Swimming Exercise Ameliorates Symptoms of MOG-Induced Experimental Autoimmune Encephalomyelitis by Inhibiting Inflammation and Demyelination in Rats / 대한배뇨장애요실금학회지

Purpose@#Multiple sclerosis is an autoimmune disease that affects the central nerve system, resulting in cumulative loss of motor function. Multiple sclerosis is induced through multiple mechanisms and is caused by inflammation and demyelination. This study aims to evaluate the neuroprotective effect of swimming exercise in experimental autoimmune encephalomyelitis (EAE) rats, an animal model of multiple sclerosis. @*Methods@#EAE was induced by an intradermal injection of 50-μg purified myelin oligodendrocyte glycoprotein 33–55 (MOG33-55) dissolved in 200-μL saline at the base of the tail. The rats in the swimming exercise group were made to swim for 30 minutes once pert a day for 26 consecutive days, starting 5 days after induction of EAE. To compare the effect of swimming exercise with interferon-β, a drug for multiple sclerosis, interferon-β was injected intraperitoneally into rats of the EAE-induced and interferon-β-treated group during the exercise period. @*Results@#Injection of MOG33-55 caused weight loss, decreased clinical disability score, and increased level of pro-inflammatory cytokines and inflammatory mediators in the lumbar spinal cord. Loss of motor function and weakness increased demyelination score. Swimming exercise suppressed demyelination and expression of pro-inflammatory cytokines and inflammatory mediators. These changes promoted recovery of EAE symptoms such as body weight loss, motor dysfunction, and weakness. Swimming exercise caused the same level of improvement as interferon-β treatment. @*Conclusions@#The results of this experiment suggest the possibility of swimming exercise in urological diseases that are difficult to treat. Swimming exercises can be considered for relief of symptom in incurable multiple sclerosis.

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 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.

Association between Obesity and Neighborhood Socioeconomic Status in Korean Adolescents Based on the 2013 Korea Youth Risk Behavior Web-Based Survey / 가정의학회지

BACKGROUND: An increase in the obese adolescent population is being recognized as a serious medical and social problem. The present study aimed to examine the association between neighborhood socioeconomic status (SES) and obesity in Korean adolescents based on total available resources and local social inequality models. METHODS: The present study used data from the 2013 Korea Youth Risk Behavior Web-based Survey in analyzing 72,438 Korean adolescents aged 12-18. The analysis investigated obesity odds ratio (OR) according to neighborhood SES adjusted for age and individual SES indices, which included family affluence scale (FAS), education level of parents, cohabitation with parents, and weekly allowance. Obesity OR was investigated according to neighborhood SES by FAS, and according to FAS by neighborhood SES. RESULTS: After adjusting for age and individual SES variables, there was no significant association between neighborhood SES and adolescent obesity for either boys or girls. However, girls in the high FAS group showed a pattern of lower neighborhood SES being associated with a significant increase in risk of obesity; in the high neighborhood SES group, boys showed a pattern of higher FAS being associated with a significant increase in risk of obesity, whereas girls show a pattern of decrease. CONCLUSION: Although limited, the present study demonstrated that some girl groups exhibited a pattern of lower neighborhood SES being associated with an increase in risk of obesity, as well as a gender-based difference in risk of obesity by individual SES. Therefore, measures to prevent adolescent obesity should be established with consideration for differences in risk according to individual and neighborhood SES.

Endovascular Revascularization for Patients with Critical Limb Ischemia: Impact on Wound Healing and Long Term Clinical Results in 189 Limbs

OBJECTIVE: To evaluate the impact on wound healing and long-term clinical outcomes of endovascular revascularization in patients with critical limb ischemia (CLI). MATERIALS AND METHODS: This is a retrospective study on 189 limbs with CLI treated with endovascular revascularization between 2008 and 2010 and followed for a mean 21 months. Angiographic outcome was graded to technical success (TS), partial failure (PF) and complete technical failure. The impact on wound healing of revascularization was assessed with univariate analysis and multivariate logistic regression models. Analysis of long-term event-free limb survival, and limb salvage rate (LSR) was performed by Kaplan-Meier method. RESULTS: TS was achieved in 89% of treated limbs, whereas PF and CF were achieved in 9% and 2% of the limbs, respectively. Major complications occurred in 6% of treated limbs. The 30-day mortality was 2%. Wound healing was successful in 85% and failed in 15%. Impact of angiographic outcome on wound healing was statistically significant. The event-free limb survival was 79.3% and 69.5% at 1- and 3-years, respectively. The LSR was 94.8% and 92.0% at 1- and 3-years, respectively. CONCLUSION: Endovascular revascularization improve wound healing rate and provide good long-term LSRs in CLI.

