A Pilot Fruit and Vegetable Prescription (FVRx) Program Improves Local Fruit and Vegetable Consumption, Nutrition Knowledge, and Food Purchasing Practices.

Fruit and Vegetable Prescription (FVRx) programs rely on diverse community and clinic partnerships to improve food security and fruit and vegetable consumption among medically underserved patient populations. Despite the growth in these programs, little is known about the feasibility or effectiveness of the unique partnerships developed to implement FVRx programs conducted in both community and free safety-net clinic settings. A 6-month nonrandomized controlled trial of an FVRx program was pilot tested with 54 Supplemental Nutrition Assistance Program (SNAP)-eligible adults with diet-related chronic conditions. The intervention combined monthly produce prescriptions for local produce at a farmers market, SNAP-Ed direct nutrition education, and health screenings for low-income adults. Process and outcome evaluations were conducted with respective samples using administrative program data (recruitment, retention, and prescription redemption) and self-administered pre- and postintervention surveys with validated measures on dietary intake, nutrition knowledge and behavior, and food purchasing practices. Descriptive statistical analyses were conducted. The FVRx program retained 77.3% of participants who spent nearly 90% of their prescription dollars. After the intervention, the FVRx group reported significantly increased total intake of fruits and vegetables, knowledge of fresh fruit and vegetable preparation, purchase of fresh fruits and vegetables from a farmers market, and significantly altered food purchasing practices compared with the control group. Community-based nutrition education organizations enhance the feasibility and effectiveness of community and clinic-based FVRx programs for improving low-income adults' ability to enhance food and nutrition-related behaviors.

Application of Interphase Fluorescent in Situ Hybridization: a Screening Tool for the Diagnosis of Microdeletion Syndrome.

BACKGROUND: Most laboratories adopt the results of metaphase fluorescent in situ hybridization (FISH) for the diagnosis of microdeletion syndromes. To investigate the discrepancy between the results of interphase and metaphase, we compared the quantitative results of FISH for 5 kinds of microdeletion syndrome and gender determination disorders (SDD). METHODS: A total of 282 (135 for DiGeorge syndrome, 20 for Kalmann syndrome, 7 for Miller-Dieker syndrome, 38 for Prader Willi/Angelman syndrome, 62 for Williams syndrome, and 20 for SDD (SRY FISH)) were enrolled. For SRY FISH, we artificially mixed fresh blood of male and female with various ratios and then compared the results of metaphase and interphase SRY FISH. Using a bio-cell chip, we performed interphase FISH in 168 patients with microdeletion syndromes and compared the results with manual interphase. RESULTS: The concordance rate between the results of metaphase and interphase was 100% in microdeletion syndrome. In the disorders of gender development, SRY FISH showed 100% concordance between interphase and metaphase when we counted 50 metaphase cells and 100 interphase cells. Comparison with mixtures of male and female blood at various ratios also showed 100% concordance. The results of bio-cell chip showed 100% concordance between previous interphase FISH results. CONCLUSIONS: Considering the complete concordance between interphase and metaphase in microdeletion syndrome, the application of interphase FISH without performing metaphase FISH can be a screening test for microdeletion syndrome. Confirmation by metaphase FISH can be performed only in cases with abnormal results by interphase FISH.

Strategies and Challenges: Qualitative Lessons Learned From Georgia Produce Prescription Programs.

Produce prescription programs (PPPs) have grown in numbers in the past decade, empowering health care providers to promote health by issuing subsidies for produce to vulnerable patients. However, little research has been conducted on the facilitators that make it easier for PPPs to succeed or the barriers that programs face, which could provide guidance on how to improve future PPP design and implementation. The study sought to identify the facilitators and barriers affecting positive outcomes in Georgia PPPs called Fruit and Vegetable Prescription (FVRx) Programs. A process evaluation with a qualitative comparative case study approach was conducted. Fifteen FVRx providers, ranging from nutrition educators to farmers market managers, were interviewed in a focus group interview or on the phone between 2016 and 2017. Two nutrition education classes and an FVRx best practices meeting were observed, and program documents were collected. Interview transcripts, field notes from observations, and documents were then thematically analyzed. Four overall themes were determined regarding facilitators and barriers experienced by FVRx programs: (1) creating accessible programming may encourage FVRx participation, (2) provider dedication to the program is important, (3) participants' challenging life circumstances can make participation difficult, and (4) the sustainability of the program is a concern. The findings of this study suggest helpful strategies and challenges for providers to consider when developing and implementing PPPs in Georgia and beyond. Research on the long-term program impact is needed, and policy options for sustainable, scaling up of PPPs should be explored.

