Associations Between Korean Coronary Heart Disease Risk Score and Cognitive Function in Dementia-Free Korean Older Adults.

BACKGROUND: Cardiovascular risk is a modifiable factor that can help prevent dementia. Given the dearth of optimal treatment options, managing dementia risk factors is crucial. We examined the association between cardiovascular risk, as measured by the Korean coronary heart disease risk score (KRS), and cognitive function in dementia-free elderly individuals. METHODS: We enrolled 8,600 individuals (average age: 69.74 years; 5,206 women) who underwent a medical evaluation from the National Health Insurance Service. KRS was calculated using age, sex, blood pressure, lipid profile, diabetes, and smoking status. Cognitive function was evaluated using Korean Dementia Screening Questionnaire-Cognition (KDSQ-C). Scores of ≥ 6 indicated a cognitive decline. Logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI). Weight, height, stroke history, coronary heart disease history, alcohol consumption, and physical activity engagement were adjusted. RESULTS: The lowest, middle, and highest groups, according to the KRS, were 5,923 (68.9%), 2,343 (27.2%), and 334 (3.9%), respectively. The highest KRS group in all participants exhibited a greater risk of cognitive decline than the lowest KRS group (OR, 1.339; 95% CI, 1.034-1.734; P = 0.027). The highest KRS female group aged 71-75 years old exhibited greater cognitive decline than the corresponding lowest KRS group (OR, 1.595; 95% CI, 1.045-2.434; P = 0.031). CONCLUSION: Individuals with high cardiovascular risk were associated with poorer cognitive function than those with low risk, especially older women. Cardiovascular risk factors should be carefully managed to promote healthy mental aging in dementia-free elderly individuals.

Hypernatremia at admission predicts poor survival in patients with terminal cancer: a retrospective cohort study.

BACKGROUND: Although palliative care providers, patients, and their families rely heavily on accurate prognostication, the prognostic value of electrolyte imbalance has received little attention. METHODS: As a retrospective review, we screened inpatients with terminal cancer admitted between January 2017 and May 2019 to a single hospice-palliative care unit. Clinical characteristics and laboratory results were obtained from medical records for multivariable Cox regression analysis of independent prognostic factors. RESULTS: Of the 487 patients who qualified, 15 (3%) were hypernatremic upon admission. The median survival time was 26 days. Parameters associated with shortened survival included male sex, advanced age (> 70 years), lung cancer, poor performance status, elevated inflammatory markers, azotemia, impaired liver function, and hypernatremia. In a multivariable Cox proportional hazards model, male sex (hazard ratio [HR] = 1.53, 95% confidence interval [CI]: 1.15-2.04), poor performance status (HR = 1.45, 95% CI: 1.09-1.94), leukocytosis (HR = 1.98, 95% CI: 1.47-2.66), hypoalbuminemia (HR = 2.06, 95% CI: 1.49-2.73), and hypernatremia (HR = 1.55, 95% CI: 1.18-2.03) emerged as significant predictors of poor prognosis. CONCLUSION: Hypernatremia may be a useful gauge of prognosis in patients with terminal cancer. Further large-scale prospective studies are needed to corroborate this finding.

Relationship between serum alkaline phosphatase level, C-reactive protein and leukocyte counts in adults aged 60 years or older.

