Objective The objective was to evaluate changes in swallow safety and dietary status after the transcutaneous injection of botulinum toxin into the upper esophageal sphincter in a series of outpatients with dysphagia. Methods Patients who were at risk for aspiration and who had an unsuccessful trial of swallowing therapy were admitted to the study. All patients showed significant pooling of fluids in the pyriform sinus. All patients were treated in the office; none had previous esophageal dilatation. The upper border of the cricoid cartilage was identified using standard electromyogram procedures and botulinum toxin was injected. Outcomes were assessed using the penetration-aspiration scale, NIH swallowiwng safety score, patients' short-term and long-term subjective impressions of their ability to swallow, and change in dietary status. Results Ten patients underwent an instrumental evaluation of swallowing function. Of the 10 patients, 9 showed an overall improvement in their ability to take an oral diet safely. The penetration-aspiration scale, NIH swallowiwng safety score, patients' short-term and long-term subjective impressions of their ability to swallow, and change in dietary status were significantly improved after office-based botox injection. Conclusion Office-based EMG guided botox injection to the cricopharyngeus muscle is a simple, safe, and effective tool for dysphagia patients. Injection of Botox in the office should be considered when the dysphagia pattern is aspiration after swallow.
In order to observe the effects of resistant starches on human glycemic response, nine female university students were investigated using cellulose (CED), resistant starch 3 (RS3D) and resistant starch 4 (RS4D) diets. Each woman's blood sugar and insulin, triacylglycerol and free fatty in plasma concentration were measured at fasting state, then 15, 30, 45, 60, 75, 90 and 120 minute after each test diet feeding. Glycemic indices of the Cellulose diet (CED: 57.9 $\pm3.00$), the Resistant starch 3 diet (RS3D: 52.6 $\pm7.9$) and the Resistant starch 4 diet (RS4D: 52.9 $\pm10.2$) were similar to each other, but they were significantly lower in comparison with those of white wheat bread diet (WWBD: 100). Insulinemic indices of the CED (49.8 $\pm8.2$), RS3D (50.0 $\pm7.3$) and RS4D (72.4 $\pm7.7$) were significantly lower in comparison with the white wheat bread diet (WWBD: 100), but among the dietary fiber diets, the insulinemic index of RS4D was significantly higher than the CED and the RS3D. Plasma triacylglycerol contents of the CED, RS3D and RS4D including WWBD showed gradual increase in tendency after lowering in early stage of each test diet feeding, but not significantly different in each dietary fiber added diet. Plasma free fatty acid contents of the CED, RS3D and RS4D including WWBD showed gradual decrease in tendency after each test diet feeding, but not significantly different by each dietary fiber added diet. In above results, we speculate that resistant starch 3 controls rapid elevation of blood sugar by delaying intestinal digestion and absorption of cellulose, but the result appears to be different from RS4 in comparison. Thus, RS3 intakes may contribute to the diet therapy of diabetic humans, but more studies on RS4 is needed in the future. (Korean J Community Nutrition 9(4): 528∼535, 2004)
Objectives: The purpose of this study was to provide a basic data of nutrition services in home health care by analyzing hospital-based home-visit nutrition education needs of patients at discharge. Methods: Data was collected from September 11 to October 12, 2012 by administering questionnaires to 289 chronic disease patients to be discharged from a university hospital in Pusan. The home-visit nutrition education instruments used for collecting data were developed by the researcher. Results: Regarding the demands of home-visit nutrition education, 62.3% of subjects were willing to use home-visit nutrition education and 37.7% weren't. The main reason for using the home-visit nutrition education was "the effective nutrient management in consultation with an individual's doctor", 38.9% and 31.2% of patients who did not wish to use the service gave the reason for their decision as, "Just by managing the nutritional requirements of a family's diet and, the patient will be able to fully recover", respectively. As for the demand, classified with the areas of home-visit nutrition education, the demand for the area of basic nutrition (3.75/5.00) was the highest followed by, the area of educational nutrition (3.74/5.00), therapeutic nutrition (3.67/5.00), and dietary nutrition (3.55/5.00). The demand for the area of educational nutrition was high "Considering the state of dietary management, such as disease status and drugs", 73.7%. As for the relation between the characteristics of the study subjects and analysis of demand home-visit nutrition education, the characteristic of subjects, that is, "regular home-visit nutrition education", "practice of diet therapy after discharge" had a significant difference statistically (p < 0.01). As for the relation between the needs for fundamental home-visit nutrition education and the demand of home-visit nutrition education, basic nutrition, educational nutrition, therapeutic nutrition, and dietary nutrition had a significant difference statistically (p < 0.01).
