Application and Evaluation of the Pilot Program for the Education Nurse System in a Medical Institution / 임상간호연구

Purpose@#This study was conducted to evaluate the performance following the application of the pilot program for the education nurse system of the Ministry of Health and Welfare in a medical institution. @*Methods@#This study was employed a non-homogeneous comparative group design by comparing new nurses who entered the medical institution after the pilot project from December 2019 to April 2020 with new nurses who entered before the pilot project during the same period. Satisfaction, academic achievement, job adaptation, personal turnover within one year, and patient safety incident rate were investigated as performance indicators. @*Results@#After the pilot project, the overall satisfaction among new nurses, preceptors, and fellow nurses increased, but there were no significant changes in academic achievement and job adaptation in new nurses. The personal turnover rate decreased from 15.6% to 9.1%, and the patient safety incident rate also decreased from 26.3% to 15.7%. Also, the preceptor overtime also decreased from 3.67 to 0.66 hours. @*Conclusion@#The performance of the pilot project for the education nurse system was related to improvements in satisfaction, turnover rate of new nurses, patient safety incident rate, and preceptor overtime. Above all long-term monitoring of each performance indicator is necessary through the continuation of the education nurse system of the Ministry of Health and Welfare.

A case of follow-up of a patient with 22q11.2 distal deletion syndrome and a review of the literature

Microdeletions of chromosome 22q11.2 are one of the most common microdeletions occurring in humans, and is known to be associated with a wide range of highly variable features. These deletions occur within a cluster of low copy repeats (LCRs) in 22q11.2, referred to as LCR22 A-H. DiGeorge (DGS)/velocardiofacial syndrome is the most prevalent form of a 22q11.2 deletions, caused by mainly proximal deletions between LCR22 A and D. As deletions of distal portion to the DGS deleted regions has been extensively studied, the recurrent distal 22q11.2 microdeletions distinct from DGS has been suggested as several clinical entities according to the various in size and position of the deletions on LCRs. We report a case of long-term follow-up of a female diagnosed with a 22q11.2 distal deletion syndrome, identified a deletion of 1.9 Mb at 22q11.21q11.23 (chr22: 21,798,906-23,653,963) using single nucleotide polymorphism array. This region was categorized as distal deletion type of 22q11.2, involving LCR22 D-F. She was born as a preterm, low birth weight to healthy non-consanguineous Korean parents. She showed developmental delay, growth retardation, dysmorphic facial features, and mild skeletal deformities. The patient underwent a growth hormone administration due to growth impairment without catch-up growth. While a height gain was noted, she had become overweight and was subsequently diagnosed with pre-diabetes. Our case could help broaden the genetic and clinical spectrum of 22q11.2 distal deletions.

Development of Pediatric Patient Classification System / 임상간호연구

Purpose@#This study was performed to develop a valid and reliable Pediatric Patient Classification System (PPCS). @*Methods@#The study was conducted in a children’s hospital which included various ward settings.Content validity was analyzed by Delphi method and to verify intraclass correlation reliability, 7 nurse managers and 29 staff nurses classified 216 patients. To verify construct validity, the staff nurses classified 216 patients according to PPCS comparing differences by age, days of stay, type of stay and medical department. @*Results@#The developed PPCS has 12 categories, 55 nursing activities and 80 criterions. High agreement among nurses (r=.90) suggested substantial reliability. Construct validity was verified by comparing differences in age, days of stay, type of stay and medical department (p<.05). The entire patient group were classified to four groups using PPCS. @*Conclusion@#The findings suggest that PPCS would be a useful tool for estimating nursing demands related to medications and the complexity of pediatric patients.

