Background Complete contact tracing of COVID-19 patients in Korea allows a unique opportunity to investigate cluster characteristics. This study aimed to investigate all the reported COVID-19 clusters in Seoul Metropolitan area from January 23 to September 24, 2020. Methods Publicly available COVID-19 data was collected from the Seoul Metropolitan city and Gyeonggi Province. Community clusters with ≥ 5 cases were characterized by size and duration and then categorized using K-means clustering, and the correlation between the types of clusters and the level of social distancing was investigated. Results A total of 134 clusters including 4,033 cases were identified. The clusters were categorized into small (Type I, II), medium (type III), and large (type IV) clusters. With the same number of daily confirmed cases, cases were composed of different types of clusters by different periods of time. Raising social distancing was related with shifting types of clusters from large to small sized clusters. Conclusions Classification of clusters may provide opportunities to better portray the pattern of COVID-19 outbreaks and implement more effective strategies. Social distancing administered by the government may be effective in suppressing large clusters but may not be effective in controlling small and sporadic clusters.

Objectives: Cadmium is widely used, leading to extensive environmental and occupational exposure. Unlike other organs, for which the harmful and carcinogenic effects of cadmium have been established, the hepatotoxicity of cadmium remains unclear. Some studies detected correlations between cadmium exposure and hepatotoxicity, but others concluded that they were not associated. Thus, we investigated the relationship between cadmium and liver damage in the general population.Methods: In total, 11 838 adult participants from National Health and Nutrition Examination Survey 1999-2015 were included. Urinary cadmium levels and the following liver function parameters were measured: alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT), total bilirubin (TB), and alkaline phosphatase (ALP). Linear and logistic regression analyses were performed to assess the associations between urinary cadmium concentrations and each liver function parameter after adjusting for age, sex, race/ethnicity, annual family income, smoking status, alcohol consumption status, physical activity, and body mass index.Results: The covariate-adjusted results of the linear regression analyses showed significant positive relationships between log-transformed urinary cadmium levels and each log-transformed liver function parameter, where beta±standard error of ALT, AST, GGT, TB, and ALP were 0.049±0.008 (p<0.001), 0.030±0.006 (p<0.001), 0.093±0.011 (p<0.001), 0.034±0.009 (p<0.001), and 0.040±0.005 (p<0.001), respectively. Logistic regression also revealed statistically significant results. The odds ratios (95% confidence intervals) of elevated ALT, AST, GGT, TB, and ALP per unit increase in log-transformed urinary cadmium concentration were 1.360 (1.210 to 1.528), 1.307 (1.149 to 1.486), 1.520 (1.357 to 1.704), 1.201 (1.003 to 1.438), and 1.568 (1.277 to 1.926), respectively.Conclusions: Chronic exposure to cadmium showed positive associations with liver damage.

Objectives: During the coronavirus disease (COVID-19) pandemic, crude incidence and mortality rates have been widely reported; however, age-standardized rates are more suitable for comparison. In this study, we estimated and compared the age-standardized incidence, mortality, and case fatality rates among countries and investigated the relationship between these rates and factors associated with healthcare resources: gross domestic product per capita, number of hospital beds per population, and number of doctors per population. Methods:The incidence, mortality, and case fatality rates of 79 countries were age-standardized using the WHO standard population. The rates for persons 60 years or older were also calculated. The relationships among the rates were analysed using trend lines and coefficients of determination (R 2 ). The Pearson's correlation coefficients between the rates and the healthcare resource-related factors were calculated. Results:The countries with the highest age-standardized incidence, mortality, and case fatality rates were Czechia (14,253 cases/100,000), Mexico (182 deaths/100,000), and Mexico (6.7%), respectively. The R 2 between the incidence and mortality rates was 0.8520 for all ages and 0.9452 for those 60 years or older. The healthcare resources-related factors were associated positively with incidence rates, and negatively with case fatality rates: the correlations were weaker among the elderly.Conclusions: Compared to age-standardized rates, crude rates showed greater variation between countries. Medical resources may be important in preventing COVID-19-related deaths; however, considering the small variation in fatality among the elderly, prevention such as vaccination is more important especially for the elderly population to minimize the mortality rates in the elderly population.

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Background A link between sarcopenia and cognitive function has been proposed and is supported by several investigations. Nevertheless, the sex-linked relationship between these two diseases has been scarcely investigated. This cross-sectional study investigated sex differences in the association between sarcopenia and mild cognitive impairment. Methods We included all 286 participants aged 60 years or older with MCI who visited the Department of Neurology at Veterans Health Service Medical Center in South Korea from January to December 2021. The diagnosis of MCI was confirmed by two neurologists based on the participants’ neuropsychological test scores. Diagnosis of sarcopenia was based on the algorithm of Asian Working Group for Sarcopenia (AWGS) 2019 including bioelectrical impedance analysis and handgrip strength, and cognitive function was assessed using Seoul Neuropsychological Screening Battery Core (SNSB-C) test. Results Among the 286 participants, 171 and 112 were men and women. After adjustment for potential covariates including APOE genotype, in women participants, there were significant associations between diagnosis of sarcopenia and MCI (OR = 4.72, 95%CI [1.39–15.97]), while there was no significant relationship in men participants. In eight subdomains of SNSB-C, we also found that women participants with sarcopenia demonstrated a significant memory decline (OR = 3.21, 95%CI [1.01–10.19]) as compared with the reference women group without sarcopenia after adjusting all covariates mentioned above. No significant association between any SNSB-C subdomain and MCI was demonstrated in men participants. Conclusions We demonstrated that there was a different relationship between sarcopenia and MCI by sex and that sarcopenia may affect the cognitive subdomain differently by sex. These results imply that, with regard to cognitive function, maintaining muscle function and muscle mass might be more crucial for women than for men.