Independent and Synergistic Associations of Aerobic Physical Activity and Resistance Exercise with Nonalcoholic Fatty Liver Disease.

Background/Aims: This study aimed to examine the independent and synergistic association of aerobic physical activity and resistance exercise with nonalcoholic fatty liver disease (NAFLD) using a nationwide representative database. Methods: This was a cross-sectional study using data from the Korea National Health and Nutritional Examination Survey between 2007 and 2010. Multiple logistic regression models were used to examine the independent and synergistic (additive interaction) associations of aerobic physical activity and resistance exercise with NAFLD after adjusting for multiple covariates. Results: The prevalence of NAFLD was 26.2% for men and 17.6% for women. In the fully adjusted multiple logistic regression model to examine the independent association of aerobic physical activity or resistance exercise with NAFLD, the odds ratios for NAFLD were significantly decreased in both men (p=0.03) and women (p<0.01) who had highly active aerobic physical activity. Regarding the frequency of resistance exercise, the odds ratio for NAFLD was decreased in men who did resistance exercise ≥5 days per week (p=0.04), but not in women (p=0.19). However, when investigating the synergistic associations of aerobic physical activity and resistance exercise, the odds ratios for NAFLD significantly decreased when the frequency of both exercises increased together in both men (p for interaction <0.01) and women (p for interaction<0.01). Conclusions: Combining aerobic physical activity and resistance exercise had a synergistic preventive association for NAFLD in Korean men and women.

Nationwide changes in physical activity, nutrient intake, and obesity in South Korea during the COVID-19 pandemic era.

Background: This study aimed to examine changes in obesity rates and obesity-related factors during the COVID-19 pandemic compared to a previous period. Methods: An ecological time-series study was designed using the Korean National Health and Nutritional Examination Survey (KNHANES) database from 2014 to 2020. The expected values of obesity rate, physical activity rate, and nutrient intake for 2020 were estimated. The differences between the predicted and actual values for 2020 were also examined. In addition, a multiple logistic regression model was used to examine the changes in obesity and physical activity rates in 2020 compared to 2019. Results: The actual obesity rates in 2020 were higher, and the walking and aerobic physical activity rates were lower than the predicted values for the same year. However, the actual resistance training rates in 2020 were higher and the total energy intake was lower than the predicted values for 2020. In the multiple logistic regression model, the odds ratios for obesity, aerobic physical activity, and walking among men in 2020 were 1.29 (95% CI: 1.08 to 1.55), 0.86 (0.74 to 1.01), and 0.84 (0.73 to 0.97), respectively, compared to those in 2019. However, there were no significant differences between the values for women in 2020 and 2019. Conclusions: This study suggests that the male obesity rate in Korea has significantly increased during the COVID-19 epidemic, mainly due to a decrease in physical activity.

Korean medical students' attitudes toward academic misconduct: a cross-sectional multicenter study.

PURPOSE: This study investigated medical students' attitudes toward academic misconduct that occurs in the learning environment during the pre-clinical and clinical periods. METHODS: Third-year medical students from seven medical schools were invited to participate in this study. A total of 337 of the 557 (60.5%) students completed an inventory assessing their attitudes toward academic misconduct. The inventory covered seven factors: scientific misconduct (eight items), irresponsibility in class (six items), disrespectful behavior in patient care (five items), dishonesty in clerkship tasks (four items), free riding on group assignments (four items), irresponsibility during clerkship (two items), and cheating on examinations (one item). RESULTS: Medical students showed a strict attitude toward academic misconduct such as cheating on examinations and disrespectful behavior in patient care, but they showed a less rigorous attitude toward dishonesty in clerkship tasks and irresponsibility in class. There was no difference in students' attitudes toward unprofessional behaviors by gender. The graduate medical school students showed a stricter attitude toward some factors of academic misconduct than the medical college students. This difference was significant for irresponsibility in class, disrespectful behavior in patient care, and free riding on group assignments. CONCLUSION: This study indicates a critical vulnerability in medical students' professionalism toward academic integrity and responsibility. Further study evidence is needed to confirm whether this professionalism lapse is confined only to this population or is pervasive in other medical schools as well.

