Comparison of Visceral Adiposity Index and Chinese Visceral Adiposity Index for Coronary Artery Calcification in Korean Adults

BACKGROUND: Visceral adiposity index (VAI) was developed to estimate visceral fat, and its association with various diseases including cardiovascular disease, insulin resistance, and fatty liver has been revealed. The Chinese VAI (CVAI) has been newly developed in China. This study aimed to compare the VAI and CVAI for coronary artery calcification by using the coronary artery calcium score (CACs)-a predictable index of asymptomatic atherosclerosis.METHODS: We conducted a cross-sectional study that included 66,011 participants (76.3% male and 23.7% female participants) visiting an university hospital for medical check-ups between January 2014 and December 2016. A receiver operating characteristic curve analysis was performed and the area under the curve (AUC) was calculated to compare the concordance of the CACs and the VAI, CVAI, waist circumference, body mass index, triglycerides, and high-density lipoprotein cholesterol.RESULTS: In all participants, the AUC for the CVAI was the largest, while that for the VAI was fourth among all the indices (AUC(CVAI)=0.653, AUC(VAI)=0.592). The AUC for the CVAI was the largest among the indices in both sexes (female AUC(CVAI)=0.77, male AUC(CVAI)=0.592), while that for the VAI was the second largest (female, AUC(CVAI) 0.771>AUC(VAI) 0.651; male, AUC(CVAI) 0.592>AUC(VAI) 0.564).CONCLUSION: In conclusion, the CVAI showed a higher degree of concordance with CACs, which is an indirect indicator of cardiovascular disease, than the VAI in Korean adults.

The Effect of Lifestyle Changes on Blood Pressure Control among Hypertensive Patients / 가정의학회지

BACKGROUND: Hypertension is highly prevalent among patients who visit primary care clinics. Various factors and lifestyle behaviors are associated with effective blood pressure control. We aimed to identify factors and lifestyle modifications associated with blood pressure control among patients prescribed antihypertensive agents. METHODS: This survey was conducted at 15 hospital-based family practices in Korea from July 2008 to June 2010. We prospectively recruited and retrospectively assessed 1,453 patients prescribed candesartan. An initial evaluation of patients' lifestyles was performed using individual questions. Follow-up questionnaires were administered at 4, 8, and 12 weeks. We defined successful blood pressure control as blood pressure <140 mm Hg systolic and <90 mm Hg diastolic. RESULTS: Of the 1,453 patients, 1,139 patients with available data for initial and final blood pressures were included. In the univariate analysis of the change in performance index, weight gain (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.52 to 3.11; P<0.001), physical inactivity (OR, 1.195; 95% CI, 1.175 to 3.387; P=0.011), and increased salt intake (OR, 1.461; 95% CI, 1.029 to 2.075; P=0.034) were related to inadequate blood pressure control. Salt intake also showed a significant association. Multivariate ORs were calculated for age, sex, body mass index, education, income, alcohol consumption, smoking status, salt intake, comorbidity, and family history of hypertension. In the multivariate analysis, sex (OR, 3.55; 95% CI, 2.02 to 6.26; P<0.001), salt intake (OR, 0.64; 95% CI 0.43 to 0.97; P=0.034), and comorbidity (OR, 1.82; 95% CI, 1.23 to 2.69; P=0.003) were associated with successful blood pressure control. CONCLUSION: Weight gain, physical inactivity, and high salt intake were associated with inadequate blood pressure control.

Correction: The Effect of Lifestyle Changes on Blood Pressure Control among Hypertensive Patients / 가정의학회지

We would like to replace Table 3 of the original paper with a revised version. We sincerely apologized to the readers.

