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Background There is no effective therapeutic intervention developed targeting cerebrovascular toxicity of drugs of abuse, including methamphetamine (METH). We hypothesize that exercise protects against METH-induced disruption of the blood–brain barrier (BBB) by enhancing the antioxidant capacity of cerebral microvessels and modulating caveolae-associated signaling. Mice were subjected to voluntary wheel running for 5 weeks resembling the voluntary pattern of human exercise, followed by injection with METH (10 mg/kg). The frequency, duration, and intensity of each running session were monitored for each mouse via a direct data link to a computer and the running data are analyzed by Clock lab™ Analysis software. Controls included mice sedentary that did not have access to running wheels and/or injections with saline. Results METH induced oxidative stress in brain microvessels, resulting in up regulation of caveolae-associated NAD(P)H oxidase subunits, and phosphorylation of mitochondrial protein 66Shc. Treatment with METH disrupted also the expression and colocalization of tight junction proteins. Importantly, exercise markedly attenuated these effects and protected against METH-induced disruption of the BBB integrity. Conclusions The obtained results indicate that exercise is an important modifiable behavioral factor that can protect against METH-induced cerebrovascular toxicity. These findings may provide new strategies in preventing the toxicity of drug of abuse.

Medical research is composed of two main parts, basic research and clinical research. This editorial will address several issues concerning clinical research which usually uses patient data to improve the outcome of general medical practice. In Korea, use of electronic medical records (EMRs) among health care providers is relatively high. However, there are lots of pitfalls in the EMR system and greater care in using rich sources of EMR data is needed even in locations where the same EMR system is used. Because EMRs are designed for health care services, not for research, they are not structured to facilitate the research process. First, the quality of EMR data is one of the most important problems to take into account when conducting research, as poor quality data can lead to biased results.1,2) EMR data can better reflect co-morbid conditions than data from diagnosis for service or medical history acquired from the patient, and can be easily linked to national data sets such as mortality rates. The complete coding of all presenting diagnoses and symptoms might reduce biased results in case ascertainments, however it is not always feasible in actual practice. Most creative research questions of clinicians using EMR data might originate from the experience of clinicians in medical practice, and would be shown in case series or case-control studies at the outset. If the important issues in medical recording are summarized in a standardized format, user-predefined templates in a predefined space are created, and physicians are regularly educated in EMR input methods, the data in the same EMR system might be easily converted to and used in evolving new research.3) The second principal concern is where the patient's records cannot be completely anonymised, for example, in the case of data linkage, informed consent must be acquired. Obtaining informed consent is desirable, however, it can be expensive, time-consuming, produce bias in terms of responders and non-responders.3) In addition, it can reduce the generalizability of research findings. Therefore, governance committees (institutional review board) have tended to take a strict position regarding medical research involving human subjects, based on the declaration of Helsinki. There are a few limitations to using EMR data as one of the first steps in identifying individuals with a specific condition and proving simple and more complex research questions. Care is required when using EMR data for research due to variability in the level of quality. Despite these challenges, there are many benefits including access to data that are not easily available, size of the data sets which might be created. Therefore, evolving appropriate technologies and continuing education for physicians will support further research using EMR data efficiently.

In modern society, stress is one of the most significant problems affecting physical as well as mental health. Stress, which is defined as a situation in which the homeostasis of the physiological system of one's mind and body is threatened, is composed of two concepts: stressors and stress reactions. A stressor is the stimulus that is perceived as a threat and arouses a stress reaction, such as a disaster or serious life event. Stress reactions are physical and mental symptoms, for example, chest tightness, dizziness, abdominal pain, dyspepsia, headache, and agitation, which are mediated by the sympathetic nervous system and stress hormones such as cortisol. These reactions, along with stress-related unhealthy behaviors, result in serious chronic diseases, including cancers and cardiovascular disease. Stress coping methods are classified into two components: cognitive behavioral interventions for stressors and mind-body interventions to reduce the stress response. Various interventions have been identified: progressive muscle relaxation, autogenic training, relaxation response, biofeedback, the emotional freedom technique, guided imagery, diaphragmatic breathing, transcendental meditation, and mindfulness-based stress reduction. Meditation and progressive muscular relaxation are wellknown and widely used procedures to reduce the stress response and to improve quality of life. Further studies to establish an evidence-based standardized program that can be easily applied at the individual level are needed.

Background Reducing salt intake is known to be an important factor for lowering blood pressure and preventing cardiovascular disease. Estimating amount of salt intake is a necessary step towards salt intake reduction. Self-reported saltiness of diet is a method most easily used to measure a patient's salt intake. The purpose of this study was to examine the value of self-reported saltiness of diet in measuring salt intake. Methods We used data from 681 participants who visited a health center at a university hospital between August 2003 and November 2005. A self-administered questionnaire was used to collect information on self-reported saltiness of diet, other dietary habits and lifestyle factors. Salt intake was estimated on the basis of 24-hour dietary recall with a computer-aided nutritional analysis program (CAN-Pro 2.0, Korean Nutrition Society). Results There was no statistically significant difference between the mean salt intake of the self-reported salty diet group (13.7 ± 4.8 g/d) and the self-reported unsalty diet group (13.3 ± 4.4 g/d). If we assume calculated salt intake as the gold standard, the sensitivity and specificity of self-reported saltiness were 39.5% and 63.6%, respectively. Salt intake was increased with higher calorie intake, frequency of eating breakfast (≥5 times/wk) and being satiated with usual diet in men, but it was increased only with higher calorie intake in women. Regardless of actual salt intake, the group satiated with a usual diet tended to be in the group of self-reported salty diet. Conclusion Self-reported saltiness of diet was not associated with actual salt intake. Further studies will be needed on the simpler and more objective tools to estimate salt intake.