Calf Circumference as a Simple Screening Marker for Diagnosing Sarcopenia in Older Korean Adults: the Korean Frailty and Aging Cohort Study (KFACS).

BACKGROUND: The purpose of this study was to explore the optimal cut-off point of calf circumference (CC) as a simple proxy marker of appendicular skeletal muscle mass (ASM) and sarcopenia in the Korean elderly and to test the criterion-related validity of CC by analyzing its relationships with the physical function. METHODS: The participants were 657 adults aged 70 to 84 years who had completed both dual energy X-ray absorptiometry (DXA) and physical function test in the first baseline year of the Korean Frailty and Aging Cohort Study. RESULTS: ASM and skeletal muscle mass index (SMI) were correlated positively with CC (male, ASM, r = 0.55 and SMI, r = 0.54; female, ASM, r = 0.55 and SMI, r = 0.42; all P < 0.001). Testing the validity of CC as a proxy marker for low muscle mass, an area under the curve (AUC) of 0.81 for males and 0.72 for females were found and their optimal cut-off values of CC were 35 cm for males and 33 cm for females. In addition, CC-based low muscle groups were correlated with physical functions even after adjusting for age and body mass index. Also, the cut-off value of CC for sarcopenia was 32 cm (AUC; male, 0.82 and female, 0.72). CONCLUSION: The optimal cut-off values of CC for low MM are 35 cm for males and 33 cm for females. Lower CC based on these cut-off values is related with poor physical function. CC may be also a good indicator of sarcopenia in Korean elderly.

Consuming Green Tea at Least Twice Each Day Is Associated with Reduced Odds of Chronic Obstructive Lung Disease in Middle-Aged and Older Korean Adults.

Background: The frequent consumption of green tea has been shown to have antioxidant and anti-inflammatory effects and to reduce the risk of lung cancer and type 2 diabetes. However, few studies have investigated the relation between green tea consumption and the risk of chronic obstructive lung disease (COPD). Objective: This study aimed to examine the association between green tea intake and COPD with the use of a nationwide representative database. Methods: This study was designed as a cross-sectional survey with the use of data from the Korean National Health and Nutritional Examination Survey collected between 2008 and 2015. Of these participants, 13,570 participants aged ≥40 y were included in the study population. COPD was defined as forced expiratory volume in 1 s (FEV1) divided by forced vital capacity (FVC) <0.70. Multiple linear and logistic regression models were used to examine the association between the frequency of green tea intake and risk of COPD after adjusting for age, sex, body mass index, smoking status, alcohol consumption, physical activity, and socioeconomic status. Results: The incidence of COPD decreased from 14.1% to 5.9% with increased frequency of green tea intake from never to ≥2 times/d (P < 0.001). In the fully adjusted multiple linear regression model, the frequency of green tea intake showed a linear dose-response relation with FEV1/FVC (P-trend = 0.031). In the multiple logistic regression model, the OR for COPD among people who consumed green tea ≥2 times/d was 0.62 (95% CI: 0.40, 0.97), compared with those who never drank green tea, after adjusting for all covariates. Conclusion: This study suggests that the consumption of green tea ≥2 times/d is associated with a reduced risk of COPD in Korean populations.

A study of satisfaction of medical students on their mentoring programs at one medical school in Korea.

PURPOSE: The purpose of this study was to investigate the awareness levels of medical students regarding the characteristics of each function within a mentoring program conducted within Kyung Hee University and to ultimately suggest points for reformation. Medical students' awareness levels were determined using a 29-item questionnaire. METHODS: The questionnaire was conducted on 347 medical students, excluding 25 students who either marked multiple answers or did not reply. The assessment of the program was based on a questionnaire with the use of a 5-point Likert scale using SPSS version 22.0. Multiple regression was conducted to examine the relationship between the satisfaction level, regarding functions of mentoring programs, and characteristics of mentoring programs. Interviews were conducted to supplement additional information that was hard to gain from the questionnaire. RESULTS: The results on demographic and functional characteristics revealed that there was no statistically significant differences in satisfaction levels across gender, whereas there were significant differences across grade levels. In addition, there were significant differences in the frequency of meetings and topics of conversation while the length of meetings and meeting place were not significantly different. CONCLUSION: For the improved mentoring programs for medical students, the program should focus on the frequency of meetings and the topics of conversation. Furthermore, mentoring programs of high quality can be expected if professors take interview results into consideration. Also, students want to be provided with psychosocial advice from mentors in various ways such as role model function.

