Kiheon Lee

Prevalence, awareness, and treatment of osteoporosis among Korean women: The Fourth Korea National Health and Nutrition Examination Survey

PURPOSE This study aimed to assess the factors associated with the prevalence, awareness, and treatment of osteoporosis in a representative sample of Korean women. METHODS Data were obtained from dual energy X-ray absorptiometry measurement of the lumbar vertebrae and femoral neck, and from a standardized questionnaire in 2870 Korean women aged 50years and older who participated in the Fourth Korea National Health and Nutrition Examination Survey 2008-2009. Osteoporosis was defined by World Health Organization T-score criteria, and awareness and treatment were defined by self-report of an osteoporosis diagnosis and self-report of current anti-osteoporotic medication use, respectively. We assessed the relationship between multiple risk factors and prevalence, awareness, and treatment. RESULTS Osteoporosis was reported in 39.1% of Korean women. Among those with osteoporosis, only 37.5% were aware of their diagnosis and 23.5% received pharmacological treatment. Despite higher prevalence among respondents who were older, of lower body weight, calcium intake, physical activity, and education levels, the awareness and treatment rates of these groups were similar or lower than that of the low-risk controls in multivariate logistic regression models. Moreover, easily identifiable risk factors (e.g., history of fracture, falls, height loss, familial osteoporosis) were not associated with awareness and treatment. Participants who had undergone health screening in the previous 2years exhibited increased awareness and treatment rates independently of other demographic factors. CONCLUSIONS Osteoporosis was highly prevalent in this Korean study but was underdiagnosed and undertreated. Routine health screenings could be an effective strategy to increase osteoporosis awareness and treatment.

Elevated Systemic Neutrophil Count in Diabetic Retinopathy and Diabetes: A Hospital-Based Cross-sectional Study of 30,793 Korean Subjects

PURPOSE To evaluate the association between systemic parameters including inflammatory markers and diabetic retinopathy (DR). METHODS This was a cross-sectional study enrolling 30,793 persons who visited a health care center for a medical checkup. Diabetic patients were classified into five DR groups: no DR; mild, moderate, or severe nonproliferative DR, and proliferative DR. A full laboratory workup and comprehensive medical data on the subjects were obtained and used for analysis. RESULTS The mean (SD) age of the participants was 47.4 (11.9) years (range, 18-90) and the male-to-female ratio was 55.7:44.3. The prevalence of diabetes and DR were 6.6% (2,020/30,793) and 5.3% (108/2,020), respectively. Among inflammatory markers, the mean absolute neutrophil count (ANC; per microliter) was significantly higher in the DR than in the non-DR group (3900 vs. 3566; P = 0.0143) and in diabetic than in nondiabetic subjects (3583 vs. 3262; P < 0.0001). Subjects in the fourth quintiles of ANC showed 2.7 odds of having DR by multivariate analysis, and there was a linear trend in the odds ratios according to increasing ANC levels. The level of ANC and the ANC/leukocyte ratio also demonstrated a linearly increasing trend with the severity of DR, even after adjustment for other clinical factors, including HbA1c. Among significant risk factors of DR, ANC showed the second strongest predictive power for DR (AUROC = 0.590) after HbA1C (0.624). CONCLUSIONS Elevated systemic neutrophil count is associated with the presence and severity of DR as well as diabetes. This result indicates that systemic subclinical inflammation is related with DR, and neutrophil-mediated inflammation may play an important role in the pathogenesis of DR.

Association Between Insulin Resistance and Bone Mass in Men

CONTEXT The association between insulin resistance and bone mass is still not clear. OBJECTIVE The purpose of this study was to evaluate the association between insulin resistance and bone mass. DESIGN AND SETTING This was a cross-sectional survey of the nationally representative population. PARTICIPANTS A total of 3113 men (aged ≥20 years) from the fourth Korean National Health and Nutrition Examination Survey of 2008-2009 were included. MAIN OUTCOME MEASURES Bone mineral density (BMD) was measured using dual-energy x-ray absorptiometry. Osteopenia and osteoporosis were defined using the World Health Organization T score criteria. Fasting plasma insulin and glucose levels were measured, and insulin resistance was evaluated using the homeostasis model assessment-estimated insulin resistance (HOMA-IR) index. RESULTS Age-, height-, and weight-adjusted mean BMD values significantly decreased as quartiles of HOMA-IR and the fasting plasma insulin level increased (P for trends <.001). In multivariable logistic regression analyses, participants who had a higher HOMA-IR or fasting plasma insulin level had a higher odds ratio for osteoporosis/osteopenia. Interestingly, the association between fasting plasma insulin level and whole-body BMD differed by the degree of insulin resistance. In the lowest quartile of HOMA-IR, the fasting insulin level was positively associated with BMD. As insulin resistance increased, however, the fasting insulin level was inversely associated with BMD, and this relationship became more significant as the degree of insulin resistance increased. CONCLUSIONS In a nationally representative sample of Korean men, insulin resistance and the fasting plasma insulin level were inversely associated with bone mass. Further studies are required to confirm this association and reveal the underlying mechanisms.

