The level of food literacy and its association with food intake and obesity status among Seoul citizens: results from Seoul Food Survey 2021

BACKGROUND/OBJECTIVES@#Food literacy (FL) is a crucial skill for selecting sustainable and healthy food options, necessitating the identification of vulnerable groups in the community using valid measurement tools. Identifying weak domains in FL is essential for enhancing the overall FL. This study examined the FL levels of Seoul citizens based on their sociodemographic characteristics and assessed the relationship between FL, food intake, and weight status. @*SUBJECTS/METHODS@#This study utilized the data from the Seoul Food Survey, a crosssectional study employing representative samples of Seoul citizens. Data collection occurred from September to October 2021, with 4,039 citizens aged 18 yrs and above participating in face-to-face surveys. Thirty-three FL items were assessed, comprising 14 items in the nutrition and safety (NS) domain, eight items in the cultural and relational (CR) domain, and 11 items in the socio-ecological (SE) domain. In addition, data on food intake sufficiency and obesity status were collected. The descriptive statistics, t-tests, analysis of variance, and logistic regression analysis were used for analysis. @*RESULTS@#Men, students, young adults, older citizens, and people experiencing food insecurity had the lowest scores for all the FL domains. The highest quartile group of NS scores had a higher probability of consuming adequate servings of vegetables and fruits, with significant linear trends observed (P for trend < 0.05). In all three FL domains, the odds ratio for obesity was significantly lower in the groups with high FL scores (P < 0.05). @*CONCLUSIONS@#A close relationship was observed between low FL, obesity, and food intake, even after controlling for other covariates. Vulnerable groups with low FL were also identified. Therefore, it is essential to develop programs to improve FL and the health and well-being of these groups.

Trends of conscious sedation in the Department of Pediatric Dentistry at the Dankook University Dental Hospital for 11 Years

Background@#Anxiety and fear in children's dental care are major impediments to successful dental care. High-quality dental treatment can be achieved using various behavioral control methods; however, conscious sedation using drugs can be used if behavioral control is difficult, owing to excessive fear and anxiety. This study aimed to examine the trends in conscious sedation implemented in pediatric dentistry at the Dankook University Dental Hospital over the past 11 years. @*Methods@#This study included 6,438 cases of dental treatment under conscious sedation conducted over 11 years between January 2011 and December 2021 in the Department of Pediatric Dentistry at Dankook University Dental Hospital. @*Results@#Over the past 11 years, the number of dental treatments under sedation has increased. In the case of inhalation sedation using nitrous oxide, the rate of increase was approximately twice every year, and the use of midazolam gradually decreased. The average age of children who underwent sedation was 5.11 years, and the rate of sedation treatment in children aged 5 years tended to increase. This is related to the trend of changes in drugs used. In a sex-based survey, sedation treatment rate was higher in males than that in females. @*Conclusion@#Appropriate selection of sedatives can reduce the frequency of general anesthesia and minimize complications through efficient and safe dental treatments. Trend analysis of sedation by year will help provide guidelines for the appropriate selection of sedation for dental treatment of children and patients with disability.

Who has experienced better or worse health conditions since the outbreak of COVID-19?: results from a representative cross-sectional survey in Seoul

BACKGROUND/OBJECTIVES@#The coronavirus disease 2019 (COVID-19) pandemic has affected the entire world population in many ways. This study aimed to analyze the patterns of changes in eating, food purchasing and preparation, physical activity, and subjective health after COVID-19 outbreak by various sociodemographic factors and to understand the factors associated with changes in subjective health. @*SUBJECTS/METHODS@#A cross-sectional survey using a representative sample from Seoul was used for the analysis. The data collection was conducted from September to October 2020. A total of 3,833 citizens aged more than 18 years old participated in the Seoul Food Survey. Descriptive statistics and generalized ordinal logistic regression models were used to understand the changes in health behaviors, health indicators, and subjective general health by various socioeconomic status. @*RESULTS@#It was shown that the changes in household income, food expenditure, food consumption and physical activities differed significantly by age, education, occupation, income, weight, and food security status. Low-income and food-insecure households were affected more severely by the pandemic. Older age, household food insecurity, income reduction, increased home cooking and frequency of having instant foods, decreased physical activity and weight gain were significant factors explaining worse perceived health during the COVID-19 pandemic. @*CONCLUSIONS@#The results suggest that focusing on older populations and low-income families with food insecurity should be prioritized during infectious disease outbreaks. In addition, the role of physical activities and instant food consumption in explaining perceived health should be investigated further in this prolonged battle with the pandemic situation.

