Changes of Body Mass Index and the Incidence of Hypertension in Late Middle Age: A Nationwide Cohort Study in South Korea

Background@#Previous studies revealed weight gain is an independent risk factor for hypertension. Hypertension in late middle age increases the risks of dementia and cardiovascular diseases. We aimed to analyze the difference in the risk of hypertension in the late middle age according to the change of body mass index (BMI) using nationwide cohort data of South Korea. @*Methods@#We used 64,136 individuals from National Health Insurance Service-Health Screening Cohort in South Korea. The primary endpoint is newly diagnosed hypertension after observation start date, which was defined as the date of first examination after 50. BMI changes were measured between two consecutive health examinations before and after 50. Cox proportional hazard regression analysis was performed to evaluate the association between the change of BMI and the risk of hypertension. @*Results@#During the mean follow-up period of 3.4±1.9 years, 8,676 individuals were diagnosed with hypertension. Both normal-to-obese group and obese-to-obese group had 19% higher risk for hypertension, and obese-to normal group had 10% higher risk for hypertension in late middle age, compared to normal-to-normal group. @*Conclusions@#We confirmed becoming obese and maintaining obese increase the risk of hypertension in late middle age. Thus, clinicians need to assess obese patients regularly for the possibility of new onset hypertension and take preventive measure to reduce the risk by losing weights before late middle age.

Impact of Sleep Duration on Decline in Kidney Function in Adult Patients with Hypertension: A Community-Based Prospective Cohort Study / 가정의학회지

Background@#Sleep duration is associated with various health conditions, including chronic kidney disease. However, the association between sleep duration and decline in kidney function in the South Korean population remains unclear. We aimed to investigate the impact of sleep duration on kidney function decline in adult patients with hypertension. @*Methods@#This cohort study was performed using data obtained from the Korean Genome and Epidemiology Study; 2,837 patients with hypertension who initially had normal kidney function were included. Glomerular filtration rates (GFRs) were estimated at baseline and throughout the 16 years of follow-up. A person was considered to have a decline in kidney function if they had a GFR <60 mL/min/1.73 m2. Sleep duration data were obtained through interviewer-assisted questionnaires. Sleep durations were classified as short (<6 hours), normal (≥6 hours but <9 hours), and long (≥9 hours). The Cox proportional hazards model was applied, with adjustments for covariates. @*Results@#After adjusting for covariates, sleep duration was not associated with a decline in kidney function. However, among men with poorly controlled hypertension at baseline, compared to men with normal sleep durations, men with sleep durations <6 hours had a significantly higher risk of kidney function decline (hazard ratio, 1.56; 95% confidence interval, 1.02–2.36). @*Conclusion@#Short sleep duration did not seem to be associated with an increased risk of decline in kidney function; however, it may be a risk factor for the decline in kidney function in men with poorly controlled hypertension.

Changes in Diagnostic Performance of Thyroid Cancer Screening before and after the Korean Thyroid Imaging Reporting and Data System Revision / 가정의학회지

Background@#Since the era of “thyroid cancer epidemic,” many Korean academic societies discouraged the use of ultrasonography in healthy individuals and revised the Korean Thyroid Imaging Reporting and Data System to address the overscreening and overdiagnosis issues. This study aimed to evaluate the change in the diagnostic effectiveness of thyroid cancer screening over the last decade. @*Methods@#This single-center, retrospective observational study analyzed the data of 125,962 thyroid nodules obtained during cancer screening at the health promotion center of Seoul National University Bundang Hospital from 2010 to 2019. Only 327 thyroid cancer cases pathologically confirmed by fine-needle aspiration (FNA) were included in the study. The strength of the association between the number of FNA and (1) the number of thyroid cancer diagnoses, (2) the positive predictive values (PPVs), and (3) the difference in PPV from the previous year were evaluated using Pearson’s correlation analysis. @*Results@#The number of thyroid FNA biopsies as well as the thyroid cancer diagnoses decreased from 2010 to 2019 (166 to 48 [-71.1%] vs. 43 to 22 [-48.8%]). The PPV of FNA biopsies increased from 25.9% to 45.8% (+76.8%) and was negatively correlated with the number of FNA biopsies performed (R=-0.87, P<0.001). The difference in PPV from the previous year increased similarly but without statistical significance (R=-0.59, P=0.09). @*Conclusion@#The diagnostic efficiency of thyroid cancer screening has increased over the last decade, as evidenced by the increasing PPV of FNA biopsies.

