Development of Korea Neuroethics Guidelines

Background@#Advances in neuroscience and neurotechnology provide great benefits to humans though unknown challenges may arise. We should address these challenges using new standards as well as existing ones. Novel standards should include ethical, legal, and social aspects which would be appropriate for advancing neuroscience and technology.Therefore, the Korea Neuroethics Guidelines were developed by stakeholders related to neuroscience and neurotechnology, including experts, policy makers, and the public in the Republic of Korea.Method: The guidelines were drafted by neuroethics experts, were disclosed at a public hearing, and were subsequently revised by opinions of various stakeholders. @*Results@#The guidelines are composed of twelve issues; humanity or human dignity, individual personality and identity, social justice, safety, sociocultural prejudice and public communication, misuse of technology, responsibility for the use of neuroscience and technology, specificity according to the purpose of using neurotechnology, autonomy, privacy and personal information, research, and enhancement. @*Conclusion@#Although the guidelines may require a more detailed discussion after future advances in neuroscience and technology or changes in socio-cultural milieu, the development of the Korea Neuroethics Guidelines is a milestone for the scientific community and society in general for the ongoing development in neuroscience and neurotechnology.

Leucrose, a Sucrose Isomer, Suppresses Hepatic Fat Accumulation by Regulating Hepatic Lipogenesis and Fat Oxidation in High-fat Diet-induced Obese Mice

Obesity is currently one of the most serious public health problems and it can lead to numerous metabolic diseases. Leucrose, d-glucopyranosyl-α-(1-5)-d-fructopyranose, is an isoform of sucrose and it is naturally found in pollen and honey. The aim of this study was to investigate the effect of leucrose on metabolic changes induced by a high-fat diet (HFD) that lead to obesity. C57BL/6 mice were fed a 60% HFD or a HFD with 25% (L25) or 50% (L50) of its total sucrose content replaced with leucrose for 12 weeks. Leucrose supplementation improved fasting blood glucose levels and hepatic triglyceride content. In addition, leucrose supplementation reduced mRNA levels of lipogenesis-related genes, including peroxisome proliferator-activated receptor γ, sterol regulatory element binding protein 1C, and fatty acid synthase in HFD mice. Conversely, mRNA levels of β oxidation-related genes, such as carnitine palmitoyltransferase 1A and acyl CoA oxidase, returned to control levels with leucrose supplementation. Taken together, these results demonstrated the therapeutic potential of leucrose to prevent metabolic abnormalities by mediating regulation of plasma glucose level and hepatic triglyceride accumulation.

Consensus guidelines for the definition of the end stage of disease and last days of life and criteria for medical judgment

In Korea, the Hospice, Palliative Care, and Life-sustaining Treatment Decision-making Act was enacted in February 2016 in order to ensure that the patient's self-determination in end-of-life care processes is respected. To enhance physicians' understanding of this act and to provide proper criteria for medical judgment in variety of clinical settings, consensus guidelines were published in November 2016. In this article, the characteristics of these guidelines and related issues regarding the definitions of ‘the end stage of disease’ and ‘last days of life’ and the criteria for medical judgment are presented and summarized. According to the guidelines, the term ‘end stage of disease’ refers to a state in which there is no possibility of a fundamental recovery and the symptoms are expected to worsen within months. The terms ‘the last days of life’ and ‘the final days of life’ refer to a state in which, despite treatment, the patient's condition is worsening and death is impending, with no possibility of recovery. The attending physician and another relevant specialist should both judge a patient's medical condition as either ‘end stage of disease’ for hospice/palliative care or ‘the last days of life’ for dying patient care according to the law. Caregivers should provide appropriate medical information to eligible patients for palliative or ‘end stage of disease’ care through advance care planning. Therefore, it is critically necessary that caregivers understand the legitimate process of hospice/palliative and dying patient care based on the patient's wishes and best interests. Physicians should apply these consensus guidelines to eligible patients considering their clinical course and the patients' wishes.

Medical Professionalism and Self-Reflection in Medical Education / 의학교육논단

Recently, unprofessional behavior by physicians and misconduct by medical students have led to increased public concern over medical professionalism. Many studies have been conducted to explore strategies that reinforce professionalism education and prevent misconduct in medical students. However, most studies focused on defining the medical professionalism and its conceptual components. In this study, we conducted a conceptual analysis based on the literature review to categorize issues of unprofessional behavior, and identified doctors' indifference to self and others as the reason for the unprofessional behavior. In this regard, self-reflection provides a practical tool to overcome such indifference. We suggest ‘education and evaluation based on self-reflection and reflective practices’ as the effective strategies to enhance the professionalism in medical students.

