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"Chang Won Won"

Original Article

The Effect of Psychological Resilience on Cognitive Decline in Community-Dwelling Older Adults: The Korean Frailty and Aging Cohort Study
Sunwoo Kim, Chang Won Won, Sunyoung Kim, Jung Ha Park, Miji Kim, Byungsung Kim, Jihae Ryu
Korean J Fam Med 2024;45(6):331-336.   Published online March 25, 2024
DOI: https://doi.org/10.4082/kjfm.23.0145
Background
Chronic stress is associated with an increased risk of cognitive impairment and Alzheimer’s disease. This study aimed to assess whether better coping with stress, as assessed using the Brief Resilience Scale (BRS), is associated with slower cognitive decline in community-dwelling older adults.
Methods
This study used 2018/2019 data and 2-year follow-up data from the Korean Frailty and Aging Cohort Study. Of the 3,014 total participants, we included 1,826 participants (mean age, 77.6±3.7 years, 51.9% female) who completed BRS and Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Battery and the Korean version of the Frontal Assessment Battery (FAB).
Results
Higher BRS score at baseline was associated with a lesser decline in the Mini-Mental State Examination score over 2 years after adjusting for age, sex, years of education, smoking status, hypertension, diabetes, and depression (B, 0.175; 95% confidence interval, 0.025–0.325) for 2 years, which represents global cognitive function. Other cognitive function measurements (Word List Memory, Word List Recall, Word List Recognition, Digit Span, Trail Making Test-A, and FAB) did not change significantly with the BRS score at baseline.
Conclusion
These findings suggest that better stress-coping ability, meaning faster termination of the stress response, may limit the decline in cognitive function.

Citations

Citations to this article as recorded by  
  • The association between stereoscopic vision and cognitive function on community-dwelling older adults: a cross-sectional study
    Yeon Jung Park, Hyun Jin Cho, Kiyoung Kim, Chang Won Won, Miji Kim
    BMC Geriatrics.2025;[Epub]     CrossRef
  • The Association between Frailty, Quality of Life and Resilience in Community-dwelling Retirement Village Residents
    Katherine Bloomfield, Zhenqiang Wu, Annie Tatton, Cheryl Calvert, Joanna Hikaka, Michal Boyd, Dale Bramley, Martin J. Connolly
    Journal of the American Medical Directors Association.2024; 25(11): 105256.     CrossRef
  • Comprehensive Health Strategies for the Post-pandemic Era: Integrating Physical Health, Psychological Resilience, Lifestyle Choices, and Occupational Well-being
    Su Hwan Cho
    Korean Journal of Family Medicine.2024; 45(6): 303.     CrossRef
  • 3,096 View
  • 101 Download
  • 4 Web of Science
  • 3 Crossref

Review Article

Management of Sarcopenia in Primary Care Settings
Chang Won Won
Korean J Fam Med 2023;44(2):71-75.   Published online March 20, 2023
DOI: https://doi.org/10.4082/kjfm.22.0224
With aging, loss of skeletal muscle mass and muscle function increases, resulting in an increased risk of falls, fractures, long-term institutional care, cardiovascular and metabolic diseases, and even death. Sarcopenia, which is derived from the Greek words “sarx” or flesh+“penia” or loss, is defined as a condition characterized by low muscle mass and low muscle strength and performance. In 2019, the Asian Working Group for Sarcopenia (AWGS) published a consensus paper on the diagnosis and treatment of sarcopenia. The AWGS 2019 guideline, specifically, presented strategies for case-finding and assessment to help diagnose “possible sarcopenia” in primary care settings. For case finding, the AWGS 2019 guideline proposed an algorithm that recommends calf circumference measurement (cut-off <34 cm in men, <33 cm in women) or the SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls) questionnaire (cut-off ≥4). If this case finding is confirmed, handgrip strength (cutoff <28 kg in men, <18 kg in women) or the 5-time chair stand test (≥12 seconds) should be performed to diagnose “possible sarcopenia.” If an individual is diagnosed as “possible sarcopenia,” AWGS 2019 recommends that the individual should start lifestyle interventions and related health education for primary healthcare users. Because no medication is available to treat sarcopenia, exercise and nutrition is essential for sarcopenia management. Many guidelines, recommend physical activity, with a focus on progressive resistance (strength) training, as a first-line therapy for the management of sarcopenia. It is essential to educate older adults with sarcopenia on the need to increase protein intake. Many guidelines recommended that older people should consume at least 1.2 g of proteins/kg/d. This minimum threshold can be increased in the presence of catabolic or muscle wasting. Previous studies reported that leucine, a branched-chain amino acid, is essential for protein synthesis in muscle, and a stimulator for skeletal muscle synthesis. A guideline conditionally recommends that diet or nutritional supplements should be combined with exercise intervention for older adults with sarcopenia.

Citations

Citations to this article as recorded by  
  • Evaluating sarcopenia and nutritional status in outpatients with liver cirrhosis: concordance of diagnostic methods
    Marina Demas Rezende Gischewski, Fernanda Lívia Cavalcante Araujo, Aryana Isabelle De Almeida Neves Siqueira, Alina Joana da Silva Wallraf, João Araújo Barros Neto, Nassib Bezerra Bueno Nassib, Juliana Célia de Farias Santos, Fabiana Andréa Moura
    Nutrición Hospitalaria.2025;[Epub]     CrossRef
  • Update on the Complications and Management of Liver Cirrhosis
    Hiba Fadlallah, Diala El Masri, Hisham F. Bahmad, Wassim Abou-Kheir, Jad El Masri
    Medical Sciences.2025; 13(1): 13.     CrossRef
  • Diabetes and Sarcopenia: Intersection of Co Morbid Conditions
    Byron J. Hoogwerf
    OBM Geriatrics.2025; 09(01): 1.     CrossRef
  • Prevalence and Associated Factors of Dynapenia, Pre-Sarcopenia, and Sarcopenia in Korean Adults: A Cross-Sectional Epidemiological Study
    Do-Youn Lee
    Medicina.2025; 61(4): 575.     CrossRef
  • The Prognostic Significance of Handgrip Strength in Cirrhosis: Simplicity Is the Ultimate Sophistication
    Binxin Cui, Ziyi Yang, Chao Sun
    Portal Hypertension & Cirrhosis.2025; 4(2): 100.     CrossRef
  • Guidelines for obesity clinic consultations in primary healthcare clinics
    Jee-Hyun Kang, Kyoung-Kon Kim
    Journal of the Korean Medical Association.2024; 67(4): 240.     CrossRef
  • Guidelines for physical activity counseling in primary healthcare clinics
    Yun Jun Yang
    Journal of the Korean Medical Association.2024; 67(4): 265.     CrossRef
  • Whole Genome Linkage and Association Analyses Identify DLG Associated Protein-1 as a Novel Positional and Biological Candidate Gene for Muscle Strength: The Long Life Family Study
    Adam J Santanasto, Sandeep Acharya, Mary K Wojczynski, Ryan K Cvejkus, Shiow Lin, Michael R Brent, Jason A Anema, Lihua Wang, Bharat Thyagarajan, Kaare Christensen, E Warwick Daw, Joseph M Zmuda, Lewis A Lipsitz
    The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences.2024;[Epub]     CrossRef
  • Predictors of hip fracture in 15 European countries: a longitudinal study of 48,533 geriatric adults using SHARE dataset
    M. Azhar Hussain, Rizwan Qaisar, Asima Karim, Firdos Ahmad, Fabio Franzese, Atif Awad, Abeer A. Al-Masri, Mohammed Alsaeed, Shaea A. Alkahtani
    Archives of Osteoporosis.2024;[Epub]     CrossRef
  • Open, Active-Controlled Clinical Study to Evaluate the Correlation between Whole Body DEXA and BIA Muscle Measurements
    Yong-Chan Ha, Shinjune Kim, Jun-Il Yoo
    Journal of Bone Metabolism.2024; 31(3): 219.     CrossRef
  • Doctor and patient perceptions of sarcopenia in community-based primary care clinics: a questionnaire survey
    Jungha Park, Daehyun Lee, Jae Young Jang, Jung-Ha Kim, Jae Uk Baek, Myungkwan Jeong, Sungwouk Kim, Moonbae Kyoung, Miji Kim, Chang Won Won
    European Geriatric Medicine.2024; 15(6): 1827.     CrossRef
  • Frequency of clinical signs in patients with Cushing's syndrome and mild autonomous cortisol secretion: overlap is common
    Leah T Braun, Frederick Vogel, Elisabeth Nowak, German Rubinstein, Stephanie Zopp, Katrin Ritzel, Felix Beuschlein, Martin Reincke
    European Journal of Endocrinology.2024; 191(4): 473.     CrossRef
  • Efficacy of a combined exercise and nutrition intervention study for outpatients with possible sarcopenia in community-based primary care clinics (ENdSarC): study protocol for a multicenter single-blinded randomized controlled trial
    Woohyuk Ji, Daehyun Lee, Minjin Kim, Nahyun Lim, Jae-Young Lim, Jae Uk Baek, Sungwouk Kim, Choong Hyung Lee, Miji Kim, Chang Won Won
    BMC Geriatrics.2024;[Epub]     CrossRef
  • Age-related increase in the excitability of mouse layer V pyramidal neurons in the primary motor cortex is accompanied by an increased persistent inward current
    Jose A. Viteri, Nikolaus Bueschke, Joseph M. Santin, W. David Arnold
    GeroScience.2024; 47(2): 2199.     CrossRef
  • The Effect of Long Chain n-3 Fatty Acid Supplementation on Muscle Strength in Older Adults: A Systematic Review and Meta-Analysis
    Maha Timraz, Ahmad Binmahfoz, Terry J. Quinn, Emilie Combet, Stuart R. Gray
    Nutrients.2023; 15(16): 3579.     CrossRef
  • 4,899 View
  • 193 Download
  • 16 Web of Science
  • 15 Crossref