The Association between Frailty and Cognition in Elderly Women / 가정의학회지

BACKGROUND: Frailty refers to the loss of physiologic complexity and the associated decline in ability to withstand stressors as one gets older. It is defined as unintentional weight loss, exhaustion, weakness, slow walking speed, and low physical activity. According to several western studies, frailty is associated with cognitive impairment, but there have been few studies about the relationship between frailty and cognitive impairment in Korea. Thus, the purpose of this study is to analyze the relationship between cognition and factors related to frailty such as grip strength, walking speed, physical activity, and depression, among female patients older than 65 in Korea. METHODS: A total of 121 subjects among the outpatients of the department of family medicine at Kangbuk Samsung Hospital who did not meet the exclusion criteria were included in this study. We divided the participants into 2 groups, according to the Korean version of the Montreal Cognitive Assessment (MoCA) score: 1 group with subjects that had normal cognition and the other group with patients that had impaired cognition. A comparison was made between the 2 groups in regards to the factors related to frailty, and we completed equation that predicting cognition from the frailty related factors. RESULTS: Compared with the impaired cognition group, the subjects in the normal cognition group had higher hand strength, and walked faster (P<0.001). There was no statistically significant difference in physical activity between the 2 groups (P=0.19). When multiple linear regression analysis was performed using age, grip strength, and walking speed as the predictor variables and MoCA score as the dependent variable, the regression coefficients were calculated to be: -0.2015, 0.2294, 1.2372, and -0.1436, respectively (P<0.05). CONCLUSION: In Korean female patients who are older than 65 years of age, cognition tends to decline as grip strength decreases, walking speed gets slower, depression becomes more severe, and as age increases.

Development of a Smartphone Application for 4th-6th Grade Elementary Students Aimed to Prevent Childhood Obesity

BACKGROUND: There is high interest in a new approach to improve children's lifestyle habits in order to prevent childhood obesity. A smartphone application (app) is a new technology platform that can be used to prevent childhood obesity. METHODS: The key messages for healthy eating habits and physical activities were selected by experts in nutrition, physical activity, and psychology and were adjusted for use in elementary school students. Gamification techniques were used to increase app user engagement. A total of 249 students in grades 4-6 were asked to rate their satisfaction for the app after 4 weeks of use. RESULTS: The main menu of "HAPPY ME" was composed of user profile, "EVERYDAY QUEST," exercise diary, diet diary, settings, and notifications. The app users were asked to complete 6-9 daily missions regarding healthy eating habits and physical activities through "EVERYDAY QUEST." The mean satisfaction scores for each variable were distributed from 3.6 to 4.0 points, and most of the students responded that they would continue to use the app (4.0 points). CONCLUSION: We developed a smartphone app (HAPPY ME) for 4th-6th grade elementary students aimed to provide educational information about healthy eating habits and physical activities in order to prevent childhood.

The Association between Subclinical Hypothyroidism and Cardiovascular Risk Factors in Post-menopausal Women / 대한폐경학회지

OBJECTIVES: The relationship between subclinical hypothyroidism and cardiovascular disease has not yet been clearly defined. This study will investigate whether or not there is a difference in the prevalence of subclinical hypothyroidism in menopausal women with respect to cardiovascular risk factors, and will furthermore analyze the relationship between cardiovascular diseases and subclinical hypothyroidism, in order to establish a foundation for subclinical hypothyroidism research. METHODS: The study subjects consisted of 713 post-menopausal women, who visited the hospital for a health check-up in 2006-2010. They were divided into a subclinical hypothyroidism group and a normal group. This study analyzed the difference in blood pressure, serum lipid, body mass index (BMI) and blood glucose level between the two groups. The data was analyzed using a two-sample t-test. RESULTS: The prevalence of subclinical hypothyroidism for menopausal women was 6.7%. The results showed no significant differences between the normal and subclinical hypothyroidism patient groups, in regards to blood pressure, BMI, and blood glucose levels (P > 0.05). However the triglyceride of serum lipid was significantly higher in the subclinical hypothyroidism group (P = 0.003). CONCLUSION: It has been confirmed that the triglyceride of the subclinical hypothyroidism group was higher than that of the normal group, and so serum lipid maintenance and caution towards cardiovascular disease is necessary for the subclinical hypothyroidism group.

