Bone Mineral Density and the Risk of Parkinson's Disease in Postmenopausal Women.

BACKGROUND: Whether bone mineral density (BMD) is related to the risk of Parkinson's disease (PD) is unclear. OBJECTIVES: The objective of this study was to examine the association between BMD status and incident PD in postmenopausal women. METHODS: We retrospectively examined a nationwide cohort of 272,604 women aged 66 years who participated in the 2009-2012 Korean national health screening for transitional ages. BMD was evaluated using dual-energy X-ray absorptiometry of the central bones. The use of antiosteoporosis medications (AOMs) was assessed. We performed multivariable Cox proportional hazards regression to evaluate the association between BMD and PD risk by calculating hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: During the median follow-up of 7.7 years, 2,884 (1.1%) incident PD cases developed. After adjusting for confounding factors, lower BMD was associated with an increased risk of PD (P for trend <0.001). Individuals with osteoporosis had a 1.40-fold higher HR (1.40, 95% CI: 1.25-1.56) than those with a normal BMD. Sensitivity analyses suggested the associations robust to longer lag periods and further adjustment. These associations were prominent in individuals without AOM use before or after enrollment (P for interaction = 0.031 and 0.014). Increased risks of PD in individuals with osteopenia and osteoporosis who did not use AOMs were attenuated by the medication use during the follow-up period, regardless of previous AOM use. CONCLUSIONS: Lower postmenopausal BMD and osteoporosis were associated with an increased risk of PD. In addition, this association could be mitigated using AOMs. Proper management of BMD in postmenopausal women may help prevent PD. © 2023 International Parkinson and Movement Disorder Society.

Validity and reliability of a Korean version of the Consultation and Relational Empathy (CARE) measure.

BACKGROUND: No validated tool is available to assess patients' perception of physician empathy in Korea. The objective of this study was to establish a Korean version of the Consultation and Relational Empathy (CARE) measure-originally developed in English and widely used internationally-and to examine its reliability and validity. METHODS: The CARE measure was translated into Korean and tested on 240 patients from one secondary care hospital and one tertiary care hospital in Korea. Internal consistency by Cronbach's alpha, exploratory analysis, and confirmatory factor analysis were conducted to verify the 10 items of the Korean CARE measure. RESULTS: The Korean CARE measure demonstrated high acceptability and face validity, excellent internal reliability (Cronbach's alpha = 0.97) and moderate test-retest reliability (Pearson correlation coefficient = 0.53; Spearman correlation coefficient = 0.51). Distribution of scores showed negative skewedness. Corrected item-total correlations ranged from 0.77-0.92, indicating homogeneity. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.949, and Bartlett's test of sphericity was good (χ2 = 3157.11, P < 0.001). Factor analysis yielded a single dimensional structure of physician empathy with all factor loadings exceeding 0.80 and showing excellent goodness of fit. CONCLUSION: This study supports the reliability and validity of the Korean CARE measure in a university hospital setting in Korea.

Effects of Prolonged Dual Antiplatelet Therapy in ST-Segment Elevation vs. Non-ST-Segment Elevation Myocardial Infarction.

BACKGROUND: The benefits and risks of prolonged dual antiplatelet therapy (DAPT) have not been studied extensively across a broad spectrum of acute coronary syndromes. In this study we investigated whether treatment effects of prolonged DAPT were consistent in patients presenting with ST-segment elevation myocardial infarction (STEMI) vs. non-STEMI (NSTEMI).Methods and Results:As a post hoc analysis of the SMART-DATE trial, effects of ≥12 vs. 6 months DAPT were compared among 1,023 patients presenting with STEMI and 853 NSTEMI patients. The primary outcome was a composite of recurrent myocardial infarction (MI) or stent thrombosis at 18 months after the index procedure. Compared with the 6-month DAPT group, the rate of the composite endpoint was significantly lower in the ≥12-month DAPT group (1.2% vs. 3.8%; hazard ratio [HR] 0.31, 95% confidence interval [CI] 0.12-0.77; P=0.012). The treatment effect of ≥12- vs. 6-month DAPT on the composite endpoint was consistent among NSTEMI patients (0.2% vs. 1.2%, respectively; HR 0.20, 95% CI 0.02-1.70; P=0.140; Pinteraction=0.718). In addition, ≥12-month DAPT increased Bleeding Academic Research Consortium (BARC) Type 2-5 bleeding among both STEMI (4.4% vs. 2.0%; HR 2.18, 95% CI 1.03-4.60; P=0.041) and NSTEMI (5.1% vs. 2.2%; HR 2.37, 95% CI 1.08-5.17; P=0.031; Pinteraction=0.885) patients. CONCLUSIONS: Compared with 6-month DAPT, ≥12-month DAPT reduced recurrent MI or stent thrombosis regardless of the type of MI at presentation.