Consensus guidelines for the definition of the end stage of disease and last days of life and criteria for medical judgment

In Korea, the Hospice, Palliative Care, and Life-sustaining Treatment Decision-making Act was enacted in February 2016 in order to ensure that the patient's self-determination in end-of-life care processes is respected. To enhance physicians' understanding of this act and to provide proper criteria for medical judgment in variety of clinical settings, consensus guidelines were published in November 2016. In this article, the characteristics of these guidelines and related issues regarding the definitions of ‘the end stage of disease’ and ‘last days of life’ and the criteria for medical judgment are presented and summarized. According to the guidelines, the term ‘end stage of disease’ refers to a state in which there is no possibility of a fundamental recovery and the symptoms are expected to worsen within months. The terms ‘the last days of life’ and ‘the final days of life’ refer to a state in which, despite treatment, the patient's condition is worsening and death is impending, with no possibility of recovery. The attending physician and another relevant specialist should both judge a patient's medical condition as either ‘end stage of disease’ for hospice/palliative care or ‘the last days of life’ for dying patient care according to the law. Caregivers should provide appropriate medical information to eligible patients for palliative or ‘end stage of disease’ care through advance care planning. Therefore, it is critically necessary that caregivers understand the legitimate process of hospice/palliative and dying patient care based on the patient's wishes and best interests. Physicians should apply these consensus guidelines to eligible patients considering their clinical course and the patients' wishes.

Graduate and postgraduate medical ethics education

This article provides an overview of medical ethics education for practicing doctors in Korea, focusing on its aims, objectives, content, pedagogical methods, educators, and key issues and challenges for future development. Education on medical ethics for practicing doctors in Korea started relatively recently on a small scale, based on the initiative of a few specialty boards. Currently, no formal aims and objectives for medical ethics education for practicing doctors have been proposed, and no formalized curricula have been developed by any specialty boards or by the Korean Medical Association. In the educational programs that currently exist, lectures are the predominant teaching method, and only a few educators who are doctors specializing in medical ethics deliver all those lectures. Thus, there are many issues and challenges in the Korean medical environment that must be thoroughly investigated and overcome. Nevertheless, medical ethics is an integral part of the medical profession and should be taught at all levels of training, including undergraduate, graduate, and postgraduate.

Graduate and postgraduate medical ethics education

This article provides an overview of medical ethics education for practicing doctors in Korea, focusing on its aims, objectives, content, pedagogical methods, educators, and key issues and challenges for future development. Education on medical ethics for practicing doctors in Korea started relatively recently on a small scale, based on the initiative of a few specialty boards. Currently, no formal aims and objectives for medical ethics education for practicing doctors have been proposed, and no formalized curricula have been developed by any specialty boards or by the Korean Medical Association. In the educational programs that currently exist, lectures are the predominant teaching method, and only a few educators who are doctors specializing in medical ethics deliver all those lectures. Thus, there are many issues and challenges in the Korean medical environment that must be thoroughly investigated and overcome. Nevertheless, medical ethics is an integral part of the medical profession and should be taught at all levels of training, including undergraduate, graduate, and postgraduate.

Regulation of Inflammation by Sucrose Isomer, Turanose, in Raw 264.7 Cells

Increased sugar consumption has been proposed to be a risk factor for obesity-related metabolic disorders. The objective of this study was to investigate the anti-inflammatory effect of turanose in Raw 264.7 macrophages. Turanose (3-O-α-D-glucosyl-D-fructose), an isomer of sucrose, naturally exists in honey. For these studies, macrophages were treated with total glucose (Glu), 50% Glu/50% turanose (T50), 25% Glu/75% turanose (T75), and 100% turanose (T100), each with a total concentration of 25 mM in cell media. Expressions of inflammatory enzymes and cytokines were analyzed. Cell viability was not affected in the turanose treated groups compared to the Glu group. Lipopolysaccharide and glucose-induced nitric oxide production, protein expression of inducible nitric oxide synthase, COX-2, and superoxide dismutase 2, and mRNA expression levels of interleukin (IL)-1β and IL-18 were significantly suppressed by turanose treatment. These results demonstrate that turanose exerts anti-inflammatory effects in vitro, and possesses potential to serve therapeutic functional sweetener for testing in vivo and in clinical trials.

