• Journal of Korean Neurosurgical Society
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• v.59 no.4
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• pp.346-351
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• 2016

Objective : Early progressive infarction (EPI) is frequently observed and related to poor functional outcome in patients with middle cerebral artery (MCA) infarction caused by MCA occlusion. We evaluated the perfusion parameters of magnetic resonance imaging (MRI) as a predictor of EPI. Methods : We retrospectively analyzed patients with acute MCA territory infarction caused by MCA occlusion. EPI was defined as a National Institutes of Health Stroke Scale increment ${\geq}2$ points during 24 hours despite receiving standard treatment. Regional parameter ratios, such as cerebral blood flow and volume (rCBV) ratio (ipsilateral value/contralateral value) on perfusion MRI were analyzed to investigate the association with EPI. Results : Sixty-four patients were enrolled in total. EPI was present in 18 (28%) subjects and all EPI occurred within 3 days after hospitalization. Diabetes mellitus, rCBV ratio and regional time to peak (rTTP) ratio showed statically significant differences in both groups. Multi-variate analysis indicated that history of diabetes mellitus [odds ratio (OR), 6.13; 95% confidence interval (CI), 1.55-24.24] and a low rCBV ratio (rCBV, <0.85; OR, 6.57; 95% CI, 1.4-30.27) was significantly correlated with EPI. Conclusion : The incidence of EPI is considerable in patients with acute MCA territory infarction caused by MCA occlusion. We suggest that rCBV ratio is a useful neuro-imaging parameter to predict EPI.

• Diabetes and Metabolism Journal
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• v.42 no.6
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• pp.513-518
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• 2018

Background: Recent studies have correlated serum cystatin C (CysC) with vascular complications, but few studies have investigated this correlation in diabetes patients without nephropathy. This study aimed to evaluate if higher serum CysC levels increase the risk for vascular complications in type 2 diabetes mellitus patients with normal renal function or mild renal impairment. Methods: A total of 806 consecutive patients with type 2 diabetes mellitus who were admitted to the diabetes center of Soonchunhyang University Hospital for blood glucose control were retrospectively reviewed. Patients with nephropathy were excluded. Subjects were categorized into quartiles of serum CysC levels (Q1, ${\leq}0.65mg/L$; Q2, 0.66 to 0.79 mg/L; Q3, 0.80 to 0.94 mg/L; and Q4, ${\geq}0.95mg/L$). Results: The proportion of patients with diabetic retinopathy (DR) (P for trend <0.001), coronary heart disease (CHD) (P for trend <0.001), and stroke (P for trend <0.001) increased across the serum CysC quartiles. After adjustment for confounding factors, the highest serum CysC level remained a significant risk factor for DR (odds ratio [OR], 1.929; 95% confidence interval [CI], 1.007 to 4.144; P=0.040). Compared with Q1, a significant positive association was observed between serum CysC and CHD in Q2 (OR, 7.321; 95% CI, 1.114 to 48.114; P=0.012), Q3 (OR, 6.027; 95% CI, 0.952 to 38.161; P=0.020), and Q4 (OR, 8.122; 95% CI, 1.258 to 52.453; P=0.007). No associations were observed between CysC and stroke after additional adjustment for confounding variables. Conclusion: Serum CysC levels are independently associated with DR and CHD, suggesting that CysC may be useful for identifying type 2 diabetes mellitus patients without nephropathy who are at high risk for vascular complications.

• Journal of Preventive Medicine and Public Health
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• v.48 no.6
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• pp.287-300
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• 2015

