• Journal of agricultural medicine and community health
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• v.49 no.3
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• pp.257-270
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• 2024

Objective: This study aimed to empirically evaluate the effectiveness of chronic disease management services utilizing ICT for patients with chronic illnesses. Methods: From May to December, 2023, 452 people who were diagnosed with hypertension and diabetes at 9 participating public health centers were provided with customized health care services for 24 weeks, and 15 performance indicators were analyzed to evaluate their effectiveness. Results: Health behavior indicators and health risk factors decreased before and after participation in the project, blood pressure control rate, hypertension and diabetes management rate, medication compliance, weight, BMI, BP, WC, FBG, and HDL-cholesterol improved(p<0.001). Service factors that influence the improvement of health behaviors included the number of activity monitor transmissions(p=0.049), confirmed concentrated consultations on physical activity(p=0.003) and nutrition(p=0.005), and the adherence to medication missions for hypertension(p=0.020). As for service factors influencing chronic disease management, the improvement in blood pressure regulation rate was due to the number of times the blood pressure monitor was linked(p=0.004), and the number of confirmed intensive consultations on physical activity(p=0.026), and nutrition(p=0.049); the improvement in hypertension control rate was due to the number of times the activity monitor and blood pressure monitor were linked(p<0.001), and the number of hypertension medication missions carried out (p=0.004); and the improvement in diabetes control rate was due to the number of times the blood pressure monitor(p=0.022) and blood sugar system were linked(p=0.017). Conclusion: Although this study has limitations as a comparative study before and after the service, it has proved that chronic disease management using ICT has a positive effect on improvement of health behavior indicator, reduction of health risk factors, hypertension, diabetes management index, weight, BMI, TG, BP, FBG improvement.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.14 no.7
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• pp.3293-3300
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• 2013

Recently, Korean prefer the slim and skinny body. Even though they are normal or underweight, they strive for weight control routinely. Due to the appearance-oriented trend prevalent in our society, severe losing weight for women has become a social problem. The purpose of this study is to examine the relationship between body dysmorphic disorder and depression. Health-related and health-unrelated college students were classified into three different groups according to BMI. This study was performed of 200 health-related and 200 health-unrelated college students respectively at K college in Gangwon province. A self-administered survey was conducted from September 10 to 21, 2012, and the 319 questionnaires were analyzed. The collected data were analyzed by the SPSS(statistical package for the social science) WIN 18.0. Regarding the relationship between the BMI of the female students and their unsatisfied parts of the body, the overweight female students were more dissatisfied with the entire lower parts of their body(${\chi}^2$=6.97, p<.05). About the waist and belly, the female students of normal weight were the most dissatisfied but of under weight were less dissatisfied than the other groups and the differences among them were statistically significant(${\chi}^2$=8.12, p<.05). About the chest and breasts, the female students of under weight were more dissatisfied than the other groups and there were significant differences according to BMI. As a result of analyzing the relationship between the BMI of the female students and their dissatisfied parts of the body, the female students of over weight were more dissatisfied with the entire lower parts of their body and whole body, and the female students of normal weight were more dissatisfied with their waist and belly than the other groups. The female students of under weight were more dissatisfied with their chest and breasts. But, there were no differences in the way they want to try for a change of the dissatisfied part of the body. Because this body dysmorphic disorder may be associated with depression and cause the social and cultural problems, the development of counseling programs and additional research should be needed.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.7 no.2
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• pp.228-238
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• 2004

