A Web-Based Decision Aid for Informed Prostate Cancer Screening: Development and Pilot Evaluation.

BACKGROUND: Prostate-specific antigen-based routine screening is not recommended for the general population due to conflicting results with mortality reduction. We aimed to develop a web-based decision aid (DA) for informed decision making for prostate cancer screening. METHODS: Using the International Patient Decision Aid Standards (IPDAS) development process model, we developed our DA based on patient and clinician interviews and multidisciplinary expert discussions. The prototype consisted of predicting individual prostate cancer risk and informed decision-making, including knowledge, risk and benefit, cost, personal value, and decision making. We conducted a pilot study on 101 healthy men, evaluating the effectiveness of DA by measuring knowledge, attitude, and intention to screen before and after using the DA, as well as decisional conflict and usefulness after using the DA. RESULTS: Of the 101 participants (median age 60 [50-69] years), 84% had not undergone screening for prostate cancer in the past two years. After using the DA, knowledge on prostate cancer screening increased (mean score [of 10] before versus after: 6.85 ± 1.03 versus 7.57 ± 1.25; P < 0.001), and intention to not screen increased from 27.7% to 51.5% (P < 0.001), but attitude toward screening did not change (P = 0.564). After use of the DA, 79 participants reported no decisional conflict, and the usefulness score was high (mean score [of 100] 77.35 ± 7.69), with 85% of participants reporting that the DA helped with decision making. CONCLUSION: Our web-based DA yielded increased knowledge, decreased screening intention, and high perceived usefulness. These findings indicate potential clinical relevance, especially among younger individuals.

Cdk5 regulates IP3R1-mediated Ca2+ dynamics and Ca2+-mediated cell proliferation.

Loss of cyclin-dependent kinase 5 (Cdk5) in the mitochondria-associated endoplasmic reticulum (ER) membranes (MAMs) increases ER-mitochondria tethering and ER Ca2+ transfer to the mitochondria, subsequently increasing mitochondrial Ca2+ concentration ([Ca2+]mt). This suggests a role for Cdk5 in regulating intracellular Ca2+ dynamics, but how Cdk5 is involved in this process remains to be explored. Using ex vivo primary mouse embryonic fibroblasts (MEFs) isolated from Cdk5-/- mouse embryos, we show here that loss of Cdk5 causes an increase in cytosolic Ca2+concentration ([Ca2+]cyt), which is not due to reduced internal Ca2+ store capacity or increased Ca2+ influx from the extracellular milieu. Instead, by stimulation with ATP that mediates release of Ca2+ from internal stores, we determined that the rise in [Ca2+]cyt in Cdk5-/- MEFs is due to increased inositol 1,4,5-trisphosphate receptor (IP3R)-mediated Ca2+ release from internal stores. Cdk5 interacts with the IP3R1 Ca2+ channel and phosphorylates it at Ser421. Such phosphorylation controls IP3R1-mediated Ca2+ release as loss of Cdk5, and thus, loss of IP3R1 Ser421 phosphorylation triggers an increase in IP3R1-mediated Ca2+ release in Cdk5-/- MEFs, resulting in elevated [Ca2+]cyt. Elevated [Ca2+]cyt in these cells further induces the production of reactive oxygen species (ROS), which upregulates the levels of Nrf2 and its targets, Prx1 and Prx2. Cdk5-/- MEFs, which have elevated [Ca2+]cyt, proliferate at a faster rate compared to wt, and Cdk5-/- embryos have increased body weight and size compared to their wt littermates. Taken together, we show that altered IP3R1-mediated Ca2+ dynamics due to Cdk5 loss correspond to accelerated cell proliferation that correlates with increased body weight and size in Cdk5-/- embryos.

Exploring socio-demographic, physical, psychological, and quality of life-related factors related with fear of cancer recurrence in stomach cancer survivors: a cross-sectional study.

