Influence of MAFLD and NAFLD on arterial stiffness: A longitudinal cohort study.

BACKGROUND AND AIMS: This cohort study investigated associations of nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) with risk of increase in arterial stiffness (AS), measured as brachial-ankle pulse wave velocity (baPWV). METHODS AND RESULTS: Participants who had health examinations between 2006 and 2019 were analyzed for fatty liver and increased baPWV using liver ultrasonography and automatic volume plethysmography device. Participants were classified based on presence of MAFLD or NAFLD and further divided into subgroups: no fatty liver disease (reference), NAFLD-only, MAFLD-only, and both NAFLD and MAFLD. Subgroups were additionally stratified by sex. Cox proportional hazard model was utilized to analyze the risk of developing baPWV ≥1400 cm/s in participants without baseline elevation of the baPWV. The NAFLD and MAFLD groups exhibited higher risks of increased baPWV (NAFLD: adjusted hazard ratio (aHR), 1.35 [95% CI, 1.29-1.42]; MAFLD: aHR, 1.37 [95% CI, 1.31-1.43]) compared to group without the conditions. Incidence of NAFLD or MAFLD were higher in men than in women but aHR of developing the increase in AS was higher in women. In subgroup analysis, the MAFLD-only group presented the strongest associations with increase in AS (aHR, 1.53 [95% CI, 1.43-1.64]), with the trend more pronounced in women than in men (Women, aHR, 1.63 [95% CI, 1.08-2.46]; Men, aHR 1.45 [95% CI, 1.35-1.56]). CONCLUSIONS: Both NAFLD and MAFLD are significantly associated with elevated AS. These associations tended to be stronger in MAFLD than in NAFLD, in women than in men.

Associations of quantitative contrast sensitivity with wide-field swept-source optical coherence tomography angiography in retinal vein occlusion.

PURPOSE: To investigate associations between contrast sensitivity (CS) and vascular metrics on wide-field swept-source optical coherence tomography angiography (WF-SS-OCTA) in patients with retinal vein occlusion (RVO). METHODS: This prospectively recruited, cross-sectional observational study included RVO patients who underwent quantitative CS function (qCSF) testing and WF-SS-OCTA using 3 × 3, 6 × 6, and 12 × 12 mm angiograms on the same day. The study measured several qCSF outcomes and WF-SS-OCTA vascular metrics, including vessel density (VD), vessel skeletonized density (VSD), and foveal avascular zone (FAZ). The data were analyzed using multivariable regression analysis controlling for age and central subfield thickness (CST). RESULTS: A total of 43 RVO eyes of 43 patients and 30 fellow eyes were included. In RVO eyes, multiple vascular metrics were associated with CS outcomes but not visual acuity (VA). On 12 × 12 images, CS thresholds at 1 cpd, 1.5 cpd, and 3 cpd were significantly associated with VD and VSD, but VA was not. When comparing standardized regression coefficients, we found that vascular metrics had a larger effect size on CS than on VA. For instance, the standardized beta coefficient for FAZ area and CS at 6 cpd (ß* = - 0.46, p = 0.007) was larger than logMAR VA (ß* = 0.40, p = 0.011). CONCLUSION: Microvascular changes on WF-SS-OCTA in RVO had a larger effect size on CS than VA. This suggests CS may better reflect the microvascular changes of RVO compared to VA. qCSF-measured CS might be a valuable adjunct functional metric in evaluating RVO patients.

Changes in wider field swept-source OCT angiography vascular metrics with anti-vascular endothelial growth factor therapy in central retinal vein occlusion.

PURPOSE: To investigate the impact of anti-VEGF therapy on vascular metrics in eyes with macular edema secondary to central retinal vein occlusion (CRVO) using wider field swept-source OCT angiography (WF SS-OCTA). METHODS: We included 23 eyes with macular edema associated with non-ischemic CRVO from 22 patients treated with anti-VEGF therapy (median number of injections: 5 [2-9]). Changes in vessel density (VD), vessel skeletonized density (VSD), and foveal avascular zone (FAZ) parameters were measured using WF SS-OCTA. Visual acuity (VA) and central subfield thickness (CST) were also measured. RESULTS: Median CST decreased significantly from 369 µm (305-531) to 267 µm (243-300, p < 0.001). VD and VSD parameters in 12 × 12 mm images showed significant reductions. For instance, VSD in the whole retina decreased from a median of 13.37 (11.22-13.74) to 11.29 (9.36-12.97, p = 0.013). Additionally, a significant increase in FAZ circularity was found, suggesting improved microvascular integrity. Significant inverse correlations were found between the number of anti-VEGF injections and all VSD and VD parameters on the 12 × 12 mm images (p < 0.05). Notably, the reductions in VSD and VD on 12 × 12 mm angiograms in the deep capillary plexus (DCP) after each injection significantly correlated with increased logMAR VA (worse VA). CONCLUSION: Anti-VEGF therapy in CRVO patients not only mitigates macular edema but also alters the overall microvascular morphology and functionality as revealed by WF SS-OCTA.

