| Bong Yul Huh | 77 Articles |
Background
Recently, in our ageing society, the change in dietary pattern and increase in obesity have caused the metabolic syndrome to increase in Korea. Because of the association of the risk of cardiovascular diseases, the metabolic syndrome must be prevented and well managed. We examined the association between the metabolic syndrome and the serum testosterone and DHEA-S concentration. Methods: The subject of this study included 231 men aged more than 40 years old who visited the health promotion center of a university hospital from March 2004 to March 2006. We excluded the subjects who were currently on medications except for antihypertensive and hypoglycemic agents. We defined the metabolic syndrome according to the ATP III with Asia-Pacific waist circumference. To examine the association between the metabolic syndrome and the serum testosterone concentration, we used the method of multiple logistic regression analysis. Results: The prevalence of the metabolic syndrome in our subjects was 32.9%. Decreased serum testosterone concentration was significantly associated with large waist circumference and high fasting blood sugar. Men with testosterone values in the upper tertile had a significantly lower risk of metabolic syndrome (OR=0.34, P=0.018). Conclusion: After statistical adjustment for age, smoking, income, exercise, alcohol intake, and body mass index, the serum testosterone concentration was negatively associated with the metabolic syndrome. (J Korean Acad Fam Med 2007;28:705-711)
Background
: Although proactive screening for sexual dysfunction in primary care has been emphasized as an important part of comprehensive care, doctors seldom ask their patients about their sexual function. Worry about patients' responses was reckoned as a major barrier, but few studies have dealt with how patients feel and what they want. This study was aimed to describe and analyze the attitudes of patients toward proactive screening for sexual dysfunction. Methods : A set of self-administered questionnaire was given to every patients who visited a family medicine clinic in a university hospital for 2 weeks from March 16, 2005. Results : A total of 185 patients were analyzed. Among them, 72.4% were willing to consult their physician when they were in trouble with their sexual function, and 84.3% said proactive screening for sexual dysfunction was necessary. Many patients did not care about 'when to be asked' and wanted to be asked in face-to-face interview rather than by a questionnaire. Sentence emphasizing that every patient is given the same question was most preferred. Conclusion : Patients' attitude toward proactive screening for sexual dysfunction in primary care was generally positive. Patients preferred to be asked ;I ask every patient about his sexual problem. If you're OK, I ask you about your sexual problem.; regardless of timing, during the interview.
Background
: The causes of eosinophilia are allergies, parasite infections, medications, skin diseases, and others. But, the etiologies of eosinophilia and variables associated with eosinophilia are not well known in Korea. Methods : This study included patients in a health check up at a general hospital from May 21, 1995 until February 14, 2004. Through self-report, serology, and stool exam, variables associated with eosinophilia were tested. Results : In the eosinophilic group, 5% were helminth infected, and more of C. sinensis infection were found the eosinophilic group with 3.9% compared to the non- eosinophilic group with 1.2% (P＜0.05) Associated variables with eosinophilia were old age, high BMI, drinking, smoking, the season of testing helminth infections, and Clonorchiasis infection. But allergy was not associated with eosinophilia. The odds ratios for eosinophilia after adjustment were 2.280 (1.694∼3.068) in helminth infections and 2.391 (1.716∼3.331) in Clonorchiasis infection. Conclusion : In the eosinophilic group, 5% were helminth infected, and more C. sinensis infection was found. Associated variables with eosinophilia were old age, high BMI, drinking, smoking, the season of testing, helminth infections, and Clonorchiasis infection. But allergy was not associated with eosinophilia.
Background
: Two representative groups of family physicians and oncologists were surveyed concerning their knowledge and attitudes toward cancer pain management (CPM). Methods : A questionnaire, designed to assess knowledge (13 items) and attitudes (6 items) toward CPM, was sent to 2,200 members of Korean Association of Family Medicine and 800 members of Korean Cancer Association. Results : Three hundred and eighty eight family physicians (17.6%) and one hundred and forty seven oncologists (18.4%) responded and completed the questionnaire. They had inadequate knowledge toward CPM, especially, chance of respiratory depression, tolerance to adverse effect, ceiling effect, risk of addiction, and use of adjuvants. Most of the physicians had positive attitude toward importance of CPM, best judge of pain severity, and priority of CPM but had negative attitude toward concerns about potential problem of addiction and earlier prescription of maximum dose of opioid. Family physicians displayed more lack of knowledge about CPM in 9 of 13 items and more negative attitudes toward 4 of 6 items. Adjustment for demographic characteristics and experiences in cancer patients with pain showed that while family physicians had poor knowledge of tolerance to confusion, they had more adequate knowledge on the effect of antidepressant and had positive attitude towards best judge of pain severity and priority of CPM. Poor knowledge about CPM was rated by 66.3% of physicians as the most important barrier to adequate CPM. Conclusion : These findings that most of the physicians had poor knowledge and negative view toward CPM suggest a continuous need for comprehensive education program focused on CPM for physicians.
Background
: The optimal screening tools for hepatocellular carcinoma are regular tests of alpha fetoprotein (aFP) and liver ultrasonography every 6 months in high risk group. To implement successful long-term project for reducing cancer-mortality, it is essential to know the reasons for non-compliance among the high risk group. Methods : A telephone survey was done among the hepatitis B surface antigen positive patient group who had not received a follow-up test of aFP and liver ultrasonography. This group was selected among the patients who had received health examinations from January, 2002 to December, 2002 at a university hospital center for health promotion, and the reasons for non-compliance were inquired. Results : There were no statistical differences in educational level, economic status, age, and sex between the patient group who had taken appropriate follow-up tests and the group who had not. But there were statistically significant differences in the admission history and transfusion history between the two groups. The reasons for non-compliance were as follows: 1. ignorance to the significance of follow-up examination (41.7%), 2. lack of time (27.8%), 3. no specific signs of cancer (22.2%), 4. high costs (5.6%), and 5. fear of discovering serious disease. Conclusion : It is important to have patients educated on the significance of screening and early diagnosis of hepatocellular carcinoma.
Background
: CRC is an ideal target for population screening because it is a prevalent disease with an identifiable precursor lesion. This study was performed for the purpose of comparing cost-effectiveness of CRC screening strategies. Methods : The natural history of a simulated cohort of 50- year-old Koreans in the general population was modeled with and without CRC screening until age 80 years. We evaluated 16 different screening strategies with Markov model. Cases of positive screening test results were worked up with a colonoscopy. After polypectomy, colonoscopy was repeated every 3 years. Our main outcome measurements were discounted lifetime costs, life expectancy and incremental cost-effectiveness (CE) ratio, comparing 16 different CRC screening strategies. Results : In base-case analysis, compliance was assumed to be 60% with the initial screen and 80% with follow-up or surveillance colonoscopy. The non-dominated strategies were colonoscopy every 10 years (COL10), colonoscopy every 5 years (COL5) and colonoscopy every 3 years (COL3). Strategies that only included sigmoidoscopy were generally not regarded as non-dominated strategies, but sigmoidoscopy every 5 years (SIG5) showed similar cost and effects as COL10 while sigmoidoscopy every 3 years (SIG3) had similar results as COL5. Other strategies recommended by the expert panel, such as sigmoidocopy plus colon study every 5 years were less cost-effective than the alternatives. Conclusion : Colonoscopy is the most cost-effective strategy in Korea for colorectal cancer screening. Unfortunately, the number of physicians skilled enough to perform colonoscopy is not enough to meet the demands of screening for colorectal cancer in average-risk adults. Therefore, we consider alternative strategies such as SIG5 or SIG3.
Background
: Although lack of exercise is well known to be a risk factor of osteoporosis, it is unclear whether weight-bearing exercise has different effects on bone mineral density compared to non weight-bearing exercise, and the amount of exercise needed to prevent osteoporosis is not clearly defined. This study was performed to clarify the relations between the type and the amount of exercise with BMD. Methods : This was a cross-sectional study of 3,661 women who had undertaken health screening including BMD measurement at Health Promotion Center of SNUH between May 1997 and March 1999. Information on sociodemographic characteristics, menarche, childbirth andexercise were gathered by means of self-reported questionnaire, and BMD was measured using DEXA. Results : The number of women with lumbar osteoporosis were 601 (16.4%) and femoral neck osteoporosis 372 (10.2%). Lumbar osteoporosis occurred more frequently with increasing age and age at menarche, and in menopausal women, but less frequently with increasing fat-free mass in multiple logistic regression analysis. When adjusted for age, age at menarche, menopause and fat-free mass, lumbar osteoporosis was less common in women who exercised, but the type and the amount of exercise had no bearing. Especially, lumbar osteoporosis was least common in women engaging in moderate amount of exercise. Femoral neck osteoporosis decreased significantly only in weight-bearing exercise group and in women engaging in high amount of exercise. Conclusion : The results of this study suggest that lumbar osteoporosis can be prevented through exercise regardless of its type and amount, and high amount or weight- bearing exercise is most effective to prevent femoral neck osteoporosis.
Background
: For cancer patients, pain is the most common symptom and the most important factor that seriously affects their treatment and quality of life. The purpose of the research was to determine the controllable factors for pain management in order to increase patients' satisfaction for pain management. Method: This study was based on the survey answers and medical records of 464 cancer patients, in 8 hospitals in Korea from March until September 2000.
