Fluvoxamine Treatment of Patients with Symptomatic COVID-19 in a Community Treatment Center:A Preliminary Result of Randomized Controlled Trial

Background@#This study aimed to evaluate whether fluvoxamine reduces clinical deterioration in adult patients with mild to moderate coronavirus disease 2019 (COVID-19), and to identify risk factors for clinical deterioration in patients admitted to a community treatment center (CTC). @*Materials and Methods@#A randomized, placebo-controlled trial was conducted in a CTC, in Seoul, Korea from January 15, 2021, to February 19, 2021. Symptomatic adult patients with positive results of severe acute respiratory syndrome coronavirus 2 real timepolymerase chain reaction within 3 days of randomization were assigned at random to receive 100 mg of fluvoxamine or placebo twice daily for 10 days. The primary outcome was clinical deterioration defined by any of the following criteria: oxygen requirement to keep oxygen saturation over 94.0%, aggravation of pneumonia with dyspnea, or World Health Organization clinical progression scale 4 or greater. @*Results@#Of 52 randomized participants [median (interquartile range) age, 53.5 (43.3 - 60.0) years; 31 (60.0%) men], 44 (85.0%) completed the trial. Clinical deterioration occurred in 2 of 26 patients in each group (P >0.99). There were no serious adverse events in either group. Clinical deterioration occurred in 15 (6.0%) of 271 patients admitted to the CTC, and all of them were transferred to a hospital. In multivariate analysis, age between 55 and 64, fever and pneumonia at admission were independent risk factors for clinical deterioration. @*Conclusion@#In this study of adult patients with symptomatic COVID-19 who were admitted to the CTC, there was no significant differences in clinical deterioration between patients treated with fluvoxamine and placebo (ClinicalTrials.gov Identifier: NCT04711863).

Association between Timed Up and Go Test and Subsequent Functional Dependency

Association between Timed Up and Go Test and Subsequent Functional Dependency

BACKGROUND@#This study aimed to evaluate the association between baseline results of the Timed Up and Go (TUG) test and subsequent functional dependency occurrence.@*METHODS@#From the National Health Insurance Service-Senior Cohort database, we identified 39,519 people who participated in the National Screening Program for Transitional Ages at the age of 66 during 2007–2008. Impaired mobility was defined as taking 10 seconds or longer to perform the TUG test. Functional dependency occurrence was defined as the initiation of receiving national Long-Term Care Insurance services—home care or admission to long-term care facilities. Cox proportional hazard regression models were used to assess the hazard ratios (HRs) for dependency occurrence according to baseline TUG test results.@*RESULTS@#The mean follow-up period was 5.7 years. Occurrence rates of dependency were 2.0 and 3.4 cases per 1,000 person-years in the normal and impaired TUG groups, respectively. Impaired mobility was associated with a higher risk of functional dependency occurrence (adjusted HR [aHR], 1.65; 95% confidence interval [CI], 1.40–1.95; P < 0.001). Additionally, in the subgroup analysis for the participants with intact baseline activities of daily living, impaired mobility was associated with a higher risk of dependency occurrence (aHR, 1.65; 95% CI, 1.33–2.04; P < 0.001).@*CONCLUSION@#The TUG test might be a useful predictive marker of subsequent functional dependency occurrence. Intervention to prevent functional dependency may be helpful for older adults with impairment on the TUG test.

Association between Timed Up and Go Test and Subsequent Functional Dependency

BACKGROUND@#This study aimed to evaluate the association between baseline results of the Timed Up and Go (TUG) test and subsequent functional dependency occurrence.@*METHODS@#From the National Health Insurance Service-Senior Cohort database, we identified 39,519 people who participated in the National Screening Program for Transitional Ages at the age of 66 during 2007–2008. Impaired mobility was defined as taking 10 seconds or longer to perform the TUG test. Functional dependency occurrence was defined as the initiation of receiving national Long-Term Care Insurance services—home care or admission to long-term care facilities. Cox proportional hazard regression models were used to assess the hazard ratios (HRs) for dependency occurrence according to baseline TUG test results.@*RESULTS@#The mean follow-up period was 5.7 years. Occurrence rates of dependency were 2.0 and 3.4 cases per 1,000 person-years in the normal and impaired TUG groups, respectively. Impaired mobility was associated with a higher risk of functional dependency occurrence (adjusted HR [aHR], 1.65; 95% confidence interval [CI], 1.40–1.95; P < 0.001). Additionally, in the subgroup analysis for the participants with intact baseline activities of daily living, impaired mobility was associated with a higher risk of dependency occurrence (aHR, 1.65; 95% CI, 1.33–2.04; P < 0.001).@*CONCLUSION@#The TUG test might be a useful predictive marker of subsequent functional dependency occurrence. Intervention to prevent functional dependency may be helpful for older adults with impairment on the TUG test.

