Discriminatory performance of insulin-like growth factor 1 and insulin-like growth factor binding protein-3 by correlating values to chronological age, bone age, and pubertal status for diagnosis of isolated growth hormone deficiency

Purpose@#The discriminatory performance of insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) was investigated by correlating their values with chronological age (CA), bone age (BA), and pubertal status (PS) for diagnosis of isolated growth hormone deficiency (IGHD). @*Methods@#We evaluated IGF-1 and IGFBP-3 levels in 310 short-stature subjects subdivided into 2 groups: IGHD (n=31) and non-IGHD (n=279). IGF-1 and IGFBP-3 were assayed using immune-radiometric assay and transformed into standard deviation score (SDS) according to CA, BA, and PS. @*Results@#The highest sensitivity was found in IGF-1-SDS for CA and IGFBP-3-SDS for CA (22.6% and 30.0%, respectively). The highest specificity was found in IGF-1-SDS for PS and IGFBP-3-SDS for PS (98.2% and 94.4%, respectively). Groups with the highest positive predictive values were IGF-1-SDS for BA and IGFBP-3-SDS for BA (10.9% and 5.1%, respectively). Highest negative predictive values were seen in IGF-1-SDS for CA and IGFBP-3-SDS for CA (98.4% and 98.4%, respectively). @*Conclusion@#IGF-1-SDS for CA, instead of IGF-1-SDS for BA or PS, could be used as a standard variable for IGHD screening. The sufficiently high specificity of IGF-1-SDS for PS suggests that this value is a useful tool for identification of IGHD.

Discriminatory performance of insulin-like growth factor 1 and insulin-like growth factor binding protein-3 by correlating values to chronological age, bone age, and pubertal status for diagnosis of isolated growth hormone deficiency

Purpose@#The discriminatory performance of insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) was investigated by correlating their values with chronological age (CA), bone age (BA), and pubertal status (PS) for diagnosis of isolated growth hormone deficiency (IGHD). @*Methods@#We evaluated IGF-1 and IGFBP-3 levels in 310 short-stature subjects subdivided into 2 groups: IGHD (n=31) and non-IGHD (n=279). IGF-1 and IGFBP-3 were assayed using immune-radiometric assay and transformed into standard deviation score (SDS) according to CA, BA, and PS. @*Results@#The highest sensitivity was found in IGF-1-SDS for CA and IGFBP-3-SDS for CA (22.6% and 30.0%, respectively). The highest specificity was found in IGF-1-SDS for PS and IGFBP-3-SDS for PS (98.2% and 94.4%, respectively). Groups with the highest positive predictive values were IGF-1-SDS for BA and IGFBP-3-SDS for BA (10.9% and 5.1%, respectively). Highest negative predictive values were seen in IGF-1-SDS for CA and IGFBP-3-SDS for CA (98.4% and 98.4%, respectively). @*Conclusion@#IGF-1-SDS for CA, instead of IGF-1-SDS for BA or PS, could be used as a standard variable for IGHD screening. The sufficiently high specificity of IGF-1-SDS for PS suggests that this value is a useful tool for identification of IGHD.

The effect of overweight on the luteinizing hormone level after gonadorelin stimulation test in girls with idiopathic central precocious puberty

PURPOSE: We investigated the effect of overweight on luteinizing hormone (LH) levels after a gonadorelin stimulation test in Korean girls with idiopathic central precocious puberty (CPP). METHODS: Medical records of 234 girls diagnosed with idiopathic CPP were reviewed retrospectively. CPP was diagnosed when the peak LH levels after gonadorelin stimulation was >5.0 U/L. The enrolled girls had a peak LH level >5.0 U/L after a gonadorelin stimulation test. Selected girls were classified as normoweight (body mass index [BMI] below the 85th percentile with respect to age) and overweight (BMI greater than the 85th percentile with respect to age). RESULTS: The peak LH (8.95±2.85 U/L vs. 11.97±8.42 U/L, P < 0.01) and peak follicle-stimulating hormone (9.60±2.91 U/L vs. 11.17±7.77 U/L, P=0.04) after gonadorelin stimulation were lower in overweight girls with idiopathic CPP than in normoweight girls with idiopathic CPP. Being overweight was negatively associated with peak LH levels after gonadorelin stimulation test (odds ratio, 0.89; 95 % confidence interval, 0.81–0.98, P=0.02). CONCLUSIONS: In girls with idiopathic CPP, being overweight led to a lower LH peak after gonadorelin stimulation. Further research is needed to better understand the role of overweight on gonadotropin secretion in precocious puberty.