Purpose: Obesity is rapidly increasing in Korean children. Obesity is a risk factor for cardiovascular morbidity and is frequently associated with hypertension, diabetes mellitus and coronary artery disease. This study was designed to evaluate risk factors of the metabolic syndrome in obese children. Methods: From February 2000 to June 2004, eighty eight obese (body mass index ${\geq}95th$ percentile) children aged 4 to 15 years were included. We measured serum lipid levels (total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol), fasting sugar levels and insulin levels. Insulin resistance was determined by homeostasis model assessment, fasting insulin/glucose ratio and quantitative insulin sensitivity check index. Results: Clustering of risk factors for the metabolic syndrome in obese children demonstrated that 60.2% had more than one risk factors. Hypertension (14.8%), hypertriglyceridemia (14.8%), HDL-hypocholesterolemia (14.8%), LDL-hypercholesterolemia (12.5%) and hyperinsulinemia (12.5%) were observed. As BMI increased, there was statistically significant increase in systolic blood pressure, insulin and insulin resistance values. Insulin resistance was correlated to systolic blood pressure, serum lipid and insulin levels. The more risk factors for the metabolic syndrome obese children had, the higher was their insulin resistance. Conclusion: The increase in insulin resistance and clustering of risk factors for the metabolic syndrome are already apparent in obese children. Monitoring these risk factors for the metabolic syndrome should become a part of routine medical care for obese children.

• KOREAN JOURNAL OF CROP SCIENCE
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• v.27 no.4
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• pp.398-410
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• 1982

Summer crops grown in uplands are greatly diversified and show a large variation in difference with year and location in Korea. The principal factor for the variation is weather, in which precipitation and temperature play a leading role and such a weather factors as wind, sun lights also influence production of the summer crops. Since artificial control of weather conditions as a main stress factor for crop production is almost impossible, it must be minimized only by an improvement of cultivation techniques and crop improvement. Precipitation plays a role as one of the most important factor for production of the summer crops and it is considered in two aspects, drought and excess moisture. This country, which belongs to monsoon territory, necessarily encounter one of this stress almost every year, even though the level is different. Therefore, the facilities for both drought and excess moisture are required, but actually it is not easy to complete for them. On this account, crops tolerant to drought, excess moisture and pests should be considered for establishing summer crops. For the districts damaged habitually every season, adequate crops should be cultured and appropriate method of planting, drainage and weed control should be applied diversely. Injuries by temperature is mainly attributed to lower temperature particularly in late fall and early spring, although higher temperature often causes some damages depending upon the kind of crops. Sometimes, lower temperature in summer season playa critical role for yield reduction in the summer crops. However, certain crops are prevented to some extent from this kind of stress by improving varieties tolerant to cold, hot weather or early maturing varieties. As is often the case, control of planting time or harvesting is able to be a good management for escaping the stress. Lodging, plant diseases and pests are considered as a direct or indirect damage due to weather stress, but these are characters able to be overcome by means of crop improvement and also controlled by other suitable methods. In addition, polytical supports capable of improving constitution of agriculture into modern industry is urgently required by programming of data for the damages, establishment of damage forecasting and compensation system.

• Clinical and Experimental Pediatrics
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• v.46 no.6
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• pp.585-590
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• 2003

Purpose : This study is designed to determine the prevalence of cardiovascular autonomic neuropathy and its relationship to risk factors in adolescents with diabetes mellitus(DM). Methods : Ninety-two diabetic patients(80 with type 1 DM and 12 with type 2 DM), ranging from eight to 26 years of age, were studied for cardiovascular autonomic function, and the relationship to age, duration of diabetes, glycated hemoglobin(HbA1c), urinary albumin excretion, and the presence of diabetic retinopathy and abnormal nerve conduction velocities(NCV) were analysed. Autonomic function was assessed by measuring heart rate variation during valsalva manoeuvre, deep breathing and standing from a lying position(30 : 15 ratio), and postural hypotension. Results : Among patients with type 1 DM, 22.5% had early, 8.7% had definite, and 1.3% had severe autonomic dysfunction, and among patients with type 2 DM, 16.7% had early, 8.3% had definite, and 8.3% had severe autonomic dysfunction. On logistic regression analysis including both type 1 and type 2 diabetic patients, the age of the patient(OR=1.133(1.003-1.279), P<0.05) and duration of diabetes(OR=1.148(1.009-1.307), P<0.05) significantly predicted cardiovascular autonomic dysfunction while HbA1c, blood pressure, urinary albumin excretion, and presence of diabetic retinopathy and abnormal NCV did not. The valsalva ratio was borderline or abnormal in 31.5% of patients, the heart rate variation on deep breathing in 41.3%, the 30 : 15 ratio in 14.1%, and postural hypotension in 9.8% of patients. The valsalva ratio and the heart rate variation on deep breathing significantly predicted cardiovascular autonomic dysfunction, but the 30 : 15 ratio and postural hypotension did not. Conclusion : Cardiovascular autonomic dysfunction was found in 32.6% of diabetic patients and 10.8 % of patients had definite or severe involvement. The risk of cardiovascular autonomic dysfunction increased with the patient's age and the duration of DM. This study suggests that the valsalva ratio and the heart rate variation on deep breathing are the most useful tests in evaluating the cardiovascular autonomic function in children and adolescents with DM.