Fruit Intake and Changes of Cardio-Metabolic Risk Factors in People with Obesity / 가정의학회지

Background@#This study aimed to explore the relationship between fruit intake, changes in fruit intake, and changes in cardiometabolic factors in people with obesity. @*Methods@#A total of 21,270 subjects (8,718 men, 12,552 women) aged 40 years and over, from the Korean-based Genome and Epidemiology Study, were followed up for an average of 4.4 years. Fruit intake was assessed using a food frequency questionnaire at baseline and the second follow-up. The beta coefficient and confidence intervals for changes in cardiometabolic risk factors according to fruit consumption were calculated using a linear regression model. @*Results@#In men, the abdominal circumference decreased with changes in fruit intake (P=0.029). Fruit intake and increased fruit intake in men were associated with a lower systolic blood pressure (P=0.012 and P=0.02, respectively) and lower triglyceride levels (P=0.002 and P<0.001, respectively). In women, abdominal circumference decreased with both fruit intake and increased fruit intake (P<0.001 and P=0.013, respectively). Systolic blood pressure and triglycerides tended to decrease only with fruit intake (P=0.048 and P<0.001, respectively). Unlike in men, fasting blood glucose tended to decrease in women with both fruit intake and increased fruit intake (P=0.011 and P=0.005, respectively). @*Conclusion@#Fruit intake and increased fruit intake may have beneficial effects on cardiometabolic risk factors among individuals who are obese.

Comparison of body water status and its distribution in patients with non-septic infection, patients with sepsis, and healthy controls

Objective@#Although fluid resuscitation is the cornerstone of treatment for sepsis, the role of body water status in sepsis is poorly understood. This study aimed to understand how body water and its distribution are modified in patients with sepsis and those with non-septic infection compared to healthy individuals. @*Methods@#Two groups of adults presumed to have non-septic infection (n=87) and sepsis (n=54) were enrolled in this prospective study in a single emergency department, and they were compared to sex-, age-, and height-matched (1:3 ratio) healthy controls (n=11,190) from retrospective data in a health promotion center. Total body water (TBW), intracellular water (ICW), and extracellular water (ECW), determined using direct segmental multi-frequent bioelectrical impedance analysis (InBody S10) were expressed as indices for normalization by body weight (BW). The ratio of ECW to TBW (ECW/TBW) was evaluated to determine body water distribution. @*Results@#TBW/BW, ICW/BW, and ECW/BW were significantly higher in the non-septic infection group than in the healthy group (P<0.001), but ECW/TBW was not significantly different (P=0.690). There were no differences in TBW/BW and ICW/BW between the sepsis and healthy groups (P=0.083 and P=0.963). However, ECW/BW and ECW/TBW were significantly higher in the sepsis group than in the healthy group (P<0.001). @*Conclusion@#Compared to the healthy group, the ratio of body water to BW was significantly increased in the non-septic infection group, while ECW/BW and ECW/TBW were significantly increased in the sepsis group. These indices could be utilized as diagnostic variables of body water deficit in septic patients.

Fruit Intake and Changes of Cardio-Metabolic Risk Factors in People with Obesity / 가정의학회지

Background@#This study aimed to explore the relationship between fruit intake, changes in fruit intake, and changes in cardiometabolic factors in people with obesity. @*Methods@#A total of 21,270 subjects (8,718 men, 12,552 women) aged 40 years and over, from the Korean-based Genome and Epidemiology Study, were followed up for an average of 4.4 years. Fruit intake was assessed using a food frequency questionnaire at baseline and the second follow-up. The beta coefficient and confidence intervals for changes in cardiometabolic risk factors according to fruit consumption were calculated using a linear regression model. @*Results@#In men, the abdominal circumference decreased with changes in fruit intake (P=0.029). Fruit intake and increased fruit intake in men were associated with a lower systolic blood pressure (P=0.012 and P=0.02, respectively) and lower triglyceride levels (P=0.002 and P<0.001, respectively). In women, abdominal circumference decreased with both fruit intake and increased fruit intake (P<0.001 and P=0.013, respectively). Systolic blood pressure and triglycerides tended to decrease only with fruit intake (P=0.048 and P<0.001, respectively). Unlike in men, fasting blood glucose tended to decrease in women with both fruit intake and increased fruit intake (P=0.011 and P=0.005, respectively). @*Conclusion@#Fruit intake and increased fruit intake may have beneficial effects on cardiometabolic risk factors among individuals who are obese.