Clinical Practice Guideline

Clinical Practice Guidelines for Managing Frailty in Community-Dwelling Korean Elderly Adults in Primary Care Settings
Hyo-Sun You, Yu-Jin Kwon, Sunyoung Kim, Yang-Hyun Kim, Ye-seul Kim, Yonghwan Kim, Yong-kyun Roh, Byoungjin Park, Young Kyu Park, Chang-Hae Park, Joung Sik Son, Jinyoung Shin, Hyun-Young Shin, Bumjo Oh, Jae-woo Lee, Jae Yong Shim, Chang Won Won, Ji Won Yoo, Sang-Hyun Lee, Hee-Taik Kang, Duk Chul Lee
Korean J Fam Med 2021;42(6):413-424.   Published online November 20, 2021
DOI: https://doi.org/10.4082/kjfm.21.0162
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.

Citations

Citations to this article as recorded by  
  • Summary of best evidence for prevention and management of frailty
    Yinning Guo, Xueyi Miao, Jieman Hu, Li Chen, Yimeng Chen, Kang Zhao, Ting Xu, Xiaoman Jiang, Hanfei Zhu, Xinyi Xu, Qin Xu
    Age and Ageing.2024;[Epub]     CrossRef
  • Frailty: Assessment and Intervention
    Hana Moon, Geon Ho Lee, DaeHyun Kim
    Keimyung Medical Journal.2024; 43(2): 100.     CrossRef
  • Clinical practice guidelines for frailty vary in quality but guide primary health care: a systematic review
    Huaxin Si, Jiaqi Yu, Qinqin Liu, Yanyan Li, Yaru Jin, Yanhui Bian, Xiaoxia Qiao, Wenyu Wang, Lili Ji, Yan Wang, Jian Du, Cuili Wang
    Journal of Clinical Epidemiology.2023; 161: 28.     CrossRef
  • Yaşlılarda Kırılganlığın Önlenmesi ve Yönetiminde Kanıta Dayalı Yaklaşımlar
    Ayşe Buket DOĞAN, Özlem CANBOLAT
    Sağlık Bilimlerinde Değer.2023; 13(3): 501.     CrossRef
  • Validation of the Korean Academy of Geriatric Dentistry screening questionnaire and oral frailty diagnostic criteria in community-dwelling older adults
    Jeong-Hyun Kang, Seong-Chan Park, Hoi-In Jung, Sun Jae Jung, Hye-Jin Park, Soo-Min Kim, Min-Ji Jo, Yun-Seon Lee, Sun-Young Han
    Epidemiology and Health.2023; 46: e2024008.     CrossRef
  • Up-to-date knowledge of frailty
    Chang Won Won
    Journal of the Korean Medical Association.2022; 65(2): 108.     CrossRef
  • Current status of nutrient intake in Korea: focused on macronutrients
    Seung-Won Oh
    Journal of the Korean Medical Association.2022; 65(12): 801.     CrossRef
  • 7,298 View
  • 182 Download
  • 5 Web of Science
  • 7 Crossref

Review Article

Diagnosis and Management of Frailty in Primary Health Care
Chang Won Won
Korean J Fam Med 2020;41(4):207-213.   Published online July 20, 2020
DOI: https://doi.org/10.4082/kjfm.20.0122
Disability in older adults has become a significant burden, both individually and socially, due to the rapidly aging population in Korea. It is important to manage both frailty and chronic diseases to delay disability. Frailty, which is considered to be a transition phase between healthy status and disability, is defined as a significant decline in functional reserves of multiple organ systems and the resultant extreme vulnerability to stressors, leading to a higher risk of adverse health-related outcomes. The frailty phenotype and frailty index are the most commonly used methods to diagnose frailty. Frailty is related to physical, psychological, cognitive, and social dysfunction, and is sometimes caused by chronic disease. Therefore, primary care providers are ideally situated to incorporate the concept of frailty into their practice, as they are champions in comprehensive care. Although the identification and treatment of frailty is not yet standard practice in primary care, primary care physicians must use the electronic frailty index to identify frailty in all the patients aged ≥65 years in the United Kingdom. In Canada, some insurance companies and governments are using a similar program, which is called the Community Actions and Resources Empowering Seniors model. The clinical practice guidelines of the International Conference of Frailty and Sarcopenia Research, as well as some additional references, will be introduced. Here, we review the current literature on how to diagnose and manage frailty in primary care.

