The purpose of the study was to find the sociopsychological factors predicting the intention of compliance with the dietary regimen in diabetes with a questionnaire. Data were collected from 282 adult noninsulin-dependent diabetics in Seoul, Kyoggida, and Kyongsangbukdo in Korea. Stepwise multiple regression analysis was conducted with predictor variables from theories of the Health Belief Model, Social Cognitive Model, The Theory of Reasoned Action, and Social Support. The behavioral intention of compliance with the prescribed diet was the independent variable. Subjects norm self-efficacy knowledge about diet therapy, outcome expectation, relationship with medical team, threat of deterioration of disease, and social support were the independent variables, The mean score of behavior intention was high ie 35.3 out to 42. Subjective norm and self-efficacy were the significant variables to predict the intention of dietary compliance. These variables comprised 39% of the common variance. To increase dietary compliance by influence of the referents and improve self-efficacy significant referents must be included and concrete and practical methods to follow the dietary regimen must be provided in nutrition education.
Adult ; Compliance* ; Diet ; Diet Therapy ; Education ; Humans ; Intention ; Korea ; Seoul ; Surveys and Questionnaires

The purpose of this study was to find the sociopsychological factors influencing the compliance of dietary regimen in diabetes by using focus group interviews. The data were collected from fifty three diabetes patients in eleven focus groups from September 1997 to March, 1998 in Seoul and Suwon Korea. The interviews were tape-recorded and the contents of the interviews were analysed by researchers. The subjects knew the causes, complications, and therapies of diabetes although they were incorrect at times . Patients had a wide range of outcome expectations from very optimistic to pessimistic. They recognized diabetes as a disease which needs life-time care, and they though that good care could provide a normal life. One the other hand they thought diabetes could lead to death through complications, and cause financial problems as well as social isolation. As for self-efficacy they recognized the importance of compliance to diet regimen but they thought the diet therapy was very difficult and were not very willing to follow it. They felt medical professionals, especially doctors, were influential for the therapies. However they frequently felt counselling provided by doctors was insufficient in time and content and led to attitude problems. They felt support from families and others was often insufficient and inadequate. Nutrition education fostering outcome expectation, social support, and self-efficacy is needed to increased compliance. The most influential referents were medical professional including doctors, nurses, dieticians, so their role in diet therapy should by emphasized.
Compliance* ; Diabetes Mellitus ; Diet ; Diet Therapy ; Education ; Focus Groups* ; Foster Home Care ; Gyeonggi-do ; Hand ; Humans ; Korea ; Nutritionists ; Seoul ; Social Isolation

BACKGROUND: The typical Korean diet includes rice, which is usually served in a rice bowl. We investigated the effects of a meal plan using rice bowls of varying sizes on dietary energy intake (EI), body weight (BW), and blood glucose levels. METHODS: Forty-two obese women with type 2 diabetes mellitus were randomly assigned to use either a 200 mL small rice bowl (SB), a 380 mL regular rice bowl (RB), or to a control group (C). Both intervention groups were asked to reduce their EI by 500 kcal/day for 12 weeks and simple instructions for using the assigned bowl were provided. Dietary EI and proportion of macronutrients (PMN) were estimated from 3-day dietary records. RESULTS: Reduction of EI was more prominent in the SB group compared to the RB and C group, although EI decreased significantly from baseline in all groups. Carbohydrate and fat intakes of the SB group were decreased greater than those of the RB and C group. However, changes in PMN were not significant across the 3 groups. Reduction of BW and HbA1c levels in the SB group was more prominent compared to the C group. Although, BW and HbA1c were decreased significantly from baseline in both bowl groups. There was no statistical difference between the two groups. CONCLUSION: The small rice bowl-based meal plan was effective at reducing EI, BW, and blood glucose levels, and the observed reductions in EI, carbohydrate, and fat intake were greater than those of the regular rice bowl-based meal plan.
Blood Glucose ; Body Weight ; Diabetes Mellitus, Type 2 ; Diet, Diabetic ; Diet ; Energy Intake ; Female ; Humans ; Meals ; Obesity ; Weight Loss

