No abstract available.
Democratic People's Republic of Korea ; Education, Medical

Dietary supplementation of calcium and vitamin D has been deemed one of the most important tools to fight against osteoporotic fractures increasing with aging of the population globally. Reports from early clinical trials demonstrated that supplementation of calcium and vitamin D for patients with osteoporosis can reduce the incidence of fragility fractures by decreasing bone loss and falls. However, following trials failed to demonstrate the efficacy of calcium and vitamin D for the prevention of osteoporotic fractures, questioning the need of calcium and vitamin D supplementation. Even metanalyses and system reviews presented opposite conclusions , depending on clinical trials included. Recent studies reported that excessive calcium supplement can increase cardiovascular risk such as non-fatal myocardial infarction and that excessive vitamin D supplement can produce more frequent falls than it is supposed to be. However, in spite of some arguments regarding the efficacy and safety of calcium and vitamin D supplementation, it seems to be essential to provide 800 to 1,000 mg elementary calcium and 800 to 1,000 IU vitamin D for the elderly whose intake of calcium and vitamin D is insufficient to prevent osteoporotic fracture.

Dietary supplementation of calcium and vitamin D has been deemed one of the most important tools to fight against osteoporotic fractures increasing with aging of the population globally. Reports from early clinical trials demonstrated that supplementation of calcium and vitamin D for patients with osteoporosis can reduce the incidence of fragility fractures by decreasing bone loss and falls. However, following trials failed to demonstrate the efficacy of calcium and vitamin D for the prevention of osteoporotic fractures, questioning the need of calcium and vitamin D supplementation. Even metanalyses and system reviews presented opposite conclusions , depending on clinical trials included. Recent studies reported that excessive calcium supplement can increase cardiovascular risk such as non-fatal myocardial infarction and that excessive vitamin D supplement can produce more frequent falls than it is supposed to be. However, in spite of some arguments regarding the efficacy and safety of calcium and vitamin D supplementation, it seems to be essential to provide 800 to 1,000 mg elementary calcium and 800 to 1,000 IU vitamin D for the elderly whose intake of calcium and vitamin D is insufficient to prevent osteoporotic fracture.

PURPOSE: We investigated how serum low-density lipoprotein (LDL) level is related to various isoforms of apolipoprotein (ApoE) polymorphism in association with obesity and metabolic syndrome. MATERIALS AND METHODS: We gathered total 332 sample of postmenopausal Korean women and analyzed ApoE isoforms, serum lipid level including LDL, blood pressure, fasting glucose, and anthropometry. The relationship between ApoE isoforms and serum lipid level, metabolic syndrome, and obesity was investigated. RESULTS: Six ApoE isoforms were found, ApoE2 [E2/2 (n=1), E2/3 (n=54), E2/4 (n=14)], ApoE3 (E3/3, n=200), ApoE4 [E3/4 (n=55), and E4/4 (n=8)]. The prevalence of metabolic syndrome and obesity showed higher ApoE3 isoform than that of other isoforms. In additon, ApoE3 isoform was related to higher serum LDL and total cholesterol level than to ApoE2 isoform. The odds ratio of having the highest LDL cholesterol quartile in ApoE3 with obesity, compared to ApoE2 without obesity, was 3.46 [95% confidence interval (CI); 1.07-11.14, p=0.037], and odds ratio of ApoE3 with metabolic syndrome compared to ApoE2 without metabolic syndrome was 5.06 (95% CI; 1.14-22.29, p=0.037). Serum LDL cholesterol was positively associated with obesity or metabolic syndrome in ApoE3 isoform. CONCLUSION: This study suggests that obesity or metabolic syndrome risk should be effectively managed in ApoE3 isomform groups to reduce serum LDL in postmenopausal Korean women.
Aged ; Apolipoproteins E/*genetics ; Cholesterol, LDL/*blood ; Female ; Humans ; Middle Aged ; Obesity/*blood ; *Polymorphism, Genetic ; Postmenopause/*blood ; Republic of Korea ; Syndrome

