The Relationship between the Blood Level of Persistent Organic Pollutants and Common Gastrointestinal Symptoms.

BACKGROUND: Persistent organic pollutants (POPs) are toxic materials that cannot be broken down naturally and that easily accumulate in the body. Although several studies have attempted to uncover the effects of POPs on the endocrine and nervous systems and on cancer, few focus on the relationship between low-dose POPs and public health. Here, we attempt to determine the relationship between the level of POPs and common gastrointestinal symptoms, including abdominal discomfort, diarrhea, and constipation. METHODS: We recruited 121 subjects who visited Kyungpook National University Medical Center for health screening. Plasma concentrations were evaluated for 40 kinds of POPs including 17 types of polychlorinated biphenyls (PCBs) and 23 types of organochlorine pesticides (OCP). Furthermore, the Korean version of the Rome III criteria was used to identify gastrointestinal symptoms. RESULTS: Based on our results, abdominal discomfort showed an inverse relationship with several PCBs and an inverted U-shaped relationship with several other OCPs including pp-DDD and pp-DDT. The effects of pp-DDD and pp-DDT on abdominal discomfort were similar to those of OCPs on obesity and metabolic syndrome. CONCLUSION: Our results suggest that mild and unspecified gastrointestinal symptoms with no clear causes could be related to POP levels.

[Associations between Body Mass Index and Chronic Atrophic Gastritis and Intestinal Metaplasia].

BACKGROUND/AIMS: Chronic atrophic gastritis (AG) and intestinal metaplasia (IM) of the stomach are premalignant lesions. The present study aimed to examine the associations between obesity and these lesions. METHODS: A total of 2,997 patients, who underwent gastroscopy, participated in this study, excluding those who had been diagnosed with gastric cancer. Participants were divided into four groups based on their body mass index (BMI). The risk of AG and IM with increasing BMI was analyzed in men and women, separately. RESULTS: The association between BMI and AG was not significant. After adjusting for age, smoking, alcohol, and AG, the odds ratios for IM in the overweight, obesity, and severe obesity groups were 2.25 (95% confidence interval [CI], 1.50-3.37), 2.32 (95% CI, 1.58-3.42), and 4.86 (95% CI, 2.04-11.5) in men, and 2.66 (95% CI, 1.29-5.47), 4.46 (95% CI, 2.28-8.75), and 9.57 (95% CI, 3.26-28.12) in women, compared with the normal BMI group. CONCLUSIONS: Gastric IM was significantly associated with increased BMI.

Obesity Markers as Predictors for Colorectal Neoplasia.

BACKGROUND: The goal of this study was to determine the relations between the risk of colorectal neoplasia and obesity markers: body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR). METHODS: The subjects who underwent screening colonoscopies at a Kyungpook National University Hospital in Daegu from July to December 2010 were enrolled. We defined colorectal neoplasia as tubular adenoma, advanced adenoma, or cancer. We performed a logistic regression analysis to investigate the correlations between obesity and colorectal neoplasia and a receiver operating characteristic (ROC) curve analysis to determine the cut-off obesity marker values for detecting colorectal neoplasia. RESULTS: Among the total of 268 subjects, 83 (31.0%) subjects had colorectal neoplasia. Subjects with neoplasia had higher BMI, WC, and WHtR than the subjects without any neoplasia. The adjusted odds ratio (aOR) of WHtR ≥0.5 with the association of neoplasia was 1.927 (95% confidence interval [CI], 1.041-3.569) in the total subjects. In women, the obesity markers of WC ≥85 cm (aOR 4.611; 95% CI, 10.166-18.240) and WHtR ≥0.5 (aOR 1.747; 95% CI, 1.149-19.617) were significantly related to neoplasia; however, there was no significant result in men. The ROC analysis showed the optimal cut-off values of BMI as >23.14 kg/m2 (P=0.002), WHtR as >0.50 (P<0.001), and WC as>82.5 cm (P=0.650) in men and >77 cm in women (P<0.001). CONCLUSION: Obesity is significantly associated with the increased risk of colorectal neoplasia. WC and WHtR have more significant correlations with neoplasia; thus, obese people should undergo regular colonoscopy screenings to detect colorectal neoplasia.