Hypertension-Mediated Organ Damage and Long-term Cardiovascular Outcomes in Asian Hypertensive Patients without Prior Cardiovascular Disease.

BACKGROUND: Hypertension-mediated organ damage (HMOD), comprising structural and functional changes in arteries or end organs, is a marker of cardiovascular (CV) disease. However, there are limited data on evaluation of risk of CV disease regarding HMOD, especially in Asians. We sought to investigate the association between CV events and HMOD, and we tried to determine the most important diagnostic marker among the component of HMOD for prevention of mortality and CV events in treated Korean hypertensive patients. METHODS: From January 2008 to December 2010, a total of 35,000 hypertensive Vietnamese War veterans who consecutively visited our hospital for medical check-up were reviewed, and 6,158 patients without established CV disease were enrolled. The patients were divided into two groups as follows: HMOD group (n = 766) and non-HMOD group (n = 5,392). The primary outcome was all-cause death. RESULTS: Median age was 63.3 years (interquartile range [IQR], 61.4-65.4), and median follow-up was 6.6 years (IQR, 5.9-7.2). Patients with old age, diabetes, and chronic kidney disease were more prevalent in the HMOD group than in the non-HMOD group (all P < 0.05). The lipid profiles were not significantly different between the two groups. Nephropathy was the most prevalent (54.7%) organ damage in the HMOD group. The 6-year incidence of all-cause death was higher in the HMOD group than in the non-HMOD group (22.5% vs. 9.0%; adjusted hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.01-2.00; P = 0.04). The incidence of cardiac death, ischemic heart disease, and ischemic and hemorrhagic stroke were also significantly higher in the HMOD group than in the non-HMOD group (P < 0.05, respectively). In multivariate analysis, proteinuria (adjusted HR, 2.21; 95% CI, 1.52-3.20; P < 0.001) was the most powerful independent risk factor to predict all-cause death among components of HMOD. As the degree of proteinuria increased, the rate of all-cause death also increased (long-rank P < 0.001). CONCLUSION: HMOD was associated with increased risk of mortality and CV events. Proteinuria was the most powerful independent risk factor for all-cause death, and the degree of proteinuria and mortality rate were proportional. Our data suggest that monitoring of the proteinuria is important to predict long-term CV events in hypertensive patients.

Motion Artifact Reduction in Wearable Photoplethysmography Based on Multi-Channel Sensors with Multiple Wavelengths.

Photoplethysmography (PPG) is an easy and convenient method by which to measure heart rate (HR). However, PPG signals that optically measure volumetric changes in blood are not robust to motion artifacts. In this paper, we develop a PPG measuring system based on multi-channel sensors with multiple wavelengths and propose a motion artifact reduction algorithm using independent component analysis (ICA). We also propose a truncated singular value decomposition for 12-channel PPG signals, which contain direction and depth information measured using the developed multi-channel PPG measurement system. The performance of the proposed method is evaluated against the R-peaks of an electrocardiogram in terms of sensitivity (Se), positive predictive value (PPV), and failed detection rate (FDR). The experimental results show that Se, PPV, and FDR were 99%, 99.55%, and 0.45% for walking, 96.28%, 99.24%, and 0.77% for fast walking, and 82.49%, 99.83%, and 0.17% for running, respectively. The evaluation shows that the proposed method is effective in reducing errors in HR estimation from PPG signals with motion artifacts in intensive motion situations such as fast walking and running.

