South Korean Study Research Articles

Impact of a multidomain lifestyle intervention on regional spontaneous brain activity

In the SoUth Korean study to PrEvent cognitive impaiRment and protect BRAIN health through lifestyle intervention in at-risk elderly people (SUPERBRAIN), we evaluated the impact of multidomain lifestyle intervention on regional homogeneity (ReHo) in resting-state functional brain magnetic resonance imaging (MRI) data. Of 152 participants aged 60–79 years without dementia assigned to either facility-based multidomain intervention (FMI), home-based MI, or controls, we analyzed 56 scanned MRIs at baseline and 24 weeks. ReHo values from regions with significant longitudinal changes were compared between the intervention and control groups and their correlations with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) or serum brain-derived neurotrophic factor (BDNF) were evaluated. ReHo values in the left medial orbitofrontal gyrus and right superior parietal lobule were increased [p = 0.021, correlated positively with serum BDNF changes (r = 0.504, p = 0.047)] and decreased [p = 0.021, correlated negatively with changes in the total (r = −0.509, p = 0.044) and attention (r = −0.562, p = 0.023). RBANS], respectively, in the participants assigned to the FMI group than those of the controls. Our results suggest that facility-based group preventive strategies may have cognitive benefits through neuroplastic changes in functional processing circuits in the brain areas which play a crucial role in the adaptive learning and internally directed cognition.

Previous psychiatric disorders in the multistep hypothesis of amyotrophic lateral sclerosis: a South Korean population study

Objective: There is accumulating evidence about an association between amyotrophic lateral sclerosis (ALS) and psychiatric disorders. We aimed to investigate the prevalence of previous psychiatric disorders before ALS onset and evaluate the contribution of psychiatric disorders to the number of steps toward developing ALS. Methods: We analyzed the National Health Insurance claims data from 2011 to 2017 and calculated the incidence of ALS. We created a multistep model using the linear least squares method with regression of the log incidence against the log age. Results: The mean annual incidence of ALS was 0.95/100,000 and frequency of familial ALS (fALS) was 5.89%. The proportions of patients who had psychiatric disorders before ALS diagnosis were 36.8% and 47.0% in fALS and sporadic ALS (sALS), respectively (p = 0.009). In both fALS and sALS, depressive disorders and anxiety and stress disorders were relatively frequent, whereas psychotic disorders and bipolar disorders were rare. Further, the slope estimates for regression analyses were 3.50 (R2 = 0.94) and 3.56 (R2 = 0.99) for fALS and sALS, respectively, suggesting a 4–5-step process to ALS onset. However, slope estimates did not differ between sALS patients with pre-symptomatic psychiatric disorders and those without. Conclusions: The incidence of ALS is relatively low in Korea and fewer steps are required to develop ALS compared to Western populations (all 6 steps). Although the prevalence of previous depression or anxiety is seemingly high, the multistep model provides no evidence that these conditions modify the risk of developing ALS in our cohort.

Impact on ALFF and ReHO mapping of lifestyle multidomain intervention: The SUPERBRAIN study

