Discussion on the Clinical Course of Adverse Effects after COVID-19 Vaccination: A Retrospective Analysis of Case Series in an Outpatient Department.

BACKGROUND: A total of 8,303 individuals (4.3%) with adverse reactions (n=191,860) after vaccination developed serious conditions or died. Such health developments could cause people not vaccinated yet or waiting for a booster shot to become fearful of the vaccination. METHODS: The 3-month (July-September 2021) clinical data of 41 patients from the family medicine department of a single medical center were analyzed retrospectively to determine risk factors and to investigate the clinical course to identify the cause of symptoms in detail. RESULTS: A significant number of older adults aged over 50 years reported experiencing general weakness (P=0.026) but fewer incidences of fever than patients aged 50 years or younger (P=0.011). Eighteen of the 41 patients were requested to visit more than twice or consult a specialist. In 14 patients, the symptoms were explained by other medical causes. CONCLUSION: The primary physician has a pivotal role in thoroughly evaluating patients who complain of adverse effects after vaccination, considering the broad multitude of symptoms and medical conditions presented. To thoroughly evaluate and appropriately advise patients with adverse reactions to their chosen vaccine, taking detailed medical history and nutritional counseling are required to identify possible underlying causes, resolve symptoms, and educate them on self-care and regarding vaccines.

Smoking and Diabetes as Predictive Factors of Accelerated Loss of Muscle Mass in Middle-Aged and Older Women: A Six-Year Retrospective Cohort Study.

Background: Preservation of muscle mass during aging reduces the risk of frailty and age-related chronic diseases. We investigated the lifestyle, psychological factors, and common cardiometabolic diseases associated with accelerated muscle loss in middle-aged and older women. Materials and Methods: A total of 881 women aged 40 years and older who underwent regular health checkup at a tertiary care hospital in Korea in 2010-2011 and underwent a 6-year follow-up were included in this study. Lifestyle and health statuses were evaluated through a standardized questionnaire and laboratory testing. Muscle mass was estimated using bioelectrical impedance analysis. Results: The accelerated loss group showing appendicular skeletal muscle mass (ASM) loss >3% for 6 years represented 24.4% (n = 215) of the total participants. Current smoking women presented a higher odds ratio (OR) for accelerated loss of ASM than nonsmoking individuals after adjusting for age, body mass index, exercise, caloric intake, alcohol consumption, menopausal state, and diabetes mellitus (DM) (OR 3.53, confidence interval [95% CI] 1.28-9.74, p = 0.015). Women with DM showed a higher OR than non-DM individuals after adjusting for the aforementioned variables and smoking status (OR 2.92, 95% CI 1.39-6.14, p = 0.005). Conclusion: Current smoking and DM are predictors for accelerated muscle mass loss in middle-aged and older women. Smokers and DM patients need to monitor muscle mass changes and apply preventive intervention steps. Smoking cessation and good glycemic control are required not only for reducing cardiovascular risk but also for improving muscle health.

Association of Lung Function with Serum 25-Hydroxyvitamin D Level according to the Presence of Past Pulmonary Tuberculosis in Korean Adults.

BACKGROUND: Vitamin D deficiency is associated with an increased risk of pulmonary tuberculosis (PTB) infection and the treatment outcome. The aim of this study was to examine the relationship between the serum 25-hydroxyvitamin D (25[OH]D) level and lung function in Korean adults according to whether or not there is a history of PTB. METHODS: The data for subjects aged 19 years or older from the Korea National Health and Nutrition Examination Survey 2008-2012 who underwent spirometry, chest radiography, and serum 25(OH)D level measurement were analyzed. RESULTS: Evidence of past PTB infection was found in 1,482 (9.6%) of 15,516 subjects. The serum 25(OH)D level was lower in the group with past PTB than in the non-PTB group (P=0.013). Respiratory dysfunction was more common in the past PTB group than in the non-PTB group (restrictive pattern, 14.0% vs. 9.6%; obstructive pattern, 29.6% vs. 8.2%; both P<0.001). After adjusting for age, sex, height, and season, the mean difference in forced expiratory volume in 1 second (FEV1) between the highest and lowest quartiles of 25(OH)D was 100.2 mL (standard error=49.3 mL, P for trend=0.049) in the past PTB group and 34.7 mL (standard error=13.6 mL, P=0.009) in the nonPTB group. CONCLUSION: FEV1 tended to increase as the vitamin D quartile increased in both study groups. This relationship was more pronounced in subjects with a history of PTB. A higher serum 25(OH)D level might be beneficial in preserving lung function after PTB infection.