6-month versus 12-month or longer dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (SMART-DATE): a randomised, open-label, non-inferiority trial.

BACKGROUND: Current guidelines recommend dual antiplatelet therapy (DAPT) of aspirin plus a P2Y12 inhibitor for at least 12 months after implantation of drug-eluting stents (DES) in patients with acute coronary syndrome. However, available data about the optimal duration of DAPT in patients with acute coronary syndrome undergoing percutaneous coronary intervention are scant. We aimed to investigate whether a 6-month duration of DAPT would be non-inferior to the conventional 12-month or longer duration of DAPT in this population. METHODS: We did a randomised, open-label, non-inferiority trial at 31 centres in South Korea. Patients were eligible if they had unstable angina, non-ST-segment elevation myocardial infarction, or ST-segment elevation myocardial infarction, and underwent percutaneous coronary intervention. Enrolled patients were randomly assigned, via a web-based system by computer-generated block randomisation, to either the 6-month DAPT group or to the 12-month or longer DAPT group, with stratification by site, clinical presentation, and diabetes. Assessors were masked to treatment allocation. The primary endpoint was a composite of all-cause death, myocardial infarction, or stroke at 18 months after the index procedure in the intention-to-treat population. Secondary endpoints were the individual components of the primary endpoint; definite or probable stent thrombosis as defined by the Academic Research Consortium; and Bleeding Academic Research Consortium (BARC) type 2-5 bleeding at 18 months after the index procedure. The primary endpoint was also analysed per protocol. This trial is registered with ClinicalTrials.gov, number NCT01701453. FINDINGS: Between Sept 5, 2012, and Dec 31, 2015, we randomly assigned 2712 patients; 1357 to the 6-month DAPT group and 1355 to the 12-month or longer DAPT group. Clopidogrel was used as a P2Y12 inhibitor for DAPT in 1082 (79·7%) patients in the 6-month DAPT group and in 1109 (81·8%) patients in the 12-month or longer DAPT group. The primary endpoint occurred in 63 patients in the 6-month DAPT group and in 56 patients in the 12-month or longer DAPT group (cumulative event rate 4·7% vs 4·2%; absolute risk difference 0·5%; upper limit of one-sided 95% CI 1·8%; pnon-inferiority=0·03 with a predefined non-inferiority margin of 2·0%). Although all-cause mortality did not differ significantly between the 6-month DAPT group and the 12-month or longer DAPT group (35 [2·6%] patients vs 39 [2·9%]; hazard ratio [HR] 0·90 [95% CI 0·57-1·42]; p=0·90) and neither did stroke (11 [0·8%] patients vs 12 [0·9%]; 0·92 [0·41-2·08]; p=0·84), myocardial infarction occurred more frequently in the 6-month DAPT group than in the 12-month or longer DAPT group (24 [1·8%] patients vs ten [0·8%]; 2·41 [1·15-5·05]; p=0·02). 15 (1·1%) patients had stent thrombosis in the 6-month DAPT group compared with ten (0·7%) in the 12-month or longer DAPT group (HR 1·50 [95% CI 0·68-3·35]; p=0·32). The rate of BARC type 2-5 bleeding was 2·7% (35 patients) in the 6-month DAPT group and 3·9% (51 patients) in the 12-month or longer DAPT group (HR 0·69 [95% CI 0·45-1·05]; p=0·09). Results from the per-protocol analysis were similar to those from the intention-to-treat analysis. INTERPRETATION: The increased risk of myocardial infarction with 6-month DAPT and the wide non-inferiority margin prevent us from concluding that short-term DAPT is safe in patients with acute coronary syndrome undergoing percutaneous coronary intervention with current-generation DES. Prolonged DAPT in patients with acute coronary syndrome without excessive risk of bleeding should remain the standard of care. FUNDING: Abbott Vascular Korea, Medtronic Vascular Korea, Biosensors Inc, and Dong-A ST.

Group randomized trial of teaching tobacco-cessation counseling to senior medical students: a peer role-play module versus a standardized patient module.

