Ki Young Son

Pre-existing diabetes mellitus increases the risk of gastric cancer: A meta-analysis

AIM To systematically assess the association between diabetes and incidence of gastric cancer. METHODS We searched MedLine (PubMed), EMBASE, and the Cochrane Library without any limitations with respect to publication date or language, we also searched the references of qualifying articles. Case-control studies and cohort studies comparing the risk of gastric cancer between diabetic patients and control subjects were included. We excluded studies reporting only standardized incidence ratios without control groups and those that investigated only mortality but not incidence. Seventeen studies met our criteria, and the qualities of these studies were assessed using the Newcastle-Ottawa Quality Assessment Scale. We performed a meta-analysis of pre-existing diabetes and gastric cancer incidence using the DerSimonian-Laird method for random-effects. For subgroup analyses, we separated the studies by study type, region, sex and method to determine confounding factors and reliability. We also conducted subgroup analyses to examine the effects of smoking, Helicobacter pylori (H. pylori) infection, and cancer site. Publication bias was evaluated using Beggs test. RESULTS A random-effects model meta-analysis showed an increased gastric cancer risk in diabetic patients [relative risk (RR) = 1.19; 95%CI: 1.08-1.31]. Subgroup analyses indicated that this result persisted in cohort studies (RR = 1.20; 95%CI: 1.08-1.34), in studies on populations of both Western (RR = 1.18; 95%CI: 1.03-1.36) and Eastern countries (RR = 1.19; 95%CI: 1.02-1.38), in a female subgroup (RR=1.24; 95%CI: 1.01-1.52), and in highly qualified studies (RR = 1.17; 95%CI: 1.05-1.31). Moreover, these results persisted when the analysis was confined to studies adjusted for well-known gastric cancer risk factors such as smoking (RR = 1.17; 95%CI: 1.01-1.34) and H. pylori infection (RR = 2.35; 95%CI: 1.24-4.46). CONCLUSION Pre-existing diabetes mellitus may increase the risk of gastric cancer by approximately 19%. This effect seems to be unrelated to geographical region.

Symptoms in the lives of terminal cancer patients: which is the most important?

Objectives: Symptoms other than their primary disease can interfere in the lives of terminal cancer patients. We sought to identify which of these symptoms is most important. Methods: We administered a questionnaire, including the M.D. Anderson Symptom Inventory (MDASI), to 142 terminal cancer patients at the National Cancer Center, Korea. The validity of the MDASI was tested by principal-axis factor analysis and Cronbach’s α coefficient. Stepwise multiple regression analysis was used to determine the symptoms that interfered most in terminal cancer patients’ lives. Results: Factor analysis showed that it was composed of two factors (symptom and interference scales). Cronbach’s α coefficients of symptom and interference scales were each >0.70. The patients had an average of 11 of 13 symptoms of the MDASI. Pain was the most common and severe, followed by feelings of distress and fatigue. Fatigue was the most highly correlated with interference sum. In stepwise multiple regression analysis, the most interfering symptom was fatigue. Conclusions: Although pain was the most common and severe symptom, fatigue was the most important symptom interfering in the lives of terminal cancer patients. In treating terminal cancer patients, healthcare providers should actively intervene to reduce both fatigue and pain.

Association between metabolic syndrome and Helicobacter pylori infection diagnosed by histologic status and serological status.

Goals: We aimed to simultaneously evaluate the association between metabolic syndrome and Helicobacter pylori (HP) infection diagnosed histologically and serologically in a large number of healthy Korean adults. Background: Serological positivity for HP does not necessarily indicate current infection. No study to date has compared the association between metabolic syndrome and HP infection diagnosed by histologic and serological status. Study: HP status was ascertained histologically and serologically in healthy Korean adults who underwent comprehensive health screening in a private health screening center in Korea. Metabolic syndrome was defined according to the International Diabetes Federation definition. Multivariate logistic analyses were performed, after adjusting for potential confounders, including age, sex, smoking, alcohol consumption, and income level. Results: A total of 5889 subjects were included in the analysis. The metabolic syndrome was more strongly associated with histologic positivity for HP [adjusted odds ratio (aOR)=1.26; 95% confidence interval (CI), 1.08-1.48] than serologic positivity (aOR=1.12, 95% CI, 0.95-1.32), after adjusting for age, sex, smoking status, alcohol consumption, and economic status. Conclusions: The stronger association between metabolic syndrome and histologic positivity than serological positivity suggests that the effects of HP infection on the pathogenesis of cardiometabolic outcomes may be reversible. Further prospective studies are needed.

