Association between Environmental Polycyclic Aromatic Hydrocarbons Exposure and Insulin Resistance: Using The Second Korean National Environmental Health Survey

Background@#A positive association between air pollution and insulin resistance has been shown in previous studies as a precursor state of type 2 diabetes, especially in older adults. This study was conducted to investigate the association between insulin resistance and environmental polycyclic aromatic hydrocarbon (PAH) exposure as ubiquitous outdoor and indoor air pollution components. @*Methods@#From the second Korean National Environmental Health Survey, 5,717 adults aged ≥19 years were included in this study. To identify the association between environmental PAH exposure (urinary 1-hydroxypyrene, 1-OHP) and insulin resistance, defined by the ratio of triglyceride to high-density lipoprotein cholesterol, we performed multiple stepwise regression analysis, adjusting for age, sex, education, physical activity, exposure to smoking and air pollution, body mass index, hypertension, and diabetes mellitus. @*Results@#Urinary 1-OHP concentration was significantly associated with the ratio of triglyceride to high-density lipoprotein cholesterol. @*Conclusion@#Environmental exposure to PAHs is associated with increased insulin resistance in adults.

Association of Sleep Duration with Hand Grip Strength in Adults: Korea National Health and Nutrition Examination Survey (2014–2017)

Background@#Hand grip strength (HGS) is used clinically with regards to rehabilitation and recommended as a basic measure in determiningmusculoskeletal function, weakness, and disability. The purpose of this study was to examine the relationship between sleep duration and musclestrength in Korean adults. @*Methods@#The Korea National Health and Nutrition Examination Survey (KNHANES) is a cohort survey investigating the health behavior, chronic diseaseprevalence, and food and nutrition intake statuses of the Korean population. We analyzed the association between sleep duration and hand gripstrength by performing a logistic regression analysis on KNHANES data from 2014 to 2017. All statistical analyses were performed with SPSS and Rtools. @*Results@#Among the 20,933 participants, compared to the group of patients who slept less than 5 hours a day, the group of patients who slept 6–7hours had higher HGS, whereas the group of patients who slept more than 9 hours had weaker HGS. This trend was more apparent in the elderlypopulation. @*Conclusion@#This study of the adult population of South Korea suggests that sleeping for approximately 6 to 7 h a day increases muscle strength andgeneral well-being, whereas extreme sleep durations, such as less than 5 h or more than 9 h, result in weaker muscle strength, in general.

Mobile Text Messaging Interventions for Smoking Cessation: A Systematic Review

BACKGROUND: Smoking is one of the most serious health problems worldwide. The aim of this systematic review was to demonstrate the effect of text messaging-based interventions on smoking cessation.METHODS: Electronic databases were searched using specific key terms. The inclusion criteria were (1) articles that employed a randomized controlled trial and (2) articles that examined the effect of text messaging interventions on smoking cessation. However, studies employing multimedia messaging service and smartphone apps were excluded.RESULTS: In total, six randomized controlled trial studies with seven interventions were included in this systematic review. Of these six studies, almost all concluded that text-messaging interventions had no significant effect on smoking cessation. However, one study conducted in England revealed that text messaging intervention groups had a higher rate of six-month prolonged abstinence from smoking than did the control group.CONCLUSION: Text messaging interventions could be effective for those who want to quit smoking. We aimed to determine the effectiveness of using text messaging interventions for smoking cessation. However, there were only six studies that employed randomized controlled trials to determine such effectiveness. More studies on the effect of text messaging interventions for smoking cessation using subjects from various age groups and socioeconomic backgrounds are needed in the future.

Postthyroidectomy obesity in a Korean population: does the extent of surgery matter?

