JUUL preference among Korean adult tobacco users and its effect on attempts to quit tobacco: A follow-up survey four months post JUUL launch.

INTRODUCTION: This study examined the various factors in the selection of JUUL (and/or), a pod-mod type electronic cigarette (EC), and the changes in EC patterns before and after the JUUL debut on 24 May 2019, using follow-up survey data of adult tobacco users in South Korea. METHODS: This study examined transition outcomes among tobacco users and factors associated with future JUUL use. Convenience sample data were collected from adult tobacco users in South Korea, from March-April 2019 (baseline, n=2173) to September 2019 (follow-up, n=779). Results were obtained from the 779 respondents in the follow-up survey, and user data of one or more tobacco products were analyzed. The changes in the proportion of EC and JUUL use during this period were calculated, and multivariate logistic regression analysis was conducted to investigate the selection factors of JUUL. RESULTS: Four months after the JUUL launch, the proportion of current EC and JUUL users among the whole sample increased by 10.3% (42.6-52.9%, p<0.001) and 17.7 % (4.0-21.7%, p<0.001), respectively, while the proportion of triple users doubled (18.7% vs 37.5%, p<0.001). Among current EC users, the percentage of quitting EC within one month decreased from 18.7% to 8.7%; this change was more pronounced among concurrent JUUL users than non-JUUL users (p<0.001). In the multivariate logistic analysis with adjustment for possible confounders, JUUL use was significantly associated with male sex, young and middle age, and metropolitan residency status at the baseline survey. CONCLUSIONS: After the launch of JUUL in South Korea, EC users, including JUUL and triple users, increased significantly, but the intention to stop EC decreased significantly. Given the serious interests of the tobacco industry in these products, additional regulation is warranted.

Association between the dual use of electronic and conventional cigarettes and NAFLD status in Korean men.

INTRODUCTION: This study investigated the association between smoking types, including dual use (usage of both combustible cigarettes and e-cigarettes), and non-alcoholic fatty liver disease (NAFLD) status in Korean men. METHODS: Data from the 7th and 8th Korea National Health and Nutrition Examination Survey (KNHANES) 2016-2020 were used. The presence of NAFLD was defined by the respective cut-off values for the Hepatic Steatosis Index (HSI), NAFLD Ridge Score (NRS), and Korea National Health and Nutrition Examination Survey NAFLD score (KNS). Multivariate logistic regression analyses were used to determine the associations between smoking types and NAFLD as determined by HSI, NRS, and KNS. RESULTS: After adjustment for confounders, an independent association was observed between dual use and NAFLD (HSI: AOR=1.47; 95% CI: 1.08-1.99, p=0.014; NRS: AOR=2.21; 95% CI: 1.70-2.86, p=0.000; KNS: AOR=1.35; 95% CI: 1.01-1.81, p=0.045). Cigarette only smokers also had significantly higher odds of NAFLD compared to never smokers for all of the NAFLD indices (HSI: AOR=1.22; 95% CI: 1.05-1.42, p=0.008; NRS: AOR=2.13; 95% CI: 1.87-2.42, p=0.000; KNS: AOR=1.33; 95% CI: 1.14-1.55, p=0.000). In subgroup analyses, no significant interaction effects were found for age, BMI, alcohol consumption, income, physical activity, and the diagnosis of T2DM. Moreover, cigarette only smokers and dual users differed significantly in terms of log-transformed urine cotinine and pack-years. The relationship between smoking type and pack-years was attenuated after stratification by age. CONCLUSIONS: This study shows that the dual use of e-cigarettes and combustible cigarettes is associated with NAFLD. Age differences may explain why dual users, with a greater proportion of young people, appear to have fewer pack-years than cigarette only smokers. Further research should be conducted to investigate the adverse effects of dual use on hepatic steatosis.

Changes in Diagnostic Performance of Thyroid Cancer Screening before and after the Korean Thyroid Imaging Reporting and Data System Revision.

