The biological standard of living of Korean men under Confucianism, colonialism, capitalism, and communism.

This study focuses on analysing the heights of 10,953 Korean men aged 20 to 40 years who were measured during the Joseon dynasty, the Japanese colonialisation period, and the contemporary period, the latter including both North and South Korea. This study thus provides rare long-term statistical evidence on how biological living standards have developed over several centuries, encompassing Confucianism, colonialism, capitalism, and communism. Using error bar analysis of heights for each historical sample period, this study confirms that heights rose as economic performance improved. For instance, economically poorer North Koreans were expectedly shorter, by about 6 cm, than their peers living in the developed South. Similarly, premodern inhabitants of present-day South Korea, who produced a gross domestic product (GDP) per capita below the world average, were about 4 cm shorter than contemporary South Koreans, who have a mean income above the world average. Along similar lines, North Koreans, who have a GDP per capita akin to that of the premodern Joseon dynasty, have not improved much in height. On the contrary, mean heights of North Koreans were even slightly below (by about 2.4 cm) heights of Joseon dynasty Koreans. All in all, the heights follow a U-shaped pattern across time, wherein heights were lowest during the colonial era. Heights bounced back to Joseon dynasty levels during the interwar period, a time period where South Korea benefitted from international aid, only to rise again and surpass even premodern levels under South Korea's flourishing market economy.

In older adults with frailty, virtual reality exercise training improves walking speed and balance.

SOURCE CITATION: Lee YH, Lin CH, Wu WR, et al. Virtual reality exercise programs ameliorate frailty and fall risks in older adults: a meta-analysis. J Am Geriatr Soc. 2023 May 10. [Epub ahead of print.] 37165743.

The biological standard of living in pre-modern Korea: Determinants of height of militia recruits during the Choson dynasty.

This paper extends the research on the biological standard of living in the Korean peninsula back to pre-modern times. Drawing on militia rosters of the Choson Dynasty from the sixteenth to eighteenth centuries, we tentatively conclude that the final height of Korean men during this period was 166cm and thus slightly above that of modern North Korean men (165cm). On the other hand, the average height of modern South Korean men is 172cm, 6cm more than what we tentatively estimate for pre-modern Korean men. Regression analysis of the height of pre-modern Korean men finds that un-free Koreans ("slaves") were significantly shorter by about 0.6-0.7cm than commoners, whereas the average height of recruits suffering from smallpox did not differ significantly from that of other recruits. Moreover, regional, as opposed to birth-dummy, variables account, and to a significant degree, for most of the differences in height. Whether or not this is a result of socioeconomic differences across provinces or a result of other regionally-varying factors remains an open question.

Academic achievement and primary care specialty selection of volunteers at a student-run free clinic.

BACKGROUND: Previous studies have reached conflicting conclusions about the associations between service and academic achievement and service and primary care specialty choice. PURPOSES: This study examines the associations between service at a student-run clinic and academic achievement and primary care specialty choice. METHODS: Retrospective review of medical student service and statistical analysis of grade point average (GPA), Step 1 and Step 2 Clinical Knowledge (CK) scores, and specialty choice were conducted, as approved by our Institutional Review Board. RESULTS: Volunteers, compared to nonvolunteers, had higher GPA (3.59 ± 0.33 vs. 3.40 ± 0.39, p < .001), Step 1 (229 ± 19 vs. 220 ± 21, p < .001), and Step 2 CK (240 ± 18 vs. 230 ± 21, p < .001) scores, but did not pursue primary care specialties at a significantly higher percentage (52% vs. 51%, χ² = .051, p = .82). CONCLUSIONS: Further exploration of the associations between service and academic achievement and primary care specialty choice is warranted.

Cost-effectiveness of health risk reduction after lifestyle education in the small workplace.

