Associations between body mass index (BMI), body fat percentage (BF%), and health risks differ between Asian and European populations. BMI is commonly used to diagnose obesity; however, its accuracy in detecting adiposity in Koreans is unknown. The present cross-sectional study aimed at assessing the accuracy of BMI in determining BF%-defined obesity in 6,017 subjects (age 20-69 yr, 43.6% men) from the 2009 Korean National Health and Nutrition Examination Survey. We assessed the diagnostic performance of BMI using the Western Pacific Regional Office of World Health Organization reference standard for BF%-defined obesity by sex and age and identified the optimal BMI cut-off for BF%-defined obesity using receiver operating characteristic curve analysis. BMI-defined obesity (> or =25 kg/m2) was observed in 38.7% of men and 28.1% of women, with a high specificity (89%, men; 84%, women) but poor sensitivity (56%, men; 72% women) for BF%-defined obesity (25.2%, men; 31.1%, women). The optimal BMI cut-off (24.2 kg/m2) had 78% sensitivity and 71% specificity. BMI demonstrated limited diagnostic accuracy for adiposity in Korea. There was a -1.3 kg/m2 difference in optimal BMI cut-offs between Korea and America, smaller than the 5-unit difference between the Western Pacific Regional Office and global World Health Organization obesity criteria.
Adipose Tissue/*physiology ; Adiposity/*physiology ; Adult ; Aged ; *Body Mass Index ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged ; Nutrition Surveys ; Obesity/*diagnosis ; ROC Curve ; Reference Standards ; Republic of Korea ; Young Adult

Associations between body mass index (BMI), body fat percentage (BF%), and health risks differ between Asian and European populations. BMI is commonly used to diagnose obesity; however, its accuracy in detecting adiposity in Koreans is unknown. The present cross-sectional study aimed at assessing the accuracy of BMI in determining BF%-defined obesity in 6,017 subjects (age 20-69 yr, 43.6% men) from the 2009 Korean National Health and Nutrition Examination Survey. We assessed the diagnostic performance of BMI using the Western Pacific Regional Office of World Health Organization reference standard for BF%-defined obesity by sex and age and identified the optimal BMI cut-off for BF%-defined obesity using receiver operating characteristic curve analysis. BMI-defined obesity (> or =25 kg/m2) was observed in 38.7% of men and 28.1% of women, with a high specificity (89%, men; 84%, women) but poor sensitivity (56%, men; 72% women) for BF%-defined obesity (25.2%, men; 31.1%, women). The optimal BMI cut-off (24.2 kg/m2) had 78% sensitivity and 71% specificity. BMI demonstrated limited diagnostic accuracy for adiposity in Korea. There was a -1.3 kg/m2 difference in optimal BMI cut-offs between Korea and America, smaller than the 5-unit difference between the Western Pacific Regional Office and global World Health Organization obesity criteria.
Adipose Tissue/*physiology ; Adiposity/*physiology ; Adult ; Aged ; *Body Mass Index ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged ; Nutrition Surveys ; Obesity/*diagnosis ; ROC Curve ; Reference Standards ; Republic of Korea ; Young Adult

The Specialty Certification Examination is an important part of the assessment of medical education. However, the step 2 skill examinations of 26 medical specialties in Korea are insufficient with respect to achieving the objective of practical examinations that evaluate clinical skill and competence. Among the current step 2 skill examination methods, picture testing using slides or reading of pathology slides/radiologic images is more suitable for testing cognition and knowledge than for testing performance. The oral examination has low reliability because of its relatively short testing period and absence of scoring criteria. In addition, the Specialty Certification Examination is a high-stakes test and the performance during the training course is not reflected in the skill examination. We have reviewed the various skill examinations including clinical practice examinations, objective structured clinical examinations of the United States and Canada, and work-based assessments of the United Kingdom. Based on the review, we suggest some plans for improving the Korean Specialty Certification Examination.
Canada ; Certification* ; Clinical Competence ; Cognition ; Diagnosis, Oral ; Education, Medical ; Great Britain ; Korea ; Mental Competency ; Pathology ; United States