BACKGROUND: An important barrier to smoking-cessation counseling for physicians is a lack of education at the undergraduate level. Interactive methods such as peer role-play (RP) or modules utilizing standardized patients (SPs) may be effective for medical students to enhance their performance on tobacco cessation counseling. This study compared the effectiveness of a module using SPs to that of a RP module for undergraduate medical students on tobacco cessation counseling. METHODS: This study was conducted over a single week of the family medicine clerkship. One hundred and thirteen fourth-year medical students were randomized into either the SP group or the RP group. A RP module involved a ten-minute encounter between the student doctor and the student patient followed by five minutes of feedback from the observer student using a group developed checklist. In a SP module, each student was asked to interview a SP portraying a smoker with willingness to quit. After the encounter, the SP provided five minutes of direct oral feedback to the student. In both modules, the total intervention lasted three-and-half hours and was supervised by faculty staff. Students' objective structured clinical examination (OSCE) scores were evaluated to determine their tobacco cessation counseling skills. Four evaluation periods were conducted at baseline, postintervention, post-clerkship, and before receiving the Korean medical licensing examination (KMLE). Students' smoking knowledge test scores and counseling self-confidence levels at pre- and post-intervention were also compared. RESULTS: In both groups, post-intervention OSCE scores increased significantly compared to baseline (Cohen's d 0.87, p < 0.001 in SP group; d 0.77, p < 0.001 in RP group). However, there were no differences between the two groups. Students achieved the highest OSCE score for smoking-cessation counseling before the KMLE. After training, student self-confidence and smoking-knowledge test scores increased significantly, regardless of the type of module. Self-confidence was higher in the SP group compared with the RP group (d 0.37, p = 0.01). CONCLUSIONS: Peer role-play may be equivalent to the SP method with regard to knowledge and skills reported during smoking-cessation counseling and SP method may be better in self-confidence. Cost and student self-confidence may be important factors when choosing among the teaching methods for smoking-cessation counseling.

Relationship between abdominal obesity and alcohol drinking pattern in normal-weight, middle-aged adults: the Korea National Health and Nutrition Examination Survey 2008-2013.

OBJECTIVE: Abdominal obesity is associated with obesity-related health risks regardless of body weight. The present study aimed to determine whether alcohol drinking pattern is associated with abdominal obesity in normal-weight, middle-aged adults. DESIGN: Cross-sectional study using complex sampling design analyses. SETTING: The Korea National Health and Nutrition Examination Survey, which was conducted from 2008 to 2013. SUBJECTS: Normal-weight participants aged 40-69 years with BMI of 18·5-25·0 kg/m2 (n 11 289, 4491 men and 6798 women) were included. Abdominal obesity was defined as waist circumference ≥90 cm for men or ≥85 cm for women. Alcohol drinking pattern was assessed by self-report on questionnaires. RESULTS: Among 11 289 normal-weight participants, 7·9 % (n 379) of men and 7·6 % (n 609) of women had abdominal obesity. Both men and women who consumed a higher quantity of alcohol per drinking occasion had higher odds (OR; 95 % CI) for abdominal obesity compared with individuals who consumed fewer than 2 drinks (1·86; 1·04, 3·32 for ≥10 drinks/typical occasion in men; and 3·28; 1·13, 9·46 in women). Men who binge drink every day had higher odds for abdominal obesity (2·10; 1·21, 3·63). In both sexes, frequency of alcohol drinking was not associated with normal-weight abdominal obesity. CONCLUSIONS: Our study showed that the amount of alcohol drinking per occasion influenced abdominal obesity in normal-weight, middle-aged individuals that may have impacted obesity-related health risks. Healthy alcohol drinking habits need to be controlled for prevention of abdominal obesity even among persons with normal weight.

Risk factors for cognitive decline associated with gait speed in community-dwelling elderly Koreans with MMSE scores of 30.

