Utilization of End-of-Life Care Rooms by Patients Who Died in a Single Hospice Unit at a National University Hospital in South Korea / 한국호스피스완화의료학회지

Purpose@#For the dignity of patients nearing the end of their lives, it is essential to provide end-of-life (EoL) care in a separate, dedicated space. This study investigated the utilization of specialized rooms for dying patients within a hospice unit. @*Methods@#This retrospective study examined patients who died in a single hospice unit between January 1, 2017, and December 31, 2021. Utilizing medical records, we analyzed the circumstances surrounding death, the employment of specialized rooms for terminally ill patients, and the characteristics of those who received EoL care in a shared room. @*Results@#During the 1,825-day survey period, deaths occurred on 632 days, and 799 patients died. Of these patients, 496 (62.1%) received EoL care in a dedicated room. The average duration of using this dedicated space was 1.08 days. Meanwhile, 188 patients (23.5%) died in a shared room. Logistic regression analysis revealed that a longer stay in the hospice unit was associated with a lower risk of receiving EoL care in a shared room (odds ratio [OR]=0.98, 95% confidence interval [CI] 0.97~0.99; P=0.002). Furthermore, a higher number of deaths on the day a patient died was associated with a greater risk of receiving EoL care in a shared room (OR=1.66, 95% CI 1.33~2.08; P＜0.001). @*Conclusion@#To ensure that more patients receive EoL care for an adequate duration in a private setting, additional research is necessary to increase the number of dedicated rooms and incorporate them into the hospice unit at an early stage.

Association between Sleep Duration and Presbycusis in Korean Adults: Korea National Health and Nutrition Examination Survey / 가정의학회지

Background@#Sleep duration is associated with hearing loss, especially presbycusis, which is the most common type of hearing loss; however, there is limited evidence regarding this association among the Korean population. We aimed to determine the relationship between sleep duration and high-frequency hearing loss in Korean adults aged ≥40 years. @*Methods@#We examined 5,547 Korean adults aged ≥40 years who completed audiometric tests and questionnaires regarding sleep duration during the 2010–2012 cycle of the Korea National Health and Nutrition Examination Survey. Mild presbycusis was defined as >25 decibels (dB) and 40 dB pure tone averages at high frequencies (3,000, 4,000, and 6,000 Hz) for both ears. Additionally, the sleep duration was divided into quartiles. Odds ratios and 95% confidence intervals were estimated using multivariable logistic regression after adjusting for covariates. @*Results@#The prevalence of presbycusis in South Korean adults was 62.1%, of which 61.4% showed moderate to severe presbycusis. The incidence of moderate-to-severe, but not mild, presbycusis showed a significant positive correlation with sleep duration. @*Conclusion@#Our findings suggest that sleep duration is associated with the prevalence of presbycusis.

Association between Serum Folic Acid Levels and Asthma in the Korean Population: A Study Based on the 2016–2018 Korea National Health and Nutrition Examination Survey / 가정의학회지

Background@#Folic acid is involved in inflammatory reactions; however, the association between folic acid and allergic diseases, particularly asthma, remains unclear. Thus, this study aimed to evaluate the association between serum folic acid levels and asthma in Koreans. @*Methods@#This study analyzed the serum folic acid levels of 6,615 individuals included in the 2016–2018 Korea National Health and Nutrition Examination Survey. The prevalence of asthma was determined using a questionnaire that identified cases of physician-diagnosed asthma. The relationship between serum folic acid levels and asthma was analyzed using logistic regression analysis. @*Results@#Multiple logistic regression analysis showed that a 1 ng/mL increase in serum folic acid level significantly reduced the risk of asthma after adjusting for confounding factors including sex, age, household income, current smoking, current alcohol use, and body mass index (odds ratio [OR], 0.930; 95% confidence interval [CI], 0.876– 0.987; P=0.017). The relationship between the adjusted odds of asthma and serum folic acid levels were consistently inverse (OR, 2.266; 95% CI, 1.126–4.420; P for trend=0.038). @*Conclusion@#Serum folic acid levels are inversely associated with physician-diagnosed asthma in the Korean population.