The Relationship between the Blood Level of Persistent Organic Pollutants and Common Gastrointestinal Symptoms.

BACKGROUND: Persistent organic pollutants (POPs) are toxic materials that cannot be broken down naturally and that easily accumulate in the body. Although several studies have attempted to reveal the effects of POPs on the endocrine and nervous system and on cancer, few studies focus on the relationship between low-dose POPs and public health. We attempted to find a relationship between the level of POPs and common gastrointestinal symptoms, including abdominal discomfort, diarrhea, and constipation. METHODS: We recruited 121 subjects who visited Kyungpook National University Hospital for a health screening. Plasma concentrations were evaluated for 40 kinds of POPs including 17 types of polychlorinated biphenyls and 23 types of organochlorine pesticides. Furthermore, the Korean version of the Rome III criteria was used to identify gastrointestinal symptoms. RESULTS: Our results showed that abdominal discomfort had an inverse relationship with several polychlorinated biphenyls. Moreover, an inverted U-shaped relationship was observed between abdominal discomfort and several other organochlorine pesticides including p,p'-dichlorodiphenyldichloroethane and p,p'-dichlorodiphenyltrichloroethane, and the effects of these pesticides on abdominal discomfort were similar to that of organochlorine pesticides on obesity and metabolic syndrome. CONCLUSION: Our results suggest that mild and unspecified gastrointestinal symptoms with no clear cause could be related to POPs levels.

Random Serum Cortisol as a Predictor for Survival of Terminally Ill Patients With Cancer: A Preliminary Study.

Although previous research found that serum cortisol levels were associated with cancer prognosis, it is unclear whether this association remains robust even at the very end of life of patients with cancer. We conducted a retrospective chart review of 125 patients with terminal cancer to investigate the role of random serum cortisol levels in predicting the remaining life expectancy. The high random cortisol group had a significantly shorter survival time than the low random cortisol group (7.5 vs 26 days). After adjusting for potential confounders, key factors such as poor performance status, hypoalbuminemia, and high random cortisol level are associated with poor survival. Our results suggest that the random serum cortisol level is an independent predictor of survival time of patients with terminally ill cancer.

Factors associated with quality of life among family caregivers of terminally ill cancer patients.

OBJECTIVE: Limited research has examined the quality of life (QOL) and its correlates among family caregivers (FCs) during the final stage of terminal cancer. The purpose of this study was to investigate the determinants of overall QOL and its subdomains among Korean FCs at the very end of life. METHODS: For this cross-sectional study, we enrolled 299 FCs of terminal cancer patients from seven palliative care units. To assess FCs' QOL and its predictors, we used the Caregiver Quality Of Life Index-Cancer, which contains four domains. Possible determinants of caregiver QOL were categorized into patient, caregiver, and environmental factors. A multiple regression model was used to identify factors associated with FCs' QOL. RESULTS: Variance in each Caregiver Quality Of Life Index-Cancer domain was explained by different factors. FCs of younger patient felt more burden but were more likely to adapt positively. Emotional distress of FCs was strongly associated with total QOL, burdensomeness, and disruptiveness. Positive adaptation was related to more visits for care, FCs' religiousness, more social support, and satisfactory perceived quality of care. Financial concerns were more likely in married FCs, FCs with less social support, or low incomes. CONCLUSION: Emotional distress of FCs was the most important factor determining the overall and negative aspects of FCs' QOL, whereas various environmental factors were associated with positive coping. Appropriate support programs directed at these factors are needed to maintain and improve FCs' QOL.

Effect of Pet Insects on the Psychological Health of Community-Dwelling Elderly People: A Single-Blinded, Randomized, Controlled Trial.

