The Association between Social Support, Metabolic Syndrome, and Incidence of Cardio-Cerebrovascular Diseases in Older Adults: The ARIRANG Study.

PURPOSE: We investigated the association between social support, metabolic syndrome, and incident cardio-cerebrovascular disease (CCVD) in rural Koreans aged ≥50 years. MATERIALS AND METHODS: We conducted a prospective study using the Korean Genome and Epidemiology Study on Atherosclerosis Risk of Rural Areas in the Korean General Population (KoGES-ARIRANG) dataset. From the baseline of 5169 adults, 1682 participants were finally included according to the exclusion criteria. For outcomes, myocardial infarction, angina, and stroke were included. For independent variables, the social support score and metabolic syndrome were used. Descriptive statistics and multivariate logistic regression were performed to investigate the association among the variables. Paired t-test was conducted to analyze the longitudinal variation of social support scores. RESULTS: During the 6.37 years of median follow-up, 137 participants developed CCVD. The adjusted odds ratio (aOR) of metabolic syndrome with persistently high social support was 2.175 [95% confidence interval (CI): 1.479-3.119]. The aOR of metabolic syndrome with persistently low social support was 2.494 (95% CI: 1.141-5.452). The longitudinal variation of the social support score of persistently high social support group was increased significantly by 4.26±26.32. The score of the persistently low social support group was decreased by 1.34±16.87 with no statistical significance. CONCLUSION: The presence of metabolic syndrome increases the likelihood of developing onset CCVD. Within the metabolic syndrome positive group, when social support was persistently low, the cohort developed more cardio-cerebrovascular disease compared to the persistently higher social support group. The social support score of the persistently low social support group could be improved through proper intervention. To prevent CCVD, metabolic syndrome components and low social support should be improved in the study participants.

Associations of Serum Uric Acid Level With Liver Enzymes, Nonalcoholic Fatty Liver Disease, and Liver Fibrosis in Korean Men and Women: A Cross-Sectional Study Using Nationally Representative Data.

BACKGROUND: This study aimed to determine whether serum uric acid (SUA) levels are associated with various indices of liver damage in the adult Korean population. METHODS: We used the Seventh (VII) Korean National Health and Nutritional Examination Surveys. Our study population comprised 6,007 men and 8,488 women. Levels of SUA were divided into four groups (≤ 5.3, 5.3-6.0, 6.0-7.0, and > 7.0 mg/dL for men and ≤ 4.0, 4.0-4.8, 4.8-6.0, and > 6.0 mg/dL for women). Elevated liver enzyme levels were defined as > 35 (men) and > 31 (women) IU/L for aspartate aminotransferase (AST), > 45 (men) and > 34 (women) IU/L for alanine aminotransferase (ALT). Hepatic steatosis index and fibrosis (FIB)-4 index was used to determine nonalcoholic fatty liver disease (NAFLD) and liver FIB, respectively. Adjusted odds ratios (aORs) were calculated by logistic regression analysis for liver enzymes, NAFLD, and liver FIB, according to the SUA level. RESULTS: Among women, the 4.8-6.0 and > 6.0 mg/dL SUA groups showed higher ORs of elevated AST (aOR, 1.78 and 2.03; 95% confidence interval [CI], 1.37-2.32 and 1.40-2.96, respectively; P < 0.001) and the 4.0-4.8, 4.8-6.0, and > 6.0 mg/dL SUA groups showed a higher ORs of ALT elevation (aOR, 1.35, 2.26, and 2.37; 95% CI, 1.02-1.79, 1.72-2.97, and 1.60-3.50, respectively; P < 0.001) compared to the lowest level SUA group. Among women with normal ALT, > 6.0 mg/dL SUA group showed higher OR of NAFLD status (aOR, 1.52; 95% CI, 1.06-2.19). Among men and women with NAFLD, hyperuricemia showed higher ORs of liver FIB (aOR, 2.25 and 1.89; 95% CI, 1.21-4.19 and 1.09-3.27, respectively) than the lowest level SUA group. CONCLUSION: High SUA levels may be associated with elevated liver enzymes and NAFLD, mainly in women. Even in women with normal ALT levels, SUA levels may predict the NAFLD status. Hyperuricemia may predict advanced liver FIB in both men and women with NAFLD. Further studies investigating the causal effects of SUA on liver damage are required.

