Adherence to general medical checkup and cancer screening guidelines according to self-reported smoking status: Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2012.

OBJECTIVES: The National Lung Screening Trial (NLST) revealed that low-dose computed tomography (LDCT) screening could reduce lung cancer mortality in heavy smokers. Lung screening with LDCT was implemented in July 2019 as part of the National Cancer Screening Program in Korea for heavy smokers who meet NLST criteria [smokers aged 55-74 years with 30 pack-years (PY) or more, excluding former smokers with more than 15 years since smoking cessation]. This study evaluated NLST-eligible heavy smokers' adherence to general medical checkup and cancer screening guidelines. METHODS: Using the Korea National Health and Nutrition Examination Survey (KNHANES) from 2010 to 2012, we compared adherence of Korean adults (55-74 years, n = 5,480) to general medical checkup and cancer (gastric, colorectal, breast, and cervical) screening guidelines according to self-reported smoking status. Smoking and PY data were available, but no data indicating when former smokers ceased smoking were available. Accordingly, smoking status was only classified as NLST (smokers with a history ≥ 30 PY) and non-NLST. Individuals who met NLST criteria were subdivided into current (NLST-current) and former smokers (NLST-former). Multivariable logistic regression was used to evaluate adherence to screening recommendations as a function of the study group (NLST-current, NLST-former, non-NLST) using possible covariates (sociodemographic factors, health-related behaviors, comorbidities, and self-reported health status). RESULTS: Weighted prevalence of NLST-current was 9.7%, of NLST-former was 9.6%, and of non-NLST was 80.7%. Overall screening rates were 70.7% (medical checkup), 59.1% (stomach cancer), 58.1% (colorectal cancer), 59.1% (breast cancer), and 48.9% (cervical cancer). Adherence to colorectal cancer screening and medical checkup was lower in NLST-current than non-NLST (AOR 0.59; 95% CI 0.44-0.78 for colorectal cancer; AOR 0.70; 95% CI 0.52-0.95 for medical checkup). Screening practices for other cancers were not different. CONCLUSIONS: Current heavy smokers meeting NLST criteria were less likely to have colorectal cancer screening or general medical checkup. Understanding the screening practices of this target population might enable the development of more effective plans to implement lung screening and improve screening compliance for other cancers.

Association between shift work and suicidal ideation: data from the Korea National Health and Nutrition Examination Survey (2008-2016).

Objective Studies on the relationship between shift work and suicidal ideation are scarce. This study aimed to investigate the impact of shift work on suicidal ideation using a nationwide representative sample from the Korean working population. Methods The association between shift work and suicidal ideation was determined using data in 17 756 Korean workers over 19 years of age with fixed work schedules. These data were collected from the nationwide cross-sectional Korean National Health and Nutrition Examination Survey (2008-2016). The odds ratios (OR) and 95% confidence intervals (CI) for suicidal ideation were calculated by sex and age using multiple logistic regression models. Results Approximately 14% of included participants were classified as shift workers. Among male workers, evening and night shift workers had a significantly increased risk of suicidal ideation compared to day workers after adjusting for demographics, lifestyle factors, comorbidities, number of work hours, and occupational type (OR 1.89, 95% CI 1.25-2.88 for evening-fixed workers and OR 1.38, 95% CI 1.03-1.86) for night-fixed workers]. Age-stratified analyses indicated that shift workers were more likely to report suicidal ideation than day workers in young and middle-aged groups. Conclusion Evening and night shift work is associated with higher suicidal ideation among male workers.

Development of Protocol for Korean Lung Cancer Screening Project (K-LUCAS) to Evaluate Effectiveness and Feasibility to Implement National Cancer Screening Program.

