Employment conditions and leisure-time physical activity among korean workers: a longitudinal study (2009-2019).

BACKGROUND: Employment conditions may affect individuals' leisure-time physical activity (LTPA). We aimed to examine the relationship between changes in working and employment conditions and LTPA among working-age populations in South Korea from 2009 to 2019. METHODS: A cohort of 6,553 men and 5,124 women aged 19-64 years was analyzed using linear individual-level fixed-effects regressions to examine changes in working and employment conditions with changes in LTPA. RESULTS: Reduced working hours, labor union membership, and part-time work were associated with increased LTPA for both sexes. Manual labor and self-reported precarious work were associated with reduced LTPA. The longitudinal relationship between employment conditions and LTPA was clear in men, but less apparent in women. CONCLUSIONS: Changes in working and employment conditions had longitudinal associations with changes in LTPA among working-age Koreans. Future research should examine changing employment conditions and their effect on LTPA, particularly among women and manual/precarious workers. These results could inform effective planning and interventions to increase LTPA.

Association between Breslow thickness and dermoscopic findings in acral melanoma.

BACKGROUND: Dermoscopy is a useful tool for the diagnosis of acral melanomas (AMs). However, little is known about the influence of tumor thickness on the dermoscopic findings of AM. OBJECTIVE: To investigate the affect Breslow thickness (BT) has on the dermoscopic patterns of AM. METHODS: Data on cases of AM on the glabrous skin were collected from 4 university hospitals. We investigated the frequency of each dermoscopic feature of AM according to the BT. Statistical analysis was performed to investigate the association between the specific dermoscopic patterns and BT. RESULTS: Multivariable analysis revealed that the colors red (odds ratio [OR] 16.482, 95% confidence interval [CI] 3.605-99.016); blue (OR 7.092; 95% CI 1.707-37.435); and white (OR 5.048, 95% CI 1.152-22.897) were more common in AM with BT >2 mm than those with BT ≤2 mm. Regarding patterns, atypical vascular (OR 34.589, 95% CI 6.458-305.852); blue-white veils (OR 9.605, 95% CI 1.971-72.062); and ulcers (OR 5.084, 95% CI 1.145-24.152) were more frequently detected in cases with BT >2 mm than those with BT ≤2 mm. LIMITATIONS: A retrospective study design and small sample size. CONCLUSION: This study showed an association between dermoscopic patterns and tumor thickness among patients with AM. Dermoscopy can be a useful adjuvant tool for predicting BT in AM.

Diagnostic criteria for and clinical review of melanonychia in Korean patients.

BACKGROUND: Melanonychia may be the presenting sign of ungual melanoma. However, there are insufficient basic clinical data for melanonychia in Korean patients. OBJECTIVE: We sought to identify basic clinical data and devise a classification algorithm for melanonychia. METHODS: In all, 275 patients with melanonychia who visited our clinic from January 2002 to August 2014 were included in this study. We reviewed medical records, clinical and dermoscopic photographs, and histopathologic findings and we assessed demographics (eg, age); medical (eg, systemic diseases), family, and trauma (eg, nail biting) history; and physical findings (eg, affected number and site). RESULTS: The 5 most common causes of melanonychia in Korean patients were subungual hemorrhage (29.1%), nail matrix nevus (21.8%), trauma-induced pigmentation (14.5%), nail apparatus lentigo (11.6%), and ethnic-type nail pigmentation (8.0%). Melanoma was diagnosed in 6.2% of patients. Ethnic-type nail pigmentation was commonly identified. LIMITATIONS: This is a retrospective study from a single center. CONCLUSION: We propose a revised diagnostic algorithm for melanonychia to assist in the evaluation of this condition.

Examining the effects of social assistance on suicide-related behaviour among impoverished older adults in Korea using a nationwide cohort study from 2010-2019.

Suicide rates among older adults in Korea are one of the highest in the world. Although prior research found that poverty is associated with suicide mortality among older adults in Korea, it is unknown whether being a recipient of social assistance may reduce suicide risk among older adults living in poverty. We examined the impact of the public assistance program on suicide-related behaviour (SRB). Data from a nationwide cohort in the Korean National Health Insurance Database, including demographic and medical treatment information, linked to the vital statistics for 2010-19 was used. The entire Korean population born before 1951 was included (n = 7,889,086). Flexible parametric survival model was performed to assess whether the risk of SRB hospitalisation and death differed across a) different levels of socioeconomic status, and b) social assistance status among the poor, using gender-stratified models. Older age, chronic disease, poverty, and being out of the labour market were associated with higher SRB hospitalisation and death for both genders. Among those living in poverty, social assistance recipients had lower rates for SRB death and hospitalisation, compared to the low-income non-recipients. Men who were non-recipients had 0.21 higher hazards ratio (95%CI 0.20 to 0.22) for SRB deaths compared to recipients, and the difference was 0.11 (95%CI 0.10 to 0.11) in women, with similar patterns for SRB hospitalizations. Poverty was associated with higher SRB death and hospitalisation among older adults in Korea. Social assistance targeting the older population may help reduce SRB.

