Investigation of the Association between Normal-tension Glaucoma and Single Nucleotide Polymorphisms in Natriuretic Peptide Gene

PURPOSE: The expression of natriuretic peptides in the neural bundles of the anterior portion of the optic nerves and their functions in regulating vessel tone and blood flow may suggest a possible role in the pathogenesis of glaucoma. The purpose of this study was to investigate the association between normal-tension glaucoma and the genetic variations of atrial natriuretic peptide (Nppa) and natriuretic peptide receptor A (Npr1) gene. METHODS: Sixty-seven Korean normal-tension glaucoma (NTG) patients and 100 healthy subjects (as normal controls) were enrolled. DNA from peripheral blood leukocytes was extracted, and the genotypes of five polymorphisms (c.94G>A, c.454T>C, IVS1+16C>T, IVS2+701G>A, and c.-764C>G) in the Nppa gene and one polymorphism (c.1023G>C) in the Npr1 gene were determined using the restriction fragment length polymorphism and the SNaPshot methods. The genotype and allele frequencies of these polymorphisms in patients with NTG and normal controls were compared using the Fisher's exact test and the chi-square test. RESULTS: In both groups, the genotype distributions were in accordance with the Hardy-Weinberg equilibrium. There was no significant difference in the frequency of the Nppa and Npr1 alleles or genotypes in the normal-tension glaucoma group as compared to the control group. CONCLUSIONS: Nppa and Npr1 gene polymorphisms are not associated with normal-tension glaucoma, suggesting that this gene does not have an important role in the pathogenesis of optic neuropathy in this disease.

What are the Characteristics of Obese Adults without Metabolic Complications?

BACKGROUND: It is known that various subtypes of obesity exist and there has been a growing interest in the various subtypes of obesity, especially in the unique "metabolically healthy but obese" subtype. The purpose of this study was to analyze the features of obese adults without metabolic complications and to provide data which can be used in strategy formation for the effective treatment of obesity. METHODS: A total of 4,561 obese adults with a BMI greater than or equal to 25 kg/m2, were recruited from a health promotion center of a university hospital. Sociodemographic and life style information were gathered by self-questionnaire. We classified them into 2 groups-one having no features (metabolically healthy obese; MHO) and the other having 1~5 features (metabolically unhealthy obese; MUHO)-using the ATP III definition for metabolic syndrome, and used the multiple logistic regression analysis to examine the association between various factors and MHO. RESULTS: Age and BMI were related with MHO independently. Adjusted odds ratio for the MHO men was 2.17 compared with women (P<0.001). Adjusted odds ratio for the MHO regular exercise group was 1.66 compared with the no exercise group (P<0.007). Additionally, those who exercised more had a greater probability of being in the MHO group. Adjusted odds ratio for the MHO in the large income group was 1.88 (P=0.007) compared with those in the small income group. As was seen with exercise, there was a direct relationship between higher income and the probability of being in the MHO group. CONCLUSION: Men compared with women, large income compared with small income, and regular exercise compared with no exercise were features of obese adults which increased their probability of being categorized as "metabolically healthy but obese".

Comparison of Physical Activity Recall with Triaxial Accelerometer

BACKGROUND: The purpose of this study was to compare the Physical Activity Recall (Stanford 7-days physical activity recall)with the Triaxial accelerometer (RT3)to assess physical activity in young adults. METHODS: Thirty-seven subjects wore the RT3 for 24 hours and then completed the physical activity recall. The Stanford 7-Day Recall records hours of sleep, light-, moderate-, hard-and very hard levels of physical activity. RESULTS: The total energy expenditure per day for the Stanford 7-day recall and RT3 was 2381.29 +/-594.93 kcal/day and 2232.97 +/-398.32 kcal/day,respectively, and showed high correlation (r=0.821).The activity energy expenditure per day for the Stanford 7-day recall and RT3 was 836.21+/-290.59 kcal/day and 509.83+/-181.57 kcal/day,respectively,and showed less high but significant correlation (r=0.327).When compared by sex, the total energy expenditure was significantly correlated in men (r=0.572)and the activity energy expenditure in women (r=0.484). CONCLUSION: The Stanford 7-day recall and the RT3 was highly correlated in the total energy expenditure and significantly correlated in the activity energy expenditure. Therefore,it may be used reciprocally to assess physical activity.