• Clinical and Experimental Pediatrics
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• v.52 no.2
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• pp.220-226
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• 2009

Purpose : Macrovascular complications are the main cause of mortality in type 1 diabetes mellitus (T1DM). The purpose of this study was to clarify the presence of early vascular changes and to assess the risk factors of macrovascular complications in young adults with T1DM diagnosed in childhood and adolescence. Methods : Seventy-two patients ($23.9{\pm}2.4$ years) with T1DM diagnosed before 18 years of age and twenty normal controls were included. The incidence of hypertension, dyslipidemia, and other risk factors of macrovascular complication were reviewed. Flow-mediated vasodilation (FMD) and mean intima-media thickness (IMT) measured by ultrasound were compared between patients and control subjects, and their correlations with macrovascular risk factors were analyzed. Results : Of the 72 patients, 32 (44.4%) had hypertension. The proportions of maleness (P=0.03) and mean body mass index (P=0.04) were higher in the hypertensive patients than in normotensive patients. Thirty-one (N=69, 44.9%) patients had dyslipidemia and LDL-cholesterol was positively correlated with mean HbA1c (r=0.32, P=0.008) and total daily insulin dose (r=0.27, P=0.02). The mean IMT was significantly higher in patients than in control subjects ($0.43{\pm}0.06$ mm vs $0.39{\pm}0.06$ mm, P=0.03). There was no difference in the value of FMD between patients and controls, but the duration of the disease after pubertal onset was negatively correlated with FMD (r=-0.34, P=0.01). Conclusion : Hypertension, dyslipidemia and atherosclerotic vascular change were observed in young adults with T1DM diagnosed during childhood and adolescence; this strongly suggests that meticulous screening of macrovascular complications and control of their risk factors should be conducted.

• Sleep Medicine and Psychophysiology
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• v.18 no.1
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• pp.40-44
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• 2011

Narcolepsy is a sleep disorder, which is characterized by excessive daytime sleepiness (EDS) that is typically associated with cataplexy, sleep fragmentation and other REM sleep-related phenomenon such as sleep paralysis and hypnagogic hallucination. Narcoleptic symptoms can be developed from various medical or neurological disorders. A 17-year-old male patient admitted for the evaluation of EDS which started three-month ago. He slept more than 18 hours a day with cataplexy and hypnagogic hallucination. He was obese with body mass index (BMI) of 30.4 kg/$m^2$. After admission he was newly diagnosed to the thyrotoxicosis. T3 391.2 ng/dL (60-181), free T4 4.38 ng/dL (0.89-1.76), TSH <0.01 ${\mu}IU$/mL (0.35-5.5) were measured. His pulse rate ranged 70-90 beats per minute and blood pressure ranged 150/100-120/70 mmHg. Polysomnography revealed many fragmentations in sleep with many positional changes (81 times/h). Sleep onset latency was 33.5 min, sleep efficiency was 47.9%, and REM latency from sleep onset was delayed to 153.6 min. REM sleep percent was increased to 27.1%. Periodic limb movement index was 13.4/h. In the multiple sleep latency test (MSLT), average sleep latency was 0.4 min and there were noted 3 SOREMPs (Sleep Onset REM sleep period) on 5 trials. We couldn't discriminate the obvious sleep-wake pattern in the actigraph and his HLA DQB1 $^*0602$ type was negative. His thyroid function improved following treatment with methimazole and propranolol. Vital sign maintained within normal range. Cataplexy was controlled with venlafaxine 75 mg. Subjective night sleep continuity and PLMS were improved with clonazepam 0.5 mg, but the EDS were partially improved with modafinil 200-400 mg. Thyrotoxicosis might give confounding role when we were evaluating the EDS, though sleep fragmentation was one of the major symptoms of narcolepsy, but enormous amount of it made us think of the influence of thyroid hormone. The loss of sleep-wake cycle, limited improvement of EDS to the stimulant treatmen, and the cataplexy not supported by HLA DQB1 $^*0602$ should be answered further. We still should rule out idiopathic hypersomnia and measuring CSF hypocretin level would be helpful.