Spatial investigation of water quality and estimation of groundwater pollution along the main stream in the Geum River Basin, Korea.

This study aims to identify spatially water quality distribution of groundwater and surface water in reservoirs, and comprehensively to address possible influencing factors. The concentration of NO3 in the reservoirs along the main stream of the Geum River was generally lower than that in groundwater. The pollution level of the reservoir, especially the particulate pollutant SS, clearly showed seasonal variations and increased significantly downstream. The H-3 concentration of the groundwater was high in the plains and low in the mountain areas, indicating a difference in residence time between the two regions. The hydrochemical properties and factor loading values of the principal components indicated that the major factors were water‒rock interactions and residence time, but a positive correlation of K-NO3 and Mg-Cl showed the influence of agricultural activities. The main groundwater pollutants were likely to be contributed by agricultural activities at upstream and seawater intrusion at downstream. The sensitive redox species uranium in the groundwater of this region existed as the uranyl ion, and it showed a positive correlation with HCO3, pH, and Ca. The results emphasize the importance of monitoring both tributaries and groundwater together in order to effectively manage the water quality of the Geum River basin.

Characteristics of the Measurement Tools for Assessing Health Information-Seeking Behaviors in Nationally Representative Surveys: Systematic Review.

BACKGROUND: The coronavirus pandemic (COVID-19) has also emerged as an infodemic, thereby worsening the harm of the pandemic. This situation has highlighted the need for a deeply rooted understanding of the health information-seeking behaviors (HISBs) of people. OBJECTIVE: The aim of this paper was to review and provide insight regarding methodologies and the construct of content in HISB surveys by answering the following research question: what are the characteristics of the measurement tools for assessing HISBs in nationally representative surveys around the world? METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used as the framework for this study. A data search was performed through 5 international and 2 Korean databases covering the years between 2008 and 2020. Initially, studies performed among nationally representative samples were included to discover HISB survey instruments. The methodologies of the studies using HISB surveys were analyzed. For content analysis, 2 researchers reached a consensus through discussion by scrutinizing the contents of each survey questionnaire. RESULTS: A total of 13 survey tools from 8 countries were identified after a review of 2333 records from the search results. Five survey tools (Health Information National Trends Survey, Health Tracking Survey, Annenberg National Health Communication Survey, National Health Interview Survey, and Health Tracking Household Survey) from the United States, 2 instruments from Germany, and 1 tool from each of the countries of the European Union, France, Israel, Poland, South Korea, and Taiwan were identified. Telephone or web-based surveys were commonly used targeting the adult population (≥15 years of age). From the content analysis, the domains of the survey items were categorized as follows: information (information about health and patient medical records), channel (offline and online), and health (overall health, lifestyle, and cancer). All categories encompassed behavioral and attitude dimensions. A theoretical framework, that is, an information-channel-health structure for HISBs was proposed. CONCLUSIONS: The results of our study can contribute to the development and implementation of the survey tools for HISB with integrated questionnaire items. This will help in understanding HISB trends in national health care.

Luteimonas granuli sp. nov., Isolated from Granules of the Wastewater Treatment Plant.