BACKGROUND: Since the era of "thyroid cancer epidemic," many Korean academic societies discouraged the use of ultrasonography in healthy individuals and revised the Korean Thyroid Imaging Reporting and Data System to address the overscreening and overdiagnosis issues. This study aimed to evaluate the change in the diagnostic effectiveness of thyroid cancer screening over the last decade. METHODS: This single-center, retrospective observational study analyzed the data of 125,962 thyroid nodules obtained during cancer screening at the health promotion center of Seoul National University Bundang Hospital from 2010 to 2019. Only 327 thyroid cancer cases pathologically confirmed by fine-needle aspiration (FNA) were included in the study. The strength of the association between the number of FNA and (1) the number of thyroid cancer diagnoses, (2) the positive predictive values (PPVs), and (3) the difference in PPV from the previous year were evaluated using Pearson's correlation analysis. RESULTS: The number of thyroid FNA biopsies as well as the thyroid cancer diagnoses decreased from 2010 to 2019 (166 to 48 [-71.1%] vs. 43 to 22 [-48.8%]). The PPV of FNA biopsies increased from 25.9% to 45.8% (+76.8%) and was negatively correlated with the number of FNA biopsies performed (R=-0.87, P<0.001). The difference in PPV from the previous year increased similarly but without statistical significance (R=-0.59, P=0.09). CONCLUSION: The diagnostic efficiency of thyroid cancer screening has increased over the last decade, as evidenced by the increasing PPV of FNA biopsies.

Perceived relative harm of heated tobacco products and electronic cigarettes and its association with use in smoke-free places: A cross-sectional analysis of Korean adults.

INTRODUCTION: Electronic cigarettes (e-cigarettes) and heated tobacco products (HTPs) are often considered to be less harmful and safer than combustible cigarettes (CCs). As a result, numerous tobacco product users opt to use e-cigarettes or HTPs as a safer alternative, though the safety of these products is not fully warranted. The present study aimed to assess the various attitudes towards e-cigarettes and/or HTPs among Korean tobacco product users and their associations with the practical use of e-cigarettes and/or HTPs in private or smoke-free public places. METHODS: A cross-sectional study using self-administered questionnaires was conducted from March 2019 to July 2019 on 2971 adult tobacco product users. Attitude towards e-cigarettes and/or HTPs, as well as the relative harm perceptions, in association with their practical use in private or smoke-free areas, were also analyzed. RESULTS: Among those surveyed, 46.8% were exclusive users (CC-only smokers 23.5%, e-cigarette-only users 10.7%, HTP-only users 12.7%), and 47.6% were poly-users. Compared with non-e-cigarette or non-HTP users, current e-cigarette or HTP users perceived e-cigarettes or HTPs as less harmful than CCs and they were more acceptable to e-cigarettes or HTPs being used indoors. Their positive attitudes were associated with their more frequent use at home or in their car. Less number of participants supported that the government should regulate e-cigarettes or HTPs in the same way as CCs, their attitude being associated with more frequent use in smoke-free public places. CONCLUSIONS: E-cigarettes or HTPs users have more positive attitudes toward their tobacco products than non-e-cigarette or non-HTP users. Those with more positive attitudes toward e-cigarettes or HTPs are closely related to their use in smoke-free places.

Combined Associations of Changes in Noncombustible Nicotine or Tobacco Product and Combustible Cigarette Use Habits With Subsequent Short-Term Cardiovascular Disease Risk Among South Korean Men: A Nationwide Cohort Study.

BACKGROUND: The associations of changes in noncombustible nicotine or tobacco product (NNTP) and combustible cigarette (CC) use habits with subsequent cardiovascular disease (CVD) risk are still unclear. METHODS: The study population consisted of 5 159 538 adult men who underwent health screening examinations during both the first (2014-2015) and second (2018) health screening periods from the Korean National Health Insurance Service database. All participants were divided into continual CC-only smokers, CC and NNTP users, recent (<5 years) CC quitters without NNTP use, recent CC quitters with NNTP use, long-term (≥5 years) CC quitters without NNTP use, long-term CC quitters with NNTP use, and never smokers. Propensity score matching analysis was conducted to further compare CVD risk among CC quitters according to NNTP use. Starting from the second health screening date, participants were followed up until the date of CVD event, death, or December 31, 2019, whichever came earliest. Multivariable Cox proportional hazards regression was used to determine the adjusted hazard ratios (aHRs) and 95% CIs for CVD risk according to changes in NNTP and CC smoking habits. RESULTS: Compared with continual CC-only smokers, CC and NNTP users (aHR, 0.83 [95% CI, 0.79-0.88]) and initial CC smokers who quit CCs and switched to NNTP use only (recent CC quitters with NNTP use, aHR, 0.81 [95% CI, 0.78-0.84]) had lower risk for CVD. After propensity score matching, recent CC quitters with NNTP use (aHR, 1.31 [95% CI, 1.01-1.70]) had higher risk for CVD than recent CC quitters without NNTP use. Similarly, compared with long-term CC quitters without NNTP use, long-term CC quitters with NNTP use (aHR, 1.70 [95% CI, 1.07-2.72]) had higher CVD risk. CONCLUSIONS: Switching to NNTP use among initial CC smokers was associated with lower CVD risk than continued CC smoking. On CC cessation, NNTP use was associated with higher CVD risk than CC quitting without NNTPs. Compared with CC smokers who quit without NNTP use, CC quitters who use NNTPs may be at higher future CVD risk.