Clinical Outcomes and Refractive Error Characteristics in Patients with Congenital Blepharoptosis after Ptosis Repair Surgery

PURPOSE@#We investigated changes in postoperative refractive error after surgery to treat congenital ptosis and the clinical outcomes by surgical method.@*METHODS@#The study was retrospective and interventional. We enrolled 73 patients in whom 86 eyes exhibited visual axis-obscuring congenital ptosis. All patients were under 8 years of age, with refractive errors or amblyopia, and underwent maximal levator resection or frontalis sling surgery with fascia lata preservation from January 2008 to January 2018; the minimum follow-up time was 6 months. Visual and surgical outcomes were assessed by reviewing clinical photographs taken before and 1 year after surgery. Refractive error changes were measured at these times.@*RESULTS@#Maximal levator resection was performed on 42 of 86 eyes (48.8%) and frontalis sling surgery with preservation of the fascia lata on 44 eyes, 95.2% and 75.0% of patients, respectively, exhibited good or fair surgical outcomes. The preoperative mean astigmatisms of the ptotic and control eyes of those with unilateral disease did not differ significantly: −0.71 ± 0.85 D for ptotic eyes and −0.66 ± 0.97 D for control eyes. The mean astigmatism increased from −0.71 ± 0.85 D preoperatively to −1.27 ± 1.2 D postoperatively (p < 0.001). The postoperative MRD1 value correlated with the increase in postoperative astigmatism (p = 0.022, r = −0.261).@*CONCLUSIONS@#Maximal levator resection tended to afford better surgical outcomes than frontalis sling surgery with preservation of the fascia lata in patients with congenital ptosis. Patients in whom the postoperative eyelid position was good tended to exhibit higher refractive errors. Careful examination and treatment are recommended to ensure good visual outcomes.

Ocular Manifestations, Treatment Outcome and Clinical Course of Infective Keratitis of Keratitis-Ichthyosis-Deafness Syndrome

PURPOSE@#To report the ocular manifestations and treatment outcomes of infective keratitis in a patient with keratitis-ichthyosis-deafness (KID) syndrome and to report a newly discovered mutation in the GJB2 gene in Korea.CASE SUMMARY: A 32-month-old boy was referred to the Ophthalmology Clinic for bilateral corneal opacity and glare. The patient showed alopecia, hyperkeratotic skin in both limbs, and hearing loss in both ears. Ocular examination showed loss of eyebrows and eyelashes, hyperkeratotic lesions of the eyelids, mucopurulent discharge in the eyelids, and opacity and scarring with superficial vascularization and conjunctivalization in both corneas. Molecular analysis showed a pathogenic variant in the GJB2 gene and confirmed the diagnosis of KID syndrome. Superficial keratectomy and amniotic membrane transplantation were performed in both eyes. Corneal opacity recurred in the left eye; treatment with bevacizumab eyedrops was instituted and penetrating keratoplasty was performed in the left eye. Corneal stromal opacity relapsed in the left eye; 5% vancomycin and 5% ceftazidime eyedrops were started and methicillin-resistant Staphylococcus aureus was cultured from a corneal scraping specimen.@*CONCLUSIONS@#A careful observation of ocular manifestations in KID syndrome is needed to prevent infective keratitis and limbal cell deficiency; intensive antibiotic eyedrop treatment is recommended to prevent permanent visual impairment.