Acute and 13-week subchronic toxicological evaluations of turanose in mice

BACKGROUND/OBJECTIVES: Turanose, α-D-glucosyl-(1→3)-α-D-fructose, is a sucrose isomer which naturally exists in honey. To evaluate toxicity of turanose, acute and subchronic oral toxicity studies were conducted with ICR mice. MATERIALS AND METHODS: For the acute oral toxicity study, turanose was administered as a single oral dose [10 g/kg body weight (b.w.)]. In the subchronic toxicity study, ICR mice were administered 0, 1.75, 3.5, and 7 g/kg b.w. doses of turanose daily for 13 weeks. RESULTS: No signs of acute toxicity, including abnormal behavior, adverse effect, or mortality, were observed over the 14-day study period. In addition, no changes in body weight or food consumption were observed and the median lethal dose (LD₅₀) for oral intake of turanose was determined to be greater than 10 g/kg b.w. General clinical behavior, changes in body weight and food consumption, absolute and relative organ weights, and mortality were not affected in any of the treatment group for 13 weeks. These doses also did not affect the macroscopic pathology, histology, hematology, and blood biochemical analysis of the mice examined. CONCLUSION: No toxicity was observed in the acute and 13-week subchronic oral toxicology studies that were conducted with ICR mice. Furthermore, the no-observed-adverse-effect level is greater than 7 g/kg/day for both male and female ICR mice.

D-Xylose as a sugar complement regulates blood glucose levels by suppressing phosphoenolpyruvate carboxylase (PEPCK) in streptozotocin-nicotinamide-induced diabetic rats and by enhancing glucose uptake in vitro

BACKGROUND/OBJECTIVES: Type 2 diabetes (T2D) is more frequently diagnosed and is characterized by hyperglycemia and insulin resistance. D-Xylose, a sucrase inhibitor, may be useful as a functional sugar complement to inhibit increases in blood glucose levels. The objective of this study was to investigate the anti-diabetic effects of D-xylose both in vitro and stretpozotocin (STZ)-nicotinamide (NA)-induced models in vivo. MATERIALS/METHODS: Wistar rats were divided into the following groups: (i) normal control; (ii) diabetic control; (iii) diabetic rats supplemented with a diet where 5% of the total sucrose content in the diet was replaced with D-xylose; and (iv) diabetic rats supplemented with a diet where 10% of the total sucrose content in the diet was replaced with D-xylose. These groups were maintained for two weeks. The effects of D-xylose on blood glucose levels were examined using oral glucose tolerance test, insulin secretion assays, histology of liver and pancreas tissues, and analysis of phosphoenolpyruvate carboxylase (PEPCK) expression in liver tissues of a STZ-NA-induced experimental rat model. Levels of glucose uptake and insulin secretion by differentiated C2C12 muscle cells and INS-1 pancreatic beta-cells were analyzed. RESULTS: In vivo, D-xylose supplementation significantly reduced fasting serum glucose levels (P < 0.05), it slightly reduced the area under the glucose curve, and increased insulin levels compared to the diabetic controls. D-Xylose supplementation enhanced the regeneration of pancreas tissue and improved the arrangement of hepatocytes compared to the diabetic controls. Lower levels of PEPCK were detected in the liver tissues of D-xylose-supplemented rats (P < 0.05). In vitro, both 2-NBDG uptake by C2C12 cells and insulin secretion by INS-1 cells were increased with D-xylose supplementation in a dose-dependent manner compared to treatment with glucose alone. CONCLUSIONS: In this study, D-xylose exerted anti-diabetic effects in vivo by regulating blood glucose levels via regeneration of damaged pancreas and liver tissues and regulation of PEPCK, a key rate-limiting enzyme in the process of gluconeogenesis. In vitro, D-xylose induced the uptake of glucose by muscle cells and the secretion of insulin cells by beta-cells. These mechanistic insights will facilitate the development of highly effective strategy for T2D.

