Augmentation of Aripiprazole versus Bupropion on Specific Symptoms of Depression in Older Adult Patients : A Post-Hoc, Multi-Center, Open-Label, Randomized Study / 생물치료정신의학

OBJECTIVES: The purpose of this study was to compare aripiprazole versus bupropion augmentation therapy in older adult patients with major depressive disorder unresponsive to selective serotonin reuptake inhibitors(SSRIs).METHODS: This is a post-hoc analysis of a 6-week, randomized prospective open-label multi-center study in thirty older adult patients with major depressive disorder. Participants were randomized to receive aripiprazole(N=16, 2.5–10mg/day) or bupropion(N=14, 150–300mg/day) for 6 weeks. Montgomery Asberg Depression Rating Scale (MADRS), 17-item Hamilton Depression Rating scale(HAM-D17), Iowa Fatigue Scale, Drug-Induced Extrapyramidal Symptoms Scale, Psychotropic-Related Sexual Dysfunction Questionnaire scores, and Clinical Global Impression-Severity (CGI-S) were obtained at baseline and after one, two, four, and six weeks. Changes on individual items of HAM-D17 were assessed as well as on composite scales(anxiety, insomnia and drive), and on four core subscales that capture core depression symptoms.RESULTS: There was a significantly greater decrease in MADRS scores in aripiprazole group compared to bupropion group at 4(p<0.05) and 6(p<0.05) weeks. There were significantly higher response rate at week 4(p<0.05) and 6(p<0.05) and remission rate at week 6 in aripiprazole group compared to bupropion group. Individual HAM-D17 items showing significantly greater change with adjunctive aripiprazole than bupropion: insomnia, late(ES=0.81 vs. −0.24, p=0.043), psychomotor retardation(ES=1.30 vs. 0.66, p=0.024), general somatic symptoms(ES=1.24 vs. 0.00, p=0.01). On three composite scales, adjunctive aripiprazole was significantly more effective than bupropion with respect to mean change for drive(p=0.005).CONCLUSION: Results of this study suggested that aripiprazole augmentation have superior efficacy in treating general and core symptoms of depression in older adult patients. Aripiprazole augmentation is associated with greater improvement in specific symptoms of depression such as psychomotor retardation, general somatic symptoms and drive.

The Changes for Strength of Oropharyngeal Muscles in Patients with Dementia and Dysphagia

Although dysphagia is an important health problem and one of the determinants of quality of life in patients with dementia, the neurophysiologic changes of dysphagia in dementia have not been fully uncovered, yet. we investigated the changes of strength of tongue lip and pharyngeal muscles in patients with dementia. This study included 30 subjects with dementia. In all subjects, clinical assessments consisted of the Iowa Oral Performance Instrument (IOPI) for tongue and lip, surface electromyography (sEMG) with Vital stim plus on suprahyoid muscles, the Mini-Mental State Examination, and Clinical Dementia Rating (CDR) scales. All subjects were classified into 3 groups according to severity; CDR 1, 2, and 3. There was no difference between IOPI and sEMG among all 3 groups. The values of tongue and lip IOPI from all 3 dementia groups were significantly lower than values of control. The comparisons for values of tongue and lip IOPI among 3 dementia group were not different from each other. The sEMG of suprahyoid muscles were not different between all 3 dementia groups and control. These findings are supportive of dysphagia therapy for oral phase would be beneficial for the restoration of swallowing function in patients with dementia and dysphagia.

