Exploring the Genetic Diversity and Molecular Evolution of Seoul and Hantaan Orthohantaviruses.

Seoul (SEOV) and Hantaan (HTNV) orthohantaviruses are significant zoonotic pathogens responsible for hemorrhagic fever with renal syndrome. Here, we investigated the molecular evolution of SEOV and HTNV through phylogenetic and bioinformatic analyses using complete genome sequences of their large (L), medium (M), and small (S) gene segments. Despite similar epizootic cycles and clinical symptoms, SEOV and HTNV exhibited distinct genetic and evolutionary dynamics. The phylogenetic trees of each segment consistently showed major genetic clades associated with the geographical distribution of both viruses. Remarkably, SEOV M and S segments exhibit higher evolutionary rates, rapidly increasing genetic diversity, and a more recent origin in contrast to HTNV. Reassortment events were infrequent, but both viruses appear to utilize the M gene segment in genetic exchanges. SEOV favors the L or M segment reassortment, while HTNV prefers the M or S segment exchange. Purifying selection dominates in all three gene segments of both viruses, yet SEOV experiences an elevated positive selection in its glycoprotein Gc ectodomain. Key amino acid differences, including a positive 'lysine fence' (through residues K77, K82, K231, K307, and K310) located at the tip of the Gn, alongside the physical stability around an RGD-like motif through M108-F334 interaction, may contribute to the unique antigenic properties of SEOV. With the increasing global dispersion and potential implications of SEOV for the global public health landscape, this study highlights the unique evolutionary dynamics and antigenic properties of SEOV and HTNV in informing vaccine design and public health preparedness.

Physical Activity Pattern of Adults With Metabolic Syndrome Risk Factors: Time-Series Cluster Analysis.

Background: Physical activity plays a crucial role in maintaining a healthy lifestyle, and wrist-worn wearables, such as smartwatches and smart bands, have become popular tools for measuring activity levels in daily life. However, studies on physical activity using wearable devices have limitations; for example, these studies often rely on a single device model or use improper clustering methods to analyze the wearable data that are extracted from wearable devices. Objective: This study aimed to identify methods suitable for analyzing wearable data and determining daily physical activity patterns. This study also explored the association between these physical activity patterns and health risk factors. Methods: People aged >30 years who had metabolic syndrome risk factors and were using their own wrist-worn devices were included in this study. We collected personal health data through a web-based survey and measured physical activity levels using wrist-worn wearables over the course of 1 week. The Time-Series Anytime Density Peak (TADPole) clustering method, which is a novel time-series method proposed recently, was used to identify the physical activity patterns of study participants. Additionally, we defined physical activity pattern groups based on the similarity of physical activity patterns between weekdays and weekends. We used the χ2 or Fisher exact test for categorical variables and the 2-tailed t test for numerical variables to find significant differences between physical activity pattern groups. Logistic regression models were used to analyze the relationship between activity patterns and health risk factors. Results: A total of 47 participants were included in the analysis, generating a total of 329 person-days of data. We identified 2 different types of physical activity patterns (early bird pattern and night owl pattern) for weekdays and weekends. The physical activity levels of early birds were less than that of night owls on both weekdays and weekends. Additionally, participants were categorized into stable and shifting groups based on the similarity of physical activity patterns between weekdays and weekends. The physical activity pattern groups showed significant differences depending on age (P=.004) and daily energy expenditure (P<.001 for weekdays; P=.003 for weekends). Logistic regression analysis revealed a significant association between older age (≥40 y) and shifting physical activity patterns (odds ratio 8.68, 95% CI 1.95-48.85; P=.007). Conclusions: This study overcomes the limitations of previous studies by using various models of wrist-worn wearables and a novel time-series clustering method. Our findings suggested that age significantly influenced physical activity patterns. It also suggests a potential role of the TADPole clustering method in the analysis of large and multidimensional data, such as wearable data.