Citations

Citations to this article as recorded by  
  • Comparison of Frailty Rates in Aged Patients Using Updated Clinical Guidelines
    Julia A. Safonova, Daria S. Dyachkova-Gertseva, Ekaterina S. Lapteva
    Russian Family Doctor.2025; 29(2): 77.     CrossRef
  • Frailty and nutrition
    Neil Wilson, William Mullaney
    British Journal of Community Nursing.2024; 29(3): 118.     CrossRef
  • The Chinese translation and cross-cultural adaptation of PRISMA-7 questionnaire: an observational study to establish the accuracy, reliability and validity
    Meredith T. Yeung, Yen Gan, Shu Qi Teo, Kai Quan Lim, Hui Xuan Leow, Myriam Jbabdi, Michel Raiche, Mingxing Yang
    BMC Geriatrics.2024;[Epub]     CrossRef
  • Frailty and Cognitive Function in Middle-Aged and Older Adults With Congenital Heart Disease
    Bo Daelman, Liesbet Van Bulck, Koen Luyckx, Adrienne H. Kovacs, Alexander Van De Bruaene, Magalie Ladouceur, Hsiao-Ling Yang, Ju Ryoung Moon, André Schmidt, Birgitte Lykkeberg, Edward Callus, Michèle de Hosson, Camilla Sandberg, Bengt Johansson, Joanna Hl
    Journal of the American College of Cardiology.2024; 83(12): 1149.     CrossRef
  • Looking out across the front yard: aboriginal peoples’ views of frailty in the community – A qualitative study
    Ebony T. Lewis, Leanne Howard, Uncle Robert Carroll, Adam Howie, Gail Kenning, Adrienne Withall, Kenneth Rockwood, Magnolia Cardona, Kylie Radford, Katherine Schreyenberg, Ruth Peters
    Ethnicity & Health.2024; 29(8): 987.     CrossRef
  • Physical activity and nutrient intake levels according to grip strength among single-household elderly in Korea: data from 2014 and 2019 Korea National Health and Nutrition Examination Survey (KNHANES)
    Mi-Young Park, Nana Chung
    Physical Activity and Nutrition.2024; 28(3): 027.     CrossRef
  • The challenge of home and community older adult care in China: a survey of the capability of primary care physicians in providing geriatric healthcare services
    Xiufang Chen, Kun Xie, Yahui Li, Dan Hu, Yong Chen, Jiaying Chen
    Frontiers in Public Health.2024;[Epub]     CrossRef
  • Patient-reported outcomes in the aging population of adults with congenital heart disease: results from APPROACH-IS
    Philip Moons, Koen Luyckx, Corina Thomet, Werner Budts, Junko Enomoto, Maayke A Sluman, Hsiao-Ling Yang, Jamie L Jackson, Paul Khairy, Stephen C Cook, Shanthi Chidambarathanu, Luis Alday, Erwin Oechslin, Katrine Eriksen, Mikael Dellborg, Malin Berghammer,
    European Journal of Cardiovascular Nursing.2023; 22(4): 339.     CrossRef
  • Nutritional and physical activity issues in frailty syndrome during the COVID-19 pandemic
    Maria Chiara Massari, Viviana Maria Bimonte, Lavinia Falcioni, Antimo Moretti, Carlo Baldari, Giovanni Iolascon, Silvia Migliaccio
    Therapeutic Advances in Musculoskeletal Disease.2023;[Epub]     CrossRef
  • Receiver Operating Characteristic Analysis of Posture and Gait Parameters to Prevent Frailty Condition and Fall Risk in the Elderly
    Valentina Presta, Laura Galuppo, Giancarlo Condello, Francesca Rodà, Prisco Mirandola, Marco Vitale, Mauro Vaccarezza, Giuliana Gobbi
    Applied Sciences.2023; 13(6): 3387.     CrossRef
  • Building resilience and reversing frailty: a randomised controlled trial of a primary care intervention for older adults
    John Travers, Roman Romero-Ortuno, John Langan, Fergal MacNamara, Darren McCormack, Christopher McDermott, Jude McEntire, Joanne McKiernan, Seán Lacey, Peter Doran, Dermot Power, Marie-Therese Cooney
    Age and Ageing.2023;[Epub]     CrossRef
  • Management of Sarcopenia in Primary Care Settings
    Chang Won Won
    Korean Journal of Family Medicine.2023; 44(2): 71.     CrossRef
  • Utilizing multimodal approach to identify candidate pathways and biomarkers and predicting frailty syndrome in individuals from UK Biobank
    Watson Hua-Sheng Tseng, Amrita Chattopadhyay, Nam Nhut Phan, Eric Y. Chuang, Oscar K. Lee
    GeroScience.2023; 46(1): 1211.     CrossRef
  • Biological Age in Congenital Heart Disease—Exploring the Ticking Clock
    Tijs K. Tournoy, Philip Moons, Bo Daelman, Julie De Backer
    Journal of Cardiovascular Development and Disease.2023; 10(12): 492.     CrossRef
  • Unsupervised Home-based Exercise for Rural Frail Elderly: An Evidence-based Case-report
    Gilbert Lazarus, Czeresna Heriawan Soejono
    Activities, Adaptation & Aging.2022; 46(3): 218.     CrossRef
  • Up-to-date knowledge of frailty
    Chang Won Won
    Journal of the Korean Medical Association.2022; 65(2): 108.     CrossRef
  • Born to Age: When Adult Congenital Heart Disease Converges With Geroscience
    Philip Moons, Ariane Marelli
    JACC: Advances.2022; 1(1): 100012.     CrossRef
  • Fragilidade e funcionalidade familiar de idosos da Atenção Domiciliar: estudo transversal analítico
    Gilmara Ramos, Mariane Lurdes Predebon, Fernanda Laís Fengler Dal Pizzol, Naiana Oliveira dos Santos, Lisiane Manganelli Girardi Paskulin, Ana Karina Silva da Rocha Tanaka, Idiane Rosset
    Acta Paulista de Enfermagem.2022;[Epub]     CrossRef
  • Predictive Ability of the Three-Time Stand and Walk Test to Determine Frailty and its Associations with Fear of Falling and Cognitive Function in Community-Dwelling Older Adults
    Sirintip Kumfu, Puttipong Poncumhak
    Annals of Geriatric Medicine and Research.2022; 26(4): 316.     CrossRef
  • Current status of nutrient intake in Korea: focused on macronutrients
    Seung-Won Oh
    Journal of the Korean Medical Association.2022; 65(12): 801.     CrossRef
  • World Health Organization Integrated Care for Older People (ICOPE) and the Integrated Care of Older Patients with Frailty in Primary Care (ICOOP_Frail) Study in Korea
    Chang Won Won, Eunmi Ha, Eunjin Jeong, Miji Kim, Juhyun Park, Ja Euk Baek, Sungouk Kim, Sung Bae Kim, Jihun Roh, Jee Hye Choi, Seung Youn Jeon, Heeeun Jung, Daehyun Lee, Yuri Seo, Hyungeun Shin, Heesun Kim
    Annals of Geriatric Medicine and Research.2021; 25(1): 10.     CrossRef
  • Clinical Practice Guidelines for Managing Frailty in Community-Dwelling Korean Elderly Adults in Primary Care Settings
    Hyo-Sun You, Yu-Jin Kwon, Sunyoung Kim, Yang-Hyun Kim, Ye-seul Kim, Yonghwan Kim, Yong-kyun Roh, Byoungjin Park, Young Kyu Park, Chang-Hae Park, Joung Sik Son, Jinyoung Shin, Hyun-Young Shin, Bumjo Oh, Jae-woo Lee, Jae Yong Shim, Chang Won Won, Ji Won Yoo
    Korean Journal of Family Medicine.2021; 42(6): 413.     CrossRef
  • Implications of frailty interventions from Korean frailty and aging cohort study
    Chang Won Won
    AGING MEDICINE.2021; 4(4): 247.     CrossRef
  • Perceived Recovery Time from Common Cold as a Possible Indicator of Physical Resilience
    Yoonki Kim, Chang Won Won, Sunyoung Kim, ByungSung Kim, Miji Kim, Eunjin Jeong, Jisoo Yang, Hyona Lee
    Annals of Geriatric Medicine and Research.2021; 25(3): 204.     CrossRef
  • Grip Strength as a Cardiometabolic Marker
    Jungun Lee
    Korean Journal of Family Medicine.2020; 41(5): 271.     CrossRef
  • 9,784 View
  • 170 Download
  • 23 Web of Science
  • 25 Crossref

Original Articles

The Relationship between Psychological Factors and Weight Gain
Hye Jin Jang, Byung Sung Kim, Chang Won Won, Sun Young Kim, Myung Weon Seo
Korean J Fam Med 2020;41(6):381-368.   Published online May 14, 2020
DOI: https://doi.org/10.4082/kjfm.19.0049
Background
This study aimed to investigate stress, depression, sleeping time, physical activity, and dietary patterns as factors causing weight gain and investigate which of these factors have a greater effect on weight gain.
Methods
Data were obtained from the seventh Korea National Health and Nutrition Examination Survey, 2016. Among the respondents, 3,163 adults aged 19–64 years were included in the survey, after excluding non-responders and those with diseases that may affect weight change. The t-test and chi-square test were used to analyze the relationship between weight gain and general characteristics. Logistic regression analysis was performed to evaluate weight changes according to stress, depression, sleep time, physical activity, and dietary patterns and evaluate the odds ratios (ORs) for measuring these associations.
Results
Participants in the weight gain group were younger and more likely to be obese than those in the control group. Factors that could cause weight gain among women were stress awareness (OR, 1.271; 95% confidence interval [CI], 1.012–1.597), physical inactivity (OR, 1.250; 95% CI, 1.018–1.535), and skipping breakfast (OR, 1.277; 95% CI, 1.028–1.587). Depression was significantly associated with weight gain among women, but not after adjusting for other variables. There were no significant associations with sleeping time. None of these factors in men were significantly associated with weight gain.
Conclusion
Stress awareness was significantly associated with weight gain among women, while other psychological factors were not significantly associated with weight gain.