• Journal of Food Hygiene and Safety
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• v.13 no.2
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• pp.106-111
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• 1998

This study has been focused on both estrogenic and proliferating activity of genistein (GEN) and bisphenol A (BPA). GEN and BPA enhance the proliferation of estrogen-dependent MCF-7 human breast cancer cells at concentrations as low as 100 nM of GEN and 8 ng/ml of BP A achieving similar effect to that of estradiol at 1 nM. Expression of the estrogen responsive gene, pS2 was also induced in MCF-7 cells by treatment with genistein at dose as low as 1 nM and BPA at dose as low as 4 ng/ml. Using 21 day-old ovariectomized nude mice, we examined end-bud formation and mammary gland development after treatment with bisphenol A or genistein. Compared with untreated control, mammary gland development and end-bud formation were significantly increased in mice fed genistein or bisphenol A (p<0.05). Taken together, it is concluded that GEN and BP A can act as an estrogen agonist resulting in cell proliferation and induction of the estrogen responsive pS2 gene in MCF-7 cells in vitro and in athymic mice in vivo, respectively. Therefore, it is suggested that GEN and BP A might modulate human endocrine system and these compounds might be considered as a endocrine modulator at the low levels of doses.

• Proceedings of the KSCN Conference
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• 2003.11a
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• pp.1070-1071
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• 2003

