Calcium- and Sodium-Rich Food Intake among Koreans with and without Metabolic Syndrome: Cross-Sectional Analysis of the Korean Genome and Epidemiology Study.

BACKGROUND: The prevalence of metabolic syndrome (MetS) is increasing. While calcium and sodium are known nutritional factors used for managing MetS, few studies have focused on food-based analyses. This cross-sectional study examined the distribution of calcium- and sodium-rich food intake among Koreans with MetS. METHODS: This cross-sectional analysis evaluated 130,423 participants from the Health Examinees-Gem cohort study. Foods contributing up to 90% of the calcium and sodium intake were selected from the semi-quantitative food frequency questionnaire, and consumption levels were calculated. MetS was defined as satisfying three or more criteria from the National Cholesterol Education Program Adult Treatment Panel III. The results are presented as odds ratios (OR) with an interquartile range (ORIQR) and 95% confidence interval. RESULTS: Participants with MetS showed a low calcium intake (ORIQR = 0.95 and 0.92 for men and women, respectively), low consumption of dairy products (ORIQR = 0.92 and 0.89), beverages except for coffee or green tea (ORIQR = 0.97 and 0.96), and bread (ORIQR = 0.96 and 0.94). Men with MetS consumed high total sodium (ORIQR = 1.04), and large amounts of Kimchi (ORIQR = 1.03), fermented paste (ORIQR = 1.04), and noodles (ORIQR = 1.07). Women with MetS consumed more Kimchi than those without MetS (ORIQR = 1.04). The odds ratio for the low calcium and high sodium group compared to the high calcium and low sodium group was 1.26. CONCLUSION: The MetS group consumed less calcium-rich foods and more sodium-rich foods than those without MetS. Patients with MetS might benefit from precise recommendations of high calcium-rich and low sodium-rich foods.

Possible Bioterrorism by North Korea and South Korea's Preparedness.

This paper reviews the elements and infection mechanisms of bioterrorism, assess North Korea's capability for biological warfare, and propose strategies for South Korea to counter potential bioterrorist threats from the North. The four critical elements of bioterrorism include the biological agent, the weaponization of the agent, the delivery system, and the impact of weather conditions on the attack. The infection routes for biological agents in bioterrorism include inhalation, ingestion, dermal exposure, and injection. The potential agents under development could include anthrax, smallpox, plague, and botulinum toxin, which might be deployed using missiles, artillery shells, or through covert operations. Proximity to North Korea significantly increases vulnerability to biological attacks. Possible methods include contaminating water supplies, food sources, or densely populated areas. Anthrax, smallpox, plague, and botulinum toxin could theoretically be delivered using packages attached to balloons. Minimizing the impact of a bioterrorism event requires strategy that includes four key actions: detection, decision-making, distribution, and dispensation. By integrating these steps, authorities can effectively manage and mitigate the effects of a bioterrorism event. Civilian doctors play a role in the early detection, diagnosis, treatment, and management of biological agents. Educating medical professionals is crucial for preparing against potential biological warfare or bioterrorism threats.

Lessons for Future Vaccination Policies: COVID-19 Vaccination Intention in People with and without Chronic Diseases.

PURPOSE: This study compared COVID-19 vaccination intentions in those with and without chronic diseases (CDs and non-CDs) in South Korea. We hypothesized that the factors associated with COVID-19 vaccination intentions would differ between CDs and non-CDs in South Korea. METHOD: Using survey data collected through a Korean online panel in June 2021, we conducted a cross-sectional secondary data analysis. Of the 2,292 participants, 411 had at least one chronic disease. To construct a comparable dataset, we selected non-CDs via a 1:1 case-control matching for age and gender. We then utilized a multivariable binary logistic regression model to explore the factors contributing to COVID-19 vaccination intentions in CDs and non-CDs. RESULTS: All told, 75% of participants in both groups indicated that they intended to vaccinate against COVID-19. In both groups, those who mistrusted general vaccine benefits reported significantly lower COVID-19 vaccination intentions. Regarding factors associated with vaccination intentions, CDs identified anxiety regarding coronavirus and exposure to COVID-19 vaccination promotions at the community level, while non-CDs highlighted hesitancy regarding vaccines and confidence in government/health services. CONCLUSION: Improving vaccination acceptance will require the development and implementation of tailored approaches for CDs and non-CDs and efforts to minimize general vaccine mistrust.

