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We investigated gender differences in psychosocial determinants that affect hand hygiene (HH) performance among physicians.
The survey included a structured questionnaire with 7 parts: self-assessment of HH execution rate; knowledge, attitude, and behavior regarding HH; internal and emotional motivation for better HH; barriers to HH; need for external reminders; preference for alcohol gel; and embarrassment due to supervision.
The study was conducted across 4 academic referral hospitals in Korea.
Physicians who worked at these hospitals were surveyed.
The survey questionnaire was sent to 994 physicians of the hospitals in July 2018 via email or paper. Differences in psychosocial determinants of HH among physicians were analyzed by gender using an independent t test or the Fisher exact test.
Of the 994 physicians, 201 (20.2%) responded to the survey. Among them, 129 (63.5%) were men. Male physicians identified 4 barriers as significant: time wasted on HH (P = .034); HH is not a habit (P = .004); often forgetting about HH situations (P = .002); and no disadvantage when I do not perform HH (P = .005). Female physicians identified pain and dryness of the hands as a significant obstacle (P = .010), and they had a higher tendency to feel uncomfortable when a fellow employee performed inadequate HH (P = .098). Among the respondents, 26.6% identified diversifying the types of hand sanitizers as their first choice for overcoming barriers to improving HH, followed by providing reminders (15.6%) and soap and paper towels in each hospital room (13.0%).
A significant difference in the barriers to HH existed between male and female physicians. Promoting HH activities could help increase HH compliance.
Mood disorders require consistent management of symptoms to prevent recurrences of mood episodes. Circadian rhythm (CR) disruption is a key symptom of mood disorders to be proactively managed to prevent mood episode recurrences. This study aims to predict impending mood episodes recurrences using digital phenotypes related to CR obtained from wearable devices and smartphones.
The study is a multicenter, nationwide, prospective, observational study with major depressive disorder, bipolar disorder I, and bipolar II disorder. A total of 495 patients were recruited from eight hospitals in South Korea. Patients were followed up for an average of 279.7 days (a total sample of 75 506 days) with wearable devices and smartphones and with clinical interviews conducted every 3 months. Algorithms predicting impending mood episodes were developed with machine learning. Algorithm-predicted mood episodes were then compared to those identified through face-to-face clinical interviews incorporating ecological momentary assessments of daily mood and energy.
Two hundred seventy mood episodes recurred in 135 subjects during the follow-up period. The prediction accuracies for impending major depressive episodes, manic episodes, and hypomanic episodes for the next 3 days were 90.1, 92.6, and 93.0%, with the area under the curve values of 0.937, 0.957, and 0.963, respectively.
We predicted the onset of mood episode recurrences exclusively using digital phenotypes. Specifically, phenotypes indicating CR misalignment contributed the most to the prediction of episodes recurrences. Our findings suggest that monitoring of CR using digital devices can be useful in preventing and treating mood disorders.
Nosocomial transmission of COVID-19 among immunocompromised hosts can have a serious impact on COVID-19 severity, underlying disease progression and SARS-CoV-2 transmission to other patients and healthcare workers within hospitals. We experienced a nosocomial outbreak of COVID-19 in the setting of a daycare unit for paediatric and young adult cancer patients. Between 9 and 18 November 2020, 473 individuals (181 patients, 247 caregivers/siblings and 45 staff members) were exposed to the index case, who was a nursing staff. Among them, three patients and four caregivers were infected. Two 5-year-old cancer patients with COVID-19 were not severely ill, but a 25-year-old cancer patient showed prolonged shedding of SARS-CoV-2 RNA for at least 12 weeks, which probably infected his mother at home approximately 7–8 weeks after the initial diagnosis. Except for this case, no secondary transmission was observed from the confirmed cases in either the hospital or the community. To conclude, in the day care setting of immunocompromised children and young adults, the rate of in-hospital transmission of SARS-CoV-2 was 1.6% when applying the stringent policy of infection prevention and control, including universal mask application and rapid and extensive contact investigation. Severely immunocompromised children/young adults with COVID-19 would have to be carefully managed after the mandatory isolation period while keeping the possibility of prolonged shedding of live virus in mind.