A Gram-reaction negative, aerobic, non-motile, light yellow colored, and rod-shaped bacterium (designated Gr-4T) isolated from granules of a wastewater treatment plant, was characterized by a polyphasic approach to clarify its taxonomic position. Strain Gr-4T was observed to grew optimally at 30 ºC and at pH 7.0 on R2A medium. Phylogenetic analysis based on 16S rRNA gene sequences indicated that strain Gr-4T belongs to the genus Luteimonas of the family Xanthomonadaceae and was most closely related to Luteimonas padinae CDR SL 15T (99.1%), Luteimonas terricola DSM 22344T (98.5%) and Luteimonas arsenica 26-35T (97.6). The genome comprises 2,917,404 bp with a G+C content of 70.5 mol%. The ANI value between strain Gr-4T and Luteimonas padinae CDR SL 15T was 87.3%. The DNA-DNA relatedness value between strain Gr-4T and Luteimonas padinae CDR SL 15T, Luteimonas terricola DSM 22344T was 36.4 ± 1.3% and 14.2 ± 1.7%, respectively. The predominant quinone was Q-8. The major fatty acids were iso-C15:0, iso-C16:0 and summed feature 9 (comprising iso-C17:1ω9c and/or C16:0 10-methyl) supported the affiliation of strain Gr-4T to the genus Luteimonas. Moreover, the physiological, biochemical results, and low level of ANI and DNA-DNA relatedness value allowed the phenotypic and genotypic differentiation of strains Gr-4T from other Luteimonas species with validly published names. The novel isolate therefore represents a novel species, for which the name Luteimonas granuli sp. nov. is proposed, with the type strain Gr-4T (=KACC 16614T = JCM 18203T).

Groundwater quality evaluation for different uses in the lower Ketar Watershed, Ethiopia.

Groundwater quality samples from 33 wells were collected in the lower Ketar watershed (Ethiopia) to study its suitability for domestic and irrigation purposes. Samples were evaluated for major ions and physicochemical properties. In 58% of the samples analyzed, Ca2+ is the dominant cation and Na+ dominates the remaining 42% of the samples. Among the anions found during analyzation, HCO3- is the solo dominant ion in all the wells sampled. The order of the concentration of the major ions was Ca2+ > Na+ > Mg2+ > K+ for the cations and HCO3- > SO42- > Cl > NO3- for the anions. AquaChem analysis shows that Ca-HCO3 and Na-HCO3 are the major water types in the area. The analyses indicated that the dissolution of fluorite or fluorapatite is the possible source of the high fluoride concentration in the area. And, the interactions between water and rock and cation exchanges mainly determine the water quality. The suitability of the groundwater for use in irrigation was evaluated based on the salinity (EC), SAR, %Na, RSC, PI, KR, and the USSL Salinity diagram. The groundwater from most of the wells can be used for irrigation without any significant restriction except for a few of the wells downstream. Its suitability for domestic use was evaluated by comparing with the WHO standard limits. The parameters limiting the use of this groundwater for drinking purposes are F- (94%), HCO3- (45%), and Ca2+ (33%). All the remaining major cations and anions complied with the WHO standard limits for drinking.

Serial testing of the ICHD-3 beta diagnostic criteria for probable reversible cerebral vasoconstriction syndrome: A prospective validation study.

Objectives To serially test the International Classification of Headache Disorders (ICHD) 3rd edition beta version criteria for 6.7.3.1 probable reversible cerebral vasoconstriction syndrome (probable RCVS) in patients with thunderclap headache. Methods We prospectively screened consecutive patients with thunderclap headache who visited the Samsung Medical Center between October 2015 and March 2017. Patients were included in the analysis if they a) visited our hospital within 1 month after onset, b) completed a diagnostic work-up, and c) had no secondary causes other than RCVS. The ICHD-3 beta 6.7.3.1 criteria were evaluated serially during the first visit (visit 1), 2 weeks after the first visit (visit 2), and 1-3 months after onset (visit 3). Results A total of 99 patients completed this study. Based on the first clinical and radiological evaluation, 63 (63.6%) were diagnosed with angiogram-proven RCVS, whilst 36 (36.4%) showed normal neuroimaging. The ICHD-3 beta 6.7.3.1 criteria were fulfilled in 76.2% of patients with angiogram-proven RCVS. In patients with normal angiograms, the ICHD diagnosis of probable RCVS changed over time: 25.0%, 47.2%, and 38.9% at visits 1, 2, and 3, respectively. The sensitivity and specificity of the criteria at visit 1 were 72.4% and 95.5%, respectively, for the prediction of a final diagnosis of overall (angiogram-proven + probable) RCVS. Conclusions The ICHD-3 beta criteria for probable RCVS are applicable for patients with thunderclap headaches at the acute stage, with the exception of criterion C3. Criteria C1 and C2 are less reliable when applied at the first visit. Repeated evaluation is necessary to enhance diagnostic sensitivity.