A qualitative thematic content analysis of medical students' essays on professionalism.

BACKGROUND: Physicians in both Western and Eastern countries are being confronted by changes in health care delivery systems and medical professionalism values. The traditional concept of "In-Sul" (benevolent art) and the modern history of South Korea have led to cultural differences between South Korea and other countries in conceptualizing medical professionalism; thus, we studied medical students' perceptions of professionalism as described in essays written on this topic. METHODS: In 2014, we asked 109 first-year medical students who were enrolled in a compulsory ethics course to anonymously write a description of an instance of medical professionalism that they had witnessed, as well as reflecting on their own professional context. We then processed 105 valid essays using thematic content analysis with computer-assisted qualitative data analysis software. RESULTS: Thematic analysis of the students' essays revealed two core aspects of professionalism in South Korea, one focused on respect for patients and the other on physicians' accountability. The most common theme regarding physician-patient relationships was trust. By contrast, distributive justice was thought to be a non-essential aspect of professionalism. CONCLUSIONS: In Western countries, physicians tend to promote justice in the health care system, including fair distribution of medical resources; however, we found that medical students in South Korea were more inclined to emphasize doctors' relationships with patients. Medical educators should develop curricular interventions regarding medical professionalism to meet the legitimate needs of patients in their own culture. Because professionalism is a dynamic construct of culture, medical educators should reaffirm cultural context-specific definitions of professionalism for development of associated curricula.

Reliability and validity test of the Korean version of Noe's evaluation.

PURPOSE: This study aims to demonstrate whether the functionalities between the widely used questionnaire in other countries and the Korean-translated version show similarity. Also, it intends to verify their reliability and validity. METHODS: The original questionnaire was first developed by professor Noe at the University of Minnesota with 29 items named as "mentoring functions" to identify the participants' psychological and career-development functions. Using the Korean-translated version of the original questionnaire, the study was conducted on total 288 Kyung Hee University medical students, ranging from the first-year students to the third-year students on December 2015. In order to investigate if the survey form could be applied to the Korean participants, exploratory factor analysis and confirmatory factor analysis were conducted, using varimax rotation. Cronbach α statistics and the figures of standardized regression weights were analyzed respectively to indicate construct, convergent, and discriminant validities. RESULTS: The result of exploratory factor analysis shows there are a total of three functions, including the additional "friendship function" (Eigen value, 1.152; significant level if higher than 1.0) with its high emphasis. The result of confirmatory factor analysis also demonstrates the similarity (p=0.000). As the whole reliability scale of the three functions is significantly high (Cronbach α , 0.971), each reliability scales of the three functions are shown to be high (0.814-0.955) as well. CONCLUSION: The model, with its three functions, proved the significant statistics regarding the reliability and validity. According to this ground, the conclusion is that the adapted questionnaire used in this study could be applied to Korean medical students.

Patient safety competence for final-year health professional students: Perceptions of effectiveness of an interprofessional education course.

As final-year medical and nursing students will soon play key roles in frontline patient care, their preparedness for safe, reliable care provision is of special importance. We assessed patient safety competencies of final-year health profession students, and the effect of a 1-day patient safety education programme on these competencies. A cross-sectional survey was conducted with 233 students in three colleges of medicine, nursing, and traditional medicine in Seoul. A before-and-after study followed to evaluate the effectiveness of the curriculum. Patient safety competency was measured using the Health-Professional Education for Patients Safety Survey (H-PEPSS) and an objective patient safety knowledge test. The mean scores were 3.4 and 1.7 out of 5.0, respectively. The communication domain was rated the highest and the teamwork domain was rated the lowest. H-PEPSS scores significantly differed between the students from three colleges. The 1-day patient safety education curriculum significantly improved H-PEPSS and knowledge test scores. These results indicated that strengthening patient safety competencies, especially teamwork, of students is required in undergraduate healthcare curricula. A 1-day interprofessional patient safety education programme may be a promising strategy. The findings suggest that interprofessional patient safety education needs to be implemented as a core undergraduate course to improve students' safety competence.