OBJECTIVES: Vitamin D deficiency, which causes secondary hyperparathyroidism, is considered to be a major contributor to osteoporosis. Because the serum 25-hydroxyvitamin D (25-OHD) level depend on sun exposure and, varies by season, the level of serum 25-OHD in each season at which vitamin D status can lead to changes in bone mineral density (BMD) is not known. METHODS: A total of 2,878 women who underwent periodic health examinations at Ajou University Hospital were included in this study. We measured the serum 25-OHD concentrations using radioimmunoassay and BMDs using dual energy x-ray absorptiometry (DXA). The differences in serum 25-OHD levels among groups as a function of age, season, and BMD were tested by one-way ANOVA. RESULTS: The serum 25-OHD level was not different based on age, but by season, with higher levels in the summer and autumn than in the winter and spring. However, the 25-OHD level did not have a significant relationship with BMD in any season. CONCLUSION: The serum 25-OHD level represents vitamin D status at the time of testing, which is not associated with long-term changes in BMD. When the 25-OHD levels are used to make clinical decisions related to the treatment of osteoporosis, careful interpretation is required.
Absorptiometry, Photon ; Bone Density ; Female ; Humans ; Hyperparathyroidism, Secondary ; Osteoporosis ; Radioimmunoassay ; Seasons ; Solar System ; Vitamin D ; Vitamin D Deficiency ; Vitamins

BACKGROUND: The metabolic syndrome is a cluster of related cardiovascular risk factors and it is the cause of morbidity and mortality in cardiovascular diseases. Recently, new diagnostic criteria of glucose metabolism impairment has been recommended. The purpose of this study was to estimate the difference of cardiovascular risk by investigating the prevalence of metabolic syndrome according to the degree of glucose metabolism impairment. METHODS: A population of 757 subjects was selected from a database of individuals who visited a health promotion center. We classified these subjects into 5 groups [Normal, Isolated impaired glucose tolerance (I-IGT), Isolated impaired fasting glucose (I-IFG), combined IGT with IFG (IGT/IFG) and Diabetes]. We compared the general characteristics, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and the prevalence of metabolic syndrome in these groups. RESULTS: HOMA-IR and the prevalence of metabolic syndrome in the IGT/IFG and the Diabetes group were significantly greater than the Normal group. HOMA-IR and the prevalence of metabolic syndrome of the I-IGT and the I-IFG group were not significantly different with the Normal group. CONCLUSION: The insulin resistance and the prevalence of metabolic syndrome in the IGT/IFG group was significantly greater than the Normal group, and its presence may increase the risk of cardiovascular diseases. Therefore, it is important to control other combined metabolic disorders to prevent cardiovascular events after effective selection for IGT/ IFG.
Cardiovascular Diseases ; Fasting ; Glucose* ; Health Promotion ; Homeostasis ; Insulin Resistance ; Metabolism* ; Mortality ; Prevalence* ; Risk Factors

PURPOSE: To evaluate the efficacy, safety and availability of a 12-week, community-based obesity control program called the Protein-Rich Oriental Diet (PRO Diet) and to compare it to a conventional diet. MATERIALS AND METHODS: A total of 515 overweight people (55 men and 460 women; mean age 41.9 +/- 9.8 years; body mass index (BMI) 28.1 +/- 3.6 kg/m2) participated in the program at two public health centers. PRO Diet was offered as the main diet recommendation for 12 weeks. As a control group, we selected a population who had followed a conventional diet program conducted at a public health center in 2006. RESULTS: 177 subjects (34.3%) completed the 12-week PRO Diet program. In a per protocol (PP) analysis, the mean changes in anthropometry were (conventional program vs. PRO Diet; weight, - 2.3 kg vs. - 4.7 kg, p < 0.001; BMI, - 1.1 kg/m2 vs. - 1.9 kg/m2, p < 0.001; waist circumference, - 3.3 cm vs. - 6.8 cm, p < 0.001; fat mass, - 2.0 kg vs. - 4.2 kg, p < 0.001; fat % mass, - 1.8% vs. - 3.9%, p < 0.001). The triglyceride reduction was significantly greater (- 30.16 mg/dL, p < 0.001) in the PRO Diet group after intervention compared to the conventional group. CONCLUSION: The PRO Diet was an effective tool for weight loss in a community-based weight control program and well-tolerated.
Adult ; Blood Glucose/analysis ; Body Mass Index ; Body Weight ; Cholesterol/blood ; *Diet, Reducing ; Dietary Proteins/*therapeutic use ; Female ; Humans ; Lipoproteins, HDL/blood ; Male ; Obesity/*diet therapy ; Triglycerides/blood ; Waist Circumference