Development of Korean NOVA Food Classification and Estimation of Ultra-Processed Food Intake Among Adults: Using 2018 Korea National Health and Nutrition Examination Survey / 대한지역사회영양학회지

Objectives@#In this study, we suggest a Korean NOVA food classification that can be applied to food consumption among Korean. Based on this suggestion, the nutritional intake of Korean adults from ultra-processed foods (UPFs) was estimated. @*Methods@#Korean commercial food was categorized based on the NOVA food classification criteria through the Korea Food Code and expert meetings. Then, the nutrient intake status of 6,991 participants in the 2018 National Health and Nutrition Examination Survey was analyzed according to the food processing level. Then, 4,152 adult participants (age 19-65) were divided into quartiles on the basis of their intake of UPFs, and the nutrient intakes from UPFs were compared. @*Results@#Korean NOVA Food Classification defines with priority Group I (Unprocessed/ Minimally processed foods) and Group II (Processed culinary ingredients) foods based on the food cooking or consumption. Then, Group III (Processed foods) and Group IV (UPFs) are classified according to whether the characteristics of the raw materials used are maintained or whether the food was consumed before the 1970s. Our analysis results showed that most of the calories in the diet were consumed by Group I (52.7%), followed by Group IV (29.3%). After categorization of the adult participants into four groups according to their energy consumption from UPFs, we found that the highest consumption group (Q4) was younger and had higher percentage of men than women. The comparative analysis of the consumption of ultra-processed foods by Korean adults revealed that participants of a younger age and men consumed higher energy from UPFs than older participants and women, respectively (P < 0.01). Furthermore, the larger intake of UPFs was associated with an increasing trend for a higher intake of energy, sugar, saturated fat (P for trend < 0.001), total fat (P for trend = 0.021), and sodium (P for trend = 0.005), whereas the intake of carbohydrate, protein, and dietary fiber had a decreasing trend (P for trend < 0.001). @*Conclusions@#With the current increase in the consumption of processed and ultra-processed foods, it is important to carefully consider not only nutrient intake but also the level of food processing.

The role of nutritional status in the relationship between diabetes and health-related quality of life

BACKGROUND/OBJECTIVES@#The association between nutritional status and health-related quality of life (HRQoL) among patients with type 2 diabetes mellitus (T2DM) is not fully understood. This study was conducted to understand the role of nutritional status on HRQoL among people with and without T2DM. @*SUBJECTS/METHODS@#Structured survey and direct measurement of anthropometric data were conducted among people with and without T2DM. Nutritional status was measured with Mini Nutritional Assessment tool and HRQoL was measured with a 36-item Short Form Healthy Survey. Data collection was conducted in Chuncheon, South Korea with 756 participants who are older than 40 yrs of age. @*RESULTS@#This study found that overall HRQoL were significantly lower in people with T2DM than people without T2DM after controlling for key covariates. When stratified by nutritional status, a greater degree of negative impact of T2DM on overall physical HRQoL was observed among well-nourished or at risk of malnutrition, whereas significant and more evident negative impact of diabetes on overall psychological HRQoL was observed only among malnourished. @*CONCLUSIONS@#The study results suggest the role of nutritional status among people with T2DM on overall, especially psychological aspects of HRQoL. Future longitudinal or intervention studies are warranted to test the impact of nutritional status on HRQoL among people with T2DM.

Using Service Design Tools in Community Nutrition Research: A Case Study in Developing Dietary Guidelines for Young Adults / 대한지역사회영양학회지

Objectives@#Recent epidemiological data reported that young adults in their 20 ~ 30s are a vulnerable population with unhealthy dietary practices and a few signs of deteriorated health indicators. However, there are no dietary guidelines that are specifically developed for the young adult population. This study introduces some data collection tools that are mostly used in the service design field, and demonstrates how these tools can be used in nutrition research for developing dietary guidelines for specific target groups. @*Methods@#To understand the context of food choices among young people, 39 people were enrolled to complete a probes booklet. Thematic analysis and word cloud were performed to capture the main themes from the probes and a persona was developed based on the findings. @*Results@#Data from the probes enabled us to grasp the various contextual meanings of eating practices among young people. Most participants understand what a healthy diet is and often have a willingness to practice it. However, there were very few participants who were following the practices. We created four types of persona for developing dietary guidelines: healthy eating, emotional eating, convenient eating, and trendy eating. @*Conclusions@#Probes and persona were used in order to understand the lives of young adults and develop targeted messages. We hope that this introduction will be helpful to researchers who are looking for new ways of understanding their target population in the field of community nutrition.

