Youngin Lee

UNSTRUCTURED AI and digital health tools are arriving faster than the ideas needed to guide preparation for this new data environment. This Viewpoint proposes the Health Data Gravity Framework (HDGF) with four interconnected aims: to provide a new way of understanding how healthcare systems are structured; to predict their trajectory as data mass redistributes from institutions to individuals; to define the changing role of primary care—both the discipline and the professionals within it—in the system that results; and to guide preparation for patients, professionals, educators, and policymakers. Inspired by general relativity, the HDGF proposes that whoever holds and controls health data shapes the healthcare landscape around themselves—pulling system resources inward not by force, but by the natural slope of the field. The model centers on three interacting ideas: data mass (the volume and quality of data an entity holds), the accessibility A(e) and usability U(e) of each entity—determining where and how data mass exerts its pull, and a policy field that raises or lowers the whole landscape. We describe four archetypal system configurations—Pre-Gravity, Institutional Gravity, Distributed Gravity, and Sovereign Gravity—through which data accessibility and usability may expand from institutions toward patients; a formal representation of these dynamics is provided in Multimedia Appendix 1 for readers who wish to explore it. In the system the HDGF predicts, primary care evolves from Data Prospector through Resource Orchestrator to Holistic Companion—a professional who holds both the reach of the patient’s data field and the irreducibly human domains that lie beyond what digital systems can fully capture: sensitive privacy, emotional complexity, and the social contexts that shape health. These human domains do not become less important as AI advances—they become more so, because they are precisely what AI cannot replace.

Background: Physical inactivity and sedentary behavior influence the prevalence of anxiety disorders. However, there is a lack of research on how these factors affect Korean adults. Therefore, we conducted a large-scale cohort study to investigate the association of physical activity and sedentary behavior with the development of anxiety disorders.Methods: This cross-sectional study included 5,615 Korean adults aged 19 years and over. This study analyzed data from the Korea National Health and Nutrition Examination Survey VIII (2021). Participants were divided into three groups based on sedentary time (minute per day), and anxiety levels were compared using the Generalized Anxiety Disorder Scale.Results: The odds ratio (OR) for severe generalized anxiety disorder was higher in the longer sedentary time group (≥480 & <660 minutes and ≥660 minutes) than in the lowest sedentary time group (<480 minutes) (≥480 & <660 minutes: OR, 1.004; 95% confidence interval [CI], 0.463–2.178; ≥660 minutes: OR, 2.233; 95% CI, 1.385–3.599; P=0.001). After adjusting for confounding factors, these correlations remained consistent and statistically significant. Furthermore, subgroup analysis revealed that middle-aged adults, women, high school graduates, individuals living with housemates, and employed individuals had a stronger association with severe anxiety as sitting time increased.Conclusion: Sitting for more than 11 hours a day is a significant risk factor for the development of severe anxiety. Incorporating regular walking into daily routines and reducing sedentary behaviors could alleviate anxiety in Korean adults.

Background/Objectives. Type 2 diabetes mellitus (T2DM) has been linked to an increased risk of several cancers. However, the influence of metformin and dipeptidyl peptidase-4 inhibitors (DPP4is) on the risk of cancers remains unclear. We investigated the association between using DPP4is and/or metformin and cancer risk compared with other glucose-lowering drugs (GLDs). Methods. This retrospective multicenter cohort study was performed using 11 hospital databases standardized to the OMOP Common Data Model (CDM) within the Observational Health Data Sciences and Informatics (OHDSI) network. T2DM patients using only DPP4is and/or metformin (DPP4is/Met group) were compared with those using other GLDs (other GLD group). From 413,344 eligible patients, propensity score (PS) 1:1 matching yielded 6674 patients in each group. Cox proportional hazards models were used to analyze cancer risk, and a random-effects meta-analysis was performed to calculate hazard ratios (HRs). Results. The DPP4is/Met group exhibited a significantly lower risk of incident cancer than the other GLD group (HR, 0.54; 95% CI, 0.41–0.69). This association was consistent across all hospitals. Regarding cancer-specific distributions, the DPP4is/Met group showed lower proportions of breast and prostate cancers, whereas the other GLD group showed higher proportions of lower gastrointestinal cancers. Conclusions. In this large multicenter study, using DPP4is and metformin showed a substantial association with a lower risk of cancer in T2DM patients relative to other GLDs. These findings suggest a potential protective effect of metformin and support the neutral-to-beneficial effect on cancer of DPP4is.

