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Background: The relationship between weight change and quality of life remains controversial. This study aimed to investigate whether changes in body weight among participants in different baseline body mass index categories are associated with physical and mental health functioning., Methods: We conducted an analysis involving 5,106 adults who participated in the Korean Genome and Epidemiology Study, a cohort comprising Korean adults aged 40 to 69 years. We categorized participants into three groups based on body weight change, and physical and mental health were assessed using the 12-Item Short-Form Health Survey in year 4. We employed logistic regression analysis to assess the association between body weight change and poor functioning at year 4. We also utilized a generalized estimating equation to determine the relationship between weight changes and mental component summary (MCS) scores over the study period for each weight group., Results: Weight gain in both the normal weight (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.13-3.11; P=0.01) and overweight groups (OR, 1.75; 95% CI, 1.05-2.91; P=0.03) was associated with poor MCS. Normal weight weight-losers were associated with a greater increase (2.69 points; 95% CI, 0.50-4.88) in MCS compared to weightmaintainers. Significant differences in mean MCS were observed for overweight weight-losers, obese weight-gainers, and underweight weight-gainers when compared to weight maintainers in each respective weight group., Conclusion: Different patterns of relationships between weight change and mental health-related quality of life were observed. Hence, it is crucial to focus on the mental health of middle-aged and older adults when assessing body weight changes.

Background: Sleep duration is associated with various health conditions, including chronic kidney disease. However, the association between sleep duration and decline in kidney function in the South Korean population remains unclear. We aimed to investigate the impact of sleep duration on kidney function decline in adult patients with hypertension., Methods: This cohort study was performed using data obtained from the Korean Genome and Epidemiology Study; 2,837 patients with hypertension who initially had normal kidney function were included. Glomerular filtration rates (GFRs) were estimated at baseline and throughout the 16 years of follow-up. A person was considered to have a decline in kidney function if they had a GFR <60 mL/min/1.73 m2. Sleep duration data were obtained through interviewer-assisted questionnaires. Sleep durations were classified as short (<6 hours), normal (≥6 hours but <9 hours), and long (≥9 hours). The Cox proportional hazards model was applied, with adjustments for covariates., Results: After adjusting for covariates, sleep duration was not associated with a decline in kidney function. However, among men with poorly controlled hypertension at baseline, compared to men with normal sleep durations, men with sleep durations <6 hours had a significantly higher risk of kidney function decline (hazard ratio, 1.56; 95% confidence interval, 1.02-2.36)., Conclusion: Short sleep duration did not seem to be associated with an increased risk of decline in kidney function; however, it may be a risk factor for the decline in kidney function in men with poorly controlled hypertension.

Background: Since the era of "thyroid cancer epidemic," many Korean academic societies discouraged the use of ultrasonography in healthy individuals and revised the Korean Thyroid Imaging Reporting and Data System to address the overscreening and overdiagnosis issues. This study aimed to evaluate the change in the diagnostic effectiveness of thyroid cancer screening over the last decade., Methods: This single-center, retrospective observational study analyzed the data of 125,962 thyroid nodules obtained during cancer screening at the health promotion center of Seoul National University Bundang Hospital from 2010 to 2019. Only 327 thyroid cancer cases pathologically confirmed by fine-needle aspiration (FNA) were included in the study. The strength of the association between the number of FNA and (1) the number of thyroid cancer diagnoses, (2) the positive predictive values (PPVs), and (3) the difference in PPV from the previous year were evaluated using Pearson's correlation analysis., Results: The number of thyroid FNA biopsies as well as the thyroid cancer diagnoses decreased from 2010 to 2019 (166 to 48 [-71.1%] vs. 43 to 22 [-48.8%]). The PPV of FNA biopsies increased from 25.9% to 45.8% (+76.8%) and was negatively correlated with the number of FNA biopsies performed (R=-0.87, P<0.001). The difference in PPV from the previous year increased similarly but without statistical significance (R=-0.59, P=0.09)., Conclusion: The diagnostic efficiency of thyroid cancer screening has increased over the last decade, as evidenced by the increasing PPV of FNA biopsies.