Prevalence of Chronic Obstructive Lung Disease in Korea Using Data from the Fifth Korea National Health and Nutrition Examination Survey

Background Chronic obstructive pulmonary disease (COPD) is the fifth leading cause of death worldwide. The awareness and treatment rate of the disease are low despite its relatively high prevalence. With the added data, this study aimed to identify changes in prevalence and risk factors of COPD using the data from the 5th KNHNES. Methods The subjects of this study were 8,969 individuals aged 40 and older who satisfied suitability and reproducibility for pulmonary function tests. The prevalence, awareness and risk factors of COPD were predicted based on the questionnaires on gender, age, educational level, income level, smoking history, body mass index (BMI) and other COPD related questions. Results Diagnosis of COPD was based on the airflow limitation (forced expiratory volume in one second/forced vital capacity <0.7) of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The prevalence of COPD from 2010 to 2012 was 13.7%, of which 23.3% was men and 6.5% women. The prevalence was on the rise, with 12.2% in 2010, 13.2% in 2011, and 15.5% in 2012. In GOLD stage 1, the percentages of those who had cough or sputum and smoking history were 12.1% and 75.5%, respectively, but only 0.1% was diagnosed with COPD. Even after adjusting for asthma and tuberculosis, men, old age, larger amount of smoking were linked with a higher prevalence of COPD, and obese and higher educational level were associated with a lower prevalence of COPD. Conclusion The prevalence of COPD in Korea has been increasing every year, and a higher prevalence was associated with male, older age, more amount of smoking, lower educational level and lower BMI.

Association between secondhand smoke exposure and blood lead and cadmium concentration in community dwelling women: the fifth Korea National Health and Nutrition Examination Survey (2010–2012)

Objectives To assess the association between secondhand smoke exposure and blood lead and cadmium concentration in women in South Korea. Design Population-based cross-sectional study. Setting South Korea (Korea National Health and Nutrition Examination Survey V). Participants 1490 non-smoking women who took part in the fifth Korea National Health and Nutrition Examination Survey (2010–2012), in which blood levels of lead and cadmium were measured. Primary outcome measures The primary outcome was blood levels of lead and cadmium in accordance with the duration of secondhand smoke exposure. Results The adjusted mean level of blood cadmium in women who were never exposed to secondhand smoke was 1.21 (0.02) µg/L. Among women who were exposed less than 1 h/day, the mean cadmium level was 1.13 (0.03) µg/L, and for those exposed for more than 1 h, the mean level was 1.46 (0.06) µg/L. In particular, there was a significant association between duration of secondhand smoke exposure at the workplace and blood cadmium concentration. The adjusted mean level of blood cadmium concentration in the never exposed womens group was less than that in the 1 h and more exposed group, and the 1 h and more at workplace exposed group: 1.20, 1.24 and 1.50 µg/L, respectively. We could not find any association between lead concentration in the blood and secondhand smoke exposure status. Conclusions This study showed that exposure to secondhand smoke and blood cadmium levels are associated. Especially, there was a significant association at the workplace. Therefore, social and political efforts for reducing the exposure to secondhand smoke at the workplace are needed in order to promote a healthier working environment for women.

Influenza Vaccination and Associated Factors among Korean Cancer Survivors : A Cross-Sectional Analysis of the Fourth & Fifth Korea National Health and Nutrition Examination Surveys

Influenza vaccination is important for cancer survivors, a population with impaired immunity. This study was designed to assess influenza vaccination patterns among Korean cancer survivors. In this cross-sectional analysis, data were obtained from standardized questionnaires from 943 cancer survivors and 41,233 non-cancer survivors who participated in the Fourth and Fifth Korea National Health and Nutrition Examination Surveys (2007-2011). We identified the adjusted influenza vaccination rates and assessed factors associated with influenza vaccination using multivariate logistic regression. Cancer survivors tended to have a higher adjusted influenza vaccination rate than the general population. The rates for influenza vaccination in specific cancer types such as stomach, hepatic, colon, and lung cancers were significantly higher than non-cancer survivors. Among all cancer survivors, those with chronic diseases, elderly subjects, and rural dwellers were more likely to receive influenza vaccination; those with cervical cancer were less likely to receive influenza vaccination. Cancer survivors were more likely to receive influenza vaccinations than non-cancer survivors, but this was not true for particular groups, especially younger cancer survivors. Cancer survivors represent a sharply growing population; therefore, immunization against influenza among cancer survivors should be concerned as their significant preventative healthcare services. Graphical Abstract

Prevalence, Awareness, Control, and Treatment of Hypertension and Diabetes in Korean Cancer Survivors: A Cross-Sectional Analysis of the Fourth and Fifth Korea National Health and Nutrition Examination Surveys

