Hemoglobin A1c (HbA1c) was adopted as a new standard criterion for diagnosing diabetes. We investigated the diagnostic utility of HbA1c by comparing the 2003 American Diabetes Association (ADA) diagnostic criteria of diabetes with HbA1c of 6.5%. Furthermore, the cut-off value for HbA1c was investigated using receiver operating characteristic curves.
This study included 224 subjects without a history of diabetes that had a fasting plasma glucose level of above 100 mg/dL. The subjects had undergone a 75 g oral glucose tolerance test, and diabetes was defined as according to 2003 ADA criteria.
The prevalence of newly diagnosed diabetes was 58.2% by the 2003 ADA criteria, and 47.8% by HbA1c of 6.5%, which underestimated the prevalence of diabetes. Compared with the 2003 ADA criteria, the sensitivity and specificity of HbA1c of 6.5% were 73.5% and 89.1%, respectively. The kappa index of agreement between 2003 ADA and HbA1c criteria was 0.60. The cut-off point of HbA1c for diagnosing diabetes was 6.45% (sensitivity, 73.3%; specificity, 88.2%; area under the curve, 0.85). HbA1c was significantly associated with fasting glucose (r = 0.82, P < 0.01), postprandial glucose (r = 0.78, P < 0.01), and homeostasis model assessment of insulin resistance (r = 0.16, P < 0.05).
For high risk patients whose fasting glucose was more than 100 mg/dL, HbA1c criterion underestimated the prevalence of newly diagnosed diabetes compared to the 2003 ADA criteria, and showed moderate agreement. The cut-off value for HbA1c was 6.45%, which was similar to the recommended diagnostic criterion of HbA1c by the 2009 ADA.
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The family medicine residency program consists mainly of clinical rotations in other specialties and the family medicine-specific training. We conducted this study to investigate how family medicine residents evaluated their training program that include family-oriented medicine, clinical preventive medicine, behavioral science and research in primary care.
In 2009, third-year residents of 129 training hospitals in Korea were surveyed to investigate the current state and their expectation of the residency program. The contents of questionnaires included training periods, conferences, procedures, interview techniques, outpatient and inpatient consultations, and written thesis.
Total 133 out of 142 residents (93.7%) responded that 3 years of training is ideal or pertinent. Residents responded that the types of conference that they need most are journal review (81%), staff lecture (73.2%), and clinical topic review (73.2%), in that order. Procedures and interview techniques that the residents want to learn most were gastroscopy (72.5%), abdominal ultrasonography (65.2%), and pain management (46.4%). Hospitals where family medicine residents do not see hospitalized patients or patients in the outpatient clinic were 7.9% and 6.5%, respectively, whereas hospitals that maintain continuous family medicine outpatient clinics were only 40.8%. Education in outpatient clinic and articlewriting seminars was done less frequently in the secondary hospitals than in the tertiary hospitals.
Evaluation and quality improvement of family medicine training program as well as specialty rotations should be considered in order to foster better family physicians. The efforts have to be made to minimize the difference in quality of each family medicine residency program.
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Whole body vibration (WBV) confers a continuous vibration stimuli to the body. While some reports have described the effects of WBV on bone mineral density, muscle mass, muscle power, study of WBV effects on body composition in postmenopausal women is rare. The aim of this pilot study was to examine the effect of WBV on the changes of body weight and body composition in postmenopausal women.
Fifteen postmenopausal healthy and obese women who were on staff of one university hospital staff located in Suwon, Korea were voluntarily recruited. Inclusion criteria were age over 50 years, and body mass index (BMI) ≥25 kg/m2. WBV group training was performed in 10 minute sessions twice weekly for 8 weeks. Before and after training, anthropometric measurements and body composition analysis were performed.