Citations

Citations to this article as recorded by  
  • Body mass as a result of psychological, lifestyle and genetic determinants. A pilot study involving overweight/obese and normal weight women in their early adulthood
    Małgorzata Obara-Gołębiowska, Katarzyna Eufemia Przybyłowicz, Anna Danielewicz, Tomasz Sawicki, Asif Jan
    PLOS ONE.2024; 19(12): e0314942.     CrossRef
  • Weightism in Asia: A Narrative Review and Implications for Practice
    Shubashini Mathialagan, Poh Li Lau
    Journal of Obesity & Metabolic Syndrome.2024; 33(4): 314.     CrossRef
  • Weight Changes and Unhealthy Weight Control Behaviors Are Associated With Dysmenorrhea in Young Women
    Kyunghee Han, Nam-Kyoo Lim, Hansol Choi, Bo Mi Song, Hyun-Young Park
    Journal of Korean Medical Science.2023;[Epub]     CrossRef
  • Factors Associated with Breakfast Skipping and Its Attitude among Undergraduate Students of King Khalid University
    Amani Hamad Alhazmi
    King Khalid University Journal of Health Sciences.2023; 8(1): 85.     CrossRef
  • Gender Differences in the Relationships between Perceived Stress, Eating Behaviors, Sleep, Dietary Risk, and Body Mass Index
    Chen Du, Mary Adjepong, Megan Chong Hueh Zan, Min Jung Cho, Jenifer I. Fenton, Pao Ying Hsiao, Laura Keaver, Heesoon Lee, Mary-Jon Ludy, Wan Shen, Winnie Chee Siew Swee, Jyothi Thrivikraman, Felicity Amoah-Agyei, Emilie de Kanter, Wenyan Wang, Robin M. Tu
    Nutrients.2022; 14(5): 1045.     CrossRef
  • Current status of health promotion in Korea
    Soo Young Kim
    Journal of the Korean Medical Association.2022; 65(12): 776.     CrossRef
  • Current status and treatment of obesity in Korea
    Jae-Heon Kang
    Journal of the Korean Medical Association.2022; 65(12): 783.     CrossRef
  • The Use of Self-Help Strategies in Obesity Treatment. A Narrative Review Focused on Hypnosis and Mindfulness
    Marianna Pellegrini, Sara Carletto, Elena Scumaci, Valentina Ponzo, Luca Ostacoli, Simona Bo
    Current Obesity Reports.2021; 10(3): 351.     CrossRef
  • Physical Activity, Stress, Depression, Emotional Intelligence, Logical Thinking, and Overall Health in a Large Lithuanian from October 2019 to June 2020: Age and Gender Differences Adult Sample
    Albertas Skurvydas, Ausra Lisinskiene, Marc Lochbaum, Daiva Majauskiene, Dovile Valanciene, Ruta Dadeliene, Natalja Fatkulina, Asta Sarkauskiene
    International Journal of Environmental Research and Public Health.2021; 18(23): 12809.     CrossRef
  • Factors Predisposing to Weight Gain in Young Adults during COVID-19 Home Confinement
    Alexandra M. Stănilă, Mihaela Oraviţan, Marius L. Matichescu, Cătălin V. Stănilă, Cristiana A. Avram, Bogdan Almăjan-Guţă, Claudiu Avram
    Timisoara Physical Education and Rehabilitation Journal.2021; 14(26): 17.     CrossRef
  • Why Does Weight Gain Put More Stress on Women?
    Young Gyu Cho
    Korean Journal of Family Medicine.2020; 41(6): 363.     CrossRef
  • 6,149 View
  • 146 Download
  • 10 Web of Science
  • 11 Crossref
Health Behavior and Factors Associated with Depression in North Korean Adolescent Defectors in South Korea: The Korea Youth Risk Behavior Web-Based Survey, 2011–2014
Min Joung Kim, Seon Yeong Yu, Sunyoung Kim, Chang Won Won, Hyunrim Choi, Byung Sung Kim
Korean J Fam Med 2017;38(5):256-262.   Published online September 22, 2017
DOI: https://doi.org/10.4082/kjfm.2017.38.5.256
Background

The number of North Korean adolescent defectors entering South Korea has been increasing. The health behavior, including mental health-related behavior, and factors associated with depression in North Korean adolescent defectors residing in South Korea were investigated.

Methods

Data obtained from the Korea Youth Risk Behavior Web-Based Survey (2011–2014) dataset were utilized. In total, 206 North Korean adolescent defectors were selected, and for the control group, 618 matched South Korean adolescents were selected. Frequency analysis was used to determine the place of birth and nationality of the parents, chi-square tests were used to compare the general characteristics of the North and South Korean subjects, and multivariate logistic regressions were conducted to compare the health behavior of the two sets of subjects. To determine the factors associated with depression in the North Korean subjects, a logistic regression was performed.

Results

The North Korean adolescents reported higher current smoking (adjusted odds ratio [aOR], 2.54; 95% confidence interval [CI], 1.48 to 4.35), current drinking (aOR, 1.85; 95% CI, 1.15 to 2.99), and drug use rates (aOR, 10.99; 95% CI, 4.04 to 29.88) than did the South Korean adolescents. The factors associated with depression in the North Korean adolescents were current smoking (aOR, 6.99; 95% CI, 1.62 to 30.06), lifetime drinking experience (aOR, 5.32; 95% CI, 1.51 to 18.75), and perceived stress (aOR, 4.74; 95% CI, 1.74 to 12.90).

Conclusion

There were differences in health behavior between the North and South Korean adolescents. A specialized approach for North Korean adolescent defectors is required to promote proper health behavior and adaptation to South Korean society.

Citations

Citations to this article as recorded by  
  • Lifestyle health behaviors and experience of depression among middle and high school students in South Korea: A comparison between 2010–2013 and 2020–2023
    Euijun Yang, Hyekyung Woo
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Body Mass Index and Mortality according to Gender in a Community-Dwelling Elderly Population: The 3-Year Follow-up Findings from the Living Profiles of Older People Surveys in Korea
Seon Yeong Yu, Byung Sung Kim, Chang Won Won, Hyunrim Choi, Sunyoung Kim, Hyung Woo Kim, Min Joung Kim
Korean J Fam Med 2016;37(6):317-322.   Published online November 18, 2016
DOI: https://doi.org/10.4082/kjfm.2016.37.6.317
Background

Body mass index is widely regarded as an important predictor of mortality. The purpose of this study was to investigate the relationship between body mass index and mortality and to compare community-dwelling elderly people in South Korea according to sex.

Methods

Data were collected from the 2008 and 2011 Living Profiles of Older People Surveys, which comprised 10,613 community-living South Korean men and women aged 65 years or older. The participants were stratified into five groups according to body mass index as defined by the World Health Organization guidelines. The sociodemographic characteristics of participants and mortality rates were compared across the body mass index groups.

Results

The highest survival rates were observed in men with a body mass index of 25.0–29.9 kg/m2. A similar trend was observed in women, but it was not statistically significant. After adjusting for covariates, this association was also found in men across all BMI index groups, but not in women.

Conclusion

This study supports previous findings that overweight or mild obesity is associated with the lowest mortality and suggests that the current categories of obesity require revision. Furthermore, the absence of statistically significant findings in the female cohort suggests that body mass index is not a suitable predictor of mortality in women and that an alternative is required.

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Predictability of Various Serial Subtractions on Global Deterioration Scale According to Education Level
Joong Soo Kim, Chang Won Won, Byung Sung Kim, Hyun Rim Choi
Korean J Fam Med 2013;34(5):327-333.   Published online September 26, 2013
DOI: https://doi.org/10.4082/kjfm.2013.34.5.327
Background

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.

Methods

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.

Results

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.

Conclusion

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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Obesity Indices and Obesity-Related Quality of Life in Adults 65 Years and Older.
Kyu Hee Chae, Chang Won Won, Hyunrim Choi, Byung Sung Kim
Korean J Fam Med 2010;31(7):540-546.   Published online July 20, 2010
DOI: https://doi.org/10.4082/kjfm.2010.31.7.540
Background
Obesity is known to influence on physical, mental, functional health problems but there have been no study of relationship between body mass index (BMI) and quality of life (QOL) in Korean elderly. Methods: A total of 216 elderly who had been attending two geriatric welfare facilities in Seoul answered the Korean version of obesity-related quality of life (KOQOL) questionnaire. Height, weight, waist circumference were measured. Body fat (%) was measured with HTM20 by impedance technique. Sociodemographic and medical factors were interviewed. QOL was assessed using KOQOL (ver.1) after excluding two sexual life related questions and one work related question. The total score is 48 points. The higher is the score, the poorer is the QOL. Results: In multivariable analysis, BMI, age, history of diabetes mellitus, history of osteoarthritis were associated with KOQOL score. Especially, BMI was significantly associated with KOQOL score after adjusting for waist circumference, body fat (%) (P = 0.002). Conclusion: The more BMI increases, the worse the obesity related QOL is in Korean ambulatory elderly.