Background: Age-adjusted bone mineral density (BMD) in postmenopausal women decreases in developed countries whereas incidence of osteoporotic fracture decreases or remains stable. We investigated secular trends of bone density from 2008 to 2017 among different age groups of postmenopausal women. Methods: We analyzed BMD data obtained from health check-ups of 4,905 postmenopausal women during three survey cycles from 2008 to 2017. We divided them into 3 groups by age (50–59 years, 60–69 years, and 70 years or more) and observed the transition of lumbar and femoral BMD in each group, before and after adjusting for variables that may affect BMD. Results: Age-adjusted BMD, bone mineral content (BMC), and T-score demonstrated a declining trend over the survey period at lumbar spine (−2.8%), femur neck (−3.5%) and total femur (−4.3%), respectively. In the analysis for the age groups, the BMD, BMC, and T-score presented linear declining trend (−6.1%) in younger postmenopausal women while women aged over 70 or more showed linear increasing trends (+6.3%) at lumbar spine during the survey period. Femoral neck and total femur BMD demonstrated a declining linear trend only in the 50–59 and 60–69 years groups (−5.5%, −5.2%, respectively), but not in the 70 years or more group. Conclusion BMD in younger postmenopausal women has decreased considerably but has increased or plateaued in elderly women. This discordance of BMD trends among different age groups may contribute to decreased incidence of osteoporotic fracture despite a recent declining BMD trend in postmenopausal women.

BACKGROUND: New educational objectives and evaluation methods in Korean medical schools have been suggested recently to cope with health care related environmental changes. Current status of family medicine clinical clerkships in Korean medical schools is to be known before establishing standards. METHODS: Educational Committee of Korean Academy of Family Medicine surveyed the family medicine clerkship in Korean medical school (about educational environment, subjects and evaluation methods) using structured questionnaires by e-mail and Fax from February through March in 2004. RESULTS: Family medicine clinical clerkship was run by 25 of 41 medical schools (65.9%). Educational subject areas included communication skill, observation in hospital based ambulatory office, primary care and family medicine, medical recording, diagnosis and treatment of common problems, residential out-hospital ambulatory programs, presentation of hospital based ambulatory programs, procedure skill, lifelong heath management plan, and health promotion, in descending order. Faculties of family medicine were directly in charge of educational subjects. However, educational methods were mainly composed of lectures and indirect observation. It should be noted that concrete and precise evaluation methods in the family medicine clerkship program had been lacking due to insufficient and obscure evaluation strategies. CONCLUSION: Clerkship period, educational environment, and number of class were variable among medical schools in Korea. Educational format needs to be standardized in terms of common educational subjects such as communication skill education, patient education, and ambulatory care clerkship. More valid methods are to be introduced for family medicine clerkship evaluation.
Ambulatory Care ; Clinical Clerkship* ; Delivery of Health Care ; Diagnosis ; Education ; Electronic Mail ; Health Promotion ; Humans ; Korea ; Lectures ; Medical Records ; Methods ; Patient Education as Topic ; Primary Health Care ; Schools, Medical* ; Surveys and Questionnaires

BACKGROUND: Despite the declining tendency of the prevalence of tuberculosis in Korea, pulmonary tuberculosls is still considered to be such an important disease in Korea that tuberculosis patients have been screened by mass miniature radiography(MMR). Although the prevalence of tuberculosis increases with age, screening of it has been done on students and young workers. There hasn't been any study about the prevalence of tuberculosis in adolescents recently. METHODS: MMR were performed on high school freshmen in Seoul from March to September, 1995. Patients with abnormal MMR were further evaluated on history taking and standard chest X-ray. Their results were classified as normal, active tuberculosis, activity-undetermined tuberculosis, healed tuberculosis, and other diseases. The prevalence of active tuberculosis by this screening method was estimated. RESULTS: Among 194,102 high school freshmen,388 were suspected to have pulmonary tuberculosis by MMR. The prevalence of tuberculosis in high school freshmen in Seoul was 0.20%, male 0.18%, female 0.23% by MMR respectively. There was significant difference between the prevalences of both sexes. History taking and standard X-ray was taken for 94 students and among them 68 students were found to have active tuberculosis(72.3% ), 14 normal(14.9% ), 3 other diseases(3.2% ), 9 healed or activity-undetermined tuberculosis(9.6% ). Newly-diagnosed patients in active tuberculosis were 59(82.9% ). There were family history in 31 out of 94 students(33.0%) and 29 out of 68 students(37.1%) with active pulmonary tuberculosis had family history of tuberculosis. CONCLUSIONS: The prevalence of pulmonary tuberculosis in high school freshmen in Seoul was 0.20% by MMR. Positive predicitive value of MMR was 72.3% in follow-up students by standard Chest X-ray. Therefore estimated prevalence of active pulmonary tuberculosis by standard chest X-ray after MMR was 0.14%.
Adolescent* ; Female ; Follow-Up Studies ; Humans ; Korea ; Male ; Mass Screening ; Prevalence ; Radiography* ; Seoul* ; Thorax ; Tuberculosis* ; Tuberculosis, Pulmonary