The 2018 Heat Wave's Impact on the Mortality of Older People in Seoul, South Korea.

Few studies on social welfare in South Korea have examined the effects of climate change, especially heat waves on vulnerable populations. The present study aims to investigate how heat waves affect vulnerable populations. This study utilized a cross-sectional study design, using the daily heat index and heat-related mortality data for Seoul, South Korea, in summer 2018. The research used micro-raw data of deaths caused by hypertensive, ischemic heart, and cerebrovascular diseases, as well as heat index data. An effect was observed for the heat index on mortality for individuals over 65 years of age, men, people with spouses, and those ages 75-79 years.

Neighbourhood environments for a healthy lifestyle among young single-person households experiencing housing poverty in Seoul, South Korea: a spatiotemporal qualitative study protocol.

INTRODUCTION: The number of single-person households is increasing globally-including in South Korea, where they account for over 30% of all households. Young single-person households in South Korea face health problems and housing challenges. Both the perceived and objective aspects of the neighbourhood environment, as a community asset, play a significant role in sustaining a healthy lifestyle. This study aims to explore and describe the meaning, roles and spatiotemporal characteristics of neighbourhood environments for a healthy lifestyle in young single-person households experiencing housing poverty in Seoul, South Korea. METHODS AND ANALYSIS: This ongoing study uses an extended qualitative geographic information systems approach to explore a district in the city of Seoul that has the highest population density of young single-person households experiencing housing poverty. The study sample comprises young single-person households aged 19-39 years who are experiencing housing poverty in the study area, with an expected saturation point of approximately 55 participants. We employ online and offline recruitment strategies to ensure the inclusion of diverse perspectives and a multimethod approach that combines descriptive and spatiotemporal data collection techniques (eg, individual in-depth interviews, field observations and mobile global positioning system tracking). The data analysis encompasses thematic and content analyses to understand the neighbourhood environment's perceived attributes and the spatiotemporal characteristics of healthy lifestyles. In the integrated analysis, we plan to combine the qualitative findings with living space and daily-life patterns using qualitative software and a hybrid relational database. ETHICS AND DISSEMINATION: The Institutional Review Board of Seoul National University approved the research protocol on 18 May 2021. The findings will be shared at international conferences and published in academic journals. Additionally, an online seminar will be conducted to share the results with policy-makers, researchers, community organisations and health workers working with young single-person households experiencing housing poverty.

GASTric Cancer HER2 Re-Assessment Study 2 (GASTHER2): HER2 Re-assessment for Initially HER2-Negative Advanced Gastric Cancer Patients after Progression on First-Line Treatment.

PURPOSE: Heterogeneous human epidermal growth factor receptor 2 (HER2) overexpression in gastric cancer may lead to a misdiagnosis of HER2 status. Accurate assessment of HER2 status is essential for optimal treatment as novel HER2-directed agents are being investigated in various clinical settings. We evaluated the usefulness of HER2 re-assessment following progression on first-line treatment in initially HER2-negative advanced gastric cancer (AGC) patients. MATERIALS AND METHODS: We enrolled 177 patients with baseline HER2-negative AGC and performed HER2 re-assessment after progression on first-line treatment from February 2012 to June 2016 at Asan Medical Center, Seoul, Korea. The re-assessed HER2 status was analyzed with baseline HER2 status and clinical characteristics. RESULTS: The median age was 54 years (range, 24 to 80 years), and 123 patients (69.5%) were men. Seven patients (4.0%) were HER2-positive on the re-assessment. Patients with baseline HER2 negativity confirmed by a single test (n=100) had a higher HER2-positive re-assessment rate compared to those who had repeated baseline testing (n=77) (5.0% vs. 2.6%). Among the patients with single baseline HER2 testing, the rate was higher in patients with baseline HER2 immunohistochemistry (IHC) 1+ compared to those with IHC 0 (13.4% vs. 3.6%). CONCLUSION: Overall, 4.0% of patients with baseline HER2-negative AGC were HER2-positive on re-assessment, and the HER2-positive re-assessment rate was higher among patients who had a single test at baseline. HER2 re assessment may be considered for initially HER2-negative patients to determine their eligibility for HER2-directed therapy, particularly if their HER2 negativity was determined by a single test, especially if they had a single baseline HER2 IHC 1+ test.

