Effects of rhGH on Body Composition and Subjective Physical Functions in Adults with Functional Growth Hormone Deficiency

BACKGROUND: There is a significant amount of evidence to indicate that some of the changes attributed to aging process can be partially reversed by GH replacement. But the GH replacement for somatopause with functional GH deficiency is still controversial. The aim of this study was to explore whether the short term GH replacement improved physical, emotional and sexual function as well as body composition. METHODS: A total of 31 adults with functional growth hormone deficiency were assigned to receive rhGH with an initial daily dose of 1.05 IU, six times a week. For evaluating physical change a 25-item questionnaire was administered to patients at initial visit and 6 months later. Body composition was determined by bioimpedence analysis at initial visit and 6 months later as well. We compared the changes for each variable using Wilcoxon's rank and Friedman's test. RESULTS: Serum IGF-1 level at 3 and 6 months were increased significantly by 31% and 43%, respectively, compared to baseline (P<0.0001). Lean body mass and percent body fat at 6 months of treatment showed a 2.2% increase and a 7.6% decrease with statistical significance. The score of the questionnaire at 6 months of treatment increased significantly in physical changes (P<0.0005), sexual function (P<0.001), self perception of physical appearances (P<0.02), chronic fatigue & immunity (P<0.03), and vitality (P<0.05). CONCLUSION: Adults with functional growth hormone deficiency showed improvements in not only body composition, but also physical function and appearances and sexual function after 6 months of treatment with rhHGH.

Serum Insulin-Like Growth Factor I and Its Relating Factors in Healthy Korean Adults Aged over 40 Years

BACKGROUND: There is a clinical need for a reference value based on healthy adults in Korea. The aim of this study was to define IGF-1 concentration in healthy Korean adults and to investigate the factors relative to IGF-1 level. METHODS: By reviewing the medical records of a hospital in Korea, healthy 112 men and 109 women aged over 40 years were studied. We determined the serum IGF-1 levels of both groups according to age, sex, health behaviors, lipid profile, bone mineral density, serum albumin, waist circumference, body mass index, total testosterone, and FSH. RESULTS: IGF-1 had no sexual difference in any age group (258.7+/-84.3 ng/mL for men, 263.7+/-86.8 ng/mL for women), but correlated negatively with age (r=-0.43 and -0.35 for men and women, respectively). The mean decline was 49.6 ng/mL and 43.9 ng/mL per 10 years for men and women, respectively. IGF-1 correlated positively with serum albumin, total cholesterol, and bone mineral density of spine and femur neck. The multiple regression analysis showed that the most powerful factors influencing IGF-1 level was serum albumin (R2; 0.13) followed by age, bone mineral density of femur neck, and total cholesterol. CONCLUSION: We present a reference value for IGF-1 in healthy Korean adults aged over 40 years. The most powerful factor influencing IGF-1 level was serum albumin.

The Predictors of Growth Hormone Secretion after L-dopa Stimulation Test in Adults

BACKGROUND: Twenty four-hour GH secretion reaches a peak in puberty and declines by 14% every decade in adult life. By age 60, most adults have a total 24-hour secretion rate indistinguishable from those of hypopituitary patients with organic lesions in pituitary gland. We performed this study to know about the predictors of GH secretion after L-dopa stimulation test in adults. METHODS: One hundred and ninety eight patients over the age of 45, who visited the menopausal clinic from Oct. 2001 to May 2002, were studied. We compared the peak GH value after the administration of L-dopa 500 mg by gender and age groups. Also, we compared the GH deficiency group to normal by anthropometric and measured variables. RESULTS: The mean of the stimulated GH peak value and the prevalence rate of growth hormone deficiency were greater in women than in men. GH-AUC after L-dopa stimulation correlated well with all measurements of adiposity. In GH deficiency group, the mean values of measured variables about adiposity were greater than normal in statistical significance. Logistic regression test revealed sex and abdominal obesity contributed significantly to predict GH deficiency after L-dopa stimulation test. The odds ratio of GH deficiency were 3.0 in women compared to men with 2.9 in abdominal obesity. CONCLUSION: Gender and adiposity were the predictors of GH deficiency in adults after L-dopa stimulation test rather than age and IGF-1 values.