Association between Time to First Cigarette and Health-Related Quality of Life of Middle-Aged Male Current Smokers: A Nationwide Representative Study in Korea / 가정의학회지

Background@#Although many studies have demonstrated that the first cigarette in the morning increases the prevalence of smoking-related morbidity, limited studies have examined the impact of time to first cigarette (TTFC) on the health-related quality of life (HRQoL). Thus, we assessed this relationship using nationally-representative data from the Korea National Health and Nutrition Examination Survey VII-1 (2016). @*Methods@#We conducted a cross-sectional study using data from 577 current male smokers aged 30–59 years, after excluding those with a certain disease. Participants were divided into four categories according to TTFC (≤5 min, 6–30 min, 31–60 min, >60 min). HRQoL was measured using self-reported EuroQol-5 (EQ-5D). The relationship between TTFC and EQ-5D index was analyzed using a multivariate-adjusted generalized linear model to assess how HRQoL varies according to TTFC. After adjusting for confounders, a multivariate-adjusted logistic regression analysis was performed to identify which of the five dimensions of the EQ-5D affected the HRQoL according to TTFC. @*Results@#The generalized linear analysis indicated that as TTFC decreased (6–30 min, 31–60 min vs. >60 min), the EQ-5D index score decreased significantly (P=0.037). Shorter TTFC (≤5 min vs. >60 min) was associated with higher pain/discomfort (odds ratio [OR], 3.82; 95% confidence interval [CI], 1.39–10.48) and anxiety/depression (OR, 7.58; 95% CI, 1.75–32.88). @*Conclusion@#Higher nicotine dependence was associated with impaired HRQoL. These results may be used to improve smoking cessation treatment outcomes.

Association between Time to First Cigarette and Health-Related Quality of Life of Middle-Aged Male Current Smokers: A Nationwide Representative Study in Korea / 가정의학회지

Background@#Although many studies have demonstrated that the first cigarette in the morning increases the prevalence of smoking-related morbidity, limited studies have examined the impact of time to first cigarette (TTFC) on the health-related quality of life (HRQoL). Thus, we assessed this relationship using nationally-representative data from the Korea National Health and Nutrition Examination Survey VII-1 (2016). @*Methods@#We conducted a cross-sectional study using data from 577 current male smokers aged 30–59 years, after excluding those with a certain disease. Participants were divided into four categories according to TTFC (≤5 min, 6–30 min, 31–60 min, >60 min). HRQoL was measured using self-reported EuroQol-5 (EQ-5D). The relationship between TTFC and EQ-5D index was analyzed using a multivariate-adjusted generalized linear model to assess how HRQoL varies according to TTFC. After adjusting for confounders, a multivariate-adjusted logistic regression analysis was performed to identify which of the five dimensions of the EQ-5D affected the HRQoL according to TTFC. @*Results@#The generalized linear analysis indicated that as TTFC decreased (6–30 min, 31–60 min vs. >60 min), the EQ-5D index score decreased significantly (P=0.037). Shorter TTFC (≤5 min vs. >60 min) was associated with higher pain/discomfort (odds ratio [OR], 3.82; 95% confidence interval [CI], 1.39–10.48) and anxiety/depression (OR, 7.58; 95% CI, 1.75–32.88). @*Conclusion@#Higher nicotine dependence was associated with impaired HRQoL. These results may be used to improve smoking cessation treatment outcomes.

