PURPOSE: To compare parameters of confocal scanning laser ophthalmoscopy (Heidelberg Retinal Tomograph [HRT] II) in high myopia with age- and sex-matched emmetropes. METHODS: A hospital-based cross-sectional study was conducted among Nepalese subjects aged 18 to 35 years at BP Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Maharajgunj, Kathmandu from November 2015 to October 2016. Fifty consecutive subjects with high myopia (spherical equivalent ranging from −6.00 to −12.00 diopters) and age- and sex-matched emmetropic subjects were enrolled for comparison. Correlations between disc area and other HRT parameters, asymmetry between the right and left eyes, and comparisons between male and female subjects in both high myopic and emmetropic groups were evaluated. RESULTS: Disc area was not significantly (p = 0.11) larger in high myopic eyes than in emmetropic eyes. HRT parameters in highly myopic eyes involved smaller cup parameters and greater rim parameters compared with emmetropic eyes. Disc area was found to be significantly positively correlated with inter disc parameters and significantly negatively correlated with rim to disc area ratio in the high myopia group. Disc area and other intra-disc parameters showed significant correlations between right and left eyes in both high myopia and emmetropia, and no significant differences between males and females from a Nepalese population. CONCLUSIONS: Characteristics of HRT parameters in high myopic eyes involved smaller cup parameters and greater rim parameters compared with emmetropic eyes in a Nepalese population. The effect of disc area on HRT parameters differed significantly only in height variation contour by emmetropic eyes.
Cross-Sectional Studies ; Emmetropia ; Female ; Humans ; Institute of Medicine (U.S.) ; Lions ; Male ; Myopia ; Ophthalmoscopy ; Optic Disk ; Optic Nerve ; Retinaldehyde

Despite the successful development of modern medical educational systems within the last century, such systems need improvement in terms of developing better ways to educate medical students as future clinicians while also nurturing them to be good physician scientists. The period from 1964 to 1972 was called the Golden Era of Nobel Laureates in Medicine. Nine laureates, all graduates from American medical schools, came to the United States National Institute of Health (NIH). During the Vietnam War, many medical doctors substituted military service for service in the NIH, became members of the United States National Academy of Sciences, and attained brilliant medical and scientific achievements. There is a crucial lesson to learn from this golden time of the NIH: ambitious young physicians given opportunities to become cutting-edge scientists can make fundamental discoveries. In hopes of encouraging a similar “golden era” for medical research in Korea, I suggest three steps. First, medical schools and the educational system should provide medical students with more opportunities to conduct in-depth medical research in various fields. Second, the Physician Scientist Program should be further expanded to include more medical students and clinical board holders. Better treatments and approaches are essential for gathering both bright candidates and brilliant mentors, who will support each other in making outstanding scientific discoveries. Finally, the flexibility of the medical educational system in terms of medical students and clinical residency needs updating. In conclusion, a national medical educational system that is well balanced can maintain and support both excellent physician scientists and skillful clinicians.
Hope ; Humans ; Internship and Residency ; Korea ; Mentors ; Military Personnel ; National Academy of Sciences (U.S.) ; Pliability ; Schools, Medical ; Students, Medical ; United States ; Vietnam

PURPOSE: This study examined the association between the serum 25-hydroxyvitamin D concentration and the cognitive functions in Korean elderly. METHODS: The subjects were 393 adults aged 60 years or older who participated in the Yangpyeong cohort between July 2009 and August 2010. The subjects were classified into deficiency, insufficiency, or adequacy groups according to the serum 25-hydroxyvitamin D concentration diagnostic criteria suggested by the US Institute of Medicine (IOM). The cognitive function was assessed based on the Korean version of the Mini-Mental State Examination (MMSE-KC). The dietary intake was assessed using the quantitative food frequency questionnaire with 106 food items. RESULTS: The proportions of deficiency, insufficiency, or adequacy in serum 25-hydroxyvitamin D were 6.6%, 44.5%, and 48.9%, respectively. The serum 25-hydroxyvitamin D concentration was significantly higher in men than in women and in outdoor workers than in other occupations. The adequacy group had higher MMSE-KC scores than the other two groups, but not to a significant degree. The proportion of cognitive impairment tended to decrease with increasing serum vitamin D concentration to deficiency, insufficiency, and adequacy (p for trend = 0.029). The deficiency group had a 2.28 times higher risk of cognitive impairment than the adequacy group, but the difference was not statistically significant (OR, 2.28; 95% CI, 0.18 ~ 1.07, p for trend = 0.119). CONCLUSION: The serum vitamin D concentration tended to be associated with the cognitive function in elderly Koreans living in rural areas. To confirm the associations, further longitudinal studies with large samples were required.
Adult ; Aged ; Cognition Disorders ; Cognition ; Cohort Studies ; Female ; Humans ; Institute of Medicine (U.S.) ; Longitudinal Studies ; Male ; Mild Cognitive Impairment ; Occupations ; Vitamin D

