Cancer therapeutic potential of hovetrichoside C from Jatropha podagrica on apoptosis of MDA-MB-231 human breast cancer cells.

Phytochemical analysis of the methanolic extracts of Jatropha podagrica stalks and roots using liquid chromatography-mass spectrometry (LC-MS) led to the isolation of six compounds: corchoionoside C (1), isobiflorin (2), fraxin (3), hovetrichoside C (4), fraxetin (5), and corillagin (6). The isolated compounds (1-6) were tested for their cytotoxicity against MDA-MB-231 human breast cancer cells. Remarkably, compound 4 (hovetrichoside C) exhibited robust cytotoxicity against MDA-MB-231 cells, displaying an IC50 value of 50.26 ± 1.22 µM, along with an apoptotic cell death rate of 24.21 ± 2.08% at 100 µM. Treatment involving compound 4 amplified protein levels of cleaved caspase-8, -9, -3, -7, BH3-interacting domain death agonist (Bid), Bcl-2-associated X protein (Bax), and cleaved poly (ADP-ribose) polymerase (cleaved PARP), while concurrently reducing B-cell lymphoma 2 (Bcl-2) levels. In totality, these findings underscore that hovetrichoside C (4) possesses anti-breast cancer activity that revolves around apoptosis induction via both extrinsic and intrinsic signaling pathways.

Association between depressive symptoms and the risk of all-cause and cardiovascular mortality among US adults.

Depression is a preventable and treatable mental health condition. Therefore, there are important clinical implications for identifying people with the highest mortality risk in a nationally representative sample. This study included 26,207 participants aged ≥18 years from the 2005-2014 National Health and Nutrition Examination Survey in USA. We investigated the association between depressive symptoms (defined as Patient Health Questionnaire 9 scores ≥10) and all-cause and cardiovascular disease (CVD) mortalities, adjusted for multiple factors (sociodemographic in Model 1, behavioral added in Model 2, and metabolic syndrome added in Model 3) and stratified by age and sex. During an average follow-up of 69.15 months (standard deviation [SD] 34.45), 1872 (7.3%) participants had died (person-years in the non-depressive and depressive groups, 12.12/1000 and 16.43/1000, respectively). Depressive symptoms increased all-cause (crude hazard ratio [HR] 1.37, 95% confidence interval [CI], 1.33-1.58) and CVD mortalities (crude HR 1.64, 95% CI, 1.20-2.24). Although the significance of all-cause mortality and CVD mortality was maintained in Models 1 (HR 1.58 and 2.08) and 2 (HR 1.48 and 1.79), it was not maintained in Model 3. Current smoking and lower physical activity were associated with reduced strength of the association between depression and all-cause mortality risk. The effect of depression on mortality risk was particularly pronounced in middle-aged men and older women. Our findings suggest that depressive symptoms increase mortality risk, even after adjusting for behavioral factors. Depression-induced mortality risk is particularly high among middle-aged men and older women.

The Clinical Usefulness of Ultrasonographic Measurement Technique in Patients with Lower Extremity Lymphedema.

Background: A previous study reported a new ultrasonography (US) measurement technique to evaluate the cross-sectional area (ΔCSA) of lymphedema in the upper extremity. This ΔCSA correlated well with parameters, such as the circumference, volumetry, and bioimpedance analysis (BIA) in healthy people and upper extremity lymphedema patients. This study examined whether a US measurement technique is clinically useful in patients with lymphedema in the lower extremity. Methods and Results: Forty patients diagnosed with unilateral lower extremity lymphedema were enrolled in this study. The subjects' leg circumference, BIA, isokinetic strength, and ΔCSA were examined on the same day. The leg circumference was measured at 15 cm above the knee (AK) and below the knee (BK) crease using a tape measure. BIA was performed by a trained physical therapist, and the data of impedance (Z) at 1 and 5 kHz of each side of the lower limbs and extracellular water (ECW) were used. A fully experienced physician measured soft tissue thickness, the distance between the skin and the fascia of the muscle, three times each at the anterior, medial, posterior, and lateral aspects of the bilateral legs by US at 15 cm AK and BK. The amount of soft tissue in the ΔCSA was calculated using the designed formula from the mean values of the thicknesses. Each parameter was calculated as the ratio of the sound side to the lesion side. The Pearson and Spearman correlation coefficients were used to assess the significance of these parameters. The ratio of ΔCSA measured at 15 cm AK and BK showed strong positive correlations with the circumference difference at the same level (rho = 0.790, p = 0.000, and rho = 0.882, p = 0.000, respectively). In addition, it showed moderate or strong correlations with the ratio of Z at 5 and 1 kHz in the BIA of the lower limbs (AK15, r = -0.511, p = 0.001 and r = -0.497, p = 0.001; BK15, r = -0.780, p = 0.000 and r = -0.756, p = 0.000, respectively). Although ECW and body mass index showed weak positive correlations with the ratio of ΔCSA measured at 15 cm BK, there was no significant correlation between the ratio of ΔCSA and the isokinetic muscle strength. Conclusion: The ΔCSA results showed moderate-to-strong correlations with other conveniently used methods except for the isokinetic muscle strength. As the US ΔCSA technique could measure lymphedema status with a structural consideration, it could also be recommended as a conventional measurement method in patients with upper and lower extremity lymphedema.