Assessing the Validity of the Preclinical Objective Structured Clinical Examination Using Messick’s Validity Framework / 의학교육논단

Students must be familiar with clinical skills before starting clinical practice to ensure patients’ safety and enable efficient learning. However, performance is mainly tested in the third or fourth years of medical school, and studies using the validity framework have not been reported in Korea. We analyzed the validity of a performance test conducted among second-year students classified into content, response process, internal structure, relationships with other variables, and consequences according to Messick’s framework.As results of the analysis, content validity was secured by developing cases according to a pre-determined blueprint. The quality of the response process was controlled by training and calibrating raters. The internal structure showed that (1) reliability by generalizability theory was acceptable (coefficients of 0.724 and 0.786, respectively, for day 1 and day 2), and (2) the relevant domains had proper correlations, while the clinical performance examination (CPX) and objective structured clinical examination (OSCE) showed weaker relationships. OSCE/CPX scores were correlated with other variables, especially grade point average and oral structured exam scores. The consequences of this assessment were (1) making students learn clinical skills and study themselves, while causing too much stress for students due to lack of motivation; (2) reminding educators of the need to apply practical teaching methods and to give feedback on the test results; and (3) providing an opportunity for faculty to consider developing support programs. It is necessary to develop the blueprint more precisely according to students’ level and to verify the validity of the response process with statistical methods.

Association between Relative Handgrip Strength and Dyslipidemia in Korean Adults: Findings of the 2014–2015 Korea National Health and Nutrition Examination Survey / 가정의학회지

Background@#Grip strength is a convenient method to measure muscle strength. Recently, relative handgrip strength (HGS) was recommended as a clinical predictor of metabolic health and disease, such as dyslipidemia, which is considered a risk factor for cardiovascular disease. The purpose of this study was to characterize the association between relative HGS and dyslipidemia. @*Methods@#We included 6,027 adults (2,934 men, 3,093 women) aged 30–69 years who participated in the Korea National Health and Nutrition Examination Survey in 2014 and 2015. Relative HGS was obtained by dividing the HGS by body mass index. Complex sampling analysis was conducted to compare the general characteristics of participants according to the quartiles of relative HGS. Logistic regression analysis was used to examine the association between quartiles of relative HGS and dyslipidemia. @*Results@#After adjustment for age, prevalence of diabetes mellitus, prevalence of hypertension, alcohol consumption, smoking status, exercise, income, and education level, relative HGS was inversely associated with dyslipidemia in both men and women. In multivariable logistic regression analysis, the odds ratios (95% confidence intervals) for dyslipidemia in quartiles 1, 2, and 3 relative to quartile 4 were 1.36 (1.00–1.83), 1.29 (0.98–1.70), 1.23 (0.95– 1.60) in men and 1.81 (1.30–2.50), 1.81 (1.32–2.47), 1.39 (1.07–1.81) in women, respectively. @*Conclusion@#Relative HGS was inversely associated with dyslipidemia risk in Korean adults. Muscle-strengthening exercise is recommended to enhance health outcomes.

The Influence of Family Mealtime on Early Adolescents’ Assessment of Their Depression and Family Function

Background@#The purpose of this study was to examine the influence of family mealtime and family structure on family functioning and early adolescents’ depression. @*Methods@#A survey was conducted with a sample of 275 middle school students in the Gangdong-gu district, Seoul. APGAR scores and Children’s Depression Inventory (CDI) scale were used to measure family functioning and depression level, respectively, along with six more questions to collect data on family structure, family mealtimes, and adolescents’ reasons for avoiding family meals. Statistical analyses including t-test, one-way ANOVA and twoway ANOVA were employed to examine the influence of family mealtime, family structure and sex on family functioning and depression levels. @*Results@#The analyses revealed that family structure and environmental factors, such as parental presence and educational attainment did not influence family functioning or adolescent depression, while variables related to family mealtime influenced both depression level and family functioning. Results also showed that females were more vulnerable to depression. @*Conclusion@#It was concluded that having family time during meals improves family functioning and helps decrease depression levels of adolescent family members. Therefore, parents should take care that they have regular family mealtimes with children, especially female children, during their adolescence.

