The effect of resource loss on depression and peritraumatic distress during the early period of the COVID-19: considering the pandemic-situational and social context.

BACKGROUND: The public experienced loss of resources, including their health and property during the COVID-19 pandemic. The Conservation of Resources (COR) theory is a useful tool to explain the effect of resource loss on mental health. This paper examines the effect of resource loss on depression and peritraumatic distress considering the situational and social context of the COVID-19 pandemic applying COR theory. METHODS: An online survey was conducted for Gyeonggi residents when the second wave of COVID-19 in South Korea declined (5 October to 13 October 2020); 2,548 subjects were included in the hierarchical linear regression analysis. RESULTS: COVID-19 infection-related experiences, resource losses (e.g., financial burden, deterioration of health, and decline of self-esteem), and fear of stigma were related to elevated levels of peritraumatic distress and depression. Risk perception was associated with peritraumatic distress. Reduced income or job loss were related to depression. Social support was a protective factor for mental health. CONCLUSIONS: This study suggests that we need to focus on COVID-19 infection-related experiences and loss of daily resources in order to understand mental health deterioration during the COVID-19 pandemic. Moreover, it is important to monitor the mental health of medically and socially vulnerable groups and those who have lost resources due to the pandemic and to provide them with social support services.

Development of a social distancing monitoring system in Republic of Korea: results of a modified Delphi process.

BACKGROUND: Social distancing policies work in different ways and at different levels. In addition, various forms of monitoring systems have been implemented in different countries. However, there is an almost complete lack of specific monitoring system in Republic of Korea to effectively monitor social distancing measures compliance and outcome. This study aims to develop a monitoring system for social distancing measures compliance and outcome in Korea to evaluate and improve the implemented policy. METHODS: A draft monitoring system was developed after reviewing Korea's social distancing measures (central and local government briefings) and checking available data about social distancing behavior. The modified Delphi process was used to evaluate the draft of the social distancing monitoring system. In total, 27 experts participated in the evaluation. The round 1 evaluation includes (1) commenting on the composition of the monitoring fields (open response), (2) monitoring indicators for each monitoring field (10-point Likert scale), and (3) commenting on the source of data used to develop the monitoring system (open response). In the round 2 evaluation, 55 indicators, excepting open responses, were re-evaluated. RESULTS: The response rate for the Delphi survey was 100% in both the first and second rounds. Of the 55 indicators, 1 indicator, which did not satisfy the quantitative criteria, was excluded. According to the experts' open response comments, 15 indicators were excluded, as these indicators overlapped with other indicators or had little relevance to social distancing. Instead, 23 new indicators were added. Finally, 62 indicators were included with 12 available data sources. The monitoring system domain was divided into 'social distancing measures state, social distancing measures compliance, social distancing outcome'. CONCLUSIONS: This study is significant in that it is the first in Korea to develop a comprehensive monitoring system for checking if social distancing measures are being followed well, and is applicable to estimates utilizing data that are immediately available for each indicator. Furthermore, the developed monitoring system could be a reference for other countries that require the development of such systems to monitor social distancing.

Thermosensitive core-rigid micelles of monomethoxy poly(ethylene glycol)-deoxy cholic acid.

BACKGROUND: Thermosensitive micelles with rigid cores that exhibit a reversible lower critical solution temperature at 30-35 °C can be applied for drug delivery. METHOD: Hydrophilic monomethoxy poly(ethylene glycol) was conjugated to hydrophobic deoxycholic acid to prepare monomethoxy poly(ethylene glycol)-deoxycholic acid (mPEG-DC). Micelle formation and thermosensitive solution behavior were studied using various methods, including hydrophobic dye solubilization, transmission electron microscopy, dynamic light scattering, turbidity measurement, microcalorimetry, and 1H-NMR spectroscopy. Drug release from the thermosensitive micelles was demonstrated using estradiol, a model drug. RESULTS: The mPEG-DC formed micelles with a critical micelle concentration of 0.05 wt.% and an average size of 15 nm. Aqueous mPEG-DC solutions exhibit a lower critical solution temperature (LCST) that is independent of concentration and reversible over heating and cooling cycles. The LCST transition is an entropically driven process involving dehydration of the PEG shell. The thermosensitive mPEG-DC micelles with rigid DC cores were applied as an estradiol delivery system in which estradiol was released, without initial burst, over the 16 days in a diffusion-controlled manner. CONCLUSIONS: This study suggests that mPEG-DCs form thermosensitive micelles with rigid cores that can function as an excellent diffusion-controlled hydrophobic drug delivery system without initial burst release. Thermosensitive core-rigid micelles of monomethoxy poly(ethylene glycol)-deoxy cholic acid.

