Background Predicting the risk of osteoporotic fractures is vital for prevention. Traditional methods such as the Fracture Risk Assessment Tool (FRAX) model use clinical factors. This study examined the predictive power of the FRAX score and machine-learning algorithms trained on FRAX parameters.
Methods We analyzed the data of 2,147 female participants from the Ansan cohort study. The FRAX parameters employed in this study included age, sex (female), height and weight, current smoking status, excessive alcohol consumption (>3 units/d of alcohol), and diagnosis of rheumatoid arthritis. Osteoporotic fracture was defined as one or more fractures of the hip, spine, or wrist during a 10-year observation period. Machine-learning algorithms, such as gradient boosting, random forest, decision tree, and logistic regression, were employed to predict osteoporotic fractures with a 70:30 training-to-test set ratio. We evaluated the area under the receiver operating characteristic curve (AUROC) scores to assess and compare the performance of these algorithms with the FRAX score.
Results Of the 2,147 participants, 3.5% experienced osteoporotic fractures. Those with fractures were older, shorter in height, and had a higher prevalence of rheumatoid arthritis, as well as higher FRAX scores. The AUROC for the FRAX was 0.617. The machine-learning algorithms showed AUROC values of 0.662, 0.652, 0.648, and 0.637 for gradient boosting, logistic regression, decision tree, and random forest, respectively.
Conclusion This study highlighted the immense potential of machine-learning algorithms to improve osteoporotic fracture risk prediction in women when complete FRAX parameter information is unavailable.
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Clinical Applicability of Machine Learning in Family Medicine Jungun Lee Korean Journal of Family Medicine.2024; 45(3): 123. CrossRef
Integrating Machine Learning for Personalized Fracture Risk Assessment: A Multimodal Approach Sheikh Mohd Saleem, Shah Sumaya Jan Korean Journal of Family Medicine.2024; 45(6): 356. CrossRef
Background With increased prevalence of colorectal cancer, it is important to establish the risk factors of colorectal cancer. The prevalence of the metabolic syndrome (MS) is also increasing. Insulin resistance may play an important role in the pathogenesis of MS and colorectal polyps. The aim of this study was to assess the relationship between MS and colorectal polyps. Methods: A total 558 subjects underwent colonoscopic examination from April 2004 to July 2005 at the health promotion center of Bundang CHA Hospital. According to the National Cholesterol Education Program (NCEP) Adult Treatment Panel III definition of MS, the waist circumference, blood pressure (BP), fasting blood glucose (FBG), triglyceride (TG) and HDL cholesterol were measured. Alcohol consumption, smoking and other confounding factors were assessed by a self-administered questionnaire. Results: The incidence of MS and colorectal polyps was 16.3% and 33.0%, respectively. In subjects with polyps, the number of men, smokers and drinkers were higher than in subjects without polyps. In subjects with polyps, BP, FBG and TG were also higher than in subjects without polyps. After adjustment for possible confounding factors, MS was associated with increased risk of colorectal polyps (odds ratio, 1.74; 95% confidence interval, 0.94∼3.22). MS strongly increased the risk of colorectal polyps in men (odds ratio 2.19; 95% confidence interval, 1.07∼4.45), but not in women. Conclusion: We concluded that MS is a risk factor for colorectal polyps in asymptomatic Korean adults and this suggests that insulin resistance may play an important role in the development of colorectal polyps. (J Korean Acad Fam Med 2007;28:134-140)
Background : It is reported that many types of psychiatric disorders, including anxiety disorder, are related with abnormal brain wave activity, and neurofeedback is associated with clinical improvement in generalized anxiety, OCD, phobic disorder, and PTSD. But in panic disorder, previous studies with neurofeedback are very lacking. Therefore, in this study, the author applied neurofeedback to patients with panic disorder, refractory to cognitive- behavioral therapy and medication.
Methods : From March 2 to May 15 in 2005, six patients with a panic disorder had received 20 sessions of neurofeedback training. The author evaluated the treatment effect by using the alteration of K-APPQ score, the frequency of panic attack, medication and individual handicap.
Results : All 6 patients completed 20 sessions of neurofeedback training. At the end, the score of total APPQ, agoraphobia, and interoceptive fear was decreased (P= 0.028) and the frequency of panic attack, medication, and individual handicap was also decreased.
Conclusion : Neurofeedback training was successful in reducing panic symptom severity, frequency and individual handicap. A controlled study on a larger population is strongly recommended.
Background : Bone mass changes in men is related to age, BMI, sex hormones and other factors. In prior studies, bone markers were negatively correlated with bone mineral density, free testosterone, and estrogen and was positively correlated with SHBG. In a study of sex hormones and bone markers in Korean men estradiol was negatively correlated with deoxypyridinoline. In this study, the relationship of testosterone, estradiol, calculated free testosterone, FEI and SHBG to bone turnover markers in adult men were investigated.