Background
: Female sexual function is influenced by much more factors than that of male and has a close relationship with psychosocial factors. A satisfying sex life has a high correlation to a happy married life. A questionnaire provides easy access to private matters and in a multidimensional manner. The objective of this study was to identify the factors related to female sexual function to help sexual adjustment in marriage. Methods : A hundred married women living with their spouses, who visited an outpatient clinic of family medicine department of a university hospital in Seoul were studied. After filling out the self-administered questionnaire, a face-to-face interview was done on all study subjects. For multivariate analysis of the related factors, the outcome variables were a binary response of the normal female sexual cycle ?drive, lubrication, orgasm, and satisfaction. Results : The multivariate analysis showed that the household income was a significant factor related to Drive (Odds Ratio: OR=0.6, 95% Confidence Interval: CI 0.4∼0.9). Age was a significant factor related to Insufficient Lubrication (OR=1.1, 95% CI 1.0∼1.3). Insufficient foreplay was a risk factor for Insufficient Lubrication (OR= 2.4, P=0.052). In multivariate analysis of the Orgasm related factors, the perceived health status showed an OR of 7.1 (95% CI 1.5∼32.6) and both marital satisfaction and open communication showed an OR of 6.0 (95% CI 1.3∼26.8) and an OR of 5.8 (95% CI 1.2∼28.2), respectively. The significant related factors to Satisfaction were in order of importance of sex life, education, and open communication, with an OR of 3.6 (95% CI 1.7∼7.6), 2.5 (95% CI 1.1∼5.9), and 2.0 (95% CI 1.0∼3.8), respectively. Conclusion : The positively related factors to female sexual function were good perceived health status, high marital satisfaction, placing importance in sex life, and open communication regarding sexual matters. Increasing age and household income were found to be factors adverse to female sexual function.
Background
: Currently, the high quality of life associated with women's rights is strongly supported and has become an important social issue. As a result, there is an increasing need for studies concerning female sexual function. The objectives of this study was to develop a questionnaire to evaluate sexual function evaluation in Korean women. Methods : A total of 100 married women, who visited an outpatient clinic of family medicine department of a university hospital in Seoul, were studied. After filling out the self-administered questionnaire, a face-to- face interview was done on all study subjects. The items of this questionnaire were adopted from questionnaires with proven validity and reliability. Factor analysis was done and Crohnbach's alpha was calculated. Results : The items of this questionnaire were classified into 5 parts: Drive, Excitement, Sexual activity, Satisfaction, and Spouse. The total variance was 51.5%. The total Crohnbach's alpha was 0.82. The internal consistency was high. Study subjects were able to complete this questionnaire within 10 minutes. Conclusion : The validity and reliability of this female sexual function questionnaire was found to be acceptable. This questionnaire can be utilized as a diagnostic adjunctive tool and feedback for treatment through further studies.
Background
: Because of improvement of economic state and eating habit changes in Korea, 60-70% of gallbladder stones are cholesterol stones. As ultrasonography was used increasingly, detection of asymptomatic gallstone were increased. There has been few studies about asymptomatic gallstone in Korea. So, this study was designed to obtain associated factor of prevalence of asymptomatic gallstone. Methods : We screened adults over 20 years who were visited the Health Promotion Center in a university hospital from May 1995 to May 1999. Subjects were defined as case group(584 subjects) who were diagnosed gallstone by abdominal ultrasonogaphy by radiologist. Control group(1153 subjects) were selected by random sampling from visitors of the Health Promotion Center. Every subjects were assessed with respect to gender, age, height, weight, fasting blood glucose, serum total cholesterol, high density lipoprotein-cholesterol, triglyceride. Social-Economic state, smoking were assessed by self-administered questionnaires. Associated factor of prevalence of asymptomatic gallstone were analyzed by Chi-square test and multiple logistic regression. Results : Age, BMI(Body Mass Index), fasting blood glucose were associated with gallstone by Chi-square test(P<0.05). Multiple logistic regression showed that prevalence of asymptomatic gallstones was increased by age (>40 years old) and were associated with BMI (>25㎏/㎡), fasting blood glucose. Conclusion : Associated factors of prevalence of asymptomatic gallstone were increased by age (>40 years old) and were associated with BMI (>25㎏/㎡), fasting blood glucose, and were not different from those in West countries. Further studies will be needed about associated factors according to the composition of gallstone and developing from asymptomatic gallstone to symtomatic gallstone.
Background
s: The education by the family physician. is important for more practical primary care medicine education. In this study, we try to know the present state of education and the future and the number of education resource and how to multiply this resource. Methods : we have got the list of family physicians who have their clinic in Seoul by the help of the Korean Academy of Family Medicine. And we performed telephone questionary. We also asked the demographic factors. Results : 134 persons were asked questionary by the telephone. 17 persons were joining in education. Trainee by the 3rd grade hospitals was the major, the next was by 2nd grade hospital, and doctors who did not have the training. 14 persons have begun education by asking of the training hospital, 3 persons wanted it, but none thought it beneficial to them. 44 persons wanted to join education in the future, and there was no difference between the 3rd and the 2nd grade hospital trainee. Conclusion : There was no difference between the 3rd and 2nd grade hospital trainee but 2nd grade hospital trainee was less joining than the 3rd. This shows that the 2nd grade hospital trainee can be the good pool of the future education if there are adequate supply. So many adequate supply is necessary.
Background
: In western countries the proportion of deaths in the hospital has somewhat decreased. While that of Korea has continuously increased, it is interesting things that the hospital death rate in Korea is less than that in western countries. Therefore we tried to find the factors associated with the place of death in Korea. Methods : We obtained the data from the National Statistical Office. They are composed of classified by ICD-10. Univariate and Mutivariate analysis were done to find the effect of each variable for the place of death. Results : Total number of the study population was 242,362 (male:136,063, female:106,299). Female died more in the hospital. The younger are more likely to die in the hospital. People having lived in metropolitan, having educated to higher level and professionals died more in the hospital. And the people having had ischemic heart disease and cancer death were more likely to die in the hospital. The single (unmarried, divorced) died more in the hospital. In multivariate analysis, the place of death was significantly different by sex, age, address, occupation, cause of death, and level of education Conclusion : In Korea sex, age, address, occupation, cause of death, and level of education are helpful in predicting the palce of death.
Background
: Ischemic heart diseases have increased by more than 80% in the past 10 years among Korean and the global risk assessment of coronary heart disease(CHD) based on the relative risk factors to the probability of developing CHD became widely used for western populations. In this study we hope to provide information on the distribution and characteristics of the relative risks of CHD using the Framingham risk score. Methods : This study involved the subjects who visited a university hospital for health promotion from 1995 to 2000 without CHD. We surveyed medical history of the subjects, and measured their blood pressure, serum glucose, total cholesterol(total-C) and HDL-cholesterol(HDL-C). Risk points from the Framingham chart were given to age, systolic BP, total-C, HDL-C, smoking, diabetes, and the global risk score was calculated from their sum. We analyzed the global risk scores and each risk points of the high risk groups. Results : For younger and older men in the high risk group, the factors smoking and high blood pressure had the highest score assigned respectively. With younger women total-C had the highest score assigned, and with older women diabetes took over but HDL-C and high blood pressure still had a higher score. Conclusion : For primary prevention of CHD, younger men need active education to quit smoking and for older aggressive blood pressure control is desperately needed. For women, concern about low HDL-C is highly needed and after menopause aggressive treatment for diabetes, high blood pressure, low HDL-C is needed.
Background
: The number of illegal migrant workers has been increasing in Korea since late 1997 in what was called the IMF era. This study was conducted to evaluate and to recognize the medical utilization and health Status for migrant workers in Korea. The goal of this study was to understand the epidemiological characteristics of the migrant workers and family physician’s role as a health provider and gate keeper to them and to provide basic data for public health policy. Methods : In September 1999, self-administered questionnaires were distributed to the migrant workers in Seoul, Sung-Nam, Pucheon and An-Yang. We classified the reasons for clinical encounters and the prescribed drugs by reviewing the medical records of all patients who visited a clinic of shelter for migrant workers in Sung-Nam from January to December 1998 and analyzed the report according to death certification of the shelter for migrant workers in Sung Nam from 1994 to September 1999 Results : The major distribution of nationality were from China, Mongo, and Bangladesh(86.9%). They were mostly between 30 and 39 years old, males are, and unmarried. Most had high school education. The average income was 756,700 won and the average working hours were 11.5 hours per day in migrant workers being in worse condition than those of Korean workers. Classified according to systems, the respiratory(21.2%), musculoskeletal(20.6%), digestive(15.8%), and cardiovascular(12.5%) symptoms were common. Repayment for death was different between before(87.7%) and after IMF era(13.0%), in late 1997. Average medical expenditure was 43,552 won comprising 5% of the total income of subjects only. Most of them did not benefit from medical insurance. Conclusion : Migrant workers’ situation seemed poor. The patterns of the disease’ were similar to those who visit family medicine clinics in general. Family physicians should take more interest in providing a more effective and better care to migrant workers.
