Associations between Body Mass Index and Chronic Atrophic Gastritis and Intestinal Metaplasia / 대한소화기학회지

BACKGROUND/AIMS: Chronic atrophic gastritis (AG) and intestinal metaplasia (IM) of the stomach are premalignant lesions. The present study aimed to examine the associations between obesity and these lesions. METHODS: A total of 2,997 patients, who underwent gastroscopy, participated in this study, excluding those who had been diagnosed with gastric cancer. Participants were divided into four groups based on their body mass index (BMI). The risk of AG and IM with increasing BMI was analyzed in men and women, separately. RESULTS: The association between BMI and AG was not significant. After adjusting for age, smoking, alcohol, and AG, the odds ratios for IM in the overweight, obesity, and severe obesity groups were 2.25 (95% confidence interval [CI], 1.50-3.37), 2.32 (95% CI, 1.58-3.42), and 4.86 (95% CI, 2.04-11.5) in men, and 2.66 (95% CI, 1.29-5.47), 4.46 (95% CI, 2.28-8.75), and 9.57 (95% CI, 3.26-28.12) in women, compared with the normal BMI group. CONCLUSIONS: Gastric IM was significantly associated with increased BMI.

The Relationship between the Blood Level of Persistent Organic Pollutants and Common Gastrointestinal Symptoms / 가정의학회지

BACKGROUND: Persistent organic pollutants (POPs) are toxic materials that cannot be broken down naturally and that easily accumulate in the body. Although several studies have attempted to uncover the effects of POPs on the endocrine and nervous systems and on cancer, few focus on the relationship between low-dose POPs and public health. Here, we attempt to determine the relationship between the level of POPs and common gastrointestinal symptoms, including abdominal discomfort, diarrhea, and constipation. METHODS: We recruited 121 subjects who visited Kyungpook National University Medical Center for health screening. Plasma concentrations were evaluated for 40 kinds of POPs including 17 types of polychlorinated biphenyls (PCBs) and 23 types of organochlorine pesticides (OCP). Furthermore, the Korean version of the Rome III criteria was used to identify gastrointestinal symptoms. RESULTS: Based on our results, abdominal discomfort showed an inverse relationship with several PCBs and an inverted U-shaped relationship with several other OCPs including pp-DDD and pp-DDT. The effects of pp-DDD and pp-DDT on abdominal discomfort were similar to those of OCPs on obesity and metabolic syndrome. CONCLUSION: Our results suggest that mild and unspecified gastrointestinal symptoms with no clear causes could be related to POP levels.

The Relationship between the Blood Level of Persistent Organic Pollutants and Common Gastrointestinal Symptoms / 가정의학회지

BACKGROUND: Persistent organic pollutants (POPs) are toxic materials that cannot be broken down naturally and that easily accumulate in the body. Although several studies have attempted to uncover the effects of POPs on the endocrine and nervous systems and on cancer, few focus on the relationship between low-dose POPs and public health. Here, we attempt to determine the relationship between the level of POPs and common gastrointestinal symptoms, including abdominal discomfort, diarrhea, and constipation. METHODS: We recruited 121 subjects who visited Kyungpook National University Medical Center for health screening. Plasma concentrations were evaluated for 40 kinds of POPs including 17 types of polychlorinated biphenyls (PCBs) and 23 types of organochlorine pesticides (OCP). Furthermore, the Korean version of the Rome III criteria was used to identify gastrointestinal symptoms. RESULTS: Based on our results, abdominal discomfort showed an inverse relationship with several PCBs and an inverted U-shaped relationship with several other OCPs including pp-DDD and pp-DDT. The effects of pp-DDD and pp-DDT on abdominal discomfort were similar to those of OCPs on obesity and metabolic syndrome. CONCLUSION: Our results suggest that mild and unspecified gastrointestinal symptoms with no clear causes could be related to POP levels.

