Effect of Aditional Brief Counselling after Periodic Health Examination on Motivation for Health Behavior Change

This study was to evaluate the effect of additional brief counseling by a primary care physician on lifestyle modification of examinees after a periodic health examination. 1,000 participants of the 2007 Korean national health screening program were asked to note any variation in their health behavior after participating in the screening program. The degree of comprehensive motivation for lifestyle modification was assessed in terms of stages of health behavior change. We calculated odds ratio of positive change (enhanced stage of change) with multiple logistic regression analysis and age-adjusted proportion of positive changers. Of 989 respondents, 486 and 503 received the basic and additional programs, respectively. Additional group were more likely to be positive changer than basic group (adjusted OR 1.78; 95% CI 1.19-2.65), and this was more prominent in older age group (adjusted OR 2.38, 95% CI 1.23-4.58). The age-adjusted proportions of positive changers were 22.7% (95% CI, 17.9-28.3) and 36.2% (95% CI, 30.4-42.4) in the basic and additional groups, respectively (P < 0.001). The additional consultation led to improvements in the stage of health behavior change after the health examination. Thus, such a consultation should be considered when designing a health-screening program.

Erratum: Correction of Misspelling of Title and Author Affiliation

We found two errors, title and author affiliation in our published article.

Association of the Metabolic Syndrome and Bone Mineral Density in Postmenopausal Women / 가정의학회지

BACKGROUND: The metabolic syndrome (MS) is a cluster of risk factors of cardiovascular disease. The association between components of the MS and bone mineral density has been researched, but no prior studies have directly evaluated the association with the metabolic syndrome and bone mineral density in Korea. METHODS: We evaluated postmenopausal women who had visited a university hospital from November 2006 to October 2007. Data on their lifestyle, current medical diseases and medications were collected from medical records. Height, body weight, waist circumference and serum lipid profiles were measured. RESULTS: The prevalence of metabolic syndrome was 21.8% in this study. In adjusted analysis including age and other factors, only waist circumference had a close correlation with bone mineral density of femur and lumbar vertebral body (P < 0.05). The bone mineral density of femur and lumbar vertebral body had no correlation with the presence of metabolic syndrome. When stratified by body mass index, corrected bone mineral density revealed no significant correlation with the presence of metabolic syndrome. CONCLUSION: The bone mineral density of postmenopausal women with metabolic syndrome has highly influenced by obesity, especially by abdominal obesity.

Association of the Metabolic Syndrome and Bone Mineral Density in Postmenopausal Women / 가정의학회지

BACKGROUND: The metabolic syndrome (MS) is a cluster of risk factors of cardiovascular disease. The association between components of the MS and bone mineral density has been researched, but no prior studies have directly evaluated the association with the metabolic syndrome and bone mineral density in Korea. METHODS: We evaluated postmenopausal women who had visited a university hospital from November 2006 to October 2007. Data on their lifestyle, current medical diseases and medications were collected from medical records. Height, body weight, waist circumference and serum lipid profiles were measured. RESULTS: The prevalence of metabolic syndrome was 21.8% in this study. In adjusted analysis including age and other factors, only waist circumference had a close correlation with bone mineral density of femur and lumbar vertebral body (P < 0.05). The bone mineral density of femur and lumbar vertebral body had no correlation with the presence of metabolic syndrome. When stratified by body mass index, corrected bone mineral density revealed no significant correlation with the presence of metabolic syndrome. CONCLUSION: The bone mineral density of postmenopausal women with metabolic syndrome has highly influenced by obesity, especially by abdominal obesity.

The Impact of Functional Constipation on the Quality of Life in the Elderly over 60 Years / 가정의학회지

BACKGROUND: Constipation is one of the most common digestive complaints. Although, there are increased interest on the socioeconomic effect of constipation and studies associated with quality of life on constipation, there is no study about the influence of constipation onto quality of life (QOL) in Korea. We studied the impact of functional constipation on QOL. METHODS: Between March to June 2008, person to person survey with 844 elderly aged over 60 years was performed at two senior care centers, a public health center, and secondary hospital in Seoul metrocity and Chung-ju city. The diagnosis of functional constipation was based on the Rome III criteria and QOL was measured by the Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey (SF-36). RESULTS: The average age was 73.6 years and the prevalence rate of constipation was 20.3%. The average SF-36 score was 63.5 in total population, 57.9 in constipation group, and 64.9 in normal group. CONCLUSION: These results suggest that the constipation lowers QOL in adults aged over 60 years old. Further study will be necessary to explore if QOL changes according to the severity of constipation and its treatment and to assess QOL using a disease-specific measurement tool that can be used for Korean environment.