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Review

Community Acquired Pneumonia.
Chang Won Won
Korean J Fam Med 2010;31(7):503-511.   Published online July 20, 2010
DOI: https://doi.org/10.4082/kjfm.2010.31.7.503
Various bacteriae, viruses, fungi, parasites may cause community acquired pneumonia and out of them, S. pneumoniae is the most common cause. As finding out causative pathogen in community acquired pneumonia which is common in primary care is often difficult, empiric antibiotic therapy is initiated. For ambulatory patients with community acquired pneumonia: 1) Ղ-lactam alone; 2) combination of Ղ-lactam and macrolides; or 3) respiratory quinolone are recommended. For inpatients without a risk of P. aeruginosa, Ղ-lactam plus macrolide or respiratory fluoroquinolone are recommended. The successful treatment of community-acquired pneumonia requires appropriate, empirical antimicrobial therapy.

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Original Articles

Influence of Loneliness on Cognitive Decline among Elderly Living Alone in Korea: One Year Prospective Study.
Sung Hoon Lee, Chang Won Won, Hak Soon Baek, Key Chung Park, Byung Sung Kim, Hyun Rim Choi, Young Ho Hong
J Korean Acad Fam Med 2008;29(9):695-702.   Published online September 10, 2008
Background: Dementia is the most important factor affecting everyday life of the elderly and there have been studies on the relationship between dementia and social withdrawal or loneliness. However, there is a lack of investigations on the relationship between loneliness and cognitive function in the elderly living alone. Methods: Ninety five community-dwelling elderly people registered to Sungbook elderly welfare center in Seoul, who were living alone, were enrolled in the study. Personal visits by three pre-trained researchers were made during April 2006. One year later, 11 elderly dropped out, and 84 elderly were interviewed in the same way. They were interviewed based on loneliness scale, social support, Hasegawa dementia scale, instrumental activities of daily living, and depression. Results: The mean age of the subjects was 78.3 years. Most of them were women (90.5%) and education level was low (no schooling in 69%). The loneliness scale did not change much during one year (P=0.63), but the instrumental activities of daily living (IADL) score had worsened from 10.5 to 11.2 (P=0.002) The mean Hasegawa dementia scale score decreased from 23.2 to 21.0 during one year (P<0.001). Multivariate regression analysis for the one-year difference in Hasegawa Dementia Scale revealed loneliness was a significant factor after adjusting for age, the level of education, social support, IADL score, and depression (regression coefficient=−0.712, P=0.02). Conclusion: Loneliness was associated with a decline in cognitive function in the elderly people living alone. In contrast, social withdrawal and depression had no effect on changes of cognitive function during one year. (J Korean Acad Fam Med 2008;29:695-702)
  • 1,740 View
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Geriatrics in Family Medicine Residency Program: Training Conditions and Suggestions.
Bodri Son, Chang Won Won, Il Sin Kim, Hyun Rim Choi, Byung Sung Kim
J Korean Acad Fam Med 2008;29(9):687-694.   Published online September 10, 2008
Background: With the number of geriatric population on a steep increase, the roles of family physicians broaden to give comprehensive medical care to the elderly. Therefore, geriatrics is becoming increasingly more important for the residents of family medicine. The authors have surveyed and researched on resident's current attention, actual training conditions, and future needs on geriatrics. Methods: Family medicine residents in 79 hospitals registered to Korean Family Medicine Resident Union were enrolled. By means of electronic and postage mail surveys, informations were gathered; including demographics, the order of importance of nine training curricula, the necessity of training itself, the facility and academic conference of geriatrics training. Results: A total of 173 residents in 45 hospitals replied with return rates of 51.9%. Among the total, 169 (97.7%) of the answered agreed on the necessity of geriatrics training. Of the nine curricula, geriatrics was considered the most important. And residents considered family medicine outpatient department and inpatient ward to be the most important place for geriatrics training. Furthermore, the residents considered elderly's diseases or symptoms as more important conference title, but the parameters such as the quality of life, physiology of aging, care in nursing home were considered less important. Conclusion: The geriatrics training program is not up to the standards of residents' satisfaction. This is considered to be due to the absence of a formal training program. To provide a better care for the elderly, it is compulsory to gain broad knowledge of geriatrics and actual experience out in the field. (J Korean Acad Fam Med 2008;29:687-694)
  • 1,311 View
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Relationship of Helicobacter pylori Infection with Appetite.
Min Han Kang, Chang Won Won, Yung Ho Ha, Hak Soon Baek, Hyun Rim Choi, Byung Sung Kim
J Korean Acad Fam Med 2007;28(12):909-915.   Published online December 10, 2007
Background
It has been reported that H.pylori causes changes in fundic leptin levels and plasma levels of ghrelin, and that eradication of H.pylori infection can increase appetite. There is also a report that showed changes of appetite between before and after eradication of H.pylori in peritoneal dialysis patients. Our study investigated the degree of appetite between H.pylori negative group and H.pylori positive group in adults. Methods: The subjects included those without appetite- related diseases. We carried out gastroscopy and then performed CLO test in subjects who had no gastric lesions. We interviewed the study subjects about appetite related behavior (three items: desire to eat, hunger before meal, deliciousness) using visual analogue scale. We examined the appetite related behavior between CLO (-) group and CLO (+) group. Results: The difference of age, sex, height, weight, body mass index, alcohol con sumption, blood pressure, hemoglobin, fasting blood sugar, AST, ALT, GGT between CLO (-) group and CLO (+) group were not statistically significant. The difference of appetite related behavior (three items) between CLO (-) group and CLO (+) group was not statistically significant. Conclusion: The degree of appetite between CLO (-) group and CLO (+) group was not different. (J Korean Acad Fam Med 2007;28:909-915)
  • 1,357 View
  • 14 Download
Prevalence and Risk Factors of Functional Constipation in the Elderly.
Hyung Jun Kim, Chang Won Won, Hyun Rim Choi, Byung Sung Kim, Jeung Eun Kim, Hyo Jong Kim, Jong Myun Bae, Hyun Mi Hwang
J Korean Acad Fam Med 2006;27(9):693-698.   Published online September 10, 2006
Background
: Gastrointestinal (GI) symptoms are believed to be common in the general population, and constipation is one of the most representative GI symptoms. However, the prevalence and risk factors of functional constipation are not well known in Korea. We aimed to study the prevalence of, and risk factors for, constipation in the elderly.

Methods : We randomly selected 852 among 854 (excluded by cancer and dementia) subjects, ages 65 yr and older, in three different geriatric welfare facilities in December, 2003. The prevalence of functional constipation was based on the Rome II criteria and the survey on risk factors for constipation was performed.

Results : Functional constipation had a prevalence of 26.6% and there was no difference between men and women. Exercise, fluid·fruit·vegetable intake, anal diseases and age related risk factors were associated with constipation.

Conclusion : In the elderly, constipation is a common complaint. Further studies are now required for risk factors of constipation.
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Insulin Resistance in Adolescence and the Related Factors: in 10th Grade High School Students in Seoul.
Sun Hyung Kim, Hyun Rim Choi, Chang Won Won, Byung Sung Kim, Sung Woon Kim, Jung Yeun Choi, Kyu Hee Chae
J Korean Acad Fam Med 2005;26(12):759-765.   Published online December 10, 2005
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  • 9 Download
The Survey of Family Medicine Clinical Clerkships in Medical Schools in Korea.
Chang Jin Choi, Bom Taeck Kim, Sang Woo Oh, Chang Won Won, Sun Mi Yoo, Hoonki Park
J Korean Acad Fam Med 2004;25(12):895-900.   Published online December 10, 2004
Background
: New educational objectives and evaluation methods in Korean medical schools have been suggested recently to cope with health care related environmental changes. Current status of family medicine clinical clerkships in Korean medical schools is to be known before establishing standards.