Burnout and peritraumatic distress of healthcare workers in the COVID-19 pandemic.

BACKGROUND: To evaluate the current status of emotional exhaustion and peritraumatic distress of healthcare workers (HCWs) in the COVID-19 pandemic, and identify factors associated with their mental health status. METHODS: An online survey involving 1068 of consented HCWs that included nurses, physicians, and public health officers was conducted in May 2020. Descriptive statistics and multivariate regression analyses were performed on the collected data. RESULTS: Although no significant difference in peritraumatic distress was observed among the surveyed HCWs, the workers' experience of emotional exhaustion varied according to work characteristics. Respondents who were female, older, living with a spouse, and/or full-time workers reported higher levels of emotional exhaustion. Public health officers and other medical personnel who did not have direct contact with confirmed patients and full-time workers had a higher level of peritraumatic distress. Forced involvement in work related to COVID-19, worry about stigma, worry about becoming infected, and perceived sufficiency of organizational support negatively predict emotional exhaustion and peritraumatic distress. CONCLUSIONS: Job-related and emotional stress of HCWs should not be neglected. Evidence-based interventions and supports are required to protect HCWs from mental illness and to promote mental health of those involved in the response to the COVID-19 pandemic.

The Development and Operation of a Home Management System during the COVID-19 Pandemic: Experience of the Local Government Gyeonggi-do in Korea.

During the three the coronavirus disease 2019 (COVID-19) surges in South Korea, there was a shortage of hospital beds for COVID-19 patients, and as a result, there were cases of death while waiting for hospitalization. To minimize the risk of death and to allow those confirmed with COVID-19 to safely wait for hospitalization at home, the local government of Gyeonggi-do in South Korea developed a novel home management system (HMS). The HMS team, comprised of doctors and nurses, was organized to operate HMS. HMS provided a two-way channel for the taskforce and patients to monitor the severity of patient's condition and to provide healthcare counseling as needed. In addition, the HMS team cooperated with a triage/bed assignment team to expedite the response in case of an emergency, and managed a database of severity for real-time monitoring of patients. The HMS became operational for the first time in August 2020, initially managing only 181 patients; it currently manages a total of 3,707 patients. The HMS supplemented the government's COVID-19 confirmed case management framework by managing patients waiting at home for hospitalization due to lack of hospital and residential treatment center beds. HMS also could contribute a sense of psychological stability in patients and prevented the situation from worsening by efficient management of hospital beds and reduction of workloads on public healthcare centers. To stabilize and improve the management of COVID-19 confirmed cases, governments should organically develop self-treatment and HMS, and implement a decisive division of roles within the local governments.

Risk factors for herpes zoster in patients with rheumatic diseases: a nationwide cohort study in Korea.

OBJECTIVE: To determine the risk factors for herpes zoster (HZ) in patients with rheumatic diseases in Korea. METHODS: We used the nationwide database of the Health Insurance Review & Assessment Service to analyse patients aged ≥20 years who had visited a hospital more than twice for rheumatic disease as a principal diagnosis from January 2009 to April 2013. HZ was identified using HZ-related Korean Standard Classification of Diseases 6 (KCD-6) codes and the prescription of antiviral agents. The relationship between demographics, comorbidities and medications and HZ risk was analysed by Cox proportional hazards models. RESULTS: HZ developed in 1869 patients. In Cox proportional hazards models, female sex but not age showed an increased adjusted hazard ratio (HR) for HZ. Comorbidities such as haematologic malignancies, hypertension, diabetes mellitus, and chronic lung and liver diseases led to an increased HR. HZ risk was higher in patients with SLE (HR: 4.29, 95% CI: 3.49, 5.27) and Behçet's syndrome (BS, HR: 4.54; 95% CI: 3.66, 5.64) than with RA. The use of conventional DMARDs, immunosuppressants, TNF inhibitors, glucocorticoids and NSAIDs increased the HR. Infliximab and glucocorticoids (equivalent prednisolone dose >15 mg/day) produced the highest HZ risk (HR: 2.91, 95% CI: 1.72, 4.89; HR: 2.85, 95% CI: 2.15, 3.77, respectively). CONCLUSION: Female sex, comorbidities and medications increased HZ risk in patients with rheumatic diseases and even young patients could develop HZ. Compared with RA, SLE and BS are stronger HZ risk factors. Patients with rheumatic diseases and these risk factors are potential target populations for HZ vaccination.

