Characteristics According to Frailty Status Among Older Korean Patients With Hypertension.

BACKGROUND: As the prevalence of hypertension increases with age and the proportion of the older population is also on the rise, research on the characteristics of older hypertensive patients and the importance of frailty is necessary. This study aimed to identify clinical characteristics of older hypertension in Korea and to investigate these characteristics based on frailty status. METHODS: The HOW to Optimize eLDerly systolic BP (HOWOLD-BP) is a prospective, multicenter, open-label, randomized clinical trial that aims to compare intensive (target systolic blood pressure [SBP] ≤ 130 mmHg) with standard (target SBP ≤ 140 mmHg) treatment to reduce cardiovascular events in older hypertensive Korean patients aged ≥ 65 years. Data were analyzed through a screening assessment of 2,085 patients recruited from 11 university hospitals. Demographic, functional (physical and cognitive), medical history, laboratory data, quality of life, and medication history of antihypertensive drugs were assessed. RESULTS: The mean age was 73.2 years (standard deviation ± 5.60), and 48.0% (n = 1,001) were male. Prevalent conditions included dyslipidemia (66.5%), obesity (body mass index ≥ 25 kg/m², 53.6%), and diabetes (28.9%). Dizziness and orthostatic hypotension were self-reported by 1.6% (n = 33) and 1.2% (n = 24), respectively. The majority of patients were on two antihypertensive drugs (48.4%), while 27.5% (n = 574) and 20.8% (n = 433) were on 1 and 3 antihypertensive medications, respectively. Frail to pre-frail patients were older and also tended to have dependent instrumental activities of daily living, slower gait speed, weaker grip strength, lower quality of life, and lower cognitive function. The frail to pre-frail group reported more dizziness (2.6% vs. 1.2%, P < 0.001) and had concerning clinical factors, including lower glomerular filtration rate, more comorbidities such as diabetes, stroke, and a history of admission. Frail to pre-frail older hypertensive patients used slightly more antihypertensive medications than robust older hypertensive patients (1.95 vs. 2.06, P = 0.003). Pre-frail to frail patients often chose beta-blockers as a third medication over diuretics. CONCLUSION: This study described the general clinical characteristics of older hypertensive patients in Korea. Frail hypertensive patients face challenges in achieving positive clinical outcomes because of multifactorial causes: they are older, have more morbidities, decreased function, lower quality of life and cognitive function, and take more antihypertensive medications. Therefore, it is essential to comprehensively evaluate and monitor disease-related or drug-related adverse events more frequently during regular check-ups, which is necessary for pre-frail to frail older patients with hypertension. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0003787.

Adherence to Physical Distancing and Health Beliefs About COVID-19 Among Patients With Cancer.

BACKGROUND: This study aimed to validate questionnaires on adherence to physical distancing and health beliefs about coronavirus disease 2019 (COVID-19) among patients with cancer and explore their interaction with depression or viral anxiety among them. METHODS: Through an online survey, data from 154 cancer patients (female: 82.5%, breast cancer: 66.2%, current cancer treatment, presence: 65.6%) were collected from March to June 2022. The survey gathered responses to questionnaires on adherence to physical distancing, health beliefs about COVID-19, perceived social norms, Stress and Anxiety to Viral Epidemics-6 items, and Patient Health Questionnaire-2. Confirmatory factor analysis (CFA) for construct validity and structural equation model (SEM) were performed. RESULTS: The CFA showed a good model fit for adherence to physical distancing (comparative fit index [CFI] = 1.000, Tucker-Lewis index [TLI] = 0.930, root-mean-square-error of approximation [RMSEA] = 0.000, and standardized root-mean-square residual [SRMR] = 0.050) and a satisfactory model fit for health beliefs about COVID-19 (CFI = 0.978, TLI = 0.971, RMSEA = 0.061, and SRMR = 0.089). Through SEM, we found that personal injunctive norms were the main mediators linking health beliefs with physical distancing in patients with cancer. Depression also mediated the effects of viral anxiety and perceived severity on physical distancing (χ² = 20.073, df = 15, P = 0.169; CFI = 0.984; RMSEA = 0.047). CONCLUSION: The questionnaires are reliable and valid. Patients with cancer may be able to adhere to physical distancing by addressing perceived severity, viral anxiety, perceived benefits, self-efficacy, perceived barriers, as well as personal injunctive norms.