The Impact of Functional Constipation on the Quality of Life in the Elderly over 60 Years / 가정의학회지

BACKGROUND: Constipation is one of the most common digestive complaints. Although, there are increased interest on the socioeconomic effect of constipation and studies associated with quality of life on constipation, there is no study about the influence of constipation onto quality of life (QOL) in Korea. We studied the impact of functional constipation on QOL. METHODS: Between March to June 2008, person to person survey with 844 elderly aged over 60 years was performed at two senior care centers, a public health center, and secondary hospital in Seoul metrocity and Chung-ju city. The diagnosis of functional constipation was based on the Rome III criteria and QOL was measured by the Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey (SF-36). RESULTS: The average age was 73.6 years and the prevalence rate of constipation was 20.3%. The average SF-36 score was 63.5 in total population, 57.9 in constipation group, and 64.9 in normal group. CONCLUSION: These results suggest that the constipation lowers QOL in adults aged over 60 years old. Further study will be necessary to explore if QOL changes according to the severity of constipation and its treatment and to assess QOL using a disease-specific measurement tool that can be used for Korean environment.

Evaluation of Osteoporosis Self-Assessment Tool Usefulness as a Screening Test for Osteoporosis in Korean Men / 가정의학회지

BACKGROUND: This study was done to determine whether the Osteoporosis Self-assessment Tool (OST) can predict central bone mineral density in Korean men above 50 years, as defined by dual energy X-ray absorptionmetry (DXA). METHODS: We applied the OST index to Korean men aged over 50 in Health Promotion Center of Konkuk University Hospital from September 2005 to September 2008. The calculated OST risk index was based on weight and age, truncated to an integer. RESULTS: The study population was 276 men. The mean age, height and weight of the men were 59.7 +/- 6.69 years, 167.6 +/- 6.14 cm and 67.5 +/- 8.93 kg respectively. By DXA, 4.7% of the men had a T score of -2.5 or less, and 46.4% had a T score of -2 or less at the spine, total hip, or femoral neck. The OST index ranged from -4 to 7. Using a cutoff score of 0, we predicted osteoporosis with a sensitivity of 85% and a specificity of 62%. The receiver operating characteristic curve showed an area under the curve of 0.77. When the subjects were analyzed by age and smoking status, the predictive value of the OST was maintained. CONCLUSION: The OST is a simple and useful method to predict osteoporosis in Korean men.

The Relating Factor and Quality of Life of Overactive Bladder in Adults / 가정의학회지

BACKGROUND: Overactive bladder syndrome (OAB) is a common disorder in primary care that affects negatively on the quality of life of outpatients. However, little information is available on related factors and the quality of life in adults with overactive bladder. The purpose of this study was to find related factors of overactive bladder and to measure the quality of life in adults with overactive bladder. METHODS: Among the people who visited a hospital in Seoul and Chung-ju for a health examination or primary care between October 1 and December 31, 2008, we selected 327 participants over 20 years old. We measured their Overactive Bladder Questionnaire (OAB-q), took medical history and reviewed their demographic data. The relationship between OAB, other independent variables and health related quality of life (HRQL) were analyzed. RESULTS: Of 327 respondents, the prevalence of OAB in adults was 38 (11.6%). The factors related to OAB were age (P = 0.007), history of prescription for congestive heart failure (P = 0.023), benign prostatic hyperplasia (BPH) (P = 0.002), and depression (P = 0.008). OAB was significantly associated with BPH medication (P = 0.042; OR = 8.757) and depression medication (P = 0.005; OR = 9.977) in multivariable logistic regression analysis. In each T-test analysis, OAB decreased in HRQL. CONCLUSION: OAB is a common disorder in adults, history of BPH medication and depression medication is more common in OAB. The symptoms that were suggestive of OAB were affected negatively on the quality of life in adults. Effective health care polices and prompt management of OAB should be implemented.

