The Effect of Exercise on Prevention of the Common Cold: A Meta-Analysis of Randomized Controlled Trial Studies / 가정의학회지

BACKGROUND: Because there is no specific treatment for the common cold, many previous studies have focused on prevention of the common cold. There were some studies reporting that regular, moderate-intensity exercise increases immunity and prevents the common cold. We conducted a meta-analysis to determine the effects of exercise on prevention of the common cold. METHODS: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL for studies released through June 2013. We manually searched the references. Two authors independently extracted the data. To assess the risk of bias of included literature, Cochrane Collaboration's tool for assessing risk of bias was used. Review Manager ver. 5.2 (RevMan, Cochrane Collaboration) was used for statistical analysis. RESULTS: Four randomized controlled trials were identified. A total of 281 participants, 134 in the exercise group and 147 in the control group, were included. The effect of exercise on the prevention of the common cold had a relative risk (RR) of 0.73 (95% confidence interval [CI], 0.56 to 0.95; I2 = 7%). The mean difference of mean illness days between exercise group and control group was -3.50 (95% CI, -6.06 to -0.94; I2 = 93%). In the subgroup analysis, the RR of under 16 weeks exercise was 0.79 (95% CI, 0.58 to 1.08). CONCLUSION: In this meta-analysis, regular, moderate-intensity exercise may have an effect on the prevention of the common cold. But numbers of included studies and participants were too small and quality of included studies was relatively poor. Subsequent well-designed studies with larger sample size are needed to clarify the association.

A Comparison of the Efficacy and Safety of Non-Steroidal Anti-Inflammatory Drugs versus Acetaminophen in Symptom Relief for the Common Cold: A Meta-Analysis of Randomized Controlled Trial Studies / 가정의학회지

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are widely used for common cold symptom relief. The objective of this study was to evaluate and compare the efficacy and safety of acetaminophen and NSAIDs in common cold symptom relief using meta-analysis of randomized controlled trial. METHODS: We searched MEDLINE (PubMed), Cochrane, EMBASE, CINAHL, KMbase, KoreaMed, National Assembly Library, and Riss4u for studies released through June 2012. Two authors independently extracted the data. To assess the risk of bias, the Cochrane Collaborations risk of bias tool was used. The Review Manager ver. 5.1 (RevMan) was used for statistics. RESULTS: We identified 5 studies. The relative benefit for participants with pain relief was 1.00 (95% confidence interval [CI], 0.96 to 1.05) and I2 = 0%. The existence of the heterogeneity between studies was not important in this study, thus subgroup analysis was not implemented. The relative benefit for participants with rhinorrhea was 1.02 (95% CI, 0.77 to 1.35) and I2 = 0%, which also indicates the existence of heterogeneity was not important. The relative risk of adverse events was 1.14 (95% CI, 0.93 to 1.40), I2 = 0%. There was no apparent asymmetry in the funnel plot. CONCLUSION: There was no difference between NSAIDs and acetaminophen in common cold symptom relief.

The Effect of Probiotics on Prevention of Common Cold: A Meta-Analysis of Randomized Controlled Trial Studies / 가정의학회지

BACKGROUND: Probiotics are currently under focus for their immune improvement function. Many studies have been performed to assess the potential efficacy of probiotics in allergic disease, viral disease, respiratory disease, as well as gastrointestinal disease. This study performed a systematic review to determine the effects of probiotics on the prevention of the common cold. METHODS: We searched MEDLINE (PubMed), EMBASE, CINAHL, and Cochrane CENTRAL for studies released through June 2011. Two authors independently extracted the data. To assess the risk of bias of included literatures, Cochrane Collaboration's risk of bias tool was used. RESULTS: We identified 10 studies in 7 articles. A total 2,894 participants, 1,588 in the probiotics group and 1,306 in the control group, were included. The effect of probiotics on the prevention of the common cold had a relative risk (RR) of 0.92 (95% CI, 0.85 to 1.00, I2 = 26%). In the subgroup analysis, the RR of administration of probiotics for 3 months or less was 0.82 (95% CI, 0.70 to 0.97). The RR of administration of probiotics over 3 months was 1.00 (95% CI, 0.92 to 1.09). The RR of administration of probiotics without any active intervention (vitamin and mineral) was 0.87 (95% CI, 0.78 to 0.97). CONCLUSION: In this meta-analysis, there was marginal effect of probiotics on the prevention of the common cold. The results implied that probiotics had a modest effect in common cold reduction. The balance of benefit and harms needs to be considered when using probiotics for common cold prevention.

