Rehabilitation Program for Improved Musculoskeletal Pain in Gastrointestinal Endoscopists: Multicenter Prospective Cohort Study

Background/Aims@#This study aimed to develop a rehabilitation program for musculoskeletal pain experienced by gastrointestinal endoscopists and to investigate its usefulness. @*Methods@#This was a multicenter cohort study. During the first 2 weeks, a questionnaire regarding daily workload and musculoskeletal symptoms was administered. Then, a rehabilitation program including equipment/posture correction and stretching was conducted during the remaining 6 weeks. Follow-up daily workload and musculoskeletal symptom surveys were distributed during the last 2 weeks. The program satisfaction survey was performed at the 6th and 8th weeks. @*Results@#Among 118 participants (69 men), 94% (n=111) complained of musculoskeletal pain at baseline. Various hospital activities at baseline were associated with multisite musculoskeletal pain, whereas only a few workloads were correlated with musculoskeletal pain after the rehabilitation program. Follow-up musculoskeletal pain was negatively correlated with equipment/ posture program performance; arm/elbow pain was negatively correlated with elbow (R=–0.307) and wrist (R=–0.205) posture; leg/foot pain was negatively correlated with monitor position, shoulder, elbow, wrist, leg, and foot posture. Higher performance in the scope position (86.8% in the improvement vs 71.3% in the aggravation group, p=0.054) and table height (94.1% vs 79.1%, p=0.054) were associated with pain improvement. An increased number of colonoscopy procedures (6.27 in the aggravation vs 0.02 in the improvement group, p=0.017) was associated with pain aggravation. Most participants reported being average (32%) or satisfied (67%) with the program at the end of the study. @*Conclusions@#Our rehabilitation program is easily applicable, satisfactory, and helpful for improving the musculoskeletal pain experienced by gastrointestinal endoscopists.

Quality of life in patients with diabetes mellitus compared with non-diabetic subjects in Korea: The 5th Korea National Health and Nutrition Examination Survey / 農村醫學 地域保健

OBJECTIVE: This study was to evaluate the health-related quality of life (HRQoL) among patients with diabetes in Korea and to compare them with the HRQoL of individuals without diabetes history. METHODS: The study subjects were 17,655 adults aged over 19 who participated in the 5th Korea National Health and Nutrition Examination Survey (2010-2012). The EuroQoL-5Dimension was used to evaluate HRQoL. Chi-square test, t-test, ANOVA and multiple regression analysis were performed to test the difference of HRQoL in diabetic subjects and controls. RESULTS: The mobility dimension was the highest reported problem: 36.4% for diabetic subjects. The proportion of any reported problem was significantly high among diabetic subjects compared with two controls in terms of mobility [reference group: diabetic subjects, chronic controls: adjusted odds ratio (aOR)=0.77, 95% confidence interval (95% CI)=0.66-0.91, healthy controls: aOR=0.61, 95% CI=0.50-0.75], self-care [reference group: diabetic subjects, chronic controls: aOR=0.68, 95% CI=0.55-0.83, healthy controls: OR=0.69, 95% CI=0.51-0.94]. and usual activities [reference group: diabetic subjects, chronic controls: aOR=0.85, 95% CI=0.72-0.99, healthy controls: OR=0.79, 95% CI=0.62-0.98]. Also, EQ-5D index were significantly low in subjects with diabetes compared to two controls. CONCLUSIONS: Subjects with diabetes had a significantly lower HRQoL compared with two controls. To improve the quality of life of diabetics, it is necessary to study various variables related to the quality of life, and develop and manage various health programs or welfare policies reflecting socio-demographic characteristics and health related features that affect the quality of life.

