Publications by authors named "Sun Jae Jung"

45 Publications

Associations Between General Perceptions of COVID-19 and Posttraumatic Stress Disorder in Korean Hospital Workers: Effect Modification by Previous Middle East Respiratory Syndrome Coronavirus Experience and Occupational Type.

J Prev Med Public Health 2021 Mar 19;54(2):86-95. Epub 2021 Jan 19.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Objectives: This study investigated associations between perceptions of coronavirus disease 2019 (COVID-19) and the prevalence of posttraumatic stress disorder (PTSD) in workers at hospitals designated to treat COVID-19, as well as the difference in the magnitude of these associations by occupational type and previous Middle East respiratory syndrome coronavirus (MERS-CoV) experience.

Methods: The participants were workers at hospitals designated to treat COVID-19 who completed a questionnaire about their perceptions related to COVID-19, work experience during the previous MERS-CoV outbreak, and symptoms of PTSD ascertained by the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders. Participants' characteristics were compared using the chi-square test. Multivariable logistic regression was performed to evaluate the associations between perceptions and the prevalence of PTSD, stratified by occupational type and previous MERS-CoV experience.

Results: Non-medical personnel showed stronger associations with PTSD than medical personnel according to general fear (odds ratio [OR], 6.67; 95% confidence interval [CI], 1.92 to 23.20), shortages of supplies (OR, 1.29; 95% CI, 1.07 to 1.56), and issue-specific fear (OR, 1.29; 95% CI, 1.05 to 1.59). Those with prior MERS-CoV quarantine experience were more prone to PTSD than those without such experience in terms of general fear (OR, 1.70; 95% CI, 1.22 to 2.37), shortages of supplies (OR, 1.24; 95% CI, 1.10 to 1.40), and issue-specific fear (OR, 1.21; 95% CI, 1.06 to 1.38).

Conclusions: During the COVID-19 pandemic, non-medical personnel tended to have higher odds of being categorized as having PTSD. Workers with prior MERS-CoV experience were more susceptible than those without such experience. These findings suggest the need for timely interventions to manage human resources for a sustainable quarantine system.
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http://dx.doi.org/10.3961/jpmph.20.540DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046607PMC
March 2021

Gender role stereotypes, patriarchal mindset, and cognitive function in the elderly rural population: A cross-sectional study.

Epidemiol Health 2021 Apr 7:e2021023. Epub 2021 Apr 7.

Yonsei University Graduated School, Department of Public Health, Seoul, Republic of Korea.

Objectives: We analyzed whether gender role stereotypes (GRS) and patriarchal mindset are associated with cognitive function in an elderly community population.

Methods: We utilized data from 580 people enrolled in the Korean Social Life, Health and Aging Project. GRS and patriarchal mindset were measured using a questionnaire. We divided GRS and patriarchal mindset into two groups following their median levels: a conservative mindset and an open mindset. Cognitive function was assessed using the Mini-Mental State Examination, Korean version (MMSE-K). Cognitive impairment was defined as MMSE-K ≤21 points. A multivariable logistic regression was performed, adjusting for sex, age, socio-demographic and lifestyle factors, and social network size. Age and lifestyle factors were stratified.

Results: Compared with open-minded people, those with a more conservative mind regarding gender roles and higher adherence to a patriarchal mindset had adjusted odds ratios of 1.88 (95% confidence interval, CI: 1. 11-3.19) and 1.67 (95% CI: 1.00-2.79) for cognitive impairment, respectively. In the stratified analysis, subgroups with a younger age and good lifestyle maintained a protective association with cognitive impairment.

Conclusion: GRS and patriarchal mindset were marginally significantly associated with cognitive impairment among women in later life.
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http://dx.doi.org/10.4178/epih.e2021023DOI Listing
April 2021

Neurocognitive Effects of Chemotherapy for Colorectal Cancer: A Systematic Review and a Meta-Analysis of 11 Studies.

Cancer Res Treat 2021 Mar 17. Epub 2021 Mar 17.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Purpose: Chemotherapy-related cognitive impairment (CRCI) is a controversial concept not much explored on colorectal cancer patients.

Materials And Methods: We identified eleven prospective studies: eight studies on 696 colorectal cancer patients who received chemotherapy and three studies on 346 rectal cancer patients who received neoadjuvant chemoradiotherapy. Standardized mean differences (SMDs) of neuropsychological test results and the cognitive quality-of-life scale were calculated using random effect models. A meta-regression was conducted to investigate the association between mean study population age and effect sizes.

Results: The association between chemotherapy and cognitive impairment was not clear in colorectal cancer patients (SMD, 0.003; 95% confidence interval, ‒0.080 to 0.086). However, a meta-regression showed that older patients are more vulnerable to CRCI than younger patients (β=‒0.016, p < 0.001).

Conclusion: Chemotherapy has an overall positive negligible effect size on the cognitive function of colorectal patients. Age is a significant moderator of CRCI.
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http://dx.doi.org/10.4143/crt.2020.1191DOI Listing
March 2021

Correlates of psychological resilience and risk: Prospective associations of self-reported and relative resilience with Connor-Davidson resilience scale, heart rate variability, and mental health indices.

Brain Behav 2021 Feb 27:e02091. Epub 2021 Feb 27.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea.

Background: There are several ways to determine psychological resilience. However, the correlation between each measurement is not clear. We explored associations of baseline relative "resilience" and risk with later self-reported trait resilience and other biological/mental health indices.

Methods: We utilized baseline and follow-up survey data from 500 participants aged 30-64 in the community cohort. Baseline "relative" resilience was defined by: (a) negative life events (NLEs) in the six months before baseline and (b) depressive symptoms at baseline, yielding four groups of individuals: i) "Unexposed and well," "Vulnerable (depression)," "Reactive (depression)," and "Resilient." "Trait" resilience at follow-up was self-reported using the Connor-Davidson Resilience Scale (CD-RISC). Associations between relative resilience at baseline, CD-RISC, and heart rate variability (HRV) indices at follow-up were assessed with generalized linear regression models after adjustments. Associations between baseline resilience and subsequent loneliness/depression indices were also evaluated.