Effectiveness of Intervntion for Cardiovascular Disease Prevention in Construction Workers / 한국직업건강간호학회지

PURPOSE: This study aimed to assess the risk of developing cardiovascular disease (CVD) and to evaluate the effects of intervention for CVD prevention in construction workers. METHODS: A total of 497 workers participated the health status survey and finally 90 workers were analyzed for evaluation of the intervention with the one-group pretest-posttest design. The data were collected from the questionnaires and health examinations in the healthcare service for road constructor's CVD prevention as secondary analysis. The intervention of the healthcare was composed of CVD prevention education for all workers and face to face counselling for the high risk group of CVD risk during 6 months in workplace. Data were analyzed with descriptive statistics, χ² test, Wilcoxon signed rank test, and paired t-test. RESULTS: The moderate and high risk groups of CVD were 9.7% and 0.8%. After the intervention, the physical activity (MET-min/week) significantly increased (Z=-5.46, p<.001). But, there were no significant differences in blood pressure, fasting glucose, body mass index, and CVD risk appraisals between pre and post intervention. CONCLUSION: The findings imply that it is necessary to develop the health promotion program for construction workers which fully reflects the characteristics of individuals and the organization.

Psychopathological Characteristics of Social Withdrawal (Hikikomori) in the Korean Adolescent / 신경정신의학

OBJECTIVES: The aim of this study was to investigate the social withdrawal tendency in Korean adolescents using the Hikikomori Behavior Checklist and to compare the psychopathological differences between the high risk group of social withdrawal (HRSW) and the low risk group of social withdrawal (LRSW). METHODS: Participants included 300 high school students from Daegu, Korea. Each participant completed several questionnaires including the demographic questionnaire, Korean-Version of the Hikikomori Behavior Checklist (K-HBCL), the Parental Screening Questionnaire for Hidden Youth (HYQ), Beck Depression Inventory (BDI), Anxiety Sensitivity Inventory (ASI), Social Avoidance and Distress scale (SAD), the Scale for Fear of Negative Evaluation (FNE), and Maudsley Obsessive-Compulsive Inventory (MOCI). The subjects were divided into two groups, the HRSW and LRSW, depending on the mean value of their total HBCL score, and their BDI, ASI, SAD, FNE, and MOCI scores were compared between HRSW and LRSW. RESULTS: The scales affecting the high-risk group were BDI, ASI, and SAD. The total score of K-HBCL showed positive correlation with the total score of BDI, ASI, SAD, FNE, and MOCI. CONCLUSION: The socially withdrawn adolescents had more problematic issues of their psychopathology. Several emotional factors would be useful in assessing the high-risk group of socially withdrawn adolescents.

Interpersonal Communication Competence and Social Anxiety in Nursing Students / 한국간호교육학회지

PURPOSE: This study aimed to identify a relationship between the communication competence and social anxiety in nursing students. METHODS: With a cross-sectional survey, a convenience sampling of 303 nursing students was taken from P-university in Y-city. The instrument for the study was a questionnaire that is consisted of the general characteristics, an Interaction Anxiousness Scale (IAS) and a Global Interpersonal Communication Competence Scale (GICC). Data was analyzed using descriptive statistics, t-test, one-way ANOVA, Kruskal-Wallis, Pearson's correlation coefficients and stepwise multiple regression with SPSS version 21.0. RESULTS: The mean score of the IAS was 41.89+/-8.74 and the GICC was 3.51+/-0.34. Communication competence significantly differed by the satisfaction of major (F=10.86, p<.001). In addition, the satisfaction of interpersonal relationships was significantly different in both communication competence (F=17.52, p<.001) and social anxiety (F=23.85, p<.001). Social anxiety had a negative correlation with communication competence (r=-.48, p<.001). Social anxiety accounted for 55.3% of the variance-social relaxation (beta=-.62), assertiveness (beta=-.18), interaction management (beta =.14) and efficiency (beta=-.13)- of communication competence's subcategories. CONCLUSION: It was found that communication competence has an influence on social anxiety. Therefore, education programs are needed to promote communication competence for a decline of social anxiety in nursing students.