Avoidable Mortality in Korea 1997-2001: Temporal Trend and its Contribution to All-cause Mortality.

Objective: This study analyzed the mortality trends from avoidable causes in Korea from 1997 to 2021, to estimate its contribution to the overall mortality in different subgroups, including. Gender, age, and cause of disease. Methods: The all-cause and avoidable mortality were presented as a time series plot and average annual percent change. Trend of avoidable mortality was also analyzed by subgroups, disease causes and the percentage attributed to each causes. Results: The decline in avoidable mortality accounted for 82.6% of all-cause mortality reduction. Preventable mortality showed a more pronounced decline than treatable mortality, explaining 72.3% of the avoidable mortality reduction. In 1997-2001, avoidable death occurred in 72.2% (537,024 cases) of all-cause deaths, which declined to 60.0% (342,979 cases) in 2017-2021. The contribution of avoidable mortality in the decline of all-cause morality was greater in males (83.6%) than in females (79.3%). Conclusion: The decline in avoidable mortality and its contribution to the all-cause mortality reduction implies general improvement of the population health in Korea. Nevertheless, the heterogenous trend within different subgroups warrants more equitable design and implementation of health services and policies.

Prevalence, Isolation, and Molecular Characterizationof Severe Fever with Thrombocytopenia Syndrome Virus in Cattle from the Republic of Korea.

Background: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne disease caused by Bandavirus dabieense. Initially identified in China, this disease has spread throughout Asian countries via tick bites and animal-to-human transmission. However, reports of the prevalence of SFTS virus (SFTSV) in cattle in Korea are lacking. This study aimed to investigate SFTSV infections in grazing cattle in the Republic of Korea (ROK). Materials and Methods: In total, 845 grazing cattle serum samples were collected over 2 years (2019 and 2020) in the ROK, and viral RNA was extracted using a kit. One-step RT-nested PCR was performed to amplify the S-segment of SFTSV. Positive serum samples were used to isolate SFTSV in Vero E6 cells, and the full sequences were analyzed. A phylogenetic tree was constructed using the maximum-likelihood method with MEGA X. In addition, immunoglobulin G antibodies against SFTSV were investigated using an enzyme-linked immunosorbent assay. Results: Here, 4.0% of serum samples (34/845) were positive for SFTSV S-segments, and one virus isolate was cultured in Vero E6 cells. Phylogenetic analysis based on the partial S-segment classified 4 SFTSV isolates as the B-2 genotype, 9 as the B-3 genotype, 18 as an unclassified B genotype, and 3 as the D genotype. One cultured virus was classified as the B-2 genotype based on SFTSV L-, M-, and S-segments. Antibody detection results showed that 21.1% of serum samples (161/763) were positive for SFTSV. Conclusion: To the best of our knowledge, this is the first study performed to identify the prevalence of SFTSV in grazing cattle in the ROK. Our findings indicate the necessity for more intensive and continuous SFTSV monitoring, not only in cattle but also in other animals, to comprehend the genetic diversity of the virus and its potential eco-epidemiological impact on human health.

Career Disruption and Employment Status of Korean Family Caregivers of Older Adults Using Home-Based Care.

This study utilized nationally approved data from the 2022 Long-Term Care Survey of Korea to examine the factors associated with career disruptions and employment status among family caregivers of home-based care recipients. Descriptive statistics, chi-square tests, one-way ANOVA, and multinomial logistic regression analysis were employed to address the research questions. The results indicated that 19.39% of family caregivers of home-based care recipients experienced career disruptions due to informal caregiving. Demographic factors such as gender, age of family caregivers, and their relationship with care recipients predicted their employment status. Gender was a significant explanatory factor, as daughters/daughters-in-law were more likely to be in insecure employment positions than sons. Lower household income and older age were also associated with employment insecurity. Recommendations include coverage expansion, family support programs, and pension credit for family caregivers to meet the needs of care recipients and their families.