Educational Program Evaluation System in a Medical School / 의학교육논단

A systematic educational program evaluation system for continuous quality improvement in undergraduate medical education is essential. Monitoring and evaluation (M&E) are two distinct but complementary processes referred to in an evaluation system that emphasizes formative purpose. Monitoring involves regular data collection for tracking process and results, while evaluation requires periodic judgment for improvement. We have recently completed implementing an educational evaluation using the M&E concept in a medical school. The evaluation system consists of two loops, one at the lesson/course level and the other at the phase/graduation level. We conducted evaluation activities in four stages: planning, monitoring, evaluation, and improvement. In the planning phase, we clarified the purpose of evaluation, formulated a plan to engage stakeholders, determined evaluation criteria and indicators, and developed an evaluation plan. Next, during the monitoring phase, we developed evaluation instruments and methods and then collected data. In the evaluation phase, we analyzed results and evaluated the criteria of the two loops. Finally, we reviewed the evaluation results with stakeholders to make improvements. We have recognized several problems including excessive burden, lack of expertise, insufficient consideration of stakeholders’ evaluation questions, and inefficient data collection. We need to share the value of evaluation and build a system gradually.

How Do Medical Students Prepare for Examinations: Pre-assessment Cognitive and Meta-cognitive Activities / 의학교육논단

Although ‘assessment for learning’ rather than ‘assessment of learning’ has been emphasized recently, student learning before examinations is still unclear. The purpose of this study was to investigate pre-assessment learning activities (PALA) and to find mechanism factors (MF) that influence those activities. Moreover, we compared the PALA and MF of written exams with those of the clinical performance examination/objective structured clinical examination (CPX/OSCE) in third-year (N=121) and fourth-year (N=108) medical students. Through literature review and discussion, questionnaires with a 5-point Likert scale were developed to measure PALA and MF. PALA had the constructs of cognitive and meta-cognitive activities, and MF had sub-components of personal, interpersonal, and environmental factors. Cronbach's α coefficient was used to calculate survey reliability, while the Pearson correlation coefficient and multiple regression analysis were used to investigate the influence of MF on PALA. A paired t-test was applied to compare the PALA and MF of written exams with those of CPX/OSCE in third and fourth year students. The Pearson correlation coefficients between PALA and MF were 0.479 for written exams and 0.508 for CPX/OSCE. MF explained 24.1% of the PALA in written exams and 25.9% of PALA in CPX/OSCE. Both PALA and MF showed significant differences between written exams and CPX/OSCE in third-year students, whereas those in fourth-year students showed no differences. Educators need to consider MFs that influence the PALA to encourage 'assessment for learning'.

The Association between Obesity Phenotypes and Early Renal Function Decline in Adults without Hypertension, Dyslipidemia, and Diabetes / 가정의학회지

BACKGROUND: The prevalence of chronic kidney disease is increasing worldwide. Several studies have suggested that obesity is associated with early renal dysfunction. However, little is known about the relationship between obesity phenotypes and early renal function decline. Therefore, this study aimed to identify the relationship between obesity phenotypes and early renal function decline in adults without hypertension, dyslipidemia, and diabetes. METHODS: We conducted a cross-sectional analysis of clinical and anthropometric data from 1,219 patients who underwent a routine health checkup in 2014. We excluded adults with cardiovascular disease, renal disease, diabetes, hypertension, dyslipidemia, or low glomerular filtration rate (<60 mL/min/1.73 m2). Renal function was determined according to the estimated glomerular filtration rate calculated using the Chronic Kidney Disease Epidemiology Collaboration creatinine-cystatin C equation. RESULTS: Age, sex, body mass index, waist circumference, triglyceride, low-density lipoprotein, and fasting glucose had an association with the estimated glomerular filtration rate. After adjusting for age, sex, smoking status, and alcohol intake, the odds ratios of the metabolically abnormal normal weight and metabolically abnormal obese phenotypes for the presence of low estimated glomerular filtration rates were 1.807 (95% confidence interval, 1.009–3.236) and 1.834 (95% confidence interval, 1.162–2.895), compared with the metabolically healthy normal weight phenotype. However, the metabolically healthy obese phenotype did not show a significant association with early renal function decline. CONCLUSION: In this cross-sectional study, we confirmed the association between the metabolically abnormal normal weight and metabolically abnormal obese phenotypes and early kidney function decline in adults without hypertension, dyslipidemia, and diabetes.