Methods : This was a cross-sectional study of 184 men who had undertaken a health screening program in one general hospital in Bundang from November, 2001 to February, 2003. We surveyed information concerning the past medical history, current medication, alcohol consumption amount per week and smoking amount by means of self questionnaire records. Serum total testosterone, estradiol, SHBG and osteocalcin, alkaline phosphatase were measured at a fasting state. Urine was tested for deoxypyridinoline. Free testosterone was calculated using albumin, SHBG, and total testosterone level.
Results : Deoxypyridinoline adjusted by age, BMI was negatively correlated with FEI (r=-0.17, P=0.020) and was positively correlated with smoking amount (r=0.20 P= 0.007). Osteocalcin was negatively correlated with calculated free testosterone and ethanol consumption amount (r=-0.186, P=.0.12, r=-0.186, P=0.012). Multiple regression analysis showed that the most powerful factor influencing deoxypyridinoline was smoking amount (R2= 0.046), followed by FEI, BMI, and the one influencing osteocalcin was BMI (R2=0.050), ethanol amount and calculated free testosterone. After adjusting for age, BMI, drinking amount and smoking amount FEI shown to be a predictor of deoxypyridinoline (β=-0.08, p＜0.01, R2=0.101). After adjusting for age, BMI, and drinking amount calculated free testosterone was shown to be a predictor of osteocalcin (β=-0.570, P＜0.01, R2=0.130) in multiple regression model.
Conclusion : In adult men, FEI shown to be a predictor of deoxypyridinoline and calculated free testosterone to be a predictor of osteocalcin as an independent variable.
Background : There are conflicting reports on the effect of subclinical hypothyroidism on plasma lipid concentrations and blood pressure. This may be due to lack of consideration for menopause status or hormone replacement therapy (HRT) in selecting the study subjects. Also, the reason may be that many subjects with transient abnormality were included in those studies. Therefore, we intended to include the subjects who satisfied the definition of subclinical hypothyroidism on repeated measures. Then, we investigated the difference of plasma lipid concentrations and blood pressure between subclinical hypothyroidism and normal control subjects.
Methods : This study involved the women above age 18, who visited a health promotion center in a general hospital and measured their serum TSH and free T4, from January 1997 to May 2003. The number patients who satisfied the definition of subclinical hypothyroidism on repeated measures, and who had no history of thyroid disease, herb medication or HRT, diabetes, abnormalities of liver and renal function were 30. Age, menopause, body mass index-matched people of 65 were selected as normal controls. Serum TSH, free T4 and plasma lipid concentrations were measured by chemiluminescent assay and enzyme method, respectively. Dyslipidemia were defined according to NCEP ATPIII guidelines.
Results : There was no significant difference of blood pressure and plasma lipid concentrations between subclinical hypothyroidism patients and normal controls irrespective of menopause. There was no significant difference of percentage of dyslipidemia and hypertension between the two groups.
Conclusion : There were no significant increase in plasma lipid concentrations and blood pressure in subclinical hypothyroidism patients despite more strict inclusion.
Background : With the population aging, osteoporosis is becoming a major health issue. Although not as common as women, osteoporosis and its clinical end point of fracture are significant health care concern in men. Despite the considerable public health burden, our understanding of their pathogenesis is incomplete, and several factors known to affect bone metabolism in men are still controversial. So this study was made to investigate relationship between testosterone and bone mineral density in men.
Methods : This was a cross-sectional study of 432 men undertaken health screening program in Pundang CHA General Hospital from January 2000 to December 2000. We surveyed information concerning exercise and consumption of alcohol and smoking by means of self questionnaire records. Serum total testosterone, SHBG, and osteocalcin were measured at a fasting state. Second morning urine was tested for deoxypyridinoline. BMD was assessed using pQCT.
Results : FTI (free testosterone index) was positively correlated with BMD (r=0.265, P＜0.01). Age, osteocalcin, SHBG, and urine deoxypridinoline were negatively correlated with BMD (r=-0.397, P＜0.01, r=-0.121, P＜0.05, r=-0.214, P＜0.01, and r=-0.126, P＜0.01). BMI and total testosterone had no significant correlation with BMD, and there were no apparent association among the level of alcohol and tobacco use, regular exercise and BMD. FTI was not independently correlated with BMD after age, BMI and urine deoxypyridinoline were adjusted, but showed a trend to significantly predict BMD (β=0.10, P=0.052).
Conclusion : These data suggest that FTI may play a role in determination of BMD in men, allowing the potential for clinical intervention. But further investigation of the role of testosterone in bone metabolism in men is necessary.
