Association between Problematic Smartphone Use and Physical Activity among Adolescents: A Path Analysis Based on the 2020 Korea Youth Risk Behavior Web-Based Survey / 가정의학회지

Background@#Physical activity is known to prevent several diseases and positively affect mental health. Previous studies have shown that smartphone addiction negatively affects the physical activity of children and adolescents. This study aimed to investigate the relationship between problematic smartphone use and physical activity among adolescents and the related factors using path analysis. @*Methods@#Using data from the 16th Youth Risk Behavior Web-based Survey from 2020, scores on the Smartphone Addiction Scale—Short Version for Adolescents, physical activity, sex, socioeconomic status (SES), academic performance, depression, smoking, drinking, and sitting time were assessed. Complex sampling and path analyses were performed. @*Results@#Of the total 54,948 students, 25.5% were smartphone risk users, including potential and high-risk users. The direct path coefficients of each factor indicated that female sex (-0.14 for male), low SES (-0.062), high academic performance (0.056), low sitting time for studying purposes (-0.033), high sitting time for non-studying purposes (0.071), and depressive mood (0.130) were related to problematic smartphone use (all P<0.001). Each factor affected problematic smartphone use, and subsequently had a negative effect on the amount of physical activity, with a direct path coefficient of -0.115 (P<0.001). @*Conclusion@#In this study, we confirmed that problematic smartphone use among adolescents was negatively associated with performing an adequate amount of physical activity and that various factors, such as sex, SES, academic performance, and sitting time, directly and indirectly affected this relationship.

Association between Type and Intensity of Physical Activity and Depression / 가정의학회지

Background@#Although numerous studies have indicated that lower levels of physical activity correlate with a higher risk of depression, an association between the type of physical activity and depression has not been identified in Korea. This study aimed to examine whether the type and intensity of physical activity are associated with depression in Korean adults. @*Methods@#This cross-sectional study used data from the Korea National Health and Nutrition Examination Survey (KNHANES). A total of 11,679 individuals were analyzed using multiple logistic regression analyses to identify any association between the type of physical activity and depressive disorders in the sample subjects. @*Results@#Measured weekly in units of energy expenditure, known as metabolic equivalents (METs), the amount of work-related physical activity was higher in individuals with depression according to the Patient Health Questionnaire- 9 than the participants without depression (386.7 vs. 206.7 MET-min/wk, P=0.01). Those diagnosed with depression tended to engage in less recreational activity per week (143.7 vs. 316.3 MET-min/wk, P<0.001) than those without depression. After controlling for covariates, the risk of depression among all participants was 1.012 times higher with a 100-unit increase in total work-related activity measured in METs (95% confidence interval [CI], 1.006–1.017; P<0.001) and 0.962 times lower with a 100-unit increase in total leisure activity measured in METs (95% CI, 0.937–0.987; P=0.003). @*Conclusion@#Different types of physical activity were shown to be differently associated with depressive disorders in Korean adults. This study might guide in reducing work-related physical activity and increasing leisure activity to prevent the occurrence of depression.

Association between Patient Experience and Medication Compliance of Dyslipidemia: Using Korea National Health and Nutrition Examination Survey (2015) / 가정의학회지

Background@#This study aimed to examine the relationship between patient experience and medication compliance of patients with dyslipidemia. @*Methods@#Based on data from the Korea National Health and Nutrition Examination Survey in 2015, the study examined 764 patients treated with dyslipidemia medication. Subjects who responded to the question “Do you currently take medication to lower your blood cholesterol?” with “daily taking” were categorized as the compliant group, and the remaining subjects were classified under the non-compliant group. The patient experience survey included four indicators, in which subjects were divided into groups with a positive and negative patient experience. Data on sociodemographic factors, health-related behaviors, and self-reported comorbid conditions were also collected. @*Results@#After adjusting the variables, the group with a positive response for the patient experience indicator “doctor spends enough time with the patient during consultation” was 1.89 times more compliant than the group with a negative response (95% confidence interval [CI], 1.03–3.48; P=0.04). For the indicator “doctor provides easy-to-understand explanations,” the group that showed a positive response was 2.74 times more compliant than the group with a negative response (95% CI, 1.39–5.39; P=0.004). For the indicator “doctor involves patients in decisions about care or treatment,” the group that showed a positive response was 2.07 times more compliant than the group with a negative response (95% CI, 1.02–4.22; P=0.04). However, for the indicator “doctor provides the patient a chance to ask questions about treatment,” positive patient experience had no significant association with medication compliance (95% CI, 0.77–2.36; P=0.30). @*Conclusion@#Building a good doctor-patient relationship with positive patient experiences can result in better outcomes for patient care through high medication compliance.