A Comparison of Efficacy and Safety of Non-steroidal Anti-inflammatory Drugs versus Acetaminophen in the Treatment of Episodic Tension-type Headache: A Meta-analysis of Randomized Placebo-controlled Trial Studies / 가정의학회지

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are widely used in the treatment of tension headache. The objective of this study was to evaluate and compare the efficacy and safety of single doses of acetaminophen and NSAIDs using meta-analysis of randomized placebo-controlled trial studies. METHODS: We searched MEDLINE, EMBASE, CINAHL, Cochrane, KMbase, KoreaMed, RiCH, National Assembly Library, Riss4u, and DBPIA for studies released through 27th July 2010. Two authors independently extracted the data. To assess the risk of bias, the Cochrane Collaborations risk of bias tool was used. Review Manager 5.0 was used for statistics. RESULTS: We identified 6 studies. The relative benefit of the NSAIDs group compared to the acetaminophen group for participants with at least 50% pain relief was 1.18 (95% confidence interval [CI], 0.99 to 1.39; I2 = 85%). We did subgroup analysis based on allocation concealment versus non-allocation concealment, and low-dose NSAIDs versus high-dose NSAIDs. The relative benefit of the low-dose NSAIDs subgroup to the acetaminophen group was 0.98 (95% CI, 0.91 to 1.06; I2 = 0%). However, the heterogeneity of other subgroup analysis was not settled. The relative risk for using rescue medication of the NSAIDs group compared to the acetaminophen group was 0.84 (95% CI, 0.64 to 1.12; I2 = 47%). The relative risk for adverse events was 1.31(95% CI, 0.96 to 1.80; I2 = 0%). CONCLUSION: In this meta-analysis, there was no difference between low-dose NSAIDs and acetaminophen in the efficacy of the treatment for tension type headache. The results suggested that high-dose NSAIDs have more effect but also have more adverse events. The balance of benefit and harm needs to be considered when using high-dose NSAIDs for tension headache.

Effects of Having Usual Source of Care on Preventive Services and Chronic Disease Control: A Systematic Review / 가정의학회지

BACKGROUND: Having usual source of care has been associated with improved receipt of preventive services and control of chronic diseases (such as hypertension, diabetes, and hypercholesterolemia). The objective of this study was to examine whether having usual source of care is associated with improved receipt of preventive services and control of chronic diseases. METHODS: We searched MEDLINE, EMBASE, Cochrane, CINAHL, KMbase, KoreaMed, RiSS4U, National Assembly Library, and KISS for studies released through May 31st 2011. Two authors independently extracted the data. We manually searched the references and twenty recent related articles on PubMed. To assess the risk of bias RoBANS tool was used. RESULTS: We identified 10 studies. Most having usual source of care were associated with improved receipt of preventive services (cervical cancer screening, clinical breast exam, mammogram, prostate cancer screening, and flu shot) compared with no usual source of care. However, gastric cancer and colon cancer screening were difficult to conclude and blood pressure checkup showed mixed results. Overall there was no association between having usual source of care and smoking behaviors and the effect on chronic disease control was difficult to conclude. CONCLUSION: Having usual source of care was associated with improved receipt of preventive services and overall the results were consistent. So, the results suggested that having usual source of care may help to receive preventive services. Hereafter, cohort studies are needed to evaluate casual relationships and more studies are needed in various countries and systems.