Recommendation for response to the COVID-19 pandemic: Korean context of "distancing in daily life," considering vulnerable population.

While the coronavirus disease 2019 (COVID-19) pandemic is an ongoing worldwide, including South Korea (hereinafter Korea), it is impossible to predict the duration of the pandemic. To stop the spread of COVID-19, "social distancing," which included mandatory lockdown, and attention to personal hygiene are being adopted globally as non-pharmaceutical preventive strategies. In Korea, after maintaining strong social distancing rules for a while, the government transitioned to implementing "distancing in daily life" since May 6, 2020. The distancing in daily life was combined with infection prevention activities to stop the COVID-19 pandemic, while guaranteeing one's daily life and economic activities.In this regard, the Ministry of Health and Welfare in Korea disclosed key rules for personal quarantine. The five key rules for individual infection control are as follows: to stay at home for 3-4 days if you feel unwell, keep a distance of two arms' length from others, to wash your hands for 30 s and cough or sneeze into your sleeves, ventilate at least twice a day and disinfect regularly, and stay connected while physically distancing. However, for vulnerable populations, it is very difficult to follow such rules.Thus, we attempted to recommend how the society could support such vulnerable populations who may face difficulties in following these individual infection control rules. Through our recommendations for the weakest part of our society, we expect to strengthen the overall social structure.

Association of Cigarette Prices with the Prevalence of Smoking in Korean University Students: Analysis of Effects of the Tobacco Control Policy.

BACKGROUND: Increased pricing of cigarettes might be one of the most effective approaches for reducing the prevalence of smoking. This study aimed to investigate the effects of increasing cigarette prices through taxation by a tobacco intervention policy on the changes in smoking prevalence in Korean university students. MATERIALS AND METHODS: The participants in this study were 23,047 healthy university students aged 18-29 years from a health examination in 2011-2015. We investigated the adjusted prevalence of daily and occasional smoking before and after increasing cigarette prices through taxation. RESULTS: The prevalence of occasional smoking was significantly decreased in 2015 from 2014 in both male (from 10.7% in 2014 to 5.4%) and female (from 3.6% to 1.1%) students, but the prevalence of daily smoking did not decrease significantly. The frequency of individuals who had attempted smoking cessation during the past year was significantly higher among occasional smokers in male students (90.2%) compared with daily smokers (64.9%). For female students, there were no differences in experience of smoking cessation, willingness for smoking cessation, or E-cigarette experience between daily and occasional smokers. CONCLUSIONS: We found that a policy of increasing cigarette prices through taxation is associated with decreases in the prevalence of occasional smokers, who have relatively lower nicotine dependence compared with individuals who smoke daily. The results of our study suggest that social support and direct intervention for smoking cessation at the community level are needed for university students alongside the pricing policy.

Modern outcome and risk analysis of surgically resected occult N2 non-small cell lung cancer.

BACKGROUND: This study was performed to assess the incidence, survival, and risk factors associated with unsuspected pathologic N2 disease in patients with resectable clinical N0-1 non-small cell lung cancer. METHODS: Between January 2002 and December 2010, 1,821 patients with clinical N0-1 non-small cell lung cancer underwent pulmonary resection and mediastinal lymph node dissection. Clinical outcomes and risk factors for pathologic N2 disease were retrospectively analyzed for this cohort. RESULTS: Unsuspected pathologic N2 disease was identified in 196 patients (10.8%). The most common type of resection was lobectomy (81.6%). Adjuvant therapy was administered in 177 patients (90.3%). The median follow-up time was 28 months (range, 1 to 101 months). N2 involvement was single-station in 121 (66.8%) and multiple-station in 65 (33.2%). The 5-year overall and disease-free survival rates were 56.1% and 35.0%, respectively. The 5-year survival rates of single-station and multiple-station N2 were 66.6% and 36.4%, respectively (p < 0.001). Adenocarcinoma, clinical N1, tumor size (>3 cm), and a right middle lobe tumor were identified as independent risk factors for unsuspected multiple-station N2 disease by multivariate analysis. Incidence of unsuspected multiple-station N2 disease in low-risk classes (aggregate score, 0 to ≤2) was only 5.5%. CONCLUSIONS: The incidence of unsuspected N2 disease in our cohort was similar to that of previous reports. Survival outcomes were favorable for unsuspected single-station N2 disease but were poor for unsuspected multiple-station N2 disease. Clinical N0-1 non-small cell lung cancer patients with risk class of low score for unsuspected multiple-station N2 disease can be exempted from aggressive mediastinal staging.