Comparison of Effects of the Volume, Texture and Taste of Food on Tongue Pressure / 대한연하장애학회지

OBJECTIVE: This study examined how changes in the volume, texture, and taste of food affect the variation of tongue pressure during the swallowing of food in healthy adults. METHODS: Fifty-four healthy subjects participated in this study. The tongue pressure was measured using an Iowa Oral. Performance Instrument (IOPI) during swallowing of food in 54 healthy adults. The food bolus with modified volumes (3, 5, 10, and 15 ml), textures (water, puree, and cracker), and tastes (pure water, sour taste, sweet taste, and salty taste) were provided and the variation of the tongue pressure was traced during the swallowing of food. RESULTS: The tongue pressure changed significantly when the volume of food chunks increased. When the texture of food was modified, the tongue pressure was significantly different when swallowing a cracker than when swallowing water and puree. In addition, the tongue pressure was increased more by a sour taste liquid than pure water or sweet taste liquid. CONCLUSION: When swallowing food, the tongue pressure at the appropriate level is essential for safe swallowing. Because modification of the volume, texture, and taste of food can induce the variation of tongue pressure, it can be recommended as an effective therapeutic method that can move food in the mouth.

Comparison of the Bupropion versus Aripiprazole Adjunctive Therapy for the Treatment of Female Depression : Post-Hoc Analyses from a Randomized Prospective Open-Label Multi-Center Study / 우울ㆍ조울병

OBJECTIVES: The purpose of this study was to examine effects of adjunctive aripiprazole versus bupropion, on depressive symptoms of female depression.METHODS: Sixty six female patients with major depressive disorders were enrolled from a six-week, randomized prospective open-label multi-center study. Participants were randomized to receive aripiprazole (2.5–10 mg/day) or bupropion (150–300 mg/day). Montgomery Asberg Depression Rating Scale, 17-item Hamilton Depression Rating scale (HAM-D17), Iowa Fatigue Scale, Drug-Induced Extrapyramidal Symptoms Scale, Psychotropic-Related Sexual Dysfunction Questionnaire scores, and Clinical Global Impression-Severity (CGI-S) were obtained at baseline and after one, two, four, and six weeks. Changes on individual items of HAM-D17 were assessed as well as on composite scales (anxiety, insomnia and drive), and on four core subscales that capture core depression symptoms.RESULTS: Overall, both treatments improved depressive symptoms, without causing serious adverse events. There were significant differences in the HAM-D17 total score (p=0.046) and CGI-S (p=0.004), between aripiprazole and bupropion augmentation, favoring aripiprazole over bupropion. Aripiprazole revealed significantly greater effect size in depressed mood (p=0.006), retardation (p=0.005), anxiety psychic (p=0.032), and general somatic symptom (p=0.01).CONCLUSION: While both treatments were effective, results of this study suggested that aripiprazole may be preferable, in treating general and core symptoms of female depression.

Maximal strength and endurance scores of the tongue, lip, and cheek in healthy, normal Koreans

OBJECTIVES: The purpose of this study was to establish normative data for healthy Korean adults by measuring the maximal strength and endurance scores of the tongue, lip, and cheek, and to examine correlations between these measurements. MATERIALS AND METHODS: This study included 120 subjects that were divided into three groups according to age: young (20-39 years), middle-aged (40-59 years), and older (over 60 years); and by gender. Measurements were taken using the Iowa Oral Performance Instrument (IOPI). RESULTS: The mean maximal tongue strengths were as follows: young men (46.7±10.2 kPa) and women (32.1±7.9 kPa), middle-aged men (40.9±9.3 kPa) and women (36.9±8.6 kPa), and older men (35.2±9.0 kPa) and women (34.5±6.9 kPa). The mean tongue endurance scores were: young men (28.8±12.6 seconds) and women (20.8±13.5 seconds), middle-aged men (17.0±8.5 seconds) and women (15.3±5.2 seconds), and older men (15.8±6.7 seconds) and women (17.9±8.1 seconds). The mean maximal lip strengths were: young men (11.6±3.0 kPa) and women (11.4±3.8 kPa), middle-aged men (11.4±4.2 kPa) and women (11.1±5.1 kPa), and older men (14.5±3.9 kPa) and women (11.7±2.6 kPa). The mean lip endurance scores were: young men (41.1±23.9 seconds) and women (22.4±21.7 seconds), middle-aged men (24.3±10.3 seconds) and women (30.5±13.4 seconds), and older men (24.9±11.0 seconds) and women (12.8±7.6 seconds). The mean maximal cheek strengths were: young men (24.5±4.6 kPa) and women (20.5±4.3 kPa), middle-aged men (25.2±6.4 kPa) and women (21.2±5.5 kPa), and older men (22.4±5.3 kPa) and women (18.0±4.8 kPa). The mean cheek endurance scores were: young men (47.8±24.4 seconds) and women (43.9±25.0 seconds), middle-aged men (27.3±11.3 seconds) and women (20.0±14.6 seconds), and older men (21.7±14.5 seconds) and women (17.2±11.4 seconds). CONCLUSION: The data collected in this study will provide an important database of standardized measurements for maximal strength and endurance scores of the tongue, lip and cheek in healthy, normal Koreans.

