| Duk Chul Lee | 31 Articles |
Aging has become a global problem, and the interest in healthy aging is growing. Healthy aging involves a focus on the maintenance of the function and well-being of elderly adults, rather than a specific disease. Thus, the management of frailty, which is an accumulated decline in function, is important for healthy aging. The adaptation method was used to develop clinical practice guidelines on frailty management that are applicable in primary care settings. The guidelines were developed in three phases: preparation (organization of committees and establishment of the scope of development), literature screening and evaluation (selection of the clinical practice guidelines to be adapted and evaluation of the guidelines using the Korean Appraisal of Guidelines for Research and Evaluation II tool), and confirmation of recommendations (three rounds of Delphi consensus and internal and external reviews). A total of 16 recommendations (five recommendations for diagnosis and assessment, 11 recommendations for intervention of frailty) were made through the guideline development process. These clinical practice guidelines provide overall guidance on the identification, evaluation, intervention, and monitoring of frailty, making them applicable in primary care settings. As aging and “healthy aging” become more and more important, these guidelines are also expected to increase in clinical usefulness.
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We examined the association between salivary mitochondrial DNA (mtDNA) copy number and chronic fatigue combined with depression and insomnia. This cross-sectional study included 58 healthy adults with moderate to severe fatigue (Brief Fatigue Inventory [BFI] ≥4) for longer than 6 months. Subjects were classified as those without combined symptoms, with either depression (Beck Depression Inventory [BDI] ≥13) or insomnia (Pittsburgh Sleep Quality Index [PSQI] ≥5), or with both depression and insomnia. Salivary mtDNA copy number was measured by real-time quantitative polymerase chain reaction. The association was evaluated using a general linear model. About 76% of participants had either depression or insomnia as additional symptoms. These subjects were predominately female, drank more alcohol, and exercised less than those without combined symptoms (P<0.05). The group with both depression and insomnia exhibited significantly higher BFI and lower mtDNA copy number than those without combined symptoms (P<0.05). After adjusting for confounding factors, significant negative associations between mtDNA copy number and usual fatigue were found in the group without combined symptoms, whereas the negative associations in the group with combined symptoms were attenuated. BDI and PSQI were not associated with mtDNA copy number. Chronic fatigue is negatively associated with salivary mtDNA copy number. Salivary mtDNA copy number may be a biological marker of fatigue with or without combined symptoms, indicating that a separate approach is necessary. Citations Citations to this article as recorded by
Atopic dermatitis (AD) is characterized by pruritic and eczematous skin lesions, which often cause depressive symptoms, anxiety, stress, sleep disturbances, social withdrawal, and stigmatization. In total, 23,442 subjects (434 AD patients and 23,008 control subjects) aged 19 years or older and without a history of major medical illness or depressive disorders were selected from The Fifth Korea National Health and Nutrition Examination Survey 2007-2012. Following the initial selection, 2,170 age- and sex-matched control subjects were selected using 1:5 propensity score matching. Multiple logistic regression analysis was performed to identify the presence of depressive symptoms of at least 2 weeks in duration. The demographic, socioeconomic, and clinical characteristics of AD patients and control subjects were presented and compared, and some variables differed significantly between groups. Presence of depressive symptoms was set as dependent variable, and multiple logistic regression analysis was performed as follows: (1) unadjusted; (2) with alcohol use, exercise status, smoking status, and body mass index (BMI) adjusted for; and (3) with alcohol use, exercise status, smoking status, marital status, occupation, BMI, total caloric intake, history of hypertension, and history of diabetes mellitus adjusted for. Depressive symptoms were significantly higher (odds ratios, 1.46, 1.40, and 1.36; 95% confidence intervals, 1.09-1.95, 1.0.4-1.88, and 1.01-1.85, respectively) in AD patients relative to those of matched controls. AD and clinical depression interact closely, and causal relationships between the two conditions have frequently been observed. Physicians should consider mental health interventions cautiously. It is particularly important that primary care physicians provide comprehensive, continuous long-term care. Citations Citations to this article as recorded by
Background