Results: Overall trait resilience and its subfactors at follow-up showed strong negative associations with "Reactive" at baseline (adj-β for total CD-RISC score: -11.204 (men), -9.472 (women)). However, resilience at baseline was not associated with later HRV, which was compared with the significant positive association observed between CD-RISC and HRV at the same follow-up time point. The "Reactive" exhibited significantly increased depressive symptoms at follow-up. The overall distribution pattern of CD-RISC subfactors differed by baseline resilience status by sex.

Conclusions: The "relative" resilience based on the absence of depression despite prior adversity seems to be highly related with trait resilience at follow-up but not with HRV. The sub-factor pattern of CD-RISC was different by sex.
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http://dx.doi.org/10.1002/brb3.2091DOI Listing
February 2021

Association between Socioeconomic Status and Longitudinal Sleep Quality Patterns Mediated by Depressive Symptoms.

Sleep 2021 Feb 25. Epub 2021 Feb 25.

Department of Public Health, Yonsei University Graduate School, Seoul, South Korea.

Study Objectives: We aimed to examine whether associations between socioeconomic status (SES) and longitudinal sleep quality patterns are mediated by depressive symptoms.

Methods: We utilized data on 3,347 participants in the Korean Genome and Epidemiology Study aged 40-69 years at baseline from 2001-2002 who were followed up for 16 years. A group-based modeling approach was used to identify sleep quality trajectories using the Pittsburgh Sleep Quality Index (year 2, 6, 8, 10, and 12). Educational attainment (college graduated or less), monthly household income (≥$2,500 or less), and occupation (unemployed, manual labor, and professional labor) at baseline (year 0) were used for analyses. Depressive symptoms were assessed using Beck's Depression Inventory at year 4. Associations between SES and sleep quality patterns were examined using a multinomial logistic regression model. The mediation effect of depressive symptoms was further examined using PROC CAUSALMED.

Results: We identified five distinct sleep quality trajectories: "normal-stable" (n=1,697), "moderate-stable" (n=1,157), "poor-stable" (n=320), "developing to poor" (n=84), and "severely poor-stable" (n=89). Overall, associations between SES levels and longitudinal sleep patterns were not apparent after full adjustment for socio-demographic and lifestyle factors measured at baseline. Depressive symptoms, however, tended to fully mediate associations between SES levels and sleep quality patterns (odds ratio range for indirect effects of depressive symptoms: for education, 1.05-1.17; for income, 1.05-1.15).

Conclusion: A significant mediating role for depressive symptoms between SES levels and longitudinal sleep quality warrants consideration among mental health care professionals.
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http://dx.doi.org/10.1093/sleep/zsab044DOI Listing
February 2021

Bi-directional association between allergic rhinitis and diabetes mellitus from the national representative data of South Korea.

Sci Rep 2021 Feb 23;11(1):4344. Epub 2021 Feb 23.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Allergic rhinitis (AR) and diabetes mellitus (DM) share a common cause in inflammation; however, potential relationships between them are not clear. Therefore, we aimed to explore the associations between AR and DM. In this cross-sectional study, data were extracted from the Korean National Health and Nutrition Examination Survey 2007-2018 and weighted based on sociodemographic characters. AR and DM were defined by diagnoses thereof. Since self-reporting was not perfect, in order to complement the validity, we additionally performed sensitivity analysis by defining DM according to HbA1c and medication history. After excluding invalid data, the number of final participants was 29,246 (mean age, 54.95 ± 14.27 years). We calculated the odds ratio (OR) of newly self-reported DM among AR patients without DM history by multivariable logistic regression adjusted for potential confounders. A reverse association was also assessed. Patients with AR showed lower ORs for DM than those without AR (OR, 95% CI: men, 0.28, 0.19-0.42; women, 0.33, 0.24-0.46). Similarly, DM patients showed lower ORs for AR than patients without DM (men, 0.41, 0.31-0.56; women, 0.34, 0.25-0.46). The same results were obtained in sensitivity analysis defining DM according to HbA1c levels or DM treatment and in stratification analysis for age, residency, comorbidity, BMI, and menopause. In conclusion, we discovered that AR and DM show mutual inverse associations, regardless of sex, in individuals aged 30 years and older.
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http://dx.doi.org/10.1038/s41598-021-83787-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902822PMC
February 2021

Bi-directional association between allergic rhinitis and diabetes mellitus from the national representative data of South Korea.

Sci Rep 2021 Feb 23;11(1):4344. Epub 2021 Feb 23.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Allergic rhinitis (AR) and diabetes mellitus (DM) share a common cause in inflammation; however, potential relationships between them are not clear. Therefore, we aimed to explore the associations between AR and DM. In this cross-sectional study, data were extracted from the Korean National Health and Nutrition Examination Survey 2007-2018 and weighted based on sociodemographic characters. AR and DM were defined by diagnoses thereof. Since self-reporting was not perfect, in order to complement the validity, we additionally performed sensitivity analysis by defining DM according to HbA1c and medication history. After excluding invalid data, the number of final participants was 29,246 (mean age, 54.95 ± 14.27 years). We calculated the odds ratio (OR) of newly self-reported DM among AR patients without DM history by multivariable logistic regression adjusted for potential confounders. A reverse association was also assessed. Patients with AR showed lower ORs for DM than those without AR (OR, 95% CI: men, 0.28, 0.19-0.42; women, 0.33, 0.24-0.46). Similarly, DM patients showed lower ORs for AR than patients without DM (men, 0.41, 0.31-0.56; women, 0.34, 0.25-0.46). The same results were obtained in sensitivity analysis defining DM according to HbA1c levels or DM treatment and in stratification analysis for age, residency, comorbidity, BMI, and menopause. In conclusion, we discovered that AR and DM show mutual inverse associations, regardless of sex, in individuals aged 30 years and older.
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http://dx.doi.org/10.1038/s41598-021-83787-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902822PMC
February 2021

Posttraumatic Stress Disorder and Likelihood of Hormone Therapy Use among Women in the Nurses' Health Study II: A 26-Year Prospective Analysis.

Cancer Epidemiol Biomarkers Prev 2021 Mar 21;30(3):492-498. Epub 2020 Dec 21.

Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

Background: Posttraumatic stress disorder (PTSD) is associated with higher risk of certain chronic diseases, including ovarian cancer, but underlying mechanisms remain unclear. Although prior work has linked menopausal hormone therapy (MHT) use with elevated ovarian cancer risk, little research considers PTSD to likelihood of MHT use. We examined whether PTSD was prospectively associated with greater likelihood of initiating MHT use over 26 years.

