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Obesity is a complex problem that is now considered a chronic metabolic disease. In Korea, phentermine has been widely used for the treatment of obesity in the primary care setting since 2004. However, there have been very few studies on the safety and efficacy of phentermine. To investigate the safety and efficacy of this drug, a postmarketing surveillance study was performed.
A total of 795 patients with obesity (body mass index ≥ 25 kg/m2) were enrolled from 30 primary care centers in Korea from September 2006 to November 2007. Patients were examined to ascertain safety and efficacy at 4-, 8-, and 12-week intervals. The criterion for efficacy was defined as a weight loss ≥ 5% of body weight.
Of the 795 enrolled patients, 735 (92.5%) were evaluated in safety assessments and 711 (89.4%) was included in efficacy assessments. A total of 266 adverse events (AEs) were reported by 218 patients (30.6%), and no serious AEs were reported. Among 711 patients, 324 patients (45.6%) lost ≥ 5% of their body weight. The mean weight loss was 3.8 ± 4.0 kg.
AEs are commonly associated with phentermine, even though phentermine is effective for weight loss and relatively well-tolerated.
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With metabolic syndrome (MS) being a major risk factor for cardiovascular disease, and central obesity being a major predisposing factor for MS, intensive research is currently being performed on cutoff values according to race and sex. Menopause is an especially significant factor in designating cutoff values for female central obesity, as menopause brings sudden bodily changes that induce central obesity and increased prevalence of MS. Therefore this study aimed to investigate the cutoff values for the obesity index and its validity in predicting the criteria for MS in Korean women according to menstrual status.
The study focused on 3,103 women 20 years of age or older participating in the 2007 Korea National Health and Nutrition Examination Survey. Definitions of non-adipose components of MS were defined by the International Diabetes Federation, and menstrual status was judged on the basis of survey results. The sensitivity, specificity, and positive and negative predictive values of the central obesity index (body mass index [BMI], waist circumference [WC], waist-to-height ratio [WHtR]) according to menstrual status for two or more non-adipose components of MS were calculated based on the Youden index.
Area under the curve (AUC) values predicting the presence of two or more metabolic risk factors were higher in pre-menopausal women, with AUC values for BMI, WC, and WHtR being, in pre- and post-menopausal women, 23.1 kg/m2 vs. 23.9 kg/m2, 76.1 cm vs. 82.5 cm, and 0.49 vs. 0.53, respectively. The WC cut off (76 cm) for pre-menopausal women was found to be more sensitive and more effective at screening for MS risks than the cutoff value given by the Korea Society for the Study of Obesity.
The central obesity index showed better predictability for MS risk in pre-menopausal women. Because the central obesity index cutoff values are lower in pre-menopausal women, the possibility of metabolic risk can be considered for pre-menopausal women with WC lower than 85 cm. Assessment and control of other risks are needed accordingly for preventing the development of MS.
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Prescribing potentially harmful drugs and omitting essential drugs to older patients is a common problem because they take so many medications. In this study, our goal was to identify potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) using Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to the Right Treatment (START) criteria to improve proper prescription and reduce improper prescription.
Enrolled in this study were 117 patients older than 65 years old who were hospitalized at Inha University Hospital in Incheon due to pneumonia from January 2012 to March 2012. Patient data, including medical histories, current diagnoses, current medications, and biochemical data were recorded from electronic records. STOPP and START were applied to their clinical datasheets.
STOPP criteria identified 24 patients who had 29 PIMs. Most potential inappropriate prescribing was of cardiovascular medications, followed by drugs whose primary effect is on the urogenital system and gastrointestinal system. START criteria identified 31 patients who had 46 PPOs. The cardiovascular system drugs comprised most of the PPOs. No PPOs were identified under the central nervous system criteria.
Given the current Korean medical system conditions and considering the many clinically important situations when prescribing drugs, STOPP/START criteria are not absolute criteria to prevent improper prescription, but sagacious usage of these standards can help physicians to prescribe properly in clinical practice.
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The serial 100-7s subtraction, an item on the Mini-Mental State Examination (MMSE), is well known for being difficult for uneducated people. Therefore, we investigated into alternative serial subtractions for serial 100-7s subtraction in uneducated people.
One hundred sixty-nine subjects were enrolled by neurologic or neuropsychiatric out-patient clinics in 4 university medical centers. The subjects were divided into two groups: an uneducated group and an educated group (at least primary schooling) by questionnaire. We investigated the correlation between incorrect number of serial subtractions and Global Deterioration Scale (GDS) score in both groups and undertook receiver operating characteristic (ROC) curve analysis. MMSE including serial 40-4s subtraction, serial 20-2s subtraction, and serial 10-1s subtraction instead of serial 100-7s subtraction were arbitrally named MMSE4, MMSE2, and MMSE1.