Differential Association of Adiposity Measures with Heart Rate Variability Measures in Koreans

PURPOSE: Although obesity has been associated with imbalances in cardiac autonomic nervous system, it is unclear whether there are differential relationships between adiposity measures and heart rate variability (HRV) measures. We aimed to examine differences in the relationship between adiposity measures and HRV indices in a healthy Korean population. MATERIALS AND METHODS: In all, 1409 non-smokers (811 males, 598 females) without known histories of cardiovascular (CV), endocrine, or neurological diseases underwent adiposity measurements [(body mass index (BMI), percentage of body fat mass (PBF), and waist-to-hip ratio (WHR)], the HRV assessment (SDNN, RMSSD, LF, HF, LF/HF, and pNN50), and examination for CV risk factors (fasting glucose, LDL-cholesterol, HDL-cholesterol, triglycerides, hs-CRP, and blood pressure). RESULTS: Compared with BMI and PBF, WHR was more strongly correlated with each HRV index and more likely to predict decreased HRV ( or =15 percentile of each HRV index) in ROC curves analysis. In linear regression analysis, all adiposity measures were inversely associated with each HRV measure before adjusting for age, gender, and CV risk factors (p or =25 kg/m2, but not for those with BMI <25 kg/m2. CONCLUSION: WHR and PBF appear to be better indicators for low HRV than BMI, and the association between abdominal adiposity and HRV may be stronger in overweight subjects.

Obesity Phenotype and Coronary Heart Disease Risk as Estimated by the Framingham Risk Score

There are conflicting data as to whether general or abdominal obesity is a better predictor of cardiovascular risk. This cross-sectional study involved 4,573 subjects aged 30 to 74 yr who participated in the Fourth Korea National Health and Nutrition Examination Survey conducted in 2008. Obesity phenotype was classified by means of body mass index (BMI) and waist circumference (WC), and participants were categorized into 4 groups. Individuals' 10-yr risk of coronary heart diseases (CHD) was determined from the Framingham risk score. Subjects with obese WC had a higher proportion of high risk for CHD compared to the normal WC group, irrespective of BMI level. Relative to subjects with normal BMI/normal WC, the adjusted odds ratios (ORs) of normal BMI/obese WC group (OR 2.93 [1.70, 5.04] and OR 3.10 [1.49, 6.46]) for CHD risk in male were higher than obese BMI/obese WC group (OR 1.91 [1.40, 2.61] and OR 1.70 [1.16, 2.47]), whereas the adjusted ORs of obese BMI/obese WC group (OR 1.94 [1.24, 3.04] and OR 3.92 [1.75, 8.78]) were higher than the others in female. Subjects with obese BMI/normal WC were not significantly associated with 10-yr CHD risk in men (P = 0.449 and P = 0.067) and women (P = 0.702 and P = 0.658). WC is associated with increased CHD risk regardless of the level of BMI. Men with normal BMI and obese WC tend to be associated with CHD risk than those with obese BMI and obese WC.

Association of Heart Rate Variability with the Framingham Risk Score in Healthy Adults / 가정의학회지

BACKGROUND: The aim of this study was to investigate the relationship between heart rate variability (HRV), the Framingham risk score (FRS), and the 10-year risk of coronary heart disease (CHD) development among Korean adults. METHODS: The subjects were 85 healthy Korean adults recruited from a health check-up center. The FRS and 10-year risk of CHD development were calculated. RESULTS: The FRS in men was inversely correlated with the standard deviation of all normal to normal RR-intervals (SDNN); the root mean square successive difference (RMSSD); the percentage of successive normal cardiac inter-beat intervals greater than 20 ms, 30 ms, and 50 ms (pNN20, pNN30, pNN50); the low frequency (LF); and the high frequency (HF) (P or = 10%. CONCLUSION: This study therefore indicates that the HRV indices, particularly SDNN, RMSSD, pNN30, LF, and HF may be useful parameters for the assessment of CHD risk. Most notably, the usefulness of these HRV measures as indicators for CHD risk evaluation may be greater among men than among women.

Wearable Physiologic Monitoring System in Health Promotion

With the development of body sensor technology, wearable health monitoring systems have been an emerging information technology in the 'ubiquitous health care' system. Wearable sensors enable long-term continuous physiological monitoring important in health promotion and management of many chronic disorders. In this paper, we present several wearable health monitoring systems developed by different countries and discuss emerging opportunities, as well as, existing challenges such as standardization, administration, validation, and discrepancy issues between technology and clinical implication.