Methods: Using data from the Nurses' Health Study II, with trauma and PTSD (symptoms and onset date) assessed by screener in 2008 and MHT assessed via biennial survey (from 1989), we performed Cox proportional regression models with women contributing person-years from age 36 years. Relevant covariates were assessed at biennial surveys. We considered potential effect modification by race/ethnicity, age at baseline, and period (1989-2002 vs. 2003-2015).

Results: Over follow-up, 22,352 of 43,025 women reported initiating MHT use. For example, compared with women with no trauma, the HR for initiating MHT was 1.18 for those with trauma/1-3 PTSD symptoms [95% confidence interval (CI), 1.13-1.22] and 1.31 for those with trauma/4-7 PTSD symptoms (95% CI, 1.25-1.36; trend < 0.001), adjusting for sociodemographic factors. Associations were maintained when adjusting for reproductive factors and health conditions. We found evidence of effect modification by age at baseline.

Conclusions: Trauma and number of PTSD symptoms were associated with greater likelihood of initiating MHT use in a dose-response manner.

Impact: MHT may be a pathway linking PTSD to altered chronic disease risk. It is important to understand why women with PTSD initiate MHT use.
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http://dx.doi.org/10.1158/1055-9965.EPI-20-1227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8049954PMC
March 2021

Comparison of Computed Tomography-based Abdominal Adiposity Indexes as Predictors of Non-alcoholic Fatty Liver Disease Among Middle-aged Korean Men and Women.

J Prev Med Public Health 2020 Jul 18;53(4):256-265. Epub 2020 Jun 18.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Objectives: We compared the associations of 3 computed tomography (CT)-based abdominal adiposity indexes with non-alcoholic fatty liver disease (NAFLD) among middle-aged Korean men and women.

Methods: The participants were 1366 men and 2480 women community-dwellers aged 30-64 years. Three abdominal adiposity indexes-visceral fat area (VFA), subcutaneous fat area (SFA), and visceral-to-subcutaneous fat ratio (VSR)-were calculated from abdominal CT scans. NAFLD was determined by calculating the Liver Fat Score from comorbidities and blood tests. An NAFLD prediction model that included waist circumference (WC) as a measure of abdominal adiposity was designated as the base model, to which VFA, SFA, and VSR were added in turn. The area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), and net reclassification improvement (NRI) were calculated to quantify the additional predictive value of VFA, SFA, and VSR relative to WC.

Results: VFA and VSR were positively associated with NAFLD in both genders. SFA was not significantly associated with NAFLD in men, but it was negatively associated in women. When VFA, SFA, and VSR were added to the WC-based NAFLD prediction model, the AUC improved by 0.013 (p<0.001), 0.001 (p=0.434), and 0.009 (p=0.007) in men and by 0.044 (p<0.001), 0.017 (p<0.001), and 0.046 (p<0.001) in women, respectively. The IDI and NRI were increased the most by VFA in men and VSR in women.

Conclusions: Using CT-based abdominal adiposity indexes in addition to WC may improve the detection of NAFLD. The best predictive indicators were VFA in men and VSR in women.
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http://dx.doi.org/10.3961/jpmph.20.140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7411244PMC
July 2020

Associations between social network properties and metabolic syndrome and the mediating effect of physical activity: findings from the Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) Cohort.

BMJ Open Diabetes Res Care 2020 07;8(1)

Department of Preventive Medicine, Yonsei University College of Medicine, Seodaemun-gu, Republic of Korea.

Introduction: Social isolation and loneliness are positively associated with metabolic syndrome. However, the mechanisms by which social isolation affects metabolic syndrome are not well understood.

Research Design And Methods: This study was designed as a cross-sectional study of baseline results from the Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) Cohort. We included 10 103 participants (8097 community-based low-risk participants, 2006 hospital-based high-risk participants) from the CMERC Cohort. Participants aged 65 years or older were excluded. Multiple imputation by chained equations was applied to impute missing variables. The quantitative properties of social networks were assessed by measuring the 'size of social networks'; qualitative properties were assessed by measuring the 'social network closeness'. Metabolic syndrome was defined based on the National Cholesterol Education Program Adult Treatment Panel III criteria. Multivariate logistic regression analyses were conducted to assess association between social network properties and metabolic syndrome. The mediating effects of physical inactiveness, alcohol consumption, cigarette smoking and depressive symptoms were estimated. Age-specific effect sizes were estimated for each subgroup.

Results: A smaller social network was positively associated with higher prevalences of metabolic syndrome in all subgroups, except the high-risk male subgroup. There was no clear association between social network closeness and metabolic syndrome. In community-based participants, an indirect effect through physical activity was detected in both sexes; however, in hospital-based participants, no indirect effects were detected. Cigarette smoking, alcohol consumption and depression did not mediate the association. Age-specific estimates showed that the indirect effect through physical activity had a greater impact in older participants.

Conclusions: A smaller social network is positively associated with metabolic syndrome. This trend could be partially explained by physical inactivity, especially in older individuals.
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http://dx.doi.org/10.1136/bmjdrc-2020-001272DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368478PMC
July 2020

Protection of Healthcare Workers Against COVID-19 at a Large Teaching Hospital in Seoul, Korea.

Yonsei Med J 2020 Jul;61(7):631-634

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Thirteen patients with coronavirus disease 2019 (COVID-19) visited a university hospital in Seoul before recognizing their disease infections, causing contact with 184 hospital workers. We classified the patients into four risk levels and provided corresponding management measures. At 31 days after the last event, all screening laboratory results were negative, and no symptoms/signs were reported.
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http://dx.doi.org/10.3349/ymj.2020.61.7.631DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329738PMC
July 2020

Depressive symptoms, its sub-factors, and augmentation index: the modifying effects according to inflammatory markers.

J Affect Disord 2020 07 1;272:380-387. Epub 2020 May 1.

