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Shift workers are increasing worldwide, and various negative health effects of shift work have been reported. This study aimed to evaluate the relationship between shift work and health behavior.
This cross-sectional study included a total of 11,680 Korean adults (6,061 men and 5,619 women) aged ≥20 years old who participated in the Fifth Korean National Health and Nutrition Examination Survey, 2010–2012. Multiple logistic regression analysis was performed to evaluate the association between shift work and health behavior after adjusting for covariates.
In men, shift work was associated with an increased risk of inadequate sleep (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.00 to 1.40) compared to day work. In women, shift work was associated with an increased risk of smoking (OR, 1.73; 95% CI, 1.34 to 2.22) and inadequate sleep (OR, 1.24; 95% CI, 1.05 to 1.47) compared to day work. In an age-stratified subgroup analysis, female shift workers aged ≥50 years old demonstrated an increased risk of smoking (OR, 5.55; 95% CI, 3.60 to 8.55), alcohol consumption (OR, 2.22; 95% CI, 1.53 to 3.23), and inadequate sleep (OR, 1.50; 95% CI, 1.10 to 2.05) compared to female day workers.
Shift work is associated with worse health behavior, and this is most evident in women aged ≥50 years. Targeted strategies to reduce the negative health effects of shift work should be implemented, with consideration of shift workers' demographic characteristics.
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This cross-sectional study aimed to evaluate the prevalence of depressive disorders and factors associated in long-term cancer survivors.
A total of 702 long-term cancer survivors over 5-years in remission were recruited in a university-affiliated tertiary hospital in Korea. Self-report using the Patient Health Questionnaire-2 and the Fatigue Severity Scale assessed depression and fatigue, respectively. Demographic characteristics, cancer-related clinical characteristics, comorbidity, health behaviors, and physical symptoms were assessed through the review of medical records or a structured self-administered questionnaire.
We identified 26.1% of patients who had a depressed mood or displayed a loss of interest. The most prevalent primary site of cancer was the stomach (65.2%), followed by lung, breast, colorectal, and thyroid cancer. We also found that 5.7% of subjects experienced double or triple primary cancers. Larger proportion among depressive group (89.1%) complained at least one physical problem than among non-depressive group (53.2%). Physical symptoms including sleep problems, dry mouth, indigestion, pain, decreased appetite, and febrile sense were more frequent in the depressive group than in the non-depressive group. The Fatigue Severity Scale scores were higher in the depressive group than in the non-depressive group (P<0.001). Multiple logistic regression analysis showed that the highest tertile level of fatigue (odds ratio, 7.31; 95% confidence interval, 3.81–14.02) was associated with the increased risk of depression.
These findings suggest that careful concern about depression is necessary in long-term cancer survivors. Fatigue may be a surrogate sign for depression, and warrants further evaluation.
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Impaired fasting glucose (IFG) is an established risk factor for type 2 diabetes and cardiovascular disease. This study evaluated the relationship between sleep duration and IFG.
This cross-sectional study included 14,925 Korean adults (5,868 men and 9,057 women) ≥19 years of age who participated in the Korean National Health and Nutrition Examination Survey between 2011 and 2012. Blood glucose levels were measured after at least eight hours of fasting. Study subjects were categorized into three groups based on self-reported sleep duration (<7, 7–8, or >8 h/d). IFG was diagnosed according to recommendations American Diabetes Association guidelines. Multiple logistic regression analysis was performed with adjustment for covariates.
In men, short sleep duration (<7 hours) was associated with increased risk of IFG (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.08 to 1.96) compared to adequate sleep duration (7–8 hours), whereas long sleep duration (>8 hours) was not associated with risk of IFG (OR, 0.90; 95% CI, 0.37 to 2.18). In women, sleep duration was not associated with risk of IFG.
The association between sleep duration and IFG differed by sex; sleep deprivation, was associated with increased risk of IFG, especially in men.
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We conducted a population-based cross-sectional study of Korean adults to evaluate the association between metabolic syndrome and microalbuminuria as a marker for early-stage chronic kidney disease.
A total of 8,497 adults (3,625 men and 4,872 women) who participated in the Korea National Health and Nutrition Examination Survey between 2011 and 2012 were included. Metabolic syndrome was defined according to recommendation from a joint interim statement of international organizations published in 2009. Microalbuminuria was defined as a urinary albumin-to-creatinine ratio of 30 to 300 mg/g. The association between metabolic syndrome and microalbuminuria was evaluated using logistic regression analysis with adjustment for covariates while considering sampling weights and the complex survey design.