Association between Electronic Cigarettes Use and Asthma in the United States: Data from the National Health Interview Survey 2016-2019.

PURPOSE: This article aimed to investigate 1) whether electronic cigarette (EC) users are more likely to experience asthma attacks or emergency room (ER) visits due to asthma than non-users and 2) how age and smoking behaviors moderate the effect size of the association. MATERIALS AND METHODS: We used National Health Interview Survey data from 2016-2019. Multiple logistic regression analysis was performed to identify the association between current EC use and having an asthma attack and ER visitation due to asthma. Interaction terms were included to explore the moderation effects of age and cigarette smoking status. Subgroup analysis was conducted according to age group. RESULTS: Of the 218911 participants, 2.0% of them experienced an asthma attack, and 0.5% visited the ER due to asthma. Current EC use was associated with higher odds of having an asthma attack. In interaction analysis, age and smoking status were identified as a moderator in the relationship between EC use and asthma attacks. Participants in their 20s or 30s showed the highest interaction effect. CONCLUSION: Our analysis indicates the potential impact of EC use on public health and the moderating effects of smoking behavior.

Socio-economic factors associated with mental health outcomes during the COVID-19 pandemic in South Korea.

Background: Individuals are at an increased risk of adverse mental health outcomes during the COVID-19 pandemic. To reduce the impact on mental health outcomes that were induced by national-level policies, which may influence an individual at the community level, exploring the comprehensive relations between individual and environmental factors are needed. The aim is to examine socio-ecological factors associated with mental health outcomes, including depressive and anxiety symptoms, with the perspective of support to provide interventions that help the community during future disease outbreaks. Method: From 5 November to 20 November 2020, a cross-sectional and population-based study was conducted to assess the socio-ecological factors of mental health outcomes during the COVID-19 pandemic. A total of 1,000 participants, aged 20-69 years, in Chungnam Region, South Korea, were included in this study. Multiple linear regression models were used to examine the association between socio-ecological factors and mental health outcomes. The primary outcomes were individuals' mental health outcomes which are measured by PHQ-9 and GAD-7 scores. Results: Of the 1,000 participants, the average PHQ-9 was 4.39, and GAD-7 was 3.21 during the COVID-19 pandemic. Specifically, the participants with moderate or severe levels of PHQ-9 and GAD-7 were 12.6 and 6.8%, respectively. Higher levels of depressive and anxiety symptoms were associated with participants who were single, reported a lower household income, had decreased support from friends or family, and increased stress from the workplace or home. In subgroup analyses by age, gender, and household income, a similar trend was reported in individual and interpersonal-level factors. There were significant associations between regional-level factors, including gross regional domestic product (GRDP), mental health institutions, psychiatrists, nurse-to-population ratios, and individuals' mental health outcomes. Conclusion: The management of depressive and anxiety symptoms of individuals during the pandemic was better explained by individual and interpersonal characteristics rather than regional-level factors, highlighting the need for more policies aimed at these lower levels.

The Impact of COVID-19 Protocols on the Continuity of Care for Patients with Hypertension.