The Relationship between Dog Ownership and Physical Activity in Korean Adults / 가정의학회지

Background@#Many studies have reported that dog ownership is effective in encouraging physical activity. However, the association between living with a dog and enhanced physical activity has not been clearly verified. Thus, this study aimed to investigate the effects of dog ownership on the amount of physical activity in a representative sample of Korean adults. @*Methods@#This cross-sectional study administered the International Physical Activity Questionnaire (IPAQ) to 1,299 individuals who visited the international healthcare center of one hospital in Seoul, Korea, between August and December in 2018. Based on responses to the IPAQ survey, the amount and duration of physical activity was calculated to analyze relationships with dog ownership. @*Results@#The total amount (P=0.02) and duration of physical activity (P=0.02) and the duration of vigorous-intensity physical activity (P=0.04) were significantly higher among dog owners than non-dog owners. The duration of daily physical activity increased with dog ownership by 18.6 minutes (P=0.01). A comparison of dog owners according to whether they walked with their dogs revealed that dog walking had no significant effect on the amount and duration of physical activity, inactivity, or health-enhancing physical activity status. There was a sex-specific association between dog ownership and total duration of physical activity in females. @*Conclusion@#The duration of physical activity increased by dog ownership. However, the higher levels of physical activity among dog owners may not necessarily be explained by dog ownership or walking with dogs. This outcome suggests that raising a dog can help promote physical activity.

Association between Patient Experience and Medication Compliance of Dyslipidemia: Using Korea National Health and Nutrition Examination Survey (2015) / 가정의학회지

Background@#This study aimed to examine the relationship between patient experience and medication compliance of patients with dyslipidemia. @*Methods@#Based on data from the Korea National Health and Nutrition Examination Survey in 2015, the study examined 764 patients treated with dyslipidemia medication. Subjects who responded to the question “Do you currently take medication to lower your blood cholesterol?” with “daily taking” were categorized as the compliant group, and the remaining subjects were classified under the non-compliant group. The patient experience survey included four indicators, in which subjects were divided into groups with a positive and negative patient experience. Data on sociodemographic factors, health-related behaviors, and self-reported comorbid conditions were also collected. @*Results@#After adjusting the variables, the group with a positive response for the patient experience indicator “doctor spends enough time with the patient during consultation” was 1.89 times more compliant than the group with a negative response (95% confidence interval [CI], 1.03–3.48; P=0.04). For the indicator “doctor provides easy-to-understand explanations,” the group that showed a positive response was 2.74 times more compliant than the group with a negative response (95% CI, 1.39–5.39; P=0.004). For the indicator “doctor involves patients in decisions about care or treatment,” the group that showed a positive response was 2.07 times more compliant than the group with a negative response (95% CI, 1.02–4.22; P=0.04). However, for the indicator “doctor provides the patient a chance to ask questions about treatment,” positive patient experience had no significant association with medication compliance (95% CI, 0.77–2.36; P=0.30). @*Conclusion@#Building a good doctor-patient relationship with positive patient experiences can result in better outcomes for patient care through high medication compliance.