Department of Public Health, Yonsei University Graduate School, Seoul, Korea; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States. Electronic address:

Background This study aimed to investigate the association between depression and the augmentation index (AIx), and to further investigate whether there is a difference in this association according to the patients' inflammatory status. Methods This study included 458 men and 815 women (mean age: 49.35 years), a community-dwelling and middle-aged Korean population. The Korean version of the Beck Depression Inventory-II (BDI-II) was used to assess depressive symptoms. Arterial stiffness was evaluated via an AIx normalized to 75 beats/min. We confirmed two factors from BDI-II after conducting a factor analysis. Multiple regression models were used after adjusting for socio-demographic factors, lifestyle factors, systolic blood pressure, diabetes history, and body mass index. We further stratified the data according to inflammatory biomarkers with cutoffs of the 75 percentile. Results There was a significant positive association between the BDI-II score and arterial stiffness (ß= 0.09, p-value=0.037). In women, the somatic-affective factor showed a stronger positive association (ß= 0.20, p-value=0.018) with arterial stiffness than the cognitive factor (ß= 0.12, p-value=0.148). There was no significant association in men (ß= -0.01, p-value=0.943). In subgroup analyses, women showed significant positive associations between the somatic affective factor of depressive symptoms on and arterial stiffness according to both inflammatory markers (IL-6: ß= 0.17, p-value=0.039; hs-CRP: ß= 0.17, p-value=0.094) Limitations The design of the cross-sectional study limits causal interpretation. Conclusion Depression and its somatic-affective factor were positively associated with arterial stiffness in women. Inflammatory status may be involved in modifying the association between depressive symptoms, its sub-factors, and AIx.
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http://dx.doi.org/10.1016/j.jad.2020.03.174DOI Listing
July 2020

Consumption of Fish and ω-3 Fatty Acids and Cancer Risk: An Umbrella Review of Meta-Analyses of Observational Studies.

Adv Nutr 2020 09;11(5):1134-1149

School of Social Work, University of Southern California, CA, USA.

Multiple studies have suggested that ω-3 fatty acid intake may have a protective effect on cancer risk; however, its true association with cancer risk remains controversial. We performed an umbrella review of meta-analyses to summarize and evaluate the evidence for the association between ω-3 fatty acid intake and cancer outcomes. We searched PubMed, Embase, and the Cochrane Database of Systematic Reviews from inception to December 1, 2018. We included meta-analyses of observational studies that examined associations between intake of fish or ω-3 fatty acid and cancer risk (gastrointestinal, liver, breast, gynecologic, prostate, brain, lung, and skin) and determined the level of evidence of associations. In addition, we appraised the quality of the evidence of significant meta-analyses by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. We initially screened 598 articles, and 15 articles, including 57 meta-analyses, were eligible. Among 57 meta-analyses, 15 reported statistically significant results. We found that 12 meta-analyses showed weak evidence of an association between ω-3 fatty acid intake and risk of the following types of cancer: liver cancer (n = 4 of 6), breast cancer (n = 3 of 14), prostate cancer (n = 3 of 11), and brain tumor (n = 2 of 2). In the other 3 meta-analyses, studies of endometrial cancer and skin cancer, there were no assessable data for determining the evidence levels. No meta-analysis showed convincing, highly suggestive, or suggestive evidence of an association. In the sensitivity analysis of meta-analyses by study design, we found weak associations between ω-3 fatty acid intake and breast cancer risk in cohort studies, but no statistically significant association in case-control studies. However, the opposite results were found in case of brain tumor risk. Although ω-3 fatty acids have been studied in several meta-analyses with regard to a wide range of cancer outcomes, only weak associations were identified in some cancer types, with several limitations. Considering the nonsignificant or weak evidence level, clinicians and researchers should cautiously interpret reported associations between ω-3 fatty acid consumption and cancer risks.
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http://dx.doi.org/10.1093/advances/nmaa055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490175PMC
September 2020

Consumption of Fish and ω-3 Fatty Acids and Cancer Risk: An Umbrella Review of Meta-Analyses of Observational Studies.

Adv Nutr 2020 09;11(5):1134-1149

School of Social Work, University of Southern California, CA, USA.

Multiple studies have suggested that ω-3 fatty acid intake may have a protective effect on cancer risk; however, its true association with cancer risk remains controversial. We performed an umbrella review of meta-analyses to summarize and evaluate the evidence for the association between ω-3 fatty acid intake and cancer outcomes. We searched PubMed, Embase, and the Cochrane Database of Systematic Reviews from inception to December 1, 2018. We included meta-analyses of observational studies that examined associations between intake of fish or ω-3 fatty acid and cancer risk (gastrointestinal, liver, breast, gynecologic, prostate, brain, lung, and skin) and determined the level of evidence of associations. In addition, we appraised the quality of the evidence of significant meta-analyses by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. We initially screened 598 articles, and 15 articles, including 57 meta-analyses, were eligible. Among 57 meta-analyses, 15 reported statistically significant results. We found that 12 meta-analyses showed weak evidence of an association between ω-3 fatty acid intake and risk of the following types of cancer: liver cancer (n = 4 of 6), breast cancer (n = 3 of 14), prostate cancer (n = 3 of 11), and brain tumor (n = 2 of 2). In the other 3 meta-analyses, studies of endometrial cancer and skin cancer, there were no assessable data for determining the evidence levels. No meta-analysis showed convincing, highly suggestive, or suggestive evidence of an association. In the sensitivity analysis of meta-analyses by study design, we found weak associations between ω-3 fatty acid intake and breast cancer risk in cohort studies, but no statistically significant association in case-control studies. However, the opposite results were found in case of brain tumor risk. Although ω-3 fatty acids have been studied in several meta-analyses with regard to a wide range of cancer outcomes, only weak associations were identified in some cancer types, with several limitations. Considering the nonsignificant or weak evidence level, clinicians and researchers should cautiously interpret reported associations between ω-3 fatty acid consumption and cancer risks.
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http://dx.doi.org/10.1093/advances/nmaa055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490175PMC
September 2020

Association between the change of total cholesterol during adolescence and depressive symptoms in early adulthood.

Eur Child Adolesc Psychiatry 2021 Feb 19;30(2):261-269. Epub 2020 Mar 19.

Department of Preventive Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.