Serum alkaline phosphatase (ALP), a useful marker of hepatobiliary or bone disorders, has been known to be associated with cardiovascular disease (CVD), which is increasingly being viewed as an inflammatory disease. C-reactive protein level and leukocyte count have also been highlighted as independent risk markers of CVD. Thus, the mechanism underlying the link between elevated ALP and CVD could be subclinical low-grade inflammation. This study aimed to examine associations of serum ALP level with inflammatory markers. This cross-sectional study included 2403 participants (1324 men and 1079 women) aged ≥60 years who participated in a health examination program. Serum ALP quartiles were categorized as follows: Q1: ≤51, Q2: 52-61, Q3: 62-74 and Q4: ≥75 U/L. The odds ratios (ORs) and 95% confidence intervals (CIs) for high CRP and leukocyte count (≥75th percentiles) were calculated after adjusting for confounding variables across serum ALP quartiles using multiple logistic regression analysis. Median CRP level and mean leukocyte count increased in accordance with serum ALP quartiles. Compared to the lowest quartile, the ORs (95% CI) of the highest quartile for high CRP and leukocyte count were 2.03 (1.50-2.76) and 1.54 (1.13-2.10) after adjusting for age, sex, body mass index, smoking status, alcohol intake, fasting plasma glucose, log-transformed triglyceride and HDL-cholesterol levels. Serum ALP level was positively and independently associated with inflammatory markers in adults aged 60 years or older.

Oxidative balance score and serum γ-glutamyltransferase level among Korean adults: a nationwide population-based study.

PURPOSE: The oxidative balance score (OBS) comprises dietary and non-dietary lifestyle pro-oxidants and antioxidants. Elevated serum γ-glutamyltransferase (GGT) level has currently emerged as a biomarker of oxidative stress. In this study, we examined whether OBS was inversely associated with serum GGT level and whether OBS could be a useful marker to predict GGT among Korean adults. METHODS: This cross-sectional study was based on data obtained from the 2010 and 2011 Korea National Health and Nutrition Examination Survey. 2087 men and 2071 women were included in final analysis. The OBS was divided into five equal interval categories, and GGT was dichotomized into low and high using its sex-specific median value. Multiple logistic regression analysis was conducted to assess the association between OBS categories and high GGT. RESULTS: Compared with the lowest OBS category as reference, the multivariable adjusted ORs (95% CIs) for the highest OBS category of men and women were 0.05 (0.01-0.19) and 0.27 (0.09-0.78), respectively (p for trend <0.01). CONCLUSION: A higher OBS that indicates a predominance of antioxidant over pro-oxidant exposure was strongly inversely associated with GGT level among Korean adults.

Serum carcinoembryonic antigen is positively associated with leukocyte count in Korean adults.

BACKGROUND: Emerging evidence shows that serum carcinoembryonic antigen (CEA) levels may modestly be increased in non-neoplastic conditions such as cardiometabolic diseases, which are increasingly being seen as inflammatory diseases. Leukocyte count is widely evaluated marker of inflammation in clinical practice and a useful predictor of cardiometabolic disease. In this study, we aimed to determine the relationship between serum CEA levels and leukocyte counts in Korean adults. METHODS: This cross-sectional study included a total of 19 834 individuals enrolled from a health promotion center between November 2006 and July 2010. Multiple linear regression analysis was performed to investigate the association between serum CEA levels and leukocyte counts after adjusting for confounding variables. RESULTS: According to both stepwise-method and enter-method multiple linear regression analyses, serum CEA levels were positively and independently associated with leukocyte counts (P<.001) after adjusting for age, sex, body mass index, systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, HDL-cholesterol, cigarette smoking, alcohol ingestion, physical activity, diabetes mellitus, and anti-inflammatory drugs. CONCLUSIONS: We demonstrate a positive relationship between serum CEA levels and leukocyte counts in Korean adults. Our results suggested that an elevated serum CEA level may reflect chronic inflammation state.

The relationship between employment status and insulin resistance in the Korean elderly population.

BACKGROUND/AIMS: This study aimed to investigate the relationship between employment status and insulin resistance in the Korean elderly population. METHODS: The study included 2325 healthy participants (862 men and 1463 women) who did not have diabetes, were 60-74 years old, and participated in the 2007-2010 Korea National Health and Nutrition Examination Survey. Their employment status was categorized as employed or unemployed. The homeostasis model assessment of insulin resistance (HOMA-IR) was used to assess insulin sensitivity. Insulin resistance was defined as values greater than the 75th percentile of the HOMA-IR (> 2.67 in men and > 2.87 in women). RESULTS: Mean HOMA-IR values were significantly higher for both sexes in the unemployed group than in the employed group. Compared with the unemployed group, the odds ratios (95% confidence intervals) for insulin resistance in the employed group were 0.55 (0.34-0.87) in men and 0.68 (0.47-0.98) in women after adjusting for confounders. CONCLUSIONS: Being employed was significantly associated with a lower risk of insulin resistance in the Korean elderly population. These findings suggest that insulin sensitivity could be increased by increasing physical activity through occupational activities in the elderly population.