PURPOSE: The purpose of this study was to investigate the prevalence of postthyroidectomy obesity, and the relationship between the extent of thyroidectomy and obesity. METHODS: A survey conducted at an outpatient clinic from June to October 2014 and retrospective charts for patients undergoing thyroidectomy at Konkuk University Medical Centers from June 2009 to December 2013 were reviewed. We compared clinical characteristics and pre- and postoperative obesity-related factors in 227 patients who underwent total thyroidectomy or lobectomy. RESULTS: Patients included 39 males and 188 females with a mean age of 46.0 ± 11.0 years; the mean follow-up period was 23.9 ± 16.7 months, and 90 of the 227 patients showed postthyroidectomy obesity. In effect of operative extent on postoperative obesity, patients who underwent TT (48.2 years) than those who underwent lobectomy (43.4 years). TT group had longer follow-up and the frequency of menopause was higher than in the lobectomy group. No differences in postthyroidectomy obesity, body weight change, or body mass index (BMI), change among 2 groups. The predictors of postthyroidectomy obesity were older age, female, heavy alcohol consumption (P = 0.029), higher preoperative BMI (P < 0.001), larger postoperative weight gain (P = 0.024), and larger BMI change. However, the extent of thyroidectomy did not affect postthyroidectomy obesity. Preoperative BMI (P < 0.001) and heavy alcohol consumption (P = 0.03) were independent factors of postthyroidectomy obesity. CONCLUSION: The extent of thyroidectomy does not affect postthyroidectomy obesity. Preoperative BMI and heavy alcohol consumption are risk factors for postthyroidectomy obesity. Studies are needed to suggest preoperative life style modification to prevent postthyroidectomy obesity.

Smoking cessation services provided by the National Health Insurance Service

Smoking cessation services are an important component of preventive medicine. Physicians can help smokers quit smoking by assessing their dependence and motivating them during their clinic visits. Brief advice provided by doctors is a simple and very cost-effective method of smoking cessation. The most effective method of helping smokers stop smoking is combining pharmacotherapy with counseling and behavioral interventions. In early 2015, the National Health Insurance Service started a smokingcessation support program that covered consultation and drug fees across the country. More than 400,000 smokers registered in this program and received assistance from doctors in 2016. The success rate at 6 months after registration was approximately 40%, which is comparable with that of smoking cessation clinics run by public health centers in local areas. Additional efforts are needed to increase the coverage levels of smoking cessation services in Korea.

Association of High-Risk Drinking with Metabolic Syndrome and Its Components in Elderly Korean Men: The Korean National Health and Nutrition Examination Survey 2010–2012 / 가정의학회지

BACKGROUND: Previous studies have examined the association between alcohol consumption and metabolic syndrome (MetS) in adults, but studies in the elderly are lacking. We examined the relationship between high-risk alcohol consumption and MetS in elderly Korean men using the Alcohol Use Disorders Identification Test (AUDIT) questionnaire from the 2010–2012 Korean National Health and Nutrition Examination Survey. METHODS: Among 25,534 subjects, 2,807 were men >60 years of age; after exclusions, we included 2,088 men in the final analysis. We categorized the study participants into three groups according to AUDIT score: low risk (0–7), intermediate risk (8–14), and high risk (≥15 points). RESULTS: Among the study population, 17.0% of the men were high-risk drinkers, who had the highest mean waist circumference, systolic and diastolic blood pressure (BP), fasting plasma glucose (FPG), and triglyceride (TG) levels. The overall prevalence of MetS was 41.9% in the elderly men, and it was significantly higher in the group with high (48.3%) versus low (31.9%) AUDIT scores. The prevalence of MetS components (elevated BP, high FPG, high TG, and low high-density lipoprotein cholesterol) was associated with a high AUDIT score. The odds ratios (95% confidence interval) of the high-risk group for MetS, elevated BP, and high TG were 1.40 (1.03–1.89), 1.82 (1.28–2.60), and 1.77 (1.30–2.41) after adjustment for confounding variables. CONCLUSION: AUDIT score was correlated with most MetS components in elderly Korean men.

Smoking cessation services provided by the National Health Insurance Service

Smoking cessation services are an important component of preventive medicine. Physicians can help smokers quit smoking by assessing their dependence and motivating them during their clinic visits. Brief advice provided by doctors is a simple and very cost-effective method of smoking cessation. The most effective method of helping smokers stop smoking is combining pharmacotherapy with counseling and behavioral interventions. In early 2015, the National Health Insurance Service started a smokingcessation support program that covered consultation and drug fees across the country. More than 400,000 smokers registered in this program and received assistance from doctors in 2016. The success rate at 6 months after registration was approximately 40%, which is comparable with that of smoking cessation clinics run by public health centers in local areas. Additional efforts are needed to increase the coverage levels of smoking cessation services in Korea.