Effects of Whole Body Vibration Exercise on Body Weight and Body Composition in Young Adults / 가정의학회지

BACKGROUND: Whole body vibration exercise is currently being researched for potential therapeutic and exercise performance benefits. Little is known about the physiological effects of whole body vibration on humans. The aim of this study was to examine the effects of whole body vibration on body weight and body compositions. METHODS: One hundred and twelve healthy college students were separated into two groups; one was the whole body vibration exercise group, the other the control group. The exercise program was more than 10 minutes of whole body vibration exercise and the frequency was more than 3 times per week during three months. Body weight and body composition were checked at the beginning and the end point of this study. RESULTS: A total of 91 students finished this study (56 males, 35 females). No significant difference was found in body weight, body mass index, muscle mass, fat mass, body fat ratio, visceral fat area between the study and the control groups. In females, slight increase as found in body weight (exercise vs. control; 1.1 +/- 1.1 kg vs. 0.3 +/- 1.9 kg, P = 0.03), body mass index (0.5 +/- 0.4 kg/m2, 0.0 +/- 0.5 kg/m2, P = 0.002), fat mass (0.8 +/- 0.9 kg, -0.3 +/- 1.4 kg, P = 0.008), and fat ratio (1.0 +/- 1.5%, -0.6 +/- 2.4%, P = 0.03) in the study group compared with the control group, clinically significant or not. The increase mainly occurred in normal body mass index group in the female study group (P < 0.05). CONCLUSION: The results of this study suggest that whole body vibration exercise has no significant effect on reducing body weight and fat mass, visceral fat area and on increasing muscle mass.

Biochemical Markers and Health Behavior Related with Bone Mineral Density in Adult Men / 가정의학회지

BACKGROUND: More than half of the causes of male osteoporosis is due to secondary osteoporosis. Therefore, it is important to detect and modify its related factors. The aim of this study was to find related lifestyle factors and biochemical markers with low bone mineral density (BMD) in Korean men. METHODS: A cross-sectional analysis was performed in men aged 40-69 years who visited a hospital for health checkup from January to March 2007. BMD was measured at proximal femur and lumbar spine by dual energy x-ray absorptionmetry. Lifestyle factors were estimated by a self-administered questionnaire and fasting glucose, uric acid, gamma glutamyltransferase, alkaline phosphatase, creatinine, free testosterone, 25-OH vitamin D, urine deoxypyridinoline, osteocalcin were measured. Multivariate logistic regression was used to find the association to the lowest tertile of BMD. RESULTS: A total of 152 subjects were included. After multivariate analysis adjusted with age, BMI, smoking, alcohol and exercise, different factors were correlated with low bone density in each site of femoral neck and lumbar spine. Factors correlated at both sites were BMI and exercise; lower BMI and doing no exercise increased risks of low bone density. Increasing age and alcohol intake > or = 14 drinks/week were associated with lower BMD at femoral neck. The factors associated with lower lumbar spine BMD only were lower level of uric acid and higher level of urine deoxypyridinoline. CONCLUSION: Different factors were associated with low bone density at femoral neck and lumbar spine in men. BMI and exercise were related in both sites; age, alcohol intake, uric acid and deoxypyridinoline were related on either site.

Concern in and Utilization of the Mass Media Health Information in Community-dwelling Elderly / 가정의학회지

BACKGROUND: Recently, the mass media serves a major role in the public health education, but have not been proven whether they are being appropriately utilized in the elderly. The aim of this study was to identify the elderly person's concern in the mass media health information and utilization behavior. METHODS: Between March to June 2008, one to one survey with the elderly people over 60 years was performed in two elderly welfare centers, one public health center, and two secondary hospitals outpatients and inpatients in Seoul and Chungju. RESULTS: A total of 999 subjects were included. By multivariate analysis, factors significantly associated with low concern in the mass media health information were low educational level, non-exercise group, and low concern in own health (P = 0.001, 0.009, < 0.001, respectively). The most frequently utilized health information source was the mass media. By comparing the frequency of health information utilization, women, low educational level, low income, non-exercise group, underweight, low level of self-evaluated health status, and low concern in health information were significantly associated with the lowest quintile of utilization (P value: < 0.001, 0.005, 0.05, < 0.001, 0.002, 0.03, 0.005, respectively). However, the presence of chronic diseases, such as hypertension, diabetes, had no association. CONCLUSION: In community-dwelling elderly, important factors associated with concern in and utilization of the mass media health information were concern in health, self-evaluated health status, exercise status and socioeconomic factors such as education or income level, rather than comorbid chronic disease.