The Relationship between Dog Ownership and Physical Activity in Korean Adults / 가정의학회지

Background@#Many studies have reported that dog ownership is effective in encouraging physical activity. However, the association between living with a dog and enhanced physical activity has not been clearly verified. Thus, this study aimed to investigate the effects of dog ownership on the amount of physical activity in a representative sample of Korean adults. @*Methods@#This cross-sectional study administered the International Physical Activity Questionnaire (IPAQ) to 1,299 individuals who visited the international healthcare center of one hospital in Seoul, Korea, between August and December in 2018. Based on responses to the IPAQ survey, the amount and duration of physical activity was calculated to analyze relationships with dog ownership. @*Results@#The total amount (P=0.02) and duration of physical activity (P=0.02) and the duration of vigorous-intensity physical activity (P=0.04) were significantly higher among dog owners than non-dog owners. The duration of daily physical activity increased with dog ownership by 18.6 minutes (P=0.01). A comparison of dog owners according to whether they walked with their dogs revealed that dog walking had no significant effect on the amount and duration of physical activity, inactivity, or health-enhancing physical activity status. There was a sex-specific association between dog ownership and total duration of physical activity in females. @*Conclusion@#The duration of physical activity increased by dog ownership. However, the higher levels of physical activity among dog owners may not necessarily be explained by dog ownership or walking with dogs. This outcome suggests that raising a dog can help promote physical activity.

Hypertension-Mediated Organ Damage and Long-term Cardiovascular Outcomes in Asian Hypertensive Patients without Prior Cardiovascular Disease

Background@#Hypertension-mediated organ damage (HMOD), comprising structural and functional changes in arteries or end organs, is a marker of cardiovascular (CV) disease.However, there are limited data on evaluation of risk of CV disease regarding HMOD, especially in Asians. We sought to investigate the association between CV events and HMOD, and we tried to determine the most important diagnostic marker among the component of HMOD for prevention of mortality and CV events in treated Korean hypertensive patients. @*Methods@#From January 2008 to December 2010, a total of 35,000 hypertensive Vietnamese War veterans who consecutively visited our hospital for medical check-up were reviewed, and 6,158 patients without established CV disease were enrolled. The patients were divided into two groups as follows: HMOD group (n = 766) and non-HMOD group (n = 5,392). The primary outcome was all-cause death. @*Results@#Median age was 63.3 years (interquartile range [IQR], 61.4–65.4), and median follow-up was 6.6 years (IQR, 5.9–7.2). Patients with old age, diabetes, and chronic kidney disease were more prevalent in the HMOD group than in the non-HMOD group (all P < 0.05).The lipid profiles were not significantly different between the two groups. Nephropathy was the most prevalent (54.7%) organ damage in the HMOD group. The 6-year incidence of all-cause death was higher in the HMOD group than in the non-HMOD group (22.5% vs.9.0%; adjusted hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.01–2.00; P = 0.04). The incidence of cardiac death, ischemic heart disease, and ischemic and hemorrhagic stroke were also significantly higher in the HMOD group than in the non-HMOD group (P < 0.05, respectively). In multivariate analysis, proteinuria (adjusted HR, 2.21; 95% CI, 1.52–3.20; P < 0.001) was the most powerful independent risk factor to predict all-cause death among components of HMOD. As the degree of proteinuria increased, the rate of all-cause death also increased (long-rank P < 0.001). @*Conclusion@#HMOD was associated with increased risk of mortality and CV events.Proteinuria was the most powerful independent risk factor for all-cause death, and the degree of proteinuria and mortality rate were proportional. Our data suggest that monitoring of the proteinuria is important to predict long-term CV events in hypertensive patients.