The prevalence of microalbuminuriain subjects with metabolic syndrome was 11% for men and 14.4% for women, whereas the prevalence in subjects without metabolic syndrome was 3.1% for men and 6.7% for women. Metabolic syndrome was significantly associated with an increased risk of microalbuminuriain both women (odds ratio, 2.79; 95% confidence interval, 2.01 to 3.88) and men (odds ratio, 3.00; 95% confidence interval, 2.11 to 4.27). All components of the metabolic syndrome were associated with a significantly increased risk of microalbuminuria with the strongest association for high blood pressure. The risk of microalbuminuria increased in a dose-dependent manner (P-value for trend < 0.001) with the number of metabolic syndrome components observed for both sexes.
These findings suggest that metabolic syndrome is a risk factor for chronic kidney disease from an early stage.
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Although hemorrhoids are one of the most common anal diseases among Koreans, risk factors for hemorrhoids have not been well identified.
We analyzed the data from the 4th Korean National Health and Nutrition Examination Survey (KNHANES) between 2007 and 2009. Study subjects were 17,228 participants of KNHANES who were aged 19 years or older. Logistic regression analysis was conducted to evaluate associations between hemorrhoids and probable risk factors.
Overall prevalence of hemorrhoids among study subjects was 14.4%, being more prevalent among women (15.7%) than among men (13.0%). Obesity and abdominal obesity were associated with a higher risk of hemorrhoids with odds ratio (OR) (95% confidence intervals, 95% CI) of 1.13 (1.01 to 1.26) and 1.16 (1.04 to 1.30), respectively. Both self-reported depression (OR, 1.83; 95% CI, 1.62 to 2.08) and physician diagnosed depression (OR, 1.71; 95% CI, 1.35 to 2.17) were associated with significantly higher risk of hemorrhoids. No regular walking (OR, 1.11; 95% CI, 1.00 to 1.23) and experience of pregnancy (OR, 1.62; 95% CI, 1.17 to 2.25) for women were also associated with higher risk of hemorrhoids. However, educational level, alcohol consumption, physical activities, diabetes mellitus, hypertension, fiber, fat intake, and energy intake were not associated with a risk of hemorrhoids. Low quality of life assessed with EuroQol-5 Dimension and EuroQol-Visual Analogue Scale was significantly associated with hemorrhoids.
This nationwide cross-sectional study of Korean adults suggests that obesity, abdominal obesity, depression, and past pregnancy may be risk factors for hemorrhoids and hemorrhoids affect quality of life negatively.
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In Korea, clinical performance examination (CPX) has been included in license examination for medical doctors since 2009 in order to improve clinical performance of medical students. This study aimed to evaluate the contribution of CPX to medical education.
Clinical competency in the differential diagnosis of secondary headache was compared between the incoming interns in 2009 unexposed to CPX and the incoming interns in 2010 exposed to CPX, using the data of patients who visited the emergency department due to headache (181 patients seen by 60 CPX non-exposed interns and 150 patients seen by 50 CPX-exposed interns). We obtained the data by reviewing electronic medical records and nominal lists of doctors. Clinical competency was assessed by sensitivity and specificity between the diagnostic impression by interns and the final diagnosis. The association between CPX exposure and clinical competency in secondary headache diagnosis was evaluated using multiple logistic regression analysis.
When we assessed clinical competency on the basis of all listed diagnostic impressions, sensitivity and specificity were 67.9% and 80.0%, respectively, for headaches seen by CPX-exposed interns, and 51.7%, and 71.7%, respectively, for headaches seen by CPX non-exposed interns. Multivariable adjusted logistic regression analysis showed exposure to CPX was not associated with increased competency for identifying secondary headache.
Exposure to CPX as a part of the medical license examination was not effective for the improvement of clinical competency of interns in identifying secondary headache.
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Death from uterine cervical cancer could be preventable by an active participation of women at risk in a screening program such as the Papanicolaou test. In order to examine the presence of socioeconomic disparity in preventable deaths, we evaluated the time trends of cervical cancer mortality by socioeconomic status in Korean women.
We selected level of educational attainment and marital status as surrogate indices of socioeconomic status. Using death certificate data and Korean Population and Housing Census data from Korea National Statistical office, we calculated age-standardized yearly mortality rates from cervical cancer between 1998 and 2009 according to the level of education as well as marital status.