Urine ß-2-glycoprotein 1 as a biomarker for diagnosis of systemic lupus erythematosus.

OBJECTIVE: The need for a biomarker with robust sensitivity and specificity in diagnosing systemic lupus erythematosus (SLE) remains unmet. Compared with blood samples, urine samples are more easily collected; thus, we aimed to identify such a biomarker based on urinary proteomics which could distinguish patients with SLE from healthy controls (HCs). METHODS: Urine samples were collected from 76 SLE patients who visited rheumatology clinic in 2019 at Asan medical center and from 25 HCs. Urine proteins were analyzed using sequential windowed acquisition of all theoretical fragment ion spectra-mass spectrometry, and the candidate marker was confirmed by enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic curve analysis was used to determine the diagnostic value of the candidate biomarker. RESULTS: Of 1157 proteins quantified, 153 were differentially expressed in urine samples from HCs. Among them were previously known markers including α-1-acid glycoprotein 1, α-2-HS-glycoprotein, ceruloplasmin, and prostaglandin-H2 D-isomerase. Moreover, the amount of ß-2 glycoprotein (APOH) was increased in the urine of patients with SLE. The ELISA results also showed the level of urine APOH was higher in patients with SLE than in HCs and patients with rheumatoid arthritis. Moreover, the level was not different between SLE patients with and without nephritis. The urine APOH had an area under the curve value of 0.946 at a cut-off value of 228.53 ng/mg (sensitivity 91.5%, specificity 92.0%) for the diagnosis of SLE. CONCLUSION: The results indicate that the urine APOH level can be an appropriate screening tool in a clinical setting when SLE is suspected.

Adapting a Nutrition Education Curriculum for Spanish-Speaking Adults Experiencing Low-Income: Recommendations from Key Stakeholders.

The purpose of this study was to understand recommendations of key stakeholders regarding cultural adaptation of an evidence-based nutrition and physical activity education curriculum for Spanish-speaking adults. Findings from focus groups with Spanish-speaking adults (n=43) and telephone interviews with experts in Spanish nutrition and health education (n=9) revealed: 1) emphasis of the heterogeneity of Spanish-speaking communities; 2) importance of including family in nutrition education; 3) importance of addressing cultural differences between Spanish-speaking and general United States culture; and 4) tips for engaging Spanish-speaking adults in health education. These findings were used to inform cultural adaptation of a nutrition education curriculum.

Methotrexate-related toxicity in patients with rheumatoid arthritis and renal dysfunction.

There are limited studies regarding the safety of methotrexate (MTX) in patients with reduced renal function. This study aimed to investigate methotrexate (MTX)-related toxicity in patients with rheumatoid arthritis (RA) and renal dysfunction. This retrospective cohort study included patients with RA and renal dysfunction. Renal dysfunction was defined as an estimated glomerular filtration rate (eGFR) of < 60 mL/min/1.73 m2. We classified the patients into two groups according to the onset of renal dysfunction: newly and previously developed group. MTX-associated toxicity included renal toxicity, hepatotoxicity, serious infection, pancytopenia, leukopenia, thrombocytopenia and mucositis. Cox analysis was performed to determine the factors associated with toxicity. The study included 120 patients with RA and renal dysfunction receiving MTX (66: newly developed; 54: previously developed). The median eGFR was 52.1 mL/min/1.73 m2 [IQR 47.1-57.3]. Thirty-five patients (29.2%) experienced toxicity, and the median time to toxicity events was 23 months (IQR 10-57). Toxicity was distributed as follows: leukopenia (10%, 12/120), renal toxicity (5.8%, 7/120), hepatotoxicity (7.5%, 9/120), serious infection (8.3%, 10/120), pancytopenia (5.0%, 6/120), thrombocytopenia (5.8%, 7/120), and mucositis (5.8%, 7/120). The toxicity rate did not differ significantly between newly and previously developed group [23/66 (34.8%) vs. 12/54 (22.2%), P = 0.130]. Multivariate analysis revealed that hydroxychloroquine use (HR 0.425, 95% CI 0.212-0.853, P = 0.016), baseline eGFR (HR 0.938, 95% CI 0.890-0.988, P = 0.015) and being female (HR 10.538, 95% CI 1.375-80.793, P = 0.023) were associated with MTX-related toxicity. Toxicity occurred in approximately 30% of patients with RA and renal dysfunction receiving MTX treatment. Hydroxychloroquine use exhibited a protective effect against MTX-associated toxicity development.