Background: Diet pattern of regular and three meals per day is commonly recommended. Studies investigated the health effect of gorging pattern of diet using meal frequency and meal skipping, but the health effect of meal calorie variation between three regular meals has never been investigated. In this study, maximum meal calorie variation was defined as subtraction calorie for a meal with minimum energy intake from calories for a meal with maximum energy intake between three meals and examined the effect of maximum meal calorie variation between three regular meals a day on cardiovascular risk factors. Methods: A total of 4,680 healthy subjects aged 20-87 years who underwent medical screening examination, at one tertiary hospital health screening center and completed 24-hour dietary recall was included. Serum cholesterol subfractions, fasting glucose and blood pressure were measured. Results: Maximum meal calorie variation was significantly related to serum concentration of total cholesterol (β = 1.77; 95% confidence interval [CI], 0.36 to 3.18) and low density lipoprotein-cholesterol (LDL-C) (β = 1.64; 95% CI, 0.37 to 2.91), body mass index (β = 0.24; 95% CI, 0.12 to 0.37) and waist circumference (β = 0.66; 95% CI, 0.34 to 0.98) after adjustment for potential confounders. Conclusion: This study suggests the notion that concentration of total cholesterol and LDL-C and obesity indices are related to maximum meal calorie variation between three meals, independently of energy intake and other confounding factors in free-living population.

Results: Proteinuria was noticed in 5.7% of the subjects with metabolic syndrome, and 2.7% without metabolic syndrome. The multivariate-adjusted odds ratios of proteinuria in participants with elevated blood pressure level, elevated plasma glucose level and high triglyceride level were 2.23 (95% confidence interval [CI], 1.95 to 2.55), 2.33 (95% CI, 2.06 to 2.62), 1.64 (95% CI, 1.45 to 1.84). The multivariate-adjusted odds ratio of proteinuria in participants with the metabolic syndrome compared with participants without the metabolic syndrome was 2.30 (95% CI, 1.91 to 2.76), respectively. Conclusion: These findings suggest that proteinuria by the urine dip-stick test might be an important predictor in the metabolic syndrome.

Reactive oxygen species have been known to be an important factor in the patho- genesis of hypertension. Bilirubin, one of the metabolites of heme degraded by heme oxygenase, is a potent anti-oxidant. We verified the effect of serum bilirubin level on the incidence of hypertension in normotensive subjects. We grouped 1,208 normoten- sive subjects by the criterion of the highest quintile value of serum bilirubin, 1.1 mg/dL. The incidence of hypertension was higher in group 1 with bilirubin less than 1.1 mg/ dL than in group 2 with bilirubin 1.1 mg/dL or more (186/908 vs. 43/300, p=0.018). The relative risk for hypertension was 0.71 (95% confidence interval, 0.51-0.99), p=0.048 in group 2 compared to group 1 by Cox's proportional hazard model. Among the groups stratified by gender, smoking, and liver function status, the group 2 showed a lower risk of hypertension in females and in non-smokers. In conclusion, a mild increase within the physiological range of serum bilirubin con- centration was negatively correlated with the incidence of hypertension. The effect of bilirubin on the development of hypertension was more evident in females and in non-smokers.

We examined the associations between physical activity (PA), fitness and all-cause mortality and compared their contributions, taking smoking status into consideration. A retrospective cohort study of 18,775 men was carried out between May 1995 and December 2003. Fitness was measured by maximum oxygen uptake and regular PA was defined as at least three times a week, for more than 30 min of leisure time PA. During the mean 6.4 yr of follow-up, 547 deaths were recorded. The hazard ratio (HR) (95% confidence interval [CI]) of regular PA for all-cause mortality was 0.63 (0.52-0.76). The HRs (95% CIs) for men with middle and highest tertile levels of fitness were decreased by 0.58 (0.47-0.70) and 0.58 (0.45-0.75) in comparison to men with lowest one. The inverse association between fitness and mortality was significant among the men who did not engage in regular PA, but not among those who did (p for interaction=0.031). Smoking status did not influence on the associations between regular PA, fitness and mortality. Our result suggested that regular PA and fitness predicted mortality in men. The influence of fitness on mortality was pronounced in the men who did not engage in regular PA.

Korean Lifetime Health Maintenance Program (KLHMP) represents one of several efforts to take a more evidence-based approach to the development of recommendations on a wide range of preventive services. This paper summarizes the methods of the third KLHMP developed by Korean Academy of Family Medicine. The review process of KLHMP was mainly based on trans contextual guideline adaptation of United States preventive service Task force (USPSTF) recommendation. The method of review process was done according to categories of recommendation (adotion of USPSTF's recommendation, adatation of USPSTF's recommendation, development of new recommendation). If the recommendation done by USPSTF is up to date and acceptable in Korean context, it was translated and adopted. If the USPSTF recommendation was not up to date, nor applicable, the recommendation was drawn by adaptation process. If the condition has not been reviewed by USPSTF, the recommendation was drawn by de novo development process, forming key question, literature search (primary researchs, systematic reviews, guidelines), literature evaluation, evidence systhesis, considering of applicability and acceptability of evidence.

Periodic Health Examination and Prevention Guidelines for Koreans were first proposed since 1988. Based on that guideline, clinical preventive services has been applied to clinic population in a few University Hospitals since 1991. In 1995, LHMP development committee in Korean Academy of Family Physician Society first published evidence based clinical practice guidelines and updated the guidelines in 2003. Lifetime Health Maintenance Program (LHMP) commitee represents efforts to take a more updated evidence-based approach to the development of the third updated clinical practice guideline in 2009. We focused on approaches that can reliably assess the extent of updating required, a model of limited literature searches with modest expert involvement to reduce the cost and time.