Associations between Dietary Fiber Intake and Bone Mineral Density in Adult Korean Population: Analysis of National Health and Nutrition Examination Survey in 2011

BACKGROUND: The correlations between the amount of daily fiber intake and bone mineral densities (BMDs) in Korean adult population were investigated in our study. METHODS: Utilizing the Korean National Health and Nutrition Examination Survey in 2011, multivariable linear regression was performed to explore the association between fiber consumption and BMD of lumbar vertebrae 1 to 4 (L1–4 total), L1, L2, L3, and L4 vertebrae, femur neck, femur total, and trochanter. All models were adjusted for age, body mass index, vitamin D level, smoking, physical activity, alcohol use, contraceptive use, hormonal replacement therapy, consumption of carbohydrate, protein, fat, calcium, phosphate, iron, thiamine, riboflavin, niacin, and vitamin C. RESULTS: In males aged between 18 and 45, fiber intake significantly increased BMDs of L1 (coefficient β=0.004, P=0.040) and L2 (β=0.004, P=0.038) while daily protein consumption significantly lowered BMDs of femur neck (β=−0.001, P=0.009), femur total (β=−0.001, P=0.008), and trochanter (β=−0.001, P=0.008). In males aged 65 and older, nutrient intake shows no significant correlations with BMDs except fat consumption was inversely associated with BMD of trochanter (β=−0.001, P=0.017). In females aged between 18 and 45, fiber intake shows no significant relationship with BMDs while daily fat consumption significantly increased BMDs of L1 (β=0.001, P=0.028), L2 (β=0.001, P=0.024), L3 (β=0.001, P=0.033), and L1–4 total (β=0.001, P=0.017). CONCLUSIONS: Fiber intake was a protective factor of lumbar spine (L1 and L2) BMD in male aged between 18 and 45 but not in female participants of any age groups.

A Possible Case of Statin-Induced Ichthyosis in an Elderly Woman / 가정의학회지

Ichthyosis is a heterogeneous group of hereditary or acquired skin disorders, characterized by increased stratum corneum production. Several systemic diseases and many drugs can occasionally cause acquired ichthyosis. We report a case of statin-induced ichthyosis in which the causality between statin and ichthyosis was found possible by using the Naranjo scale. A 79-year-old woman presented with pruritic skin lesions on both legs that appeared erythematous, scaly, and cracked. A clinical diagnosis of acquired ichthyosis was made and the statin was suspected as the cause. The skin lesions improved after 6 weeks of dose reduction of the statin.

Association of Serum 25-hydroxy-vitamin D Concentration and Arterial Stiffness among Korean Adults in Single Center

BACKGROUND: There are growing concerns about the role of vitamin D deficiency in cardiovascular diseases. Therefore, we investigated the correlation between serum 25-hydroxy-vitamin D (25[OH]D) and arterial stiffness among Korean adults. METHODS: We retrospectively reviewed the medical charts of 302 people (115 women and 187 men) who visited a tertiary hospital from January 2015 to December 2016. Serum 25(OH)D was measured using the radioimmunoassay technique, and brachial-ankle pulse wave velocity (baPWV) was measured using an automatic wave analyzer. We obtained the doctor's report on the medical history of the participants, their alcohol consumption and smoking habits, and their exercise status. Metabolic syndrome was diagnosed based on guidelines from the National Cholesterol Education Program (NCEP)-Adult Treatment Panel (ATP III) and the International Diabetes Federation (IDF). Results of basic blood tests and physical assessment were also collected. RESULTS: In the Pearson correlation analysis, serum 25(OH)D and baPWV showed a statistically significant inverse relationship (r=-0.279, P<0.001). Using multiple regression analysis, and after adjusting for possible confounders, serum 25(OH)D concentration was found to be significantly associated with baPWV (β=-0.121, P=0.011). CONCLUSIONS: We observed an association between serum 25(OH)D concentration and arterial stiffness. Further studies involving larger sample sizes will be needed to confirm this associations.

