It is well established that excessive sodium intake is related to a higher incidence of chronic diseases such as hypertension, stroke, coronary heart disease, cardiovascular disease and gastric cancer. Although the upper limit of the current sodium intake guideline by WHO is set at 2,000 mg/day for adults, sodium intake of Koreans is well over 4,700 mg/capita/day implying an urgent need to develop and implement sodium intake reduction policy at the national level. This study investigated the cost-effectiveness of the sodium intake reduction policy, for the first time, in Korea. Analyses were performed using most recent and representative data on national health insurance statistics, healthcare utilization, employment information, disease morbidity/mortality, etc. The socioeconomic benefits of the policy, resulting from reduced morbidity of those relevant diseases, included lower medical expenditures, transportation costs, caregiver cost for inpatients and income losses. The socioeconomic benefits from diminished mortality included reductions in earning losses and welfare losses caused by early deaths. It is estimated that the amount of total benefits of reducing sodium intake from 4.7 g to 3.0 g is 12.6 trillion Korean Won; and the size of its cost is 149 billion Won. Assuming that the effect of sodium intake reduction would become gradually evident over a 5-year period, the implied rate of average return to the sodium reduction policy is 7,790% for the following 25 years, suggesting a very high cost-effectiveness. Accordingly, development and implementation of a mid-to-long term plan for a consistent sodium intake reduction policy is extremely beneficial and well warranted.
Adult ; Cardiovascular Diseases ; Caregivers ; Chronic Disease ; Coronary Disease ; Cost-Benefit Analysis ; Delivery of Health Care ; Employment ; Health Expenditures ; Humans ; Hypertension ; Incidence ; Inpatients ; Korea ; National Health Programs ; Sodium ; Stomach Neoplasms ; Stroke ; Transportation

We report a case of pedicle screw loosening treated by modified transpedicular screw augmentation technique using polymethylmethacrylate (PMMA), which used the anchoring effect of hardened PMMA. A 56-year-old man who had an L3/4/5 fusion operation 3 years ago complained of continuous low back pain after this operation. The computerized tomography showed a radiolucent halo around the pedicle screw at L5. We augmented the L5 pedicle screw with modified pedicle screw augmentation technique using PMMA and performed an L3/4/5 pedicle screw fixation without hook or operation field extension. This modified technique is a kind of transpedicular stiffness augmentation using PMMA for the dead space around the loosed screw. After filling the dead space with 1-2 cc of PMMA, we inserted a small screw. Once the PMMA hardened, we removed the small screw and inserted a thicker screw along the existing screw threading to improve the pedicle screws' pullout strength. At 10 months' follow-up, x-ray showed strong fusion of L3/4/5. The visual analogue scale (VAS) of his back pain was improved from 9 to 5. This modified transpedicular screw augmentation with PMMA using anchoring effect is a simple and effective surgical technique for pedicle screw loosening. However, clinical analyses of long-term follow-up and biomechanical studies are needed.
Back Pain ; Follow-Up Studies ; Humans ; Low Back Pain ; Middle Aged ; Osteoporosis ; Polymethyl Methacrylate ; Pseudarthrosis

Mitral ring motion and indices of left ventricular diastolic filling were measured by M-mode and Doppler echocardiography in apical 4 chamber view in 11 dilated cardiomyopathy patients and 9 normal subjects without clinical evidence of heart disease. The mean age of patients was 52 years and average heart rate was 76 beats/min. The parameters of mitral annulus motion include earley relaxation amplitude(ER), late atrial contraction amplitude(AC) and A2-peak excursion(A2-PE). Transmitral flow velocity parameters include peak flow velocity of early diastolic flow velocity(PFVE), peak flow velocity of late atrial contraction(PFVA), the ratio between early and late peak flow velocity(PFVE/PFVA), Acceleration rate of early diastolic peak flow(AR), deceleration rate of early diastolic peak flow(DR), time velocity integral of early diastolic flow velocity(TVIE), time velocity integral of late atrial contraction flow velocity(TVIA) and ratio between early diastolic and late atrial flow velocity integral(TVIE/TVIA). In patients with dilated cardiomyopathy, ER(4.5+/-2.3mm) and AC(2.3+/-1.6mm) were significantly decreased than normal(10.7+/-2.6mm, 6.6+/-1.6mm, p<0.01, p<0.01, respectively), whereas ER/AC(1.7+/-0.7) was not significantly different than normal subjects(1.6+/-0.5). A2-PE(100+/-80 msec) was significantly delayed in dilated cardiomyopathy patients than normal subjects(35+/-25 msec, p<0.01). In analysis of transmitral flow velocities, PFVE, PFVA and PFVE/PFVA, etc were not significantly different compared to normal subjects in patients with dilated cardiomyopathy. Mitral ring motion amplitude was decreased and A2-peak excursion time interval(A2-PE) was delayed in patients with dilated cardiomyopathy, but transmitral flow velocities were not significantly different from normal subjects in patients with dilated cardiomyopathy. These results reflect the facts that early diastolic relaxation amplitude is decreased by the change of compliance of LV and late atrial contractin amplitude is decreased by decrease of atrial contractility and increased stiffness of LA and LV. Despite of decreased mitral ring motion, transmitral flow velocity is not significantly different compared to normal subjects in patients with dilated cardiomyopathy. From these evidences, not only transmitral flow velocity affected by multiple factors but also mitral ring motion affected by LA and LV function are considered in assessment of LV diastolic dysfuction.
Acceleration ; Blood Flow Velocity* ; Cardiomyopathy, Dilated* ; Compliance ; Deceleration ; Echocardiography, Doppler ; Heart Diseases ; Heart Rate ; Humans ; Relaxation