There are growing evidences that structural and functional brain reserves may be crucial in cognitive function of late life. In old men, height as an important marker of growth and development, is related to late life cognitive decline or dementia. The purpose of this study is to examine the relationship of height to cognitive function in community dwelling old women. Methods: A total of 150 community dwelling old women who can carry out daily life independently were recruited in this study. We measured height, weight and blood pressure with an automatic device and investigated medical history and behavioral habits. We obtained fasting blood samples for the glucose and lipid profile tests and measured physical performance. The Korean version of Mini Mental State Examination (K-MMSE) was used for the assessment of cognitive function. Results: The acceptable cognition group (K-MMSE score ≥ 24) was taller than the impaired cognition group (K-MMSE score < 24) (mean height 150.9 ± 6.1, 148.0 ± 5.4, respectively, P-value < 0.01). In Pearson correlation analysis, height was positively associated with K-MMSE score (r = 0.342, P < 0.01). Multiple linear regression analysis showed that height independently related to K-MMSE score after adjustment of age, waist circumference, systolic blood pressure, diabetes, hyperlipidemia, alcohol drinking, residential district, education, gait speed ( = 0.102, P = 0.03). Conclusion: Height was independently associated with cognitive function in community dwelling old women. For the evaluation of the relationship between height and cognition in diverse cohorts, many studies will be necessary. Citations Citations to this article as recorded by
Background
Several studies showed the relationship between serum homocysteine and pulse wave velocity, but their subjects were confi ned to high risk group for cardiovascular diseases and recent study revealed no relationship in young healthy adults. We hypothesized that time interval would be needed for serum homocysteine to infl uence pulse wave velocity after exposure to vascular endothelium. The purpose of this study was to determine the relationship between serum homocysteine and pulse wave velocity in middle aged women on the basis of that hypothesis and necessity for further study in general population.Methods: The study subjects were 110 middle aged women who visited a health promotion center of a general hospital. We collected medical history by means of self-reported questionnaire and measured height, weight, blood pressure and brachial-ankle pulse wave velocity (baPWV). Blood sampling was performed after overnight fasting. We analyzed the relationship between several cardiovascular risk factors and baPWV and performed multiple regression analysis.Results: BaPWV velocity was correlated signifi cantly with age, mean blood pressure, serum homocysteine, total cholesterol and diabetes mellitus, but not with body mass index, high-density lipoprotein cholesterol, triglyceride, creatinine clearance, alcohol intake, hypertension and smoking. In multiple regression, there was a signifi cant association between age (P = 0.04), moderate hyperhomocysteinemia (P = 0.02), mean blood pressure (P < 0.001) and baPWV.Conclusion: In middle aged women, there was an independently positive association between serum homocysteine and baPWV. Citations Citations to this article as recorded by
Background: More attention is given to oxidative hypothesis which causes atherosclerosis to be recognized as inflammatory response. The relationship between serum ferritin which catalyzes lipid peroxidation and high sensitivity C-reactive protein which reflects vascular inflammation was investigated among adults in a health promotion center. Methods: The study group consisted of 297 men and women (men 86, women 211) who visited the health promotion center of a hospital in Seoul to have a health checkup from October 1, 2004 to April 1, 2005. These subjects answered the questionnares and were measured in the following; blood tests, brachial-ankle pulse wave velocity and several anthropometric measurements. Statistical analysis was performed on 111 subjects after exclusion of those subjects who were taking antihypertensive agents or antidiabetic agents, and who had acute inflammatory diseases, acute liver diseases, anemia, and who had a WBC ≥11,000×103/mm3 or a serum ferritin ≥200 ug/L or a ABI (Ankle Brachial Index) <0.9. Results: The average serum ferritin concentration of men against women was 132.57±43.12 ng/ml to 78.23±38.10 ng/ml which means that men have about 1.7 times as high concentration than women (P<0.001). Serum ferritin was significantly correlated with high sensitivity C-reactive protein (r=0.332). Even in multiple stepwise regression analysis, there was a independent relationship between serum ferritin and high sensitivity C-reactive protein (Ղ=0.138, P=0.010). When we analyzed with distinction of sex, this relationship in women was constant (Ղ=0.131, P=0.031), but serum ferritin in men just showed the trend of correlation with BMI (Ղ=9.510, P=0.059). Conclusion: There is a significant relationship between the increase of serum ferritin and high sensitivity C- reactive protein in healthy women; furthermore, studies in men need to be confirmed. (J Korean Acad Fam Med 2008;29:908-914)
Background
The incidence of obesity is acutely increasing resulting in increased mortality rate and medical expenses among Koreans. But it is rare to find effective obesity management program, that are readily accessible by general local community residents. This study was aimed to develop and evaluate an effective and specialized obesity management program utilizing the local public health institutes. Methods: One hundred forty nine obese adults residing in Kwangju were enrolled in a tentative, 12-week scheduled obesity management program from August 2006 to October 2006. The program constituted of weekly education and practice by specialists, and exercise for more than an hour for 5 days a week. The effectiveness of the program was evaluated according to the change of body weight, body component, blood pressure, and serum lipid concentration. After the program was completed, each participant was surveyed on the degree of satisfaction and lifestyle changes. Results: Ninety participants (60.4%) completed the program to the end. The average decrement of body weight after the program was 1.9±1.5 kg. Eleven participants (12.2%) lost more than 5% of the initial body weight. The waist circumference and average blood pressure significantly decreased among the group who lost more than 5% of the initial body weight. The total cholesterol and triglycerides also slightly decreased among this group. Overall 87.3% of the participants were satisfied with the results of the program. The lifestyle of the participants had also changed by the program. Conclusion: The authors expect that establishing easily- approachable obesity management program in local public health institutes will make a great contribution to the maintenance of proper body weight and decrement of cardiovascular diseases among local community residents. (J Korean Acad Fam Med 2008;29:121-133)