The epidemiology and economic burden of Clostridium difficile infection in Korea.

The prevalence of Clostridium difficile infection and the associated burden have recently increased in many countries. While the main risk factors for C. difficile infection include old age and antibiotic use, the prevalence of this infection is increasing in low-risk groups. These trends highlight the need for research on C. difficile infection. This study pointed out the prevalence and economic burden of C. difficile infection and uses the representative national data which is primarily from the database of the Korean Health Insurance Review and Assessment Service, for 2008-2011. The annual economic cost was measured using a prevalence approach, which sums the costs incurred to treat C. difficile infection. C. difficile infection prevalence was estimated to have increased from 1.43 per 100,000 in 2008 to 5.06 per 100,000 in 2011. Moreover, mortality increased from 69 cases in 2008 to 172 in 2011. The economic cost increased concurrently, from $2.4 million in 2008 to $7.6 million, $10.5 million, and $15.8 million in 2009, 2010, and 2011, respectively. The increasing economic burden of C. difficile infection over the course of the study period emphasizes the need for intervention to minimize the burden of a preventable illness like C. difficile infection.

[Returning students' perspectives on adjusting to medical graduate school in Korea: an interview study].

PURPOSE: The recent trend of switching from medical graduate school to medical school in Korea raises questions about the adjustments that students must make in medical education. We examined the perceptions of medical graduate students with regard to their adaptation in medical education. METHODS: Sixteen semistructured, in-depth interviews were administered to medical graduate students who received their first degrees in foreign countries. The interviews addressed their perceptions of their experience in medical graduate school and on how well they adjusted to medical education. RESULTS: Students perceived their adaptation to medical graduate school in two dimensions: academic achievement and cultural adjustment. In academic achievement, a limited student-teacher relationship was recognized by students. Students tended to be passive in the classroom due to an uncomfortable atmosphere. They also reported witnessing culture shock in relation to the paucity of information on entrance into medical graduate school. Freshmen voiced many difficulties in adjusting to the unique culture in medical graduate school, in contrast to upper classmen. However, only 32% of students experienced helpful mentoring for their problems. CONCLUSION: Students' perspectives should guide all decisions made about medical education in an altered educational system.Self-regulated learning and a good mentoring program can help prepare students for medical education and professional life.

Blood cadmium levels are associated with a decline in lung function in males.

BACKGROUND: Cadmium exposure was found to cause a decline in lung function among the general population, but these findings were limited to smokers and gender differences were not explored. OBJECTIVES: To examine the relationship between cadmium and chronic obstructive pulmonary disease (COPD) according to gender and smoking status in Korea. METHODS: Cross-sectional data from the Korean National Health and Nutrition Examination Survey from 2008 to 2011 were analyzed. COPD was defined by a pre-bronchodilator forced expiratory volume in 1s divided by forced vital capacity of <0.70. A logistic regression model was used to elucidate the association between blood cadmium levels and COPD according to gender and smoking status. RESULTS: Among 3861 eligible participants, 3622 were included in the analysis. The prevalence of COPD demonstrated an increasing trend in males (P for trend<0.001), but not in females (P for trend=0.67). After adjusting for covariates, a higher blood cadmium level, but within the normal range, was associated with COPD in males, including those who had never-smoked (P for trend <0.001 and P for trend=0.008). However, a higher blood cadmium level was not significantly associated with COPD in females, including those who had never smoked (P for trend=0.39 and P for trend=0.43). CONCLUSIONS: A higher blood cadmium level, within the normal range, was associated with COPD in males, including those who had never smoked. However, there was no significant association between blood cadmium levels and COPD in females.

Educational effect of intraosseous access for medical students.