Correlation between Overactive Bladder Syndrome and Obsessive Compulsive Disorder in Women / 가정의학회지

BACKGROUND: Overactive bladder syndrome is characterized by urinary urgency, usually accompanied by Frequent urination and nocturia, with or without urgent urinary incontinence. There must be the absence of causative infection or pathological conditions. Overactive bladder syndrome is related to mental disorders, particularly depression and anxiety. However, obsessive-compulsive symptoms are investigated much less frequently. The purpose of the present study was thus to assess obsessive-compulsive symptoms in overactive bladder syndrome patients. METHODS: Fifty-seven women patients with overactive bladder syndrome and fifty-seven women without it (age matched control group) were prospectively enrolled. They completed the overactive bladder syndrome-validated 8-question screener and the Korean version of the Maudsley Obsessional-Compulsive Inventory Questionnaire at the same time they visited the clinic. Patients were compared with controls on the Korean version of the Maudsley Obsessional-Compulsive Inventory Questionnaire and its checking, tidiness, doubting, and fear of contamination components. RESULTS: Patients showed more obsessive traits than controls on the Korean version of the Maudsley Obsessional-Compulsive Inventory Questionnaire total score (P=0.006) and on the checking subscale (P=0.001). Odds ratio for the overactive bladder syndrome group's obsessive-compulsive symptoms traits (score> or =14) was 5.47 (P=0.001). The Korean version of the Maudsley Obsessional-Compulsive Inventory Questionnaire total score was associated with the overactive bladder syndrome-validated 8-question screener score in patients (P=0.03). CONCLUSION: Obsessive-compulsive symptoms may constitute an important aspect of the psychiatric profile of overactive bladder syndrome patients. The severity of obsessive-compulsive symptoms seems to be related to the degree of the overactive bladder syndrome severity. Clinicians may consider screening women with overactive bladder syndrome for obsessive-compulsive symptoms.

Predictors of Successful Smoking Cessation after Inpatient Intervention for Stroke Patients / 가정의학회지

BACKGROUND: Smoking is a well-known risk factor of cancer, chronic disease, and cerebrovascular disease. Hospital admission is a good time to quit smoking but patients have little opportunity to take part in an intensive smoking cessation intervention. The purpose of this study was to identify the factors of successful smoking cessation among stroke patients who undergo an intensive cessation intervention during the hospitalization period. METHODS: Thirty-nine male smokers who were admitted with stroke were enrolled in the study. They participated in a smoking cessation intervention during hospitalization. Smoking status was followed up by telephone 3 months later. Nicotine dependence, sociodemographic factors, and other clinical characteristics were assessed. RESULTS: After 3 months post-intervention, the number of patients who stopped smoking was 27 (69.2%). In addition, there was no significant difference in nicotine dependence, sociodemographic factors, and clinical characteristics. Only the stages of readiness for smoking cessation were a significant predictor (odds ratio, 18.86; 95% confidence interval, 1.59-223.22). CONCLUSION: This study shows that a patient's willingness to quit is the most significant predictor of stopping smoking after Inpatient cessation Intervention for stroke Patients.

Exertional Rhabdomyolysis after Spinning / 가정의학회지

Any strenuous muscular exercise may trigger rhabdomyolysis. We report an episode of clinically manifested exertional rhabdomyolysis due to stationary cycling, commonly known as spinning. Reports of spinning-related rhabdomyolysis are rare in the English literature, and the current case appears to be the first such case reported in South Korea. A previously healthy 21-year-old Asian woman presented with severe thigh pain and reddish-brown urinary discoloration 24–48 hours after attending a spinning class at a local gymnasium. Paired with key laboratory findings, her symptoms were suggestive of rhabdomyolysis. She required hospital admission to sustain renal function through fluid resuscitation therapy and fluid balance monitoring. Because exertional rhabdomyolysis may occur in any unfit but otherwise healthy individual who indulges in stationary cycling, the potential health risks of this activity must be considered.

