Primary care physicians should encourage their patients to engage in adequate physical activity. Current recommendations for physical activity in adults are as follows: at least 150–300 minutes per week of moderate-intensity, 75–150 minutes per week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Adults should also perform muscle-strengthening activities of moderate intensity or higher that involve all major muscle groups for 2 or more days per week. The elderly should perform additional balance training and fall prevention exercises more than 3 times a week. Children and adolescents should perform at least 1 hour of moderate-to-vigorous physical activity daily, which includes vigorous aerobic activity at least 3 days per week. As part of their 60 minutes or more of daily physical activity, resistance training and bone strengthening exercise should be done at least 3 days per week. According to new evidence, one bout of any exercises can be shorter than 10 minutes. Previously, physical activities were recommended for more than 10 minutes. For patients with diabetes, it is advisable to perform resistance exercise or short-distance running before aerobic exercise to prevent hypoglycemia. New evidence shows that dynamic resistance training is safe and effective in patients with hypertension provided the load is not too heavy. Exercise reduces pain and improves quality of life and physical function in patients with osteoarthritis,. Therefore, the treatment guidelines for osteoarthritis have been changed recently from not recommending exercise to highly recommending it.
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Background Patients’ perceptions of care tend to correlate with the quality of care provided. Different health care systems and service environments may show different associations between types of usual source of care (USC) and overall service quality assessment. We attempted to analyze this association as a benefit of having a USC.
Methods This study used the 2012 Korea Health Panel data version 1.1 as representative national household survey data. The total number of subjects aged 18 years or more was 12,708. The number of subjects in the final analysis was 10,665. Multiple logistic regression analysis was used to assess the association between types of USC and overall health care service quality. The main outcome variable was users’ ratings of the quality of health care service.
Results People having a usual doctor (n=1,796) were more likely to positively assess the quality of health care they received than those not having a USC (n=7,920; odds ratio [OR], 1.39; 95% confidence interval [CI], 1.20–1.60) or with those having only a place as a USC without a usual doctor (n=949; OR, 1.29; 95% CI, 1.05–1.58) after adjustment for demographic characteristics and health-related variables.
Conclusion People having a usual doctor rated overall health care service quality as high, which might be due to benefits of primary care attributes related to usual doctors. Further studies are needed to elucidate the causal relationship. This finding implies that health policies encouraging people to have a usual doctor are needed in Korea.
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Background Being common, mild anemia is sometimes considered a mere consequence of aging; however, aging alone is unlikely to lead to anemia. Therefore, this study aimed to investigate the association between mild anemia and total mortality and cause-specific mortality in apparently healthy elderly subjects.
Methods A retrospective cohort study was conducted on 10,114 apparently healthy elderly individuals who underwent cancer screening and routine medical check-ups at one Health Promotion Center between May 1995 and December 2007. We defined mild anemia as a hemoglobin concentration between 10.0 g/dL and 11.9 g/dL in women and between 10.0 g/dL and 12.9 g/dL in men. We assessed the relationship between the overall, cardiovascular (CV), and cancer mortality and mild anemia using Cox proportional hazard models.
Results Mild anemia was present in 143 men (3.1%) and 246 women (6.1%). During an average follow-up of 7.6 years, 495 deaths occurred, including 121 CV and 225 cancer deaths. After adjustments, mild anemia was associated with a 128% increase in the risk of all-cause mortality hazard ratio (HR, 2.28; 95% confidence interval [CI], 1.54– 3.37) in men and cancer-related mortality (HR, 2.25; 95% CI, 1.22–4.13), particularly lung cancer (HR, 2.70; 95% CI, 1.03–7.08) in men, but not in women. In the subgroup analyses based on smoking status, obesity, and age, the associations were more prominent in never or former smoker groups and the older group.
Conclusion The present study shows that overall and cancer-related mortality was associated with mild anemia in elderly men. Future prospective studies are needed to consolidate our findings.
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Background This study aimed to investigate the association between physical fitness and cardiometabolic health of Korean children and adolescents.
Methods In total, 168 participants (89 boys and 79 girls) aged 10–16 years were recruited for the Intervention for Childhood and Adolescent Obesity via Activity and Nutrition Study in 2016. The subjects were categorized into two groups using the definition of metabolic syndrome by the International Diabetes Federation: metabolically unhealthy (with at least two of the five criteria) and healthy groups (with less than one criterion). Correlation analysis of the participants’ general characteristics was performed. Odds ratios (ORs) of physical fitness for cardiometabolic risk were evaluated via logistic regression.