Influence of Intolerance of Uncertainty on Preoccupation With Coronavirus Disease 2019 Among Frontline Nursing Professionals: Mediating Role of Reassurance-Seeking Behavior and Adherence to Physical Distancing.

BACKGROUND: This study investigated the relationship between preoccupation with coronavirus disease 2019 (COVID-19), reassurance-seeking behavior, viral anxiety, intolerance of uncertainty, and adherence to physical distancing among frontline nursing professionals working in COVID-19 inpatient wards. Additionally, the study aimed to determine whether the commitment to physical distancing mediates the influence of intolerance of uncertainty on viral anxiety. METHODS: Frontline healthcare professionals working in the COVID-19 inpatient wards at three tertiary-level affiliated hospitals in Korea were surveyed between April 7 and 26, 2022. The survey included scales-such as the Obsession with COVID-19 Scale, Coronavirus Reassurance-Seeking Behaviors Scale, Fear of COVID-19 Scale, and Intolerance of Uncertainty Scale-12 and a questionnaire on adherence to physical distancing. A total of 256 responses were analyzed after excluding inappropriate or incomplete responses. RESULTS: Pearson's correlation analysis found that age was significantly associated with the Obsession with COVID-19 Scale (r = -0.12, P < 0.05) and adherence to physical distancing (r = 0.27, P < 0.01). Linear regression analysis ascertained that age (ß = -0.07, P = 0.002), Coronavirus Reassurance-Seeking Behaviors Scale (ß = 0.35, P < 0.001), and Fear of COVID-19 Scale (ß = 0.24, P < 0.001) were predictors of obsession with COVID-19 (Adjusted R² = 0.60, F = 78.1, P < 0.001). The indirect pathway by mediation analysis showed that reassurance-seeking and viral anxiety mediated the effect of intolerance of uncertainty on the preoccupation with COVID-19. CONCLUSION: During the pandemic, there may be a strong association between reassurance-seeking behavior, viral anxiety, and a heightened preoccupation with COVID-19 among frontline healthcare workers. Thus, from the early stages of infectious disease, a psychological support team for medical staff responding to the disease should be established, and periodic evaluations should be conducted to identify high-risk groups.

Factorial Validity of the Arabic Version of the Stress and Anxiety to Viral Epidemics-6 Items (SAVE-6) Scale among the General Population in Lebanon.

This study explored the psychometric properties of the Arabic version of the Stress and Anxiety to Viral Epidemics-6 items (SAVE-6) scale for assessing people's anxiety in response to the viral epidemic in Lebanon. The 406 participants responded voluntarily to the online survey that included the SAVE-6, Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) tools. The single-structure SAVE-6 model showed good internal consistency (Cronbach's α = 0.773). The SAVE-6 scale also showed good convergent validity with the GAD-7 (Spearman's ρ = 0.42, P < 0.001) and PHQ-9 (ρ = 0.38, P < 0.001). Receiver operating characteristic (ROC) analysis revealed an Arabic SAVE-6 cut-off score of 12 points (area under the curve [AUC] = 0.753; sensitivity = 62.74%; specificity = 78.26%) for an at least mild degree of anxiety (GAD-7 score ≥ 5). The Arabic version of the SAVE-6 was a reliable, valid, and solely usable scale for measuring the anxiety response of the general population to the viral epidemic.

Antidepressant Prescription Patterns in Bipolar Disorder: a Nationwide, Register-based Study in Korea.

BACKGROUND: The role of antidepressants (ADs) in bipolar disorder is long-standing controversial issue in psychiatry. Many clinicians have used ADs as a treatment for bipolar depression, and the selection of therapeutic agents is very diverse and inconsistent. This study aimed to examine recent AD prescription patterns for patients with bipolar disorder in Korea, using the nationwide, population-based data. METHODS: This study utilized the Korean nationwide, whole population-based registry data of the year 2010, 2011, and 2013. All prescription data of the ADs, antipsychotics, and mood stabilizers of the sampled patients diagnosed with bipolar disorder (n = 2,022 [in 2010]; 2,038 [in 2011]; 2,626 [in 2013]) were analyzed for each year. RESULTS: Annual prescription rate of ADs was 27.3%-33.6% in bipolar disorder, which was gradually increasing over the 3-year period. The combination pattern of ADs and antipsychotic drugs tended to increase over 3 years. The proportion of females and the prevalence of comorbid anxiety disorder were significantly higher in AD user group in all three years. Among individual ADs, escitalopram was prescribed most frequently, and fluoxetine and bupropion were prescribed to the next many patients. The mean duration of bipolar depressive episodes was 135.90-152.53 days, of which ADs were prescribed for 115.60-121.98 days. CONCLUSION: Our results show prescription rate of ADs in bipolar disorder was maintained at substantial level and increased in recent 3 years. More empirical data and evidence are needed to establish practical treatment consensuses.