AbstractBackgroundIn the South Korean study to prevent cognitive impairment and protect brain health through lifestyle intervention in at‐risk elderly people (SUPERBRAIN), we explored impact on amplitude of low‐frequency fluctuation (ALFF) and regional homogeneity (ReHo) mapping of 24‐week facility‐based multidomain intervention (FMI) and home‐based MI (HMI).MethodA total of 152 participants, aged 60‐79 years without dementia but with ≥ 1 modifiable dementia risk factor, were randomly assigned to the FMI, HMI, or control groups. Among them, 56 participants (20 FMI, 20 HMI, and 16 control) took brain MRIs at baseline and 24 weeks. We compared between each intervention and control groups in change of ALFF and ReHo mapping. The changes in ALFF and ReHo mapping were compared using analysis of covariance with age, sex, education, and scan centers as covariates. ROI‐based analysis was controlled for multiple comparisons with a false discovery rate threshold of P < 0.05.ResultOnly in the FMI group, a significant increase of ALFF in left medial orbitofrontal gyrus was observed after intervention. When 24‐week ALFF change in the left medial orbitofrontal gyrus was compared between each intervention and control groups, there was no difference. In HMI, increased ReHo was evident in right cuneus at follow‐up, whereas increased ReHo in left medial orbitofrontal gyrus and left anterior cingulate and decreased ReHo in right superior parietal lobule and right precuneus were observed in FMI group. The ReHo change in right cuneus was significantly higher in HMI group compared to the control group. The ReHo change in left medial orbitofrontal gyrus was notably higher in FMI compared to the control group. The correlation analysis revealed a positive correlation between the ReHo change in left medial orbitofrontal gyrus and change of serum brain‐derived neurotrophic factor (BDNF) levels in FMI group.ConclusionSignificant differences between the FMI and control groups on changes in ReHo in at‐risk elderly without substantial impairment in the SUPERBRAIN suggest that group preventive strategies at the facility may be beneficial on cognition through neuroplastic changes of functional processing circuits in the brain areas which play a crucial role in processing social information.

SoUth Korean study to PrEvent cognitive impaiRment and protect BRAIN (SUPERBRAIN) showed improvement in cognitive function mostly in individuals with nutritional improvement: Sub‐analysis of SUPERBRAIN results

AbstractBackgroundThe MIND diet (Mediterranean‐DASH Intervention for Neurodegenerative Delay) is reported to be effective in preventing dementia. As the number of older adults with dementia in Korea increases, intervention programs suitable for older adults with dementia are needed. Therefore, we developed a Korean multi‐domain dementia prevention program including nutrition, exercise, cognitive training, vascular disease prevention and motivation.MethodOne‐hundred fifty three participants aged 60‐79 years with at least 1 dementia risk factor were randomly assigned in a 1:1:1 ratio to the FMI (Facility‐based intervention), HMI (Home‐based intervention) and the control group. The nutrition education program consisted of 10 classes during 24 weeks: the FMI received 7 group sessions and 3 1:1 sessions, the HMI received 4 group sessions and 3 1:1 sessions with 3 times homework sessions. The NQ‐E (Nutrition Quotient for Elderly) and the MNA (Mini Nutritional Assessment) were used to evaluate nutritional status. The RBANS (Repeatable Battery for Neuropsychological Status) and the CCI (Cognitive Complaint Interview) were used to evaluate cognitive function.ResultA total of 136 people (36 males and 100 females) completed the program with an 11.1% dropout rate. The NQ‐E score (p=0.009) and the RBANS score (p=0.001) were significantly increased in the FMI (N=45) and HMI (N=49) compared to the control group (N=42) after the study. The changes in the MNA score and the CCI score did not differ significantly among groups. As a result of sub‐analysis with the changes in the NQ‐E score before and after the study, there was no significant difference in cognitive function indicators among three groups when there was no change or improvement in the NQ‐E score. On the other hand, for those whose NQ‐E score was improved, the RBANS scores of the FMI (N=32) and the HMI (N=37) were significantly increased compared to the control group (N=25) (FMI: 0wk 496.69 points, 24wk 510.41 points; HMI: 0wk 502.86 points, 24wk 519.86 points, p=0.024).ConclusionIn conclusion, nutritional intervention focused on the MIND diet as a part of a multi‐domain intervention had an effect on improving the nutritional status and cognitive function score in the high‐risk group of dementia.