Performance of the AUDIT Alcohol Consumption Questions (AUDIT-C) and AUDIT-K Question 3 Alone in Screening for Problem Drinking / 가정의학회지

BACKGROUND: In the busy primary care setting, there are several limitations in applying Alcohol Use Disorders Identification Test in Korea (AUDIT-K) to screen problem drinking. Thus, for primary healthcare practice, we evaluated AUDIT-C, which covers questions from 1 to 3 in AUDIT-K, and AUDIT-K Question 3 Alone to present cut points for these two screening questionnaire according to AUDIT-K test scores. METHODS: In a university hospital, we surveyed 302 males with a drinking history via self-administered questionnaire including AUDIT-K, from November 2007 to April 2008. On the basis of total score in AUDIT-K, we divided them into four groups: normal, problem drinking, alcohol use disorder, and alcohol dependence. For each alcohol drinking behavior pattern, we drew the receiver operating characteristics (ROC) curves to present cut points for appropriate sensitivity and specificity. In addition, we compared the performance of AUDIT-C and AUDIT-K Question 3 Alone through area under the curve (AUC). RESULTS: For AUDIT-C, we designated the score 8 or more as problem drinking, 9 or more as alcohol use disorder, and 11 or more as dependence. The results of sensitivity/specificity for each group were 82%/76%, 76%/79%, 80%/86%, respectively, which were suitable for screening. For AUDIT-K Question 3 Alone, we defined the score 3 or more as problem drinking or alcohol use disorder and the score 4 as dependence. The results of sensitivity/specificity for each group were 79%/80%, 84%/67%, 85%/77%, which were appropriate for screening. For every drinking behavior group, AUDIT-C was superior to AUDIT-K Question 3 Alone in screening performance (problem drinking: 0.88 vs. respectively 0.85, alcohol use disorder: 0.86 vs. 0.82, alcohol dependence: 0.88 vs. 0.81) CONCLUSION: We confirmed that both AUDIT-C and AUDIT-K Question 3 Alone, which are more convenient and have fewer time con-straints than AUDIT-K, are reasonable screening methods for problem drinking. Thus, we recommend further drinking assessment and proper intervention for male drinkers who have scores 8 or more in AUDIT-C or 3 or more in AUDIT-K Question 3 Alone.

Fasting Plasma Glucose Levels and Metabolic Syndrome in Normoglycemic Adults

BACKGROUND: Metabolic syndrome has been introduced to increase the incidence of cardiovascular diseases and type 2 diabetes mellitus. Our aim of this study was to investigate the association of fasting plasma glucose levels and metabolic syndrome in normoglycemic adults. METHODS: We examined lifestyle factors, anthropometric and laboratory measurement of adults with no personal history of diabetes and normal fasting glucose from the Korean National Health and Nutrition Examination Survey 2001. We categorized the fasting plasma glucose levels below 100 mg/dl into the quintiles and assessed the association of metabolic syndrome with increasing glycemia in normoglycemic adults. RESULTS: Quintiles of normal fasting plasma glucose levels showed a positive trend with metabolic risk factors including abdominal obesity, high blood pressure, and obesity in normoglycemic adults (P<0.001). Hypertriglyceridemia, low HDL-cholesterolemia, smoking, heavy drinking, and physical activity were of no significance. A multivariate model, adjusted for age, sex, smoking status, physical activity, and heavy drinking, revealed a progressively increased odds ratio of metabolic syndrome, 1.05 (95% CI, 0.76~1.44), 1.15 (95% CI, 0.84~1.58), 1.33 (95% CI, 0.99~1.80), 1.55 (95% CI, 1.14~2.10), with increasing fasting plasma glucose levels, as compared with fasting plasma glucose level of 81 mg/dl or less (P<0.001). CONCLUSION: Higher fasting plasma glucose levels within the normoglycemic range may constitute a risk of metabolic syndrome in normoglycemic adults.