노년기의 독립적인 생활유지와 삶의 질을 향상시킬 수 있는 바람직한 영양섭취 방법을 모색하기 위한 종적연구의 대상자로 자원한 서울지역의 건강한 40-64세의 중년 293명(남 121명, 여172명)을 대상으로 생활습관과 영양섭취실태를 조사한 결과는 다음과 같다. 대상자의 평균 연령은 남자 52.0$\pm$7.3세, 여자 519$\pm$6.9세였고, 대부분 부부 중심으로 조사하였다. 교육수준은 남자의 71.9%, 여자의 39.5%가 대학졸업 이상이었으며, 남자의 43.0%가 전문직, 24.8%가 행정ㆍ사무직이었고, 가계의 한 달 평균 수입이 200만원 이상자가 72.5%로써 본 조사의 자원자는 대체적으로 고학력, 전문직종의 중류층이었다. 건강에 대한 염려를 가끔 또는 자주 하는 대상자가 66.9%로 건강에 대한 관심은 높았으나 건강을 지키기 위한 실천은 낮은 것으로 나타났다. 그 예로 지난 1년간 체중이 증가하고 있는 대상자가 37.5%였고, 이들 중 75%가 2kg 이상의 체중이 늘고 있지만 체중을 줄이려고 노력하는 대상자는 37.5%뿐이었다. 음주는 남성의 56.5%가 평균 주 2회 정도 하는 편이었고, 1회 음주량은 소주로 1병 이하가 대부분(88%)이었다. 현재 흡연자는 남자의 40.5%였고, 금연자는 30.6%로 비교적 흡연율이 낮았다. 식사시간은 대부분(83.6%) 규칙적이었다. 식사를 주 2-3회 이상 거르는 대상자가 남자는 23%인 반면 여자는 49%였고, 이들 대부분(60.3%)이 아침을 먹지 않았다. 1주일에 1번 이상 외식하는 대상자는 남자의 84%, 여자의 66%였다. 식사시 식품의 배합에 대하여 별로 관심이 없다는 사람이 50%였지만 실제로 식품군별 섭취 시에는 상당한 관심이 있는 것으로 나타났다. 즉, 육류의 기름기를 대충 또는 거의 다 제거하고 먹는 대상자가 남자의 68%, 여자의 88%였고, 육류를 자주 먹지 않거나 소량씩 먹는 대상자가 94%, 생선.두부 및 콩제품을 하루 1끼 이상 섭취하는 대상자가 87%, 채소를 하루 1번 이상 섭취하는 대상자가 96%인 반면, 인스턴트식품이나 패스트푸드를 주 2-3회 이상 먹는 대상자는 23% 정도였다. 영양지식점수(15.4$\pm$3.1/25)와 영양태도점수(50.5$\pm$4.9/75)는 비교적 양호하였다. 전체적으로 오답률이 높은 문항은 체중조절에 있어서 식사와 운동의 관계, 당뇨병 환자의 흰쌀밥 섭취 문제, 비타민제의 섭취와 감기, 고단백 식사의 문제점 등에 관한 것이었다. 반면 철분 섭취와 빈혈의 관계, 비만의 위험성, 동물성 기름의 섭취와 혈중 콜레스테롤치, 우유가 Ca의 급원이면서 성인에게도 필요하다는 것 등은 잘 인식되고 있었다. 조사 대상자의 평균 에너지 섭취량은 RDA의 77.3 $\pm$ 13.6%였으나, 이들 대부분(80%)의 활동 정도가 가벼운 활동에 속하므로 에너지가 부족하다고 할 수는 없다. 반면 평균 단백질 섭취량은 RDA의 109.9 $\pm$ 23.5%로 충분하였고, 3대 열량영양소 즉, 단백질:지방:탄수화물의 구성비는 16:22:62로 지방의 섭취가 약간 높으나 바람직한 구성비를 보였다. 권장량의 75% 이하를 섭취하고 있는 영양소는 칼슘(70.7$\pm$23.9%)뿐이었다. 과체중자의 비율을 체질량지수(BMI) 25이상으로 구분하면 남자의 45%, 여자의 23%가 과체중자로 나타나나, 23이상으로 구분하면 남자의 71%, 여자의 52%가 과체중자로 분류되었다. 이를 WHR의 기준치로 분류하면 남자의 25%, 여자의 26%가 과체중자로 나타났다. 대부분 대상자의 hemoglobin치(99%), hematocrit치(90%), 혈장 albumin치(99.7%)는 양호하였다. 혈당이 140mg/㎗ 이상인 대상자는 2.7%에 불과하였다. 혈중 총콜레스테롤치가 240mg/㎗ 이상인 대상자는 19%, 중성지방치가 250mg/㎗ 이상인 대상자는 9%, HDL-콜레스테롤치가 35mg/㎗ 이하인 대상자는 2.4%로 혈중 지질 profile은 양호하였다. 이상의 결과로 보아 본 연구 대상자는 영양섭취상태와 생화학적 건강상태가 양호하다고 판단되므로 종적연구의 대상자로 적합하다고 사료된다.

• The Korean Journal of Gastroenterology
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• v.72 no.5
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• pp.271-273
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• 2018

