"본 논문은 대한외과학회지 2006년 제70권제1호에 실렸던 논문으로 대한외과학회 편집위원회 승인을 득하고 본 협회지에 게재함. Purpose: Malnutrition has been frequently reported for patients on their admission to the hospital and it has been associated with an increase in morbidity, mortality and the length of the hospital stay. Although a number of screening tools have been developed to identify those patients at risk for malnutrition, there is no' gold standard' for defining malnutrition and the malnourished patients remain largely unrecognized. The aim of this study is to evaluate the efficacy of a nutritional screening tool for use in Dankook University Hospital. Methods Nutritional evaluation was performed for 53 patients who were admitted to the department of surgery and internal medicine between October and December 2004. The screening tool was completed by the ward nurse and the nutritional support team nurse on the same patients within24 hours of admission. The nutritional support team nurse performed the full assessment. The screening sheet included 4 questions regarding body mass index, recent unintentional weight loss, food intake and disease severity. Each answer was scored and a total of 5 was tested as the criterion fey malnutrition. The full assessment included current body weight, recent weight loss, triceps skinfold thickness, mid-arm muscle circumference, serum albumin)in and total lymphocyte count. Malnutrition was defined by 3 or more values below the reference values. The reliability of the screening tool was assessed using kappa statistic. Sensitivity, specificity and accuracy were calculated to evaluate the validity of the screening tool. The receiver operating characteristic(ROC) curve was drawn to choose a cutoff valve that maximizes sensitivity and specificity. Results' The level of agreement between the ward nurse and the NST nurse was good for BMI and food intake and moderate for weight loss and disease severity. The full assessment identified7 patients(13.2%) as malnourished. The screening sheet had a sensitivity of 86% and a specificity of 80%. According to the ROC curve, a score of 5 points provided the best validity. Conclusion The nutritional screening tool is reliable when completed by different observers and it is valid for nutritional assessment.

"본 논문은 대한내과학회지 2006년 제70권 제3호에 실렸던 논문으로 대한내과학회 편집위원회의 승인을 득하고 본 협회지에 게재함. Background : Diabetes mellitus is a major independent risk factor for atherosclerosis. In recent years non-invasive high resolution B-mode ultrasound methods have been developed to measure the intima-media thickness(IMT) of the carotid artery as an indicator for early atherosclerosis. Itis known that obesity plays a role in the development of type 2 diabetes and cardiovascular disease, and it has also been reported that not only the amount but also the distribution of body fat is important. This study investigated the relationship between obesity and the development of carotid atherosclerosis in type 2 diabetic patients. Methods: Carotid IMT was measured by ultrasound B-mode imaging in 144 patients with type 2diabetes mellitus. All subjects underwent assessment for the degree and distribution of obesity, the presence of coronary artery disease risk factors, and the presence of diabetic complications. Resuts: Carotid IMT was increased in the abdominal obese group defined by waist circurference. However, there was no significant difference in carotid TMT between the non-obese group and obese group as defined by body mass index, waist to hip ratio, and total body fat percent measured by bio electrical impedance analysis. There were positive correlations between carotid IMT and age, duration of diabetes, systolic blood pressure, and waist circumference. Multiple linear regression analysis revealed the variable that interacted independently with carotid IMT was age in type 2 diabetic patients. Carotid IMT was significantly increased in type 2 diabetic patients with macrovascular complications and microvascvlar complications .Conclusion: This study suggested that abdominal obesity rather than general obesity was associated with carotid atherosclerosis reflected by increment of carotid IMT in type 2 diabetic subjects.

