The effect of depression on cognitive decline among Korean retirees.

Background: Little information is available on the characteristics of cognitive ability among retirees. This study aimed to identify factors associated with cognitive impairment among Korean retirees. Materials and Methods: We used data from the Korean Longitudinal Study of Ageing survey. A total of 1755 retirees aged 45 years or older who had normal cognition were followed up for 12 years to identify cognitive impairment. Stepwise multivariate logistic models were used to assess odds ratios (ORs) and 95% confidence intervals (CIs) for cognitive decline. Results: Well-known risk factors, such as age (OR, 1.07; 95% CI, 1.06-1.09), female sex (OR, 1.49; 95% CI, 1.08-2.04), low education (OR, 2.45; 95% CI, 1.91-3.14), and depressive mood (OR, 1.51; 95% CI, 1.16-1.97), remained significantly associated with cognitive decline. Sex-stratified analysis revealed that depressive mood was significantly associated with cognitive decline in male retirees only (OR, 1.90; 95% CI, 1.31-2.75). Conclusion: Our finding indicates that screening male retirees for depressive mood is required to retard cognitive aging.

Association between continuous deep sedation and survival time in terminally ill cancer patients.

PURPOSE: Our study aimed to evaluate the association between CDS and survival time using the likelihood of receiving CDS to select a matched non-CDS group through an accurate measurement of survival time based on initiation of CDS. METHODS: A retrospective cohort study was performed using an electronic database to collect data regarding terminally ill cancer patients admitted to a specialized palliative care unit from January 2012 to December 2016. We first used a Cox proportional hazard model with receiving CDS as the outcome to identify individuals with the highest plausibility of receiving CDS among the non-CDS group (n = 663). We then performed a multiple regression analysis comparing the CDS group (n = 311) and weighted non-CDS group (n = 311), using initiation of CDS (actual for the CDS group; estimated for the non-CDS group) as the starting time-point for measuring survival time. RESULTS: Approximately 32% of participants received CDS. The most common indications were delirium or agitation (58.2%), intractable pain (28.9%), and dyspnea (10.6%). Final multiple regression analysis revealed that survival time was longer in the CDS group than in the non-CDS group (Exp(ß), 1.41; P < 0.001). Longer survival with CDS was more prominent in females, patients with renal dysfunction, and individuals with low C-reactive protein (CRP) or ferritin, compared with their counterpart subgroup. CONCLUSIONS: CDS was not associated with shortened survival; instead, it was associated with longer survival in our terminally ill cancer patients. Further studies in other populations are required to confirm or refute these findings.

Weekend catch-up sleep is associated with reduced metabolic derangements in Korean adults.

BACKGROUND: Deficits in sleep are associated with metabolic derangements, but the effect of sleep supplementation on metabolic derangements remains to be elucidated. This study aimed to investigate whether weekend catch-up sleep is associated with metabolic derangements in Korean adults. METHODS: A total of 10,749 individuals over 40 years old were identified from the 2016-2017 Korea National Health and Nutrition Examination Survey. Data on demographics, health behaviors, self-reported sleep duration, and physician-diagnosed metabolic diseases were used in this analysis. The odds ratio for each metabolic derangement was determined via stepwise multivariable logistic regression models. RESULTS: Short weekday sleep and insufficient weekend catch-up sleep were independently associated with an increased risk for all metabolic derangements, except hypertension. Individuals who did not make up sleep on the weekend were more likely to be obese and have type 2 diabetes or hypercholesterolemia.

Association between handgrip strength and mental health in Korean adolescents.

BACKGROUND AND OBJECTIVES: Muscle strength is associated with adverse mental health outcomes in adults; however, few studies have examined this association among adolescents. This study investigated the association between handgrip strength and mental health in a nationally representative sample of Korean adolescents. METHODS: We performed a cross-sectional study of 3530 adolescent (12-18 years old) from the 2014-2017 Korean National Health and Nutrition Survey. Handgrip strength was defined as the maximum measurement in kilograms from the dominant hand. Adverse mental health included the presence of perceived stress, depressive mood and suicidal ideation. Logistic regression models were used with adjustment for potential confounders. RESULTS: The mean age ± SD of the study participants was 14.9 ± 2.0 years. Girls (47.5% of participants) had poorer mental health than boys. For boys, each 1-kg increase in handgrip strength was associated with a 3% decrease in the odds of having perceived stress and depressive moods. For girls, there was a positive association between handgrip strength and perceived stress. The relationship between handgrip strength and perceived stress was dose dependent for both sexes. CONCLUSIONS: Low handgrip strength was associated with poor mental health among boys. Future research is required to validate our findings and to establish whether interventions to increase muscular strength can reduce the prevalence of perceived stress and depressive mood in boys.