Effect of TNF inhibitors on bone mineral density in rheumatoid arthritis patients receiving bisphosphonate: a retrospective cohort study.

We aimed to determine whether tumor necrosis factor inhibitors (TNFi) have beneficial effects on bone mineral density (BMD) in rheumatoid arthritis (RA) patients with osteoporosis receiving bisphosphonate. A total of 199 RA patients, who were newly diagnosed with osteoporosis and receiving bisphosphonate between January 2005 and March 2017, were reviewed. Changes in BMD after 1 year were compared between patients treated with and without TNFi. The inverse probability of treatment weighting (IPTW) method using the propensity score was performed to minimize confounding factors, and logistic regression analysis was applied to identify any factors associated with significant BMD improvement (≥ 3%) at the lumbar spine and femur neck. Among patients receiving bisphosphonate, 29 were exposed to TNFi, and 170 patients were not exposed. The percentage change in BMD and the proportion of significant improvements at the lumbar spine and femur neck were similar between patients treated with and without TNFi, before and after IPTW adjustment. In addition, the disease activity score 28 (DAS28) with three variables [adjusted odds ratio (OR) 0.741, 95% confidence interval (CI) 0.592-0.927, p = 0.009] and cumulative steroid dose (adjusted OR 0.639, 95% CI 0.480-0.851, p = 0.002) were inversely associated with an improvement in BMD. Conversely, TNFi use was not associated with any improvement in BMD after adjustment by IPTW using the propensity score. TNFi did not influence BMD improvement in RA patients with osteoporosis receiving bisphosphonate, suggesting that TNFi cannot be considered as a preferred therapeutic option for increasing BMD.

Psychological Impact of Quarantine on Caregivers at a Children's Hospital for Contact with Case of COVID-19.

Quarantine often provokes negative psychological consequences. Thus, we aimed to identify the psychological and behavioral responses and stressors of caregivers quarantined with young patients after a close contact to a coronavirus disease 2019 case at a children's hospital. More than 90% of the caregivers reported feelings of worry and nervousness, while some of them reported suicidal ideations (4.2%), and/or homicidal ideations (1.4%). Fear of infection of the patient (91.7%) and/or oneself (86.1%) were most frequently reported stressors. A multidisciplinary team including infection control team, pediatrician, psychiatrist, nursing staff and legal department provided supplies and services to reduce caregiver's psychological distress. Psychotropic medication was needed in five (6.9%), one of whom was admitted to the psychiatry department due to suicidality. Quarantine at a children's hospital makes notable psychological impacts on the caregivers and a multidisciplinary approach is required.

Clinical features and risk of recurrence of acute calcium pyrophosphate crystal arthritis.

OBJECTIVES: It is unclear whether attack recurrence rates are similar between acute calcium pyrophosphate (CPP) crystal arthritis and gout. This study compared the clinical features and recurrence rates of both conditions. METHODS: In this retrospective study, we reviewed 106 patients with acute CPP crystal arthritis (based on the presence of CPP crystals and/or chondrocalcinosis) and 173 patients with gout (based on the presence of monosodium urate crystals). We analysed clinical variables and compared them between the two conditions. We identified factors associated with the recurrence of acute CPP crystal arthritis. RESULTS: Patients with acute CPP crystal arthritis were older (76.5 vs. 62 years, p<0.001) and female (69.8% vs. 6.9%, p<0.001); they had a lower body mass index (22.3 vs. 23.7, p=0.002), lower renal insufficiency rate (27.4% vs. 41.6%, p=0.016), and higher rate of preceding infection (22.6% vs. 11.0%, p=0.009) than those with acute gout. Recurrence rates were similar between the groups (19.1% vs. 22.9%, p=0.562). Use of proton pump inhibitors (PPIs) [hazard ratio (HR), 5.625; 95% CI, 1.672-18.925; p=0.005] and warfarin (HR, 7.301; 95% CI, 1.930-27.622; p=0.003) or exposure to chemotherapy (HR, 5.663; 95% CI, 1.180-27.169; p=0.03) were associated with acute CPP crystal arthritis recurrence. CONCLUSIONS: Acute CPP crystal arthritis was more common than acute gout in older women with preserved renal function. Physicians should be aware of the association between recurrence and PPI, warfarin, or chemotherapy use in these patients.