PURPOSE: To evaluate the usefulness of dynamic gadolinium-enhanced MR imaging in the staging of bladder cancer. MATERIALS AND METHODS: Twenty-four patients with histologically proven bladder cancer underwent MR imaging before tumor resection. Pre contrast axial or sagittal T1- and T2-weighted images were obtained in all patients. In 12, dynamic MR imaging was performed using the 3D-EFGRE technique in the axial plane. Images were obtained 30, 90, and 180 sec after a rapid hand injection of Gd-DTPA. T1W1, T2W1, and Gd-enhanced dynamic images were compared on the basis of lesion conspicuity and correlated with histologic specimens. The signal intensity ratio (SIR) of bladder tumors, muscle, and perivesical fat during each phase, and the contrast-to-noise ratio (CNR) of lesion-to-muscle and lesion-to-fat were determined. RESULTS: The accuracy of tumor staging using both T1WI and T2WI was 38% (9/24), and the accuracy of dynamic gadolinium enhanced MR imaging was 58% (7/12). The difference was statistically significant (p<0.05). The SIR of tumors was highest during the capillary phase, and decreased during the venous phase. During all phases i t was significantl y higher than that of bladder muscle and perivesi cal fat ( P < 0.05). The CNR of tumor-to-muscle and tumor-to-perivesical fat increased abruptly during the arterial phase, was highest during the capillary phase and decreased slightly during the venous phase. CONCLUSION: Dynamic gadolinium enhanced MR imaging improves the diagnostic accuracy of both T1WI and T2WI in the preoperative staging of bladder cancer and can be useful in the management and estimation of prognosis. For evalvation of the staging of bladder cancer, the capillary phase is optimal.
Capillaries ; Gadolinium ; Gadolinium DTPA ; Hand ; Humans ; Magnetic Resonance Imaging* ; Neoplasm Staging ; Prognosis ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: To evaluate the usefulness of dynamic gadolinium-enhanced MR imaging in the staging of bladder cancer. MATERIALS AND METHODS: Twenty-four patients with histologically proven bladder cancer underwent MR imaging before tumor resection. Pre contrast axial or sagittal T1- and T2-weighted images were obtained in all patients. In 12, dynamic MR imaging was performed using the 3D-EFGRE technique in the axial plane. Images were obtained 30, 90, and 180 sec after a rapid hand injection of Gd-DTPA. T1W1, T2W1, and Gd-enhanced dynamic images were compared on the basis of lesion conspicuity and correlated with histologic specimens. The signal intensity ratio (SIR) of bladder tumors, muscle, and perivesical fat during each phase, and the contrast-to-noise ratio (CNR) of lesion-to-muscle and lesion-to-fat were determined. RESULTS: The accuracy of tumor staging using both T1WI and T2WI was 38% (9/24), and the accuracy of dynamic gadolinium enhanced MR imaging was 58% (7/12). The difference was statistically significant (p<0.05). The SIR of tumors was highest during the capillary phase, and decreased during the venous phase. During all phases i t was significantl y higher than that of bladder muscle and perivesi cal fat ( P < 0.05). The CNR of tumor-to-muscle and tumor-to-perivesical fat increased abruptly during the arterial phase, was highest during the capillary phase and decreased slightly during the venous phase. CONCLUSION: Dynamic gadolinium enhanced MR imaging improves the diagnostic accuracy of both T1WI and T2WI in the preoperative staging of bladder cancer and can be useful in the management and estimation of prognosis. For evalvation of the staging of bladder cancer, the capillary phase is optimal.
Capillaries ; Gadolinium ; Gadolinium DTPA ; Hand ; Humans ; Magnetic Resonance Imaging* ; Neoplasm Staging ; Prognosis ; Urinary Bladder Neoplasms* ; Urinary Bladder*