The Quality of Reporting of Cohort, Case-Control Studies in the Korean Journal of Family Medicine / 가정의학회지

BACKGROUND: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement was developed to improve the reporting of observational studies. We aimed to evaluate the quality of reporting in cohort studies and case-control studies among observational studies published in the Korean Journal of Family Medicine. METHODS: We searched for cohort studies and case-control studies published as original articles in the Journal of the Korean Academy of Family Medicine during the period January 1992 through December 2009. The main outcome measures were the number and proportion of cohort studies and case-control studies that reported each of 22 checklist items of STROBE. RESULTS: We identified a total of 84 articles, of which 46 articles were cohort studies and 38 were case-control studies. Concerning methods, study designs (10%), bias (13%), study size (0%), statistical methods (12-c and 12-e items, 0%; 12-d item, cohort study, 6%) have been poorly reported. Of results, participants (5-6%), descriptive data (14-b item, 5%), and funding (1%) among other information have been poorly reported. CONCLUSION: The degree of adherence the STROBE recommendations was relatively low in cohort studies and case-control studies published in the Korean Journal of Family Medicine. An effort to improve the reporting of observational studies by application and recommendation of the STROBE statement is required.

Misinterpreting Odds Ratio in the Articles Published in Korean Journal of Family Medicine / 가정의학회지

BACKGROUND: In reporting results of case-control studies, odds ratios are useful methods of reporting findings. However, odds ratios are often misinterpreted in the literature and by general readers. METHODS: We searched all original articles which were published in the Korean Journal of Family Medicine from 1980 to May 2011 and identified those that report "odds ratios." Misinterpretation of odds ratios as relative risks has been identified. Estimated risk ratios were calculated when possible and compared with odds ratios. RESULTS: One hundred and twenty-eight articles using odds ratios were identified. Among those, 122 articles were analyzed for the frequency of misinterpretation of odds ratios as relative risks. Twenty-two reports out of these 122 articles misinterpreted odds ratios as relative risks. The percentage of misinterpreting reports decreased over years. Seventy-seven reports were analyzed to compare the estimated risk ratios with odds ratios. In most of these articles, odds ratios were greater than estimated risk ratios, 60% of which had larger than 20% standardized differences. CONCLUSION: In reports published in the Korean Journal of Family Medicine, odds ratios are frequently used. They were misinterpreted in part of the reports, although decreasing trends over years were observed.

Correlation of CPX Scores with the Scores on Written Multiple-Choice Examinations on the Certifying Examination for Family Medicine in 2009 to 2011 / 한국의학교육

PURPOSE: Recently, the clinical practice examination (CPX) using standardized patients has been introduced into several specialty certifying examinations in Korea. The purpose of this paper was to determine the correlation of a resident's performance on the CPX with the comprehensive written multiple-choice question (MCQ) examination on the certifying examination for family medicine. METHODS: The subjects of this study were 1,023 residents who completed the 1st and 2nd certifying examination for family medicine between 2009 and 2011. We determined the correlation between the total scores and 4 domain scores (history taking, physical examination, patient education, and patient-physician interaction) on the CPX with the MCQ scores of the 1st written test and 2nd slide examination and the correlation between the total CPX score and scores on the CPX domains. RESULTS: The correlation between CPX score with each MCQ examination (0.21~0.45 with 1st written MCQ, 0.15~0.33 with 2nd slide MCQ) was lower than that between each MCQ examination (0.46~0.59). The CPX score on patient education did not correlate with the 1st written and 2nd MCQ scores. The CPX scores on history taking and physical examination correlated slightly with the 1st written MCQ scores. The global ratings of preceptor examiners had the highest correlation (r=0.68~0.82) with the total CPX scores. CONCLUSION: Considering the mild correlation of CPX scores with each MCQ examination, the CPX is more likely to measure other qualities, such as critical thinking and communication skills.