BACKGROUND: Stomach cancer is one the most common neoplasms with high mortality. However, fear of cancer recurrence (FCR) in stomach cancer survivors has been scarcely evaluated. Thus, the aim of this study was to evaluate FCR and factors related to FCR in Korean stomach cancer survivors. METHODS: A total of 363 stomach cancer survivors who had completed primary treatment and had no metastasis or recurrence were recruited between September 2014 and March 2017 regardless of time lapse after the initial diagnosis. FCR was assessed using the Korean version of the FCR Inventory (FCRI). Participants were divided into two groups; clinical FCRI group (score of severity subscale of FCRI ≥ 13) and non-clinical FCRI group (the scores < 13). Socio-demographic factors, cancer stage, treatment, psychological factors, health-related quality of life (HRQoL), and health promotion and disease prevention behaviors were obtained using a self-administered questionnaire supplemented with face-to-face interview to fill out incomplete information. Factors associated with FCR were evaluated using linear regression analysis and multiple logistic regression analysis after adjusting for age, sex, cancer stage, time since cancer diagnosis, family cancer diagnosis, and comorbidities. RESULTS: Average (standard deviation) time interval between cancer diagnosis and study participation was 7.3 (3.2) years. The distribution of socio-demographic and cancer-related factors did not differ according to the level of FCR. The higher FCRI level was associated with lower levels of social support (ß: -0.190, p < 0.001), lower emotional function (ß: -0.356, p < 0.001), more severe fatigue (ß: 0.333, p < 0.001), more sleep problems (ß: 0.299, p = 0.002), higher anxiety (ß: 0.443, p < 0.001), and higher depression (ß: 0.207, p < 0.001). However, clinical level of FCR was not associated with health promotion and disease prevention behaviors. CONCLUSIONS: FCR in stomach cancer survivors was associated with social, psychological, and HRQoL factors rather than demographic, socioeconomic, or cancer-related factors. This finding suggests that careful attention to FCR is necessary to provide more comprehensive survivorship care for stomach cancer survivors.

The Association between Serum Vitamin D Concentration and Colon Polyp: A Cross-Sectional Study Using Health Care Screening Database in a Tertiary Hospital in Korea.

BACKGROUND: As indoor activity increases with modern lifestyles changes, reduced exposure to sunlight may lead to reduced vitamin D synthesis. Previous studies demonstrated that increased vitamin D level is associated with decreased risk of colon cancer; therefore, this study attempted to determine the association between vitamin D and colon polyps, which may be precancerous lesions, in participants who underwent colonoscopy exams. METHODS: A total of 31,004 participants who underwent routine health checkups, including vitamin D level and colonoscopy, at Samsung Medical Center in South Korea from 2010 to 2018 were included in the study. Colorectal polyps were diagnosed through biopsy after performing colonoscopy exams. Participants were categorized into three groups according to level of vitamin D (deficient: <20 ng/mL), insufficient: 20≤ vitamin D <30 ng/mL, and sufficient: ≥30 ng/mL). We analyzed the presence of colorectal polyps according to vitamin D level, and performed multiple logistic regression analyses for the association between vitamin D level and colorectal polyps. RESULTS: About 50% of participants had colorectal polyps (hyperplastic polyp, n=4,864; adenomatous polyp, n=10,470; adenocarcinoma, n=24). There were no significant associations between vitamin D categories and colorectal polyp and colorectal cancer. However, when further analyzing by type of polyp, the risk of hyperplastic polyps significantly decreased with increasing vitamin D levels (P for trend=0.006). CONCLUSION: We did not find evidence for an association between vitamin D and overall colorectal polyps; however, we observed a trend for decreased odds of hyperplastic polyps with increased vitamin D levels in comparison to vitamin D deficient subjects.

Individual 5-Year Lung Cancer Risk Prediction Model in Korea Using a Nationwide Representative Database.