Hypertension-Mediated Organ Damage and Long-term Cardiovascular Outcomes in Asian Hypertensive Patients without Prior Cardiovascular Disease

Background@#Hypertension-mediated organ damage (HMOD), comprising structural and functional changes in arteries or end organs, is a marker of cardiovascular (CV) disease.However, there are limited data on evaluation of risk of CV disease regarding HMOD, especially in Asians. We sought to investigate the association between CV events and HMOD, and we tried to determine the most important diagnostic marker among the component of HMOD for prevention of mortality and CV events in treated Korean hypertensive patients. @*Methods@#From January 2008 to December 2010, a total of 35,000 hypertensive Vietnamese War veterans who consecutively visited our hospital for medical check-up were reviewed, and 6,158 patients without established CV disease were enrolled. The patients were divided into two groups as follows: HMOD group (n = 766) and non-HMOD group (n = 5,392). The primary outcome was all-cause death. @*Results@#Median age was 63.3 years (interquartile range [IQR], 61.4–65.4), and median follow-up was 6.6 years (IQR, 5.9–7.2). Patients with old age, diabetes, and chronic kidney disease were more prevalent in the HMOD group than in the non-HMOD group (all P < 0.05).The lipid profiles were not significantly different between the two groups. Nephropathy was the most prevalent (54.7%) organ damage in the HMOD group. The 6-year incidence of all-cause death was higher in the HMOD group than in the non-HMOD group (22.5% vs.9.0%; adjusted hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.01–2.00; P = 0.04). The incidence of cardiac death, ischemic heart disease, and ischemic and hemorrhagic stroke were also significantly higher in the HMOD group than in the non-HMOD group (P < 0.05, respectively). In multivariate analysis, proteinuria (adjusted HR, 2.21; 95% CI, 1.52–3.20; P < 0.001) was the most powerful independent risk factor to predict all-cause death among components of HMOD. As the degree of proteinuria increased, the rate of all-cause death also increased (long-rank P < 0.001). @*Conclusion@#HMOD was associated with increased risk of mortality and CV events.Proteinuria was the most powerful independent risk factor for all-cause death, and the degree of proteinuria and mortality rate were proportional. Our data suggest that monitoring of the proteinuria is important to predict long-term CV events in hypertensive patients.

Long-term Survival in Korean Elderly Patients with Symptomatic Severe Aortic Stenosis Who Refused Aortic Valve Replacement

BACKGROUND AND OBJECTIVES: Aortic valve replacement (AVR) is the treatment of choice in severe symptomatic aortic stenosis (AS) patients. However, a substantial number of elderly patients refuse AVR and treated medically. We investigated their long-term prognosis. METHODS: From January 2005 to December 2016, we analyzed elderly patients with severe symptomatic AS who refused to have AVR. RESULTS: After screening of total 534 patients, we analyzed total 180 severe symptomatic AS patients (78±7 years old, 96 males). Hypertension was the most common cardiovascular risk factor (72%) and the most common symptom was dyspnea (66%). Calculated aortic stenosis area was 0.73±0.20 cm2 and mean left ventricular ejection fraction (LVEF) was 57.8±12.2%. Total 102 patients died during follow-up period (39.1±31.0 months). One-, 3-, and 5-year all-cause mortality rate was 21.1±3.0%, 43.1±3.8%, and 56.5±4.2%, respectively. Of them, 87 died from cardiac causes, and 1-, 3-, and 5-year cardiac mortality rate was 18.0±2.9%, 38.2±3.8%, and 50.7±4.3%, respectively. Their all-cause mortality and cardiac mortality were significantly higher than those of controls. Univariate analysis showed that age, anemia, LVEF, and Log N-terminal pro B-type natriuretic peptide (NT-proBNP) were significant parameters in all-cause mortality (p < 0.001, p=0.001, p=0.039, and p=0.047, respectively) and in cardiac mortality (p < 0.001, p < 0.001, p=0.046, and p=0.026, respectively). Multivariate analysis showed that age and anemia were significant prognostic factors for cardiac and all-cause mortality. CONCLUSIONS: In elderly severe symptomatic AS patients who treated medically, their 1-, 3- and 5-year all-cause mortality rate was 21.1±3.0%, 43.1±3.8%, and 56.5±4.2%, respectively. Age and anemia were significant prognostic factors for cardiac and all-cause mortality.