Association of cardiovascular health screening with mortality, clinical outcomes, and health care cost: A nationwide cohort study

OBJECTIVE To determine whether a cardiovascular disease (CVD) health screening program is associated with CVD-related health conditions, incidence of cardiovascular events, mortality, healthcare utilization, and costs. METHODS Cohort study of a 3% random sample of all Korea National Health Insurance members 40years of age or older and free of CVD or CVD-related health conditions was conducted. A total 443,337 study participants were followed-up from January 1, 2005 through December 31, 2010. RESULTS In primary analysis, the hazard ratios for CVD mortality, all-cause mortality, incident composite CVD events, myocardial infarction, cerebral infarction, and cerebral hemorrhage comparing participants who attended a screening exam during 2003-2004 compared to those who did not were 0.58 (95% CI: 0.53-0.63), 0.62 (95% CI: 0.60-0.64), 0.82 (95% CI: 0.78-0.85), 0.84 (95% CI: 0.75-0.93), 0.84 (95% CI: 0.79-0.89), and 0.73 (95% CI: 0.67-0.80), respectively. Screening attenders had higher rates of newly diagnosed hypertension, diabetes mellitus, and dyslipidemia, lower inpatient days of stay and cost, and lower outpatient cost compared to non-attenders. CONCLUSIONS Participation in CVD health screening was associated with lower rates of CVD, all-cause mortality, and CVD events, higher detection of CVD-related health conditions, and lower healthcare utilization and costs.

Behavioral risk factors and use of preventive screening services among spousal caregivers of cancer patients

PurposeCaregiving of cancer patients is burdensome and is likely to affect health behavior and outcome of caregivers. However, there are only a small number of studies on lifestyle behavior and use of preventive services by caregivers of cancer patients, especially in Asian populations. The aim of this study was to compare the status of lifestyle behavior and use of preventive services in spousal caregivers of cancer patients and controls.MethodsOne hundred pairs of cancer patients and their spousal caregivers who visited the Cancer Daycare Center of Seoul National University Hospital were requested to fill out constructed self-administered questionnaires. Four age- and sex-matched controls were selected randomly for each caregiver from the Korea National Health and Nutritional Examination Survey III (KNHANES III) (n = 400) in order to compare adherence to recommended health behavior and use of preventive services.ResultsCompared to controls, caregivers were more likely to receive all types of cancer screening: gastric (adjusted proportion, 53.8% vs 37.1%, p = 0.011), colorectal (adjusted proportion, 54.3% vs 20.5%, p = 0.002), cervical (adjusted proportion, 66.4% vs 46.5%, p = 0.006), and breast cancer (adjusted proportion, 62.9% vs 40.6%, p = 0.003). However, no differences were observed for health risk behaviors (current smoking, high-risk drinking, and physical inactivity) and screening for chronic diseases (hypertension, diabetes mellitus, and hypercholesterolemia).ConclusionAlthough spousal caregivers of cancer patients were more likely to use cancer screening services, their health behavior with regard to other aspects were not different from controls. There is a need to improve other types of health behaviors, especially lifestyle behavior, and balance these with cancer screenings in caregivers.

Validity and reliability of the Korean version of the Caregiver Reaction Assessment Scale in family caregivers of cancer patients

Hyung-Kook Yang, Dong Wook Shin*, So-Young Kim, Juhee Cho, So-Hyun Chun, Ki Young Son, Boram Park and Jong-Hyock Park* National Cancer Control Institute, National Cancer Center, Goyang, Korea Department of Family Medicine, Seoul National University Hospital, Seoul, Korea Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea

Disparities in Health-Risk Behaviors, Preventive Health Care Utilizations, and Chronic Health Conditions for People With Disabilities: The Korean National Health and Nutrition Examination Survey

