Juyeong Kim

Clinical courses of pure sleep epilepsies.

This study aims to understand seizure control outcomes and the risk of developing new wake seizures (WS) related to the different types of pure sleep epilepsies (SE), which is important in making rational management plans. A retrospective review of the Yonsei Epilepsy Clinic Registry identified 63 patients with pure SE not belonging to any specific epileptic syndromes. They were divided into the group of generalized tonic-clonic seizures during sleep (S-GTCS : n = 21) and the group of partial epilepsies during sleep (S-PE: n = 42) on the basis of seizure phenomenology, EEG, and neuroimaging data. These patients were followed for 2 years and their clinical variables were analysed for seizure control outcomes and development of new WS. Of 21 patients with S-GTCS, 17 achieved a seizure-free outcome and only one patient developed a new WS, which was consistent with a partial-onset secondary GTCS in phenomenology. Of 42 patients with S-PE only 15 patients achieved a seizure-free outcome and 11 patients developed WS during the 2-year follow-up period. Higher baseline seizure frequency and longer duration of epilepsy were associated with a higher incidence of new WS. The results suggest that the patients with S-GTCS carry a favorable clinical course, thus driving privileges or freedom of daily activities can be conferred without delay once their seizures are well controlled. However, the seizure control outcome was poor and the development of WS was frequent in patients with recurrent S-PE.

The synergistic effect of breastfeeding discontinuation and cesarean section delivery on postpartum depression: A nationwide population-based cohort study in Korea

BACKGROUNDnThe relationships between breastfeeding discontinuation and cesarean section delivery, and the occurrence of postpartum depression (PPD) remain unclear. Therefore, we aimed to investigate the association of breastfeeding discontinuation and cesarean section delivery with PPD during the first 6 months after delivery.nnnMETHODSnData were extracted from the Korean National Health Insurance Service-National Sample Cohort for 81,447 women who delivered during 2004-2013. PPD status was determined using the diagnosis code at outpatient or inpatient visit during the 6-month postpartum period. Breastfeeding discontinuation and cesarean section delivery were identified from prescription of lactation suppression drugs and diagnosis, respectively. Cox proportional hazards models were used to calculate adjusted hazard ratios.nnnRESULTSnOf the 81,447 women, 666 (0.82%) had PPD. PPD risk was higher in women who discontinued breastfeeding than in those who continued breastfeeding (hazard ratio=3.23, P<0.0001), in women with cesarean section delivery than in those with vaginal delivery (hazard ratio=1.26, P=0.0040), and in women with cesarean section delivery who discontinued breastfeeding than in those with vaginal delivery who continued breastfeeding (hazard ratio=4.92, P<0.0001).nnnLIMITATIONSnStudy limitations include low PPD incidence; use of indirect indicators for PPD, breastfeeding discontinuation, and working status, which could introduce selection bias and errors due to miscoding; and potential lack of adjustment for important confounders.nnnCONCLUSIONSnBreastfeeding discontinuation and cesarean section delivery were associated with PPD during the 6-month postpartum period. Our results support the implementation of breastfeeding promoting policies, and PPD screening and treatment programs during the early postpartum period.

The impact of sitting time and physical activity on major depressive disorder in South Korean adults: a cross-sectional study

BackgroundPrevious studies have examined associations between sitting time and negative health outcomes and mental health. However, the relationship between overall sitting time and major depressive disorder (MDD) in South Korea has not been studied. This study examined the association between MDD and overall sitting time and physical activity in South Koreans.MethodsData from the sixth Korean National Health and Nutrition Examination Survey (KNHANES), a cross-sectional, nationally representative survey, were analyzed. Total participants were 4145 in 2014. MDD was assessed using the Patient Health Questionnaire (PHQ-9). Participants’ data regarding self-reported sitting time and physical activity were analyzed via multiple logistic regression.ResultsResults showed that people who sat for 8–10xa0h (OR: 1.56, 95% CI: 1.15–2.11) or more than 10xa0h (OR: 1.71, 95% CI: 1.23–2.39) had increased risk of MDD compared to those who sat for less than 5xa0h a day. Subgroup analysis showed that the strongest effect of reported sitting time on risk of MDD was found in men with lower levels of physical activity who sat for 8 to 10xa0h (OR: 3.04, 95% CI: 1.15–8.01) or more than 10xa0h (OR: 3.43, 95% CI: 1.26–9.35). Level of physical activity was not an independent predictor for MDD.ConclusionsSitting for long periods was associated with greater risk of MDD in South Korean adults. Reducing sitting time in people with MDD could help to prevent associated physical health problems and may improve mental health.