Results Metabolically unhealthy children showed greater weight, height, and body mass index, higher Children’s Depression Inventory score, and longer screen time than did the metabolically healthy children. Metabolically healthy children showed greater upper and lower extremity muscular strength than did the metabolically unhealthy children (P=0.04 and P<0.001, respectively). In the multiple logistic regression analysis, lower extremity muscle strength was inversely related to the clustered cardiometabolic risk of the children and adolescents with or without adjustment for confounders (OR, 4.32; 95% confidence interval [CI], 1.87–9.97; OR, 7.64; 95% CI, 1.55– 37.74, respectively).
Conclusion Physical fitness, especially lower extremity muscle strength, is significantly inversely associated with individual and clustered cardiometabolic risks in Korean children and adolescents.
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Background Several studies have suggested that breastfeeding has a positive effect on long-term obesity, diabetes, hypertension, and hyperlipidemia. This study aimed to examine maternal bone health, muscle mass, and obesity based on breastfeeding duration.
Methods This study was based on the Korea National Health and Nutrition Examination Survey 2010–2011. We selected 2,027 elderly women by screening survey participants with a history of delivery. Multivariate logistic regression analyses were performed to estimate the odds ratios (ORs) of sarcopenia, osteoporosis, and obesity among four breastfeeding groups.
Results The OR of sarcopenia significantly decreased with increasing breastfeeding duration (OR, 0.27; 95% confidence interval [CI], 0.11–0.65; P for trend <0.001), whereas the OR of obesity significantly increased with increasing breastfeeding duration (OR, 2.56; 95% CI, 1.43–4.60; P for trend=0.009) after adjusting for potential confounding variables. We also found a positive correlation between the duration since last delivery and sarcopenia.
Conclusion Our results suggest a negative correlation between prolonged breastfeeding and the prevalence of sarcopenia, and a positive correlation between prolonged breastfeeding and the prevalence of obesity. Further studies are needed to clarify the relationship between breastfeeding and sarcopenia in the future.
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Background Knee osteoarthritis is highly prevalent, especially among the elderly. However, its risk factors have not been well identified, especially in the Korean population. This study aimed to assess the epidemiologic characteristics and risk factors of knee osteoarthritis in the Korean population.
Methods Data of 2,280 (1,295 women) participants of the 2013 Korea National Health and Nutrition Examination Survey aged ≥50 years who underwent knee radiography were analyzed. According to the American College of Rheumatology clinical/radiographic classification criteria, knee osteoarthritis was defined as knee pain and radiographic knee osteoarthritis. The association between risk factors and knee osteoarthritis was analyzed using the chi-square test and binominal logistic regression.
Results The participants had an average age of 62.6 years; 56.8% of them were women. The average body mass index was 24.2 kg/m2 , and 296 (13%) participants were diagnosed with knee osteoarthritis. After adjustment for multiple risk factors, age of ≥65 years (adjusted odds ratio [OR], 2.552; 95% confidence interval [CI], 1.868–3.486), female sex (OR, 2.050; 95% CI, 1.275–3.295), obesity (body mass index, ≥25.0 kg/m2 ; OR, 1.563; 95% CI, 1.191–2.051), hypertension (OR, 1.394; 95% CI, 1.052–1.846), low educational level (lower than or equal to elementary school: OR, 4.761; 95% CI, 2.131–10.635; middle school: OR, 3.184; 95% CI, 1.375–7.369), and low strength exercise frequency (<2 times/wk; OR, 1.829; 95% CI, 1.202–2.784) increased the risk of knee osteoarthritis.
Conclusion Old age, sex, obesity, hypertension, low educational level, and low strength exercise frequency were found to be risk factors for knee osteoarthritis.
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Background The prevalence of chronic kidney disease is increasing worldwide. Several studies have suggested that obesity is associated with early renal dysfunction. However, little is known about the relationship between obesity phenotypes and early renal function decline. Therefore, this study aimed to identify the relationship between obesity phenotypes and early renal function decline in adults without hypertension, dyslipidemia, and diabetes.