Factors Affecting Adherence to Antihypertensive Medication / 가정의학회지

BACKGROUND: Hypertension is a major contributor to the global disease burden of cardiovascular and cerebrovascular disease. The aim of this study was to determine demographic and clinical factors associated with adherence to antihypertensive medication. METHODS: From August 2012 to February 2015, we recruited 1,523 Korean patients with hypertension who visited family physicians. The study was conducted in 24 facilities located in urban and metropolitan areas. Of these facilities, two were primary care clinics and 22 were level 2 or 3 hospitals. Adherence was assessed using the pill count method; a cut-off value of 80% was used as the criterion for good adherence. Sociodemographic and lifestyle factors were compared between the adherent and nonadherent groups using the chi-square test for categorical variables and t-test for continuous variables. Binary logistic regression analysis was performed with medication adherence as the outcome variable. RESULTS: Of the 1,523 patients, 1,245 (81.7%) showed good adherence to antihypertensive medication. In the multivariate logistic analysis, age ≥65 years, exercise, treatment in a metropolitan-located hospital, being on ≥2 classes of antihypertensive medication and concomitant medication for diabetes, and a family history of hypertension or cardiovascular diseases were associated with good adherence. Patients who had a habit of high salt intake were less adherent to medication. CONCLUSION: Multiple classes of antihypertensive medications, concomitant medication, and exercise were associated with good adherence to antihypertensive medication, and high salt intake was associated with poor adherence to antihypertensive medication. These factors should be considered to improve hypertension control.

The Association of Body Fat and Arterial Stiffness Using the Brachial-Ankle Pulse Wave Velocity / 가정의학회지

BACKGROUND: BMI alone may not serve as an index of obesity because it does not reflect body composition. The present study aimed to compare arterial stiffness as assessed by the brachial-ankle pulse wave velocity (ba-PWV) among groups defined by body fat percentage (pBF) and BMI. METHODS: This cross-sectional study was based on 1,700 participants (1,044 men and 656 women) who completed a health screening examination at a national hospital between January 2011 and February 2016. Participants were divided into four groups according to BMI and pBF: normal fat and normal weight (NFNW); excessive fat and normal weight (EFNW); normal fat and obese (NFO); and excessive fat and obese (EFO). The ba-PWV and other cardiometabolic factors were compared among the four groups in men and women separately. RESULTS: For both sexes, the NFNW group had a lower metabolic risk compared to that in the other groups (EFNW, NFO, and EFO). After adjusting for multiple variables, the NFO males had a significantly lower ba-PWV compared to those in the other groups, including NFNW males. The NFO group had significantly more skeletal muscle mass and muscle mass compared the other groups (P < 0.05). Among women, the NFNW group had a significantly lower ba-PWV compared the other groups, even after adjusting for multiple variables. CONCLUSION: Lower pBF in obese men may be associated with improved cardiovascular risk.

Prediction of Patient Discharge Status Based on Indicators on Admission / 한국호스피스완화의료학회지

PURPOSE: To provide effective palliative care, it is important to predict not only patients' life expectancy but their discharge status at a time of inpatient admission to a hospice care facility. This study was aimed to identify meaningful life expectancy indicators that can be used to predict patients' discharge status on admission to the facility. METHODS: Among 568 patients who were admitted to the hospice ward of P hospital from April 1, 2016 through December 31, 2017, 377 terminal cancer patients were selected. This retrospective cohort study was performed by using performance status, symptoms and signs, socioeconomic status, laboratory findings on admission. RESULTS: Alive discharge was associated with a good performance status that was measured with the Karnofsky and Eastern Cooperative Oncology Group (ECOG) scales and the Global health and Mental status. Less anorexia, dyspnea, dysphagia and fatigue were also associated with symptoms and signs. Associated laboratory findings were close to normal Complete Blood Cell (CBC) count, Liver Function Test (LFT) and Blood Urea Nitrogen (BUN). CONCLUSION: Our findings suggest that Karnofsky Performance Status (KPS), ECOG, Global health, Mental status, anorexia, dyspnea, dysphagia, fatigue, CBC, LFT, BUN are meaningful indicators when predicting discharge status for inpatients. Further investigation is warranted.