Correlation of CPX Scores with the Scores on Written Multiple-Choice Examinations on the Certifying Examination for Family Medicine in 2009 to 2011 / 한국의학교육

PURPOSE: Recently, the clinical practice examination (CPX) using standardized patients has been introduced into several specialty certifying examinations in Korea. The purpose of this paper was to determine the correlation of a resident's performance on the CPX with the comprehensive written multiple-choice question (MCQ) examination on the certifying examination for family medicine. METHODS: The subjects of this study were 1,023 residents who completed the 1st and 2nd certifying examination for family medicine between 2009 and 2011. We determined the correlation between the total scores and 4 domain scores (history taking, physical examination, patient education, and patient-physician interaction) on the CPX with the MCQ scores of the 1st written test and 2nd slide examination and the correlation between the total CPX score and scores on the CPX domains. RESULTS: The correlation between CPX score with each MCQ examination (0.21~0.45 with 1st written MCQ, 0.15~0.33 with 2nd slide MCQ) was lower than that between each MCQ examination (0.46~0.59). The CPX score on patient education did not correlate with the 1st written and 2nd MCQ scores. The CPX scores on history taking and physical examination correlated slightly with the 1st written MCQ scores. The global ratings of preceptor examiners had the highest correlation (r=0.68~0.82) with the total CPX scores. CONCLUSION: Considering the mild correlation of CPX scores with each MCQ examination, the CPX is more likely to measure other qualities, such as critical thinking and communication skills.

Ginseng Intake and Gastric Cancer Risk: A Meta-Analysis of Observational Epidemiological Studies / 가정의학회지

BACKGROUND: A number of observational studies have found that ginseng intake may reduce the risk of developing gastric cancer. However, studies have yielded inconsistent results as to whether consuming ginseng can lower the risk of gastric cancer. We conducted a meta-analysis of studies that assessed the association between ginseng intake and the risk of gastric cancer. METHODS: We searched MEDLINE, EMBASE, CINAHL, KMbase, KoreaMed, RiCH, National Assembly Library, Riss4u, and DBPIA for studies released through August 2007. We manually searched the references. Two authors independently extracted the data. To assess the quality of the studies Scottish Intercollegiate Guidelines Network (SIGN) Methodology Checklist for case-control studies and cohort studies were used. Review Manager 5.0 (RevMan) was used for statistical analysis. RESULTS: We identified one case-control study and three cohort studies. The risk ratio (RR) for ginseng intake of all studies was 0.83 (95% confidence interval [CI], 0.46 to 1.51) and I2 = 91% for heterogeneity. We did subgroup analysis according to different types of study design, nation, and author. The results were consistent only when we did subgroup analysis according to authors. The RR of subgroup by different authors was 1.43 (95% CI, 1.10 to 1.80) and I2 = 0% without showing heterogeneity. CONCLUSION: In this meta-analysis, the results suggested that there was insufficient evidence to confirm the association between ginseng intake and the risk of gastric cancer. Subsequent more powerful, well-designed, and larger observational epidemiological studies are needed to clarify the association.

The Validity and Reliability of Korean Version of Lubben Social Network Scale / 가정의학회지

BACKGROUND: Over the past decade, considerable evidence has been accumulated showing that social networks influence health. However few valid and reliable instruments exist for assessing social networks among elderly population. Therefore, we translated the Lubben social network scales (LSNS) and tested the validity and reliability of Korean version. METHODS: Ten items, self-administered questionnaires were translated by multidisciplinary committee members. Also they were reverse translated by bilingual and modified from pretest procedure. Reliability was tested by 4 weeks testretest reliability and internal consistency (Cronbach's alpha). Validity was tested by factor analysis and construct validity comparison with the Korean version of Duke-UNC and Korean Health Related Quality of Life Scale (KQOLS) were tested for validity testing. RESULTS: Cronbach's alpha was 0.75. Four weeks test-retest Pearson coefficient was 0.78 (P < 0.0001). Correlation coefficient with the Korean version of Duke-UNC was 0.58 (P < 0.0001). Correlation coefficient with social function domain of KQOLS was 0.40 (P < 0.0001). Principal components analysis identified 3 factors. Three contents areas are family and friends networks, interdependent social support and living arrangements. CONCLUSION: Korean version of LSNS is both valid and reliable instrument, but fine refinements will be needed to adapt for use in practical settings.