Effects of Pregnancy and Delivery Methods on Change in Ankylosing Spondylitis Treatment Using the Korean Health Insurance Review and Assessment Service Claims Database.

BACKGROUND: Women with ankylosing spondylitis (AS) show a higher rate of cesarean section (CS) compared with healthy women. In this study, we determined the effects of pregnancy and delivery methods on AS worsening by analyzing prescription patterns. METHODS: The subjects were women with AS aged 20-49 years listed in the Korean Health Insurance Review and Assessment Service claims database. Change in treatment was defined as change in prescriptions 1-2 years before delivery or 1 year after delivery. We compared change in prescriptions between AS women with delivery or without delivery (1:1 matched). Moreover, we evaluated change in prescriptions according to delivery method among AS women with delivery. RESULTS: A total of 6,821 women with AS were included. Women in the delivery group (n = 996) were younger and showed less drug use and lower comorbidity rates than those in the no delivery group. Change in prescriptions did not differ between the delivery and no delivery groups (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.56-1.05). Furthermore, the overall change in prescriptions did not significantly differ between vaginal delivery (VD) and CS (OR, 0.72; 95% CI, 0.45-1.14). CONCLUSION: The rate of change in prescriptions was comparable between AS patients with and without delivery. There was no association between the method of delivery and change in prescription. Therefore, pregnancy and VD may not be the factors associated with AS worsening.

Low white-matter integrity between the left thalamus and inferior frontal gyrus in patients with insomnia disorder

Background: Previous studies have reported functional and structural abnormalities in the thalamus and the pars triangularis of the inferior frontal gyrus in patients with insomnia disorder. However, no studies have been conducted on the white-matter tracts between these 2 brain regions. We aimed to compare the white-matter integrity and structure of the left thalamus­pars triangularis tracts between patients with insomnia and controls, and to characterize the relationship between white-matter integrity and clinical features in patients with insomnia. Methods: In total, 22 participants with insomnia disorder and 27 controls underwent overnight polysomnography and brain magnetic resonance imaging, and then completed self-report clinical questionnaires and neurocognitive tests for spatial planning. Structural and diffusion measures such as fractional anisotropy, axial diffusivity, radial diffusivity and trace were analyzed in group comparison and correlation analyses. Results: The insomnia group showed significantly lower fractional anisotropy (F = 8.647, p = 0.02) and axial diffusivity (F = 5.895, p = 0.038) in the left thalamus­pars triangularis tracts than controls. In patients with insomnia, fractional anisotropy in the tracts was correlated with the results of the Stockings of Cambridge test (r = 0.451, p = 0.034), and radial diffusivity was correlated with Epworth Sleepiness Scale score (r = 0.437, p = 0.042). Limitations: Limitations included analyses of limited brain regions and the cross-sectional design. Conclusion: The insomnia group showed decreased integrity in the left thalamus­pars triangularis tracts, and integrity was correlated with cognition and daytime sleepiness. These results may imply that insomnia is characterized by disintegration of the white-matter tract between the left thalamus and inferior frontal gyrus.

A mixed-methods evaluation using low-income adult Georgians' experience with a smartphone-based eLearning nutrition education programme.