Defining Food Literacy and Its Application to Nutrition Interventions: A scoping Review / 대한지역사회영양학회지

Objectives@#Food literacy (FL) can be an important concept that embodies the nutritional capabilities of individuals. The purpose of this study was to introduce the definition and core elements of FL from previous literature, to summarize measurement tools and intervention programs with FL, and to suggest the direction of future research and programs to integrate the concept of FL. @*Methods@#The literature review was conducted through PubMed and Google Scholar databases by combining the search term ‘food literacy’ with ‘definition’, ‘measurement’, ‘questionnaire’, ‘intervention’, and ‘program’. Among the 94 papers primarily reviewed 31 manuscripts that suited the purpose of the study were used for analyses. @*Results@#There is no consensus on the definition of FL that encompasses the multidimensional aspects of the concept. The definitions of FL were slightly different depending on the authors, and the interpretation of the core elements also varied. Based on the review, we propose a framework of FL that is in line with the current discussion among international researchers. This focuses on the core elements adapted from health literacy, namely functional, interactive, and critical FL. Specifically, we suggest some detailed elements for interactive and critical FL, which were often the subject of divergent views among researchers in previous literature. We found that most of the tools in the reviewed literature provided information on validity and reliability and were developed for a specific target population. Also, most of the tools were focused on functional FL. Similarly, most of the interventions targeted functional FL. @*Conclusions@#This study reviewed the definition and core elements of FL, available measurement tools, and intervention programs using validated tools. We propose the development of tools with sound reliability and validity that encompass the three core elements of FL for different age groups. This will help to understand whether improving food literacy can translate into better nutritional intake and health status among individuals and communities.

Defining Food Literacy and Its Application to Nutrition Interventions: A scoping Review / 대한지역사회영양학회지

Objectives@#Food literacy (FL) can be an important concept that embodies the nutritional capabilities of individuals. The purpose of this study was to introduce the definition and core elements of FL from previous literature, to summarize measurement tools and intervention programs with FL, and to suggest the direction of future research and programs to integrate the concept of FL. @*Methods@#The literature review was conducted through PubMed and Google Scholar databases by combining the search term ‘food literacy’ with ‘definition’, ‘measurement’, ‘questionnaire’, ‘intervention’, and ‘program’. Among the 94 papers primarily reviewed 31 manuscripts that suited the purpose of the study were used for analyses. @*Results@#There is no consensus on the definition of FL that encompasses the multidimensional aspects of the concept. The definitions of FL were slightly different depending on the authors, and the interpretation of the core elements also varied. Based on the review, we propose a framework of FL that is in line with the current discussion among international researchers. This focuses on the core elements adapted from health literacy, namely functional, interactive, and critical FL. Specifically, we suggest some detailed elements for interactive and critical FL, which were often the subject of divergent views among researchers in previous literature. We found that most of the tools in the reviewed literature provided information on validity and reliability and were developed for a specific target population. Also, most of the tools were focused on functional FL. Similarly, most of the interventions targeted functional FL. @*Conclusions@#This study reviewed the definition and core elements of FL, available measurement tools, and intervention programs using validated tools. We propose the development of tools with sound reliability and validity that encompass the three core elements of FL for different age groups. This will help to understand whether improving food literacy can translate into better nutritional intake and health status among individuals and communities.