Methods : Educational Committee of Korean Academy of Family Medicine surveyed the family medicine clerkship in Korean medical school (about educational environment, subjects and evaluation methods) using structured questionnaires by e-mail and Fax from February through March in 2004.

Results : Family medicine clinical clerkship was run by 25 of 41 medical schools (65.9%). Educational subject areas included communication skill, observation in hospital based ambulatory office, primary care and family medicine, medical recording, diagnosis and treatment of common problems, residential out-hospital ambulatory programs, presentation of hospital based ambulatory programs, procedure skill, lifelong heath management plan, and health promotion, in descending order. Faculties of family medicine were directly in charge of educational subjects. However, educational methods were mainly composed of lectures and indirect observation. It should be noted that concrete and precise evaluation methods in the family medicine clerkship program had been lacking due to insufficient and obscure evaluation strategies.

Conclusion : Clerkship period, educational environment, and number of class were variable among medical schools in Korea. Educational format needs to be standardized in terms of common educational subjects such as communication skill education, patient education, and ambulatory care clerkship. More valid methods are to be introduced for family medicine clerkship evaluation.
  • 1,483 View
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The Validity and Reliability of Korean Version of Bathel ADL Index.
Soo Young Kim, Chang Won Won, Yong Gyun Rho
J Korean Acad Fam Med 2004;25(7):534-541.   Published online July 10, 2004
Background
: The functional status of elderly has been measured by many different methods including Karz ADL index, Bathel ADL index and physical self- maintenance scale. Among them, Bathel ADL index has been widely used in many countries because of easiness to scoring and administration. Therefore, we translated the Bathel ADL index and tested the translation validity and psychometric properties (validity and reliability) of Korean version of Bathel ADL index.

Methods : The Bathel ADL index was translated by multidisciplinary committee members. The quality of translation was rated by committee members using three criteria (clarity, use of common language, conceptual equivalence). Reliability was tested by internal consistency (Cronbach's alpha), two weeks test-retest reliability, and intraobserver agreement. Clinical validity and construct validity comparison with brain disability grade were tested for validity testing.

Results : Cronbach's alpha was 0.97. Two weeks test-retest correlations coefficient was 0.95 (P=0.00). Interrator agreements were high in all 10 items (κ=0.82∼1.0). Normal control group had lower scores than the patient group (P=0.000). Correlation coefficients between the Korean version of Bathel ADL index score and brain- disability grade was -0.58 (P=0.000).

Conclusion : The Korean version of Bathel ADL index is a valid and reliable instrument for measuring functional status of the elderly.
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A Change in Referral from Department of Family Medicine to Other Departments of One Tertiary Hospital after Partial Changes in Health Care System.
Yong Min Yang, Hyun Rim Choi, Byung Sung Kim, Chang Won Won, Won Wha Kim
J Korean Acad Fam Med 2003;24(10):934-941.   Published online October 10, 2003
Background
: Since March 1, 1989, a new health care system has been introduced. But the departments of ENT, ophthalmology, dermatology and PMR (rehabilitation medicine) in tertiary health care hospitals were exempted from the new system and were allowed to see patients directly. Thereafter, the Ministry of Health revised the National Health Insurance regulation, and required the above departments to see patients only with referral. This study was done to analyze whether the revision has contributed to providing adequate specialized medical services and to know what role family physicians can assume under revision by analyzing the referred patients.

Methods : From November 1998 to June 2000 and from July 2000 to February 2002, both 20 months, we reviewed the charts of 331 patients who were referred from family medicine department of KHMC (Kyung Hee Medical Center) to the above four departments and analysis has done.

Results : During both periods, the number of cases increased from 94 to 237, and the patients group had no significant difference in age and sex. Reviewing the number of referred cases, before revision, cases were concentrated to the department of ENT and to PMR. After revision, cases were evenly distributed in three departments. except for PMR. Reviewing referral contents, the three departments except for dermatology showed no significant difference.

Conclusion : The sum of cases increased by 2.5 times, but the three departments except for dermatology showed no significant difference in referral and diagnosis content. In dermatology, the majority of the patients wanted a referral with the objective of obtaining a referral paper. Therefore, we can consider that the revision didnot contribute to specialized medical services. But after revision, referral cases to ophthalmology and dermatology increased by 4 and 6 times. We recommend that family physicians know and experience more about these.
  • 1,286 View
  • 14 Download

Review

A Brief Discussion on Family Medicine in Edmonton, Alberta, Canada.
Lina Bohee Kim, Chang Won Won, Yun Jin Kim
J Korean Acad Fam Med 2003;24(7):605-611.   Published online July 10, 2003
In early May 2003, a small group of four, including three family physicians and a media person, visited various family medicine education and training facilities in Edmonton, Alberta, Canada. This paper is a brief discussion of what knowledge and insight was gained during this trip.
  • 1,179 View
  • 9 Download

Original Articles

Blood Pressure Difference between Right and Left Arms of Some College Freshmen.
Ha Jin Kim, Chang Won Won, Eun Suk Ann, Jung Ju Jung, Byung Sung Kim, Hyun Rim Choi
J Korean Acad Fam Med 2003;24(2):166-171.   Published online February 10, 2003
Background
: Hypertension is a main cause of heart blood vessel disease. To diagnose and treat hypertension, it is necessary to measure blood pressure accurately. There are various factors that influence blood pressure. According to real clinical demonstrators and some recent studies, blood pressure differences between right and left arms are often observed. This study was intended to know whether the differences are really found and wheather the correlation exists between mid-arm circumferences and the blood pressure differences according to right-handed or left-handed which were considered as an important factor in affecting blood pressures.

Methods : One hundred sixty nine college freshmen of year 2001 were chosen. Among them, 103 were right- handed and 66 left-handed. Which arms to be checked first were determined randomly. This sequence was repeated two times on each person. Their mid-arm circumferences were measured, also.

Results : For right-handed persons, systolic blood pressure in right arm (119.2±12.3 mmHg) was significantly higher than in left arm (118.0±12.0 mmHg) (P<0.005). But diastolic blood pressure differences between right arm (75.3±10.0 mmHg) and left arm (75.0±9.5 mmHg) was not significant statistically. For left-handed persons, systolic blood pressure was 120.3±9.9 mmHg in right arm and 120.0±10.3 mmHg in left arm. However, diastolic blood pressure in right arm (76.7±9.4 mmHg) was significantly higher than in left arm (75.0±8.6 mmHg) (P<0.005). For right handed persons, their arm circumferences (26.2±2.8 cm) were significantly thicker than left ones (25.9±2.9 cm). For left-handed, left arm circumference (25.9±2.7 cm) was significantly thicker than right one (25.5±2.6 cm). As for the blood pressure difference in arm tested order, the first measured systolic blood pressure (right arm; 120.9±11.7 mmHg, left arm; 120.0±11.9 mmHg) was significantly higher than the second measured one (right arm; 118.3±11.8 mmHg, left arm; 117.8±11.6 mmHg) (P<0.005). However, the first measured diastolic blood pressure (right arm; 76.3±10.5 mmHg, left arm; 75.5±9.4 mmHg) did not have more significance than the second measured one (right arm; 75.4±9.9 mmHg, left arm; 74.6±10.8 mmHg).

Conclusion : The right-handed person's blood pressure was higher in the right arm, but for the left-handed persons it was not significantly different in both arms. The second measurement of blood pressure was lower than the first measurement in both arms. The arm circumference depending on the right/left-handedness influenced the blood pressure, but clear correlation between them was not observed. Therefore, if possible, when the blood pressure is measured, it is advised to check blood pressure in both arms before diagnosing hypertension.
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Validity and Reliability of the Korean Version of the Arthritis Impact Measurement Scales 2 (Korean-AIMS2) in Patients with Osteoarthritis.
Jae Ho Lee, Ho Cheol Shin, Cheol Hwan Kim, Yun Jun Yang, Chang Won Won, Kyung Hwan Cho, Belong Cho, Hwa Jae Jeong, Seong Il Bin, Eun Sook Park
J Korean Acad Fam Med 2003;24(1):19-44.   Published online January 10, 2003
Background
: The second version of the Arthritis Impact Measurement Scales (AIMS2) is an improvement on an evaluation instrument that was developed to measure patient outcome in the rheumatic diseases. The goal of this study was to validate a translated version of the revised and expanded Arthritis Impact Measurement Scales (AIMS2) to be used by Korean patients with osteoarthritis (OA) of the knee.