Short-Term Success Rates of Smoking Cessation Support Programs and Factors Predicting Smoking Relapse: Using Data from a Smoking Cessation Clinic in a Hospital / 가정의학회지

BACKGROUND: Although the number of medical institutions running a smoking cessation clinic is on the rise, there remains a paucity of research on the long- and short-term success rates of smoking cessation programs, as well as on smoking relapse rates, before and after project implementation. This study assessed the general characteristics of patients visiting the smoking cessation clinic, success rate of smoking cessation in the short term, and risks of relapse. METHODS: Medical records from March 2015 to April 2017 were analyzed and telephone surveys were conducted with 151 smokers who visited a hospital smoking cessation clinic from March 2015 to April 2017. RESULTS: Of the 139 smokers who were eligible for follow-up, 22 (15.8%) failed to quit smoking initially. The clinic's 6-month success rate of smoking cessation was 64.83%. Those with higher medication compliance had a lower risk of primary failure (odds ratio, 0.056; 95% confidence interval, 0.005–0.609), whereas those with higher age (hazard ratio [HR], 0.128; P=0.0252) and a greater number of visits to the clinic (HR, 0.274; P=0.0124) had a lower risk of relapsing. CONCLUSION: The risk of primary failure to quit was higher with low medication compliance, and that of relapsing was higher with lower age and fewer number of clinic visits. Various evaluation and analysis methods can be carried out in the future based on the accumulated data for maintenance of smoking cessation and relapse prevention.

Long-term Survival in Korean Elderly Patients with Symptomatic Severe Aortic Stenosis Who Refused Aortic Valve Replacement

BACKGROUND AND OBJECTIVES@#Aortic valve replacement (AVR) is the treatment of choice in severe symptomatic aortic stenosis (AS) patients. However, a substantial number of elderly patients refuse AVR and treated medically. We investigated their long-term prognosis.@*METHODS@#From January 2005 to December 2016, we analyzed elderly patients with severe symptomatic AS who refused to have AVR.@*RESULTS@#After screening of total 534 patients, we analyzed total 180 severe symptomatic AS patients (78±7 years old, 96 males). Hypertension was the most common cardiovascular risk factor (72%) and the most common symptom was dyspnea (66%). Calculated aortic stenosis area was 0.73±0.20 cm2 and mean left ventricular ejection fraction (LVEF) was 57.8±12.2%. Total 102 patients died during follow-up period (39.1±31.0 months). One-, 3-, and 5-year all-cause mortality rate was 21.1±3.0%, 43.1±3.8%, and 56.5±4.2%, respectively. Of them, 87 died from cardiac causes, and 1-, 3-, and 5-year cardiac mortality rate was 18.0±2.9%, 38.2±3.8%, and 50.7±4.3%, respectively. Their all-cause mortality and cardiac mortality were significantly higher than those of controls. Univariate analysis showed that age, anemia, LVEF, and Log N-terminal pro B-type natriuretic peptide (NT-proBNP) were significant parameters in all-cause mortality (p < 0.001, p=0.001, p=0.039, and p=0.047, respectively) and in cardiac mortality (p < 0.001, p < 0.001, p=0.046, and p=0.026, respectively). Multivariate analysis showed that age and anemia were significant prognostic factors for cardiac and all-cause mortality.@*CONCLUSIONS@#In elderly severe symptomatic AS patients who treated medically, their 1-, 3- and 5-year all-cause mortality rate was 21.1±3.0%, 43.1±3.8%, and 56.5±4.2%, respectively. Age and anemia were significant prognostic factors for cardiac and all-cause mortality.