Two aphid-transmitted RNA viruses, broad bean wilt virus 2 (BBWV2) and cucumber mosaic virus (CMV), are the most prevalent viruses in Korean pepper fields and cause chronic damage in pepper production. In this study, we employed a screening system for pathotype-specific resistance of pepper germplasm to BBWV2 and CMV by utilizing infectious cDNA clones of different pathotypes of the viruses (two BBWV2 strains and three CMV strains). We first examined pathogenic characteristics of the BBWV2 and CMV strains in various plant species and their phylogenetic positions in the virus population structures. We then screened 34 commercial pepper cultivars and seven accessions for resistance. While 21 pepper cultivars were resistant to CMV Fny strain, only two cultivars were resistant to CMV P1 strain. We also found only one cultivar partially resistant to BBWV2 RP1 strain. However, all tested commercial pepper cultivars were susceptible to the resistance-breaking CMV strain GTN (CMV-GTN) and BBWV2 severe strain PAP1 (BBWV2-PAP1), suggesting that breeding new cultivars resistant to these virus strains is necessary. Fortunately, we identified several pepper accessions that were resistant or partially resistant to CMV-GTN and one symptomless accession despite systemic infection with BBWV2-PAP1. These genetic resources will be useful in pepper breeding programs to deploy resistance to BBWV2 and CMV.
We quantitatively assessed the fit failure rate of N95 respirators according to the number of donning/doffing and hours worn.
A tertiary-care referral center in South Korea.
In total, 10 infection control practitioners participated in the fit test.
The first experiment comprised 4 consecutive 1-hour donnings and fit tests between each donning. The second experiment comprised 2 consecutive 3-hour donnings and fit tests between each donning. The final experiment comprised fit tests after an 1-hour donning or a 2-hour donning.
For 1-hour donnings, 60%, 70%, and 90% of the participants had fit failures after 2, 3, and 4 consecutive donnings, respectively. For 3-hour donnings, 50% had fit failure after the first donning and 70% had failures after 2 consecutive donnings. All participants passed the fit test after refitting whenever fit failure occurred. The final experiment showed that 50% had fit failure after a single use of 1 hour, and 30% had fit failure after a single use of 2 hours.
High fit-failure rates were recorded after repeated donning and extended use of N95 respirators. Caution is needed for reuse (≥1 time) and extended use (≥1 hour) of N95 respirators in high-risk settings such as those involving aerosol-generating procedures. Although adequate refitting may recover the fit factor, the use of clean gloves and strict hand hygiene afterward should be ensured when touching the outer surfaces of N95 respirators for refitting.
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.
Background: Mumps, a contagious disease, is transmissible by respiratory droplet particles and is preventable by vaccination. In South Korea, mandatory vaccination against mumps has markedly reduced its incidence. However, both the incidence and the number of reported cases of mumps have persistently increased in South Korea since 2007. Despite high vaccination rates, mumps outbreaks continue to occur, and many studies have been conducted on mumps seroprevalence in children and adolescents. In comparison, few reports have been published regarding mumps seroprevalence in healthcare workers (HCWs) in South Korea. Objective: We investigated the seroprevalence of HCWs in South Korea. Methods: This study was conducted at Asan Medical Center, a 2,705-bed tertiary-care hospital in Seoul, South Korea, with 8,329 HCWs. In 2018, we performed mumps antibody testing for HCWs. We administered MMR vaccination to all HCWs whose antibody test yielded equivocal or negative results. However, we did not repeat mumps antibody testing after MMR vaccination. Results: In total, 6,055 HCWs (73%) underwent mumps antibody testing. The overall mumps seropositivity rate was 87% (95% CI, 86%–87%). Seropositivity rates of all birth cohorts ranged from 72% to 92%. Mumps seropositivity rates were 88% in HCWs born before 1970, 87% in those born between 1970 and 1989, and 88% in those born between 1990 and 1995 (P = .59). Mumps seropositivity rates for both women and men HCWs were 87% (3,770 of 4,311 women and 1,517 of 1,744 men); the difference was not statistically significant (P = .62). The overall mumps seropositivity rate was 87%, which was above the herd immunity threshold of 75%–86%. Conclusions: Our results revealed that the overall mumps seropositivity rate in South Korean HCWs was above the herd immunity threshold. On the basis of this finding, we recommend that MMR vaccination after serologic testing may be a more reasonable approach than universal MMR vaccination alone in Korea.