Uterine Leiomyoma Is Associated with Female Sexual Dysfunction in Postmenopausal Women

PURPOSE: To determine the relationship between uterine leiomyoma and female sexual dysfunction (FSD) among premenopausal and postmenopausal women. MATERIALS AND METHODS: The study population consisted of consecutive women who underwent gynecologic screening tests, including transvaginal ultrasound, and completed the questionnaires on FSD. A total of 841 women were included from January 2010 to December 2011. FSD was defined as Female Sexual Function Index (FSFI) ≤26.55. The relationship between uterine leiomyoma and FSD were compared according to menopausal status. RESULTS: In premenopausal group (n=564), there were no differences in the frequency of FSD (55.0% vs. 58.8%, p=0.387) and total FSFI score. However, in postmenopausal group (n=277), women with uterine leiomyoma had a lower frequency of FSD than those without uterine leiomyoma (71.3% vs. 86.4%, p=0.003). This relationship between uterine leiomyoma and lower frequency of FSD in postmenopausal women remained significant after adjusting for confounding variables. CONCLUSION: The relationship between uterine leiomyoma and FSD is different depending on the menopausal status.

Associations between atherosclerosis and periodontitis, physical health and dental care: a pilot study / 대한구강보건학회지

OBJECTIVES: This pilot study aimed to obtain preliminary data on the associations between atherosclerosisand periodontitis, physical health status, and general and oral health behaviors. METHODS: Thirty-three subjects were recruited from among those who underwent carotid computed tomography (CT) angiography and general health check-up at the Seoul National University Hospital Health Examination Center (SNUHHEC). Two trained dentists conducted a periodontal examination to evaluate probing pocket depth and clinical attachment loss. A self-administered questionnaire was completed by study subjects, following informed consent. Data on physical health status were collected through review of medical records from the SNUHHEC. Information on general health behavior was obtainedfrom the self-reported questionnaire. Descriptive and comparative analyses were performed using IBM SPSS Statistics 21.0®. Statistical significance was set at P<0.05. RESULTS: A marginal, but non-significant association was noted between atherosclerosis and periodontitis(P=0.373). Flossing habit showed a significant association with periodontitis (P=0.007) and obesity (P=0.033). A possible association was noted between daily exercise and flossing (P=0.073). The habitual use of interdental brush also showed borderline association with smoking (P=0.098) and a stronger associationwith previous periodontal treatment (P=0.067); however, these associations were not statisticallysignificant. CONCLUSIONS: Our pilot study did not show an association between arteriosclerosis and periodontal disease.However, positive oral health care behavior, especially flossing, seems to alleviate arteriosclerosis. In other words, in this pilot survey, we confirmed the possibility that healthy oral care behavior can help to alleviate arteriosclerosis. Future large-scale studies are needed to confirm whether positive oral health care behaviors improve overall health.

Knowledge, Current Status, and Barriers toward Healthcare Worker Vaccination among Family Medicine Resident Participants in a Web-Based Survey in Korea / 가정의학회지

BACKGROUND: We investigated the knowledge, status, and barriers toward healthcare workers receiving vaccinations among Korean family medicine residents. To date, a systematic study has not been conducted among medical practitioners examining these variables. METHODS: A web-based, anonymous, self-administered questionnaire was distributed to all 942 family medicine residents working in 123 training hospitals in Korea. A multiple logistic regression analysis was performed to investigate factors affecting vaccination completion. RESULTS: Korean family medicine residents (N=242, 25.7%) from 54 training hospitals (43.9%) participated in the survey. Only 24 respondents (9.9%) had correct knowledge on all the recommended vaccinations by the Korean Society of Infectious Diseases. The complete vaccination rates against hepatitis B virus and influenza were relatively high (69.4% and 83.0%, respectively), whereas they were relatively low against other infections (e.g., 16.5%– 53.1%). The most common reason for not receiving a vaccination was the belief that there was little possibility of infection from the vaccine-preventable diseases. CONCLUSION: Knowledge and vaccination coverage were poor among family medicine residents in Korea. Medical schools should provide vaccination information to healthcare workers as part of their mandatory curriculum. Further research should confirm these findings among primary care physicians and other healthcare workers.