Weight control behaviors of obese adolescents

BACKGROUND: As childhood-onset obesity has been known to have a poor prognosis, and its prevalence is rapidly increasing, many children and adolescents are becoming concerned about obesity and try various weight control methods. This study assessed the experience and behaviors of weight control in obese adolescents. METHODS: A total of 732 among 840 obese students from 28 schools in Seoul metropolitan area were assessed with a self-administered questionnaire. RESULTS: Middle school students showed the highest trial rate of weight control. Elementary and high school girls showed significantly higher trial rates of weight control than boys(P<0.05). The methods more frequently used were physical exercise, and diet, drugs and other methods, and visits to obesity clinics in that order. Elementary school girls most frequently tried physical exercise while high school girls went on a diet most frequently. All groups of girls were dieting significantly more often than boys(P<0.05). High school girls were the most frequent users of drugs and other methods while elementary school boys and middle schoolgirls visited obesity clinics most frequently. Unhealthy weight control methods observed were monodiet(2.7%), fasting(1.9%), dieting pills(1.4%), and vomiting(0.1%). The mean number of weight control methods was decreased with increasing age. The possibility of overall weight control was significantly higher in girls, having higher weight dissatisfaction levels. The possibility of physical exercise was significantly higher in younger ages, having mother with a career and a family history of obesity. The possibility of dieting was significantly higher in girls, older ages, having higher obesity index. The possibility of using drugs and other methods was significantly higher if they had higher weight dissatisfaction levels and a family history of obesity. The possibility of visiting obesity clinics was significantly higher if they had higher obesity index. CONCLUSION: Although, exercise and diet were frequently chosen by obese adolescents for weight control, the munber unhealthy methods chosen were found to be higher and physical exercise decreased with increasing age. Therefore, an appropriate weight control program that is not detrimental to normal growth and development is called for in early adolescence.

Computer use and factors affecting computer use by family physicians

BACKGROUND: Computers can in many ways improve the quality and efficacy of medical care. The purpose of this study was to perform a comprehensive survey of present computer use and investigate the factors affecting computer use by family physicians. METHODS: One thousand and 1250 family physicians were surveyed by mail from May to August, 1999. The survey protocol included demographic characteristics, opinions on computer use in medicine, present computer usages and wanted applications in the future. RESULTS: Of the 306 responses received, 291 responses were analysed. 91.4% replied that they used computers in the medical field, and 58.1% said they used computers during medical interview. Factors preventing computer use in medicine were cost(33%), time(16%), insufficient information(14%), the doctor-patient relationship(12%) and no perceived need(6%). While 46% of the responders who used computers in the medical field cited fellow doctors for their interest in computer use in the medical field, only 6.2% answered that medical societies or associations had promoted their interest. Present usage of computers included word processing, online communication, internet, medical insurance billing, in descending order. Factors affecting the present degree of computer use that were statistically significant, were the computer system used, factors preventing computer use and the present form of practice. CONCLUSION: Although, most family physicians use computers in the medical field, its use is still limited to a few areas.

Core procedure of family medicine residency programs

BACKGROUND: There has been no systematic investigation of the necessary core procedures in primary care in Korea. The purpose of this study is to examine the core procedures necessary in primary care and to have the results reflected in residency programs. METHODS: A mail survey was conducted fram May 2, to August 20, 1997 among 478 physicians who qualified as a family physician specialist since 1989. The contents of the questionnaire included 1) sex, age, locatian and size of the hospital 2) of the 93 procedures that should be taught during residency pragrams as suggested by the [American Academy of Family Physicians] and the [Korean Academy of Family Physicians a) procedures taught in residency programs, b) procedures performed by practicing family physicians, and, c) procedures considered as necessary in primary care. RESULTS: 1) Of the 93 procedures, 78 were taught in residency programs, 35 were performed by practicing family physicians, and 77 were considered necessary in primary care. 2) All of the 35 procedures performed by family physicians were taught in the residency programs. Of the 77 procedures considered necessary in primary care, 71 were taught but the remaining 6 were infrequently taught. 3) 7 procedures were taught but was considered unnecessary ; Procedures taught but not actually performed amounted to a total of 43. 4) 42 procedures were considered necessary but not performed. 5) More procedures were performed by male doctors(p<0.05). Surgical procedures were performed more often in regional hospitals than those in Seoul and in the larger cities(p<0.05), and more were performed in private practice(p<0.05). CONCLUSIONS: Although almost all of the procedures considered necessary in primary care were taught in residency programs, many procedure's were not being performed in current medical practice. We suggest that it would be more effective to intensively train the core procedures than to provide exposure to a wide array of procedures. As the procedures performed were found to vary in relat