Objectives: Self-rated health is a measure of perceived health widely used in epidemiological studies. Our study investigated the determinants of poor self-rated health in middle-aged Korean adults with diabetes. Methods: A cross-sectional study was conducted based on the Health Examinees Study. A total of 9759 adults aged 40 to 69 years who reported having physician-diagnosed diabetes were analyzed with regard to a range of health determinants, including sociodemographic, lifestyle, psychosocial, and physical variables, in association with self-rated health status using multivariate logistic regression models. A p-value <0.05 was considered to indicate statistical significance. Results: We found that negative psychosocial conditions, including frequent stress events and severe distress according to the psychosocial well-being index, were most strongly associated with poor self-rated health (odds ratio $[OR]_{\text{Frequent stress events}}$, 5.40; 95% confidence interval [CI], 4.63 to 6.29; $OR_{\text{Severe distress}}$, 11.08; 95% CI, 8.77 to 14.00). Moreover, younger age and being underweight or obese were shown to be associated with poor self-rated health. Physical factors relating to participants' medical history of diabetes, such as a younger age at diagnosis, a longer duration of diabetes, insulin therapy, hemoglobin A1c levels of 6.5% or more, and comorbidities, were other correlates of poor reported health. Conclusions: Our findings suggest that, in addition to medical variables, unfavorable socioeconomic factors, and adverse lifestyle behaviors, younger age, being underweight or obese, and psychosocial stress could be distinc factors in predicting negative perceived health status in Korean adults with diabetes.

• Journal of Preventive Medicine and Public Health
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• v.56 no.2
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• pp.190-195
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• 2023

Objectives: Pregnancy complications, including pre-eclampsia, gestational diabetes (GDM), and perinatal mood and anxiety disorders (PMADs), impact long-term health. We compared the frequency of screening documentation for pregnancy complications versus a general medical history at well woman visits between providers in primary care and obstetrics and gynecology. Methods: We conducted a retrospective cohort study of subjects with at least 1 prior birth who presented for a well woman visit in 2019-2020. Charts were reviewed for documentation of a general medical history (hypertension, diabetes, and mood disorders) versus screening for comparable obstetric complications (pre-eclampsia, GDM, and PMADs). The results were compared using the McNemar and chi-square tests as appropriate. Results: In total, 472 encounters were identified, and 137 met the inclusion criteria. Across specialties, clinicians were significantly more likely to document general medical conditions than pregnancy complications, including hypertensive disorders (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.18 to 5.48), diabetes (OR, 7.67; 95% CI, 3.27 to 22.0), and mood disorders (OR, 10.5; 95% CI, 3.81 to 40.3). Obstetrics and gynecology providers were more likely to document any pregnancy history (OR, 4.50; 95% CI, 1.24 to 16.27); however, they were not significantly more likely to screen for relevant obstetric complications (OR, 2.49; 95% CI, 0.90 to 6.89). Overall, the rate of pregnancy complication documentation was low in primary care and obstetrics and gynecology clinics (8.8 and 19.0%, respectively). Conclusions: Obstetrics and gynecology providers more frequently documented a pregnancy history than those in primary care; however, the rate was low across specialties, and providers reported screening for clinically relevant complications less frequently than for general medical conditions.

• The Journal of Korean Medicine
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• v.24 no.4
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• pp.19-24
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• 2003

Background and Purposes : Smoking is a well-known risk factor for ischemic stroke. It may contribute to s1Toke by inducing the aggregation of platelets and formation of atheroma, reducing cerebral blood flow, and increasing fibrinogen. However, the relative risk varies according to different ethnicity and area. Therefore, we performed this study to assess the risk of smoking for ischemic s1Toke in Korea. Methods : Cigarette smoking habit was studied in 308 patients with ischemic s1Toke and in 348 age- and sex-matched control subjects who had no history of stroke using case control methods. In multiple logistic regression analysis, smoking had a significant value of odds ratio adjusted for hypertension, diabetes mellitus, and hyperlipidemia. Results : The adjusted odds ratio (AOR) and 95％ confidence interval (CI) was significant in the medium smokers (AOR, 1.92; 95％ CI, 1.11 to 3.33: p< 0.05) and heavy smokers (AOR, 2.80; 95％ CI, 1.64 to 4.78: p< 0.05). Furthermore, the OR was higher in hypertensive subjects than in normotensive subjects compared to non-smokers (AOR, 1.98; 95％ CI, 1.01 to 3.85: p< 0.05). Conclusions : Our findings suggest that smoking is an independent risk factor for ischemic stroke in Korea.