Comparison of body water status and its distribution in patients with non-septic infection, patients with sepsis, and healthy controls

Objective@#Although fluid resuscitation is the cornerstone of treatment for sepsis, the role of body water status in sepsis is poorly understood. This study aimed to understand how body water and its distribution are modified in patients with sepsis and those with non-septic infection compared to healthy individuals. @*Methods@#Two groups of adults presumed to have non-septic infection (n=87) and sepsis (n=54) were enrolled in this prospective study in a single emergency department, and they were compared to sex-, age-, and height-matched (1:3 ratio) healthy controls (n=11,190) from retrospective data in a health promotion center. Total body water (TBW), intracellular water (ICW), and extracellular water (ECW), determined using direct segmental multi-frequent bioelectrical impedance analysis (InBody S10) were expressed as indices for normalization by body weight (BW). The ratio of ECW to TBW (ECW/TBW) was evaluated to determine body water distribution. @*Results@#TBW/BW, ICW/BW, and ECW/BW were significantly higher in the non-septic infection group than in the healthy group (P<0.001), but ECW/TBW was not significantly different (P=0.690). There were no differences in TBW/BW and ICW/BW between the sepsis and healthy groups (P=0.083 and P=0.963). However, ECW/BW and ECW/TBW were significantly higher in the sepsis group than in the healthy group (P<0.001). @*Conclusion@#Compared to the healthy group, the ratio of body water to BW was significantly increased in the non-septic infection group, while ECW/BW and ECW/TBW were significantly increased in the sepsis group. These indices could be utilized as diagnostic variables of body water deficit in septic patients.

Risk Factors of Cardiovascular Disease according to Alcohol Behavioral Change after Cancer Diagnosis / 가정의학회지

Background@#Problem drinking increases the incidence of all-cause mortality and specific cancers, and persistent drinking is associated with cardiovascular disease in certain cancer survivors. This study analyzed the cardiovascular risk factors before and after diagnosis in Korean cancer survivors. @*Methods@#Data for the period between 2002 and 2013 were collected from the National Health Insurance Service Health-Examinee Cohort Database. Among the 27,835 patients included, those with moderate alcohol consumption before and after cancer diagnosis were excluded. Problem drinking was defined as males under 65 years consuming over 14 glasses a week, and males over 65 years or females consuming over seven glasses a week. A t-test, chi-square test, and linear regression analysis were performed for differences in cardiovascular risk factors and differences according to cancer types. @*Results@#There was a difference in the body mass index, systolic and diastolic blood pressure, and total cholesterol among patients who became moderate drinkers after diagnosis, but fasting blood glucose did not show any significant changes. Risk factors for cardiovascular disease were analyzed in patients with liver, stomach, rectal, and breast cancer with improved drinking behavior, and there were significant differences in body mass index, systolic and diastolic blood pressure, fasting blood glucose, and total cholesterol in stomach cancer patients. @*Conclusion@#Moderate drinking can lower cardiovascular risk in cancer survivors, and among the many drinking-related cancers, stomach cancer patients demonstrated significantly reduced cardiovascular risk factors.

The Inhibitory Mechanism on Acetylcholine-Induced Contraction of Bladder Smooth Muscle in the Streptozotocin-Induced Diabetic Rat

Most diabetic patients experience diabetic mellitus (DM) urinary bladder dysfunction. A number of studies evaluate bladder smooth muscle contraction in DM. In this study, we evaluated the change of bladder smooth muscle contraction between normal rats and DM rats. Furthermore, we used pharmacological inhibitors to determine the differences in the signaling pathways between normal and DM rats. Rats in the DM group received an intraperitoneal injection of 65 mg/kg streptozotocin and measured blood glucose level after 14 days to confirm DM. Bladder smooth muscle contraction was induced using acetylcholine (ACh, 10⁻⁴ M). The materials such as, atropine (a muscarinic receptor antagonist), U73122 (a phospholipase C inhibitor), DPCPX (an adenosine A1 receptor antagonist), udenafil (a PDE5 inhibitor), prazosin (an α₁-receptor antagonist), papaverine (a smooth muscle relaxant), verapamil (a calcium channel blocker), and chelerythrine (a protein kinase C inhibitor) were pre-treated in bladder smooth muscle. We found that the DM rats had lower bladder smooth muscle contractility than normal rats. When prazosin, udenafil, verapamil, and U73122 were pre-treated, there were significant differences between normal and DM rats. Taken together, it was concluded that the change of intracellular Ca²⁺ release mediated by PLC/IP3 and PDE5 activity were responsible for decreased bladder smooth muscle contractility in DM rats.