Association between consumption of fruits and vegetables with suicidal ideation.

OBJECTIVE: To investigate the association between fruit and vegetable (F&V) intake with suicidal ideation. DESIGN: Cross-sectional study using a Korean Community Health Survey. SETTING: F&V consumers were defined as individuals who had consumed fruits or vegetables more than once per day. Multivariable logistic regression models were used to identify factors associated with suicidal ideation including F&V consumption and to estimate the prevalence of having suicidal ideation after consideration of potential confounders. PARTICIPANTS: 221 081 Korea adults (nationally representative). RESULTS: Approximately 55 % of participants were F&V consumers. They were more likely to be young, be women, attain high educational levels, be married and be healthier physically and psychologically than the F&V non-consumers. Non-consumers had an increased risk for suicidal ideation than consumers even when potential confounders were considered, and this trend was more remarkable with vegetable intake. CONCLUSION: F&V intake is associated with low risk for suicidal ideation.

Association between height and sleep duration in Korean adults.

The relationship between height and sleep duration is poorly understood in adults. We analysed the data from 32 698 adults collected by the 2007-2016 Korean National Health and Nutrition Examination Survey. A total of 44.4% and 9.1% participants reported short (≤6 h) and long (≥9 h) sleep duration, respectively. A shorter height was significantly associated with increased likelihood of both short and long sleep. A sex-stratified analysis revealed that the relationship between height and sleep duration was only significant in males. In conclusion, height was independently related to sleep duration in Korean men.

Association between sources of stress and depressive mood in Korean adults.

OBJECTIVE: The present study investigated the association between different sources of stress and depressive mood in Korean adults. METHODS: A total of 4464 adults who completed the 2018 Korean National Health and Nutrition Examination Survey were included in the analysis. Data included sources of stress, depressive mood assessed by the nine-item Patient Health Questionnaire, sociodemographic characteristics, and health-related habits. Multiple logistic regression models were applied to calculate the odds ratio for depressive mood according to each source of stress and stratified by sex and age. RESULTS: Fully adjusted models revealed that individuals who reported a financial problem or health concern as their main source of stress were more likely to experience depressive mood; when data were stratified by sex, these associations remained significant among females only. An age-stratified analysis indicated that financial problems were associated with depressive mood in middle-aged individuals and health concerns were associated with depressive mood in elderly. CONCLUSION: Korean adults with specific sources of stress should be monitored for the development of emotional distress.

Height Is Associated with Dyslipidemia in Korean Premenopausal Women: Data from the Korea National Health and Nutrition Examination Survey.

BACKGROUND: The association between height and cardiovascular disease (CVD) has been reported in epidemiological studies for decades; however, the mechanism for this relationship is still unclear. We previously reported that dyslipidemia was associated with adult height in Korean men without CVD. OBJECTIVES: This study explored the potential -relationship between height and dyslipidemia in premenopausal women. METHODS: This study used data from the 2007-2016 Korea National Health and Nutritional Examination Survey (KNHANES). We identified 16,361 premenopausal women aged ≥19 years without a history of CVD (myocardial infarction/stroke) or cancer. Fasting total cholesterol, triglyceride, and high-density lipoprotein cholesterol (HDL-C) levels were measured. Dyslipidemia was further classified as hypercholesterolemia (total cholesterol level ≥240 mg/dL or treatment with lipid-lowering medications), hypertriglyceridemia (triglyceride level ≥200 mg/dL), and low HDL-C (HDL-C level <40 mg/dL). Subjects were divided into four groups by their height (<155, 155-159.9, 160-164.9, and ≥165 cm), and the prevalence of dyslipidemia was compared. RESULTS: Multiple regression analysis revealed that short premenopausal women had a higher likelihood of hypercholesterolemia (ptrend = 0.002), hypertriglyceridemia (ptrend = 0.010), and low HDL-C (ptrend = 0.002) when adjusted for age, comorbidities, waist circumference, health-related habits, and economic status. CONCLUSION: There was a dose-dependent correlation between adult height and adverse lipid profile in premenopausal Korean women who did not have CVD. This finding could serve as further evidence that dyslipidemia can be a link between shortness and CVD.

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

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

Waist circumference and risk of breast cancer in Korean women: A nationwide cohort study.