Background
: Women smoker faces increased risk for heart disease, stroke, cancers, and respiratory diseases as well as a number of gender specific risks. Maternal smoking has been linked to harmful effects on their offspring such as increased incidence of premature, stillbirth and sudden infant death syndrome, etc. Recently, the rate of female adolescent smoking in Korea is increasing, and the rate of adult woman has expected to increase. This study is aimed at obtaining basic information about smoking patterns and factors associated with smoking in Korean adult women. Methods : From May 1995 to April 1999, a self-administered questionnaire was distributed to the female visitors of Health Promotion Center in Seoul National university hospital. The number of smokes was 492. The control group(984 nonsmokers) was selected by 1:2 age group matched random sampling. Smokers and control group were divided into three age group-young age(20-39 years), middle age(40-59 years), old age(60 years and over) - and analyzed the results using SPSS and EpiInfo software. Results : The most frequent amount of cigarette smoking was below 10 cigarettes in all age groups. The duration of smoking was below 10 years in most young and middle age groups. In the old age group the duration of smoking was longer than others. Variables positively associated with smoking included alcohol drinking, being engaged in trade service, being unmarried or divorced or separated or parted for ever, high stress status, dissatisfation of life in young age group. The variable of no exercise was added to them in middle age group. In old age group alcohol drinking, no exercise, no school education were the positive meaningful factors associated with smoking in multivariant logistic regression analysis. Conclusion : The modifiable variables associated with smoking in Korean adult women include alcohol drinking, high stress status, dissatisfaction of life and no exercise.
Background
: An inverse relationship between cholesterol level and the degree of depressive symptoms was found in several studies targeted to Westerners. But, other studies failed to replicate this finding giving diverse opinion on this matter. The objective of the study was to investigate the association between the degree of depressive symptoms and lipid level, total calorie intake and fat intake respectively in adults screened in a health promotion center in Korea. Method: The study group consisted of 352 men and women who visited the Health Promotion Center of Seoul National University Hospital from Jane to August in 1998. Their depressive symptoms were measured by Korean version of the Center for Epidemiologic Studies Depression Scale(CES-D). Lipid level was measured by enzymatic methods with fasting blood specimen. Total calorie and fat intake were calculated from a self-reported questionnaire on the types and amount of food. Results : Depressive symptoms were not significantly related to lipid levels, total calorie intake, fat intake, age, exercise, BMI, smoking or alcohol consumption(p<0.05). But sex(p<0.05), marital status(p<0.05). educational level(p<0.05) and average income(p<0.05) were significantly related to depressive symptoms in the whole study group(n=352). Educational level(p<0.05), menopausal status(p<0.05) and LDL cholesterol(P<0.05) were significantly related to depressive symptoms only in women(n=185). However in multivariate models which adjusted for confounding factors these associations were not found(p>0.05). Conclusion : In contrast to the results of previous studies, no significant association between he degree of depressive symptoms and lipid levels, total calorie intake and fat intake respectively were found in Korean adults after adjusting for several factors related to health.
Background
: Recently, many large epidemiological studies revealed that total cholesterol (TC) / high density lipoprotein-cholesterol (HDL-C) ratio is a better predictor of risk for coronary heart disease than total cholesterol, high density lipoprotein-cholesterol, or low density lipopoteim-cholesterol as a single factor. Our study is designed to examine the factors associated with TC/HDL-C ratio in healthy Korean adults. Methods : The study involved 6,584 adults who visited the SNUH Health Promotion Center from March 1997 to February 1998. We examined their demographic data, medical history, smoking habits, alcohol intake and exercise through a questionnaire. Serum lipid levels were checked after 14 hours of fasting. We analyzed the data by covariance and multiple regression analysis. Results : 3,774 healthy adults (men 1,976, women 1,798) were statistically analyzed. The average TC/HDL-C ratio was 4.2±1.2 in men, 3.6±1.0 in women. TC/HDL-C ratio was highest in over age 70(4.4±1.3), and was increased as BMI, the amount of smoking increased, and was decreased as alcohol intake increased in men. In women, TC/HDL-C ratio was increased as BMI increased, and was lower in exercise groups(3.5±1.0) than inactive group(3.7±1.0), but there was no difference according to the smoking amount. Regression analyses revealed a positive correlation between TC/HDL-C ratio and BMI, smoking (P<0.05, respectively), and a negative correlation between TC/HDL-C ratio and alcohol intake(P<0.05) in women, there was a positive correlation between TC/HDL-C ratio and BMI, age(P<0.05, respectively), and a negative correlation between TC/HDL-C rato and exercise amount and alcohol intake(P<0.05, respectively). In both men and women, BMI showed the highest correlation with TC/HDL-C ratio. Conclusion : BMI, smoking, exercise as well as sex and age are related to TC/HDL-C ratio. Thus, primary physicians should consider correction of these factors.
Background
: Korea is an endemic area of viral hepatitis B. In spite of the HBV vaccination program since 1983, the prevalence of HBV antigen had remained high, which was 3.9% in male, 2.7% in female in 1994. But there is no approved management guideline on isolated anti-HBc and the meaning of which is not clear except the evidence of past infection. Therefore, we tried to investigate the factors which influence th seroconversion of anti-HBs during follow-up period. Methods : Medical records of 239 subjects with isolated anti-HBc, who visited a health promotion center from 1995 to 1997 and who were retested at least once during the 1-3 years' follow-up period, were analyzed. Results : The seroconversion rate of anti-HBs was 45.61%(109/239) on the follow-up test. The number of newly vaccinated or non-newly vaccinated subjects during the follow-up period was 156 and 72, respectively. the seroconversion rate of anti-HBs of each group were 57.69(90/156) and 22.22%(16/72) respectively(P<0.01). The subjects without previous history of HBV vaccination was 103. Among them the seroconversion rate of anti-HBs of the newly vaccinated or the non-newly vaccinated group were 59.70%(40/67) and 22.22%(8/36), respectively(P<0.01). Sex, age, BMI, smoking, previous history of HBV vaccination did not influence significantly on th seroconversion rate of anti-HBs among the subjects with isolated anti-HBc. Conclusion : The seroconversion rate in people with isolated anti-HBc was significantly higher in the newly vaccinated than the non-newly vaccinated regardless of the previous history of HBV vaccination in this study. In spite of the nondifferentiation of anamnestic response from primary antibody response, we can expect to benefit from HBV vaccination in those with isolated anti-HBc.
Background
: Since the winter of 1997, Korea has been in an economic crisis. During this period family the most important and basic social unit faced many problems. The purpose of this survey was to assess Korean family's functional status and emphasize family as a social support unit. Methods : During April-May 1998 Nationwide Telephone survey was done. Sampling was done by Multi State Random Sampling technique. We questioned subjects on 5 categories of present family problems and used Modified Faces-III Questionnaire for evaluation of family function. Results : By 5 point scale, the impact of present economic problems to the family showed the highest score(3.7). Other causes had a score range of 1.7-2.1. Economic impact was greater in 4th and 5th life cycle step, those with low income, and those in bereavement. Family type was divided in to 3 groups; extreme type 20%, mid range 50%, and balanced 30%. Among extreme groups chaotic adoption and enmeshed cohesion type were the most common(10.8%). Conclusion : In the korean family 1998, economic problem seems to be the most important impact factor and the proportion of extreme type family is high.
Background
: Alcohol use is a major source of health problem. The social and economic costs related to alcohol use are enormous. Thus, alcohol use is a public health issue. Previous studies on alcohol use were based on hospitalized patients(especially alcoholics) or community subjects, but national survey is lacking. In this study, we describe alcohol use among the Koreans. Methods : Household telephone survey was carried out using multistage stratified random sampling methods from April to May, 1997. Fifteen to sixty-nine year old subjects were randomly selected from household and asked to report type, quantity and frequency of alcoholic beverage consumption. Results : The prevalences of alcohol drinking during the last month were 64.0% for men, 37.8% for women, and 64.7% for those in their twenties, and it decreased with increasing age. In multivariate logistic regression model, men, the unmarried, those in their twenties, administrative and professional personnel were associated with higher prevalence of alcohol drinking. Proportions of nearly daily drinker were 16.5% for men, 2.2% for women, and more than 20% for those in their forties and over and increased with increasing age. Mean alcohol consumption was 56 grams for men, 12 grams for women. Heavy drinkers, defined as average intake of 30 grams or more per day, were found in 23.4% of men and 2.4% of women. The most widely consumed beverages were soju, beer and makuli. In multivariate logistic regression model, men, the unmarried, those in their twenties, and administrative and professional personnel were highly associated with heavy drinking. Conclusion : The prevalences of alcohol drinking during the last month was 49.0%. The proportion of heavy drinker was 11.4%. Men, the unmarried, those in their twenties, and administrative and professional personnel were highly associated with heavy drinking. Therefore, efforts should be made to reduce heavy alcohol drinking among the risk groups.
Background
: Blood pressure is normally lower during night times than in day times. But in some people, this nocturnal blood pressure drop is decreased or absent. In essential hypertensives, absence of nocturnal blood pressure drop(the 'nondipping' pattern) has been associated with increased target organ damage and cardiovascular morbidity. Present study was intended to describe the proportion of 'nondippers' among untreated essential hypertensives in Korea and to investigate the influences of independent clinical factors on the nocturnal fall of blood pressure. Methods : We studied 50 untreated Korean essential hypertensives who underwent 24-hour ambulatory blood pressure monitoring. Subjects with a nocturnal drop in systolic or diastolic blood pressure, or both, 10% were defined as 'dippers', the others as 'nondippers'. Their demographic and clinical characteristics were obtained through medical record and questionnaire. Above characteristics were considered to be independent variables and the dipping status, dependent. Results : Thirty four percent of essential hypertensives were 'nondippers'. Nocturnal blood pressure drop decreased with reporting of family history of hypertension and higher 24-hour ambulatory mean blood pressure. Previous studies insisted on the influence of age on the dipping status, but in our study, age showed no impact on nocturnal blood pressure drop. Conclusion : About one third of untreated subjects with essential hypertension were observed to be nondippers. Family history of hypertension and high 24-hour ambulatory mean blood pressure significantly decreased nocturnal blood pressure drop in our study. According to previous studies, above factors might work through affecting the normally decreased sympathetic activity during sleep time. Longitudinal studies of the influence of nondipping on the long term prognosis of hypertension and large scale studies to establish the factors influencing nocturnal blood pressure drop and their mechanisms are further needed.