Correlation of Arterial Stiffness and Bone Mineral Density by Measuring Brachial-Ankle Pulse Wave Velocity in Healthy Korean Women / 가정의학회지

BACKGROUND: An association between arterial stiffness and osteoporosis has previously been reported. Therefore, we investigated the relationship between arterial stiffness, measured by brachial-ankle pulse wave velocity, and bone mineral density in a sample of healthy women undergoing routine medical checkup. METHODS: We retrospectively reviewed the medical charts of 135 women who had visited the Health Promotion Center (between May 2009 and December 2012). Brachial-ankle pulse wave velocity was measured using an automatic wave analyzer. Bone mineral density of the lumbar spine (L1-L4) and femur was measured by dual-energy X-ray absorptiometry. Metabolic syndrome was defined according to National Cholesterol Education Program-Adult Treatment Panel III criteria, using body mass index >25 kg/m2 instead of waist circumference >88.9 cm. RESULTS: Pearson's correlation analysis revealed significant inverse relationships between pulse wave velocity and bone mineral density of the lumbar spine (r=-0.335, P<0.001), femur neck (r=-0.335, P<0.001), and total femur (r=-0.181, P=0.04). Pulse wave velocity showed the strongest association with age (r=0.586, P<0.001). Multiple regression analysis identified an independent relationship between pulse wave velocity and lumbar spine bone mineral density in women after adjusting for age, metabolic syndrome, body mass index, smoking status, alcohol intake, and exercise (r=-0.229, P=0.01). CONCLUSION: This study confirmed an association between arterial stiffness and bone mineral density in women.

Association of Arterial Stiffness and Osteoporosis in Healthy Men Undergoing Screening Medical Examination

BACKGROUND: Association of arterial stiffness and osteoporosis has been previously reported in women. However, this association is still controversial for men. Therefore, we investigated correlation of arterial stiffness and osteoporosis by measuring brachial-ankle (ba) pulse wave velocity (PWV) and bone mineral density (BMD). METHODS: We reviewed medical charts of 239 people (women: 128, men: 111) who visited the Health Promotion Center, retrospectively. ba-PWV was measured by automatic wave analyzer. Lumbar spine (L1-L4) BMD and femur BMD were measured by dual energy X-ray absorptiometry. Metabolic syndrome was based on the National Cholesterol Education Program (NCEP)-Adult Treatment Panel (ATPIII) definition. Body mass index (BMI)>25 kg/m2 was used instead of waist circumference. RESULTS: In Pearson's correlation analysis, PWV and femur BMD (Neck, total) had a significant inverse relationship in men (r=-0.254, P=0.007; r=-0.202, P=0.034). In women, PWV and the L-spine, femur (Neck, total) had a significant inverse relationship. (r=-0.321, P<0.001; r=-0.189, P=0.032; r=-0.177, P=0.046) Age and PWV showed the greatest association in both men and women (r=0.46 P<0.001; r=0.525, P<0.001) In multiple regression analysis, the L-spine BMD and PWV had an independent relationship in women after adjusting for age, metabolic syndrome, BMI, smoking, drinking and exercise. (r=-0.229, P=0.015). No independent association was found between PWV and BMD in men. CONCLUSIONS: The association between arterial stiffness and BMD was confirmed in women. However, this association was not statistically significant for men.

Predictability of Impending Events for Death within 48 Hours in Terminal Cancer Patients / 한국호스피스완화의료학회지

PURPOSE: Recognition of impending death is crucial not only for efficient communication with the caregiver of the patient, but also determination of the time to refer to a separate room. Current studies simply list the events 'that have already occurred' around 48 hours before the death. This study is to analyze the predictability of each event by comparing the time length from 'change' to death. METHODS: Subjects included 160 patients who passed away in a palliative care unit in Incheon. The analysis was limited to 80 patients who had medical records for the last week of their lives. We determined 9 symptoms and 8 signs, and established the standard of 'significant change' of each event before death. RESULTS: The most common symptom was increased sleeping (53.8%) and the most common sign was decreased blood pressure (BP) (87.5%). The mean time to death within 48 hours was 46.8% in the case of resting dyspnea, 13.6% in the ease of low oxygen saturation, and 36.9% in the case of decreased BP. The symptom(s) which had the highest positive predictive value (PV) for death within 48 hours was shown to be resting dyspnea (83%), whereas the combination of resting dyspnea and confusion/delirium (65%) had the highest negative PV. As for the most common signs before death within 48 hours, the positive PVs were more than 95%, and the negative PV was the highest when decreased BP and low oxygen saturation were combined. The difference in survival patterns between symptoms and signs was significant. CONCLUSION: The most reliable symptoms to predict the impending death are resting dyspnea and confusion/delirium, and decline of oxygen saturation and BP are the reliable signs to predict the event.

Applying Inhaled Furosemide for Refractory Breathlessness in Terminally-ill Cancer Patients: Based on Seminar of Palliative Medicine Research Group, The Korean Academy of Family Medicine / 한국호스피스완화의료학회지

Breathlessness is a frequent and distressing symptom in terminal cancer patients. Refractory breathlessness is defined as a state that does not respond to conventional disease-specific therapy with an exclusion of reversible underlying causes, and the main classes of symptomatic drug treatments include opioids and benzodiazepines. Korean Family Medicine Palliative Medicine Research Group discussed two terminal cancer patients in whom severe breathlessness with different causes were treated with inhalation of nebulized furosemide, which is an emerging option of palliative treatment. It still remains unclear how it becomes effective or how much it is effective, therefore, its routine use seems to be somewhat early. Nevertherless, if a patient with intractable breathlessness does not have a marked obstructive airway lesion, its use should be considered. Based on the discussion in the seminar, we want to share our experience of the application of inhaled furosemide with other palliative care practitioners and strongly recommend further research on this topic in the future.

