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Objective: To investigate temporal trends in mortality rates and underlying causes of death in persons with disabilities before and during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Annual mortality rates and causes of death were analyzed using data covering the 2017-2022 period. Results: The mortality rate among people with disabilities increased from 2017 to 2022; the rate was five times higher during COVID-19 in this population than in the general population. When analyzing the cause of death, the incidence of infectious diseases and tuberculosis decreased after COVID-19. In contrast, the incidence of other bacillary disorders (A30-A49) increased. The incidence of respiratory system diseases (J00-J99), influenza and pneumonia (J09-J18), and other acute lower respiratory infections (J20-J22) decreased before COVID-19, while the incidence of lung diseases due to external agents (J60-J70), other respiratory diseases principally affecting the interstitium (J80-J84), and other diseases of the pleura (J90-J94) increased during the pandemic. The risk of COVID-19 death among people with disabilities was 1.1-fold higher for female patients (95% CI = 1.06-1.142), 1.41-fold for patients aged 70 years and older (95% CI = 1.09-1.82), and 1.24-fold higher for people with severe disabilities (95% CI = 1.19-1.28). Conclusions: The mortality rate in people with disabilities significantly increased during COVID-19, compared with that before the pandemic. People with disabilities had a higher mortality rate during COVID-19 compared with the general population. Risk factors must be reduced to prevent high mortality rates in this population.
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COVID-19 , Personas con Discapacidad , Humanos , COVID-19/mortalidad , COVID-19/epidemiología , República de Corea/epidemiología , Femenino , Masculino , Personas con Discapacidad/estadística & datos numéricos , Persona de Mediana Edad , Adulto , Anciano , Causas de Muerte , Incidencia , SARS-CoV-2 , Mortalidad/tendencias , Pandemias , Adolescente , Adulto Joven , Niño , Anciano de 80 o más AñosRESUMEN
Trial Design: Phase 3, randomized, controlled, multicenter, equivalence trial. Methods: Recruitment of participants occurred between 04Februray2020 and 15July2020 at four centers in the Philippines: University of the East - Ramon Magsaysay Memorial Medical Center Inc., Quezon City; University of Philippines Manila - National Institute of Health, Ermita Manila; Asian Hospital and Medical Center, Metro Manila, Philippines Study; and Medical Research Unit, Tropical Disease Foundation, Makati City, Metro Manila, Philippines. Participants: 1800 adults and children 6-months to 45-years of age. Interventions: Participants received a single injection of multidose (MD) or single dose (SD) Vi-DT as test vaccines or meningococcal conjugate vaccine as a comparator. Objective: To evaluate immune equivalence of SD and MD formulations of Vi-DT, and to assess the safety of both formulations compared with comparator vaccine. Outcome Measurement: Blood draw for immunogenicity was performed at baseline prior to vaccine receipt and at four weeks after vaccination for a subset of participants to determine anti-Vi IgG geometric mean titers (GMT) and seroconversion rates. The primary outcome was comparison of anti Vi-IgG seroconversion and GMT between the two formulations of Vi-DT at 4 weeks following vaccine administration. Immune equivalence of MD and SD formulations was confirmed when the two-tailed 95% confidence interval (CI) of the GMT ratio is within [0.67, 1.5] at a two-sided significance level of 0.05. All participants were followed for safety events for six months after vaccine administration. Randomization: Participants were randomized to receive SD Vi-DT, MD Vi-DT, or meningococcal conjugate vaccines in 2.5:2.5:1 allocation ratio. Blinding: Study participants and observers were blinded to treatment assignment. Findings: Immune equivalence of SD (n=252) and MD (n=247) formulations was confirmed by anti-Vi IgG GMT ratio of 1.14 (95%CI: 0.91, 1.43) with respective GMTs in the MD and SD groups of 640.62 IU/mL (95%CI: 546.39, 751.11) and 562.57 IU/mL (95%CI: 478.80, 661.00) (p=0.259). Similarly, anti-Vi IgG seroconversion rate difference between the two formulations of â0.43% (95%CI: -4.42, 3.56) confirmed immune equivalence with corresponding seroconversion rates of 98.38% (95%CI: 95.91, 99.37) and 98.81% (95%CI: 96.56, 99.59) in MD and SD Vi-DT formulations, respectively (p=0.722). Both formulations of Vi-DT had a satisfactory safety profile - all five serious adverse events reported during the study were unrelated to the investigational product. Interpretation: The MD and SD formulations of Vi-DT elicited robust and equivalent immune responses following one dose vaccination, and both formulations demonstrated a favorable safety profile. Trial Registration: ClinicalTrials.gov: NCT04204096. Funding: This study was funded by the Bill & Melinda Gates Foundation (OPP 1115556).