OBJECTIVE: The prevalence rate of osteoarthritis in Koreans aged 50 years or older is 14.3%, and the total amount of medical costs is more than KRW 1 trillion. Recently, the reimbursement guidelines for osteoarthritis treatment have changed. METHODS: In this study, we sought to describe prescription patterns of nonsteroidal anti-inflammatory drugs (NSAIDs) and gastro-protective agent (GPA) and analyze the clinical and economic impacts of the new policy using the national health insurance claims data. The incidence of upper gastrointestinal adverse event by policy change was identified through the odds ratio, and changes in medicine and medical costs related to osteoarthritis through mean and median. RESULTS: There were 204,552 patients before the reimbursement guidelines relaxation and 239,710 after it, a 17.2% rise. The prescription ratio was 3.3% for the patients prescribed with COX-2 selective NSAIDs alone and 1.3% for those with both COX-2 selective NSAIDs and GPA combination before the reimbursement guidelines relaxation. The reimbursement guidelines relaxation significantly increased their ratios to 6.9% and 2.8%, respectively. Gastrointestinal adverse events significantly reduced by 1.21%p after reimbursement guidelines relaxation. The average medicine cost per person increased significantly to KRW 140,291 from KRW 137,323 after the reimbursement guidelines relaxation, while the average medical cost per person slightly decreased from KRW 311,605 to KRW 310,755 after the relaxation, showing no meaningful difference. CONCLUSION: The reimbursement guidelines relaxation may influence on decreasing the upper gastrointestinal adverse event, increasing the medicine costs and maintaining the medical costs for osteoarthritis.

BACKGROUND: The number of internet users is increasing rapidly and internet addiction among adolescents has become a serious public health problem in Korea. In the light of behavioral addiction, this study was aimed to identify the associations between the risk of internet addiction and other problem behaviors which can lead to addiction, such as cigarette smoking, alcohol drinking, drug abuse, and sexual intercourse among a nationally representative sample of Korean adolescents. METHODS: Data from the 2010 Korean Youth Risk Behavior Web-based Survey (respondents, 73,238) were analyzed. Risk of internet addiction was assessed by the 'Korean Internet Addiction Proneness Scale for Youth-Short Form: Self Report' which was developed by the Korean National Information Society Agency in 2008. Multiple logistic regression analysis was used to calculate the odds ratios of problem behaviors among adolescents at high risk for internet addiction and adolescents at low risk for internet addiction. RESULTS: The odds of smoking experience, drug abuse experience, and sexual intercourse experience were significantly higher among boys at high risk for internet addiction compared to boys at low risk for internet addiction. Among girls at high risk of internet addiction, the odds of smoking experience, drinking experience, and drug abuse experience were significantly higher compared with girls at low risk of internet addiction. CONCLUSION: The risk of internet addiction was associated with cigarette smoking, alcohol drinking, drug abuse, and sexual intercourse experience among Korean adolescents.
Adolescent ; Alcohol Drinking ; Behavior, Addictive ; Coitus ; Drinking ; Humans ; Internet ; Korea ; Light ; Logistic Models ; Odds Ratio ; Public Health ; Risk-Taking ; Sexual Behavior ; Smoke ; Smoking ; Substance-Related Disorders

PURPOSE: Periodontal ligament (PDL) cell differentiation into osteoblasts is important in bone formation. Bone formation is a complex biological process and involves several tightly regulated gene expression patterns of bone-related proteins. The expression patterns of bone related proteins are regulated in a temporal manner both in vivo and in vitro. The aim of this study was to observe the gene expression profile in PDL cell proliferation, differentiation, and mineralization in vitro. METHODS: PDL cells were grown until confluence, which were then designated as day 0, and nodule formation was induced by the addition of 50 microg/mL ascorbic acid, 10 mM beta-glycerophosphate, and 100 nM dexamethasone to the medium. The dishes were stained with Alizarin Red S on days 1, 7, 14, and 21. Real-time polymerase chain reaction was performed for the detection of various genes on days 0, 1, 7, 14, and 21. RESULTS: On day 0 with a confluent monolayer, in the active proliferative stage, c-myc gene expression was observed at its maximal level. On day 7 with a multilayer, alkaline phosphatase, bone morphogenetic protein (BMP)-2, and BMP-4 gene expression had increased and this was followed by maximal expression of osteocalcin on day 14 with the initiation of nodule mineralization. In relationship to apoptosis, c-fos gene expression peaked on day 21 and was characterized by the post-mineralization stage. Here, various genes were regulated in a temporal manner during PDL fibroblast proliferation, extracellular matrix maturation, and mineralization. The gene expression pattern was similar. CONCLUSIONS: We can speculate that the gene expression pattern occurs during PDL cell proliferation, differentiation, and mineralization. On the basis of these results, it might be possible to understand the various factors that influence PDL cell proliferation, extracellular matrix maturation, and mineralization with regard to gene expression patterns.
Alkaline Phosphatase ; Anthraquinones ; Apoptosis ; Ascorbic Acid ; Biological Processes ; Bone Morphogenetic Proteins ; Cell Differentiation ; Cell Proliferation ; Dexamethasone ; Durapatite ; Extracellular Matrix ; Fibroblasts ; Gene Expression ; Genes, fos ; Genes, myc ; Glycerophosphates ; Humans ; Osteoblasts ; Osteocalcin ; Osteogenesis ; Periodontal Ligament ; Proteins ; Real-Time Polymerase Chain Reaction ; Transcriptome