Impact of baseline daily physical activity on cognitive and physical effects of lifestyle multidomain intervention: The SUPERBRAIN study

AbstractBackgroundIn the South Korean study to prevent cognitive impairment and protect brain health through lifestyle intervention in at‐risk elderly people (SUPERBRAIN), we explored impact of baseline daily physical activity on cognitive and physical effects of 24‐week lifestyle multidomain intervention.MethodA total of 152 participants, aged 60‐79 years without dementia but with ≥ 1 modifiable dementia risk factor, were randomly assigned to the facility‐based multidomain intervention (FMI), and home‐based MI (HMI), or control groups. Among them, 82 participants (27 FMI, 34 HMI, and 21 control) took their physical activity for 7 days using the accelerometer (Actigraph GT3X+, FL, USA) at baseline. We divided 61 participants in the FMI or HMI into two groups according to their physical activity at baseline: Group I who met WHO physical activity guidelines for older adults (more than 150 minutes of moderate activity per week) and Group Ⅱ who did not meet the guidelines. We compared changes of cognitive and physical measures after 24‐week intervention between group I and Group Ⅱ. Cognitive function was measured using the total sale index score of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the physical fitness was measured by the hand grip strength test, 30 s sit‐to‐stand test, 3 m sit–walk‐and‐return test, sit‐and‐reach test, 2‐min stationary march, and Figure‐8‐walks. Due to not satisfying the normality test, the nonparametric tests Mann‐Whitney and Wilcoxon were analyzed using IBM SPSS Statistics25.ResultGroups I and II had no significant difference in the baseline total sale index score of the RBANS, whereas the group I had a higher physical fitness at baseline (sit‐and‐reach test and 3m sit‐walk‐and‐return test <0.05; Figure‐8‐walks <0.01). After the intervention, only Group I showed significant improvement in the total sale index score of the RBANS. Both groups were significantly improved in 30 s sit‐to‐stand test, 2‐min stationary march, and Figure‐8‐walks. However, hand grip strength was improved in only Group I.ConclusionSignificant improvement in both cognitive and physical function in at‐risk but active elderly without substantial impairment in the SUPERBRAIN suggest that preventive strategies may be more beneficial on cognitive and physical function in active older adults.

Significance of the in vivo endocannabinoid level to predict effectiveness of lifestyle multidomain intervention: The SUPERBRAIN study

AbstractBackgroundIn the South Korean study to prevent cognitive impairment and protect brain health through lifestyle intervention in at‐risk elderly people (SUPERBRAIN), we explored changes of in endocannabinoid after 24‐week intervention and impact of baseline endocannabinoid on cognitive and physical effects of intervention.MethodA total of 152 participants, aged 60‐79 years without dementia but with ? 1 modifiable dementia risk factor, were randomly assigned to the facility‐based multidomain intervention (FMI), and home‐based MI (HMI), or control groups. Among them, 125 participants (43 FMI, 44 HMI, and 38 control) took measurement for their levels of cortisol, anandamide (N‐arachidonoylethanolamine; AEA), and 2‐AG (2‐arachidonoylglycerol). Plasma levels were determined by liquid chromatography‐selected reaction monitoring quantification using a QTrap5500 mass spectrometer (ABSciex, Foster City, CA, USA). We compared changes of compound levels between intervention and control groups. In addition, we analyzed whether the baseline level of the compound was independent predictor for changes in clinical measures after intervention.ResultNeither the ratios, cortisol to AEA + 2‐AG, cortisol to AEA, and cortisol to 2‐AG nor the levels in AEA, 2‐AG, and cortisol showed noteworthy differences before and after the SUPERBRAIN program, between control and intervention groups. Some changes in the physical fitness and cognitive function variables were associated with the baseline AEA and cortisol, especially in the intervention group: Figure‐8‐walks (p<0.05),and ‘pre‐contemplation stage’ score of the readiness to change questionnaire for motivational enhancement (p<0.05) for cortisol; Prospective Retrospective Memory Questionnaire (PRMQ) by caregiver (p<0.05), and total scale index score of Repeatable Battery for the Assessment of Neuropsychological Status (RBANS, p<0.05) for AEA; ‘Confirmed control’ score of the questionnaire for motivational enhancement (p<0.05) for both. Among them, intervention status and baseline AEA seemed to be possible independent variables for changes in two cognitive function items, PRMQ by caregiver and total scale index score of RBANS. However, further analysis showed no interaction between intervention status and baseline AEA level on cognitive function.ConclusionBaseline level of in vivo endocannabinoids may predict the cognitive change after a multidomain dementia prevention intervention program, though its modulation on multidomain dementia prevention intervention for cognitive effects needs to be more revealed.