PURPOSE: To reduce lung cancer mortality, lung cancer screening was recommended using low-dose computed tomography (LDCT) to high-risk population. A protocol for multicenter lung cancer screening pilot project was developed to evaluate the effectiveness and feasibility of lung cancer screening to implement National Cancer Screening Program in Korea. MATERIALS AND METHODS: Multidisciplinary expert committee was comprised to develop a standardized protocol for Korean Lung Cancer Screening Project (K-LUCAS). K-LUCAS is a population-based single arm trial that targets high-risk population aged 55-74 years with at least 30 pack-year smoking history. LDCT results are reported by Lung-RADS suggested by American Radiology Society. Network-based system using computer-aided detection program is prepared to assist reducing diagnostic errors. Smoking cessation counselling is provided to all currently smoking participants. A small pilot test was conducted to check the feasibility and compliance of the protocols for K-LUCAS. RESULTS: In pilot test, 256 were participated. The average age of participants was 63.2 years and only three participants (1.2%) were female. The participants had a smoking history of 40.5 pack-year on average and 53.9% were current smokers. Among them, 86.3% had willing to participate in lung cancer screening again. The average willingness to quit smoking among current smokers was 12.7% higher than before screening. In Lung-RADS reports, 10 (3.9%) were grade 3 and nine (3.5%) were grade 4. One participant was diagnosed as lung cancer. CONCLUSION: The protocol developed by this study is assessed to be feasible to perform K-LUCAS in multicenter nationwide scale.

A Possible Case of Statin-Induced Ichthyosis in an Elderly Woman.

Ichthyosis is a heterogeneous group of hereditary or acquired skin disorders, characterized by increased stratum corneum production. Several systemic diseases and many drugs can occasionally cause acquired ichthyosis. We report a case of statin-induced ichthyosis in which the causality between statin and ichthyosis was found possible by using the Naranjo scale. A 79-year-old woman presented with pruritic skin lesions on both legs that appeared erythematous, scaly, and cracked. A clinical diagnosis of acquired ichthyosis was made and the statin was suspected as the cause. The skin lesions improved after 6 weeks of dose reduction of the statin.

Effect of Influenza Vaccination on Risk of Stroke: A Systematic Review and Meta-Analysis.

BACKGROUND: Despite the presence of a strong association between influenza infection and stroke, whether influenza vaccination reduces the risk of stroke is yet a matter of controversy. We conducted a meta-analysis to determine whether influenza vaccination protects against stroke. METHODS: We searched PubMed, EMBASE, and the Cochrane Library from database inception date to November 18, 2016, without language restrictions, to identify studies investigating the effect of influenza vaccination on subsequent risk of stroke. We conducted a meta-analysis to quantify the risk of stroke in overall and subgroup analyses and calculated a pooled OR for developing stroke with a 95% CI. Publication bias was assessed by Begg's rank correlation test. RESULTS: Eleven studies fulfilled our inclusion criteria. In a random-effects model, vaccinated individuals had a decreased risk of stroke compared with unvaccinated individuals (OR 0.82; 95% CI 0.75-0.91; p < 0.001). The relationship between influenza vaccination and stroke risk remained robust in subgroup analyses. The significant effect of influenza vaccination was associated with ascertainment of vaccination status and stage of prevention. CONCLUSION: Vaccination against influenza is associated with a lower risk of stroke. Well-designed prospective studies are needed to provide stronger evidence of the protective effect of influenza vaccination against stroke.

Does Weight Gain Associated with Thiazolidinedione Use Negatively Affect Cardiometabolic Health?

Thiazolidinediones (TZDs) are oral anti-diabetic drugs that are peroxisome proliferator-activated receptor gamma (PPARγ) agonists and act as insulin sensitizers. The clinical efficacy and durability of the currently available TZDs in improving glycemic control are well established. However, TZDs cause weight gain, which has been thought to be a class effect of TZDs. TZD-associated weight gain may result mainly from increased fat mass and fluid retention and may be in part congruent to the mechanism of action of TZD. Increases in fat mass are almost exclusively limited to subcutaneous fat, while there are no effects or even decreases in visceral fat. Insulin resistance and cardiovascular risk associated with fat accumulation (obesity) depend on body fat distribution, with visceral fat associated with insulin resistance and a greater degree of risk than subcutaneous fat. Therefore, despite TZD-associated weight gain, TZDs are less likely to confer an increased risk of insulin resistance and cardiovascular complications. As patients with diabetes are younger and/or more obese in Korea, TZDs may be a cost-effective treatment option, offering a unique insulin-sensitizing action and good durability for the long-term management of type 2 diabetes.

Association between blood lead levels and blood pressures in a non-smoking healthy Korean population.