OBJECTIVE: For Posterior lumbar interbody fusion(PLIF) various cages or iliac bone dowels are used with or without pedicle screw fixation(PSF). To evaluate and compare the clinical and radiological results of different fusion methods, we intend to verify the effect of added PSF on PLIF, the effect of bone cages and several factors which are thought to be related with the postoperative prognosis. METHODS: One hundred and ninety seven patients with lumbar spinal stenosis and instability or spondylolisthesis underwent various fusion operations from May 1993 to May 2003. The patients were divided into five groups, group A (PLIF with autologous bone dowels, N=24), group B (PLIF with bone cages, N=13), group C (PLIF with bone dowels and PSF, N=37), group D (PLIF with bone cages and PSF, N=30) and group E (PSF with intertransverse bone graft, N=93) for comparison and analyzed for the outcome and fusion rate. RESULTS: Outcome was not significantly different among the five groups. In intervertebral height (IVH) changes between pre- and post-operation, Group B (2.42+/-2.20mm) was better than Group A (-1.33+/-2.05mm). But in the Group C, D and E, the IVH changes were not different statistically. Fusion rate of group C, D was higher than that of Group A and B. But the intervertebral height(IVH) increased significantly in group B(2.42+/-2.20mm). Fusion rate of group C and D were higher than that of group A and D. CONCLUSION: Intervertebral cages are superior to autologous iliac bone dowels for maintaining intervertebral height in PLIF. The additional pedicle screw fixation seems to stabilize the graft and improve fusion rates.
Humans ; Prognosis ; Spinal Stenosis ; Spine* ; Spondylolisthesis ; Transplants

OBJECTIVE: Although minimally invasive posterior cervical foraminotomy (MI-PCF) is an established approach for motion preservation, the outcomes are variable among patients. The objective of this study was to identify significant factors that influence motion preservation after MI-PCF. METHODS: Forty-eight patients who had undergone MI-PCF between 2004 and 2012 on a total of 70 levels were studied. Cervical parameters measured using plain radiography included C2–7 plumb line, C2–7 Cobb angle, T1 slope, thoracic outlet angle, neck tilt, and disc height before and 24 months after surgery. The ratios of the remaining facet joints after MI-PCF were calculated postoperatively using computed tomography. Changes in the distance between interspinous processes (DISP) and the segmental angle (SA) before and after surgery were also measured. We determined successful motion preservation with changes in DISP of ≤3 mm and in SA of ≤2°. RESULTS: The differences in preoperative and postoperative DISP and SA after MI-PCF were 0.03±3.95 mm and 0.34±4.46°, respectively, fulfilling the criteria for successful motion preservation. However, the appropriate level of motion preservation is achieved in cases in which changes in preoperative and postoperative DISP and SA motions are 55.7 and 57.1%, respectively. Based on preoperative and postoperative DISP, patients were divided into three groups, and the characteristics of each group were compared. Among these, the only statistically significant factor in motion preservation was preoperative disc height (Pearson’s correlation coefficient=0.658, p<0.001). The optimal disc height for motion preservation in regard to DISP ranges from 4.18 to 7.08 mm. CONCLUSION: MI-PCF is a widely accepted approach for motion preservation, although desirable radiographic outcomes were only achieved in approximately half of the patients who had undergone the procedure. Since disc height appears to be a significant factor in motion preservation, surgeons should consider disc height before performing MI-PCF.
Foraminotomy* ; Humans ; Neck ; Radiography ; Surgeons ; Zygapophyseal Joint