Immune Response to Hepatitis B Vaccination for Adults with Isolated Antibody to Hepatitis B Core Antigen in the Hepatitis B Endemic Area

BACKGROUND: Korea is a highly prevalent area of isolated anti-HBc with a rate of 15%, but there is neither vaccination nor management guideline agreed. To know the management for Hepatitis B Vaccination for adults with isolated anti-HBc, we investigated immune response to hepatitis B vaccination in adults with isolated anti-HBc. METHODS: The 23 adults with persistent isolated anti-HBc, who visited a health promotion center from Dec. 1998 to Aug. 1999, were vaccinated with Hepavax?-B by the standard schedule (0, 1, 6 month) and anti-HBs titers were measured 1 month after 1st and 3rd vaccinations (1, 7 month). RESULTS: After the 1st vaccination, 18 (78.26%) developed anti-HBs seroconversion. Among them, 4 (17.39%) had titers of 10~49 mIU/ml, 8 (34.78%) 50~99 mIU/ml, and 6 (26.09%) more than 100 mIU/ml. All non-responders after the 1st vaccination remained as such even with 3 doses of complete vaccination. The majority of seroconverted group did not show more anti-HBs response with further vaccination. CONCLUSIONS: Since none of adults with isolated anti-HBc had a primary response, which indicated few false positive results. Therefore they should be excluded on vaccination programs in Korea. To differentiate between immunity and occult infections, a single dose of vaccine with a follow-up anti-HBs test is preferable for adults with isolated anti-HBc. If the test shows a seroconversion it would indicate protective immunity, if not, then occult infection may be suspected.

Cost-effectiveness Analysis of Colorectal Cancer Screening in Korean General Population

BACKGROUND: CRC is an ideal target for population screening because it is a prevalent disease with an identifiable precursor lesion. This study was performed for the purpose of comparing cost-effectiveness of CRC screening strategies. METHODS: The natural history of a simulated cohort of 50- year-old Koreans in the general population was modeled with and without CRC screening until age 80 years. We evaluated 16 different screening strategies with Markov model. Cases of positive screening test results were worked up with a colonoscopy. After polypectomy, colonoscopy was repeated every 3 years. Our main outcome measurements were discounted lifetime costs, life expectancy and incremental cost-effectiveness (CE) ratio, comparing 16 different CRC screening strategies. RESULTS: In base-case analysis, compliance was assumed to be 60% with the initial screen and 80% with follow-up or surveillance colonoscopy. The non-dominated strategies were colonoscopy every 10 years (COL10), colonoscopy every 5 years (COL5) and colonoscopy every 3 years (COL3). Strategies that only included sigmoidoscopy were generally not regarded as non-dominated strategies, but sigmoidoscopy every 5 years (SIG5) showed similar cost and effects as COL10 while sigmoidoscopy every 3 years (SIG3) had similar results as COL5. Other strategies recommended by the expert panel, such as sigmoidocopy plus colon study every 5 years were less cost-effective than the alternatives. CONCLUSION: Colonoscopy is the most cost-effective strategy in Korea for colorectal cancer screening. Unfortunately, the number of physicians skilled enough to perform colonoscopy is not enough to meet the demands of screening for colorectal cancer in average-risk adults. Therefore, we consider alternative strategies such as SIG5 or SIG3.

The Development of Female Sexual Function Questionnaire in Family Medicine Outpatients

BACKGROUND: Currently, the high quality of life associated with women's rights is strongly supported and has become an important social issue. As a result, there is an increasing need for studies concerning female sexual function. The objectives of this study was to develop a questionnaire to evaluate sexual function evaluation in Korean women. METHODS: A total of 100 married women, who visited an outpatient clinic of family medicine department of a university hospital in Seoul, were studied. After filling out the self-administered questionnaire, a face-to- face interview was done on all study subjects. The items of this questionnaire were adopted from questionnaires with proven validity and reliability. Factor analysis was done and Crohnbach's alpha was calculated. RESULTS: The items of this questionnaire were classified into 5 parts: Drive, Excitement, Sexual activity, Satisfaction, and Spouse. The total variance was 51.5%. The total Crohnbach's alpha was 0.82. The internal consistency was high. Study subjects were able to complete this questionnaire within 10 minutes. CONCLUSION: The validity and reliability of this female sexual function questionnaire was found to be acceptable. This questionnaire can be utilized as a diagnostic adjunctive tool and feedback for treatment through further studies.