Effectiveness of Medical Education Assessment Consortium Clinical Knowledge Mock Examination (2011–2016) / 의학교육논단

Good assessment is crucial for feedback on curriculum and to motivate students to learn. This study was conducted to perform item analysis on the Medical Education Assessment Consortium clinical knowledge mock examination (MEAC CKME) (2011–2016) and to evaluate several effects to improve item quality using both classical test theory and item response theory. The estimated difficulty index (P) and discrimination index (D) were calculated according to each course, item type, A (single best answer)/R (extended matching) type, and grading of item quality. The cut-off values used to evaluate P were: >0.8 (easy); 0.6–0.8 (moderate); and <0.6 (difficult). The cut-off value for D was 0.3. The proportion of appropriate items was defined as those with P between 0.25–0.75 and D ≥0.25. Cronbach α was used to assess the reliability and was compared with those of the Korean Medical Licensing Examination (KMLE). The results showed the recent mean difficulty and decimation index was 0.62 and 0.20 for the first MEAC CKME and 0.71 and 0.19 for the second MEAC CKME, respectively. Higher grade items evaluated by a self-checklist system had better D values than lower grade items and higher grade items gradually increased. The preview and editing process by experts revealed maintained P, decreased recall items, increased appropriate items with better D values, and higher reliability. In conclusion, the MEAC CKME (2011–2016) is deemed appropriate as an assessment to evaluate students' competence and prepare year four medical students for the KMLE. In addition, the self-checklist system for writing good items was useful in improving item quality.

Factors That Influence Educational Effectiveness and Learning Satisfaction in Biomedical Research Programs during Premedical School / 의학교육논단

Although student research programs have been implemented worldwide, research programs during premedical school have unique characteristics. The purpose of this study is to evaluate factors that influence the effects of premedical school research programs. Eighty second-year premedical students at Pusan National University were included in the study. Effect elements and influential factors were extracted through reference reviews and in-depth individual interviews. A Likert scale questionnaire was developed using the extracted elements and factors, and Cronbach's alpha coefficient was used to analyze the reliability of the survey. The mean value and the standard deviation for each question were calculated to evaluate education effectiveness and learning satisfaction, and the influence of each factor on effect was analyzed using correlation analysis. Students' research skills and knowledge were improved in the short term; however, interest in research or in a career as a researcher did not increase. Student interest, participation, and contributions were important factors. Among professors, passion, considerateness, and teaching method including the level of lesson were influential factors. Implementation of curriculum and support and guidance were influential as well, whereas evaluation system was not a factor. To improve student research programs, several factors that influence education effectiveness and learning satisfaction should be considered.

Relationship of Peer- and Self Assessments in the Anatomy Laboratory and Academic Performance of Gross Anatomy / 체질인류학회지

Gross anatomy, with cadaver laboratory dissection, is in a unique position to preside over a rich number of activities such as the team work, integrity, active learning, communication in the small group-all aspects of professional conduct. The purposes of this study are to investigate the correlation of professionalism with academic performance and the characteristics of groups of students in the performance variables. First-year Pusan National University School of Medicine students (n=108) from the Class of 2015 taking the gross anatomy course were required to do the self- and peer assessment about the professional behaviors of each of the six members of their dissecting group. The students were classified into one of four subgroups based on their deviation from the self- and peer assessment medians, such as high peer/high self (HP/HS), high peer/low self (HP/LS), low peer/high self (LP/HS), low peer/low self (LP/LS). There were significant higher scores in the high peer groups (HP/HS, HP/LS) in comparison with low peer groups (LP/HS, LP/LS) in the academic performance of end-of-term (F=3.24), credit (F=3.54), pre-Lab (F=3.94), practical examination (F=3.60) scores. Significant correlations among academic performance variables were observed generally. There were some differences in the correlation in the practical examination and other variables. The relatively high correlation between practical examination and other variables is HP/HS, followed by LP/LS, LP/HS and then HP/LS. In conclusion, peer- and self assessment subgroups showed a significant differences in the academic performance. This assignment would be available to evaluate work habits of professionalism in the gross anatomy laboratory. It is suggested that HP/HS group was more adaptable in the contextual leaning the gross anatomy course.