Phylodynamic analysis revealed that human mobility and vaccination were correlated to the local spread of SARS-CoV-2 in Republic of Korea.

Following the global emergence of the SARS-CoV-2 Alpha variant of concern (VOC) in 2020, the Delta variant triggered another wave in 2021. The AY.69 lineage, a Delta VOC, was particularly prevalent in Republic of Korea (South Korea) from May 2021 to January 2022, despite the synchronized implementation of vaccination programmes and non-pharmaceutical interventions (NPIs) such as social distancing. In this study, we used phylogeographic analysis combined with a generalized linear model (GLM) to examine the impact of human movement and vaccination on viral transmission. Our findings indicated that transmission primarily originated in South Korea's metropolitan areas, and a positive correlation was observed between total human mobility (tracked by GPS on mobile phones and estimated through credit card consumption) and viral spread. The phylodynamic analysis further revealed that non-vaccinated individuals were the primary transmitters of the virus during the study period, even though vaccination programmes had commenced three months prior to the AY.69 outbreak. Our study emphasizes the need to focus on controlling SARS-CoV-2 transmission in metropolitan regions and among unvaccinated populations. Furthermore, the positive correlation between mobility data and viral dissemination could contribute to the development of more accurate predictive models for local spread of pandemics.

Predicting Habitual Use of Wearable Health Devices Among Middle-aged Individuals With Metabolic Syndrome Risk Factors in South Korea: Cross-sectional Study.

BACKGROUND: Prevention of the risk factors for metabolic syndrome (MetS) in middle-aged individuals is an important public health issue. Technology-mediated interventions, such as wearable health devices, can aid in lifestyle modification, but they require habitual use to sustain healthy behavior. However, the underlying mechanisms and predictors of habitual use of wearable health devices among middle-aged individuals remain unclear. OBJECTIVE: We investigated the predictors of habitual use of wearable health devices among middle-aged individuals with risk factors for MetS. METHODS: We proposed a combined theoretical model based on the health belief model, the Unified Technology of Acceptance and Use of Technology 2, and perceived risk. We conducted a web-based survey of 300 middle-aged individuals with MetS between September 3 and 7, 2021. We validated the model using structural equation modeling. RESULTS: The model explained 86.6% of the variance in the habitual use of wearable health devices. The goodness-of-fit indices revealed that the proposed model has a desirable fit with the data. Performance expectancy was the core variable explaining the habitual use of wearable devices. The direct effect of the performance expectancy on habitual use of wearable devices was greater (ß=.537, P<.001) than that of intention to continue use (ß=.439, P<.001), and the total effect estimate of the performance expectancy was 0.909 (P<.001), including the indirect effect (ß=.372, P=.03) on habitual use of wearable devices via intention to continue use. Furthermore, performance expectancy was influenced by health motivation (ß=.497, P<.001), effort expectancy (ß=.558, P<.001), and risk perception (ß=.137, P=.02). Perceived vulnerability (ß=.562, P<.001) and perceived severity (ß=.243, P=.008) contributed to health motivation. CONCLUSIONS: The results suggest the importance of the users' performance expectations for wearable health devices for the intention of continued use for self-health management and habituation. Based on our results, developers and health care practitioners should find better ways to meet the performance expectations of middle-aged individuals with MetS risk factors. They also should generate device use easier and find a way to encourage users' health motivation, thereby reducing users' effort expectancy and resulting in a reasonable performance expectancy of the wearable health device, to induce users' habitual use behaviors.

Analyzing the Historical Development and Transition of the Korean Health Care System.