Association Between Orthostatic Hypertension and Frailty Among Older Patients With Hypertension.

BACKGROUND: Frailty frequently coexists with hypertension in older patients. We aimed to evaluate the association between frailty and positional change in blood pressure, especially orthostatic hypertension. METHODS: Participants were recruited from 12 University hospitals in South Korea. Using a digital device, trained research nurses measured blood pressure in the supine and standing positions. Physical frailty was evaluated using the Korean version of the FRAIL questionnaire, gait speed, and handgrip strength. Orthostatic hypertension was defined as a ≥20-mm Hg increase in systolic blood pressure within 3 minutes of standing and upright systolic blood pressure of ≥140 mm Hg. RESULTS: We analyzed the data of 2065 participants who had been enrolled until December 31, 2022. The mean age was 73.2±5.6 years, and 52.0% were female. The mean blood pressure was 137.1±14.9/75.1±9.7 mm Hg. Among the participants, 1886 (91.3%) showed normal response after standing, but 94 (4.6%) had orthostatic hypertension, and 85 (4.1%) had orthostatic hypotension. Orthostatic hypertension was associated with female sex, obesity, cognitive function, physical frailty, and lower quality of life. In the multivariable analysis, body mass index and frailty status were independently associated with orthostatic hypertension. CONCLUSIONS: Orthostatic hypertension is associated with physical frailty, cognitive impairment, and low quality of life in older patients with hypertension. Therefore, evaluation of orthostatic blood pressure changes to confirm orthostatic hypertension or hypotension in frail older adults will serve as an important diagnostic procedure in vulnerable patients. Further studies are required to identify the underlying mechanisms of this association.

Psychometric properties of the Korean version of questionnaires on adherence to physical distancing and health beliefs about COVID-19 in the general population.

Introduction: We aimed to examine the psychometric properties of the Korean version of the questionnaires on adherence to physical distancing and health beliefs about COVID-19 in the general population in South Korea. In addition, we investigated how the various sections interacted with each other and with viral anxiety and depression, and ultimately affected adherence to physical distancing. Methods: An anonymous online survey was conducted among members of the general population in South Korea between 10 and 18 January 2022. We recruited 400 respondents and measured their demographic information, symptoms, and responses to questions about COVID-19. First, we examined the reliability and validity of the questionnaires, which included questions about people's adherence to physical distancing guidelines and COVID-19-related health beliefs. Second, we examined the relationship between physical distancing and viral anxiety or depression, as assessed using the six-item Stress and Anxiety to Viral Epidemics (SAVE-6) scale and the Patient Health Questionnaire-9 (PHQ-9). Results: All 400 participants (204 men, age 41.6 ± 10.8) completed the survey. Confirmatory factor analysis revealed a good model fit for adherence to physical distancing (CFI = 1.000, TLI = 1.019, RMSEA = 0.000, and SRMR = 0.034) and health beliefs about COVID-19 (CFI = 0.993, TLI = 0.991, RMSEA = 0.030, and SRMR = 0.052). It also showed good reliability for Factor I (Cronbach's α = 0.826) and Factor II (α = 0.740). Four categories of the COVID-19 health beliefs questionnaire also showed good reliability for perceived susceptibility (α = 0.870), perceived severity (α = 0.901), perceived benefit (α = 0.935), and barriers to following physical distancing (α = 0.833). Structural equation models showed that the effects of health beliefs and viral anxiety and depression were mediated mostly by personal injunctive norms. Goodness-of-fit measures indicated a good fit. (Chi-square = 24.425, df = 7, p < 0.001; CFI = 0.966; RMSEA = 0.079). Conclusion: The Korean version of the COVID-19 adherence to physical distancing and health beliefs questionnaires showed good reliability and validity in the Korean general population. In addition, the effects of health beliefs, along with viral anxiety and depression, were mainly mediated by personal injunctive norms.