Patterns of follow-up mental health care after hospitalization for suicide-related behaviors among older adults in South Korea.

OBJECTIVE: This study aimed to investigate the sociodemographic and clinical factors associated with receiving follow-up mental healthcare within 7 days and 30 days after hospitalization for suicide-related behaviors (SRB) among older adults in South Korea. METHODS: Data from the Korean National Health Information Database were used, including information on sociodemographic variables and healthcare utilization. The study cohort consisted of individuals born in 1950 or before with a prior hospitalization record for suicide attempts or probable suicide attempts. Logistic regression analysis was conducted to predict the odds of receiving follow-up care within 7 days and 30 days, adjusting for covariates. RESULTS: Among the 37,595 older adults discharged from hospitalization for SRB, 29.13 % and 37.86 % received follow-up care within 7 days and 30 days, respectively. Follow-up care was more common among younger individuals, women, those with higher socio-economic status (SES), urban residents, and individuals with comorbidities. CONCLUSION: The provision of mental health follow-up care for older adults after hospitalization for suicide attempts is inadequate in South Korea. Increasing access to follow-up care among those with lower income, residing in rural areas, and older age is crucial. Public awareness campaigns, stigma reduction training for healthcare providers, and system-level changes, such as telemedicine and integrated care pathways, can help bridge the healthcare gap and reduce suicide mortality among older adults.

Outbreak investigation of pertussis in an elementary school: a case-control study among vaccinated students.

PURPOSE: A pertussis patient from an elementary school, in Gyeonggi Province, Korea, was notified to public health authority on July 25, 2017. Epidemiologic investigation was conducted to identify the magnitude, possible source of infection and risk factors for this outbreak on August 17, 2017. MATERIALS AND METHODS: A case was defined as the school student experiencing cough for more than two weeks with or without paroxysmal, whoop, or post-tussive vomiting. Control was defined as the student polymerase chain reaction-negative at the school. School based surveillance was implemented to identify additional cases. RESULTS: From June 29 to August 27, 2017, nine patients of pertussis were identified from an elementary school. Among nine cases, eight were confirmed by polymerase chain reaction positive. All cases had cough, one (11%) had post-tussive vomiting, and one (11%) had fever. Eight cases had macrolide for 7 days in outpatient clinic, and one case admitted in a hospital. There was no significant difference of demographic factors including gender (p=0.49), age group (p=0.97), number of series of vaccination of pertussis (p=0.52), the number of participation of after school activity (p=0.28), and the time elapsed since last vaccination (p=0.42). However, we found the history of contact within the classroom or after-school activity was only the independent risk factor among all the demographic factors collected (odds ratio, 63.61; 95% confidence interval, 4.35 to 930.79). CONCLUSION: The contributing factor for transmission is associated with the case-contact. Immediate identification of pertussis with use of appropriate diagnostic test may help to avoid a large number of cases.

Dermoscopic "Landscape Painting Patterns" as a Clue for Labial Melanotic Macules: An Analysis of 80 Cases.

BACKGROUND: Labial melanotic macules (LMMs) are benign pigmented lesions that usually take the shape of flat asymmetrical macules with tan-brown to black color and variable size. Whereas the dermoscopic features of other pigmented skin lesions have been relatively well described, little is known about LMMs. OBJECTIVE: To describe the dermoscopic features and find typical and schematic dermoscopic patterns in LMMs. METHODS: A retrospective dermoscopic study was conducted on 80 lesions with histopathologically proved LMMs. RESULTS: We described and defined, for the first time to our knowledge, landscape painting patterns found in 65 of 80 melanotic lesions (81.3%), characterized by parallel lines or circle lines, overlapping vessels with background brown pigmentation. The background brown pigmentations were observed in 74 of 80 lesions (92.5%), the parallel lines in 62 (77.5%), the circle lines in 20 (25.0%), and overlapping vessels in 69 (86.3%). The structureless black pigmentations were only presented in 26 of 80 (32.5%). CONCLUSION: Dermoscopy can be useful for the clinical detection of LMMs, and "Landscape painting patterns" may represent a dermoscopic clue for the diagnosis of these lesions.

High rates of secondary non-adherence causes decreased efficacy of 0.1% topical tacrolimus in adult eczema patients: results from a multicenter clinical trial.