OBJECTIVES: Many economically advanced countries have attempted to minimize public expenditures and pursue privatization based on the principles of neo-liberalism. However, Korea has moved contrary to this global trend. This study examines why and how the Korean health care system was formed, developed, and transformed into an integrated, single-insurer, National Health Insurance (NHI) system. METHODS: We describe the transition in the Korean health care system using an analytical framework that incorporates such critical variables as government economic development strategies and the relationships among social forces, state autonomy, and state power. This study focuses on how the relationships among social forces can change as a nation's economic development or governing strategy changes in response to changes in international circumstances such as globalization. RESULTS: The corporatist Social Health Insurance (SHI) system (multiple insurers) introduced in 1977 was transformed into the single-insurer NHI in July 2000. These changes were influenced externally by globalization and internally by political democratization, keeping Korea's private-dominant health care provision system unchanged over several decades. CONCLUSION: Major changes such as integration reform occurred, when high levels of state autonomy were ensured. The state's power (its policy capability), based on health care infrastructures, acts to limit the direction of any change in the health care system because it is very difficult to build the infrastructure for a health care system in a short timeframe.

Nurse-Perceived Patient Adverse Events depend on Nursing Workload.

OBJECTIVES: The purpose of this study was to investigate the correlation between nursing workload and nurse-perceived patient adverse events. METHODS: A total of 1,816 nurses working in general inpatient units of 23 tertiary general hospitals in South Korea were surveyed, and collected data were analyzed through multilevel logistic regression analysis. RESULTS: Among variables related to nursing workload, the non-nursing task experience had an influence on all four types of patient adverse events. Nurses with non-nursing tasks experienced patient adverse events-falls [odds ratio (OR) = 1.31], nosocomial infections (OR = 1.23), pressure sores (OR = 1.16), and medication errors (OR = 1.23)-more often than occasionally. In addition, when the bed to nurse ratio was higher, nurses experienced cases of pressure sores more often (OR = 1.35). By contrast, nurses who said the nursing workforce is sufficient were less likely than others to experience cases of pressure sores (OR = 0.78). Hospitals with a relatively high proportion of nurses who perceived the nursing workforce to be sufficient showed a low rate of medication error (OR = 0.28). CONCLUSION: The study suggested that the high level of nursing workload in South Korea increases the possibility of patient adverse events.

Unmet healthcare needs depending on employment status.

OBJECTIVES: The purpose of study is to find relevance between unmet healthcare needs and employment status and if factors have relevance to unmet healthcare needs due to "economic burden" and "no time to spare". METHODS: The study conducted a survey of 9163 respondents who said they needed a medical treatment or checkup were asked why the need for care was unmet. RESULTS: 22.9% of the respondents said they did not receive a medical treatment or checkup they needed at least once. The rate of unmet healthcare needs caused by "economic burden" was higher among temporary workers (ORs=2.13), day workers (ORs=1.92). However, the rate of unmet needs due to "no time to spare" was lower for temporary workers (ORs=.58) than for regular workers, studies (ORs=.33), housework (ORs=.26), early retirement (ORs=.19) and disease or injury (ORs=.07). CONCLUSION: Non-regular waged workers were more likely to have an unmet need for healthcare due to "economic burden" than regular waged workers. On the other hand, regular waged workers were less likely to receive necessary healthcare services due to "no time to spare" than non-regular waged workers and economically inactive people.

Influence of the nursing practice environment on job satisfaction and turnover intention.

OBJECTIVES: To examine whether the nursing practice environment at the hospital-level affects the job satisfaction and turnover intention of hospital nurses. METHODS: Among the 11 731 nurses who participated in the Korea Health and Medical Workers' Union's educational program, 5654 responded to our survey. Data from 3096 nurses working in 185 general inpatient wards at 60 hospitals were analyzed using multilevel logistic regression modeling. RESULTS: Having a standardized nursing process (odds ratio [OR], 4.21; p<0.001), adequate nurse staffing (OR, 4.21; p<0.01), and good doctor-nurse relationship (OR, 4.15; p<0.01), which are hospital-level variables based on the Korean General Inpatients Unit Nursing Work Index (KGU-NWI), were significantly related to nurses' job satisfaction. However, no hospital-level variable from the KGU-NWI was significantly related to nurses' turnover intention. CONCLUSIONS: Favorable nursing practice environments are associated with job satisfaction among nurses. In particular, having a standardized nursing process, adequate nurse staffing, and good doctor-nurse relationship were found to positively influence nurses' job satisfaction. However, the nursing practice environment was not related to nurses' turnover intention.