Effects of Module Development and Role Play Course on Clinical Practice Examination Scores during a 4th Year Clerkship / 가정의학회지

BACKGROUND: After introduction of clinical skills assessment in the Korean Medical Licensing Examination, medical schools have reinforced both experiential learning with real patients and preparatory programs. This study was conducted to investigate whether a clinical practice examination (CPX) preparation program improves students' CPX score in terms of case specificity. METHODS: One hundred and thirteen senior students in a medical school participated in this study. During the fourth-year clerkship, 28 students (24.8%) from three rotation groups took a 3-day CPX preparation course consisting of module development, role play, and comprehensive physical exam skills training. Eleven rotation groups (n=85) were compared as control. Both the intervention and control group took two comprehensive CPXs before and after the clerkship was completed. RESULTS: There was no significant difference in age, sex, and school type between the two groups. On pre-test CPX, there was no significant difference in total and sectional scores between the two groups. On post-test CPX, total scores of the intervention group were higher than those of the control groups (69.5±4.3 vs. 67.5±4.4, P < 0.05). History taking scores were higher in intervention groups (70.0±6.0 vs. 66.0±6.6, P=0.01). The station scores of vaginal discharge with case similarity were higher in the intervention groups (73.0±6.3 vs. 68.9±9.3, P=0.03). CONCLUSION: A short CPX preparation course improved history taking ability, but its effect was greater only in a specific case, similar to the pre-course case. Whether this effect was due to the test experience or true improvement in competency requires further investigation.

Association between Breastfeeding and Prevalence of Diabetes in Korean Parous Women: The Korea National Health and Nutrition Examination Survey, 2010–2014 / 가정의학회지

BACKGROUND: It is well known that breastfeeding has a significant impact on the health of mothers and children. With the growing importance of breastfeeding, the present study aimed to investigate the relationship between breastfeeding and the prevalence of diabetes in Korean parous women. METHODS: The data of 5,448 premenopausal parous women aged 20–49 years who agreed to participate in the 5th–6th Korea National Health and Nutrition Examination Survey were analyzed in this study. Control group included women who had not breastfed. The subjects who had breastfed were classified into three groups based on the duration of breastfeeding: 0–6 months, 6–12 months, and >12 months. The variables included age, body mass index, education level, income, alcohol drinking, smoking, family history of diabetes, use of oral contraceptives, the number of pregnancies, and regular exercise. RESULTS: Among the subjects, the prevalence of diabetes was significantly lower in women who had breastfed compared to those who had not, with an odds ratio of 0.534 (95% confidence interval [CI], 0.289–0.976) in women who breastfed for 0–6 months and 0.575 (95% CI, 0.321–0.990) in women who breastfed for 6–12 months (both P < 0.05). CONCLUSION: The present study found a reduced prevalence of diabetes in women who had breastfed compared to those who had not. However, no association between the duration of breastfeeding and the prevalence of diabetes could be found.

Relationship between Marital Status and Metabolic Syndrome in Korean Middle-Aged Women: The Sixth Korea National Health and Nutrition Examination Survey (2013–2014) / 가정의학회지

BACKGROUND: This study aimed to investigate the relationship between marital status and the incidence of metabolic syndrome in Korean middle-aged women. METHODS: Based on data from the sixth Korea National Health and Nutrition Examination Survey (2013–2014), 3,225 women aged 40–69 years were subjected to the analysis. Marital status was categorized as married, unmarried, separated, widowed, or divorced. The odds ratios (ORs) for metabolic syndrome were calculated based on marital status. After adjustment for age, income level, education level, alcohol intake, smoking status, leisure physical activity, menopause status, daily calories, and fat intake, changes in the OR for metabolic syndrome based on marital status were examined by multivariate logistic regression analysis. RESULTS: The OR for metabolic syndrome in the widowed group to the married group was 4.818 (95% confidence interval [CI], 3.861–6.002; P < 0.001) and that after adjustment of age, economic level, education level, alcohol intake, smoking status, physical activity, menopause status, total daily calories, and fat intake was 2.141 (CI, 1.432–3.199; P < 0.001), both of which were statistically significant. The OR for metabolic syndrome in the unmarried group to the married group was 0.246 (CI, 0.141–0.431; P < 0.001) after adjustment of all components. On the contrary, the ORs of the separated group and the divorced group to the married group were not significant. CONCLUSION: In comparison with the married middle-aged group, the widowed middle-aged group tended to have a higher risk of metabolic syndrome, which is speculated to be related to socioeconomic factors and health behavior.