Regional Disparities in the Infant Mortality Rate in Korea Between 2001 and 2021.

BACKGROUND: The infant mortality rate (IMR) has been considered an important indicator of the overall public health level. Despite improvements in recent decades, regional inequalities in the IMR have been reported worldwide. However, there are no Korean epidemiological studies on regional disparities in the IMR. METHODS: We extracted causes of death data from the Statistics Korea through the Korean Statistical Information Service database between 2001 and 2021. The total and regional IMRs were calculated to determine regional disparities. Based on causes of death and using Seoul as a reference, the excess infant deaths and population attributable fractions (PAFs) were calculated for 15 other metropolitan cities and provinces. The average annual percent changes by region from 2001 to 2021 were obtained using a joinpoint regression program. To assess inequities in IMR trends, the rate ratios (RRs) and rate differences (RDs) of the 15 regions were calculated by dividing the study period into period 1 (2001-2007), period 2 (2008-2014), and period 3 (2015-2021). RESULTS: The overall IMR in Korea was 3.64 per 1,000 live births, and the IMRs in the 14 regions were relatively higher than that in Seoul, with RRs ranging from 1.15 (95% confidence interval [CI], 1.04, 1.27) in Jeju-do to 1.62 (95% CI, 1.54, 1.71) in Daegu, over the total study period. Significant differences in infant deaths by region were observed for all causes of death, with PAFs ranging from 2.2% (95% CI, 1.7, 2.6) in Gyeonggi-do to 38.4% (95% CI, 38.1, 38.6) in Daegu. The leading cause of excess infant deaths was perinatal problems. The IMR disparities in the relative and absolute measures decreased from 1.44 (1.34, 1.54) to 1.21 (1.10, 1.31) for RRs and from 0.79 (0.63, 0.96) to 0.30 (0.15, 0.45) for RDs between periods 1 and 2, followed by an increase from 1.21 (1.10, 1.31) to 1.36 (1.21, 1.53) for RRs and from 0.30 (0.15, 0.45) to 0.51(0.36, 0.67) for RDs between period 2 and 3. CONCLUSION: Infant death is associated with place of residence and regional gaps have recently widened again in Korea. An in-depth investigation of the causes of regional disparities in infant mortality is required for effective governmental policies to achieve equality in infant health.

Dosimetric assessment in the brain for downlink EMF exposure in Korean mobile communication networks.

Because the position and direction of the human body is not fixed in an actual environment, the incidence direction of the electromagnetic field (EMF) from mobile communication base stations, WiFi access points, broadcasting towers, and other far-field sources is arbitrary. To analyze the overall health effects of radio frequency EMF exposure, the dosimetric assessment for such environmental exposures created from an unspecified number of sources in daily life, along with exposures from specific EMF sources, must be quantified. This study is aimed at numerically evaluating the time-averaged specific absorption rate (SAR) of the human brain for environmental EMF exposure in the frequency range of 50-5800 MHz. Whole-body exposure to EMFs that are evenly incident spatially is considered. By comparing the results of several incidence directions and the number of polarizations, an optimal calculation condition has been derived. Finally, based on the results measured in Seoul at the end of 2021, the SAR and daily specific energy absorption (SA) in the brains of both a child and an adult for downlink exposures from 3G to 5G base stations are reported. Comparison results of the daily brain SA for exposure to DL EMF in all 3G to 5G mobile networks and exposure to a 10-min voice call (uplink EMF) using a mobile phone connected to a 4G network show that the SA from the downlinks is much higher than that from the uplinks.

Determination of heavy metals and risk assessment in nail cosmetics sold in Seoul, Korea.