Depressive symptoms of house-poor persons: Korean panel data evidence

Background: There are no studies researching the relationship between house-poor persons and mental health. Therefore, this study aimed to investigate the relationship between house-poor status and depressive symptoms. Aim: To examine the relationship between the house-poor and depressive symptoms according to household income. Methods: Data from the Korean Welfare Panel Study were used. House-poor were defined as people having possession with over 10% house-related interest in disposable income. About 7,565 participants over the age of 19u2009years were followed up from 2011 to 2013. The generalized estimating equations were used for analysis. Results: Individuals with more house-related debt showed increasingly higher depression scores (possession with under 5% related debt to disposable income βu2009=u20090.2024, pu2009=u2009.1544; under 10% βu2009=u20090.7030, pu2009=u2009.0008; over 10% βu2009=u20091.3207, pu2009<u2009.0001). Individuals possessing houses with over 10% ratio of house-related debts to disposable income had higher depression scores than individuals without house ownership (no possession βu2009=u20090.8927, pu2009<u2009.0001). Conclusion: Individuals without houses and individuals owning houses with higher percentages of house-related interests showed higher levels of depressive symptoms. Therefore, this study affirmed that the importance of considering the most vulnerable groups in addressing the mental health of individual.

Effect of the Online Game Shutdown Policy on Internet Use, Internet Addiction, and Sleeping Hours in Korean Adolescents

PURPOSEnInternet addiction has emerged as a major public health problem worldwide. In November 2011, the South Korean government implemented an online game shutdown policy, lasting from 12:00 to 6:00 am, as a means of preventing Internet addiction in adolescents aged 15 or below. This study analyzed the effect of this shutdown policy on adolescent Internet use, addiction, and sleeping hours.nnnMETHODSnWe analyzed data collected from the Korea Youth Risk Behavior Web-based Survey from 2011 to 2015. Respondents were divided into two groups by age: aged 15 or below (maleu2009=u200976,048, femaleu2009=u200966,281) and aged 16 or above (maleu2009=u200952,568, femaleu2009=u200949,060). A difference-in-difference analysis was used to evaluate the effect of this shutdown policy.nnnRESULTSnIn 2012, which is immediately following policy enforcement, daily amount of Internet use (in minutes) decreased more in adolescents affected by the policy (i.e., the aged 15 or below group). However, it steadily increased in 2013, 2014, 2015, and showed no meaningful long-term improvements 4 years after policy implementation (-3.648 minutes in 2012 [pu2009=u2009.001], -3.204 minutes in 2013 [pu2009=u2009.011], -1.140 minutes in 2014 [pu2009=u2009.384], and 2.190 minutes in 2015 [pu2009=u2009.107]). The shutdown policy did not alter Internet addiction or sleeping hours. Interestingly, female adolescents, adolescents with low academic performance, and adolescents with low exercise levels exhibited comparatively stronger and longer lasting initial declines in Internet usage.nnnCONCLUSIONSnThe shutdown policy had practically insignificant effects in reducing Internet use for target adolescents. Thus, policymakers aiming to reduce or prevent Internet addiction should use different strategies.

The impact of living arrangements on quality of life among Korean elderly: findings from the Korean Longitudinal Study of Aging (2006-2012).

PurposeTo investigate the impact of different living arrangements on quality of life (QoL) and health-related quality of life (HRQoL) in the elderly.MethodsWe used data from the first to fourth wave of the Korean Longitudinal Study of Aging. Using the first wave as a baseline, the data included 5050 individuals aged 60xa0years and older with at least one living child. QoL and HRQoL were measured using a visual analogue scale developed by the Korean Labor Institute that bears similarity to the EQ-VAS. Living arrangements were categorized based on household composition (single household, one-generation household, two-generation household, and three-generation household) and the marital status of a cohabiting adult child. A generalized estimating equation was used to examine the association between living arrangements and QoL/HRQoL.ResultsCompared to elderly individuals living in three-generation families with a married child, those in a single household (QoL: βxa0=xa0−2.67 [Pxa0=xa00.001]; HRQoL: βxa0=xa0−2.24 [Pxa0=xa00.007]), those living in a three-generation family with an unmarried adult child (QoL: βxa0=xa0−5.19 [Pxa0<xa00.0001]; HRQoL: βxa0=xa0−3.41 [Pxa0<xa00.0001]), and those living in a two-generation family with an unmarried adult child (QoL: βxa0=xa0−2.88 [Pxa0<xa00.0001]; HRQoL: βxa0=xa0−2.80 [Pxa0<xa00.0001]) were more likely to have lower QoL and HRQoL. These associations were particularly strong for women and individuals in the lowest equivalent household income group.ConclusionIt is necessary to devise government programs not only for elderly individuals living alone, but also for those living with an unmarried adult child; elderly persons who are female and part of the lowest equivalent household income group must receive particular attention.

Are Mothers’ Working Hours Associated with General and Abdominal Obesity in Children and Adolescents? The Korean National Health and Nutrition Examination Survey (2008–2012)

