Background: Depression increases the risk of cardiovascular risk factors in adults. However, the association between depression and cardiovascular risk factors was not well evaluated in South Korea. Our study was done to evaluate the association between depression and cardiovascular risk factors in workers. Methods: The study population was selected among adults working in several industries that had more than 50 employees. They had received their medical examinations at the Health Promotion Center of Hallym University Sacred Heart Hospital between March and November 2005. We estimated the odds ratio to determine whether depression (Korean Center for Epidemiologic Studies Depression Scale score ≥21) was associated with each cardiovascular risk factors (hypertension, diabetes mellitus, hypercholesterolemia, and obesity). Results: The prevalence of depression was 15.5%. Depression was significantly associated with hypertension (P＜0.001), obesity (P=0.03) and hypercholesterolemia (P=0.004). The adjusted odds ratio for hypertension and hypercholesterolemia were 1.41 (95% CI 1.04∼1.91) and 1.59 (95% CI 1.05∼2.40), respectively. The association between depression and obesity was eliminated after adjustment (1.25, 95% CI: 0.97∼1.61). Conclusion: Depression was significantly associated with hypertension and hypercholesterolemia in workers. Further long-term study on the association of depression with cardiovascular risk factors is necessary. (J Korean Acad Fam Med 2008;29:645-650)
Background: Metabolic syndrome has been introduced to increase the incidence of cardiovascular diseases and type 2 diabetes mellitus. Our aim of this study was to investigate the association of fasting plasma glucose levels and metabolic syndrome in normoglycemic adults. Methods: We examined lifestyle factors, anthropometric and laboratory measurement of adults with no personal history of diabetes and normal fasting glucose from the Korean National Health and Nutrition Examination Survey 2001. We categorized the fasting plasma glucose levels below 100 mg/dl into the quintiles and assessed the association of metabolic syndrome with increasing glycemia in normoglycemic adults. Results: Quintiles of normal fasting plasma glucose levels showed a positive trend with metabolic risk factors including abdominal obesity, high blood pressure, and obesity in normoglycemic adults (P＜0.001). Hypertriglyceridemia, low HDL-cholesterolemia, smoking, heavy drinking, and physical activity were of no significance. A multivariate model, adjusted for age, sex, smoking status, physical activity, and heavy drinking, revealed a progressively increased odds ratio of metabolic syndrome, 1.05 (95% CI, 0.76∼1.44), 1.15 (95% CI, 0.84∼1.58), 1.33 (95% CI, 0.99∼1.80), 1.55 (95% CI, 1.14∼2.10), with increasing fasting plasma glucose levels, as compared with fasting plasma glucose level of 81 mg/dl or less (P＜0.001). Conclusion: Higher fasting plasma glucose levels within the normoglycemic range may constitute a risk of metabolic syndrome in normoglycemic adults. (J Korean Acad Fam Med 2008;29:651-657)
Background: We assessed the state of diabetes control in Korean adults from the 2001 Korean National Health and Nutrition Survey. Methods: A total of 271 adult diabetes patients (125 males, 146 females) were identified from the health interview survey. Diabetes control status was assessed by the American Diabetic Association (ADA) recommendations. Socioeconomic characteristics and the health status were assessed by an interview and the health- related behavior was assessed by self-questionnaire. A one-day 24-hour recall was used for the dietary assessment. Blood pressure and anthropometric measurements were done. Fasting blood was drawn for glucose, HbA1c, and lipids profile. Results: The proportions of patients reaching the recommended goals for fasting plasma glucose (≤130 mg/dl), HbA1c (＜7%), blood pressure (＜130/80 mmHg), low density lipoprotein cholesterol (＜100 mg/dl), triglyceride (＜200 mg/dl), and high density lipoprotein cholesterol (＞45 mg/dl for males, ＞55 mg/dl for females) were 57.2%, 19.9%, 24.4%, 27.8%, 64.5% and 20.7%, respectively. Body mass index, and smoking in males and age, and diabetes duration in females were associated with HbA1c level. Conclusion: This study shows that diabetes in Korean adult is not adequately controlled. National effort is needed to achieve the recommended treatment goals and to manage modifiable risk factors such as obesity and smoking. (J Korean Acad Fam Med 2008;29:658-667)
Background: Nowadays, decreased physical activity is considered to be a contributor to increase the prevalence of many diseases such as obesity, coronary heart disease and so on. Many researches demonstrated that regular physical activity reduce all cause mortality. To increase the physical activities of the population, accurate estimation of the activities is needed. Actical and actigraph are confirmed as accurate tools to measure physical activities. But the target populations of the validity studies were not Asian people. Therefore, the accuracy of the accelerometers should be confirmed in Asian people. The accuracy of the tools could be different. Therefore head to head comparison study between the tools would be needed. Methods: Thirty volunteers from the community, ages over 20 yrs, were recruited. The participants put on the two accelerometers (Actical, Actigraph) on the waists, secured with elastic belts, and performed a session of rest and three structured activities (two walking speeds, 4 km/hr and 6 km/hr, and one jogging speed, 8 km/hr). During each activity, expired respiratory gases were collected, and oxygen consumption (VO2) was measured by indirect calorimetry (Model Quark Ղ2Ⱂ). The calories measured by gas analyzer and two accelerometers were compared by correlation analysis using SPSS program. Results: Pearson correlation coefficient between gas analyzer and two accelerometers was calculated at three structured activities. The r in Actical was 0.747, 0.785, and 0.677, at speed of 4, 6, 8 km/hr, respectively (P＜0.05), and the same measures in Actigraph was 0.617, 0.737, and 0.530 (P＜0.05), respectively. Pearson correlation coefficient was also calculated between the two accelerometers, and the r was 0.881, 0.927, and 0.824, at each speed. Conclusion: The Actical and Actigraph are valid tools for measuring physical activities in Korean people. (J Korean Acad Fam Med 2008;29:668-674)