Usual managements of flat anterior chamber following filtering surgery are deepening of anterior chamber using cycloplegics and mydriatics, and pressure patch technique compressing the fistula. But the pressure patch technique may worsen chamber depth problem because exact compression on the filtering area is difficult by pressure patching. Prolonged pressure patching may also cause deterioration of filtering function. The tampon with glaucoma shell provides enough resistance to excessive outflow, allows the anterior chamber to reform promptly, and can prevent choroidal separation. We treated the flat anterior chamber following trabeculectomy using glaucoma shell in 7 eyes. The anterior chamber in each eye was restored promptly within 2-4 days after the placement of glaucoma shell. Glaucoma shell is easy to handle, gives minimal discomfort to patient, and may need less time to restore flat anterior chamber than pressure patching.
Anterior Chamber* ; Choroid ; Filtering Surgery ; Fistula ; Glaucoma* ; Humans ; Mydriatics ; Trabeculectomy*

PURPOSE: Exposure to dietary phytoestrogens such as genistein during early childhood is a growing public health concern. We examined the effect of early exposure to genistein on sexual maturation in immature rats. METHODS: Weaning (3wk-old) Sprague-Dawley female rats were assigned to three groups (n=6 for each): fed by high dose of genistein (100 mg/kg/d), low dose of genistein (10 mg/kg/d) and control group. First vaginal opening (VO) day was observed. Structural alterations in the ovary and uterus were assessed by histologically. Expression of genes of ERalpha, ERbeta, and progesterone receptor (PR) in the ovary and uterus were investigated by RT-PCR. RESULTS: High genistein group had earlier VO than control and low genistein group. Graafian follicle s and corpora lutea were observed from the ovary of genistein-treated groups, while primary, secondary follicles and small atretic follicles were observed in the control group. Hypertrophy of luminal and glandular uterine epithelia were found in the genistein-treated groups while poor development of gland and fewer myometrial cell layers were evident in control group. In ovary, the transcriptional activities of ERalpha and ERbeta were higher in high genistein group than in controls. In uterus, the transcriptional activities of ERalpha, ERbeta and PR were higher in low genistein group than in controls. CONCLUSION: Acute exposure to genistein during the prepubertal period could activate the reproductive endocrine system resulting in the early onset of puberty in female rats. Further clinical investigation on the effect of genistein on the sexual maturation in children is warranted.
Animals ; Child ; Corpus Luteum ; Endocrine System ; Estrogen Receptor alpha ; Estrogen Receptor beta ; Female ; Genistein ; Humans ; Hypertrophy ; Ovarian Follicle ; Ovary ; Phenobarbital ; Phytoestrogens ; Puberty ; Public Health ; Rats ; Receptors, Progesterone ; Sexual Maturation ; Uterus ; Weaning

BACKGROUND: Arterial stiffness is an important factor in atherosclerosis. Thus we examined whether aerobic exercise could reduce arterial stiffness in obese women with type 2 diabetes without diabetic complication. METHODS: A total of 35 women with type 2 diabetes (body mass index, 26.6+/-2.8 kg/m2; age, 56.4+/-1.9 years; duration of diabetes, 4.7+/-4.8 years) were assigned to aerobic exercise group (AEG) or control group (CG). AEG completed a 12-week exercise program (3.6 to 5.2 metabolic equivalents, 3 day/week, 60 min/day), with their exercise activities monitored by accelerometers. We measured abdominal total fat area (TFA), visceral fat area (VFA), and subcutaneous fat area (SFA) by computed tomography, insulin sensitivity by insulin tolerance test (K(ITT)), and augmentation index (AIx) by SphygmoCor at baseline and at the end of the 12-week program. RESULTS: The AIx was improved in the AEG compared with the CG (P<0.001). The percent change of AIx had significant correlation with the improvement of physical activity energy expenditure (PAEE), aerobic capacity, TFA, and SFA (r=-0.416, P=0.013; r=0.560, P<0.001; r=0.489, P=0.003; r=0.531, P=0.001, respectively), but not with insulin sensitivity, energy intake, or VFA. CONCLUSION: Improvement in aortic stiffness by aerobic exercise is related with the improvement of aerobic capacity, PAEE, and total fat but not with insulin sensitivity or energy intake in obese women with type 2 diabetes.
Abdominal Fat ; Atherosclerosis ; Diabetes Complications ; Diabetes Mellitus, Type 2 ; Energy Intake ; Energy Metabolism* ; Exercise* ; Female ; Humans ; Insulin ; Insulin Resistance* ; Intra-Abdominal Fat ; Metabolic Equivalent ; Motor Activity* ; Subcutaneous Fat ; Vascular Stiffness*