Evaluating the Predictive Ability of Initial Staging F-18 FDG PET/CT for the Prognosis of Non-HodgkinMalignant Lymphoma Patients Who Underwent Stem Cell Transplantation / 대한핵의학회잡지

OBJECTIVES: This study aimed to determine the value of clinical prognostic factors and semiquantitative metabolic parameters from initial staging fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) in non-Hodgkin lymphoma (NHL) patients treated with stem cell transplantation (SCT).METHODS: A total of 39 malignant lymphoma patients who underwent initial staging F-18 FDG PET/CT were enrolled in this study. SUVmax, MTV_wb, and TLG_wb were measured during the initial staging PET/CT. Receiver operating characteristic curve (ROC) analysis was adopted to dichotomize continuous variables. Log-rank test and Cox proportional hazard regression analysis were used to evaluate disease-free survival (DFS) rate.RESULTS: Among the 39 patients with malignant lymphoma, 17 (43.6%) had a relapse. For several clinical factors such as age, ECOG performance score, AMC/ALC score, stages, and revised International Prognostic Index score, differences between the two dichotomized groups were statistically insignificant. In univariate analysis, DFS estimates were 71.0 ± 7.8 months and 18.0 ± 5.9 months in high-SUVmax and low-SUVmax group, respectively (P < 0.01). For MTV_wb, DFS estimates were 46.6 ± 12.4 months and 69.1 ± 8.5 months in high-MTV_wb and low-MTV_wb group, respectively (P = 0.12). For TLG_wb, DFS estimates were 65.3 ± 7.5 months and 13.7 ± 8.6 months in high-TLG_wb and low-TLG_wb group, respectively (P = 0.02). In Cox proportional hazard regression analysis, only MTV_wb showed statistical significance (HR 3.01, 95% CI 1.04−8.74, P = 0.04).CONCLUSION: In NHL patients treated with SCT, the MTV_wb of initial staging F-18 FDG PET/CTwas an independent prognostic factor.

Evaluating the Predictive Ability of Initial Staging F-18 FDG PET/CT for the Prognosis of Non-HodgkinMalignant Lymphoma Patients Who Underwent Stem Cell Transplantation / 대한핵의학회잡지

OBJECTIVES@#This study aimed to determine the value of clinical prognostic factors and semiquantitative metabolic parameters from initial staging fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) in non-Hodgkin lymphoma (NHL) patients treated with stem cell transplantation (SCT).@*METHODS@#A total of 39 malignant lymphoma patients who underwent initial staging F-18 FDG PET/CT were enrolled in this study. SUVmax, MTV_wb, and TLG_wb were measured during the initial staging PET/CT. Receiver operating characteristic curve (ROC) analysis was adopted to dichotomize continuous variables. Log-rank test and Cox proportional hazard regression analysis were used to evaluate disease-free survival (DFS) rate.@*RESULTS@#Among the 39 patients with malignant lymphoma, 17 (43.6%) had a relapse. For several clinical factors such as age, ECOG performance score, AMC/ALC score, stages, and revised International Prognostic Index score, differences between the two dichotomized groups were statistically insignificant. In univariate analysis, DFS estimates were 71.0 ± 7.8 months and 18.0 ± 5.9 months in high-SUVmax and low-SUVmax group, respectively (P < 0.01). For MTV_wb, DFS estimates were 46.6 ± 12.4 months and 69.1 ± 8.5 months in high-MTV_wb and low-MTV_wb group, respectively (P = 0.12). For TLG_wb, DFS estimates were 65.3 ± 7.5 months and 13.7 ± 8.6 months in high-TLG_wb and low-TLG_wb group, respectively (P = 0.02). In Cox proportional hazard regression analysis, only MTV_wb showed statistical significance (HR 3.01, 95% CI 1.04−8.74, P = 0.04).@*CONCLUSION@#In NHL patients treated with SCT, the MTV_wb of initial staging F-18 FDG PET/CTwas an independent prognostic factor.