The Comparative Field Evaluation of Four Different Traps for Mosquito Surveillance in the Republic of Korea.

Monitoring mosquito populations is essential for controlling mosquito-borne diseases, and the selection of mosquito traps should be tailored to specific surveillance objectives. Here, we tested four mosquito traps for their efficiency and applicability: the Nozawa-style black light trap (BLT), BG-sentinel trap II (BGT), UV-LED Blackhole Plus Mosquito Buster trap (LED), and digital mosquito monitoring system (DMS). The traps were rotated weekly for a 24 h cycle at the same location for 13 weeks. Overall, 1649 female mosquitoes belonging to seven genera and sixteen species were collected by the traps. The traps exhibited differences in both the number of collected individuals and species composition. The BLT showed superior collection efficiency in terms of the number of collected individuals and species evenness, whereas the BGT showed the highest species diversity among all the traps. Thus, the BLT and BGT are the best choices for effective mosquito surveillance based on trap performance. Additionally, despite the relatively low efficiency of the LED and DMS observed in this study, the LED is known to be efficient when used for indoor conditions such as cowsheds, while the DMS has an advanced function that can automatically count the number of mosquitoes. Thus, our findings provide significant guidelines for planning new mosquito surveillance projects in the ROK.

Molecular Identification of Spotted Fever Group Rickettsiae in Ticks in the Republic of Korea.

The Rickettsia species transmitted by ticks are mostly classified within the spotted fever group rickettsiae (SFGR), which causes tick-borne rickettsiosis. Although efforts have been made to investigate their prevalence in the Republic of Korea (ROK), research has been limited to certain areas. Furthermore, the pooling method for ticks does not fully reflect the exact infection rate. Therefore, we aimed to perform molecular identification of SFGR in ticks to elucidate the current prevalence of tick-borne rickettsiosis in the ROK. The SFGR of ticks was identified using polymerase chain reaction targeting the 17 kDa antigen, ompA, and gltA, followed by sequencing for species identification and phylogenetic analysis. In total, 302 ticks belonging to four species (Haemaphysalis flava, H. longicornis, Ixodes nipponensis, and Amblyomma testudinarium) were collected between April and November 2022. The overall SFGR infection rate was 26.8% (81/302 patients). Both adult and nymphal ticks and the SFGR infection rate increased during April-May, reaching their peaks in June, followed by a marked decline in August and July, respectively. Phylogenetic analysis revealed three species (R. monacensis, R. heilongjiangensis, and Candidatus R. jingxinensis) of SFGR. Thus, our results emphasize the importance of tick surveys for the prevention and management of tick-borne rickettsiosis.

Long-term Outcome of Cryoballoon Ablation in Korean Patients With Atrial Fibrillation: Real-world Experience From the Cryo Global Registry.

BACKGROUND AND OBJECTIVES: Atrial fibrillation (AF), the most common atrial arrhythmia (AA), is an increasing healthcare burden in Korea. The objective of this sub-analysis of the Cryo Global Registry was to evaluate long-term efficacy, symptom burden, quality of life (QoL), and healthcare utilization outcomes and factors associated with AA recurrence in Korean patients treated with cryoballoon ablation (CBA). METHODS: Patients were treated and followed up according to local standard-of-care in 3 Korean hospitals. Kaplan-Meier estimates were used in analyzing (1) efficacy defined as freedom from ≥30 second recurrence of AA at 24 months, (2) healthcare utilization, and (3) predictors of 24-month AA recurrence. Patient-reported QoL (using European Quality of Life-5 Dimensions-3 Levels) and predefined AF-related symptoms were assessed at baseline and 24-month follow-up. RESULTS: Efficacy was 71.9% in paroxysmal AF (PAF) and 49.3% in persistent AF (PsAF) patients (p<0.01). A larger left atrial diameter (LAD), an increased time from AF diagnosis to CBA, and PsAF were independent predictors of AA recurrence. The percentage of patients with no AF symptoms significantly increased from baseline (24.5%) to 24-month (89.5%) follow-up (p<0.01). Improvement in QoL from baseline to 24 months was not statistically different between AF cohorts. PAF patients experienced greater freedom from repeat ablations (93.9% vs. 81.4%) and cardiovascular hospitalizations (91.3% vs. 72.5%, p<0.001 for both). CONCLUSIONS: In alignment with global outcomes, CBA is an effective treatment for AF in the Korean population, with patients possessing a large LAD and not receiving ablation soon after diagnosis being the most at risk for AA recurrence. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02752737.