Family Physicians' Perception on Hearing Impaired People

BACKGROUND: Hearing impaired people have a lot of difficulty in communicating when they visit medical institutions. This study was to reveal the family physicians' perception and attitude for the hearing impaired people, and the effect of those factors on the actual physicians' practice behavior for the disabled. METHODS: We sent questionnaires by post mail to 1,000 members listed in the 2007 address book of the Korean Association of Family Medicine. RESULTS: Among the total of 90 family physicians who had answered, 72 (80.8%) had willing attitude to treat the hearing impaired people, and the most important reason was that it was essentially a doctor's duty. In the group who were unwilling to treat the disabled, the most principal reason was that they were not equipped with sufficient facility and medical system. Gender was the only factor affecting the physicians' attitude significantly and the female doctors had a higher intention to treat the hearing impaired people than male doctors (P=0.035). Age, location of hospital, number of patients, practical experience of hearing impaired people had no significant effect on doctors' attitude. The number of physicians who volunteered to participate for the hearing impaired people's health promotion personally was significantly higher in the group of treatment intention (P=0.007). Nevertheless, few physicians had the willingness to equip the hospital facility for the hearing disabled, even in the group of willingness to treat the disabled. The most important reason was that very few disabled patients visit their clinic, and so forth they felt no necessity to improve and re-organize their clinical environment. CONCLUSION: Most family physicians are willing to treat hearing impaired people. But even in the willing group, almost all of them are unwilling to improve or equip the medical facilities for the hearing impaired people personally, because only a few disabled people visit the primary care hospital in the real practice.

The Usefulness of Heavy Smoking Index as a Test for Nicotine Dependence

BACKGROUND: The Fagerstrom Test for Nicotine Dependence (FTND) is a widely used six-item questionnaire. Its completion require a few minutes, but such time may be too much for busy clinicians and large epidemiologic surveys. The goals of this study was to compare the sensitivity and the specificity of Heavy Smoking Index (HSI) of high nicotine dependence. METHODS: The FTND was administered to 943 current smokers from a smoking-cessation clinic in Gwangjin-gu, Seoul. The HSI which combines two items of the FTND (the number of cigarettes per day and the time of the first cigarette of the day) was compared to the FTND. We measured cigarette per day, duration of smoking, and age of smoking initiation. RESULTS: A cutoff score equal or greater than 4 on the HSI detected a similar rate of nicotine dependence as a cutoff score equal or greater than 6 on the FTND. The HSI showed a sensitivity of 88.0% and a specificity of 86.5%. The concordance between the two instruments was high (kappa= 0.74). CONCLUSION: The HSI was proven to be very useful. If HSI had a proper validity, the HSI can be a good standard of high nicotine dependence for busy clinician and epidemiologists.

Relations between the Dietary Habits and Components of the Metabolic Syndrome in Premenopausal Women

BACKGROUND: In these days the metabolic syndrome threatens many people of Korea. Several studies have suggested that the dietary habits are associated with the risk of the metabolic syndrome. The purpose of this study was to find out relations between the components of the metabolic syndrome and the dietary habits. METHODS: The subjects of this study included 1,005 non-smoking premenopausal females aged from 20 to 49 years old who visited the health promotion center of a university hospital. Dietary questionnaire was composed of dietary habits and specific food intake frequency during the past 3 months. RESULTS: The subjects who had more than one metabolic components were 361 (36%), and those who had the metabolic syndrome was 35 (3.5%). After multivariate logistic analysis adjusted with age, BMI, smoking status, alcohol intake, and exercise, the abdominal obesity risk was significantly increased in those who had irregular meals (P for trend= 0.049), skip meals (P for trend=0.050), faster meal time (P=0.017), and intake of saturated fat more frequently (P=0.043). The abdominal obesity risk was significantly increased in those who overate or binged eating 7gt; or =3 times/week than <1 time/week {OR (95% CI), 2.49 (1.07~5.80)}, intake fruit <1 time/week than 6~7 times/week {OR (95% CI), 4.46 (1.20~16.54)}. A risk for high blood pressure was significantly increased in those who had breakfast 1~2 times/week than those had it 6~7 times/week {OR (95% CI), 1.91 (1.07~3.42)}. The risk for impaired fasting glucose was significantly increased in those had breakfast <1 time/week than those who had 6~7 times/week {OR (95% CI), 2.27 (1.20~4.28), P for trend=0.018}. CONCLUSION: There was a correlation between dietary habits and metabolic syndrome components. Among the dietary habits, irregular meals, skipping breakfast, skipping meals, fast meal time, overeating or binge eating tendency, low intake of fruits and high intake of saturated fat were associated with the risk of the metabolic syndrome components.