Characteristics and demographics of reversible cerebral vasoconstriction syndrome: A large prospective series of Korean patients.

Objectives To report demographics and characteristics of reversible cerebral vasoconstriction syndrome (RCVS) in the Korean cohort. Methods We prospectively recruited patients with definite (imaging-proven) RCVS and probable (imaging-negative) RCVS who visited Samsung Medical Center between June 2012 and September 2016. Clinical manifestations, neuroimaging, treatment, and clinical outcomes were evaluated in all patients. Characteristics of RCVS without typical causes ("idiopathic RCVS") were compared with those of RCVS with identifiable causes ("secondary RCVS"). International Classification of Headache Disorders (ICHD)-3 beta criteria for 6.7.3 RCVS and 6.7.3.1 probable RCVS were tested. Results A total of 138 patients (104 definite and 34 probable RCVS) were included in this study. Patients with definite RCVS were predominantly female (85.6%) and middle-aged (mean, 50.7 [range, 23-82] years). Probable RCVS was associated with less female predominance (70.6%, p = 0.049), more typical manifestations ( p < 0.001), and none of neurological complications. One-hundred and one (97.1%) patients with definite RCVS had headache, but the typical "recurrent and/or triggered" thunderclap headache was reported in only 83 (82.2%). In most patients with definite RCVS (84.6%), RCVS was idiopathic, while only 16 (15.4%) had secondary causes. Compared to those with secondary RCVS, patients with idiopathic RCVS were older (52.8 ± 11.42 vs. 39.1 ± 9.55 years, p < 0.001). Patients with secondary RCVS had more complications than those with idiopathic RCVS (40.5% vs. 12.5%, p = 0.018). Among idiopathic RCVS patients, 33 (37.5%) reported a preceding event or a change in lifestyle, environment, health, or medication within one month before onset. Conclusion In our cohort, RCVS was benign and idiopathic in most patients, and occurred frequently in middle-aged women. Manifestations of RCVS were more diverse than previously recognized, and forms without any headache existed. Different genetic, social, and environmental factors should be taken into account to unveil the spectrum and pathophysiology of RCVS.

Intracranial structural alteration predicts treatment outcome in patients with spontaneous intracranial hypotension.

Background Intracranial structural dislocation in spontaneous intracranial hypotension (SIH) can be measured by various intracranial angles and distances. We aimed to identify the clinical significance of structural dislocation in relation to treatment outcome in patients with SIH. Methods In this retrospective analysis, we identified patients with SIH who received an epidural blood patch (EBP) at Samsung Medical Center from January 2005 to March 2015. Structural dislocation in pretreatment MRIs of SIH patients was assessed by measuring tonsillar herniation, mamillopontine distance, the angle between the vein of Galen and straight sinus (vG/SS angle), the pontomesencephalic angle, and the lateral ventricular angle. After the first EBP, poor response was defined as the persistence of symptoms that prompted a repeat EBP. Results Out of the 95 patients included, 31 (32.6%) showed poor response. Among the radiological markers of structural dislocation, the vG/SS angle was associated with poor response (49.82 ± 16.40° vs 66.58 ± 26.08°, p = 0.002). Among clinical variables, premorbid migraine ( p = 0.036) was related to poor response. In multivariate analysis, reduced vG/SS angle was independently associated with poor response (OR 1.04 [95% CI 1.01 - 1.07] per 1° decrease, p = 0.006). In 23 patients who underwent MRI after successful treatment, the vG/SS angle significantly increased after the EBP ( p < 0.001, by paired t-test), while two patients with aggravation or recurrence showed a further reduction of their vG/SS angles. Conclusions Intracranial structural dislocation, measured by the vG/SS angle, is associated with poor response to the first EBP in patients with SIH. Successful treatment can reverse the structural dislocation.

What to Consider in a Culturally Tailored Technology-Based Intervention?

The purpose of this article is to identify practical issues in implementing a culturally tailored technology-based intervention among Asian American survivors of breast cancer. In a large-scale technology-based breast cancer intervention study, research team members wrote memos on issues in implementing a culturally tailored technology-based intervention and plausible reasons for the issues. Then, the content of the research diaries was analyzed, along with written records of the research team. The practical issues found in the research process included those related to (1) technology literacy and preferences; (2) language issues; (3) cultural attitudes, beliefs, and values; (4) intervention staff competence; (5) security and confidentiality issues; and (6) time and geographical constraints. Based on the issues, several recommendations are proposed for future research using culturally tailored technology-based interventions among racial and ethnic minorities.