Early detection of lung cancer by screening has contributed to reduce lung cancer mortality. Identifying high risk subjects for lung cancer is necessary to maximize the benefits and minimize the harms followed by lung cancer screening. In the present study, individual lung cancer risk in Korea was presented using a risk prediction model. Participants who completed health examinations in 2009 based on the Korean National Health Insurance (KNHI) database (DB) were eligible for the present study. Risk scores were assigned based on the adjusted hazard ratio (HR), and the standardized points for each risk factor were calculated to be proportional to the b coefficients. Model discrimination was assessed using the concordance statistic (c-statistic), and calibration ability assessed by plotting the mean predicted probability against the mean observed probability of lung cancer. Among candidate predictors, age, sex, smoking intensity, body mass index (BMI), presence of chronic obstructive pulmonary disease (COPD), pulmonary tuberculosis (TB), and type 2 diabetes mellitus (DM) were finally included. Our risk prediction model showed good discrimination (c-statistic, 0.810; 95% CI: 0.801-0.819). The relationship between model-predicted and actual lung cancer development correlated well in the calibration plot. When using easily accessible and modifiable risk factors, this model can help individuals make decisions regarding lung cancer screening or lifestyle modification, including smoking cessation.

A cross-sectional study of factors associated with influenza vaccination in Korean cancer survivors.

OBJECTIVE: To investigate factors associated with influenza vaccination in cancer survivors. METHODS: Study subjects were 1,945 Korean adult cancer survivors. Through medical record review and self-administered questionnaires, social and medical information was collected. Influenza vaccination was defined as ever having received a flu vaccine between one year before cancer diagnosis and the survey date. Multiple logistic regression analysis was used to evaluate factors associated with influenza vaccination. RESULTS: Overall, 60.8% of study subjects had received an influenza vaccination. Younger survivors had a significantly lower vaccination rate than did the elderly survivors (80.22% vs. 54.73%). In younger survivors, longer time elapsed since cancer diagnosis, lifestyle modification counselling during cancer treatment, adequate physical exercise (≥150 min/week) and complementary medication use were positively associated with vaccination, whereas extra-pulmonary cancers, multimodality (≥3) cancer treatment and higher educational achievement were inversely associated. In elderly survivors, fewer factors had a positive (adequate physical exercise) or inverse (multimodality cancer treatment and current smoking) association with influenza vaccination. CONCLUSION: Influenza vaccination rate was suboptimal, especially among younger cancer survivors. Targeted strategies are necessary to improve influenza vaccination in cancer survivors with consideration of individual characteristics such as age, lifestyle, cancer treatment modality, cancer type and education level.

D,L-Methadone causes leukemic cell apoptosis via an OPRM1-triggered increase in IP3R-mediated ER Ca2+ release and decrease in Ca2+ efflux, elevating [Ca2+]i.

The search continues for improved therapy for acute lymphoblastic leukemia (aLL), the most common malignancy in children. Recently, D,L-methadone was put forth as sensitizer for aLL chemotherapy. However, the specific target of D,L-methadone in leukemic cells and the mechanism by which it induces leukemic cell apoptosis remain to be defined. Here, we demonstrate that D,L-methadone induces leukemic cell apoptosis through activation of the mu1 subtype of opioid receptors (OPRM1). D,L-Methadone evokes IP3R-mediated ER Ca2+ release that is inhibited by OPRM1 loss. In addition, the rate of Ca2+ extrusion following D,L-methadone treatment is reduced, but is accelerated by loss of OPRM1. These D,L-methadone effects cause a lethal rise in [Ca2+]i that is again inhibited by OPRM1 loss, which then prevents D,L-methadone-induced apoptosis that is associated with activation of calpain-1, truncation of Bid, cytochrome C release, and proteolysis of caspase-3/12. Chelating intracellular Ca2+ with BAPTA-AM reverses D,L-methadone-induced apoptosis, establishing a link between the rise in [Ca2+]i and D,L-methadone-induced apoptosis. Altogether, our findings point to OPRM1 as a specific target of D,L-methadone in leukemic cells, and that OPRM1 activation by D,L-methadone disrupts IP3R-mediated ER Ca2+ release and rate of Ca2+ efflux, causing a rise in [Ca2+]i that upregulates the calpain-1-Bid-cytochrome C-caspase-3/12 apoptotic pathway.