Background
Metabolic syndrome (MetS) is characterized by a core set of disorders, including abdominal obesity, dyslipidemia, glucose intolerance and hypertension. Many studies have shown that MetS is associated with increased risk of developing cardiovascular diseases and related mortality. However, the relationship of MetS with early stage of cardiovascular diseases, which is even more important from a prevention prespective, has not been examined extensively. Brachial-ankle pulse wave velocity (baPWV) is known to predict future cardiovascular events. Thus, we examined the relationship of MetS, defined using the NCEP-ATP III criteria, with baPWV. Methods: We examined a total of 400 participants who did not have a past history of either coronary heart disease or peripheral vascular disease. All subjects underwent physical examination, blood chemistry, and baPWV. Results: Compared with subjects without MetS, subjects with MetS had increased age, body mass index (BMI), and ALT. Mean value of baPWV (adjusted for age, BMI, and blood pressure) was significantly higher in subjects with MetS (P=0.002). The baPWV was positively correlated with age, BMI, systolic and diastolic blood pressure in subjects with MetS. In group without MetS, the baPWV was associated with age, waist circumference, blood pressure, total cholesterol, LDL cholesterol, triglyceride, fasting blood sugar, AST, ALT, homocysteine, CRP, and ferritin. The mean values of baPWV with 0, 1, 2, 3, 4, 5 components of MetS were 1,362.3⁑182.2 cm/s, 1,531.3⁑267.0 cm/s, 1,694.1⁑315.8 cm/s, 1,777.0⁑334.0 cm/s, 2,087.7⁑192.3 cm/s, respectively. Conclusion: In this study, the MetS was associated with the risk for increased baPWV. (J Korean Acad Fam Med 2007;28:271-277)
Background
: Increased abdominal obesity is clearly associated with metabolic diseases and associated with increased risk for atherosclerosis and cardiovascular diseases. But the mechanisms underlying these associations are not completely understood. The aim of this study was to correlate the regional body composition with pulse wave velocity in the overweight and obese women. Methods : We investigated 104 overweight and obese participants. Regional body composition was distinguished by anthropometry, dual-energy X-ray absorptiometry, and computed tomography (CT). For estimates of arterial stiffness, we measured brachial ankle pulse wave velocity (baPWV). Fasting blood glucose, lipid parameters, CRP, and free fatty acid were measured. Pearson's correlation analysis and multiple regression analysis were conducted to identify the relationship between baPWV and regional body composition. Results : Average age, fasting blood sugar, HDL-cholesterol, triglyceride, HOMA-IR, abdominal visceral fat area measured by CT, visceral fat area/ subcutaneous fat area (VSR), and visceral fat area/midthigh muscle area (VMR) were all significantly higher in the visceral obesity group than the subcutaneous obesity group. BaPWV was positively correlated with age, blood pressure, triglyceride, waist circumference, waist hip ratio, abdominal visceral fat area measured by CT, and VSR and inversely correlated with thigh subcutaneous fat area. In multiple regression models, after adjustment for confounding factors, baPWV was independently correlated with abdominal visceral fat area measured by CT (R2=0.560, P=0.006). Conclusion : Abdominal visceral fat area measured by CT was the only measurement positively associated with baPWV which explains the relationship of regional body composition and arterial stiffness.
Background
: Although many studies have focused on the association of hyperuricemia with components of metabolic syndrome, there are only few studies of independent relation between uric acid and metabolic syndrome itself. In this study, we evaluated healthy subjects and assessed the relationship of serum uric acid with metabolic syndrome. Methods : Between January and February of 2005, we evaluated 164 healthy patients who visited a health evaluation center. Patients were evaluated for metabolic syndrome and risk factors were assessed using a questionaire, blood test and physical examination. Results : Metabolic risk factors significantly increased as uric acid level markedly increased (P＜0.05). Even after limiting the variables such as age, sex, smoking, exercise, total cholesterol, low-density lipoprotein cholesterol, and LogCRP, the group with metabolic syndrome had markedly increased uric acid levels than those without metabolic syndrome [Odds ratio 1.494 (95% CI, 1.072∼2.084)]. Conclusion : The number of components of metabolic syndrome increased according to serum uric acid level. Uric acid level was significantly higher in metabolic syndrome than normal. Even after considering health behavior variables such as smoking, alcohol status, and exercise, they showed an independent relationship. Further massive prospective studies on whether collecting serum uric acid level can be used as a screening test or predictor of mortality for early metabolic syndrome and cardiovascular disease will be needed.