Exertional Rhabdomyolysis after Spinning / 가정의학회지

Any strenuous muscular exercise may trigger rhabdomyolysis. We report an episode of clinically manifested exertional rhabdomyolysis due to stationary cycling, commonly known as spinning. Reports of spinning-related rhabdomyolysis are rare in the English literature, and the current case appears to be the first such case reported in South Korea. A previously healthy 21-year-old Asian woman presented with severe thigh pain and reddish-brown urinary discoloration 24–48 hours after attending a spinning class at a local gymnasium. Paired with key laboratory findings, her symptoms were suggestive of rhabdomyolysis. She required hospital admission to sustain renal function through fluid resuscitation therapy and fluid balance monitoring. Because exertional rhabdomyolysis may occur in any unfit but otherwise healthy individual who indulges in stationary cycling, the potential health risks of this activity must be considered.

Non-alcoholic Fatty Liver Disease and Chronic Kidney Disease in Koreans Aged 50 Years or Older / 가정의학회지

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD) share common pathogenic mechanisms and many risk factors, and both are linked to an increased risk of cardiovascular diseases. The aim of this study was to assess the association between NAFLD and CKD according to the presence of hypertension and diabetes mellitus in Koreans aged 50 years or older. METHODS: A cross-sectional study of 1,706 subjects who received their routine health examination was conducted between May 2008 and April 2010 at Konkuk University medical center. Biochemical tests for liver and abdominal ultrasonography were performed. CKD was defined as either proteinuria or glomerular filtration rate < or =60 mL/min per 1.73 m2. RESULTS: Among the 1,706 subjects, There were 545 (31.9%) with non-alcoholic fatty liver disease and 424 (24.9%) with chronic kidney disease. In univariate logistic regression analysis, NAFLD was significantly associated with CKD (odds ratio [OR], 1.69; 95% confidence interval [CI], 1.34 to 2.12). In multivariate logistic regression analysis adjusted for age, sex, current smoking, abdominal obesity, aspartate aminotransferases, alanine aminotransferases, gamma-glutamyltransferase, hypertension, diabetes mellitus, hypertriglyceridemia, and low high-density lipoprotein cholesterol, NAFLD was associated with CKD (adjusted OR, 1.68; 95% CI, 1.27 to 2.24). This relationship remained significant after classification according to the presence of hypertension or diabetes mellitus. CONCLUSION: NAFLD diagnosed by ultrasonography was significantly associated with CKD in Koreans aged 50 years or older.

Preference and Awareness of Telemedicine in Primary Care Patients / 가정의학회지

BACKGROUND: The telemedicine services in Korea are expected to rapidly expand its use to the general population due to the development of digital networking, and its recent revision of related law and regulations. The purpose of this study was to investigate the knowledge and attitude of telemedicine in primary care patients. METHODS: We enrolled a total 243 participants, visited Family Medicine clinics and health promotion centers of university hospital in Seoul metrocity and Chungju city from April 1, 2010 to May 31, 2010. Data was collected by questionnaire, including demographic variables, knowledge and attitude of telemedicine. RESULTS: Among the total of 243 participants, 117 (49.8%) respondents were aware of telemedicine, and 178 (73.3%) respondents preferred telemedicine. The awareness showed differences according to the residence (P = 0.007), education (P = 0.03), and occupation (P = 0.02) of the respondents. The patient preference showed the differences at 50 years of age (P = 0.01) and in income of the participants (P = 0.005). CONCLUSION: Awareness of telemedicine in primary care patients was low. As for the patients more than 50 years of age who will be having difficulty manipulating the instruments, more education is crucial. Establishment of appropriate plans to increase patient preference is needed, especially for patients with low-incomes.

The Impact of Functional Constipation on the Quality of Life in the Elderly over 60 Years / 가정의학회지

BACKGROUND: Constipation is one of the most common digestive complaints. Although, there are increased interest on the socioeconomic effect of constipation and studies associated with quality of life on constipation, there is no study about the influence of constipation onto quality of life (QOL) in Korea. We studied the impact of functional constipation on QOL. METHODS: Between March to June 2008, person to person survey with 844 elderly aged over 60 years was performed at two senior care centers, a public health center, and secondary hospital in Seoul metrocity and Chung-ju city. The diagnosis of functional constipation was based on the Rome III criteria and QOL was measured by the Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey (SF-36). RESULTS: The average age was 73.6 years and the prevalence rate of constipation was 20.3%. The average SF-36 score was 63.5 in total population, 57.9 in constipation group, and 64.9 in normal group. CONCLUSION: These results suggest that the constipation lowers QOL in adults aged over 60 years old. Further study will be necessary to explore if QOL changes according to the severity of constipation and its treatment and to assess QOL using a disease-specific measurement tool that can be used for Korean environment.