Impact of Parental Mental Health and Help-Seeking on Adolescents' Suicidal Ideations and Help-Seeking Behaviors.

This study aimed to evaluate the impact of parental mental health on adolescent offspring. Data regarding 6512 families from the 2010-2021 Korean National Health and Nutrition Examination Survey were analyzed; among them, 428 were placed in the suicidal ideation (SI) group and 421 were placed in the matched control (MC) group. This number was selected for the use of the propensity score matching method. The findings highlighted significant associations between parental mental health and adolescent suicidal ideation, with mothers in the SI group having higher odds of Diagnosed Depression (OR 2.109, 1.023-4.350 95% CI), Depressive Mood (OR 2.155, 1.224-3.793 95% CI), and Suicidal Ideation (OR 2.532, 1.322-4.851 95% CI) compared to the MC group. Regarding the fathers, paternal Suicidal Ideation (OR 4.295, 1.747-10.599 95% CI) was the only significant factor for adolescent suicidal ideation. In contrast, maternal depressive symptoms and help-seeking behavior significantly impacted adolescent help-seeking; Maternal Depressive Mood increased with adolescent Help-Seeking (OR 4.486, 1.312-15.340 95% CI) while Maternal Suicidal Ideation reduced the probability of Help-Seeking in the SI group (OR 0.15, 0.031-0.721, 95% CI). Chronic and severe depressive symptoms in mothers could make adolescents less likely to seek help for their suicidal ideations. Therefore, clinicians working with adolescents should prioritize a family-oriented approach.

Trauma Exposure and Suicidal Ideation among Korean Male Firefighters: Examining the Moderating Roles of Organizational Climate.

Background: This study investigated the relationship between trauma exposure and suicidal ideation. Moreover, this study examines the moderating roles of organizational climate on the association between trauma exposure and suicidal ideation in Korean male firefighters. Methods: A total of 15,104 male firefighters who completed a questionnaire were analyzed. The data were obtained using an online self-administered questionnaire from the Firefighter Research on Enhancement of Safety and Health Study. Poisson regression analysis was performed to determine the effects of trauma exposure on suicidal ideation and the moderating effect of organizational climate. Results: The results showed that 389 firefighters (2.6%) responded that they had experienced suicidal ideation. In the final model, trauma exposure was positively related to suicidal ideation (adjusted risk ratio [aRR], 1.076; 95% confidence interval [CI]: 1.051-1.103), and organizational climate was negatively associated with suicidal ideation (aRR, 0.772; 95% CI: 0.739-0.806). Additionally, the interaction term (trauma exposure × organizational climate) was related to suicidal ideation (aRR, 1.016; 95% CI: 1.009-1.023). Conclusions: This study suggests that trauma exposure might play a significant role in developing suicidal ideation and that positive organizational climate moderates the negative effects of trauma exposure on suicidal ideation among firefighters. It is necessary to perform a follow-up study of various intervention strategies to maintain a healthy organizational climate or work environment. Such interventions should promote lasting trust within teams, provide social support and belonging, and nurture job value.

Impact of Wildfire Smoke Exposure on Health in Korea.

PURPOSE: The characteristic topography and climate often affect the occurrence of large-scale wildfires in the Eastern Gangwon-do region of Korea. However, there are no studies on the health effects of these wildfires in Korea. This study aimed to analyze the differences in medical use between a wildfire-affected area and an adjacent non-affected area before and after a wildfire in 2019 in Gangwon-do, Korea. MATERIALS AND METHODS: We used medical usage data from the Korean National Health Insurance Corporation. Rates of medical use were determined for citizens of a wildfire-affected area in the Eastern Yeongdong region and a non-affected area in the Western Yeongseo region. Logistic regression analysis was performed considering an increase in medical use per individual as a dependent variable; age, sex, income, smoking, drinking, and exercise were included as confounding variables. RESULTS: The odds ratio for medical use in Yeongdong region increased significantly after 3 days, 3 months, and 1 year after a fire occurred, compared with Yeongseo region. CONCLUSION: The results of this study confirmed that the use of medical care increased for residents of a wildfire-affected area, compared with those of an adjacent non-affected area. This is the first study on the relationship between wildfires and inpatient medical use in Korea.