Background
: Serum γ-GT is one of the biliary enzymes with the only enzymatic activity capable of cleaving extracellular glutathione, thus originating precursor amino acids for the intracellular resynthesis of glutathione. Several population-based studies have shown a strong cross-sectional association between serum γ-GT concentration and cardiovascular risk factors. And prospective studies showed that serum γ-GT concentration had a prognostic impact on cardiovascular mortality. But, the mechanism by which γ-GT is associated with cardiovascular disease is not elucidated. We hypothesized that there was an association between serum γ-GT and ferritin, a marker of oxidative stress. In this study, we investigated the relationship between serum γ-GT and serum ferritin. Methods : By reviewing the medical records of 288 healthy adults, we determined the serum levels of γ-GT and ferritin according to age, body mass index, systolic blood pressure, diastolic blood pressure, triglycerides, total cholesterol, LDL-cholesterol, fasting blood sugar, hs-CRP, serum ferritin, AST, ALT, uric acid and smoking history. We studied the relationship between the variables by Pearson correlation coefficients and multiple stepwise regression analysis. Mean values of serum γ-GT according to the smoking history were compared using t-test. Results : Serum γ-GT correlated positively with serum ferritin (r=0.42; P＜0.001). BMI, triglycerides, total cholesterol, fasting blood sugar, AST and ALT also showed statistically significant correlation. Smokers showed significantly higher serum γ-GT. Serum γ-GT correlated with serum ferritin, ALT, current smoking and triglycerides by multiple stepwise regression analysis. Conclusion : Serum γ-GT correlated positively with serum ferritin.
Background
: Several studies have revealed a relationship between the cognitive decline and several cardiovascular diseases. The relationship between the metabolic syndrome and cognitive function has not been studied yet in Korea. The objective of our study was to determine the relationship between the metabolic syndrome and cognitive function in elders above 50 years old. Methods : We examined subjects who visited the health promotion center of one college hospital in Seoul. The metabolic syndrome was defined according to the National Cholesterol Education Program guidelines and we categorized the two groups by the presence of the metabolic syndrome. We used the Korean version of Mini Mental State Examination to check the cognitive functions and compared scores between these two groups. Results : There were a total of 400 subjects (195 men and 205 women). Compared with those without the metabolic syndrome, elders with the metabolic syndrome had lower mean scores in K-MMSE (26.6±2.0-28.2±1.8, P＜0.001). In subcategories of K-MMSE, the average scores of concentration or calculation were lower in the metabolic syndrome group (3.5±1.3) than in the control group (4.3±1.0) and the average scores of delayed recall were lower in those with the metabolic syndrome (1.7±0.9) than the control group (2.2±0.8) (P＜0.001). After controlling for age, sex, education, smoking, alcohol, and body mass index, multiple regression yielded the metabolic syndrome to be independent associated factor in cognitive function (P＜0.001). Conclusion : We found a significant relationship between decreased cognitive function and the metabolic syndrome. There are needs for prospective study about the possible development of dementia in the metabolic syndrome and probable prevention of dementia when cardiovascular risk factors in those are modulated.
Background
: Recently, thermal therapy such as sauna and sweating room is popular as a health behavior. In patients with heart failure, sauna treatment improves hemodynamic data and clinical symptoms by restoring endothelial function. The purpose of this study was to investigate that sauna bath could decrease pulse wave velocity reflecting vascular function of people in the community. Methods : A total of 43 volunteers (11 male, 32 female) older than 40 years old were kept in 60℃ dry sauna for 15 to 20 minutes. We measured the brachial-ankle pulse wave velocity (baPWV), blood pressure, heart rate, body weight and body temperature before and, 30 and 60 minutes after sauna bath and assessed the differences of the means of these measurements with repeated measures of ANOVA. Then, we performed multiple regression analysis to find out the factors independently associated with the amount of baPWV change. Results : The BaPWV and systolic and diastolic blood pressure decreased significantly 30 and 60 minutes after sauna bath comparing to those before (P＜0.001, P=0.003, P=0.011, respectively). Multiple regression analysis showed that baseline baPWV and history of hypercholesterolemia independently influenced on the amount of baPWV change (β=-0.47, P=0.002; β=-0.36, P=0.013, respectively). Conclusion : We studied the acute reduction of pulse wave velocity after sauna bath in adults over 40 years old. This change was striking in the subjects with faster baseline baPWV. This result suggests that sauna bath can improve vascular function in the high risk group of cardiovascular diseases.
Background
: Sullivan has suggested that higher incidence of coronary heart disease in men and postmenopausal women is due to higher levels of stored iron in these two groups. A few epidemiologic studies in humans have reported the association between iron stores and increased risk of cardiovascular diseases. But there is conflicting evidence regarding the relationship between iron and cardiovascular diseases. The present study evaluated the relationship between ferreting and well established cardiovascular risk factors. Methods : There were 288 healthy subjects who visited a health promotion center of a general hospital. We collected data by means of self-reported questionnaire and measured height, weight and blood pressure. Serum ferritin, fasting blood glucose, lipid profiles, and C-reactive protein were measured at a fasting state. Results : Mean serum ferritin values were 150.1±82.2 ng/mL in men and 61.7±38.2 ng/mL in women (P＜0.001). Serum ferritin level in current smoker was higher than in non-smoker (157.6±111.8 ng/mL versus 100.5±64.2 ng/mL, P=0.006). Serum ferritin was significantly and positively correlated with body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol and triglyceride. There was no statistical significance in age, C-reactive protein, high- density lipoprotein cholesterol and low-density lipoprotein cholesterol. In multiple regression analysis, there was association between ferritin and sex (β=-80.333, P＜0.001) and triglycerides (β=0.182, P=0.030). Conclusion : The serum ferritin level in men is higher than in women in healthy adults. Serum ferritin is positively associated with triglycerides.