Increasing evidence suggests that serum lipids are associated with depressive symptoms. However, previous studies have mostly employed a cross-sectional design and assessed middle-aged or older adult populations, making it difficult to discern the impact of lipid changes early in life on the development of depression. Accordingly, we sought to investigate changes in blood cholesterol levels during adolescence and the development of depressive symptoms in early adulthood. This prospective cohort study included participants aged 15-16 years from the JS High School Study (JSHS), with an average follow-up of 6 years. Participants had no diagnosed depression at baseline. Multivariable linear regression models were used to estimate associations between changes in total cholesterol during adolescence and depressive symptoms in adulthood. Changes in total cholesterol during adolescence were classified as "consistently low," "decreased," "moderate," "increased," or "consistently high". In men, depressive symptoms were higher in the consistently low (β = 3.20, p = 0.036) and increased total cholesterol groups (β = 3.48, p = 0.017), compared with the moderate group. In the consistently high group, although a positive linear association was observed, it lacked statistical significance (β = 2.71, p = 0.067). While similar tendencies were noted in women, the associations were not statistically significant. Consistently low or increased total cholesterol levels during adolescence may pose an increased risk of depressive symptoms in early adulthood. These findings suggest that different strategies should be adopted to manage the lipid risk factors with consideration of age and sex.
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http://dx.doi.org/10.1007/s00787-020-01511-wDOI Listing
February 2021

Self-Reported Diet Management and Adherence to Dietary Guidelines in Korean Adults with Hypertension.

Korean Circ J 2020 May 20;50(5):432-440. Epub 2020 Jan 20.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Background And Objectives: Although dietary management is strongly recommended in patients with hypertension, little is known about how many manage their diet and follow the guidelines for hypertension. We investigated the prevalence of dietary management among adults with known hypertension and evaluated their compliance to the dietary guidelines.

Methods: Data from the Korea National Health and Nutrition Examination Survey 2013-2016 were used. Among 15,870 adults aged 30-79 years, 4,162 reported a physician-diagnosed hypertension. Diet management behavior was defined by self-report response. Actual dietary intake was assessed by a 24-hour dietary recall. Dietary quality was evaluated using the Korean Healthy Eating Index (KHEI).

Results: Among adults with hypertension, 28.0% reported that they were managing their diet. Those with hypertension consumed significantly less dietary sodium (p value<0.01), but also less potassium (p value<0.01), resulting in no difference of sodium-to-potassium ratio compared to those without hypertension (p value=0.66). Among those with hypertension, diet-managing adults had better KHEI score (66.9, p value<0.01) and consumed less sodium (3,354.3 mg, p value<0.01) than not-managing adults (63.6 score and 3,554.5 mg, respectively). However, total KHEI score was rather lower in those with hypertension (p value<0.01) than those without hypertension and their sodium intake was still over the recommended amount.

Conclusions: More than two-thirds of Korean adults with hypertension did not manage their diet in daily life. More effective strategies are needed to increase the level of compliance with dietary recommendations for people with high blood pressure.
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http://dx.doi.org/10.4070/kcj.2019.0230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098818PMC
May 2020

Self-reported diet management, dietary quality, and blood pressure control in Korean adults with hypertension.

Clin Hypertens 2019 15;25:24. Epub 2019 Dec 15.

1Department of Preventive Medicine, Yonsei University College of Medicine, Yonse-ro 50-1, Seodaemun-gu, 03722 Seoul, Republic of Korea.

Objectives: Hypertension control is a major public health concern. Daily preventive practices of the affected individual are essential for controlling blood pressure (BP). We investigated the association of diet management practice, dietary quality, and BP control among Korean adults with known hypertension.

Methods: We included 4107 participants aged 40-79 years who reported physician-diagnosed hypertension in the Korea National Health and Nutrition Examination Survey 2013-2016. Dietary management practice was defined by self-report, and dietary intakes were assessed by a 24-h dietary recall. Dietary quality and adherence were evaluated based on the Korean Healthy Eating Index (KHEI) using food and nutrient intakes assessed by a 24-h dietary recall. BP control was defined as systolic/diastolic BP < 140/90 mmHg.

Results: While the prevalence of dietary management was higher in women than men, BP control rate was not different by sex. Dietary management practice had no significant association with BP control in both men and women. Only in men, dietary quality was positively associated with BP control (OR: 1.10 per KHEI 10 score increase, 95% CI: 1.00-1.20, -value = 0.04). Men who had a highly adherent diet seemed to have a higher possibility of BP control, but there was no statistical significance (OR: 1.54, 95% CI: 0.84-2.81, -value = 0.16).

Conclusions: A high-quality diet was positively associated with BP control in Korean men aware of their hypertension. Our findings highlight the beneficial impact of dietary management as a means for achieving blood pressure control.
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http://dx.doi.org/10.1186/s40885-019-0130-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911701PMC
December 2019

Perceived Discrimination, Depression, and the Role of Perceived Social Support as an Effect Modifier in Korean Young Adults.

J Prev Med Public Health 2019 Nov 24;52(6):366-376. Epub 2019 Oct 24.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Objectives: The relationships among discrimination, social support, and mental health have mostly been studied in minorities, and relevant studies in the general population are lacking. We aimed to investigate associations between discrimination and depressive symptoms in Korean non-minority young adults, considering the role of social support.

Methods: In total, 372 participants who completed the psychological examinations conducted in the third wave of the Jangseong High School Cohort study were included. We used the Everyday Discrimination Scale to evaluate perceived discrimination and the Beck Depression Inventory-II to measure depressive symptoms. Social support was measured by the Multidimensional Scale of Perceived Social Support. Multivariate linear regression was conducted to investigate associations between discrimination and depression, along with the effect modification of social support. We stratified the population by gender to investigate gender differences.

Results: Perceived discrimination was significantly associated with depressive symptoms (β=0.736, p<0.001), and social support was negatively associated with depression (β=-0.245, p<0.001). In men, support from friends was the most influential factor (β=-0.631, p=0.011), but no significant effect modification was found. In women, support from family was the most influential factor (β=-0.440, p=0.010), and women with higher familial support showed a significantly diminished association between discrimination and depression, unlike those with lower family support.

Conclusions: Discrimination perceived by individuals can lead to depressive symptoms in Korean young adults, and this relationship can may differ by gender and social support status.
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http://dx.doi.org/10.3961/jpmph.19.114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893228PMC
November 2019

Stressful life events and augmentation index: results from the Cardiovascular and Metabolic Diseases Etiology Research Center.