Factors Associated with Depressive Symptom in Chronic Obstructive Pulmonary Disease Based on the Third (2005) and Fourth (2008) Korea National Health and Nutritional Examination Survey (KNHANES III, IV) / 가정의학회지

BACKGROUND: Depressive symptoms accompanied by chronic obstructive pulmonary disease (COPD) can be influenced by socioeconomic status, associated chronic diseases and the current smoking status. This study was conducted to assess factors that are associated with depressive symptoms accompanied by COPD, using the data obtained from the Korea National Health and Nutritional Survey (KNHANES) conducted in 2005 and 2008. METHODS: From the third (2005) and the fourth (2008) KNHANES, 407 (0.9%) with physician-diagnosed COPD were selected. Of the 407 subjects, only 180 (0.4%) who reported having depressive symptoms were included in this study. The associations of depressive symptoms with socioeconomic status, associated chronic diseases and smoking status were investigated. RESULTS: Of the total 180 subjects, 45 (25%) had depressive symptoms. There were 102 males (55%) and 78 females (45%) with a slight predilection for males. In multivariate analysis, significant predictors of depressive symptoms were dependent activities of daily living (odds ratio [OR], 2.42; 95% confidence interval [CI], 2.06 to 2.84) and association with number of chronic diseases (OR of one, two, and three, 1.40, 1.72, 2.60; 95% CI of one, two, and three, 1.20 to 1.63,1.41 to 2.10,1.99 to 3.39). CONCLUSION: This study provides the basis for managing COPD patients in a clinical setting by understanding the number and characteristics of COPD patients with depressive symptoms. The results of this study suggest that primary physicians should manage COPD patients with consideration of risk factors for depressive symptom.

Factors Related to Eating Behavior Assessed Using the Dutch Eating Behavior Questionnaire and Change of Eating Behavior after Receiving Weight Reduction Treatment / 가정의학회지

BACKGROUND: This study aimed to examine the factors related to eating behavior subscales and change of eating behavior subscales among obese patients received weight reduction management. METHODS: Eating behavior subscales (restrained eating, emotional eating, and external eating) were assessed using the Korean version of Dutch Eating Behavior Questionnaire in 76 obese female patients at obesity clinic and 83 female visitors at health promotion center. Fifty nine patients received weight reduction management and completed follow-up survey after 2-3 months. Demographics, physical activity, health behaviors, diet experience, BMI, and weight change were assessed. RESULTS: The score of restrained eating was significantly higher in obese patients compared to controls, while scores of other subscales were not different between the two groups. Diet experience, score of emotional eating, and BMI explained 15% of variance of restrained eating score after adjustment for covariates. Likewise, increase of restrained and external eating scores and younger age explained 27% of variance of emotional eating score. External eating score was associated with increase in emotional eating score, higher education, regular exercise, and frequent overeating (R2=30%). Among obese patients, the follow-up score of restrained eating was significantly higher compared to that score at baseline, while the scores of emotional and external eating were not significantly changed. After adjustment for covariates, only irregular eating habit was associated with the change of restrained eating score. CONCLUSION: Restrained eating score was associated with BMI regardless of subjects group, while, among obese patients, the change of restrained eating score was associated with frequent irregular eating habit.

Factors Related to Eating Behavior Assessed Using the Dutch Eating Behavior Questionnaire and Change of Eating Behavior after Receiving Weight Reduction Treatment / 가정의학회지

BACKGROUND: This study aimed to examine the factors related to eating behavior subscales and change of eating behavior subscales among obese patients received weight reduction management. METHODS: Eating behavior subscales (restrained eating, emotional eating, and external eating) were assessed using the Korean version of Dutch Eating Behavior Questionnaire in 76 obese female patients at obesity clinic and 83 female visitors at health promotion center. Fifty nine patients received weight reduction management and completed follow-up survey after 2-3 months. Demographics, physical activity, health behaviors, diet experience, BMI, and weight change were assessed. RESULTS: The score of restrained eating was significantly higher in obese patients compared to controls, while scores of other subscales were not different between the two groups. Diet experience, score of emotional eating, and BMI explained 15% of variance of restrained eating score after adjustment for covariates. Likewise, increase of restrained and external eating scores and younger age explained 27% of variance of emotional eating score. External eating score was associated with increase in emotional eating score, higher education, regular exercise, and frequent overeating (R2=30%). Among obese patients, the follow-up score of restrained eating was significantly higher compared to that score at baseline, while the scores of emotional and external eating were not significantly changed. After adjustment for covariates, only irregular eating habit was associated with the change of restrained eating score. CONCLUSION: Restrained eating score was associated with BMI regardless of subjects group, while, among obese patients, the change of restrained eating score was associated with frequent irregular eating habit.