OBJECTIVE: To understand low-income adults' expectations and experiences using an innovative smartphone and theory-based eLearning nutrition education programme, entitled Food eTalk. DESIGN: Longitudinal mixed-methods single case study including a series of focus group and individual interviews, demographic and Internet habits surveys, and user-tracking data. Interviews were transcribed verbatim, analysed using the constant comparative method and digitalized using Atlas.ti. Descriptive statistics were analysed for demographics and user-tracking data. SETTING: Community-based locations including libraries, public housing complexes, schools, safety-net clinics and food pantries. SUBJECTS: Low-income Georgian adults aged ≥18 years (n 64), USA. RESULTS: Participants found Food eTalk easy to navigate and better designed than expected. Primary themes were twofold: (i) motivation to engage in eLearning may be a formidable barrier to Food eTalk's success but improved programme content, format and external incentives could mitigate this barrier; and (ii) applying knowledge to change nutrition-related behaviour is challenging. To encourage engagement in eLearning nutrition education, programme format should highlight interactive games, videos, be short in length, and feature content that is relevant and important from the perspective of the priority audience. Examples of these topics include quick and easy recipes, chronic disease-specific diet information and tips to feed 'picky' children. Additionally, external incentives may help mitigate barriers to healthful eating behaviour and increase engagement in the programme. CONCLUSIONS: The findings suggest eLearning nutrition education programmes are best designed to match low-income adults' typical smartphone habits, include content considered particularly relevant by the intended audience and highlight solutions to barriers to healthful eating.

fMRI brain activation in patients with insomnia disorder during a working memory task.

PURPOSE: This study used functional magnetic resonance imaging (fMRI) to investigate differences in the functional brain activation of patients with insomnia disorder (n = 21, mean age = 36.6) and of good sleepers (n = 26, mean age = 33.2) without other comorbidities or structural brain abnormalities during a working memory task. METHODS: All participants completed a clinical questionnaire, were subjected to portable polysomnography (PSG), and performed the working memory task during an fMRI scan. The subjects who were suspected of major sleep disorder and comorbid psychiatric disorders except insomnia disorder were excluded. To compare the brain activation on working memory from the insomnia group with those from the good-sleeper group, a two-sample t test was performed. Statistical significance was determined using 3DClustSim with the updated algorithm to obtain a reasonable cluster size and p value for each analysis. RESULTS: We observed higher levels of brain activation in the right lateral inferior frontal cortex and the right superior temporal pole in the insomnia group compared to good sleepers (cluster-based multiple comparison correction, p < 0.001, k = 34 @ α = 0.01). CONCLUSION: Thus, patients with insomnia disorder showed increased brain activation during working memory relative to good sleepers, and this may be indicative of compensatory brain activation to maintain cognitive performance in patients with insomnia disorder without other comorbidities.

Antidepressant Prescription Patterns in Bipolar Disorder: a Nationwide, Register-based Study in Korea.

BACKGROUND: The role of antidepressants (ADs) in bipolar disorder is long-standing controversial issue in psychiatry. Many clinicians have used ADs as a treatment for bipolar depression, and the selection of therapeutic agents is very diverse and inconsistent. This study aimed to examine recent AD prescription patterns for patients with bipolar disorder in Korea, using the nationwide, population-based data. METHODS: This study utilized the Korean nationwide, whole population-based registry data of the year 2010, 2011, and 2013. All prescription data of the ADs, antipsychotics, and mood stabilizers of the sampled patients diagnosed with bipolar disorder (n = 2,022 [in 2010]; 2,038 [in 2011]; 2,626 [in 2013]) were analyzed for each year. RESULTS: Annual prescription rate of ADs was 27.3%-33.6% in bipolar disorder, which was gradually increasing over the 3-year period. The combination pattern of ADs and antipsychotic drugs tended to increase over 3 years. The proportion of females and the prevalence of comorbid anxiety disorder were significantly higher in AD user group in all three years. Among individual ADs, escitalopram was prescribed most frequently, and fluoxetine and bupropion were prescribed to the next many patients. The mean duration of bipolar depressive episodes was 135.90-152.53 days, of which ADs were prescribed for 115.60-121.98 days. CONCLUSION: Our results show prescription rate of ADs in bipolar disorder was maintained at substantial level and increased in recent 3 years. More empirical data and evidence are needed to establish practical treatment consensuses.

The Feasibility of an eLearning Nutrition Education Program for Low-Income Individuals.