The Relationship between the Blood Level of Persistent Organic Pollutants and Common Gastrointestinal Symptoms / 가정의학회지

BACKGROUND: Persistent organic pollutants (POPs) are toxic materials that cannot be broken down naturally and that easily accumulate in the body. Although several studies have attempted to reveal the effects of POPs on the endocrine and nervous system and on cancer, few studies focus on the relationship between low-dose POPs and public health. We attempted to find a relationship between the level of POPs and common gastrointestinal symptoms, including abdominal discomfort, diarrhea, and constipation. METHODS: We recruited 121 subjects who visited Kyungpook National University Hospital for a health screening. Plasma concentrations were evaluated for 40 kinds of POPs including 17 types of polychlorinated biphenyls and 23 types of organochlorine pesticides. Furthermore, the Korean version of the Rome III criteria was used to identify gastrointestinal symptoms. RESULTS: Our results showed that abdominal discomfort had an inverse relationship with several polychlorinated biphenyls. Moreover, an inverted U-shaped relationship was observed between abdominal discomfort and several other organochlorine pesticides including p,p'-dichlorodiphenyldichloroethane and p,p'-dichlorodiphenyltrichloroethane, and the effects of these pesticides on abdominal discomfort were similar to that of organochlorine pesticides on obesity and metabolic syndrome. CONCLUSION: Our results suggest that mild and unspecified gastrointestinal symptoms with no clear cause could be related to POPs levels.

Efficacy of Chronic Disease Self-management Program in Older Korean Adults with Low and High Health Literacy

PURPOSE: We evaluated the efficacy of the Chronic Disease Self-management Program (CDSMP) among older Korean adults and investigated the question of whether the effects differed according to their levels of health literacy. METHODS: Measures of self efficacy, physical activity, physical health, and mental health were assessed at baseline, and at 6-week, and 18-week follow up for the CDSMP intervention group (n = 23) and control group (n = 31) according to their health literacy status. RESULTS: The older adults in the CDSMP intervention group showed significantly higher levels of self efficacy and physical activity at follow up. Participants with low health literacy had greater benefits from the intervention than had those with high health literacy. CONCLUSIONS: The CDSMP is a beneficial intervention for older Korean adults with chronic disease. Healthcare professionals should encourage older Korean adults with chronic illness to participate in the CDSMP, in particular for those with low health literacy.

Risk Factors Related to Development of Delirium in Hospice Patients / 한국호스피스완화의료학회지

PURPOSE: Delirium is a common and serious neuropsychiatric complication among terminally ill cancer patients. We investigated risk factors related to the development of delirium among hospice care patients. METHODS: Between May 2011 and September 2012, we included patients who were mentally alert and had no psychiatric disease or drug addiction at the hospice ward of two local hospitals. Among them, participants who had been diagnosed with delirium by two doctors according to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-4th edition) criteria were grouped as Delirium Group. We analyzed results of psychometric and other laboratory tests performed at the time of patient's admission - psychometric tests included cognitive function (mini-mental status examination, MMSE), depression (Beck Depression Inventory, BDI), anxiety, and insomnia (Insomnia Severity Index, ISI). Logistic regression analysis was used to compare delirium and the related factors. Cox's proportional hazard model was performed using significant factors of logistic regression analysis. RESULTS: Of the 96 patients who met the inclusion criteria, 41 (42.7%) developed delirium. According to the logistic regression analysis, primary cancer site, cognitive impairment (MMSE or =16), and insomnia (ISI> or =15) were significant factors related to delirium. Among the four factors, depression (OR 5.130; 95% CI, 2.009~13.097) and cognitive impairment (OR 5.130; 95% CI, 2.009~13.097) were found significant using Cox's proportional hazard model. CONCLUSION: The development of delirium was significantly related to depression and cognitive impairment among patients receiving hospice care. It is necessary to carefully monitor depression and cognitive function in hospice care.

The Association between Pain and Depression, Anxiety, and Cognitive Function among Advanced Cancer Patients in the Hospice Ward / 가정의학회지

BACKGROUND: Pain is the most common but severe physical symptom among cancer patients. This study aimed to identify correlation between pain and psychological symptoms for terminal cancer patients. METHODS: The total sample consisted of 69 subjects who were recruited through two hospice wards, limited to patients who were mentally alert and had no psychiatric diseases. The subjects were divided into two groups according to the numerical rating scale: the pain-free group, 0 to 3 points; and the pain group, 4 to 10 points. We used the Beck depression inventory (BDI), Beck anxiety inventory (BAI), mini-mental status examination-Korea (MMSE-K), and short form 36 health survey (SF-36). Logistic regression analysis was performed to verify the correlation between pain and other psychosocial disorders. RESULTS: The mean scores of BDI in the pain-free and pain groups were 25.7 and 31.5; mean BAI scores were 23.4 and 34.7; mean MMSE-K scores were 25.7 and 21.8, respectively. There were no significant differences between the two groups in SF-36 score except scores of body pain. The results of logistic regression analysis adjusted for age, sex, marital status, types of cancer, history of chemotherapy, or radiotherapy showed significant correlation between pain and depression (BDI > or = 24; odds ratio [OR], 4.199; 95% confidence interval [CI], 1.171 to 15.060), and pain and cognitive impairment (MMSE or = 22; OR, 3.011; 95% CI, 0.907 to 9.997). CONCLUSION: Pain significantly affects depression and cognitive impairment among advanced cancer patients in the hospice ward. Accordingly, more aggressive treatment of pain is required to reduce not only physical suffering but also physiological distress.