Effect of atopic dermatitis on the natural course of food allergy in infants and young children

PURPOSE: There have been studies showing that food allergy plays a role in the pathogenesis of atopic dermatitis. However, there have been few studies about the effect of atopic dermatitis on remission of food allergy. Thus, this study aimed to evaluate the difference in remission according to the presence of atopic dermatitis in infants and young children with milk or egg allergy. METHODS: A retrospective study was performed on 109 infants and young children with IgE-mediated food allergy in a tertiary hospital. They divided into food allergy with atopic dermatitis (FA with AD) and without atopic dermatitis (FA without AD). RESULTS: In the milk allergy group, initial milk-specific IgE levels were 21.16±27.98 kU(A)/L and 11.36±22.88 kU(A)/L, respectively, in FA with AD and FA without AD under 12 months of age. The remission rates of milk allergy at 36 months of age were 64.9% and 90.0%, respectively, in FA with AD and FA without AD. In the egg allergy groups, initial egg-specific IgE levels were 34.48±36.72 kU(A)/L and 15.66±28.60 kU(A)/L, respectively, in FA with AD and FA without AD under 12 months of age. The remission rates of egg allergy at 36 months of age were 61.2% and 90.0% in children with FA with AD and FA without AD. CONCLUSION: Atopic dermatitis may play an important role in the natural history of food allergy in infants. Different strategies are needed for the management of food allergy in young children with atopic dermatitis.

Correlation of Molecular Subtypes of Invasive Ductal Carcinoma of Breast with Glucose Metabolism in FDG PET/CT: Based on the Recommendations of the St. Gallen Consensus Meeting 2013 / 대한핵의학회잡지

PURPOSE: This study aimed to investigate the relationship between the SUVmax of primary breast cancer lesions and the molecular subtypes based on the recommendations of the St. Gallen consensus meeting 2013.METHODS: Clinical records of patients who underwent F-18 FDG PET/CT for initial staging of invasive ductal carcinoma (IDC) of SUVmax was correlated with the molecular subtypes defined by the St. Gallen Consensus Meeting 2013, i.e., luminal A-like (LA), luminal B-like HER2 negative (LBHER2−), luminal Blike HER2 positive (LBHER2+), HER2 positive (HER2+), and triple negative (TN), and with the clinicohistopathologic characteristics.RESULTS: The molecular subtype was LA in 38 patients, LBHER2− in 72, LBHER2+ in 21, HER2+ in 30, and TN in 22. The mean SUVmax in the LA, LBHER2−, LBHER2+, HER2+, and TN groups were 4.5 ± 2.3, 7.2 ± 4.9, 7.2 ± 4.3, 10.2 ± 5.5, and 8.8 ± 7.1, respectively. Although SUVmax differed significantly among these subtypes (p < 0.001), the values showed a wide overlap. Optimal cut-off SUVmax to differentiate LA from LBHER2−, LBHER2+, HER2+ and TN were 5.9, 5.8, 7.5, and 10.2 respectively, with area under curve (AUC) of 0.648, 0.709, 0.833, and 0.697 respectively. The cut-off value of 5.9 yielded the highest accuracy for differentiation between the LA and non-LA subtypes, with sensitivity, specificity, and AUC of 79.4 %, 57.9 %, and 0.704 respectively.CONCLUSION: The SUVmax showed a significant correlation with the molecular subtype. Although SUVmax measurements could be used along with immunohistochemical analysis for differentiating between molecular subtypes, its application to individual patients may be limited due to the wide overlaps in SUVmax.

Development of Graves' Ophthalmopathy after Radioactive Iodine Ablation Using Recombinant Human Thyrotropin for Incidentally Discovered Papillary Thyroid Carcinoma

Several studies have revealed an association between radioactive iodine (RAI) therapy for Graves' disease and new or worsening Graves' ophthalmopathy. In the present case, thyroid papillary cancer was incidentally detected in a 43-year-old woman who was receiving medication for Graves' disease. This patient had undergone RAI ablation using recombinant human thyrotropin (rhTSH) after total thyroidectomy. The patient subsequently complained of a unilateral eyelid abnormality at approximately 6 months after the RAI ablation, and was diagnosed with bilateral Graves' ophthalmopathy after a thorough ophthalmological examination. I report this case for its interesting clinical features, rarity of occurrence and to highlight the importance of careful observation for appropriate management of Graves' ophthalmopathy developing or worsening after RAI ablation in differentiated thyroid cancer patients.