Basic Concepts and Detailed Dimensions of Food Security and Related Indicators for Policy Development and Evaluation / 대한지역사회영양학회지

Objectives@#Standardized guidelines and reference points for a food security policy are necessary to guarantee that basic social safety nets work properly. Therefore, this study aimed to explore the basic concepts and detailed dimensions of food security, including the potential relevant indicators, and sought to establish standardized well-being baselines. @*Methods@#A literature review and 14 expert roundtable discussions were carried out to analyze and extract the key concepts of food security. After determining these concepts and detailed dimensions of food security, a conceptual framework was modeled. Then, indicators for each local government that could be monitored and evaluated for each sub-area were suggested. @*Results@#The concept of food security was defined as follows: Individuals should be provided with sufficient, safe, and quality food, which should be accessible to the community and available for use to achieve health and well-being. In addition, food security should be ensured sustainably in a changing environment. Four dimensions were suggested while conceptualizing food security. First, sufficient food, which means sufficient food supply in quantity, quality, and safety. Second, equitable food which includes creating environments in which high-quality and safe food can be purchased at an appropriate price and can be provided regardless of the socioeconomic gap. Third, healthy food which should be provided to promote people’s health and happiness through the eco-friendly consumption of food.Fourth, sustainable food, which can be supplied in a sustainable manner and as part of an eco-friendly food system that considers the conservation of natural environments. @*Conclusions@#The basic concepts and detailed areas of food security including the potential indicators proposed in this study, may be useful for developing and implementing various policies and programs to support food and nutrition security in the future.

Factors contributing to the reduction of sodium intake by food manufacture and cooking venues according to the national sodium reduction policies / 한국영양학회지

Purpose@#Sodium intake is persistently decreasing because of the government's sodium reduction policy. This study aimed to identify foods and dishes that contributed to the reduction of sodium intake and evaluate the effects of the sodium reduction policy. @*Methods@#The subjects were 57,809 participants in the Korea National Health and Nutrition Survey from 2010 to 2017. To identify food and dish sources of sodium intake, the food and dish groups were classified into 23 and 21 groups, respectively. Foods and dishes that contributed to sodium intake were categorized according to the production and cooking venues: production by manufacturers, home cooking, cooking at catering service, and restaurant cooking. @*Results@#Sodium intake was 4,876 mg in 2010 to 3,477 mg in 2017, showing a 29.7% decrease in intake in 2010. Sodium intake was decreased mainly in foods produced by manufacturers and home-cooked foods. The main contributory factors to sodium from the food and dish groups differed according to the food manufacturer and cooking venue. The kimchi produced by manufacturers, cooked soup/tang/jjigae/hotpot at home and catering services, and cooked noodles/dumplings in restaurants were the main contributors to the sodium intake. @*Conclusion@#The type of foods and dishes that contribute to sodium intake tended to expand over the years from specific foods and dishes to various groups of foods and dishes. These results provide evidence for the development and production of low-salt foods and dietary education related to low-salt intake.

Factors contributing to the reduction of sodium intake by food manufacture and cooking venues according to the national sodium reduction policies / 한국영양학회지

Purpose@#Sodium intake is persistently decreasing because of the government's sodium reduction policy. This study aimed to identify foods and dishes that contributed to the reduction of sodium intake and evaluate the effects of the sodium reduction policy. @*Methods@#The subjects were 57,809 participants in the Korea National Health and Nutrition Survey from 2010 to 2017. To identify food and dish sources of sodium intake, the food and dish groups were classified into 23 and 21 groups, respectively. Foods and dishes that contributed to sodium intake were categorized according to the production and cooking venues: production by manufacturers, home cooking, cooking at catering service, and restaurant cooking. @*Results@#Sodium intake was 4,876 mg in 2010 to 3,477 mg in 2017, showing a 29.7% decrease in intake in 2010. Sodium intake was decreased mainly in foods produced by manufacturers and home-cooked foods. The main contributory factors to sodium from the food and dish groups differed according to the food manufacturer and cooking venue. The kimchi produced by manufacturers, cooked soup/tang/jjigae/hotpot at home and catering services, and cooked noodles/dumplings in restaurants were the main contributors to the sodium intake. @*Conclusion@#The type of foods and dishes that contribute to sodium intake tended to expand over the years from specific foods and dishes to various groups of foods and dishes. These results provide evidence for the development and production of low-salt foods and dietary education related to low-salt intake.