Nicotine Dependence Evaluated by Urinary Cotinine and Heaviness of Smoking Index among Smokers, Vapers, and Dual Users: A Cross-Sectional Study Using the Korea National Health and Nutrition Examination Survey Data.

BACKGROUND: Many people use both combustible cigarette (CC) and electronic cigarette (EC). We compared nicotine dependence among CC, EC, and dual users using questionnaires and urinary cotinine levels. METHODS: Data from the Korea National Health and Nutrition Examination Survey (2014-2017) databases were analyzed; 3,917 CC, EC, and dual users were administered the urinary cotinine test, and 1,045 current CC and dual users completed the Heaviness of Smoking Index (HSI) questionnaires. Weighted geometric means of urine cotinine levels were compared between exclusive CC, exclusive EC, and dual users. The distribution rate, based on time to first cigarette (TTFC), cigarettes per day (CPD), and the HSI was analyzed in two weighted groups, exclusive CC and dual users. RESULTS: Among those who currently use any type of cigarette, 89.4%, 1.4%, and 9.2% were exclusive CC, exclusive EC, and dual users, respectively. Weighted geometric means of urine cotinine were highest in dual users (1,356.4 ng/mL), followed by exclusive CC (1,270.3 ng/mL), and exclusive EC (867.7 ng/mL) with significant differences between all three groups (P<0.05). There were no statistically significant differences in CPD between exclusive CC and dual users (P=0.626). The proportion of TTFC ≤5 minutes was 21.5% and 29.5% in the two groups, respectively (P=0.010); however, HSI differences in the two groups was marginal (P=0.557). CONCLUSION: In this study, the urinary cotinine value could distinguish the three groups, CC, EC, and dual users, but the questionnaire using HSI could not distinguish the three groups.

The characterization of exosomes from fibrosarcoma cell and the useful usage of Dynamic Light Scattering (DLS) for their evaluation.

Exosomes are a type of extracellular vesicles containing mRNA, miRNA, and proteins of origin cells, which can control the characteristics of other cells or surroundings. Despite increasing evidence on oncogenic properties of tumor-derived exosomes, fibrosarcoma-derived exosomes remain largely unrevealed. While the proper extraction and characterization of exosomes is critical in exosomes research, there are various limitations in techniques to measure the size and homogeneity of exosomes. Here, we analyzed exosomes from a fibrosarcoma cell line WEHI-164 compared with a breast cancer cell line MDA-MD-231 as a control. Results from dot blot and western blot analysis demonstrated that GM1 ganglioside, and TSG101, HSC70 and GAPDH proteins were contained in exosomes from the WEHI-164 fibrosarcoma cell line. The existence of tetraspanins such as CD81, CD63 and CD9 was confirmed in the exosomes by ExoView analysis. The results obtained from TEM showed their sphere-like shapes of around 50 to 70 nm in radius. Through DLS, we found out that the mean radius of the exosomes derived from WEHI-164 and MDA-MB-231 cell lines was 94.4 nm and 107.8 nm, respectively, with high homogeneity. When comparing the radius measured by TEM with the radius measured by DLS, it was revealed that the difference between the two methods was about 40 nm. This study has significance in characterizing the molecular properties of exosomes from a fibrosarcoma, which has not been researched much before, and in providing clear evidence that DLS can be used as an efficient, convenient and noninvasive technique to simply check the homogeneity and size of exosomes.