Quality Assessment of Randomized Controlled Trials in the Journal of the Korean Academy of Family Medicine / 가정의학회지

BACKGROUND: Because low quality trials may lead to wrong conclusions, quality assessments are necessary. Thus, this study scrutinizes randomized controlled trials (RCTs) in the Journal of the Korean Academy of Family Medicine (KAFM) to assess the quantity and the quality. METHODS: Upon extracting randomized controlled trials from all the articles published in the Journal of the KAFM from 1980 to 2005, assessments were made on the Jadad scale and the adequacy of allocation concealment. The selections and assessments were performed independently by two researchers, and adjustment of the differences were done by a third-party researcher. In addition, the factors that may affect the quality levels were analyzed. RESULTS: Twenty-three trials were included. In 1980s, there were only 1.09% of the total original articles, but in 2000s, 2.63% were RCTs. The mean total Jadad score increased from 1 point in 1980s to 2.17 in 2000s, and the "good quality" trials also increased from 0% to 33.33%. As for the adequate allocation concealment, however, only two studies were observed in 2000s. The most lacking aspect was the appropriate double-blinding. Also, studies intervened by medicine or funded or examined by Institutional Review Boards (IRBs) tended to receive higher quality assessments. CONCLUSION: Although RCTs consistently increased in quantity and quality, in future studies, researchers should continue to strive towards achieving adequate allocation concealment and appropriate double-blinding. In addition, researchers must become more interested in receiving funds and examination by IRBs.

Beta-glucan for Glycemic Control Effects in Adults: a Meta-analysis

BACKGROUND: Recently, there has been an increase of emerging concerns between dietary fiber and diabetics. Increasing intake of dietary fiber leads to delaying absorption of glucose, and lowering of serum insulin levels. In the past studies, there were inconsistent glycemic control effect of beta-glucan. Our purpose was to assess the glycemic control effect of beta-glucan in adults. METHODS: Electronic searches (Cochrane, PubMed, EMBase), hand-searching and review of reference were done. The search term for beta-glucans [mh], "Avena sativa" [mh], "Hordeum" [mh], beta glucan* [tw], oat [tw], barley [tw], with no language restriction were used. All RCT that included available data of beta-glucan or that could impute dose of beta-glucan, at least one relevant outcome of glycemic control, run-in period more than 2 weeks, and intervention period of more than 2 weeks or greater were selected. A fixed-effect model was used to assess the summary effect of studies. RESULTS: A total of 43 articles were identified, 4 studies met our inclusion criteria and then analyzed. In pooled analysis, the effect size of fasting glucose level was 0.13 (95%CI: -1.25 to 1.51), and serum insulin level was -0.95 (95%CI, -2.37 to 0.47). It was impossible to adjust for sex and age owing to the lack of raw data. CONCLUSION: In this review, the results suggested that there were negative impacts of beta-glucan on fasting glucose and serum insulin level in adults, but we concluded that there was insufficient evidence to confirm about glycemic control effect. More powerful and well-designed RCT were required to confirm about glycemic control effect of beta-glucan.

The Quality of Reporting of Randomized Controlled Trials in Korean Medical Journals Indexed in KoreaMed: Survey of Items of the Revised CONSORT Statement

BACKGROUND: The revised Consolidated Standards for Reporting of Trials (CONSORT) were developed to improve the reporting of Randomized Controlled Trials. We studied to survey the extent to which RCTs report items included in the revised CONSORT recommendations. METHODS: A descriptive survey of RCTs enrolled in 2005 at KoreaMed, which is a representative database in Korea was done. The main outcome measures were the proportion of RCTs that reported each of 22 checklist items of CONSORT. RESULTS: We identified 125 RCTs from 26 journals. Random sequence implementation (0%), estimated effect size and its precision (0%), sample size determination (8.9%), method of random sequence generation (7.3%), allocation concealment (3.2%), participant flow (4.8%) and any other analysis (7.3%), generalizability of the trial findings (0.8%) were pooly reported. CONCLUSION: The proportions of following the CONSORT recommendations in Korean medical journals were very low. An effort to improve the reporting of RCTs by application and recommendation of CONSORT statement is required.