Background
: Hormone replacement therapy(HRT) has an established role in reducing cardiovascular risk and in preventing osteoporosis. But compliance with HRT is not good as expected. Therefore, so we assessed perimenopausal women's knowledge and attitude towards menopause and HRT too. Methods : Questionnaires were provided to the students' mothers of a high school located in Seoul from June 10th to 15th, 1996. General characteristics and routine breast examination, routine Pap smear, the knowledge and practice of high calcuim diet for preventing osteoporosis, their menstrual pattern, the information source of HRT, in attitude for HRT, and the reasons for refusing. Results : Among 560 women, 362 women(64.6%) responsed, and the mean age was 45.5 years. For osteoporosis prevention, they knew milk(74.7%) were, anchovy(27.4%), calcium(23.6%). HRT(7.4%) were beneficial. And almost(91.8%) all subjects answered that menopause was a natural course and 40.5% of women answered that physical change after menopause could not prevent. Among 34 postmenopause, 5(14.2%) received HRT and 48(20.3%) answered that they would receive HRT, and 57(24.1%) answered that they would not receive HRT. The reasons for refusing HRT were that menopause was a natural course, therefore devoiding the need for artificial hormone therapy(22.4%), increased incidence of breast cancer(21.8%), and that lack of information for HRT(13.9%). The association was not proven between the attitude for HRT and regular Pap smear, regular breast examination, exercise, oral intake for osteoporosis prevention. Conclusion : Almost all of the respondents recognized that menopause was a natural course. And the effectiveness of diet and exercise in preventing osteoporosis was more well known compared to HRT.
Background
: Ministry of Health and Welfare offered 'Home Doctor Registration Program' to reinforce primary care and to increase the efficiency of national health delivery system. But, it failed because it was not supported by doctors and nations. We designed this study to develope and evaluate a practical version of 'Home Doctor Registration Program'. Methods : We invited primary care doctors who were concerned with 'Home Doctor Registration Program' via PC-communication and developed a practical version of this program. After 6 months of this program, surveys on participated doctors and patients were done. Results : 8 primary care doctors and 285 patients have participated in this study. All the 8 doctors have offered the 4 obligatory services and 3 doctors have offered telephone counselling and no doctor has offered visiting examination. After 6 months of this program, CCPQ score was increased significantly and all the health risk factors of participated patients were decreased. Doctors have thought that Family Chart Service, Health Risk Appraisal, Vaccination and Screening Test are more necessary in this program. But, patients have thought that Telephone Counselling and Visiting Examination are more important in this program. Conclusion : Almost of participated doctors and patients have been satisfied with this practical version of 'Home Doctor Registration Program'. But, subjective feeling about which service was more necessary in this program was different between doctors and patients.
Background
: The BEPSI(Brief Encounter Psychosocial Instrument) was developed as an instrument for quick assessment of stress in a busy office setting, and well correlated with other stress scales. Bae et al. developed the BEPSI(Korean version)[BEPSI-K] in Korea, which was used broadly in health examination. In this study, we attempted to assess degree of stress and to find stress-related factors amon Koreans by the BEPSI-K. Methods : A household telephone survey of 1,060 responders was carried out using multistage stratifed random sampling technique from April to May, 1997. The data were collected from 947 subjects who answered all the items of the BEPSI-K. Results : The reliability of the BEPSI-K was demonstrated (Cronbach's alpha 0.71). The BEPSI-K sore showed left-shifted distribution, and its mean was 1.72. It also was significantly high in the unmarried, those with a low educational level, those with a low income, non-economic group, hypertensie patients, smokers, non-exercisers and drinker. Among 947 subjects, 7.7 percent was high stress according to tercile of the original BEPSI score. Conclusion : Stress-related factors were marital status, educational level, income level, occupation, exercise, smoking, drinking, and hypertension in Korea.
Background
: Hypothyroidism may be involved in a significant portion of the causes of hypercholesterolemia in Korea. In this study, we determined the frequency of suspected hypothyroidism in hypercholesterolemic patients and compared the frequency of elevated thyrotropin levels among the groups with various total cholesterol levels. Methods : The study subjects were healthy, asymptomatic people who visited Health Promotion Center of Seoul National University Hospital. We excluded subjects with history of hypertension, DM and hypothyroidism. The study subjects underwent physical examination and filled out a questionnaire on health risk factors. Also blood chemistry and thyroid function test were done. Results : Among 6479 subjects, 194(2.99%) had elevated(>4.1μIU/ml) thyrotropin levels. Among the hypercholesterolemic(≥240mg/dl) patients(n=868), 40(4.60%) had elevated thyrotropin levels. And there was statistically significant difference between normal cholesterolemic and hypercholesterolemic subjects(P<0.05). Among the patients with total cholesterol above 280mg/dl (n=180), 15(8.33%) had elevated thyrotropin levels. As amount of the total cholesterol increased, the frequency of elevated thyrotropin levels increased(P=0.001). And this result was consistent following adjustment for age, sex, BMI, smoking and drinking status(P<0.01). Conclusion : Practicing physicians should be aware of the possibility of secondary hypercholesterolemia due to hypothyroidism and keep in mind the importance of evaluating TSH level.
Background
: In order to improve the quality of life of dying patients so that they may die with dignity, they need to receive not only the physical, psychological, social, and spiritual care, but also systematic and continuous care. However, there is no adequate medical service at present. We studied terminal cancer patients' behavior patterns of health care utilization, the problems of caring for the patient, and medical services that bereaved families suggested for terminal cancer patients and their families. Methods : From 271 patients' families who participated in our hospice program from March 1991 to February 1996, 108 bereaved families whom we could have contacted were interviewed by three student nurses with a structured questionnaire. Results : The terminal cancer patients received their medical care through admission to hospital(45.4%), outpatient clinic(22.2%), emergency room(16.7%), and oriental medicine(12.0%). But during their terminal phase of the illness, 32.4% of patients never received medical care including oriental medicine, and 28.7% received alternative medicine care such as intake of mushroom and elm tree. 26 bereaved families(24.1%) pointed out the indifference of the medical team as a problem receiving proper hospital care, and 22 bereaved families(20.4%) emphasized emotional strain of their helplessness with the patient's suffering as a problem of caring for the patient at home. Over 90% of bereaved families from their experience suggested needs of continuous care, hospice care, home care, and 24hr telephone service. Conclusion : There were inappropriate behavior patterns of health care utilization which resulted in large proportion of terminal cancer patients received alternative medicine never receiving proper medical care. Therefore, there is a need to develop the continuous and comprehensive care for terminal cancer patients and their family, such as hospice.
Background
: Korea is known to be endemic area of viral hepatitis B, and 5-6% of population are carriers. Immunization can reduce the spread of hepatitis B infection. Ho-wer, not all people respond to hepatitis B immunsation. 5-15% of primary vacciness fail to be immunized. After revaccination, only 37.5%-44% of the primary failures elicit antibody response. Recent studies have reported that it is effective to inject a double dose vaccina-tion in immunocompromsed patients. In some country, they recommend that neonate whode mother is HBV carrier shoud receive double dose vaccination. This study documented the results of double dose vaccintion only once to nonrsponders toward the HBV immunzation. Methods : Healthy nonresponders to Hepatitis B immunization were recuited from Sep. 1995 to Aug. 1996. Subjects with their AST/ALT level over 40, or over 65 years old were excluded. They were received 2ml of plasma-derived vaccine(Hepavax-B) intramuscularly in the deltoid muscle. Anti-HBs antibody testing were performend at 1 to 3 months after vaccintion. Results : 17 healthy nonreponders to Hepatitis B immunization(male 10, female 7) were included. Their mean ages were 47(32 to64). AST/ALT level 20/19(16 to 28/11 to 35), smoking 4.3pys(1 to 7). Seroconversion occured in 13 of them(76.5%). Conlusions: Nonresponders to Hepatitis B vaccintion respond well to double dose vacci-nation once.
Background
: A survey is the only direct way of determining the distribution of behav-ioral risk factors among a population. The department of Family Medicine in Seoul national university hospital adopted telephone interviewing for collecting information about behavior-al risk factors of Koreans. Because methodological aspect of telephone survey is different according to the telephone and communication environment of the area in which the sur-vey would be held, we tried to figure out adequate methodological aspects of a telephone survey on the behavioral risk factor in Korea. Methods : We sampled telephone numbers from the telephone number database which is supported by Infornet Ltd. with stratified cluster random sampling method and selected re-spondent by using algorithm of Kish. 13 part-time job interviewers were trained for 6 hours and then interviews were made in a fixed area for the time assigned. Results : 13 interviewers tried to do 1,826 interviews for 4 weeks. Sociodemographic characteristics of respondents were compared with the census estimates and another face-to-face interview and there were no significant differences. A response rate of 79.8%, re-fusal rate of 12.9% and interview efficiency of 58.1% were obtained, yielding 1060 comple-ted interview. A total of 28,830 person minutes of interview time were spent on the survey with an average of 27.2 minutes per completed interview. Conclusion : Sampling method using the telephone number database could be used keeping the representativeness of the samples and telephone survey was considered to be reliable and affordable method for determining the prevalence of behavioral risk factors in Korea.