Longitudinal changes in cerebral blood flow velocities in different clinical courses of migraine.

Objective To assess longitudinal changes in cerebral blood flow velocities (ΔCBFVs) according to the clinical course of migraine. Methods We retrospectively included migraine patients with two or more attacks per month at baseline who were followed up within 2 years with transcranial Doppler in a tertiary headache clinic. ΔCBFVs were analyzed in relation to clinical courses, defined as remission (0-1 headache days/month), persistence (2-14/month), or progression (≥15/month) in episodic migraine (EM), and conversion to EM (<15/month) and persistence (≥15/month) in chronic migraine (CM). Results A total of 166 patients (90 EM and 76 CM) were included. In EM, the remission group ( n = 30) showed a decrease in CBFV in the middle cerebral artery (MCA) and the basilar artery (BA). The progression group ( n = 10) showed increasing CBFVs in the bilateral MCAs. Patients with the persistence course ( n = 50) showed generally unchanged CBFVs. In CM, ΔCBFVs decreased in the BA and increased in the posterior cerebral artery (PCA) after conversion to EM ( n = 61), whereas they remained unchanged in the persistence group ( n = 15). In all patients, % change in headache days was positively correlated with the %ΔCBFVs of the bilateral MCAs and the BA. Conclusions CBFV changes are associated with the different clinical courses of migraine. The association is more prominent in EM than CM.

Hydrochemical variations in selected geothermal groundwater and carbonated springs in Korea: a baseline study for early detection of CO2 leakage.

A baseline hydrochemistry of the above zone aquifer was examined for the potential of CO2 early detection monitoring. Among the major ionic components and stable isotope ratios of oxygen, hydrogen, and carbon, components with a relative standard deviation (RSD) of <10 % for the seasonal variation were selected as relatively stable. These components were tested for sensitivity to the introduction of 0.1 mol/L CO2 (g) using the PHREEQC simulation results. If the relatively stable components were sensitive to the introduction of CO2, then they could be used as indicators of CO2 leakage into the above zone. As an analog to the zone above CO2 storage formation, we sampled deep groundwater, including geothermal groundwater from well depths of 400-700 m below the ground surface (bgs) and carbonated springs with a high CO2 content in Korea. Under the natural conditions of inland geothermal groundwater, pH, electrical conductivity (EC), bicarbonate (HCO3), δ18O, δ2H, and δ13C were relatively stable as well as sensitive to the introduction of CO2 (g), thus showing good potential as monitoring parameters for early detection of CO2 leakage. In carbonated springs, the parameters identified were pH, δ18O, and δ2H. Baseline hydrochemistry monitoring could provide information on parameters useful for detecting anomalies caused by CO2 leakage as measures for early warning.

Clinical patterns of primary stabbing headache: a single clinic-based prospective study.

BACKGROUND: The clinical features and disease courses of primary stabbing headache (PSH) are diverse. We aimed to identify distinct clinical patterns of PSH. METHODS: We prospectively screened consecutive first-visit patients who presented with stabbing headache at the Samsung Medical Centre Headache Clinic from June 2015 to March 2016. Demographics, headache characteristics, and disease courses were prospectively evaluated. After discerning factors related to the chronicity at the time of presentation, clinical patterns were identified based on the frequency (daily vs. intermittent), clinical course (remitted or not), and total disease duration (<3 or >3 months). RESULTS: In the 65 patients with PSH included in this study, monophasic (n = 31), intermittent (n = 17), and chronic daily (n = 12) patterns were identified. The median disease durations were 9 days for monophasic PSH, 9 months for chronic daily PSH, and 2 years for intermittent PSH. The features of monophasic PSH were greater severity, single and side-locked locations, more attacks per day, daily occurrence, and good treatment response. Chronic daily PSH was associated with female predominance, longer-lasting stabs, and multiple or migrating locations on bilateral or alternating sides. The characteristics of intermittent PSH included female predominance and sporadic stabs with less intensity. CONCLUSIONS: Our study demonstrated distinct clinical patterns of PSH. In addition to help early recognition of disease, our findings suggest different pathophysiologic mechanisms. Future prospective studies are required to reveal the etiologies of these different PSH patterns and their optimal treatment strategies.