Neurologic Manifestations according to Serotypes of Enterovirus in Pediatric Inpatient in Incheon

PURPOSE: Enterovirus infection in children can manifest various disease and enterovirus have many serotypes. This study was aimed to investigate neurologic manifestations according to serotypes of enterovirus in pediatric inpatients in Incheon. METHODS: We collected the stool samples from the admitted pediatric patients in Inha University Hospital from January 2015 to September 2016. Enterovirus detection and serotypes identification were performed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) and semi-nested RT-PCR. RESULTS: A total of 527 samples were collected during study period and 170 patients (32.2%) were diagnosed with enterovirus infections. Genetic sequences of enteroviruses were identified: echovirus 18 (50, 40.5%), enterovirus 71 (12, 9.6%), coxakievirus A10 (10, 8.0%), echovirus 6 (7, 5.6%). Virus in patient with meningitis were identified: echovirus 18 (15, 75%), coxakievirus B5 (2, 10%), enterovirus 71 (2, 10%), and echovirus 6 (1, 5%). Neurologic manifestations of echovirus 18 are headache (15, 30%), vomiting (17, 34%), meningeal irritation sign (10, 20.0%). And enterovirus 71 have headache (3, 25%), vomiting (3, 25%), meningeal irritation sign (2, 16.0%), seizure (1, 8.3%), neurologic sequelae (1, 8.3%). Echovirus 18 and neurologic manifestation have a statistically significant correlation with other serotypes (r=0.701, P < 0.01) CONCLUSION: Echovirus 18 infection was more prominent in neurological symptoms than in other serotypes. The major serotype of meningitis was echovirus 18 but there was no reported neurologic sequelae. Enterovirus infection has different neurological symptoms, depending on the serotypes.

Drug-induced liver injury caused by iodine-131

Iodine-131 is a radioisotope that is routinely used for the treatment of differentiated thyroid cancer after total or near-total thyroidectomy. However, there is some evidence that iodine-131 can induce liver injury . Here we report a rare case of drug-induced liver injury (DILI) caused by iodine-131 in a patient with regional lymph node metastasis after total thyroidectomy. A 47-year-old woman was admitted with elevated liver enzymes and symptoms of general weakness and nausea. Ten weeks earlier she had undergone a total thyroidectomy for papillary thyroid carcinoma and had subsequently been prescribed levothyroxine to reduce the level of thyroid-stimulating hormone. Eight weeks after surgery she underwent iodine-131 ablative therapy at a dose of 100 millicuries, and subsequently presented with acute hepatitis after 10 days. To rule out all possible causative factors, abdominal ultrasonography, endoscopic ultrasonography (on the biliary tree and gall bladder), and a liver biopsy were performed. DILI caused by iodine-131 was suspected. Oral prednisolone was started at 30 mg/day, to which the patient responded well.

Effects of Simulation-Based Learning in the Nursing Care of Children with Asthma / 한국간호교육학회지

PURPOSE: The purpose of this study was to examine the effects of simulation-based learning on the knowledge about and performance confidence in the nursing care of children with asthma. METHODS: A one-group pre- and post- study design was used. A total of 70 nursing students participated in the study. In groups of five, the participants experienced simulation-based learning during their child health nursing practicum. The given scenario was about nursing care for children with asthma. The simulation learning was provided for 3 hours, and included a group discussion before the simulation and a debriefing. RESULTS: After the simulation, knowledge about and performance confidence in the nursing care of children with asthma significantly increased. The nursing students reported a high level of satisfaction with the simulation-based learning. There was a significant positive correlation between knowledge and performance confidence. CONCLUSION: Simulation-based learning was effective for nursing students in the nursing care of children with asthma. Our results suggest utilizing this new way of learning to strengthen the clinical experience of child health nursing in nursing students.