OBJECTIVE: The Korea National Health and Nutrition Examination Survey (KNHANES) has been performed every 3 years in Korea to help prevent cardiovascular mortality in the general population. Previous studies showed an association between blood lead levels and cardiovascular mortality. In order to assess the relationship between blood lead concentration and blood pressure in the healthy general population, we investigated whether blood lead levels were related to blood pressure in a non-smoking healthy population without any known medical diseases in the 2013 KNHANES. METHODS: 896 (mean age 40.55±13.83 years; body mass index 23.06±3.33 kg/m2) subjects who had no known diseases were included among 8018 subjects. Exclusion criteria were: hypertension, diabetes, hyperlipidaemia, cerebrovascular events, renal insufficiency, liver cirrhosis, thyroid dysfunction, any cardiovascular or renal disease, and any malignancy. Blood pressures were measured three times by sphygmomanometers, 5 min apart. Blood pressures were then expressed as the average between the second and third values. Height, weight, waist circumferences and blood pressure, as well as total cholesterol, high density lipoprotein cholesterol, triglycerides, low density lipoprotein cholesterol, aspartate aminotransferase (AST), alanine aminotransferase (ALT), white blood cell count and blood lead levels were measured. In addition, dietary components were analysed by 24 hour recall. RESULTS: The association between log blood lead levels and systolic/diastolic pressure was stronger after it was controlled for age, sex, education, body mass index (BMI), waist circumference and fasting plasma glucose (FPG) (p=0.048, 0.002). Furthermore, the association between log blood lead levels and systolic pressure (p=0.048) and diastolic pressure (p=0.002) was more evident when controlled for age, sex, education, BMI, waist circumference, FPG, AST and ALT. CONCLUSIONS: Blood lead levels are significant determinants of systolic and diastolic blood pressure in a healthy Korean population, irrespective of sociodemographic factors and metabolic derangements.

HEPATIC VISCERAL LARVA MIGRANS DUE TO TOXOCARA CANIS IN A 72-YEAR-OLD MAN.

Hepatic toxocariasis is visceral larva migrans caused by Toxocara. We report a case of hepatic toxocariasis detected incidentally during a health checkup. The patient had elevated levels of eosinophils, total IgE, and anti-Toxocara IgG antibodies. On contrast-enhanced computed tomography (CT) imaging he had a single, 2.16 cm, oval, ill-defined, low-attenuation hepatic nodule which was best appreciated during the portal venous phase of the scan. Clinicians should consider hepatic toxocariasis as a possible diagnosis in any individual who presents with eosinophilia of unknown etiology and an ill-defined hepatic lesion on CT imaging.

Association between the emotional status of family caregivers and length of stay in a palliative care unit: A retrospective study.

OBJECTIVE: Several factors associated with referral time to hospice and/or palliative care services have been identified, but there is no literature on the association between these services and the emotional status of the family caregivers (FCs). This article is intended to address that issue. METHOD: A semistructured interview was employed to collect data for a retrospective cohort study. The primary FCs of terminally ill cancer patients were interviewed at the time of the patient's referral to the palliative care unit. Interview data were combined with patients' medical record data for our analysis. The emotional status of the FCs was categorized into one of three groups according to their responses to the anticipated death of their family member: acceptance, anxious/depressed, and denial/angry. A Cox proportional hazard model was used to examine and identify the factors related to the length of stay (LOS) in the palliative care unit. RESULTS: A total of 198 patient-FC pairs were identified. The median LOS was 18 days. A multivariate analysis with adjustment for potential variables revealed significant differences in LOS according to cancer type and time since cancer diagnosis. The denial/angry FC category was independently associated with a shorter LOS (vs. acceptance, adjusted hazard ratio (aHR) 2.11; 95% confidence interval (CI), 1.11-4.03). SIGNIFICANCE OF RESULTS: We found that terminally ill cancer patients who were referred late had FCs who were in denial or were angry about the anticipated death of their loved one. The emotional status of FCs should be considered when patients with terminal cancer are referred to palliative care.

Relationship between indices of obesity obtained by anthropometry and dual-energy X-ray absorptiometry: The Fourth and Fifth Korea National Health and Nutrition Examination Survey (KNHANES IV and V, 2008-2011).