In the educated group, serial 100-7s subtraction showed the highest correlation with GDS score (correlation coefficient, 0.465; P < 0.001). In the uneducated group, serial 40-4s subtraction showed the highest correlation with GDS score (correlation coefficient, 0.608; P < 0.001), and serial 100-7s indicated the lowest correlation (correlation coefficient, 0.378; P = 0.023). In ROC curve analysis for MMSE, MMSE4, MMSE2, and MMSE1 to assess the presence of dementia (GDS score ≥ 3) in uneducated subjects, the area under the curve (AUC) was 0.648, 0.770, 0.758, and 0.711, respectively, and in educated subjects, AUC for MMSE, MMSE4, MMSE2, and MMSE1 was 0.729, 0.719, 0.716, and 0.714, respectively.
Out of MMSE items, serial 100-7s is adequate in the educated elderly, but may be less adequate in the uneducated elderly. Serial 40-4s seems to be more appropriate for MMSE in the uneducated elderly.
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Allostatic load (AL) measures overall physiological wear and tear on one's body, as a preclinical marker of pathophysiologic processes that precede the onset of disease. We studied the association of dietary habits with AL.
Consecutive patients visiting a tertiary hospital Health Promotion Center from September 2009 to February 2010, older than 20 years with metabolic syndrome were selected for study (n = 204). By multivariable linear regression analysis, we investigated the association of various dietary habits evaluated by questionnaires.
In male, multivariable linear regression showed a significant negative association between fat preference and AL with BMI ≥ 30 (1st quartile [Q] vs. 2Q: β = -3.71; 95% confidence interval [CI], -6.26 to -1.16), a significant negative association between salt preference and AL with BMI 25-30 (β = -1.36; 95% CI, -2.46 to -0.26), a negative association between appetite control and AL with BMI < 25 (1Q vs. 3Q: β = -1.54; 95% CI, -3.00 to -0.096), a significant positive association between appetite control and AL with BMI 25-30 (1Q vs. 3Q: β = 1.30; 95% CI, 0.12 to 2.48), and a significant positive association between eating in response to food cues and AL in males with BMI 25-30 (1Q vs. 4Q: β = 1.09; 95% CI, 0.020 to 2.15).
Our results suggest that metabolic syndrome patients should be discouraged from eating fat and eating in response to food cues, and should be educated about nutrition and balanced diet.
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Pain is the most common but severe physical symptom among cancer patients. This study aimed to identify correlation between pain and psychological symptoms for terminal cancer patients.
The total sample consisted of 69 subjects who were recruited through two hospice wards, limited to patients who were mentally alert and had no psychiatric diseases. The subjects were divided into two groups according to the numerical rating scale: the pain-free group, 0 to 3 points; and the pain group, 4 to 10 points. We used the Beck depression inventory (BDI), Beck anxiety inventory (BAI), mini-mental status examination-Korea (MMSE-K), and short form 36 health survey (SF-36). Logistic regression analysis was performed to verify the correlation between pain and other psychosocial disorders.
The mean scores of BDI in the pain-free and pain groups were 25.7 and 31.5; mean BAI scores were 23.4 and 34.7; mean MMSE-K scores were 25.7 and 21.8, respectively. There were no significant differences between the two groups in SF-36 score except scores of body pain. The results of logistic regression analysis adjusted for age, sex, marital status, types of cancer, history of chemotherapy, or radiotherapy showed significant correlation between pain and depression (BDI ≥ 24; odds ratio [OR], 4.199; 95% confidence interval [CI], 1.171 to 15.060), and pain and cognitive impairment (MMSE < 24; OR, 5.495; 95% CI, 1.449 to 20.843); but not between pain and anxiety (BAI ≥ 22; OR, 3.011; 95% CI, 0.907 to 9.997).
Pain significantly affects depression and cognitive impairment among advanced cancer patients in the hospice ward. Accordingly, more aggressive treatment of pain is required to reduce not only physical suffering but also physiological distress.
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Practitioners of family medicine are essential to primary care practices in Korea. Resident training staffs in Korean family medicine departments have a crucial role in producing well-trained family physicians. This study assesses the aspects of satisfaction and difficulties of Korean family medicine resident training staffs.
We surveyed the resident training staffs of various Korean family medicine departments using an online survey tool. The survey used in this study was modified from previously used questionnaires. Respondents rated items using a five-point Likert scale and a 0-10 visual analogue scale.
The response rate was 43.9% (122/278). The mean satisfaction score with regard to current family medicine residency programs was 7.59 out of 10. Resident training staffs found the administrative aspects of their role to be the most difficult. There were considerable differences in the reported difficulties of resident training according to the differing characteristics of each staff member, including age, sex, type of hospital, number of staff members, role as chief, and duration of staff. Most respondents (91.9%) cited a need for faculty development programs.
Korean family medicine resident training staffs need faculty development programs for the improvement of resident training. For the strengthening of core competencies among resident training staffs, faculty development programs or courses should be designed and implemented in Korea.
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Acupuncture treatment is generally regarded as a relatively safe procedure. However, most procedures have some complications and acupuncture treatment is no exception. Reported complications of acupuncture treatment were mostly mild or temporary symptoms, but certain severe adverse effects were also observed. We report here for the first time a case of liver abscess following acupuncture and moxibustion treatment.
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