In this study, data from the 7th (2016~2018) and 8th (2019) Korea National Health and Nutrition Examination Surveys were used, which included 5,325 subjects. Health behavior, dietary and nutrient intake status, physical measurement and biochemical characteristics, and risk factors for elderly related chronic diseases were classified and analyzed according to the changing composition of single households and other households in the current society. As a result, the ratio of current smokers and drinkers in young adult single households, walking less than 30 minutes per day, subjective health status was poor, breakfast rate less than three times per week, eating out frequency more than once a day, lipid intake ratio to total calories, saturation fatty acid intake were significantly higher. In addition, waist circumference, and diastolic blood pressure were significantly higher. However, dietary fiber intake level was significantly lower. The results for hypertension, which is the representative chronic disease that causes old age-related chronic diseases, were significantly higher in single households (ORs=1.400 (95% CI: 1.095, 1.791), p=0.007). Although young adults may not have showed particularly serious health problems yet, education is believed as important to recognize and prevent age-related disease risk factors.
국민건강보험공단에 따르면 불규칙한 식습관, 스트레스, 운동 부족 등의 요인으로 젊은 당뇨 환자가 2017년 대비 2021년에 3,564,059명으로 24.3% 증가 추세를 보였다. 모든 연령층에서 증가 중인 당뇨병은 약물치료, 규칙적인 운동, 식사요법 관리가 필요하다. 이 중 식사요법은 적절한 열량 및 균형 잡힌 3대 영양소 섭취를 필요로 하므로 매우 체계적인 관리가 필요하다. 현재 당뇨 식단 추천은 개인 정보, 건강 정보, 사회적, 문화적 측면을 고려하여 식단을 제안하지만, 건강 정보에 대한 다중 변수를 고려하지 않은 부분이 미흡하다. 이에 본 논문은 당뇨병 환자의 라이프로그 데이터를 이용한 식단 추천 시스템을 제안하여 데이터 다중 변수를 고려해 개인의 건강 상태에 따른 맞춤형 식단을 추천하고자 한다.
Objectives: The aim of this study was to examine self-management status, nutritional knowledge, barrier factors in dietary management and needs of nutritional management program for women with Gestational Diabetes Mellitus (GDM). Methods: A total of 100 women with GDM were recruited from secondary and tertiary hospitals in Seoul. The questionnaire composed of general characteristics, status of self-management, dietary habits, nutrition knowledge, barrier factors in dietary management, needs for nutrition information contents and nutritional management programs. Data were collected by a self-administered questionnaire. All data were statistically analyzed using student's t-test and chi-square test using SAS 9.3. Results: About 35% of the subjects reported that they practiced medical nutrition and exercise therapy for GDM control. The main sources of nutrition information were 'internet (50.0%)' and 'expert advice (45.0%)'. More than 70% of the subjects experienced nutrition education. The mean score of nutrition knowledge was 7.5 point out of 10, and only about half of the subjects were reported to be correctly aware of some questions such as 'the cause of ketosis', 'the goal of nutrition management for GDM', 'the importance of sugar restriction on breakfast'. The major obstructive factors in dietary management were 'eating more than planned when dining out', 'finding the appropriate menu when dining out'. The preferred nutrition information contents in developing management program were 'nutritional information of food', 'recommended food by major nutrients', 'the relationship between blood glucose and food', 'tips on menu selection at eating out'. The subjects reported that they need management program such as 'example of menu by calorie prescription', 'recommended weight gain guide', 'meal recording and dietary assessment', 'expert recommendation', 'sharing know-how'. Conclusions: Based on the results of this study, it is necessary to develop a program that provide personalized information by identifying the individual characteristics of the subjects and expert feedback function through various information and nutrition information contents that can be used in real life.
Cooking practice is keenly related to not only the betterment of family health but to the improvement of dietary life. Cooking is a kind of practical skill and one is skill in it by repeated practice. The aim of cooking practice in school is to fix cooking method practically and scientifically, to acquire cooking skill. To achieve this aim there are many unrecognized or unsolved problems in the first-line schools. The problems and efficient ways of cooking practice in the middle and high school are as follows; 1. The aim of cooking practice: It should be first of all remembered that the practice is so practical that the knowledge and skill of cooking should be related to the future domestic life. Second, the practice should be able to serve the communal and national life by scientifying and improving life. 2. The content of the practice: First, it should be so arranged step by step that the content of each year should not be repeated. Second, the ratio of Korean cooking practice should be increased and the material of the practice should be chosen in consideration of the peculiarity of the community, seasons and economical problems so that it may be applied to the very day life. Third, to improve dietary life, the practice should be a way of the simplification of dietary life, of the nutritional efficiency. Forth, for the betterment of physical condition of the family the practice should involve balanced dietary plans and dietary therapy. 3. Teaching method: First, the practice should be scientific and comprehensive in consideration of not only cooking skills but also knowledge of nutrition. Second, micro-class system should be adopted, and practice labor should be allotted each student to develop cooperative attitude and the sense of responsibility. Third, in addition to the practice conducted in a body, comparative cooking, applicable cooking and experimental ability and the content of the text. Fourth, teachers should let the students examine and find problems by bringing them to a focus on the basis of theory. 4. Administration method: First, the practice schedule should be planned that a class has practices at least more than twice a semester. Second, two hours of class should be continued without cessation after beforehand survey and theory study. Third, facilities and utensils for practice should be enlarged. That is, cooking practice rooms, tools, utensils should be prepared. Fourth, enough cost of practice should be secured. The above mentioned points show the present situation and problems with which cooking practice teaching is confronted. In order to normalize cooking practice teaching, the first-line schools should give the above mentioned problems their careful consideration and improve the present situation so that efficient, creative, practical cooking practice will be possible.