OBJECTIVE To examine how disability status is related with health disparities in South Korea. DESIGN The study compared 3 indicators of health (health-risk behaviors, preventive health care utilizations, and chronic health conditions) according to the presence of disabilities using the Third Korean National Health and Nutrition Examination Survey, 2005 (KNHANES III). SETTING We obtained data from the KNHANES III, which is the third nationwide representative study using a stratified, multistage probability sampling design. PARTICIPANTS Subjects (N=5475) aged 20 years or older were included in the study; persons with disabilities (n=218) and persons without disabilities (n=5257). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Nonconditional multiple logistic regression and adjusted mean were used to identify health disparities in health-risk behaviors, preventive health care utilizations, and chronic health conditions. RESULTS Subjects with disabilities were more likely to be physically inactive (adjusted odds ratio [AOR]=3.06; 95% confidence interval [CI], 1.71-5.48 for no physical activity; AOR=1.70; 95% CI, 1.19-2.43 for insufficient physical activity) than those without disabilities. Women aged 40 years or older with disabilities were less likely to receive cervical cancer screening services (AOR=0.52; 95% CI, 0.27-0.98). Adults with disabilities had higher proportion of osteoporosis (AOR=2.41; 95% CI, 1.50-3.88), underweight (AOR=2.14; 95% CI, 1.07-4.28), suicidal thoughts (AOR=1.86; 95% CI, 1.35-2.56), and had impaired quality of life (95% CI of adjusted mean, 60.89-65.35 compared to 69.95-70.84 in adults without disabilities). CONCLUSIONS There exists substantial disability-related health disparities in South Korea. People with disabilities may be the underserved subpopulation demonstrating health disparities. The findings in this study underscore the continued needs in order to reduce health problems and disparities for people with disabilities.

Genetic association of APOA5 and APOE with metabolic syndrome and their interaction with health-related behavior in Korean men

BackgroundGenome-wide association studies have been used extensively to identify genetic variants linked to metabolic syndrome (MetS), but most of them have been conducted in non-Asian populations. This study aimed to evaluate the association between MetS and previously studied single nucleotide polymorphisms (SNPs), and their interaction with health-related behavior in Korean men.MethodsSeventeen SNPs were genotyped and their association with MetS and its components was tested in 1193 men who enrolled in the study at Seoul National University Hospital.ResultsWe found that rs662799 near APOA5 and rs769450 in APOE had significant association with MetS and its components. The SNP rs662799 was associated with increased risk of MetS, elevated triglyceride (TG) and low levels of high-density lipoprotein, while rs769450 was associated with a decreased risk of TG. The SNPs showed interactions between alcohol drinking and physical activity, and TG levels in Korean men.ConclusionsWe have identified the genetic association and environmental interaction for MetS in Korean men. These results suggest that a strategy of prevention and treatment should be tailored to personal genotype and the population.

Stomach cancer screening and preventive behaviors in relatives of gastric cancer patients

AIM To investigate gastric cancer screening and preventive behaviors among the relatives of patients with gastric cancer [i.e., gastric cancer relatives (GCRs)]. METHODS We examined the Korean National Health and Nutrition Examination Survey 2005 (KNHANES III) database and compared the gastric cancer screening and preventive behaviors of GCRs (n = 261) with those of non-GCRs (n = 454) and controls without a family history of cancer (n = 2842). RESULTS The GCRs were more likely to undergo gastric cancer screening compared with the control group (39.2% vs 32.3%, adjusted odds ratio: 1.43, CI: 1.05-1.95), although the absolute screening rate was low. Dietary patterns and smoking rates did not differ significantly between the groups, and a high proportion of GCRs reported inappropriate dietary habits (i.e., approximately 95% consumed excessive sodium, 30% were deficient in vitamin C, and 85% were deficient in dietary fiber). CONCLUSION The gastric cancer screening and preventive behaviors of GCRs have yet to be improved. To increase awareness among GCRs, systematic family education programs should be implemented.

Associations between Metabolic Syndrome and Inadequate Sleep Duration and Skipping Breakfast

Background The prevalence of metabolic syndrome is increasing worldwide, and previous studies have shown that inadequate sleep duration and skipping breakfast may be related to metabolic syndrome. Therefore, we investigated the effects of inadequate sleep and skipping breakfast on metabolic syndrome using data from the Korea National Health and Nutrition Examination Survey (KNHANES) IV & V reports (2007-2009 and 2010-2012, respectively). Methods The sample included 12,999 subjects who participated in the KNHANES IV & V. Sleep duration and breakfast eating were self-reported, and metabolic syndrome was defined according to the modified National Cholesterol Education Program Adult Treatment Panel III guidelines. Subjects were divided into 12 groups according to breakfast eating and sleep duration patterns, and multiple logistic regression analyses adjusted for age, sex, household income, education level, smoking status, alcohol drinking, physical activity, and total daily energy intake were conducted. Results In subjects under 50 years of age, sleeping less than 6 hours was significantly associated with increased metabolic syndrome except among those who ate breakfast on only 1 of the past 2 days. In subjects over 50 years of age, sleeping less than 6 hours was significantly associated with a decreased risk of metabolic syndrome among those who ate breakfast on both days. Conclusion In conclusion, significant associations between metabolic syndrome and sleep duration were identified, and these associations differed according to age group.