Are Heated Tobacco Product Users Less Likely to Quit than Cigarette Smokers? Findings from THINK (Tobacco and Health IN Korea) Study.

Since the advent of heated tobacco products in June 2017 in South Korea, the sale of heated tobacco products accounted for 10.5% of total tobacco sales in 2019. However, the decreasing trend in total tobacco sales is gradually weakening and the number of visitors using stop smoking services has also dropped. This study examines the association between the use of new tobacco products and related products and cessation behaviors. A cross-sectional study using a self-administered questionnaire was conducted from March 2019 to July 2019 for 2831 adult tobacco users. The difference in rates of quit attempts using the type of tobacco products and related products in the past year were noted (55.6% (any cigarette smoker), 46.7% (any e-cigarette user), and 39.6% (any heated tobacco product user)). About a 30% increase in quit attempts was observed for the triple users of either conventional cigarette or heated tobacco product than exclusive users. Exclusive heated tobacco product and e-cigarette users were approximately 40% and 20% less likely to quit the product they used than exclusive cigarette smokers, respectively. These findings can explain recent occurrences in South Korea, such as the reduction of visitors at smoking cessation clinics and the attenuation of the decline in tobacco sales.

Risk Factors of Cardiovascular Disease according to Alcohol Behavioral Change after Cancer Diagnosis.

BACKGROUND: Problem drinking increases the incidence of all-cause mortality and specific cancers, and persistent drinking is associated with cardiovascular disease in certain cancer survivors. This study analyzed the cardiovascular risk factors before and after diagnosis in Korean cancer survivors. METHODS: Data for the period between 2002 and 2013 were collected from the National Health Insurance Service Health-Examinee Cohort Database. Among the 27,835 patients included, those with moderate alcohol consumption before and after cancer diagnosis were excluded. Problem drinking was defined as males under 65 years consuming over 14 glasses a week, and males over 65 years or females consuming over seven glasses a week. A t-test, chi-square test, and linear regression analysis were performed for differences in cardiovascular risk factors and differences according to cancer types. RESULTS: There was a difference in the body mass index, systolic and diastolic blood pressure, and total cholesterol among patients who became moderate drinkers after diagnosis, but fasting blood glucose did not show any significant changes. Risk factors for cardiovascular disease were analyzed in patients with liver, stomach, rectal, and breast cancer with improved drinking behavior, and there were significant differences in body mass index, systolic and diastolic blood pressure, fasting blood glucose, and total cholesterol in stomach cancer patients. CONCLUSION: Moderate drinking can lower cardiovascular risk in cancer survivors, and among the many drinking-related cancers, stomach cancer patients demonstrated significantly reduced cardiovascular risk factors.

Dual use of electronic and conventional cigarettes is associated with higher cardiovascular risk factors in Korean men.

Most smokers who use electronic cigarettes (e-cigarettes) to stop smoking simultaneously use conventional cigarettes (dual users). We aimed to compare the prevalence of cardiovascular risk factors among dual users, cigarette-only smokers, and never smokers in Korean men. We used data acquired from Korean National Health and Nutrition Examination Survey (2013-2017) pertaining to 7,505 male participants aged 19 years or older. About 85% of e-cigarette users were dual users. Dual users had greater nicotine dependence and higher urinary cotinine levels than cigarette-only smokers. Dual users had more psychosocial and behavioural risk factors, including perceived high stress, depressive mood, high daily intake of energy, and obesity, than never smokers and cigarette-only smokers. The prevalence of metabolic syndrome (MetS) was higher among dual users, and their multivariate-adjusted prevalence odds ratio for MetS was 2.79 (P < 0.001) compared with never smokers and 1.57 (P = 0.038) compared with cigarette-only smokers. Given that most e-cigarette users are dual users and dual users are more vulnerable to cardiovascular risk factors than cigarette-only smokers and never smokers, more active treatment for smoking cessation and intensive lifestyle interventions for dual users should be considered with priority.

Effects of smoking habit change on hospitalized fractures: a retrospective cohort study in a male population.