Background: Hearing impaired people have a lot of difficulty in communicating when they visit medical institutions. This study was to reveal the family physicians' perception and attitude for the hearing impaired people, and the effect of those factors on the actual physicians' practice behavior for the disabled. Methods: We sent questionnaires by post mail to 1,000 members listed in the 2007 address book of the Korean Association of Family Medicine. Results: Among the total of 90 family physicians who had answered, 72 (80.8%) had willing attitude to treat the hearing impaired people, and the most important reason was that it was essentially a doctor's duty. In the group who were unwilling to treat the disabled, the most principal reason was that they were not equipped with sufficient facility and medical system. Gender was the only factor affecting the physicians' attitude significantly and the female doctors had a higher intention to treat the hearing impaired people than male doctors (P=0.035). Age, location of hospital, number of patients, practical experience of hearing impaired people had no significant effect on doctors' attitude. The number of physicians who volunteered to participate for the hearing impaired people's health promotion personally was significantly higher in the group of treatment intention (P=0.007). Nevertheless, few physicians had the willingness to equip the hospital facility for the hearing disabled, even in the group of willingness to treat the disabled. The most important reason was that very few disabled patients visit their clinic, and so forth they felt no necessity to improve and re-organize their clinical environment. Conclusion: Most family physicians are willing to treat hearing impaired people. But even in the willing group, almost all of them are unwilling to improve or equip the medical facilities for the hearing impaired people personally, because only a few disabled people visit the primary care hospital in the real practice. (J Korean Acad Fam Med 2008;29:675-686)
Background: With the number of geriatric population on a steep increase, the roles of family physicians broaden to give comprehensive medical care to the elderly. Therefore, geriatrics is becoming increasingly more important for the residents of family medicine. The authors have surveyed and researched on resident's current attention, actual training conditions, and future needs on geriatrics. Methods: Family medicine residents in 79 hospitals registered to Korean Family Medicine Resident Union were enrolled. By means of electronic and postage mail surveys, informations were gathered; including demographics, the order of importance of nine training curricula, the necessity of training itself, the facility and academic conference of geriatrics training. Results: A total of 173 residents in 45 hospitals replied with return rates of 51.9%. Among the total, 169 (97.7%) of the answered agreed on the necessity of geriatrics training. Of the nine curricula, geriatrics was considered the most important. And residents considered family medicine outpatient department and inpatient ward to be the most important place for geriatrics training. Furthermore, the residents considered elderly's diseases or symptoms as more important conference title, but the parameters such as the quality of life, physiology of aging, care in nursing home were considered less important. Conclusion: The geriatrics training program is not up to the standards of residents' satisfaction. This is considered to be due to the absence of a formal training program. To provide a better care for the elderly, it is compulsory to gain broad knowledge of geriatrics and actual experience out in the field. (J Korean Acad Fam Med 2008;29:687-694)
Background: Dementia is the most important factor affecting everyday life of the elderly and there have been studies on the relationship between dementia and social withdrawal or loneliness. However, there is a lack of investigations on the relationship between loneliness and cognitive function in the elderly living alone. Methods: Ninety five community-dwelling elderly people registered to Sungbook elderly welfare center in Seoul, who were living alone, were enrolled in the study. Personal visits by three pre-trained researchers were made during April 2006. One year later, 11 elderly dropped out, and 84 elderly were interviewed in the same way. They were interviewed based on loneliness scale, social support, Hasegawa dementia scale, instrumental activities of daily living, and depression. Results: The mean age of the subjects was 78.3 years. Most of them were women (90.5%) and education level was low (no schooling in 69%). The loneliness scale did not change much during one year (P=0.63), but the instrumental activities of daily living (IADL) score had worsened from 10.5 to 11.2 (P=0.002) The mean Hasegawa dementia scale score decreased from 23.2 to 21.0 during one year (P<0.001). Multivariate regression analysis for the one-year difference in Hasegawa Dementia Scale revealed loneliness was a significant factor after adjusting for age, the level of education, social support, IADL score, and depression (regression coefficient=−0.712, P=0.02). Conclusion: Loneliness was associated with a decline in cognitive function in the elderly people living alone. In contrast, social withdrawal and depression had no effect on changes of cognitive function during one year. (J Korean Acad Fam Med 2008;29:695-702)
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