OBJECTIVE: The objective of this study was to evaluate some toxic levels of nail cosmetics marketed in Seoul, Korea and health risk assessment on humans. METHODS: We collected 45 random nail cosmetics and analysed for lead, cadmium, arsenic and antimony by inductively coupled plasma-optical emission spectrometry (ICP-OES). RESULTS: Four metals concentrations were Pb 0.037 ± 0.083 (

The buffering effect of social capital for daily mental stress in an unequal society: a lesson from Seoul.

This study attempted to illustrate whether mental health deterioration could be alleviated by high social capital in an environment with high economic inequality. Daily mental stress was employed as a mental health factor when analyzing the association with economic inequality in the Seoul Survey data. Regarding social capital, community trust and altruism were included as cognitive dimensions, and participation and cooperation were included as structural dimensions in each model. The first finding showed a significantly positive relationship between economic inequality and daily stress, meaning that, like other mental health problems, daily mental stress is also high in regions with high economic inequality. Second, the slope of the daily stress increased in respondents with high social trust and participation was alleviated in an economically unequal environment. This indicates that social trust and participation have a buffering effect by moderating the slope of daily stress in societies with high inequality. Third, the buffering effect differs depending on the social capital factor. The buffering effect of trust and participation showed in an unequal environment, while the buffering effect of cooperation showed regardless of the unequal environment. In summary, social capital factors showed the effect of relieving daily mental stress in the relationship with economic inequality. Also, the buffering effect of social capital on mental health may show different aspects for each element.

Adverse impacts of Asian dust events on human health and the environment-A probabilistic risk assessment study on particulate matter-bound metals and bacteria in Seoul, South Korea.

This study aimed to assess the impact of Asian dust (AD) on the human health and the environment. Particulate matter (PM) and PM-bound trace elements and bacteria were examined to determine the chemical and biological hazards associated with AD days and compared with non-AD days in Seoul. On AD days, the mean PM10 concentration was ∼3.5 times higher than that on non-AD days. Elements generated from the Earth's crust (Al, Fe, and Ca) and anthropogenic sources (Pb, Ni, and Cd) were identified as major contributors to coarse and fine particles, respectively. During AD days, the study area was recognized as "severe" for pollution index and pollution load index levels, and "moderately to heavily polluted" for geoaccumulation index levels. The potential cancer risk (CR) and non-CR were estimated for the dust generated during AD events. On AD days, total CR levels were significant (in 1.08 × 10-5-2.22 × 10-5), which were associated with PM-bound As, Cd, and Ni. In addition, inhalation CR was found to be similar to the incremental lifetime CR levels estimated using the human respiratory tract mass deposition model. In a short exposure duration (14 days), high PM and bacterial mass deposition, significant non-CR levels, and a high presence of potential respiratory infection-causing pathogens (Rothia mucilaginosa) were observed during AD days. Significant non-CR levels were observed for bacterial exposure, despite insignificant levels of PM10-bound elements. Therefore, the substantial ecological risk, CR, and non-CR levels for inhalation exposure to PM-bound bacteria, and the presence of potential respiratory pathogens, indicate that AD events pose a significant risk to both human lung health and the environment. This study provides the first comprehensive examination of significant non-CR levels for bacteria and carcinogenicity of PM-bound metals during AD events.

Sustainability assessment of retrofitting alternatives for large and old wastewater treatment plants in Seoul.

Old wastewater treatment plants (WWTPs) must be upgraded to alleviate the problems associated with aging and reduce their total environmental impacts. To enhance the environmental sustainability in retrofitting large and old WWTPs, the decision-making process for selecting the most appropriate alternative is complicated. In this study, evaluation criteria were proposed to select the most sustainable alternatives for mid- to long-term retrofitting plans for a large WWTP with the treatment capacity of 1.6 M m3/d, which is initially built in 1987. An analytic hierarchy process was applied to estimate the weights of each criterion. Fourteen experts evaluated the relative importance of criteria through pairwise comparisons. In order to assess the current retrofitting opinions, three retrofitting alternatives were constructed: A focused on energy sufficiency; B expanded the bioreactor capacity and enhancement of the facility for incinerating the sludge leaving the anaerobic digestor; C emphasized the treatment of contaminants of emerging concerns (CECs). A achieved the highest score (0.623) owing to the environmental benefits associated with recycling and first flush stormwater treatment. C exhibited the second highest score (0.612) as the focus on CECs removal. B corresponded to the lowest sustainability (0.426), with the lowest scores pertaining to effective land use and first flush stormwater treatment.