The aim of this study was to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the continuity of care (COC) for patients with hypertension. Additionally, the factor of whether participants were treated via telemedicine was also considered. This study used the National Health Insurance and Medical Aid claims data of the Republic of Korea between 2019 and 2020. Multivariable regression analysis was performed to identify the differences in the number of visits and the most frequent provider continuity (MFPC) of hypertensive patients before and after the appearance of COVID-19 in Korea. Additional analysis was performed with data that excluded cases of patients who received telemedicine services. A total of 5,791,812 hypertensive patients were included in this study. The MFPC decreased by 0.0031 points after the appearance of COVID-19, and it showed the same decrease even when telemedicine cases were excluded. The number of outpatient clinic visit days decreased by 0.2930 days after the appearance of COVID-19. Without the telemedicine cases, the number of outpatient clinic visit days decreased by 0.3330 days after the appearance of COVID-19. Accordingly, the COVID-19 protocols did not affect hypertension patients' COC but impacted the frequency of their outpatient visits. In other words, with or without telemedicine, the utilization of healthcare was not disrupted, but there was a significant difference in the volume of healthcare use depending on the inclusion of telemedicine cases.

pH-Dependent interaction mechanism of lignin nanofilms.

Lignin has been spotlighted as an abundant renewable bioresource for use in material technologies and applications such as biofuels, binders, composites, and nanomaterials for drug delivery. However, owing to its complex and irregular structure, it is difficult to investigate its fundamental interaction mechanism, which is necessary to promote its use. In this study, a surface forces apparatus (SFA) was used to investigate the pH-dependent molecular interactions between a lignin nanofilm and five functionalized self-assembled monolayers (SAMs). The lignin nanofilm adhered most strongly to the amine-functionalized SAM, indicating that the molecular interactions with lignin were mainly electrostatic and cation-π interactions. The force-distance profile between lignin and a methyl-functionalized SAM revealed pH-dependent interactions similar to those between two lignin nanofilms. This finding indicates that the dominant cohesion mechanism is hydrophobic interactions. A quartz crystal microbalance with dissipation was used to investigate the adsorption of free lignin molecules on functionalized SAMs. Lignin molecules, which were free in solution, were most effectively adsorbed to the phenyl-functionalized SAM. To investigate whether the nanoscopic interaction forces could be extended to macroscopic properties, the compressive strength of activated carbon-lignin composites prepared at different pH values was evaluated. As the pH increased, the compressive strength decreased owing to the reduced hydrophobic interactions between the activated carbon and lignin, consistent with the SFA results. These quantitative results regarding lignin interactions can advance the potential use of lignin as an eco-friendly biomaterial.

The Effects of Social Media Use on Preventive Behaviors during Infectious Disease Outbreaks: The Mediating Role of Self-relevant Emotions and Public Risk Perception.

While there has been increasing attention to the role of social media during infectious disease outbreaks, relatively little is known about the underlying mechanisms by which social media use affects risk perception and preventive behaviors during such outbreaks. Using data collected during the 2015 Middle East Respiratory Syndrome coronavirus (MERS-CoV) outbreak in South Korea, this study explores the relationships among social media use, risk perception, and preventive behaviors by examining the mediating role of two self-relevant emotions: fear and anger. The findings demonstrate that social media use is positively related to both of these emotions, which are also positively related to the public's risk perception. The findings also indicate that social media use can significantly increase preventive behaviors via the two self-relevant emotions and the public's risk perception.

Establishment of a platform of non-small-cell lung cancer patient-derived xenografts with clinical and genomic annotation.

BACKGROUND: Preclinical models that can better predict therapeutic activity in clinical trials are needed in this era of personalized cancer treatment. Herein, we established genomically and clinically annotated patient-derived xenografts (PDXs) from non-small-cell lung cancer (NSCLC) patients and investigated whether these PDXs would faithfully recapitulate patient responses to targeted therapy. METHODS: Patient-derived tumors were implanted in immunodeficient mice and subsequently expanded via re-implantation. Established PDXs were examined by light microscopy, genomic profiling, and in vivo drug testing, and the successful engraft rate was analyzed with the mutation profile, histology, or acquisition method. Finally, the drug responses of PDXs were compared with the clinical responses of the respective patients. RESULTS: Using samples from 122 patients, we established 41 NSCLC PDXs [30 adenocarcinoma (AD), 11 squamous cell carcinoma (SQ)], among which the following driver mutation were observed: 13 EGFR-mutant, 4 ALK-rearrangement, 1 ROS1-rearrangement, 1 PIK3CA-mutant, 1 FGFR1-amplification, and 2 KRAS-mutant. We rigorously characterized the relationship of clinical features to engraftment rate and latency rates. The engraft rates were comparable across histologic type. The AD engraft rate tended to be higher for surgically resected tissues relative to biopsies, whereas similar engraft rates was observed for SQ, irrespective of the acquisition method. Notably, EGFR-mutants demonstrated significantly longer latency time than EGFR-WT (86 vs. 37days, P = 0.007). The clinical responses were recapitulated by PDXs harboring driver gene alteration (EGFR, ALK, ROS1, or FGFR1) which regressed to their target inhibitors, suggesting that established PDXs comprise a clinically relevant platform. CONCLUSION: The establishment of genetically and clinically annotated NSCLC PDXs can yield a robust preclinical tool for biomarker, therapeutic target, and drug discovery.