Validation of the healthcare workers' version of the Pandemic Grief Scale among frontline nursing professionals during the COVID-19 pandemic in Korea.

Introduction: Nurses have been repeatedly exposed to unexpected death and grief during COVID-19 pandemic, and it is necessary to provide grief support for the nurses who have experienced the loss of patients to COVID-19. We aimed to explore the reliability and validity of the Pandemic Grief Scale (PGS) for Healthcare Workers among frontline nursing professionals working in COVID-19 inpatient wards whose patients may have died. Methods: An anonymous online survey was performed among frontline nursing professionals working in COVID-19 wards in three tertiary-level general hospitals in Korea between April 7 and 26, 2021. In total, 229 from participants who confirmed they had witnessed death of patients were employed for the statistical analysis. The survey included demographic characteristics and rating scales, including the Korean version of the PGS for Healthcare Workers, the Fear of COVID-19 scale, the Generalized Anxiety Disorder-7 items, and the Patient Health Questionnaire-9 items. Results: The single-factor structure of the Korean version of the PGS for Healthcare Workers showed good fits for the model. The scale had good internal consistency and convergent validity with other anxiety and depression scales. Conclusion: The Korean version of the PGS of Healthcare Workers was valid and reliable for measuring grief reactions among nursing professionals facing the pandemic. It will be helpful in evaluating the grief reaction of the healthcare workers and providing them with a psychological support system.

Validation of the Grief Support in Healthcare Scale among frontline nursing professionals working in COVID-19 inpatient wards in Korea.

Introduction: During the COVID-19 pandemic, healthcare workers (HCWs) have been exposed to higher levels of anxiety and psychological stress than the general population. Nurses who cared for COVID patients could not avoid repeated mourning as they witnessed the deaths of their patients. Therefore, tools are needed to evaluate whether there is adequate support for the grieving process of HCWs in both qualitative and quantitative manners. Methods: Data from 229 nurses who witnessed the deaths of COVID-19 inpatients were analyzed using an online survey of nurses working in three tertiary hospitals. Factor analysis was conducted to validate the 10-item Korean version of Grief Support in Healthcare Scale (GSHCS). Stress and Anxiety to Viral Epidemics-9 was used to measure stress and anxiety caused by coronavirus, Generalized Anxiety Disorder-7 was used to measure overall anxiety, and Patient Health Questionnaire-9 was used for depression. Convergent validity correlation analysis was also performed with GSHCS. Results: The two-factor model showed a good fit for the 10-item GSHCS (χ 2 = 35.233, df = 34, p = 0.410, CFI = 0.999, TLI = 0.990, RMSEA = 0.013, SRMR = 0.064). Cronbach's alpha is 0.918 and McDonald's omega is 0.913, suggesting that the 10-item version of the GSHCS is reliable for determining psychometric properties. Conclusion: According to this study, the 10-item Korean version of the GSHCS is a reliable and valid measure of psychological support for grief among frontline nursing professionals who have witnessed the deaths of patients they cared for while working in COVID-19 inpatient wards. A two-factor model of the GSHCS has a good model fit and good convergent validity with other rating scales that measure viral anxiety, depression, and general anxiety.

Grief Response of Nursing Professionals Is Associated With Their Depression, Loneliness, Insomnia, and Work-Related Stress While Working in COVID-19 Inpatients Wards.