Nurse-perceived patient adverse events and nursing practice environment.

OBJECTIVES: To evaluate the occurrence of patient adverse events in Korean hospitals as perceived by nurses and examine the correlation between patient adverse events with the nurse practice environment at nurse and hospital level. METHODS: In total, 3096 nurses working in 60 general inpatient hospital units were included. A two-level logistic regression analysis was performed. RESULTS: At the hospital level, patient adverse events included patient falls (60.5%), nosocomial infections (51.7%), pressure sores (42.6%) and medication errors (33.3%). Among the hospital-level explanatory variables associated with the nursing practice environment, 'physician- nurse relationship' correlated with medication errors while 'education for improving quality of care' affected patient falls. CONCLUSIONS: The doctor-nurse relationship and access to education that can improve the quality of care at the hospital level may help decrease the occurrence of patient adverse events.

The incidence of stroke by socioeconomic status, age, sex, and stroke subtype: a nationwide study in Korea.

OBJECTIVES: To date, studies have not comprehensively demonstrated the relationship between stroke incidence and socioeconomic status. This study investigated stroke incidence by household income level in conjunction with age, sex, and stroke subtype in Korea. METHODS: Contributions by the head of household were used as the basis for income levels. Household income levels for 21 766 036 people were classified into 6 groups. The stroke incidences were calculated by household income level, both overall within income categories and further by age group, sex, and stroke subtype. To present the inequalities among the six ranked groups in a single value, the slope index of inequality and relative index of inequality were calculated. RESULTS: In 2005, 57 690 people were first-time stroke patients. The incidences of total stroke for males and females increased as the income level decreased. The incidences of stroke increased as the income level decreased in those 74 years old and under, whereas there was no difference by income levels in those 75 and over. Intracerebral hemorrhage for the males represented the highest inequality among stroke subtypes. Incidences of subarachnoid hemorrhage did not differ by income levels. CONCLUSIONS: The incidence of stroke increases as the income level decreases, but it differs according to sex, age, and stroke subtype. The difference in the relative incidence is large for male intracerebral hemorrhage, whereas the difference in the absolute incidence is large for male ischemic stroke.

Application of revised nursing work index to hospital nurses of South Korea.

PURPOSE: Based on the Revised Nursing Work Index (NWI-R), this research aimed to develop a Korean Hospital General Inpatient Unit-Nursing Work Index (KGU-NWI). This study also aimed to compare the common points and differences between the subfactors of the KGU-NWI and the subfactors from previous studies. METHODS: Based on opinions from 3,151 nurses in Korean hospital general inpatient unit, this research used 57 items of NWI-R and the principal axis factor analysis for deriving subfactors. We evaluated the convergent validity through factor analysis and the content validity of KGU-NWI in terms of the association between nurses' job outcome and the subfactors derived. RESULTS: Six subfactors and 26 items for KGU-NWI were derived from NWI-R. Among them, 'physician-nurse relationship', 'adequate nurse staffing' and 'organizational support and management of hospital' were the same with results from previous studies. In addition, two subfactors, 'participation of decision-making processes' and 'education for improving quality of care', which were similar with results from previous Korean studies, were newly added by using Korean hospital cases. In contrast to previous Korean studies, a unique subfactor this study found was 'nursing processes'. This research confirmed that the six subfactors were highly correlated with job satisfaction, intention to leave, and quality of health care, which represented a nurse's job outcome. CONCLUSION: KGU-NWI including six subfactors and 26 items is an applicable instrument to investigate nurse work environment in Korean hospital general inpatient unit.

Inequalities in medical care utilization by South Korean cancer patients according to income: a retrospective cohort study.