Marital Status and Health Behaviors in Middle-Aged Korean Adults: from the 2007-2010 Korea National Health and Nutrition Examination Survey

BACKGROUND: Marital status is not only an important sociodemographic variable for health studies but influences health behavior and health condition of individuals. This study assessed a representative sample to see whether marital status is associated with health behavior in middle-aged Korean adults, and if the association differed by sex. METHODS: This is a cross-sectional study of 9,535 Korean middle-aged adults who participated in the 2007-2010 Korean National Health and Nutrition Examination Survey. Our data were from this survey. The subjects were classified as married and living with a partner, widowed, separated/divorced, or never married. We assessed the relationship between marital status and five health behaviors (smoking, high risk alcohol intake, regular exercise, regular breakfast consumption, and periodic health screening) after controlling covariates. RESULTS: In men, the separated/divorced group had a higher risk for high risk alcohol consumption (odds ratio [OR], 1.52; 95% confidence interval [CI], 1.05-2.19) and lower tendencies to have breakfast regularly (OR, 0.44; 95% CI, 0.29-0.67) and to undergo health screening (OR, 0.54; 95% CI, 0.37-0.79) than the married and living with a partner group while men were more likely to exercise regularly (OR, 1.81; 95% CI, 1.13-2.88). In women, both of the separated/divorced group and had a significantly higher risk for smoking and high risk alcohol consumption than married and living with a partner group by 3-6 times. The separated/divorced women group was less likely to have breakfast regularly (OR, 0.55; 95% CI, 0.41-0.74). Significant interactions between sex and marital status were observed with smoking (P<0.001), high risk alcohol intake (P<0.001), regular breakfast consumption (P<0.001), and periodic health screening (P=0.003). CONCLUSIONS: The association between marital status and health behaviors differed by sex. Even in the single group, differences were seen according to the subtypes of the single group.

Marital Status and Health Behaviors in Middle-Aged Korean Adults: from the 2007-2010 Korea National Health and Nutrition Examination Survey

BACKGROUND: Marital status is not only an important sociodemographic variable for health studies but influences health behavior and health condition of individuals. This study assessed a representative sample to see whether marital status is associated with health behavior in middle-aged Korean adults, and if the association differed by sex. METHODS: This is a cross-sectional study of 9,535 Korean middle-aged adults who participated in the 2007-2010 Korean National Health and Nutrition Examination Survey. Our data were from this survey. The subjects were classified as married and living with a partner, widowed, separated/divorced, or never married. We assessed the relationship between marital status and five health behaviors (smoking, high risk alcohol intake, regular exercise, regular breakfast consumption, and periodic health screening) after controlling covariates. RESULTS: In men, the separated/divorced group had a higher risk for high risk alcohol consumption (odds ratio [OR], 1.52; 95% confidence interval [CI], 1.05-2.19) and lower tendencies to have breakfast regularly (OR, 0.44; 95% CI, 0.29-0.67) and to undergo health screening (OR, 0.54; 95% CI, 0.37-0.79) than the married and living with a partner group while men were more likely to exercise regularly (OR, 1.81; 95% CI, 1.13-2.88). In women, both of the separated/divorced group and had a significantly higher risk for smoking and high risk alcohol consumption than married and living with a partner group by 3-6 times. The separated/divorced women group was less likely to have breakfast regularly (OR, 0.55; 95% CI, 0.41-0.74). Significant interactions between sex and marital status were observed with smoking (P<0.001), high risk alcohol intake (P<0.001), regular breakfast consumption (P<0.001), and periodic health screening (P=0.003). CONCLUSIONS: The association between marital status and health behaviors differed by sex. Even in the single group, differences were seen according to the subtypes of the single group.

Clinical Characteristics of Patients with Medically Unexplained Chronic Widespread Pain: A Primary Care Center Study / 가정의학회지