Alcoholic Beverage Preference and High Risk Drinking

BACKGROUND: Most recent studies have suggested that beer is associated with high risk of mortality and morbidity. The purpose of this study was to investigate how beverage types affected high risk drinking for chronic harm. METHODS: We analyzed data from 1997 Korea's Behavioral Risk Factor Surveillance System Survey collected through telephone interview based on the multi-stage stratified random sampling (N=1,045). According to the WHOs guidelines, we categorized alcohol consumption per day into three risk levels for chronic harm and employed logistic regression analyses by adjusting for confounding factors including the number of beverages consumed, smoking, BMI, stress, and subjective health. RESULTS: Those who preferred soju were almost three to four times as likely to involve medium or high risk as those who preferred beer. In addition, compared to the beer-preferring drinkers, those who preferred spirits had more than five times of possibility in high risk drinking. However, both of those who preferred makkolli or wine and of those who preferred beer were exposed to high risk drinking to a similar degree. CONCLUSION: In Korea, preferred types of alcoholic beverage turned out to be very important factor of high risk drinking behavior. Therefore, we need to encourage drinkers to switch high alcohol to low alcohol content beverages.

Current Status and Vision of e-Care

Internet is changing almost every facet of our daily lives and the health care is not the exception. About half of the Korean population are using Internet and Korea has the highest rate of high bandwidth Internet use such as ADSL, Cable TV, and so on. E-health has been around health information, e-commerce, and connectivity. Now it migrates toward patient care, so called, e-care. E-care tries to improve the quality of care and reduce the health care costs like the traditional health care. The examples are health risk assessment, information and support, disease management, and interactive medical channel. Health risk assessment provides a comprehensive appraisal of risk factors, summarized by the health age. Information and support sites are specified for special age groups and special diseases. Many medical institutions such as hospitals or HMOs are providing medical channels as a part of their health care services. Many chronic diseases such as diabetes mellitus and congestive heart failure are managed on-line supplementing the traditional doctors' care and management of such diseases. For the first time in Korea, an e-care system, named "Lifetime Health Clinic" is introduced. It provides health information for 80~90% of health problems occurring in a typical home. It also provides a lifetime cancer screening guideline and guidelines to manage registered members' health risks such as smoking, exercise, stress, nutrition, and weight. Clients select their own family physicians and their questions are answered by them on a one-to-one basis. It will improve the quality of medical care supplementing the traditional doctor's role.

A study on the change of hepatitis B markers with the passage of time in nonvaccinees-A follow-up data of visitors in a health examination center for three years

BACKGROUND: Korea is an epidemic area of hepatitis B. There are needs for longitudinal study to measure quantity of hepatitis B infection status in Korea. This study was designed to observe natural course of hepatitis B markers in the same person for three years. The objective of this study was to investigate incidence of new infection and persistence of previous infection. METHODS: The study subjects were clients who visited a health examination center in Seoul twice with an interval of three years, from 1995 to 2000. They replied as nonvaccinee on both occasions for hepatitis B by self-administered questionnaire. Hepatits B markers were measured by radioimmunoassay on all visits. There were 103 subjects with 61 men and 42 women. RESULTS: The positive rate of hepatitis B surface antigen was 20.4% initially, which changed to 18.5% after three years. The positive rate of hepatitis B surface antigen was 20.4% initially, that was changed as 18.5% after three years. The positive rate of hepatitis B surface antibody was 61.2% initially, which increased to 66.0% after three years. The positive rates of hepatitis B surface antibody in men were 63.9% initially and 68.9% after three years, which showed statistically significant trend. (P=0.08). The positive rate of hepatitis B core antibody was 89.3%, which remained the same after three years. There was no positive conversion case of hepatitis B surface antigen. The negative conversion rate of hepatitis B surface antigen was 2/63(3.2%). The positive conversion rate of hepatitis B surface antibody was 7/40(17.5%), and negative conversion rate of that was 2/63(3.2%). The positive conversion rate of hepatitis B core antibody was 3/11(27.3%), and negative conversion rate of that was 3/92(3.3%). CONCLUSION: Hepatitis B markers changed in the direction of increase of infection incidence, rather than natural disappearance of markers in nonvaccinees. The mechanism was postulated as occurrence of new infection mainly, but the possibility of double infection by variants of hepatitis B virus could not be ruled out. We confirmed that positive rate of hepatitis B marker in males was not only higher cross-sectionally, but also increased higher longitudinally. We suggest a follow-up study of hepatits B markers to be performed because hepatits B markers showed dynamic changes. We think the high risk groups of hepatitis B infection have a priority in follow-up study.