Background: Measles is a highly contagious disease that is transmissible by airborne particles but is preventable by vaccination. South Korea has maintained a highly immunized adult population; however, small local outbreaks of measles continued to occur, and there have been some reports of pockets of underimmunity among the young adult population. It is important to know the seroepidemiology of healthcare workers (HCWs) for policy-making process, but data on the seroprevalence of measles in HCWs in South Korea are limited. Methods: We investigated the seroprevalence of HCWs at Asan Medical Center, a 2,705-bed tertiary-care hospital in Seoul, South Korea, with 8,329 HCWs. In 2014, after an outbreak of measles occurred in a university in Seoul, Asan Medical Center required measles IgG tests for all HCWs born in and after 1967 for point-prevalence surveillance. In addition, we have routinely performed measles antibody test for new HCWs since 2014. In 2018, antibody tests were administered to HCWs who were born before 1967 or who had taken a leave of absence in 2014. We provided MMR vaccination to all HCWs whose antibody tests yielded negative results. Results: In total, 7,411 HCWs (89%) underwent measles antibody tests from 2014 to 2018. The overall seropositivity was 73% (95% CI, 72%–74%); seroprevalence was 73% in HCWs born in of after 1967, whereas the seroprevalence in HCWs born before 1967 was 98%. The seroprevalence sharply decreased from 85% in the 1986 birth cohort to 42% in the 1995 birth cohort. Conclusions: In conclusion, the proportion of measles-susceptible individuals was substantially high in HCWs, especially in young adults. Because the impact of measles outbreak in healthcare facilities would be critical, a policy regarding routine serologic screening followed by measles vaccination or routine measles vaccination in healthcare facilities should be considered, especially for young Korean HCWs.
The Bipolar Depression Rating Scale (BDRS) is a scale for assessment of the clinical characteristics of bipolar depression. The primary aims of this study were to describe the development of the Korean version of the BDRS (K-BDRS) and to establish more firmly its psychometric properties in terms of reliability and validity.
The study included 141 patients (62 male and 79 female) who had been diagnosed with bipolar disorder, were currently experiencing symptoms of depression, and were interviewed using the K-BDRS. Other measures included the Montgomery and Asberg Depression Scale (MADRS), the 17-item Hamilton Depression Scale (HAMD), and the Young Mania Rating Scale (YMRS). Additionally, the internal consistency, concurrent validity, inter-rater reliability, and test-retest reliability of the K-BDRS were evaluated.
The Cronbach's α-coefficient for the K-BDRS was 0.866, the K-BDRS exhibited strong correlations with the HAMD (r = 0.788) and MADRS (r = 0.877), and the mixed symptoms score of the K-BDRS was significantly correlated with the YMRS (r = 0.611). An exploratory factor analysis revealed three factors that corresponded to psychological depressive symptoms, somatic depressive symptoms, and mixed symptoms.
The present findings suggest that the K-BDRS has good psychometric properties and is a valid and reliable tool for assessing depressive symptoms in patients with bipolar disorder.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
There is considerable uncertainty regarding changes in future mortality rates. This article investigates the impact of such longevity risk on discounted government annuity benefits for retirees. It is critical to forecast more accurate future mortality rates to improve our estimation of an expected annuity payout. Thus, we utilize the Lee–Carter model, which is well-known as a parsimonious dynamic mortality model. We find strong evidence that female retirees are likely to receive more public lifetime annuity than males in the USA, which is associated with systematic mortality rate differences between genders. A cross-country comparison presents that the current public annuity system would not fully cover retiree's longevity risk. Every additional year of life expectancy leaves future retirees exposed to high risk, arising from high volatility of lifetime annuities. Also, because the growth in life expectancy is higher than the growth of expected public pension, there will be a financial risk to retirees.