Background : Phentermine classified by "sympathomimmetic amie", is a stimulant of sympatheic tone But there has been no concrete study which presents the influence of phentermine on autonomic nervous system. Analysis of Heart rate variability is reliable, non-invasive and very useful for evaluating function of autonomic nervous system. We tried to elucidate the influence of phentermine on autonomic nervovs system by heart rate variability. MethodsAmong the 70 candidates who participated in the double-blind case control study whichwas designed in purpose of approving whether- Adipekⓓ is effective for treatment of obesity, 45persons were folled up. From April, 2005 to May 2005, HRV of the candidates who takes phentermine or placebo for 1month, was recorded using BFM-5000ⓓ(medi-core) for 5 minutes in resting state. HRV measures were assessed by time-domain and by frequency- domain analysis. Time domain parameters contain SDNN(Standard Deviation of NN intervals) and RMSSD(Root-Mean-Square of Successive Differences), etc and frequency domain Parameters contain Total Power(TP), Low frequency(LF'0.04-0.15Hz) power. High Frequency(HF:0.15-0.4Hz) power and LF/HF ratio etc. Results: Intakes of phentermine reduce HRV significant1y. SDNN & RMSSD, the main tine domain parameters of HRV, were decreased significantly(P=0.007. 0.016). PSI(Physical Stress Index of Pressure Index) was increase significantly(P=0.002)The main frequency domain parameters(TP, LF & VLF), also decreased significantly. (P=0.024,0.033, 0.015)Conclusion: The result showed that intakes of phentermine reduce heart rate variability and influence on most parameters of HRV. So phentermine not only accelerates sympathetic tone, but also inhibit the balance and function of autonomic nervous system.

Background : Diabetes mellitus is chronic condition which needs patients' understanding of disease status and effort for disease control. We investigated whether the patients' estimation for blood glucose control was reliable or not comparing with their HbA1C value, Method: Among people who visited one health promotion center in Seoul from 1995 to 2003,those who answered as having diabetes mellitus on self reported questionnaire were identified. Subsequent question was whether his or her diabetes was well controlled or not. We compared these replies with their HbA1C values. When their HbA1C values were below7% with answering not well controlled, we analyzed if there was any variable which can predict the discrepancy. And the same analyze we did for the opposite situation. Result: A total of 1193 patients were eligible. Those who answered as well controlled formed32.9% of the group with HbA1C values above 7%. In the cases with well controlled though significantly associated with this discrepancy, Conclusion: Considerable proportion of diabetic patients' estimation for diabetic control status was not matched with glycemic control guideline. For successful management of diabetes mellitus, more efforts for patient education and communication skills are essential.

"본 논문은 대한영상의학회지 2005년 제52권 제1호에 실렸던 논문으로 대한영상의학회의 승인을 득하고 본 협회지에 게재함. Purpose: We wished to compare CT colonography with conventional colonoscopy for the detection of colorectal poiypoid lesions, and we wanted to evaluate the role of IV contrast-enhanced CT colonography for the differentiation between benign polypoid lesions and malignant polypoid lesions. Materials and Methods: Thirty-four consecutive patients underwent CT colonography prior to conventional colonoscopy, Precontrast prone-position CT images and post contrast supine position CT images were obtained and the virtual colonoscopic images were reconstructed, Axial, sagittal and presence, size and morphologic features of colorectal polypoid lesions, and thor these findings were compared with the colonoscopic findings. The degree of enhancement of colorecralpolypoid lesions was measured by subtracting the attenuation valves obtained with precontrastand postcontrast CT images for the differentiation of benignity and malignancy of the colorectal polypoid lesions. Results. Among 75 colorectal polypoid lesions identified on conventional colonoscopy, 49neoplasms were found on CT coloaographv, and the overall detection rate was 65,3%.Detection rate of lesions smaller than l0mm was 52.1%(24/46), and the detection rate for lesions equal to or larger than 10mm was 86.2%(25/29), Morphologic features of the sessile type lesions on CT colonography were well correlated with those noted on colonoscopy, but the stalks were not identified in 6 of 13 polyps on CT colonography. There was no statistical correlation between benignity and malignancy and the degree of contrast enhancement on CT colonography, Conclusion CT colonography is a useful modality for the detection of colorectal polypoid lesionsequal to or polyps. However, CT colonography cannot differentiate benignity from malignancy.

Purpose : Asian Quality Assurance Survey program(AQuAS) is and activity of Asian Network for Clinical Laboratory Standardization and Harmonization(ANCLS) which had begun her first colloquium in 1999 in Jakarta, Indonesia by laboratory physicians led by Professors Noriyuki Tatsumi and Yoshinori Funahara with themes of standardization and harmonization of clinical laboratories in Asia. Methods : AQuAS had begun its first survey in July. 2001 and done November and March, three times per year in the fields of Chemistry, Hematology. Coagulation and Urinalysis. As of June 2006 the 15th survey have been completed. Korean Association of Health Promotion(KAHP) had participated in it since July, 2004 in the fields of chemistry, hematology and urinalysis.ゝ⨀

For identification of four sibling species of the Anopheles hyrcanus complex found in Korea, the 5.8 rDNA-ITS2-28S rDNA region of each species was sequenced and the species-specific primers wee designed The amplified PCR products obtained from each species were analyzed by agarose gel electrophoresis. The result showed a single species- specific band, I.e. 559bp, 432bp, 322bp and 192bp for An. sinensis, An. sp., An. lesteri and An. pullus, respectively. In conclusion, the species-specific PCR primers designed from ITS2 variable regions functioned successfully and specifically, and can be applied as a useful tool for identifying species of the Anopheles hyrcanus complex found in Korea.