OBJECTIVE: We aimed to explore whether nursing professionals' psychological states affect their grief response for a patient's death in the coronavirus disease-2019 (COVID-19) inpatients' ward. METHODS: Survey was conducted among frontline nursing professionals working in COVID-19 inpatients wards at three tertiary-level affiliated hospitals of the University of Ulsan during April 7-26, 2022. Participants' information such as age, years of employment, or marital status were collected, and their responses to rating scales including Pandemic Grief Scale (PGS) for healthcare workers, Stress and Anxiety to Viral Epidemics-9 items (SAVE-9), Patient Health Questionnaire-9 (PHQ-9), Loneliness and Social Isolation Scale, and Insomnia Severity Scale (ISI) were collected. RESULTS: All 251 responses were analyzed. We observed that 34% reportedly suffered from depression. The linear regression analysis showed that a high PGS score was expected by high SAVE-9 (ß=0.12, p=0.040), high PHQ-9 (ß=0.25, p<0.001), high loneliness (ß=0.17, p=0.006), and high ISI score (ß=0.16, p=0.006, F=20.05, p<0.001). The mediation analysis showed that the depression of nursing professionals directly influenced their pandemic grief reaction, and their work-related stress and viral anxiety, insomnia severity, and loneliness partially mediated the association. CONCLUSION: We confirm that frontline nursing professionals' depression directly influenced their grief reaction, and their work-related stress and viral anxiety, insomnia severity, and loneliness partially mediated the association. We hope to establish a psychological and social support system for the mental health of nurses working in the COVID-19 wards.

Stratifying the risk of ovarian cancer incidence by histologic subtypes in the Korean Epithelial Ovarian Cancer Study (Ko-EVE).

INTRODUCTION: This study aimed to verify the association between ovarian cancer (OC) and reproductive- and lifestyle-related risk factors stratified by the subtype of OC. METHODS: In this matched case-control study derived from the Korean epithelial ovarian cancer study (Ko-EVE), we calculated the risk of OC subtypes using odds ratios (ORs) and 95% confidence intervals (95% CIs) in a logistic regression model. RESULTS: As a result of matching, 531 cases and 2,124 controls were selected. Smoking had positive association with high-grade serous (HGS) OC (OR = 2.69, 95% CI = 1.15-6.30), whereas alcohol consumption had positive association with mucinous type (MUC) (OR = 3.63, 95% CI = 1.39-9.49). Obesity (≥30 kg/m2 ) was associated with clear cell type (CLC) (OR = 4.57, 95% CI = 1.06-19.77). Spontaneous abortion was negatively associated with CLC (OR = 0.34, 95% CI = 0.13-0.90), in contrast to HGS (OR = 1.43, 95% CI = 0.96-2.15). Tubal ligation, hysterectomy, and oophorectomy were associated with decreased risk of HGS (OR = 0.14, 95% CI = 0.05-0.39; OR = 0.23, 95% CI = 0.07-0.73; OR = 0.28, 95% CI = 0.08-0.97, respectively). Early menarche was strongly associated with increased risk of CLC, but not MUC (OR = 6.11, 95% CI = 1.53-24.42; OR = 3.23, 95% CI = 0.98-10.86). Further, childbirth (≥2 times) was negatively associated with endometrioid type OC and CLC (OR = 0.11, 95% CI = 0.04-0.35; OR = 0.12, 95% CI = 0.02-0.37, respectively). Oral contraceptives and hormone replacement therapy were negatively associated with OC (OR = 0.61, 95% CI = 0.40-0.93; OR = 0.51, 95% CI = 0.32-0.80, respectively), and similar negative associations were also observed in HGS (OR = 0.69; OR = 0.60, respectively). Associations between family history of breast cancer and OC, regular exercise (≥5/week), and artificial abortion and OC were similar across all subtypes (OR = 3.92; OR = 0.41; OR = 0.72, respectively). CONCLUSION: A heterogeneous association between some risk factors and the incidence of each subtype of epithelial OC was observed, suggesting that the carcinogenic mechanisms of each subtype may be partly different.

Heart rate variability in the subsyndromal depressive phase of bipolar disorder.

AIMS: To compare the heart rate variability of bipolar patients in the subsyndromal depressive phase with healthy controls and to evaluate the relationship between severity of subsyndromal depressive symptoms and heart rate variability. METHODS: Thirty-three bipolar patients in the subsyndromal depressive phase and 59 healthy controls were enrolled. A patient was considered to be in a subsyndromal depressive phase when the Montgomery-Åsberg depression rating scale score was ≤10 and the Clinical Global Impression-Severity scale (CGI-S) was ≤3 for the previous 1 month. After approximately 10 min of supine rest, all participants underwent resting electrocardiograms for 5 min in the supine position using limb leads. Different parameters of heart rate variability were analyzed in the time and frequency domains. RESULTS: Bipolar patients had significantly lower standard deviation of all RR intervals (SDNN), proportion of adjacent NN intervals that differ by >50 ms (pNN50), log total power (log TP) and very low frequency power (VLF) compared to healthy controls. There were significant negative correlations between CGI-S score and some heart rate variability parameters, including heart rate variability index, SDNN, root mean square successive difference (RMSSD), pNN50, log TP, VLF, low frequency power (LF) and high frequency power (HF). CONCLUSION: Patients with bipolar disorder in the subsyndromal depressive state have reduced heart rate variability relative to healthy controls, and reduction of heart rate variability appears to be correlated with severity of symptoms in bipolar patients.