BACKGROUND: There is evidence that animal-assisted therapy has positive effects on mental health, especially in elderly people. Caring for insects is easy, relatively inexpensive, and does not require much space. OBJECTIVE: The aim of this 8-week randomized, controlled, single-blinded study was to investigate the effect of pet insects on the psychological health of community-dwelling elderly people. METHODS: Elderly subjects (≥65 years old) attending a community center in Daegu, Korea, were enrolled in the study between April and May 2014 and randomized at a 1:1 ratio to receive insect therapy and health advice or only health advice. The insect group received 5 crickets in a cage with sufficient fodder and a detailed instruction manual. At baseline and at 8 weeks, all subjects underwent psychometric tests via a direct interview [Beck Anxiety Inventory, Geriatric Depression Scale (GDS-15), Mini-Mental State Examination (MMSE), 36-Item Short Form Health Survey, Insomnia Severity Index, Fatigue Severity Scale, and Brief Encounter Psychosocial Instrument] and laboratory analyses of inflammatory and oxidative stress markers (erythrocyte sedimentation rate, high-sensitivity C-reactive protein, biological antioxidant potential, and derivatives of reactive oxygen metabolites). RESULTS: The insect-caring (n = 46) and control (n = 48) groups did not differ in baseline characteristics. The insect-caring group had significantly lower GDS-15 scores at week 8 (3.20 vs. 4.90, p = 0.004) and, after adjustment for baseline values, a significantly greater change in GDS-15 scores relative to baseline (-1.12 vs. 0.20, p = 0.011). They also had a significantly greater change in MMSE scores relative to baseline (1.13 vs. 0.31, p = 0.045). The two groups did not differ in terms of other psychometric and laboratory tests. No serious risks or adverse events were reported. CONCLUSION: Caring for insects, which is cost-effective and safe, was associated with a small to medium positive effect on depression and cognitive function in community-dwelling elderly people.

Efficacy of chronic disease self-management program in older Korean adults with low and high health literacy.

PURPOSE: We evaluated the efficacy of the Chronic Disease Self-management Program (CDSMP) among older Korean adults and investigated the question of whether the effects differed according to their levels of health literacy. METHODS: Measures of self efficacy, physical activity, physical health, and mental health were assessed at baseline, and at 6-week, and 18-week follow up for the CDSMP intervention group (n = 23) and control group (n = 31) according to their health literacy status. RESULTS: The older adults in the CDSMP intervention group showed significantly higher levels of self efficacy and physical activity at follow up. Participants with low health literacy had greater benefits from the intervention than had those with high health literacy. CONCLUSIONS: The CDSMP is a beneficial intervention for older Korean adults with chronic disease. Healthcare professionals should encourage older Korean adults with chronic illness to participate in the CDSMP, in particular for those with low health literacy.

Dietary magnesium intake and risk of cancer: a meta-analysis of epidemiologic studies.

The aim of this study was to investigate the association between dietary magnesium and the risk of overall cancer using a meta-analysis. We searched PubMed, SCOPUS, and the Cochrane Review through November 2012. All the articles searched were independently reviewed by 3 authors based on predetermined selection criterion. A total of 13 epidemiologic studies, 6 case-control studies, and 7 prospective cohort studies involving 1,236,004 participants were included in the final analysis. When all studies were pooled, the relative risk (RR) of overall cancer for the highest level of dietary magnesium intake was 0.801 [95% confidence interval (CI): 0.664-0.966) compared with the lowest level of dietary magnesium intake. In subgroup meta-analyses by study design, there was a significant inverse association between dietary magnesium and the risk of cancer in case-control studies (RR = 0.663, 95% CI: 0.475-0.925), whereas there was no significant association in prospective cohort studies (RR = 0.888, 95% CI: 0.745-1.060). Furthermore, there was a significant preventive effect of dietary magnesium for colorectal cancer (RR = 0.775, 95% CI: 0.655-0.919), but not for other cancer. Our meta-analysis showed that higher dietary magnesium intake seems to have a protective effect for cancer, especially colorectal cancer and in females.