Medical students' empathy and its effect on the physicianpatient relationship / 한국의학교육

PURPOSE: Recent studies have emphasized the importance of empathy in the physician-patient relationship (PPR). The purpose of this study was to examine the association between empathy scores, as measured by the student version of the Jefferson Scale of Empathy, Korean edition (JSE-S-K), and PPR scores on the clinical performance examination (CPX). METHODS: The sample comprised 104 third-year medical students. Prior to undertaking 12 cases on the CPX, the students completed the JSE-S-K and Myers-Briggs Type Indicator. We analyzed the differences in empathy and PPR scores according to their sociodemographic characteristics and personality types and verified the link between empathy and PPR scores by stepwise multiple linear regression analysis. RESULTS: PPR scores were positively associated with total JSE-S-K scores (r=0.232, p<0.05) and its affective domain scores (r=0.229, p<0.05). Education program (undergraduate or graduate entry) and empathy score were the best predictors of PPR score (R2=0.153). CONCLUSION: The positive association between empathy and PPR scores suggests that empathy is an important factor that influences the PPR.

Effects of xylooligosaccharide-sugar mixture on glycemic index (GI) and blood glucose response in healthy adults / 한국영양학회지

PURPOSE: The objective of this study was to investigate the effects of xyloologosaccharide (XOS)-sugar mixture on glycemic index (GI) and blood glucose in human subjects. METHODS: Randomized double-blind cross-over studies were conducted to examine the effect of sucrose with 14% xyloologosaccharide powder (Xylo 14) and sucrose with 20% xylooligosaccharide powder (Xylo 20) on GI and postprandial glucose response at 15, 30, 45, 60, 90, and 120 min. RESULTS: GIs of Xylo 14 and Xylo 20 were 60.0 +/- 23.5 classified within medium GI range, and 54.3 +/- 17.7 within low GI range, respectively. Xylo 14 and Xylo 20 showed significantly lower area under the glucose curve (AUC) for 0-15 min (p = 0.0113), 0-30 min (p = 0.0004), 0-45 min (p < 0.0001), 0-60 min (p < 0.0001), 0-90 min (p < 0.0001), and 0-120 min (p = 0.0001). In particular, compared with glucose, the blood glucose levels of Xylo 14 and Xylo 20 were significantly lower at every time point between 15 and 120 min. CONCLUSION: The results of this study suggested that Xylo 14 and Xylo 20 had an acute suppressive effect on GI and the postprandial glucose surge.

Ethical principles and practice guidelines concerning the usage of public database for medical researches

In this paper, ethical principles and practice guidelines concerning the usage of public database for medical researches were developed and proposed. Although there are several personal health databases with comprehensive information of each individual, researches aiming at public good are often hindered because of legal, managerial and technical barriers to the usage of public databases. Ethical principles and guidelines are indispensible to promote medical research that will benefit society while protecting personal information from bleaching and abuse. These principles and guidelines should be a basis of trust and supports from society. For this purpose, the meaning of public good was given, and the current status of the linkage and usage of public databases were explored. As a result, three ethical principles-guaranteeing public good, protecting personal information, and transparency were established and eight recommendations were proposed.

The Amount of Physical Activity According to the Level of High Density Lipoprotein Cholesterol in Korean Adults

BACKGROUND: A low level of high-density lipoprotein-cholesterol (HDL-C) is well known as an important cardiovascular risk factor which is closely associated with physical activity levels. However, there is a very few studies conducted on relationship between physical activity and HDL-C status among Korean adults. METHODS: We selected total 22,294 people aged 19 to 69 years old who had not taken lipid lowering agents from the 2005 Korea National Health and Nutrition Examination Survey (NHANES) data. The population was classified into three groups using the criteria for HDL-C of Adult Treatment Panel III. The relationship between the physical activity and HDL-C was investigated and the amount of physical activity levels of the three HDL-C groups were obtained with analysis of covariance with adjustments for various factors influencing the physical activity levels. RESULTS: After adjusted for various factors influencing HDL-C, physical activity is significantly associated with HDL-C. As physical activity is increased, HDL-C is much higher (P<0.001).The physical activity levels were significantly different among the three HDL-C groups. The amount of physical activity in low HDL-C group was significantly low compared to high HDL-C group (1653.08+/-65.31 MET-min/wk vs. 1916.70+/-102.86 MET-min/wk, P<0.001). CONCLUSIONS: We confirmed that the amount of physical activity level in low HDL-C group was significantly lower compared with that of high HDL-C group in Korean adults.