Viral Anxiety Mediates the Influence of Intolerance of Uncertainty on Adherence to Physical Distancing Among Healthcare Workers in COVID-19 Pandemic.

Introduction: The aims of this study were to examine the mediation effect of viral anxiety of healthcare workers on the influence of their intolerance of uncertainty on the adherence to physical distancing during the COVID-19 pandemic. Methods: An online survey was conducted among 329 healthcare workers (female: 81.4%, nursing professionals: 59.0%, and shift workers: 22.3%) on November 29, 2021. Participants responded to questionnaires on adherence to physical distancing, health beliefs, and perceived social norms, and rating scales of the Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), Patient Health Questionnaire-9 items (PHQ-9), and the Intolerance of Uncertainty-12 items (IUS-12) scale. Results: Adherence to physical distancing of healthcare workers was predicted by perceived benefits of physical distancing (ß = 0.13, p = 0.01), personal injunctive norms (ß = 0.32, p < 0.001), SAVE-6 score (ß = 0.13, p = 0.02), and IUS-12 score (ß = 0.10, p = 0.045) (adjusted R2 = 0.21, F = 22.3, p < 0.001). Viral anxiety mediated the association between intolerance of uncertainty and adherence to physical distancing but not the influence of perceived benefits and personal injunctive norms on adherence to physical distancing. Conclusion: We observed that viral anxiety of healthcare workers mediated the association between intolerance of uncertainty and adherence to physical distancing. During this pandemic, exploring adherence to physical distancing and its predicting factors will be helpful for the safety of healthcare workers and the patients for whom they care.

The Mediating Effect of Reassurance-Seeking Behavior on the Influence of Viral Anxiety and Depression on COVID-19 Obsession Among Medical Students.

Objectives: Healthcare workers experienced great psychological burden due to the continuation of the COVID-19 pandemic. During the pandemic, medical healthcare workers experienced greater instances of insomnia, anxiety, depression, somatization, and obsessive-compulsive symptoms than the general population. This study aimed to explore the association between viral anxiety and obsession with COVID-19 among medical students with reassurance-seeking behavior as a mediator. Methods: In October 2021, an online survey was conducted among medical students at the University of Ulsan College of Medicine. The clinical characteristics of 162 participants and their responses to rating scales, including stress and anxiety to viral Epidemics-6 items (SAVE-6), Coronavirus Reassurance-Seeking Behaviors Scale (CRBS), Patient Health Questionnaire-9 items (PHQ-9), and Obsession with COVID-19 scale were collected. Results: Medical students' obsession with COVID-19 was based on the PHQ-9 (ß = 0.15, p = 0.01), SAVE-6 (ß = 0.43, p < 0.001), and CRBS (ß = 0.38, p < 0.001) scores (adjusted R2 = 0.49, F = 39.9, p < 0.001). Mediation analysis showed that medical students' viral anxiety and depression directly influenced their obsession with COVID-19, and their reassurance-seeking behavior partially mediated the effects of depression or viral anxiety on obsession with COVID-19. Conclusions: Medical students' viral anxiety and depression may affect their obsession with COVID-19, and reassurance-seeking behaviors may mediate this. Therefore, medical students should adopt adaptive coping strategies to prevent high levels of viral anxiety and recurrent reassurance-seeking behavior.

Projection of Cancer Incidence and Mortality From 2020 to 2035 in the Korean Population Aged 20 Years and Older.