The Association of Level of Internet Use with Suicidal Ideation and Suicide Attempts in South Korean Adolescents: A Focus on Family Structure and Household Economic Status.

OBJECTIVE: To examine the association between the level of Internet addiction and suicidal ideation and suicide attempts in South Korean adolescents, focusing on the roles of family structure and household economic status. METHODS: Data from 221 265 middle and high school students taken from the 2008-2010 Korea Youth Risk Behavior Web-based Survey were used in this study. To identify factors associated with suicidal ideation/attempts, multiple logistic regression analysis was performed. The level of Internet use was measured using the simplified Korean Internet Addiction Self-assessment Tool. RESULTS: Compared with mild users of the Internet, high-risk users and potential-risk users were more likely to report suicidal ideation (nonuser, odds ratio [OR] 1.10, 95% confidence interval [CI] 1.05 to 1.15; potential risk, OR 1.49, 95% CI: 1.36 to 1.63; high risk OR 1.94, 95% CI 1.79 to 2.10) or attempts (nonuser, OR 1.33, 95% CI 1.25 to 1.42; potential risk, OR 1.20, 95% CI 1.04 to 1.38; high risk, OR 1.91, 95% CI 1.71 to 2.14). The nonuser group also had a slightly higher risk of suicidal ideation/attempts compared with mild users. This association appeared to vary by perceived economic status and family structure. CONCLUSIONS: Our study suggests that it is important to attend to adolescents who are at high risk for Internet addiction, especially when they do not have parents, have stepparents, or perceive their economic status as either very low or very high.

Readmission rates of South Korean psychiatric inpatients by inpatient volumes per psychiatrist.

BACKGROUND: Readmission rates of psychiatric inpatients are higher in South Korea than other Organization for Economic Co-operation and Development (OECD) countries. In addition, the solution for readmission control is deficient based on the characteristics of the South Korean National Health Insurance (NHI) system. Therefore, it is necessary to identify ways to reduce psychiatric inpatient readmissions. This study investigated the relationship between inpatient volume per psychiatrist and the readmission rate of psychiatric inpatients in South Korea. METHOD: We used NHI claim data (N = 37,796) from 53 hospitals to analyze readmission within 30 days for five diagnosis (organic mental disorders, mental and behavioral disorders due to psychoactive substance use, schizophrenia, mood disorders, neurotic disorders, and stress-related and somatoform disorders) between 2010 and 2013. We performed χ2 and analysis of variance tests to investigate associations between patient and hospital-level variables and readmission within 30 days. Finally, generalized estimating equation (GEE) models were analyzed to examine possible associations with readmission. RESULTS: Readmissions within 30 days accounted for 1,598 (4.5 %) claims. Multilevel analysis demonstrated that inpatient volume per psychiatrist were inversely related with readmission within 30 days (low odds ratio [OR]: 0.38, 95 % confidence interval [CI]: 0.28-0.51; mid-low OR: 0.48, 95 % CI: 0.36-0.63; mid-high OR: 0.55, 95 % CI: 0.44-0.69; Q4 = ref). The subgroup analysis by diagnosis revealed that both "schizophrenia, schizotypal, and delusional disorders" and "mood disorders" had inverse relationships with readmission risk for all volume groups. CONCLUSIONS: We observed an inverse association between inpatient volume per psychiatrist and the 30-day readmission rate of psychiatric inpatients, suggesting that it could be a useful quality indicator in mental health care.