One-Year Experience Managing a Cancer Survivorship Clinic Using a Shared-Care Model for Gastric Cancer Survivors in Korea

Given the rapid growth of the population of cancer survivors, increased attention has been paid to their health problems. Although gastric cancer is one of the most common cancers, empirical evidence of survivorship care is limited. The objectives of this study were to describe the health care status of gastric cancer survivors and to report the experience of using the shared-care model during a one-year experience at the cancer survivorship clinic in Seoul National University Hospital. This is a descriptive, single-center study of 250 long-term gastric cancer survivors who were referred to the survivorship clinic. The status of their health behaviors, comorbid conditions, secondary cancer screenings, and survivorship care status were investigated through questionnaires and examining the medical records. Among the survivors, 7.2% were current smokers, 8.8% were at-risk drinkers, and 32.4% were physically inactive. Among the patients who did not know their bone density status, the majority were in the osteopenic (37.1%) or osteoporotic range (24.1%). Screening among the eligible population within the recommended time intervals were 76.3% for colorectal cancer, but only 13.6% for lung cancer. All of the survivors were provided with counseling and medical management at the survivorship clinic, as appropriate. In conclusion, Long-term gastric cancer survivors have various unmet needs. Shared-care through survivorship clinics can be an effective solution for providing comprehensive care to cancer survivors.

Treatment Gap in the National Health-screening Program in Korea: Claim-based Follow-up of Statin Use for Sustained Hypercholesterolemia

Participation in a screening program by itself may not improve clinical outcomes. Treatment gaps in the program may limit its full benefit. We evaluated statin prescription rates for subjects with sustained hypercholesterolemia to assess the treatment gaps in the National Health Screening Program (NHSP) in Korea. A retrospective, random cohort was established among National Health Insurance Corporation (NHIC) members. Finally, we examined 465,499 individuals who attended the NHSP from 2003 to 2010 without any history of dyslipidemia, statin prescription, or hospitalization for cardiovascular events until the end of 2002. The subsequent statin prescription rates were identified from the NHIC medical service claim database from 2003 to 2011. Descriptive data and odds ratio from multivariate logistic analyses on statin prescription rates and the corresponding correlations were evaluated. The NHSP detected 114,085 (24.5%) cases of newly diagnosed hypercholesterolemia. However, only 8.6% of these received statin prescription within 6 months of diagnosis. For cases of sustained hypercholesterolemia determined in the next screening visit by the NHSP, the statin prescription rate increased, but only to 12.2%. Statin prescriptions were more common among females, older individuals, and hypertension or diabetes patients. Furthermore, the statin prescription rates had increased over the study period. The NHSP exhibited low statin prescription rate which has been improving. For the NHSP to be effective, it would be worthwhile to decrease the gap between the diagnosis of hypercholesterolemia and the following treatment.

Hospitalization as a Teachable Moment for Cigarette Smoking Cessation / 가정의학회지

No abstract available.

Associations between Metabolic Syndrome and Inadequate Sleep Duration and Skipping Breakfast / 가정의학회지

BACKGROUND: The prevalence of metabolic syndrome is increasing worldwide, and previous studies have shown that inadequate sleep duration and skipping breakfast may be related to metabolic syndrome. Therefore, we investigated the effects of inadequate sleep and skipping breakfast on metabolic syndrome using data from the Korea National Health and Nutrition Examination Survey (KNHANES) IV & V reports (2007-2009 and 2010-2012, respectively). METHODS: The sample included 12,999 subjects who participated in the KNHANES IV & V. Sleep duration and breakfast eating were self-reported, and metabolic syndrome was defined according to the modified National Cholesterol Education Program Adult Treatment Panel III guidelines. Subjects were divided into 12 groups according to breakfast eating and sleep duration patterns, and multiple logistic regression analyses adjusted for age, sex, household income, education level, smoking status, alcohol drinking, physical activity, and total daily energy intake were conducted. RESULTS: In subjects under 50 years of age, sleeping less than 6 hours was significantly associated with increased metabolic syndrome except among those who ate breakfast on only 1 of the past 2 days. In subjects over 50 years of age, sleeping less than 6 hours was significantly associated with a decreased risk of metabolic syndrome among those who ate breakfast on both days. CONCLUSION: In conclusion, significant associations between metabolic syndrome and sleep duration were identified, and these associations differed according to age group.

