Educating restaurant owners and cooks to lower their own sodium intake is a potential strategy for reducing the sodium contents of restaurant foods: a small-scale pilot study in South Korea.

BACKGROUND/OBJECTIVES: This study was conducted to evaluate the feasibility of a sodium reduction program at local restaurants through nutrition education and examination of the health of restaurant owners and cooks. SUBJECTS/METHODS: The study was a single-arm pilot intervention using a pre-post design in one business district with densely populated restaurants in Seoul, South Korea. The intervention focused on improving nutrition behaviors and psychosocial factors through education, health examination, and counseling of restaurant personnel. Forty-eight restaurant owners and cooks completed the baseline survey and participated in the intervention. Forty participants completed the post-intervention survey. RESULTS: The overweight and obesity prevalences were 25.6% and 39.5%, respectively, and 74.4% of participants had elevated blood pressure. After health examination, counseling, and nutrition education, several nutrition behaviors related to sodium intake showed improvement. In addition, those who consumed less salt in their baseline diet (measured with urine dipsticks) were more likely to agree that providing healthy foods to their customers is necessary. This study demonstrated the potential to reduce the sodium contents of restaurant foods by improving restaurant owners' and cooks' psychological factors and their own health behaviors. CONCLUSIONS: This small pilot study demonstrated that working with restaurant owners and cooks to improve their own health and sodium intake may have an effect on participation in restaurant-based sodium reduction initiatives. Future intervention studies with a larger sample size and comparison group can focus on improving the health and perceptions of restaurant personnel in order to increase the feasibility and efficacy of restaurant-based sodium reduction programs and policies.

The Relationship between Type D Personality and Heart Rate Variability in Community Mental Health Center Users.

OBJECTIVE: Type D personality can be regarded as a promising cardiovascular risk marker that has been repeatedly linked to relevant indicators of mental health, quality of life, morbidity, and mortality in cardiac patients. Heart rate variability (HRV) is a non-invasive technology that can provide information regarding a patient's sympathetic/parasympathetic balance and the control mechanisms of the autonomic systems in the cardiovascular system. As both type D personality and HRV are parameters related to the cardiovascular system, we assumed a relationship between type D personality and HRV. This study set out to identify the relationship between type D and HRV and the differences in HRV variables between type D and non-type D personalities. METHODS: Patients who visited Guro Community Mental Health Center from January 2011 to December 2012 were surveyed. They were evaluated using both the Korean version of the Type D Personality-14 for type D personality and HRV. During the survey, those who reported major cardiovascular disease that can affect heart rate variability were excluded from the study. RESULTS: Our analysis included 559 participants, 249 of whom were classified as type D personality. No significant differences were found in the HRV variables between the type D group and the non-type D group. There were also no clinically meaningful correlations between HRV variables and type D total/subscale scores when controlled for patient age. CONCLUSION: A relationship between HRV and type D personality was not identified using short-term HRV measurements in non-clinical patients with no definitive cardiovascular disease. Further studies using long-term HRV measurements in patients with cardiovascular disease are necessary to conclude an association between HRV and type D personality.

Long-term and cross-reactive immunogenicity of inactivated trivalent influenza vaccine in the elderly: MF59-adjuvanted vaccine versus unadjuvanted vaccine.