• Diabetes and Metabolism Journal
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• v.42 no.6
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• pp.496-512
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• 2018

Background: This study aimed to investigate the association between the presence and severity of cardiovascular autonomic neuropathy (CAN) and development of long-term glucose fluctuation in subjects with type 2 diabetes mellitus. Methods: In this retrospective cohort study, subjects with type 2 diabetes mellitus who received cardiovascular autonomic reflex tests (CARTs) at baseline and at least 4-year of follow-up with ${\geq}6$ measures of glycosylated hemoglobin (HbA1c) were included. The severity of CAN was categorized as normal, early, or severe CAN according to the CARTs score. HbA1c variability was measured as the standard deviation (SD), coefficient of variation, and adjusted SD of serial HbA1c measurements. Results: A total of 681 subjects were analyzed (294 normal, 318 early, and 69 severe CAN). The HbA1c variability index values showed a positive relationship with the severity of CAN. Multivariable logistic regression analysis showed that CAN was significantly associated with the risk of developing higher HbA1c variability (SD) after adjusting for age, sex, body mass index, diabetes duration, mean HbA1c, heart rate, glomerular filtration rate, diabetic retinopathy, coronary artery disease, insulin use, and anti-hypertensive medication (early CAN: odds ratio [OR], 1.65; 95% confidence interval [CI], 1.12 to 2.43) (severe CAN: OR, 2.86; 95% CI, 1.47 to 5.56). This association was more prominent in subjects who had a longer duration of diabetes (>10 years) and lower mean HbA1c (<7%). Conclusion: CAN is an independent risk factor for future higher HbA1c variability in subjects with type 2 diabetes mellitus. Tailored therapy for stabilizing glucose fluctuation should be emphasized in subjects with CAN.

• Journal of Preventive Medicine and Public Health
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• v.34 no.4
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• pp.309-315
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• 2001

Objective : To develop a boner understanding of the relationship between weight status and the prevalence of obesity related diseases in the Korean population. Methods : The 1998 Korean National Health and Nutrition Survey was used and 10,880 persons who had previously taken health examinations were selected for study. The Korean Society for the Study of Obesity's classification of weight status was used. Hypertension, diabetes mellitus, dyslipidemia, osteoarthritis, chronic heart disease, stroke were included as obesity related disease. A logistic regression model was developed to estimate the prevalence odds ratio by obesity class adjusted for demographic and socioeconomic factors and we converted the odds ratio to a prevalence ratio using the base line prevalence of disease to aid in the interpretation of the ratios. Results : The prevalence of obesity was 26.3% based on the KSSO classification $(BMI\geq25)$. A graded increase in the prevalence ratio was observed with increasing severity of overweight and obesity for all health outcomes with the exception of chronic heart disease in men and stroke in both men and women. With normal weight individuals as the reference, for men who were younger than 50 years, the prevalence ratios were highest for hypertension BMI<23-25: 1.70(95% CI=1.41-2.05), 25$BMI\geq30$: 4.83(95% CI=3.70-5.84). The prevalence ratios for dyslipidemia were as high as hypertension, but were lower than hypertension for diabetes mellitus and osteoarthritis. Prevalence ratios generally were greater in younger adults. The prevalence of having 2 or more obesity related diseases increased with weight status category, except in people who were older than 50 years. Conclusions : Based on results, obesity is an increasingly important health problem in Korea and the disease burden increases according to weight status. For Korean adults, the strongest relationship was seen between weight status and hypertension and dyslipidemia. In older people the impact of excess weight and obesity is stronger than that seen in younger people. Increased efforts in the study of obesity and prevention and treatment of obesity and obesity related disease are required.