Background
: The patients visiting the primary care complain of the various symptoms. This symptoms may induce the stress or the recerse. In fact the stres can influence the symptoms and signs. So this study was done for the correlation of the symptoms and signs with stress. Methods : This study was done about the patients visiting the family medicine department of the one university hospital. We collected the all items that can find in the charts for examining the symptoms and signs, and did the requests parter the patients wrote by themselves. The stress test was Psychosocial well being index to be constructed from the General Health Questionnaire. We tested the study by t-test, anova, chi-square, linear logistic regression. Results : The total study numbers were 351. The stress cut-off point was 63 score. The stress group was consisted of 15 males and 43 females. The meaningful symptoms were headache, diz-ziness, fatigue, weakness, insomnia, anxiety or depression. The meaningful diagnoses were anx-iety or depression, tension headache(p<0.05). The meaningful sociodemographic factors were female, housewife or unemployed, menopause, monthly income below 200 ten thousands won. Conclusion : It was found that the some symptoms and signs were statistically correlated with stress.
Background
: Diet and weight concerns are commonplace and almost accepted features of life for girls during adolescence. Until recently, younger age groups have largely been ignored, as these concerns were thought to be a product of pubertal development and sexual maturity. Girls under the age of fifteen therefore, have been assumed to be free of the pressures experienced by adult women. However, this belief is now hard to sustain. The object of the present study was to investigate the self-perception and body shape satisfaction in different weight categories of boys and girls aged 12-years old in Korea. Methods : In May, 1995, one hundred and sixty seven boys and one hundred and twenty girls from two schools in Seoul completed assessments of body-esteem, self-esteem, body shape preference. The children's body weight and height were also measured. Results : The heaviest children expressed the most discontent, having a low body-esteem, a desire for thinness. By the age of 12, girls boys already differ in their body shape satisfaction and differ in their body shape satisfaction and differ in their body shape aspirations. There was a significant effect of weight category on the children's body esteem(boys(P=.005), girls(P=.0001). Children in both extreme categories, under-and over-weight, had lower body-es-teem scores than those in other weight categories. However, it was the overweight children who had the lowest reported body-esteem. Body esteem was highest among girls in the 'slightly underweight' category and highest among boys on the 'average weight' category. There was no effects of either weight category or gender on the children's appraisal of self-esteem. A comparison of the points chosen on the silhouestte scales to reflect current and preferred body shapes revealed clear gender differences. Of the girls, 63% placed their preferred body shape at a point thinner than their currently perceived shape, while only 15% chose a broader figure. In contrast, 41% of the boys rated their preferred figure as broader than their current perception, and 37% as thinner than their current perception. Conclusion : This study has noted a relationship between body weight and self-perception in 12-year old children. The heaviest children expressed low body-esteem, a desire for thinness. This pattern was more characteristic of girls than boys. Even at this age, well before they have completed physical maturation, girls are aspiring to a body shape which is thinner than their average. This discontent experienced by the heaviest. children on this sample was apparent in their lower body-esteem and the distance between their current and preferred body shapes. The girls' preference was for thinness, while in the boys it was for a body shape which was broader than their current shape. From their responses, it would appear that the boys' desire was not for fatness, but for a more athletic and muscular build.
Background
: Recently in Europe, some epidemiologic studies reported that various physical symptoms and social, psychological wellbeing are related to low blood pressure. But in Korea, none has been studied on symptoms related to low blood pressure yet. In this study, we would like to see if the somatic symptoms and social, psychological wellbeing shown to be related to low SBP is truly associated with it. Methods : Questionnaire interview was done to the people who have visited Department of family practice in two university hospitals and two health promotion center from April, 1996 to August, 1996. Seven somatic symptoms and Psychosocial Wellbeing Index(PWI) for the evaluation of social, psychological health status were included in the questionnaire. SAS statistics packages was used in statistical precess. We used logistic regression to see the frequency of somatic symptoms related to the systolic blood pressure(SBP) group and the confirmation of confounding variables was done by ANOVA. Results : Total of 304 completed the questionnaire. Average age was 44 years old and average SBP was 115.4±16.4. 84of them(27.6%)felt that they had a low BP & 69 were women compared to 21 men, being meaningfully more common. 107(35.2%) people answered that they had heard that their blood pressure was low and 66% were from doctors. Only 32(38.1%) of the group who felt of having hypotensive symptoms and 38 of the group who heard of having hypotension actually had SBP of below 100mmHg. Vocation, income, smoking & alcohol history, present illness, marital status were not significant as a confounding variable. SBP of 100 or below group had a less presentation of fatigue & significantly higher PWI than the group of above 100mmHg(p<0.05). The group who felt that they had a low BP had more complaints fatigue, dizziness, palpitation, cold hands and feet and had significantly higher PWI than the group who didn't. Conclusion : SBP of 100mmHg or below group has more frequent manifestion of fatigue and low level of sociopsycholgiacl health index than the above 100mmHg group. But most of the people who complained of hypotensive symptoms didn't have low blood pressure and a lot of them misunderstand of having low blood pressure and after checking blood pressure by doctors, so great deal of caution is called for when seeing patients.
Research Background : It is well-known that there are significant differences in clinic blood pres-sure (CBP) and ambulatory blood pressure (ABP) among many hypertensive patients. These differen-ces are called the "white-coat effect"(WCE). There have been studies to find a method of predicting the WCE and to investigate a correlation between the WCE and anxiety of paients. However, anxiety scales adopted in the former studies were fount to be inadequate to measure the anxiety which patients experience in clinics. In this study we developed a new scale, called the "white-coat anxiety scale"(WCAS), which can effectively measure the anxiety of hypertensive partients in clinics and help to find a method of predicting white-coat hypertension in the future.
Methouds: The WCAS was developed on the basis of te test anxiety scale and the manifest anxiety scale, whose validity and reliability have been proved. First, a test questionnaire was made with professional advices of a psychiatrist, a preventive medicine staff, and a professor of education. Patient anxiety symptoms were classified into three categories : autonomic hyperactivity, motor ten-sion, and cognitive symptom. Twelve questions were made in each category to make the test question-naire of 36 questions. Second, after a pre-test, a final questionnaire was made by rejecting two ques-tion, whose internal consistencies were found to be poor, in each category. The final questionnaire of 30 questions was checked with the test-retest correlation method. Third, a survey was actually done on hypertensive patients whose 24 hours ABP's were monitered either in department of family medicine, a university hospital of in a general hospital. Finally, based on the survey, the correlation between the WCE and WCAS was evaluated. The WCE was determined by subtracting the CBP value with the aerage value of 24 hours ABP. Results : The study subjects were composed of 15 patients in departiment of family medicine, a university hospital and 25 patients in a general hospital. They consisted of 23 male and 17 female patients, and their average age was 50.6 years. The internal consistency of the WCAS was estimated to be 0.87, and the correlation of the test-retest results was found to be 0.90. The correlation coefficients between the WCAS and the WCE were 0.48 for the daytime systoli lood pressure(SBP), 0.33 for the night-time DBP, and 0.45 for the mean DBP. These values show that the difference of the CBP from daytime blood pressure has a strong correlation with the WCAS. The correlation between the WCE and the WCAS was found to be similar for the SBP and the DBP. Among the patient anxiety symptoms, the cognitive symptom is not correlated wit the WCAS. Conclusion : The newly developed WCAS has a high reliability and shows a strong correlation with the WCE. In order to introduce the new scale to a clinical use, more studies are required to find a cutoff value of the WCAS and to check the possibilities of predicting white coat hypertension with the WCAS.
Background
: It has been estimated that up to 80% of all illness in a physician's office is due to psychosocial stress. The BEPSI was developed as instrument of stress measurement in a busy practice and was well correlated with other stress scales. In Korea, Bae JM et al developed Korean-translated BEPSI, which was used broadiy in health examination. In this study, authors, attempted to measure reliabilty, validity and cut-off point of Modified-Korean BEPSI which was modified in two items Methd: Data were collected from 201 subject over 20 years old who first visited outpatient clinic of Department of Family Medicine, Seoul National University Hospital.The validity was measu-red with correlation with Lee's 98 items which have proven valdity. Resuls: The study subjects was 56% female and 44% male, 93% married, 53% with high school education or less, 62% employed. Test-retest reliability and Cronbachs alpha of the Modified BEPSI was 0.68, 0.80 respectively. The correlation coefficient of the Modified BEPSI was 0.23(P<0.01). The Modified BEPSI showed normal distribution and cut-off point according to quartile and 1 standard deviation was 2.2, 2.4 respectively. Conclustions: The Modified BEPSI correlates with Lee's 98 items and has no difference with previous study(Bae JM et al, 1992) and can be substituted for previous BEPSI version.
Cronbacch's alpha was 0.6438 and with a score over 0.6, the coping score is found to have reliability. Correlation was found between the total score and individual items' scores.(P<0.0001) The R coefficiency between the coping score and the interview score was determined to be 0.5697 also showing correlation.(P<0.0001) The R coefficiency between the coping score and the interview score was determined to be 0.5697 also showing correlation.(P<0.0001) The R coefficiency between the coping score and APGAR score was 0.6410 again showing correlation (P<0.0001) and demonstrating the validity of the coping score.