This study explores income inequalities in the utilization of medical care by cancer patients in South Korea, according to type of medical facilities and survival duration. The five-year retrospective cohort study used data drawn from the Korean Cancer Registry, the National Health Insurance database, and the death database of the Korean National Statistical Office. The sample consisted of 43,433 patients diagnosed with cancer in 1999. The authors found significant quantitative inequalities as a function of income in the patients' utilization of medical care. Cancer patients from the highest income class used inpatient and outpatient care more frequently than did patients from the lowest income class. Those with higher incomes tended to use more inpatient and outpatient services at major tertiary hospitals, which were known as providing better medical care than other types of hospitals and clinics. Moreover, horizontal inequality in cancer-care expenditures favoring those with higher incomes was observed during earlier periods of treatment. In conclusion, income substantially affects the utilization of inpatient and outpatient services, amount of medical expenditures, and type of medical facilities.

Trends in pneumonia and influenza-associated hospitalizations in South Korea, 2002-2005.

Pneumonia and influenza are leading causes of morbidity and mortality across the globe. Korea has established the national health-insurance system to cover the entire Korean population since 1989. The aim of this study was to describe the epidemiologic trends in pneumonia and influenza-associated hospitalizations and deaths using the Korean National Health Insurance databases and national vital statistics. During 2002-2005, 989,472 hospitalizations and 10,543 deaths due to pneumonia and influenza were recorded. Eighty-one percent of the hospitalizations were related to diagnoses with unspecified aetiology. The average annual rate of hospitalizations due to pneumonia and influenza was 5.2 per 1,000 people [95% confidence interval (CI) 5.2-5.3], and the hospitalization rate increased by 28% (from 4.5 to 5.8 per 1,000 people) during the four-year study period. In addition, deaths due to pneumonia and influenza increased by 48% (2,829 during 2003, 3,522 during 2004, and 4,192 during 2005). Overall, the national burden of hospitalizations and deaths due to pneumonia and influenza in Korea was high, and it increased for all age-groups during the study period. A comprehensive review of potential interventions by the government authorities should aim to reduce the burden of pneumonia and influenza.

Body mass index and serum aminotransferase levels in Korean men and women.

BACKGROUND AND AIMS: Obesity has been postulated as contributing to the risk of nonalcoholic steatohepatitis. With the surging obesity epidemic, an ensuing epidemic of nonalcoholic steatohepatitis and its sequelae is of concern. The objectives of this clinical research study were to examine the association between body mass index (BMI) and serum aminotransferase levels. METHOD: A study was carried out on 1,166,847 Koreans (731,560 men and 435,287 women), 30 to 95 years of age, who received health insurance from the National Health Insurance Corp and had a biennial medical evaluation from 1992 to 1995. RESULTS: Across the range of BMI values (<18.5 to >or=32 kg/m) in men, alanine aminotransferase (ALT) was estimated to increase by 18.8 U/L and aspartate aminotransferase (AST) increased by 7.1 U/L. In women, ALT increased by 9.9 U/L, whereas AST increased by 4.5 U/L. In men, interactions between BMI and alcohol consumption were significant (P<0.001) for ALT and AST, but the degree of effect modification was quantitatively minor. However, ALT and AST levels were somewhat higher in heavy alcohol drinkers than in nondrinkers. For women, the relationship of aminotransferase levels with BMI did not vary by alcohol consumption. The relationship of BMI with aminotransferase weakened with increasing age. CONCLUSIONS: In Korea, ALT and AST are strongly associated with BMI and increased progressively from the lowest to the highest strata of BMI. The association of BMI with aminotransferase levels was modified by age and sex.

Determinants of public satisfaction with the National Health Insurance in South Korea.

