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Population structures are changing in many developed countries, and Korean society is currently one of the fastest ageing worldwide.1 This circumstance is due to a rapidly decreasing birth rate and an increasing life expectancy in recent decades, and this situation is likely to continue for a prolonged period. A national epidemiological investigation predicted that Korea will move from an ageing society to a ‘superaged’ society in only 25 years, from 2000 to 2025, with 46.5% (18.3 million) of the population expected to be older than 65 years by 2067.1 This demographic change gives rise to substantial challenges in dealing with increased demands on medical services relating to chronic and degenerative diseases, particularly related to the increasing prevalence of dementia in elderly patients (which was 9.2% in 2014).2 The care needs of community-residing people with dementia are complex and depend on the severity of dementia symptoms, such as cognitive impairment, functional dependencies and behavioural and psychological symptoms.3
Given the dynamic characteristic of an individual’s drinking behaviours, comprehensive consideration of alcohol consumption variation using repeated measures may improve insight into the nature of its association with blood pressure (BP) change. We examined the association between longitudinal alcohol consumption (trajectory and quantity) and changes in BP and pulse pressure (PP) among Korean aged ≥ 40 years living in rural areas. Totally, 1682 hypertension-free participants who completed all three health examinations (median, 5·3 years) were included. All three visits were used to determine the cumulative trajectory of and quantity of alcohol consumption and the latest two visits and the last visit were used for the recent trajectory and the most recent quantity of alcohol consumption, respectively. Changes in BP and PP from the baseline to the third visit were used as outcome. In men, ≥30 ml/d cumulative average alcohol consumption was associated with the greatest increase in systolic BP (SBP) in both baseline outcome-unadjusted (2·9 mmHg, P = 0·032) and -adjusted models (3·6 mmHg, P = 0·001), and the given association for the most recent alcohol consumption was observed in the baseline outcome-adjusted model (3·9 mmHg, P = 0·003). For PP, similar associations were observed only in the baseline outcome-adjusted model. No meaningful associations in diastolic BP in men and any BP or PP in women existed. The quantity of alcohol consumption rather than the trajectory may be significantly related to raised SBP, and a possible short-term influence of the most recent alcohol consumption may exist when baseline SBP is adjusted in men.
Early replacement of a new central venous catheter (CVC) may pose a risk of persistent or recurrent infection in patients with a catheter-related bloodstream infection (CRBSI). We evaluated the clinical impact of early CVC reinsertion after catheter removal in patients with CRBSIs.
We conducted a retrospective chart review of adult patients with confirmed CRBSIs in 2 tertiary-care hospitals over a 7-year period.
To treat their infections, 316 patients with CRBSIs underwent CVC removal. Among them, 130 (41.1%) underwent early CVC reinsertion (≤3 days after CVC removal), 39 (12.4%) underwent delayed reinsertion (>3 days), and 147 (46.5%) did not undergo CVC reinsertion. There were no differences in baseline characteristics among the 3 groups, except for nontunneled CVC, presence of septic shock, and reason for CVC reinsertion. The rate of persistent CRBSI in the early CVC reinsertion group (22.3%) was higher than that in the no CVC reinsertion group (7.5%; P = .002) but was similar to that in the delayed CVC reinsertion group (17.9%; P > .99). The other clinical outcomes did not differ among the 3 groups, including rates of 30-day mortality, complicated infection, and recurrence. After controlling for several confounding factors, early CVC reinsertion was not significantly associated with persistent CRBSI (OR, 1.59; P = .35) or 30-day mortality compared with delayed CVC reinsertion (OR, 0.81; P = .68).
Early CVC reinsertion in the setting of CRBSI may be safe. Replacement of a new CVC should not be delayed in patients who still require a CVC for ongoing management.
To propose a new anthropometric index that can be employed to better predict percent body fat (PBF) among young adults and to compare with current anthropometric indices.
All measurements were taken in a controlled laboratory setting in Seoul (South Korea), between 1 December 2015 and 30 June 2016.
Eighty-seven young adults (18–35 years) who underwent dual-energy x-ray absorptiometry (DXA) were used for analysis. Multiple regression analyses were conducted to develop a body fat index (BFI) using simple demographic and anthropometric information. Correlations of DXA measured PBF (DXA_PBF) with previously developed anthropometric indices and the BFI were analysed. Receiver operating characteristic curve analyses were conducted to compare the ability of anthropometric indices to identify obese individuals.