This study was designed to investigate the amount of free sugar according to each beverage category in coffee and beverage stores. The groups were categorized as 15 groups based on the kind of beverage material. The beverage groups contributing to total sugar per 100 mL were milk + syrup or powder, hot (12.9 g), ade (12.6 g), milk + syrup or powder + crushed ice (11.9 g), and espresso shot + milk + syrup + crushed ice (11.4 g). The beverage groups contributing to free sugar per 100 mL were ade (12.6 g), milk + syrup or powder + crushed ice (10.8 g), espresso shot + milk + syrup + crushed ice (10.3 g), and milk + syrup or powder, hot (9.7 g). The beverage groups contributing to total sugar (energy) per portion size were milk + syrup or powder + crushed ice 56.6 g (332.3 kcal), espresso shot + milk + syrup + crushed ice 49.3 g (333.4 kcal), milk + syrup or powder, hot 46.3 g (372.1 kcal), and milk + syrup or powder, ice 38.1 g (325.9 kcal). The beverage groups contributing to free sugar per portion size were milk + syrup or powder + crushed ice 51.2 g, espresso shot + milk + syrup + crushed ice 44.9 g, ade 37.1 g, milk + syrup or powder, hot 34.6 g, and milk + syrup or powder, ice 30.1 g. The percent of average free sugar per portion size of the WHO recommendation (free sugars <10% of total energy; <50 g/2,000 kcal) was milk + syrup or powder + crushed ice 102.4%, espresso shot + milk + syrup + crushed ice 89.8%, ade 74.1%, and milk + syrup or powder, hot 69.2%. The proportion of beverage in excess of WHO recommendation per portion size was 14.6% in espresso shot + milk + syrup + crushed ice, 22.7% in ade, and 10.9% in milk + syrup or powder, hot. Therefore, in coffee and beverage stores, menu development with reduced sugar content is needed, and nutrition information should be provided through sugar nutrition labeling.
Beverages ; Carbohydrates ; Coffee ; Food Labeling ; Ice ; Milk

OBJECTIVES: To investigate the use frequency and amount of food sources of sodium and knowledge requirement, and job satisfaction with school food services according to the school types in Busan. METHODS: A total of 98 schools were surveyed and knowledge requirement and job satisfaction were assessed using a questionnaire. In addition, the use frequency and amount of food sources of sodium for 10 school days were examined. RESULTS: The response rate of the most difficult area among dietitians' tasks was significantly high in 'nutrition education and counseling' for elementary schools and 'hygiene management' for high schools (p < .05). The response rate of the factors to be considered in meal planning was significantly high in 'energy and nutrients requirement' for elementary schools and 'menu/taste preference of students' for middle and high schools (p < .05). The response rate of whether school food services affect health and eating habits of students or not was significant high in 'very helpful' for elementary schools (p < .001). The average sodium contents in the meals of elementary, middle and high schools was 1981.4 mg/meal/person/day, 1867.3 mg/meal/person/day and 1,329.9 mg/meal/person/day, respectively. For foods in highest sodium, Kimchi, Oribulgogi, and Kare rice were ranked 1st, 2nd and 3rd respectively. The main reason for not providing the fruits was 'price' among all groups. The knowledge requirement such as 'nutrition and menu management', 'nutrition education', and 'nutrition counseling' was significantly higher in elementary school compared with middle and high school (p < .001, p < .01, and p < .01 respectively). The dietitians and nutrition teachers of elementary schools have a higher job satisfaction compared with those of middle schools (p < .01). The job satisfaction was positively correlated with knowledge requirement of dietitians and nutrition teachers of elementary and middle schools. CONCLUSIONS: The results suggest that developing dietitians' education program about knowledge requirement contribute to increasing the school food service and job satisfaction in elementary and middle schools.
Busan ; Eating ; Education ; Food Services ; Fruit ; Humans ; Job Satisfaction* ; Meals ; Nutritionists* ; Surveys and Questionnaires ; Sodium*

