Trends in chronic kidney disease awareness and related clinical and demographic characteristics from 1998 to 2018 in Koreans.

PURPOSE: Chronic kidney disease (CKD) is a common and growing problem in Korea. Although CKD awareness is the first step in CKD management, evidence indicates that the rate of CKD awareness is unsatisfactory worldwide. Thus, we investigated the trend of CKD awareness for CKD patients in Korea. METHODS: Through analyzing data from the Korea National Health and Nutrition Examination Survey (KNHAES) in 1998, 2001, 2007-2008, 2011-2013, and 2016-2018, we evaluated the rate of CKD awareness according to CKD stage in each phase of KNHANES. Clinical and sociodemographic characteristics were compared between CKD awareness and unawareness groups. Multivariate regression analysis was used to calculate the adjusted odds ratio (OR) and 95% confidence interval (CI) for CKD awareness [adjusted OR (95% CI)] in given socioeconomic and clinical factors. RESULTS: The overall awareness rate of CKD stage 3 remained at low levels of less than 6.0% through all phases of KNHAES except that of V-VI. In particular, CKD awareness was remarkably low in stage 3 CKD. Compared to CKD unawareness group, CKD awareness group was of young age, higher income, higher education, more medical aid, higher prevalence of comorbidities, and more advanced CKD. In multivariate analysis, CKD awareness was significantly associated with age [0.94 (0.91-0.96)], medical aid [3.23 (1.44-7.28)], proteinuria [0.27 (0.11-0.69)], and renal function [0.90 (0.88-0.93)]. CONCLUSION: CKD awareness has been consistently low in Korea. This trend warrants the special endeavor to promote CKD awareness in Korea.

Application of the theory of planned behavior to understand physical activity intentions and behavior among Korean breast cancer survivors.

PURPOSE: The purpose of this study was to apply the theory of planned behavior (TPB) to understand physical activity intentions and behaviors among Korean breast cancer survivors. METHODS: A total of 286 Korean breast cancer survivors (Mage52.3 ± 8.3) completed a self-reported survey administered face to face by a trained interviewer. The survey assessed the physical activity frequency and intensity in a typical week after breast cancer diagnosis, demographic factors, and theory of planned behavior variables including attitude, subjective norm, perceived behavioral control (PBC), planning, and intentions to participate in physical activity. We used structural equation modeling to examine the direct and indirect effects of the TPB variables on physical activity intentions and behavior. Covariates included age, cancer stage, and clinical treatment. RESULTS: Confirmatory factor analyses indicated a satisfactory model fit. We observed direct effects for instrumental attitude (ß = 0.34, p < 0.001), subjective norm (ß = 0.12, p < 0.05), and PBC (ß = 0.57, p < 0.001) on physical activity intentions. PBC (ß = .17, p < 0.01) and physical activity intentions (ß = 0.46, p < 0.01) had direct effects on planning. PBC (ß = 0.28, p < 0.01) and planning (ß = 0.22, p < 0.01) had direct effects on physical activity behavior. CONCLUSION: The TPB was a useful model for understanding Korean breast cancer survivors' physical activity intentions and behavior. Interventions that can enhance attitudes, subjective norm, PBC, intention, and planning may facilitate physical activity intentions and behaviors in this population.

A case of vasculitis triggered by infective endocarditis in a patient undergoing maintenance hemodialysis: a case report.

BACKGROUND: Immunoglobulin A vasculitis (IgA vasculitis) is one of the most common forms of vasculitis in children. It rarely occurs in adults. It is a systemic vasculitis with IgA deposition and is characterized by the classical tetrad of purpura, arthritis/arthralgia, gastrointestinal and renal involvement. Certain types of infections, and pharmacological agents have been reported to be associated with IgA vasculitis. Here, we describe a case of IgA vasculitis triggered by infective endocarditis in a patient undergoing maintenance hemodialysis. CASE PRESENTATION: A 70-year-old man undergoing hemodialysis was admitted because of skin purpura, abdominal pain, diarrhea, and lower back pain. We suspected him as IgA vasculitis based on the clinical features and skin biopsy findings. Transesophageal echocardiography revealed infective endocarditis, which predisposed him to IgA vasculitis. He was treated with antibiotics and low-dose corticosteroids, which led to resolution of vasculitis. CONCLUSIONS: This is the first case of IgA vasculitis triggered by infective endocarditis in a patient undergoing hemodialysis. Patients undergoing hemodialysis are at a high risk of infection because of immune dysfunction and frequent venipuncture. The incidence of infective endocarditis associated with IgA vasculitis is very low, but it has been repeatedly reported. Therefore, it is necessary to consider infective endocarditis in patients with clinical features that indicate IgA vasculitis.

Changes in DNA methylation after 6-week exercise training in colorectal cancer survivors: A preliminary study.

AIM: Behavioral interventions such as exercise may induce epigenetic changes. Only few studies investigated the effects of exercise on epigenetic alterations in colorectal cancer survivors. The aim of this study was to explore the changes of genome-wide DNA methylation after 6-week exercise training in colorectal cancer survivors. METHODS: This preliminary study used a subset of data from a randomized controlled trial in 15 colorectal cancer survivors. Participants were randomized either to the 6-week exercise group or control group. The exercise intervention consisted of a weekly, group-based, supervised resistance exercise program and a home-based same resistance exercise plus walking six times per week. Blood samples were collected at baseline and after the intervention and data from eight subjects were analyzed for genome-wide DNA methylation on 865,918 CpG sites. RESULTS: Compared to the control group, the exercise group shows notable methylation changes in 756 CpG sites (22.7-25.2%). Gene ontology and disease annotation analysis showed that the genes targeting 81 CpG sites in promoter region with significant group-difference were linked in biological process such as immune response and transcription and related to metabolic and immune diseases. Also, hypermethylation on genes related to disease prevention seemed to be inhibited in the exercise group compared to the control group, indicating a likelihood of transcriptional activity of these genes. CONCLUSION: We found a preliminary evidence of the positive effects of exercise intervention on epigenetic markers in colorectal cancer survivors. Larger scale randomized controlled trials are warranted to further investigate our findings.

Does Regular Exercise without Weight Loss Reduce Insulin Resistance in Children and Adolescents?

Despite considerable efforts to tackle childhood obesity, it is recognized as one of the biggest health problems globally. Childhood obesity is a leading cause of many comorbid conditions such as metabolic syndrome and insulin resistance as well as type 2 diabetes. A strong body of evidence suggests that regular exercise without calorie restriction or weight loss is associated with reduced insulin resistance as well as improved insulin sensitivity in overweight and obese adults. However, despite the well-known benefits associated with regular exercise alone, the independent role of exercise training without calorie restriction on insulin resistance is still uncertain in youth. Some studies observed that both the aerobic and resistance type of exercise training without calorie restriction resulted in meaningful changes in insulin sensitivity, suggesting that exercise alone is an effective therapeutic strategy for reducing insulin resistance in overweight and obese youth. However, only few studies are available on the optimal dose of exercise training without calorie restriction or preferred exercise modality for reducing insulin resistance, which warrants further investigations in the pediatric population.