Triglyceride to high density lipoprotein cholesterol ratio and its association with periodontal disease in Korean adults: findings based on the 2012-2014 Korean national health and nutrition examination survey.

OBJECTIVES: The aim of this study is to evaluate whether the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio is associated with periodontal disease in Korean adults. MATERIALS AND METHODS: This cross-sectional study included 12,249 individuals (4,941 men and 7,308 women) who took part in the 2012-2014 Korean National Health and Nutrition Examination Survey. We categorized the TG/HDL-C ratio into three groups. Periodontal disease was defined as a community pocket index score ≥3 with at least one affected site. Multiple logistic analyses were used to analyze the association between TG/HDL-C ratio and periodontal disease. RESULTS: In the study population, prevalence of periodontal disease was 31.6% in men and 21% in women. Compared to the lowest tertile group, OR (95% CI) of the highest tertile group for periodontal disease was 1.474 (1.220-1.780) in men and 1.259 (1.041-1.522) in women after adjusting for age, waist circumference, systolic blood pressure, fasting glucose, current smoking, alcohol drinking, physical activity, household income, oral health behavior, and use of anti-dyslipidemia medication. CONCLUSION: Our study suggests that the TG/HDL-C ratio is associated with periodontal disease in Korean adults. CLINICAL RELEVANCE: TG/HDL-C ratio is a simple and useful marker to reflect insulin resistance. And periodontal disease is also known to be related with insulin resistance. This study indicates that TG/HDL-C ratio was associated with periodontal disease in Korean adults.

The relationship between pulmonary function and suicidal ideation in Korean adults: a nationwide survey.

Controversy surrounds the association between lung function and mental health in the general population, and previous reported results were confounded by the effect of other chronic illnesses. This study aimed to investigate whether reduced lung function was related to mental health issues, taking into consideration the relevant potential confounders. We used data from the 2008-2013 Korean National Health and Nutrition Examination Survey to examine the relationship between lung function and three mental issues (recognized stress, depressive mood, and suicidal ideation) among 22,068 Korean adults. A multiple logistic regression with adjustment for potential covariates including chronic illnesses revealed that a .5-L decrement of forced vital capacity increased the risk for suicidal ideation in both genders, but there was no significant association with recognized stress or depressive mood. We found an inverse relationship between lung function and suicidal ideation in the Korean general population.

Comparative Evaluation of Recombinant Human Bone Morphogenetic Protein-2/Hydroxyapatite and Bovine Bone for New Bone Formation in Alveolar Ridge Preservation.

PURPOSE: Hydroxyapatite treated with recombinant human bone morphogenetic protein-2/Hydroxyapatite (rhBMP-2/HA) or bovine bone was applied on extraction sockets for alveolar ridge preservation, and the results were compared with respect to clinical and histological bone formation. MATERIALS AND METHODS: This was a prospective, randomized controlled clinical trial performed on 20 implant placement sites (10 in the experimental and 10 in the control group). rhBMP-2/HA was applied on extraction sockets in the experimental group and bovine bone on those of the control group. The bone at the corresponding sites was biopsied 3 months later, and clinical, histological, and histomorphometric analyses were performed. RESULTS: The alveolar bone height was well preserved in both groups with relatively less change in width in the experimental group compared with the control group. The percentage of new bone was 25.37% ± 17.23% in the experimental group and 6.13% ± 4.32% in the control group; the difference was statistically significant. CONCLUSIONS: The alveolar ridge was preserved clinically and histologically in both groups. rhBMP-2/HA resulted in greater new bone formation than bovine bone 3 months after the surgery.