Impact on cerebral cortical thickness of lifestyle multidomain intervention: The SUPERBRAIN study

AbstractBackgroundIn the South Korean study to prevent cognitive impairment and protect brain health through lifestyle intervention in at‐risk elderly people (SUPERBRAIN), we explored impact on cortical thickness of 24‐week facility‐based multidomain intervention (FMI) and home‐based MI (HMI).MethodA total of 152 participants, aged 60‐79 years without dementia but with ≥ 1 modifiable dementia risk factor, were randomly assigned to the FMI, HMI, or control groups. Among them, 55 participants (20 FMI, 19 HMI, and 16 control) took brain MRIs at baseline and 24 weeks. We compared between each intervention and control groups in change of global/regional mean cortical thickness at 76 region‐of‐interest (ROI)s of the automated anatomical labelling (AAL); the total scale index score of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); and Serum brain‐derived neurotrophic factor (BDNF) levels. The changes in mean cortical thickness were compared using analysis of covariance with age, sex, education, and scan centers as covariates. ROI‐based analysis was controlled for multiple comparisons with a false discovery rate threshold of P < 0.05.ResultComparing with the control group, the total scale index score of RBANS was more significantly improved in both FMI group (p=0.002) and HMI group (p=0.013), respectively. The serum BDNF more significantly increased only in the FMI group (p=0.029). Mean global cortical thickness more significantly increased only in the FMI group (0.033±0.070 vs ‐0.003±0.040, p=0.035). ROI‐based analysis showed more significantly increased cortical thickness of the orbital, medial, medial orbital parts of right superior frontal gyrus, right olfactory cortex, right rectal gyrus, right anterior cingulate and paracingulate gyri, right middle temporal gyrus, medial orbital and dorsolateral parts of the left superior frontal gyrus, the orbital part of the left middle frontal gyrus, left middle occipital gyrus, and left middle temporal gyrus in the FMI group.ConclusionSignificant differences between the FMI and control groups on changes in cortical thicknesses in at‐risk elderly without substantial impairment in the SUPERBRAIN suggest that group preventive strategies at the facility may be beneficial on cognition through structural neuroplastic changes in the brain areas which play a crucial role in processing social information.

Operation and management of a community treatment center using telemedicine for foreign patients with mild COVID-19 symptoms.

South Korean studies on coronavirus disease-2019 (COVID-19) treatment have described the use of community treatment centers (CTCs), which combine elements of the home and hospital, to isolate and treat mild COVID-19 patients. While the number of South Koreans diagnosed with COVID-19 cases has varied greatly by season, the number of confirmed cases in foreign nationals has shown no seasonality, with an average of around 25 to 30 per day. For foreign patients, accommodation arrangements and travel routes may be difficult; they may also have difficulty accessing medical care, so require careful management.We discuss our experience in operating and managing a CTC for foreign COVID-19 patients arriving in South Korea with mild symptoms. We also propose guidelines for efficient use of resources with respect to treating these patients in CTCs.We present the clinical findings of patients treated at the CTC between 7 October and 22 November 2020, and make some recommendations. We quarantined and treated foreign patients with mild symptoms of COVID-19 at the Ansan CTC. Discharge is determined based on clinical symptoms rather than polymerase chain reaction results. Medical and administrative staff use building A, while building B is used for isolating patients. Medical rounds are in the form of twice-daily video calls. Three kinds of foods with medication are served according to the patient's country of origin.In total, 315 patients were admitted to the Ansan CTC between 7 October and 22 November 2020; 145 of them were discharged from the CTC and 26 were transferred to other hospitals.To utilize medical resources efficiently during the pandemic, it is desirable to reserve CTCs exclusively for foreign patients.