Background: Caffeine, a widely consumed stimulant, affects sleep and mental health. Shift work disrupts the circadian rhythm and has been associated with various mental health issues, such as depression, anxiety, and suicidal ideation. Objective: This study explored the associations between caffeine consumption, sleep duration, and mental health outcomes, particularly suicidal ideation, among shift workers in Korea. Methods: Data from the 6th Korea National Health and Nutrition Examination Survey (2013, 2015), which comprised 4723 adults aged 19 and older, were analyzed. Participants were categorized into groups based on average daily coffee consumption and work patterns. Multiple logistic regression analyses were conducted to determine the impact of caffeine consumption and work patterns on mental health outcomes. Results: Participants worked longer hours, reported higher perceived stress levels, and slightly decreased sleep duration as daily coffee consumption increased. However, no significant differences were observed in depression or suicidal ideation across the coffee consumption groups. Logistic regression analysis indicated a trend towards higher suicidal ideation risk with increased coffee intake, particularly among those who consumed three or more cups per day (OR 5.67, 95% CI 1.82–17.59). Conclusion: This study suggests a complex relationship between caffeine consumption, work patterns, and mental health outcomes. Although caffeine intake is associated with increased work hours and stress, its impact on suicidal ideation is influenced by occupational factors.

Background: Skipping breakfast is associated with an increased risk of chronic inflammatory diseases. This study aimed to examine the association between breakfast-eating habits and inflammation, using high-sensitivity C-reactive protein (hs-CRP) as a marker.Methods: A total of 4,000 Korean adult males with no history of myocardial infarction, angina, stroke, diabetes, rheumatoid arthritis, cancer, or current smoking were included. Data from the 2016–2018 Korea National Health and Nutrition Examination Survey were used for analysis. The frequency of breakfast consumption was assessed through a questionnaire item in the dietary survey section asking participants about their weekly breakfast consumption routines over the past year. Participants were categorized into two groups, namely “0–2 breakfasts per week” and “3–7 breakfasts per week”; hs-CRP concentrations were measured through blood tests.Results: Comparing between the “infrequent breakfast consumption (0–2 breakfasts per week)” and “frequent breakfast consumption (3–7 breakfasts per week)” groups, the mean hs-CRP was found to be significantly higher in the “infrequent breakfast consumption” group, even after adjusting for age, body mass index, physical activity, alcohol consumption, systolic blood pressure, blood pressure medication, fasting blood glucose, and triglycerides (mean hs-CRP: frequent breakfast consumption, 1.36±0.09 mg/L; infrequent breakfast consumption, 1.17±0.05 mg/L; P-value=0.036).Conclusion: Less frequent breakfast consumption was associated with elevated hs-CRP levels. Further large-scale studies incorporating adjusted measures of daily eating patterns as well as food quality and quantity are required for a deeper understanding of the role of breakfast in the primary prevention of chronic inflammatory diseases.

Background: Sarcopenia and obesity are age-related conditions associated with dietary habits. However, the relationship between eating speed and sarcopenia, particularly in older adults >65 years of age remains unclear. Methods: To investigate the effect of eating speed on the occurrence of sarcopenia, obesity, and sarcopenic obesity, we examined eating speed, socioeconomic factors, and disease history of 6202 patients at baseline and their changes over a 16-year follow-up period. Results: A fast eating speed was significantly associated with a higher risk of developing sarcopenia (normal eating: HR 1.284, 95% CI 1.107–1.490; slow eating: HR 1.583, 95% CI 1.279–1.958). Slower eating was associated with a reduced risk of obesity (normal eating: HR 0.865, 95% CI 0.786–0.952; slow eating: HR 0.680, 95% CI 0.577–0.802). These trends were consistent among participants aged <65 years. Among participants aged ≥65 years, fast eating was associated with a higher incidence of sarcopenia (HR 1.603, 95% CI 1.119–2.298), but no significant relationship existed with obesity (normal eating: HR 0.846, 95% CI 0.623–1.150; slow eating: HR 0.792, 95% CI 0.537–1.168). Conclusions: Slow eating speed decreased the incidence of obesity but increased that of sarcopenia in adults aged <65 years. However, in adults aged ≥65 years, slow eating speeds increased the incidence of sarcopenia but did not reduce the incidence of obesity.

Background: Residential smoking cessation therapy programs offer intensive treatment for heavy smokers who struggle to quit independently, particularly those with high nicotine dependence and health conditions that necessitate urgent cessation. While previous studies have established the effectiveness of such programs and identified various factors influencing smoking cessation success, it remains unclear how changes in smokers’ thoughts and attitudes following residential therapy correlate with their ability to quit smoking. We investigated the relationship between smoking cessation-related characteristics, smoking-related psychological status, and participants’ smoking cessation success after a residential smoking cessation therapy program.Methods: From January 2017 to December 2018, 291 participants completed the program. All participants completed questionnaires on smoking cessation-related characteristics and smoking-related psychological status before the program and on the 5th day. Six months later, smoking cessation success was assessed using a urine cotinine test.Results: After 6 months, 222 participants successfully quit smoking, while 69 failed. The success and failure groups exhibited statistically significant differences in age, marital status, total smoking duration, stress, and emotion regulation strategies. Participants who used ineffective emotion regulation strategies more frequently had a lower rate of smoking cessation success (odds ratio [OR], 0.969; 95% confidence interval [CI], 0.948–0.991). Moreover, an increase in the perception of the negative effects of smoking cessation (OR, 0.982; 95% CI, 0.967–0.997) and smoking temptation (OR, 0.960; 95% CI, 0.929–0.993) was associated with higher cessation success. Conclusion: Emotion regulation strategies, perceptions of the effects of smoking cessation, and smoking temptation were associated with successful smoking cessation.