Background
: Pulse pressure, a clinical marker of arterial stiffness, is an independent and strong predictor of cardiovascular disease, and reflects aging of arterial system. It is a well known fact that serum IGF-1 level is a parameter of growth hormone (GH) secretion and decreased GH secretion is related to aging. The aim of this study was to find out if there was any correlation between pulse pressure and IGF-1 concentration. Methods : By reviewing the medical records of a hospital in Korea, healthy 194 men and 180 women were studied. We measured serum IGF-1, triglyceride, total cholesterol, HDL cholesterol concentrations and fasting blood sugar (FBS). Also, anthropometric and blood pressure measurements were performed. Results : In men, the pulse pressure was positively correlated with age (r=0.29, P＜0.001), systolic blood pressure (SBP) (r=0.70, P＜0.001), diastolic blood pressure (DBP) (r=0.22, P=0.003), and body mass index (BMI) (r= 0.28, P＜0.001) and inversely with IGF-1 levels (r=-0.27, P＜0.001). In women, pulse pressure was positively levels with SBP (r=0.28, P＜0.001), BMI (r=0.27, P＜0.001), triglyceride (r=0.19, p=0.011), total cholesterol (r=0.15, P=0.049) levels, and FBS (r=0.17, P=0.027) and was not correlated with age, DBP, and serum IGF-1 levels. After adjustment for age, BMI, triglyceride, total cholesterol, and FBS, the pulse pressure was independently negatively correlated with serum IGF-1 levels (β=-6.052, P=0.007) in men. The multiple regression analysis showed that serum IGF-1 levels (R2=0.04) was the third most powerful factor influencing the pulse pressure. Conclusion : There was as independent negative correlation between the pulse pressure and serum IGF-1 levels in healthy men.
Background
: The purpose of this study was to examine the prevalence of obesity based on body mass index data and to assess the long-term effect of breast feeding on obesity among children in elementary schools. Methods : A total of 997 children in 1st grade were recruited from 3 public primary schools in Gangdong-gu and 1 private primary school in Nowon-gu, Seoul. A questionnaire was used to gather demographic background and lifestyle-related information infant feeding methods and duration. Results : There were 101 boys (24.6%) and 100 girls (25.0%) identified as an obese group (BMI ≥85 percentile). The birth weight was higher in the obese group (3.34±0.46kg) than in the normal body mass index group (3.24±0.43kg). The parental body mass index was higher in the obese group than the normal group. Average hours of daily watching TV, video or computer use was higher in the obese group (2.2±1.2) than in the normal body mass index group (2.0±1.0). In the obese group, children ate more than the normal group. After adjusting for potential confounding factors, there seemed to be some risk reduction for obesity in the breast fed group for at least 7 months, compared to the never breast fed group, but had no statistical significance. Conclusion : Whether child was breast fed or not nor the duration of breast feeding did not seem to reduce the risk of developing obesity.
Background
: DHEA is the most abundant steroid hormone secreted from the adrenal cortex and has several roles such as increasing insulin sensitivity, lowering serum lipid, improving obesity, and anti-cancer effects. DHEA levels vary profoundly and levels decline as age increases. But the role of DHEA in the aging process is not yet fully understood. Total antioxidant status(TAS) which provides information of one's antioxidant capacity, also decreases with age. In this study, we investigated the relationship between TAS and serum DHEA-s concentration. Methods : By reviewing the medical records of 197 healthy adults, we determined the serum levels of DHEA-s and TAS according to BMI, pulse pressure, WBC, hs-CRP, A/G ratio, LDL-cholesterol, triglyceride, ferritin, uric acid and total bilirubin. We studied the relationship between the parameters by Pearson correlation coefficients and multiple regression analysis. Results : The mean level for TAS and serum DHEA-s was 1.20 mml/L and 177.3 ug/mL, respectively. Serum DHEA-s correlated positively with TAS (r=0.44) and negatively for age (r=-0.44). WBC, triglyceride and uric acid also showed statistically significant correlations. But, according to multiple regression analysis DHEA-s only correlated with TAS and age. Conclusion : Serum DHEA-s correlates positively with TAS.