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People with intellectual disabilities (ID) age faster and have a higher prevalence of degenerative diseases. The aim of this study was to identify the patterns/ causes of death among people with ID. We conducted a nationwide, retrospective, cross-sectional study of people with ID in South Korea. The database was compiled by merging data of people registered with ID, based on the 2015-2019 Standards from the Ministry of Health and Welfare, with the cause of death data published by the Korea National Statistical Office. The International Classification of Diseases-10 (ICD-10) was used to categorize causes of death. The mortality and standardized mortality rates were calculated and major causes of death were analyzed. As of 2019, the mortality rate of people with ID in South Korea was 784.6. The rate showed an irregular pattern, increasing or decreasing year by year (increasing from 725 in 2015 to 834 in 2018). The mortality rate of people with ID was approximately 1.4 times higher than the general population; the standardized mortality rate was 3.2 times higher. The main causes of death (48%) in people with ID were, in order of prevalence, circulatory diseases (cerebrovascular disease), neoplasms (malignant neoplasms of the digestive system), and diseases of the respiratory system (pneumonia). The leading causes of death (>60%) in the general population were, in order of prevalence, neoplasms, diseases of the circulatory system, and respiratory system diseases. An accurate understanding of the causes of death of people with ID is important to promote the development and application of health promotion programs and management thereof.
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BACKGROUND: Commercial vehicle accidents are the leading cause of occupational fatalities and an increased risk of traffic accidents is associated with excessive fatigue, other health problems as well as poor sleep during work. This study explores individual and occupational factors associated with different levels of daytime sleepiness and identifies their association with driving risk among occupational drivers working at construction sites. METHODS: This cross-sectional and correlational study adopted a self-reported questionnaire of Korean construction drivers (N = 492). The data were collected from October 2018 to February 2019 using a battery of six validated instruments about participants' sociodemographic, health-related, and occupational characteristics. One-way ANOVA and multinomial logistic regression were conducted using IBM SPSS WIN/VER 25.0, with a two-tailed alpha of .05. RESULTS: Based on the Epworth Sleepiness Scale, "moderate" (31.7%) and "severe" (10.2%) daytime sleepiness groups were identified. There were significant differences in break time, driving fatigue, depressive symptom, subjective sleep quality, physical and mental health, and driving risk among the three groups (all p-values < .001). Driving fatigue (Adjusted Odds Ratio [aOR] = 1.08, 1.17), depressive symptoms (aOR = 0.91, 0.98), subjective sleep quality (aOR = 1.18 in moderate only), and driving over the speed limit (aOR = 1.43, 2.25) were significant factors for determining "moderate" and "severe" daytime sleepiness groups, respectively. CONCLUSION: A significant number of construction drivers experience excessive daytime sleepiness; thus it is important to reduce the negative impact of driving fatigue and other factors on daytime sleepiness. Our study findings suggest that occupational health care providers should pay attention to development and implementation of health management interventions to reduce driving fatigue that incorporate the drivers' physical, mental, and occupational factors. Professional organizations need to establish internal regulations and public policies to promote health and safety among occupational drivers who specifically work at construction sites.
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Conducción de Automóvil , Trastornos de Somnolencia Excesiva , Accidentes de Tránsito , Estudios Transversales , Trastornos de Somnolencia Excesiva/epidemiología , Promoción de la Salud , Humanos , República de Corea/epidemiología , Calidad del Sueño , Encuestas y CuestionariosRESUMEN
This study aimed to compare the psychological symptoms of humidifier disinfectant survivors to the general population and explore socio-demographic factors influencing survivors' psychological symptoms. A one-way Multivariate Analysis of Covariance (MANCOVA) and a series of two-way MANCOVA were conducted with a sample of 228 humidifier disinfectant survivors and 228 controls. The results demonstrated that the survivor group displayed higher anxious/depressed symptoms, withdrawn symptoms, somatic complaints, thought problems, attention problems, aggressive behavior and rule-breaking behavior than the general group. Moreover, among the socio-demographic factors, the two-way interaction effects of group × family economic status and group × number of friends were found to be statistically significant. The limitations and implications of this study are discussed.