Since 2006, type 1 diabetes in Finland has plateaued and then decreased after the authorities' decision to fortify dietary milk products with cholecalciferol. The role of vitamin D in innate and adaptive immunity is critical. A statistical error in the estimation of the recommended dietary allowance (RDA) for vitamin D was recently discovered; in a correct analysis of the data used by the Institute of Medicine, it was found that 8895 IU/d was needed for 97.5% of individuals to achieve values ≥50 nmol/L. Another study confirmed that 6201 IU/d was needed to achieve 75 nmol/L and 9122 IU/d was needed to reach 100 nmol/L. The largest meta-analysis ever conducted of studies published between 1966 and 2013 showed that 25-hydroxyvitamin D levels <75 nmol/L may be too low for safety and associated with higher all-cause mortality, demolishing the previously presumed U-shape curve of mortality associated with vitamin D levels. Since all-disease mortality is reduced to 1.0 with serum vitamin D levels ≥100 nmol/L, we call public health authorities to consider designating as the RDA at least three-fourths of the levels proposed by the Endocrine Society Expert Committee as safe upper tolerable daily intake doses. This could lead to a recommendation of 1000 IU for children <1 year on enriched formula and 1500 IU for breastfed children older than 6 months, 3000 IU for children >1 year of age, and around 8000 IU for young adults and thereafter. Actions are urgently needed to protect the global population from vitamin D deficiency.
Adaptive Immunity ; Child ; Cholecalciferol ; Finland ; Humans ; Institute of Medicine (U.S.) ; Milk ; Mortality ; No-Observed-Adverse-Effect Level ; Public Health ; Recommended Dietary Allowances ; Vitamin D Deficiency ; Vitamin D* ; Vitamins* ; Young Adult

OBJECTIVE: To evaluate the risk of emergency cesarean section according to the prepregnancy body mass index (BMI) and gestational weight gain per the 2009 Institute of Medicine guidelines. METHODS: A retrospective analysis of data from 2,765 women with singleton full-term births (2009 to 2012) who attempted a vaginal delivery was conducted. Pregnancies with preeclampsia, chronic hypertension, diabetes, planned cesarean section, placenta previa, or cesarean section due to fetal anomalies or intrauterine growth restriction were excluded. Odds ratios (ORs) and confidence intervals (CIs) for emergency cesarean section were calculated after adjusting for prepregnancy BMI or gestational weight gain. RESULTS: Three-hundred and fifty nine (13.0%) women underwent emergency cesarean section. The adjusted OR for overweight, obese, and extremely obese women indicated a significantly increased risk of cesarean delivery. Gestational weight gain by Institute of Medicine guidelines was not associated with an increased risk of cesarean delivery. However, inadequate and excessive weight gain in obese women was highly associated with an increased risk of emergency cesarean section, compared to these in normal BMI (OR, 5.56; 95% CI, 1.36 to 22.72; OR, 3.63; 95% CI, 1.05 to 12.54; respectively), while there was no significant difference between normal BMI and obese women with adequate weight gain. CONCLUSION: Obese women should be provided special advice before and during pregnancy for controlling weight and careful consideration should be needed at the time of vaginal delivery to avoid emergency cesarean section.
Body Mass Index* ; Cesarean Section* ; Emergencies* ; Female ; Humans ; Hypertension ; Institute of Medicine (U.S.)* ; Odds Ratio ; Overweight ; Parturition ; Placenta Previa ; Pre-Eclampsia ; Pregnancy ; Retrospective Studies ; Weight Gain*

OBJECTIVES: To evaluate the mobile health applications (apps) developed by a single tertiary hospital in Korea with a particular focus on quality and patient safety. METHODS: Twenty-three mobile health apps developed by Asan Medical Center were selected for analysis after exclusion of the apps without any relationship with healthcare or clinical workflow, the apps for individual usage, and the mobile Web apps. Two clinical informaticians independently evaluated the apps with respect to the six aims for quality improvement suggested by the United States Institute of Medicine. All discrepancies were resolved after discussion by the two reviewers. The six aims observed in the apps were reviewed and compared by target users. RESULTS: Eleven apps targeted patients, the other 12 were designed for healthcare providers. Among the apps for patients, one app also had functions for healthcare providers. 'My cancer diary' and 'My chart in my hand' apps matched all the six aims. Of the six aims, Timeliness was the most frequently observed (20 apps), and Equity was the least observed (6 apps). Timeliness (10/11 vs. 10/12) and Patient safety (10/11 vs. 9/12) were frequently observed in both groups. In the apps for patients, Patient-centeredness (10/11 vs. 2/12) and Equity (6/11 vs. 0/12) were more frequent but Efficiency (5/11 vs. 10/12) was less frequent. CONCLUSIONS: Most of the six aims were observed in the apps, but the extent of coverage varied. Further studies, evaluating the extent to which they improve quality are needed.
Chungcheongnam-do ; Delivery of Health Care ; Health Personnel ; Humans ; Institute of Medicine (U.S.) ; Korea ; Patient Safety ; Patient-Centered Care ; Quality Improvement* ; Telemedicine* ; Tertiary Care Centers* ; United States