Effects of Passive Smoking on Pulmonary Function in Adults

BACKGROUND: Passive smoking is an important worldwide public health issue. In many Korean studies, parental smoking has been reported to be associated with reduced pulmonary function in children. But few studies have evaluated the effects of passive smoking on pulmonary function in adults. Therefore, we looked into this association in the study. METHODS: Participants in the study included non-smoking, healthy men (n=46) and women (n=326) from rural Korea enrolled from June to December 2006. Exposure to passive smoking was assessed by a self-administered questionnaire, and standardized pulmonary function tests were performed. RESULTS: There were significant reductions in forced expiratory volume in 1 second (FEV1, % of predicted) and forced mean expiratory flow rate 25-75% (%) among the men exposed to passive smoke compared with those not exposed (55.7 vs 75.8, P=0.010; 33.9 vs 58.6, P=0.029, respectively). There were significant reductions in FEV1 among men exposed at both workplace and home compared with men exposed only at either workplace or home (42.8 vs 49.3, 64.6; P=0.034). No significant difference in pulmonary function was found between women exposed to passive smoke compared those not exposed. There were, however, reductions in FEV1 and FEV1/forced vital capacity among the women exposed at workplace. Regression analysis showed that passive smoking negatively affected lung function, which were not statistically significant. CONCLUSIONS: Exposure to environmental tobacco smoke, particularly at the workplace, adversely affects pulmonary function in adults.

Relationship between Changes in Body Mass Index and Pulmonary Function in Adults

BACKGROUND: Obesity is linked to a wide range of respiratory diseases. Several studies have shown that body weight at baseline and weight change were related to pulmonary function. The purpose of this study was to investigate the relationship between change in body mass index (BMI) and pulmonary function in adults. METHODS: Of those aged 40-64 years at baseline who had initially visited the health promotion center at one university-level hospital from January 2000 to December 2002, 499 (men: 309, women: 190) patients revisited the center over a 5-year period up to December 2009 and were enrolled in the study. Subjects were classified into 4 groups- group 1: normal-normal, group 2: normal-obese, group 3: obese-normal, and group 4: obese-obese, based on their BMI at baseline and follow-up. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC were measured by spirometry. RESULTS: Change in FEV1/FVC was significantly associated with change in BMI for men in all 4 groups. Change in FEV1/FVC was significantly different between group 1 and 3 and between group 1 and 4. Changes in FEV1, FVC and FEV1/FVC were significantly associated with change in BMI for women in all 4 groups. Change in FEV1 was significantly different between group 3 and 4, and change in FVC was significantly different between group 1 and 3. CONCLUSIONS: These results suggest that a change in BMI is negatively associated with change in pulmonary function. Obesity itself can be a risk factor for pulmonary dysfunction, and a decrease in BMI through weight reduction could reduce pulmonary dysfunction or improve pulmonary function in adults.

Quality Indicators of End-of-Life Cancer Care from the Family Members' Perspective in Korea / 한국호스피스완화의료학회지

PURPOSE: The Assessing Care Of Vulnerable Elders project has developed indicators for the quality of the end-of-life (EOL) care. However, family members of cancer patients may have a different view on the quality indicators (QIs) established by health care experts. We evaluated the QIs from the family members' perspective. METHODS: The information used in this study was gathered by surveying family members of cancer patients who were admitted to the inpatient hospice ward in Korea. A cross-sectional anonymous questionnaire was distributed to 120 potential respondents from July to October 2009. We included 69 responses in this study (effective response rate, 57.5%). Statistical analysis was performed by using SPSS for Win ver. 14.0, with independent t-test and Pearson's chi-square test. RESULTS: Among QIs for good hospice care, families agreed the most on "Medical examination by the palliative care team or specialist" (88.4%) and "Dying in the family's presence" (88.4%). They agreed the least on "Discussing cardiopulmonary resuscitation with patients" (15.9%). Among QIs for bad hospice care, "Occurrence of fall or pressure ulcer are undesirable" showed the highest agreement rate (94.2%). The lowest agreement rate was 11.6% on "Dying in the hospital is undesirable." In addition, women, patients who were aware of their prognoses, and people with a high socioeconomic status tended to agree more on the QIs. CONCLUSION: Patients' families did not agree on some of the QIs recommended by previous studies. Family members' characteristics were related to their opinions on QIs.