Practice Patterns in Distinguishing Between Background Pain and Breakthrough Pain During Patient Education: a Korean Physician Survey.

This study sought to explore the association between physician practice patterns and patient education, with a focus on breakthrough cancer pain (BTcP). A nationwide online survey was conducted by 92 Korean physicians. Thirteen questions on Korean physician's assessment, prescription, patient education practices, and knowledge regarding BTcP were administered. Based on their responses, physicians were divided using two methods: (1) by their patient education practices, where the "education group" always explained the distinction between background pain and BTcP and the "less education group" which explained it less frequently; and (2) by their definition of BTcP, as occurring "after control of background pain" or "regardless of background pain." We compared practice patterns using Fisher's exact test or Student's t test and performed multiple logistic regression analysis. The "education group" (65 physicians, 70.7 %) was more likely than the "less education group" to assess BTcP meticulously (odds ratio [OR] 17.13, 95 % confidence interval [CI] 4.98-58.94), prepare rescue medications in advance (OR 3.67, 95 % CI 1.36-9.90), and give explicit instructions regarding medications (OR 36.68, 95 % CI 5.63-239.15). Physicians who defined BTcP as occurring "after control of background pain" were more likely to explain how to take rescue medication (P < 0.05) than physicians who defined BTcP as occurring "regardless of background pain." Korean physicians' BTcP practice patterns may be affected by whether they consistently educate patients on the distinction between background pain and BTcP, regardless of their knowledge of the definition of BTcP.

Smokers With Adequate Vitamin C Intake Show a Preferable Pulmonary Function Test.

OBJECTIVE: Airflow obstruction often results from the chronic inflammation caused by cigarette smoke. It has been concluded that cigarette smoke-induced oxidative damage is prevented by ascorbic acid on a cellular level. The purpose of the current study was to explore the effect of vitamin C intake on pulmonary function in established smokers (100 or more cigarettes) and never-smokers in a Korean population. METHODS: The 2974 enrolled men and women over the age of 40 in the Korea National Health and Nutrition Examination Survey IV 2008 were divided into 4 groups based on smoking patterns (never-smoker vs established smoker) and vitamin C intake from dietary assessment (higher vs lower; median value: 77.18 mg/day). RESULTS: Univariate analysis showed associations between forced expiratory volume in 1 second (FEV1), FEV/forced vital capacity (FVC) and age, gender, body mass index (BMI), pack-years, vitamin C intake, and additional micronutrient intake. On multiple logistic regression analysis, the odds ratios (95% confidence interval) for FEV1 < 80% predicted were 1.000 (never-smokers, higher vitamin C intake), 1.067 (0.823, 1.383; never-smokers, lower vitamin C intake), 1.224 (0.871, 1.721; established smokers, higher vitamin C intake), and 1.479 (1.057, 2.072; established smokers, lower vitamin C intake). The odds ratios for FEV1/FVC < 0.70 were 1.177 (0.821, 1.687; never-smokers, lower vitamin C intake), 1.637 (1.094, 2.445; established smokers, higher vitamin C intake), and 2.093 (1.403, 3.122; established smokers, lower vitamin C intake) after adjusting for confounding factors (p < 0.001). CONCLUSIONS: Korean smokers with adequate vitamin C intake showed a preferable pulmonary function test.

The association between platelet count and metabolic syndrome in children and adolescents.

UNLABELLED: The goal of this study was to evaluate the association between platelet count and metabolic syndrome (MetS) in children and adolescents in Korea. This study included data from 2228 subjects (1201 boys and 1027 girls) who participated in the 2010-2012 Korean National Health and Nutrition Examination Survey (KNHANES-V). We used the modified National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria to define MetS. Odds ratios (95% confidence intervals [CIs]) for MetS were calculated with a multiple logistic regression analysis after adjusting for confounding factors across platelet count quartiles. The overall prevalence of MetS according to the modified NCEP-ATP III criteria was 4.9% (± 0.7%) in boys and 5.7% (± 0.9%) in girls. The prevalence of MetS significantly increased with increasing platelet quartiles in both boys and girls. In a multiple logistic regression analysis, the adjusted ORs (95% CIs) for the highest vs. the lowest quartile were 5.03 (1.30-19.48) in boys and 4.08 (1.20-13.93) in girls after adjusting for age and total cholesterol. CONCLUSIONS: Higher platelet count was associated with increased prevalence and risk of MetS in children and adolescents.