We examined effects of smoking habit change on fracture risk in men. Long-term quitters and never smokers showed decreased risk for overall fractures, lumbar fractures, and other site fractures. Short-term quitters did not show decreased risk. Longer time since smoking cessation may lead to decreased fracture risk in men. PURPOSE: Cigarette smoking is a well-known modifiable risk factor of osteoporosis and fractures. This study investigated the effects of change in smoking habits on risks of all types of fractures in men using a nationwide health claims database. METHODS: Retrospective study was performed using the Korean National Health Insurance Service-National Sample Cohort Data. Cox proportional hazards regression analyses were performed to estimate risks of all types of hospitalized fractures, hip fractures, lumbar fractures, and other site fractures (all other fractures excluding the lumbar and hip areas). RESULTS: Compared to continued smokers, long-term quitters and never smokers showed decreased risk for all types of fractures (adjusted hazard ratio (aHR) 0.83, 95% confidence interval (CI) 0.78-0.88 and aHR 0.84, 95% CI 0.80-0.89, respectively). According to skeletal site, long-term quitters and never smokers showed decreased risk for lumbar fractures (aHR 0.82, 95% CI 0.68-0.98 and aHR 0.85, 95% CI 0.73-0.99, respectively) and other site fractures (aHR 0.83, 95% CI 0.78-0.89 and aHR 0.85, 95% CI 0.81-0.90, respectively). Hip fractures were decreased in never smokers (aHR 0.77, 95% CI 0.62-0.94). Short-term quitters did not show decreased risk for fractures. CONCLUSIONS: Longer time since smoking cessation in men may lead to decreased risk for fractures, especially lumbar and other site fractures. Physicians should counsel patients at risk for fractures both to quit smoking and to maintain abstinence from smoking. Further studies may be required to help comprehend how smoking cessation can affect fracture risk.

Association of smoking cessation after atrial fibrillation diagnosis on the risk of cardiovascular disease: a cohort study of South Korean men.

BACKGROUND: While smoking elevates the risk for cardiovascular disease (CVD) among atrial fibrillation (AF) patients, whether smoking cessation after AF diagnosis actually leads to reduced CVD risk is unclear. We aimed to determine the association of smoking cessation after AF diagnosis with subsequent CVD Risk among South Korean men. METHODS: This retrospective cohort study included 2372 newly diagnosed AF male patients during 2003-2012 from the Korean National Health Insurance Service database. Self-reported smoking status within 2 years before and after diagnosis date were determined, after which the participants were divided into continual smokers, quitters (smokers who quit after AF diagnosis), sustained-ex smokers (those who quit prior to AF diagnosis), and never smokers. Participants were followed up from 2 years after AF diagnosis until 31 December 2015 for CVD. Cox proportional hazards regression was used to determine the adjusted hazard ratios (aHRs) and 95% confidence interval (CIs) for CVD according to the change in smoking habits before and after AF diagnosis. RESULTS: The mean (standard deviation, minimum-maximum) age of the study subjects was 62.5 (8.6, 41-89) years. Among AF patients, quitters had 35% reduced risk (aHR 0.65, 95% CI 0.44-0.97) and never smokers had 32% reduced risk (aHR 0.68, 95% CI 0.52-0.90) for CVD compared to continual smokers (p for trend 0.020). Similarly, compared to continual smokers, quitters had 41% risk-reduction (aHR 0.59, 95% CI 0.35-0.99) and never smokers 34% risk-reduction (aHR 0.66, 95% CI 0.46-0.93) for total stroke (p for trend 0.047). Quitters had 50% reduction (aHR 0.50, 95% CI 0.27-0.94), sustained ex-smokers had 36% reduction (aHR 0.64, 95% CI 0.42-0.99), and never smokers had 39% reduction (aHR 0.61, 95% CI 0.41-0.91) in ischemic stroke risk (p for trend 0.047). The risk-reducing effect of quitting on CVD risk tended to be preserved regardless of aspirin or warfarin use. CONCLUSIONS: Smoking cessation after AF diagnosis was associated with reduced CVD, total stroke, and ischemic stroke risk.

Prevalence and Predictors of Sustained Smoking after a Cancer Diagnosis in Korean Men.