Comparison of Reliability in Diabetic Macular Edema Estimates between Two Image Analysis Algorithms

PURPOSE: To evaluate segmentation reliability in diabetic macular edema (DME) estimates between a Cirrus™ HD-OCT image analysis algorithm and an Iowa reference algorithm, which are an automatic segmentation software. METHODS: Thirty eyes from 23 patients diagnosed with DME were included and underwent spectral-domain optical coherence scans (Cirrus™ HD-OCT). Central foveal thickness (CFT) and ganglion cell layer-inner plexiform layer segmentation data were compared with those produced by the Cirrus™ HD-OCT segmentation algorithm and Iowa reference algorithm. Measurement agreement was assessed using intraclass correlation (ICC) and segmentation errors were confirmed by 2 ophthalmologists. RESULTS: The mean CFT in the 1-mm central area determined by the manufacturer-supplied Cirrus software and Iowa reference algorithm was 512.07 ± 182.35 µm and 476.53 ± 32.36 µm, respectively (p < 0.05). The mean paired difference was 35.53 ± 92.46 µm (ICC, 0.929). Segmentation errors were demonstrated in eyes with a CFT less than 400 µm, specifically for 45% of scans obtained by the Cirrus algorithm and 9% from the Iowa algorithm; in eyes with a CFT equal to or higher than 400 µm, the error rates were 95% and 42%, respectively. CONCLUSIONS: CFT measurement in eyes with diabetic macular edema using the Cirrus algorithm and Iowa algorithm showed relatively high degrees of agreement and significant correlation. In eyes with a CFT equal to or higher than 400 µm, the Iowa algorithm showed higher reliability in retinal segmentation than the Cirrus algorithm.

The Relationship Between Tongue Pressure and Oral Dysphagia in Stroke Patients

OBJECTIVE: To evaluate the relationships between tongue pressure and different aspects of the oral-phase swallowing function. METHODS: We included 96 stroke patients with dysphagia, ranging in age from 40 to 88 years (mean, 63.7 years). Measurements of tongue pressure were obtained with the Iowa Oral Performance Instrument, a device with established normative data. Three trials of maximum performance were performed for lip closure pressure (LP), anterior hard palate-to-tongue pressure (AP), and posterior hard palate-to-tongue pressure (PP); buccal-to-tongue pressures on both sides were also recorded (buccal-to-tongue pressure, on the weak side [BW]; buccal-to-tongue pressure, on the healthy side [BH]). The average pressure in each result was compared between the groups. Clinical evaluation of the swallowing function was performed with a videofluoroscopic swallowing study. RESULTS: The average maximum AP and PP values in the intact LC group were significantly higher than those in the inadequate lip closure group (AP, p=0.003; PP, p<0.001). AP and PP showed significant relationships with bolus formation (BF), mastication, premature bolus loss (PBL), tongue to palate contact (TP), and oral transit time (OTT). Furthermore, LP, BW, and BH values were significantly higher in the groups with intact mastication, without PBL and intact TP. CONCLUSION: These findings indicate that the tongue pressure appears to be closely related to the oral-phase swallowing function in post-stroke patients, especially BF, mastication, PBL, TP and OTT.