BACKGROUND: Chronic widespread pain (CWP) is known as a common symptom of several organic and psychological disorders. Although medically unexplained CWP (MUE) has lots of clinical distress symptoms, there were no distinct symptoms or signs. Therefore, we conducted this study to investigate clinical distress symptoms of MUE distinct from those of medically explained CWP (ME). METHODS: One hundred nine patients with CWP were enrolled in the study. We classified the study subjects into three groups depending on their medical problems associated with CWP: organic group (ORG), psychological group (PSY), and MUE. All subjects were asked to fill out self-report questionnaires consisting of clinical distress scales including the Korean version of the Fibromyalgia Impact Questionnaire (FIQ-K), fatigue scale, depression scale, and stress scale. And physicians examined 18 tender points over their entire body of the subjects. RESULTS: MUE patients had higher FIQ-K and fatigue severity scores than ORG patients (all P < 0.05). The average number of tender points were 11.33 in MUE patients, 6.48 in ORG patients and 5.02 in PSY patients and statistically significant (P < 0.0001). There were no statistically different factors between MUE and PSY patients with exception for the number of tender points. Depressive symptom was the highest in PSY patients but not statistically different from MUE patients. CONCLUSION: MUE patients had higher physical impairments, fatigue severity and more number of tender points than ORG patients, but had no different clinical characteristics from PSY patients except for the number of tender points.

A Randomized Controlled Trial of SMS Text Messaging versus Postal Reminder to Improve Attendance after Lipid Lowering Therapy in Primary Care / 가정의학회지

BACKGROUND: In the primary care setting, compliance with lipid lowering therapy was relatively low. In order to compare the efficacy of a short messaging service (SMS) text messaging and postal reminder as means of improving attendance rates during the first 24 weeks of lipid-lowering therapy, a randomized controlled trial of 918 patients from 19 family practice clinics was conducted between February 2003 and June 2006. METHODS: Patients were randomly assigned into 3 groups: SMS (327), postal (294),and control (297) group. To ascertain attendance rates, patients were followed up at 24 weeks after their treatment. Reminders were sent at 16 weeks from the coordinating center. RESULTS: Overall attendance rate was 74.1%. This differed between groups, with 76.1% attendance for the SMS group, 73.5% for the postal group, and 72.4% for the control group. According to a multivariate analysis, the SMS group had a significantly higher attendance rate (Odds ratios [OR] 1.48; 95% confidence interval [CI], 1.01 to 2.16) than the control group, but the postal group (OR, 1.15; 95% CI, 0.79 to 1.69) did not. Moreover, the cost per attendance for the SMS reminder (155 Korean Won [KRW]) was much lower than that for the postal reminder (722 KRW). CONCLUSION: SMS reminder may be more cost saving method to improve the attendance rate compared with the postal reminder.

Patterns of Complementary and Alternative Medicine Therapies in Patients with Chronic Fatigue or Pain / 가정의학회지

BACKGROUND: It is well-known that patients with chronic fatigue or frequent pain seek complementary and alternative medicine therapies (CAT) in Western countries. We conducted this study to determine the pattern of CAT use and the factors related to CAT use in patients with chronic fatigue or pain in Korea. METHODS: This was a cross-sectional study. The participants (n = 143) with chronic fatigue or pain completed a self-reported questionnaire including demographic characteristics and lifestyle as well as disease-related and CAT-related items. RESULTS: The frequency of CAT use was 51.0& and 39.2& over the past 10 years and 1 year, respectively. The most common type of CAT used was herbal medicine. The therapeutic effects of the CAT were similar to physicians' prescriptions. CAT were most often used in combination with conventional medicine rather than alone. More than 70.0& of subjects did not consult their physicians for the use of CAT. The duration of illness, severity of fatigue and pain was signifi cantly related to the use of CAT. CONCLUSION: Many patients with chronic fatigue or pain use CAT. Most of these patients do not consult their physicians regarding CAT use.

Cutoff of Percent Body Fat to Predict Obesity and Metabolic Risk in Children and Adolescents: 2007 Children and Adolescent Physical Growth Standard / 가정의학회지