The Effects of Weight Control Behaviors among Korean Obese Adults / 가정의학회지

BACKGROUND: This study aimed to identify and examine the effects of weight control behaviors correlated with weight loss in obese individuals who attempted to lose weight within the past year. METHODS: In this cross-sectional study, data from 9,461 obese individuals were collected from the fifth and sixth Korean National Health and Nutrition Examination Survey (2010–2014). Three of nine verified methods of weight control suggested in the survey were selected: diet therapy (reduced food intake), exercise therapy (exercise), and medication therapy (prescribed weight loss medications). Participants were divided into one of seven groups (diet therapy alone; exercise therapy alone; drug therapy alone; combined diet and exercise therapy; combined exercise and drug therapy; combined diet and drug therapy; or combined diet, exercise, and drug therapy). Logistic regression analysis was used to determine whether the group that tried to lose weight in the past year had indeed lost weight compared to the group that did not. RESULTS: The odds ratios for weight loss (≥3 but < 6 kg vs. ≥6 but < 10 kg) for the combined therapies were 2.05 (95% confidence interval, 1.23–3.41) for combined diet and exercise therapy and 5.43 (1.74–16.92) for combined diet, exercise, and drug therapy. CONCLUSION: All levels of weight loss were significantly associated with combined diet and exercise therapy. Weight loss ≥6 kg but < 10 kg was significantly associated with combined diet and exercise therapy as well as with combined diet, exercise, and medication therapy among individuals who tried to lose weight in the past year.

Comparison of Patient-Physician Interaction Scores of Clinical Practice Examination between Checklists and Rating Scale / 가정의학회지

BACKGROUND: The clinical practice examination (CPX) was introduced in 2010, and the Seoul-Gyeonggi CPX Consortium developed the patient-physician interaction (PPI) assessment tool in 2004. Both institutions use rating scales on classified sections of PPI but differ in their scoring of key components. This study investigated the accuracy of standardized patient scores across rating scales by comparing checklist methods and verified the concurrent validity of two comparable PPI rating tools. METHODS: An educational CPX module dyspepsia case was administered to 116 fourth-year medical students at Hanyang University College of Medicine. One experienced standardized patient rated exams using two different PPI scales. She scored checklists composed of 43 items related to the two original PPI scales through video clips of the same students. From these checklists, we calculated Pearson's correlation coefficient. RESULTS: The correlations of total PPI score between the checklist and rating scale methods were 0.29 for the Korean Medical Licensing Examination (KMLE) tool and 0.30 for the consortium tool. The correlations between the KMLE and consortium tools were 0.74 for checklists and 0.83 for rating scales. In terms of section scores, the consortium tool showed only three significant correlations between the two methods out of seven sections and the KMLE tool showed only two statistically significant correlations out of five sections. CONCLUSION: The rating scale and checklist methods exhibited a weak relationship in the PPI assessment, but a high correlation between assessment tools using the same method. However, the current rating scale requires modification by reorganizing key scoring components through factor analysis.

Serum Lipid Levels in Relation to Consumption of Yogurt: The 2012 Korea National Health and Nutrition Examination Survey / 가정의학회지

BACKGROUND: The purpose of this study was to evaluate serum lipid levels in Korean adults after consumption of different types of yogurt. METHODS: Study subjects were 3,038 individuals (≥19 years of age) who participated in the 2012 Korean National Health and Nutrition Examination Survey. Yogurt intake was assessed with a food frequency questionnaire by using the 24-hour recall method. We conducted complex samples general linear analysis with adjustment for covariates. RESULTS: The serum triglyceride levels in the group consuming viscous yogurt were lower than those in the group consuming non-viscous yogurt. CONCLUSION: Consumption of viscous yogurt is associated with low serum triglyceride levels in Korean adults.