To determine the effectiveness of a workplace wellness programme intervention in improving participants’ behaviour towards choosing a healthy diet and the correlation with health indicators.
A retrospective cohort study.
Wellness programme in the Midwest, USA.
Employees (n 12 636) who participated in a wellness programme for three consecutive years during years 2004 to 2013 and who completed web-based health risk questionnaires. The wellness programme included annual health screening, laboratory measures, health risk questionnaire and personalized health-care programme. Participants’ food group intakes, BMI and health indicators were compared between the first and last year of participation. McNemar’s non-parametric test was used for paired nominal data. Pearson correlations were computed for paired food and health indicator measurements. Correlations between dietary intake and BMI, cholesterol and TAG were computed using Pearson correlations and McNemar’s test.
There were negative correlations between intakes of fruits, vegetables, grains, dairy, healthy eating pattern and health outcome indicators such as BMI and TAG levels. Additionally, the percentage of employees who increased their consumption of fruits (16·88 v. 12·08 %, P<0·001), vegetables (15·20 v. 11·44 %, P<0·001) and dark green leafy vegetables (12·03 v. 7·27 %, P 0·001) was significantly higher than the percentage of participants who decreased their intake of these food groups during the third-year follow-up.
The wellness programme improved some health indicator parameters and had a positive impact on increasing participants’ intakes of fruits, vegetables and whole grains at the third year of follow-up.
Adequate facepiece fit of N95 filtering facepiece respirators (FFRs) is crucial for optimal protection against airborne pathogens. The quantitative fit test (QNFT) pass rates of the 4 N95 FFR models commonly used in Korea were below 50%. Male sex was identified as a single independent predictive factor for QNFT pass.
To secure the reliability of flexible electronics, the effect of multicomponent stress on the device properties during complex mechanical deformation needs to be thoroughly understood. The electrical resistances of metal interconnects are investigated by in situ monitoring at different twisting angles and with different pattern positions. As the twisting angle increased, the electrical resistance increased earlier. Furthermore, in the line pattern located far from the central axis, severe electrical degradation and fatigue damage formation were observed. Multicomponent stress evolution during twisting was analyzed by the finite-element simulation method. For easy practical application for estimating the representative twisting strain, an analytic solution of twisting deformation was formulated and compared with the simulation. Using the equivalent strain, the fatigue lifetime was fitted, and the exponents were obtained for lifetime expectation. This systematic study provides the guidelines for highly reliable flexible devices and the tools for determining the expected fatigue lifetime.
The preparation of transmission electron microscopy (TEM) samples from powders is quite difficult and challenging. For powders with particles in the 1–5 μm size range, it is especially difficult to select an adequate sample preparation technique. Epoxy is commonly used to bind powder, but drawbacks, such as differential milling originating from unequal milling rates between the epoxy and powder, remain. We propose a new, simple method for preparing TEM samples. This method is especially useful for powders with particles in the 1–5 μm size range that are vulnerable to oxidation. The method uses solder as an embedding agent together with focused ion beam (FIB) milling. The powder was embedded in low-temperature solder using a conventional hot-mounting instrument. Subsequently, FIB was used to fabricate thin TEM samples via the lift-out technique. The solder proved to be more effective than epoxy in producing thin TEM samples with large areas. The problem of differential milling was mitigated, and the solder binder was more stable than epoxy under an electron beam. This methodology can be applied for preparing TEM samples from various powders that are either vulnerable to oxidation or composed of high atomic number elements.