BFI showed a strong correlation with DXA_PBF (r = 0·84), which was higher than the correlations of DXA_PBF with the traditional (waist circumference, r = 0·49; waist to height ratio, r = 0·68; BMI, r = 0·36) and alternate anthropometric indices (a body shape index, r = 0·47; body roundness index, r = 0·68; body adiposity index, r = 0·70). Moreover, the BFI showed higher accuracy at identifying obese individuals (area under the curve (AUC) = 0·91), compared with the other anthropometric indices (AUC = 0·71–0·86).
The BFI can accurately predict DXA_PBF in young adults, using simple demographic and anthropometric information that are commonly available in research and clinical settings. However, larger representative studies are required to build on our findings.
We have developed new flexible dye-sensitized solar cells (DSSCs) comprising organic dye (JH-1), cobalt redox electrolyte and hierarchically structured TiO2 (HS-TiO2) photoelectrode prepared using an electrostatic spray method. The performance of JH-1 sensitized flexible DSSC with a cobalt redox electrolyte was compared with those of N719-based DSSC and DSSC with I-/ I3- redox electrolyte. As a result, JH-1 sensitized flexible DSSC with [Co(Ⅲ/Ⅱ)(bpy-pz)3](PF6)3/2 redox system exhibited a high photocurrent density of 9.17 mA cm-2, an open circuit voltage of 0.953 V, a fill factor of 0.70, and a power conversion efficiency of 6.12% under 1 sun illumination (100 mW cm-2). The incident photon-to-current conversion efficiency was measured to explain the photocurrent generation difference by different dyes and electrolytes. The electron recombination lifetime of cells was measured by intensity-modulated photovoltage spectroscopy. Mass transport in DSSCs employing cobalt redox electrolytes was also investigated by the photocurrent transient measurements and electrochemical impedance spectroscopy (EIS) analysis.
It has not been well established whether dietary folate intake reduces the risk of diabetes development. We aimed to clarify the prospective association between dietary folate intake and type 2 diabetes (T2D) risk among 7333 Korean adults aged 40 years or older who were included in the Multi-Rural Communities Cohort. Dietary folate intake was estimated from all 106 food items listed on a FFQ, not including folate intake from supplements. Two different measurements of dietary folate intake were used: the baseline consumption and the average consumption from baseline until just before the end of follow-up. The association between folate intake and T2D risk was determined through a modified Poisson regression model with a robust error estimator controlling for potential confounders. For 29 745 person years, 319 cases of diabetes were ascertained. In multivariable analyses, dietary folate intake was inversely associated with risk of T2D for women, not for men. For women, the incidence rate ratio of diabetes in the third tertile compared with the first tertile was 0·57 (95 % CI 0·38–0·87, Pfor trend=0·0085) in the baseline consumption model and 0·64 (95 % CI 0·43–0·95, Pfor trend=0·0244) in the average consumption model. These inverse associations was found in both normal fasting blood glucose group and impaired fasting glucose group among women. Among non-users of multinutrients and vitamin supplements, the significant inverse association remained. Thus, higher dietary intake of folate is prospectively associated with lower risk of diabetes for women.
A growing number of studies are emphasizing the importance of positive and negative appraisals of caregiving and the utilization of social resources to buffer the negative effects of caring for persons with dementia. By assessing the roles of unmet needs and formal support, this study tested a hypothesized model for Korean family caregivers’ satisfaction and burden in providing care for persons with dementia.
The stress process model and a two-factor model were used as the conceptual framework for this study. Data for 320 family caregivers from a large cross-sectional survey, the Seoul Dementia Management study, were analyzed using structural equation modeling. In the hypothesized model, the exogenous variables were patient symptoms, including cognitive impairment, behavioral problems, and dependency on others to help with activities of daily living and with instrumental activities of daily living. The endogenous variables were the caregiver's perception of the unmet needs of the patient, formal support, caregiving satisfaction, and caregiving burden.