Hypertens Res 2020 01 25;43(1):45-54. Epub 2019 Sep 25.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Several studies have reported a positive association between psychological stress and cardiovascular diseases; however, there is scarce evidence about various aspects of life stress, including traumatic, positive, and negative events. We aimed to evaluate the association between various stressful life events and indicators of cardiovascular risk, including the augmentation index. A total of 3276 participants from the Cardiovascular and Metabolic Diseases Etiology Research Center cohort (Mean age: 50.9) were analyzed cross-sectionally. By using the Life Experience Questionnaire, exposures were grouped as a "positive event," "negative event," or "traumatic event." The augmentation index and subclinical atherosclerosis were measured. Multivariate polytomous logistic regression was used. Overall, stressful life events did not show any significant association with any cardiovascular index; however, increased odds ratios were observed between augmentation index quartiles and those who had experienced traumatic events (quartile 4: odds ratio = 1.41, 95% confidence interval = 1.09-1.82). The association remained valid among women when stratified by sex. There was no significant result in men. Traumatic events in women were positively associated with the augmentation index. These findings suggest that more attention should be paid to trauma in the context of increased cardiovascular risk in women.
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http://dx.doi.org/10.1038/s41440-019-0331-6DOI Listing
January 2020

Association between depression and disease-specific treatment.

J Affect Disord 2020 01 23;260:124-130. Epub 2019 Aug 23.

Department of Public Health, Yonsei University Graduate School, Seoul, Republic of Korea; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States. Electronic address:

Background: Depression is a known risk factor for noncompliance to medical treatment. However, it remains unclear whether comorbidities alter the relationship between depression and treatment compliance. We explored whether depression is associated with disease-specific treatment service utilization.

Methods: This cross-sectional study utilized data from 499,492 individuals who had at least one comorbidity in the Korean Community Health Survey, 2009-2013. Self-reported lifetime depression diagnosis by a physician, current depressive symptoms, and utilization of medical services were queried. The association between depression status and the use of overall treatment services was investigated using multiple logistic regression models and further stratified by use of specific medical treatment under conditions predefined with the Charlson Comorbidity Index (CCI).

Results: Compared with non-depressed people, individuals with a "lifetime history of depression with current depressive symptom" showed higher odds of using overall medical treatment services in both men (OR=1.21, 95%CI: 1.00-1.47) and women (OR=1.13, 95% CI: 1.02-1.25). However, depressed individuals with CCI comorbidities (e.g., diabetes mellitus or angina) exhibited less utilization of treatment services than non-depressed individuals.

Limitations: The nature of the cross-sectional study limits the ability to infer a temporal causal relationship.

Conclusion: Overall, depressed individuals with a lifetime history of depression used treatment services more frequently than non-depressed individuals; however, depressed individuals with major illnesses tended to seek treatment for their medical conditions less. The mental health of patients who seek for medical services should be carefully considered in primary care for the proper health service utilization.
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http://dx.doi.org/10.1016/j.jad.2019.08.073DOI Listing
January 2020

Racial characteristics of alopecia areata in the United States.

J Am Acad Dermatol 2020 Oct 3;83(4):1064-1070. Epub 2019 Jul 3.

Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island. Electronic address:

Background: Epidemiologic studies on the association between race and alopecia areata (AA) are limited.

Objective: To characterize racial differences of AA in the United States.

Methods: Cross-sectional study of self-registered AA patients and noncases in the National Alopecia Areata Registry (NAAR). We evaluated odds of AA and its subtypes for 5 ethnic/racial groups using logistic regression. A sex-stratified analysis and a sensitivity analysis among dermatologist-confirmed cases were also performed.

Results: We identified 9340 AA patients and 2064 noncases. Compared with whites, African Americans had greater odds of AA (odds ratio, 1.77; 95% confidence interval, 1.37-2.28) and Asians had lower odds (odds ratio, 0.40; 95% confidence interval, 0.32-0.50) of AA. The results were consistent in AA subtypes, dermatologist-confirmed cases, and by sex.

Limitations: Residual confounding due to limited number of covariates. Recall or recruitment bias not representative of the entire disease spectrum. Also, outcome misclassification was possible because not all AA cases in the registry were confirmed by dermatologists.

Conclusion: Our findings suggest higher odds of AA in African Americans and lower odds in Asians compared with whites. Future studies examining racial disparity in AA from clinical and genetic perspectives are warranted for a better understanding of the disease pathogenesis.
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http://dx.doi.org/10.1016/j.jaad.2019.06.1300DOI Listing
October 2020

Racial characteristics of alopecia areata in the United States.

J Am Acad Dermatol 2020 Oct 3;83(4):1064-1070. Epub 2019 Jul 3.

Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island. Electronic address:

Background: Epidemiologic studies on the association between race and alopecia areata (AA) are limited.

Objective: To characterize racial differences of AA in the United States.

Methods: Cross-sectional study of self-registered AA patients and noncases in the National Alopecia Areata Registry (NAAR). We evaluated odds of AA and its subtypes for 5 ethnic/racial groups using logistic regression. A sex-stratified analysis and a sensitivity analysis among dermatologist-confirmed cases were also performed.

Results: We identified 9340 AA patients and 2064 noncases. Compared with whites, African Americans had greater odds of AA (odds ratio, 1.77; 95% confidence interval, 1.37-2.28) and Asians had lower odds (odds ratio, 0.40; 95% confidence interval, 0.32-0.50) of AA. The results were consistent in AA subtypes, dermatologist-confirmed cases, and by sex.

Limitations: Residual confounding due to limited number of covariates. Recall or recruitment bias not representative of the entire disease spectrum. Also, outcome misclassification was possible because not all AA cases in the registry were confirmed by dermatologists.

Conclusion: Our findings suggest higher odds of AA in African Americans and lower odds in Asians compared with whites. Future studies examining racial disparity in AA from clinical and genetic perspectives are warranted for a better understanding of the disease pathogenesis.
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http://dx.doi.org/10.1016/j.jaad.2019.06.1300DOI Listing
October 2020

Association between sedative-hypnotic medication use and incidence of cancer in Korean Nation Health Insurance Service data.

Sleep Med 2019 08 4;60:159-164. Epub 2019 Apr 4.

Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address:

Objectives: We aimed to investigate the association between the use of various sedative-hypnotics and the incidence of overall and individual cancers in a large, population-based, retrospective cohort study.