Reliability and Validity of Korean Version of Questionnaire for Weight Bias Measurement / 가정의학회지

BACKGROUND: Korean versions of Fat Phobia Scale (short form) (F-scale), Beliefs About Obese Persons Scale (BAOP), and Attitudes Toward Obese Persons Scale (ATOP) which are scales of rating weight bias were assessed to find out the reliability and validity. METHODS: Korean versions of F-scale, BAOP, and ATOP were completed twice by 165 adults (85 males, 80 females; 73 hospital staffs, and 92 teachers). Validity was tested using Spearman correlation and factor analysis. Reliability was analyzed using test-retest analyses (Spearman Rho value). RESULTS: Using factor analyses, F-scale comprised of three factors explaining 55.20% of the total variance, BAOP two factors explaining 53.3% of the total variance, and ATOP six factors explaining 61.61% of the total variance. Spearman correlation between F-scale and ATOP was -0.28 to -0.36 (P < 0.05), suggesting that people who worried about being obese tended to have negative attitudes against obesity. The correlation between F-scale and BAOP was -0.25 to -0.27 (P < 0.05), meaning that people who worried about being obese had a tendency to blame obesity on environmental factors. Cronbach's alpha coefficients were 0.79 to 0.90 for F-scale, 0.34 to 0.38 for BAOP and 0.82 to 0.87 for ATOP. Spearman Rho values were 0.47 for F-scale, 0.50 for BAOP, and 0.47 for ATOP (P < 0.05). The scores of each scale were not related to subjects' sex, BMI, body perception, and weight control efforts, while for ATOP scores older subjects were more likely to have a negative view for obesity (P < 0.05). CONCLUSION: The Korean version of F-scale, ATOP and BAOP could be considered as a tool to evaluate weight-bias however, further study is needed for appropriate application.

Characteristics of Diagnosed Novel Influenza A (H1N1) Cases in the Community Sentinel Hospital and Usefulness of Clinical Diagnosis / 가정의학회지

BACKGROUND: The purpose of this paper is to investigate for the epidemiologic and clinical characteristics of patients with diagnosed novel influenza A (H1N1) and to evaluate the usefulness of clinical diagnosis. METHODS: Out of 696 patients who visited the community sentinel hospital for novel influenza from 27 Aug 2009 to 10 Sep 2009, 557 patients had performed the conventional RT-PCR test. Of these patients, 540 patients were enrolled to our study excluding 17 patients who had performed the test for their own request without clinical suspicion. RESULTS: The 79 patients (14.6%) were finally diagnosed as novel influenza by conventional RT-PCR, with median age 19. Main clinical symptoms were febrile sense, cough, rhinorrhea, and sore throat. The odd ratios of the symptoms with fever, febrile sense and myalgia, acute febrile respiratory disease, influenza-likely illness, the age with 10 to 19, and students were statistically significantly higher in finally diagnosed patients group. The sensitivity, specificity, and positive and negative predictive values of rapid antigen test for influenza were 29.4%, 99.3%, 90.9%, and 85.7%, respectively. In the acute febrile respiratory disease and influenza-likely illness, the sensitivity, specificity, and positive and negative predictive value were 77.2%, 38.3%, 17.7%, and 90.7%, and 69.6%, 46.6%, 18.3%, and 89.9%, respectively. CONCLUSION: In the community sentinel hospital, the patients with novel influenza A (H1N1) present the clinical manifestations similar to the common seasonal influenza. Primary health care providers might have a lot of difficulties in differentiation and treatment necessitating consideration of a variety of diagnostic methods.