BACKGROUND: Body mass index (BMI) for gender and age and percentage-weight-for-height (PWH) for gender and height have been frequently used to diagnose childhood obesity. However, few studies have examined the optimal cutoff of percent body fat (%BF) to predict metabolic abnormalities in obese children. METHODS: One thousand fifteen obese children aged 10 to 15 years were enrolled in this study. The %BF cutoff values were calculated by ROC analysis for metabolic abnormalities. We also calculated %BF cutoff values corresponding to a BMI of > 85th or 95th percentile for gender and age and a PWH of > 120% for gender and height based on the 2007 Korean children and adolescents growth standard chart. To define metabolic abnormalities in children, we used the criteria of metabolic syndrome recommended by International Diabetes Federation consensus for children and adolescents. RESULTS: The %BF cutoff corresponding to the group having more than one metabolic abnormality in this study population were 38.4% (sensitivity 40.1%, specificity 84.4%) in total, 38.4% (sensitivity 35.4%, specificity 84.8%) in boys and 39.5% (sensitivity 38.9%, specificity 90.9%) in girls. The %BF cutoff values corresponding to a BMI > or = 95 percentile were 38.1% (sensitivity 50.5%, specificity 72.7%), a BMI > or = 85 percentile were 34.5% (sensitivity 69.3%, specificity 74.2%), and a PWH > or = 120% were 36.4% (sensitivity 72.3%, specificity 64.4%) in total. CONCLUSION: The optimal cutoff value of percent body fat to predict metabolic abnormalities in obese children may be 38.4% (boys 38.4, girls 39.5%) and we suggest 34.5% as a cutoff value of %BF for screening childhood obesity.

The Relation of Physical Activity to Helath Related Quality of Life

BACKGROUND: Numerous studies have identified that physical activity influences decrements of both mortality and morbidity. Besides these objective indices, positive influences of physical activity on individuals' lives are being studied upon various populations. The purpose of this study was to evaluate the association of physical activity on health-related quality of life (HRQOL) in relatively healthy adults of Korea. METHODS: Questionnaires were sent by mail to one thousand examinees who were scheduled for health check-up. We analyzed data from 214 men and 195 women. The physical activities were measured using the International Physical Activity Questionnaraire (IPAQ)-short form and the HRQOL was assessed by the CMCHS ver 1.0. The subjects were separated by gender and into either a recommended level of physical activity group or a lower physical activity group according to the physical activity scale. RESULTS: The group with physical activity beyond the recommended level had better HRQOL measures than those who did not. After revising the factors that affected the HRQOL, cognition of present heath status, satisfaction for health status, bodily pain, physical function, emotional function, social function and general health measure scores were significantly higher in the female group with physical activity beyond recommended quantity than those who did not. However, there were no statical significance in the male group. CONCLUSION: Physical activity was associated with health related quality of life in middle aged women.

Colorectal Cancer Screening Recommendations by Primary Care Physicians' in Seoul

BACKGROUND: Regular colorectal cancer (CRC) screening is known to reduce the CRC incidence and mortality. Health care providers can play a key role in recommending screening to healthy people. However, data on providers' CRC screening knowledge, attitude, and practice are sparse in Korea. We investigated primary care physicians' perception and performance of practice guidelines for CRC screening recommendations, and their view of barriers to physicians' adherence to guidelines. METHODS: A questionnaire was administered to 760 primary care physicians of internal medicine, general surgery, and family medicine in Seoul, Korea. The data were collected from March 2 to April 30, 2004, and those of 106 respondents (response rate 14%) were analyzed. RESULTS: Forty seven percent of respondents reported they recommended CRC screening. The most common screening test equipment in primary care settings was the fecal occults blood test (22.6%) followed by sigmoidoscopy (16.0%), colonoscopy (16.0%), and double contrast barium enema (10.4%). However, colonoscopy was recommended the most as a CRC screening method (54%) and only 43% of respondents complied with the interval indicated on the guidelines. Awareness (64.8%) and agreement (93.2%) to CRC screening recommendation by primary care physicians in Seoul, Korea was high, but the screening delivery was suboptimal. Many primary care physicians regarded patient-related factors were more important barriers of CRC screening than environment-related factors. CONCLUSION: There were many barriers to physicians' guideline adherence. It may be useful to develop and improve guidelines in considerationt these barriers to establish appropriate cancer screening.