OBJECTIVES: This study aimed to identify the current patterns of cancer incidence and estimate the projected cancer incidence and mortality between 2020 and 2035 in Korea. METHODS: Data on cancer incidence cases were extracted from the Korean Statistical Information Service from 2000 to 2017, and data on cancer-related deaths were extracted from the National Cancer Center from 2000 to 2018. Cancer cases and deaths were classified according to the International Classification of Diseases, 10th edition. For the current patterns of cancer incidence, age-standardized incidence rates (ASIRs) and age-standardized mortality rates were investigated using the 2000 mid-year estimated population aged over 20 years and older. A joinpoint regression model was used to determine the 2020 to 2035 trends in cancer. RESULTS: Overall, cancer cases were predicted to increase from 265 299 in 2020 to 474 085 in 2035 (growth rate: 1.8%). The greatest increase in the ASIR was projected for prostate cancer among male (7.84 vs. 189.53 per 100 000 people) and breast cancer among female (34.17 vs. 238.45 per 100 000 people) from 2000 to 2035. Overall cancer deaths were projected to increase from 81 717 in 2020 to 95 845 in 2035 (average annual growth rate: 1.2%). Although most cancer mortality rates were projected to decrease, those of breast, pancreatic, and ovarian cancer among female were projected to increase until 2035. CONCLUSIONS: These up-to-date projections of cancer incidence and mortality in the Korean population may be a significant resource for implementing cancer-related regulations or developing cancer treatments.

Optimal blood pressure target in the elderly: rationale and design of the HOW to Optimize eLDerly systolic Blood Pressure (HOWOLD-BP) trial.

BACKGROUND/AIMS: The optimal systolic blood pressure (SBP) goal for elderly patients with hypertension, especially to reduce cardiovascular disease (CVD) incidence and improve outcome, is unclear. This study aimed to evaluate the beneficial effects of intensive treatment for hypertension on the incidence of CVD in elderly Korean patients. METHODS: The HOW to Optimize eLDerly systolic Blood Pressure (HOWOLD-BP) trial is a multicenter, parallel-design, open-label, randomized controlled trial designed to evaluate whether intensive treatment (SBP ≤ 130 mmHg) will provide more benefits in lowering the incidence and mortality associated with CVD than standard treatment (SBP ≤ 140 mmHg) in elderly patients with hypertension aged ≥ 65 years. For this study, eleven university hospitals in Korea will enroll approximately 3,176 elderly patients with hypertension between 2019 and 2022. Patients will be requested to visit the clinic every 4 months for the first year and every 6 months thereafter for 36 months. Parameters, including clinic and home blood pressure, anthropometric and laboratory findings, and frailty assessments, will be collected according to the standardized protocol. The primary outcome is a composite of CVD (acute coronary syndrome, stroke, and heart failure) incidence and cardiovascular deaths. RESULTS: As of December 2021, 1,655 participants had been enrolled in the study, including 831 patients in the standard group and 824 patients in the intensive group. CONCLUSION: The HOWOLD-BP trial is the first study performed in Korea to evaluate the beneficial effects of intensive blood pressure treatment on CVD in elderly patients with hypertension. The results of this study will help clarify the appropriate target SBP for this population.

Stress and Anxiety to Viral Epidemics-6 for Medical Students: Psychometric Properties of the Anxiety Measure for the COVID-19 Pandemic.

The aim of this study was to explore the psychometric properties and validity of Stress and Anxiety to Viral Epidemics-6 items (SAVE-6) among medical students who are at high risk of coronavirus disease 2019 (COVID-19) infection. A total of 212 medical students participated in the online anonymous survey that used SAVE-6, Coronavirus Anxiety Scale (CAS), Generalized Anxiety Disorder-7 items (GAD-7), and Work and Social Adjustment Scale (WSAS). We observed that the single-factor structure model of the SAVE-6 scale showed good internal consistency (Cronbach's alpha = 0.756) and a good convergent validity with GAD-7 (rho = 0.320, p < 0.001), CAS (rho = 0.229, p < 0.001), and WSAS (rho = 0.278, p < 0.001). The appropriate cut-off score of the SAVE-6 scale was determined as 15 points in accordance with at least a mild degree of generalized anxiety (GAD-7 score of 5) among medical students. In conclusion, the SAVE-6 scale can be applied to medical students as a reliable and valid rating scale to assess anxiety response to the present viral pandemic.

Risk Perception, Unhealthy Behavior, and Anxiety Due to Viral Epidemic Among Healthcare Workers: The Relationships With Depressive and Insomnia Symptoms During COVID-19.