Background: This study aimed to explore the relationship between fruit intake, changes in fruit intake, and changes in cardiometabolic factors in people with obesity., Methods: A total of 21,270 subjects (8,718 men, 12,552 women) aged 40 years and over, from the Korean-based Genome and Epidemiology Study, were followed up for an average of 4.4 years. Fruit intake was assessed using a food frequency questionnaire at baseline and the second follow-up. The beta coefficient and confidence intervals for changes in cardiometabolic risk factors according to fruit consumption were calculated using a linear regression model., Results: In men, the abdominal circumference decreased with changes in fruit intake (P=0.029). Fruit intake and increased fruit intake in men were associated with a lower systolic blood pressure (P=0.012 and P=0.02, respectively) and lower triglyceride levels (P=0.002 and P<0.001, respectively). In women, abdominal circumference decreased with both fruit intake and increased fruit intake (P<0.001 and P=0.013, respectively). Systolic blood pressure and triglycerides tended to decrease only with fruit intake (P=0.048 and P<0.001, respectively). Unlike in men, fasting blood glucose tended to decrease in women with both fruit intake and increased fruit intake (P=0.011 and P=0.005, respectively)., Conclusion: Fruit intake and increased fruit intake may have beneficial effects on cardiometabolic risk factors among individuals who are obese.

Background: Problem drinking increases the incidence of all-cause mortality and specific cancers, and persistent drinking is associated with cardiovascular disease in certain cancer survivors. This study analyzed the cardiovascular risk factors before and after diagnosis in Korean cancer survivors., Methods: Data for the period between 2002 and 2013 were collected from the National Health Insurance Service Health-Examinee Cohort Database. Among the 27,835 patients included, those with moderate alcohol consumption before and after cancer diagnosis were excluded. Problem drinking was defined as males under 65 years consuming over 14 glasses a week, and males over 65 years or females consuming over seven glasses a week. A t-test, chi-square test, and linear regression analysis were performed for differences in cardiovascular risk factors and differences according to cancer types., Results: There was a difference in the body mass index, systolic and diastolic blood pressure, and total cholesterol among patients who became moderate drinkers after diagnosis, but fasting blood glucose did not show any significant changes. Risk factors for cardiovascular disease were analyzed in patients with liver, stomach, rectal, and breast cancer with improved drinking behavior, and there were significant differences in body mass index, systolic and diastolic blood pressure, fasting blood glucose, and total cholesterol in stomach cancer patients., Conclusion: Moderate drinking can lower cardiovascular risk in cancer survivors, and among the many drinking-related cancers, stomach cancer patients demonstrated significantly reduced cardiovascular risk factors.

Background: Osteoarthritis (OA) is a chronic disease that commonly afflicts the elderly. This disease reduces the health-related quality of life (HRQoL) and causes a significant social burden. Whether the effect of coexisting chronic conditions on HRQoL varies according to the presence of OA remains unclear. Therefore, this study aimed to investigate this notion., Methods: A total of 13,395 participants were identified from the 2009-2013 Korean National Health and Nutrition Examination Survey for analysis. HRQoL was assessed using the European quality of life-5 dimensions (EQ-5D) index. Patients with OA were defined as those diagnosed by a physician or those who displayed both, symptoms and radiological findings consistent with OA at the time of the survey. Associations between OA and 8 chronic conditions were tested using regression analysis., Results: The EQ-5D index was lower in patients with OA than in those without (mean difference, -0.145; 95% confidence interval [CI], -0.138 to -0.151; P<0.001). Most patients with OA and chronic conditions showed a lower score than those without. EQ-5D was particularly lower in OA patients with hypertension, dyslipidemia, stroke, and renal failure. The estimated β coefficient for the interaction term was significant in renal failure (-0.034; 95% CI, -0.055 to -0.012), after adjusting for demographic and socio-economic variables., Conclusion: OA significantly affects HRQoL of Korean elderly individuals alone or when combined with other conditions. OA combined with renal failure is particularly detrimental. These results indicate the importance of managing OA, which is an underestimated disease in public health surveys., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported.

Background: Dyslipidemia is a major risk factor contributing to cardiovascular disease and its prevalence is steadily rising. Although screening tests are readily accessible, dyslipidemia remains undertreated. Evaluating health behavior patterns after diagnosis may help improve lifestyle interventions for the management of dyslipidemia., Methods: Data from the fifth Korean National Health and Nutrition Examination Survey 2010-2012 were used. A total of 6,624 dyslipidemia patients over 20 years old were included according to National Cholesterol Education Program-Adult Treatment Panel III guidelines. Logistic regression analysis was completed using a weighted method to determine whether awareness of dyslipidemia was associated with health behavior. Health behavior was divided into two categories: behavioral factors (smoking, alcohol consumption, exercise) and nutritional factors (adequate intake of fiber, carbohydrate, fat, protein)., Results: There were no significant differences in health behavior among dyslipidemia patients according to awareness after adjustment for covariates, diabetes and hypertension. Awareness in women was associated with decreased smoking (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.32 to 0.94), but when adjusted for diabetes and hypertension the result was not significant (OR, 0.61; 95% CI, 0.35 to 1.06). The same pattern applied to intake of carbohydrate in men (OR, 1.28; 95% CI, 0.99 to 1.67) and protein in women (OR, 1.22; 95% CI, 0.98 to 1.50). In subgroup analysis, awareness of dyslipidemia in men without hypertension or diabetes was associated with adequate intake of carbohydrate (OR, 1.70; 95% CI, 1.06 to 2.72)., Conclusion: Increasing awareness alone may not be enough to improve healthy behavior in patients with dyslipidemia. Efforts including patient education and counseling through a multi-team approach may be required., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported.