Methods : The AIMS2 was translated into Korean according to a recommended translation guideline. The Korean version of AIMS2 (K-AIMS2) was administered to a cohort of 239 outpatients with symptomatic OA of the knee who attended 7 participating University Hospitals in Seoul, Ilsan and Taejon. Forty eight patients readministered the K-AIMS2, 7 days after the first visit, to evaluate the instrument's test-retest reliability. After 6 weeks of NS AIDs therapy, 79 subjects were asked to complete a second survey of the questionnaire.

Results : The internal consistency reliability of each scale score, as estimated by Cronbach's alpha coefficient, was high and indicated that the components of the scale measured the same construct. The items were all correlated with each other, but there was no redundancy; this indicated that each domain addressed a somewhat different aspect of functional disability. The test-retest reliability equalled or exceeded 0.86 for 12 scales. Factor analysis provided a three-factor health status model explaining 58.2% of the variance. The upper limb function scales formed the first factor. Psycho-social scale were loaded on the second factor. Arthritis pain together with physical scales for mobility level and walking and bending were loaded on the third factor (the lower limb function). The scale for support from family and friends was not loaded on any factors. These results demonstrate that the physical health status scales of the K-AIMS2 are valid, as shown by the significant, moderate to high correlations between the K-AIMS2 subscales and the majority of the clinical measures.

Conclusion : Our data suggest that, like the original questionnaire, the Korean version of AIMS2 is a reliable, consistent and valid instrument for measuring health status and physical functioning in patients with OA of the knee.
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Usability of HHIE S as a screening test of hearing imairment in the Korean elderly.
Young San Kim, Chang Won Won, Byoung Sung Kim, Hyun Rim Choi, Sung Hoon Kim, Jun Chul Kim, Jong Bum Lim
J Korean Acad Fam Med 2001;22(6):878-885.   Published online June 1, 2001
Background
: Hearing impairment is one of the most common physical handicaps of the aged. This diseases has recently attracted such amount of social attention and understanding as never attracted several years age, and high degree of achievement was made with regard to screening test method, diagnosis, treatment and rehabilitation. However, unfortunately, even now, not enough attention is being paid upon early discovery hearing handicap for patients frequently encountered in clinics.
Therefore, as a screening test method of senile hypacusis, we were to apply "Hearing Handicap Inventory for the Elderly - Screening Version" (HHIE-S) inquiries in Korea and studied the usabulity, sensitivity, specificity, positive predictive value and negative predictive value and cutoff point of this method.

Methods : This study was performed for 120 persons over the age of 60, who visited general health screening centers of one university hospital located in Seou, during the period of October 1996 through to March 1999. HHIE-S questionnaires were used and pure tone audiometry was performed to generate gold standard.

Results : Only 119 out of 120 initial subjects were included in the study because of incomplete questionnaire answers by excluded 10 subject. We defined gold standard of hearing handicap to be ⑴ lower than 30 dB of hearing capability of both ears to frequency between 1000 Hz and 2000 Hz or ⑵ lower than 40 dB of hearing capability of an ear to frequency between 1000 Hz and 2000 Hz, as determined by pure tone audiometry. Assuming cutoff point of HHIE-S as 4 points, the sensitivity and specificity resulted to bo 80%, and 67% each. Assuming cutoff point of HHIE-S as 6 points, the sensitivity and specificity were 76% and 78% each. At 8 points, the percentages were 64%, and 80%, At 10 points, the percentages were 64% and 85%. As a result of this study, the appropriate cutoff point is 6 points. In order to specify the correlation between questionnaire result and pure tone audiometry, we performed 500 Hz, 100 Hz and 200 Hz audi-ometry which are within conversational range, calculated arithmetic mean from the results, and inspected correlation between the resultant mean of the better performing ear and questionnaire resultant points. The correlation coefficient was 0.612 and Chronbach's alpha, as a measurement of internal consistency of the questionnaire was 0.9044.

Conclusion : HHIE-S proved to be useful in screening hearing handicap in the Korean elderly.
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Development of categorial rating scale about pain intensity.
Chang Won Won, Dong Hoon Yang, Seong Hoon Kim, Byung Sung Kim, Hyun Rim Choi
J Korean Acad Fam Med 2001;22(5):721-731.   Published online May 1, 2001
Background
: Categorial rating scale about pain intensity has been used in many studies without any validation. So we tried to score the pain intensity of phrases which Koreans commonly use for description of pain intensity, and developed categorial rating scale about pain intensity.

Methods : After gathering the phrases which Koreans commonly use for description of pain intensity, the authors selected 23 common phrases. For the each 23 phrase, we asked 69 outpatients at a family Medicine clinic and 76 hospital employee to check on the visual analogue scale according to the intensity. To estimate the reliability of the answers, we asked them to respond to the same questionnaire two weeks later.

Results : Of 145 people interviewed, 63 were male and 82 were female. We found out the absolute pain intensity of 23 phrases. Then we could present 5 point categorial rating scale and 4 point categorial rating scale. Correlation coefficients of two weeks test-retest were from 0.355 to 0.570, which were all statistically significant.

Conclusion : We developed 5 point categorial rating scale and 4 point categorial rating scale which can be used for evaluation of Korean's pain intensity.
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The effect of Tai Chi(9 basic forms) on the equilibrium in the aged: a controlled trial.
Chang Won Won, Byung Sung Kim, Hyun Rim Choi
J Korean Acad Fam Med 2001;22(5):664-673.   Published online May 1, 2001
Background
: Accidental fall is a major risk factor of hip fractures in the aged. Recently Tai chi exercise is reported to reduce the frequency of falls in the American elderly. This study was to evaluate the effects of Tai Chi exercise on equilibrium in the Koreas elderly.

Methods : we selected 4 clubs for the elderly in the same district. The elderly(11 men, 9 women) who attended two of the clubs were offered Tai Chi(9 basic forms) exercise and the elderly(4 men , 21 women) who attended the other two of them were offered regular medical examination. Intervention length was 12 weeks, with outcomes measured before and after intervention.

Results : In men, single left leg standing with eyes open improved in Tai chi group as compared with non-Tai chi group(p=0.026). In women, single right leg standing with eyes open improved in Tai Chi group as compared with non-Tai Chi group(p=0.023), and single left leg standing with eyes open showed improvement in Tai Chi group as compared with non-Tai Chi group(p=0.085). MMSE-K showed improvement in Tai Chi group as compared with non-Tai Chi group, but it was not significant(p>0.05). Those who said these 9 basic forms were not difficult were 81.8% in men, 77.8% in women.

Conclusion : '9 basic forms of Tai Chi' is easy to practice and helpful for equilibrium in the aged. The effect of 9 basic forms of Tai Chi on cognition of the aged needs further studies.
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The comparision of the quality of life between the well controlled hypertension group and the uncontrolled hypertension group.
Young Mook Kim, Hyun Rim Choi, Do Young Park, Jong Bum Lim, Chang Won Won, Byung Sung Kim, Yong Woo Park
J Korean Acad Fam Med 2001;22(4):565-574.   Published online April 1, 2001
Background
: Hypertension is an important as well as common disease in primary practice, so family physicians should concern about it. It is well known that if hypertension were well controlled, it could lower cardiovascular complications. However, there are few studies on the impact of hypertension affecting the quality of life. Therefore, we carried out this study to compare the quality of life in the hypertensive patients by whether it is well controlled or not.

Methods : The authors surveyed the quality of life using the questionnaire named as CMC Health Survey Version 1.0 for the hypertensive patients. The subjects had no complications and no other diseases, and aged 40 or more, and visited doctors at the Department of Family Medicine, Kyung-Hee University Hospital or the Department of Internal Medicine, Sungmin Hospital from May 1 to Aug 31, 1998. We categorized the subjects into the two groups of the well-controlled group(SBP<140mmHg and DBP<90 mmHg) and the uncontrolled group(SBP≥140mmHg or DBP ≥ 90mmHg) and compared the quality of life and lifestyle.