As people age, structural as well as neural degeneration occurs throughout the auditory system. Many older adults experience difficulty in understanding speech especially in adverse listening conditions although they can hear speech sounds. According to a report of the Committee on Hearing and Bioacoustics and Biomechanics of the National Research Council, peripheral, central-auditory, and cognitive systems have long been considered major factors affecting the understanding of speech. The present study aims to review 1) age-related changes in the peripheral, central-auditory, and cognitive systems, 2) the resulting decline in the understanding of speech, and 3) the clinical implication for audiologic rehabilitation of older adults. Once the factors affecting the understanding of speech in older adults are identified and the characteristics of age-related speech understanding difficulties are examined, clinical management could be developed for prevention and treatment. Future research about problems related to the understanding of speech in older adults will help to improve the quality of life in the elderly.
Adult ; Aged ; Aging* ; Cognition ; Correction of Hearing Impairment ; Hearing ; Humans ; National Academy of Sciences (U.S.) ; Phonetics ; Quality of Life

OBJECTIVE: Appropriate gestational weight gain (GWG) is important in diabetic women. Current GWG guideline is for US general population, but not specific for diabetic women. We compared the effect of GWG on perinatal outcomes between diabetic and non-diabetic women. METHODS: Fifty two hundred and twelve women who delivered live singleton infants at Korea University Medical Center from January 2009 to December 2013 were included. One hundred twenty-nine overt diabetes women and 322 gestational diabetes women were categorized as diabetic women, and the others were categorized as none-diabetic women. 5,212 women were categorized by GWG (low 1,081; adequate 2,102; or high 2,029; according to the 2009 Institute of Medicine guidelines), and each of the 3 GWG groups was categorized into 2 groups; diabetic or non-diabetic women. And then, we compared perinatal outcomes between diabetic and non-diabetic groups. RESULTS: In each 3 GWG groups, primary cesarean section delivery, high birth weight, and large for gestational age rates were significantly higher in diabetic women than non-diabetic women. Only in adequate GWG group, preterm birth rate was significantly higher in diabetic women than non-diabetic women. CONCLUSION: Our study shows that diabetic women had higher rates of adverse perinatal outcomes than non-diabetic women, although they achieved same GWG. It suggests that current GWG guideline may not be adequate for diabetic women, and that diabetic women may need more strict GWG control than normal population.
Academic Medical Centers ; Birth Weight ; Cesarean Section ; Diabetes, Gestational ; Female ; Gestational Age ; Humans ; Infant ; Institute of Medicine (U.S.) ; Korea ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Premature Birth ; Weight Gain*

Improving mental health and reducing the burden of mental illness are complementary strategies which, along with the treatment and rehabilitation of people with mental disorders, significantly improve population health and well-being. A Institute of Medicine report describes a range of interventions for mental disorders that included treatment and maintenance, reserving the term "prevention" for efforts that occur before onset of a diagnosable disorder. Mental health problems affect 10-20% of children and adolescents worldwide. Despite their relevance as a leading cause of health-related disability and their long lasting consequences, the mental health needs of children and adolescents are neglected. Early intervention can help reduce the significant impacts that children and adolescents with serious mental health problems may experience. Screening is the first step in early intervention, recognizing emotional and behavioral problems and providing help at an early stage. It is essential to implement early intervention in a sensitive and ethical manner to avoid any of the negative outcomes.
Adolescent* ; Child* ; Early Intervention (Education) ; Humans ; Institute of Medicine (U.S.) ; Mass Screening ; Mental Disorders ; Mental Health* ; Primary Prevention ; Rehabilitation ; Resin Cements

Stress management is a very effective educational strategy for women with gestational diabetes mellitus (GDM). The long-term goal for women with GDM is prevention of diabetes in both mothers and their offspring. Thus, when we teach the women with GDM, we must emphasize continuous lifestyle modification and regular monitoring of blood glucose during the postpartum period. In obese women with GDM who maintain normoglycemia, the optimal gestational weight gain for a favorable pregnancy outcome is about 3 kg, much less than that given by the guidelines of the Institute of Medicine. Hemoglobin A1c (HbA1c) can potentially identify women who are have a high risk for adverse outcomes associated with GDM, including macrosomia and postpartum glucose intolerance. Until delivery, it is important that HbA1c levels are maintained below 6.0%, but ideally should be less than or equal to 5.5%.
Blood Glucose ; Diabetes, Gestational ; Female ; Glucose Intolerance ; Hemoglobin A, Glycosylated ; Hemoglobins ; Humans ; Institute of Medicine (U.S.) ; Life Style ; Mothers ; Obesity ; Postpartum Period ; Pregnancy ; Pregnancy Outcome ; Weight Gain