Background : The age-related increase in fat mass seems related to decrease in hormone level. Few studies have been done in Korea concerning the association between testosterone, GH (growth hormone) and fat mass. This study was undertaken to evaluate the relationship among testosterone, IGF-1 and fat mass.
Methods : The study was performed from February to October 2001 in the Health Screening Center of Pundang CHA Hospital with 243 men as subjects. Fat intake was measured through interview with diet therapist and other data were obtained by self-questionnaire. Fat mass was measured using Inbody 3.0 and the level of total testosterone, SHBG and IGF-1 in serum were measured.
Results : Smoking was negatively correlated with fat mass and WHR (waist to hip ratio) (P＜0.05) and fat intake was positively correlated with fat mass (P＜0.05). Fat mass was negatively correlated with total testosterone, calculated free testosterone, and SHBG (r=-0.26; P＜0.01, r=-0.15; P＜0.05, r=-0.31; P＜0.01). WHR was positively correlated with age (r=0.26; P＜0.01) and negatively correlated with total testosterone, calculated free testosterone, and IGF-1 (r=-0.24; P＜0.01, r=-0.20; P＜0.01, r=-0.16; P＜0.05). After adjustment for age, body mass index, smoking, and fat intake, the calculated free testosterone and IGF-1 were independently negatively correlated with fat mass (β=-0.072; P＜0.01, β=-0.0035; P＜0.05) and WHR (β=-6.9E-04; P＜0.05, β=-4.0E-05; P＜0.05) but, total testosterone and SHBG were not independently correlated with fat mass and WHR.
Conclusion : The results indicate that the calculated free testosterone and IGF-1 can be independent determinants of fat mass and WHR in middle-aged men.
Background : This study was done to investigate the clinical risk factors of delirium in general hospital's elderly inpatients.
Methods : A case-control study design was used. Forty cases and age-sex matched 120 controls were identified using hospital discharge data from June 1995 to May 2001. The controls were selected during the same period. The clinical records of each subject were reviewed using discharged disease code to select cases. Subsequently, the data were recorded from clinical records.
Results : The subjects admitted with delirium with delirium tended to have increased age (P=0.007), hypoxia (P=0.018), low hemoglobin(P=0.011), sleep disturbance(P=0.001), more ADL total dependence(P=0.018), diagnoses with infections (P=0.006), diabetes (P=0.046), and hypertension (P=0.041). Above risk factors seemed to be clinically associated with delirium.
Conclusion : These findings indicate that rapid infection control, maintenance of good sleep hygiene, well-controlled diabetes and hypertension, and correction of hypoxia may help to prevent delirium in general hospital's elderly inpatients.
Background : Although it has become obvious that male osteoporosis represent a public health issue, few studies has been done in Korea concerning the association between grip strength and bone mineral density(BMD) in men. This study was undertaken to enforce the necessity of muscle strengthening exercise program to improve BMD in middle-aged men by evaluate the association between grip strength and BMD.
Methods : The study was performed from January to December 1998 in the health screening center of CHA hospital with 174 men who measured both BMD and grip strength. BMD was measured at the proximal and distal radius of the dominant hand using Osteoplan p-DXA and grip strength was measured from the dominant hand using dynamometer. Daily calcium intake was measured through the interview with the diet therapist. Other datas were obtained from the questionnaire.
Results : We found a significant positive correlation between grip strength and BMD of distal and proximal radius(r=0.208; P<0.01, r=0.2555; P<0.01) and a significant negative correlation between age and BMD of distal and proximal radius(r=-0.313; P<0.01,r=-0.190; P<0.05). There was no correlation between calcium intake and BMD. BMI was correlated significantly only with BMD of distal Radius(r=0.194; P<0.05). There was no significant difference in BMD either by smoking or exercise. The multiple regression analysis showed that grip strength was independently correlated with BMD of the proximal radius significantly(β=1.731, P<0.05), but not with BMD of the distal radius after adjusting the confounding variables.
Conclusion : In conclusion, there is a significant correlation between grip strength and BMD in middle aged men. Therefore it can be safely concluded that it is helpful to carry out muscle strengthening program to improve muscle strength and increase BMD for preventing male osteoporosis.
Background : The prevalance of coronary heat disease is significantly higher in men than in premenopausal women of the same age. Impact that endogenous androgens have on serum lipid has many arguments and few researches were made in Korea. So this study was made to investigate correlation between total testosterone and serum lipid known as effect on cardiovascular disease.
Methods : This was a cross-sectional study on 560 middle aged men undertaken health screening program in Pundang General Hospital. Korea for June 1999 to June 2000. We surveyed informations concerning exercise, consumption of alcohol and smoking by means of self questionnaire records and total testosterone and serum lipid were measured at fasting state.