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Desinfectantes , Humidificadores , Demografía , Desinfectantes/efectos adversos , Humanos , Esterilización , SobrevivientesRESUMEN
External causes of injury are major contributors to mortality among people with disabilities. We analyzed the 10-year trend (2008-2017) of mortality attributed to external causes of injury among people with disabilities. We conducted an observational, population-based, retrospective, cross-sectional study among people with disabilities in South Korea. The database was compiled by merging two data sets: registered people with disabilities during 2008-2017 from the Ministry of Health and Welfare, and the data published by the Korea National Statistical Office. Between 2008 and 2017, the all-cause mortality among people with disabilities showed a rising trend and increased from 2641 per 100,000 in 2008 to 2751 per 100,000 in 2017. During this 10-year period, 6.5-9.2% of the total number of deaths were caused by injuries. Disabilities that were associated with a high crude mortality rate shared the same three most frequent causes of death: suicide, motor vehicle crashes, and falling. Mortality due to external causes of injury increased among older people with disabilities. Thus, effective strategies are required to decrease preventable deaths caused by unintentional injuries among people with disabilities.
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Personas con Discapacidad , Mortalidad/tendencias , Suicidio , Heridas y Lesiones , Anciano , Anciano de 80 o más Años , Causas de Muerte , Estudios Transversales , Humanos , República de Corea/epidemiología , Estudios RetrospectivosRESUMEN
BACKGROUND: As the number of individuals living alone increases, it becomes clear that health disparities vary according to a person's living arrangement. However, very few studies have investigated the characteristics of individuals who improve or maintain multiple healthy behaviors based on their living arrangements. This study aimed to explore the differing individual characteristics and multiple health behaviors in Korean adults living alone compared to those living with others and to identify the factors significantly associated with these behaviors. METHODS: This study utilized a secondary analysis, using 2013-2015 Korea National Health and Nutrition Examination Survey data, with a cross-sectional and descriptive correlational design (N = 15,934). Multiple health behaviors, based on the comparison of past and present behaviors, included smoking, alcohol consumption, and weight control. The total number of health behaviors was calculated as the sum of each single health behavior. The different numbers of health behaviors were categorized into four levels: from 0, none of the three health behaviors to 3, all three health behaviors. Descriptive statistics and generalized ordinal logistic regression analysis were used. RESULTS: People living alone engaged in fewer healthy behaviors (p < 0.05) and reported lower rates of maintenance of abstinence from smoking and weight control compared to those living with others, but they maintained a status of abstaining from alcohol consumption more than those living with others (p ≤ 0.001). In particular, higher self-rated health statuses (Adjusted Odds Ratio [aOR] = 2.03, 95% Confidence Interval [CI] = 1.04-3.97), being overweight (aOR = 1.46, 95% CI = 1.11-1.92), and having shorter sleep durations per day (aOR = 0.74, 95% CI = 0.55-0.99) were significantly associated with 0, 1 versus 2, 3 levels of healthy behaviors in those living alone. CONCLUSIONS: Korean adults who lived alone had different factors associated with different combinations of multiple healthy behaviors compared to those living with others. Therefore, we need to manage healthy behaviors by considering associated factors for those living alone. Specifically, clinicians should consider the vulnerability of health behaviors in people living alone and provide customized approaches and multidimensional interventions based on their living arrangements.