• The Journal of the Korea Contents Association
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• v.14 no.10
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• pp.198-209
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• 2014

Diabetes Mellitus (DM) is well known for increasing morbidity and mortality, especially related to their complications. The purpose of this study was to investigate the factors affecting the prevalence rate of DM and provide a fundamental material to develop an intervention strategy to reduce the prevalence rate of DM. The study subjects were adults aged over 19 on the basis of the primitive data of "The Fifth Korean National Health and Nutrition Examination Survey, 2012". Therefore, the data of 5995 participants were analyzed. For data process, the complex sample analysis module of SPSS 18.0 program was employed to add weighting before analysis. According to the analysis, the prevalence rate of DM of the study subjects was 10.5%. Regarding the odds ratio of DM prevalence, the subjects who graduated from middle school had the odds ratio 2.51 times higher than those who graduated from college and more; those in subjective bad health condition 4.77 times higher than those in subjective good health condition; those in obesity 1.44 times higher; those with high blood pressure 2.57 times higher; those with hyperlipidemia 2.63 times higher; those who fail to control their weight 1.31 times higher; those going on a diet 2.75 times higher. This study revealed that a level of education, perceived health status, obesity, high blood pressure, hyperlipidemia, weight control, and dietary therapy were the predictable variables of the prevalence rate of DM, and thereby suggested the nursing direction and research direction to reduce the prevalence rate of DM.

• Journal of the Korean Society of Food Science and Nutrition
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• v.43 no.5
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• pp.763-771
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• 2014

The objective of this study was to assess the relationship between dietary sodium intake and prevalence of abdominal obesity in Korean adults. We used data from the Korea National Health and Nutrition Examination Survey V-1 and analyzed data on 4,475 Koreans (${\geq}30$ years old). Subjects were divided into three groups according to fasting plasma glucose (FPG): 1) normal (FPG <100 mg/dL), 2) pre-diabetes ($100mg/dL{\leq}FPG{\leq}125mg/dL$), and 3) diabetes (FPG ${\geq}126mg/dL$ or subjects diagnosed with diabetes). The subjects in each category were stratified by dietary sodium intake as well as index of abdominal obesity. We found that dietary sodium intake was positively correlated with waist circumference (WC) (P=0.002) and was particularly high in the pre-diabetes group. In multiple logistic regression analysis, the normal and diabetes groups showed no association between dietary sodium intake and WC, whereas the pre-diabetes group with a high sodium intake exhibited a significant association (odds ratio (OR)=1.479, P=0.029) between dietary sodium intake and WC. Further, the OR for abdominal obesity in the high sodium intake group with pre-diabetes was 1.590 after adjusting for age and sex (P=0.012). In addition, the ORs for the prevalence of abdominal obesity with fasting glucose, fasting insulin, and homeostasis model assessment of insulin resistance were significantly higher in the pre-diabetes group with high sodium intake compared with low sodium intake. Moreover, these associations were significant even after adjusting for confounding variables (model 2: age and sex; model 3: age, sex, and total energy intake). Our results suggest a strong association between sodium intake and abdominal obesity in pre-diabetes Korean adults.

• Health Policy and Management
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• v.26 no.2
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• pp.125-134
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• 2016

Background: Glycemic control is an effective way to reduce the cardiovascular complications of diabetes, but more than half of the adults with diabetes in Korea are improperly controlling their glycemic levels. The purpose of this study is to identify the factors associated with poor glycemic control in type 2 diabetes patients. Methods: This study analyzed 1,261 subjects ${\geq}30years$ old diagnosed with type 2 diabetes who participated in the fifth Korean National Health and Nutrition Examination Survey (2010-2012). Poor glycemic control rates were defined as hemoglobin A1c (HbA1c) level ${\geq}7%$. To shed light on the causes of poor glycemic control, socio-demographics, diabetes severity, health status, and health behavior factors were adjusted and logistic regression was done. Results: Of the total 1,261 patients, 53.0% of patients with type 2 diabetes had HbA1c ${\geq}7%$. After running a logistic regression model, the odds ratio of poor glycemic control was higher in high school graduates than elementary school graduates; in people living in Chungcheong and Jeolla/Jeju than those living in Seoul; in the group with diabetes for over 5 years had diabetes less than 5 years; in a group with insulin and oral hypoglycemic agent treatment than non-treatment; in a group with hypertriglyceridemia than without hypertriglyceridemia; and in the group with slept less than 6 hours slept 7-8 hours. Conclusion: We need a comprehensive public health policy to reduce the poor glycemic control rates in type 2 diabetes patients. We should recognize the education levels, duration of diabetes, diabetes treatment, hypertriglyceridemia, and sleep duration were associated with poor glycemic control.