The Impact of Functional Constipation on the Quality of Life in the Elderly over 60 Years / 가정의학회지

BACKGROUND: Constipation is one of the most common digestive complaints. Although, there are increased interest on the socioeconomic effect of constipation and studies associated with quality of life on constipation, there is no study about the influence of constipation onto quality of life (QOL) in Korea. We studied the impact of functional constipation on QOL. METHODS: Between March to June 2008, person to person survey with 844 elderly aged over 60 years was performed at two senior care centers, a public health center, and secondary hospital in Seoul metrocity and Chung-ju city. The diagnosis of functional constipation was based on the Rome III criteria and QOL was measured by the Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey (SF-36). RESULTS: The average age was 73.6 years and the prevalence rate of constipation was 20.3%. The average SF-36 score was 63.5 in total population, 57.9 in constipation group, and 64.9 in normal group. CONCLUSION: These results suggest that the constipation lowers QOL in adults aged over 60 years old. Further study will be necessary to explore if QOL changes according to the severity of constipation and its treatment and to assess QOL using a disease-specific measurement tool that can be used for Korean environment.

Association of the Metabolic Syndrome and Bone Mineral Density in Postmenopausal Women / 가정의학회지

BACKGROUND: The metabolic syndrome (MS) is a cluster of risk factors of cardiovascular disease. The association between components of the MS and bone mineral density has been researched, but no prior studies have directly evaluated the association with the metabolic syndrome and bone mineral density in Korea. METHODS: We evaluated postmenopausal women who had visited a university hospital from November 2006 to October 2007. Data on their lifestyle, current medical diseases and medications were collected from medical records. Height, body weight, waist circumference and serum lipid profiles were measured. RESULTS: The prevalence of metabolic syndrome was 21.8% in this study. In adjusted analysis including age and other factors, only waist circumference had a close correlation with bone mineral density of femur and lumbar vertebral body (P < 0.05). The bone mineral density of femur and lumbar vertebral body had no correlation with the presence of metabolic syndrome. When stratified by body mass index, corrected bone mineral density revealed no significant correlation with the presence of metabolic syndrome. CONCLUSION: The bone mineral density of postmenopausal women with metabolic syndrome has highly influenced by obesity, especially by abdominal obesity.

Association of the Metabolic Syndrome and Bone Mineral Density in Postmenopausal Women / 가정의학회지

BACKGROUND: The metabolic syndrome (MS) is a cluster of risk factors of cardiovascular disease. The association between components of the MS and bone mineral density has been researched, but no prior studies have directly evaluated the association with the metabolic syndrome and bone mineral density in Korea. METHODS: We evaluated postmenopausal women who had visited a university hospital from November 2006 to October 2007. Data on their lifestyle, current medical diseases and medications were collected from medical records. Height, body weight, waist circumference and serum lipid profiles were measured. RESULTS: The prevalence of metabolic syndrome was 21.8% in this study. In adjusted analysis including age and other factors, only waist circumference had a close correlation with bone mineral density of femur and lumbar vertebral body (P < 0.05). The bone mineral density of femur and lumbar vertebral body had no correlation with the presence of metabolic syndrome. When stratified by body mass index, corrected bone mineral density revealed no significant correlation with the presence of metabolic syndrome. CONCLUSION: The bone mineral density of postmenopausal women with metabolic syndrome has highly influenced by obesity, especially by abdominal obesity.

Evaluation of Osteoporosis Self-Assessment Tool Usefulness as a Screening Test for Osteoporosis in Korean Men / 가정의학회지

BACKGROUND: This study was done to determine whether the Osteoporosis Self-assessment Tool (OST) can predict central bone mineral density in Korean men above 50 years, as defined by dual energy X-ray absorptionmetry (DXA). METHODS: We applied the OST index to Korean men aged over 50 in Health Promotion Center of Konkuk University Hospital from September 2005 to September 2008. The calculated OST risk index was based on weight and age, truncated to an integer. RESULTS: The study population was 276 men. The mean age, height and weight of the men were 59.7 +/- 6.69 years, 167.6 +/- 6.14 cm and 67.5 +/- 8.93 kg respectively. By DXA, 4.7% of the men had a T score of -2.5 or less, and 46.4% had a T score of -2 or less at the spine, total hip, or femoral neck. The OST index ranged from -4 to 7. Using a cutoff score of 0, we predicted osteoporosis with a sensitivity of 85% and a specificity of 62%. The receiver operating characteristic curve showed an area under the curve of 0.77. When the subjects were analyzed by age and smoking status, the predictive value of the OST was maintained. CONCLUSION: The OST is a simple and useful method to predict osteoporosis in Korean men.