Silent Coronary Artery Disease in Symptomatic Candidates for Carotid Revascularization Intervention.

BACKGROUND: Concurrent coronary artery disease (CAD) and carotid artery stenosis (CAS) are frequently detected in clinical practice and have important prognostic implications in symptomatic patients who are considered for revascularization. The aim of this study was to assess the frequency of asymptomatic CAD in stroke patients with CAS and the associated factors. METHODS: Coronary angiography was performed at a single session after cerebral angiography in patients with symptomatic CAS, which was considered a candidate for revascularization. RESULTS: Ninety-six patients were enrolled. We detected significant (defined as a degree of stenosis ≥50%) atherosclerotic coronary lesions in 58 patients (60.4%). Of these 58 patients, 32 (55.2%) had one-vessel, 19 (32.7%) 2-vessel, and 7 (12.1%) 3-vessel disease. Potential factors associated with the silent CAD were hypertension (OR 3.86, p = 0.022), a high level (≥140 mg/dl) of non-high-density lipoprotein cholesterol (OR 3.20, p = 0.041), and combined intracranial atherosclerosis steno-occlusion on cerebral angiogram (OR 4.39, p = 0.015). CONCLUSIONS: About 60% of stroke patients with extracranial CAS have an incident CAD. Hypertension, hyperlipidemia, and the atherosclerotic changes of combined extracranial carotid and intracranial arteries may increase the risk of asymptomatic CAD in symptomatic candidates for carotid revascularization intervention.

Transient Ischemic Attacks Preceding Acute Lacunar Infarction.

BACKGROUND: It has been reported that some patients with lacunar infarction have transient ischemic attacks (TIAs) before stroke. This study was aimed at evaluating the factors and prognostic value related to TIAs preceding acute lacunar stroke. METHODS: A total of 1,424 patients were admitted to the hospital for first-ever ischemic stroke. Of which 314 patients with acute lacunar infarction were enrolled for this study. The patients were divided into 2 groups based on the occurrence of TIAs before stroke. RESULTS: Fifty-eight patients (18.5%) had a history of preceding TIAs. The interval between TIA and stroke was less than 24 h in most patients (87.9%). Diabetes mellitus was more often found in patients with TIAs than in those without TIAs (48.3 vs. 28.9%, p = 0.004). Initial National Institute of Health Stroke Scale scores showed no significant difference between the 2 groups (median 2 vs. 3, p = 0.067). However, patients with preceding TIAs had a more favorable outcome (modified Rankin scale 0-1) than those without TIA at 3 months after stroke (79.6 vs. 63.2%, p = 0.021). CONCLUSION: Lacunar TIA may occur due to small perforating microatheromatous arteries caused by diabetes. This study suggests that ischemic tolerance may play a role in patients with preceding TIAs before lacunar infarct, allowing better recovery from a subsequent ischemic stroke.

Caffeine discontinuation improves acute migraine treatment: a prospective clinic-based study.

BACKGROUND: Caffeine has both excitatory and vasoconstrictive effects on central nervous system. Caffeine use might be associated with development and chronification of migraine. We aimed to evaluate the effect of caffeine cessation on the acute treatment of migraine. METHODS: We prospectively recruited migraine patients who consumed caffeine drinks daily and instructed them to discontinue their caffeine intake. Triptans were prescribed for acute treatment. Patients were followed up after at least two weeks after screening and evaluated the efficacy of acute treatment with the migraine assessment of current therapy (Migraine-ACT) questionnaire. Excellent efficacy was defined as Migraine-ACT score of 4. Chronic migraine, body mass index, allodynia, depression, anxiety, antiemetic use, and use of prophylactic medication were included in the multivariate analysis if the univariate p < 0.2. FINDINGS: Among 108 patients included, 36 completely discontinued their caffeine intake (abstinence group). The efficacy of acute treatment was assessed at median 34.5 days (interquartile range, 28-89) after the screening. Twenty-six patients (72.2 %) in the abstinence group and 29 (40.3 %) in the non-abstinence group reported an excellent efficacy (p = 0.002). The abstinence group also showed a trend toward greater reduction of headache impact test-6 (HIT-6) scores (p = 0.085). Caffeine abstinence was independently associated with an excellent efficacy of acute treatment (multivariate odds ratio, 3.2; 95 % confidence interval, 1.2-8.4; p = 0.018) after controlling for covariates. CONCLUSIONS: Caffeine abstinence is associated with better efficacy of acute migraine treatment. Our uncontrolled study results encourage a further confirmatory study on this issue.