Elderly people are at great risk for influenza-related serious complications. However, influenza vaccine-induced antibodies are believed to decline more rapidly in the elderly. This study was designed to evaluate the long-term and cross-reactive immunogenicity among those aged ≥65 years for two seasonal trivalent influenza vaccines during the 2009-2010 influenza season. One vaccine had the MF59 adjuvant, while the other did not contain an adjuvant. Serum hemagglutinin inhibition (HI) titers were determined pre-vaccination and at 1 and 6 months post-vaccination. Of the 100 subjects, 95 (95%) were followed-up for 1 month after vaccination, and 76 (76%) were followed-up for 6 months after vaccination. Both vaccines met the European Medicines Agency (EMA) criteria 1 month after vaccination. However, seroprotection for influenza B was not satisfactory, with a rate of 55.3% for the MF59 adjuvant vaccine and 47.9% for the vaccine without adjuvant. At 6 months post-vaccination, the MF59-adjuvanted vaccine showed a higher seroprotection rate than the unadjuvanted vaccine. At this point, the MF59-adjuvanated vaccine still met the criteria of EMA for A/H1N1 (62.5% vs. 55.5%, P = 0.64) and A/H3N2 (72.5% vs. 47.2%, P = 0.04). Both vaccines showed excellent cross-reactive immunogenicity for influenza A/Solomon Island/3/2006 (H1N1) and A/Wisconsin/67/2005 (H3N2), without significant differences. In comparison, cross-reactive immunogenicity was not remarkable for the A/California/7/2009 (H1N1) and A/New Caledonia/20/1999 (H1N1) strains, which have a greater antigenic distance. In conclusion, the MF59-adjuvanted influenza vaccine showed superior long-term immunogenicity in the elderly compared to the unadjuvanted vaccine. However, cross-reactive immunogenicity was not remarkably enhanced with the MF59 adjuvant.

Low level of immunity against hepatitis A among Korean adolescents: vaccination rate and related factors.

BACKGROUND: We evaluated the current vaccination rate and immunity in the Korean adolescent population and analyzed their parents' attitudes toward hepatitis A virus (HAV) vaccination. METHODS: Between March and April 2011, sera were collected for immunoglobulin (Ig) G anti-HAV testing from students in their first year of high school from 12 different high schools located in southwestern Seoul. Simultaneously, questionnaires were given to the parents of the students to evaluate factors related to HAV vaccination, including demographics, HAV vaccination status, reason for getting the vaccination, and awareness regarding HAV. RESULTS: Sera from 2,879 subjects and questionnaires from their parents were collected. The HAV vaccination rate among adolescents aged between 14 and 17 years was 18.9%, and the seroprevalence was 15.4%. Among subjects who reported receiving the HAV vaccination, the IgG anti-HAV seropositivity rate was only 42.2%. For subjects who were not vaccinated, the IgG anti-HAV seropositivity rate was 9.1%. The most significant reason for receiving the vaccination was recommendation from health care providers; the most important source of information regarding the vaccination was public health organizations. CONCLUSION: HAV vaccination rate and anti-HAV seroprevalence in Korean adolescents was low; the seropositivity rate in the vaccinated group was lower than expected. Actively recommending HAV vaccination in this group is required, and routine, nationwide, government-sponsored vaccination of adolescents against HAV should be considered.

Elevated vaspin and leptin levels are associated with obesity in prepubertal Korean children.

Adipokines are associated with obesity. However, the relationships between adipokines, specifically vaspin, obesity, and obesity-related variables remain controversial, and only a few studies have been conducted which examines them in children. We investigated the relationships between obesity in prepubertal Korean children and three types of adipokines: vaspin, leptin, and visfatin. In this cross-sectional study, 168 nine-year-old boys and 176 nine-year-old girls participated in a school-based health examination program. Children were classified as overweight using the Korean Pediatric Society 2007 guidelines. Overweight boys and girls had higher leptin and vaspin levels than both boys and girls of normal weight, whereas only overweight boys had higher visfatin levels than normal weight boys. Leptin, visfatin and vaspin concentrations were correlated with obesity-related variables. A multiple logistic regression analysis showed that systolic blood pressure (SBP), total cholesterol (TC), alanine aminotransferase (ALT), homeostasis model assessment of insulin resistance (HOMA-IR), leptin, and vaspin were associated with an increased risk of being overweight, whereas high-density lipoprotein (HDL) cholesterol was associated with a decreased risk of being overweight. Elevated vaspin and leptin levels are associated with obesity in prepubertal Korean children.

Structure-oriented versus process-oriented approach to enhance efficiency for emergency room operations: what lessons can we learn?