INTRODUCTION: Investigations suggest that worksite health promotions in large companies decrease employer health costs and the risk for chronic disease. However, evidence of the success of such programs in small organizations is lacking. The purpose of this study was to determine whether a worksite health promotion program improves health risk and is cost-effective for a small employer. METHODS: Intervention (n = 29) and comparison (n = 31) participants from a 172-employee organization underwent health screening of risk factors for coronary heart disease at baseline (fall 2006) and at 12 months (fall 2007). The intervention group attended lifestyle education videoconferences and reported physical activity. We used the Framingham Risk Score to calculate risk of coronary heart disease. To calculate cost-effectiveness, we used direct employer costs of the program divided by either the relative reduction in low-density lipoprotein cholesterol or the absolute change in coronary heart disease risk. RESULTS: At 12 months, low-density lipoprotein cholesterol, total cholesterol, and number of metabolic syndrome markers were significantly higher in the comparison group than in the intervention group. Total cholesterol was significantly lower at 12 months than at baseline in the intervention group. Waist circumference and number of metabolic syndrome markers increased significantly from baseline in the comparison group. Cost-effectiveness of the intervention was $10.17 per percentage-point reduction of low-density lipoprotein cholesterol and $454.23 per point reduction in coronary heart disease risk. CONCLUSION: This study demonstrated the cost-effectiveness in a small organization of a worksite health promotion that improved low-density lipoproteins and coronary heart disease risk in participating employees.

Chronic idiopathic neutrophilia: experience and recommendations.

OBJECTIVES: To distinguish chronic idiopathic neutrophilia (CIN) in a cost-effective manner from neutrophilia caused by important underlying illnesses. METHODS: This was a retrospective review of patients visiting a Veterans Affairs Medical Center over the last 10 years with a diagnosis of leukocytosis or myeloproliferative disorder. Of this group, fifty-seven patients from 1999 to 2008 were identified with CIN. Clinical and laboratory parameters were examined to identify CIN and establish its course. Eighty-one patients who presented from 2005 to 2010 with myeloproliferative disorders were also studied at time of diagnosis to determine any possible confusion with CIN. RESULTS: The patients with CIN were followed for a mean of ≥ 7.3 years without progression to other serious disorders. Compared to non-CIN patients evaluated for neutrophilia, in multiple logistic regression analyses, smoking (P = .001) and increased BMI (P = .004) were significantly associated with CIN. No CIN patient developed a clinically apparent myeloproliferative disorder other than chronic myeloid leukemia (CML). Of the patients with myeloproliferative neoplasms reviewed at the time of their initial diagnosis, only CML occasionally presented with a picture consistent with CIN. For nonsmokers, the BMI of CIN patients was significantly higher than the average VA population (P < .001). CONCLUSION: Cigarette smoking and obesity are confirmed as factors associated with CIN and may be causative. CIN is unlikely to develop into a clinically recognizable myeloproliferative neoplasm other than CML. Cost-effective guidelines for the diagnostic evaluation of neutrophilia in otherwise healthy patients are presented.

Sickle cell hospital unit: a disease-specific model.

American urban hospitals often serve large populations of sickle cell disease (SCD) patients. Those hospitals that choose to implement an adult SCD-specific inpatient unit have the opportunity to acquire multiple operational benefits. Such units may ultimately reduce patient morbidity and mortality; improve timely access to quality medical care in a cost-effective manner; reduce overcrowding in the emergency department; and increase patient, family, physician, and payer satisfaction. SCD is a serious, painful, genetic blood disorder that affects a growing population of adults in the United States. A single mistake in the gene that codes for hemoglobin causes crescent-shaped red blood cells that are sticky, are stiff, and have a short life span. These cells cause blockages, tremendous pain brought on by lack of oxygen in the muscles, organ damage, stroke, and problems with infections. The cells' short life span often results in anemia. The unpredictable pain event-sickle cell disease with crisis-is the most common reason for presentation to the emergency department and for hospital admission. For many SCD patients, the emergency department process and the general, overly conservative approach to pain relief lead to a delay in treatment and prolong needless suffering. Regional Medical Center at Memphis (Tennessee) established an SCD unit and developed an inpatient care delivery model that decreases the burden of caring for SCD patients on its busy emergency department, improves SCD patients' satisfaction and access to timely quality care, and reduces the needless pain and suffering of SCD patients. This SCD model may be replicated in large urban hospitals with a daily SCD patient census of five or more.

Understanding school-age obesity: through participatory action research.

