Clinical Practice Guidelines for Managing Frailty in Community-Dwelling Korean Elderly Adults in Primary Care Settings / 가정의학회지

Aging has become a global problem, and the interest in healthy aging is growing. Healthy aging involves a focus on the maintenance of the function and well-being of elderly adults, rather than a specific disease. Thus, the management of frailty, which is an accumulated decline in function, is important for healthy aging. The adaptation method was used to develop clinical practice guidelines on frailty management that are applicable in primary care settings. The guidelines were developed in three phases: preparation (organization of committees and establishment of the scope of development), literature screening and evaluation (selection of the clinical practice guidelines to be adapted and evaluation of the guidelines using the Korean Appraisal of Guidelines for Research and Evaluation II tool), and confirmation of recommendations (three rounds of Delphi consensus and internal and external reviews). A total of 16 recommendations (five recommendations for diagnosis and assessment, 11 recommendations for intervention of frailty) were made through the guideline development process. These clinical practice guidelines provide overall guidance on the identification, evaluation, intervention, and monitoring of frailty, making them applicable in primary care settings. As aging and “healthy aging” become more and more important, these guidelines are also expected to increase in clinical usefulness.

Physical Activity Patterns and Their Associated Factors Measured by Global Physical Activity Questionnaire Survey among Korean / 대한스포츠의학회지

Research on physical activity and health is actively being conducted. In the Korea National Health and Nutrition Examination Survey (KNHANES), the Global Physical Activity Questionnaire (GPAQ) was newly introduced in 2014. The purpose of this study was to investigate the levels of physical activity and related factors in Koreans who were assessed through the GPAQ by dividing the physical activity by occupation, leisure, and transport domain. This study used data from the KNHANES (2014–2016), the study population of which included 17,357 participants aged 12 to 80 years. We compared the differences in physical activity by sociodemographic factors, health-related factors, and psychological health-related factors. Moreover, we also compared the mean metabolic equivalent of task and daily sitting time according to physical activity domain by sex and age group. Finally, we investigated the sociodemographic factors, health-related factors, and psychological health-related factors that significantly affect the average physical activity per week. The various factors were found to differ in the frequency of physical activity levels. In addition, there was a difference in the amount of physical activity per occupation, leisure, and transport domain in each age group. Finally, age, sex, high-density lipoprotein cholesterol levels, arthritis, allergic rhinitis and sinusitis, sleeping time, and perceived health status significantly affected physical activity. The levels of physical activity significantly differed by sociodemographic factors, health-related factors, and psychological health-related factors. There was also a difference in the physical activity levels according to the age and sex per each domain of physical activity.

Prediction of Suicidal Ideation among Korean AdultsUsing Machine Learning: A Cross-Sectional Study

Objective@#Suicidal ideation (SI) precedes actual suicidal event. Thus, it is important for the prevention of suicide to screen the individualswith SI. This study aimed to identify the factors associated with SI and to build prediction models in Korean adults using machinelearning methods. @*Methods@#The 2010–2013 dataset of the Korea National Health and Nutritional Examination Survey was used as the training dataset(n=16,437), and the subset collected in 2015 was used as the testing dataset (n=3,788). Various machine learning algorithms were appliedand compared to the conventional logistic regression (LR)-based model. @*Results@#Common risk factors for SI included stress awareness, experience of continuous depressive mood, EQ-5D score, depressivedisorder, household income, educational status, alcohol abuse, and unmet medical service needs. The prediction performances of themachine learning models, as measured by the area under receiver-operating curve, ranged from 0.794 to 0.877, some of which were betterthan that of the conventional LR model (0.867). The Bayesian network, LogitBoost with LR, and ANN models outperformed the conventionalLR model. @*Conclusion@#A machine learning-based approach could provide better SI prediction performance compared to a conventional LRbasedmodel. These may help primary care physicians to identify patients at risk of SI and will facilitate the early prevention of suicide.Psychiatry Investig 2020;17(4):331-340

Vaccination for Athletes: Evidence and Recommendations / 대한스포츠의학회지

As interest in sports rapidly grows in Korea, fostering of elite athletes and preservation of the athletic ability no longer became the task of advanced countries only. In that aspect, health of athletes and their associated coaches, athlete trainers, team members such as team doctors, and even their families is certainly a matter of concern. Especially when it comes to the inoculation of infectious disease prevention, it needs to be considered as one of the most economical and effective ways to promote health in sports people as well as elite athletes. The purpose of this article is to go over the specific circumstances of the athletes and related literatures on vaccination. In addition, we provide recommendations on the vaccination of athletes regarding the actual situation of sports in Korea.