Weight (-1.18 ± 1.61 kg), BMI (-0.49 ± 0.66 kg/m2), waist circumference (-2.34 ± 2.48 cm) and muscle mass (-0.54 ± 0.59 kg) decreased significantly the 8 week intervention. Decrease of muscle mass was correlated with weight (r = 0.621, P = 0.013), BMI (r = 0.596, P = 0.019) and percent body fat (r = -0.518, P = 0.048). Linear regression analysis revealed that the changes of muscle mass had negative relationship with percent body fat change and a positive relationship with body weight changes.
WBV might display a weak but positive effect on body weight and waist circumference reduction in healthy postmenopausal obese women. However, attention must be given to avoid a decrease of muscle mass.
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Pulse wave velocity (PWV) and ankle-brachial pressure index (ABI) are non-invasive tools to measure atherosclerosis and arterial stiffness. Heart rate variability (HRV) has proven to be a non-invasive powerful tool in the investigation of the autonomic cardiovascular control. Therefore, the purpose of this study was to determine the relationship among PWV, ABI, and HRV parameters in adult males.
The study was carried out with 117 males who visited a health care center from April, 2009 to May, 2010. We conducted blood sampling (total cholesterol, triglyceride, high density lipoprotein, cholesterol, fasting glucose) and physical examination. We studied brachial-ankle PWV (baPWV) and ABI. We examined HRV parameters including standard deviation of NN interval (SDNN), low frequency (LF), high frequency (HF), LF/HF ratio. We analyzed the relationship among baPWV, ABI, and HRV parameters.
SDNN had a significant negative correlation with age, systolic blood pressure and heart rate. LF and HF had a significant negative correlation with age, and age and heart rate, respectively. baPWV was significantly and positively associated with age, systolic and diastolic blood pressures, total cholesterol, fasting glucose and heart rate. ABI was negative correlated significantly with systolic and diastolic blood pressures and heart rate. After adjusting for all associated variables, baPWV was not correlated with HRV parameters, but there was a significant positive association between SDNN and ABI (r = 0.195, P = 0.014).
SDNN of HRV parameters had a significant positive correlation with ABI.
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Obesity increases the risk of many chronic diseases and contributes to functional disabilities. We assessed the relationship among obesity and obesity related chronic disease and disability in Korean adults.
This study used data from the 2005 Korean National Health and Nutrition Examination Survey. A total of 5,462 persons (2,325 men, 3,137 women) aged 20 years and older were included in this analysis. Obesity was measured by body mass index and abdominal obesity was by waist circumference. Information on the presence of chronic diseases was based on the self-report of having been diagnosed by physicians. Functional disability was assessed using the Korean activities of daily living (K-ADL) and the Korean instrumental ADL (K-IADL) scales.
The relationship between obesity and prevalence of obesity-related chronic diseases was higher in the older aged group (>60 years for men, >70 years for women) than in the younger aged group. Waist circumference was more related to a higher prevalence of chronic diseases than body mass index in the younger aged group. Abdominal obesity increased the risk (odds ratio, 2.59; 95% confidence interval, 1.19 to 5.66) of having limitation in activities of daily living for the younger aged men after adjustments for age, smoking status, presence of chronic diseases, and body mass index. Body mass index was not associated with disability in either men or women.
The association between obesity and prevalence of chronic disease differed depending on age and sex. It is important to control abdominal obesity to prevent disability in younger aged men.
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An ischemic foot can be developed by acute arterial occlusion. Given proper treatment within critical time, the patient can avoid foot amputation and death. Early proper diagnosis and treatment by family physician at the initial clinical interviewing is important in saving the affected leg and the life. Thrombosis and embolism are the common causes of acute arterial occlusion. Thrombosis mostly arises from underlying cardiac disease such as arrhythmia, coronary artery disease and valvular heart disease while arterial occlusion by embolism can be shown on a narrowed artery related with systemic atherosclerosis. Because the treatment options depend on the underlying cause of the acute ischemic foot, it is important to identify the cause of acute ischemic foot. At this paper, we reported a case that the cause of acute ischemic foot of the patient proved paroxysmal atrial fibrillation after some diagnostic tests.
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