Results : Body mass index was positively correlated with total cholesterol and triglycerides(r=2.023;P<0.01, r=0.229;P<0.01) but negatively correlated with HDL-cholesterol (r=-0.284;P<0.001). Total testosterone concentrations were negatively correlated with total cholesterol and triglyceride(r=-0.096; P<0.05, r=-0.145; P<0.01) but positively correlated with HDL-cholesterol(r=0.155; P<0.001). Total testosterone concentrations were independently correlated with HDL-cholesterol after age and body mass index were adjusted(B=0.734; P<0.05). And after statistical adjustment for age, body mass index, exercise, smoking and alcohol, total, testosterone concentrations were significantly correlated with triglyceride(B=-10.467; P<0.05).
Conclusion : The result indicate that total testosterone can be a independent determinant of HDL-cholesterol and we expect that appropriate maintenance of total tetosterone concentrations will have a protective effect for cardiovascular disease.
Background : Cognitive impairment often goes unrecognized by physicians because the many previous tools to evaluate cognitive function in the clinical setting are difficult and time-consuming. The purpose of this study was to compare the Clock Drawing Test(CDT) with the Mini-Mental State Examination(MMSE) as a cognitive screening tool for elderly patients.
Methods : In a hospital-based outpatient clinic, 99 patients aged 65 or older were administered with the MMSE and were asked to mark the digits in the pre-drawn clock. They are also evaluated with the Geriatric depression scale, the Activities of Daily Living, and the Instrumental Activities of Daily Living.
Results : Correlation between CDT and MMSE was high(r=-0.606; p<0.001). With respect to CDT, there were significant correlations with all subscales of MMSE except registration of memory(p<0.01). CDT with scores of 2 had a sensitivity of 68.2% and a specificity of 70.9% for mild cognitive impairment. CDT with scores of 4 had a sensitivity of 80.8% and a specificity of 84.8% for severe cognitive impairment.
Conclusion : CDT can be an effective and simple cognitive screening tool for the elderly patients in the primary care outpatient clinic, if compensated for registration of memory among the cognitive function.
Background : Clinicians are based on routine urinalysis when they treated urinary tract infection as primary laboratory finding. In this study we analyzed the relationship between routine urinalysis and the results of urine cultures in order to identify predictors of cultures result in the diagnosis of UTI.
Methods : Bacteriuria, pyuria and nitrite test as predictors of UTI's in patients, who were not tooked medication, were eveluated in 158 visits in one hospital, using a positive urine culture as a gold standard.
Results : The overall culture positivity rate was 34.8%(55 out of 158 cases). A difference was not found between ages(P>0.05). The sensitivity and specificity of microscopic bacteriuria were 78.2% and 79.6%, repectively. The results of nitrite of nitrite test were 50.9% and 87.3%. The validity of pyuria was increased by increasing number of WBC, but specificity was higher than sensitivity. Urine tests consisting of a positive nitrite test, microscopic bacteriuria, microscopic WBC>15/HPF, the sensitivity and specificity were 34.8% and 89.5%, respectively.
Conclusion : Sensitivity and specificity of bacteriuria and specificity of nitrite test were contributed the highest validity in the prediction of urine culture result.
In order to be available in fundamental data for establishment & assesment of OB & Gyn. Curriculum and for practice guidance in family practice residency program practiced by a family physician at a community hospital from Jan. in 1990. The results were as follows ; 1. The age distribution in 277 outpatients of this study was 39.9% in the twenties, 22.2% in the thrties, 16.4% in forties, 13.3% in fifties, 6.45% in the over sixty years old, 1.8% in the under nineteen years old. 2. The total number of chief complaints of problems of the outpatients was 436 and among them, leukorrhea was the most common problem(20.4%) 2nd was amenorrhea or antenatal care(18.7%). The percentage of problems from the most frequent to the 10th most frequent was 91.9%. 3. The following history takings were asked to the patients by physican : menstrual & parity history to 93.6%, 91.6% of patients, respectively. Contraceptives & sexual history to 29.2% of patients, family history & other medical history to 27.9% of patients. 4. The average number of diagnostic tools done per patient was 1.4, of which the top 10 most commonly performed tests comprised 99.2% of the total. Gram stain & wet smear ranked first comprising 21.8% of the total and followed by Pap smear with 19.0%, and pelvic sonogram with 15.0%. 5. The diagnosis by physician were classified according to 378 items in the ICH PPC-2 defined method. Among 356 diagnoses, pregnancy or antenatal care was the most common diagnosis(21.9%) and followed by nonspecific vaginitis(18.0%). The cumslative percentage from the most common diagnosis to 19th most common accounted for 95.9%. 6. Among them, normal delivery was 87.8%, vacuum delivery was 4.9%, and Cesarean section was 7.3%.
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