Comparative Analysis of Lung Perfusion Scan and SPECT/CT for the Evaluation of Functional Lung Capacity / 대한핵의학회잡지

PURPOSE@#This study aimed to compare lung perfusion scan with single photon emission computed tomography/computed tomography (SPECT/CT) for the evaluation of lung function and to elucidate the most appropriate modality for the prediction of postoperative lung function in patients with lung cancer.@*METHODS@#A total of 181 patients underwent Tc-99m macroaggregated albumin lung perfusion scan and SPECT/CT to examine the ratio of diseased lung and diseased lobe. Forty-one patients with lung cancer underwent both preoperative and postoperative pulmonary function tests within 1 month to predict postoperative pulmonary function. Predicted postoperative forced expiratory volume in 1 s (ppoFEV₁) was calculated by the % radioactivity of lung perfusion scan and SPECT, and the % volume of the residual lung, assessed on CT.@*RESULTS@#The ratios of diseased lung as seen on lung perfusion scan and SPECT showed significant correlation, but neither modality correlated with CT. The ratios of the diseased lung and diseased lobe based on CT were higher than the ratios based on either perfusion scan or SPECT, because CT overestimated the function of the diseased area. The lobar ratio of both upper lobes was lower based on the perfusion scan than on SPECT but was higher for both lower lobes. Actual postoperative FEV₁ showed significant correlation with ppoFEV₁ based on lung perfusion SPECT and perfusion scan.@*CONCLUSIONS@#We suggest SPECT/CT as the primary modality of choice for the assessment of the ratio of diseased lung area. Both perfusion scan and SPECT/CT can be used for the prediction of postoperative lung function.

Comparative Analysis of Lung Perfusion Scan and SPECT/CT for the Evaluation of Functional Lung Capacity / 대한핵의학회잡지

PURPOSE: This study aimed to compare lung perfusion scan with single photon emission computed tomography/computed tomography (SPECT/CT) for the evaluation of lung function and to elucidate the most appropriate modality for the prediction of postoperative lung function in patients with lung cancer.METHODS: A total of 181 patients underwent Tc-99m macroaggregated albumin lung perfusion scan and SPECT/CT to examine the ratio of diseased lung and diseased lobe. Forty-one patients with lung cancer underwent both preoperative and postoperative pulmonary function tests within 1 month to predict postoperative pulmonary function. Predicted postoperative forced expiratory volume in 1 s (ppoFEV₁) was calculated by the % radioactivity of lung perfusion scan and SPECT, and the % volume of the residual lung, assessed on CT.RESULTS: The ratios of diseased lung as seen on lung perfusion scan and SPECT showed significant correlation, but neither modality correlated with CT. The ratios of the diseased lung and diseased lobe based on CT were higher than the ratios based on either perfusion scan or SPECT, because CT overestimated the function of the diseased area. The lobar ratio of both upper lobes was lower based on the perfusion scan than on SPECT but was higher for both lower lobes. Actual postoperative FEV₁ showed significant correlation with ppoFEV₁ based on lung perfusion SPECT and perfusion scan.CONCLUSIONS: We suggest SPECT/CT as the primary modality of choice for the assessment of the ratio of diseased lung area. Both perfusion scan and SPECT/CT can be used for the prediction of postoperative lung function.

Understanding how organizational environments affect food intake among employees in South Korea / 한국영양학회지

PURPOSE: Previous studies have highlighted that the nutritional behaviors among South Korean workers are far from ideal. This study examined the organizational influences affecting the eating practices of office workers in South Korea.METHODS: We conducted in-depth interviews with 22 office workers at 12 companies in South Korea. The interviewer inquired about the employees' daily routines on food and beverage intake. The various factors that influence their food choices in their work environments were also explored. The interviews were transcribed and then analyzed using a content analysis.RESULTS: A framework analysis revealed 7 key recurring themes, and these were grouped under three levels: team-, company-, and corporate group-levels. First, team dinners are core social events for all the workers and they tend to include high-caloric food and alcoholic beverages. The frequency of team meals and the food associated with them depend on various team characteristics such as gender composition, the nature of a team's work and the team leaders' emphasis on group meals. Second, the company's policies and practices regarding budget allocation for team meals and subsidies for cafeteria meals affect the workers' food intake practices. In addition, the physical environment of the worksite cafeterias can influence the choices of foods. Third, various corporate group policies that were not designed to target food intake had additional positive effects on the workers' eating behaviors.CONCLUSION: This study provides important insights into the broader organizational influences on the food consumption of employees in their workplace. These insights can be used to design and implement more effective intervention strategies for improving the nutritional behaviors of office workers.