The Validity of Michigan Neuropathy Screening Instrument as a Screening Test and Risk Factors for Diabetic Peripheral Neuropathy

BACKGROUND: Diabetic neuropathy is a common complication of diabetes. Since neuropathy leads to ulceration and amputation, efforts to detect early and to elucidate its risk factors are ongoing. The goal of this study was to check the validity of Michigan neuropathy screening instrument (MNSI) as a screening test and its risk factors for diabetic neuropathy. METHODS: A total of 75 subjects with type II diabetes mellitus, who visited a university hospital, were investigated. We measured their duration of diabetes, height, weight, systolic blood pressure, diastolic blood pressure, fasting glucose, glycosylated hemoglobin, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total cholesterol, serum creatinine, and 24-h urine albumin. MNSI tested and electrophysiological test were performed. RESULTS: The sensitivity, specificity, positive predictive value, and negative predictive value of MNSI was 63.5%, 78.3%, 86.8%, and 48.6%, respectively. Statistically significant relationships were found between neuropathy and the duration of diabetes and total cholesterol. CONCLUSION: MNSI seemed to be an appropriate screening test for diabetic neuropathy. More attention must be paid to the duration of diabetes and the total cholesterol of type 2 diabetic patients with peripheral neuropathy.

Prevalence and Risk Factors of the Metabolic Syndrome as Defined by NCEP-ATP III

BACKGROUNDS: The Third Report of the Adult Treatment Panel (NCEP-ATP III) has newly introduced the clinical diagnosis guideline of the metabolic syndrome which is characterized by clustering of the CHD risk factors. The purpose of this study was to estimate the prevalence of the metabolic syndrome in Korean adults by the newly introduced guideline and to evaluate possible risk factors with the syndrome. METHODS: The subject of this study included 3,873 adults (males 2,144, females 1,729) aged 20 years or older who visited the Health Promotion Center of SNUH. Among the subjects, we excluded those who did not have records of physical parameters, blood test results and who were on current medications except antihypertensives and oral hypoglycemic agents. We estimated the prevalence of the metabolic syndrome in Korean adults according to the ATP III waist-circumference guideline, Asia-Pacific waist- circumference, and Body Mass Index (BMI), respectively, and calculated the age-adjusted prevalence of the metabolic syndrome using the direct standardized method. While applying the Asia-Pacific waist circumference, we estimated the prevalence of the metabolic syndrome by age group and the prevalence of the individual abnormalities of the metabolic syndrome. To identify variables associated with the metabolic syndrome, we used the multiple logistic regression method to estimate the prevalence odds ratios for the metabolic syndrome vs. the non-metabolic syndrome. RESULTS: The age-adjusted prevalence of the metabolic syndrome in Korean adults was 9.3% when ATP III waist-circumference was applied, 15.4% for Asia-Pacific waist-circumference, and 18.6% for body mass index (BMI). The highest prevalence of the individual criteria among the metabolic syndrome diagnostic criteria in men was hypertension, followed by hypertriglyceridemia, abdominal obesity, high fasting blood glucose, and low HDL-cholesterolemia. And in women, it was also hypertension, followed by abdominal obesity, low HDL- cholesterolemia, hypertriglyceridemia, and high fasting blood glucose. The prevalence increased from 3.8% among participants aged 20 through 29 years to 27.1% for ages 60 through 69 years and 31.6% for ages above 70 years. Females, increasing age, increased BMI, current smoking, physical inactivity were higher risk factors for the metabolic syndrome, but mild drinking was a lower risk factor for the metabolic syndrome. CONCLUSION: These results show that the metabolic syndrome is highly prevalent although less prevalent than in American adults. The family physician should focus on the screening and comprehensive management of the metabolic syndrome.