Gender gap in self-rated health in South Korea compared with the United States / Diferencias de género en la salud autopercibida en Corea del Sur en comparación con Estados Unidos

Addressing the gender gap issue is a key to the reduction of the health gap between and within nations. This study aimed to describe gender differences in SRH of populations in South Korea and the United States (U.S.). Data on 33,240 eligible participants from the KNHNES and 39,646 participants from the NHNES was included in the study. Multiple logistic regression analysis was performed to identify gender differences in SRH. SRH was rated as poor in 18.8% and 16.3% of the participants in South Korea and in the U.S. The results of this study indicated that South Korean women had a higher risk of poor SRH, differed from women in the U.S. The 20---39 age group had a higher risk for poor SRH in both South Korea and the U.S. It suggested that South Korea’s traditional gender roles negatively affect women. Thus, the welfare of South Korean should be improved to reduce these between-country health gaps by applying health-related laws to differentiation of beneficiaries’ gender and age group (AU)

Se abordan las diferencias de género como clave para la reducción de la brecha de salud. Este estudio se plantea describir las diferencias de género en salud autoinformada en Corea del Sur y Estados Unidos. Un total de 33.240 participantes de los KNHNES y 39.646 de la NHNES se incluyeron en el estudio. Se realizó un análisis de regresión logística múltiple para identificar las diferencias de género en salud autoinformada. Ésta fue calificada como pobre por el 18,8% y 16,3% de los participantes en Corea del Sur y en los Estados Unidos, respectivamente. Los resultados indicaron que las mujeres de Corea del Sur tienen mayor riesgo de mala salud autoinformada, difiriendo de las mujeres estadounidenses. El grupo de edad 20-39 años tuvo un mayor riesgo de mala salud autoinformada, tanto en Corea del Sur como en Estados Unidos. Se sugiere que los roles de género tradicionales de Corea del Sur afectan negativamente a las mujeres. Por lo tanto, el bienestar de Corea del Sur debe ser mejorado para reducir estas brechas de salud entre países mediante la aplicación de leyes que tengan en cuenta el género y el grupo de edad de los beneficiarios (AU)

Gender gap in self-rated health in South Korea compared with the United States.

Addressing the gender gap issue is a key to the reduction of the health gap between and within nations. This study aimed to describe gender differences in SRH of populations in South Korea and the United States (U.S.). Data on 33,240 eligible participants from the KNHNES and 39,646 participants from the NHNES was included in the study. Multiple logistic regression analysis was performed to identify gender differences in SRH. SRH was rated as poor in 18.8% and 16.3% of the participants in South Korea and in the U.S. The results of this study indicated that South Korean women had a higher risk of poor SRH, differed from women in the U.S. The 20-39 age group had a higher risk for poor SRH in both South Korea and the U.S. It suggested that South Korea's traditional gender roles negatively affect women. Thus, the welfare of South Korean should be improved to reduce these between-country health gaps by applying health-related laws to differentiation of beneficiaries' gender and age group.

Se abordan las diferencias de género como clave para la reducción de la brecha de salud. Este estudio se plantea describir las diferencias de género en salud autoinformada en Corea del Sur y Estados Unidos. Un total de 33.240 participantes de los KNHNES y 39.646 de la NHNES se incluyeron en el estudio. Se realizó un análisis de regresión logística múltiple para identificar las diferencias de género en salud autoinformada. Ésta fue calificada como pobre por el 18,8% y 16,3% de los participantes en Corea del Sur y en los Estados Unidos, respectivamente. Los resultados indicaron que las mujeres de Corea del Sur tienen mayor riesgo de mala salud autoinformada, difiriendo de las mujeres estadounidenses. El grupo de edad 20-39 años tuvo un mayor riesgo de mala salud autoinformada, tanto en Corea del Sur como en Estados Unidos. Se sugiere que los roles de género tradicionales de Corea del Sur afectan negativamente a las mujeres. Por lo tanto, el bienestar de Corea del Sur debe ser mejorado para reducir estas brechas de salud entre países mediante la aplicación de leyes que tengan en cuenta el género y el grupo de edad de los beneficiarios.

Sexually Transmitted Infections and First Sexual Intercourse Age in Adolescents: The Nationwide Retrospective Cross-Sectional Study.