BACKGROUND AND AIM: We aimed to investigate the association between lower gait speed and cognitive decline over a 3-year period in community-dwelling older people with mini-mental state examination (MMSE) scores of 30 at baseline. METHODS: The study was based on data from 10,003 Koreans aged 60 years or older who completed the National Elderly Survey in both 2008 and 2011. Among them 620 subjects achieved MMSE scores of 30 in 2008. Over a 3-year period, preservation of MMSE score 28 or more was defined as preserved cognition and decrease of three or more points as cognitive decline. A 4-m gait speed was measured at baseline. Data on sociodemographic factors (age, number of schooling years, and household composition), alcohol drinking, current smokers, Korean version of Short form Geriatric Depression Scale score, and self-reported comorbid conditions, were collected. RESULTS: Of 620 (weighted 884) respondents included in the analysis, 208 (52.3 %) of 398 males (weighted 567) and 152 (68.5 %) of 222 females (weighted 317) suffered cognitive decline over the 3-year period. After adjustment, lower gait speed was associated with cognitive decline in males (OR 2.29; 95 % CI 1.07-4.89, P = 0.032). Educational level was a significant risk factor for both men and women (OR 0.86; 95 % CI 0.79-0.93 in males, OR 0.75; 95 % CI 0.65-0.87 in females). Males diagnosed with hypertension (OR 0.44; 95 % CI 0.22-0.88) or male smokers (OR 0.38; 95 % CI 0.19-0.75) were significantly less likely to have cognitive decline. There was no significant association between cognitive decline and gait speed in females. CONCLUSIONS: Higher 4-m gait speed is associated with preservation of cognitive function over time in men, but not in women.

Comparing the standards of one metabolic equivalent of task in accurately estimating physical activity energy expenditure based on acceleration.

The purpose of the study is to analyse how the standard of resting metabolic rate (RMR) affects estimation of the metabolic equivalent of task (MET) using an accelerometer. In order to investigate the effect on estimation according to intensity of activity, comparisons were conducted between the 3.5 ml O2 · kg-1 · min-1 and individually measured resting VO2 as the standard of 1 MET. MET was estimated by linear regression equations that were derived through five-fold cross-validation using 2 types of MET values and accelerations; the accuracy of estimation was analysed through cross-validation, Bland and Altman plot, and one-way ANOVA test. There were no significant differences in the RMS error after cross-validation. However, the individual RMR-based estimations had as many as 0.5 METs of mean difference in modified Bland and Altman plots than RMR of 3.5 ml O2 · kg-1 · min-1. Finally, the results of an ANOVA test indicated that the individual RMR-based estimations had less significant differences between the reference and estimated values at each intensity of activity. In conclusion, the RMR standard is a factor that affects accurate estimation of METs by acceleration; therefore, RMR requires individual specification when it is used for estimation of METs using an accelerometer.

The Effect of Sleep Quality on the Development of Type 2 Diabetes in Primary Care Patients.

Sleep has important effects on physical and mental health, and sleep disorders are associated with increased mortality and morbidity. This study was conducted to evaluate the relationship between sleep duration or sleep quality and the risk of type 2 diabetes. The FACTS (FAmily CohorT Study in primary care) was established to investigate the relations between familial environment and health which was conducted at 22 family medicine outpatient clinics in general hospitals. Total 563 patients without diabetes who received ≥1 year follow-up examination were included in the analysis. We used the Pittsburgh Sleep Quality Index to determine sleep quality, and a score of ≥5 was considered to define poor sleep quality. Patients taking oral hypoglycemic agents, having a fasting glucose level of >126 mg/dL, or diagnosed with diabetes by physicians were classified as having diabetes. The median follow-up period was 2.5 years. Poor sleep quality was associated with a higher risk of diabetes after adjusting for age, sex, body mass index, income, physical activity, and family history of diabetes (relative risk=2.64; 95% confidence interval, 1.03-6.78). As a risk factor for the development of diabetes, poor sleep quality may independently increase the incidence of diabetes.

Changes in Fatty Liver Disease and Incident Diabetes Mellitus in Young Korean Adults.