Although postmenopausal breast cancer (BC) risk has been linked to adiposity, associations between adiposity and premenopausal BC remain unclear. To address this question, we investigated the association of BC risk with measures of adiposity, including body mass index (BMI) and waist circumference (WC), in a large cohort of Asian women. We used a nationwide cohort of adult Korean women selected from the National Health Insurance Corporation database merged with national health examination data from 2009 to 2015. A total of 11,227,948 women were tracked to retrospectively identify incident cases of BC. Our analysis used Cox proportional hazards models to calculate hazard ratios and assess the association of BC risk with BMI and/or WC in both pre- and postmenopausal women. BMI and WC were robustly associated with increased risk for postmenopausal BC (ptrend <0.001 for both BMI and WC) but not with premenopausal BC. Association between WC and premenopausal BC was only statistically significant when considering BMI (ptrend =0.044). In contrast, postmenopausal BC was negatively associated with WC when considering BMI (ptrend =0.011). In premenopausal women, WC may predict increased BC risk when considering BMI. However, in postmenopausal women, WC is not superior to BMI as an indicator of BC risk.

Waist circumference and risk of 23 site-specific cancers: a population-based cohort study of Korean adults.

BACKGROUND: Large waist circumference (WC) is a risk factor for several site-specific cancers, but a large-scale systematic investigation across all common cancers adjusted for potential confounders has not been conducted. This study aimed to evaluate the possible links between WC and common cancers. METHODS: We prospectively examined the association between WC and the risk of cancers in a 7-year cohort study of nearly 22.9 million Korean adults. Using the claims database merged with the national health check-up data, we fitted proportional hazard models to investigate associations between WC and 23 of the most common cancers, with adjustment for potential confounders, including body mass index (BMI). We also evaluated the modification of BMI on the relationships between WC and the incidence of cancer. RESULTS: A total of 769,871 cancer cases were identified. WC was positively associated with 18 of 23 cancers, and the effects varied substantially by site in each sex. The modification of BMI on the WC-cancer association also varied across the cancer site; in most cases it mitigated the association. For cancers of the oral cavity, larynx, oesophagus, lung, and premenopausal breast, the BMI adjustment reversed the association toward being positive (all Ptrend < 0.001). CONCLUSIONS: Central obesity, independent of general obesity, was associated with the risk of several cancers. The heterogeneity in the mediating effects of BMI suggests that different mechanisms are associated with different cancer sites. Based upon these findings, active strategies to monitor and prevent central obesity should be implemented.

A Nationwide Population-Based Cohort Study of Dementia Risk Among Acid Suppressant Users.

OBJECTIVE: Data regarding the potential link between acid suppressant use and dementia are inconsistent. This study assessed the association between cumulative exposure to proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) and dementia risk among Korean adults. DESIGN AND METHODS: A population-based longitudinal study was conducted using the Korean National Health Insurance Corporation claims database merged with national health examination data for 2002-2013. The study cohort included 70,529 subjects who were dementia-free in 2007. Incident dementia was assessed throughout follow-up until 2013. Exposure to acid suppressants prior to 2007 was assessed using a standardized defined daily dose system. Potential associations between acid suppressant use and dementia risk were analyzed using time-dependent Cox regression estimated hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: There were 1,297 cases of dementia during the study period. Multivariate analyses identified several factors associated with dementia risk: old age, female, current smoker, Type 2 diabetes, comorbidities, and use of nonaspirin nonsteroidal anti-inflammatory drugs. H2RA users had a significantly increased risk of dementia compared with non-H2RA users (HR 1.31, 95% CI 1.13-1.51), whereas PPI use was not associated with increased risk. CONCLUSION: Our results indicate that exposure to H2RAs (but not PPIs) is associated with increased dementia risk. Further randomized controlled trials and basic research examining the underlying mechanism are needed to confirm this association.

Age is related to neurological outcome in patients with out-of-hospital cardiac arrest (OHCA) receiving therapeutic hypothermia (TH).