내시경 시술 전 일시적으로 항응고제를 중단하는 것은 위장관 출혈의 위험과 혈전색전증의 위험 사이에 적절한 균형을 잡기 어렵기 때문에 논란의 여지가 많다. 와파린은 새로운 경구용 항응고제(direct oral anticoagulant agent, DOAC)보다 임상의에게 더 친숙하고, 효과를 쉽고 빠르게 전환시킬 수 있다는 장점이 있지만 복잡한 약역동학 특징과 좁은 치료적 범위 때문에 관리가 어렵다. 반면, DOAC는 약물의 모니터링 및 용량 조절 없이 정해진 용량으로 처방이 가능하며, 빠르게 작용하고, 반감기가 짧아 관리가 쉽지만 해독제가 없다는 단점이 있다. 이전 연구들에서 DOAC를 복용한 환자들은 와파린을 복용한 환자들보다 시술과 관련되지 않은 위장관 출혈의 위험이 높았다고 보고한 바 있다. 하지만 시술과 관련된 위장관 출혈 위험에 대하여는 알려진 바가 없는 실정이다. 미국이나 유럽 내시경 가이드라인들에서는 저위험 내시경 시술을 받는 환자들에서는 와파린과 DOAC를 유지하도록 권고하고 있으며, 고위험 시술의 경우에는 와파린를 사용하는 환자들에서 헤파린 교량 요법(heparin bridging)을 시행하도록 권고하고 있다. 임상적으로 DOAC를 사용하는 환자들 또한 혈전색전증을 예방하기 위하여 헤파린 교량 요법을 시행해볼 수 있는데, 와파린 및 DOAC의 헤파린 교량 요법과 관련된 출혈 및 혈전색전증 위험의 차이 또한 명확하지 않다. 따라서 저자들은 1) 와파린과 DOAC 치료를 받는 환자들에서의 출혈, 혈전색전증 및 사망의 위험을 비교하고자 하였으며, 2) 13종류의 고위험 내시경 시술 중에서 시술별 위험을 비교하고, 3) 헤파린 교량 요법이 합병증의 발생을 증가시키지 않는지 확인하고자 본 연구를 진행하였다. 일본 대규모 국가 입원 환자 데이터베이스를 이용하여 2014년 4월부터 2015년 5월까지 시술 전 와파린 또는 DOAC(rivaroxaban, apixaban, dabigatran, edoxaban)를 복용하고, 13종류의 고위험 내시경 시술을 시행받은 20세 이상의 성인 환자 총 16,977명을 확인하였다. 고위험 시술은 용종 절제술, 내시경 점막절제술, 내시경 점막하박리술, 협착 부위의 풍선확장술, 내시경 지혈술, 내시경 정맥결찰술, 내시경 주사 경화요법, 내시경 괄약근절개술, 내시경 초음파 유도하 미세침 흡인 검사, 경피적 위루술을 포함하였다. 일대일 성향 점수 매칭 분석(propensity score matching, 나이, 성별, 체질량 지수, 기저 질환, 병원의 규모, 시술의 종류, 약물의 종류를 매칭)을 시행하여 와파린군과 DOAC군에서 시술 위장관 출혈 및 혈전색전증, 사망의 발생을 비교하였다. 또한 경구항혈전제와 헤파린 교량 치료 시행 유무에 따라, DOAC 단독군, 와파린 단독군, DOAC와 헤파린 교량 요법군, 와파린과 헤파린 교량요법군으로 나누어, 하위군(subgroup) 분석을 시행하였다. 5,046쌍이 성향 점수 매칭 분석에 포함되었으며, 와파린군에서 DOAC군보다 통계적으로 의미 있게 위장관 출혈의 비율이 높았다(12.0% vs. 9.9% p=0.02). 혈전색전증 발생률(5.4% vs. 4.7%)과 입원중 사망률(5.4% vs. 4.7%)은 양 군에서 의미 있는 차이는 없었다. DOAC 종류별로 나누어 하위군 분석을 시행하였을 때, 와파린군은 rivaroxaban군에 비하여 위장관 출혈의 비율이 높았으며, rivaroxaban군, dabigatran군에 비하여 혈전색전증의 비율이 높았고, 입원 중 사망률에서는 의미 있는 차이는 없었다. 내시경 시술의 종류로 보정하였을 때 위장관 출혈 및 혈전색전증, 사망률은 DOAC 단독으로 치료한 환자에서보다 와파린과 헤파린 교량 요법(bridging) 또는 DOAC과 헤파린 교량 요법을 시행한 환자에서 높았다. 시술 종류 중에서는 위루관 삽입술에 비하여 내시경 점막하박리술, 내시경 점막절제술 및 내시경 정맥류결찰술, 내시경 주사경화요법을 시행한 환자에서 위장관 출혈의 위험이 가장 높았으며, 하부 내시경 점막절제술, 하부 용종 절제술, 내시경적 유두괄약근절제술 또는 내시경 초음파 유도하 미세침 흡인 검사는 중등도 위험을 보였다.