Effectiveness of telemedicine: videoconferencing for low-income elderly with hypertension.

OBJECTIVES: Develop educational materials and a classification system for remote consultations and home-based healthcare through videoconferencing, manage the blood pressure of patients through a ubiquitous-health (u-health) service, and identify its effects on the blood pressure and level of depression of the service recipients (i.e., low-income elderly patients with hypertension). MATERIALS AND METHODS: This study is a nonequivalent control group pre-test-post-test, quasi-experimental study. Low-income essential hypertensive patients above 65 years of age living in public rental housing were our target group. They were divided into two groups: an experimental group of 25 who had received blood pressure monitoring as well as inbound-outbound remote video consultation and a control group of 24 who received blood pressure monitoring through u-health equipment but no other management. In total, 16 sessions were conducted twice a week for 8 weeks. RESULTS: (1) The hypothesis that there would be a difference in the level of depression between the control group and the experimental group who received the u-health service was rejected because of the lack of a significant statistical difference (t=-0.142, p=0.889). However, there was a significant difference before and after the service in the experimental group (t=2.49, p=0.021). (2) Concerning the second hypothesis-that there would be a difference in systolic and diastolic blood pressure between the control group and the experimental group-there was a statistically significant decrease in systolic blood pressure (F=10.26, p=0.003), but diastolic blood pressure showed no significant difference (F=2.802, p=0.101). Thus, the hypothesis was partially adopted. (3) The third hypothesis stated that the rates of sleep (p=0.012) and hobbies (p=0.036) as aspects of a healthy lifestyle in the experimental group would be significantly higher than those of the control group. CONCLUSIONS: These findings confirm that the u-health nursing service via videoconferencing made a measurable contribution to a healthier lifestyle by reducing systolic blood pressure levels compared with those who were only monitored for high blood pressure. Therefore, this service is recommended as part of a hypertension management regimen for low-income elderly people as an effective means of nursing intervention.

A health recreation program for u-healthcare clients: effects on mental health.

INTRODUCTION: In this study, a health recreation program was implemented with elderly patients (60 years of age or older) who were receiving ubiquitous healthcare (u-healthcare) services. Furthermore, we examined the effects of health recreation on perceived stress, anxiety, and depression, by comparing survey results before and after the recreation program was conducted. Thus, the aim of this study was to develop an offline service with the ability to promote the impact of the u-healthcare service on mental healthcare. MATERIALS AND METHODS: A health recreation program, consisting of a variety of weekly games, songs, and minilectures about mental health over a 10-week period, was offered at a senior citizens center in K-Gu, Seoul, Korea. This program targeted 18 elderly people currently receiving u-healthcare services. Data on the impact of the program on the mental health of the elderly were collected through surveys administered before and after the recreation program, and the results were compared with those of a control group. The control group consisted of 18 elderly people who were receiving u-healthcare services from the same district. RESULTS: The perceived stress and anxiety of the experimental group decreased significantly compared with those of the control group. However, the program did not result in a significant reduction in depression. CONCLUSIONS: This offline health recreation program offered to elderly u-healthcare service clients contributed to the promotion of their mental health. Further studies will be required to better incorporate the offline mental healthcare program into their daily lives within the u-healthcare service.

Impact of dewatering inorganic coagulants on anaerobic digestion treating food waste leachate.

Anaerobic digestion of food waste leachate (FWL) provides a viable solution for waste treatment and energy production. Returning solids from digested sludge to the reactor maintains a high microbial concentration and enhances digestion efficiency. However, this requires coagulants because the digestate has low dewaterability. This study analyzed methane production and microbial communities using biochemical methane potential tests for inorganic coagulants (AlCl3, Al2(SO4)3, FeCl3, and Fe2(SO4)3) in FWL treatment. Cumulative methane production was the highest in the control and decreased in the order of Fe2(SO4)3, AlCl3, FeCl3, and Al2(SO4)3. Iron ions inhibited H2S production while aluminum ions increased it compared to the control group. Despite the absence of significant changes in microbial communities following coagulant injection, a substantial increase in damaged cells was observed. These findings highlight the intricate repercussions of coagulant introduction in anaerobic digestion, emphasizing notable alterations in methane production dynamics and the integrity of microbial cells.