Risk of Sarcopenia and Osteoporosis in Male Tuberculosis Survivors: Korea National Health and Nutrition Examination Survey.

Short-term prospective studies have suggested that pulmonary tuberculosis (TB) preludes permanent loss of lean tissue and fat mass even when TB treatment is effective. The aim of this study was to estimate the risk of sarcopenia and osteoporosis among Korean male TB survivors. Data of the population-based, Korea National Health and Nutrition Examination Survey (KNHANES) (2008-2011) were analyzed, including 3,228 males aged 50 years or older who underwent chest X-ray (CXR) and dual-energy x-ray absorptiometry (DEXA). TB survivors having both medical history and TB scars on CXR had increased risk of sarcopenia (odds ratio [OR] 3.44, 95% confidence interval [CI] 1.79-6.68) and osteoporosis (OR 1.75, 95% CI 1.04-2.95) after adjusting for age, height, smoking, alcohol, physical activity, serum 25-hydroxyvitamin D, parathyroid hormone level, education, and fat mass index. Having TB scars on CXR without medical history of TB was an independent risk factor of sarcopenia (OR 2.05, 95% CI 1.05-4.00), but not a risk factor of osteoporosis. Sarcopenia and low bone mineral density are prevalent in pulmonary TB survivors with TB scars on CXR. Medical history of TB with TB scars on CXR is an independent risk factor for sarcopenia and osteoporosis.

The Definition of Past Tuberculosis Affects the Magnitude of Association between Pulmonary Tuberculosis and Respiratory Dysfunction: Korea National Health and Nutrition Examination Survey, 2008-2012.

Tuberculosis (TB) is associated with an increased risk of chronic lung impairment. The aim of this study was to compare the clinical characteristics and lung functions according to definition of past TB. We used the population-based, Korea National Health and Nutrition Examination Survey (KNHANES) (2008-2012) to analyze 13,522 subjects age 40 years or older who underwent spirometry and chest X-ray (CXR). Subjects with TB lesions on CXR (with or without a history of TB) were older, more likely to be male, ever smokers, and of low socioeconomic status than subjects with only a history of TB or without evidence of TB. Airflow obstruction (AFO) was associated with only a history of TB (odds ratio [OR] 1.53, 95% confidence interval [CI] 0.95-2.46), only TB lesion on CXR (OR 2.37, 95% CI 1.80-3.12), and both a history and TB lesions on CXR (OR 4.47, 95% CI 3.07-6.51) after adjustment for gender, age, body mass index, education, income, and smoking amount (P for trend < 0.001). Spirometric restriction was associated with only a history of TB (OR 1.29, 95% CI 0.80-2.08), only TB lesions on CXR (OR 2.03, 95% CI 1.49-2.76), and both a history and TB lesions on CXR (OR 2.65, 95% CI 1.74-4.05) after adjustment for the above variables (P for trend < 0.001). How to define past TB in population study affects the magnitude of association between past TB and respiratory dysfunction. Without considering TB lesions on CXR, the association between TB and respiratory dysfunction could be underestimated.

Medical students' and patients' perceptions of patient-centred attitude.