The efficiency and quality of a healthcare system can be defined as interactions among the system structure, processes, and outcome. This article examines the effect of structural adjustment (change in floor plan or layout) and process improvement (critical pathway implementation) on performance of emergency room (ER) operations for acute cerebral infarction patients. Two large teaching hospitals participated in this study: Korea University (KU) Guro Hospital and KU Anam Hospital. The administration of Guro adopted a structure-oriented approach in improving its ER operations while the administration of Anam employed a process-oriented approach, facilitating critical pathways and protocols. To calibrate improvements, the data for time interval, length of stay, and hospital charges were collected, before and after the planned changes were implemented at each hospital. In particular, time interval is the most essential measure for handling acute stroke patients because patients' survival and recovery are affected by the promptness of diagnosis and treatment. Statistical analyses indicated that both redesign of layout at Guro and implementation of critical pathways at Anam had a positive influence on most of the performance measures. However, reduction in time interval was not consistent at Guro, demonstrating delays in processing time for a few processes. The adoption of critical pathways at Anam appeared more effective in reducing time intervals than the structural rearrangement at Guro, mainly as a result of the extensive employee training required for a critical pathway implementation. Thus, hospital managers should combine structure-oriented and process-oriented strategies to maximize effectiveness of improvement efforts.

Lifestyle modification increases circulating adiponectin concentrations but does not change vaspin concentrations.

The objective of the study was to evaluate the effects of a 10-month lifestyle intervention on the components of the metabolic syndrome (MetSyn) in Koreans with MetSyn as well as on blood concentrations of adiponectin and vaspin. One hundred thirty-eight patients with MetSyn, recruited from a community health care center, were consecutively enrolled in the study; 12 patients dropped of the intervention, leaving 126 subjects (76 men and 50 women; age, 65.3 ± 9.0 years). All participants followed a 10-month lifestyle modification interventional program, including dietary counseling, advice on increasing physical activity, and recommendations to stop or limit smoking and alcohol drinking. Anthropometric and biochemical parameters related to the components of the MetSyn, including blood concentrations of adiponectin and vaspin, were assessed pre- and postintervention. At baseline, adiponectin concentrations were moderately negatively correlated to insulin concentrations and insulin resistance evaluated by the homeostasis model assessment. In response to lifestyle modification, statistically significant changes were found in systolic and diastolic blood pressure, total cholesterol, triglyceride, and insulin concentrations, as well as in homeostasis model assessment of insulin resistance. Adiponectin concentrations postintervention, compared with the preintervention levels, increased (7.2 ± 4.0 vs 6.8 ± 3.9 µg/mL, respectively; P < .05), whereas vaspin concentrations remained unchanged (0.25 ± 0.19 vs 0.26 ± 0.20 ng/mL, respectively; P = .64). A 10-month lifestyle modification program in Korean patients with MetSyn led to favorable changes in metabolic parameters and adiponectin but not vaspin concentrations.

Long-term immunogenicity of influenza vaccine among the elderly: Risk factors for poor immune response and persistence.

The elderly have been considered as the priority group for influenza vaccination, but their influenza vaccine-induced antibody was believed to decline more rapidly. Long-term immunogenicity of the influenza vaccine among the elderly was evaluated as compared to young adults. Serum hemagglutinin inhibition (HI) titers were determined at pre- and post-vaccination periods (at 1, 6, and 12 months after vaccination). Of the 1018 subjects, 716 (70.3%) were followed up during a 12-month period. Seroprotection rates at 1 month post-vaccination ranged from 70.1% to 90.3% depending on the age group and influenza vaccine virus strain. At 6 months post-vaccination, seroprotection rates for all three strains had declined significantly in adults >or=65 years (P<0.01), but still met the EMEA criteria. Low pre-vaccination HI titer (<1:40) and advanced age were associated with early decline of HI titers, falling below seroprotective levels around 6 months after vaccination.