Personalized 5-Year Prostate Cancer Risk Prediction Model in Korea Based on Nationwide Representative Data.

Prostate cancer is the fourth most common cause of cancer in men in Korea, and there has been a rapid increase in cases. In the present study, we constructed a risk prediction model for prostate cancer using representative data from Korea. Participants who completed health examinations in 2009, based on the Korean National Health Insurance database, were eligible for the present study. The crude and adjusted risks were explored with backward selection using the Cox proportional hazards model to identify possible risk variables. Risk scores were assigned based on the adjusted hazard ratios, and the standardized points for each risk factor were proportional to the ß-coefficient. Model discrimination was assessed using the concordance statistic (c-statistic), and calibration ability was assessed by plotting the mean predicted probability against the mean observed probability of prostate cancer. Among the candidate predictors, age, smoking intensity, body mass index, regular exercise, presence of type 2 diabetes mellitus, and hypertension were included. Our risk prediction model showed good discrimination (c-statistic: 0.826, 95% confidence interval: 0.821-0.832). The relationship between model predictions and actual prostate cancer development showed good correlation in the calibration plot. Our prediction model for individualized prostate cancer risk in Korean men showed good performance. Using easily accessible and modifiable risk factors, this model can help individuals make decisions regarding prostate cancer screening.

Factors associated with pneumococcal vaccination uptake by cancer survivors.

PURPOSE: This study aimed to evaluate factors associated with pneumococcal vaccination uptake (PVU) of cancer survivors. METHODS: A total of 2032 Korean adult cancer survivors diagnosed between June of 1975 and February of 2018 have participated. Information on PVU status and selected variables were collected through self-administered questionnaires and medical record review. Factors associated PVU were investigated using multiple logistic regression analysis. RESULTS: PVU rate markedly differed by age strata and cancer sites: 73.9% for elderly (≥ 65 years) survivors and 34.6% for younger (< 65 years) survivors and 73.4% for lung cancer survivors and 42.1% for non-lung cancer survivors. Regular physical exercise was associated with higher PVU in both age groups: Odds ratio (OR) and 95% confidence interval (CI) were 1.52 (1.20, 1.94) for younger and 1.78 (1.09, 2.90) for elderly survivors. Complementary medication use was positively associated with PVU with borderline significance in both age groups. However, the association of PVU with other factors differed between the two age groups. In younger survivors, a positive association with PVU was evident for longer time lapse after cancer diagnosis, chronic disease, and living with spouse/or partner, while cancer stage, educational achievement, and alcohol use were inversely associated PVU. On the other hand, multi-modality (≥ 3) cancer treatment was inversely associated with PVU only in elderly survivors. CONCLUSIONS: PVU of Korean cancer survivors was suboptimal in younger survivors and non-lung cancer survivors. Factors associated with PVU differed between younger and elderly survivors, and more diverse factors were identified for younger survivors. IMPLICATIONS FOR CANCER SURVIVORS: In order to promote adherence to PVU in cancer survivors, careful consideration of high-risk factors for non-immunization within cancer survivorship context would be necessary together with free-of-charge vaccination policy.

Association between perception of care coordination and health outcomes in Korean cancer survivors.