Treatment of Late-Onset Legg-Calve-Perthes Disease by Arthrodiastasis

BACKGROUND: To evaluate the efficacy of arthrodiastasis for Legg-Calve-Perthes disease. METHODS: Arthrodiastasis was conducted using external fixator devices (Orthofix) in 7 patients at least 8 years of age with a diagnosis of Legg-Calve-Perthes disease. The average follow-up was 80 months (range, 32 to 149 months), and their average age was 9.1 years (range, 8 to 12 years). The results of treatment were evaluated by measuring the degree of hip pain and the range of motion of the hip at 6 months after the operation and comparing the values with preoperative measurements. Radiological recovery was evaluated by the epiphyseal index and compared with the preoperative values. At the final follow-up, clinical and radiological results were evaluated using the Iowa hip score and the Stulberg classification. RESULTS: On the clinical evaluation performed at 6 months after arthrodiastasis, the degree of pain decreased by 1.8 points on average, and the average flexion, internal rotation, and abduction increased by 35°, 16°, and 11°, respectively. Based on radiological findings, the epiphyseal index showed a remarkable increase of 6.6 on average (from 19 preoperatively to 26 postoperatively). At the final follow-up, the average Iowa hip score improved from 65 points preoperatively to 84 points. There were 1 Stulberg class I hip, 2 Stulberg class II hips, 3 Stulberg class III hips, 1 Stulberg class IV hip, and no Stulberg class V hip. CONCLUSIONS: We conclude that arthrodiastasis using an external fixator can be a relatively promising surgical procedure for the treatment of late-onset Legg-Calve-Perthes disease.

The Relation of Blood Iron Level with Frontal Function in Children with Attention-Deficit/Hyperactivity Disorder / 신경정신의학

OBJECTIVES: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder showing many neuropsychological deficits. Many environmental risk factors have been thought to increase the risk for the disorder. We examined blood iron levels in children with ADHD and a control group to find an association between iron deficit and diagnosis, neuropsychological characteristics and clinical features. METHODS: An ADHD group (n=50) and control group (n=45) of children 6-12 years of age were recruited. Both groups were diagnosed by semi-structured interview, and they were evaluated using the Korean version of the ADHD Rating Scale (K-ARS), Korean version of IOWA Conner's Rating Scale (K-IOWA), intelligence quotient (IQ), and neurocognitive function tests (continuous performance test, children's color trails test, Stroop color-word test). Iron levels in blood were determined using the inductively coupled plasma mass spectrometry instrument. Independent t-test and correlation were used to determine the relation of blood iron levels with symptom ratings and neurocognitive function. Logistic regression was performed to determine the diagnostic value of blood iron levels. RESULTS: Blood iron levels were significantly lower in ADHD than in control and showed negative correlation with K-ARS and K-IOWA scores. Blood iron levels showed positive association with IQ and Stroop color-word test results and negative association with results of continuous performance testing. Low blood iron levels predicted the diagnosis of ADHD. CONCLUSION: Lower levels of blood iron were associated with ADHD symptom severity, IQ, and frontal lobe-mediated neurocognitive function. As blood iron levels may influence ADHD, measurement of iron levels in blood may be useful for evaluation of symptoms and neurocognitive function in ADHD.

Prevalence of oral cancer self-examination among elderly people treated under Brazil's Unified Health System: household health survey / Prevalência de autoexame bucal é maior entre idosos assistidos no Sistema Único de Saúde: inquérito domiciliar

The aim of this study was to examine the prevalence of oral cancer self-examinationamong the elderly and confirm whether prevalence was higher among users of the dental services provided by Brazil's Unified Health System (SUS, acronym in Portuguese). A transversal study of elderly people aged between 65 and 74 years living in a large-sized Brazilian municipality was conducted using simple random sampling. Logistic regression was conducted and results were corrected for sample design and unequal weighting using the SPSS(r) software. The study assessed 740 individuals. A total of 492 met the inclusion criteria, of which 101 (22.4%) reported having performed an oral cancer self-examination. Prevalence was higher among users of the dental services provided by the SUS, higher-income individuals, people with higher levels of education, individuals that used a removable dental prosthesis, and people who had not experienced discomfort attributed to oral condition, and lower among people who sought regular and periodic dental treatment and individuals who did not have a drinking habit. This type of self-care should be encouraged by public health policies which respond to the needs of the elderly, with emphasis on users of private and philanthropic services, and other services outside the public health network.