Accuracy of predictive equations for resting metabolic rate in Korean athletic and non-athletic adolescents

BACKGROUND/OBJECTIVES: Athletes generally desire changes in body composition in order to enhance their athletic performance. Often, athletes will practice chronic energy restrictions to attain body composition changes, altering their energy needs. Prediction of resting metabolic rates (RMR) is important in helping to determine an athlete's energy expenditure. This study compared measured RMR of athletic and non-athletic adolescents with predicted RMR from commonly used prediction equations to identify the most accurate equation applicable for adolescent athletes. SUBJECTS/METHODS: A total of 50 athletes (mean age of 16.6 +/- 1.0 years, 30 males and 20 females) and 50 non-athletes (mean age of 16.5 +/- 0.5 years, 30 males and 20 females) were enrolled in the study. The RMR of subjects was measured using indirect calorimetry. The accuracy of 11 RMR prediction equations was evaluated for bias, Pearson's correlation coefficient, and Bland-Altman analysis. RESULTS: Until more accurate prediction equations are developed, our findings recommend using the formulas by Cunningham (-29.8 kcal/day, limits of agreement -318.7 and +259.1 kcal/day) and Park (-0.842 kcal/day, limits of agreement -198.9 and +196.9 kcal/day) for prediction of RMR when studying male adolescent athletes. Among the new prediction formulas reviewed, the formula included in the fat-free mass as a variable [RMR = 730.4 + 15 x fat-free mass] is paramount when examining athletes. CONCLUSIONS: The RMR prediction equation developed in this study is better in assessing the resting metabolic rate of Korean athletic adolescents.

Clinical Instructors' Role Experience in College of Nursing / 한국간호교육학회지

PURPOSE: The purpose of this study was to understand the clinical instructors' role experience in college of nursing. METHODS: Two focus group interviews were held with a total of 12 clinical instructors. All interviews were recorded and transcribed as they were spoken, and the collected data were analyzed using content analysis of Downe-Wamboldt(1992). RESULTS: Three themes and six subthemes were extracted from the analysis: 1) Getting recognition of special roles as a clinical instructor: 'Recognizing the role of clinical instructor for guiding student's individual practice goals', 'Recognizing helping and supporting roles for student's successful clinical practice', 2) Having difficulty in performing the role of clinical practice instructor: 'Difficulty from the lack of knowledge and experience as a clinical practice instructor', 'Difficulty from the gap between current clinical practice and purpose of clinical nursing practice', 3) Making efforts to overcome the difficulties as a clinical instructor and accomplishing personal development: 'Making efforts to acquire personal knowledge and experience', 'Making a chance to reflect on and grow up oneself'. CONCLUSION: Clinical instructors take an important part of clinical nursing education. To improve the quality of clinical nursing education, it is needed role reestablishment and institutional support for clinical instructors on the basis of the understanding of instructors' experience.

Multiple Hypercoagulability Disorders at Presentation of Non-Small-Cell Lung Cancer / 결핵및호흡기질환

Hypercoagulability disorders are commonly encountered in clinical situations in patients with a variety of cancers. However, several hypercoagulability disorders presenting as first symptoms or signs in cancer patients have rarely been reported. We herein described a case of a woman with adenocarcinoma of the lung presenting with deep vein thrombosis, nonbacterial thrombotic endocarditis, recurrent cerebral embolic infarction, and heart failure.

Multiple Hypercoagulability Disorders at Presentation of Non-Small-Cell Lung Cancer / 결핵및호흡기질환

Hypercoagulability disorders are commonly encountered in clinical situations in patients with a variety of cancers. However, several hypercoagulability disorders presenting as first symptoms or signs in cancer patients have rarely been reported. We herein described a case of a woman with adenocarcinoma of the lung presenting with deep vein thrombosis, nonbacterial thrombotic endocarditis, recurrent cerebral embolic infarction, and heart failure.