The survival time of terminal cancer patients: prediction based on clinical parameters and simple prognostic scores.

AIM: By examining clinical parameters associated with survival time and analyzing patients' survival times using prognostic scores, this study aimed to provide helpful information related to the treatment of terminal cancer patients. METHODS: We retrospectively reviewed the medical records of 415 inpatients who died in the hospices of two hospitals from March 2009 to August 2011 then analyzed differences in survival times and relative risk for clinical parameters and prognostic scores. RESULTS: There were 15 parameters associated with survival time. Performance decline was the most influential factor. The optimal scores for predicting four-week survival were over 4.5 on the Palliative Prognostic Index (PPI), over 10 on the Palliative Prognostic (PaP) Score, and 30 or under on the Palliative Performance Scale (PPS). CONCLUSION: Performance decline is a major factor affecting survival time. The PaP is the most useful tool for predicting four-week survival, with an optimal value of over 10.

The Association between Pain and Depression, Anxiety, and Cognitive Function among Advanced Cancer Patients in the Hospice Ward.

BACKGROUND: Pain is the most common but severe physical symptom among cancer patients. This study aimed to identify correlation between pain and psychological symptoms for terminal cancer patients. METHODS: The total sample consisted of 69 subjects who were recruited through two hospice wards, limited to patients who were mentally alert and had no psychiatric diseases. The subjects were divided into two groups according to the numerical rating scale: the pain-free group, 0 to 3 points; and the pain group, 4 to 10 points. We used the Beck depression inventory (BDI), Beck anxiety inventory (BAI), mini-mental status examination-Korea (MMSE-K), and short form 36 health survey (SF-36). Logistic regression analysis was performed to verify the correlation between pain and other psychosocial disorders. RESULTS: The mean scores of BDI in the pain-free and pain groups were 25.7 and 31.5; mean BAI scores were 23.4 and 34.7; mean MMSE-K scores were 25.7 and 21.8, respectively. There were no significant differences between the two groups in SF-36 score except scores of body pain. The results of logistic regression analysis adjusted for age, sex, marital status, types of cancer, history of chemotherapy, or radiotherapy showed significant correlation between pain and depression (BDI ≥ 24; odds ratio [OR], 4.199; 95% confidence interval [CI], 1.171 to 15.060), and pain and cognitive impairment (MMSE < 24; OR, 5.495; 95% CI, 1.449 to 20.843); but not between pain and anxiety (BAI ≥ 22; OR, 3.011; 95% CI, 0.907 to 9.997). CONCLUSION: Pain significantly affects depression and cognitive impairment among advanced cancer patients in the hospice ward. Accordingly, more aggressive treatment of pain is required to reduce not only physical suffering but also physiological distress.

Determination of the beginning age for colonoscopic screening among colonoscopy-naïve individuals.

OBJECTIVE: This study purported to analyze the results of colonoscopy for different age groups and to identify the optimal beginning age for colonoscopic screening. METHODS: A total of 3102 cases of asymptomatic, average-risk, colonoscopy-naïve individuals who underwent colonoscopy at the Health Promotion Center at the Kyungpook National University Hospital during the period from January 2005 to December 2010 and colonoscopy results were analyzed. RESULTS: The prevalence of any colorectal neoplasia in 30s, 40s, 50s and over 60 group was 14.9%, 28.9%, 43.1% and 45.1% respectively. Compared with the 30s age group, the adjusted odd ratios (aOR) for any colorectal neoplasia in 40s, 50s and over 60 group was 2.38, 4.73 and 5.42 respectively (P<0.001), and the aOR for advanced neoplasia in 40s, 50s and over 60 group was 4.34, 9.68 and 14.71 respectively (P<0.001). Based on the results of the ROC curve analysis, the optimal beginning age for CRC screening was found to be below age 46 for any neoplasia and below age 47 for advanced neoplasia. CONCLUSION: The prevalence of colorectal neoplasms significantly increased from age 40s in asymptomatic, average-risk, colonoscopy-naïve individuals and the beginning age for colonoscopic screening was approximately age 46.