Background
: Platelet activation has been implicated in the pathogenesis of a number of diseases, which include atherosclerosis, coronary vascular disease, and cerebrovascular disease. There have been controversies with the influence of hormone therapy on platelet activation. The purpose of this study was to define the effect of long-term hormone therapy on platelet activation. Methods : We recruited a total of 162 postmenopausal women aged 55 and above among wihch eighty healthy postmenopausal women had received hormone therapy for more than 5 years and the remaining eighty- two healthy postmenopausal women with no hormone therapyapy. Baseline characteristics as well as the parameters related to platelet activation were compared between the two groups using T-test. After platelet activation was defined by the reference range, multivariated logistic regression analysis was performed determining the odds ratio of hormone therapy on platelet activation. Results : The MPC and PCDW were significantly lower in the HT group than the Non-HT group (P＜0.001), which suggests that platelets were more activated in the HT group more than in the non-HT group. Multiple logistic regression analysis showed that the odds ratio of the possibility of platelet activation in HT group was 19 times (P＜0.001). Conclusion : Long term hormone therapy increased platelet activation significantly, which may be a contributing factor of thromboembolism.
Background
: There is a significant amount of evidence to indicate that some of the changes attributed to aging process can be partially reversed by GH replacement. But the GH replacement for somatopause with functional GH deficiency is still controversial. The aim of this study was to explore whether the short term GH replacement improved physical, emotional and sexual function as well as body composition. Methods : A total of 31 adults with functional growth hormone deficiency were assigned to receive rhGH with an initial daily dose of 1.05 IU, six times a week. For evaluating physical change a 25-item questionnaire was administered to patients at initial visit and 6 months later. Body composition was determined by bioimpedence analysis at initial visit and 6 months later as well. We compared the changes for each variable using Wilcoxon's rank and Friedman's test. Results : Serum IGF-1 level at 3 and 6 months were increased significantly by 31% and 43%, respectively, compared to baseline (P＜0.0001). Lean body mass and percent body fat at 6 months of treatment showed a 2.2% increase and a 7.6% decrease with statistical significance. The score of the questionnaire at 6 months of treatment increased significantly in physical changes (P＜0.0005), sexual function (P＜0.001), self perception of physical appearances (P＜0.02), chronic fatigue & immunity (P＜0.03), and vitality (P＜0.05). Conclusion : Adults with functional growth hormone deficiency showed improvements in not only body composition, but also physical function and appearances and sexual function after 6 months of treatment with rhHGH.
Background
: There is a clinical need for a reference value based on healthy adults in Korea. The aim of this study was to define IGF-1 concentration in healthy Korean adults and to investigate the factors relative to IGF-1 level. Methods : By reviewing the medical records of a hospital in Korea, healthy 112 men and 109 women aged over 40 years were studied. We determined the serum IGF-1 levels of both groups according to age, sex, health behaviors, lipid profile, bone mineral density, serum albumin, waist circumference, body mass index, total testosterone, and FSH. Results : IGF-1 had no sexual difference in any age group (258.7±84.3 ng/mL for men, 263.7±86.8 ng/mL for women), but correlated negatively with age (r=-0.43 and -0.35 for men and women, respectively). The mean decline was 49.6 ng/mL and 43.9 ng/mL per 10 years for men and women, respectively. IGF-1 correlated positively with serum albumin, total cholesterol, and bone mineral density of spine and femur neck. The multiple regression analysis showed that the most powerful factors influencing IGF-1 level was serum albumin (R2; 0.13) followed by age, bone mineral density of femur neck, and total cholesterol. Conclusion : We present a reference value for IGF-1 in healthy Korean adults aged over 40 years. The most powerful factor influencing IGF-1 level was serum albumin.
Background
: Pharmacological stress tests for the diagnosis of GH deficiency are unpleasant, labor intensive and potentially dangerous. Reports on urinary GH measurement for the assessment of GH have been published after highly sensitive immunoassaies were developed. The aim of this study was to determine whether a 24- hour urine GH as an alternative method for GH assessment were reliable in predicting GH deficiency defined by L-dopa stimulation test. Methods : Thirty women, ages 45 to 67, were studied. L-dopa stimulation tests were performed with an ingestion of 500 mg of L-dopa. Serum GH and IGF-1 were measured by a radioimmunoassay using commercially available reagents and uGH was estimated from the 24-hour urine. Then, the mean and its distribution of uGH values were compared according to the GH status defined by L-dopa stimulation test. Results : The correlation between the uGH and the peak values after L-dopa stimulation test was significant (r=0.46; P＜0.01). The mean value of uGH in the GH deficiency group was significantly lower than that of the normal group (P＜0.05). But because of the broad overlap of uGH in the two groups uGH showed no good separation GH deficiency from normal group although uGH reflects GH status significantly. Conclusion : uGH reflects GH status significantly, but because of broad overalp uGH couldn't separate GH deficiency form normal group defined by L-dopa stimulation test.