Comparison of real data and simulated data analysis of a stopping rule based on the standard error of measurement in computerized adaptive testing for medical examinations in Korea: a psychometric study.

PURPOSE: This study aimed to compare and evaluate the efficiency and accuracy of computerized adaptive testing (CAT) under two stopping rules (SEM 0.3 and 0.25) using both real and simulated data in medical examinations in Korea. METHODS: This study employed post-hoc simulation and real data analysis to explore the optimal stopping rule for CAT in medical examinations. The real data were obtained from the responses of 3rd-year medical students during examinations in 2020 at Hallym University College of Medicine. Simulated data were generated using estimated parameters from a real item bank in R. Outcome variables included the number of examinees' passing or failing with SEM values of 0.25 and 0.30, the number of items administered, and the correlation. The consistency of real CAT result was evaluated by examining consistency of pass or fail based on a cut score of 0.0. The efficiency of all CAT designs was assessed by comparing the average number of items administered under both stopping rules. RESULTS: Both SEM 0.25 and SEM 0.30 provided a good balance between accuracy and efficiency in CAT. The real data showed minimal differences in pass/fail outcomes between the 2 SEM conditions, with a high correlation (r = 0.99) between ability estimates. The simulation results confirmed these findings, indicating similar average item numbers between real and simulated data. CONCLUSION: The findings suggest that both SEM 0.25 and 0.30 are effective termination criteria in the context of the Rasch model, balancing accuracy and efficiency in CAT.

Characteristics of Work-related Fatal Injuries Among Aged Workers in Republic of Korea.

Objectives: The present paper aimed to examine whether an aging workforce is associated with an increase in work-related fatal injuries and to explore the underlying reasons for this potential increase. Material and methods: Aged workers were defined as those who were at least 55 years old. Work-related fatalities were assessed in aged and young workers who were registered with the workers' compensation system in 2021 in the Republic of Korea. Total waged workers, based on raw data from the Local Area Labor Force Survey in 2021, were used as the denominator to estimate the work-related fatality rates. Results: Most work-related fatalities in the aged workers occurred among individuals working in the "construction sector" (58.9%), those with "elementary occupations (unskilled workers)" (46.1%), and those with the employment status of "daily worker" (60.8%). The estimated incidence (0.973/10,000) of work-related fatalities among aged workers was about four times higher than that (0.239/10,000) among younger workers. "Falling," "collision," "struck by an object," and "trip and slip" were more frequent types of work-related fatalities among aged workers relative to young workers. The category of "buildings, structures, and surfaces" was a more frequent cause of work-related fatalities among aged workers than among young workers. Conclusions: Aged workers had a higher incidence of work-related fatalities than young workers. Frequent engagement in precarious employment and jobs, coupled with the greater physical vulnerability of aged workers, were likely causes of their higher level of work-related fatal injuries.

Prevalence and Genetic Characterization of Porcine Respiratory Coronavirus in Korean Pig Farms.