INTRODUCTION: Sexually transmitted infections (STIs) are major causes of medical and psychological problems globally, while adolescents in South Korea have recently shown rapid changes in sexual behaviors. AIMS: We aimed to examine the association between the age of first sexual intercourse and the experience of STIs among adolescents. Additionally, in which specific time period would more likely to get infected from sexual intercourse. METHODS: We used data from the 2007-2013 Korea Youth Risk Behavior Web-based Survey. Only adolescents with sexual intercourse experience (N = 22,381) were included, and multiple logistic regression analysis was performed. MAIN OUTCOME MEASURES: One dichotomized measure and one continuous measure were assessed: (i) STIs experience (defined as having had STIs); and (ii) association between STIs experience and absolute age gap (defined as temporal differences between secondary sexual character emergence age and first sexual intercourse age). RESULTS: Approximately 7.4% of boys and 7.5% of girls reported had STI. For both boys and girls, the chance of experiencing STIs increased as the age of first sexual intercourse decreased (boys: before elementary school [age 7 or under]: odds ratio [OR] = 10.81, first grade [age 7 or 8]: OR = 4.44, second grade [age 8 or 9]: OR = 8.90, fourth grade [age 10 or 11]: OR = 7.20, ninth grade [age 15 or 16]: OR = 2.31; girls: before elementary school: OR = 18.09, first grade: OR = 7.26, second grade: OR = 7.12, fourth grade: OR = 8.93, ninth grade: OR = 2.74). The association between the absolute age gap and STI experience was examined additionally (boys: OR = 0.93, girls: OR = 0.87). CONCLUSIONS: This study shows that earlier initiation of sexual intercourse increases the odds of experiencing STIs. Also as the age gap gets shorter, the odds of experiencing STIs increase. Our study suggests that it is important to consider the time period of first sexual intercourse and to reinforce a monitoring system along with the development of other preventive strategies.

Is secondhand smoke associated with stress in smokers and non-smokers?

BACKGROUND: Secondhand Smoking (SHS) has been suggested as a major health problem in the world and is known to cause various negative health effects that have in turn caused the deaths of almost 600,000 people per year. Evidence has suggested that SHS may have an effect on health problems and such findings have influenced the implementation of smoking-free areas. However, few studies have investigated the effects of SHS on stress which is considered major risk factor for mental health. Thus, the purpose of our study was to investigate the association between exposure to SHS and stress. METHODS: We performed a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey (2007-2012). In our study, a total of 33,728 participants were included to evaluate the association between SHS exposure and stress based on smoking status. Association between SHS exposure and stress was examined using logistic regression models. RESULTS: A total of 12,441 participants (42.9 %) were exposed to SHS in the workplace or at home. In our study, exposure to SHS was significantly associated with higher stress compared to non-exposure, regardless of smoking status (smoker odds ratio [OR]: 1.22; ex-smoker OR: 1.25; never-smoker OR: 1.42). Our results showed that the effect of SHS on stress was greater when exposure took place both at home and in the workplace in smokers and never-smokers. CONCLUSIONS: Exposure to SHS in the workplace and at home is considered to be a risk factor for high stress in both smokers and never-smoker. Therefore, strict regulations banning smoke which can smoking ban reduce SHS exposure are recommended in order to improve the populations' health.

Associations of volume and other hospital characteristics on mortality within 30†days of acute myocardial infarction in South Korea.

OBJECTIVE: The mortality for acute myocardial infarction (AMI) has declined worldwide. However, improvements in care for AMI in South Korea have lagged slightly behind those in other countries. Therefore, it is important to investigate how factors such as hospital volume, structural characteristics of hospital and hospital staffing level affect 30-day mortality due to AMI in South Korea. SETTING: We used health insurance claim data from 114 hospitals to analyse 30-day mortality for AMI. PARTICIPANTS: These data consisted of 19,638 hospitalisations during 2010-2013. INTERVENTIONS: No interventions were made. OUTCOME MEASURE: Multilevel models were analysed to examine the association between the 30-day mortality and inpatient and hospital level variables. RESULTS: In the 30 days after hospitalisation, 10.5% of patients with AMI died. Hospitalisation cases at hospitals with a higher AMI volume had generally inverse associations with 30-day mortality (1st quartile=ref; 2nd quartile=OR 0.811, 95% CI 0.658 to 0.998, 3rd quartile=OR 0.648, 95% CI 0.500 to 0.840, 4th quartile=OR 0.807, 95% CI 0.573 to 1.138). In addition, hospitals with a greater proportion of specialists were associated with better outcomes (above median=OR 0.789, 95% CI 0.663 to 0.940). CONCLUSIONS: Health policymakers need to include volume and staffing when defining the framework for treatment of AMI in South Korean hospitals. Otherwise, they must consider increasing the proportion of specialists or regulating the hiring of emergency medicine specialists. In conclusion, they must make an effort to reduce 30-day mortality following AMI based on such considerations.