Characterizing the Profile of Obese Patients: Example from the Newly Opened Obesity Clinic at a Single University Hospital

PURPOSE: An obesity clinic was newly opened at a single university hospital in South Korea. We aimed to characterize the profile of patients and current status of the clinic. MATERIALS AND METHODS: 60 patients who have visited the obesity clinic from October 2015 to April 2016 were included in this study. Baseline examination included anthropometric measurement, bioelectrical impedance analysis, blood sampling, and abdominal computed tomography (CT) analysis to estimate abdominal fat distribution. Weight loss program of the clinic constituted of 8 sessions of physician encounter and nutrition counselling. Data on the profile of patients and their completion status were collected and analyzed. RESULTS: Sixty obese adults (21 males and 39 females) were included in the study. The mean (±standard deviation [SD]) body mass index was 31.1±5.7, and abdominal circumference was 100.2±18.3. The mean±SD percentage of body fat measured by bioelectrical impedance analysis was analyzed 35.7±6.2% in males, and 40.6±6.2% in females. The average intra-abdominal fat area was 243.7 cc in males, and 142.5 cc in females. Among 60 subjects, 37 patients (61.7%) are currently on their sessions; 11 patients (18.3%) completed 8 sessions of the program; 8 patients (13.3%) dropped out; 4 patients (6.7%) did not register the program session with initial evaluation only. The mean weight loss (kg) of 11 completers was 5.1 kg. CONCLUSION: Using the strengths of a university hospital as multidisciplinary team care, effective treatment strategies for overweight and obesity are the future directions of our clinic.

The Effect of Sleep Quality on the Development of Type 2 Diabetes in Primary Care Patients

Sleep has important effects on physical and mental health, and sleep disorders are associated with increased mortality and morbidity. This study was conducted to evaluate the relationship between sleep duration or sleep quality and the risk of type 2 diabetes. The FACTS (FAmily CohorT Study in primary care) was established to investigate the relations between familial environment and health which was conducted at 22 family medicine outpatient clinics in general hospitals. Total 563 patients without diabetes who received > or =1 year follow-up examination were included in the analysis. We used the Pittsburgh Sleep Quality Index to determine sleep quality, and a score of > or =5 was considered to define poor sleep quality. Patients taking oral hypoglycemic agents, having a fasting glucose level of >126 mg/dL, or diagnosed with diabetes by physicians were classified as having diabetes. The median follow-up period was 2.5 years. Poor sleep quality was associated with a higher risk of diabetes after adjusting for age, sex, body mass index, income, physical activity, and family history of diabetes (relative risk=2.64; 95% confidence interval, 1.03-6.78). As a risk factor for the development of diabetes, poor sleep quality may independently increase the incidence of diabetes.

Predictors of clinical practice examination scores of fourth year medical students after core clinical clerkships / 한국의학교육

PURPOSE: Clinical performance examination (CPX) has been used to assess clinical competence as one step of medical license examination. Initial CPX score of the fourth year medical student is important since it indicates how to prepare successfully for the final examination. This study was conducted to assess the predictors of CPX scores of the fourth year medical students who completed core clinical clerkship. METHODS: One hundred eleven fourth year medical students took a formative CPX in February. The score was compared with the scores of cognitive area and those of behavioral area which students had acquired in the past. We analyzed the correlation between the scores and determined the predictors of the fourth year CPX score. RESULTS: The fourth year CPX score showed stronger correlation with the scores of behavioral area than those of cognitive area. The significant predictors of fourth year CPX score included third year simple procedure exam score and third year clerkship CPX score. The risk factors for low fourth year CPX score included second year patient-physician interaction (PPI) score and third year CPX score after adjusted for age, sex, and school type. The risk factors of being selected as a low PPI score group of fourth year included low PPI scores of first, second, and third year exams. CONCLUSION: Our study highlights importance of educational balance between cognitive and behavioral areas. To improve clinical competence of final year medical students, clinical interview training using standardized patient with other modules is to be enhanced and initiated early in the medical curriculum.