Analysis of time-dependent effects of ambient temperatures on health by vulnerable groups in Korea in 1999-2018.

This study compared the relative risks of heat days on mortalities by vulnerable groups (elderly, single-person households, less-educated) in the past decade (1999-2008) and the recent decade (2009-2018) in four cities, Seoul, Incheon, Daegu, and Gwangju, in Korea. It has been known that the health impacts of heatwaves have gradually decreased over time due to socio-economic development, climate adaptation, and acclimatization. Contrary to general perception, we found that the recent relative risk of mortality caused by heat days has increased among vulnerable groups. It may associate with recent increasing trends of severe heat days due to climate change. The increasing relative risk was more significant in single-person households and less-educated groups than in the elderly. It implies that the impacts of climate change-induced severe heat days have been and will be concentrated on vulnerable groups. It suggests that social polarization and social isolation should be addressed to reduce heatwave impacts. Furthermore, this study shows the necessity of customized heatwave policies, which consider the characteristics of vulnerable groups.

Role of Seaports and Imported Rats in Seoul Hantavirus Circulation, Africa.

Seoul orthohantavirus (SEOV) is not considered a major public health threat on the continent of Africa. However, Africa is exposed to rodentborne SEOV introduction events through maritime traffic after exponential growth of trade with the rest of the world. Serologic studies have already detected hantavirus antibodies in human populations, and recent investigations have confirmed circulation of hantavirus, including SEOV, in rat populations. Thus, SEOV is a possible emerging zoonotic risk in Africa. Moreover, the range of SEOV could rapidly expand, and transmission to humans could increase because of host switching from the usual brown rat (Rattus norvegicus) species, which is currently invading Africa, to the more widely installed black rat (R. rattus) species. Because of rapid economic development, environmental and climatic changes, and increased international trade, strengthened surveillance is urgently needed to prevent SEOV dissemination among humans in Africa.

Effect of Ambient Air Pollutants on the Medical Costs of Allergic Rhinitis in Seoul, Korea.

BACKGROUND: Ambient air pollutants are considered significant factors that influence allergic diseases. This study aimed to evaluate the effect of ambient air pollution on the medical costs of allergic rhinitis (AR) through a time-series analysis. METHODS: We used data from the Korean National Health Insurance Database from January 2016 to December 2019. The total cost for medical management and outpatient prescriptions for AR, estimated by the National Health Insurance Service for 25 districts, was summed as the total medical costs. The monthly concentrations of PM10 , PM2.5 , NO2 , CO, O3 , and SO2 were calculated, and time-series analysis was performed to evaluate the effect of ambient air pollutants on the medical cost of AR using the seasonal autoregressive integrated moving average (SARIMA) model. RESULTS: Time-series analysis revealed that the concentrations of PM10 , NO2 , and CO were significantly associated with an increased medical cost of AR when adjusting for monthly differences and seasonality (p = 0.048, p = 0.001, and p = 0.001 respectively). The increase in medical costs of AR was 6.22% (95% confidence interval [CI]: 0.0%-12.37%), 11.27% (95% CI: 6.03%-16.50%), and 11.05% (95% CI: 7.09%-15.01%) per one standard deviation increase in PM10 , NO2, and CO respectively. CONCLUSIONS: The monthly concentrations of PM10 , NO2 , and CO were significantly associated with the increased medical costs of AR when adjusting for monthly differences and seasonality. This analysis provides a better understanding of the health and economic effects of ambient air pollutants on AR. LEVEL OF EVIDENCE: N/A Laryngoscope, 133:1828-1833, 2023.