Effects of the 'Intervention - Mother's Song' on Physical Response and Behavioral State of Low-Birth Weight Infants in a Neonatal Intensive Care Unit

PURPOSE: This study was done to identify the effectiveness of the 'intervention - mother's recorded song' on low-birth weight infants in an neonatal intensive care unit (NICU). METHODS: This study was conducted with a nonequivalent control group pre-posttest quasi-experimental design and the participant group was low-birth weight infants who were admitted to the NICU. Forty-eight infants, 24 in each from two groups, the experimental and control group, participated in the study. RESULTS: For physical response according to vital signs, there were no significant statistical differences in heart rate, respiration rate and pulse oximetry saturation between the experimental group and the control group. For behavioral state, there was a significant statistical difference between the experimental and control group. CONCLUSION: The study results indicate that the intervention using mother's song had some significance as a nursing intervention with positive impacts. Such an intervention can help pediatric nurses improve infants' stabilization of their vital signs and behavioral states. By showing the effectiveness of such an intervention, the results of this study provide further evidence-based information in developing the practice of pediatric nursing.

Measurement of Length between Bronchial Carina and Superior Vena Cava-right Atrial Junction for Optimal Positioning of Central Venous Catheters in the Korean Adult Population / 대한혈관외과학회지

PURPOSE: Bronchial carina (BC) is one of the landmarks often used during central venous catheter (CVC) insertion. The aim of this study is to measure the superior vena cava (SVC) length and the length between the BC and the SVC-right atrial junction (LBCSAJ), using chest computed tomography (CT) scans in the Korean adult population, and to review the optimal location for the catheter tip, during CVC access using BC. METHODS: The study subjects were 238 consecutive subjects who underwent a chest CT scan with contrast and 5 mm thickness, in Inha University Hospital, between January 2010 and December 2011. Subjects who had any lung disease were excluded before enrollment. The subjects' clinical characteristics and imaging data were reviewed. The SVC length and LBCSAJ was measured at a 3-dimension workstation (Osirix). RESULTS: The mean age was 56.69+/-4.83 years, mean body weight 61.09+/-11.12 kg, height 161.72+/-9.15 cm, and body mass index (BMI) was 23.07+/-4.45 kg/m2. The mean length of the SVC was 47.67+/-10.92 mm, and the mean LBCSAJ was 30.80+/-9.03 mm. Men have a longer SVC and LBCSAJ than women (52.80+/-10.59 vs. 42.96+/-8.72, P=0.000). The age and height were significant covariates of the SVC length and the LBCSAJ. BMI was a significant covariate of the LBCSAJ in multivariate analysis. CONCLUSION: An understanding of anatomy and the actual length of the SVC in relation to bronchial carina is important for proper placement of a central venous catheter. This study gives its basic characteristics in the Korean adult population.

Comparison of Activity Factor, Predicted Resting Metabolic Rate, and Intakes of Energy and Nutrients Between Athletic and Non-Athletic High School Students

This study compared activity factor, predicted resting metabolic rate (RMR), and nutrient intakes between athletic and non-athletic high school students in Gangwon-do. Fifty soccer players (30 males and 20 females; mean ages 16.7+/-1.0 years and 16.4+/-1.1 years, respectively) and 50 non-athletic (30 males and 20 females; mean ages 17.5+/-0.4 years and 16.4+/-1.1 years respectively) high school students were included. Anthropometric measurements included: weight and height, triceps skinfold, mid-arm circumference, and body fat. Prediction equations consisted of those from the Harris-Benedict, FAO/WHO/UNU, IMNA, Cunningham, Mifflin et al., and Owen et al. A one-day activity diary was collected by interview, and the 24-hour recall method was used to analyze nutrient intakes of subjects. The activity factors of the male and female athletic groups (2.23 and 2.16, respectively) were significantly higher than those (1.52 and 1.46, respectively) of the non-athletic group. There was only a significant difference in RMR by use of the Cunningham's equation between two groups. For the males, almost all nutrient intakes of the athletic group (except carbohydrate, iron, vitamin B1, B6, and niacin) of athletic group were significantly higher than those of the non-athletic group. The female athletic group showed significantly higher nutrient intakes with the exception of most vitamins. These results suggest that assessments of energy balance between energy intake and energy expenditure by employing RMR and activity factors would be useful to prevent and treat obesity in high school athletes. In addition, the Cunningham's equation would be appropriate for predicting their energy needs.