BACKGROUND: Patients tend to apply topical medications less frequently, in improper amounts. Not only frequency but also application amount may influence treatment outcome. However, studies on relationship between application amount and objective treatment outcome have rarely been conducted. OBJECTIVE: To assess efficacy of topical agent according to application amount in adult patients, using the finger-tip unit method. METHODS: The efficacy of 0.1% topical tacrolimus in adult patients with localised atopic dermatitis was assessed using EASI, TIS, IGA, and PGA scores at baseline, follow-up. Adherence in amount was evaluated after 2 weeks of treatment using the ratio of the actual amount applied to the expected amount applied (A/E). RESULTS: Twenty-seven patients (20.93%) used topical tacrolimus in proper amounts (A/E: 0.8-1.2). However, 86 patients (66.67%) underused topical tacrolimus; 16 (12.40%) patients overused topical tacrolimus. Decreases in EASI scores between baseline and 2 weeks of follow-up in each group (under-amount, proper amount, over-amount) were 1.64, 4.65 and 4.21, respectively. Treatment efficacy increased in accordance with application amount. Further, TIS, IGA, PGA, VAS for Itch and DLQI scores improved concomitantly, exhibiting similar tendencies. CONCLUSION: Application amount of topical agent is important in increasing treatment efficacy in adult patients with atopic dermatitis.

Inappropriate amounts of topical tacrolimus applied on Korean patients with eczema.

BACKGROUND: The limited efficacy of topical tacrolimus may result from insufficient frequency of application or amount applied in eczema patients. OBJECTIVE: To investigate the frequency of application and amount of use of topical tacrolimus in patients with various types of eczema. METHODS: The frequency of application and the applied amount of topical tacrolimus were assessed over two weeks. RESULTS: A total of 200 eczema patients completed this study. The average number of applications per day was 1.75 ± 0.53, despite instructions to apply the topical tacrolimus twice daily. With respect to the frequency of application, 147 (73.5%) and 122 (61.0%) of patients followed the prescription in the first and second weeks, respectively. The average amount applied per 2% of total body surface area (TBSA) was 0.54 ± 0.52 g. Only 53 (26.5%) patients applied between 80 and 120% of expected amount of topical tacrolimus. LIMITATIONS: The frequency of application was self-reported, possibly resulting in limited accuracy. CONCLUSION: Korean patients with eczema tend to apply topical tacrolimus less frequently and in inappropriate amounts. Clear instructions regarding both the frequency and amount of application are needed to improve the therapeutic outcome with treatment with topical tacrolimus.

Arborizing Vessels on Dermoscopy in Various Skin Diseases Other Than Basal Cell Carcinoma.

BACKGROUND: Arborizing vessels (AVs) are dermoscopically defined as telangiectasias with distinct treelike branching, and are a characteristic feature of basal cell carcinoma (BCC). However, AVs are observed in various conditions other than BCC. OBJECTIVE: The aim of this study was to investigate skin diseases showing AV and investigates dermoscopic differences between BCC and non-BCC. METHODS: Dermoscopic images showing AV were prospectively collected and classified into BCC/non-BCC. Non-BCC was further classified into tumors (benign cystic, benign non-cystic, premalignant, and malignant) and non-tumors. We compared AV focusing, widest diameter of stem vessels, widest diameter ratio of stem vessel to first branch, and number of ramifications between groups. RESULTS: Among 124 images, 54.0% were BCC and 46.0% were non-BCC. Non-BCC included epidermal cysts, hypertrophic scars/keloids, intradermal nevi, actinic keratoses, etc. The proportion of focused AV in BCC was significantly higher and the proportion of unfocused AV in BCC was lower than that of premalignant and malignant non-BCC. The widest diameter ratio of stem vessel to first branch was higher in non-BCC. Number of ramifications was significantly less in benign cystic non-BCC than BCC. CONCLUSION: Various skin diseases showed AV, so that diagnoses other than BCC should be considered. The findings in this study could help discriminate BCC from non-BCC.

Five Cases of Phytophotodermatitis Caused by Fig Leaves and Relevant Literature Review.

Phytophotodermatitis is a condition caused by sequential exposure to photosensitizing substances present in plants followed by ultraviolet light. Several plants (e.g., limes, celery, fig, and wild parsnip) contain furocoumarin compounds (psoralens). It is important for dermatologists to be aware of phytophotodermatitis because it may be misdiagnosed as cellulitis, tinea, or allergic contact dermatitis. We present five patients with a sharply defined erythematous swollen patch with bullae on both feet. They described soaking their feet in a fig leaves decoction to treat their underlying dermatologic diseases. Within 24 hours, all patients had a burning sensation in their feet, and erythema and edema had developed on the feet dorsa with exception of the portion of the skin covered by the sandals. Histopathologic examinations revealed sub-epithelial blisters with intensive epidermal necrosis. Phytophotodermatitis was ultimately diagnosed and, after several days, the patients' skin lesions began to recover upon treatment with systemic and topical corticosteroids. Unfortunately, since there are no studies providing sufficient evidence on the benefits of fig leaves, they should be used with caution.