BACKGROUND: Recent studies suggest that coffee consumption has an influence on kidney function. This study investigated the relationship between habitual coffee consumption and renal impairment in Korean women, in consideration of diabetic status. METHODS: This study involved 2,673 women aged 35 to 84 years who had participated in the Fourth Korea National Health and Nutrition Examination Surveys, conducted in 2008. Habitual coffee consumption was classified into three categories: less than 1 cup per day, 1 cup per day, and 2 or more cups per day. Renal function impairment was defined as an estimated glomerular filtration rate less than 60 mL/min/1.73 m2 by the Modification of Diet in Renal Disease equation. RESULTS: The prevalence of diabetes and renal function impairment was higher in women who drank < 1 cup of coffee per day. Compared with drinking < 1 cup of coffee per day, the odds ratio (OR) for renal function impairment was significantly lower (OR, 0.59; 95% confidence interval [CI], 0.37 to 0.95; P = 0.03) in those who habitually drank > or = 2 cups per day after adjusting for multiple confounding factors. When data were stratified according to the presence of diabetes, coffee consumption > or = 2 cups of coffee per day showed an inverse association with renal function impairment in only diabetic women (OR, 0.14; 95% CI, 0.02 to 0.88; P = 0.04), compared with consumption < 1 cup of coffee per day. CONCLUSION: In a representative sample of Korean women, coffee consumption was significantly associated with a decreased risk of renal impairment especially in middle and elderly-aged diabetic women.
Aged ; Coffee ; Diabetes Mellitus ; Diet ; Drinking ; Female ; Glomerular Filtration Rate ; Humans ; Kidney ; Korea ; Nutrition Surveys ; Odds Ratio ; Prevalence

BACKGROUND: This study examined the differences in factors associated with albuminuria according to gender and comorbidities of hypertension (HTN) and diabetes mellitus (DM). METHODS: We included 3,859 participants aged 20 to 79 years (55% female) from the 5th Korea National Health and Nutrition Examination Survey. Participants were excluded if they took antihypertensive or anti-diabetic medication, had chronic renal failure, had malignant tumor, were pregnant or menstruating during the health examination, or had missing urine albumin data. Albuminuria was defined by the participant's urine albumin-creatinine ratio (uACR). Relationships between dependent and independent variables were analyzed using the Pearson's correlation test and simple linear regression. Due to possible muticollinearity, multiple linear regression analysis was used to determine whether the association between the dependent and independent variables of interest remained significant after adjustment for other potentially confounding independent variables. RESULTS: The variables significantly correlated with uACR were different between the genders and between subjects with HTN or DM as a comorbidity. In the multiple linear regression models, hemoglobin A1c (P=0.01) was positively associated with uACR in men without HTN and DM. In men with HTN or DM, systolic blood pressure and fasting glucose (P<0.01) were positively associated with uACR. In women with HTN or DM, waist circumference (P=0.011) and gamma-glutamyl transpeptidase (P<0.001) were positively correlated with uACR (P<0.05) and glucose level (P=0.019) was negatively correlated with uACR. CONCLUSION: The study suggested factors correlated with albuminuria were different for men and women according to comorbidities such as HTN and DM.
Albuminuria* ; Blood Pressure ; Comorbidity* ; Diabetes Mellitus ; Fasting ; Female ; gamma-Glutamyltransferase ; Gender Identity ; Glucose ; Humans ; Hypertension* ; Kidney Failure, Chronic ; Korea ; Linear Models ; Male ; Nutrition Surveys ; Waist Circumference