PURPOSE: Although smoking has a significant impact on mortality and morbidity of cancer patients, many patients continue to smoke post-diagnosis. The purpose of this study was to investigate prevalence and predictors of sustained smoking among male cancer survivors. MATERIALS AND METHODS: The Korean National Health Insurance Service-National Health Screening Cohort database was used for this population-based, retrospective study. Study subjects were 15,141 men who were diagnosed with their first incident cancer between 2004 and 2011. Changes in smoking status before and after a cancer diagnosis were investigated. For patients who were current smokers pre-diagnosis, association between post-diagnosis sustained smoking and demographic, socioeconomic, and clinical variables were examined. RESULTS: Of the 4,657 pre-diagnosis smokers, 2,255 (48%) had quit after cancer diagnosis, while 2,402 (51.6%) continued to smoke. In a multivariate logistic regression analysis, younger age at cancer diagnosis (adjusted odds ratio [aOR], 1.37; 95% confidence interval [CI], 1.21 to 1.55; p < 0.001), low socioeconomic status (aOR, 1.29; 95% CI, 1.15 to 1.45; p ≤ 0.001), pre-diagnosis heavy smoking (aOR, 1.24; 95% CI, 1.09 to 1.41; p=0.001), diagnosis of non-smoking- related cancer (aOR, 1.67; 95% CI, 1.42 to 1.96; p < 0.001), and high serum glucose level (aOR, 1.23; 95% CI, 1.03 to 1.46; p=0.019) were associated with sustained smoking after a cancer diagnosis. CONCLUSION: Almost half of the male smokers continue to smoke after a cancer diagnosis. Targeted interventions for smoking cessation should be considered for patients with younger age, low socioeconomic status, heavy smoking history, non-smoking-related cancer, and high blood glucose levels.

Factors associated with continued smoking after the diagnosis of type 2 diabetes: a retrospective study in the Korean cohort.

OBJECTIVE: To investigate the factors associated with continued smoking in patients newly diagnosed with type 2 diabetes. DESIGN: Retrospective study using the Korean National Health Insurance Service-National Health Screening Cohort (2002-2013) database. PARTICIPANTS: Male patients newly diagnosed with type 2 diabetes between 1 January 2004 and 31 December 2011. MEASUREMENT: Change in smoking behaviour after the diabetes diagnosis was assessed using a self-reported questionnaire, which was administered before and after the diagnosis. To identify the factors associated with continued smoking after diabetes diagnosis, a multivariate-adjusted logistic regression was conducted using only the variables with statistical significance from the univariate analyses. RESULTS: Younger age, lower economic status, heavier smoking habit, lower Charlson Comorbidity Index and comorbid hypertension were identified as factors associated with continued smoking after the diagnosis of type 2 diabetes. Older patients (adjusted OR (aOR) 0.71, 95% CI 0.63 to 0.79) and patients with longer diabetic duration (1-2 years OR 0.88, 95% CI 0.80 to 0.98, ≥3 years OR 0.63, 95% CI 0.55 to 0.73) were more likely to quit smoking. Contrastingly, smokers in the lower economic status (aOR 1.29, 95% CI 1.18 to 1.42) and heavier smoking habit (moderate: aOR 1.53, 95% CI 1.35 to 1.72; heavy: aOR 1.90, 95% CI 1.67 to 2.17) categories were more likely to continue smoking after the diagnosis. CONCLUSIONS: It is important to identify the factors associated with smoking behaviour in patients with type 2 diabetes. Recognising the factors that contribute to the vulnerability of patients to continued smoking will be helpful in developing policies and intervention strategies in future. Vulnerable patients may require intensive education and encouragement to quit smoking. We recommend physicians to take a more proactive approach, such as encouraging frequent clinical sessions for behavioural counselling and even early pharmacological interventions, when they encounter patients with the factors outlined in this study.

Association between Physical Activity and Depressive Mood among Korean Adults with Chronic Diseases.