BACKGROUND: Body mass index (BMI), waist circumference (WC), and even dual-energy X-ray absorptiometry (DXA) are used for obesity diagnosis. However, it is not known which DXA-derived index of obesity correlates best with BMI and/or WC and it is not clear whether such an index is accurate or not. OBJECTIVES: The aim of this study is to show the relationship between anthropometric measurements (BMI, WC) and body fat indices from DXA and to determine which DXA indices are strongly related to BMI and WC. SUBJECTS: This study was based on data obtained from the Fourth and Fifth Korea National Health and Nutrition Examination Survey (KNHANES IV-V). DXA measurements were performed on survey subjects over 10 years old from July 2008 through to May 2011. Of these, 18 198 individuals, aged 19 years and older for whom DXA data were available, were included. METHODS: Weighted Pearson's correlated coefficients (r) were calculated among indices, according to sex, age group and menopause, and the coefficients were compared with each other. RESULTS: BMI correlates most with trunk body fat mass in kg (r=0.831) and then with total body fat in kg (r=0.774, P<0.00043 for difference of r). In the older age group, BMI correlates with total body fat mass (r=0.822) better than with trunk fat mass (r=0.817, P<0.00043). WC correlates with trunk body fat mass most in both genders and all age groups (0.804≤r≤0.906). Correlations of BMI (r=0.645 for men, 0.689 for women) and WC (r=0.678 for men, 0.634 for women) to body fat percentages (%) were less robust than those to body fat mass. CONCLUSIONS: BMI and WC reflect trunk and total body fat in kg more than body fat percentage derived by DXA.

Obesity explains gender differences in the association between education level and metabolic syndrome in South Korea: the results from the Korean National Health and Nutrition Examination Survey 2010.

This study aimed to examine the association of educational level with metabolic syndrome (MS) and its risk factors by gender in South Korea. A total of 6178 participants aged 20 years or older from The Fifth Korean National Health and Nutrition Examination Survey were included in this study. A generalized linear model and adjusted proportion were used to identify educational disparities in MS, its components, and its risk factors (smoking, high-risk alcohol consumption, obesity, and stress). In women, a clearly inverse association between education level and MS were observed with significant trend, and the decreasing trends of all risk factors across education quartiles were in line with the inverse association. However, the association between education level and MS was not observed with a significant trend among men. An opposite trend of risk factors across education levels was shown in men, with an increasing trend for obesity and decreasing trends for smoking and high-risk alcohol consumption. These findings demonstrate that obesity can explain gender differences in the association between education level and MS in South Korea.

Association of arterial stiffness and osteoporosis in healthy men undergoing screening medical examination.

BACKGROUND: Association of arterial stiffness and osteoporosis has been previously reported in women. However, this association is still controversial for men. Therefore, we investigated correlation of arterial stiffness and osteoporosis by measuring brachial-ankle (ba) pulse wave velocity (PWV) and bone mineral density (BMD). METHODS: We reviewed medical charts of 239 people (women: 128, men: 111) who visited the Health Promotion Center, retrospectively. ba-PWV was measured by automatic wave analyzer. Lumbar spine (L1-L4) BMD and femur BMD were measured by dual energy X-ray absorptiometry. Metabolic syndrome was based on the National Cholesterol Education Program (NCEP)-Adult Treatment Panel (ATPIII) definition. Body mass index (BMI)>25 kg/m(2) was used instead of waist circumference. RESULTS: In Pearson's correlation analysis, PWV and femur BMD (Neck, total) had a significant inverse relationship in men (r=-0.254, P=0.007; r=-0.202, P=0.034). In women, PWV and the L-spine, femur (Neck, total) had a significant inverse relationship. (r=-0.321, P<0.001; r=-0.189, P=0.032; r=-0.177, P=0.046) Age and PWV showed the greatest association in both men and women (r=0.46 P<0.001; r=0.525, P<0.001) In multiple regression analysis, the L-spine BMD and PWV had an independent relationship in women after adjusting for age, metabolic syndrome, BMI, smoking, drinking and exercise. (r=-0.229, P=0.015). No independent association was found between PWV and BMD in men. CONCLUSIONS: The association between arterial stiffness and BMD was confirmed in women. However, this association was not statistically significant for men.

Influence of eating behaviors on short-term weight loss by orlistat and anorectic agent.