Background: The efficacy of two artificial tears, carboxymethylcellulose (CMC) and hyaluronate (HA), was compared in the treatment of patients with dry eye disease., Methods: We conducted a systematic review and meta-analysis on randomized controlled trials in the PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases. The efficacy was compared in terms of the mean change from baseline in tear break-up time. The meta-analysis was conducted using both random and fixed effect models. The quality of the selected studies was assessed for risk of bias., Results: Five studies were included involving 251 participants. Random effect model meta-analysis showed no significant difference between CMC and HA in treating dry eye disease (pooled standardized mean difference [SMD]=-0.452; 95% confidence interval [CI], -0.911 to 0.007; P=0.053). In contrast, fixed effect model meta-analysis revealed significant improvements in the CMC group when compared to the HA group (pooled SMD=-0.334; 95% CI, -0.588 to -0.081; P=0.010)., Conclusion: The efficacy of CMC appeared to be better than that of HA in treating dry eye disease, although meta-analysis results were not statistically significant. Further research is needed to better elucidate the difference in efficacy between CMC and HA in treating dry eye disease., Competing Interests: No potential conflict of interest relevant to this article was reported.

Background: Fatigue is one of the most common presenting symptoms in primary care in Korea. In this study, we aimed to determine the effect of exercise intervention on the severity of fatigue of unknown medical cause during a period of follow-up., Methods: We used the data collected from an outpatient fatigue clinic in Seoul National University Bundang Hospital. The study was conducted from March 3, 2010 to May 31, 2014. We measured the body mass index of each patient and evaluated variables including lifestyle factors (smoking, alcohol consumption, and regular exercise), quality of sleep, anxiety, depression, stress severity, and fatigue severity using questionnaires. A total of 152 participants who completed questionnaires to determine changes in fatigue severity and the effect of exercise for each period were evaluated. We used univariate analysis to verify possible factors related to fatigue and then conducted multivariate analysis using these factors and the literature., Results: Of 130 patients with the complaint of chronic fatigue for over 6 months, over 90 percent reported moderate or severe fatigue on the Fatigue Severity Scale and Brief Fatigue Inventory questionnaires. The fatigue severity scores decreased and fatigue improved over time. The amount of exercise was increased in the first month, but decreased afterwards., Conclusion: There was no significant relationship between changes in the amount of exercise and fatigue severity in each follow-up period. Randomized controlled trials and a cohort study with a more detailed exercise protocol in an outpatient setting are needed in the future.

Background: Chronic obstructive pulmonary disease (COPD) is the fifth leading cause of death worldwide. The awareness and treatment rate of the disease are low despite its relatively high prevalence. With the added data, this study aimed to identify changes in prevalence and risk factors of COPD using the data from the 5th KNHNES., Methods: The subjects of this study were 8,969 individuals aged 40 and older who satisfied suitability and reproducibility for pulmonary function tests. The prevalence, awareness and risk factors of COPD were predicted based on the questionnaires on gender, age, educational level, income level, smoking history, body mass index (BMI) and other COPD related questions., Results: Diagnosis of COPD was based on the airflow limitation (forced expiratory volume in one second/forced vital capacity <0.7) of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The prevalence of COPD from 2010 to 2012 was 13.7%, of which 23.3% was men and 6.5% women. The prevalence was on the rise, with 12.2% in 2010, 13.2% in 2011, and 15.5% in 2012. In GOLD stage 1, the percentages of those who had cough or sputum and smoking history were 12.1% and 75.5%, respectively, but only 0.1% was diagnosed with COPD. Even after adjusting for asthma and tuberculosis, men, old age, larger amount of smoking were linked with a higher prevalence of COPD, and obese and higher educational level were associated with a lower prevalence of COPD., Conclusion: The prevalence of COPD in Korea has been increasing every year, and a higher prevalence was associated with male, older age, more amount of smoking, lower educational level and lower BMI.