Methods: We selected a 5% random sample of individuals aged 50 years or older from data maintained by the Korean National Health Insurance Service for the years 2002-2015, excluding individuals with a prior diagnosis of cancer and with any sedative-hypnotic use in the initial two years of follow-up, leaving 236,759 participants for the final analysis. Exposure to sedative-hypnotics was defined by type of drug, standardized to a defined daily dose, and coded as a time-varying variable. Cox proportional hazard models were applied after adjusting for sex, socio-economic status, and comorbidities.

Results: We observed increased risk for overall cancer among men and women who used sedative-hypnotics (hazard ratio (HR) = 1.07, 95% confidence interval (CI) = 1.01-1.13 for men; HR = 1.21, 95% CI = 1.09-1.25 for women) compared with non-users after full adjustment. In the fully adjusted model, women with any sedative-hypnotic use had significantly increased risk for thyroid (HR = 1.53, 95% CI = 1.24-1.87), breast (HR = 1.29, 95% CI = 1.04-1.61), ovarian (HR = 1.65, 95% CI = 1.10-2.46), and lung cancer (HR = 1.40, 95% CI = 1.17-1.69) compared with non-users. Men with sedative-hypnotic use had increased risk for prostate (HR = 1.36, 95% CI = 1.16-1.58), brain (HR = 1.67, 95% CI = 1.04-2.69), and lung cancer (HR = 1.20, 95% CI = 1.07-1.35) compared with non-users.

Conclusion: We found a significant increase in overall cancer incidence among participants who used sedative-hypnotics, and both male and female sedative-hypnotic users had significantly increased risk for certain types of cancer.
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http://dx.doi.org/10.1016/j.sleep.2019.03.018DOI Listing
August 2019

Systematic review of evidence on public health in the Democratic People's Republic of Korea.

BMJ Glob Health 2019 9;4(2):e001133. Epub 2019 Mar 9.

Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.

Background: Engaging in public health activities in the Democratic People's Republic of Korea (DPRK, also known as North Korea) offers a means to improve population health for its citizens and the wider region. Such an engagement requires an understanding of current and future needs.

Methods: We conducted a systematic search of five English and eight Korean language databases to identify available literature published between 1988 and 2017. A narrative review of evidence was conducted for five major categories (health systems, communicable diseases (CDs), non-communicable diseases (NCDs), injuries, and reproductive, maternal, newborn and child health (RMNCH) and nutrition).

Findings: We found 465 publications on the DPRK and public health. Of the 253 articles that addressed major disease categories, we found under-representation of publications relative to proportion of disease burden for the two most significant causes: NCDs (54.5% publications vs 72.6% disability adjusted life years (DALYs)) and injuries (0.4% publications vs 12.1% DALYs), in comparison to publications on the third and fourth largest disease burdens, RMNCH and nutrition (30.4% publications vs 8.6% DALYs) and CDs (14.6% publications vs 6.7% DALYs) which were over-represented. Although most disease category articles were on NCDs, the majority of NCD articles addressed mental health of refugees. Only 165 articles addressed populations within the DPRK and among these, we found publication gaps on social and environmental determinants of health, CDs, and NCDs.

Conclusion: There are gaps in the public health literature on the DPRK. Future research should focus on under-studied, significant burdens of disease. Moreover, establishing more precise estimates of disease burden and their distribution, as well as analysis on health systems responses aimed at addressing them, can result in improvements in population health.
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http://dx.doi.org/10.1136/bmjgh-2018-001133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441257PMC
March 2019

Posttraumatic stress disorder symptoms and television viewing patterns in the Nurses' Health Study II: A longitudinal analysis.

PLoS One 2019 21;14(3):e0213441. Epub 2019 Mar 21.

Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.

Introduction: The relation between TV viewing and posttraumatic stress disorder (PTSD) is controversial; prior work focused exclusively on whether TV viewing of disaster events constitutes a traumatic stressor that causes PTSD. This study evaluates a possible bidirectional relation between PTSD and TV viewing in community-dwelling women.

Methods: Data are from the PTSD subsample of the Nurses' Health II study, an ongoing prospective study of women aged 24-42 years at enrollment and who have been followed biennially (N = 50,020). Trauma exposure and PTSD symptoms (including date of onset) were assessed via the Brief Trauma Questionnaire and the Short Screening Scale for DSM-IV PTSD. Average TV viewing was reported at 5 times over 18 years of follow-up. Linear mixed models assessed differences in TV viewing patterns by trauma/PTSD status. Among women with trauma/PTSD onset during follow-up (N = 14,374), linear spline mixed models assessed differences in TV viewing patterns before and after PTSD onset.

Results: Women with high PTSD symptoms reported more TV viewing (hours/wk) compared to trauma-unexposed women at all follow-up assessments (β = 0.14, SE = 0.01, p < .001). Among the women who experienced trauma during follow-up, significant increases in TV viewing (hours/day) prior to onset of high PTSD symptom levels were evident (β = 0.15, SE = 0.02, p < .001).

Conclusions: TV viewing following trauma exposure may be a marker of vulnerability for developing PTSD and also a consequence of having PTSD. High TV viewing levels may be linked with ineffective coping strategies or social isolation, which increase risk of developing PTSD.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0213441PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6428392PMC
December 2019

Posttraumatic stress disorder and incidence of thyroid dysfunction in women.

Psychol Med 2019 11 29;49(15):2551-2560. Epub 2018 Nov 29.

Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Background: Abnormal thyroid function is prevalent among women and has been linked to increased risk of chronic disease. Posttraumatic stress disorder (PTSD) has been linked to thyroid dysfunction in some studies; however, the results have been inconsistent. Thus, we evaluated trauma exposure and PTSD symptoms in relation to incident thyroid dysfunction in a large longitudinal cohort of civilian women.

Methods: We used data from 45 992 women from the ongoing Nurses' Health Study II, a longitudinal US cohort study that began in 1989. In 2008, history of trauma and PTSD were assessed with the Short Screening Scale for Diagnostic and Statistical Manual of Mental Disorders, fourth edition, PTSD, and incident thyroid dysfunction was determined by participants' self-report in biennial questionnaires of physician-diagnosed hypothyroidism and Graves' hyperthyroidism. The study period was from 1989 to 2013. Proportional hazard models were used to estimate multivariable-adjusted hazard ratios and 95% confidence intervals (CIs) for incident hypothyroidism and Graves' hyperthyroidism.

