Effect of Chronic Kidney Disease on All-Cause Mortality After Hip Fracture Surgery: A Retrospective Cohort Study.

In this retrospective cohort study, we investigated: (1) The impact of comorbid chronic kidney disease (CKD) on postoperative mortality in patients with a hip fracture; (2) mortality variations by dialysis type, potentially indicating CKD stage; (3) the efficacy of different hip fracture surgical methods in reducing mortality for patients with CKD. This study included 25,760 patients from the Korean National Health Insurance Service-Senior cohort (2002-2019) who underwent hip fracture surgery. Participants were categorized as CKD and Non-CKD. Mortality rate was determined using a generalized linear model with a Poisson distribution. The effect size was presented as a hazard ratio (HR) through a Cox proportional-hazard model. During follow-up, we ascertained that 978 patients (3.8%) had CKD preoperatively. Compared to the Non-CKD group, the mortality risk (HR) in the CKD group was 2.17 times higher (95% confidence interval [CI], 1.99-2.37). In sensitivity analysis, the mortality risk of in patients who received peritoneal dialysis and hemodialysis was 6.21 (95% CI, 3.90-9.87) and 3.62 times (95% CI, 3.11-4.20) higher than that of patients who received conservative care. Mortality risk varied by surgical method: hip hemiarthroplasty (HR, 2.11; 95% CI, 1.86-2.40), open reduction and internal fixation (HR, 2.21; 95% CI, 1.94-2.51), total hip replacement (HR, 2.27; 95% CI, 1.60-3.24), and closed reduction and percutaneous fixation (HR, 3.08; 95% CI, 1.88-5.06). Older patients with CKD undergoing hip fracture surgery had elevated mortality risk, necessitating comprehensive pre- and postoperative assessments and management.

Association between nurse staffing level in intensive care settings and hospital-acquired pneumonia among surgery patients: result from the Korea National Health Insurance cohort.

This study examined the association between the number of nursing staff in intensive care units (ICUs) and hospital-acquired pneumonia (HAP) among surgical patients in South Korea. Data were obtained between 2008 and 2019 from the Korean National Health Insurance Service Cohort Database; 37,706 surgical patients who received critical care services were included in the analysis. Patients with a history of pneumonia 1 year prior to surgery or those who had undergone lung-related surgery were excluded. The ICU nursing management fee is an admission fee that varies based on the grading determined by nurse-to-bed ratio. Using this grading system, we classified four groups from the highest to the lowest level based on the proportion of beds to nurses (high, high-mid, mid-low, and low group). HAP was defined by the International Classification of Disease, 10th revision (ICD-10) code. Multilevel logistic regression was used to investigate the relationship between the level of ICU nurse staffing and pneumonia, controlling for variables at the individual and hospital levels. Lower levels of nurse staffing were associated with a greater incidence of HAP than higher levels of nurse staffing (mid-high, OR: 1.33, 95% CI: 1.12-1.57; mid-low, OR: 1.61, 95% CI: 1.27-2.04; low, OR: 2.13, 95% CI: 1.67-2.71). The intraclass correlation coefficient value was 0.177, and 17.7% of the variability in HAP was accounted for by the hospital. Higher ICU nursing management fee grades (grade 5 and above) in general and hospital settings were significantly associated with an increased risk of HAP compared to grade 1 admissions. Similarly, in tertiary hospitals, grade 2 and higher ICU nursing management fees were significantly associated with an increased risk of HAP compared to grade 1 admissions. Especially, a lower level of nurse staffing was associated with bacterial pneumonia but not pneumonia due to aspiration. In conclusion, this study found an association between the level of ICU nurse staffing and HAP among surgical patients. A lower level of nurse staffing in the ICU was associated with increased rates of HAP among surgical patients. This indicates that having fewer beds assigned to nurses in the ICU setting is a significant factor in preventing HAP, regardless of the size of the hospital.

Trends in private caregiving cost after implementing a comprehensive nursing service covered by national health insurance: Interrupted time series.