Background : Osteoporosis and atrophic cell pattern in Pap smear are frequent findings In postmenopausal women due to loss of ovarian function, The present study attempted to find out possible correlation between morphologic characteristics of Pap smear and osteoporosis. Material & methods: The subjects were 825 women(age from 35 to 80) who had undergone Pap smear and bone mineral density(BMD) at The Korea Association of Health Promotion, Seoul Branch, from March 8 to May 10, 2005. Pap smears from 825 women were reviewed and classified either mature cell pattern or atrophic cell pattern by their cytologic patterns, BMD were measured using LUNAR DPX MdIQ(Minster, Ohio, USA). BMD value of lumbar spine(Ll, L2,L3 and L4) were measured from 825 women and BMD value of proximal region off emur(neck NK, Wards triangle WT, and trochanter TR) were measured from 818 women and their bone status were classified as normal( T-sore:>-1.0), osteopenia (T-score: -l~<-2,5) and osteoporosis(T-score: ≤ -2.5). And age distribution of Pap smear, average T-value andfrequency ofsteoporo-sis of each region of the bone, percentage of osteoporosis of each boneregion by age group and changing pattern of percentage of osteopenia and osteoporosis in certain postmenopausal period were compared between mature and atrophic cell pattern. Results: Pap smears revealed total mature cell pattern 53,9%(445/825) and total atrophic cell pattern 46.1%(380/825), Percentage of mature cell pattern decreased from 98.2%(168/171)under 44 age group to 13,3%(17/128) over 65 age group and mature cell pattern increased from 1.8%(3/171) under 44 age group to 86.7%(111/128) oyer 65 age group. Mean T-value of each region of lumbar spine and femur of mature cell pattern were lower than that of atrophic cell pattern about -1,5. And osteoporosis has noted in atrophic cell pattern showing odds ratio Ll 13.9, L2 15.3, L3 12.0, L4 10,4, UK 6.7, WT 10.9 and TR 4.1.Atrophic cell pattern started to increase after 45 years of age and osteoporosis of a trophic cell pattern started after 55 years of age. During 50 to 64 years of age period, L3, L4 and WT revealed parallel increased of osteopenia and osteoporosis and Ll, L2 revealed decreased of osteopenia and increased of osteoporosis. nia Conclusion: Above findings suggest that atrophic cell pattern of Pap smear precedes osteoporosis about 10 years and one of predictor of osteoporosis.

Background Cardiovascular disease is becoming an important national health issue since its recent increase in incidence and mortality. The study was conducted to find out the prevalence of metabolic syndrome according to the clinical identification criteria by NCEP-ATP3 and Asia-Pacific criteria. Meterials & Methods: The subjects were 759 people -male 375 and female 384 after twenties age - who had undergone medical examinations at Korea Association of Health, Daejeon- Chungnam Branch. The prevalence of metabolic syndrome was assessed as defined by the NCEP ATP3, while abdominal obesity was assessed according to the Asia-Pacific guidelines. Anthropometric variables and cardiovascular risk factors were measured, and Associated factors with metabolic syndroms was analyzed by logistic regression analysis. Results The prevalence of metabotic syndrome was 24.O% for male and 27.1% for female The high blood pressure was the highest prevalent risk factors of metabolic syndrome. In the age group of thirties, the prevalence of metabolic syndrome was higher in men than in women, however it was significantly higher in women than in men in fifties and six ties. The metabolic syndrome was more prevalent in aged people over 50 years. and .significantly associated with BMI index(odds ratio 2.58 in male, 9.87 in female)Conclusions The prevalence of metabolic syndrome is over 20%.Early detection and intervention of risk factors by health examination and promotion are needed for prevention of metabolic syndrome.