PURPOSE: Ezrin is a membrane cytoskeletal linker protein and it is known to be associated with metastasis of primary osteosarcoma. The aim of this study is to determine the relationship between an ezrin expression and several key clinical parameters and to elucidate its potential prognostic value for patients with osteosarcoma. MATERIALS AND METHODS: Seventy patients with histologically confirmed osteosarcoma and who had no distant metastasis were enrolled between 1995 and 2005 at Yonsei Cancer Center, Severance Hospital, Korea. The clinical parameters were retrospectively reviewed and immunohistochemical staining (IHC) for ezrin was performed using the surgically resected specimens. RESULTS: Of the 70 tumor specimens, 39 (55.7%) revealed an ezrin expression. More of an osteoblastic histology and an elevated initial ALP level were observed in the ezrin positive patients than in the ezrin negative patients (p=0.008 and 0.001, respectively). The proportion of patients who favorably responded to neoadjuvant chemotherapy (> or =90% necrosis) was significantly higher in the group of ezrin positive patients than that in the group of ezrin negative patient (72.2% vs 45.2%, respectively, p=0.024). The ezrin positive patients showed more frequent recurrence than did the ezrin negative patients (64.1% vs 35.5%, respectively, p=0.017). The patients with an ezrin expression also demonstrated poorer survival than did those patients without ezrin expression (5-year EFS: 31.7% vs 61.3%, respectively, p=0.023, 5-year OS: 53.4% vs 71.0%, respectively, p=0.022). When comparing EFS according to both an ezrin expression and chemoresponsiveness, there were trends that the ezrin negative/chemoresponsive group showed the best 5-year EFS (71.4%), followed by the ezrin negative/chemoresistant group (52.9%), the ezrin positive/chemoresponsive group (38.1%) and the ezrin positive/chemoresistant group (13.6%). These trends were statistically significant (p=0.036). CONCLUSION: The expression of ezrin by IHC staining was found in 55.7% of the patients with metastasis-free osteosarcoma. Immunoreactivity to ezrin is a negative prognostic factor for survival for the patients suffering with osteosarcoma. Identifying an ezrin expression might offer a valuable piece of information when treating patients with primary osteosarcoma.
Cytoskeletal Proteins ; Humans ; Korea ; Membranes ; Neoplasm Metastasis ; Osteoblasts ; Osteosarcoma ; Recurrence ; Retrospective Studies ; Stress, Psychological

BACKGROUND: Our goal was to investigate the effects of low intensity resistance training on body fat, muscle mass and strength, cardiovascular fitness, and insulin sensitivity in type 2 diabetes. METHODS: Twenty-eight overweight women with type 2 diabetes were randomly assigned to a resistance training group (RG, n = 13) or a control group (CG, n = 15). RG performed resistance training using elastic bands, of which strength was equal to 40 to 50% of one repetition maximum (1RM), for three days per week. Each exercise consisted of three sets for 60 minutes. We assessed abdominal fat using computed tomography, muscle mass using dual-energy X-ray absorptiometry, and muscle strength using Keiser's chest and leg press. Insulin sensitivity was measured using the insulin tolerance test, and aerobic capacity was expressed as oxygen uptake at the anaerobic threshold (AT-VO2) before and after the 12-week exercise program. RESULTS: The age of participants was 56.4 +/- 7.1 years, duration of diabetes was 5.9 +/- 5.5 years, and BMI was 27.4 +/- 2.5 kg/m2, without significant differences between two groups. During intervention, a greater increase in muscle mass and greater decreases in both total fat mass and abdominal fat were observed in RG compared to those of CG (P = 0.015, P = 0.011, P = 0.010, respectively). Increase in 1RM of upper and lower extremities was observed in the RG (P = 0.004, P = 0.040, respectively), without changes in AT-VO2 and insulin resistance in either group. CONCLUSION: In conclusion, the low intensity resistance training was effective in increasing muscle mass and strength and reducing total fat mass without change of insulin sensitivity in type 2 diabetic patients.
Abdominal Fat ; Absorptiometry, Photon ; Adipose Tissue ; Anaerobic Threshold ; Diabetes Mellitus, Type 2 ; Female ; Humans ; Insulin ; Insulin Resistance ; Leg ; Lower Extremity ; Muscle Strength ; Muscles ; Overweight ; Oxygen ; Resistance Training ; Thorax