PURPOSE: The purpose of this study was to determine the educational effects of intraosseous (IO) vascular access for medical students and analyze the possibility of including IO access in medical education. METHODS: A before-and-after study was conducted in a course with 50 participating medical students. The course comprised a 1-hour didactic lecture and a 1-hour hands-on session with a battery-operated EZ-IO device (Vidacare Corp.) and artificial tibia. After the course, the participant skills were tested (final success rate, mean procedural time, and detailed skills) with regard to IO access. Before and after the course, the knowledge, possibility of clinical use, and adequacy of medical education on IO access were examined in a structured questionnaire. RESULTS: The final success rate of insertion was 88% (n=44), and the mean procedural time for the first trial was 78.1±20.6 seconds. "Combination needle with drill" and "proper angle during insertion" were the procedures that were performed the best, and "dressing on insertion site" was the worst-performed procedure. "Proper location of landmarks" was the only significant skill factor that was related to the success of IO access between those who succeeded and failed (p<0.05). In the analysis of the structured questionnaire, median knowledge score, possibility for clinical use, and adequacy of IO access in medical education increased significantly after the course (p<0.01). CONCLUSION: The educational effect of IO access for medical students was tremendous, and the knowledge of and attitude toward IO access improved significantly after the training course. We consider IO access to be adequate for medical education in Korea.

Changes of empathy in medical college and medical school students: 1-year follow up study.

BACKGROUND: This study aims to determine the correlation between medical education systems, medical college (MC) and medical school (MS), and empathy by investigating the changes in empathy among students with each additional year of medical education. METHODS: The subjects were MC and MS students who had participated in the same study the previous year. All participants completed the same self-report instruments: a questionnaire on sociodemographic characteristics, and the Korean edition of the Student Version of the Jefferson Scale of Empathy (JSE-S-K), Among 334 students, the final analysis was conducted on the data provided by 113 MC and 120 MS students, excluding 101 with incomplete data. RESULTS: The age and sex did not affect the changes in empathy. Though the JSE-S-K score of MS was significantly higher than that of MC in initial investigation, this study found no difference of empathy between MC and MS. CONCLUSION: Empathy increased significantly after one year of medical education. The difference between two education systems, MC and MS, did not affect the changes in empathy.

Relationship between body mass index and early menarche of adolescent girls in Seoul.

OBJECTIVES: The object of this study was to determine the relationship between body mass index (BMI) and early menarche in adolescent girls in Seoul. METHODS: A retrospective study was conducted with 144 middle school students in Seoul who provided informed consent. We measured their body composition, and used the questionnaire survey method for data collection from November to December 2008. Past elemental body composition data were collected from elementary school health records of first year of middle school. RESULTS: The early menarcheal group was taller and heavier than the late menarcheal group (p<0.05 from 8-12 years old). The body fat percentage (%), BMI were higher in the early menarcheal girls than the late-menarcheal girls (p<0.05, age at 13). In the result of multiple logistic regression, the BMI at the age of 8 and 9 was associated with early menarche after adjusting for birth weight, breast feeding and age at menarche of the mother (BMI at the age of 8: p for trend=0.01, BMI at the age of 9: p for trend=0.04). An increase in BMI from 7 to 8 year was associated with early menarche after adjusting for birth weight, breast feeding, age at menarche of the mother (p for trend=0.048). CONCLUSIONS: The BMI at the age of 8 and 9 was associated with the early menarche of girls and increase in BMI from 7 to 8 year was associated with the early menarche of girls. These results suggest that BMI and increase in BMI before menarche cause early menarche. Although this study does not represent all Korean adolescent girls, it is one of the few studies that have investigated the temporal relationship between BMI and early menarche.

Health and economic burden of major cancers due to smoking in Korea.

Cigarette smoking is one of the most important public health concerns in Korea and worldwide. A number of studies have been conducted to measure the health and economic burden of smoking, but these did not reflect recent changes such as the decrease in smoking rate and the increase in the incidence of cancer. The purpose of this study was to provide up-to-date estimates of the health and economic burden of cancer caused by smoking and to compare the results with those of previous studies. Cancer-related burden was assessed with nationally representative data such as claims data from the National Health Insurance Corporation, and cause of death records from the National Statistical Office and the Korea Health Panel. We determined the smoking-attributable burden by multiplying the smoking-attributable fraction by the total burden. As a result, the burden of major cancers due to smoking was found to be substantial despite a recent sharp decrease in smoking by the Korean population. The total economic cost reaches $2,234.0 million in males and $870.0 million in females. Also, the health burden of cancers due to smoking is 2,038.9 disability adjusted life years (DALYs) per 100,000 individuals in men and 732.2 DALYs per 100,000 individuals in women. Among all cancers, cancers of the trachea, lungs and bronchus are the leading causes of health and economic burden. The huge burden caused by cancers linked to smoking makes it imperative that adequate policies to decrease the prevalence of smoking be developed, particularly considering the recent increase in smoking rate among women.