Combining Tissue Doppler Echocardiography and Lung Rockets Sign in the Differential Diagnosis of Acute Dyspnea

PURPOSE: We tried (1) to determine the discriminating ability of lung rockets sign in lung ultrasound and E/Ea (the ratio of peak early diastolic mitral inflow velocity to peak early mitral annular velocity measured by tissue Doppler echocardiography) known as an indicator of pulmonary edema in acute dyspnea and (2) to develop a new algorithm using two variables. METHODS: This prospective observational study was performed in an urban emergency department. For the patient with dyspnea at rest, we performed bedside emergency ultrasound assessing the presence of lung rockets sign and measuring the E/Ea. Patients were divided into two groups depending on the cause of dyspnea: pulmonary edema or other cause. We compared the two variables and developed an algorithm using decision tree analysis. RESULTS: A total of 66 patients (39 pulmonary edema, 27 other causes) were enrolled. By univariate analyses, there were significant differences between the two groups in the presence of lung rockets sign (p 13.27 had 100% specificity and positive predictive value for pulmonary edema. CONCLUSION: Lung rockets sign in lung ultrasound and measurement of E/Ea could be helpful in the differential diagnosis of shortness of breath quickly and easily in ED.

Usefulness of Bedside Emergency Ultrasound for Detecting Significant Dehydration in Children

PURPOSE: Using bedside emergency ultrasonography (EUS), measurement of the ratio of inferior vena cava (IVC) to abdominal aorta (Ao) diameter may be useful in objectively assessing children with dehydration. The objectives of this study were (1) to analyze the predictability of the ratio of IVC to Ao diameters (IVC/Ao) in dehydrated children and (2) to determine which measurement method would be best to detect significant dehydration in children. METHODS: This prospective observational study was performed in an urban emergency department. Children between 6 months and 6 years of age with clinical suspicion of dehydration and who were admitted to the hospital were enrolled. Using bedside EUS, measurement of IVC and Ao diameters and body weight check were done before IV hydration. We followed up on their body weight during hospitalization. Dividing subjects into (1) a moderate and severely dehydrated group, which was defined as weight change more than 5% during hospitalization, and (2) a non-dehydrated group, we compared the IVC/Ao ratios of the two groups. RESULTS: A total of 59 patients were enrolled. There were significant differences between dehydrated and nondehydrated groups in IVC/Ao on longitudinal views and in the major diameter of IVC/Ao on transverse views (p=0.010 and <0.01, respectively). Its area under the curve in ROC analysis was 0.69 and 0.81, respectively. The cut-off value for the major diameter of IVC/Ao was 0.879 with 85% sensitivity and 79.9% specificity. Laboratory tests such as the BUN/Cr ratio, total CO2, and bicarbonate didn't show any differences between the two groups. CONCLUSION: The IVC/Ao ratio measured in transverse views by bedside EUS could help the emergency physician identify significant dehydration in clinically suspected pediatric patients.

A Cause Analysis of Missed Fractures in an Emergency Medical Center

PURPOSE: A missed fracture is a very common occurrence in the Emergency Department (ED) and can have serious results because of delays in treatment, resulting in long-term disability. It is also one of the most common causes leading to medical legal issues. We analyzed the causes of missed fractures by using a bone scan which is known to be an effective tool for diagnosing bony lesions. METHODS: We reviewed the medical records of trauma patients who underwent a bone scan after being discharged the ED from September 2006 to March 2008. Cases of missed fractures were identified by using electronic medical records to review each diagnosis. Definition of missed fracture was read after bone scan by radiologist. We decided that there was no fracture if we read 'trauma-related lesion' or 'cannot rule out fracture' on a bone scan read by a radiologist. Enrolled patients were analyzed by age, sex, time until bone scan and Injury Severity Score (ISS). Patients were divided into two groups, alert mentality and not-alert mentality, so there were split between a diagnosis group and a missed fracture group. ISS was also used in determining the severity of the patient's injury upon discharge from the ED. RESULTS: A total of 532 patients were enrolled in this study. Of those, 487 patients were in the diagnosis group, and 45 patients (8.4%) were discovered to have had a fracture. Of the 45 missed fracture patients, 34 patients (6.4%) had one-site fractures, 8 patients (1.5%) had two-site fractures, and 3 patients (0.6%) had threesite fractures. The most commonly missed fracture was multiple rib fractures (18 patients, 30.5%), followed by lumbosacral (LS) spine fractures (10 patients, 16.9%), thoracic spine fractures (8 patients, 13.6%), and clavicle fractures (6 patients, 10.2%). Mean age was 50.12+/-18.54 years in the diagnosis group and 57.38+/-16.88 years in the missed fracture group. For the diagnosis group, the mean ISS was 9.03+/-8.26, but in the missed fracture group it was 17.53+/-9.69. Missed fractures were much more frequent in the not-alert mentality (p or =16) group (p<0.01). CONCLUSION: Missed fractures occur most frequent in patients of old age, not-alert mentality, and high ISS. Multiple rib and spine fractures were found to be the most frequent missed fractures, regardless of trauma severity. This study also shows a high possibility of clavicle and scapula fractures in patients with severe trauma.