Survival and medical costs of melanoma patients with subsequent cancer diagnoses: A South Korean population-based retrospective cohort study.

AimSubsequent cancers (SCs) after melanoma diagnosis further increases the risks of mortality and medical costs. This population‐based analysis aimed to evaluate risk factors for SC, mortality, and medical costs of melanoma patients with SC.MethodsA retrospective cohort analysis was conducted using a nationwide claims database during 2002‐2017 in South Korea. SC was defined as having other types of cancer diagnoses other than subsequent melanoma during‐up to 5 years after melanoma diagnosis. Melanoma patients were divided into patients with and without SC, and the overall and subgroup survival rates, the risk of developing SC, and the total medical costs were analyzed using a Kaplan–Meier method and regressions.ResultsA total of 3740 melanoma patients were included in the analysis (mean age, 62.3 ± 15.4 y; 47.2% men), and 2273 patients (1157 within 2 months, 756 after 2 months of melanoma diagnosis) had SC. Higher Charlson comorbidity index score and male sex significantly increased the risk of developing SC. Five‐year survival rate and cumulative medical costs were 62.3% (95% confidence interval [CI], 60.8‐63.9) and $21,413, respectively, in all patients. Patients with SC diagnosed after 2 months showed the lowest survival rate of 47.8% (95% CI, 44.3‐51.4) and the highest costs of $27,081, showing a mortality hazard ratio of 1.65 (range, 1.46‐1.86) and a cost ratio of 1.189 (range, 1.112‐1.271) compared with those without SC.ConclusionThis study presented survival outcomes and medical costs in melanoma patients and confirmed that SC after the first diagnosis of melanoma significantly increased disease burden in terms of mortality and medical costs.

A high proportion of SARS-CoV-2–infected university students are asymptomatic

Many individuals infected with SARS-CoV-2 never become symptomatic. In a South Korean study, these infected individuals remained asymptomatic for a prolonged period while maintaining the same viral load as symptomatic patients, suggesting that they are just as infectious.

Incidence, mortality, and cardiovascular diseases in pituitary adenoma in Korea: a nationwide population-based study.

Few nationally representative studies have evaluated the epidemiology of PA (pituitary adenoma). This South Korean study evaluated the incidence of different PA subtypes, cardiovascular disease (CVD), and related mortality. This population-based study evaluated 31,898 patients with PA during 2005-2015. The incidence of PA, mortality, and CVD occurrence in PA cases were evaluated during a median follow-up of 5.3years (range: 0-10years). Cox regression analysis was used to evaluate the associations between CVD and mortality. The annual incidences (per 100,000 population) were 3.5 for non-functioning pituitary adenoma (NFPA), 1.6 for prolactinoma (PRL), 0.5 for growth hormone-secreting pituitary adenoma (GH), and 0.2 for adrenocorticotropic or thyroid-stimulating hormone-secreting pituitary adenoma (ACTH + TSH). The standardized mortality ratios were 1.9 for ACTH + TSH, 1.7 for NFPA with hypopituitarism, 1.4 for NFPA without hypopituitarism, 1.3 for GH, and 1.1 for PRL. During 2005-2015, the overall incidence of CVD among PA patients was 6.6% (2106 cases), and the standardized incidence ratios were 4.1 for hemorrhagic stroke, 3.0 for ischemic stroke, and 1.7 for acute myocardial infarction. The standardized incidence ratios for stroke were significantly higher in the ACTH + TSH and NFPA groups, which also had higher risks of CVD-related mortality, relative to the PRL and GH groups. South Korea had a relatively high incidence of NFPA. The incidence of stroke was highest for ACTH + TSH and NFPA, which was directly related to mortality during long-term follow-up. Patients with these types of PA should receive stroke prevention measures to reduce their risk of mortality.