Concern in and Utilization of the Mass Media Health Information in Community-dwelling Elderly / 가정의학회지

BACKGROUND: Recently, the mass media serves a major role in the public health education, but have not been proven whether they are being appropriately utilized in the elderly. The aim of this study was to identify the elderly person's concern in the mass media health information and utilization behavior. METHODS: Between March to June 2008, one to one survey with the elderly people over 60 years was performed in two elderly welfare centers, one public health center, and two secondary hospitals outpatients and inpatients in Seoul and Chungju. RESULTS: A total of 999 subjects were included. By multivariate analysis, factors significantly associated with low concern in the mass media health information were low educational level, non-exercise group, and low concern in own health (P = 0.001, 0.009, < 0.001, respectively). The most frequently utilized health information source was the mass media. By comparing the frequency of health information utilization, women, low educational level, low income, non-exercise group, underweight, low level of self-evaluated health status, and low concern in health information were significantly associated with the lowest quintile of utilization (P value: < 0.001, 0.005, 0.05, < 0.001, 0.002, 0.03, 0.005, respectively). However, the presence of chronic diseases, such as hypertension, diabetes, had no association. CONCLUSION: In community-dwelling elderly, important factors associated with concern in and utilization of the mass media health information were concern in health, self-evaluated health status, exercise status and socioeconomic factors such as education or income level, rather than comorbid chronic disease.

Performance of the AUDIT Alcohol Consumption Questions (AUDIT-C) and AUDIT-K Question 3 Alone in Screening for Problem Drinking / 가정의학회지

BACKGROUND: In the busy primary care setting, there are several limitations in applying Alcohol Use Disorders Identification Test in Korea (AUDIT-K) to screen problem drinking. Thus, for primary healthcare practice, we evaluated AUDIT-C, which covers questions from 1 to 3 in AUDIT-K, and AUDIT-K Question 3 Alone to present cut points for these two screening questionnaire according to AUDIT-K test scores. METHODS: In a university hospital, we surveyed 302 males with a drinking history via self-administered questionnaire including AUDIT-K, from November 2007 to April 2008. On the basis of total score in AUDIT-K, we divided them into four groups: normal, problem drinking, alcohol use disorder, and alcohol dependence. For each alcohol drinking behavior pattern, we drew the receiver operating characteristics (ROC) curves to present cut points for appropriate sensitivity and specificity. In addition, we compared the performance of AUDIT-C and AUDIT-K Question 3 Alone through area under the curve (AUC). RESULTS: For AUDIT-C, we designated the score 8 or more as problem drinking, 9 or more as alcohol use disorder, and 11 or more as dependence. The results of sensitivity/specificity for each group were 82%/76%, 76%/79%, 80%/86%, respectively, which were suitable for screening. For AUDIT-K Question 3 Alone, we defined the score 3 or more as problem drinking or alcohol use disorder and the score 4 as dependence. The results of sensitivity/specificity for each group were 79%/80%, 84%/67%, 85%/77%, which were appropriate for screening. For every drinking behavior group, AUDIT-C was superior to AUDIT-K Question 3 Alone in screening performance (problem drinking: 0.88 vs. respectively 0.85, alcohol use disorder: 0.86 vs. 0.82, alcohol dependence: 0.88 vs. 0.81) CONCLUSION: We confirmed that both AUDIT-C and AUDIT-K Question 3 Alone, which are more convenient and have fewer time con-straints than AUDIT-K, are reasonable screening methods for problem drinking. Thus, we recommend further drinking assessment and proper intervention for male drinkers who have scores 8 or more in AUDIT-C or 3 or more in AUDIT-K Question 3 Alone.