The impacts of three-dimensional anatomical atlas on learning anatomy / 대한해부학회지

Gross anatomy has traditionally been the foundation of medical education. Medical students have learned the structure of the human body through dissection, lecture, and textbooks. As tablets and three-dimensional (3D) applications are developed, 3D atlas applications are utilized in learning anatomy by medical students. The purpose of this research is to investigate the impacts of 3D atlas applications on students' understanding of gross anatomy. This research was targeted at medical students taking the Anatomy and Embryology class in 2017 and 2018, at Ewha Womans University. The correlation between use of 3D atlas and student's results on the Anatomy and Embryology test was analyzed. An open-book anatomy quiz was also carried out to analyze the correlation between the type of atlas each student refers to and the results of the quiz. Independent t test between groups did not show statistically significant difference in the results of the Anatomy and Embryology test. However, the group referring to 3D atlas showed significantly higher results on the simple questions of the open-book anatomy quiz (P<0.05). In conclusion, 3D atlas is not very helpful in acquiring deep anatomical knowledge or memorizing the location of anatomical structures, but it can simply aid in the rapid identification of anatomical structures. Additionally, the 3D atlas will show good synergy with the two-dimensional atlas if used properly in anatomy education, because most students think it is useful to use the 3D atlas.

Leg Length Discrepancy to Influence on Kinematic Changes of the Pelvis and the Hip during Gait

PURPOSE@#The purpose of this study was to investigate the effects of leg length discrepancy on kinematic changes of the pelvis and hip during gait.@*METHODS@#A total of ten healthy women with no history of neurological, musculoskeletal surgery or injuries, or pain in the lower limbs were recruited. They were assigned to two groups; the experimental group (LLD) consisting of five subjects leg length discrepancy of 10mm to 18mm and the control group (CON) consisting of five subjects leg length discrepancy of<10 mm. All participants were instructed to perform three walking trials for further analysis by using the Cortex 3.0 software program. Independent T-test and Mann-Whitney test were used to examine the effects of mild LLD on kinematic changes of the pelvis and hip during gait.@*RESULTS@#Angles of hip flexion, hip abduction, pelvic obliquity, and pelvic tilt in the experimental group were not significantly different compared to those of the control group.@*CONCLUSION@#Mild leg length discrepancy induces kinematic changes in the lower limbs, including decreased hip flexion, increased hip abduction, and increased pelvic obliquity in the shorter limb, and increased hip adduction and increased pelvic obliquity in the longer limb. However, those changes were not significant.

One Menu Please: Parents Want Affordable, Right-sized Portions for Their Children in Restaurants

One contributing factor to the obesity epidemic is the large portion sizes served in restaurants. However, no study has looked at the parents' desire for smaller-portioned meals for their children at restaurants in the U.S. This study examined parents' preference for restaurants to offer smaller, lower-priced child portions for their children and reasons for the preference. Multivariable logistic regression was used to estimate adjusted odds ratios (ORs) for the association between preference for child portions and variables on parental sociodemographic characteristics and weight status. About 70% of parents said they would prefer that restaurants offer smaller, lower-priced child portions of all menu offerings. The adjusted odds of preferring child portions were significantly higher among Hispanic parents (OR, 1.95 vs. non-Hispanic whites) but significantly lower among parents with lower education (≤ high school, OR, 0.64; some college, OR, 0.69 vs. college graduate) and parents residing in the Midwest or West (Midwest, OR, 0.61; West, OR, 0.58 vs. South). The most common reason for preferring child portions of all meals was “wanting my child to eat healthier foods that are not offered on the children's menu” (72%). These findings can be used to encourage restaurants and other venues to consider offering child portions of healthier menu items.