BACKGROUND: This study aimed to investigate the association between physical activity and depressive mood among Korean adults with chronic diseases. METHODS: This study analyzed the 2014 Korean National Health and Nutrition Examination Survey data. The study was restricted to participants aged ≥20 years who had completed the survey and were not diagnosed as having depression. After exclusion, 4,676 participants were included in the final analysis. Subjects were categorized according to their level of physical activity. Physical activity was assessed using the International Physical Activity Questionnaire. Patients were categorized into two groups according to depressive traits (normal and depressed) based on the 9-item Patient Health Questionnaire scores. RESULTS: In univariate analysis, significant associations were observed between the level of physical activity and depressive mood in both chronic and healthy groups. Participants with higher levels of physical activity had lower risks of depressive mood than those with lower levels of physical activity, especially patients with chronic diseases (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.31-0.73). Similar trends were observed in multivariate logistic regression analysis (OR, 0.54; 95% CI, 0.34-0.88). CONCLUSION: Physical activity significantly decreased the development of depressive mood among Korean adults with chronic diseases compared with their healthy counterparts. Physical activity must be emphasized in patients with chronic diseases.

Effects of smoking habit change on all-cause mortality and cardiovascular diseases among patients with newly diagnosed diabetes in Korea.

This study aimed to investigate the effects of smoking habit change on the risks of all-cause mortality and cardiovascular diseases (CVDs) among patients with newly diagnosed diabetes using the Korean National Sample Cohort data. Survival regression analyses for the risks of all-cause mortality and CVDs were performed. Quitters without body mass index (BMI) change (adjusted hazard ratio [aHR], 0.68; 95% confidence interval [CI], 0.46-1.00) and quitters with BMI loss (aHR, 1.76; 95% CI, 1.13-2.73) showed significantly reduced and substantially the increased risk of all-cause mortality, respectively, compared with sustained smokers. Smoking reduction after diabetes diagnosis may have potential positive effects. However, definite benefits on the health outcomes were not identified in this study. Participants who started smoking after diabetes diagnosis had higher risks of all-cause mortality and CVDs than those who were never smokers or ex-smokers, although not statistically significant. In conclusion, smoking cessation after diabetes diagnosis could reduce the risks of all-cause mortality and cardiovascular events among patients with newly diagnosed diabetes when accompanied by proper weight management. Therefore, physicians should advice patients with newly diagnosed type 2 diabetes on the importance of smoking cessation in combination with long-term weight management to maximize the benefits of smoking cessation.

Weight gain after smoking cessation does not modify its protective effect on myocardial infarction and stroke: evidence from a cohort study of men.

Aims: This study aimed to investigate the association between smoking cessation, post-cessation body mass index (BMI) change and risk of myocardial infarction (MI) and stroke in men. Methods and results: A prospective cohort study using the National Health Insurance Service (NHIS) data set collected from 2002 to 2013 was implemented. Based on the first (2002-03) and second (2004-05) NHIS health check-up periods, 108 242 men aged over 40 years without previous diagnoses of MI or stroke were grouped into sustained smokers, quitters with BMI gain, quitters without BMI change, quitters with BMI loss, and non-smokers. Body mass index change was defined as the difference of more than 1.0 kg/m2 between the two health check-up periods. The participants were followed-up from 1 January 2006 to 31 December 2013. Hazard ratios (HRs) and 95% confidence intervals (HR, 95% CI) were computed using Cox proportional hazard models adjusted for sociodemographic, health status, and family health history. Compared to the sustained smokers, the risk of MI and stroke was significantly reduced in both quitters with BMI gain (HR 0.33; 95% CI 0.16-0.70 for MI and HR 0.75; 95% CI 0.57-1.00 for stroke) and without BMI change (HR 0.55; 95% CI 0.37-0.83 for MI and HR 0.75; 95% CI 0.62-0.92 for stroke), but no significant association was found in quitters with BMI loss (HR 0.91; 95% CI 0.43-1.91 for MI and HR 0.86; 95% CI 0.57-1.31 for stroke), respectively. Non-smokers had lower risk of MI (HR 0.37; 95% CI 0.32-0.43) and stroke (HR 0.68; 95% CI 0.64-0.73) compared to the sustained smokers. Conclusion: Post-cessation BMI change did not significantly modify the protective association of smoking cessation with MI and stroke.

Effect of Smoking Cessation and Reduction on the Risk of Cancer in Korean Men: A Population Based Study.