INTRODUCTION: In this study, we retrospectively reviewed the patients' outcomes after cardiac arrest based on age in one center, to determine whether geriatric patients had worse outcomes. METHODS: This was a single-center, retrospective cohort study. The patients admitted to the intensive care unit on successful resuscitation after OHCA were retrospectively identified and evaluated. RESULTS: This was a retrospective cohort study of patients over 18years of-age with return of spontaneous circulation (ROSC) (>24h) after cardiac arrest who were admitted to the emergency intensive care unit (EICU) and received post-cardiac arrest care between March 2007 and December 2013. Finally, a total of 295 patients were enrolled during the study period; of these, 79 patients (36.6%) had a good cerebral performance category (CPC). In stepwise multivariate analysis, young age (per 10years) (odds ratio [OR] 1.42, 95% CI 1.00-1.99, p=0.044), high hemoglobin level (per 1g/dL) (OR 1.31, 95% CI 1.07-1.60, p=0.008), non-diabetic patients (OR 15.21, 95% CI 1.85-125.3, p=0.01), cardiogenic cardiac arrest (OR 8.68, 95% CI 3.72-20.30, p<0.001), pre-hospital cardiopulmonary resuscitation (CPR) by bystander (OR 3.61, 95% CI 1.23-10.57, p=0.019), short time from collapsed to ACLS (per 1min) (OR 1.12, 95% CI 1.06-1.18, p<0.001) had good CPC at 6-month post-admission. CONCLUSION: Elderly patients with OHCA had a poor neurological outcome; but several other factors were also related with the outcome. In decision-making for resuscitation, physicians should consider the patients' physiologic factors as well as age.

Casual alcohol consumption is associated with less subclinical cardiovascular organ damage in Koreans: a cross-sectional study.

BACKGROUND: Epidemiologic studies have presented protective effects of alcohol against cardiovascular (CV) events. However, such studies were performed mainly on Westerners. We investigated the effects of alcohol on the subclinical CV morbidity in healthy Koreans. METHODS: The coronary artery calcium (CAC) score, ankle-brachial pulse wave velocity (abPWV), and carotid intima-media thickness (cIMT) of 1004 subjects (age, years±standard deviation [SD] 53 ± 10; 72% were men) with no CV disease history were assessed. The subjects were divided into three groups based on their drinking patterns: Group 0 (abstainers), Group 1 (casual drinkers), and Group 2 (problematic drinkers; > 14 standard drinking/week for men, > 7 standard drinking/week for women). As drinking patterns can be influenced by age/sex, a regression analysis was performed in another four groups (men/women, age < 65/≥65 years). RESULTS: Group 1 exhibited lower CAC (score ± SD, 44 ± 155 vs. 13 ± 48 vs. 50 ± 159) and abPWV (cm/s ± SD, 1448 ± 284 vs. 1340 ± 190 vs. 1447 ± 245) scores and thinner cIMT (mm ± SD, 0.64 ± 0.14 vs. 0.59 ± 0.11 vs. 0.63 ± 0.13) than Groups 0 and 2 (p < 0.05 for all). Problematic drinking (odds ratio [OR]: 2.269; 95% confidence interval [CI]: 1.454-3.541) was associated with a high prevalence of CAC deposits among men aged < 65 years and casual drinking with a lower prevalence of CAC deposits (OR: 0.057; 95% CI: 0.023-0.140) among men aged ≥65 years. Conversely, problematic drinking in older women [OR: 0.117; 95% CI: 0.014-0.943) and casual drinking in younger women (OR: 0.349; 95% CI: 0.153-0.792) were associated with a lower prevalence of CAC deposits. Casual drinking was associated with a lower abPWV and thinner cIMT in the diabetes mellitus/hypertension-adjusted regression analysis. CONCLUSIONS: Compared with abstinence or problematic drinking, casual drinking was associated with less severe CV organ damage in the subclinical stages in Koreans.

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

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

Effect of Influenza Vaccination on Risk of Stroke: A Systematic Review and Meta-Analysis.

BACKGROUND: Despite the presence of a strong association between influenza infection and stroke, whether influenza vaccination reduces the risk of stroke is yet a matter of controversy. We conducted a meta-analysis to determine whether influenza vaccination protects against stroke. METHODS: We searched PubMed, EMBASE, and the Cochrane Library from database inception date to November 18, 2016, without language restrictions, to identify studies investigating the effect of influenza vaccination on subsequent risk of stroke. We conducted a meta-analysis to quantify the risk of stroke in overall and subgroup analyses and calculated a pooled OR for developing stroke with a 95% CI. Publication bias was assessed by Begg's rank correlation test. RESULTS: Eleven studies fulfilled our inclusion criteria. In a random-effects model, vaccinated individuals had a decreased risk of stroke compared with unvaccinated individuals (OR 0.82; 95% CI 0.75-0.91; p < 0.001). The relationship between influenza vaccination and stroke risk remained robust in subgroup analyses. The significant effect of influenza vaccination was associated with ascertainment of vaccination status and stage of prevention. CONCLUSION: Vaccination against influenza is associated with a lower risk of stroke. Well-designed prospective studies are needed to provide stronger evidence of the protective effect of influenza vaccination against stroke.