Variation in Genotype and DNA Methylation Patterns Based on Alcohol Use and CVD in the Korean Genome and Epidemiology Study (KoGES).

Alcohol consumption can increase the risk of chronic diseases, such as myocardial infarction, coronary artery disease, hyperlipidemia, and hypertension. We aimed to assess the association between genotype, DNA methylation patterns, alcohol consumption, and chronic diseases in Korean population. We analyzed 8840 subjects for genotypes and 446 for DNA methylation among the 9351 subjects from the Korean Genome and Epidemiology Study (KoGES). We further divided both groups into two sub-groups according to the presence/absence of chronic diseases. We selected genes whose methylation varied significantly with alcohol consumption, and visualized genotype and DNA methylation patterns specific to each group. Genome-wide association study (GWAS) revealed single nucleotide polymorphisms (SNPs) rs2074356 and rs11066280 in HECT domain E3 ubiquitin protein ligase 4 (HECTD4) to be significantly associated with alcohol consumption in both the presence. The rs12229654 genotype also displayed significantly different patterns with alcohol consumption. Furthermore, we retrieved differentially methylated regions (DMRs) from four groups based on sex and chronic diseases and compared them by drinking status. In genotype analysis, cardiovascular diseases (CVDs) showed a higher proportion in drinker than in non-drinker, but not in DMR analysis. Additionally, we analyzed the enriched Gene Ontology terms and Kyoto Gene and Genome Encyclopedia (KEGG) pathways and visualized the network, heatmap, and upset plot. We show that the pattern of DNA methylation associated with CVD is strongly influenced by alcoholism. Overall, this study identified genetic and epigenetic variants influenced by alcohol consumption and chronic diseases.

Effects of Emergency Duties on Cardiovascular Diseases in Firefighters: A 13-Year Retrospective Cohort Study.

OBJECTIVES: This study aimed to examine the effects of firefighters' emergency duties on the incidence of cardiovascular disease (CVD). METHODS: We used a 13-year follow-up in a nationwide retrospective cohort study. A total of 363,137 employees were recruited. The sex-and age-specific incidence of CVD (hypertension, angina pectoris, and acutemyocardial infarction [AMI]) in firefighters and public officials was estimated. RESULTS: The overall age-specific sex-based incidence of CVD, except for hypertension, was higher in firefighters than in public officials. The age-stratified hazard ratios for the three types of CVD in male firefighters were also higher. AMI was more common in younger firefighters, whereas angina pectoris and hypertension were common in older firefighters. CONCLUSIONS: Firefighters' duties are more likely to increase the risk of CVD, and preventive strategies with proven benefits are required.

Regional Gray Matter Volume Related to High Occupational Stress in Firefighters.

BACKGROUND: Firefighters inevitably encounter emotionally and physically stressful situations at work. Even firefighters without diagnosed post-traumatic stress disorder receive clinical attention because the nature of the profession exposes them to repetitive trauma and high occupational stress. This study investigated gray matter abnormalities related to high occupational stress in firefighters using voxel-based morphometry (VBM) and surface-based morphometry (SBM). METHODS: We assessed 115 subjects (112 males and 3 females) using magnetic resonance imaging and evaluated occupational stress by the Korean Occupational Stress Scale-26 (KOSS-26). Subjects were classified into highly or lowly stressed groups based on the median value of the KOSS-26. RESULTS: In VBM analysis, we found that firefighters with high occupational stress had lower gray matter volume (GMV) in both sides of the insula, the left amygdala, the right medial prefrontal cortex (mPFC), and the anterior cingulate cortex than firefighters with low occupational stress. In SBM analysis based on regions of interest, the GMV of the bilateral insula and right mPFC were also lower in the highly stressed group. Within the highly stressed group, low GMV of the insula was significantly correlated with the length of service (left: r = -0.347, P = 0.009; right: r = -0.333, P = 0.012). CONCLUSION: Our findings suggest that regional GMV abnormalities are related to occupational stress. Regional gray matter abnormalities and related emotional dysregulation may contribute to firefighter susceptibility to burnout.

Negative Impacts of Prolonged Standing at Work on Musculoskeletal Symptoms and Physical Fatigue: The Fifth Korean Working Conditions Survey.