Comparison of Activity Factor, Predicted Resting Metabolic Rate, and Intakes of Energy and Nutrients Between Athletic and Non-Athletic High School Students

This study compared activity factor, predicted resting metabolic rate (RMR), and nutrient intakes between athletic and non-athletic high school students in Gangwon-do. Fifty soccer players (30 males and 20 females; mean ages 16.7+/-1.0 years and 16.4+/-1.1 years, respectively) and 50 non-athletic (30 males and 20 females; mean ages 17.5+/-0.4 years and 16.4+/-1.1 years respectively) high school students were included. Anthropometric measurements included: weight and height, triceps skinfold, mid-arm circumference, and body fat. Prediction equations consisted of those from the Harris-Benedict, FAO/WHO/UNU, IMNA, Cunningham, Mifflin et al., and Owen et al. A one-day activity diary was collected by interview, and the 24-hour recall method was used to analyze nutrient intakes of subjects. The activity factors of the male and female athletic groups (2.23 and 2.16, respectively) were significantly higher than those (1.52 and 1.46, respectively) of the non-athletic group. There was only a significant difference in RMR by use of the Cunningham's equation between two groups. For the males, almost all nutrient intakes of the athletic group (except carbohydrate, iron, vitamin B1, B6, and niacin) of athletic group were significantly higher than those of the non-athletic group. The female athletic group showed significantly higher nutrient intakes with the exception of most vitamins. These results suggest that assessments of energy balance between energy intake and energy expenditure by employing RMR and activity factors would be useful to prevent and treat obesity in high school athletes. In addition, the Cunningham's equation would be appropriate for predicting their energy needs.

Effect of Body Composition, Serum Lipid Level and Resting Metabolic Rate by Nutritional Education and Exercise Program in Middle Aged Women

The purpose of this study was to investigate the change of body composition, biochemical index level, resting metabolic rate and daily activities by the public health center's health-promoted program in overweight middle aged women. The workout program of 12 subjects constituted by exercise(aerobic exercise & resistance training) and nutritional education for 10 weeks. As the results, there was a significant decrease in all the weight(59.0+/-8.9 vs 57.2+/-8.3kg, p<0.05), body fat percentage(33.4+/-4.3 vs 30.5+/-4.5%, p<0.05) and body fat mass(19.8+/-5.4 vs 17.7+/-4.9kg, p<0.05) after program. Fat free mass and RMR which tend to be higher after than before program were found not to be significantly. In addition, the serum HDL-cholesterol(54.3+/-8.1 vs 59.7+/-13.9mg/dl, p<0.05) and TG level(65.2+/-418 vs 89.4+/-65.6mg/dl, p<0.05) of the subjects increased at the end of the study significantly and significant correlation found between total-cholesterol and TG before program. When the other laboratory parameter were compared before and after program, hematocrit(35.1+/-3.3 vs 39.7+/-3.3%, p<0.001), platelet(225.9+/-49.6 vs 244.3+/-49.7cell/ul, p<0.05) and fasting glucose(88.0+/-6.5 vs 76.6+/-9.7mg/dl, p<0.001) increased significantly but hemoglobin(13.3+/-1.3 vs 12.9+/-1.3mg/dl, p<0.01) decreased. And in activities analysis, 'moderate activity(18.8 vs 5.8minutes, p<0.05)' clearly showed a significant decrease but 'severe activity(17.7 vs 11.4minutes, p<0.05)' showed a increase. These results suggest that continuous health-promoted program involved exercise and nutritional education at the public health center are effective to reduce body fat and to improve resting metabolic rate(RMR). Further research is required to develop more effective public health program for the middle aged women in community.