BACKGROUND: To determine relationship between cancer survivors' perception of care coordination and their health outcomes. METHODS: Study subjects were 1306 Korean adulthood cancer survivors who were enrolled in two academic hospital and completed a questionnaire consisting of questions asking two aspects of care coordination for cancer treatment they had received: 1) who played a main coordinator role and 2) whether care services had met their necessitated health concerns. We measured health outcomes including new comorbidity, number of clinic visits, health-related quality of life (HRQoL) and fear of cancer recurrence (FCR). Associations between the level of care coordination and health outcomes were evaluated by multiple logistic regression analysis after adjusting for covariates. RESULTS: Survivors with uncoordinated care were more likely to have more new comorbidities after cancer diagnosis, visit clinic more frequently and have worse HRQoL and higher FCR. Females and unmarried survivors were more likely to have received uncoordinated care than males and ever married survivors. Uncoordinated care group had an increased the risk of new comorbidity (odds ratio 1.73, [95% confidence interval] 1.02-2.92), multiple clinic visits (1.69, 1.00-2.88), severe FCR (2.28, 1.33-3.93), low EuroQoL Visual Analogue Scale (1.82, 1.28-2.60), low global health status (1.51, 1.04-2.21), and poor physical (2.00, 1.31-3.04), role (2.46, 1.69-3.56) and emotional function (2.62, 1.81-3.78). CONCLUSIONS: Coordinated care of Korean cancer survivors was associated with their health outcomes, including new comorbidity, clinic visits, HRQoL and FCR. Good care coordination may be reinforced to improve outcomes of survivorship care.

Cancer Survivorship in Primary Care.

With the early detection of cancer and improvement in cancer therapy, the number of cancer survivors is rapidly increasing. This number is expected to reach 2 million by the end of 2019. Cancer survivors struggle with not only cancer-related health problems but also diverse acute and chronic diseases. These health issues make cancer survivorship more complex, and proper care coordination is necessary. This study aimed to summarize the definition of cancer experience and management of cancer survivors, specifically focused on gastric, colorectal, lung, breast, thyroid, prostate, and cervical cancers. Furthermore, it aimed to discuss the role of primary care in cancer survivorship and survivorship care models and the National Policy for Cancer Survivors and Future Challenges.

Hospital cancer pain management by electronic health record-based automatic screening.

OBJECTIVES: A cancer pain clinic (CPC) service is a thorough, comprehensive consultation service for patients with uncontrolled cancer pain. The aim of this study was to determine the success of a new CPC service with enrollment via electronic health record-based automatic screening at 1 cancer center in Korea. STUDY DESIGN: A case-control study and a satisfaction survey. METHODS: The intervention group (n = 158) was enrolled in the CPC service, whereas the control group (n = 158), which was matched using propensity scores, did not participate in the service. The pain scores of participants were compared using an independent t test. Thirty-nine patients and 20 physicians completed a self-administered survey on instructions for pain-relief medications, effective usage of long-acting and short-acting opioids, perceptions of or barriers to CPC services, knowledge of opioid use, and overall satisfaction. RESULTS: Although the baseline pain score of the intervention group was significantly higher than that of the control group (P = .013), the difference in the decrease of pain between the groups was significant at days 1 (P = .001) and 2 (P = .039). Although the difference in pain scores disappeared on day 3, total pain score was significantly lower in the intervention group than in the control group (P = .012). When comparing pain relief events (<4 points on a 0-10 numeric rating scale that measured pain daily), the intervention group experienced more relief events than did controls (P = .017). Patients were satisfied with their physicians giving clear instructions and considering their opinions about pain-relief medications. The oncology residents expressed satisfaction with the management of patients with opioid-naïve or intractable pain. CONCLUSIONS: The new CPC service seems to provide effective pain relief and users seem to be highly satisfied with it. These results support the importance of an integrated and specialized approach to cancer-related pain management.

The Risk of Microalbuminuria by Obesity Phenotypes according to Metabolic Health and Obesity: The Korean National Health and Nutrition Examination Survey 2011-2014.