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Conductas Relacionadas con la Salud , Características de la Residencia/estadística & datos numéricos , Adulto , Anciano , Consumo de Bebidas Alcohólicas , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , República de Corea/epidemiología , Fumar , Adulto JovenRESUMEN
BACKGROUND: Geriatric depression is a societal problem, specifically in those living alone in Korea. This study aims are to investigate (1) how sociodemographic factors, health status, and health behaviors are differently associated with depressive symptoms in older Koreans living alone compared to those living with others and (2) how living arrangements attenuated or strengthened the associations between four types of health behaviors and depressive symptoms. METHODS: This secondary data analysis was conducted using data from the 2014 Korean Longitudinal Study of Aging. A structured survey assessing sociodemographic factors, health status, and health behaviors was conducted with people aged 65 or older who lived alone (n = 1359) and living with others (n = 2864). A multiple linear regression with interaction terms was conducted between mean-centered health behaviors and the status of living alone. All statistical analyses were performed using SPSS Statistics 23.0, and the two-tailed level of significance was set at 0.05. RESULTS: Those living alone reported higher levels of depressive symptoms than those living with others (Mdiff = 2.129, SE = 0.005, p < 0.001). The variance of depressive symptoms explained by 13 variables was 18.1% for those living alone compared to 23.7% for those living with others. Compared to health behaviors, sociodemographic factors and health status more explained depressive symptoms, specifically with psychiatric disorders, pain, and impaired functionality as risk factors. Smoking, alcohol abstinence, physical inactivity, and social inactivity were associated with more depressive symptoms. Living arrangements moderated the association between depressive symptoms and each health behavior, except for physical inactivity (all p values < 0.001). CONCLUSIONS: Older Koreans living alone were exposed to different risk factors for depressive symptoms compared to those living with others. Non-modifiable sociodemographic and health status factors were highly associated with depressive symptoms relative to health behaviors; thus, it is important to conduct early assessment and classification of vulnerable subgroups regarding geriatric depression. Specific assessment instruments should be prepared in practice according to living arrangements among older Koreans. Targeted interventions are essential to addressing living arrangements and modifying health behaviors to reduce smoking, alcohol consumption, and social inactivity, specifically in those living alone.
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Envejecimiento/psicología , Análisis de Datos , Depresión/epidemiología , Depresión/psicología , Conductas Relacionadas con la Salud , Características de la Residencia , Anciano , Anciano de 80 o más Años , Depresión/diagnóstico , Femenino , Estado de Salud , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , República de Corea/epidemiología , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
BACKGROUND: ß-sitosterol is a cholesterol-like phytosterol, which widely distributed in the plant kingdom. Here, anti-fibrotic effect of the ß-sitosterol was studied using the activated human hepatic stellate cell (HSC) model and dimethylnitrosamine (DMN)-induced mouse hepatic fibrosis model. METHOD: HSCs were activated by transforming growth factor-ß (TGF-ß) and the collagen-1 and α-smooth muscle actin (α-SMA) expressions were measured at the mRNA and protein level. We also studied the effect ß-sitosterol using DMN-induced mouse hepatic fibrosis model. We then measured the collagen-1 and α-SMA expression levels in vivo to investigate anti-hepatofibrotic effect of ß-sitosterol, at both of the mRNA and protein level. RESULTS: ß-sitosterol down regulated the mRNA and protein expression levels of collagen-1 and α-SMA in activated HSC. Oral administration of the ß-sitosterol successfully alleviated the DMN-induced mouse liver damage and prevented collagen accumulation. The mRNA and protein expression levels of collagen-1 and α-SMA were also down regulated in ß-sitosterol treated mouse group. CONCLUSIONS: This study shows the effect of ß-sitosterol on the TGF-ß -or DMN-induced hepatofibrosis. Hence, we demonstrate the ß-sitosterol as a potential therapeutic agent for the hepatofibrosis.