Background
: Hypercholesterolemia is the one of the major risk factors of coronary heart disease, and is increasing due to the change of diet habits in Korea. In the United States of America, National Cholesterol Education Program (NCEP) recommends total serum cholesterol, if possible with HDL-cholesterol, as screening test, and dietary therapy and physical activity as treatment before starting lipid lowering drug therapy. In our study we assessed the effects of brief diet education by doctors on blood total cholesterol. Methods : We conducted a case-control study for the patients who's serum total cholesterol level were 200-300mg/dL, during routine health examination at an university hospital between April to July 1994. They were divided into two groups by inclusion orders. We educated case groups for dietary therapy, and simply noticed high blood cholesterol levels for control groups. After 1 month We re-checked total serum cholesterol levels. Three residents of family medicine were dedicated to the patient education using the patient education materials which were produced by the department of family medicine of an university hospital. Results : 85 patients, 42 case group and 43 control group, were followed for 1 month There was no difference between two groups for age, sex, BMI, education, smoking and alcohol habits. Baseline cholesterol levels of control and case groups were 231.1±18.5mg/dL and 239.9±24.3mg/dL for case group. The dicreases were 7.4±23.0mg/dL (P<0.05), 29.6±20.1mg/dL (P<0.0001) Seperately which were stastitically significant. but, there was significant difference between two groups by ANCOVA test. (P=0.0001) Conclusion : In our study brief diet education by doctors was more effective in blood cholesterol reduction than simple notice of high blood cholesterol level.
Background
: Department of Family Medicine in Seoul national university hospital has started lifelong health maintenance program(LHMP) since Feb 1991, and developed Health Risk Appraisal to evaulate personal health risk factors. This study aimed to evaluate the effect of LHMP by changes in health rik factors. Methods : From May to September 1994, those who have been participated in LHMP more than 1 year were enrolled. We made subject answer to Health Risk Appraisal questionnaire when they had registered the LHMP and now, then cmpared with each other. We analysed categorical data for significance using the chi-squre test and analysed quantitative data for significance using t-test. Results : 169 subjects were included. The overall population had mean age of 50.7±11.6 years and female were 59.2%. Significant change were detected in DM, BP, hepatitis B vaccination, sleep duration and pap smear. 30.6%(26/86) of the unvaccinated were vaccinated, 66.7%(10/15) of the pap-unchecked were ckecked. 75.0%(3/4) of poorly-controlled diabetes were changed to well-controlled. 27.5%(8/29) of smoker quitted smoking, 23.8%(24/102) of non exercisers started regular exercise. 94.1%(16/17) of heavy drinker decreased their drinking amount, 50.0%(5/10) of unmedicated hy[ertensive patients started medication, 54.5%(18/33) of seat belt non-user used seat belt. Recognition rate increased in DM by 78.8%(41/52), in blood pressure by 88.5%(23/26), in hepatitis B antibody by 40.0%(37/84). Conclusion : Lifelong health maintenance program decreased health risk factor significantly in doctor-leading parts(ex : DM, HT, hepatitis Vaccination, pap smera) but didn't decreased risk factors in patient-leading parts(ex : smoking, exercise, seatbelt).
Background
: Hysterectomy and hysterectomy with oophorectomy are the one of the most common surgical operations, and the cases of this surgical operations have been increasing now. Moreover, the concern about hormone replacement therapy to postmenopausal women is growing now, therefore the importance of accurate information about oophorectomy state is more emphasized than before. We can get information about oophorectomy state through patient medical record and self-report, but in Korea the only available source of information in reality is patient self-report on primary care setting, regrettably. Many physicians in Korea are skeptical to self-report of patient. Therefore this study is designed to know accuracy of patient's recall about bilateral oophorectomy in whom received hystrectomy and bilateral oophorectomy through medical record review and telephone interview. And we analyze factors with the accuracy of patient's recall. Methods : The subject of this study is the patients who is accessible through telephone interview and medical record review of those who was received hysterecomy with bilateral oophorectomy in a third grade hospital. Their surgical operations were done from Jan. 1990 to Aug. 1993. The patient proven to have malignancy was excluded. The inforamation about accuracy of their self-report and associated factor was achieved through medical record review and telephone interview. Results : The number of accessible subject is 117. Of 117 woemn, 112(95.7%) know their hysterectomy state accurately. But the number of persons who know their own bilateral oophorectomy state accurately is 74(63.3%), and the persons who don't know their bilateral oophorectomy state accurately is 43(36.8%). Of whom who don't know accurately their bilateral oophorectomy state, 28(23.9%) women answer that they didn't know whether bilateral oophorectomy had been done or not, 15(12.8%) women denied their bilateral oophorectomy state. Women who know accurately their bilateral oophrectomy state in comparison with who don't know their bilateral oophorectomy state are younger in average age, higher in education level, and have more opportunities of listening doctor's explanation of their post organ extraction state, and have received hormone replacement therapy more. And this differences of two groups are statistically significant. The differences between two groups on monthly salary, having occupation or not, living in city or not, marital state, period after operation, pre-operative diagnosis, and whether she knows post operative diagnosis or not, are not significant statistically. The major determinants in the accurate knowledge of their own bilateral oophorectomy state are whether patients listened Doctor's personal explanation of their state or not, and whether she received hormone replacement therapy ever or not. Conclusion : The proportion of whom know accurately their own bilateral oophorectomy state is 63.3%. That proportion is considerably low which leads to conclude that it is not advisable to make a clinical decision based on patient self-report state only in this sugical operation cases. And because the most important determinants of the accuracy knowledge of their own bilateral oophorectomy state is whether patients listened medical doctor's personal explanation of their state, therefore the importance of this aspect of doctor's education must be emphasized to medical doctors.
Background
: In recent years, the interest of people in health promotion and disease prevention is increased by virtue of economic growth. And the effort of promoting health, preventing and treating disease through food is added up too. In order to investigate the recognition about food which affects health and disease, we carried out this study. Methods : We selected randomly the patients (group 1) who visited family medicine clinic of SNUH during period from August to September 1993 and one high school students family members(group 2) who are above 20 years old, for 4 paged questionnaire. Results : Group 1 consists of 292 persons(male 36.0%, chronic patients 50%) and group 2 consists of 172 persons(male 35.5%, chronic patients 16.5%). Both groups answer that the food is the most important factor that affects health and disease. And they think that the best food for health is vegetable and the worst food is irritative one. They answer that the recommendation from the doctor is the most important factor that affects the diet therapy in chronic patients. Conclusion : People regard food as the most important tool to promote health. The response on the importance of the food as the way of preventing and treating disease in positive in general. And it is proved that doctors play the most significant role of the diet therapy education for the chronic patients.
Background
: It is well known that breast-feeding is the best for infant feeding until 6 months. Breast-feeding tends to increase in 1970's, when breast-feeding was regarded as ideal method, but tends to decrease in 1980's worldwide. In Korea, breast-feeding tends to decrease since 1970. According to the past study about breast-feeding, the fact is that mothers don't know about the merit of breast-feeding that they have denied and education for continued breast-feeding, and that medical personnel don't always give great emphasis on breast-feeding. So this study is done to know whether Dr's recommendation and education on breast-feeding may influence on choice of feeding method. Methods : The study subject was pregnant women who visited one OB & GYN clinic and bedelivered vaginally. Doctor recommend breast-feeding to them and offered education material about the merit and main point of breast-feeding. After 1 month of delivery, we examined feeding method by telephone immediately after delivery and 1 month later. Results : Experimental group was 72 and control group was 71. Breast-feeding rate immediately after delivery was 56.3% in control, and 59.7% in experimental group, but there is no statistically significant difference. Breast feeding rate after 1 month was 38.0% in control, 41.7% in experimental group, and there is no statistically significant difference, too. The variable which influences choice of feeding method is feeding pattern determined before the delivery, those who determined to breast-feed before the delivery tend to feed breast milk(P<0.05). The variables which influence feeding method at 1 month are feeding method immediately after delivery and recommendation of close associates. Immediate breast feeders tend to breast feed continually until 1 month, and have been received less recommendation from close associats. Reasons of breast-feeding failure are insufficient amount of breast milk, refusal of babies, jaundice, and retracted nipple. Conclusion : Dr's simple recommendation is not helpful for the choice of breast feeding. The variables which influences on feeding is feeding method before the delivery, which influences 1 month later.
Background
: Recently many otolaryngologists use OMU CT(Ostiomeatal unit CT) scan to diagnose chronic sinusitis because PNS plain radiograph has many limitations to perform detailed anatomic examination about ostiomeatal unit. But many primary physicians have depended on plain radiograph to diagnose chronic sinusitis due to high medical cost and accessibility problem. In this study, I compared plain radiograph with OMU CT to know how accurately plain radiograph diagnose and localize the residual sinus diseases. Methods : I performed a prospective study of 71 patients who were clinically suspected to have a chronic sinusitis. all patients in this study had conventional sinus radioraph and OMU CT. Two examinations were performed on the same day. Before undertaken two examinations, all patients completed a qestionnaire which was accociated with symptoms of chronic sinusitis. The plain radiograph was interpreted by two radiologists and OMU CT were interpreted independently of the plain radiograph. Results : Of the 71 patients studied, 40 were men and 31 women. Their ages ranged from 15 to 67 years. There is no significant symptom difference between normal and abnormal OMU CT group. With respect to the location of sinusitis, maxillary sinus was most common site and then ethmoid, sphenoid, frontal sinus in sequence. Validity of plain radiograph is as follows : sensitivity 75.5%, specificity 61.1%, positive predictive value 85.1% and negative predictive value 45.8%. Validity of plain radiograph by each sinus shows some difference acording to the sinus (Table 6). Sensitivity is relatively high in maxillary sinus(About 79% and 68% in right and left) but others low(Below 50%). Specificity is almost over 90% except maxillary sinus. Conclusion : Chronic sinusitis often underdiagnosed or overdiagnosed on the finings of plain radiograph. But considering health care cost and acessibility PNS plain radiograph is still useful diagnositc modality in primary care.