BACKGROUND: The present study aimed at identifying the difference in the risk of microalbuminuria among individuals with various obesity phenotypes in terms of metabolic health and obesity. METHODS: This cross-sectional study included 15,268 individuals and used data from the National Health and Nutrition Survey conducted from 2011 to 2014. Obesity was defined as body mass index ≥25 kg/m². Metabolically unhealthy was defined as meeting two or more of the following criteria: systolic and diastolic blood pressure ≥130/85 mm Hg or current use of hypertensive drugs; triglyceride level ≥150 mg/dL; high-density lipoprotein level <40/50 mg/dL (in both men and women); and fasting blood glucose level ≥100 mg/dL or current use of oral antidiabetic medications. The participants were further classified into four subgroups: metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUNO), and metabolically unhealthy obese (MUO). RESULTS: A significant difference was observed in the microalbuminuria ratio among the four groups. The MHNO group was considered as the reference group, and the MHO, MUNO, and MUO groups were at an increased risk for microalbuminuria by 1.42 fold (95% confidence interval [95% CI], 1.03-1.96), 2.02 fold (95% CI, 1.61-2.53), and 3.40 fold (95% CI, 2.70-4.26), respectively, after adjusting confounding factors. CONCLUSION: The MUNO group had a higher risk of developing microalbuminuria than the MHNO group. Thus, based on this result, differences were observed in the risk of developing microalbuminuria among individuals with various obesity subtypes.

Association between Female Urinary Incontinence and Geriatric Health Problems: Results from Korean Longitudinal Study of Ageing (2006).

BACKGROUND: Urinary incontinence (UI) is highly prevalent in the aging population. UI is one of the most common geriatric syndromes and affects overall health, quality of life, and economical burden in patients. The aims of this study were to investigate the characteristics of patients with UI and to assess its association with other geriatric health problems. METHODS: We used data from the Korean Longitudinal Study of Ageing obtained in 2006. Among the 10,254 individuals aged 45 years and older, we analyzed data from 2,418 women aged 65 years and older. Data were obtained using questionnaires for UI, comorbidities, and lifestyle factors. RESULTS: Among the 2,418 women aged 65 years and older, 506 (20.9%) had UI. Cerebrovascular disease (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.26 to 3.23), arthritis (OR, 1.44; 95% CI, 1.18 to 1.77), and fear of falling (OR, 1.62; 95% CI, 1.18 to 2.22) were significantly associated with UI, while chronic lung disease, psychiatric disease, difficulty in daily living due to visual and hearing problems, and experiencing a fall in the last 2 years were not associated with UI. CONCLUSION: Cerebrovascular disease, arthritis, and especially fear of falls were significantly associated with UI in elderly Korean women.

Validation of the Korean Version of the Breakthrough Pain Assessment Tool in Cancer Patients.

CONTEXT: Breakthrough cancer pain has not been properly evaluated and treated because there are relatively few available measurements. The Breakthrough Pain Assessment Tool (BAT) is currently recognized as a brief, multidimensional, and reliable measurement. OBJECTIVES: The objective of this study was to validate the Korean version of the BAT (BAT-K) in adult cancer patients. METHODS: We conducted a forward-backward translation and cross-cultural equivalence test. The psychometric properties with 120 cancer patients were assessed using factor analysis, reliability, and validity. RESULTS: The Korean translation was well accepted by participants. Factor analysis revealed the presence of two underlying factors: frequency/severity and duration/medication efficacy. Cronbach alpha coefficient was 0.743. Severity, distress, and disruption of normal life showed strong reliability. The intraclass correlation for the test-retest reliability was 0.782 (95% confidence interval 0.694-0.854). The BAT-K had significant correlations with the Brief Pain Inventory, Pain Management Index, and Eastern Cooperative Oncology Group performance status (all P values < 0.05). CONCLUSION: The BAT-K is a valid and reliable measurement of breakthrough cancer pain in Korean cancer patients.

Risk of Cardiovascular Disease Using Framingham Risk Score in Korean Cancer Survivors.