Sex differences in the relationship between blood mercury concentration and metabolic syndrome risk.

BACKGROUND: Mercury exposure enhances free radical production and reduces activity of anti-oxidant enzymes, resulting in detrimental health effects. Some researchers have reported an association between blood mercury and increased risk of metabolic syndrome (MetS); however, sex differences in the relationship were not fully considered. AIM: To examine the sex differences in the relationship between blood mercury concentration and the increased risk of MetS in Korean men and women. MATERIALS AND METHODS: A nationwide cross-sectional study was conducted to examine the relationship between blood mercury concentration and MetS in 2,976 men and 3,074 women over 19 years of age (aged 19-87 years), using data from the 2010-2012 Korean National Health and Nutrition Examination Survey (KNHANES-V). Multiple logistic regression analysis was used to assess the relationship between blood mercury concentration and the prevalence risk of MetS after adjusting for confounding variables. RESULTS: Compared to the lowest quartile of blood mercury concentration, the OR (95 % CI) for MetS of the highest quartile in men was 1.62 (1.15-2.28) after adjusting for age, smoking status, alcohol consumption, regular exercise, and BMI. Similarly, in multiple logistic regression analysis using log2-transformed blood mercury as a continuous variable, the OR (95 % CI) for having MetS with doubling of blood mercury was 1.20 (1.05-1.36) after adjusting for the same co-variables. However, the relationship was not observed in women after adjusting for the same co-variables. CONCLUSIONS: Blood mercury concentration was independently associated with an increased risk of MetS in men.

Body weight status misperception and its association with weight control behaviours, depressive mood and psychological distress in nulliparous normal-weight young women.

BACKGROUND: Understanding body weight status dissatisfaction may be important for understanding weight control behaviours and mental health. AIMS: To investigate the relationships between body weight status misperceptions in nulliparous normal-weight young women and weight control-related behaviours and mental health. SUBJECTS AND METHODS: Body weight perceptions, weight control methods, depressive mood and psychological distress were measured in 717 nulliparous normal-weight women, aged 18-40 years, who participated in the 2007-2009 Korean National Health and Nutrition Examination Surveys (KNHANES-IV). RESULTS: Among 717 participants, 24 subjects (4.1 ± 1.0%) misperceived themselves to be underweight and 295 subjects (39.2 ± 2.2%) misperceived themselves to be overweight. Those with overweight misperceptions were more likely to fail to maintain their targeted body weights, despite weight control efforts (p < 0.001). Weight control behaviours such as taking diet pills were more common among women with overweight misperception (p < 0.001). Compared to the accurate body weight perception group, age-adjusted ORs for depressive mood and psychological distress were 1.82 (1.06-3.13) and 1.65 (1.10-2.47) in the overweight misperception group. CONCLUSIONS: Body weight status misperception may be important for understanding weight control-related behaviours and psychiatric illness among nulliparous normal-weight young women.

Effect of fruits and vegetables on metabolic syndrome: a systematic review and meta-analysis of randomized controlled trials.