Comparison of Propacetamol plus Fentanyl and Fentanyl alone with Patient Controlled Analgesia after Total Knee Arthroplasty

OBJECTIVE: Opioid analgesics, for postoperative pain management, are an indispensable group of medication; however, they also have a variety of adverse drug reactions (ADR). Multimodal methods, combining non-opioid analgesics with opioid analgesics, have been investigated to increase the effects of analgesics and reduce ADR with opioid-sparing effects. The purpose of this study was to compare the effects of patient-controlled analgesia (PCA) with fentanyl alone, and PCA with fentanyl and intravenous (i.v.) propacetamol to determine the effects of pain control, cumulative opioid usage, and opioid ADR. METHODS: The subjects were patients who underwent total knee arthroplasty at the Seoul Veterans hospital from January 1, 2015 to December 31, 2016. The study period was from postoperative day 0 (POD0) to day 3 (POD3), and the retrospective study was conducted using electronic medical records. RESULTS: Pain severity was significantly low at POD1 (p = 0.017), POD2 (p = 0.003), and POD3 (p = 0.002) in the multimodal group. The fentanyl only group frequently reported both moderate and severe pain at a statistically significant level. This was consistent with the analysis of the pro re nata (PRN) intramuscular analgesia usage at the time of numerical rating scale (NRS) 4 and above. The opioid-sparing effect confirmed that the average opioid dose equivalent to i.v. morphine dose was 9.4 mg more than that used for the multimodal group in the fentanyl only group. The ADRs and length of stay between the two groups were not statistically different. CONCLUSION: The results of this study suggest that the combination therapy of fentanyl and i.v. propacetamol is superior to fentanyl monotherapy.

Community-Based Policies and Support for Free Drinking Water Access in Outdoor Areas and Building Standards in U.S. Municipalities

We examined community-level characteristics associated with free drinking water access policies in U.S. municipalities using data from a nationally representative survey of city managers/officials from 2,029 local governments in 2014. Outcomes were 4 free drinking water access policies. Explanatory measures were population size, rural/urban status, census region, poverty prevalence, education, and racial/ethnic composition. We used multivariable logistic regression to test differences and presented only significant findings. Many (56.3%) local governments had at least one community plan with a written objective to provide free drinking water in outdoor areas; municipalities in the Northeast and South regions and municipalities with ≤ 50% of non-Hispanic whites were less likely and municipalities with larger population size were more likely to have a plan. About 59% had polices/budget provisions for free drinking water in parks/outdoor recreation areas; municipalities in the Northeast and South regions were less likely and municipalities with larger population size were more likely to have it. Only 9.3% provided development incentives for placing drinking fountains in outdoor, publicly accessible areas; municipalities with larger population size were more likely to have it. Only 7.7% had a municipal plumbing code with a drinking fountain standard that differed from the statewide plumbing code; municipalities with a lower proportion of non-Hispanic whites were more likely to have it. In conclusion, over half of municipalities had written plans or a provision for providing free drinking water in parks, but providing development incentives or having a local plumbing code provision were rare.

Creating a school nutrition environment index and pilot testing it in elementary and middle schools in urban South Korea

BACKGROUND/OBJECTIVES: The role of a school's nutrition environment in explaining students' eating behaviors and weight status has not been examined in an Asian setting. The purpose of this study was to create a school nutrition environment index and to pilot test the index in elementary and middle schools in urban South Korea. SUBJECTS/METHODS: This study used a mixed-methods approach. Environment assessment tools were developed based on formative research, which comprised literature reviews, in-depth interviews, and focus group discussions. Key elements from the formative research were included in the assessment tool, which consisted of a structured survey questionnaire for school dietitians. Fifteen school dietitians from 7 elementary and 8 middle schools in Seoul completed the questionnaire. RESULTS: The formative research revealed four main sections that guided a summary index to assess a school's nutrition environment: resource availability, education and programs, dietitians' perceptions and characteristics, and school lunch menu. Based on the literature reviews and interviews, an index scoring system was developed. The total possible score from the combined four index sections was 40 points. From the 15 schools participating in the pilot survey, the mean school nutrition-environment index was 22.5 (standard deviation ± 3.2; range 17-28). The majority of the schools did not offer classroom-based nutrition education or nutrition counseling for students and parents. The popular modes of nutrition education were school websites, posters, and newsletters. CONCLUSIONS: This paper illustrates the process used to develop an instrument to assess a school's nutrition environment. Moreover, it presents the steps used to develop a scoring system for creation of a school nutrition environment index. As pilot testing indicated the total index score has some variation across schools, we suggest applying this instrument in future studies involving a larger number of schools. Future studies with larger samples will allow investigation of the validity and reliability of this newly developed tool.