Background
: Nowadays, since Aquired immunodeficiency syndrome(AIDS) prevailing all of the world has no exact cure yet, the only countermeasure is to guide the masses' steps in the path of awareness through publicity & education. In the first stage, only the high risk group and countries hea the opportunity of infection. But, at the present the way of infection has changed to 'within the general publics' and multiplied among Koreans. Since, it has become important to educate the low risk groups(general publics). We research the general public's knowledge of AIDS. Methods : A questionnaire was given to two groups; one was composed of the people who visited a hospital for periodic health examinations during one month(April 1993). The other group was composed of people who worked in a government office. Results : A total of 289 people answered the questionnaire. The rate of response was 90.1%. And the percentage of males was 53.3%, Concerning the question of the latent period, 49.5% had a correct understanding of the fact that AIDS development took more than several years after HIV infection. 52.2% of the subjects of investigation didn't want to visit hospital even though they felt they might have the infection. Among them, 83% said that the reason was the contempt and isolation from society, when they are regarded as AIDS patient. Once guaranted of security, most of them(78.9%) wanted a consultant, especially by phone(36%). Concerning the risk routes of infection, most of them(from 83.1% to 99.0% each items) looked at in the right light. However, concerning the possibility of the infection in daily life, they have some misconception, c.g. mosquitoes(88%), donation of blood(48%0, swimming(36.1%) etc. Only 56% know that condoms can protect from AIDS. Conclusion : Nearly half of the respondents would not visit a hopital, even though they have recognized their infection with AIDS. Almost all of them duly recognized the importance of sex and blood in AIDS transmission. But, many of them considered AIDS as an acute disease and had misconceptions that it was carried by the donation of blood, mosquitoes. We also find that half of the subjects of investigation didn't acknowledge that condoms could prevent AIDS.
Background
: In 1979, when Family Practice Residency Training Program began, family practice was presented as a solution to a serious national health care problem of maldistribution among physicians, under-emphasis of primary care, and preference of specialists. In 1992, after fourteen years, the current number of graduates of family practice residency training programs is up to 402. At this point, an assessment of whether family practice has indeed had such an effect on the health care system is appropriate. This study was done to assess the satisfaction level of family practice residency program graduates about their present practice, to survey their geographic distribution, and to identify possible factors associated with their current status. Methods : From July to September of 1992, a questionnaire was sent to 352 graduates of family practice residency programs whose addresses were known among total of 402 graduates. Response rate was 39.8%. The questionnaire contained items concerning type and location of present practice. Possible factors associated with this status was also asked: place of birth, education history, residency training hospital, religion, medical occupation prior to residency training reasons for selecting current practice, and reasons for choosing family practice. Result: Greater proportion of the respondents are practicing in smaller communities compared to the geographical distribution of physicians in Korea. Rate of "satisfied" or "very satisfied" responses to the profession of medical doctor was 82.4%, to family life 71.6%, and to being a family practice specialist 68.4%. However, only 46.0% of the respondents responded "satisfied" or "very satisfied" with their social life, 45.6% with type of practice, and 35.6% with income. 71.4% of the respondents who trained in non-university hospital setting, 65.5% of respondents with history of medical occupation prior to residency training, and 73.9% of respondents who were married before residency training are in private clinic practice. 60.3% of respondents practice near their residency training program; 59.5% practice near their medical school. The majority of respondents are in practice settings which they desired at the beginning of their residency training. Reasons for selecting their current practice setting were varied. "Comprehensive care", "well suited to primary care", preference for humanistic principles of family medicine, and being useful for missionary or service work were frequently mentioned as reasons for selecting family practice. Other mentioned reasons included the short duration of training and the newness of family practice as a medical specialty. The great majority of graduates(95.0%) practice as family physicians. 48.6% of the respondents work in private clinic setting, 32.9% in hospitals, and 2.1% in other medical specialty fields. 39.3% of the respondents are located in Seoul, 13.6% in large cities, 23.6% in small cities, and 14.3% in rural areas. Conclusion : Respondents are generally satisfied with their professional and family life, and larger percentage of them are practicing in smaller cities compared with the distribution of physicians in Korea. Location of residency training program and medical school, history of medical occupation prior to residency training, type of practice desired at the beginning of residency training, and time of marriage are related to the type or location of current practice.
Background
: The proportions of Korean smokers and long-term smokers(10years) are very high and the smoking related diseases such as lung cancer and ischemic heart disease are increasing. But physicians had played limited role in reducing smoking in the nation. One reason is that they don't have an effective anti-smoking method to use in their daily practics. Nicotine patch reduces withdrawal symptoms which are major barriers in somking cessation. Reports showed the nicotine patch helps 10~35% more smokers quit smoking than the placebo. The objectives of this study are to develpo physician's anti-smoking service using nicotine patch, to find out its effectiveness and side effects, and to measure compliance with patches and proper duration of patch use. Methods : As a double blinded randomized controlled study, it was conducted in 4 hospitals in Seoul. The study subjects were men of 20 years or older, smoking more than 15 cigarrets a day for the last three years and had intention to quit smoking. The physician's anti-smoking service consisted of distributing a simple brochure on smoking cessation and a guidance note for using nicotine patch and about side effects, urging smoking cessation, and providing nicotine or placebo patches. The subjects were suggested to use patches for 6 weeks and to visit the clinic every 2 weeks. Those who failed to visit were contacted by phone and asked about smoking status and use of patches. Results : One hundred and twenty-one subjects (80 in nicotine, 41 in placebo group) participated in the study and 17 persons (13 in nicotine, 4 in placebo group) were dropped out among them. The anti-smoking service developed for this study was used by 14 family doctors and reported to use the service in 3 minutes during their usual pracitce. Nicotine group showed significantly higher smoking cessation rate than placebo throughout 6 weeks. At the 6th week, 41.8% of nicotine group and 19.4% of placebo group stopped smoking(p=0.02). Nicotine group showed average weight gain of 0.9kg through 6 weeks whereas placebo gorup showed that of 1.1kg, side effects were very common. Seventy-seven percent in nicotine group and 68% in placebo group experienced at least one side effect. Itching and rash were most common as local reactions and nausea, headache, urticaria, insomnia and change of taste were reported as systemic reactions. Nicotine group used only 21.1 pactches out of 42 pactches supposed to use throughout 6 weeks and placebo group used 19.3 patches. The patch compliance decreased every week. Conclusion : The physician's anuti-smoking service using nicotine patch was significantly more effective in smoking cessation than placebo. side effects were common, but the subjects rarely stopped using patches because of those. Even though patches were supposed to use for 6 weeks, the patch complinance was moderate.
Background
: in order to provide basic data which are necessary for the standard reference of residency training program in family medicine(F.M.), we surveyed all of 47 training hospital's current residency traing program in Korea. Methods : There are 38 training hospitals which fulfilled the inclusion criteria among the 47 residency training hospitals registered to the Korean academic society of family practice as of March 1, 1992. Survey included general characteristics, number of staff, ratio of staff to residents, facilities in F.M. center, out-patient care by resident and preceptorship, academic activities, and curriculi. We classified and compaired them by history of hospital(less than 2 years vs, more than 3 years) and character(non-university vs. university hospital) of residency training hospita. Results : Among 38 training hospitals, there were 13(34.2%) hospitals with less than 2 years of history, 25(65.8%) hospitals with more than 3 years of histroy. There were 23(60.5%) non-university hospitals, and 15(39.5%) university hospitals. Total number of staff was 56. There were 24(63.2%) hospitals which had only 1 staff member, 11(28.9%) were 2, 2(5.3%) were 3, and 1(2.6%) hospital which were 4. Total number of residents were 378. The number of hospitals whose ratio of staff to residents exceeded 1:6 was 14(36.8%). The percentage of Facilities which had Examining Room Resident Room, Care Room, Conference Room, Conunselling Room Clinical Lab, Record Room and Admission Room in the F.M. center were 97.4%, 84.2%, 57.9%, 57.9%, 26.3%, 23.7%, 18.4% and 55.3% each others. 28(73.7%) of teaching hospitals had outpatient care by residents and 14(36.8%) had preceptorship available. In a 3 year period, hospitals which had at least 150 inhouse conferences and 3 conferences outside the hospital were 26(68.4%). Average months of 3 year curriculum were as follows : Internal Medicaine 6.9, Pediatrics 3.7, General Surgery 3.2, Obstetrics and Gynecology 3.1, Emergency Room 0.8, Family Medicine 5.9 and Essential electives 8.7, Free electives 1.1. Conclusion : Generally, there were some problems in the family medicine residency programs. most important is the lack of staff members and the lack of outpatient care by residents, especially in non-university hospitals which had les than 2 years history.