Evidence regarding the effect of fruit and vegetable consumption on metabolic syndrome remains inconclusive. Using MEDLINE, EMBASE, and Cochrane, we searched for relevant studies published before 10 December 2013. Of the 383 articles identified, eight randomized controlled trials with 396 participants (205 in intervention groups and 191 in control groups) were included in the final analyses. Fruit and vegetable intake was associated with a reduction in diastolic blood pressure (standardized mean difference: -0.29; 95% confidence interval: -0.57 to -0.02; p = 0.04); however, such intake did not affect waist circumference, systolic blood pressure, fasting glucose, high-density lipoprotein cholesterol, and triglyceride levels in metabolic syndrome patients. In a subgroup analysis, there were no statistically significant differences found according to the intervention period and provision type. Our results suggest an inverse association between fruit and vegetable consumption and diastolic blood pressure in metabolic syndrome patients.

EORTC QLQ-C15-PAL quality of life score as a prognostic indicator of survival in patients with far advanced cancer.

PURPOSE: Quality of life (QoL) and performance status predict survival in advanced cancer patients; these relationships have not been explored in the hospice palliative care setting. The aim of this study was to examine the survival predictability of patient-reported QoL using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C15-PAL questionnaire in far advanced cancer inpatients at the very end of life. METHODS: This is a retrospective cohort study. Patients reported QoL using the EORTC QLQ-C15-PAL. One hundred sixty-two inpatients in hospice palliative wards of six hospitals in South Korea were followed until death or the end of the study. Additional symptoms and performance status were assessed by the MD Anderson Symptom Inventory-Korean (MDASI-K), Palliative Performance Scale (PPS) and Eastern Cooperative Oncology Group (ECOG) performance status. Correlations between EORTC QLQ-C15-PAL, MDASI-K, PPS, and ECOG were assessed. Survival analyses were performed using Cox proportional hazard models. RESULTS: Patients' median survival was less than 1 month. Physician-reported PPS significantly predicted survival (hazard ratio [HR] 0.493; p<0.001). From the EORTC QLQ-C15-PAL, patient-reported physical functioning predicted survival (HR=0.65; p<0.001). Other six domains of EORTC QLQ-C15-PAL were significantly related to survival after adjustment. Those domains were global health status, emotional functioning, fatigue, nausea/vomiting, appetite loss, and constipation. CONCLUSIONS: EORTC QLQ-C15-PAL can be an independent prognostic factor in inpatients with far advanced cancer. Patient-reported physical functioning showed survival predictability as good as physician-reported performance status. It is notable that the QLQ instrument is useful even for patients in their final month of life. Cancer anorexia-cachexia syndrome-related symptoms may be independent prognostic symptoms. Prospective study is warranted.

Trends in prevalence of overweight and obesity in Korean adults, 1998-2009: the Korean National Health and Nutrition Examination Survey.

BACKGROUND: Although obesity is increasing worldwide and becoming a major public health problem, some countries report a trend toward stabilization. We investigated prevalence trends in overweight/obesity and obesity among Korean adults during a 12-year period. METHODS: This study was based on the Korean National Health and Nutrition Examination Survey (KNHANES) I (1998), II (2001), III (2005), and IV (2007-2009). The χ(2) and ANOVA tests were used to compare the prevalence and mean values for age and BMI, respectively. P-values for trends were determined by linear and logistic regression analyses, with KNHANES phase as the continuous variable. RESULTS: The prevalences of overweight/obesity in KNHANES I through IV were 50.8%, 57.4%, 62.5%, and 62.6%, respectively, among men (P for trend = 0.002, ß = 0.021) and 47.3%, 51.9%, 50.0%, and 48.9% among women (P for trend = 0.017, ß = -0.015). The respective prevalences of obesity were 26.0%, 32.4%, 35.1%, and 36.3% among men (P for trend = 0.006, ß = 0.018) and 26.5%, 29.3%, 28.0%, and 27.6% among women (P for trend = 0.143, ß = -0.008). During the same period, the respective prevalences of grade 2 obesity (BMI ≥30 kg/m(2)) were 1.7%, 2.8%, 3.6%, and 3.8% among men (P for trend = 0.075, ß = 0.005) and 3.0%, 3.5%, 3.4%, and 4.0% among women (P for trend = 0.398, ß = 0.003). CONCLUSIONS: The prevalences of overweight/obesity and obesity showed an upward trend among men during the 12-year period, whereas the prevalence of overweight/obesity slightly decreased among women from 2001.