INTRODUCTION: This study sought to assess the association between the changes in nonalcoholic fatty liver disease (NAFLD) and risk of type 2 diabetes in young individuals with prediabetes. METHODS: Data from the Korean National Health Insurance System database were collected from 2009 to 2019 and analyzed in 2022. A total of 446,813 young adults aged 20-39 years with prediabetes who underwent two National Health Screening examinations from 2009 to 2012 were followed up. NAFLD was defined as a fatty liver index≥60 without liver disease or history of alcohol abuse. Multivariable Cox proportional hazards regression was used to calculate the HR and CIs for type 2 diabetes according to NAFLD changes. RESULTS: During a median follow-up of 8.3 years, 26,464 (5.9%) young individuals developed type 2 diabetes. Multivariable adjusted HR of type 2 diabetes according to the NAFLD change was 5.38 (95% CI 5.08-5.70) in individuals with persistent NAFLD when compared to those who never had NAFLD. Even in individuals who were consistently nonobese, resolved NAFLD, new NAFLD, and persistent NAFLD were associated with>3-fold increased risk of type 2 diabetes compared to nonobese individuals without NAFLD. The risk of type 2 diabetes also increased in obese individuals without NAFLD by 2-fold when compared to nonobese individuals without NAFLD. CONCLUSIONS: NAFLD that either existed persistently or ever existed plays a critical role in the development of type 2 diabetes in young adults with or without obesity. Nonobese individuals with NAFLD warrant special attention.

Association between Mothers' Working Hours and Metabolic Syndrome in Children and Adolescents: Data from the Korea National Health and Nutrition Examination Survey, 2016-2020.

Background: Prevention and management of metabolic syndrome (MetS) during childhood are crucial. Recently, obesity among children and adolescents has increased with an increase in mothers' working hours. The present study was conducted to determine the relationship between mothers' working hours and MetS in their children. Methods: Data from the 2016-2020 National Health and Nutrition Examination Survey were used, and 2,598 children and adolescents aged 10-18 years were included. Logistic regression analysis was conducted to confirm the association between MetS and mothers' working hours for each risk factor. Linear regression analysis was conducted to confirm the association between mothers' working hours and the number of risk factors for MetS. Results: Abdominal obesity in children was higher when the mothers' working hours were 53 hours or more (odds ratio [OR], 2.267; 95% confidence interval [CI], 1.21-4.25). In the trend analysis, the OR of children's abdominal obesity increased significantly as mothers' working hours increased (P-value <0.05). Additionally, sex-stratified analysis revealed a significant trend between maternal work hours and the presence of MetS in female children (P=0.016). The adjusted OR of the presence of MetS in female children with mothers working 53 hours or more weekly was 6.065 (95% CI, 1.954-18.822). Conclusion: Mothers' working hours were highly correlated with the risk of abdominal obesity in their children. The OR of the presence of MetS significantly increased in female children with mothers having longer working hours compared with those with stay-at-home mothers.

Serum 25-hydroxyvitamin D concentrations are inversely associated with all-cause mortality among Koreans: a nationwide cohort study.

Evidence on the association between serum 25-hydroxyvitamin D (25(OH)D) concentration and all-cause and cause-specific mortality in Asians, especially Koreans, is limited. We hypothesized that high concentrations of 25(OH)D are associated with lower all-cause and cause-specific mortality in the general Korean population. This study included 27,846 adults participating in the Fourth and Fifth Korean National Health and Nutrition Examination Survey 2008-2012, followed up through December 31, 2019. Hazard ratios (HR) and 95% confidence intervals (CIs) for mortality from all causes, cardiovascular disease (CVD), and cancer were estimated using multivariable-adjusted Cox proportional hazards regression. The weighted mean serum 25(OH)D of study participants was 17.77 ng/mL; 66.5% had vitamin D deficiency (<20 ng/mL) and 94.2% had insufficient vitamin D (<30 ng/mL). During a median follow-up of 9.4 years (interquartile range, 8.1-10.6 years), 1680 deaths were documented, including 362 CVD deaths and 570 cancer deaths. Serum 25(OH)D levels ≥30 ng/mL were inversely associated with all-cause mortality (HR, 0.57; 95% CI, 0.43-0.75) compared with serum 25(OH)D levels <10 ng/mL. Based on the quartile cutoffs of serum 25(OH)D concentration, the highest quartile of serum 25(OH)D concentration (≥21.8 ng/mL) was associated with the lowest all-cause mortality (HR, 0.72; 95% CI, 0.60-0.85; P trend < .001), and CVD mortality (HR, 0.60; 95% CI, 0.42-0.85; P trend = .006). No association with cancer mortality outcome was found. In conclusion, higher serum 25(OH)D levels were associated with lower all-cause mortality in the general Korean population. An additional association was found between higher quartile of serum 25(OH)D and lower CVD mortality.