Cervical cancer mortality peaked in 2003 and then decreased gradually over time. Cervical cancer mortality was the highest in the group with the lowest level of educational attainment in all age groups and the gap between the lowest and the highest educational level has increased over time. Cervical cancer mortality was lower in married women than unmarried women in all age groups, and the degree of difference did not change over time.
In the Korean population, socioeconomic differential in cervical cancer mortality has persisted over time.
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Although cigarette smoking is a major modifiable risk factor for the occurrence of primary and secondary cardiovascular disease (CVD), not all survivors from CVD attacks can successfully stop smoking. However, little is known about the factors associated with the change in smoking behavior after CVD attack.
Study subjects included 16,807 participants (≥19 years) in the fourth Korean National Health and Nutrition Examination Surveys. From them, we selected 180 persons who had previous CVD diagnosis (angina pectoris, myocardial infarction, or stroke) and were smoking at the time of CVD diagnosis. Then, we categorized the 180 persons into two groups according to change in smoking status after the CVD: quitter and non-quitter. Logistic regression analysis was done to evaluate multivariable-adjusted association.
Even after CVD diagnosis, 63.60% continued to smoke. Fully-adjusted analysis revealed that regular drinking (odds ratio [OR], 4.44) and presence of smokers among family members (OR, 5.86) were significantly (P < 0.05) associated with greater risk of persistent smoking, whereas lower education level (OR, 0.20), larger amount of smoking (OR, 0.95), longer time since diagnosis (OR, 0.88), and diabetes (OR, 0.36) were significantly (P < 0.05) associated with decreased risk of persistent smoking after CVD.
A great proportion of CVD patients tended to continue smoking in the Korean population. In order to reduce smoking rates among CVD patients further, more aggressive efforts towards smoking cessation should be continuously made with consideration of individual socioeconomic, behavioral, and clinical characteristics of CVD patients.
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Blood lipid profiles have been suggested to be a risk factor for osteoporosis. However, the association between lipid profiles and bone mineral density (BMD) is still unclear. This study aimed to evaluate an association between blood lipid profiles and BMD through both a cross-sectional and a longitudinal study.
Study subjects were 958 postmenopausal Korean women who have repeatedly undertaken laboratory tests and BMD measurements at lumbar spine and femur neck with an interval of 7.1 years. The associations between lipid profiles and BMD were examined using Spearman correlation analysis with an adjustment for age, smoking, alcohol drinking, physical activity, body mass index, and follow-up duration.
Lumbar spine BMD was not associated with total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HLD-C) regardless of when the measurement was performed. In an analysis using data measured at the beginning of the study, femur neck BMD was not associated with TC and LDL-C. However, femur neck BMD showed weak but significantly positive correlation with HDL-C (correlation coefficient, 0.077; 95% confidence interval, 0.005 to 0.149). When the analysis was repeated with data measured at the end of the follow-up, there was no significant correlation between femur neck BMD and any lipid profile. In addition, change in femur neck BMD during follow-up was not associated with the change in lipid profiles.
Although further study with a consideration of calcium intake and osteoporosis medication seems necessary, this study found no association between serum lipid profiles and BMD in postmenopausal Korean women.
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Metabolite Profiling of Osteoporosis and Atherosclerosis in Postmenopausal Women: A Cross-Sectional Study
Recently, a revised telehealth legislation that allows direct doctor to patient teleconsultation was proposed in Korea. However, there have been some debates. This study aimed to examine the attitude of primary care physicians towards telehealth.
A questionnaire asking attitude towards telehealth and revised telehealth legislation was self-administered to 1,988 registered members of Practitioners Council of Korean Academy of Family Medicine. A total of 218 complete responses by family physicians were included in the study.
Large proportion (60.6%) of participants disagreed to the main clause of revised telehealth legislation, which allowed doctor to patient teleconsultation. Participants tended to expect that negative outcomes are more likely to occur than positive outcomes after the enforcement of the revised telehealth legislation. Around 50% of participants had an intention to adopt telehealth just as soon (4.6%) or afterwards (45.4%). The majority of participants suggested that; primary care clinic as the most appropriate telehealth facility (75.4%); patients with low accessibility to medical care (74.3%) as the best target of telehealth service; and tele-radiology (61.9%) or tele-pathology (41.3%) as the most applicable medical field for telehealh service. Around 89% of participants suggested telehealth service fee to be similar or higher than current medical consultation fee.
The majority of family physicians participating in this study were not in favor of the revised telehealth legislation. However, the majority of the participants had an intention to adopt telehealth to their practice and held clear opinion about practical aspects of telehealth.
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