Effects of laughter therapy on depression, cognition and sleep among the community-dwelling elderly.

AIM: To investigate the effects of laughter therapy on depression, cognitive function, quality of life, and sleep of the elderly in a community. METHODS: Between July and September 2007, the total study sample consisted of 109 subjects aged over 65 divided into two groups; 48 subjects in the laughter therapy group and 61 subjects in the control group. The subjects in the laughter therapy group underwent laughter therapy four times over 1 month. We compared Geriatric Depression Scale (GDS), Mini-Mental State Examination (MMSE), Short-Form Health Survey-36 (SF-36), Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) between the two groups before and after laughter therapy. RESULTS: There were no significant differences in baseline characteristics between the two groups. Before laughter therapy, the GDS scores were 7.98 ± 3.58 and 8.08 ± 3.96; the MMSE scores were 23.81 ± 3.90 and 22.74 ± 4.00; total scores of SF-36 were 54.77 ± 17.63 and 52.54 ± 21.31; the ISI scores were 8.00 ± 6.29 and 8.36 ± 6.38; the PSQI scores were 6.98 ± 3.41 and 7.38 ± 3.70 in laughter therapy group and control groups, respectively. After laughter therapy, the GDS scores were 6.94 ± 3.19 (P=0.027) and 8.43 ± 3.44 (P=0.422); the MMSE scores were 24.63 ± 3.53 (P=0.168) and 23.70 ± 3.85 (P=0.068); total scores of SF-36 were 52.24 ± 17.63 (P=0.347) and 50.32 ± 19.66 (P=0.392); the ISI scores were 7.58 ± 5.38 (P=0.327) and 9.31 ± 6.35 (P=0.019); the PSQI scores were 6.04 ± 2.35 (P=0.019) and 7.30 ± 3.74 (P=0.847) in both groups, respectively. CONCLUSION: Laughter therapy is considered to be useful, cost-effective and easily-accessible intervention that has positive effects on depression, insomnia, and sleep quality in the elderly.

Perception and performance of preventive behaviors for the pandemic influenza in hospital employees and outpatients.

PURPOSE: A new strain of the H1N1 subtype of influenza A virus resulted in a pandemic outbreak. In South Korea, cases of pandemic influenza have increased. Therefore, we explored perception or preventive behaviors for this virus in hospital employees and outpatients. MATERIALS AND METHODS: Data was collected from hospital employees and outpatients at three university hospitals located in Daegu, Gyeongju in South Korea between the 21st and 30th of September, 2009 using a self-administrated questionnaire. We estimated perception by components of The Health Belief Model (HBM), preventive behaviors consisted of avoidance behaviors, and the recommended behaviors by the Korea Center of Disease Control and Prevention (KCDC). Desire for vaccination was identified. RESULTS: The 1,837 participants comprised hospital employees (n = 880, 47.9%) and outpatients (n = 957, 52.1%). Of all hospital employees, 491 (55.8%) and 708 (80.5%) perceived susceptibility of the pandemic influenza and benefits of the preventive behaviors, respectively. Among all outpatients, 490 (51.2%) and 651 (68.0%) perceived susceptibility of the pandemic influenza and benefits of the preventive behaviors, respectively. Recommended preventative behaviors were adopted by 674 (76.6%) of hospital employees and 631 (65.9%) of outpatients. Vaccination was desired by 479 (54.4%) of hospital employees and 484 (50.6%) of outpatients. Factors influencing preventative behaviors included gender, economic status (for hospital employees) and educational level (for outpatients). All HBM components except perception of barriers were associated with the preventive behaviors in both groups. CONCLUSION: The majority of the surveyed hospital employees and outpatients perceived the benefits of preventive behaviors for pandemic influenza and performed them.