The Relationship Between Obesity and Depressive Trends in Elementary School Children

PURPOSE: This study was designed to evaluate the relationship between obesity and depressive trends in elementary school children. METHODS: In 1999, we surveyed 2,091 elementary school children(1,079 boys and 1,012 girls) whose ages ranged from 10 to 12 years. Obesity was defined as an obesity index over 20 percent. The degree of depression was compared between the obese group and the normal body weight group according to Korean Children's Depression Inventory(CDI) of Kovacs and Beck. RESULTS: Among the subjects, 1,884(88.2%) formed the normal body weight group, 128(6.1%) formed mildly obese group, 98(4.7%) formed the moderately obese group and 21(1.0%) formed the severely obese group. The mean depression score in the obese group was significantly higher than that of the normal body weight group, and the more severely obese the more significantly the depression score increased. The depression score of the obese girls' group was higher than the obese boys' group. The depression score was significantly higher in the obese group who hate exercise and like computer games, than in the group who like exercise and don't play computer games. The depression score was significantly higher in the obese group who hate physical education than the group who like it. CONCLUSION: The depression score of the obese group was significantly higher than normal body weight group in elementary school children. Physicians should provide psychological support in the treatments of obese children.

The Effects of Nutrition Counseling on Food Intakes and Bloodlipids in Cardiac Patients / 대한지역사회영양학회지

The purpose of this study was to investigate whether nutrition counseling and exercise could be beneficial to patients with acquired cardiac disease (ACD). Twenty-five ACD patients participated in this program, which was based on guidelines for serum lipid management. To measure the effects of the nutrition counseling and exercise education, outpatients with ACD were selected and randomly assigned to three groups which were a control group, a diet only group and a diet and exercise group. Nine diet only group patients and nine diet and exercise group patients received nutrition counseling or nutrition counseling and exercise education every other week. Patients who served as a non counseled control group did not receive any counseling during the same study period. Various markers of disease risk, including lifestyle, anthropometric indices, eating behaviors, and serum lipid levels were measured before and after the program. The program lasted up to 12 weeks, depending on the individuals involved. Database management and statistical analyses were performed using SPSS 7.5 software. As a result, BMI and %IBW showed decreased trends in the diet only and the diet and exercise group. Food habit scores were significantly increased in the diet only group and the frequency of saturated fatty acid, dietary cholesterol, salty food and instant food intake were decreased in the diet only group. Comparisons of the daily nutrient intakes of the groups showed their total calorie, carbohydrate and protein intake had decreased significantly, and also the total fat and dietary cholesterol intake had decreased in the nutrition counseling group. The serum total cholesterol and LDL-cholesterol decreased after 12 weeks in the nutrition counseling group. The diet and exercise group showed less interest in diet control than the diet only group. These results show that a well-planned nutrition counseling program would reduce the risks of ACD and cardiovascular disease and help to care such diseases.

The Relationship of Maternal Disorder with Neonatal Cord Blood Leptin - Preeclampsia, Diabetes Mellitus, Antenatal Steroid Treatment -

PURPOSE: Leptin, the product of the ob gene is primarily by adipose tissue but also by the human placenta. Leptin may also have a role as a regulator of fetal growth and development during normal pregnancy as well as in pregnancies associated with anomalous fetal growth. Our study aimed to discover whether or not leptin concentration in neonatal cord blood correlates with maternal disorder(preeclampsia, antenatal steroid). METHODS: Seventy newborns - twenty of preeclampsia, twenty of antenatal steroid treatment, ten of diabetes mellitus, twenty of neonatal asphyxia- and their mother were enrolled in this study. Gestational age, birth weight, length and placental weight were measured. Maternal age and weight were measured. Cord blood and maternal venous samples were collected and serum was separated and stored at -70dgreesC. Leptin was measured by radioimmunoassay. RESULTS: Neonatal cord leptin concentration was significantly elevated in infants whose mothers received antenatal steroid, preeclamptic mothers and diabetic mothers Also, neonatal cord leptin concentration was correlated with maternal serum leptin concentration in those maternal disorders. Cord blood leptin concentration in neonatal asphyxia group was significantly elevated, but wasn't significantly correlated with their maternal serum leptin concentration. CONCLUSION: Neonatal cord leptin concentration was significantly increased in mothers with preeclampsia, diabetes mellitus, and exposure of the antenatal steroid. We find that maternal disorders affected leptin concentration in cord blood, and that increased cord blood leptin in neonatal asphyxia was shown to be a product of fetus.