Usefulness of the Patient Health Questionnaire-2 in Screening for Depression

BACKGROUND: While various screening tools are available for depression, they are not feasible in clinical practice because of their excessive number of questions. The Patient Health Questionnaire-2 (PHQ-2) consists of two questions gauging the frequency of depressed mood and anhedonia over the past two weeks. This study aimed to assess the usefulness of the PHQ-2 as a brief screening tool for depression.METHODS: This study used Korean National Health and Nutrition Examination Survey data from 2014, and the study population consisted of 4,946 individuals. We analyzed the validity of the PHQ-2 compared with ‘depression by PHQ-9,’ and obtained the optimal cut point for screening depression. The agreement between PHQ-2 and depression by PHQ-9 and the agreement between PHQ-2 and ‘currently diagnosed as depression’ were analyzed using Cohen's kappa. The correlation between EuroQol-5D (EQ-5D) index scores and PHQ-2 scores was analyzed using Student's t-test.RESULTS: Using ‘depression by PHQ-9’ as the criterion standard, PHQ-2 scores ≥2 had a sensitivity of 89% and a specificity of 87%, and a receiver operating characteristic analysis identified PHQ-2≥2 as the optimal cut point for screening. The agreement between PHQ-2 and depression by PHQ-9 was 0.430 when PHQ-2 ≥2 was used as a cut point. The agreement between PHQ-2 and ‘depression by questionnaire’ was poor. The EQ-5D index score of the depressive group was significantly lower than that of the normal group.CONCLUSION: The PHQ-2 is an effective measure for screening depression and is expected to be useful in busy clinical settings.

Dietary Patterns Assessed by the Diet Quality Index-International Among Cancer Survivors Compared with Healthy Control Subjects: Using the Korea National Health and Nutrition Examination Surveys 2013–2015

BACKGROUND: Dietary patterns have a significant impact on prognosis, recurrence, and survival in patients with cancer. This study investigated dietary patterns using the Diet Quality Index-International (DQI-I) in cancer survivors compared to those in the general population without cancer.METHODS: Using the Korea National Health and Nutrition Examination Survey VI data, cancer survivors were defined as those diagnosed with cancer more than 1 year before the survey. The associations between possible predictors and the DQI-I score were examined using t-tests and analysis of variance. Adjusted multiple linear regression analysis was performed to compare the differences in DQI-I scores between cancer survivors and controls.RESULTS: In univariate analysis of 9,351 subjects (433 cancer survivors and 8,918 controls), age, sex, body mass index, marital status, education level, income, residential area, smoking status, and alcohol consumption were associated with the DQI-I score (each P-value < 0.05). After adjustment, cancer survivors showed higher DQI-I scores than the controls (67.40±8.90 vs. 65.50±9.40, P-value=0.007). In subgroup analysis, cancer survivors within 5 years after cancer diagnosis showed higher DQI-I scores than the controls (68.70±8.30 vs. 65.50±9.40, P-value=0.034), whereas those who survived beyond 5 years post-diagnosis did not show significant differences from the controls (66.70±9.20 vs. 65.50±9.40, P-value=0.063).CONCLUSION: Cancer survivors within 5 years of cancer diagnosis showed better dietary patterns than those in the general population. However, the differences were not observed after 5 years post-diagnosis. To reduce the risks of second primary cancer and mortality, targeted inventions for dietary habits are necessary for long-term survivors of cancer.