PURPOSE: We aimed to investigate variations in the risk of low back pain (LBP), lower extremity muscle pain, and whole body fatigue according to differences in prolonged standing work hours in relation to risk factor exposure and rest frequency. MATERIALS AND METHODS: From the fifth Korean Working Conditions Survey data collected in 2017, data for 32970 full-time workers who worked for more than 1 year at their present job were analyzed. We classified the workers according to exposure to fatigue or painful postures, carrying heavy objects, performance of repetitive movements that burden the musculoskeletal system, and how often they took a break. Relationships between time spent in a standing posture at work and risks of LBP, lower extremity muscle pain, and whole body fatigue were analyzed by multivariate logistic regression. RESULTS: Of the full-time workers in the survey, 48.7% worked in a standing position for more than half of their total working hours. A higher odds ratio (OR) value for lower extremity muscle pain was observed in female not exposed to carrying heavy objects [OR: 3.551, 95% confidence interval (CI): 3.038-4.150] and not exposed to performing repetitive movements (OR: 3.555, 95% CI: 2.761-4.557). CONCLUSION: Changes in work methodologies are needed to lower the number of hours spent in a prolonged standing posture at work, including being able to rest when workers want to do so, to reduce pain and fatigue.

Moderating Effects of Organizational Climate on the Relationship between Emotional Labor and Burnout among Korean Firefighters.

This study examined the association of emotional labor and organizational climate with burnout and elucidated the moderating effect of organizational climate on the relationship between emotional labor and burnout among 18,936 Korean firefighters (male: 17,790, 93.9%, female: 1146, 6.1%). To examine the effects of organizational climate on the relationships between five sub-scales of emotional labor and burnout, four groups were created using various combinations of emotional labor ("normal" vs. "risk") and organizational climate ("good" vs. "bad"): (1) "normal" and "good" (Group I), (2) "normal" and "bad" (Group II), (3) "risk" and "good" (Group III), and (4) "risk" and "bad" (Group IV). A hierarchical multiple linear regression analysis indicated that firefighters' burnout was significantly higher in the group with "bad" than "good" organizational climate and was significantly higher among people with "risk" than "normal" emotional labor. Combined effects of organizational climate with emotional labor on burnout were observed in all five sub-scales. Groups II, III, and IV were more likely to experience burnout than Group I (trend p < 0.001). Additionally, the moderating effects of organizational climate on the relationship between the five sub-scales of emotional labor and burnout were observed, except for factor 5. These results emphasize the importance of stress management to alleviate burnout caused by emotional labor at the organizational level and coping strategies to reinforce the personal potentiality suitable to organizational norms at the individual level.

Organizational Climate Effects on the Relationship Between Emotional Labor and Turnover Intention in Korean Firefighters.

BACKGROUND: The purpose of this study is to examine the combined effects of organizational climate (OC) with emotional labor (EL) on turnover intention in Korean firefighters. METHODS: The data were obtained from the study Firefighters Research: Enhancement of Safety and Health. A total of 4,860 firefighters whose main duty was providing "emergency medical aid" were included. To examine the effects of OC on the relationships between five subscales of EL and turnover intention, four groups were created using various combinations of OC ("good" vs. "bad") and EL ("normal" vs. "risk"): (1) "good" and "normal" (Group I), (2) "bad" and "normal" (Group II), (3) "good" and "risk" (Group III), and (4) "bad" and "risk" (Group IV). Multivariate logistic regression analyses were performed to estimate the risk of turnover intention for the combinations of OC and EL. RESULTS: The results showed turnover intention was significantly higher in the group with "bad" OC (17.7%) than in that with "good" OC (7.6%). Combined effects of OC and EL on turnover intention were found in all five subscales with the exception of Group I for emotional demands and regulation. Groups II, III, and IV were more likely to experience risks of turnover intention than Group I (p for trend <0.001). CONCLUSIONS: A positive and cooperative OC plays a role in decreasing the risk of turnover intention and in attenuating the negative effects of EL on turnover intention in firefighters.

Effects of Occupational and Leisure-Time Physical Activities on Insomnia in Korean Firefighters.