Evidence Based Evaluation of Health Information in the Television News

BACKGROUND: A rapid growth of socioeconomic status in Korea has triggered health information resolution of unprecedented magnitude among the general population. Despite its obvious benefits, the increase in the amount of information could also result in many potentially harmful effects on both consumers and professionals who do not use it appropriately. METHODS: This study was performed to evaluate health information in the television news from June 2003 through January 2004. We evaluated the quality and the accuracy of health information provided in the night news. We reviewed the health information for quality using the evidence-based medicine tools which evaluate the accuracy required to understand the text. RESULTS: A total of 85 types of information were identified. Among them, 34 (40.0%) contained inaccurate or misleading statement based on evidence-based medicine. These included confusing surrogate outcome with an end outcome (15.3%), extrapolating nonhuman results to human (8.2%), exaggerating results in conclusion (12.9%), incorrect words (7.1%), indefinite study methods (2.4%) In broadcasting stations A, B and C, the rate of error were 55.6%, 38.2% and 42.4%, respectively. The rate of error were higher in information of Korean source compared to those of international sources (65.8% and 27.3%). CONCLUSION: Many inaccurate medical information exist in the television news.

The Usefulness of Waist/Height Ratio as an Obesity Index

BACKGROUND: Waist circumference and BMI have been known as an independent predictor for cardiovascular diseases. But some people with a normal BMI or normal waist circumference may have cardiovascular risk factors. Therefore, the purpose of this study was to investigate the simplicity and the usefulness of waist/height ratio as an index of obesity and to investigate the waist/height ratio as a predictor for metabolic risks in individuals with normal weight and/or normal waist circumference. METHODS: The subjects were 1,157 individuals (635 men, 522 women). The morbidity index for metabolic risk factors was calculated by the sum of the risk factors scores (one point per item, if present). We set the criteria of obesity as BMI>or=25 kg/m2, waist circumference of >or=90 cm in males and >or=80 cm in females, waist/hip ratio of >or=0.9 in males and >or=0.8 in females, and waist/height ratio of >or=50 cm/cm*100. RESULTS: There was a significant correlation among waist/ height ratio, waist/hip ratio, BMI, and waist circumference (P=0.000). The odds ratios for morbidity index (>or=3) in normal BMI, waist circumference, and waist/hip ratio subjects with waist/height over 50 were significantly higher with 4.60, 3.83, and 2.79, respectively, and also higher in normal BMI with normal waist circumference subjects with 3.90 (P=0.000). CONCLUSION: Waist/height ratio may be used a simple and practical index of obesity. Especially, it may be useful in subjects with normal BMI or normal waist circumference when predicting their metabolic risks.

The Association between C-Reactive Protein and Features of the Metabolic Syndrome

BACKGROUNG: The Metabolic Syndrome is highly associated with an increased risk of coronary heart disease. C-reactive protein (CRP), a sensitive systemic marker of inflammation, is considered to show an association with risk of coronary heart disease. This study was done to assess the association of circulating levels of CRP with different components of the Metabolic Syndrome. METHODS: Total cholesterol (TC), triglycerides (TG), HDL cholesterol, body mass index (BMI), waist circumference, fasting glucose, hemoglobin A1c (HbA1c), blood pressure (BP), and CRP were measured in 1,203 men and women who have visited the Health Promotion Center in Kangdong Sacred Heart Hospital. The relationship of CRP and variables of the metabolic syndrome using t-test and regression analysis as assessed. RESULTS:CRP was associated with BMI (P<0.001), waist circumference (P<0.0001), diastolic blood pressure (P= 0.004), HDL cholesterol (P=0.015), and TG (P<0.0001). Subjects with the Metabolic Syndrome had a significantly higher CRP concentration (0.89 mg/L) than individuals without the metabolic syndrome (0.33 mg/L, P<0.0001). CONCLUSION: CRP seems to be related to variables of the metabolic syndrome. The data suggest that a variety of features of the metabolic syndrome are associated with systemic inflammation.

