Sang Hyuck Kim

Association between bone mineral density and nonalcoholic fatty liver disease in Korean adults.

PurposeNonalcoholic fatty liver disease (NAFLD) is associated with various metabolic abnormalities that can increase the risk of an osteoporotic fracture. Across the few previous studies of the association between NAFLD and bone mineral density (BMD), the association was not consistent. We examined the association between BMD and NAFLD in generally healthy adults.MethodsThe subjects who visited the Seoul National University Hospital for health checkup between 2005 and 2015 were included. Men aged more than 40 and postmenopausal women were included. Lumbar spine and femoral neck (FN) BMD were measured using dual-energy X-ray absorptiometry. Liver ultrasonography was conducted to evaluate the extent of fatty changes. After excluding subjects with a secondary cause of liver disease such as heavy drinking or viral hepatitis, multivariable linear regression analysis adjusted for possible cofactors was performed to investigate the association between BMD and NAFLD.ResultsA total of 6634 subjects was included in this study (men:womenxa0=xa03306:3328). Multivariate regression analysis revealed a significant negative association between FN BMD and NAFLD in men (βxa0=xa0−0.013, pxa0=xa00.029). However, there was a positive correlation between lumbar spine BMD and NAFLD in postmenopausal women (βxa0=xa00.022, pxa0=xa00.005).ConclusionsModerate or severe NAFLD exerted a detrimental effect on FN BMD in men. However, moderate or severe NAFLD had a positive effect on lumbar spine BMD in postmenopausal women. Potential sex-specific differences of the effect of NAFLD on BMD need to be elucidated further.

Terminal Versus Advanced Cancer: Do the General Population and Health Care Professionals Share a Common Language?

Purpose Many end-of-life care studies are based on the assumption that there is a shared definition of language concerning the stage of cancer. However, studies suggest that patients and their families often misperceive patients’ cancer stages and prognoses. Discrimination between advanced cancer and terminal cancer is important because the treatment goals are different. In this study, we evaluated the understanding of the definition of advanced versus terminal cancer of the general population and determined associated socio-demographic factors. Materials and Methods A total of 2,000 persons from the general population were systematically recruited. We used a clinical vignette of a hypothetical advanced breast cancer patient, but whose cancer was not considered terminal. After presenting the brief history of the case, we asked respondents to choose the correct cancer stage from a choice of early, advanced, terminal stage, and don’t know. Multinomial logistic regression analysis was performed to determine sociodemographic factors associated with the correct response, as defined in terms of medical context. Results Only 411 respondents (20.6%) chose “advanced,” while most respondents (74.5%) chose “terminal stage” as the stage of the hypothetical patient, and a small proportion of respondents chose “early stage” (0.7%) or “don’t know” (4.4%). Multinomial logistic regression analysis found no consistent or strong predictor. Conclusion A large proportion of the general population could not differentiate advanced cancer from terminal cancer. Continuous effort is required in order to establish common and shared definitions of the different cancer stages and to increase understanding of cancer staging for the general population.

Expected and perceived efficacy of complementary and alternative medicine: A comparison views of patients with cancer and oncologists

BACKGROUND & AIMSnThis study sought to identify discrepancies between the expectations of patients with cancer and oncologists regarding the efficacy of complementary and alternative medicines (CAMs), and to determine how patients evaluate CAM efficacy after its use.nnnMETHODSnData from the Cancer Patient Experience Study, a nationwide survey, were used. Seven subdivided efficacy domains were included in the survey. An oncologist-patient matching analysis was done to assess the concordance of CAM efficacies between oncologists and patients with cancer. In addition, the patients expectations of CAM efficacies were compared before and after use.nnnRESULTSnOut of 719 participants, 201 patients with cancer (28.0%) reported using CAMs. The patients with cancer generally tended to be more positive about CAM efficacies than the oncologists. The largest discrepancy in efficacy perception was found in the efficacy domain of survival benefit, which included complete disease remission and prolonged survival. Many patients reported that they did not experience the positive efficacy they had anticipated before use. However, a substantial proportion of patients indicated that CAMs were as effective as they had expected, even though there is little evidence supporting the CAM efficacies.nnnCONCLUSIONSnThere was a marked discrepancy and a lack of concordance in expectations of CAM efficacy between patients with cancer and oncologists. Better communication between the patients and oncologists regarding CAM efficacy would be needed to make the patients to have shared expectations, and to reduce unnecessary CAM use.