Little data exists concerning whether eating behaviors determine the response to orlistat treatment, especially with added anorectic agents. This study was a sub-investigation of a 12-week randomized controlled trial for the additive effect of orlistat on sibutramine treatment. The analysis presented here was restricted to 98 women who had fulfilled the protocol. The Dutch eating behavior questionnaire and three-factor eating questionnaire were used to assess eating behaviors. Scores of emotional eating, external eating, disinhibition and hunger are significantly interrelated. Using multiple logistic analysis with adjustment for potential confounders, such as age, initial BMI and the other 2 eating behavior scores, traits of emotional eating (OR 0.30, 95% CI 0.13-0.74) and disinhibition (OR 0.61, 95% CI 0.40-0.82) have a significant influence on prediction for additional 5% weight loss in the treatment with orlistat and sibutramine. Subjects with less vulnerability to emotional cues had significantly more weight loss with orlistat treatment and anorectic agents.

Effects of CYP3A5, CYP2C19, and CYP2B6 on the clinical efficacy and adverse outcomes of sibutramine therapy: a crucial role for the CYP2B6*6 allele.

BACKGROUND: Various cytochrome P450 isoforms modulate sibutramine activity and influence sibutramine plasma levels and pharmacokinetics. However, there are no available data to demonstrate the association of these polymorphisms with the clinical outcomes of sibutramine administration. METHODS: This study was a sub-investigation of a 12-week, double-blind, placebo-controlled trial examining the additive effect of orlistat on sibutramine. The final analysis was restricted to 101 women who had fulfilled the protocol. We evaluated the effects of genetic polymorphisms of CYP3A5, CYP2C19 and CYP2B6 on the % weight loss and the occurrence of adverse events. RESULTS: The change of pulse rate from baseline value was affected by both CYP2B6 and CYP3A5 genetic polymorphisms (P<.01 for CYP3A5 and P=.01 for CYP2B6). Both CYP2B6 and CYP3A5 showed gene-gene interactions (P<.01). After adjusting for significant variables in the backward stepwise regression model, the change of pulse rate and time-dependent weight reduction were significant only among the CYP2B6 genotypes (P=.027 and P<.01, respectively). CONCLUSION: The CYP2B6*6 allele influences the extent of weight reduction and pulse rate changes in patients undergoing sibutramine treatment.

Association of oral health behaviors and status with depression: results from the Korean National Health and Nutrition Examination Survey, 2010.

OBJECTIVE: To examine the association of depression with oral health behaviors and oral health status in a large nationwide sample of Korean adults. METHODS: This study included 6,139 participants aged 19 years or older who participated in the fifth Korean National Health and Nutrition Examination Survey. Binary and polychotomous logistic regression analyses were used to estimate adjusted odds ratios (AORs) and 95 percent confidence intervals (CIs). RESULTS: Participants with lifetime depression (self-report of past or present depression) brushed their teeth less frequently (AOR = 1.30, 95 percent CI 1.03-1.65) and were more likely not to receive treatment when experiencing dental problems (AOR = 1.43, 95 percent CI 1.23-1.66) than those without lifetime depression after adjusting for sociodemographic factors, gender, and age. After adjusting for significant oral health behaviors, current smoking status, and sociodemographic factors, participants with lifetime depression had poorer oral health status than those without this disorder: uncomfortable mastication (AOR = 1.25, 95 percent CI 1.05-1.50), toothache (AOR = 1.18, 95 percent CI 1.01-1.39), temporomandibular joint symptoms (AOR = 1.41, 95 percent CI 1.08-1.85), and maxillary periodontal bleeding (AOR = 1.29, 95 percent CI 1.03-1.61 for the right side; AOR = 1.40, 95 percent CI 1.13-1.74 for the left side). CONCLUSION: Depression was significantly associated with oral health status, even after adjusting for the impact of oral health behaviors in Korean adults. Thus, our findings suggest the necessity of further investigation to detect underlying mechanisms in the relationship between depression and oral health that are not mediated by oral health behavior.

What are patient factors associated with the quality of diabetes care?: results from the Korean National Health and Nutrition Examination Survey.