BACKGROUND: The Korean National Health and Nutrition Examination Surveys reported 65% of daily energy intake (EI) as carbohydrate (CHO) in the Korean population and main source of CHO was cooked rice. We used a standardized-small sized rice bowl for diet education and investigated its effectiveness on body weight, glucose and lipid, compared to the conventional food exchange system in type 2 diabetes obese women. METHODS: Type 2 diabetic women with body mass index > or = 23 kg/m2 were randomly assigned to small rice bowl-based meal plan (BM) and food exchange-based meal plan (ExM) group. Both groups were asked to reduce their EI by 500 kcal/day for 12 weeks. The macronutrient composition was instructed: 55 to 60% of EI as CHO, 15 to 20% as protein, and 20 to 25% as fat. BM group received only a simple instruction for application of the rice bowl. Nutrient intake was estimated with the 3-day dietary records. RESULTS: Finally, 44 subjects finished the study. The percent reduction of body weight was significant both BM group (-5.1 +/- 2.6%) and ExM group (-4.8 +/- 2.8%) after 12 weeks (P < 0.001) but there was no difference between the groups. There was no difference in the proportional change of CHO, protein and fat in EI between the groups. Additionally, the change of HbA1c and low density lipoprotein-cholesterol were not significantly different between the two groups. CONCLUSION: The BM group was as effective as ExM for body weight and glucose control in type 2 diabetes obese women.
Body Mass Index ; Body Weight ; Diabetes Mellitus, Type 2 ; Diet, Diabetic ; Diet ; Diet Records ; Energy Intake ; Female ; Glucose ; Humans ; Meals ; Obesity ; Weight Loss

BACKGROUND: Insulin resistance is related to central obesity and the amount of skeletal muscle. A simple and practical anthropometric marker for muscle mass is not known, although waist circumference (WC) is used as an indicator of abdominal obesity. The aims of this study were to investigate whether arm (AC) and thigh circumferences (TC) can be used as an indicator of muscle mass and if they are related to muscle strength. METHODS: A total of 110 obese (body mass index [BMI]> or =25 kg/m2) women with type 2 diabetes were enrolled, and WC, AC, and TC were measured. Abdominal visceral fat (AVF), subcutaneous fat (ASF), and total fat (ATF) were assessed by computed tomography, regional muscle (MM), and fat mass by dual-energy X-ray absorptiometry, muscle strength by one repetition maximum (1RM) of both extremities (chest and leg press) and insulin resistance by KITT. RESULTS: The mean age was 56.2+/-7.3 years, duration of diabetes was 4.2+/-4.4 years, and BMI was 27.2+/-2.8 kg/m2. WC was correlated with ATF, AVF, and ASF (r=0.728, P<0.001; r=0.515, P<0.001; r=0.608, P<0.001, respectively). Arm MM was correlated with AC (r=0.500, P<0.001), and leg MM with TC (r=0.291, P=0.002). Upper 1RM was related to AC/WC ratio (r=0.359, P<0.001), and lower 1RM was to TC/WC ratio (r=0.286, P=0.003). Insulin resistance had significant relations with AVF, WC, and total MM (r=-0.262, P=0.008; r=-0.217, P=0.029; r=0.160, P=0.031, respectively). CONCLUSION: The muscle mass was related to extremity circumferences, and muscle strength was to extremity/waist circumference ratio in obese women with type 2 diabetes.
Absorptiometry, Photon ; Arm ; Diabetes Mellitus, Type 2 ; Extremities ; Female ; Humans ; Insulin Resistance ; Intra-Abdominal Fat ; Leg ; Muscle Strength ; Muscle, Skeletal ; Muscles ; Obesity, Abdominal ; Subcutaneous Fat ; Thigh ; Waist Circumference