The Relationship between Health Risk Appraisal and Health-related Quality of Life among Middle-aged Men

BACKGROUND: Recently, several health risk appraisal programs have been developed to suit Korean character which is currently implemented. This study was conducted to find out the correlation with health age and health-related quality of life through health risk appraisal. METHODS: From March 1, 2004 to July 30, 2004, 107 male patients aged 30 to 59 who visited the family medicine clinic in a university hospital and had agreed to participate in the study have been assessed to determine the correlation between health age and health-related quality of life by measuring tools of health risk appraisal, CMCHS V1.0 questionnaire and Yangseng measurement questionnaire. RESULTS: Among the total 107 subjects, 3 were excluded because of incomplete questionnaire. There were 28 people aged in their thirties, 36 in forties, and 40 in fifties. The health age and health-related quality of life showed a negative correlation. The correlation in men in their fift showed the strongest. Indexes between the health age and health perception, changes in health, vitality, morality Yangseng, diet Yangseng, sleep Yangseng and active and rest Yangseng have shown a strong negative correlation (P<0.05). CONCLUSION: The lower the health age is, the better health-related quality of life in several domains of CMCHS V1.0 and Yangseng in middle aged Korean men.

Fatigue Related Factors in Chronic Fatigue Patients with Chronic Widespread Pain after Treatment

BACKGROUND: The mechanism of fatigue in patients with fibromyalgia (FM) and CFS (CFS) has not been clarified, but recently there are opinions that chronic pain is a major factor causing chronic fatigue. We performed this study to identify major factors related to chronic fatigue. METHODS: The subjects were 37 patients aged over 18 who visited the primary care institute of a university hospital, whose major symptoms were chronic widespread pain and chronic fatigue and who were given the diagnosis of FM or CFS. The research was carried out through four weeks of symptomatic treatment. The correlation of fatigue severity with the intensity of pain, depression level and anxiety level was analyzed, and regression analysis was conducted to examine the relation between improvement of fatigue after the four weeks' treatment and changes in the intensity of pain, depression level and anxiety level. RESULTS: After the four week treatment, only the intensity of pain was significantly correlatied with fatigue severity. In addition, only change in the intensity of pain was statistically significantly correlatied with the improvement of fatigue. CONCLUSION: In patients who complained of chronic fatigue and chronic widespread pain, the improvement of fatigue after treatment was related to the reduction of pain but not emotional factors such as depression and anxiety.

Primary Care Physicians Attitudes Toward Medically Unexplained Symptoms

BACKGROUND: The medically unexplained symptoms present one of the most common problems in medical practice and the role of primary care physicians is becoming greater to manage them. Our goal was to investigate how the primary care physicians conceive and deal with patients complaining of medically unexplained symptoms (MUS). METHODS: A group of 840 primary care physicians, 524 internist and 316 family physicians in Seoul were surveyed. The questionnaire regarding the perception and the way of consultation about MUS was posted by mail. RESULTS: A total of 180 questionnaires were collected via mail and fax. Ten of them were uncompleted, and the response rate was 22%. Over half of the respondents felt that the consultation of MUS was difficult and they were concerned about the possibility of overlooking some of organic problems (57.6%). Average consultation rate of MUS in daily practice was 14%. The anxiety toward failure of treatment was the most common concern during the MUS consultation. Seventeen percent answered they knew the efficient method to deal with MUS patients. Respondents complained of the deficiency of contents and experiences to deal with MUS during the period of training (80%). More family physicians compared to internists perceived patients with MUS to have personality problems and they often tended to prescribe psychotropic drugs. Family physicians also answered that the training courses provided proper knowledge and contents regarding MUS consultation more than the internists. CONCLUSION: MUS consultation imposes a burden on primary care physicians. Therefore, continuing education not only for residency but for post graduates should be considered for effective management for MUS.