Letter: The Risk of COVID-19 Infection During Neurosurgical Procedures: A Review of Severe Acute Respiratory Distress Syndrome Coronavirus 2 (SARS-CoV-2) Modes of Transmission and Proposed Neurosurgery-Specific Measures for Mitigation.

Letter: The Risk of COVID-19 Infection During Neurosurgical Procedures: A Review of Severe Acute Respiratory Distress Syndrome Coronavirus 2 (SARS-CoV-2) Modes of Transmission and Proposed Neurosurgery-Specific Measures for Mitigation.

Alcohol? Not for Non-alcoholic Fatty Liver Disease Patients.

Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease worldwide, with an estimated global prevalence of 25%, liver-specific mortality of 0.77 persons per 1,000, and overall mortality of 11.77 per 1,000 person-years (1). It has long been debated whether alcohol consumption influences the course of NAFLD. Three of the most recent studies have shed light over this important issue. In a study conducted in the United States, alcohol consumption of at least 30 g/day for men and 15 g/day for women was associated with increased mortality in individuals with fatty liver and metabolic syndrome (2). In a Finnish study, even low alcohol intake in fatty liver disease was associated with increased risks for advanced liver disease and cancer (3). Finally, in a South Korean study, even though low alcohol consumption was linked to a decreased risk of incident hepatic steatosis, the same levels of low alcohol consumption were associated with a higher risk of developing advanced liver fibrosis in those subjects who progressed to more severe NAFLD over time (4).

South Korean Study to Prevent Cognitive Impairment and Protect Brain Health Through Lifestyle Intervention in At-Risk Elderly People: Protocol of a Multicenter, Randomized Controlled Feasibility Trial.

Background and PurposeThe prevalence of dementia is increasing in South Korea. Multidomain interventions may be useful for preventing dementia. Such programs need to be disseminated to elderly Koreans throughout the country. We have developed programs of the SoUth Korean study to PrEvent cognitive impaiRment and protect BRAIN health through lifestyle intervention in at-risk elderly people (SUPERBRAIN), which consists of a facility-based multidomain intervention (FMI) program and a home-based multidomain intervention (HMI) program suitable for elderly Koreans. We aim to determine the feasibility of the SUPERBRAIN programs before a large-scale randomized controlled trial.MethodsWe will recruit 150 participants among those without dementia aged 60–79 years with at least 1 modifiable dementia risk factor. They will be randomly assigned in a 1:1:1 ratio to the FMI, HMI, and the waiting-list control arm. The 6-month multidomain intervention consists of management of metabolic and vascular risk factors, cognitive training and social activity, physical exercise, nutritional guidance, and motivational enhancement programs. The primary outcomes are adherence and retention rates and changes in the total scale index score of the Repeatable Battery for the Assessment of Neuropsychological Status from baseline to the study end. The main secondary outcomes are disability, depressive symptoms, quality of life, vascular risk factors, physical performance, nutritional assessment, and motivation questionnaire. There will be an exploratory evaluation of neurotrophic, neurodegeneration, and neuroinflammation factors, microbiome, telomere length, electroencephalography, and neuroimaging measures.ConclusionsThe results obtained will provide information on the applicability of these multidomain intervention programs to at-risk elderly people.