Relationship between Obesity and Depression in the Korean Working Population

This study was conducted to investigate potential relationship between obesity and depression in Korean working population. A total of 8,121 workers, aged 21-75 yr, participated in this nationwide cross-section research. The participants asked to complete a questionnaire regarding the socio-demographic factors and health-related behaviors, height, and weight. To measure degree of depression, the Korean version of the Center for Epidemiologic Studies-Depression scale (CES-D) was used. Chi-square test and multivariate logistic regression analyses were performed to examine the degree of association between obesity and depression. Compared to normal-weight women, overweight women had a lower adjusted odds ratio (OR) for depression (OR=0.65, 95% confidence interval 0.46 to 0.97). Underweight (1.42, 0.83 to 2.44) and obese women (BMI > or =30) had higher ORs for depression (1.47, 0.64 to 3.36), but these were insignificant. Compared to normal-weight men, obese men had higher crude ORs (1.94, 1.03 to 3.62) and adjusted ORs (1.77, 0.89 to 3.53) for depression, while underweight and overweight men showed no significant differences. These findings suggest that being overweight may protect Korean female worker against depression.

Inpatient Smoking Cessation Program and Its Success Rate for Abstinence among Korean Smokers / 가정의학회지

BACKGROUND: Inpatient smoking cessation programs have been known to be quite effective for smoking cessation, but it was rarely conducted among Koreans. This study was to investigate the effect of inpatient smoking cessation program among Korean smokers. METHODS: From March 1 to April 30, 2008, we carried out a randomized controlled trial for inpatient smoking cessation program among 70 smokers who were 18 years of age or over and admitted to a university hospital in Seoul, Korea. For the intervention group, a trained doctor conducted the systematic educational program for smoking cessation of 30 minutes to an hour. For the control group, they were advised with a 3-minute explanation for smoking cessation. We assessed the abstinence rates of study participants at 1 week, 1 month, and 3 months after discharge. RESULTS: In 3 months after the discharge, the abstinence rate for the intervention group was 37.1% while that of the control group was 14.3%. In simple logistic regression analysis, the smokers among the intervention group were 3.5 times more likely to abstain than those in the control group. After controlling for confounding factors, the smokers among the intervention group was 11.4 times more likely to abstain than those in the control group. CONCLUSION: For Korean smokers, the inpatient smoking cessation program showed a higher success rate of abstinence compared to simple advice and limited counselling.

Correlation between Frailty Level and Disability of the Elderly and Frailty Related Factors / 가정의학회지

BACKGROUND: Frailty is a wasting syndrome that presents loss of physiological function by aging, lowering of reserve capacity, and disability of body system. It is currently being considered an important issue in geriatrics. This study examined frailty level of Korean elderly in community and whether frailty can be meaningful a predictive factor for functional disability. METHODS: Demographic characteristics, the number of chronic diseases and medications, cardiovascular health study (CHS) frailty index, study of osteoporotic fractures (SOF) frailty index, activities of daily living, Instrumental activities of daily living, depression, mini-mental state examination (MMSE) and fall history were examined for 302 men and women over 65 years old who visited the three community seniors welfare centers from February 2008 to June 2008. RESULTS: There were definite differences of frailty status by age, educational level, marital status, monthly income, body mass index, the number of chronic diseases, the number of medications, depression, MMSE and fall history (P < 0.05), except in gender (P < 0.432). In logistic regression analysis for functional disability with frailty status defined by SOF frailty index, odds ratio to dependency of instrumental activities of daily living (IADL) from the healthy to the prefrail stage increased 6.84 times while from the healthy to the frail stage increased 130.87 times. These effects still increased after covariate adjustment. Also, the CHS frailty index showed the same result although there was some difference in odds ratio. CONCLUSION: There were meaningful correlations of frailty with functional disability when dividing Korean elderly's frailty levels into the healthy, the prefrail and the frail stages.

Relationship between Brand Nicotine Yield of Cigarettes and Urine Cotinine Level in Male Smokers / 가정의학회지