Background: Personal health records (PHRs) are web based tools that help people to access and manage their personalized medical information. Although needs for PHR are increasing, current serviced PHRs are unsatisfactory and researches on them remain limited. The purpose of this study is to show the process of developing Seoul National University Bundang Hospital (SNUBH)'s own PHR system and to analyze consumer's use pattern after providing PHR service., Methods: Task force team was organized to decide service range and set the program. They made the system available on both mobile application and internet web page. The study enrolled PHR consumers who assessed PHR system between June 2013 and June 2014. We analyzed the total number of users on a monthly basis and the using pattern according to each component., Results: The PHR service named Health4U has been provided from June 2013. Every patient who visited SNUBH could register Health4U service and view their medical data. The PHR user has been increasing, especially they tend to approach via one way of either web page or mobile application. The most frequently used service is to check laboratory test result., Conclusion: For paradigm shift toward patient-centered care, there is a growing interest in PHR. This study about experience of establishing and servicing the Health4U would contribute to development of interconnected PHR.

Background: Given that a substantial number of daily activities take place in neighborhoods, a convenient and effective method for measuring the physical activity of individuals is needed. Therefore, we tested the validity and reliability of the Korean version of the Neighborhood Physical Activity Questionnaire (K-NPAQ), which was developed through translation and back-translation of the NPAQ., Methods: The K-NPAQ was administered twice, with a 1-week interval, to participants in the study who were recruited at a health promotion center. We assessed energy expenditure and compliance using an accelerometer and an activity diary. The Kappa statistic and Spearman correlation coefficient were used to evaluate the test-retest reliability of the K-NPAQ, and the Spearman rank correlation was used to assess the validity., Results: Of the 122 participants, 43 were excluded owing to a lack of compliance. The Kappa values for all items that were used to assess walking or cycling within or outside the neighborhood were >0.424; 0.251-0.902 for 5 items related to the purpose of the physical activity; 0.232-0.912 for most items related to the number of times and the duration for each types of physical activity. The total energy expenditure and the energy expenditure in the neighborhood were significantly correlated with the K-NPAQ and the accelerometer, with correlation coefficients of 0.192-0.264., Conclusion: The K-NPAQ is a valid and reliable tool for measuring physical activity in the neighborhood, and it can be used for individual education and counseling in order to augment physical activity in specific neighborhood environments.

Background: Allostatic load (AL) measures overall physiological wear and tear on one's body, as a preclinical marker of pathophysiologic processes that precede the onset of disease. We studied the association of dietary habits with AL., Methods: Consecutive patients visiting a tertiary hospital Health Promotion Center from September 2009 to February 2010, older than 20 years with metabolic syndrome were selected for study (n = 204). By multivariable linear regression analysis, we investigated the association of various dietary habits evaluated by questionnaires., Results: In male, multivariable linear regression showed a significant negative association between fat preference and AL with BMI ≥ 30 (1st quartile [Q] vs. 2Q: β = -3.71; 95% confidence interval [CI], -6.26 to -1.16), a significant negative association between salt preference and AL with BMI 25-30 (β = -1.36; 95% CI, -2.46 to -0.26), a negative association between appetite control and AL with BMI < 25 (1Q vs. 3Q: β = -1.54; 95% CI, -3.00 to -0.096), a significant positive association between appetite control and AL with BMI 25-30 (1Q vs. 3Q: β = 1.30; 95% CI, 0.12 to 2.48), and a significant positive association between eating in response to food cues and AL in males with BMI 25-30 (1Q vs. 4Q: β = 1.09; 95% CI, 0.020 to 2.15)., Conclusion: Our results suggest that metabolic syndrome patients should be discouraged from eating fat and eating in response to food cues, and should be educated about nutrition and balanced diet.

Attending conferences is important for doctors and residents in family medicine. Nevertheless, departments of family medicine at many hospitals find it difficult to hold regular conferences. Holding joint videoconferences between Family Medicine Departments of several hospitals through a videoconferencing system could solve this problem. Therefore, Family Medicine Departments of Seoul National University Hospital, Seoul National University Bundang Hospital, and Kangwon National University Hospital decided to hold regular joint videoconferences via a videoconferencing system. Eighty-one joint videoconferences were held from April 1 to October 29, 2010. PowerPoint slideshows were transferred to the other two locations in the same resolution as presenter's monitor. Image and voice of the speaker were transferred in real time and in acceptable quality. Joint videoconferences are feasible, satisfactory and useful for medical education, especially when individual family medicine departments are small and lack resources to hold face-to-face conferences. We expect that more family medicine departments will choose to participate in implementing similar joint videoconferencing systems in the future.