BACKGROUND: The Korean government has implemented a comprehensive nursing care service system (CNS) to mitigate the stress faced by caregivers. OBJECTIVE: This study aimed to assess trends in the estimated average costs of private caregiving and determine the difference in costs between those using CNS and those not using it. DESIGN: A comparative interrupted time series analysis with a 2-year lag period verified total private caregiving cost trends; biannual differences in costs were evaluated based on using CNS. PARTICIPANTS: The main unit of analysis was episode. We extracted a total of 6418 episodes of hospitalization in acute care settings that included the use of caregiving services (formal, informal caregiving and CNS). METHODS: We conducted segmented regression to assess the impact of CNS on total private caregiving costs using data from 2012 to 2018, excluding the years 2015 and 2016 of the Korean Health Panel dataset. RESULTS: We presented that the immediate mean difference in total private caregiving costs between CNS users and non-users was -444.7 USD two years after the implementation of the CNS policy (95 % CI -714.5 to -174.5, p-value 0.001). Among individuals living in rural areas, two years after the implementation of the CNS policy, there was a significant immediate mean cost difference of -476.9 USD in total private caregiving costs between CNS users and non-users (p-value 0.011). Similarly, for episodes with a Charlson Comorbidity Index (CCI) score of 0 to 1, there was a substantial immediate mean cost difference in total private caregiving costs between CNS users and non-users, amounting to -399.9 USD two years after the CNS policy (p-value 0.008). CONCLUSIONS: This study evaluated the trend of total private caregiving costs between groups using and not using CNS. After two years of being covered by CNS health insurance, those who utilized CNS paid $433 less for their total private caregiving cost over a 6-month period, compared to those who did not use CNS. The adoption of CNS may be an effective system for relieving the financial burden on inpatients in need of private caregiving services. TWEETABLE ABSTRACT: Korean Comprehensive Nursing Service reduces private caregiving costs.

Socioeconomic Status and Dementia Risk Among Intensive Care Unit Survivors: Using National Health Insurance Cohort in Korea.

BACKGROUND: In aging populations, more elderly patients are going to the intensive care unit (ICU) and surviving. However, the specific factors influencing the occurrence of post-intensive care syndrome in the elderly remain uncertain. OBJECTIVE: To investigate the association between socioeconomic status (SES) and risk of developing dementia within two years following critical care. METHODS: This study included participants from the Korean National Health Insurance Service Cohort Database who had not been diagnosed with dementia and had been hospitalized in the ICU from 2003 to 2019. Dementia was determined using specific diagnostic codes (G30, G31) and prescription of certain medications (rivastigmine, galantamine, memantine, or donepezil). SES was categorized into low (medical aid beneficiaries) and non-low (National Health Insurance) groups. Through a 1:3 propensity score matching based on sex, age, Charlson comorbidity index, and primary diagnosis, the study included 16,780 patients. We used Cox proportional hazard models to estimate adjusted hazard ratios (HR) of dementia. RESULTS: Patients with low SES were higher risk of developing dementia within 2 years after receiving critical care than those who were in non-low SES (HR: 1.23, 95% CI: 1.04-1.46). Specifically, patients with low SES and those in the high-income group exhibited the highest incidence rates of developing dementia within two years after receiving critical care, with rates of 3.61 (95% CI: 3.13-4.17) for low SES and 2.58 (95% CI: 2.20-3.03) for high income, respectively. CONCLUSIONS: After discharge from critical care, compared to the non-low SES group, the low SES group was associated with an increased risk of developing dementia.

Association between anti-smoking campaign types and smoking cessation attempts.