BACKGROUND Management of hypertension and diabetes in cancer survivors is an important issue; however, not much is known about the level of management of such chronic disease in Korea. This study therefore assessed the prevalence, awareness, control, and treatment of hypertension and diabetes in Korean cancer survivors compared to non-cancer survivors. MATERIALS AND METHODS A cross-sectional design was employed, wherein data were obtained from standardized questionnaires completed by 943 cancer survivors and 41,233 non-cancer survivors who participated in the Fourth and Fifth Korea National Health and Nutrition Examination Surveys (2007-2011). We calculated adjusted proportions for prevalence and management of hypertension and diabetes in non-cancer survivors and cancer survivors. We also assessed the associated factors with prevalence and management of cancer survivors. RESULTS Cancer survivors are more likely than the general population to have higher prevalence, awareness, treatment, and control of hypertension. However, diabetic management was not significantly higher in cancer survivors than in non-cancer survivors, despite their having a higher prevalence. Several factors, such as, age, drinking, years since cancer diagnosis, self-perceived health status, and specific cancer types were found to affect to management of hypertension and diabetes. CONCLUSIONS These data suggest that cancer survivors appear to be better than non-cancer survivors at management of hypertension, but not diabetes. There is a need for healthcare providers to recognize the importance of long-term chronic disease management for cancer survivors and for the care model to be shared between primary care physicians and oncologists.

Implementation of a Videoconferencing System between Multiple Family Medicine Departments.

Attending conferences is important for doctors and residents in family medicine. Nevertheless, departments of family medicine at many hospitals find it difficult to hold regular conferences. Holding joint videoconferences between Family Medicine Departments of several hospitals through a videoconferencing system could solve this problem. Therefore, Family Medicine Departments of Seoul National University Hospital, Seoul National University Bundang Hospital, and Kangwon National University Hospital decided to hold regular joint videoconferences via a videoconferencing system. Eighty-one joint videoconferences were held from April 1 to October 29, 2010. PowerPoint slideshows were transferred to the other two locations in the same resolution as presenters monitor. Image and voice of the speaker were transferred in real time and in acceptable quality. Joint videoconferences are feasible, satisfactory and useful for medical education, especially when individual family medicine departments are small and lack resources to hold face-to-face conferences. We expect that more family medicine departments will choose to participate in implementing similar joint videoconferencing systems in the future.

Associations of smoking and smoking cessation with CT-measured visceral obesity in 4656 Korean men.

OBJECTIVES Although obesity is shown to be less common among current smokers than never smokers, the association between visceral obesity and smoking remains uncertain. METHODS For this cross-sectional analysis, we recruited 4656 Korean men of 19 to 79 years who received a regular checkup at a health examination center between 2008 and 2010. Computed tomography was performed to measure the area of visceral and subcutaneous adipose tissue (VAT and SAT). We compared the mean VAT by multiple regression analysis across smoking status after adjusting for confounders. RESULTS Both current and former smokers had more mean VAT than never smokers. Current smokers who consumed more than 20 cigarettes per day had 11% higher mean VAT than never smokers (P<0.01). Longer smoking duration, higher daily cigarette consumption before quitting, and shorter abstinence duration among ex-smokers were associated with increasing mean VAT (all P for trend<0.01). The mean VAT in former smokers was highest within 2 years of abstinence. There was no significant difference of mean VAT between ex-smokers with >20 years of abstinence duration and never smokers. CONCLUSION Both current and former smoking is associated with increased VAT. The risk of visceral obesity is proportional to the degree of exposure to cigarette smoking.

Efficacy of Carboxymethylcellulose and Hyaluronate in Dry Eye Disease: A Systematic Review and Meta-Analysis

Background The efficacy of two artificial tears, carboxymethylcellulose (CMC) and hyaluronate (HA), was compared in the treatment of patients with dry eye disease. Methods We conducted a systematic review and meta-analysis on randomized controlled trials in the PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases. The efficacy was compared in terms of the mean change from baseline in tear break-up time. The meta-analysis was conducted using both random and fixed effect models. The quality of the selected studies was assessed for risk of bias. Results Five studies were included involving 251 participants. Random effect model meta-analysis showed no significant difference between CMC and HA in treating dry eye disease (pooled standardized mean difference [SMD]=-0.452; 95% confidence interval [CI], -0.911 to 0.007; P=0.053). In contrast, fixed effect model meta-analysis revealed significant improvements in the CMC group when compared to the HA group (pooled SMD=-0.334; 95% CI, -0.588 to -0.081; P=0.010). Conclusion The efficacy of CMC appeared to be better than that of HA in treating dry eye disease, although meta-analysis results were not statistically significant. Further research is needed to better elucidate the difference in efficacy between CMC and HA in treating dry eye disease.