Este estudo objetivou identificar a prevalência do autoexame bucal entre idosos e constatar se essa prevalência foi maior entre usuários de serviços odontológicos prestados pelo Sistema Único de Saúde (SUS). Estudo transversal conduzido a partir de amostragem probabilística complexa por conglomerados, entre idosos (65-74 anos) de um município brasileiro de grande porte populacional. Foi realizada regressão logística binária, as estimativas foram corrigidas pelo efeito de desenho e por ponderações, utilizando-se o SPSS(r). Dentre os 740 avaliados, atenderam aos critérios de inclusão 492 idosos e, destes, 101 (22,4%) relataram a prática do autoexame bucal. Esta prática foi maior entre idosos usuários dos serviços odontológicos prestados no SUS, entre aqueles com maior renda per capita, os com maior escolaridade, aqueles que utilizavam prótese dentária removível e entre os que não tiveram impactos decorrentes das desordens bucais; foi menor entre os que usaram serviços odontológicos por rotina e os que não possuíam hábito etilista. A prevalência do autoexame bucal entre idosos foi baixa e maior entre aqueles usuários do SUS. O estímulo à adesão a este autocuidado deve ser considerado nas políticas de saúde do idoso vigentes, especialmente entre usuários de serviços particulares, supletivos e filantrópicos.

The Effect of Depression in Decision Making Process : Based on Quantitative Methodology / 신경정신의학

The increasing number of patients with depression is a serious social issue in contemporary Korean society. To fully understand the pathophysiology of depression, this paper reviewed how depression affects the decision making process of humans. Various recent studies in behavioral economics, mathematics, medicine, and neurobiology have shown how humans make decisions and how emotional disturbances, such as depressive disorder, affect this process. There has been great progress in behavioral economics during this decade, and numerous experiments have been designed to evaluate decision making process in humans. In general, economic decision making is evaluated using the Iowa Gambling Task, and social decision making is assessed using the ultimatum game. Numerous research studies have analyzed the performance and reaction of patients with depression in these games. As a result of the advancement of neurophysiology, research has successfully identified the part of the brain that causes the specific results of tests being conducted on patients with depression. Meanwhile, computational neuroscientists have established decision making models based on bayesian framework. These models also match with the neuroanatomy. Although a large part remains unclear, researchers look forward to achieving a better understanding in depression by analyzing the distinct patterns of responses that patients under depression show in the experiment of behavioral economics.

Interlocking Intramedullary Nailing for Far Distal Tibia Fractures in AO Classification 43 / 대한정형외과학회잡지

PURPOSE: This retrospective study was conducted in order to evaluate the results of interlocking intramedullary nailing of far distal tibia fractures located within AO classification 43. MATERIALS AND METHODS: Seventy patients with far distal tibia fractures in AO classification 43 treated with interlocking intramedullary nailing from May 2008 to April 2012 were evaluated. The minimum follow-up period was 12 months. We analyzed preoperative fracture pattern, associated injury, and complication. All cases were treated with use of either two or three distal interlocking screws during intramedullary nailing. Patients received regular post-operative radiographic check-up and ankle function was evaluated using the Iowa ankle-evaluation rating system. RESULTS: The fractures healed completely within an average of 18 weeks. None of the patients showed malaligment on the final radiographic evaluation. Average of varus-valgus aligment was 1.9 degrees and average of anterior-posterior alignment was 1.1 degrees. According to the Iowa ankle-evaluation rating system, we obtained satisfactory clinical results in 14 cases. Complication occurred in two cases. There was one case of hypertrophic nonunion and one breakage of the distal locking screw with delayed union. CONCLUSION: We consider that interlocking intramedullary nailing of far distal tibia fractures located within AO classification 43 is a considerable method when a plate is not used due to accompanying severe open wound, etc. For satisfactory results, accurate technique and experience of the operator were required.