BACKGROUND/OBJECTIVES: South Korean's sodium consumption level is more than twice the upper limit level suggested by the WHO. Steep increases in the prevalence of hypertension and cardiovascular disease in Korea necessitate more effective sodium reduction programs. This study was conducted in order to compare sodium intake-related eating behaviors and key psychosocial factors according to age group and gender. SUBJECTS/METHODS: Using an online survey, a total of 1,564 adults (20-59 years old) considered to be geographically representative of South Korea were recruited and surveyed. The major outcomes were perceived behaviors, knowledge, intentions, and self-efficacy related to sodium intake. RESULTS: The results show that perceived behavior and level of self-efficacy related to low sodium consumption differed by age and gender. Female participants showed better behavior and intention towards low sodium intake than male counterparts. Young participants in their 20s showed the lowest intention to change their current sodium intake as well as lowest self-efficacy measures. CONCLUSIONS: Future sodium reduction interventions should be developed with tailored messages targeting different age and gender groups. Specifically, interventions can be planned and implemented at the college level or for workers in their early career to increase their intention and self-efficacy as a means of preventing future health complications associated with high sodium intake.
Adult ; Cardiovascular Diseases ; Feeding Behavior ; Female ; Humans ; Hypertension ; Intention ; Korea ; Male ; Prevalence ; Psychology ; Social Marketing ; Sodium*

This study was performed to investigate the dietary habits, body satisfaction and nutritional knowledge according to body image of middle school girl students (n = 284). The subjects were classified as lean, normal and fat groups according to body image. The weight, body mass index (BMI) and the score of body image were significantly higher in the students who recognized their body image as 'fat'. The satisfaction of present body image was significantly lower in students who recognized their body image as 'lean'. The interest in weight control and experience of weight control were significantly higher in students who recognized their body image as 'fat'. The necessity of nutrition education was higher in all groups (lean 67.2%, normal 59.0% and fat 52.8%). The products used to feel sweetened were sweetened ice (68.7%), processed milk (68.3%), confectionery (62.3%), carbonated beverage (55.3%), fermented milk (38.0%) and none (6.0%). The frequency of consumption of fruit juices and fried food was significantly higher in 'normal' compared to 'fat'. There was no significant difference in the frequency of consumption of snack and nutritional knowledge among the three groups. In the multiple regression analysis, the score of body image was negatively associated with the frequency of snack consumption in the 'lean'. The score of body image was positively associated with identification of nutrition labels and an interest in weight control but was negatively associated with satisfaction of present body image in the 'fat'. Based on these results, we conclude that, the middle school girl students need correct recognition of body image and continuous and practical nutrition education in order to maintain healthy dietary habits.
Body Image* ; Body Weight ; Carbonated Beverages ; Education ; Female* ; Food Habits* ; Fruit ; Humans ; Ice ; Milk ; Snacks

OBJECTIVE: The objective of this study was to analyze the correlation between further compression and necrotic area in osteoporotic vertebral fracture (OVF) patients with contrast-enhanced magnetic resonance imaging (CEMRI). In addition, we investigated the radiological and clinical outcome according to the range of the necrotic area. METHODS: Between 2012 and 2014, the study subjects were 82 OVF patients who did not undergo vertebroplasty or surgical treatment. The fracture areas examined on CEMRI at admission were defined as edematous if enhancement was seen and as necrotic if no enhancement was seen. The correlation between further compression and the necrotic and edematous areas of CEMRI, age, and bone mineral density was examined. Also, necrotic areas were classified into those with less than 25% (non-necrosis group) and those with more than 25% (necrosis group) according to the percentages of the entire vertebral body. For both groups, further compression and the changes in wedge and kyphotic angles were examined at admission and at 1 week, 3 months, and 6 months after admission, while the clinical outcomes were compared using the visual analog scale (VAS) and Eastern Cooperative Oncology Group (ECOG) performance status grade. RESULTS: Further compression was 14.78±11.11% at 1 month and 21.75±14.43% at 6 months. There was a very strong correlation between the necrotic lesion of CEMRI and further compression (r=0.690, p<0.001). The compression of the necrosis group was 33.52±12.96%, which was higher than that of the non-necrosis group, 14.96±10.34% (p<0.005). Also, there was a statistically significantly higher number of intervertebral cleft development and surgical treatments being performed in the necrosis group than in the non-necrosis group (p<0.005). Moreover, there was a statistical difference in the decrease in the height of the vertebral body, and an increase was observed in the kyphotic change of wedge angle progression. There was also a difference in the VAS and ECOG performance scales. CONCLUSION: The necrotic area of CEMRI in OVF had a strong correlation with further compression over time. In addition, with increasing necrosis, intervertebral clefts occurred more frequently, which induced kyphotic changes and resulted in poor clinical outcomes. Therefore, identifying necrotic areas by performing CEMRI on OVF patients would be helpful in determining their prognosis and treatment course.
Bone Density ; Humans ; Magnetic Resonance Imaging* ; Necrosis ; Prognosis ; Vertebroplasty ; Visual Analog Scale ; Weights and Measures