The adjusted model explained the mediating effect of unmet needs on the relationship between patient symptoms or formal support and caregiving satisfaction. Formal support also had a mediating effect on the relationship between patient symptoms and unmet needs. Patient symptoms and caregiving satisfaction had a significant direct effect on caregiving burden.
The level of unmet needs of persons with dementia and their family caregivers must be considered in the development of support programs focused on improving caregiving satisfaction.
Diet may play an important role in breast cancer recurrence or survival, and therefore assessment of long-term diet among breast cancer survivors is important in breast cancer survivorship research. Given that the diet of breast cancer survivors may differ from that of the general population, the use of a FFQ specific to this group may be needed. The objective of this study was to develop a FFQ for breast cancer survivors, the most commonly used tool to measure long-term dietary patterns in nutritional epidemiological studies. We collected information on the foods and amounts of foods consumed using 3-d dietary records from a total of 192 women who had been diagnosed with stage I–III breast cancers and had undergone breast cancer surgery at least 6 months before the baseline study. A total of 1254 foods and dishes consumed were re-grouped by the similarity of the main ingredients and/or serving units, and several dishes commonly consumed among the Korean population were added. After we performed contribution analyses and variability analyses to detect between-person variation for selected nutrients, we listed a total of 123 foods and dishes for the FFQ specific to breast cancer survivors. Our breast cancer survivor-specific FFQ can be used to estimate long-term dietary intake and to examine its association with breast cancer prognosis in epidemiological studies of breast cancer in Korea.
A CoCrFeNiMn high-entropy alloy (HEA), in the form of a face-centered cubic (fcc) solid solution, was processed by high-pressure torsion (HPT) to produce a nanocrystalline (nc) HEA. Significant grain refinement was achieved from the very early stage of HPT through 1/4 turn and an nc structure with an average grain size of ∼40 nm was successfully attained after 2 turns. The feasibility of significant microstructural changes was attributed to the occurrence of accelerated atomic diffusivity under the torsional stress during HPT. Nanoindentation experiments showed that the hardness increased significantly in the nc HEA during HPT processing and this was associated with additional grain refinement. The estimated values of the strain-rate sensitivity were maintained reasonably constant from the as-cast condition to the nc alloy after HPT through 2 turns, thereby demonstrating a preservation of plasticity in the HEA. In addition, a calculation of the activation volume suggested that the grain boundaries play an important role in the plastic deformation of the nc HEA where the flow mechanism is consistent with other nc metals. Transmission electron microscopy showed that, unlike conventional fcc nc metals, the nc HEA exhibits excellent microstructural stability under severe stress conditions.
To trace the surficial responses of lowlands to past climate change, we investigated δ13C in total organic carbon (TOC), C/N ratios, magnetic susceptibility (MS), and silicon (Si) intensity (directly proportional to concentration) in wetland sediments collected from the Gimpo area of central Korea, covering 6600–4600 cal yr BP. Two organic layers with high TOC%, negatively depleted δ13CTOC values (− 27 to − 29‰), low MS values, and low Si intensities were found at 6200–5900 and 5200–4800 cal yr BP, respectively. These middle Holocene wet periods corresponded to relatively intensified summer monsoon and solar activity periods. The intervening dry period (5900–5200 cal yr BP) with high MS, high Si, and low TOC% corresponded to an intensified dust-activity interval and stronger winter monsoon. This multi-centennial climatic fluctuation of wet periods (6200–5900 cal yr BP and 5200–4800 cal yr BP) and an intervening dry period (5900–5200 cal yr BP) in central Korea was more synchronous with climate change in the arid inner part of China than with that in South China, suggesting possible strong high-latitude-driven climatic influences (e.g., North Atlantic cooling events) during the middle Holocene.
Caregiver burden is a complex and multidimensional construct. Although previous studies have explored numerous factors associated with caregiver burden, these factors have not been identified with a large population-based sample in a theory-based multidimensional way. This study explores multidimensional determinants associated with family caregiver burden to determine the main contributors of caregiver burden in Alzheimer's disease (AD) using a large community dataset.
A retrospective secondary data analysis was conducted on 1,133 patients with AD and 1,133 primary caregivers who were registered in a metropolitan city dementia center in South Korea. The patient data included socio-demographic and disease profiles. The caregiver data consisted of socio-demographic and caregiving profiles.