Studies have been conducted on the association between physical activity (PA) and sleep, but to the best of our knowledge, a simultaneous analysis of the effects of occupational PA (OPA) and leisure time PA (LTPA) on South Korean firefighters' sleep has never been conducted. This study aims to analyze how OPA and LTPA affect these individuals' risk of suffering from insomnia with-in this specific population of subjects. The study includes data from an online self-report survey in which 9788 South Korean firefighters participated. The survey used the Insomnia Severity Index and the OPA- and LTPA-related characteristics were investigated. The independent two-sample t-test, χ2 test, and multiple logistic regression analysis were performed. Subgroup logistic regression analyses were also completed in accordance with the OPA level. Among 9788 participants, 890 (9.1%) suffered from insomnia. A logistic regression analysis revealed that higher levels of feeling of job loading (FoJL), rising levels of physical strength utilization rate (PSUR), greater frequency levels of occupational activities, and high-intensity LTPA were significantly correlated with an increased risk of insomnia, while execution of LTPA and getting enough rest after LTPA was correlated with a decreased risk. However, the subgroup analysis showed that high-intensity LTPA was correlated with a significantly increased the risk in the group with high OPA, but this did not apply to the group with low OPA. Although the risk of suffering from insomnia was overall significantly higher in the high OPA group, the risk was significantly lower in groups getting enough rest after partaking in LTPA, regardless of the OPA level. Thus, the intensity of exercise programs pre-scribed to groups with high OPA and individuals with higher risks of suffering from insomnia, such as firefighters, police officers, and soldiers, should be considered.

Effectiveness of a Flexible and Continuous Case Management Program for Suicide Attempters.

The purpose of this study was to investigate the effect of continuous case management with a flexible approach on the prevention of suicide by suicide reattempt in a real clinical setting. The subjects in this study were 526 suicide attempters who visited emergency rooms in a teaching hospital in South Korea. Subjects were provided a continuous case management program with a flexible approach according to the severity of their suicide risk and needs. During the entire observation period (from 182 days to 855 days, mean = 572 ± 254), 18 patients (3.7%) died by suicide reattempt: Eight patients (2.27%) in the case management group and 10 patients (7.35%) in the no-case management group. The Cox regression analysis showed that the case management group had a 75% lower risk of death from suicide attempts than the no-case management group (HR = 0.34, 95% CI = 0.13-0.87). This result was shown to be more robust after adjusting for confounding factors such as gender, age, psychiatric treatment, suicide attempts, and family history of suicide (adjusted HR = 0.27, 95% CI = 0.09-0.83). This study was conducted in a single teaching hospital and not a randomized controlled one. A flexible and continuous case management program for suicide attempters is effective for preventing death by suicide reattempts.

Mediating Effects of Burnout in the Association Between Emotional Labor and Turnover Intention in Korean Clinical Nurses.

BACKGROUND: The current lack of the number of nurses and high nurse turnover rate leads to major problems for the health-care system in terms of cost, patient care ability, and quality of care. Theoretically, burnout may help link emotional labor with turnover intention. The purpose of this study was to investigate the mediating effect of burnout in the association between emotional labor and turnover intention in Korean clinical nurses. METHODS: Using data collected from a sample of 606 nurses from six Korean hospitals, we conducted a multiple regression analysis to determine the relationships among clinical nurses' emotional labor, burnout, and turnover intention, looking at burnout as a mediator. RESULTS: The results fully and partially support the mediating role of burnout in the relationship between the subfactors of emotional labor and turnover intention. In particular, burnout partially mediated the relationship between emotional disharmony and hurt, organizational surveillance and monitoring, and lack of a supportive and protective system in the organization. In addition, we found that burnout has a significant full mediation effect on the relationship between overload and conflicts in customer service and turnover intention. Although the mediating effect of burnout was significantly associated with the demands and regulation of emotions, no significant effects on turnover intention were found. CONCLUSION: To reduce nurses' turnover, we recommend developing strategies that target both burnout and emotional labor, given that burnout fully and partially mediated the effects of emotional labor on turnover intention, and emotional labor was directly associated with turnover intention.

Leisure Time Physical Activity to Reduce Metabolic Syndrome Risk: A 10-Year Community-Based Prospective Study in Korea.