Clinical changes in terminally ill cancer patients and death within 48 h: when should we refer patients to a separate room?

BACKGROUND: There is scant research concerning the prediction of imminent death, and current studies simply list events "that have already occurred" around 48 h of the death. We sought to determine what events herald the onset of dying process using the length of time from "any change" to death. METHODS: This is a prospective observational study with chart audit. Inclusion criteria were terminal cancer patients who passed away in a palliative care unit. The analysis was limited to 181 patients who had medical records for their final week. Commonly observed events in the terminally ill were determined and their significant changes were defined beforehand. We selected the statistically significant changes by multiple logistic regression analysis and evaluated their predictive values for "death within 48 h." RESULTS: The median age was 67 years and there were 103 male patients. After adjusting for age, sex, primary cancer site, metastatic site, and cancer treatment, multiple logistic regression analyses for association between the events and "death within 48 h" revealed some significant changes: confused mental state, decreased blood pressure, increased pulse pressure, low oxygen saturation, death rattle, and decreased conscious level. The events that had higher predictability for death within 48 h were decreased blood pressure and low oxygen saturation, and the positive and negative predictive values of their combination were 95.0 and 81.4%, respectively. CONCLUSION: The most reliable events to predict impending death were decreased blood pressure and low oxygen saturation.

Developing a scoring guide for the Appraisal of Guidelines for Research and Evaluation II instrument in Korea: a modified Delphi consensus process.

Korea has a relatively short history in the development and use of clinical practice guidelines (CPGs). Additionally, it has been difficult to employ the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument due to the lack of consensus and the presence of differences in Korean medical settings and in the Korean socio-cultural environment. An AGREE II scoring guide was therefore developed to reduce differences among evaluators using the same tool. In consideration of the importance of using a quantitative measure of satisfaction with the elements described in the AGREE II manual, a final draft was developed through a Delphi consensus process. Ninety-two draft scoring guides for anchor points 1, 3, 5, and 7 (full score) in 23 items were developed. Consensus was defined as agreement among at least 70% of the raters. Agreement on 88 draft scoring guidelines was reached in the first Delphi round, and agreement for the remaining four was achieved in the second round. The development of an AGREE II scoring guide in this study is expected to contribute to improving the CPG environment.

Association between the Urine Cotinine Level and Blood Pressure in Korean Adults with Secondhand Smoke Exposure: Korea National Health and Nutritional Examination Survey 2016-2018.

BACKGROUND: Similar to smoking, exposure to secondhand smoke is a risk factor for developing hypertension and cardiovascular diseases; however, there is no standardized method for measuring smoke exposure. Measuring urine cotinine levels is one possible means for determining the degree of exposure to secondhand smoke. This study investigated the association between urinary cotinine levels and blood pressure in Korean adults exposed to secondhand smoke. METHODS: Data from the Korea National Health and Nutrition Examination Survey conducted between 2016 and 2018 were used. A total of 9,273 participants aged ≥19 years self-reported as current non-smokers, which was cotinine- verified. A complex sample general linear model regression analysis was performed to analyze the association between urine cotinine and blood pressure. A P-value of <0.05 was considered statistically significant. RESULTS: Corrected urine cotinine levels were positively associated with systolic and diastolic blood pressure in female participants (P<0.001 and P=0.040, respectively). Furthermore, a 10-fold increase in the corrected urine cotinine level of those in contact with secondhand smoke was independently associated with 2.085 mm Hg and 0.575 mm Hg increases in systolic and diastolic blood pressure, respectively. However, there was no association between systolic and diastolic blood pressure in male participants (P=0.226 and P=0.256, respectively). CONCLUSION: Urinary cotinine levels were positively associated with increased blood pressure in females exposed to secondhand smoke. Therefore, urinary cotinine may be used as an indicator to quantify and monitor the effects of blood pressure elevation in females exposed to secondhand smoke.