Perception and Performance of Preventive Behaviors for the Pandemic Influenza in Hospital Employees and Outpatients

PURPOSE: A new strain of the H1N1 subtype of influenza A virus resulted in a pandemic outbreak. In South Korea, cases of pandemic influenza have increased. Therefore, we explored perception or preventive behaviors for this virus in hospital employees and outpatients. MATERIALS AND METHODS: Data was collected from hospital employees and outpatients at three university hospitals located in Daegu, Gyeongju in South Korea between the 21st and 30th of September, 2009 using a self-administrated questionnaire. We estimated perception by components of The Health Belief Model (HBM), preventive behaviors consisted of avoidance behaviors, and the recommended behaviors by the Korea Center of Disease Control and Prevention (KCDC). Desire for vaccination was identified. RESULTS: The 1,837 participants comprised hospital employees (n = 880, 47.9%) and outpatients (n = 957, 52.1%). Of all hospital employees, 491 (55.8%) and 708 (80.5%) perceived susceptibility of the pandemic influenza and benefits of the preventive behaviors, respectively. Among all outpatients, 490 (51.2%) and 651 (68.0%) perceived susceptibility of the pandemic influenza and benefits of the preventive behaviors, respectively. Recommended preventative behaviors were adopted by 674 (76.6%) of hospital employees and 631 (65.9%) of outpatients. Vaccination was desired by 479 (54.4%) of hospital employees and 484 (50.6%) of outpatients. Factors influencing preventative behaviors included gender, economic status (for hospital employees) and educational level (for outpatients). All HBM components except perception of barriers were associated with the preventive behaviors in both groups. CONCLUSION: The majority of the surveyed hospital employees and outpatients perceived the benefits of preventive behaviors for pandemic influenza and performed them.

Perception and Performance of Preventive Behaviors for the Pandemic Influenza in Hospital Employees and Outpatients

PURPOSE: A new strain of the H1N1 subtype of influenza A virus resulted in a pandemic outbreak. In South Korea, cases of pandemic influenza have increased. Therefore, we explored perception or preventive behaviors for this virus in hospital employees and outpatients. MATERIALS AND METHODS: Data was collected from hospital employees and outpatients at three university hospitals located in Daegu, Gyeongju in South Korea between the 21st and 30th of September, 2009 using a self-administrated questionnaire. We estimated perception by components of The Health Belief Model (HBM), preventive behaviors consisted of avoidance behaviors, and the recommended behaviors by the Korea Center of Disease Control and Prevention (KCDC). Desire for vaccination was identified. RESULTS: The 1,837 participants comprised hospital employees (n = 880, 47.9%) and outpatients (n = 957, 52.1%). Of all hospital employees, 491 (55.8%) and 708 (80.5%) perceived susceptibility of the pandemic influenza and benefits of the preventive behaviors, respectively. Among all outpatients, 490 (51.2%) and 651 (68.0%) perceived susceptibility of the pandemic influenza and benefits of the preventive behaviors, respectively. Recommended preventative behaviors were adopted by 674 (76.6%) of hospital employees and 631 (65.9%) of outpatients. Vaccination was desired by 479 (54.4%) of hospital employees and 484 (50.6%) of outpatients. Factors influencing preventative behaviors included gender, economic status (for hospital employees) and educational level (for outpatients). All HBM components except perception of barriers were associated with the preventive behaviors in both groups. CONCLUSION: The majority of the surveyed hospital employees and outpatients perceived the benefits of preventive behaviors for pandemic influenza and performed them.

The Effect of Laughter Therapy on Sleep in the Community-dwelling Elderly / 가정의학회지