PURPOSE: The purpose of this study was to investigate the effect of smoking habit change on the risk of cancer. MATERIALS AND METHODS: From the Korean National Health Insurance Service database, we determined the change in smoking habit between the first (2002 and 2003) and second (2004 and 2005) health examination periods. A total of 143,071 men were categorized into baseline heavy (≥ 20 cigarettes per day), moderate (10-19 cigarettes per day), light (< 10 cigarettes per day) smokers, quitters, and never smokers, after which the change in smoking status was determined during the second health examination. The participants were then followed up from 2006 to 2013 for all cancer, smoking related cancer, and lung cancer. RESULTS: Compared to heavy continual smokers, heavy smokers who quit had reduced risk of smoking related cancer (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.56 to 0.97) and tended to have reduced risk of all cancer (HR, 0.87; 95% CI, 0.75 to 1.00). Moderate smokers who reduced the amount of smoking to light levels had decreased risk of all cancer (HR, 0.82; 95% CI, 0.72 to 0.94), smoking related cancer (HR, 0.74; 95% CI, 0.59 to 0.93), and lung cancer (HR, 0.55; 95% CI, 0.38 to 0.79) compared to heavy continual smokers. CONCLUSION: Smoking reduction decreases the risk of all cancer, smoking related cancer, and lung cancer. While smoking cessation should be the treatment of choice for smokers, smoking reduction may serve as an alternative strategy for those who cannot quit.

Effect of post-cessation hyperglycemia on cardiovascular disease and mortality among middle-aged men: an eight-year longitudinal study.

Smoking cessation reduces the risk of cardiovascular disease (CVD), but also elevates fasting serum glucose (FSG) levels. The effect of post-cessation hyperglycemia on cardiovascular disease is unknown. The study population consisted of 127,066 men without type 2 diabetes from the Korean National Health Insurance System - Health Screening Cohort database. Change in smoking habits and FSG was determined by the difference in smoking status and FSG levels from the first (2002 and 2003) and second (2004 and 2005) health examinations. Continual smokers, quitters, ex-smokers, and never smokers were stratified according to FSG elevation. The study participants were followed-up for CVD and CVD-related death from 2006 to 2013. Compared to continual smokers, quitters had decreased risk of CVD among those without FSG elevation (hazard ratio, HR, 0.76, 95% confidence interval, CI, 0.66-0.86) and with FSG elevation (HR 0.83, 95% CI 0.72-0.96). Similarly, quitters had a tendency towards reduced risk of CVD-related death among those without FSG elevation (HR 0.74, 95% CI 0.51-1.09) and with FSG elevation (HR 0.68, 95% CI 0.46-1.03). Post-cessation hyperglycemia did not attenuate the beneficiary risk-reducing effects of quitting on CVD and CVD-related death.

Prognostic assessment of sarcomatous histologic subtypes of ovarian carcinosarcoma.

OBJECTIVE: Ovarian carcinosarcoma is a rare subtype of this disease that has not been thoroughly investigated. The aim of this study was to evaluate the prognostic factors and out comes in patients with ovarian carcinosarcoma. METHODS: All patients with histologically confirmed ovarian carcinosarcoma who were treated at Cheil General Hospital and Women's Healthcare Center between January 2000 and December 2015 were identified and analyzed. Data were extracted from medical records, and statistical analyses were performed to determine correlations between clinicopathological parameters and survival outcomes. RESULTS: Of the 822 patients diagnosed with ovarian cancer over 16 years, 11 (1.3%) had ovarian carcinosarcoma histology. Every patient underwent surgery as the initial treatment followed by intravenous adjuvant chemotherapy. Only 18.1% of cases were early stage (I or II) while 81.8% were advanced stage (III or IV) according to the FIGO (International Federation of Gynecology and Obstetrics) classification. Six cases were of the homologous subtype (54.5%) and five were of the heterologous subtype (45.5%). There was no significant difference in survival according to stage (P=0.24). The heterologous subtype and residual disease were associated with poor disease-free survival (P=0.02 and P=0.04) and overall survival (P=0.02 and P=0.04), On multivariate analysis, the histological subtype was an independent prognostic factor (P=0.02). CONCLUSION: Optimal cytoreduction without gross residual disease and a homologous subtype are favorable prognostic factors in terms of disease relapse and survival.