The Relationship between Electronic Cigarette Use with or without Cigarette Smoking and Alcohol Use among Adolescents: Finding from the 11th Korea Youth Risk Behavior Web-based Survey / 가정의학회지

BACKGROUND: Electronic cigarette (EC) consumption (‘vaping’) is rapidly increasing, not only in adults but also in adolescents. Little is known about the association between vaping and problem behaviors such as drinking. METHODS: We used data from the 11th Korea Youth Risk Behavior Web-based Survey, which was conducted in 2015 and included 68,043 participants who were Korean middle and high school students. The survey assessed EC, cigarette, and alcohol use. Multiple regression analysis was used to examine risk of current drinking and problem drinking across the following categories of users: never user (never used either product), former user (use of EC or cigarettes in the past, but not currently), vaping only, smoking only, and dual user (current use of both products). RESULTS: EC only users were 1.2% in males, and 0.3% in females. Dual user of both conventional cigarettes and ECs were 5.1% in males, and 1.2% in females. Drinking frequency, drinking quantity per once, and problem drinking were higher among vapers than non-vapers and former-vapers, moreover, were higher among daily vapers than intermittent vapers. Compared to never users, EC only users were higher on risk of current drink and problem drink. The dual users were highest on risk of current drink. CONCLUSION: Vaping is independently associated with alcohol use problems in Korean students, even those not currently smoking. Moreover, dual use of cigarettes and ECs is strongly associated with alcohol use problems. Therefore, vaping students should be concerned about their hidden alcohol use problems.

Erratum: Instant noodle consumption is associated with cardiometabolic risk factors among college students in Seoul

The paper by Huh et al. [1] was printed with an error the name and affiliation of author.

Cut-Off Values for Visceral Fat Area Identifying Korean Adults at Risk for Metabolic Syndrome / 가정의학회지

BACKGROUND: Cut-off values for visceral fat area (VFA) measured by computed tomography (CT) for identifying individuals at risk of metabolic syndrome (MetS) have not been clearly established in Korean adults, particularly for large populations. We aimed to identify optimal VFA and waist circumference (WC) cut-off values and compare the ability of VFA and WC to predict the presence of ≥2 metabolic risk factors. METHODS: We included 36,783 subjects aged 19–79 years undergoing abdominal fat CT during regular health checkups between January 2007 and February 2015 in Seoul. The risk factors for MetS except WC were based on the International Diabetes Federation criteria. Receiver operating characteristic curve analyses were used to determine the appropriate VFA and WC cut-off values for MetS. RESULTS: VFA was a more significant predictor of metabolic risk factors than WC and body mass index (BMI). The optimal cut-off values for VFA and WC were 134.6 cm2 and 88 cm for men and 91.1 cm2 and 81 cm for women, respectively. We estimated age-specific cut-off values for VFA, WC, and BMI. VFA cut-off values increased with age, particularly among women. CONCLUSION: This large population study proposed the cut-off values for VFA and WC for identifying subjects at risk of MetS among Korean adults. For more accurate diagnosis, different age-specific cut-off values for VFA and WC may be considered.

Improvement of Health Indicators after Participating in Health Promotion Program of General Hospital Staff: A Pilot Study

BACKGROUND@#An 8-week health program is achieved for health providers in a general hospital in Seoul to verify whether health parameters are enhanced by improving life habits. We want to examine the effect of this program with measuring health parameters and exercise ability. This study is performed as a pilot study, and the goal is to introduce the outcome of health program with experimental methods.@*METHODS@#Participants of this research consist of 42 health providers who were overweight, and they enrolled an 8-week health program in 2015. They took a class about improving eating habits and recorded daily diet. Moreover, they implemented exercise program with encouraging active participation by rewarding members who attended the program frequently.@*RESULTS@#The result is analyzed with 31 participants who finished the program. There are 4 men whose physical indices correspond with the criteria of metabolic syndrome. Otherwise, 27 women have physical indices below the criteria. The result indicates that physical indices would not reveal meaningful changes. However, basal fitness comprised of flexibility, sit-up, and back muscle strength implies meaningful improvement.@*CONCLUSIONS@#Even though there were some problems to revise in exercise intervention, it was accomplished systematically while nutrition intervention was not controlled strictly. In addition, factors including inspiring the enrollment of men and extending the period of program should be considered to improve the next program. The final goal of the health promoting hospital is to improve the health of health providers by sustaining this program with developing exercise and nutrition intervention in detail.