The Use of Rapid Ventricular Pacing to Facilitate Stent Graft Deployment in the Distal Aortic Arch / 대한흉부외과학회지

Systemic hypotension has been traditionally used to facilitate deployment of thoracic stent grafts. Decreasing blood pressure with vasodilating agents further increases cardiac output and, consequently, the cardiac output-mediated windsock effect during deployment. Use of rapid ventricular pacing reduces the windsock effect during stent graft deployment and allows the graft to appose to the aortic wall under zero cardiac output, thus minimizing aortic wall shear stress. In this case we report the use of transvenous rapid ventricular pacing, a safe and reproducible technique to allow precise deployment of a Valiant Captivia stent graft in the distal thoracic arch for a saccular thoracic aneurysm.

Validation of Simple Screening test for Dementia in the Elderly: The Time and Change Test

BACKGROUND: Dementia has emerged as a leading public health problem with elderly persons and its early detection is important for treatment in curable cases. Although dementia screening tests are available, they are still complex and time consuming in practice and therefore difficult to use. Our goal was to validate the time and change(T&C) test, a simple, standardized method for detecting dementia in the elderly populations. METHODS: Participants were 59 patients aged 65 years or older at an urban hospital from November 1 to December 31, 2001. The time test evaluated the understanding of clock hands indicating 11:10, and the change test the ability making 1,000 Won from a group of coins consisting one 500 Won, seven 100 Won, seven 50 Won. T&C ratings were validated against a reference standard based on physician`s diagnosis. Test-retest reliability and inter-observer reliability were assessed. RESULTS: The T&C test had a sensitivity of 73.0%, specificity of 90.9%, positive predictive value of 93.1%, and negative predictive value of 66.7%. Test-retest and inter-observer agreement rates were 95% and 95%, respectively. The T&C test was not influenced by education. The time and change tests took a mean of 7.5 seconds and 19.6 seconds to complete respectively, and was acceptable to participants. When timed cut points were added, the T&C test had a sensitivity of 86.5%, specificity of 40.9% and test-retest and inter-observer agreement rates were 77.3% and 81.8%, respectively. CONCLUSION: The T&C test is a simple, accurate reliable, performance-based tool for detection of dementia in the elderly.

The Effects of Combined Spinal Epidural Anesthesia for Hip Surgery in the Elderly / 대한마취과학회지

BACKGROUND: With recently increase in geriatric population, hip surgery of the aged is increasing likewise as one of the major surgical procedures for orthopedic surgeons. It is the purpose of this paper to study the effects of combined spinal epidural anesthesia on blood pressure, heart rate, pulse oxygen saturation, level of blockade, postoperative pain control and complication in geriatric hip surgery. METHODS: Combined spinal epidural anesthesia was performed with a 27G Whitacre spinal needle through a 18G Weiss epidural needle in 30 patients undergoing elective hip surgery of geriatric patients. 0.5% heavy bupivacaine 2 ml (10 mg) was injected intrathecally. Prolonged anesthesia over 2 hours of operation was accomplished by adding 0.5% bupivacaine through epidural catheter. Onset of sensory anesthesia and motor blockade were measured at frequent intervals. Blood pressure, heart rate and pulse oxygen saturation were checked in preoperative state, 1, 2, 3, 4, 5, 7, 9, 11, 13, 15 minute after injection, and then every 3 minute until the operation was finished. 0.125% bupivacaine 110 ml with morphine 3 mg was provided by Baxter infusor (Baxter Healthcare CO. Deerfield, USA) for postoperative pain control. RESULTS: All 30 patients had adequate anesthesia. Sensory block level was at least above T10 dermatome and motor blockade of lower extremity was Bromage 3 in all patients. Systolic blood pressure and diastolic blood pressure were significantly different (P<0.05) after 3 minutes compared to preoperative state, but any patient had no specific problem. Postoperative pain control was excellent with no significant complication. CONCLUSIONS: Combined spinal epidural anesthesia provided reliable anesthesia for hip surgery of geriatric patients without significant complication.