High neutrophil to lymphocyte ratios predict intracranial atherosclerosis in a healthy population

BACKGROUND AND AIMSnAlthough atherosclerosis has been shown to be an inflammatory disease, intracranial atherosclerosis (ICAS) has not been well addressed. The purpose of this study was to evaluate the relationship between the neutrophil to lymphocyte ratio (NLR) and the presence of ICAS lesions in a generally healthy population.nnnMETHODSnA consecutive series of subjects, who voluntarily visited for health check-ups between January 2006 and December 2013, were selected. Brain magnetic resonance imaging, brain magnetic angiography (MRA), and blood cell count data were assessed. ICAS was defined as an occlusion or more than 50% stenosis of intracranial vessels, as observed on brain MRA images. NLR was calculated based on absolute neutrophil and lymphocyte counts.nnnRESULTSnA total of 2842 subjects were evaluated, and 76 ICAS cases were found. The median NLR was 1.52 [1.17-2.01]. In multivariate analysis, NLR remained an independent predictor of ICAS [adjusted OR (aOR)u202f=u202f1.72, 95% confidence interval (CI)u202f=u202f1.01-2.95, pu202f=u202f0.048]. Age (aORu202f=u202f1.08, 95% CIu202f=u202f1.05-1.11, pu202f<u202f0.001) and hypertension (aORu202f=u202f1.81, 95% CIu202f=u202f1.11-2.94, pu202f=u202f0.017) were also significant factors for ICAS independent of NLR. Regarding ICAS burdens, NLR was significantly higher when the number of ICAS lesions (pu202f=u202f0.017) or occlusive ICAS lesions (pu202f=u202f0.005) was increased in a dose-response manner.nnnCONCLUSIONSnA high NLR was associated with both prevalence and burdens of ICAS in a healthy population.

Self-reported health status as a predictor of functional decline in a community-dwelling elderly population: Nationwide longitudinal survey in Korea

As the elderly population is increasing, the prediction and prevention of functional decline in older adults are of great concern. The present study aimed to evaluate whether poor self‐reported health status (SRHS) could predict functional decline after 2u2009years in the elderly population.

Association between cognitive impairment and poor antihypertensive medication adherence in elderly hypertensive patients without dementia

Adherence to antihypertensive medication is a critical factor to control blood pressure and prevent complications. However, cognitive impairment can negatively affect medication adherence. In this study, we investigated the association between cognitive function and antihypertensive medication adherence among elderly hypertensive patients using the Korean National Health Insurance Service National Sample Cohort Data of the Elderly Cohort. The study included 20,071 elderly hypertensive patients and the prevalence of poor medication adherence to antihypertensive medications was 16.4%. A multivariate logistic regression analysis showed that lower cognitive function was associated with poor medication adherence (adjusted odds ratio 0.980, 95% confidence interval 0.961–0.999). Additionally, high income levels, living in metropolitan areas, and comorbidities (such as stroke, coronary heart disease, diabetes, and dyslipidemia) were positively associated with medication adherence, while patients diagnosed with cancers showed poor medication adherence. Our study demonstrated that cognitive impairment is a possible risk factor for poor antihypertensive medication adherence, even in patients without dementia. Thus, clinicians involved with geriatric care should monitor patients’ cognitive function and medication adherence. And if a patient shows cognitive impairment, clinicians need to educate patients and caregivers about the importance of proper adherence, and consider proper interventions to optimize the cognitive function of elderly patients.