To explore the determinants of public satisfaction with the National Health Insurance, this study re-analyzed the 2004 public satisfaction survey with the Korean National Health Insurance (KNHI) conducted by Korean National Health Insurance Corporation (KNHIC). One thousand samples were selected with probability proportional to population size (by region/sex/age). The data collected by home-visit interview were transformed into the final data set by matching them to the insured's benefit database and the qualification database. The results showed that metropolitan residence, insured type, relationship between respondent and householder, subjective health status, benefit-cost ratio, and attitudes toward KNHI were direct determinants of satisfaction with KNHI. In addition, various demographic and socioeconomic variables and the health status of the respondent's family indirectly influenced satisfaction with KNHI. Among these variables, the attitude toward KNHI was the most vital factor to determine public satisfaction. The study results show that equity in monthly contributions and an enhanced quantity and quality of medical services are required to improve public satisfaction with KNHI. Furthermore, it is important to improve the public perception of social values and solidarity for increased public satisfaction with KNHI.

Tooth loss, hypertension and risk for stroke in a Korean population.

Tooth loss has been suggested as a potential risk factor for stroke. We conducted a prospective cohort study of stroke in Korea on hypertension, diabetes, smoking, and tooth loss to characterize their independent effects and interactions. The overall risk of stroke and the risk of different subtypes of stroke were evaluated in relation to tooth loss using Cox proportional hazards models among 867,256 Korean men and women, aged 30-95 years, who received health insurance from the National Health Insurance Corporation and were medically evaluated between 1992 and 1995, with tooth loss measured. The overall prevalence of having at least one tooth removed among the people in the study was 29.8% (31.9% for men and 22.3% for women). During a 14-year follow-up, 28,258 strokes with 5105 fatal strokes occurred. For men and women, tooth loss was associated with total stroke and stroke subtypes. In a multivariable model adjusting for selected covariates, a graded association between higher tooth loss and higher risk of total stroke was observed in men [> or =7 lost teeth versus 0 (hazard ratio (HR)=1.3; 95% confidence interval (CI), 1.2-1.4)] and in women (HR=1.2; 95% CI, 1.0-1.3). The HRs for ischemic and hemorrhagic stroke were also similar in men and women. There was evidence of interaction of hemorrhagic stroke risk with hypertension and tooth loss. Tooth loss is independently associated with increased risk of stroke and hypertension does interact antagonistically, particularly for hemorrhagic stroke.

Caregiver burden among caregivers of Koreans with dementia.

BACKGROUND: Most studies on caregiver burden have been conducted in Western countries, while few studies on the correlates of caregiver burden have been performed in Korea. OBJECTIVE: To suggest better policies for the care of dementia patients by using a nationwide database to identify factors that affect caregiver burden in Korea. METHODS: The database of the Korean National Health Insurance (KNHI) and National Medical Aid (NMA) programs, which covers all Koreans, was used. A sample of 609 dementia patients and their caregivers was selected from a total of 85,281 dementia patients in 2004 and interviewed to evaluate the total cost of care and caregiver burden. Stepwise multiple linear regression analysis was then performed to identify significant independent predictors of caregiver burden. RESULTS: Among caregiver-related factors, caregiver burden was higher in those who were female, had a history of home care during the previous year, and had less education. Among patient-related factors, poor ADL/IADL function was significant. The most interesting result was that subjective sense of socioeconomic status (good/fair/poor) was a stronger predictor of caregiver outcome than actual economic costs. CONCLUSION: The results of this study suggest that interventions to assist patients with dementia should focus on female caregivers, especially those considered likely to be suffering from an economic burden. Interventions should also aim to improve the ADL and IADL capacities of patients.

Job loss and re-employment of cancer patients in Korean employees: a nationwide retrospective cohort study.