PURPOSE: Patient-centred care can increase patient satisfaction and lead to better clinical outcomes for them, such as improved physical status and higher health-related quality of life. However, doctors' and patients' views on patient-centred attitude might differ and could be affected by culture and the community environment. To clarify the differences in primary care patients' and senior medical students' perceptions of medical students' patient-centred attitude. METHODS: A total of 1,025 subjects-827 patients from primary care institutions and 198 fourth-year medical students from a medical college in South Korea-completed the Patient Practitioner Orientation Scale (PPOS). The students completed the self-reported questionnaire at the end of their clinical clerkship. Descriptive statistics, t-tests, and one-way analysis of variances were conducted in SPSS version 21.0. RESULTS: Firstly, sharing subscale scores were higher among patients than among medical students (students, 3.61 vs. patients, 3.76; p<0.001), but secondly, caring subscale scores were higher among medical students (students, 4.18 vs. patients, 3.82; p<0.001). Thirdly, PPOS total scores were higher among medical students (students, 3.90 vs. patients, 3.79; p=0.001). Finally, male students had the lowest sharing scores (F=6.811, p<0.001) and female students showed the highest PPOS total scores (F=5.805, p=0.001). CONCLUSION: Significant differences between medical students' and patients' perceptions of medical students' patient-centred attitudes suggest the necessity of educational efforts to overcome the gap between the groups.

Relationship between breast-feeding and bone mineral density among Korean women in the 2010 Korea National Health and Nutrition Examination Survey.

Breast-feeding has the deleterious effect of hypoestrogenemia coupled with loss of calcium in the maternal bone mass. It is not clear whether changes in bone metabolism in lactating women lead to changes in maternal bone mineral density (BMD) over a longer period. The aim of the present study was to investigate the relationship between the duration of breast-feeding and BMD in healthy South Korean women. We analyzed data from the 2010 Korea National Health and Nutrition Examination Survey, a cross-sectional survey of Korean citizens. A total of 1342 women older than 19 years were selected for analysis. In postmenopausal women, the duration of breast-feeding per child was associated with low lumbar spine BMD after adjustment for age, body mass index, smoking, alcohol intake, physical activity, serum 25-hydroxyvitamin D level, and daily intake of calcium and calories (P < 0.05, P trend < 0.005). Prolonged breast-feeding for more than 1 year per child was associated with a deleterious effect on lumbar spine BMD compared with never breast-feeding or a shorter duration of breast-feeding (P < 0.05). These effects were not shown in premenopausal women or in femur BMD. In conclusion, the duration of breast-feeding per child is negatively correlated with lumbar spine BMD in postmenopausal women, but not in premenopausal women. Although the cause of the different results between postmenopausal and premenopausal women is not clear, our findings suggest that proper protective strategies should be recommended during prolonged breast-feeding to maintain bone health later in life.

Changes in the degree of patient expectations for patient-centered care in a primary care setting.

BACKGROUND: To date, the medical environment has been undergoing continual changes. It is therefore imperative that clinicians recognize the changing trends in the degree of patient expectations for patient-centered care. We conducted this study to examine changes in the degree of patient expectations for patient-centered care and the related socio-demographic factors in a primary care setting over a 5-year period. METHODS: We evaluated patients' attitudes toward patient-centered care using the Patient-Practitioner Orientation Scale, which provides 'sharing' and 'caring' scores. The study included 359 and 468 patients in phase I (March-July, 2005) and II (March-July, 2010). We also examined the relationship of their changes to their socio-demographic factors. RESULTS: In phase II, as compared with phase I, the 'sharing' score was higher (3.67 ± 0.68 vs. 3.82 ± 0.44; P < 0.001) and 'caring' one was lower (4.01 ± 0.57 vs. 3.67 ± 0.58; P = 0.001). Further, 'sharing' and 'caring' scores were associated with age, monthly income, education level, marital status, and the functional health status of patients. CONCLUSION: These results would be of help for providing patient-centered care for patients because it makes clinicians are aware of the degree to which patients' expect it.

Changes in medical students' patient-centeredness attitudes by implementation of clinical performance examination.