Purpose: With remarkable increase in the prevalence of childhood obesity, nonalcoholic fatty liver disease increased, The aim of this study is to evaluate the prevalence of the increase liver enzymes, lipid levels and fasting blood glucose level in normal and obese children. Methods: A total of 2206 elementary students were grouped according to obesity index; normal group and obesity group(mild, moderate, severe). Aspartate aminotransferase(AST, SGOT) and alanine aminotrausferase(ALT, SGPT) were measured with tota1 cholesterol, triglyceride and fasting blood glucose. Results: Compared with the 2.7% of ALT > 50 IU/L in normal group, obese groups showed significantly higher prevalence; 6.7% in mild obesity group, 11.8% in moderate group and 15.0% in severe group. The prevalence of hypertriglyceremia was 12,4% in normal weight group, which is significantly lower than obesity group(mild obesity group 24.8%, moderate and severe 32.1% each). Conclusion: The prevalence of nonalcoholic fatty liver increased along with severity of obesity. Of Nutritional assessment, intervention, and preferably prevention are necessary for health promotion elementary students.

Background: This survey has focused on Client-Satissfaction for health examination services of Korean Association of Health Promotion, This research will help final weak point and promote the qualify of the services provided. Methods: This survey was done on 400 visitors of the clinic. Between Jan. 2 and May 3l, 2005 Questionaires were distributed to the visitors with a informed consent. Results: The visitㅐrs for health examination at Daegu chapter of Korean Association of Health promotion had high-school or higher level education(79.8%) and were self-employed persons with an average monthly income of 3~4 million won(27.7%), and housewives(33.0%). The most frequent complaints of the visitors was the difficulty in access to the center. The motives for taking health examination were cheap cost of examination(32.7%) and recommendation by fami1y members and friends(42.0%). The possitive attitude of the employees of KAHP were kind reponses to phone calls(85.3%) and kind explanations to questions(68.5%). Regarding the merits of the examination at KAHP, appropriate equipments(68.0%) and quality of equipments(66.0%) and they expressed their desire for further use revisit to the KAHP(85.3%).Conclusions. It is concluded that this KAHP is providing services meeting their demands in cost and qualitatively of health examination. However, it is noted that there are several weak points in own system that make own clients uneasy in taking health examination. They have to be solved by providing transporting for accession, kind attitudes and comfortable facilities.

Basically, diagnosis is a comprehensive judgement of the biochemical data which were collected from the patient directly. Therefore, no matter what kinds of well-managed data control are there, if data sample itself is not perfectly appropriate for any reason. we can not rule out high possibility of misunderstanding or wrong diagnosis. Among many possible reasons inadequate sample were collected maybe three situation and circumstances could be assumed as follows. 1. Client did not know what they are supposed to do for sampling 2. Technicians are to qualified or less-experienced on the job 3. Wrong managing or careless treat of the biochemical data sample If it is true, we could manage these problems to be solved through the information sharing and education. In order to verify this hypothesis, actually 5,800 cases were studied from January to August this year. Owing to the thorough education the rate of unappropriated samples reduced to 0.4% from 1.2%. This outcome strongly support the hypothesis of the mutual relation between the proper sample and well-designed education in advance. The importance of information sharing on right process of sample collection should be emphasized.

Background: Inadequate samples make laboratory tests delay cause errors, which will deteriorate the quality of the tests. Therefore, adequate samples are essential for reliable test result. To reduce the inadequate samples, they should to analyze problems and seek a way of improvement through CQI (Continuous Quality Improvement) activity. This will minimize errors during the test and produce a fast and accurate result. Eventrally, the qualily of entire test may be improved, and as a result, a good quality of medical care service may be provided. Methods: At first, inappropriate testing items were collected. Then, generating fctors and problems were investigated and analyzed in each case, In addition, the category with higher frequency wes primarily supervised. In consegalnce, a reduction of are dustion of improper testing sample was oxpected through continuous education and CQI activity. Conclusion : At the beginning of CQI activitv, the number of inadequate testing sample was of 8,591 total samples, which gives the frequency of 0.72%. As CQI activity was carried out the number of improper testing sample reduced to 58 out of 11,415 cases, which yields the frequency of 0,51%. One may notice the difference 0.2%. Among the inadequate sample(blood), there was a high frequency of hemolysis; thus, more of CQI activity is required for this specific matter. Because the occurrence of inadequate testing affects the clinical outcomes, it is extremely important that one manages each step of the procedure in collecting samples and mamtaines the quality of entire tests.