Ischemic stroke is among the principal causes of death and disability in the elderly. Although control of blood pressure, decreased cigarette smoking, and modified dietary habits are among important reasons for stroke decline, the use of antithrombotic therapy, rigorously prescribed. Several antiplatelet agents are approved to reduce the risk of recurrent stroke. Aspirin is the best-studied and most widely used antiplatelet agent for stroke prevention; it provides approximately 15% to 25% relatively risk reduction for secondary prevention of stroke or the major vascular death. Combining 2 antiplatelet agents with different mechanism of action was demonstrated to provide a substantial increase in efficacy in several studies. Anticoagulation should be considered first with potential cardiac sources of embolism. Heparin reduces development of erythrocyte-fibrin thrombi that form in regions of vascular stasis especially within the heart, in severely stenosed arteries sometimes engrafted on white thrombi, in acute arterial occlusion. Heparin should not be indiscriminately given to all acute brain ischemia patients, but may contribute to treatment of large artery occlusion and severe stenosis, cardiogenic embolism with a high acute recurrence risk, and dural sinus and cerebral venous thromobosis.
A systematic review and meta-analysis of the literatures was conducted to evaluate the effectiveness of nutrition intervention by dietitian. The 31 studies that were all randomized controlled trials, were identified from computerized search of published researches on MEDLINE, Embase database until January, 2003 and review of reference lists. The main search terms were the combination “dietitian”, “dietary intervention”, “nutrition intervention” or “nutritional intervention” and “effectiveness”. The subgroup analysis was performed by the publication year, quality score, type of disease, content of intervention, intervention provider, type of intervention (nutritional counseling and education/nutrilion counseling and education + diet modification), method of intervention (individual/group/individual + group) and follow-up period. Two reviewers independently selected trials for inclusion, assessed the quality and extracted the data. The meta-analysis of 31 studies based on the random effect model showed that the medical nutrition therapy was significantly effective in treating the diseases (effect size 0.1715 : 95% confidence interval 0.0938-0.2491). This study showed the clear evidence of the effectiveness of nutrition intervention through the meta-analysis. So the nutrition intervention by dietitian should be recommended and recognized as the effective therapy of treating the diseases. Also the nutrition intervention should be conducted regularly to maintain the effectiveness of the nutrition intervention. The nutrition intervention was significantly effective in treating the diseases on the random effect model (effect size 0.1715 : 95% confidence interval 0.0938-0.2491).
Homocystinuria is a metabolic disorder caused by a deficiency of cystathionine ${\beta}$-synthase (CBS). Patients with homocystinuria show clinical symptoms such as mental retardation, lens dislocation, vascular disease with life-threatening thromboembolisms and skeletal deformities. Generally, the major treatments for CBS deficiency include pharmacologic doses of pyridoxine or dietary restriction of methionine. However, there is no effective treatment for this disease up till today and gene therapy can be an attractive novel approach to treatment of the disease. We investigated whether a recombinant adeno-associated virus could be used as a CBS gene transfer vector to reduce the excessive homocysteine level in the homocystinuria mouse model. Recombinant adeno-associated virus vector encoding the human CBS gene (rAAV-hCBS), driven by EF1-a promoter, was infused into CBS-deficient mice ($CBS^{-/-}$) via intramuscular (IM) and intraperitoneal (IP) injection. IP injection was more efficient than IM injection for prolongation of lives and reduction of plasma homocysteine levels. After 2 weeks of gene transfer by IP injection, serum homocysteine level was significantly decreased in treated mice compared with the age-matched controls and the life span was extended about 1.5 times. Also, increased expression of CBS gene was observed by immunohistochemical staining in livers of treated $CBS^{-/-}$ mice and microvesicular lipid droplets was decreased in cytoplasm of liver. These results demonstrate the possibility and efficacy of gene therapy by AAV gene transfer in homocystinuria mice.
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