Association of CFTR gene polymorphisms with papillary thyroid cancer.

The incidence of thyroid cancer has been on the increase in a number of countries, and certain genetic factors associated with the increased incidence of the papillary thyroid cancer (PTC) have been identified. However, little is known about the effect of mutations of the cystic fibrosis transmembrane conductance regulator (CFTR) gene, expressed in the thyroid. We hypothesized and investigated that CFTR single nucleotide polymorphisms (SNPs) may be associated with the risk and/or progression of PTC. A total of 105 PTC patients, confirmed by pathological tests, and 323 controls, without any thyroidal disease, were recruited. One promoter SNP (rs4148682) and one coding SNP (rs213950, Val470Met) in the CFTR gene were analyzed, using direct sequencing. The PTC patients were sub-grouped and compared by their clinical and pathological characteristics of PTC. The results showed that the association between SNPs in the CFTR gene and the development of PTC was statistically insignificant. However, in the clinical and pathological features, rs4148682 was found to be correlated with multifocal tumors, location and cervical node metastasis of PTC. rs231950 was also correlated with multifocal tumors, location and nodal metastasis of PTC. The G allele of rs213950 was correlated with increased risk of multifocal tumors and bilateral lobe location. However, in cervical lymph node metastasis, the A allele of rs213950 was found to reflect high risk. Our study suggests that the CFTR gene polymorphisms studied may not be associated with the development of PTC, but that rs4148682 and rs213950 may be associated with clinical features and prognosis, such as multifocality, location of cancer and cervical lymph node metastasis of PTC.

Socioeconomic costs of overactive bladder and stress urinary incontinence in Korea.

PURPOSE: We quantified and described the economic burden of overactive bladder and stress urinary incontinence in Korea. We calculated direct costs by identifying public and private data sources that contain population-based data on resource utilization by patients with stress urinary incontinence and overactive bladder. METHODS: For estimating indirect costs (productivity loss), the human capital approach was applied. Data were collected from several institutes, including the Health Insurance Review Agency. RESULTS: The estimated total economic cost in treating overactive bladder was 117 billion Korean Won (KRW, the currency of South Koea) in 2006 and 145 billion KRW in 2007. The estimated total cost in treating stress urinary incontinence was 122 billion KRW in 2006 and 59 billion KRW in 2007. CONCLUSIONS: By quantifying the total economic costs of overactive bladder and stress urinary incontinence, this study provides an important perspective in Korea. Because the average age of the Korean population is rapidly increasing, this study provides important information on the direct and indirect costs of overactive bladder and stress urinary incontinence for an aging society.

Relationship between socioeconomic variables and obesity in Korean adolescents.

BACKGROUND: Despite the importance of obesity and its association with socioeconomic status, little is known about this condition in Korean adolescents. We examined the relationship between obesity in Korean adolescents and several socioeconomic variables and compared the association of obesity with conventional and subjective indicators of socioeconomic status. METHODS: The study comprised 60 643 Korean adolescents aged 12 to 18 years who participated in the 2007 Korea Youth Risk Behavior Web-Based Survey. The dependent variable, obesity, and the independent variables of parental education levels, family affluence scale, subjective family economic status, and subjective school achievement were collected by using a self-administered anonymous questionnaire. Data on behavioral and psychological characteristics were also collected and used as confounding factors. Multivariate logistic regression was conducted to identify associations between socioeconomic status and obesity. RESULTS: In the descriptive analysis, adolescents with low parental education, low family affluence level, low subjective family economic status, and low subjective school achievement were more likely to be obese. However, after controlling for other risk factors in multivariate analysis, only the associations with subjective family economic status and subjective school achievement remained statistically significant. CONCLUSIONS: Our results provide further evidence that the prevalent pattern of obesity in Korean adolescents-i.e., the inverse relationship between obesity and socioeconomic status-is similar to that in developed countries. In addition, these findings support the hypothesis that, as compared with objective socioeconomic status, subjective social status is more closely related to obesity.