Validity and Reliability of the Korean Version of Neighborhood Physical Activity Questionnaire / 가정의학회지

BACKGROUND: Given that a substantial number of daily activities take place in neighborhoods, a convenient and effective method for measuring the physical activity of individuals is needed. Therefore, we tested the validity and reliability of the Korean version of the Neighborhood Physical Activity Questionnaire (K-NPAQ), which was developed through translation and back-translation of the NPAQ. METHODS: The K-NPAQ was administered twice, with a 1-week interval, to participants in the study who were recruited at a health promotion center. We assessed energy expenditure and compliance using an accelerometer and an activity diary. The Kappa statistic and Spearman correlation coefficient were used to evaluate the test-retest reliability of the K-NPAQ, and the Spearman rank correlation was used to assess the validity. RESULTS: Of the 122 participants, 43 were excluded owing to a lack of compliance. The Kappa values for all items that were used to assess walking or cycling within or outside the neighborhood were >0.424; 0.251-0.902 for 5 items related to the purpose of the physical activity; 0.232-0.912 for most items related to the number of times and the duration for each types of physical activity. The total energy expenditure and the energy expenditure in the neighborhood were significantly correlated with the K-NPAQ and the accelerometer, with correlation coefficients of 0.192-0.264. CONCLUSION: The K-NPAQ is a valid and reliable tool for measuring physical activity in the neighborhood, and it can be used for individual education and counseling in order to augment physical activity in specific neighborhood environments.

Association between Muscle Loss and Urinary Incontinence in Elderly Korean Women / 가정의학회지

BACKGROUND: Incontinence and muscle loss are important senior health issues. Nevertheless, there are no available domestic or international studies on the association between urinary incontinence and muscle loss. The aim of this study was to investigate the association between muscle loss and urinary incontinence in elderly Korean woman. METHODS: Korean women (1,313) > or =65 years of age whose complete body composition data were collected using dual X-ray absorptiometry were analyzed from the Fourth Korean National Health and Nutritional Examination Surveys. Class I and II losses of the appendicular, truncal, and total muscle mass were defined using adjustments for weight and height. Each participant's incontinence status was collected using constructed questionnaires. Multiple logistic regression was performed to examine the association between muscle loss and incontinence. RESULTS: On the basis of physician-diagnosed incontinence, weight- and height-adjusted muscle loss showed no association with urinary incontinence (weight-adjusted muscle loss: class I adjusted odds ratio [aOR], 0.77; 95% confidence interval [CI], 0.34 to 1.73; class II aOR, 1.37; 95% CI, 0.59 to 3.18; height-adjusted muscle loss: class I aOR, 0.51; 95% CI, 0.18 to 1.51; class II aOR, 1.86; 95% CI, 0.22 to 15.79). Similar results were observed for truncal muscle and total muscle mass as well as self-reported urinary incontinence. CONCLUSION: Our study found no association between urinary incontinence and appendicular, truncal, and total muscle loss in elderly Korean women.

Development and Validity and Reliability of Korean Comprehensive Assessment Tools for Geriatric Ambulatory Care

BACKGROUND: The purpose of this study was to develop and to evaluate the applicability of the Korean comprehensive geriatric assessment tools through reliability and validity testing. METHODS: We developed standard and short-form assessment tools comprised of questionnaires on medical, functional, mental, socioeconomic status and lifestyle information and functional tests. The tools were administered as test-retest on 111 elderly outpatients at four university hospitals and two welfare centers in Seoul. Weighted kappa value, kappa value, Pearson's correlation coefficients and overall percent agreement were calculated to evaluate reliability. Validity coefficient was estimated by using the reliability coefficient. RESULTS: Reliability and validity coefficients were higher than 0.50 (fair or good) for 29 of 36 items. For test-retest reliability, the median was 0.66 (range, 0.29 to 1.00) for the kappa value and 0.83 (range, 0.53 to 1.00) for the Pearson's correlation coefficients. Compared to the standard form, the short-form assessment questionnaires showed to be reliable and valid. CONCLUSION: The Korean Comprehensive Assessment Tools, both the standard form and the short form, were shown to be a reliable and valid screening medium for assessing the health status of the elderly in the ambulatory care setting. These instruments can be used conveniently for comprehensive outpatient geriatric assessment.

Erratum: Correction of Misspelling of Title and Author Affiliation

We found two errors, title and author affiliation in our published article.