PURPOSE: Metabolic syndrome (MetS) is a major public health problem related to increased risks of cardiovascular disease and type 2 diabetes. We investigated whether recommended levels of leisure time physical activity (LTPA) decrease the risk of MetS in a community-based prospective cohort study (Ansung and Ansan cohort). MATERIALS AND METHODS: A total of 3910 adults (1890 men, 2020 women) without MetS examined in 2001-2002 (baseline) were included in this study and followed up from 2013 to 2014. We measured LTPA energy expenditure using the standard metabolic equivalent value [metabolic equivalent of task (MET)-h/wk]. Individuals were categorized into five groups (physically inactive, 0.1 to <7.5, 7.5 to <15.0, 15.0 to <22.5, 22.5 to <40.0, and ≥40.0 MET-h/wk). RESULTS: The mean follow-up period was 11.8 years. Among the cohort, 482 men (25.5%) and 541 women (26.8%) were diagnosed with newly developed MetS. Multivariate logistic analysis revealed a 4.4% lower MetS risk among those performing two to three times the recommended minimum of 7.5 MET-h/wk [multivariate relative risk (RR), 0.956; 95% confidence interval (CI), 0.654-1.398] and a 21.9% lower risk among those performing three to four times the physical activity minimum (multivariate RR, 0.781; 95% CI, 0.574-1.063). This association was only significant in females performing three to four times the minimum (crude RR, 0.655; 95% CI, 0.432-0.994). CONCLUSION: We noted that physical activity at more than 2 times the recommended minimum prevents MetS. Healthcare professionals should encourage inactive adults to be physically active during their leisure time to take advantage of its health benefits.

Does Emotional Labor Increase the Risk of Suicidal Ideation among Firefighters?

PURPOSE: To investigate whether emotional labor is associated with suicidal ideation in Korean firefighters. MATERIALS AND METHODS: Data were obtained from the Firefighter Research: Enhancement of Safety & Health (FRESH) Study, which was designed to investigate the effects of job characteristics on mental and physical health among Korean firefighters. A total of 18101 firefighters were chosen from a nationwide sample. The Korean Emotional Labor Scale (K-ELS) was used to evaluate exposure to emotional labor, which consisted of five sub-factors: emotional demand and regulation, overload and conflict in customer service, emotional disharmony and hurt, organizational surveillance and monitoring, and lack of a supportive and protective system in the organization. RESULTS: Firefighters who were in the risk group were more likely to experience suicidal ideation than those in the normal group for each of the five sub-scales of emotional labor. The estimated mean values for suicidal ideation in the risk group were significantly higher than those in the normal group: 1.667 (95% CI: 1.344-2.069) for emotional demand and regulation, 1.590 (95% CI: 1.243-2.033) for overload and conflict in customer service, 2.409 (95% CI: 1.954-2.969) for emotional disharmony and hurt, 2.214 (95% CI: 1.832-2.676) for organizational surveillance and monitoring, and 1.665 (95% CI: 1.387-1.999) for lack of a supportive and protective system in the organization. CONCLUSION: These results suggest that experience and exposure to chronic and excessive emotional labor might play a crucial role in the development of suicidal ideation among firefighters.

Blood pressure and the risk of major adverse cardiovascular events among firefighters.

OBJECTIVE: No long-term follow-up study has investigated the effect of blood pressure (BP) on cardiovascular disease mortality and morbidity in firefighters. To investigate the effects of BP on the risk of major adverse cardiovascular events (MACEs) using a national representative population-matched cohort. METHODS: We enrolled all firefighters (N = 8242) and 28 678 referent controls aged more than 40 years who underwent baseline health examinations in 2002 and 2003. Records of hospitalization and mortality until 2015 were checked. To evaluate the causal effect of BP on MACE, subcohort analysis using a propensity score-matched (PSM) cohort with respect to job classification (firefighter vs. control) was performed. RESULTS: Hypertension significantly increased the risk of MACEs compared with normal BP in both firefighters and the age--sex matched cohort, but in participants with elevated BP, significantly increased risk of MACEs [hazards ratio 1.41, 95% confidence interval (CI) 1.06-1.88] was observed only among firefighters. In the PSM cohort, firefighters had a significantly higher risk of death or hospitalization from MACEs (hazard ratio 1.29, 95% CI 1.14-1.47), myocardial infarction (hazard ratio 1.24, 95% CI 1.07-1.43), and ischemic stroke (hazard ratio 1.43, 95% CI 1.12-1.82) than controls. Firefighters with elevated BP (hazard ratio 1.58, 95% CI 1.04-2.40), stage 1 (hazard ratio 1.24, 95% CI 1.00-1.52), and stage 2 (hazard ratio 1.39, 95% CI 1.13-1.71) hypertension had higher risk of MACEs than PSM controls. CONCLUSION: Firefighters showed significantly higher cardiovascular risk than referent controls when comparing those within the same BP category, suggesting that firefighters with elevated BP and hypertension may be at high risk of adverse prognosis.