PURPOSE: The aim of this study was to investigate whether a diagnosis of cancer has an impact on the cancer patients' job loss and re-employment and to identify the factors affecting job loss and re-employment during 6 years of follow-up of Korean employees with cancer. PATIENTS AND METHODS: All employees except for the self-employed in Korea who were diagnosed with cancer during the 2001 calendar year (n = 5,396) were identified as the first baseline patients and were followed every 3 months over 6 years to estimate the time taken to job loss. Patients who lost their job within the first year after a diagnosis of cancer (n = 1,398) were identified as the second baseline patients and were followed up over 5 years to estimate the time taken to re-employment using the National Health Insurance claims data. Patient demographic, socioeconomic, and clinical variables were investigated as factors that affected job loss and re-employment. RESULTS: Among the first baseline cancer patients, 47.0% lost their job, and among the second baseline patients, 30.5% were re-employed over 69 to 72 months of follow-up. Female sex, younger age and older age, company employee, lower income, blood cancer, and brain and CNS, lung, and liver cancer were significant predictors of early job loss or delayed re-employment. CONCLUSION: The diagnosis of cancer affects cancer patients' employment status differently according to different factors: sex, age, type of job, income, and cancer site. Efforts should be made to support re-employment and reduce unnecessary work cessation and disparity between different demographic and socioeconomic groups of cancer survivors.

Pancreatic cancer and factors associated with the insulin resistance syndrome in the Korean cancer prevention study.

There is increasing evidence that type 2 diabetes mellitus and glucose intolerance are a cause, not just a consequence, of pancreatic cancer. We examined whether other factors that characterize the insulin resistance syndrome are also risk factors for pancreatic cancer in a prospective cohort study of 631,172 men and women (ages 45+ years) who received health insurance from the Korean Medical Insurance Corporation. The biennial medical evaluations from 1992 to 1995 provided the baseline information for this study. Relative risks (RR) were estimated using proportional hazards models adjusted for age, sex, smoking, and fasting serum glucose (after excluding the first 2 years of follow-up). There were 2,194 incident cases of pancreatic cancer diagnosed in the cohort over a median follow-up of 12 years. There was no evidence that pancreatic cancer risk was associated with total cholesterol, systolic blood pressure, WBC count, or body mass index. Abnormal levels of aspartate aminotransferase and alanine aminotransferase were both associated with a moderately increased risk of developing the disease (40+ versus <20; RR, 1.33; 95% CI, 1.14-1.55; P(trend) = 0.05 and RR, 1.34; 95% CI, 1.16-1.56; P(trend) = 0.02, respectively). Excluding 6 years of follow-up reduced this RR (95% CI) for aspartate aminotransferase to 1.22 (1.01-1.49), but even after excluding 10 years follow-up the RR (95% CI) for alanine aminotransferase was unchanged [1.36 (1.01-1.83)]. Although fasting serum glucose has been found previously to be associated with pancreatic cancer risk in this cohort, most other factors that characterize insulin resistance syndrome were not associated with pancreatic cancer risk. The association with elevated liver enzyme levels is a novel finding that warrants further investigation.

BMI and stroke risk in Korean women.

OBJECTIVE: Obesity is known to be associated with diverse disease outcomes; however, the effect of body weight on the occurrence of stroke remains controversial and has not been studied sufficiently, particularly among Asian populations and among women. The purpose of this study was to investigate the effect of BMI on the risk of stroke among Korean women. METHODS AND PROCEDURES: The overall risk of stroke and the risk of different subtypes of stroke were evaluated in relation to BMI using Cox's proportional hazard models among 439,582 Korean women, aged 30-95 years, in a 13-year prospective cohort study with enrollment from 1992-1995. Stratified analyses were performed for age groups and cigarette smoking status. RESULTS: The average BMI was 23.2 kg/m(2) at baseline. The overall risk of stroke was the lowest in the group with a BMI <20.0 and increased with BMI in a dose-dependent manner. However, the direction and strength of association varied according to the type of stroke and age groups. The risk of ischemic stroke (IS) showed a strong and progressive linear relationship with an increase in the BMI, while the relationship was less linear for hemorrhagic stroke (HS). The association between the risk of stroke and BMI was modified by age, with a weaker association at higher ages. DISCUSSION: In Korean women, the BMI showed a progressive and linear relationship with the occurrence of stroke. The association of BMI with the risk of stroke was modified by age.