Association between Problematic Smartphone Use and Physical Activity among Adolescents: A Path Analysis Based on the 2020 Korea Youth Risk Behavior Web-Based Survey.

BACKGROUND: Physical activity is known to prevent several diseases and positively affect mental health. Previous studies have shown that smartphone addiction negatively affects the physical activity of children and adolescents. This study aimed to investigate the relationship between problematic smartphone use and physical activity among adolescents and the related factors using path analysis. METHODS: Using data from the 16th Youth Risk Behavior Web-based Survey from 2020, scores on the Smartphone Addiction Scale-Short Version for Adolescents, physical activity, sex, socioeconomic status (SES), academic performance, depression, smoking, drinking, and sitting time were assessed. Complex sampling and path analyses were performed. RESULTS: Of the total 54,948 students, 25.5% were smartphone risk users, including potential and high-risk users. The direct path coefficients of each factor indicated that female sex (-0.14 for male), low SES (-0.062), high academic performance (0.056), low sitting time for studying purposes (-0.033), high sitting time for non-studying purposes (0.071), and depressive mood (0.130) were related to problematic smartphone use (all P<0.001). Each factor affected problematic smartphone use, and subsequently had a negative effect on the amount of physical activity, with a direct path coefficient of -0.115 (P<0.001). CONCLUSION: In this study, we confirmed that problematic smartphone use among adolescents was negatively associated with performing an adequate amount of physical activity and that various factors, such as sex, SES, academic performance, and sitting time, directly and indirectly affected this relationship.

Outcome Evaluation of a Transnational Postgraduate Capacity-Building Program Using the Objective Structured Clinical Examination.

Previous studies have applied interview-oriented self-reported or peer-centered evaluation methods, rather than an objective and quantitative method, to evaluate outcome of a postgraduate capacity-building program and have mainly focused on the cognitive level. To investigate the feasibility of the objective structured clinical examination (OSCE) in an international setting and report the results of the outcome evaluation for the behavioral aspect. A case-control study. Ninety examinees divided into 2 case-control groups: 17 program-experienced doctors and 17 control doctors in the first group, and 28 mentees of the program-experienced doctors and 28 control doctors in the second group. A six-station OSCE was implemented. The OSCE scores were measured to evaluate (1) the direct educational effect regarding learning in the first group and (2) the indirect educational effects regarding transfer in the second group. Written questionnaire and interview data were collected for qualitative analysis. The quantitative results of the overall or subcomponent OSCE scores indicated no significant differences in the comparisons of the first and second case-control groups. The qualitative data indicated that the program improved participants' medical knowledge, skills, and self-confidence, however, it also revealed limited learning environment provided by the program. This transnational study has demonstrated the process for introducing and successfully completing the testing of an OSCE in Laos. Discrepancy in the goals of the OSCE and the education program limited the usefulness of OSCE as an assessment tool, leading to the lack of significant differences in its results.

Body mass index and prevalence of metabolic syndrome among Korean adults before and after the COVID-19 outbreak: a retrospective longitudinal study.