Various Dermatoses What the Patients with Cutaneous Melanoma Had Anxiety for the Recurrence during Postoperative Surveillance.

BACKGROUND: The incidence and mortality rates associated with cutaneous melanoma (CM) have steadily increased over the last 20 years. Even with successful treatment, melanoma patients usually experience substantial anxiety regarding the development of terrible recurrence. To date, few studies have investigated various dermatoses what the patients with CM had anxiety for the recurrence during postoperative surveillance (Dw). OBJECTIVE: To describe various Dw and to evaluate the risk of subsequent malignant skin disease in patients with CM. METHODS: We performed a prospective study between August 2002 and August 2015. RESULTS: Fifty-six patients presented with a total of 68 Dw. Among them, melanocytic nevus was the most common (n=27), followed by seborrheic keratosis (n=9) and CM recurrence (n=7). Approximately 5.6% of the lesions were diagnosed as malignant skin diseases. This was a single-center study, so the prevalence of malignant skin diseases following primary melanoma may not represent that of all patients with CM. CONCLUSION: The results of this study can be referred by dermatologists dealing with melanoma especially when CM patients have too excessive or unrealistic anxiety for melanoma recurrence during postoperative surveillance of CM. However, the importance of postoperative surveillance must still be emphasized because of real risk of melanoma recurrence and other malignant skin.

Change in Antimicrobial Susceptibility of Skin-Colonizing Staphylococcus aureus in Korean Patients with Atopic Dermatitis during Ten-Year Period.

BACKGROUND: A small subset of adolescents atopic dermatitis (AD) tends to persist. This also leads to get more antibiotics exposure with advancing years. Antibiotic resistance has been regarded as a serious problem during Staphylococcus aureus treatment, especially methicillin-resistant S. aureus (MRSA). OBJECTIVE: It was investigated the S. aureus colonization frequency in the skin lesions and anterior nares of adolescent AD patients and evaluated the changes in S. aureus antimicrobial susceptibility for years. METHODS: Patients who visited our clinic from September 2003 to August 2005 were classified into group A, and patients who visited from August 2010 to March 2012 were classified into group B. To investigate the differences with regard to patients' age and disease duration, the patients were subdivided into groups according to age. Lesional and nasal specimens were examined. RESULTS: Among the 295 AD patients, the total S. aureus colonization rate in skin lesions was 66.9% (95/142) for group A and 78.4% (120/153) for group B. No significant changes in the systemic antimicrobial susceptibilities of S. aureus strains isolated from adolescent AD patients were observed during about 10-year period. The increased trend of MRSA isolation in recent adolescent AD outpatients suggest that the community including school could be the source of S. aureus antibiotic resistance and higher fusidic acid resistance rates provides evidence of imprudent topical use. CONCLUSION: Relatively high MRSA isolation and fusidic acid resistance rates in recent AD patients suggest that the community harbors antibiotic-resistant S. aureus.

Clinical features and course of generalized pustular psoriasis in Korea.

The clinical course of generalized pustular psoriasis (GPP) is variable and unpredictable. Sufficient data on the clinical course of the disease has not been reported due to its rarity. To investigate the clinical features and course of GPP according to its subtypes, medical records of patients diagnosed with GPP from 2002 to 2012 at two tertiary hospitals were reviewed. The data included patient demographics, associated symptoms, aggravating factors, patterns of relapse and prognosis. Thirty-three patients with GPP were included in our study, with a mean age of 45.6 years and a male : female ratio of 1:1.2. Patients were categorized based on the following subtypes: acute GPP, 21 (63.6%); GPP of pregnancy, two (6.1%); juvenile GPP, three (9.1%); and annular GPP, seven (21.2%). In the acute GPP population, skin lesions cleared within 2 months in 11 (73.3%) patients, and six (40.0%) of these had no relapse. Severe complications, abortion or death, were observed in two patients (100.0%) with GPP of pregnancy. Nineteen (76.0%) of the GPP patients experienced persistence or relapse of skin lesions. The patterns of skin lesions upon relapse included plaques in six patients (31.6%), pustules in eight patients (42.1%), and plaques and pustules in five patients (26.3%). Among acute GPP patients, 16.7% of patients with no relapse had a history of plaque psoriasis. However, 77.8% of patients with persistence and relapse in their clinical course had a history of plaque psoriasis. In conclusion, our study presents the detailed clinical course of GPP by subtype in Korean patients.