Cost-effectiveness analysis of the implementation of a National Immunization Program for rotavirus vaccination in a country with a low rotavirus gastroenteritis-related mortality: A South Korean study

Rotavirus is a leading cause of severe gastroenteritis among children younger than 5 years in South Korea. Two rotavirus vaccines (RVs), pentavalent human-bovine reassortant vaccine (Rotateq®; RV5) and attenuated human strain originated monovalent vaccine (Rotarix®; RV1), have been available for voluntary vaccination using out-of-pocket payment since 2007 and 2008, respectively. Yet, RVs are not included in the National Immunization Program (NIP), partly because of the low associated mortality rate. We assessed the cost-effectiveness of RVs to assist the evidence-based decision-making process for NIP implementation in South Korea. Using a transparent age-structured static cohort model, we simulated the experience of ten annual birth cohorts of South Korean children from 2018 to 2027. Model inputs included rotavirus gastroenteritis (RVGE) incidence and mortality rates, RVGE treatment costs, vaccine coverage and timeliness, and vaccine effectiveness and price. The incremental costs of including RVs in the NIP compared to no vaccination were 59,662,738 USD and 152,444,379 USD for RV1 and RV5, respectively. The introduction of RV1 and RV5 can prevent 4799 disability-adjusted life years (DALYs) and 5068 DALYs. From the societal perspective, the incremental cost-effectiveness ratios (ICERs) for adopting RV into the NIP versus no vaccination were 12,432 USD per DALY averted for RV1 and 30,081 USD per DALY averted for RV 5. The weighted average for the ICERs of the two vaccines computed using the market share of each vaccine in the current voluntary use as a weight, was 21,698 USD per DALY averted. The estimated ICER was below 1 × gross domestic product per capita (30,000 USD), which has been a commonly used willingness-to-pay threshold for health care technology assessment in South Korea, suggesting that introducing RVs into the NIP would be cost-effective.

A structural path to job satisfaction, burnout, and intent to leave among child protection workers: A South Korean study

The child protection service workforce has been constantly challenged by high turnover due to the stressful nature of the job. To address high turnover, prior research has examined a wide range of predictors of child protection workers' intent to leave. This study aimed to identify the interrelationships of risk and protective factors, job satisfaction and burnout to child protection workers' intent to leave, the relative impact between job satisfaction and burnout on intent to leave, and their mediating roles for the risk and protective factors. Analyzing survey data from 93.9% of all public child protection workers in South Korea, we estimated a structural path from risk and protective factors to child protection workers' job satisfaction, burnout, and intent to leave. Path analysis revealed that with the significant effects of emotional exhaustion (β = 0.52, p < 0.000) and a diminished sense of personal accomplishment (β = 0.13, p < 0.024) on intent to leave, the organizational risk factors of role overload (β = 0.12, p < 0.000), safety concerns at work (β = 0.06, p < 0.021), and secondary traumatic stress (β = 0.09, p < 0.003) increased workers' intent to leave indirectly through emotional exhaustion. Rapport with supervisor (β = −0.15, p < 0.010) directly mitigated intent to leave. There was no significant effect of job satisfaction on intent to leave. Results suggest that for effective retention of child protection service manpower, it is crucial to prevent workers' emotional exhaustion by alleviating stressful working conditions and strengthening supervisory support.

Adjuvant therapy is associated with improved survival in pT1N1 gastric cancer in a heterogeneous western patient population.

36 Background: Two recent South Korean studies showed adjuvant therapy (AT) was not associated with improved survival in pT1N1 gastric adenocarcinoma (GAC). We aimed to establish the prognostic utility of lymph node status, determine the pattern of use of AT, and compare survival stratified by type of AT in pT1N1 GAC in a Western patient population. Methods: We identified patients with pT1N0 and pT1N1 GAC using the National Cancer Database from 2004 to 2012. Clinicopathologic variables, treatment regimens, and overall survival (OS) were compared. Results: We compared 4,516 (86.6%) pT1N0 to 696 (13.4%) pT1N1 patients. pT1N1 tumors were larger (median size 2.5 vs. 1.8 cm, p &lt; 0.001), more often poorly differentiated (56.2% vs. 39.6%, p &lt; 0.001), and had higher median retrieved lymph nodes (RLN) (14 vs. 12, p &lt; 0.001) compared to pT1N0. pT1N1 was associated with worse median OS (6.9 years vs. 9.9 years for pT1N0, p &lt; 0.001). pN1 was independently associated with worse OS (HR 2.17 95% CI 1.84-2.56). Increased RLN was associated with improved OS (HR 0.73, 95% CI 0.65-0.83). Among pT1N1 patients, 330 (47.4%) had observation (OBS), 77 (11.1%) received adjuvant chemotherapy (ACT), 68 (9.8%) received adjuvant radiation therapy (ART), and 221 (31.8%) received adjuvant chemoradiation therapy (ACRT). ACT and ACRT were independently associated with improved OS (HR 0.37, 95% CI 0.22-0.65 and HR 0.40, 95% CI 0.28-0.57). Conclusions: pN1 was associated with worse survival and RLN ≥ 15 was associated with improved survival in pT1 GAC. ACT and ACRT were independently associated with improved survival in pT1N1 gastric cancer suggesting a valuable role in Western patients.