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Artemisia/química , Células Estrelladas Hepáticas/efectos de los fármacos , Cirrosis Hepática/metabolismo , Extractos Vegetales/farmacología , Sitoesteroles/farmacología , Actinas/análisis , Actinas/genética , Actinas/metabolismo , Animales , Línea Celular , Supervivencia Celular/efectos de los fármacos , Colágeno Tipo I/análisis , Colágeno Tipo I/genética , Colágeno Tipo I/metabolismo , Dimetilnitrosamina/efectos adversos , Expresión Génica/efectos de los fármacos , Humanos , Cirrosis Hepática/inducido químicamente , Masculino , Ratones , Ratones Endogámicos C57BL , Extractos Vegetales/química , Sitoesteroles/químicaRESUMEN
Recently developed bacterial hemoglobin (VHb) fusion expression vector has been widely used for the production of many target proteins due to its distinctive properties of expressing fusion protein with red color which facilitates visualization of the steps in purification, and increasing solubility of the target proteins. However, after intensive use of the vector, several defects have been found. In this report, we present a modified VHb fusion vector (pPosKJ) with higher efficiency, in which most of the defects were eliminated. First, it was found that thrombin protease often digests target protein as well as inserted thrombin cleavage site, so it was replaced by a TEV cleavage site for more specific cleavage of VHb from target protein. Second, a glycine-rich linker sequence was inserted between 6x his-tag and VHb to improve the affinity of 6x his-tag to Ni-NTA resin, resulting in higher purity of eluted fusion protein. Third, EcoRI and XhoI restriction sites located elsewhere in the vector were removed to make these restriction sites available for the cloning of target protein coding genes. A pPosKJ vector was fully examined with an anti-apoptotic BCL-2 family member of Caenorhabditis elegans, CED-9. A C-terminal VHb fusion expression vector (pPosKJC) was also constructed for stable expression of target proteins that may be difficult to express with an N-terminal fusion. Vaccinia-related kinase 1 (VRK1) was also successfully expressed and purified using the vector with high yield. Taken together, we suggest that the VHb fusion vector may be well suited for high-throughput protein expression and purification.
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Proteínas Bacterianas/aislamiento & purificación , Proteínas Bacterianas/metabolismo , Vectores Genéticos , Hemoglobinas/aislamiento & purificación , Hemoglobinas/metabolismo , Secuencia de Aminoácidos/genética , Proteínas Reguladoras de la Apoptosis , Secuencia de Bases/genética , Proteínas de Caenorhabditis elegans/aislamiento & purificación , Proteínas de Caenorhabditis elegans/metabolismo , Clonación Molecular , Citosina/química , Glicina/química , Guanina/química , Proteínas del Helminto/aislamiento & purificación , Proteínas del Helminto/metabolismo , Hemoglobinas/genética , Histidina/química , Concentración de Iones de Hidrógeno , Datos de Secuencia Molecular , Mutagénesis Insercional , Mutagénesis Sitio-Dirigida , Concentración Osmolar , Proteínas Proto-Oncogénicas/aislamiento & purificación , Proteínas Proto-Oncogénicas/metabolismo , Proteínas Proto-Oncogénicas c-bcl-2 , Proteínas Recombinantes de Fusión/aislamiento & purificación , Proteínas Recombinantes de Fusión/metabolismo , Solubilidad , TemperaturaRESUMEN
The authors reflect on the intentional model of relationship building in Clinical Pastoral Education (CPE) and its roots in the Western concept of the self as a rational, autonomous, and bounded agent. They compare the Western idea to the Confucian two-dimensional self orientation as relational as well as autonomous, and discuss possible difficulties that Asian students from Confucian background may encounter entering CPE. The chaplains explore implications and suggestions for how CPE supervisors and students may enter into dialogue in order to create mutual understanding and help Asian students translate CPE learning methods into meaningful cultural contexts.
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Pueblo Asiatico/psicología , Confucionismo/psicología , Relaciones Interpersonales , Cuidado Pastoral/educación , Autoimagen , Estudiantes/psicología , Asia/etnología , Pueblo Asiatico/etnología , Clero/psicología , Características Culturales , Procesos de Grupo , Humanos , Autorrevelación , Autopsicología , Mundo OccidentalRESUMEN
Using the personal experience of "homecoming" funcrary journey from the U.S. to Korea the author of this article probes the cultural construction of familial bond in Korean and biblical (Genesis) tuneral narratives. He highlights the cultural differences between American and Korean funeral traditions--(1) dying at hospital vs. dying at home, (2) embalming vs sup/yom (washing/binding of the corpse), (3) metal casket vs. wooden coffin, (4) committal vs. banhon (returning of the spirit)--to explore the religious and practical implications of the multicultural grieving process for pastoral care and grief ministry in which death is conceived as returning to the familial, cultural, and spiritual homes.