The National Institute of Neurological Disease and Stroke-Canadian Stroke Network (NINDS-CSN) 5-minute neuropsychology protocol consists of only verbal tasks, and is proposed as a brief screening method for vascular cognitive impairment. We evaluated its feasibility within two weeks after stroke and ability to predict the development of post-stroke dementia (PSD) at 3 months after stroke.
We prospectively enrolled subjects with ischemic stroke within seven days of symptom onset who were consecutively admitted to 12 university hospitals. Neuropsychological assessments using the NINDS-CSN 5-minute and 60-minute neuropsychology protocols were administered within two weeks and at 3 months after stroke onset, respectively. PSD was diagnosed with reference to the American Heart Association/American Stroke Association statement, requiring deficits in at least two cognitive domains.
Of 620 patients, 512 (82.6%) were feasible for the NINDS-CSN 5-minute protocol within two weeks after stroke. The incidence of PSD was 16.2% in 308 subjects who had completed follow-up at 3 months after stroke onset. The total score of the NINDS-CSN 5-minute protocol differed significantly between those with and without PSD (4.0 ± 2.7, 7.4 ± 2.7, respectively; p < 0.01). A cut-off value of 6/7 showed reasonable discriminative power (sensitivity 0.82, specificity 0.67, AUC 0.74). The NINDS-CSN 5-minute protocol score was a significant predictor for PSD (adjusted odds ratio 6.32, 95% CI 2.65–15.05).
The NINDS-CSN 5-minute protocol is feasible to evaluate cognitive functions in patients with acute ischemic stroke. It might be a useful screening method for early identification of high-risk groups for PSD.
Echinochloa species are among the most troublesome weeds in
rice cultivation, and grow in a broad habitat range in Korea. Although
various ecotypes of Echinochloa have been collected as
germplasm for future studies, it has been difficult to classify them due to
their high level of morphological similarity. This study was thus conducted
to develop and investigate the phylogenetic relationships between 77
Echinochloa accessions with the use of 23 simple
sequence repeat (SSR) markers and 24 morphological traits. Of 77
Echinochloa accessions, including 57 accessions from
Korea and 5 reference species, late watergrass was clearly clustered as a
distinctive group from barnyardgrass and other Echinochloa
species. In this analysis, we also identified core genetic and morphological
markers that can be used for the future identification and classification of
Echinochloa species. Five out of 23 SSR makers produced
distinctive bands that discriminate late watergrass from barnyardgrass and
other Echinochloa species. Four morphological traits of the
reproductive organs were the most influential contributors for classifying
Echinochloa species. Although there was no clear
consensus generated in this study between SSR markers and morphological
trait analyses, our results support the potential use of the selected SSR
markers and morphological traits in future studies of
The objective of this study was to examine whether high serum 25-hydroxyvitamin D (25(OH)D) concentration was associated with high skeletal muscle mass, taking into account the effects of sex and age among the participants of the Korea National Health and Nutrition Examination Survey (KNHANES) aged 40 years or older. This was a cross-sectional study using data from the 2009 to 2010 KNHANES; a total of 8406 subjects (3671 men and 4735 women) were included. The appendicular skeletal muscle mass index (ASMMI, kg/m2) was estimated to measure the skeletal muscle mass. Hypovitaminosis was classified when the level of serum 25(OH)D was <20 ng/ml. The general linear model adjusted for confounding factors was used to determine differences in means of ASMMI by 25(OH)D status. The mean values of ASMMI were higher for men when compared with women. Women had a greater proportion of hypovitaminosis (71·1 %) compared with men (53·2 %). After adjusting for multiple factors, men were seen to have significant differences in ASMMI based on 25(OH)D status regardless of age, showing a lower mean value of ASSMI in those with hypovitaminosis. However, there was no difference in ASMMI by 25(OH)D status among women in both younger and older age groups. In conclusion, we found that there might be a positive relationship between 25(OH)D and skeletal muscle mass in men, indicating that interventions to improve 25(OH)D levels that are aimed at increasing muscle mass could be beneficial for men with more rapid decreased rate of skeletal muscle mass.