Background
: HBsAg carriers are 6-12% of population in Korea. The patients' knowledge on hepatitis B and regular follow-up tests are important, because HBsAg carriers have infectivity and the disease may progress without symptoms. We surveyed their knowledge on the hepatitis B and the frequency of follow-up blood test and sonogram. Methods : From March 1993 through September 1994, 630 patients who were diagnosed as HBsAg positive and Anti-HBs negative in a health promotion center of college hospital were surveyed by mailing questionnaire. The questionnaire included the result of HBV viral marker test, transmission routes, complications, and prevention methods of Hepatitis B, frequency of follow-up test, and doctor's recommendation. Results : Of the 490 questionnaires excluded the 140 questionaires returned due to wrong address, 100 were answered, making the reply rate 20.4%. As for the result of HBV marker test, 64% answered their HBV marker as HBsAg positive, 10% answered HBsAg negative, and 26% answered 'I don't know'. 65% answered that they are HBV carrier. As for the mode of transmission, 59% answered that HBV is transmitted by blood, 57% form carrier mother at birth, 29% by sexual intercourse. 76% of responders know that vaccination is needed for preventing vertical transmission. When making score on their knowledge, significant differences were showed according to education, income and doctor's recommendation about regular follow-up test. The number of persons who took regular blood test every 6 to 12 months were 56(56%), and the number of persons who took regular abdominal ultrasonogram were 39(39%). The number of patients who were recommended regular follow-up by doctor was 76%. In this group, 51 persons(67.0%) took regular blood test and 35 persons(35%) took regular sonogram so this frequency is significantly higher than the other group(each 20.8%, 16.7%). Conclusion : The knowledge on hepatitis B in HBsAg positive patients is relatively low and the frequency of regular follow-up test is significantly higher in the group who took doctor's recommendation. So it is very important that HBsAg carriers must be educated about the infectivity, preventive methods, and regular follow-up for early detection of complication like hepatocellular cancer.
Background
: The national health care system where primay care health service functions properly, provide better medical outcomes in individual health service as well as national health policy. This is quasi experimentally designed, prospective study for the purpose of developing a model of primary health service in Korea. We provided Family Registration Program reinforcing primary health care for 1 year in order to assess medical outcomes and verify the benefit of the program. Methods : Three board certified family physician assigned to 263 families, 1057 people provide 6 items of medical service reinforcing accesibility, comprehensiveness, continuity, accountability for 1 year. After the program the use of the medical services was reviewed by the medical records, to assess the quality of care during the program two self reporting questionnaire surveys was perfor-med by Continuity, Comprehensiveness, Personal relationship Questionnaire(CCPQ) before and after the program. Another self reporting questionnaire survey was also performed to assess the factors relating the use of the program. Results : Over the seventy percents of families utilized at least one service item, most frequently using service item was medical service in outpatient department, total number of visit was 695 by 161 people in 102 families. The number of beeper call was 226, 75.3 per a family physician. The reason of beeper call were medical problem(59.7%), services to inform laboratory result(25.9%), and appointment for medical service(13.7%). The scores of CCPQ before and after program were 6.48±1.48 and 8.66±1.76, which meant that better quality of medical service was provided during the program. The reason for under-utilization of the program were 'No health program'(52.9%), 'Not Familiar with how to use the program' (34.3%), 'Felt sorry to call'(20.6%), which meant many families misunderstood the program. Over the seventy percents families had visited other physicians' offices during the program by the reasons of 'Near home' (56.7%), 'Already have a regular doctor'(26.9%). Sixty eight percents families satisied the program and 88.1% of families willed to participate in the re-registraion program. Conclusion : By the fact that most of families registered were satisfied with familiy registration program, we conclude that this program provided quality care and could be settled in our medical system, but still remains a lot of efforts to make to have such a program known to public and utilized by many people.
Background
: Falling, urinary incontinence, and sleep desturbance are common physical problems in elderly. These conditions are generally assumed to negatively influence overall health and functio-ning and tend to be interrelated with depression. The purpose of this study is to investigate the prevalence of falling, urinary incontinence, sleep disturbance, and depression in nursing home residing older persons aged 65 or above and to determine the interelations between these conditions. Method: Subjects were 90 older adults residing in 2 nursing home including 35 Sakhalin immigra-nts who had different sociocultiral background from others. Seven investigators interviewed the subjects by questionnaires about recent history of falling, urinary incontinence, and sleep disturbance, geriatric depression scale(GDS), and 'Barthel Activities of Daily Living(BADL)'. Dependent variable was depression defined by GDS, and independent airiables were 3 physical conditions and other convariants. Result: Failling occured in 32.2% during last 1 year, urinary incontinence affected 21.1%, and 81.1% of the subjects experienced sleep disturbance. Prevalence of depression defined by GDS score above 11 was 50.0%. Sakhalin immigrants were more vulnerable to depression that Korean old people(p<0.0005). In multiple and logistics regression procedure, sociocultural factor and urinary incon-tinence were significant predictors of depression in elderly. And the relative risk for depression was 5.5 in Sakhalin immigrants, and 5.1 in elderly affected by urinary incontinenece. Though most older adults reported urinary incontinence to family or friends, none of them discussed this condition to health providers including doctors or nurses. Conclusion : Urinary incontinence was an important risk factor for depression in elderly, and health providers should have more concerns to this condition.