Objective: This study explored the association between anti-smoking campaign types and smoking cessation attempts. Methods: This study included 4,594 individuals (3,292 male and 1,302 female) from the Korea Youth Risk Behavior Web-based Survey (KYRBWS) in 2018 and 2020. The methods of anti-smoking promotion were divided into online, offline, online and offline, and none. Attempts to quit smoking were classified as yes or no. Multiple logistic regression was performed to examine the association between antismoking campaign type and smoking cessation attempts. Results: Those who saw anti-smoking advertisements both online and offline were found to have tried to quit smoking more than those who did not. (Online & offline: male, odds ratio [OR] 1.36; 95% confidence interval [95% CI], 1.08-1.71; female, OR, 1.75; 95% CI 1.21-2.54) In a subgroup analysis of the independent variables into which smoking cessation advertisements were subdivided, males were found to have the highest OR for smoking cessation attempts when they encountered advertisements in newspapers. (Newspaper: male, OR, 2.25; 95% CI, 1.00-5.02) Females had the highest OR for smoking cessation attempts when accessed via the Internet. (Internet: female, OR, 1.93; 95% CI, 1.07-3.50). Conclusion: This study showed that there is a correlation between smoking cessation advertisements and adolescents' smoking cessation attempts. The possibility of smoking cessation attempts is high when encountering smoking cessation advertisements both online and offline. Although offline smoking cessation advertisements have a great effect on adolescents' smoking cessation attempts, it can be confirmed that the frequency of exposure for offline advertisements is less than that for online advertisements.

Association between smoking cessation and non-alcoholic fatty liver disease using NAFLD liver fat score.

Background: Smoking is well known to be associated with a higher prevalence and incidence of liver diseases such as advanced fibrosis. However, the impact of smoking on developing nonalcoholic fatty liver disease remains controversial, and clinical data on this is limited. Therefore, this study aimed to investigate the association between smoking history and nonalcoholic fatty liver disease (NAFLD). Methods: Data from the Korea National Health and Nutrition Examination Survey 2019-2020 were used for the analysis. NAFLD was diagnosed according to an NAFLD liver fat score of >-0.640. Smoking status was classified as into nonsmokers, ex-smokers, and current smokers. Multiple logistic regression analysis was conducted to examine the association between smoking history and NAFLD in the South Korean population. Results: In total, 9,603 participants were enrolled in this study. The odds ratio (OR) for having NAFLD in ex-smokers and current smokers in males was 1.12 (95% confidence interval [CI]: 0.90-1.41) and 1.38 (95% CI: 1.08-1.76) compared to that in nonsmokers, respectively. The OR increased in magnitude with smoking status. Ex-smokers who ceased smoking for <10 years (OR: 1.33, 95% CI: 1.00-1.77) were more likely to have a strong correlation with NAFLD. Furthermore, NAFLD had a dose-dependent positive effect on pack-years, which was 10 to 20 (OR: 1.39, 95% CI: 1.04-1.86) and over 20 (OR: 1.51, 95% CI: 1.14-2.00). Conclusion: This study found that smoking may contribute to NAFLD. Our study suggests cessation of smoking may help management of NAFLD.

Associations between environmental tobacco smoke exposure and oral health symptoms in adolescents.

BACKGROUND: Oral health condition in adolescence impacts the oral well-being throughout life. This study aimed to determine the association between environmental tobacco smoke (ETS) exposure and oral health in adolescents, using nationally representative data. METHODS: Using data from the 2020 Korea Youth Risk Behavior Web-based Survey, we assessed self-reported data on ETS exposure and oral health symptoms in 37,591 non-smoking adolescents. The dependent variables were self-reported oral health symptoms of adolescents (tooth fracture, dental pain, and gum bleeding). ETS exposure was the primary independent variable. Chi-square tests and multivariable logistic regression analyses were performed to examine these relationships. RESULTS: ETS exposure was positively associated with oral symptoms compared to no-ETS exposure in adolescents [boys, odds ratio (OR) 1.56, 95% confidence interval (CI) 1.46-1.66; girls, OR 1.50, 95% CI 1.41-1.60]; individuals with good oral health habits such as frequent tooth brushing [boys, three times or more a day, OR 1.38, 95% CI 1.24-1.53] and less soda consumption [girls, less than once a day, OR 1.73, 95% CI 1.29-2.33] had a weaker association. ETS exposure was positively associated with dental pain [boys, OR 1.55, 95% CI 1.45-1.66; girls, OR 1.50, 95% CI 1.41-1.60] and gum bleeding [boys, OR 1.43, 95% CI 1.29-1.58; girls, OR 1.32, 95% CI 1.21-1.44]; however, tooth fracture was significantly associated only in girls [OR 1.28, 95% CI 1.13-1.45]. CONCLUSIONS: ETS in various environments is negatively associated with oral health in adolescents. This association could vary depending on health habits. Sophisticated policies to protect South Korean adolescents from ETS can be developed from these findings.