Clostridioides difficile Infection in Chronic Kidney Disease/End-Stage Renal Disease.

Clostridioides difficile infection (CDI) is a major health-care burden and increasingly seen in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Increased antibiotic use, alteration in host defenses, and gastric acid suppression are some of the etiologies for increased risk of CDI in these populations. Patients with CKD/ESRD have a higher risk of initial episode, recurrence, and development of severe CDI than those without CKD or ESRD. Diagnosis and management of CDI in patients with CKD/ESRD are similar to that in the general population. The mortality, length of stay, and health-care costs are higher in patients with CDI and CKD/ESRD. Antimicrobial stewardship with reduction in antibiotic use along with infection-control measures such as contact isolation and hand hygiene with soap and water is essential in the control and prevention of CDI in patients with CKD/ESRD.

Adjuvant Therapy is Associated with Improved Survival in pT1N1 Gastric Cancer in a Heterogeneous Western Patient Population.

Two recent South Korean studies showed adjuvant therapy (AT) was not associated with improved survival in pT1N1 gastric adenocarcinoma (GAC). We established the prognostic utility of lymph node status, determined the pattern of use of AT, and compared survival stratified by type of AT in pT1N1 GAC in a Western patient population. We identified patients with pT1N0 and pT1N1 GAC using the National Cancer Database from 2004 to 2012. Clinicopathologic variables, treatment regimens, and overall survival (OS) were compared. We compared 4516 (86.6%) pT1N0 to 696 (13.4%) pT1N1 patients. pT1N1 tumors were larger (median size 2.5 vs. 1.8cm, p < 0.001), more often poorly differentiated (56.2% vs. 39.6%, p < 0.001), and had higher median retrieved lymph nodes (RLN) (14 vs. 12, p < 0.001) compared with pT1N0. pT1N1 was associated with worse median overall survival (OS) (6.9 vs. 9.9years for pT1N0, p < 0.001). pN1 was independently associated with worse OS (hazard ratio [HR] 2.17, 95% confidence interval [CI] 1.84-2.56). Increased RLN was associated with improved OS (HR 0.73, 95% CI 0.65-0.83). Among pT1N1 patients, 330 (47.4%) had observation (OBS), 77 (11.1%) received adjuvant chemotherapy (ACT), 68 (9.8%) received adjuvant radiation therapy (ART), and 221 (31.8%) received adjuvant chemoradiation therapy (ACRT). ACT and ACRT were independently associated with improved OS (HR 0.37, 95% CI 0.22-0.65 and HR 0.40, 95% CI 0.28-0.57). pN1 was associated with worse survival and RLN ≥ 15 was associated with improved survival in pT1 GAC. ACT and ACRT were independently associated with improved survival in pT1N1 gastric cancer suggesting a valuable role in Western patients.

How South Koreans Interpreted Modern China: South Korean Studies of Modern Chinese History during the Cold War Era

How South Koreans Interpreted Modern China: South Korean Studies of Modern Chinese History during the Cold War Era