The change of signaling pathway on the electrical stimulated contraction in streptozotocin-induced bladder dysfunction of rats

Bladder dysfunction is a common complication of diabetes mellitus (DM). However, there have been a few studies evaluating bladder smooth muscle contraction in DM in the presence of pharmacological inhibitors. In the present study, we compared the contractility of bladder smooth muscle from normal rats and DM rats. Furthermore, we utilized pharmacological inhibitors to delineate the mechanisms underlying bladder muscle differences between normal and DM rats. DM was established in 14 days after using a single injection of streptozotocin (65 mg/kg, intraperitoneal) in Sprague-Dawley rats. Bladder smooth muscle contraction was induced electrically using electrical field stimulation consisting of pulse trains at an amplitude of 40 V and pulse duration of 1 ms at frequencies of 2–10 Hz. In this study, the pharmacological inhibitors atropine (muscarinic receptor antagonist), U73122 (phospholipase C inhibitor), DPCPX (adenosine A₁ receptor antagonist), udenafil (PDE5 inhibitor), prazosin (α₁-receptor antagonist), verapamil (calcium channel blocker), and chelerythrine (protein kinase C inhibitor) were used to pretreat bladder smooth muscles. It was found that the contractility of bladder smooth muscles from DM rats was lower than that of normal rats. In addition, there were significant differences in percent change of contractility between normal and DM rats following pretreatment with prazosin, udenafil, verapamil, and U73122. In conclusion, we suggest that the decreased bladder muscle contractility in DM rats was a result of perturbations in PLC/IP₃-mediated intracellular Ca²⁺ release and PDE5 activity.

Osteoarthritis Affects Health-Related Quality of Life in Korean Adults with Chronic Diseases: The Korea National Health and Nutritional Examination Surveys 2009–2013 / 가정의학회지

BACKGROUND: Osteoarthritis (OA) is a chronic disease that commonly afflicts the elderly. This disease reduces the health-related quality of life (HRQoL) and causes a significant social burden. Whether the effect of coexisting chronic conditions on HRQoL varies according to the presence of OA remains unclear. Therefore, this study aimed to investigate this notion. METHODS: A total of 13,395 participants were identified from the 2009–2013 Korean National Health and Nutrition Examination Survey for analysis. HRQoL was assessed using the European quality of life-5 dimensions (EQ-5D) index. Patients with OA were defined as those diagnosed by a physician or those who displayed both, symptoms and radiological findings consistent with OA at the time of the survey. Associations between OA and 8 chronic conditions were tested using regression analysis. RESULTS: The EQ-5D index was lower in patients with OA than in those without (mean difference, −0.145; 95% confidence interval [CI], −0.138 to −0.151; P<0.001). Most patients with OA and chronic conditions showed a lower score than those without. EQ-5D was particularly lower in OA patients with hypertension, dyslipidemia, stroke, and renal failure. The estimated β coefficient for the interaction term was significant in renal failure (−0.034; 95% CI, −0.055 to −0.012), after adjusting for demographic and socio-economic variables. CONCLUSION: OA significantly affects HRQoL of Korean elderly individuals alone or when combined with other conditions. OA combined with renal failure is particularly detrimental. These results indicate the importance of managing OA, which is an underestimated disease in public health surveys.

Association Between the Awareness of Dyslipidemia and Health Behavior for Control of Lipid Levels Among Korean Adults with Dyslipidemia / 가정의학회지

BACKGROUND: Dyslipidemia is a major risk factor contributing to cardiovascular disease and its prevalence is steadily rising. Although screening tests are readily accessible, dyslipidemia remains undertreated. Evaluating health behavior patterns after diagnosis may help improve lifestyle interventions for the management of dyslipidemia. METHODS: Data from the fifth Korean National Health and Nutrition Examination Survey 2010–2012 were used. A total of 6,624 dyslipidemia patients over 20 years old were included according to National Cholesterol Education Program-Adult Treatment Panel III guidelines. Logistic regression analysis was completed using a weighted method to determine whether awareness of dyslipidemia was associated with health behavior. Health behavior was divided into two categories: behavioral factors (smoking, alcohol consumption, exercise) and nutritional factors (adequate intake of fiber, carbohydrate, fat, protein). RESULTS: There were no significant differences in health behavior among dyslipidemia patients according to awareness after adjustment for covariates, diabetes and hypertension. Awareness in women was associated with decreased smoking (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.32 to 0.94), but when adjusted for diabetes and hypertension the result was not significant (OR, 0.61; 95% CI, 0.35 to 1.06). The same pattern applied to intake of carbohydrate in men (OR, 1.28; 95% CI, 0.99 to 1.67) and protein in women (OR, 1.22; 95% CI, 0.98 to 1.50). In subgroup analysis, awareness of dyslipidemia in men without hypertension or diabetes was associated with adequate intake of carbohydrate (OR, 1.70; 95% CI, 1.06 to 2.72). CONCLUSION: Increasing awareness alone may not be enough to improve healthy behavior in patients with dyslipidemia. Efforts including patient education and counseling through a multi-team approach may be required.