Shift Work Is Associated with Metabolic Syndrome in Young Female Korean Workers / 가정의학회지

BACKGROUND: Shift work is associated with health problems, including metabolic syndrome. This study investigated the association between shift work and metabolic syndrome in young workers. METHODS: A total of 3,317 subjects aged 20–40 years enrolled in the 2011–2012 Korean National Health and Nutrition Examination Survey were divided into shift and day workers. We conducted a cross-sectional study and calculated odds ratios using multivariate logistic regression analysis in order to examine the association between shift work and metabolic syndrome. RESULTS: The prevalence of metabolic syndrome was 14.3% and 7.1% among male and female shift workers, respectively. After adjusting for confounding factors, shift work was associated with metabolic syndrome in female workers (odds ratio, 2.53; 95% confidence interval, 1.12 to 5.70). CONCLUSION: Shift work was associated with metabolic syndrome in young women. Timely efforts are necessary to manage metabolic syndrome in the workplace.

Association Between Serum 25-Hydroxyvitamin D Levels and Dry Eye in Korean Adults: A Study Based on Korean National Health and Nutrition Examination Survey, 2010–2011 / 가정의학회지

BACKGROUND: Dry eye is a common disease. Many patients continue to experience residual symptoms despite optimal treatment. Thus, new treatment options are required. The purpose of this study was to evaluate the association between serum 25-hydroxyvitamin D [25(OH)D] levels and dry eye. METHODS: This study was performed using data from the fifth Korean National Health and Nutrition Examination Survey, which is a cross-sectional study of the Korean population that was conducted from 2010 to 2011. We included adults aged >19 years who underwent ophthalmologic interviews and examinations. We excluded subjects who had comorbid conditions (rheumatoid arthritis, thyroid disease, chronic kidney disease, or depression) that are associated with dry eye. The subjects were divided into normal and dry eye groups. The dry eye group consisted of those who had clinically diagnosed dry eye syndrome or symptoms. Multiple logistic regression analysis was conducted to determine the association between serum 25(OH)D levels and dry eye. RESULTS: In the univariate model, the 25(OH)D levels were lower in the dry eye group than in the normal group (P=0.01). A significant association was found between severe vitamin D deficiency (<10 ng/mL) and dry eye (P=0.04). However, after multivariate adjustment, the statistical significance of the association disappeared (P-values= 0.49, vitamin D insufficiency; P=0.33, vitamin D deficiency; P=0.18, severe vitamin D deficiency). CONCLUSION: Severe vitamin D deficiency was associated with dry eye in an unadjusted model, but the association was not statistically significant after adjustment.

Medical Management of Obesity

We, as health advocates, aim to raise awareness on the importance of a long-term approach for managing obesity as a chronic disease rather than merely a cosmetic issue. The cornerstone of obesity management remains the application of comprehensive lifestyle programs designed to modify dietary habits, physical activity, and behavior. Drug therapy for obesity should be used in addition to comprehensive lifestyle management. Appropriate use of anti-obesity drugs, approved by Food and Drug Administration, may help patients with obesity. Therefore, clinicians need to follow both a comprehensive and a personalized approach to treat obesity. Initially, it is necessary to assess patient's readiness to lose weight and to elicit the reasons and motivations for weight loss. Then, realistic goals should be set based on the patient's health status. The goals include reducing and preventing comorbidities related to obesity. Even a modest weight loss, such as 5~10% of total body weight, can significantly improve metabolic health. Finally, both the patient and the physician should be aware that weight maintenance is as important as weight loss.