BACKGROUND: Online eLearning may be an innovative, efficient, and cost-effective method of providing nutrition education to a diverse low-income audience. AIMS: The intent of this project is to examine perceptions of nutrition educators regarding the feasibility of an eLearning nutrition education program tailored to low-income Georgians. METHOD: Semistructured individual interviews were conducted, guided by the constructivist theory. The interview guide focused on three themes: accessibility, literacy, and content. A prototype of the program also served as a talking point. Interviews were conducted in two urban Georgian counties in a location chosen by each participant. We recruited a convenience sample of Georgian nutrition educators ( n = 10, 100% female, 50% Black). Interviews were transcribed and analyzed using constant comparative method. RESULTS AND DISCUSSION: Motivation is considered the primary barrier to program feasibility. Neither access to the Internet nor literacy are considered significant barriers. Inclusion of skill-based, visual education methods such as cooking videos, recipes, and step-by-step teaching tools was highlighted. Nutrition educators perceived this program would be a feasible form of nutrition education for the priority audience. CONCLUSIONS: Findings from this study will inform the user-centered development of the program.

Association between non-compliance with psychiatric treatment and non-psychiatric service utilization and costs in patients with schizophrenia and related disorders.

BACKGROUND: The relationship between medication non-compliance in patients with schizophrenia and related disorders, and increased psychiatric service utilization and costs are well documented; however, non-psychiatric service utilization and costs are not. Therefore, we investigated the association of non-compliance with psychiatric treatment and the utilization and costs of non-psychiatric services. METHODS: Data on South Korean individuals with a lifetime diagnosis of schizophrenia or a related disorder, who were treated in a psychiatric clinic at least twice during 2011, were selected among national data collected for the Health Insurance Review and Assessment Service-National Patients Sample between January 1, 2011 and December 31, 2011. The sample was divided into two overlapping groups with two different classifications of patterns of medication prescription refills: (1) adherent versus non-adherent group, and (2) persistent versus non-persistent group. A matching method was used to remove the effects of different follow-up durations and insurance system on medical service utilization and costs. The final sample for analysis consisted of data from 5,548 individuals in the adherent versus non-adherent group and 3,912 in the persistent versus non-persistent group. Comparisons of the psychiatric and non-psychiatric service utilizations were made between the groups. RESULTS: The number of psychiatric service utilizations were significantly lower in the non-adherent than the adherent group. They were also significantly lower in the non-persistent group than the persistent group. The number of non-psychiatric service utilizations was significantly higher in the non-adherent group. They were also significantly higher in the non-persistent group than the persistent group. All psychiatric costs per person during the study period were lower in the non-adherent than the adherent group, and lower in the non-persistent than the persistent group. All non-psychiatric costs per person were higher in the non-adherent than the adherent group, and higher in the non-persistent than the persistent group. CONCLUSION: Non-adherence to psychiatric treatment by patients with schizophrenia and related disorders was associated with higher medical service utilization and increased personal and societal medical costs.

Single-incision Laparoscopic Appendectomy Versus Conventional Laparoscopic Appendectomy: Experiences From 1208 Cases of Single-incision Laparoscopic Appendectomy. Experiences From 1208 Cases of Single-incision Laparoscopic Appendectomy.

OBJECTIVE: Currently single-incision laparoscopic appendectomy (SIL-A) has become an option for treating appendicitis. The aim of this study was to evaluate the safety and feasibility of SIL-A compared with conventional laparoscopic appendectomy (CL-A) on a large experimental cohort. BACKGROUND: Several studies had reported the safety and technical feasibility of SIL-A, albeit with a limited number of study subjects. METHODS: A total of 2587 patients (1208 SIL-A and 1379 CL-A) who underwent laparoscopic appendectomy from May 2008 to April 2013 were studied retrospectively. The clinical characteristics and short-term operative outcomes of these patients were reviewed and analyzed. RESULTS: There were more simple type appendicitis in the SIL-A group and more complicated type appendicitis in CL-A group (81.0% vs 74.7% and 19% vs 25.3%, P <0.001, respectively). The operative time (minutes) was similar between the 2 groups (40.1 ±â€Š18.6 vs 38.8 ±â€Š25.2, P = 0.154). However, on subgroup analysis, operative time for simple type appendicitis was longer in the SIL-A group (36.6 ±â€Š14.9 vs 32.3 ±â€Š18.3, P < 0.001). The superficial incisional surgical site infection rate was higher in the SIL-A group (4.4% vs 2.3%, P = 0.003). The readmission rate was higher in the CL-A group (0.8% vs 1.7%, P = 0.042). The postoperative hospital stay (days) was shorter in the SIL-A group (3.05 ±â€Š1.97 vs 3.35 ±â€Š2.14, P < 0.001). CONCLUSIONS: In this study, SIL-A was technically feasible and safe option for appendicitis. The SIL-A group had more favorable outcomes such as shorter time to start diet and less hospital stay after surgery than the CL-A group. However, superficial incisional surgical site infection rate was higher in the SIL-A group than in the CL-A group, an effort to reduce superficial incisional SSI should be made.