Improvement of Health Indicators after Participating in Health Promotion Program of General Hospital Staff: A Pilot Study

BACKGROUND: An 8-week health program is achieved for health providers in a general hospital in Seoul to verify whether health parameters are enhanced by improving life habits. We want to examine the effect of this program with measuring health parameters and exercise ability. This study is performed as a pilot study, and the goal is to introduce the outcome of health program with experimental methods. METHODS: Participants of this research consist of 42 health providers who were overweight, and they enrolled an 8-week health program in 2015. They took a class about improving eating habits and recorded daily diet. Moreover, they implemented exercise program with encouraging active participation by rewarding members who attended the program frequently. RESULTS: The result is analyzed with 31 participants who finished the program. There are 4 men whose physical indices correspond with the criteria of metabolic syndrome. Otherwise, 27 women have physical indices below the criteria. The result indicates that physical indices would not reveal meaningful changes. However, basal fitness comprised of flexibility, sit-up, and back muscle strength implies meaningful improvement. CONCLUSIONS: Even though there were some problems to revise in exercise intervention, it was accomplished systematically while nutrition intervention was not controlled strictly. In addition, factors including inspiring the enrollment of men and extending the period of program should be considered to improve the next program. The final goal of the health promoting hospital is to improve the health of health providers by sustaining this program with developing exercise and nutrition intervention in detail.

The Association between Sitting Time and Health-Related Quality of Life According to Body Mass Index in Elderly Korean

BACKGROUND: Although obesity and health-related quality of life (HRQOL) in elderly are well known to be associated with obesity and sitting time, it is unclear whether effect of sedentary lifestyle on HRQOL is affected by body mass index (BMI) or not. So we analyzed the relationship between sitting time and HRQOL according to BMI groups in elderly Korean. METHODS: Participants aged over 60 from the 6th Korea National Health and Nutrition Examination Survey (2014 and 2015) were included. Participants were classified as normal weight and overweight/obese groups. Mean sitting times were compared between groups according to the EuroQol 5 dimension (EQ-5D) And logistic regression analyses were performed. RESULTS: Men with mobility, usual activity, or pain/discomfort domain problem had longer sitting time. Women with a problem in every domain had longer sitting time. Overweight/obese women with problem showed longer sitting time. Odds ratios (ORs) of mobility, usual activity, pain or discomfort, and low EQ-5D score domain were increased regardless of BMI groups in men. But, ORs of all domains were increased only in overweight/obese group in women. CONCLUSIONS: In elderly Korean, prolonged sitting time associated with decreased HRQOL. Impaired HRQOL is associated with increased sitting time regardless of BMI in men. But only overweight/obese group showed association between prolonged sitting time and impaired HRQOL in women. These results represents that decrease in quality of life according to the increase of the sitting time differs according to the BMI in elderly Korean women.

A Twenty-Minute Nap Boosts the Planning Domain of Executive Function in Sleep Deprived Late Adolescents

OBJECTIVES: The positive effects of nap on cognitive function and memory have been researched intensively among children and adults. However, the relationship between afternoon nap and executive function among sleep deprived late adolescents has not been studied as much. METHODS: Ten sleep deprived, otherwise healthy Korean high school students were recruited, and asked to fill out Pittsburgh Sleep Quality Index questionnaire. They were put to nap for 5 min on three days during the first week, then for 10, 20, and 30 min in the same protocol during the consecutive weeks. After a 1-h class, both the students themselves and their corresponding teachers evaluated the participation level of the participants. They were then divided into two groups, and were instructed to play iPad game ‘Free Flow’. One group took a nap while the other group was prohibited from taking a nap. Both groups were instructed to play the game again. This was repeated once every afternoon for three days. RESULTS: The experiment showed that 20-min nap was superior in subjective evaluations to the other nap duration, and the mean game score differences before and after were significantly higher in the nap taking group after the 20-min nap when analyzed using non-parametric statistical method (p-value 0.04). CONCLUSIONS: Therefore, 20-min nap is likely to boost planning domain of executive function on sleep deprived late adolescents.

The Association between Hand Grip Strength and Health-Related Quality of Life in Korean Adults / 대한스포츠의학회지

We investigated the association between hand grip strength (HGS) and health-related quality of life (HRQOL). A total number of 9,211 participants from the sixth Korean National Health and Nutrition Examination Survey (2014– 2015) were included. HRQOL was measured by EuroQol-5 dimension (EQ-5D) and EQ-5D index score. Participants were classified as normal HRQOL group or impaired HRQOL group according to the EQ-5D responses and the EQ-5D index scores. HGS was measured using Takei dynamometer. Impaired HRQOL group represented lower mean HGS than that of normal HRQOL group. According to the quintile groups of HGS, group with the lowest HGS showed the lowest mean EQ-5D index score in both sexes. And the more HGS increases, the more EQ-5D index score increases also (p-value for trend <0.001). Men and women with lower grip strength were more likely to report ‘some’ or ‘extreme problem’ in EQ-5D domains (except anxiety/depression and pain/discomfort domain in men), and also more likely to belong to the lowest 20% level group in EQ-5D index score according to logistic analyses. Our findings suggest that HGS is associated HRQOL. Low HGS is associated with impaired status of HRQOL by EQ-5D and EQ-5D index score in Korean men and women. More research is needed to evaluate the specific plausibility between HGS and HRQOL.