The study results identified that dementia-related factors were the most significant factors, representing 25.6% of caregiver burden and were followed by caregiving-related factors explaining caregiver burden significantly. Behavioral problems and instrumental activities of daily living (IADL) dependency of the patient, spousal relationship, hours of caregiving, and the number of diseases associated with the caregiver were found to be significant individual variables.
It is vital to develop a service and support program with a greater emphasis on the behavioral problems and IADL deficiency of patients with AD as well as on improving the competence ability of caregivers to deal with such difficulties.
The highest increase in the prevalence of dementia in the elderly population is expected in South Korea than in any other country in the world. However, there is no assessment of the community-based general populations’ understanding of dementia in South Korea, in spite of the increasing burden of dementia. Thus, this study assessed the public knowledge about dementia.
This is a population-based, cross-sectional study of 2,189 participants, aged 10 years or older, and living in Seoul, South Korea. A 12-item questionnaire with true/false responses was used to assess the knowledge about dementia from June to November 2011. The data obtained were analyzed using quantitative methods.
The mean score for the knowledge about dementia was 9.0 ± 2.1 points out of 12 points. More than half of the respondents (52.7%) reported that dementia is not treatable, and one-third of the participants did not know that Alzheimer's disease is the most common cause of dementia. The level of dementia knowledge was negatively associated with increasing age, and positively associated with higher education level.
Our results suggest that although laypersons had a fair knowledge about dementia, further educational programs and campaigns are needed to improve knowledge about dementia, more focusing on elderly adults as the target audience and emphasizing the causes and treatments of dementia as educational contents.
We aimed to evaluate the reproducibility and validity of the newly developed FFQ for the Korean National Health and Nutrition Examination Survey (KNHANES) and to estimate the measure’s calibration factors.
The 109-item FFQ was administered twice, approximately 9 months apart. We also collected four seasonal 3 d dietary records (DR) as a reference method. Correlation coefficients and joint classification were computed to compare intakes of energy, thirteen nutrients and eleven food groups between the two FFQ to evaluate reproducibility. For validity, de-attenuated and energy-adjusted correlation, joint classification and Bland–Altman statistics were calculated for energy and nutrients between the first FFQ and the DR. To calibrate the FFQ, we performed a linear regression analysis in which the DR were the dependent variables and FFQ, age and sex were the independent variables.
Seoul metropolitan area, Republic of Korea.
A total of 126 adults aged 20–65 years.
The average correlation coefficients measuring reproducibility were 0·54 for nutrients and 0·57 for food groups. The mean correlation coefficient measuring validity was 0·40 for all nutrients between the first FFQ and the DR. On average, 75 % of the participants were classified into the same or adjacent quartiles, while 5 % of the participants were grossly misclassified. The mean energy and nutrient intakes estimated by the calibrated FFQ were similar to the means estimated by the DR.
The newly developed FFQ for assessing dietary intake in the KNHANES has acceptable reproducibility and modest validity compared with a 12 d DR collected over a 9-month period.
This study aimed to investigate the influences of age, education, and gender on the two total scores (TS-I and TS-II) of the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological assessment battery (CERAD-NP) and to provide normative information based on an analysis for a large number of elderly persons with a wide range of educational levels.
In the study, 1,987 community-dwelling healthy volunteers (620 males and 1,367 females; 50–90 years of age; and zero to 25 years of education) were included. People with serious neurological, medical, and psychiatric disorders (including dementia) were excluded. All participants underwent the CERAD-NP assessment. TS-I was generated by summing raw scores from the CERAD-NP subtests, excluding Mini-Mental State Examination and Constructional Praxis (CP) recall subtests. TS-II was calculated by adding CP recall score to TS-I.
Both TS-I and TS-II were significantly influenced by demographic variables. Education accounted for the greatest proportion of score variance. Interaction effect between age and gender was found. Based on the results obtained, normative data of the CERAD-NP total scores were stratified by age (six overlapping tables), education (four strata), and gender.
The normative information will be very useful for better interpretation of the CERAD-NP total scores in various clinical and research settings and for comparing individuals’ performance of the battery across countries.
Social support programs for dementia caregivers were widely used in order to reduce care burden. We investigated which types of social supports can reduce psychological and non-psychological burdens of dementia caregivers, and explored the mechanism of those social supports.