BACKGROUND: Cardiovascular disease is an important cause of morbidity and mortality in cancer survivors. The aim of this study was to investigate the modifiable cardiovascular disease risk factors and 10-year probability of the disease based on the Framingham risk score in cancer survivors, compared with the general population. METHODS: A total of 1,225 cancer survivors and 5,196 non-cancer controls who participated in the 2007-2013 Korea National Health and Nutrition Examination Surveys were enrolled. We assessed modifiable cardiovascular disease risk factors including smoking, body mass index, physical inactivity, high blood pressure, high cholesterol, and elevated blood glucose level. The 10-year probability of cardiovascular disease was determined by applying the Framingham cardiovascular disease risk equation among cancer survivors and non-cancer controls, ranging from 30 to 74 years old who had no overt cardiovascular diseases. RESULTS: The proportion of subjects who had higher fasting glucose levels, hemoglobin A1c levels, systolic blood pressure, and low density lipoprotein cholesterol levels, and those who had lower high density lipoprotein cholesterol levels was significantly higher in the cancer survivors than in the non-cancer controls. The average 10-year probability of cardiovascular disease among the cancer survivors was higher than that in the non-cancer controls in both men and women. The average 10-year probability of cardiovascular disease in relation to the cancer type was significantly higher in patients with hepatic, colon, lung, breast, and gastric cancer. CONCLUSION: Cancer survivors have a higher cardiovascular disease risk and 10-year probability of cardiovascular disease than non-cancer controls. Control of cardiovascular disease risk factors and implementation of a well-defined cardiovascular disease prevention program are needed for treating cancer survivors.

Association between Smoking and Periodontal Disease in Korean Adults: The Fifth Korea National Health and Nutrition Examination Survey (2010 and 2012).

BACKGROUND: This study aimed to evaluate an association between smoking, smoking cessation, and periodontal disease in Korean adults. METHODS: The data were collected from 8,336 participants, aged between 20 and 64 years, who participated in the fifth Korea National Health and Nutrition Examination (2010 and 2012). Smoking status was assessed using self-administered questionnaires. Periodontal disease was defined as a community periodontal index ≥3 points. Logistic regression analysis was used to evaluate an association between smoking, smoking cessation, and periodontal disease after adjusting for age, sex, education, monthly income, diabetes, obesity, alcohol intake, and frequency of tooth brushing. RESULTS: The risk of periodontal disease was higher among current smokers (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.21-1.83) than never smokers. Among current smokers, the risk of periodontal disease was increased in smokers of ≥10 cigarettes/d, ≥20 years duration, and >10 pack-years compared with never smokers (P<0.05). Among former smokers, the risk of periodontal disease after 10 years since cessation declined to 0.56 (95% CI, 0.42-0.75) compared with current smokers and was indistinguishable statistically from never smokers. CONCLUSION: Periodontal disease is significantly associated with smoking status in Korean adults.

Factors Associated with Fatigue in Korean Gastric Cancer Survivors.

BACKGROUND: Gastric cancer is the second most common cancer in Korea. Fatigue is a common symptom among cancer survivors. The aim of this study was to identify factors associated with fatigue in gastric cancer survivors. METHODS: Data were analyzed from 199 gastric cancer survivors who visited a cancer survivor outpatient clinic from July 2013 to June 2014. Patients were surveyed using a questionnaire containing a fatigue severity scale (FSS) and questions regarding associated symptoms. Participants were divided into fatigue (FSS) and non-fatigue groups based on FSS scores (≥4 and <4, respectively). Age, sex, weight, body mass index, cancer stage, pathology, surgery type, chemotherapy, radiotherapy, comorbid disease, family history of cancer, smoking, alcohol consumption, exercise, and laboratory results were investigated. RESULTS: The fatigue and non-fatigue groups contained 42 and 157 survivors, respectively. Their mean age was 58 years, and the mean post-operative period was 6.58 years. Arthralgia (odds ratio [OR], 12.95; 95% confidence interval [CI], 3.21-52.34), dyspnea (OR, 10.54; 95% CI, 2.94-37.80), dyspepsia (OR, 8.26; 95% CI, 2.63-25.96), changed bowel habits (OR, 4.56; 95% CI, 1.09-19.11), anemia (OR, 3.18; 95% CI, 1.26-8.05), and regular exercise (OR, 0.31; 95% CI, 0.12-0.77) were significantly associated with fatigue in gastric cancer survivors, while weight, treatment, and depressive mood were not. CONCLUSION: Arthralgia, dyspnea, dyspepsia, bowel habit change, anemia, and regular exercise are associated with fatigue in gastric cancer survivors.