PURPOSE: From 2009, the Korean Medical Licensure Exam implemented a clinical performance examination (CPX) that highlighted the importance of good patient-physician relationships in medical education. This study aimed to examine changes in medical students' attitudes before and after implementation of the CPX in their medical education curriculum. METHODS: In 2006 and 2009, 236 fourth-year medial students of C College of Medicine took the Patient Practitioner Orientation Scale (PPOS) by Krupet et al. (2000), which measures patient-centered attitudes in patient-physician relationships. The data were analyzed by independent t-test and two-way analysis of variance using SPSS 21.0. RESULTS: The PPOS scores of year 2006 students were 3.88±0.25 for males and 3.98±0.38 for females. For year 2009 students, males scored 3.81±0.42 and females scored 4.01±0.48. All students had higher Care scores than Share scores (2006: Share, 3.67±0.47 vs. Care, 4.19±0.51; 2009: Share, 3.56±0.34 vs. Care, 4.18±0.53). There were significant differences in PPOS and Share scores by gender before and after the CPX. With regard to Care scores, female students' scores tended to rise and males' scores declined over time. CONCLUSION: An educational program is needed for students to foster patient-centered attitudes, but gender differences should be taken into account.

Relationship between serum 25-hydroxyvitamin D and lung function among Korean adults in Korea National Health and Nutrition Examination Survey (KNHANES), 2008-2010.

CONTEXT: The relationship between vitamin D status and pulmonary function has not been investigated for an East Asian population. OBJECTIVE: The aim of the present study was to examine the relationship of serum 25-hydroxyvitamin D [25(OH)D] with lung function in Korean adults. DESIGN AND SETTING: The analysis used data from the Korea National Health and Nutrition Examination Survey (KNHANES), a cross-sectional survey of Korean civilians, conducted from 2008 to 2010. PARTICIPANTS: A total of 10 096 people aged 19 years and older were selected from 16 administrative districts in South Korea. MAIN OUTCOME MEASURES: Serum 25(OH)D levels with lung function [forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC)]. RESULTS: Serum 25(OH)D concentration was positively associated with lung function after controlling for age, sex, height, and season. For FEV1 and FVC, the differences between top and bottom quartiles in 25(OH)D were 51 mL (SE, 17 mL, P trend <.001) and 58 mL (SE, 20 mL, P trend <.005) greater volume, respectively. Association of serum 25(OH)D with FEV1 and FVC was only slightly attenuated after adjustment for body mass index, lifestyle and socioeconomic factors, and respiratory illness. The subjects with a history of pulmonary tuberculosis showed a much higher increase in FEV1; the difference between top and bottom quartiles in 25(OH)D was 229 mL (SE, 87 mL, P trend <.01). CONCLUSION: Serum 25(OH)D levels have a positive correlation with pulmonary function. This relationship appears prominent in subjects with susceptibility to pulmonary tuberculosis.

Reactivity of heart rate variability after exposure to colored lights in healthy adults with symptoms of anxiety and depression.

Studies on human psychological domains associated with color specific light effects have been reported. The heart rate variability (HRV) has been suggested to be a useful tool for the detection of short-term effects of light on the autonomic nervous system (ANS). The emotional state of an individual has an independent effect on the HRV. The purpose of this study was to investigate the acute HRV reactivity after illumination with colored lights and determine the possible interaction between the colored lights and emotional states. Ninety-two healthy adult volunteers underwent short-term measurement of HRV before and after exposures to blue (λ max 420, 380-495 nm, 0.04 lux, 0.41 µW/cm(2)), red (λ max 765 nm, 620-780 nm, 0.4 lux, 1.62 µW/cm(2)) and white (49.5 lux, 12.9 µW/cm(2)) colored fluorescent lights for 5 min during the daytime. A depressed group and an anxious group were identified in 28 (30.4%) and 23 (25.0%) of the subjects, respectively, according to their responses to the Korean version of the hospital anxiety and depression scale (score ≥ 8). The high frequency (HF) reactivity and the root mean square successive differences (RMSSD) were significantly different in the depressed (p<.05) and anxious groups (p<.05) based on the colored lights. The parasympathetic activity was decreased with red light in the depressed and anxious groups; this activity was further decreased in subjects with both symptoms. However, it was unchanged in the subjects without symptoms of depression and anxiety. The results of this study showed that the emotional state of the subjects was an important modulator of the acute effects of dim colored light on the ANS.