Analgesic Effects according to the Dose of Continuous Epidural Infusion of Morphine and Clonidine after Epidural Anesthesia for Cesarean Section / 대한마취과학회지

BACKGROUND: Epidurally administered clonidine represents an approach to control the pain after cesarean section that produces analgesia by an alpha 2-adrenergic mechanism and may provide postoperative analgesia without nausea, pruritus, and respiratory depression associated with systemic or intraspinal opioid administration. This study was undertaken to evaluate the analgesic effect according to the dose of appropriate bolus and the combination of epidural morphine and clonidine after cesarean section. METHOD: Forty five women, ASA physical status 1 or 2, scheduled for elective cesarean section were randomly assigned to receive epidural administration for postoperative pain control. Group A (n=15) received 1 mg morphine and 75 g clonidine bolus followed by 4 mg morphine and 150 g clonidine. Group B received 2 mg morphine and 75 g clonidine bolus followed by 4 mg morphine and 300 g clonidine. Group C received 3 mg morphine and 75 g clonidine bolus followed by 4 mg morphine and 450 g clonidine. Each combination of drug was injected at Bromage scale 1 after surgery. RESULTS: All groups showed relatively stable hemodynamic status. Analgesic effect was significantly better in Group B and C than Group A (p<0.05). Sedative effect was not a problem in all groups. The incidence of side effects in Group C was more than Group B, which than Group A, but almost cases did not require treatment. CONCLUSION: 2 mg morphine and 75 g clonidine bolus followed by 4 mg morphine and 300 g clonidine with excellent analgesic effect and less side effects is considered as adequate dose in postoperative pain control after cesarean section with epidural anesthesia.

A Study on the Prevalence of Dementia and its Related Factors in the Rural Elderly

For the purpose of investigation of prevalence, etiology and its related factors of the dementia in the rural elderly, the author examined 650 elderly people aged 60 years or more via cluster sampling by using a door to door 2 phase design from June 1992 to July 1992. The cognitive impairment was assessed by MMSEK in the first screening phase, and in the second phase 252 people in the dementia suspected group (MMSEK score 24) were taken to the clinical examination for the diagnosing dementia. The results were as follows; 1. The prevalence rate of dementia was 21.3% in the rural elderly, and was higher in females (31.1%) than in males (10.7%) (p<0.01). 2. The prevalence rates of dementia in males aged 60-69, 70-79 and over 80 were 4.1%, 16.7% and 50.0% respectively and those in female were 8.7%, 49.3%, 72.2% respectively. The rates increased significantly with increasing age in both sexes (p<0.01). 3. The prevalence rates of the mild, moderate and severe dementia were 8.4%, 9.3% and 3.6% respectively and increased significantly with increasing age in females (p<0.001). 4. The proportional distribution of dementia type by etiological classification was 63.6% senile dementia of Alzheimer's type, 17.7% vascular dementia, 10.4% mixed dementia, 4.2% alcoholic dementia, 1.0% posttraumatic dementia and 3.1% for others. 5. In multiple logistic regression analysis for affecting factors of the dementia, the significant variables were level of physical activity, age, education and sex. The Odds ratios in factors were low level of physical activity 6.0 x (95% CI 2.4-15.1), age over 70 4.8 x (95% CI 2.2-10.7), no formal education 3.9 x (95% CI 1.1-13.8), and female sex 2.2 x (95% CI 1.0-5.0).