One Case of Malignant Mixed Mullerian Tumor Developed in a Postmenopausal Woman under Hormone Therapy / 가정의학회지

Hormone therapy for peri- and postmenopausal women is widely used for relieving vasomotor symptoms or preventing osteoporosis. Even though exogenous hormone is the most common cause of vaginal bleeding in postmenopausal women under hormone therapy, in clinical practice, physicians must never exclude the possibility of endometrial disorders, such as endometrial hyperplasia or cancer. Taking thorough medical history and performing physical and pelvic examinations are essential for the evaluation of abnormal uterine bleeding in menopausal hormone therapy. Transvaginal ultrasonography, endometrial aspiration biopsy, dilatation and curettage, and hysteroscopy are the options which physicians may use. This case is about a woman with continuous combined hormone therapy for 5 years who had experienced rather sudden onset of vaginal spotting lasting for several months and was finally diagnosed as having malignant mixed Mullerian tumor. Our purpose is to inquire into the proper approaching steps for vaginal bleeding in menopausal hormone therapy.

Two Cases of Dengue Fever in Family Medicine

Dengue fever is an acute febrile illness caused by dengue virus infection. Found predominantly in tropical urban areas, dengue virus is transmitted to humans by a female mosquito vector, Aedes aegypti. The clinical features of dengue fever include fever, headache, skin rash and bleeding. These symptoms are usually mild and not fatal, but dengue hemorrhagic fever is life threatening without proper management. The diagnosis of dengue fever can be established with a dengue virus-infected cell culture or with isolated dengue IgM. No specific treatment exists for dengue fever except for symptomatic management. With the recent global increase of dengue fever incidence, the number of cases of dengue fever in returning travelers is on the increase in Korea. Therefore, it is possible that Korean primary physicians will confront dengue fever cases. We report two cases of dengue fever that we experienced in the Department of Family Medicine in 2007.

The Impact of Urinary Incontinence on the Quality of Life in Women

BACKGROUND: Urinary incontinence has a negative impact on the lifestyle of sufferers, affecting not only their physical condition but also their well-being. But only few patients visit doctors for treatment. The purpose of this study was to measure the quality of life in women with urinary incontinence. METHODS: Among the people who visited a tertiary hospital in Seoul for a health exam or primary care during April 2002, we selected 161 women over 20 years old. We measured their quality of life by the Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey (SF-36) questionnaire. Excel 2000 statistical program was used for statistical analysis. RESULTS: The active incontinence group, who experienced urinary incontinence within 1 year, were 48 women and the normal group without urinary incontinence at all were 65 women. The average SF-36 score was 76.5 in total women, 69.0 in active incontinence group, and 81.5 in normal group. The percentage of those seeking treatment was 10.4% and 64.6% of women have never sought help. CONCLUSION: These Results suggest that the incontinent patient had a much lower quality of life than normal women, but there were only few patients who sought treatment.

Determinants of Self-assessed Health among Elderly Adults

BACKGROUND: Self-assessed health is a crude and simple measure which was used as a summary of an individual's general state of health. In this study, we examined the relationship between comprehensive variables and self-assessed health and identified the major determinants of self-assessed health among community dwelling elderly. METHODS: We performed a study on variables using comprehensive geriatric assessment in 308 elderly people who visited the department of family medicine or the department physical medicine and rehabilitation of 11 university hospitals or general hospitals in Korea from July 1, 1999 through October 31, 1999. The association of self-assessed health and variables was examined by X2-test and multiple linear regression analysis. For dependent variable a question "How would you describe your health now?" was used and the subjects responded from these categories: very good, good, fair, poor, and very poor. The independent variables were sociodemographic characters, health behavior, diseases, physical and social function, family and social support. RESULTS: In the X2-test, self-assessed health was significantly associated with income, exercise, nutrition, number of disease, cardiac disease, cerebrovascular disease, fall, ADLs, IADLs, depression and social support. In the multiple linear regression analysis, majority of the explained variance in self-assessed health was nutrition, cardiac disease and depression. CONCLUSION: Self-assessed health among older adults was influenced by various factors. Based on the results, multidimensional approach needs to be developed to improve health.