Efficacy of Carboxymethylcellulose and Hyaluronate in Dry Eye Disease: A Systematic Review and Meta-Analysis / 가정의학회지

BACKGROUND: The efficacy of two artificial tears, carboxymethylcellulose (CMC) and hyaluronate (HA), was compared in the treatment of patients with dry eye disease. METHODS: We conducted a systematic review and meta-analysis on randomized controlled trials in the PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases. The efficacy was compared in terms of the mean change from baseline in tear break-up time. The meta-analysis was conducted using both random and fixed effect models. The quality of the selected studies was assessed for risk of bias. RESULTS: Five studies were included involving 251 participants. Random effect model meta-analysis showed no significant difference between CMC and HA in treating dry eye disease (pooled standardized mean difference [SMD]=-0.452; 95% confidence interval [CI], -0.911 to 0.007; P=0.053). In contrast, fixed effect model meta-analysis revealed significant improvements in the CMC group when compared to the HA group (pooled SMD=-0.334; 95% CI, -0.588 to -0.081; P=0.010). CONCLUSION: The efficacy of CMC appeared to be better than that of HA in treating dry eye disease, although meta-analysis results were not statistically significant. Further research is needed to better elucidate the difference in efficacy between CMC and HA in treating dry eye disease.

Establishing a Personal Health Record System in an Academic Hospital: One Year's Experience / 가정의학회지

BACKGROUND: Personal health records (PHRs) are web based tools that help people to access and manage their personalized medical information. Although needs for PHR are increasing, current serviced PHRs are unsatisfactory and researches on them remain limited. The purpose of this study is to show the process of developing Seoul National University Bundang Hospital (SNUBH)'s own PHR system and to analyze consumer's use pattern after providing PHR service. METHODS: Task force team was organized to decide service range and set the program. They made the system available on both mobile application and internet web page. The study enrolled PHR consumers who assessed PHR system between June 2013 and June 2014. We analyzed the total number of users on a monthly basis and the using pattern according to each component. RESULTS: The PHR service named Health4U has been provided from June 2013. Every patient who visited SNUBH could register Health4U service and view their medical data. The PHR user has been increasing, especially they tend to approach via one way of either web page or mobile application. The most frequently used service is to check laboratory test result. CONCLUSION: For paradigm shift toward patient-centered care, there is a growing interest in PHR. This study about experience of establishing and servicing the Health4U would contribute to development of interconnected PHR.

Prevalence of Chronic Obstructive Lung Disease in Korea Using Data from the Fifth Korea National Health and Nutrition Examination Survey / 가정의학회지

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is the fifth leading cause of death worldwide. The awareness and treatment rate of the disease are low despite its relatively high prevalence. With the added data, this study aimed to identify changes in prevalence and risk factors of COPD using the data from the 5th KNHNES. METHODS: The subjects of this study were 8,969 individuals aged 40 and older who satisfied suitability and reproducibility for pulmonary function tests. The prevalence, awareness and risk factors of COPD were predicted based on the questionnaires on gender, age, educational level, income level, smoking history, body mass index (BMI) and other COPD related questions. RESULTS: Diagnosis of COPD was based on the airflow limitation (forced expiratory volume in one second/forced vital capacity <0.7) of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The prevalence of COPD from 2010 to 2012 was 13.7%, of which 23.3% was men and 6.5% women. The prevalence was on the rise, with 12.2% in 2010, 13.2% in 2011, and 15.5% in 2012. In GOLD stage 1, the percentages of those who had cough or sputum and smoking history were 12.1% and 75.5%, respectively, but only 0.1% was diagnosed with COPD. Even after adjusting for asthma and tuberculosis, men, old age, larger amount of smoking were linked with a higher prevalence of COPD, and obese and higher educational level were associated with a lower prevalence of COPD. CONCLUSION: The prevalence of COPD in Korea has been increasing every year, and a higher prevalence was associated with male, older age, more amount of smoking, lower educational level and lower BMI.