A Case of Hepatitis after Occupational Exposure of Trichloethylene / 대한간학회지

Trichloroethylene (TCE) is currently used as a degreasing agent in the jewelry manufacturing industry. The characteristic sign arising after the exposure of TCE are hepatitis and contact dermatitis. The incidence of toxicity is relatively rare, therefore, the mechanism of occurrence is considered as hypersensitivity. A previously healthy 21-year-old male began to work at jewelry industry. The solvent used in that place was TCE. Over the next month, he experienced symptoms of weakness, fever, dry skin, red rash and bumps, peeling face, and jaundice. At that time, he had marked liver enzyme elevation with evidence of cholestasis. After two weeks of avoidance of TCE exposure, his liver enzymes showed a marked reduction in ALT from a peak of 1132 to 131 IU/L. The total bilirubin reduced from 9.3 to 4.6 mg/dL. Tests for hepatitis A, B, and C, CMV, HIV were all negative. The patch test showed primary irritant reaction to TCE and its metabolite, trichloroethanol. This is the second report of TCE induced hepatotoxicity in Korea. We consider this case as a TCE induced hepatotoxicity due to possibly hypersensitivity mechanism.

A Case of an Organoaxial Type of Chronic Gastric Volvulus / 대한소화기내시경학회지

Gastric volvulus is a rotation of the stomach of at least 180 associated with a closed loop obstruction. Pare described the first case of gastric volvulus m 1579. Laxity of the gastric ligament, a congenital or acquired diaphragmatic defect, increased abdominal pressure, and a genetic component contributing to gastric volvulus. Gastric volvulus has been classified clinically as acute and chronic gastric volvulus, and can be classified anatomically as organoaxial, mesenteroaxial or a mixed type. Gastric volvulus occurs in children usually before 1 year of age or elderly patients. In acute gastric volvulus, and be patients complain of sudden abdominal or chest pain. The chest pain, which can radiate to the arms and neck accompanied by dyspnea, may initially lead to consideration of ischemic heart disease. Chronic gastric volvulus is difficult to diagnose because it may be associated with mild and nonspecific symptoms such as epigastric discomfort, fullness or heartburn. We experienced a case of 83 year old male with an organoaxial type of chronic gastric volvulus, iagnosed by upper gastrointestinal series, and treated with conservative rnanagement.

Dispersion of QT Interval and Other Repolarization Indexes in Acute Myocardial Infarction

BACKGROUND: It is known that QT dispersion represents asynchronous repolarization of ventricle which is related to ventricular fibrillation. The incidence of ventricular arrhythmia is increased after acute myocardial infarction. So this study compared QT dispersion and other repolarization indexes for detection of asynchronous repolarization in acute myocardial infarction. We also investigated which portion of repolarization is the key portion of the asynchrony. METHODS: In 37 acute myocardial infarction patients and 38 angina patients dispersion of QT, JT, JTpeak and QTpeak were measured. We also measured maximum adjacent dispersion of same parameters in precordial leads. In 20 survived patients and 17 dead patients after acute myocardial infarction were also compared. We also investigated correlation of PVC's on Holter monitoring with these repolarization parameters. RESULTS: 1) All ventricular repolarization indexes(QT, QTc, JT, JTpeak, QT peak and TpeakTend dispersion) were significantly increased in acute myocardial infarction group than compared with those of angina group(p<0.05). 2) Maximal precordial dispersion(QT, QTc, JT, JTpeak and QTpeak) were also significantly increased in acute myocardial infarction group than angina group(p<0.05). 3) Dead patient group after myocardial infarction showed significantly increased QTc and TpeskTend dispersion compared with those of survived patient group(p<0.05). 4) Multivariate linear correlation showed that TpeakTend dispersion and JT dispersion was correlated with QT dispersion. CONCLUSIONS: There were asynchronous myocardial repolarization changes in acute myocardial infarction. Our study demonstrated that T wave change was major determinant of dispersion of myocardial repolarization.