EAT score according to weight control, depression level and body mass index(BMI)

BACKGROUND: It is reported that abnormal eating behavior is more frequent in the group of weight control than those of no control. Repeated and chronic binge eating behavior has associations with impaired work and social functioning, overconcerns with body shape and weight. The purpose of this study is to investigate the degree of abnormal eating behavior according to weight management, depression level and obesity. METHODS: From June 1999 to July 1999, we collected self record questionnaire including body mass index(BMI), Beck Depression Inventory(BDI), Eating Attitude Test(EAT) from 1292 students of one girl's high school in Seoul. Study subjects were divided by BMI, the set point was 25 kg/m2. EAT score associated with weight control, BMI, BDI, smoking and alcohol was assessed by multiple linear regression. Study subjects were also grouped by the existence of the history of weight management behavoir, then BMI, EAT score and BDI in each subgroups was assessed by t test. RESULTS: Obese students were 42, whereas those of BMI under 25 kg/m2 were 1191. BDI score ranging from 5 to 20 were 940, 21 to 63 were 179. The EAT score has significant relevance to the history of weight control, BMI, and BDI score in order. The EAT score and BMI were higher in the subjects who experienced various modes of weight control (48.41+/-14.47 vs 33.63+/-12.52 in EAT, 20.34+/-2.26 vs 18.72+/-1.89)(p<0.01). CONCLUSION: EAT score was associated with weight control, BMI and BDI. EAT score and BMI were higher in weight control samples.

Comparative consistency between obesity determination standards using Body Mass Index and Ideal body weight

BACKGROUND: Ideal Body Weight(IBW) is commonly used to determine obesity levels because of its usefulness as target weight. This study was attempted to evaluate the comparative consistency between standards of determining obesity levels using the BMI and IBW. And the authors here provide a definition of IBW and attempt to suggest a new classification of obesity by IBW. METHODS: The test subjects for the research were 24,816 patients who received treatment at the SNUH Health Promotion Center between May 1, 1996 and December 31, 1999. The comparative consistency between standards of determining obesity levels using the BMI and IBW were analyzed calculating the kappa value. RESULTS: The IBW from the Broca method produced a kappa value of 0.668(p<0.001), while the calculation method for IBW recommended by the Japan Obesity Institute produced a kappa value of 0.664(p<0.001). On the other hand, an IBW calculated as 21(kg/m2)X[height(m)]2 (kg) produced the highest value of consistency at a kappa value of 0.911(p<0.001). After calculating IBW as 21(kg/m2)X[height(m)]2 (kg) and comparing the kappa values while adjusting the boundary zone standards, it was found that defining underweight as below 88% of IBW and obesity as above 145% produced the highest value of concurrence at a kappa value of 0.935(p<0.001). CONCLUSION: The validity and confidence with respect to the definition of IBW and the determination method for obesity as proposed by the authors may be confirmed through the methods high level of consistency [kappa value=0.935(p<0.001)] with determination methods using the BMI.

The effect of exercise on daily minor stress

BACKGROUND: Stress can be induced from minor daily life event, and it is widely accepted that this daily minor stress is better predictive factor for relationship between disease and stress. In a number of laboratory studies, investigator reported that perception of stress can be reduced by physical exercise. So in this study, we observed relationship between exercise and stress from minor daily life event, and tried to clarify the effect of exercise on daily stress. METHODS: Volunteer was recruited from health promotion center of one university hospital. and they were doing regular exercise in more than three days per week. Participants completed measures of daily stress inventory and amount of daily exercise for seven days. To compare the daily stress amount between exercise day and no exercise day, we used repeated measures analysis of variance. We used the Wilcoxon signed rank test to compare difference of stress in different sex and different trait anxiety group. RESULTS: There was significant difference in appraisal of daily stress between exercise days and no exercise days. The amount of daily stress was significantly reduced in continuous low level of anxiety group and male by exercise. CONCLUSION: Exercise is associated with a reduction of daily stress appraisal from minor life event. And there is different effect of exercise on daily minor stress in the different anxiety level group and different sex group.