Clinical observation on balaria in Kang Hwa Hospital

BACKGROUND: In the Republic of Korea, there had been no reports about indigenous malaria cases since 1984 until a vivax malaria case was detected in 1993. Thereafter fram 1993 to 1996, 486 malaria cases were reported. Most of the patients were soldiers in the northern militarized zone. However, since 1997, several patients with malaria were detected in Kang Hwa where there had previously been no report of malaria cases. It is our intent to report the 16 cases diagrnosed in Kang Hwa Community Hospital from January 1, 1997 to August 10, 1998. METHODS: Medical records of the malaria cases from January 1, 1997, to August 10, 1998 in Kang Hwa Community Haspital were reviewed. All of the patients had no histories of traveling abroad, drug abuse or blood transfusion. They were all civilians. Laboratory studies including blood cell count, routine chemistry and platelet-associated IgG(PAIgG) and abdominal sanography were taken. RESULTS: All of the patients were diagnosed with malaria by blood smears. Common symptams were fever(100%), headache(94%), rigors(81%), myaJgia(56%), nausea or vomiting(44%), alternate day fever (25%), left flank pain(19%), diarrhea(13%), and abdominal pain(13%). Splenomegaly was detected in 92% of cases by sonography. Laboratory findings included leukopenia(37.5%), anemia(37.5%) and thrombocytopenia(81.3%). Platelet-associated IgG was elevated in 1 of 5 thrombocytopenic patients who had had the laboratory study performed. All recovered withaut complications. CONCLUSIONS: Cases of indigenous malaria have been progressively increasing in the Republic of Korea. Fortunately, patients responded well to treatment, but continued interest will be required in the future.

The effects of the adolescent smoking cessation program

BACKGROUND: Despite widespread recognition of the hazardous health effects of smoking, adolescent smoking continues to increase, emerging as a public health problem. However few studies have focused on smoking cessation programs for adolescent smokers. The purpose of this study was to measure the short-term effects of the adolescent smoking cessation program performed by the Seoul School Health Center. METHODS: Four hundred and twenty adolescent smokers referred from their schools from March to December of 1996 were assessed before and immediately after the program with a self-questionnaire. The data acquired from these 420 students was analyzed. RESULTS: Males were found to have a higher rate of daily smoking as compared with females. Middle school students had a earlier starting age than those of high school students. About 70% of the students had tried to stop smoking and about 1/3 had a high level of self-efficacy in stop smoking. More than 80% of the students were current alcohol drinkers and 10% ever had experience with other drugs. Many showed poor academic performance and low degree of satisfaction with their schools. More than 50% had experienced punishment at school Middle and high economic status were more common than low status, 73.3% had smokers in their families and 43.3% showed severe dysfunction in family APGA-R. Smoking cessation rate immediately after the program was 37.4%, highest in female high school students and lowest in male high school students Factors shown to be significantly associated with smoking cessation in males were school age, FTQ scores, presence of peer smokers, smoking and alcohol status, self-efficacy in stop smoking and degree of satisfaction with their schools. School age, presence of peer smakers, smoking and other drug use status, self-efficacy in stop smoking, academic performance, degree of satisfaction with their schools, experienoe of runaway from home, economic status and presence of smokers in their families were significant factors in females. Stepwise logistic regression showed that current alcohol users were less likely to succeed in smoking cessation and those with a higher level of self-efficacy in stop smoking were more likely to succeed in males. In females, high school students with higher economic status were more likely to succeed while those with smokers in their families or experience of runaway from home were less likely to succeed. CONCLUSIONS: To promote smoking cessation, specified and risk-based approaches are considered to encourage the motivation of adolescent smokers. For more effectiveness, programs will need to comprehensively include the school, the family, peers, alcohol and other drug issues as well as smoking problem itself.