Effects of social activity on health-related quality of life according to age and gender: an observational study.

BACKGROUND: The aim of this study was to examine the relationship between types and amount of social activity and health-related quality of life according to gender and age group. METHODS: This study used data from the Community Health Survey (CHS), which was collected in 2011 and consisted of 229,226 participants aged 19 or older. A linear mixed effects model was used to evaluate the factors influencing health-related quality of life among individuals tracked in the CHS and, in particular, to analyze the associations between the amount and types of social activities participated in and the EuroQol EQ-5D assessment. RESULTS: We found that the average quality of life increased according to the amount of social activities individuals participated in (zero = 89.30, one = 93.28, two = 95.25, three = 96.27, four = 96.85). When people participated in one social activity, social activity was more strongly associated with EQ-5D in the elderly age group (males: 19-34 years = 0.195, 35-49 years = 0.642, 50-64 years = 1.716, ≥ 65 years = 4.408; females: 19-34 years = 0.170, 35-49 years = 0.502, 50-64 years = 1.411, ≥ 65 years = 4.180). More participation was positively associated with higher EQ-5D (one = 1.939, two = 2.377, three = 2.439, four = 2.515, p for trend < 0.0001). In females, those who participated in relationship organizations had a higher EQ-5D than those who participated in other types of social activities (Females ≥ 65 age group; Relationship = 4.373, Leisure = 2.620, Religion = 1.842, Charity = 1.544). CONCLUSION: There was a positive association between the increase in the number of social activities and increase in health-related quality of life, especially when evaluated in terms of type of social activities and health-related quality of life according to gender and age group.

The outcomes of psychiatric inpatients by proportion of experienced psychiatrists and nurse staffing in hospital: New findings on improving the quality of mental health care in South Korea.

Readmission rates for mental health care are higher in South Korea than other Organization for Economic Development (OECD) countries. Therefore, it is worthwhile to continue investigating how to reduce readmissions. Taking a novel approach, we determined the relationship between psychiatrist experience and mental health care readmission rates. We used National Health Insurance claim data (N=21,315) from 81 hospitals to analyze readmissions within 30 days of discharge for "mood disorders" or "schizophrenia, schizotypal and delusional disorders" during 2010-2013. In this study, multilevel models that included both patient and hospital-level variables were analyzed to examine associations with readmission. Readmissions within 30 days of discharge accounted for 1079 (5.1%) claims. Multilevel analysis demonstrated that the proportion of experienced psychiatrists at a hospital was inversely associated with risk of readmission (OR: 0.79, 95% CI: 0.74-0.84 per 10% increase in experienced psychiatrists). Readmission rates for psychiatric disorders within 30 days of discharge were lower in hospitals with a higher number of nurses (OR: 0.95, 95% CI: 0.94-0.96 per 10 nurses). In conclusion, health policymakers and hospital managers should make an effort to reduce readmissions for psychiatric disorders and other diseases by considering the role that physician experience plays and nurse staffing.

Positive correlation between care given by specialists and registered nurses and improved outcomes for stroke patients.

BACKGROUND: Cerebrovascular diseases are the second-highest cause of death in South Korea (9.6% of all causes of mortality in 2013). South Korea has a shortage of trained medical personnel compared with other countries and the demands for health care are continuously increasing. Our study sought to determine the relationship between hospital human resources and the outcomes of stroke patients. METHODS: We used data from NHI claims (n=99,464) at 120 hospitals to analyze readmission or death within 30 days after discharge or hospitalization for stroke patients during 2010-2013. We used multilevel models that included both patient-level and hospital-level variables to examine factors associated with readmission or death within 30 days. RESULTS: A total of 1782 (1.8%) patients were readmitted within 30 days, and death occurred within 30 days for 6926 (7.0%) patients. Patients cared for by a higher percentages of specialists or registered nurses had a lower risk of readmission or death within 30 days (readmission per 10% increase in registered nurses, OR=0.89 and SD=0.85-0.94; death per 10% increase in specialists, OR=0.93 and SD=0.89-0.98). CONCLUSIONS: The percentages of specialist and registered nurses caring for stroke patients were positively correlated with better patient outcomes, particularly for patients with cerebral infarction.