BACKGROUND: Aging process causes several changes in the typical sleep patterns. Elderly people complain frequently about sleep duration, changes of sleep/wake rhythm and day time sleepiness. This study was performed to evaluate improvement of sleep quality after laughter therapy. METHODS: On July 2007, the study participants aged over 65 were recruited through a community center in Daegu. There were 48 subjects in the experimental group and 61 in the control group. The laughter therapy program was applied to the experimental group. We compared Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) before and after laughter therapy. Data were analyzed by independent t-test, chi-square test, paired t-test, and ANCOVA using SPSS windows ver. 14.0. RESULTS: At initial study, there were no significant differences in baseline characteristics. The ISI scores were 8.00 +/- 6.29 and 8.36 +/- 6.38; the PSQI scores were 6.98 +/- 3.41 and 7.38 +/- 3.70; The Geriatric Depression Seals (GDS) scores were 7.98 +/- 3.58 and 8.08 +/- 3.95 in experimental and control groups, respectively. After laughter therapy, the ISI scores were 7.58 +/- 5.38 (P = 0.327) and 9.31 +/- 6.35 (P = 0.019), PSQI scores were 6.04 +/- 2.35 (P = 0.019) and 7.30 +/- 3.74 (P = 0.847), GDS scores were 6.94 +/- 3.19 (P = 0.027), 8.43 +/- 3.44 (P = 0.422) in experimental and control groups, respectively. CONCLUSION: The laughter therapy is considered to be useful for the elderly people in a community that improves insomnia and sleep quality.

Relationship between Bone Mineral Density and Pulmonary Function in Adult Females

BACKGROUND: Reduced pulmonary function is a common outcome in pulmonary patients with reduced bone mineral density. But, there are few studies on the relationship in adult females who do not have pulmonary diseases. Thus, this study was to assess the correlation between bone mineral density and pulmonary function in healthy women. METHODS: A total of 193 subjects was selected among adult females who visited a health promotion center. BMD was measured by Dual energy X-ray absorptiometry and T-score of lumbar spine (L1-L4) was used. Pulmonary function was measured by spirometer and questionnaire survey was used to obtain information from the subjects. RESULTS: Mean T-score of L-spine was -0.284, FEV1 (pred %) was 98.82% and BMI was 23.50 kg/m2. The results showed positive correlation (0.128) between BMD and FEV1 by multiple regression analysis (P<0.05). CONCLUSION: As FEV1 of subjects increased, BMD increased in adult women who did not have pulmonary diseases.

Hypocholesterolemia and neurotic symptoms

BACKGROUND: An association between low serum cholesterol concentrations and depressive symtoms has ever been found in several studies. The objective of this study is to evaluate neurotic symptoms in hypocholesterolemia. METHODS: In the course of two months (from June to August, 1998), 81 subjects were selected among the people who screened in adult disease survey of one university hospital. As the control group, 80 subjects were selected from a healthy population. In the study population, we excluded people who had medical history of hypertension, diabetes mellitus, ischemic heart disease, chronic liver disease and history of any medication to lipid metabolism and other psychotic disease history. Neurotic symptoms were measured by Symptom Checklist for Minor Psychiatric Disorders (SCL-MPD) questionnaire. RESULTS: There was no difference between the distribution of age and sex in the hypocholesterolemia groups. As the level of the education and kind of employment, no significant difference between two groups. Hypocholesterolemia groups scored significantly higher than conrol group in some questionnaire of SCL-MPD. The results of depression scale (p<0.01) and anxiety, hypochondriasis scale (p<0.05) were significant. The men of hypocholesterolemia groups have significant relation to hypochondriasis scale (p<0.001) and the women to anxiety scale (p<0.05). CONCLUSION: Though in some scale of neurotic symptoms, the association between hypocholesterolemia and neurotic symptoms was found in our study. There need to be a further study on the correlation of hypocholesterolemia and neurotic symptoms.

The relationship between low serum cholesterol and depression

BACKGROUND: Although elevated serum cholesterol level has been considered as a significant health problem because it is associated with coronary artery disease, the relation with various health problem (esp. depression) from low serum cholesterol is not well known in Korean people. The authors tried to observe the degree of depression in low serum cholesterol group for its better management. METHODS: The study population was selected among adults who visited the National University Hospital Health Screening Center between May and July 1998. They had no history of cancer and liver disease and no significant medical illnesses which may affect blood cholesterol level. Using the Korean standard BDI, we evaluated the degree of depression scale. RESULTS: The number of subjects with low serum cholesterol was 77 (males 42, females 35) and that of the control group was 82 (males 47, females 34). The low serum cholesterol group had a statistically significantly higher BDI score(12.2+/-8.2) than the control group (7.6+/-6.3) (P<0.05). In males the mean BDI score of 11.9+/-7.4 in the low serum cholesterol group was significantly higher than the mean score of 5.0+/-3.8 in the control group (P<0.05). In females, there was no significant difference in depression scale between both groups. CONCLUSION: Since the male low serum cholesterol group had a high depression scale, the multi-disciplinary approaches which include psychological supports may be required to manage and treat them. And persistent significant association between low serum total cholesterol level and psychological problems suggests that further long-term study on the association of low cholesterol with depression is necessary.