Objectives Despite an increase in the female work force and recent increase in childhood obesity, the association between working hours of mothers and childhood obesity as well as how such association differs according to mothers’ weight and intake frequency of energy-dense, nutrition-poor (EDNP) foods remain unclear. Methods Data from the Korean National Health and Nutrition Examination Survey (2008–2012) that included samples from 3914 children in 2526 households were analyzed. Two-level (household-children) mixed-effects modeling was performed to investigate the association between mothers’ working hours and childhood obesity based on body mass index (BMI) and waist circumference (WC). Results Long working hours (h) of mothers were associated with both BMI (βxa0=xa0−xa00.14; Pxa0=xa00.324 for 1–20xa0h, βxa0=xa00.10; Pxa0=xa00.334 for ≤xa021–40xa0h; βxa0=xa00.09; Pxa0=xa00.429 for 41–68xa0h, βxa0=xa00.51; Pxa0=xa00.015 for ≥xa069xa0h) and WC of the child (βxa0=xa00.06; Pxa0=xa00.809 for 1–20xa0h; βxa0=xa00.46; Pxa0=xa00.017 for ≤xa021–40xa0h; βxa0=xa00.59; Pxa0=xa00.004 for 41–68xa0h, βxa0=xa01.35; Pxa0<xa00.001 forxa0≥xa069xa0h), and the mean increase was greater for mothers workingxa0≥xa069xa0h compared to those working 0xa0h. We also observed that the association between mothers’ working hours and child’s BMI and WC was greater for children whose mothers were either overweight or obese and frequently consumed energy-dense, nutrient-poor foods (EDNP). Conclusions for Practice Long working hours of mothers are associated with higher BMI and WC in children. Thus, it is important to improve labor welfare for mothers who work long hours, and provide interventions to promote good health behaviors in both children and working mothers.

Differences in Fracture Incidence According to Caregiver Type in Stroke Survivors

BACKGROUNDnTo assess whether the type of primary caregiver is a risk factor of the incidence of fracture among older adults who have survived a stroke.nnnMETHODSnData from 4282 stroke survivors in the National Health Insurance Service-Senior Cohort (2002-2013) were used in this study. We categorized type of primary caregiver as none, spouse/family caregiver, and formal caregiver. The incidence of fracture within the year postdischarge was used as the outcome variable. These data were subjected to a survival analysis using the Cox proportional hazard model.nnnRESULTSnOf the 4282 stroke survivors, 308 (7.2%) experienced a fracture during the 1-year follow-up period. According to type of primary caregiver, the adjusted hazard ratio (HR) of fracture was lower among those whose caregiver was a spouse (HRu202f=u202f.68, 95% confidence interval [CI], .48-.96] and those with a formal caregiver (HRu202f=u202f.59, 95% CI, .36-.97) compared to stroke survivors with no caregiver. In particular, those with a family or formal caregiver who were being cared for in nursing facilities were less likely to be associated with fracture than those with no caregiver.nnnCONCLUSIONSnThe adjusted HR of fracture among stroke survivors was lower among those with primary caregivers compared to those without them. Thus, the government should monitor and allocate the appropriate attention to stroke survivors after discharge in order to ensure that they obtain the needed health care, especially for stroke survivors who are without a primary caregiver.

Association between missed appointment and related factors of patients with cancer in a tertiary hospital

For the hospital administration, 1 major responsibility is to prevent the outflow of existing patients and minimize losses because of the failure of patients with cancer to attend appointments. We analyzed the association between no-show rates and characteristics of patients with cancer at a tertiary hospital in Seoul using patient affair data. Among the 680xa0190 patients, no-show rates were 4.39% and 3.37% for males and females, respectively. Male patients with colon and rectum, pancreas, and liver cancer had higher no-show rates (5.81%, 5.8%, and 5.1%). Among females, pancreas, colon and rectum, and liver cancer were associated with high no-show rates (5.65%, 5.44%, and 4.92%). For both males and females, liver (males: ORxa0=xa02.02; 95% CI: 1.68-2.44; females: ORxa0=xa01.91; 95% CI: 1.60-2.28) and pancreas (males: ORxa0=xa01.98; 95% CI: 1.57-2.50; females: ORxa0=xa01.97; 95% CI: 1.61-2.42) cancer were associated with high no-show rates. To reduce the rate of no-shows, hospitals should establish and enforce missed appointment policies as well as its effect upon health outcome.

Incidence of Pressure Ulcers During Home and Institutional Care Among Long-Term Care Insurance Beneficiaries With Dementia Using the Korean Elderly Cohort

OBJECTIVEnTo assess whether type of long-term care service is a risk factor of the incidence of pressure ulcers among older adults with dementia who are receiving long-term care insurance (LTCI).nnnMETHODSnData from LTCI beneficiaries (benefit level 1 or 2) with dementia, aged 60 and older (nxa0=xa07841), in the Korean Elderly Cohort data set from 2008 to 2013 were used. Type of long-term care service was categorized into home or institutional care using the LTCI Claims Database. The National Health Insurance Claims Database was used to identify the incidence of pressure ulcers as the outcome variable in a survival analysis using the time-dependent Cox proportional hazard model.nnnRESULTSnOf the 7841 participants, 98 (1.2%) exhibited pressure ulcers. Compared with beneficiaries receiving home care, those receiving institutional care had a higher adjusted hazard ratio for pressure ulcers (hazard ratio 6.48, 95% confidence interval 3.48-10.86). These associations were particularly strong among beneficiaries without pressure ulcers during the mandatory assessment for benefit eligibility and who were partially ambulatory.nnnDISCUSSIONnBeneficiaries receiving institutional care were more likely to have pressure ulcers than were those receiving home care. The government must monitor the quality of institutional long-term care services and encourage service providers to improve such care.