As indoor space becomes more important in our daily life, the demand to build digital twins for indoor spaces is increasing accordingly. The properties of indoor spaces, however, differ from those of outdoor spaces, and we need to apply different approaches to build indoor digital twins. In our work, we propose a framework for building an indoor digital twin with a use case for hospitals in general and large hospitals in particular, which may be considered as one of the most complicated types of digital twin. One of our goals is to establish a framework for building indoor digital twins based on standards and our framework starts from OGC IndoorGML, which is a standard for indoor data models and encoding schemes for indoor spatial data. In this paper, each step of the framework is presented for the construction of an indoor hospital digital twin focusing on a use case of epidemic analysis of COVID-19 transmission in a hospital. The use case study covers the entire life cycle of the indoor spatial application from requirement analysis, data modeling, and building indoor spatial data to the development of a COVID-19 transmission analysis. Our work represents a use case for indoor digital twins based on the OGC IndoorGML standard and eventually may serve as a framework and reference for building indoor digital twins. As our work is mainly focused on the construction of hospital digital twins, the study on COVID-19 infection model itself is limited in this paper. Improvement of the infection models and validations will be the next step of our work. As HVAC (heat, ventilation, and air conditioning) was not fully considered in our use case, we also expect that it is possible to strengthen our use case by including HVAC for the analysis of airflow dynamics.

Background: Renal cell carcinoma (RCC) is a highly aggressive malignancy accounting for the majority of kidney cancers. Despite recent advancements in therapeutic options, the prognosis for advanced-stage RCC remains poor. Niemann–Pick C1-Like 1 (NPC1L1) plays a crucial role in cholesterol absorption and has been implicated in cancer progression across various cancers. However, its expression patterns and prognostic significance in RCC remain unclear. Methods: In this study, NPC1L1 expression in normal and RCC tissues, including subtypes, was compared using TCGA, GEPIA2, and The Human Protein Atlas. Clinical correlations were assessed, and the impact of NPC1L1 on overall survival (OS) and progression-free survival (PFS) was evaluated. Gene effect scores were analyzed using the DepMap tool to determine the involvement of NPC1L1 in RCC progression. Results: NPC1L1 expression was significantly lower in RCC tissues compared to normal tissues, particularly in the clear cell RCC (ccRCC), papillary RCC (pRCC), and chromophobe RCC (chRCC) subtypes, but increased in advanced tumor stages. Higher NPC1L1 expression was associated with worse OS and PFS in RCC patients. Multivariable Cox regression confirmed NPC1L1 as an independent prognostic marker. Additionally, gene effect scores showed that NPC1L1 is essential for the survival of specific RCC cell lines. Conclusions: This study determines NPC1L1 as an independent prognostic indicator in RCC, with higher expression associated with poor survival outcomes. These findings suggest that NPC1L1 could serve as a valuable marker for identifying high-risk RCC patients. Further research is required to investigate the molecular mechanisms underlying the role of NPC1L1 in RCC progression.

Background and Objectives: This study aimed to investigate the association between insulin resistance, as measured by the triglyceride–glucose index (TyG index), and hearing impairment in middle-aged women in Korea. Materials and Methods: This cross-sectional survey utilized data from the Korea National Health and Nutrition Examination Survey (KNHANES) IV (2007–2009), specifically from the period after July 21, 2009, when hearing test results became available, and from the KNHANES V (2010–2012). This study was conducted on 5416 women aged 40 to 69 who had completed both the health examination survey and audiometric tests, excluding those with missing data on menopausal status and the use of hormone replacement therapy. Results: In the study group, the prevalence of high-frequency hearing loss according to the TyG index was significantly higher in the mild hearing loss group (OR = 1.29; 95% CI: 1.12, 1.49, p < 0.001) and the moderate hearing loss group (OR = 1.27; 95% CI: 1.09, 1.48, p = 0.002). Conversely, the prevalence of low-frequency hearing loss did not show a significant difference in either the mild hearing loss group (OR = 1.17; 95% CI: 0.99, 1.37, p = 0.065) and the moderate hearing loss group (OR = 1.13; 95% CI: 0.94, 1.35, p = 0.199) Conclusions: Since diabetes can induce hearing impairment in women, it is recommended that women with a high TyG index undergo early hearing tests