Effects of Add-on Ramelteon on Cognitive Impairment in Patients with Schizophrenia: An Open-label Pilot Trial

OBJECTIVE: This open-label study examined the effects of ramelteon on cognitive functions in 10 outpatients with schizophrenia. METHODS: Ramelteon (8 mg/day) was administered to 10 patients with schizophrenia for six months. The verbal fluency test, Trail-Making Test, the Wisconsin Card Sorting Test, the Stroop Test, the Digit Span Distraction Test, Iowa Gambling Task, the Rey Auditory Verbal Learning Test were evaluated at baseline and 6 months after treatment with ramelteon. RESULTS: Ramelteon improved significantly the scores of Rey Auditory Verbal Learning Test. Additionally, ramelteon exerted improvements in the verbal fluency and Iowa Gambling Task in 4 patients. CONCLUSION: Ramelteon could be a potential therapeutic drug, in adjunctive treatment of learning and memory deficits seen in patients with schizophrenia.

Construction of the Nursing Diagnosis Ontology in Obstetric and Gynecologic Nursing Unit using Nursing Process and SNOMED CT

PURPOSE: This study was performed to propose an ontology methodology based on standardized nursing process as framework in obstetric and gynecologic nursing practice. METHODS: The instrument used in this study was based on the nursing diagnosis classification established by North American Nursing Diagnosis Association (NANDA) (2009-2011), fifth edition of the Nursing Interventions Classification (NIC) (2008), forth edition of the Nursing Outcomes Classification (NOC) (2008) developed by Iowa State University and systematized nomenclature of medicine clinical terms (SNOMED CT). The nursing records data were collected from electronic medical records of one hospital from August to October 2010. RESULTS: One hundred and forty-one nursing diagnosis statements used in obstetric and gynecologic nursing unit were linked standardized nursing classifications and constructed nursing diagnosis ontology including interoperability. CONCLUSION: Not only will this result be helpful to complete nurse's lack of knowledge and experience, it will also help to determine nursing diagnosis logically by using standardized nursing process. It will be utilized as the method to construct ontology including interoperability in other nursing units. It will be presented nursing interventions according to nursing diagnosis and thus will be easier to establish nursing planning. This can provide immediate feedback of the nursing process application.

Iowa satisfaction with anesthesia scale / 대한마취과학회지

No abstract available.

A Comparison of the Prospective Memory among College Students, Normal Elderly, and Parkinson's Disease Patients

BACKGROUND: This study was conducted to examine the effects of normal aging and cerebral pathology on the prospective memory and the relationships between the prospective memory and frontal lobe functions. METHODS: The subjects were 30 college students, 30 normal elderly, and 30 Parkinson's disease patients. There was no significant difference in the mean age or education level between the normal elderly and Parkinson's disease patients. The Cambridge Prospective Memory Test and the Prospective and Retrospective Memory Questionnaire were administered to evaluate the prospective memory. The Seoul Verbal Learning Test and Rey Complex Figure Test were given to assess the verbal and visual episodic memories. The subjects also took the Sorting Test, the Korean-Color Word Stroop Test, and the Iowa Gambling Task to assess the frontal lobe functions. RESULTS: The results showed that the prospective memory declines with aging and pathological process. The normal elderly showed significantly lower scores on the time-based prospective memory than the event-based prospective memory, although the college students and Parkinson's disease patients did not show any differences between them. Many significant correlations were found between the prospective memory tests and frontal lobe tests in the normal elderly and Parkinson's disease patients, although only a few correlations were found in the college students. CONCLUSIONS: These quantitative and qualitative changes in the prospective memory by aging and frontal lobe dysfunction would support the de-differentiation hypothesis of aging.