Porcine respiratory coronavirus (PRCV) is a member of the species Alphacoronavirus 1 within the genus Alphacoronavirus of the family Coronaviridae. A few studies have been conducted on the prevalence of PRCV since its first identification in 1997, but there have been no recent studies on the prevalence and genetic characterization of the virus in Korea. In this study, the seroprevalence of PRCV was determined in Korean pig farms using a commercially available TGEV/PRCV differential enzyme-linked immunosorbent assay kit. The farm-level seroprevalence of PRCV was determined to be 68.6% (48/70), similar to previous reports in Korea, suggesting that PRCV is still circulating in Korean pig herds nationwide. Among the 20 PRCV-seropositive farms tested in this study, PRCV RNAs were detected in 17 oral fluid samples (28.3%) from nine farms (45.0%), while TGEV RNAs were not detected in any sample. To investigate the genetic characteristics of Korean PRCV strains, genetic and phylogenetic analyses were conducted on PRCV spike gene sequences obtained in this study. The three Korean PRCV strains (KPRCV2401, KPRCV2402, and KPRCV2403) shared 98.5-100% homology with each other and 96.2-96.6% and 91.6-94.5% homology with European and American strains, respectively. A 224-amino acid deletion was found in the S gene of both Korean and European PRCVs but not in that of American PRCVs, suggesting a European origin for Korean PRCVs. Phylogenetic analysis showed that Korean PRCVs are more closely related to European PRCVs than American PRCVs but clustered apart from both, suggesting that Korean PRCV has evolved independently since its emergence in Korean PRCVs. The results of this study will help expand knowledge on the epidemiology and molecular biology of PRCV currently circulating in Korea.

Development of examination objectives for the Korean paramedic and emergency medical technician examination: a survey study.

PURPOSE: The duties of paramedics and emergency medical technicians (P&EMTs) are continuously changing due to developments in medical systems. This study presents evaluation goals for P&EMTs by analyzing their work, especially the tasks that new P&EMTs (with less than 3 years' experience) find difficult, to foster the training of P&EMTs who could adapt to emergency situations after graduation. METHODS: A questionnaire was created based on prior job analyses of P&EMTs. The survey questions were reviewed through focus group interviews, from which 253 task elements were derived. A survey was conducted from July 10, 2023 to October 13, 2023 on the frequency, importance, and difficulty of the 6 occupations in which P&EMTs were employed. RESULTS: The P&EMTs' most common tasks involved obtaining patients' medical histories and measuring vital signs, whereas the most important task was cardiopulmonary resuscitation (CPR). The task elements that the P&EMTs found most difficult were newborn delivery and infant CPR. New paramedics reported that treating patients with fractures, poisoning, and childhood fever was difficult, while new EMTs reported that they had difficulty keeping diaries, managing ambulances, and controlling infection. CONCLUSION: Communication was the most important item for P&EMTs, whereas CPR was the most important skill. It is important for P&EMTs to have knowledge of all tasks; however, they also need to master frequently performed tasks and those that pose difficulties in the field. By deriving goals for evaluating P&EMTs, changes could be made to their education, thereby making it possible to train more capable P&EMTs.

Age-specific association between meal-skipping patterns and the risk of hyperglycemia in Korean adults: a national cross-sectional study using the KNHANES data.

BACKGROUND: Glucose metabolism regulation is influenced by age and meal skipping, although research on their interplay with hyperglycemia remains limited. This study aims to explore the intricate relationship between meal-skipping patterns and hyperglycemia risk across distinct age groups in South Korean adults. METHODS: Utilizing data from the Korea National Health and Nutrition Examination Surveys (KNHANES) conducted from 2013 to 2020, comprising 28,530 individuals aged 19 years and older, this study employed multivariable logistic regression models to examine the associations between meal-skipping patterns and the risk of hyperglycemia. RESULTS: Meal-skipping patterns were categorized into three groups: no skipping (NS), skipping breakfast (SB), and skipping dinner (SD). Age groups were defined as "young" (aged 19-44), "middle-aged" (aged 45-64), and "elderly" adults (over 65 years old). Among "young" adults, SB was associated with a 1.33-fold higher risk of hyperglycemia (OR = 1.33, 95% CI = 1.14-1.54) compared to NS. Conversely, in "elderly" adults, SD was linked to a 0.49-fold reduced risk (95% CI = 0.29-0.82) when compared to NS. Additionally, we observed that the Korean Health Eating Index (KHEI) scores, representing the quality of diet on a scale of 0 to 100, were consistently lower in SB compared to NS across all age groups. Intriguingly, specifically among the "elderly" group, this score was higher in SD compared to NS (p < 0.001). CONCLUSIONS: This study demonstrates age-specific variations in the association between meal-skipping patterns and the risk of hyperglycemia.