The diagnosis distribution in health examination and associated sociodemographic factors

BACKGROUND: According as people have an increased interest in early detection of disease and health promotion, people who take health examinations are increased. So this study is aimed to survey common problems about health in community and their frequency by way of investigation on diagnosis in health examination data and to evaluate the effects of health risk factors on each disease patterns. METHODS: The medical records of the clients who have taken health examinations for the first time from March 1995 to February 2000 at a health examination center of a university hospital in Seoul were reviewed. The category and number of judged diagnosis, sociodemographic factors are compared and analyzed. RESULTS: The selected medical records accounted to 22,393. The study subjects consist of 11,544(51.6%) male. Mean age is 52.0+/-10.5 years(range 16~90). Mean number of judged diagnosis is 4.04+/-2.13(range 0~9) per one person and female took more diagnosis than male on an average(4.09+/-2.17 Vs 3.99+/-2.09). The organic diagnosis(56.4%) is most in total and other diagnosis is 35.7%, functional diagnosis is 7.9%. The common diagnoses are liver disease(7.07%), decreased physical strength(6.68%), hyperlipidemia(6.53%), obesity(5.90%), osteoporosis or postmenopausal syndrome(4.72%), need for immunization against viral hepatitis(4.69%), hypertension(4.20 %), functional gastrointestinal disease(3.93%). The number of total diagnosis and organic diagnosis is larger in older age, no exercise, female, smoker, no spouse, lower education(p<0.05). The number of functional diagnosis is larger in female, younger age, non smoker, lower education(p<0.05). The number of other diagnosis is larger in no exercise, smoker, female, younger age(p<0.05). CONCLUSION: According to health examination, total diagnosis and organic diagnosis are influenced by age, exercise, sex, smoking, spouse, education, functional diagnosis is influenced by sex, age, smoking, education and other diagnosis is influenced by exercise, smoking, sex, age.

Clinical efficacy of the 7-Minute Screen at primary care setting

BACKGROUND: Because dementia tends to be underdiagnosed, Solomon PR developed a brief neurocognitive screening battery to identify Alzheimer's dementia. The 7-Minute Screen consists of four individual tests(orientation, memory, clock drawing, verbal fluency). It can be rapidly administered and it may be appropriately used in the primary care setting. We attempted to develop a screening tool of dementia based on the 7-Minute Screen at primary care setting in Korea. METHODS: We adapted the 7 Minute Screen to the Korean version of 7 Minute Screen(7 MS-K). 7 MS-K and MMSE-K were administered to 61 elderly people who visited the Sungbuk Public Health Center. Inter-rater reliability and test-retest reliability were evaluated. RESULTS: The 7 MS-K has a sensitivity of 92% and a specificity of 90% for cutoff point of MMSE-K 23/24. Inter-rater reliability and test-retest reliability for the entire battery was very high(both r=1). Mean time of administration was 10 minutes. CONCLUSION: 7 MS-K has a reasonable validity, reliability and can be administered in a brief period, and requires no clinical judgement and minimal training. It may be a useful tool for screening dementias in primary care setting.

Medical Information Technology Improving the Quality of Care

No abstract available.

Primary Care Informatics

No abstract available.

Primary Care Oriented Telemedicine

No abstract available.