The relative importance of macro versus micro geographical scale in explaining suicide variation in Seoul, South Korea 2014-2016.

BACKGROUND: As ecological factors are getting attention as important determinants of suicide, it is important to identify the unit at which the largest variation exists for more tailed strategy to prevent suicide. We examined the relative importance of two administrative levels for geographic variation in the suicide rate between 2014-2016 in Seoul, the capital city of Korea. METHODS: Two-level linear regression with Dongs (level 1) nested within Gus (level 2) was performed based on suicide death data aggregated at the Dong-level. We performed pooled analyses and then year-stratified analyses. Dong-level socioeconomic status and environmental characteristics were included as control variables. RESULTS: The overall age- and sex- standardized suicide rate across all Dongs decreased over time from 24.9 deaths per 100,000 in 2014 to 23.7 deaths in 2016. When Dong and Gu units were simultaneously considered in a multilevel analysis, most of the variation in suicide rate was attributed to within-Gu, between-Dong differences with a contribution of Gu-level being small and decreasing over time in year (Variance partitioning coefficient of Gu = 5.3% in 2014, <0.1% in 2015 and 2016). The number of divorce cases per 100,000 explained a large fraction of variation in suicide rate at the Dong-level. CONCLUSIONS: Findings from this study suggest that ecological micro-area unit is more important in reducing the geographic variation in the suicide rate. More diverse ecological-level data needs to be collected for targeted area-based suicide prevention policies in Korea.

Trends and disparities in avoidable, treatable, and preventable mortalities in South Korea, 2001-2020: comparison of capital and non-capital areas.

OBJECTIVES: This study aimed to describe the regional avoidable mortality trends in Korea and examine the trends in avoidable mortality disparities between the Seoul Capital Area and non-Seoul-Capital areas, thereby exploring the underlying reasons for the trend changes. METHODS: Age-standardized mortality rates from avoidable causes between 2001-2020 were calculated by region. Regional disparities in avoidable mortality were quantified on both absolute and relative scales. Trends and disparities in avoidable mortality were analyzed using joinpoint regression models. RESULTS: Avoidable, treatable, and preventable mortalities in Korea decreased at different rates over time by region. The largest decreases were in the non-Seoul-Capital non-metropolitan area for avoidable and preventable mortality rates and the non-Seoul- Capital metropolitan area for treatable mortality rates, despite the largest decline being in the Seoul Capital Area prior to around 2009. Absolute and relative regional disparities in avoidable and preventable mortalities generally decreased. Relative disparities in treatable mortality between areas widened. Regional disparities in all types of mortalities tended to improve after around 2009, especially among males. In females, disparities in avoidable, treatable, and preventable mortalities between areas improved less or even worsened. CONCLUSIONS: Trends and disparities in avoidable mortality across areas in Korea seem to have varied under the influence of diverse social changes. Enhancing health services to underserved areas and strengthening gender-oriented policies are needed to reduce regional disparities in avoidable mortality.

Spatial Disparity of Visitors Changes during Particulate Matter Warning Using Big Data Focused on Seoul, Korea.

This study examined the changes in the number of visitors to regions during periods of high particulate matter (PM) concentrations in Seoul and analyzed the regional differences of these changes. Further, it examined the spatial characteristics that affect these regional differences. This study mapped the regional differences by conducting a spatial cluster analysis using GIS and examined factors affecting the regional differences using logistic regression analysis. The visiting population data used in this study were obtained from the Big Data on the de facto population measured every hour at mobile base stations, and all analyses were conducted in terms of weekdays and weekends. The results indicated that the visiting population decreases significantly on weekdays when there are high PM concentrations; however, visits increase on weekends, even during periods of high PM concentrations. Moreover, there was a huge regional gap in visiting population changes. Regions with more commercial use, higher bus accessibility, and better pedestrian environment (pedestrian paths, Walk Score) were more likely to be hotspots, whereas regions with high residential and industrial use were more likely to be cold spots. These results can be used as the basic data for PM policies based on regional characteristics.