OBJECTIVES: Studies evaluating weight changes during the coronavirus disease 2019 (COVID-19) pandemic have yielded inconsistent results, and most of those studies were based on self-reported anthropometric measures. We investigated changes in body mass index (BMI), professionally measured waist circumference (WC), and metabolic syndrome components from before to during the pandemic in a sample of the adult population in Korea. METHODS: This retrospective study included 1,118 male and female (age≥18 years) who underwent health checkups at a university medical center between January 1, 2016 and March 31, 2022. Changes in BMI, lifestyles, and metabolic syndrome components during the pandemic were analyzed using the paired t-test, McNemar test, generalized estimating equations, and repeated-measures analysis of variance. RESULTS: Changes in body weight, BMI, and body fat percentage during the pandemic were not clinically significant. However, statistically significant results were found for decreased physical activity (p<0.001) and WC (p<0.001), and exacerbation of all metabolic syndrome components (except serum triglyceride levels). Moreover, the metabolic syndrome prevalence increased significantly from 20.2% to 31.2% during the pandemic (p<0.001). The prevalence of abdominal obesity and high fasting blood glucose levels also significantly increased from 2019 to 2021. CONCLUSIONS: Metabolic syndrome, its components, and fat distribution worsened significantly after the implementation of social distancing and lockdowns, despite no clinically significant changes in body weight and BMI. Further studies on the post- pandemic period should investigate the long-term impact of social lockdowns on BMI and the prevalence of metabolic syndrome.

Quantitative measurement of empathy and analysis of its correlation to clinical factors in korean patients with chronic diseases.

BACKGROUND: Empathy is the core of the physician-patient relationship. The Consultation and Relational Empathy (CARE) measure is a useful tool for assessing patient-rated empathy. There have been scarce data on empathy in chronic disease patients in Korea. We aim to evaluate empathy using the Korean CARE measure in patients from various clinical environments and the factors influencing the degree of empathy in patients with chronic disease. METHODS: Data were collected from patients with chronic diseases. Patients were from primary, secondary, and tertiary clinics. Characteristics of the patients, physicians, and disease status were collected. The difference in CARE score was studied according to the clinical factors. RESULTS: A total of 162 patients with chronic diseases were included. About 60% of patients were male. The mean age was 62 years. They had an average number of 2.6 diseases. More than half of patients experienced overt cardiovascular disease. About half of them had a history of hospitalization due to cardiovascular disease. The overall average CARE score was 45.6 ± 7.0. The CARE score was not significantly different according to the characteristics of the patient, physician, or disease status. Regarding marital status, the CARE score was significantly lower for the small number of patients (n = 4, 2.5%) who refused to provide their marital status than for other groups. Except for four patients, there was no significant difference in the CARE score among married, unmarried, or divorced groups. This trend was maintained in hypertensive patients. CONCLUSIONS: The Korean CARE measure could assess patient-rated empathy in various clinical practices. The empathy of patients was high regardless of multiple factors.

Fatty Liver Change in Older Adults as an Important Risk Factor for Type 2 Diabetes: A Nationwide Cohort Study.

OBJECTIVE: To examine the association between changes in fatty liver disease (FLD) over time and the risk of type 2 diabetes in elderly individuals with prediabetes. METHODS: A total of 156,984 elderly individuals with prediabetes who underwent national health screening in 2009 and 2011 were followed up through December 31, 2019. The FLD status was defined as a change in the fatty liver index. Prediabetes was defined as impaired fasting glucose levels at baseline. Multivariable Cox proportional hazards regression was used to calculate the hazard ratio and CIs for type 2 diabetes according to the changes in FLD. RESULTS: During a median of 8.35 years of follow-up, type 2 diabetes developed in 29,422 (18.7%) elderly individuals with prediabetes. Multivariable adjusted hazard ratio of type 2 diabetes according to FLD change was 2.22 (95% CI, 2.11 to 2.34) in individuals with persistent FLD compared with those who have never had FLD. Although overall weight loss of 5% or more was associated with a 7% lower risk of type 2 diabetes in total participants, fatty liver status was important. Even with weight loss, those with a history of fatty liver-resolved FLD, new FLD, or persistent FLD-had an increased risk of type 2 diabetes. The risk of type 2 diabetes did not increase in individuals with sustained FLD-free status, regardless of weight change. CONCLUSION: The presence and change of FLD are important factors for the development of type 2 diabetes in elderly individuals with prediabetes.