The factors associated with satisfaction about body image and weight control behaviors in adolescents

BACKGROUND: Obesity is not anly one of the risk factors that affects the prevalence and aggravation of chronic diseases, but is also the cause of social unfitness because slimness has become a standard of beauty. We surveyed on the satisfaction about self body image, the factors which are related to it and weight control behavior of the adolescents in a local area of Korea. METHODS: The survey was performed in a high school of Pocheon on August, 1996. Five classes out of 14 classes in 1st and 2nd grade were selected. The body mass index(BMI) was calculated from the measured height and weight. The satisfaction about body image which was estimated by the difference between present body image and wanted body image in 9 graded figures of body image was obtained from the questionnaire. The information about sex, religion, history of being teased about body image, body image of their parents, mean duration of watching TV in a day, body esteem, and binge-eating was obtained from the questiannaire and we evaluated the relationship between all of the above with BMI and body image satisfaction. We also investigated on the interest in education about weight control and efforts made by adolescents from the questionnaire on weight control behavior. RESULTS: Total of 224 students participated in this study and only 14.7% of them were satisfied with their body image. 58.9% wanted weight reduction and 26.4% wanted weight gain. They were more dissatisfied with their body image when they were girls(p<0.01), had the experience of being teased about their body image(p<0.01), had low body esteem(p<0.01), and had high BMl(p<0.01). We could not find statistically significant relationship between body image satisfaction and other factors such as religion, the duration of watching TV in a day, the body image of their parents and binge eating. 64.3% of the subjects tried to control their weight and most(87.5%) tried to lose weight. The selected methods were diet control(65.3%) and exercise(52.1%) and the most preferred method of diet control was skipping meah(45.7%). CONCLUSIONS: Most of adolescents were not satisfied with their body image and this dissatisfaction was related to gender, history of being teased about their body image, BMI, and body esteem. Many of them had tried to lose weight and among the methods of weight reduction, there were behaviors that were injurous to their health and growth

The attitude and behavior if primary physicians in seoul toward alternative medicine

BACKGROUND: Alternative medicine is defined as a non-orthodox therapeutic practices including chiropractic, acupunture, herbal medicine, faith, spiritual therapy or as all sorts of medical care that do not follow the medical community standards. Patients do not think of modern medicine as the absolute solution to their health problems and they will sometimes ask for complementary therapy and in want of referral to alternative practitioner. We have investigated the primary physicians' attitude and behavior towards alternative medicine. METHODS: Randomly selected 770 practitioners, in primary care practice in Seoul, were questioned from July to September in 1996 about the attitude to wards alternative medicine, the reasons and symptoms when referring, and experience in alternative medicine practice. RESULTS: 150 questionnaires were returned and among them 139 completed ones (18.1%) were analyzed. Among 770 doctors, 35 (25.2%) have referred patients to alternative practitioner before and more referrals were made when they worked together closely or had some prior training. The belief of special effect of alternative medicine on certain disease was the first reason to refer. Other reasons were for herbal medicine, acupunture, and chiropractice in the order of seguence. The standard way to learn alternative medicine was to attend seminars available through certain institutions. On referral either chronic pain or musculoskeletal disease were the most chief complaints or main diseases of patients. 15 doctors (10.8% ) had some experience in practicing an alternative approach and the patient subjeccts were more likely to be women, and there was increased tendency to be working with another doctor, and to have been trained for such practice. The items used by alternative practitioners were acupunture, herbs in the order of seguence. CONCLUSIONS: Alternative medicine is accepted somewhat by primary physicians in Seoul although the rate of referral and practice is lower than 54% compared to 16% in Canada.

Degree of stress and stress-related factors by the Korean version of the BEPSI

BACKGROUND: The BEPSI(Brief Encounter Psychosocial Instrument) was developed as an instrument for quick assessment of stress in a busy office setting, and well correlated with other stress scales. Bae et al. developed the BEPSI(Korean version)[BEPSI-K] in Korea, which was used broadly in health examination. In this study, we attempted to assess degree of stress and to find stress-related factors among Koreans by the BEPSI-K. METHODS: A household telephone survey of 1,060 responders was carried out using multistage stratifed random sampling technique from April to May, 1997. The data were collected from 947 subjects who answered all the items of the BEPSI-K. RESULTS: The reliability of the BEPSI-K was demonstrated (Cronbachs alpha 0.71). The BEPSI-K score showed left-shifted distribution, and its mean was 1.72. It also was significantly high in the unmarried, those with a low educational level, those with a low income, non-economic group, hypertensive patients, smokers, non-exercisers and drinkers. Among 947 subjects, 7.7 percent was high stress according to tercile of the original BEPSI score. CONCLUSIONS: Stress-related factors were marital status, educational level, income level, occupation, exercise, smoking, drinking, and hypertension in Korea.