Development of a quantitative evaluation tool for Seoul's community-based participatory health program 'building healthy communities'.

Community-based participatory health (CBPH) programs are important for addressing health disparities; however, the limited development of validated scales to measure outcomes may hinder the utilization and upscaling of such programs. Thus, this study aimed to develop a culturally appropriate and valid tool for the quantitative evaluation of a CBPH program and to test theory-driven pathways of associations among participation, social capital, empowerment and health outcomes. This study used a participatory and mixed methods approach. Formative research, including a literature review, survey results over the past 2 years, focus group interviews and participatory evaluation committee meetings, was conducted. Four program components-participation, social capital, empowerment and quality of life (QoL)-were identified and used to construct a validated evaluation tool. A total of 317 participants (89.9% women, mean age = 57.7 ± 11.5 years) responded to the survey. The data were analyzed for internal consistency and factor structure. Structural equation modeling (SEM) was used to test the theoretical pathways of health promotion through the CBPH program. The SEM results showed two significant mediation pathways such that participation in interventions was associated with higher QoL via social capital accumulation and improved empowerment. Our results exemplify a validated scale that can be used to evaluate the intermediate- and long-term outcomes of a CBPH program.

This study aimed to develop a reliable and valid tool for the evaluation of community-based participatory health (CBPH) programs and to test a pathway to explain how participation may be associated with better health. The study used mixed methods, including focus group interviews, analysis of survey data from the past 2 years, participatory evaluation committee meetings and a main survey. Four core program components were identified: participation, social capital, empowerment and quality of life. In total, 317 participants responded to the survey. The results also showed that program participation was associated with a higher quality of life through increased social capital and empowerment. In conclusion, the developed evaluation tool can be used to evaluate the intermediate-and long-term outcomes of a CBPH program.

Effects of a Medical Aid program on medical utilization patterns for low-income patients with affective disorder in Seoul.

ABSTRACT: Mental illness has been increasing globally and its global burden of disease has reached a significant level, and urban dwellers have more chances of having worse mental health status due to high population density, isolated social networks. In Korea's medical security system, Medical Aid (MA) program and National Health Insurance (NHI), patients covered by MA pay much smaller out-of-pocket payments for outpatient services because of exempt from hospitalization fees. However, as a result of focusing on improving access to medical services for the urban poor due to lower out-of-pocket payment, their healthcare costs have greatly increased, while their health management has thus far been inadequate. In light of the background, this study investigated the differences in patterns of medical utilization among affective disordered patients covered by the MA program and the NHI system respectively.Data used for this study were extracted from customized health information data from the National Health Insurance Service (NHIS). The data source used in this study, customized claims data from the NHIS, is census data, which strengthens the representativeness and reliability of the study results. A total of 6754 inpatients (MA: 3327 and NHI 20%: 3327) diagnosed with the affective disorder were retrieved by Propensity Scores Matching (PSM).The length of stay of MA beneficiaries was found to be longer than that of NHI enrollees. However, the rate of hospital emergency room visits by NHI enrollees was higher than that of MA beneficiaries.Overall, community-based interventions are required to prevent and treat mental health by providing primary medical care in the community, and linking with mental health centers. Such policies will ultimately improve the financial sustainability of medical security systems.

Preoperative volume assessment using bioelectrical impedance analysis for minimizing blood loss during hepatic resection.