Results: In multivariable-adjusted models, we found significant associations for PTSD only with hypothyroidism [p-trend <0.001; trauma with no PTSD symptoms, 1.08 (95% CI 1.02-1.15); 1-3 PTSD symptoms, 1.12 (95% CI 1.04-1.21); 4-5 PTSD symptoms, 1.23 (95% CI 1.13-1.34); and 6-7 PTSD symptoms, 1.26 (95% CI 1.14-1.40)]. PTSD was not associated with risk of Graves' hyperthyroidism (p-trend = 0.34). Associations were similar in sensitivity analyses restricted to outcomes with onset after 2008, when PTSD was assessed.

Conclusions: PTSD was associated with higher risk of hypothyroidism in a dose-dependent fashion. Highlighted awareness for thyroid dysfunction may be especially important in women with PTSD.
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http://dx.doi.org/10.1017/S0033291718003495DOI Listing
November 2019

Pressure and Temperature Dependence of Field-Induced Oscillation in Two-Terminal Device Based on Vanadium Dioxide Thin Film.

J Nanosci Nanotechnol 2019 Mar;19(3):1500-1505

Interdisciplinary Program of Biomedical Mechanical and Electrical Engineering, Pukyong National University, 45 Yongso-ro, Nam-gu, Busan 48513, Korea.

In this paper, we investigated the pressure and temperature dependence of the frequency and amplitude of the field-induced oscillation created in a two-terminal device based on a vanadium dioxide (VO₂) thin film. First, a simple oscillation circuit was constructed using a VO₂-based two-terminal device, a standard resistor, and a DC power supply. Then, the frequency and amplitude variation of the field-induced oscillation was observed for pressure changes applied to the VO₂ device in a pressure chamber. This variation of the oscillation characteristics was also examined for ambient temperature changes applied to the VO₂ device using a plate heater. When the chamber pressure increased from 0 to 5 MPa with a step of 1 MPa at 25 °C, the oscillation frequency increased from ~592 to ~739 kHz, and the oscillation amplitude decreased from ~12.60 to ~11.40 V. Similarly, when the heater temperature increased from 25 to 50 °C (step: 5 °C) without applied pressure, the oscillation frequency increased from ~592 to ~819 kHz, and the oscillation amplitude decreased from ~12.60 to ~7.16 V. Owing to linear pressure and temperature responses of the VO₂ oscillation, the pressure and temperature sensitivities of the oscillation frequency and amplitude could be obtained as four different constant coefficients from the measurement results. These coefficients can be directly utilized for simultaneously measuring pressure and temperature variation applied to the VO₂ device, which can be beneficially applied to localized temperature and pressure sensing at a very small area less than 1 mm².
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http://dx.doi.org/10.1166/jnn.2019.16161DOI Listing
March 2019

Trends in prescriptions for sedative-hypnotics among Korean adults: a nationwide prescription database study for 2011-2015.

Soc Psychiatry Psychiatr Epidemiol 2019 Apr 7;54(4):477-484. Epub 2018 Nov 7.

Department of Psychiatry, Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul, Republic of Korea.

Purpose: This study investigated prescriptions for sedative-hypnotics via data obtained from the Health Insurance Review and Assessment (HIRA) service.

Methods: Data on sedative-hypnotic prescriptions from the HIRA service of the Republic of Korea were analyzed from 2011 to 2015. We included prescriptions for subjects > 18 years of age from hospitals and community healthcare centers. In addition, subgroup analyses with a subsample restricted to prescriptions from patients with diagnostic codes F510 (nonorganic insomnia) or G470 (insomnia) were performed. After analyzing the number of prescriptions by individual pharmacy items, the prescription codes were grouped as: (1) benzodiazepines; (2) non-benzodiazepines, including zolpidem; (3) antidepressants; and (4) antipsychotics. We calculated the monthly percent change in the number of prescriptions by drug group using Joinpoint regression.

Results: Among the sedative-hypnotic groups, benzodiazepines were the most commonly prescribed drugs in Korea during the study period. As a single sedative-hypnotic item, zolpidem was the most frequently prescribed medication for patients with insomnia. Prescriptions for all groups of sedative-hypnotics increased significantly during the study period. When stratified by age group, antipsychotic prescriptions increased significantly by 0.19-0.21% per month among men and women aged 50-59 years and > 70 years. Prescriptions for antidepressants in 30-39-year-old men increased significantly by 0.20%.

Conclusions: Benzodiazepine prescriptions as well as those for antipsychotics and antidepressants to treat insomnia increased during 2011-2015 in Korea. Monitoring the use of sedative-hypnotics at the national level is necessary, especially in the elderly population.
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http://dx.doi.org/10.1007/s00127-018-1615-xDOI Listing
April 2019

Use of Sedative-Hypnotics and Mortality: A Population-Based Retrospective Cohort Study.

J Clin Sleep Med 2018 10 15;14(10):1669-1677. Epub 2018 Oct 15.

Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea.

Study Objectives: Researchers have previously reported a possible association between sedative-hypnotics and increased mortality. However, the relationship remains controversial. We investigated the association between sedative-hypnotics and mortality using a large population-based database from the Republic of Korea.

Methods: We used a National Health Insurance Service database. The study population was a 5% random sample of the database from the years 2002- 2015. Individuals who were age 40 years and older were included in the analysis. The sedative-hypnotic users were defined as individuals prescribed 30 or more defined daily doses of sedative-hypnotics per year since January 2004. Sedative-hypnotics were classified based on type and total amount. We estimated the risk of mortality (death from January 2004 to December 2015) using time-dependent Cox regression model adjusted for age, sex, Charlson Comorbidity Index, and psychiatric comorbidity.

Results: We identified 180,823 study participants who used sedative-hypnotics and 320,136 nonusers. In a multivariate model, study participants who used sedative-hypnotics had significantly higher mortality risk than nonusers (hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.12-1.16). Specifically, study participants who used zolpidem had a higher mortality risk (HR 1.59, 95% CI 1.52-1.67) than nonusers.

Conclusions: Based on the current study results, sedative-hypnotics were associated with an increased risk of mortality, especially in study participants who used zolpidem.
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http://dx.doi.org/10.5664/jcsm.7370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175798PMC
October 2018