Association of loneliness with mental disorders in Korean adults: national mental health survey of Korea 2021.

PURPOSE: Loneliness is a risk factor for mental and physical disorders. Rapid individualization, with increasing associated social burden, is a contributing factor to loneliness among Koreans. This study aimed to investigate the relationship between loneliness and mental disorders, as well as to determine whether long-term loneliness is a factor predicting the occurrence of mental disorders in adults. METHODS: The National Mental Health Survey of Korea 2021, a nationally representative survey on mental disorders, was conducted. Responses from 5511 participants were collected using the Korean version of the Composite International Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders fourth edition, Structured Clinical Interview for Internet Gaming Disorder, and the World Health Organization Adult Attention-deficit Hyperactivity Disorder (ADHD) self-report scale. Loneliness and its duration were investigated among these participants. RESULTS: Loneliness was reported by approximately 2.9% of the general population. Loneliness was associated with an increased adulthood prevalence of alcohol use disorders, nicotine use disorders, depressive disorders, anxiety disorders, adult ADHD, and internet gaming disorders. Long-term loneliness was significantly associated with an elevated risk of alcohol use disorders, nicotine use disorders, depressive disorders, and anxiety disorders. Internet gaming disorder was associated with loneliness lasting > 1 year. CONCLUSION: Various adult psychiatric disorders were associated with loneliness. The significant dose-effect relationship indicated the importance of early detection of and intervention for loneliness to reduce its negative consequences on mental health.

Assessing COVID-19 Vulnerability Among HIV-positive Men Who Have Sex With Men in Korea: The Role of Vaccination and Sexual Behaviors.

OBJECTIVES: Comorbidities increase susceptibility to severe coronavirus disease 2019 (COVID-19) infections, but limited information has been published regarding human immunodeficiency virus (HIV) and COVID-19 co-infections. This study explored the relationships among socioeconomic characteristics, sexual behaviors, and COVID-19 infection rates among Korean men who have sex with men (MSM) who are also living with HIV. METHODS: Data were collected through a web survey aimed at members of the largest gay portal site in Korea, supported by the National Research Foundation of Korea (n=1005). The primary independent variables included COVID-19-related vaccinations and sexual behaviors. The dependent variable was the incidence of COVID-19 infection among respondents during the pandemic. For statistical analysis, hierarchical multiple logistic regression was performed, controlling for potential confounding variables. RESULTS: Model I indicated that older MSM were less likely to contract COVID-19 (adjusted odds ratio [aOR], 0.98; 95% confidence interval [CI], 0.96 to 0.99). Model II demonstrated that HIV-positive MSM were nearly twice as likely to be infected with COVID-19 compared to their HIV-negative counterparts (aOR, 1.97; 95% CI, 1.14 to 3.41). Furthermore, even after accounting for COVID-19 vaccination status in model III, HIV-positive MSM continued to show a higher risk of infection (aOR, 1.93; 95% CI, 1.12 to 3.35). CONCLUSIONS: The findings of this study indicate that HIV-positive MSM are at an increased risk of contracting COVID-19, even when their vaccination status is considered. Therefore, it is essential to prioritize the prevention of COVID-19 infections in HIV-positive individuals by administering appropriate antiretroviral therapy and ensuring adherence to public health guidelines.

Survey study on the Korean quarantine-at-home system for Covid-19: suggestions for improvements.

We examined whether quarantined individuals complied with rules to prevent transmission at home and whether the government provided appropriate support to individuals in quarantine. Between November 2020 and August 2021, we surveyed 198 individuals who had been or were quarantined at home without infection. The online survey results show that respondents experienced difficulties living in close quarters with their cohabitants and had low compliance with in-house hygiene rules. The government needed to provide adequate employment protection, living expense, or care support. Such failures of the system were mainly due to a lack of legal grounds for the government to operate. To improve compliance, the government can amend laws to permit active communication of public health messages with those quarantined at home and provide the necessary support.