BACKGROUND: Maintaining low central venous pressure (CVP) is an effective strategy to reduce blood loss during hepatic resection. As an alternative to measuring CVP, which requires the placement of a central venous catheter, bioelectrical impedance analysis (BIA) is a noninvasive method recently used for monitoring volume status in critically ill patients. METHODS: We investigated 192 patients who underwent hepatic resection from January 2017 to December 2020. The ratio of extracellular water:total body water (ECW/TBW), as an index of volume status, was measured using InBody S10 (Biospace, Seoul, Korea). The correlation between the ECW/TBW and CVP was determined, and their influences on operative outcomes were analyzed. RESULTS: ECW/TBW and CVP showed a significant correlation; an ECW/TBW <0.378 correlated with a CVP <5 mmHg (R2 = 0.839, P<0.001). Estimated blood loss (EBL) was significantly increased in patients with an ECW/TBW ≥0.378 compared to those with a ratio <0.378 (508 ± 321 vs. 324 ± 193, mL, P<0.001). Identified predictors for an EBL ≥500 mL were operative time (odds ratio [OR], 1.008; 95% confidence interval [CI], 1.001-1.015; P = 0.021) and an ECW/TBW <0.378 (OR, 0.263; 95% CI, 0.121-0.572; P = 0.001). CONCLUSIONS: BIA can be utilized for preoperative volume assessment to minimize blood loss during hepatic resection.

Health risk assessment of exposure to organochlorine pesticides in the general population in Seoul, Korea over 12 years: A cross-sectional epidemiological study.

This study evaluated the 12-year trends in serum levels of 28 organochlorine pesticides (OCPs) in 880 adults living in Seoul, Korea. The OCP levels decreased from 2006 to 2017, and p,p'-dichlorodiphenyldichloroethylene was a predominant compound. OCP levels were higher in females than in males, and showed positive associations with BMI and age. The OCP concentrations had inverted U-shaped associations with low-density lipoprotein cholesterol and total cholesterol. Concentrations of ß-hexachlorocyclohexane were significantly higher in patients with hypertension than in participants that were normotensive. OCP levels showed positive associations with uric acid, creatinine, and thyroid-stimulating hormone, but negative associations with free thyroxine. Participants with diabetes had significantly higher OCP levels than those without it. Principal component analysis suggested possible differences in disease manifestation depending on the composition of OCPs. These results suggest that OCPs might disturb renal transport and thyroid homeostasis. To our knowledge, the inverted U-shaped associations of heptachlor epoxide and endosulfan with cholesterol, the epidemiological associations of trans-nonachlor and endosulfan with thyroid hormones, and the association of p,p'-DDE with hyperuricemia have not been previously reported in general population. This is the first long-term study to show trends of 28 OCPs in serum and associations with various health indicators in Korea.

Factors influencing caregiver burden by dementia severity based on an online database from Seoul dementia management project in Korea.

BACKGROUNDS: As the prevalence of dementia rises, caregiver burden also increases in South Korea, especially for informal family caregivers. This study aimed to analyze factors affecting caregiver burden by the severity of dementia based on data of patients in Seoul. METHODS: A total of 12,292 individuals aged ≥65 years enrolled in the Seoul Dementia Management Project from 2010 to 2016 in an online database were selected. Caregiver's burden was assessed using the Korea version of Zarit Burden Interview. Multiple regression analyses were performed to determine factors associated with primary caregiver's burden after stratifying the severity of dementia. RESULTS: Most patients showed moderate levels of cognitive impairment (49.4%), behavior problems (82.6%), and ADL dependency (73.6%). After stratifying the severity of dementia, caregivers caring for patients with mild symptoms of dementia were experienced with higher caregiver burden if patients were under a lower score of IADL. Significant factors for caregiver burden among caregivers supporting patients with moderate symptoms of dementia include caregivers' residence with patients, subjective health status, and co-work with secondary caregivers. Lastly, caregivers for patients with severe dementia symptoms experienced a higher caregiver burden from limited cognitive function, problematic behavior, and caregivers' negative health status. CONCLUSION: In terms of sample size, this study had far more patients than any other domestic or international study. It was meaningful in that it analyzed characteristics of patients with dementia and caregivers affecting the burden of caregivers in Korea. Intensive social supports with multiple coping strategies focusing on different levels of patients' clinical symptoms and caregivers' needs should be planned to relieve the caregiver burden.