk and the Risk-Based Definition of Heat Wave in South Korea: A Nationwide Time-Series Study for 2011-2017.

Studies on the pattern of heatwave mortality using nationwide data that include rural areas are limited. This study aimed to assess the risk of heatwave-related mortality and evaluate the health risk-based definition of heatwave. We collected data on daily temperature and mortality from 229 districts in South Korea in 2011-2017. District-specific heatwave-related mortality risks were calculated using a distributed lag model. The estimates were pooled in the total areas and for each urban and rural area using meta-regression. In the total areas, the threshold point of heatwave mortality risk was estimated at the 93rd percentile of temperature, and it was lower in urban areas than in rural areas (92nd percentile vs. 95th percentile). The maximum risk of heatwave-related mortality in the total area was 1.11 (95% CI: 1.01-1.22), and it was slightly greater in rural areas than in the urban areas (RR: 1.23, 95% CI: 0.99-1.53 vs. RR: 1.10, 95% CI: 1.01-1.20). The results differ by age- and cause-specific deaths. In conclusion, the patterns of heatwave-related mortality risk vary by area and sub-population in Korea. Thus, more target-specific heatwave definitions and action plans should be established according to different areas and populations.

COVID-19 in South Korea: epidemiological and spatiotemporal patterns of the spread and the role of aggressive diagnostic tests in the early phase.

BACKGROUND: South Korea experienced the novel coronavirus disease (COVID-19) outbreak in the early period; thus data from this country could provide significant implications for global mitigation strategies. This study reports how COVID-19 has spread in South Korea and examines the effects of rapid widespread diagnostic testing on the spread of the disease in the early epidemic phase. METHODS: We collected daily data on the number of confirmed cases, tests and deaths due to COVID-19 from 20 January to 13 April 2020. We estimated the spread pattern with a logistic growth model, calculated the daily reproduction number (Rt) and examined the fatality pattern of COVID-19. RESULTS: From the start date of the epidemic in Korea (18 February 2020), the time to peak and plateau were 15.2 and 25 days, respectively. The initial Rt was 3.9 [95% credible interval (CI) 3.7 to 4.2] and declined to <1 after 2 weeks. The initial epidemic doubling time was 3.8 days (3.4 to 4.2 days). The aggressive testing in the early days of the epidemic was associated with reduction in transmission speed of COVID-19. In addition, as of 13 April, the case fatality rate of COVID-19 in Korea was 2.1%, suggesting a positive effect of the targeted treatment policy for severe patients and medical resources. CONCLUSIONS: Our findings provide important information for establishing and revising action plans based on testing strategies and severe patient care systems, needed to address the unprecedented pandemic.

MANAGEMENT OF VITREAL LOSS FROM POSTERIOR CAPSULAR RUPTURE DURING CATARACT OPERATION: Posterior Versus Anterior Vitrectomy.

PURPOSE: To compare the efficacy between 23-gauge sutureless pars planar vitrectomy (PPV) and anterior vitrectomy in the management of vitreous loss associated with posterior capsular rupture during cataract surgery. METHODS: Medical records of 139 eyes which sustained posterior capsular rupture and vitreal prolapse to anterior chamber during cataract surgery were retrospectively reviewed. Thirty-two eyes which underwent 23-gauge sutureless PPV (group PPV) and 107 eyes which underwent anterior vitrectomy (group AntV) were compared in postoperative visual and anatomical outcomes, operation time, and complications. RESULTS: No significant differences were found between the groups in final best-corrected visual acuity of 20/40 or better (AntV vs. PPV = 80.4 vs. 90.6%, P = 0.139). However, the visual recovery rates (20/40 or better) 1 day, 1 week, 1 month postoperatively were significantly higher in group PPV (AntV vs PPV = 22.4 vs. 44%, 32.2 vs 58.6, 51.9 vs. 78.1%). Postoperative intraocular pressure-related complications requiring medication were less evident in group PPV (AntV vs. PPV = 52.3 vs. 6.3%, P < 0.001). Twelve cases (11.2%) of group AntV and 0 cases of group PPV underwent secondary operation during follow-up. Although no postoperative complications occurred in group PPV, complications such as endophthalmitis, retinal detachment, cystoid macular edema, intraocular lens instability were observed in the AntV group (none vs. 14%, P = 0.022). CONCLUSION: Twenty-three-gauge sutureless PPV is a safe and reliable solution for managing vitreous loss during cataract surgery. Therefore, it is expected to be considered primarily in institutes with vitreoretinal surgeons.

Outcome of smooth surface tunnel porous polyethylene orbital implants (Medpor SST) in children with retinoblastoma.

AIM: To evaluate the surgical outcome after the insertion of smooth surface tunnel porous polyethylene orbital implants (Medpor SST) in children with retinoblastoma. METHODS: 44 consecutive children with retinoblastoma who underwent primary enucleation and Medpor SST implantation at Seoul National University Hospital from November 2004 to August 2009, with at least 24 months of follow-up were included. A retrospective review of cases was performed. RESULTS: Mean age at the time of surgery was 24.7 months (range 1-65 months). The diameter of the spherical implant was 20 mm in 36 patients (81.8%) and 18 mm in 8 patients (18.2%). During a mean follow-up period of 60.1 months (range 26-93 months), there were no cases of implant exposure, extrusion or infection. Transient conjunctival thinning developed in three patients, but all resolved with conservative treatment. Anophthalmic socket complications such as lower lid malposition (retraction or entropion) (n=10, 22.7%), blepharoptosis (n=8, 18.2%) and enophthalmos (n=2, 4.5%) developed, but most showed acceptable cosmesis. CONCLUSIONS: Medpor SST is relatively safe, allowing for a mean follow-up of 5 years in terms of implant exposure, and may be a good choice of orbital implant for children with retinoblastoma.

Genetic and non-genetic factors affecting the visual outcome of ocular Behcet's disease.

OBJECTIVE: To examine the prognostic factors for visual outcome in Korean BD patients with uveitis. METHODS: Seventy-seven Korean BD patients with uveitis were enrolled. HLA-B and HLA-A genotypes were determined by PCR-based method. Visual acuity was measured by Snellen chart. Vision loss was graded into visual impairment (VI) defined as VA<20/40 for more than 6 months, loss of useful vision (LUV) as VA < 20/200, and near total blindness (NTB) as VA of light perception or worse. RESULTS: VI was associated with a longer duration of uveitis, posterior uveitis, and cataract, LUV with male gender, a longer duration of uveitis, posterior uveitis, and cataract, and NTB with a longer duration of uveitis, cataract, and glaucoma. HLA-B*51 and HLA-A*26:01 did not show any association with VI, LUV, or NTB. However, HLA-B*51 carriers had earlier onset of uveitis and HLA-A*26:01 was strongly associated with posterior uveitis. In patients with posterior uveitis, VI was associated with a longer duration of uveitis and cataract, LUV with a longer duration, and NTB with HLA-B*51. CONCLUSION: Longer duration of uveitis, posterior uveitis, male gender, cataract, and glaucoma were found to be associated with poor visual outcome in BD-related uveitis. HLA-B*51 was associated with NTB in patients with posterior uveitis. HLA-A*26:01 showed no association with VI, LUV, or NTB, however, was strongly associated with posterior uveitis.