Characteristics of Comorbid Physical Disease in Patients With Severe Mental Illness in South Korea: A Nationwide Population-Based Study (2014-2019).

OBJECTIVE: The purpose of this study was to identify the associations of chronic physical disease between patients with severe mental illness (SMI) and the general population of South Korea. METHODS: This study was conducted with National Health Insurance Corporation data from 2014 to 2019. A total of 848,058 people were diagnosed with SMI in this period, and the same number of controls were established by matching by sex and age. A descriptive analysis was conducted on the sociodemographic characteristics of patients with SMI. Conditional logistic regression analysis was performed to identify the associations between comorbid physical disease in patients with SMI and those of the general population. SAS Enterprise Guide 7.1 (SAS Inc, Cary, NC, USA) were used to perform all statistical tests. RESULTS: The analysis revealed significant differences in medical insurance, income level, and Charlson Comorbidity Index weighted by chronic physical disease, between patients with SMI and the general population. Conditional logistic regression analysis between the two groups also revealed significant differences in eight chronic physical diseases except hypertensive disease. CONCLUSION: This study confirmed the vulnerability of patients with SMI to chronic physical diseases and we were able to identify chronic physical disease that were highly related to patients with SMI.

Modulation of Bone Mineral Density and Its Response to Menopausal Hormone Therapy according to the Apolipoprotein E Genotype in Postmenopausal Korean Women.

OBJECTIVES: Genetic factors are a major cause of osteoporosis. The present study evaluated the association of the apolipoprotein E (ApoE) genotype with bone mineral density (BMD) and its response to menopausal hormone therapy (MHT) in postmenopausal Korean women. METHODS: This retrospective cohort study included 172 postmenopausal women with no endocrine diseases, medications, or lifestyles that would affect bone metabolism and who were continuously treated with MHT for at least 2 years. BMDs were measured at baseline and periodically. RESULTS: Linear regression analysis demonstrated similar baseline BMDs at the lumbar spine, but significantly lower at the femur neck and total hip in the ApoE ε4 carrier than in the noncarrier group, after controlling for age, body mass index, and history of MHT usage. Overall, the Wilcoxon signed rank test demonstrated that MHT increased the BMD percentage change at all three regions, and the Generalized Estimating Equation (GEE) demonstrated significant time trends at the lumbar spine and femur neck. ApoE ε4 noncarriers exhibited a significant time trend in BMD changes at the femur neck, whereas ε4 carriers exhibited a time trend at the lumbar spine. However, BMD changes at each time point were comparable at all regions between the groups. Notably, GEE adjusted for baseline characteristics and BMD revealed a significant interaction effect of time and ApoE ε4 allele in BMD changes at the femur neck. CONCLUSIONS: Postmenopausal Korean women carrying the ApoE ε4 allele demonstrated a lower hip BMD compared with ε4 noncarriers. Furthermore, the ε4 allele may modulate hip BMD responses to MHT.

Factors influencing children's emotional and behavioral problems perceived by North Korean refugee mothers: a descriptive study.

PURPOSE: The study investigated the relationships between key variables, including the level of parenting knowledge, acculturative stress, depression, and the strengths and difficulties associated with their children's emotions and behavior, among North Korean refugee mothers who faced the challenging task of adapting to Korean society while raising their children. METHODS: A descriptive study design was used. Data were collected from 130 North Korean refugee mothers between September and November 2023. RESULTS: The participants had very limited parenting knowledge, and 82.3% of them scored 21 or higher on the depression scale used in community epidemiological studies. Higher levels of parenting knowledge and lower levels of depression were associated with lower levels of acculturative stress. Moreover, higher levels of depression were associated with more emotional and behavioral difficulties in children. Maternal depression, age, and employment status were identified as factors that influenced emotional and behavioral problems in preschool-aged children. CONCLUSION: These findings underscore the importance of providing parent education and mental health support programs for North Korean refugee families in order to improve parents' parenting skills and emotional well-being.