Association between Smoking Status and Insulin Resistance in Apparently Healthy Korean Men / 가정의학회지

BACKGROUND: Several studies have suggested that smoking may cause insulin resistance. However, the association between smoking and insulin resistance is still controversial. The purpose of this study was to investigate the association between smoking status and insulin resistance in Korean nondiabetic male population. METHODS: A total of 5,969 men, aged > 20 years were recruited from those who visited the Health Promotion Center, Samsung Medical Center between 2005 and 2006. All subjects were divided into three categories: on-smokers (n = 2,594), ex-smokers (n = 1,580), and current-smokers (n = 1,795). Fasting values for glucose and insulin were used to estimate insulin resistance by HOMA (homeostasis model assessment). An independent association between smoking status and HOMA-IR (homeostasis model assessment of insulin resistance) was assessed after adjustment for factors influencing insulin sensitivity such as age, exercise, alcohol, body mass index, abdominal circumference, and blood pressure. RESULTS: HOMA-IR was signifi cantly higher in ex-smokers and current-smokers than in non-smokers (2.09 +/- 0.94 vs. 2.04 +/- 0.90, 1.96 +/- 0.86, P or = 40 pack-years smokers than in non-smokers CONCLUSION: Based on HOMA-IR, previous-smoking and chronic smoking were significantly associated with insulin resistance in apparently healthy Korean nondiabetic men.

An Emergency Ultrasound (EUS)-Enhanced Scoring System for Diagnosing Acute Appendicitis in Patients with Right Lower Quadrant (RLQ) Pain; Constant or Aggravated Pain, Male Sex, and Ultrasound (CAMUS) Scores

PURPOSE: We hypothesized that a new scoring system that included emergency ultrasound (EUS) and clinical or laboratory predictors for diagnosing acute appendicitis (AA) in patients with right lower quadrant (RLQ) pain could decrease the false negative rate when EUS is performed alone. METHODS: During a 10 month period, patients with RLQ pain were evaluated with EUS just after history taking and physical examination. We also checked the 17 well-known predictors of AA. Univariate analyses for each predictor including EUS findings identified 11 predictors. We then tested those predictors with logistic regression analysis. RESULTS: A total 397 patients (mean age=31.13+/-18.25 years: 196 males, 201 females) were enrolled in this study. Among the 397, 247 underwent an operation, but 14 turned out to have normal appendices. Among 233 patients with appendicitis, 75 had a perforated appendix. Four independent correlates of AA (constant pain, aggravated pain, male sex, and positive EUS findings) were identified with logistic regression analysis. We developed a novel scoring system using regression coefficients as follows: 6 points for a positive EUS, 3 points for aggravated pain, 2 points for constant pain, and 2 points for being male. We named the new scoring system "CAMUS" for "Constant or Aggravated pain, Male sex, and UltraSound score". The area under the receiver-operating characteristic curve (ROC) for the CAMUS score for AA was 0.93(95% confidence interval: 0.871 to 0.959). CONCLUSION: Our new CAMUS scoring system can help emergency physicians diagnose AA accurately and rapidly.

Factors Associated with Premenstrual Syndrome in High School Students / 가정의학회지

BACKGROUND: Premenstrual syndrome (PMS) is a common and disabling disorder among adolescents. But the research addressing premenstrual disorders in adolescents is sparse and such disorders may well be underrecognized. In this regard, the study aimed at identifying attributes to premenstrual symptoms by surveying one high school located in Busan, Korea. METHODS: A total of 381 adolescent females who accepted the participation in this study were recruited from one academic high school in Busan, Korea. For the evaluation of risk factors on the PMS, we investigated menstrual patterns, severity of premenstrual symptoms, environment and life events, stress, and physical activity. RESULTS: In bivariate analysis, earlier menarche (P = 0.007), higher BEPSI score (P < 0.001), higher physical activity score (P = 0.003), and drinking alcohol (P = 0.047) were related to PMS symptom severity. On multiple regression analysis, Brief Encounter Psychosocial Instrument Score (P < 0.001), age of menarche (P = 0.003) and physical activity (P = 0.004) were independent explanatory variables of PMS symptom severity. CONCLUSION: This study showed that the relationship between PMS symptom severity and age of menarche and stress was statistically significant in high school girls.