Association between lifestyle factors and the risk of metabolic syndrome in the South Korea.

This study aimed to examine the association between lifestyle factors and metabolic syndrome risk in South Korean adults. Korea National Health and Nutrition Examination Survey 2016-2018 data were used. The study included 6,995 subjects (2835 male; 4,160 female). Multiple logistic regression was used to estimate the relationship between the lifestyle factors, including sedentary time, sleep duration, alcohol consumption, smoking status, and dietary intake. Metabolic syndrome prevalence in healthy adults was 25.6% and 12.4% in men and women, respectively. Male with over four lifestyle risk factors had a higher OR for metabolic syndrome risk (over four lifestyle factors: OR 1.97, CI 1.18-3.27). Female with more than one lifestyle risk factor had a higher OR for metabolic syndrome risk (one lifestyle factor: OR 1.58, CI 1.10-2.28; two lifestyle factors: OR 2.08, CI 1.39-3.11; three lifestyle factors: OR 1.94, CI 1.20-3.13). In particular, female with more lifestyle factors had increased likelihood of abdominal obesity, hypertension, and high triglycerides. Male with more lifestyle factors had increased likelihood of high triglycerides. Sedentary time was significantly associated with increased metabolic syndrome in male and female. This study found a significant association between the number of lifestyle risk factors and the risk of metabolic syndrome in Korean adults. The greater the number of lifestyle risk factors, the higher the risk of metabolic syndrome in both sexes. People with a greater number of poor lifestyle behaviors tended to exhibit increased likelihood of especially elevated triglyceride levels.

Typical three-domain cry proteins of Bacillus thuringiensis strain A1462 exhibit cytocidal activity on limited human cancer cells.

Bacillus thuringiensis strain A1462 produced two parasporal inclusion proteins with a molecular mass of 88 kDa that were converted to 64-kDa toxins when activated by proteinase K digestion. Both toxins exhibited strong cytocidal activity against two human cancer cell lines, HL60 (myeloid leukemia cells) and HepG2 (liver cancer cells), while low or no toxicities were observed against 11 human and three mammalian cell lines, including four non-cancer cell lines. The cytotoxicity of both toxins on susceptible cells was characterized by rapid cell swelling. Gene cloning experiments provided two novel genes encoding 88-kDa Cry proteins, Cry41Aa and Cry41Ab. The amino acid sequences of the two proteins contain five block regions commonly conserved in B. thuringiensis insecticidal Cry proteins. This is the first report of the occurrence of typical three-domain Cry proteins with cytocidal activity preferential for cancer cells.

Cloning and characterization of two novel crystal protein genes from a Bacillus thuringiensis serovar dakota strain.

Two genes encoding the 32- and 40-kDa polypeptides of Bacillus thuringiensis strain 90-F-45-14 crystals were cloned, expressed in an acrystalliferous B. thuringiensis strain, and sequenced. The polypeptides had deduced molecular weights of 30,319 and 33,885, respectively. The amino acid sequence of the 32-kDa protein was 37.7% identical to the known sequence of a non-insecticidal parasporal protein in B. thuringiensis serovar thompsoni crystals. The sequence of the cloned 40-kDa protein was 37.0% and 22.3% identical to that of the existing Cry protein classes, Cry15Aa1 and Cry23Aa1, respectively. Thus, this protein constitutes a novel protein class, Cry33Aa1. The open reading frames of the two genes were located on the predominant plasmid of 17,629 bp (=11,752 MDa) in the same orientation, and they were separated by the sequence of 32 nucleotides. The two proteins are likely produced simultaneously from a single transcript to form spherical crystals.