Background
: Improving quality of care by increasing continuity, comprehensiveness, and personal relationship of care is one of the important concepts in family medicine. A self-report questionnaire was designed to assess the improvement in quality of care from the above 3 aspects of care Methods : 27 questions about the 3 concepts were designed by 5 family physicians and were given to 8 other family physicians and 13 residents to evaluate whether each question meant what it was originally intended to mean. or not. It there was a consistency more than 50% between the testees and the developers, those questions were considered to have content validity and were pilot-tested to decide whether they had internal consistency among questions of the same concept or not. Finally were given the chosen questions to patients visiting family medicin clinics of 3 university hospitals. Comparison was made between the new patient group and the old patient group to evaluate whether there were any differences as expected or not. Results : 24 questions were considered to have content validity among the original 27 questions. Finally were chosen 21 questions with internal consistency consisting of 4 continuity items (a=0.795), 9 comprehensiveness items (a=0.700) and 9 personal relationship items (a=0.616). The scores of total, continuity, comprehensiveness and personal relationship in the old patient group were significantly higher statistically (P<0.01) than those of the new patient group. Conclusion : our questionnaire could be used to assess the quality of care indirectly in family practice which has a goal of increasing continuity, comprehensiveness and personal relationship in care.
Background
: The colon cancer is the fourth most common cancer in Korea. But its incidence tends to increase in recent days. The fecal occult blood test which can be used in screening test of colon cancer is simple, specific and low in cost. But the effectiveness of the test for early detection of colon lesion has not been evaluated in Korea. The purpose of this study is to evaluate the detection rate of the fecal occult blood test for colorectal lesions-colon cancer, etc in health examination. Methods : We reviewed 8,865 medical records of patients who received health examination in Yongdong Sevrance Hospital since November 9th, 1992 until June 20th, 1994 and collected data with positive results in guaiac test to evaluate further diagnostic methods and treatment modalities for the detected lesions. Results : Four hundred forty nine cases(5.1%) were found to have positive of 8,865 cases. Forty five cases(10.0%) with positive results received further evaluation to see if they have any disease. As a further evaluation method, Ba enema and endoscopy were performed on 84.4% and 26.7% of 45 cases, respectively, 64.4% of these had normal results. The most common diagnosis of the abnormal results were hemorrhoids, followed by polyps, diverticuli and a cancer. Conclusion : 35.6% of cases had positive guaiac thest had abnormal colorectal lesions, Therefore it is considered the neccessity of the positive cases to get further evaluation in Korea, too.
Background
: In actual primary care practice, patients and family physician may have different perceptions about the family phyician's role and attitude that can cause the conflict between them. The purpose of this study was to explore conflicting area about family physiian's role attitude, and practice which might show discrepancy between physicians and patients. Methods : Ninety family physicians and residents from 10 teaching hospitals with family practice training program and 537 patients from 10 primary and secondary level of family practice center were surveyed by the same questionnaire from Sept. 5 to 9. The data was analyzed statistically by SAS program. Results : Family physician's and patient's expectation showed a marked discrepancy in referring to specialty. Seventy-six percent of the patients felt physician should refer a serious problem to a specialist and one of the most important family physician's role was referring his patient to the most appropriate specialty properly. But only 38.9% of family physicians agreed to this concept. Most family physicians and patients clearly recognized general gatekeeping role of family physicians, but about the half ot the patients felt it was better to get the proper specialties according to his condition than primary care services, but the most family physician disagreed to this concept. Gatekeeping role of the family physicians accepted more frequently in highly educated patients(P<0.0001) and female(P<0.05). Most patients and doctors agreed that family physician was competent to manage most medical problems in family circumstances and family physicians should get periodic assessment of his medical competence. Sixty-seven pecent of family physicians agreed that family physician should concern about the nonmedical problem but only 40% of patients agreed that. Seventy one percent of patients felt it was important to know family circumstances for proper management but forty eight percent of physicians agreed to this. Patients prefered to be told what to do in everything but forty eight percent of family physicians agreed to this. Patients considered best attitude of family physician was profession, caring, responsibility, considerate, familiarity, sympathetic in the order of frequency. There was marked disagreement in medical problems which chould be handled without referral by family physicians. Those were pneumonia, pulmonary tuberculosis, examinations for breast cancer, acute and chronic hepatitis, circumcision, hypertension in the order of frequency. Conclusion : Perceptions of family physicians and patients strongly conflicted in the area of referral. There was also disagreement in the gatekeeping role and some areas of practice without consultation.
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