Desired Weight of Obesity Patients

BACKGROUND: Although expert panels and guidelines recommend that 5~10% weight reductions of initial body weight have beneficial effects for decreasing obesity-related complications, obese persons tend to desire greater weight losses. Little is known about the patients' expectations and the disparity of goal weight between physicians and patients. The aim of this study was to evaluate the patients' weight loss expectation, and the association between the degree of desired weight losses and treatment outcomes. METHODS: A total of 283 obese subjects (84 men, 199 women), aged > or =20 years with body mass index (BMI) over 25 kg/m2 from 19 obesity clinics were included. Patients' desired weight as evaluated using modified GRWQ (Goals and Relative Weight Questionnaire) which included goal weight, ideal weight, satisfactory weight, acceptable weight, and disappointed weight. After 12 weeks, subsequent weight changes and treatment adherence were investigated. RESULTS: Mean BMI of men and women were 30.9+/-4.2 kg/m2 and 29.1+/- 3.8 kg/m2, respectively. Men expected 13.2 kg (14.0%) mean weight reductions and women expected 10.8 kg (15.7%) mean reductions during the 3 months. The heavier the patient's weight, the greater the reduction amount was desired in both men and women. During the 3 months, the dropout rates of men and women were 40.1% and 46.2%, respectively. In women, the amount of desired weight reduction as significantly higher in the dropout group compared to the non-dropout group. Those who attained pre-determined goal weight after 3 months were 6% for men and 4% for women. After 3 months, 81% of male subjects and 80% of female subjects had not achieved even their predefined disappointed weight. CONCLUSION: Obese patients seeking treatment expected average of 15% weight reduction, greater than 'medically reasonable or successful' weight reductions. The disparities between patients' expectations and physicians' recommendations could influence treatment adherence.

Association between Type and Amount of Exercise with Bone Mineral Density in Adult Women

BACKGROUND: Although lack of exercise is well known to be a risk factor of osteoporosis, it is unclear whether weight-bearing exercise has different effects on bone mineral density compared to non weight-bearing exercise, and the amount of exercise needed to prevent osteoporosis is not clearly defined. This study was performed to clarify the relations between the type and the amount of exercise with BMD. METHODS: This was a cross-sectional study of 3,661 women who had undertaken health screening including BMD measurement at Health Promotion Center of SNUH between May 1997 and March 1999. Information on sociodemographic characteristics, menarche, childbirth andexercise were gathered by means of self-reported questionnaire, and BMD was measured using DEXA. RESULTS: The number of women with lumbar osteoporosis were 601 (16.4%) and femoral neck osteoporosis 372 (10.2%). Lumbar osteoporosis occurred more frequently with increasing age and age at menarche, and in menopausal women, but less frequently with increasing fat-free mass in multiple logistic regression analysis. When adjusted for age, age at menarche, menopause and fat-free mass, lumbar osteoporosis was less common in women who exercised, but the type and the amount of exercise had no bearing. Especially, lumbar osteoporosis was least common in women engaging in moderate amount of exercise. Femoral neck osteoporosis decreased significantly only in weight-bearing exercise group and in women engaging in high amount of exercise. CONCLUSION: The results of this study suggest that lumbar osteoporosis can be prevented through exercise regardless of its type and amount, and high amount or weight- bearing exercise is most effective to prevent femoral neck osteoporosis.

Factors of Patient Satisfaction with Pain Management in Cancer Patients

BACKGROUND: For cancer patients, pain is the most common symptom and the most important factor that seriously affects their treatment and quality of life. The purpose of the research was to determine the controllable factors for pain management in order to increase patients' satisfaction for pain management. METHOD: This study was based on the survey answers and medical records of 464 cancer patients, in 8 hospitals in Korea from March until September 2000. RESULTS: As shown by Chi-square test, according to the degree of satisfaction for cancer pain management, those patients who were "satisfied" with pain treatment showed better activity rate (P=0.007) than the "unsatisfied" group. Additionally, the frequency of using painkillers according to WHO step-ladder, Pain Management Index (PMI), or patients own knowledge and attitude toward cancer pain control was not found to be relevant to patients satisfaction (P=0.106, P=0.382, P>0.05). But, in the "satisfaction" group, more patients were informed of the importance of pain management (P=0.004) and reported less pain (P<0.05). A close relationship between higher satisfaction and lower pain interference rate was discovered, but no correlation was found for activity, mood, or gate. The average of interference rate was lower in the "satisfaction" group (P<0.05). CONCLUSION: For higher satisfaction rate for pain management among cancer patients, high activity rate, patient education of importance of pain management, less severity of pain, and low interference rate in life are found to be the determinants.