Health-Related Quality of Life and Cardiovascular Disease Risk in Korean Adults.

BACKGROUND: Health-related quality of life (HRQoL) is considered an important outcome measure in chronic diseases, in particular cardiovascular disease (CVD), which is known to be associated with impaired HRQoL. However, few studies have examined HRQoL in individuals at high risk of CVD. METHODS: Using the Fifth Korea National Health and Nutrition Examination Survey 2010-2012, we analyzed data from 10,307 adults aged ≥30 years. The study subjects were stratified into 3 groups on the basis of their Framingham risk score-a 10-year estimate of CVD risk: <10.0% (low risk), 10.0%-19.9% (moderate risk), and ≥20.0% (high risk). The EuroQol-5D (EQ-5D) was used to evaluate HRQoL. RESULTS: A significantly higher proportion of high-risk subjects than low-risk participants had impaired HRQoL (defined as the lowest quartile of the EQ-5D index); this held true even after adjustment for confounding factors in multivariable logistic regression analysis (men: odds ratio [OR], 1.62; 95% confidence interval [CI], 1.24-2.11; women: OR, 1.46; 95% CI, 1.02-2.08). In terms of the 5 EQ-5D dimensions, a 10-year CVD risk ≥20.0% was significantly associated with self-reported problems of mobility in men (OR, 3.15; 95% CI, 2.02-4.90), and of mobility (OR, 1.56; 95% CI, 1.09-2.24), self-care (OR, 2.14; 95% CI, 1.09-4.22), and usual activity problems (OR, 1.80; 95% CI, 1.17-2.78) in women. CONCLUSION: A high CVD risk is associated with impaired HRQoL. After adjustment for demographic and clinical factors, a 10-year CVD risk ≥20.0% is an independent predictor of impaired HRQoL in the general population; in particular, of mobility problems in men, and of mobility, self-care, and usual activity problems in women.

Suicidal ideation in underweight adults who attempt to lose weight: Korea national health and nutrition examination survey, 2007-2012.

BACKGROUND: Being underweight has been related to health risks. However, little is known about the relationship between suicidal ideation and attempting to lose weight. This study was conducted to examine if there is an association between suicidal ideation and attempting to lose weight among underweight adults. METHODS: A cross-sectional study of 1,122 underweight adults (range, 19 to 69 years) was conducted based on the Korea National Health and Nutrition Examination Survey, 2007-2012. We examined suicidal ideation, doctor-diagnosed depression, depressive mood, stress, physical activity, health-related behavior, comorbidity, and socioeconomic status by weight loss attempts. Logistic regression analysis was performed to examine the association between suicidal ideation and weight loss attempts. The following covariates were controlled for: age, sex, physical activity, alcohol problem, marital status, education, income, occupation, self-perception of body image, chronic disease, and body mass index. RESULTS: There were 101 subjects in the weight loss attempt group and 1,021 in the non-attempt group. The attempt group had a higher risk of suicidal ideation (odds ratio [OR], 2.47; 95% confidence interval [CI], 1.35 to 4.53) and depressive symptoms (OR, 2.17; 95% CI, 1.19 to 3.98). After depressive symptoms were added to the covariates, the risk of suicidal ideation was also significant (OR 2.11, 95% CI: 1.03 to 4.35). The two groups did not significantly differ in doctor-diagnosed depression and stress. CONCLUSION: Weight loss attempts were associated with suicidal ideation in underweight Korean adults.