[Effects of Hospital Characteristics on Employment Rate, Working Period and Retirement of Ward Nurses in Korea: A Retrospective Cohort Study Based on HIRAS Data].

PURPOSE: The purpose of this study was to investigate the effects of hospital characteristics on employment rate, working period, and retirement of ward nurses in Korea through a retrospective cohort study based on HIRAS data. METHODS: Data were obtained from a report on medical care institutions of Health Insurance Review & Assessment Service (HIRAS). Data from 259,941 nurses who were working for a day or more from January 1, 2012, to December 31, 2016, at 2,942 medical care institutions were analyzed. Life table method analysis, Kaplan-Meier analysis, and Cox proportional hazard regression analysis were conducted. RESULTS: The employment rates of 5 yeas and 10 years for the total sample were 38% and 28%, respectively. The estimated mean value of the working period was 3,642.7 days (SE: 17.4 days). Cox proportional hazard regression analyses revealed that nurses who were working at the general hospital/hospital, clinic, and nursing hospital were more likely to leave the hospital compared to those who were working at the 3rd general hospital. Nurses who were working at the medical institutions which were located in cities and countries, established by the private foundation, rated lower levels of nursing, and owned an insufficient number of beds, nurses and doctors were more likely to leave their workplace compared to those of the counterparts. CONCLUSION: This study indicates that hospital characteristics may play a significant role in retirement and working period of ward nurses in Korea. The improvement of hospital conditions to reduce ward nurses' retirement are needed.

Effect of Burnout on Post-traumatic Stress Disorder Symptoms Among Firefighters in Korea: Data From the Firefighter Research on Enhancement of Safety & Health (FRESH).

OBJECTIVES: It is well-known that post-traumatic stress disorder (PTSD) among firefighters contributes to their job-related stress. However, the relationship between burnout and PTSD in firefighters has rarely been studied. This study therefore explored the association between burnout and its related factors, such as trauma and violence, and PTSD symptoms among firefighters in Korea. METHODS: A total of 535 firefighters participated in the Firefighter Research on Enhancement of Safety & Health study at 3 university hospitals from 2016 to 2017. The 535 participants received a baseline health examination, including questionnaires assessing their mental health. A Web-based survey was also conducted to collect data on job-related stress, history of exposure to violence, burnout, and trauma experience. The associations among burnout, its related factors, and PTSD symptoms were investigated using structural equation modeling. RESULTS: Job demands (ß=0.411, p<0.001) and effort-reward balance (ß=-0.290, p<0.001) were significantly related to burnout. Burnout (ß=0.237, p<0.001) and violence (ß=0.123, p=0.014) were significantly related to PTSD risk. Trauma (ß=0.131, p=0.001) was significantly related to burnout; however, trauma was not directly associated with PTSD scores (ß=0.085, p=0.081). CONCLUSIONS: Our results show that burnout and psychological, sexual, and physical violence at the hands of clients directly affected participants' PTSD symptoms. Burnout mediated the relationship between trauma experience and PTSD.

Association Between Chronic Exposure to Pesticide and Suicide.

OBJECTIVE: We investigated the association between suicide and pesticide exposure in a community-based cohort study. METHODS: We performed a longitudinal analysis of 6333 who participated in the initial survey of the Korean Genome and Epidemiology Study. Data were collected using a questionnaire to assess the prevalence of suicide. We calculated the hazard ratios (HRs) for suicide by pesticide exposure using the Cox proportional hazard model. RESULTS: After adjusting for variables, participants exposed to pesticides had a 1.88-fold increased risk of suicide (HR, 1.88; 95% confidence interval [CI], 1.11 to 3.16) than those who were not exposed. Study populations with greater pesticide use (HR, 2.42; 95% CI, 1.27 to 4.60) and pesticide addiction had the highest suicide rates (HR, 1.91; 95% CI, 1.03 to 3.56). CONCLUSIONS: Pesticide exposure for suicide should be considered during the development and implementation of suicide prevention in rural area.