PURPOSE: This study aimed to assess current levels of overweight (obesity) and fitness among school students using objective data. METHODS: School-based action research teams were recruited statewide by the New Hampshire Healthy Schools Coalition, the state team of the National Action for Healthy Kids Coalition. Action teams consisted of a physical education teacher, a school nurse, and a school administrator. Data were collected from 6,511 student participants aged 6 to 14 years, which was a representative cross-section from New Hampshire school districts. Key variables of interest in the study were body mass index, and ability to pass five fitness tests using FITNESSGRAM. Pearson's correlation was used to assess the relationships among body mass index, age, gender, and the percent of students that passed FITNESSGRAM tests. RESULTS: The ability of participants to pass the FITNESSGRAM tests declined markedly with age and differed between boys and girls, although the healthy fitness zones for any particular test was lower for girls. Body mass index was significantly negatively correlated with performance on all tests. Age was also statistically negatively correlated with performance on all tests; the relationship between gender and performance on the tests was less striking. CLINICAL IMPLICATIONS: Results reflected an increase in the prevalence of overweight school children, even in New Hampshire, which is purported to be one of the healthiest states in the nation. Results offered evidence that body mass index is a valid proxy measure for fitness levels and that fitness programs are necessary to effectively combat the obesity epidemic. Evidence-based changes need to be implemented to address obesity-related factors in schools, because children spend many of their waking hours in that setting. Physical activity during recess and physical education classes could help to increase energy expenditure and develop sound minds and bodies. Schools should consider the development of school-based wellness teams to advise and advocate improved school-based wellness policies. School nurses can take an active part in these initiatives.

The testing effect: teaching to enhance learning in health administration education.

Article reports the value associated with testing in promoting student learning and retention of course material--the testing effect. Testing prompts students to retrieve information from memory and promotes long-term memory. Using the testing effect in health administration education may assist faculty to better achieve intended student learning outcomes.

Primary gluteal abscess due to Salmonella typhimurium: a case report and review of the literature.

Infections due to nontyphoidal salmonellae are common, and their incidence has been increasing in the last few years. In this case report, we document the unusual finding of a gluteal abscess caused by Salmonella typhimurium in the absence of detectable bacteremia. Fluoroquinolones remain an important treatment option for salmonellosis, and to avoid potential treatment failures, we underscore the importance of routine screening for nalidixic acid susceptibility with all extraintestinal Salmonella isolates. To our knowledge, this is the first published case of S typhimurium gluteal abscess in the absence of bacteremia and risk factors for salmonellosis.

Residents' perceptions of a college health clinic to train internal medicine residents in adolescent and primary care internal medicine.

PURPOSE: To assess internal medicine residency graduates' perception of the value of a college health clinic in providing adolescent medicine and general primary care training to internal medicine residents. METHODS: An 11-item questionnaire was sent in mid-2004 to all physicians who had received training at a college health clinic during their internal medicine residency program. Variables examined included time in the clinic and current practice characteristics. In addition, the physicians were asked to compare their residency college clinic with their continuity clinic in the following educational areas: care of the adolescent patient, diagnosis and management of primary care conditions, coding, practice modeling, and overall learning experience. RESULTS: There was a response rate of 71% (30/42). Respondents reported that 31% of their current patients had conditions seen at the college health clinic. The college clinic was felt to be better than the continuity clinic in preparation for the office practice of general internal medicine; the care of the adolescent patient; the diagnosis and management of illnesses such as upper respiratory infections, urinary tract infections, and eating disorders; modeling an effective and efficient office practice; and as an overall learning experience. Ninety percent of respondents recommended continuing the use of a college clinic as part of the educational experience for internal medicine residents. CONCLUSION: Internal medicine residency training programs should consider using college health clinics to provide adolescent medicine training and training for the practice of primary care medicine.

Using a general internal medicine consult service to teach residents and care for patients.

A general medicine consult service can be difficult to manage because house staff are unaccustomed to the consultant role, the required knowledge is new and diverse, and the curriculum may be poorly defined. Within the last 3 decades, perioperative consultation has been more rigorously studied and a more evidence-based method has emerged. The consultative service at the University of Tennessee has developed a systematic approach to medical consultation that provides efficient, evidence-based patient care along with resident education. The curricular model, which reflects the newly required competencies of the American Board of Internal Medicine and the Residency Review Committee, is transferable to most training settings.