Extraintestinal migration of Centrorhynchus sp. (Acanthocephala: Centrorhynchidae) in experimentally infected rats.

Reptiles were known to serve as paratenic hosts for Centrorhynchus (Acanthocephala: Centrorhynchidae) in Korea, but the infection course in experimental animals was not elucidated yet. In this study, the tiger keelback snakes (Rhabdophis tigrinus) were collected and digested with artificial pepsin solution, and the larvae of Centrorhynchus were recovered from them. Then, the collected larvae were orally infected to rats for developmental observations. In rats, all the larvae were observed outside the intestine on day 3 post-infection (PI), including the mesentery and abdominal muscles. As for the development in rats, the ovary of Centrorhynchus sp. was observed at day 15 PI, and the cement glands were 3 in number. Based on the morphological characteristics, including the arrangement of proboscis hooks, these larvae proved to be a species of Centrorhynchus, and more studies were needed for species identification.

Are medical students satisfied with their medical professionalism education?

PURPOSE: This study aims to examine the satisfaction of undergraduate medical students with their medical professionalism education. METHODS: Two hundred and one premedical students and 1,287 medical students (from year 1 to 4) participated in a five-point Likert scale survey. There were 27 items in the premedical students' survey and 31 items in the medical students' questionnaire. Statistical analysis including one-way ANOVA was performed. RESULTS: Among the 27 items concerning premedical professionalism education, only six topics scored "average" level. In the survey of medical students only nine items out of 31 were rated "average" which did not reach the satisfactory level. Nine items from the medical students' survey showed significant positive improvements in satisfaction as the academic year increased; however, the changes were not large enough for any of the topics to receive a satisfactory score. CONCLUSION: Overall students were dissatisfied with their professionalism education. The reasons for these results and possible approaches for improving students' satisfaction should be considered in future research.

To compare the efficacy and safety of nifedipine sustained release with Ginkgo biloba extract to treat patients with primary Raynaud's phenomenon in South Korea; Korean Raynaud study (KOARA study).

This study examined the efficacy and safety of nifedipine sustained release (nifedipine SR) compared with Ginkgo biloba extract as treatment for primary Raynaud's phenomenon (RP) in Korea. Primary RP were screened and assigned to either the nifedipine SR group (Group N) or the Ginkgo biloba extract group (Group G) in the ratio of 2:1. After a run-in period of 2 weeks, patients received treatment for 8 weeks. We observed the percent improvement of the RP attack rate between before and after the 8-week treatment. Ninety-three subjects were randomly assigned. The percent improvement in Group N was 50.1% at 8 weeks after treatment, while it was 31.0% in Group G (p = 0.03). No serious adverse events occurred, and almost adverse events were mild and improved without specific treatment. nifedipine SR was more effective than Ginkgo biloba extract for treatment of primary RP in Korean patients. Both drugs were tolerable with primary RP patients.

Cut-off values of visceral fat area and waist circumference: diagnostic criteria for abdominal obesity in a Korean population.

The aim of this study was to determine the appropriate cut-off values for visceral fat area and waist circumference (WC) associated with an increase in risk for obesity-related disorder, and to validate diagnostic criteria for abdominal obesity and the metabolic syndrome in a Korean adult population. We included 413 subjects (174 men and 239 women) for this study. Subjects were selected among Korean adults who visited the obesity clinic at St. Mary's Hospital and Kangnam St. Mary's Hospital from January 1999 to August 2005. All patients had computed tomography performed. The cut-off value, of visceral fat area associated with an increase risk of obesity-related disorder, according to the receiver operating characteristics curve, was 103.8 cm2 (sensitivity 74.5%, specificity 64.7%, p<0.001). The cut-off value for the WC was 89.8 cm in men (sensitivity 84.7%, specificity 91.7%, p<0.005) and 86.1 cm in women (sensitivity 83.9%, specificity 62.9%, p<0.001). Based on the results of this study, the visceral fat area associated with an increased risk of obesity-related disorder in Korea was 103.8 cm2 and the WC was 89.8 cm in men and 86.1 cm in women.