Methods We conducted a cross-sectional analysis of clinical and anthropometric data from 1,219 patients who underwent a routine health checkup in 2014. We excluded adults with cardiovascular disease, renal disease, diabetes, hypertension, dyslipidemia, or low glomerular filtration rate (<60 mL/min/1.73 m2). Renal function was determined according to the estimated glomerular filtration rate calculated using the Chronic Kidney Disease Epidemiology Collaboration creatinine-cystatin C equation.
Results Age, sex, body mass index, waist circumference, triglyceride, low-density lipoprotein, and fasting glucose had an association with the estimated glomerular filtration rate. After adjusting for age, sex, smoking status, and alcohol intake, the odds ratios of the metabolically abnormal normal weight and metabolically abnormal obese phenotypes for the presence of low estimated glomerular filtration rates were 1.807 (95% confidence interval, 1.009– 3.236) and 1.834 (95% confidence interval, 1.162–2.895), compared with the metabolically healthy normal weight phenotype. However, the metabolically healthy obese phenotype did not show a significant association with early renal function decline.
Conclusion In this cross-sectional study, we confirmed the association between the metabolically abnormal normal weight and metabolically abnormal obese phenotypes and early kidney function decline in adults without hypertension, dyslipidemia, and diabetes.
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Background Fertility and childbearing are the most important determinants of population variation around the world. This study was conducted with the aim of determining the psychological and sociodemographic factors predicting fertility intention among women referred to comprehensive health centers in Hamadan based on the beliefs, attitudes, subjective norms, and enabling factors (BASNEF) model.
Methods This descriptive analytical study was performed in comprehensive health centers in Hamadan in 2016. Through a multi-stage sampling method, 484 women were enrolled in the study. The data collection tool was a selfreport questionnaire based on the constructs of the BASNEF model. Data were analyzed using linear regression, independent t-test, and a one-way analysis of variance using IBM SPSS software ver. 22.0 (IBM Corp., Armonk, NY, USA).
Results The mean±standard deviation of the women’s age was 31.85±6.13 years. The variables of motivation to comply (β=0.228), enabling factors (β=0.162), subjective norms (β=0.134), and attitude (β=0.122) were the predictors of fertility intention in women. This model was able to explain 16.8% of variance in behavioral intention. Also, lower age, higher education, shorter duration of marriage, and having a daughter resulted in a greater fertility intention.
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Background Studies have shown the health literacy effects on the general state of health and its related factors, as well as health outcomes, physical and mental health, and health-related quality of life. This study aimed to investigate the effect of training based on health literacy through social networking strategies to promote health-related quality of life among students of Islamic Azad University, Shahr Rey Branch, Iran.
Methods This randomized controlled trial was conducted on 120 students with poor or average quality of life score. Participants were randomly assigned into experimental and control groups (60 participants each). Health literacy and quality of life data were collected at baseline, immediately after, and 3 months after intervention. The educational intervention was conducted online using social networking services. Data were analyzed using SPSS ver. 16.0 (SPSS Inc., Chicago, IL, USA).
Results The results showed no significant differences between the two groups in terms of health literacy and quality of life at baseline (P=0.979 and 0.269, respectively). The mean score of health literacy and quality of life in the experimental group, compared with the control group, significantly increased immediately after and 3 months after the intervention (P<0.001).
Conclusion The educational intervention administered by applying health literacy strategies online, through social networking services, can be effective in improving the quality of life of students.
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Profound weight loss with painful symmetrical peripheral neuropathy in diabetic patients was first described as diabetic neuropathic cachexia more than 4 decades ago. It is a distinct type of diabetic peripheral neuropathy that occurs in the absence of other microvascular and autonomic complications of diabetes. The mechanism and precipitating cause are unknown. It was reported to have good prognosis with spontaneous recovery within months to 2 years. However, it was frequently missed by clinicians because the profound weight loss is the most outstanding complaint, rather than the pain, numbness, or weakness. This often leads to extensive investigation to exclude more sinister causes of weight loss, particularly malignancy. We report a case of a young woman with well-controlled diabetes who presented with profound unintentional weight loss (26 kg), symmetrical debilitating thigh pain, and clinical signs of peripheral neuropathy. As the disease entity may mimic an inflammatory demyelinating cause of neuropathy, she was treated with a trial of intravenous immunoglobulin, which failed to give any significant benefit. However, she recovered after 6 months without any specific treatment, other than an antidepressant for the neuropathic pain and ongoing rehabilitation.
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