We evaluated 731 community-dwelling dementia patients and their caregivers from the National Survey of Dementia Care in South Korea. We investigated the five types of social supports (emotional support, informational support, tangible support, positive social interaction, affectionate support) using the Medical Outcomes Study Social Support Survey in each caregiver. The mechanisms of specific types of social support on psychological/non-psychological burden were examined using path analysis.
Positive social interaction and affectionate support reduced psychological burden via direct and indirect paths. Tangible support reduced the non-psychological burden via direct and indirect paths. Informational support and emotional support were not helpful for reducing psychological or non-psychological burden. A maximum of 20% of psychological burden could be relieved by positive social interaction and 10.3% of that could be reduced by affectionate support. Tangible support was associated with a 15.1% maximal improvement in non-psychological burden.
In order to reduce caregiver burden in dementia effectively, psychosocial interventions should be tailored to target type of caregiver burden.
Lutein has significant nutritional benefits for human health. Therefore, enhancing soybean lutein concentrations is an important breeding objective. However, selection for soybeans with high and environmentally stable lutein concentrations has been limited. The objectives of this study were to select soybeans with high seed lutein concentrations and to determine the stability of lutein concentrations across environments. A total of 314 genotypes were screened and 18 genotypes with high lutein concentrations and five genotypes with low lutein concentrations were selected for further examination. These 23 genotypes and two check varieties were evaluated under six environments (two planting dates for 2 years at one location and two planting dates for 1 year at another location). Lutein concentrations were influenced by genotype, environment and genotype × environment interactions. Genotypes with late maturity and low lutein concentrations were more stable than those with early maturity and high concentrations. Early (May) planting resulted in greater lutein concentrations than late (June) planting. Among the genotypes evaluated, PI603423B (7.7 μg/g) and PI89772 (5.8 μg/g) had the greatest mean lutein concentrations and exhibited medium and high stability across the six environments, respectively. Thus, these genotypes may be useful for breeding soybeans with high and stable seed lutein concentrations.
Sources of variation in nutrient intake have been examined for Western diets, but little is known about the sources of variation and their differences by age and sex among Koreans. We examined sources of variation in nutrient intake and calculated the number of days needed to estimate usual intake using 12 d of dietary records (DR). To this end, four 3 d DR including two weekdays and one weekend day were collected throughout four seasons of 1 year from 178 male and 236 female adults aged 20–65 years residing in Seoul, Korea. The sources of variation were estimated using the random-effects model, and the variation ratio (within-individual:between-individual) was calculated to determine a desirable number of days. Variations attributable to the day of the week, recording sequence and seasonality were generally small, although the degree of variation differed by sex and age (20–45 years and 46–65 years). The correlation coefficient between the true intake and the observed intake (r) increased with additional DR days, reaching 0·7 at 3–4 d and 0·8 at 6–7 d. However, the degree of increase became attenuated with additional days: r increased by 13·0–26·9 % from 2 to 4 d, by 6·5–16·4 % from 4 to 7 d and by 4·0–11·6 % from 7 to 12 d for energy and fifteen nutrients. In conclusion, the present study suggests that the day of the week, recording sequence and seasonality minimally contribute to the variation in nutrient intake. To measure Korean usual dietary intake using open-ended dietary instruments, 3–4 d may be needed to achieve modest precision (r>0·7) and 6–7 d for high precision (r>0·8).
Increasing number of massive globular clusters (GCs) in the Milky Way are now turned out to host multiple stellar populations having different heavy element abundances enriched by supernovae. Recent observations have further shown that [CNO/Fe] is also enhanced in metal-rich subpopulations in most of these GCs, including ω Cen and M22 (Marino et al. 2011, 2012). In order to reflect this in our population modeling, we have expanded the parameter space of Y2 isochrones and horizontal-branch (HB) evolutionary tracks to include the cases of normal and enhanced nitrogen abundances ([N/Fe] = 0.0, 0.8, and 1.6). The observed variations in the total CNO content were reproduced by interpolating these nitrogen enhanced stellar models. Our test simulations with varying N and O abundances show that, once the total CNO sum ([CNO/Fe]) is held constant, both N and O have almost identical effects on the HR diagram (see Fig. 1).