Correlates of Social Engagement in Nursing Home Residents with Dementia

PURPOSE: The social needs of nursing home (NH) residents with dementia are often ignored even though they are capable of expressing their emotions and responding in social interactions. Insufficient social engagement in this population is known to be associated with low quality of life as well as many negative health outcomes, such as mortality, agitation, and functional decline. The purpose of this study was to identify the correlates of social engagement in NH residents with dementia. METHODS: The study used a descriptive, correlational design. A total of 153 older adults with dementia in 17 Iowa NHs participated in this study. Minimum Data Set for NH version 2.0 served as an outcome measure to evaluate social engagement, cognitive and physical functions, depression, and behavioral symptoms. Demographic data were obtained from the participants' medical records. RESULTS: The findings indicated that no significant relationship was found between demographic characteristics and social engagement. There were significant and negative correlations between the degree of social engagement and the levels of cognitive impairment, activities of daily living impairment, depression, and vision. Among these correlates, depression was the most potent predictor of engagement. CONCLUSION: The study provided information about the correlates of social engagement in NH residents with dementia. Future research needs to be conducted to develop nursing interventions to involve these individuals in social activities tailored to functional levels, and depression in more diverse geographic regions.

Nutritional intake of Korean population before and after adjusting for within-individual variations: 2001 Korean National Health and Nutrition Survey Data

Accurate assessment of nutrient adequacy of a population should be based on usual intake distribution of that population. This study was conducted to adjust usual nutrient intake distributions of a single 24-hour recall in 2001 Korean National Health and Nutrition Surveys (KNHNS) in order to determine the magnitude of limitations inherent to a single 24-hour recall in assessing nutrient intakes of a population. Of 9,960 individuals who provided one 24-hour recall in 2001 KNHNS, 3,976 subjects provided an additional one-day 24-hour recall in 2002 Korean National Nutrition Survey by Season (KNNSS). To adjust for usual intake distribution, we estimated within-individual variations derived from 2001 KNHNS and 2002 KNNSS using the Iowa State University method. Nutritionally at risk population was assessed in reference to the Dietary Reference Intakes for Koreans (KDRIs). The Korean Estimated Average Requirement (Korean EAR) cut-point was applied to estimate the prevalence of inadequate nutrient intakes except for iron intakes, which were assessed using the probability approach. The estimated proportions below Korean EAR for calcium, riboflavin, and iron were 73%, 41%, and 24% from usual intake distribution and 70%, 51%, and 39% from one-day intake distribution, respectively. The estimated proportion of sodium intakes over the Intake Goal of 2,000 mg/day was 100% of the population after adjustment. The energy proportion from protein was within Korean Acceptable Macronutrient Distribution Ranges (Korean AMDR), whereas that of carbohydrate was higher than the upper limit and that of fat was below the lower limit in the subjects aged 30 years or older. According to these results, the prevalence of nutritional inadequacy and excess intake is over-estimated in Korea unless usual intake distributions are adjusted for one-day intakes of most nutrients.

Switching from Methylphenidate-Immediate Release (MPH-IR) to Methylphenidate-OROS (OROS-MPH): A Multi-center, Open-label Study in Korea

OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of methylphenidate HCL OROS extended-release (OROS-MPH) among children with attention deficit hyperactivity disorder (ADHD) who had been previously treated with methylphenidate HCL immediate-release (MPH-IR). METHODS: The sample included 102 children aged 6-12 (9.4+/-2.6) years who had been diagnosed with ADHD according the criteria of the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV; American Psychiatric Association, 1994) and who were attending seven centers in Korea. All participants had been medicated with a stable dose of MPH (10-60 mg/day) for at least 3 weeks before entry into the study. Doses of OROS-MPH were comparable to daily doses of MPH. Efficacy was assessed at baseline (day 0) and at day 28 with the Inattentive-Overactive with Aggression (IOWA) Conners Rating Scale, which was completed by parents/caregivers and teachers, the Peer Interaction Rating Items, which were completed by teachers, and the Clinical Global Impression (CGI) scale, which was completed by child psychiatrists. Paired t-tests were used, and P-values were set at the 0.05 level. RESULTS: Of the subjects, 92.2% were boys and 79.4% were students in the first to fourth grades of elementary school. 72% were diagnosed with the combined type of ADHD, 23% were diagnosed with the inattentive type, and 5% were diagnosed with the hyperactive-impulsive type. The results of the parents' responses to the Inattention/Hyperactivity (I/H) and Oppositional/Defiant (O/D) subscales of the IOWA Conners scale indicated statistically significant improvement in childrens behavior after 4 weeks of treatment with OROS-MPH (t=6.28, p<.001, t=4.12, p<.001). However, the teachers' responses to the Conners I/H and O/D subscales indicated no significant improvement at 4 weeks. The teachers also reported no significant improvements under the OROS-MPH compared with the MPH-IR condition with respect to peer interactions. Scores on the CGI scale showed that 46.1% of children with ADHD were rated by psychiatrists as "minimally improved", 27.5% as "much improved," 1.0% as "very much improved," 3.9% as "minimally worse," and 16.7% as showing "no change". Children exhibited significantly fewer tics with OROS-MPH treatment than with MPH-IR treatment (19.6% vs. 27.7%). We found no differences between in sleep and appetite problems according to medication. CONCLUSION: The results of this study indicated that an MPH-IR regimen can be successfully changed to a once-daily OROS-MPH regimen without any serious adverse effects. The changes in parent/caregiver IOWA Conners ratings suggested that OROS-MPH improved the control of symptoms after school, a finding that is consistent with the 12-h duration of action of this medication. Because the therapeutic effect of OROS-MPH is sufficiently longer than that of a b.i.d. dose of MPH-IR, OROS-MPH had significant positive effects on oppositional/defiant behavior in addition to its effects on the core symptoms of ADHD.

Dexmedetomidine is effective for monitored anesthesia care in outpatients undergoing cataract surgery / 대한마취과학회지

BACKGROUND: Dexmedetomidine has a sedative analgesic property without respiratory depression. This study evaluated the efficacy of dexmedetomidine as an appropriate sedative drug for monitored anesthesia care (MAC) in outpatients undergoing cataract surgery on both eyes compared with combination of propofol and alfentanil. METHODS: Thirty-one eligible patients were randomly divided into two groups on the first operation day. Dexmedetomidine was administered in group D at 0.6 microg/kg/h, and propofol and alfentanil was infused concomitantly in group P at a rate of 2 mg/kg/h and 20 microg/kg/h, respectively. Sedation was titrated at Ramsay sedation score 3. Iowa satisfaction with anesthesia scale (ISAS) of the patients was evaluated postoperatively. Systolic blood pressure (SBP), heart rate (HR), respiration rate (RR), and peripheral oxygen saturation (SpO2) were recorded throughout the surgery. For the second operation, the group assignments were exchanged. RESULTS: Postoperative ISAS was 50.3 (6.2) in group D and 42.7 (8.7) in group P, which was statistically significant (P < 0.001). SBP was significantly lower in group D compared with group P from the beginning of the operation. HR, RR, and SpO2 were comparable between the two groups. There were 8 cases (25.8%) of hypertension in group P, and 1 case (3.2%) in group D (P < 0.05). In contrast, 1 case (3.2%) of hypotension and 1 case (3.2%) of bradycardia occurred in group D. CONCLUSIONS: Compared with the combined use of propofol and alfentanil, dexmedetomidine could be used appropriately for MAC in cataract surgery with better satisfaction from the patients and a more stable cardiovascular state.