Poor Socioeconomic and Nutritional Status Are Associated with Osteoporosis in Korean Postmenopausal Women: Data from the Fourth Korea National Health and Nutrition Examination Survey (KNHANES) 2009.

OBJECTIVE: As the population ages, osteoporosis is a growing global public health problem. This study examined potential risk factors associated with osteoporosis in a nationally representative sample of Korean postmenopausal women. METHODS: This study used data from a nationally representative sample of Korean menopausal women participating in the Korea National Health and Nutrition Examination Survey KNHANES 2009 (n = 1467; mean age ± SE = 65.2 ± 0.3 years). Bone mineral density of total femur, femoral neck, and spine was measured by dual-energy X-ray absorptiometry. Osteoporosis was determined as t-score of -2.5 or below in at least 1 of the 3 sites. Menopausal status was confirmed by self-reports. RESULTS: About 41% of the study sample met the criteria for osteoporosis. Poor socioeconomic status, lower BMI, and shorter estrogen exposure duration were significantly associated with osteoporosis in the study sample. Poor dietary intake was also related to osteoporosis. In the age- and energy-adjusted logistic regression models, participants consuming less protein, vitamin B2, or vitamin C than the estimated average requirement (EAR) showed higher odds of having osteoporosis than their counterparts. Participants consuming no milk or milk products had 45% increased odds of having osteoporosis than those consuming milk or milk products. CONCLUSION: The findings of this study suggest several risk factors associated with osteoporosis, which can be addressed in the development and implementation of tailored nutritional interventions to promote the bone health of Korean postmenopausal women.

Effects of the combination of respiratory muscle training and abdominal drawing-in maneuver on respiratory muscle activity in patients with post-stroke hemiplegia: a pilot randomized controlled trial.

PURPOSE: No study has examined the effects of the combination of respiratory muscle training (RMT) and abdominal drawing-in maneuver (ADIM) on respiratory muscle activity and function in stroke patients during early pulmonary rehabilitation. The purpose of this study was to investigate the effects of RMT combined with ADIM on decreased respiratory muscle activity and function in patients with post-stroke hemiplegia. METHODS: Thirty-seven subjects with post-stroke hemiplegia were randomly allocated to three groups; integrated training group (ITG), respiratory muscle training group (RMTG), and control group (CG). All of the subjects received routine therapy for stroke rehabilitation for 1 hour, five times a week for 6 weeks. Especially, the ITG received RMT using an incentive respiratory spirometer and ADIM using a Stabilizer, and the RMTG only received RMT using incentive respiratory spirometer for 15  minutes a day, five times a week for 6 weeks. Pulmonary function was evaluated using spirometry for measuring the forced vital capacity (FVC) and force expiratory volume in 1  second (FEV1). Additional surface electromyography (sEMG) analysis was included by measuring the respiratory muscle activity. RESULTS: Our results showed that changes between the pre- and post-test values of FVC (F = 12.50, P = 0.02) and FEV1 (F = 12.81, P = 0.01) (P < 0.05) in the ITG were significantly (P < 0.05) greater. Changes in EMG activation of the diaphragm (F = 13.75, P = 0.003) and external intercostal (F = 14.33, P = 0.002) (P < 0.01) muscles of patients in the ITG during maximal static inspiratory efforts were significantly (P < 0.05) greater than those in patients of the RMTG and the CG at post-test. CONCLUSIONS: Our findings suggested that RMT combined with ADIM could improve pulmonary function in patients with post-stroke hemiplegia.