We aimed to investigate the relationship between mental health problems and unhealthy behaviors among healthcare workers in response to the COVID-19 pandemic. Using an online survey, we collected data on healthcare workers' perception regarding COVID-19 exposure in a work unit. Workers' depression, insomnia, and anxiety symptoms were assessed using the Patient Health Questionnaire-9, Insomnia Severity Index, and Generalized Anxiety Disorder-7 scale, respectively. Work-related stress and anxiety in response to the viral epidemic were measured using the Stress and Anxiety to Viral Epidemic-9 (SAVE-9) scale. We found that work-related stress and anxiety in response to the viral epidemic was associated with female sex, perception of the workplace as being dangerous, and depressive symptoms. Unhealthy behaviors, such as smoking and drinking as coping behaviors during the pandemic, were associated with male sex, young age, depression, and insomnia. During the COVID-19 pandemic, it is necessary to closely observe the patterns of work-related stress and anxiety reactions among healthcare workers to reduce their burnout.

Attitude of Medical Students About Their Role and Social Accountability in the COVID-19 Pandemic.

Background: In this study, we aimed to explore the attitude of medical students toward their role and social accountability in this pandemic era. An online survey was developed to elicit information on (1) the role of medical students in the pandemic era; (2) Medical education in the "new normal," and (3) the impact of COVID-19 on medical students. Methods: The online survey, developed by a team consisting of three medical students, three psychiatry residents, and three professors of psychiatry, was conducted on 574 participants (213 medical students, 180 graduates, and 181 professors) in the University of Ulsan College of Medicine, Seoul, South Korea. Anxiety symptom rating scales, including the Stress and Anxiety to Viral Epidemics-6 (SAVE-6) scale and the Generalized Anxiety Disorder-7 (GAD-7) scale, were applied to measure participant anxiety level. Results: Medical students indicated their willingness to join the healthcare response to the COVID-19 pandemic, if requested; however, graduates and professors recommended that medical students continue their training rather than join the pandemic healthcare response. In the new normal era, medical education has had to change appropriately. Moreover, adequate knowledge of COVID-19 infection and spread must be considered for the continuation of clinical clerkships during the pandemic. Overall, medical students who indicated anxiety about treating possible or confirmed cases of COVID-19 rated higher on the SAVE-6 scale. Finally, medical students who reported that COVID-19 had an impact on their studies and daily life rated higher on the general anxiety scale (GAD-7). Conclusion: Social accountability is an important issue for medical students in the pandemic era. At the same time, non-disruption of their academic calendar would ensure continuous availability of component medical professionals, which is important for adequate future healthcare responses.

Resilience and Work-Related Stress May Affect Depressive Symptoms in Nursing Professionals during the COVID-19 Pandemic Era.

OBJECTIVE: We aimed to investigate the effect of nursing professionals' resilience on their mental health, work-related stress, and anxiety in response to the COVID-19 pandemic. METHODS: We conducted an online survey in the Asan Medical Center and Ulsan University Hospital, South Korea. We extracted data of 824 nursing professionals who consented to participate, including demographic variables and the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), PHQ-9, GAD-7, and Brief Resilience Scale scores. RESULTS: Resilience was negatively correlated with Patient Health Questionnaire-9 (PHQ-9) (rho=-0.23), Generalized Anxiety Scale-7 items (GAD-7) (rho=-0.25), Stress and Anxiety to Viral Epidem-ics-6 items (SAVE-6) (rho=-0.15), and Stress And anxiety to Viral Epidemics-3 items (SAVE-3) (rho=-0.13, all, p<0.001). Logistic regression analysis adjusting age, marital status, and years of employment revealed that high level of general anxiety [adjusted odds ratio (aOR)=1.40, 95% confidence interval (CI)=1.31-1.50], work-related stress during viral epidemics (aOR=1.16, 95% CI=1.03-1.29), and a low level of resilience (aOR=0.91, 95% CI=0.85-0.97) were expecting variables for the depression of healthcare workers. CONCLUSION: Nursing professionals' level of resilience may be associated with low level of work-related stress and anxiety induced by a viral epidemic. We need to explore further the possibility of resilience as coping strategy of healthcare workers in this pandemic era.