The Korean Physical Activity Questionnaire for Elderly (PAQE): Development and Evaluation of Validity and Reliability

BACKGROUND: As individuals age, there is an obvious decline in their physical activity level. Thus, this is an area where an easy to use assessment instrument is needed. But presently, there is no tool that meets this need. In addition, there is no such instrument tailored for the Korean elderly. This study aimed to fill this void by developing a physical activity assessment instrument for this particular population that is easy to use. METHODS: Item collection was performed through a literature review and a survey of 100 elderly individuals residing in a community setting. Items were selected through expert consensus; and the Physical Activity Questionnaire for elderly (PAQE) was created. For validation, 120 community dwelling elderly persons were enrolled. PAQE and an accelerometer were administered to each participant, and the questionnaire was re-administered 2 weeks later. The Spearman rho between the questionnaire and the accelerometer was calculated for concurrent validity. The Cronbach's alpha was calculated for internal consistency. Test-retest reliability was assessed by calculating the Spearman rho. RESULTS: Of the 119 participants, 80.34% were female with the average age being 72.74+/-7.29 years. Energy expenditure measured by the accelerometer was 220.36+/-96.96 kcal/day compared to 368.33+/-257.29 kcal/day measured through the developed questionnaire. Although the Spearman rho between the energy expenditure measured by the accelerometer and calculated through the recreational activity report in the questionnaire was 0.235 (p=0.011), the total energy expenditure was 0.105 (p=0.259) and the energy expenditure by household activity was 0.002 (p=0.983). The Cronbach's alpha was 0.781. The Spearman rho was 0.720 (p<0.001) for test-retest reliability. CONCLUSION: Our findings show that PAQE is a reliable questionnaire, a valid instrument for estimating energy expenditure during recreational physical activity in the Korean elderly person. However, energy expenditure of household activity did not correlate well with the accelerometer. In conclusion, the PAQE questionnaire can be used to assess kinds and frequency of household activities.

Association of Health Risk Behaviors with Mental Health among Elderly Koreans

BACKGROUND: Korea is currently experiencing a rapid aging of its population. With regards to healthy aging, a mental health status is an important factor in the elderly. The purpose of our study was to investigate the prevalence of mental health problems (depression symptoms, anxiety symptoms, poor quality of life) and to examine the relationships between health behaviors and mental health status. METHODS: The data were collected from the Korean Longitudinal Study on Aging, which was designed to compile information on several aspects of aging for use, as a basic statistical data in interdisciplinary research. A total of 5,548 elderly aged 60 years or older were included in this descriptive cross-sectional study. The results were examined with multiple logistic regression analysis. RESULTS: The prevalence of depression, anxiety experience, and poor quality of life was 40.8%, 29.9%, and 54.6%, respectively. Current smoking was significantly associated with the risk of anxiety symptoms and poor quality of life (adjusted prevalence odds ratio [POR], 1.24; 95% confidence interval [CI], 1.02 to 1.52 and adjusted POR, 1.34; 95% CI, 1.12 to 1.60, respectively). Also, not exercising regularly was significantly associated with all of the mental health problems (depression and anxiety symptoms, and poor quality of life), which were measured in this study (adjusted POR, 1.31; 95% CI, 1.14 to 1.51 and adjusted POR, 1.39; 95% CI, 1.19 to 1.62 and adjusted POR, 1.45; 95% CI, 1.27 to 1.65, respectively). CONCLUSION: Elderly Koreans with health risk behaviors are likely to be vulnerable to mental health concerns. This finding underscores the continued needs to design and implement mental health policies at the community or the country level, especially in elderly Koreans with health risk behaviors.

Effect of Aditional Brief Counselling after Periodic Health Examination on Motivation for Health Behavior Change

This study was to evaluate the effect of additional brief counseling by a primary care physician on lifestyle modification of examinees after a periodic health examination. 1,000 participants of the 2007 Korean national health screening program were asked to note any variation in their health behavior after participating in the screening program. The degree of comprehensive motivation for lifestyle modification was assessed in terms of stages of health behavior change. We calculated odds ratio of positive change (enhanced stage of change) with multiple logistic regression analysis and age-adjusted proportion of positive changers. Of 989 respondents, 486 and 503 received the basic and additional programs, respectively. Additional group were more likely to be positive changer than basic group (adjusted OR 1.78; 95% CI 1.19-2.65), and this was more prominent in older age group (adjusted OR 2.38, 95% CI 1.23-4.58). The age-adjusted proportions of positive changers were 22.7% (95% CI, 17.9-28.3) and 36.2% (95% CI, 30.4-42.4) in the basic and additional groups, respectively (P < 0.001). The additional consultation led to improvements in the stage of health behavior change after the health examination. Thus, such a consultation should be considered when designing a health-screening program.