BACKGROUND: Recently there has been a growing interest in healthcare quality control in Korea. We examined the association between patient factors and quality indicators of diabetic care among Korean adults with diabetes. METHODS: We obtained a sample of 335 adults aged 20 or older diagnosed with diabetes from the 2005 Korean National Health and Nutrition Examination Survey. Patient factors were divided into two categories: socioeconomic position and health-related factors. Quality indicators for diabetes care were defined as receiving preventive care services for diabetes complications (e.g., fundus examination, microalbuminuria examination, diabetes education) and diabetes-related clinical outcomes (e.g., HbA1c, blood pressure, LDL-cholesterol). We performed multiple logistic regression analyses for each quality indicator. RESULTS: We found that people with lower education levels or shorter duration of diabetes illness were less likely to receive preventive care services for diabetes complications. Women or people with longer duration of diabetes were less likely to reach the glycemic target. Obese diabetic patients were less likely to accomplish adequate control of blood pressure and LDL-cholesterol. CONCLUSIONS: Several factors of patients with diabetes, such as education level, duration of illness, gender, and obesity grade are associated with the quality of diabetes care. These findings can help inform policy makers about subpopulations at risk in developing a public health strategy in the future.

Factors associated with the use of uterine cervical cancer screening services in korean elderly women.

BACKGROUND: The Papanicolaou (Pap) smear test is an effective screening test for the early detection of uterine cervical cancer. The Pap test still plays an important role in Korean elderly women, as uterine cervical cancer remains a frequent form of cancer and an important cause of death. However, the participation rate and other factors related to the Pap test in Korean elderly women have been studied insufficiently. METHODS: This study included 654 individuals aged 65 and over who completed a cervical cancer screening questionnaire from the Third Korean National Health and Nutrition Examination Survey 2005. Using multiple logistic regression, odds ratios and confidence intervals for the association between attendance of the Pap test and sociodemographic or health-related factors were calculated. RESULTS: One hundred and eleven individuals (17.0%) of the study population showed compliance with Pap testing within the previous 2 years. We recognized that the most elderly women (75 years and over) or those with lower levels of education were less likely to have had the test. CONCLUSION: Primary health care providers need to make efforts to improve attendance rates of Pap smear screening in Korean elderly women, individually taking into account previous Pap results, life expectancy, risk factors for cervical cancer, and preferences. More attention will especially be needed among the eldest elderly or less educated elderly women.

Disparities in health-risk behaviors, preventive health care utilizations, and chronic health conditions for people with disabilities: the Korean National Health and Nutrition Examination Survey.

OBJECTIVE: To examine how disability status is related with health disparities in South Korea. DESIGN: The study compared 3 indicators of health (health-risk behaviors, preventive health care utilizations, and chronic health conditions) according to the presence of disabilities using the Third Korean National Health and Nutrition Examination Survey, 2005 (KNHANES III). SETTING: We obtained data from the KNHANES III, which is the third nationwide representative study using a stratified, multistage probability sampling design. PARTICIPANTS: Subjects (N=5475) aged 20 years or older were included in the study; persons with disabilities (n=218) and persons without disabilities (n=5257). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Nonconditional multiple logistic regression and adjusted mean were used to identify health disparities in health-risk behaviors, preventive health care utilizations, and chronic health conditions. RESULTS: Subjects with disabilities were more likely to be physically inactive (adjusted odds ratio [AOR]=3.06; 95% confidence interval [CI], 1.71-5.48 for no physical activity; AOR=1.70; 95% CI, 1.19-2.43 for insufficient physical activity) than those without disabilities. Women aged 40 years or older with disabilities were less likely to receive cervical cancer screening services (AOR=0.52; 95% CI, 0.27-0.98). Adults with disabilities had higher proportion of osteoporosis (AOR=2.41; 95% CI, 1.50-3.88), underweight (AOR=2.14; 95% CI, 1.07-4.28), suicidal thoughts (AOR=1.86; 95% CI, 1.35-2.56), and had impaired quality of life (95% CI of adjusted mean, 60.89-65.35 compared to 69.95-70.84 in adults without disabilities). CONCLUSIONS: There exists substantial disability-related health disparities in South Korea. People with disabilities may be the underserved subpopulation demonstrating health disparities. The findings in this study underscore the continued needs in order to reduce health problems and disparities for people with disabilities.