Instant noodle consumption is associated with cardiometabolic risk factors among college students in Seoul

BACKGROUND/OBJECTIVES: Increased consumption of instant noodles has recently been reported to be positively associated with obesity and cardiometabolic syndrome in South Korea, which has the highest per capita instant noodle consumption worldwide. This study aimed to investigate the association between instant noodle consumption and cardiometabolic risk factors among college students in Seoul. SUBJECTS/METHODS: The study subjects consisted of 3,397 college students (1,782 male; 1,615 female) aged 18-29 years who participated in a health checkup. Information on instant noodle consumption was obtained from the participants' answers to a question about their average frequency of instant noodle intake over the 1 year period prior to the survey. RESULTS: Statistical analysis using a general linear model that adjusted for age, body mass index, gender, family income, health-related behaviors, and other dietary factors important for cardiometabolic risk, showed a positive association between the frequency of instant noodle consumption and plasma triglyceride levels, diastolic blood pressure, and fasting blood glucose levels in all subjects. Compared to the group with the lowest frequency of instant noodle intake (≤ 1/month), the odds ratio for hypertriglyceridemia in the group with an intake of ≥ 3/week was 2.639 [95% confidence interval (CI), 1.393–5.000] for all subjects, while it was 2.149 (95% CI, 1.045–4.419) and 5.992 (95% CI, 1.859–21.824) for male and female students, respectively. In female students, diastolic blood pressure was also higher among more frequent consumers of instant noodles. CONCLUSIONS: Our results suggest that frequent consumption of instant noodles may be associated with increased cardiometabolic risk factors among apparently healthy college students aged 18–29 years.

Effects of Three-Week Stair Climbing Exercise for Weight Control: A Case Series Study / 대한스포츠의학회지

This study is designed to check whether everyday-life stair climbing, which is a low-cost and readily accessible form of exercise, is effective for reducing overweight of sedentary people in various health indicators. We selected four overweight people and measured body weight, body fat percentage, muscle quantity, pulmonary function, lower-extremity strength and volume of thigh muscle and fat. After 3-week exercise of climbing stairs in more than 5 minutes twice a day, same procedures were taken. Body weight was reduced by 3.35 kg on average (standard deviation [SD], 0.79), and body fat mass by 2.53 kg (SD, 1.36). Lower extremity strength improved about 5%, and slight loss of thigh fat (right 3.2%; left 13.4%) was observed. However, pulmonary function and muscle quantity did not grow significantly. Although only four people may not be representative as targets, but it is suggested that stair climbing has sufficient utility as an easily accessible exercise.

Six-week Diet Correction for Body Weight Reduction and Its Subsequent Changes of Gut Microbiota: A Case Report

Impact of intestinal microbes on obesity and health is a new topic recently started to get attention. Comparing to the global concern and research trends, there are few research on the association between intestinal bacteria and life style disease in Korean. One voluntary case (female) was reported to show the change in gut microbiota and weight by diet intervention. She was overweight (BMI 23.2 kg/m2) and has abnormal liver function, and the causes of overweight were frequent drinking and meat consumption at the late evening hours. For 47 days, she was administered an improved diet on breakfast and dinner with reduction of meat consumption frequency by 50%. Alcohol consumption was reduced to once a week. As a result, she lost 3 kilograms of body weight. Her fecal sample was collected before and after the intervention, and gut microbiota change was compared using a high-throughput sequencing technique. After diet correction, the shift of gut microbiota was clearly observed with decreased proportion of Firmicutes (from 75.7% to 47.3% in total microbiota) but increased proportion of Bacteroidetes upto 47.7%. After incorporating the diet intervention, it is meaningful to confirm the changes in dominant gut microbiota and weight loss.

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.

Physical Activity and Exercise for Men with Late Onset Hypogonadism / 대한남성과학회지

Late onset hypogonadism (LOH, also referred to as age-associated testosterone deficiency syndrome, TDS) is a clinical and biochemical syndrome associated with advancing age and characterized by symptoms and a deficiency in serum testosterone levels. It may result in a significantly reduced quality of life and adversely affect the function of multiple organ systems. Although the treatment of LOH is primarily based on hormone replacement, other treatment modalities (medical or non-medical treatment) can also be considered for various accompanying symptoms. The efficacy of exercise in the treatment of LOH has already been evaluated in several studies, and many of them show beneficial effects for some specific symptoms and diseases. This study was designed to evaluate the relationship between exercise and plasma testosterone levels, and the potential beneficial effects of exercise for each specific symptom of LOH, and finally to consider the appropriate exercise treatment for LOH.