BACKGROUND: As one of harm reduction strategies, tobacco manufacturers have begun to introduce lower-yield cigarettes. Lower-yield cigarettes, so called light cigarettes, have been perceived as less hazardous by some smokers. However, there have been very few studies concerning smoking lower yield products the lead to lower nicotine absorption. We evaluated the association between brand nicotine yield of cigarettes and actual nicotine intake by measuring urinary cotinine. METHODS: Four hundred sixty four male smokers aged 18 or over who participated in health check-ups in a hospital from May to October 2007 filled out a self-administered smoking questionnaire. Urinary cotinine concentration was measured at the time of participation. The subjects were divided into three groups (ultralight [nicotine: 0.05 mg], light [0.1 mg], and regular [> 0.1 mg] group) according to the level of brand nicotine yield of cigarettes which they smoked. RESULTS: The median urinary cotinine concentrations of ultralight (N = 62), light (N = 216), and regular (N = 186) groups were 735.5 ng/mL (interquartile range, 320 to 1,300 ng/mL), 956.0 ng/mL (429 to 1,491 ng/mL), and 1,067.5 ng/mL (615 to 1,613 ng/mL), respectively. There was a signifi cant difference in urinary cotinine between the regular and the other groups (P = 0.015). However, multiple logistic regression analysis to evaluate the risk of being in the highest quartile of urinary cotinine concentration (> or = 1,532 ng/mL) after adjusting for possible confounding variables showed that the odds ratios were 0.84 (95% CI, 0.52 to 1.37) in the light nicotine group and 0.82 (95% CI, 0.38 to1.72) in the ultralight nicotine group compared to the regular nicotine group. CONCLUSION: There was no significant difference in the risk of elevated urinary cotinine concentrations in male adult smokers according to brand nicotine yield of cigarettes groups.

Fasting Plasma Glucose Levels and Metabolic Syndrome in Normoglycemic Adults

BACKGROUND: Metabolic syndrome has been introduced to increase the incidence of cardiovascular diseases and type 2 diabetes mellitus. Our aim of this study was to investigate the association of fasting plasma glucose levels and metabolic syndrome in normoglycemic adults. METHODS: We examined lifestyle factors, anthropometric and laboratory measurement of adults with no personal history of diabetes and normal fasting glucose from the Korean National Health and Nutrition Examination Survey 2001. We categorized the fasting plasma glucose levels below 100 mg/dl into the quintiles and assessed the association of metabolic syndrome with increasing glycemia in normoglycemic adults. RESULTS: Quintiles of normal fasting plasma glucose levels showed a positive trend with metabolic risk factors including abdominal obesity, high blood pressure, and obesity in normoglycemic adults (P<0.001). Hypertriglyceridemia, low HDL-cholesterolemia, smoking, heavy drinking, and physical activity were of no significance. A multivariate model, adjusted for age, sex, smoking status, physical activity, and heavy drinking, revealed a progressively increased odds ratio of metabolic syndrome, 1.05 (95% CI, 0.76~1.44), 1.15 (95% CI, 0.84~1.58), 1.33 (95% CI, 0.99~1.80), 1.55 (95% CI, 1.14~2.10), with increasing fasting plasma glucose levels, as compared with fasting plasma glucose level of 81 mg/dl or less (P<0.001). CONCLUSION: Higher fasting plasma glucose levels within the normoglycemic range may constitute a risk of metabolic syndrome in normoglycemic adults.

Polypharmacy and Inappropriate Drug Prescription in Community-dwelling Elderly

BACKGROUND: Due to rapidly growing elderly population, there are increasing numbers of older persons with multiple chronic disorders and geriatric problems arising from polypharmacy. In this study we tried to find out the state of polypharmacy and inappropriate drug prescription and their related factors in community-dwelling elderly by review of drugs taken by older persons visiting a day health center. METHODS: From April 2007 to July 2007, 80 subjects of 65 year-old or over with chronic illness who visited a elderly-wellness and health care center were randomly sampled. All of them were surveyed by structured questionnaires, medical records review, pill counts about all medications they are taking and experience of adverse drug reactions. And all the prescribed medications were reviewed or their drug prescription's appropriateness for each elderly according to Beers criteria. Data results were evaluated by frequency and correlation analyses. RESULTS: The average counts of drugs taken by elderly with chronic disorders were 7.23, minimum 1 to maximum 27 drugs a day. Patients experienced more adverse effects significantly when more prescribed medications were taken (P=0.005), and patients with lack of information about their drugs had taken increased number of medications (P<0.001). Referred to Beers criteria, inappropriate cases of prescription were observed in 26 persons. Those drugs were NSAIDs including aspirin in 17 subjects (21%), amitrityline in 3 (4%), short-acting benzodiazepines in 3 (4%), long acting benzodiazepines in 2 (3%), and anticholinergic antihistamine in 1 (1%). CONCLUSION: Polypharmacy is very common in community-dwelling elderly with chronic disorders. More medications were related to more adverse drug reactions and lack of information about their drugs related to increased number of drug taking. High proportion of inappropriate drug prescriptions was observed in the elderly, which may have resulted from poor education concerning geriatric care of the medical personnels.