Architecture Design of Healthcare Software-as-a-Service Platform for Cloud-Based Clinical Decision Support Service / 대한의료정보학회지

OBJECTIVES: To design a cloud computing-based Healthcare Software-as-a-Service (SaaS) Platform (HSP) for delivering healthcare information services with low cost, high clinical value, and high usability. METHODS: We analyzed the architecture requirements of an HSP, including the interface, business services, cloud SaaS, quality attributes, privacy and security, and multi-lingual capacity. For cloud-based SaaS services, we focused on Clinical Decision Service (CDS) content services, basic functional services, and mobile services. Microsoft's Azure cloud computing for Infrastructure-as-a-Service (IaaS) and Platform-as-a-Service (PaaS) was used. RESULTS: The functional and software views of an HSP were designed in a layered architecture. External systems can be interfaced with the HSP using SOAP and REST/JSON. The multi-tenancy model of the HSP was designed as a shared database, with a separate schema for each tenant through a single application, although healthcare data can be physically located on a cloud or in a hospital, depending on regulations. The CDS services were categorized into rule-based services for medications, alert registration services, and knowledge services. CONCLUSIONS: We expect that cloud-based HSPs will allow small and mid-sized hospitals, in addition to large-sized hospitals, to adopt information infrastructures and health information technology with low system operation and maintenance costs.

Monitor Preference for Electronic Medical Record in Outpatient Clinic / 대한의료정보학회지

OBJECTIVES: The objective of this paper is to assess which wide type monitor configurations are preferred when physicians use an Electronic Medical Record (EMR) system in an outpatient clinic setting. METHODS: We selected three kinds of monitor configurations available for adoption at outpatient clinics with reference to monitor market trends. Fifteen attending physicians of the Seoul National University Bundang Hospital used each monitor configuration in their outpatient clinics. After completing the outpatient sessions, they selected the best monitor configuration for criteria described in five questionnaire items. We counted the number of votes and reviewed opinions of participants. RESULTS: The Wide Quad High Definition (WQHD) 27-inch single monitor configuration was most preferred for all questionnaire items. All participants answered that the WQHD 27-inch single monitor configuration was the best for desk space utilization. Eleven out of fifteen participants chose the WQHD 27-inch single monitor configuration as the most suitable monitor for outpatient practice. CONCLUSIONS: This study found that physicians preferred the WQHD 27-inch single monitor configuration in outpatient clinic settings. Healthcare organizations need to consider this finding when they purchase wide type monitors for EMR systems instead of the standard type monitor.

The Prevalence of Chronic Diseases among Migrants in Korea According to Their Length of Stay and Residential Status / 가정의학회지

BACKGROUND: Migrant health is becoming public health issues, as the migrant populations are increasing and their length of stay is prolonged. This study aims to analyze the differences in prevalence of chronic diseases among migrants according to length of stay and residential status. METHODS: An initial population pool were 3,024 who were assessed with health screening programs by Migrant Health Association. 2,459 migrants were selected for final analysis. Via Stata 10 we conducted univariate logistic regression analysis to examine the effects of their length of stay and residential status on the prevalence of hypertension, diabetes, dyslipidemia, and obesity. In the final analysis, the result of each sex was adjusted for age, nationality, length of stay, and residential status via multiple logistic regression analysis. RESULTS: Longer length of stay tends to increase the prevalence of hypertension in male; 4-6 year stay-duration group demonstrated statistically significant excess compared to 1 year or less stay-duration group (adjusted odds ratio [OR], 1.39; confidence interval [CI], 1.01 to 1.92). After adjustment, male migrants stayed more than 7 year showed considerably higher dyslipidemia than male migrants stayed less than 1 year (adjusted OR, 1.95; CI, 1.05 to 3.64). Compared to the group with 1 year or less stay-duration, the prevalence of obesity in male was significantly higher among 4-6 year (adjusted OR, 1.65; CI, 1.17 to 2.32) and 7 year or more stay-duration group (adjusted OR, 1.65; CI, 1.11 to 2.45). CONCLUSION: Longer length of stay correlated to higher prevalence of hypertension, dyslipidemia, and obesity among some population of migrants. So more researches and new developing policies are needed for this problem.