Results : The total number of subjects was 119, that of well-controlled group was 69, and that of the uncontrolled group was 50. Mean systolic and diastolic blood pressure was 133.1±7.5mmHg and 85.3±5.2 mmHg in the well-controlled group, 159.2±7.4 mmHg and 100.2±5.5 mmHg in the uncontrolled group. The comparison of the distribution of age, sex, education, occupation, and monthly income between the two groups showed no difference. The comparision of the lifestyle between two groups by Alameda-7 questionnaire showed no difference, too. As for the comparison of quality of life between two groups, the well-controlled group had significantly higher scores in the domain of physical function, social function, general health, vitality(above P<0.01), emotional function, role limitation, and health perception(above P<0.05) than uncontrolled group. However, the scores of the domain of change in health, satisfaction, bodily pain were not significantly different between two groups. After covariated by obesity, the comparison of quality of life between two groups showed similar results.

Conclusion : We confirmed that the well-controlled group had better quality of life than the uncontrolled group. So family physicians should consider the quality of life when they consult the patients with hypertension.
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Association between family APGAR and depression for one university freshmen.
Jong Bum Lim, Byung Sung Kim, Jun Churl Kim, Chang Won Won, Dong Hoon Yang, Hyun Rim Choi
J Korean Acad Fam Med 2001;22(3):354-362.   Published online March 1, 2001
Background
: Though many adolescents are suffering from depression in Korea, there have been few studies about the prevalence of it and depressive adolescents are not managed appropriately yet because of ignorance of the society and family. This study was intended to find out college freshmen's prevalence of depression, and the relationship between family function and depression.

Methods : The subjects were college freshmen of one university both in Seoul and Suwon and the study period was from January to February, 1999. Family APGAR was used as a family function index Beck's Depression Inventory (BDI) was used to measure the degree of depres-sion. Chi square tests and logistic regression were done for analysis using SPSS 8.0/PC program.

Results : The prevalence of depression among college freshmen was 1.5% (37 out of 2465) as of BDI score 21 or more. Depression was more common in the families with low Family APGAR score and those in Suwon campus. No significant differences were found in gender, age, blood pressuere, blood type, BMI, present illness, number of families, marital status of parents or siblings. Relative risks of depression were 4.5 times for family dysfunction group and 2.6 times for Suwon campus group.

Conclusion : Depression is not a rare disease among college freshmen. Therefore, family physician as a primary care physician should consider the possibility of depression among adolescence and screen depression using BDI for adolescents in dysfunctional family particularly.
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Differences in tumor markers and rheumatoid factors between elderly and young adults.
Jung Lim, Chang Won Won, Sue Youn Kwon, Shin Hyung Park, Byung Sung Kim, Hyun Rim Choi
J Korean Acad Fam Med 2001;22(3):336-344.   Published online March 1, 2001
Background
: The elderly is known to have many different clinical laboratory data compared with the young adults. There have been rare studies comparing tumor markers and rheumatoid factors between young adults and the elderly in Korea. This study was conducted to evaluate the differences in tumor markers and rheumatoid factor between elderly and young adults.

Methods : We gathered 94 healthy elderly cases and 91 healthy young adults who have taken periodic health examination from November 1996 to February 1997 at one hospital. We compared the mean of rheumatoid factor and tumor markers between two groups and took multiple regression analysis.

Results : In the elderly, the mean of CEA and AFP are significantly higher than young adults. The number of abnormally elevated rheumatoid factor is significantly higher in elderly group, but in case of CEA the number of abnormal data is not significantly different. The CEA level is significantly high in smoker group than non-smoker group. The factors that increase the CEA level are old age, smoking amount, albumin level. The factors that increase the AFP level are old age, hemoglobin level. The factor that increase the rheumatoid factor is old age only.
Conciusions: When we interpret the level of tumor markers and rheumatoid factor, we must consider the patient's age. Aging is a factor that is associated with CEA, AFP, rheumatoid factor.
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HBsAg and anti-HBs prevalence in North Korean defectors.
Hyun Rim Choi, Byung Sung Kim, Chang Won Won, Hyung Cheol Ahn
J Korean Acad Fam Med 1999;20(12):1778-1783.   Published online December 1, 1999
Background
: Hepatitis B is a world widely distributed disease. The hepatitis B prevalence of South East nations is reported to be higher than that of America or Europe. Korea is known to be one of high prevalent nation among Asia-Pacific nations. But hepatitis B prevalence in North Korea, separate from South Korea due to politics and ideology, is not reported. This study was performed using the data of North Korean defectors to estimate the prevalence of hepatitis B in North Korea.

Methods : We analyzed the data of 107 persons (98, males, 9 females) who defected from North Korea and underwent screening examination in a general hospital from July 1987 to March 1996. Twenty nine persons(25 males, 4 females) were excluded because of incomplete data. The HBsAg test was carried out by reversed passive hemagglutination(RPHA) and the anti-HBs test was carried out by passive hemagglutination(PHA). The liver function tests were carried out by biochemical quantitative analysis method of Dimension.

Results : The study group was 73 males(93.6%) and 5 females(6.4%). Mean age was 33.0±8.4 years and third decade was the largest as 35 persons(44.9%). The overall HBsAg positive rate was 15.4% and anti-HBs positive rate was 33.3%. Those who need vaccination were 51.4%. The only item among liver function tests which was statistically different by the hepatitis B viral marker groups was alkaline phosphatase. Mean total cholesterol was 176.4±38.0mg/dL. But no other item of liver function tests was statistically different in abnormal value by the hepatitis B viral marker groups.

Conclusion : The overall HBsAg positive rate of North Korean defects was much higher than that of South Korean and anti-HBs positive rate was much lower. So HBsAg positive rate of North Korean seems to be higher than that of South Korean. We think that a large study of hepatitis B for North Korean should be performed at y opportunity and take a measure to meet the situations. ( J Korean Acad Fam Med 1999;20:1778-1783)
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Usefulness of distal radius by BMD using DEXA.
Soo Yeol Kim, Chang Won Won, Hee Jin Lim, Byung Sung Kim, Hyun Rim Choi, Deog Yoon Kim
J Korean Acad Fam Med 1999;20(1):79-88.   Published online January 1, 1999
Background
: The purpose of this study is to investigate the correlations between distal radius BMD and other skeletal site(L2-L4, Femoral neck, Ward's triangle, Trochanter) BMD's, and to find out the usefulness of DTX-200. Methods : The authors surveyed the subjects of 76 perimenopausal women who had visited Kyu-nghee Medical Center and measured their bone mineral densities(BMDs) from February, 1997 to July, 1997. Measurements were done for distal radius, ultradistal-8mm radius BMD using DTX-200(OSTEOMETER, Denmark), and other skeletal sites(L2-L4, Femoral neck, Ward's triangle, Trochanter) BMDs using EXPERT(Lunar, USA). Using SPSS for windows, the correlation coefficients of the BMDs of both instruments were calculated. Results : The total number of subjects were 76 (average age:54.8 years, range 32~78years). Among them, 67 were postmenopausal women. The BMD measurements of various skeletal sites were as follows : distal radius, 0.41±0.07(g/cm²), ultradistal-8mm radius 0.34±0.07(g/cm²), femoral neck 0.82±0.18(g/cm²), trochanter 0.72±0.17(g/cm²), Ward's triangle 0.59±0.22(g/cm²), L2-L4 0.98±0.16(g/cm²). The correlations of BMDs between distal radius and femoral neck, trochanter, Ward's triangle, and L2-L4 were 0.44, 0.35, 0.47, and 0.63, respectively. The correlations of BMDs between ultradistal-8mm radius and femoral neck, trochanter, Ward's triangle, and L2-L4 were 0.64, 0.34, 0.41, and 0.69 respectively. Conclusion : The correlations of BMDs between distal radius and those of femoral neck, trochanter, Ward's triangle, L2-L4 were moderately high.
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Case Report
A Case of polymyalgia rheumatica.
Hee Jin Lim, Chang Won Won, Seung Hun Kim, Jong Bum Lim, Byung Sung Kim, Hyun Rim Choi
J Korean Acad Fam Med 1998;19(12):1428-1431.   Published online December 1, 1998
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