Evaluation of Residency Program Using the Result of in-training Examination / 한국의학교육

BACKGROUND: There has been widespread use of in-training examination for the evaluation of clinical competence of residents. The result of in-training examination seems to be helpful for improving the quality of residency programs using feedback system, further. We evaluated the relationship between residency program and the result of in-training examination. METHODS: Reports on the contents of residency program(82 programs) which were submitted in 1999 and in-training examination scores of 516 family medicine residents in 1998 were linked each other through the name of resident. Correlation analysis, t test, ANOVA analysis, and the multiple linear regression analysis were used. RESULTS: Mean score acquired by residents of tertiary hospital residency program(59.4+/-7.79) was significantly higher than that of secondary hospital(56.4+/-8.45) among all three residency years. Residents who have seen their own patients in ambulatory care clinic(58.5+/-8.14) and were given feedback by peer review of teaching faculty(60.2+/-7.71) acquired significantly better results compared to those who have not(56.1+/-8.35, 57.5+/-8.27). Residents in programs with moderate ratio of the number of residents to teaching faculty acquired significantly better results compared to those with smaller or larger ratio; the score were 56.2+/-6.90, 59.2+/-8.64, 58.7+/-7.90, 57.1+/-8.82 for the ratio of < or =3, 4-6, 7-9, and 9 <, respectively. Statistically significant but low correlation coefficients(less than 0.25) were observed between in-training examination score and the period of rotation to learn family medicine, general medicine, dermatology, musculo- skeletal problem, and the neuro-sensory problem. After controlling probable confounders, third year of residency, residency program in tertiary hospital, and the moderate ratio of residents to teaching faculty were significantly associated with the better result of in-training examination. CONCLUSION: For improving clinical competence of residents in family practice, limiting the ratio between residents and teaching faculty in residency program to appropriate level and substantiality in contents of hospital teaching rotation program should be needed.

Association between coffee consumption and serum gamma glutamyltransferase in male alcohol drinking adults

BACKGROUND: According to previous studies, it was suggested that coffee consumption may protect liver toxicity caused by alcohol drinking. Our study is design to analyze association between coffee consumption and serum gamma glutamyltransferase(GGT) in alcohol drinking male adults. METHODS: From 1996 May to 1995 July, data were collected from alcohol drinking male adults who visited a university hospitals for health check up. Among them, subjects who had disease could affect liver function test were excluded. Sociodemographic data, alcohol drinking amount, smoking status, coffee drinking amount data were collected by questionnaire and subject's weight and height were measured. RESULTS: We excluded 12 male adults because they had a disease which may cause liver dysfunction. In analysis of variance, coffee consumption and BMI were significantly associated with serum GGT(p=0.023). Alcohol drinking and cigarettes smoking were not significantly associated with GGT. In multiple regression analysis, coffee consumption was inversely related to serum GGT levels independently(p=0.002). Cigarettes smoking was also independently and positively associated with serum GGT levels(p=0.040). CONCLUSION: Coffee consumption may lower serum GGT levels in alcohol drinking male. It may suggest that coffee consumption protect liver toxicity caused by alcohol drinking and It must be validated in large sized prospective study involving non alcohol drinker.

The Usability of Item-Total Correlation as the Index of Item Discrimination / 한국의학교육

Item analysis is the evaluating process of items used for tests. Item difficulty, discrimination, and distractor analysis are the main components of the analysis. Discrimination index(D) by the method of extreme groups had been used for the item discrimination, but it had been known to have some disadvantages compared to item-total correlation(ITC). This study was conducted to evaluated the feasibility and the advantages of the ITC. Medical specialist qualifying examination carried out in Jan. 1999 was selected for the study material and the items of tests for the 4 major disciplines(internal medicine, general surgery, pediatrics, and obstetrics & gynecology) were analysed. The numbers of the items and examinee are 120 items/428 persons, 140/219, 140/229, and 140/226 (in the order of IM, GS, Ped, OB & Gyn) respectively. The average discrimination index(D) of all items is 0.170 and the standard deviation is 0.120. For the ITC, average is 0.210 and standard deviation is 0.117. There is positive correlation between D and ITC(r=0.677). The variation of the ITC is 0.880, which is wider than that of discrimination index(D), 0.713. Especially on the items with item's p-value greater than 0.9(n=140), the variations are 0.542 and 0.273 respectively. The difference is much distinct. These results imply that ITC can be used as the index of the item discrimination, and has some advantages compared to discrimination index(D). The advantages are the significance of the number itself and rather independence from the item difficulty.