Background
: Recently, disease pattern in Korea is changing with the change of lifestyle, which results in increased mortality rates by atherosclerosis. Hyperlipidemia is the most important risk factor for atherosclerosis. Early detection and lowering of cholesterol level reduces mortality rates from atherosclerosis. Serum total cholesterol is a choice screening test for hyperlipidemia. Our study was done to find the correlations between serum total cholesterol level and other factors expected to have influence on the serum total cholesterol level. Factors such as drinking, smoking, physical activity, diet, blood pressure, and fasting blood sugar level were chosen. Methods : We measured height, weight, blood pressure, fasting blood sugar and fasting serum total cholesterol level of 445 men who received Employee Periodic Health Examination. Data for drinking, smoking, physical activity, and diet were collected through interview by three residents of family medicine. Results : Correlation coefficients with serum total cholesterol level was 0.213 for age, 0.266 for Body Mass Index, 0.196 for systolic blood pressure, 0.144 for diastolic blood pressure, 0.233 for fasting blood sugar.(P<0.05) Drinking, smoking, diet had low correlation with serum total cholesterol. Serum total cholesterol level was not affected by the level of exercise.(P>0.05) Conclusion : Age, blood pressure, Body Mass Index, blood sugar level had weak correlation with cholesterol but drinking, smoking, diet, physical activity had no relationship with serum total cholesterol.
Background
: There is probably overwhelming consensus that addictive disorder such as cigarette smoking is markedly resistant to long-term modification. But studies of nontherapeutic populations indicate that long-term self-cure of smoking is relatively common events. So it is of considerable importance to understand variables which are as associated with quitting among smokers. Methods : Among 1627 about males who registered in life long health maintenance program of Seoul National University Hospital, 121 quitters (for more than 1 year) and 277 persistent smokers were selected. We analyzed the contents of health risk appraisals of them Results : The variables positively associated with smoking cessation included age, education, marriage, and exercise. But multivariate analysis showed that age, education and exercise were associated with smoking cessation and marriage was not related with smoking cessation. Conclusion : This analysis focused upon the relationship between baseline variables and cessation for smokers who were not offered any particular program. These findings could be used in the future design of more refined study on baseline factor associated with smoking behavior and more effective smoking cessation program.
Background
: It has been estimated that up to 80% of all illnesses seen in a physician's office is due to psychosocial stress. But, previous instruments of stress measurement cannot assess patient stress rapidly in a busy practice. This study was attempted to develop a new instruments to measure the amount of stress in outpatient clinic setting in Korea Methods : The data were collected from 387 subjects of 20 years of age and older, living in Seoul and Incheon city. The Questionnaire was composed of the Korean-translated BEPSI(Brief Encounter Psychosocial Instrument), reformed 30-items SRRQ(Social Readjustment Rating Questionnaire), and Lee's 98-items SRRQ. Results : The reliability of Korean-translated BEPSI is demonstrated(Cronbach's alpha 0.84). The validity is measured through correlation with Lee's 98-items. The correlation coeffciency of translated BEPSI is 0.25 (P<0.01), and of reformed 30-items SRRQ is 0.98(P<0.01). Conclusion : Korean-translated BEPSI and reformed 30-items SRRQ in Korean are applicable to rapid measurement of stress in outpatient clinic setting.
Background
: Informing patients of their cancer diagnosis is a difficult task for most physicians and is a traumatic event from the patient's point of view. With the remarkable development of medical science, prolongation of life is possible and some cancers are curable. Also, expanding medical technology has enabled nonsurgical physicians to sample tissues for pathologic examination. The doctor's office may become the primary place where the patients are told their cancer diagnosis in the future. Because there is little empirical literature to guide the clinician an how to inform the patients, and in what context to present cancer diagnosis, analysis of the experience of groups of cancer patients may be valuable in gaining a wider view of this issue. Methods : Forty patients with knowledge on their cancer, undergoing chemotherapy were interviewed to learn how patients were told, their feelings how and where they were told, and the patient's opinion on how other patients should be told in the future. Results : 45% of forty patients were told by physicians, 30% by family and 25% by accident. 57.5% of patients were told in the hospital room. 30% in the doctor's office and 12.5% in the home. When asked whether they should be told about cancer diagnosis 87.5% of all respondents answered "yes", 12.5% answered "dependent on situation" and none answered "no". When asked who should tell the diagnosis, 80% answered "doctor", and 20% answered "family". When asked who should be informed of the cancer diagnosis first, 62.5% of respondents answered "the family", 22.5% "the patient", 15% "simultaneously". Conclusion : This study showed that cancer patient should be told the diagnosis and the informant should be the physician. This study also showed that in contrast to western society, the family should be considered in the presentation of cancer diagnosis. In order to achieve active participation of the patient in the treatment of their cancer, the doctor should inform the patients their cancer diagnosis in a hopeful and caring environment with the support of their family.
Background
: In Korean family medicine, 73.3~76.4 percent of three year resident training time is spent in outside rotations with other specialties. But there has been no study which investigated the attitudes of family medicine faculties, residents, and non-family medicine specialists regarding the contents of family medicine resident training rotations, such as whether a family physician should perform Caesarean section, etc. In order to achieve a family medicine program whose content is based on the consensus of family medicine faculties, residents, and nonfamily medicine specialists, we compared the attitudes of these groups toward various components of family medicine resident training in internal medicine, pediatrics, general surgery, obstetrics-gynecology, and psychiatry which account for 68.5% of outside rotations of family medicine resident training programs. Methods : A questionnaire was sent to 679 family medicine faculties, family medicine residents and non-family medicine specialists in 21 different family medicine centers and related hospitals. Total response rate was 57.6%. Results : Significantly more numbers of non-family medicine specialists felt that various skills and tasks should not be performed by family physicians. Family medicine residents and family medicine faculties were generally similar to each other in their attitudes toward training in various skills and tasks, but, in some elements of psychiatric training, more family medicine faculties failed to see the need for such training compared with family medicine residents. Conclusion : In many elements of family medicine resident training, family medicine faculties and nonfamily medicine specialists do not agree. In order to resolve this problem, it is urgent to establish a curriculum, which is agreed upon between by family medicine faculties, residents, and nonfamily medicine specialists who are involved in the training of family medicine residents.
Background
: Screening test is one of the most important tools of periodic health examination for health promotion and disease prevention. To achieve effective health screening, diseases which require early detection and treatment need to be targeted. These target diseases should be selected with respect to age and sex. Also, screening tests with efficacy in early detection and safety should be selected. Methods : We reviewed health risk appraisal results, medical charts and screening test results of 2177 adults who visited Seoul National University Hospital Lifetime Health Maintenance Program from February to December in 1991. We selected 1011 subjects who were asymptomatic adults. Results : There were high positive rates in liver ultrasonography(27.3%), blood pressure measurement (14.5%) and urine analysis (12.7%), hemoglobin (9.6%), and serum cholesterol test (8.8%). In males, positive rates in chest X-ray, upper G. I series and sGPT test were more than twice those of females. But in females, positive rates of abnormality of hemoglobin, hematocrit and urine analysis test were greater than twice those of males. The detection rates of target diseases were 18.6% overall, 17.9% in males, and 9.0% in females. hypercholesterolemia (5.2%) and hypertension (4.1%) were found to have the highest detection rates among target diseases and accounted for 51% of the total detection cases. Detection rate of liver diseases was higher in males (6.3%) than in females (1.3%), but detection rate of iron deficiency anemia (IDA) in females (3.4%) was higher than in males (0.4%). Males and females in the 5th and 6th decades had higher detection rates than other groups. Among males, higher detection rates of liver diseases were seen in the 3rd and 4th decades: hypercholesterolemia, hypertension, and liver diseases in the group older than 40years. Among females, higher detection rates of IDA, hypercholesterolemia, and hypertension were seen in the 5th decade : only IDA in the 3rd and 4th decades. Females in older than 50 years of age had higher detection rates of hypercholesterolemia, hypertension, and liver diseases. Conclusion : We detected target diseases in 18.6% of asymptomatic adults by screening tests. Males and females in the 5th and 6th decades had higher detection rates than other groups. Detected target diseases revealed different detection rates according to age and sex
Background
: Bacause head trauma patients can have serious sequelae, head trauma patients should be evaluated quickly by sensitive and specific diagnostic tools. For this reason, the use of brain computed tomographic(CT) scan is increasing. But unnecessary brain CT scans can reasult in increased medical cost and loss of critical time for managment of other fatal injuries. Therefore certain criteria for requesting brain CT scan is needed. This prospective study was attempted to see if the positive brain CT scan can be predicted by the patient's clinical features and, if so, to develop indications for brain CT scan use in Korea. Methods : The data were collected from 130 subjects who were treated in the emergency room for head trauma and received brain CT scan. The sensitivity, specificity, positive and negative predictive vlaues were calculated the association between each clinical feature and positive CT scan was tested by X²-test and forward stepwise logistic regression. The score system was developed using likelihood ratio, and the cut-off point was estimated in Receiver Operating Characteristic(ROC) curve between sensitivity and false-positive rate. Results : The percent total of positive CT scan was 30% and the classification of head injuries were Subdural Hematoma(SDH), Epidural Hematoma(EDH), Intracranial Hemorrhage(ICH), Brain contusion, Subarachnoid Hemorrhage(SAH), and traumatic infarction in order of decreasing freaquency. There were significant statistical associations between positive CT scan and loss of consciousness more than 5 minutes, Glasgow coma scale, skull fracture by forward stepwise logistic regression. The cut-off point in this scoring system using likelihood ratio was 12. Conclusion : The positive CT scan can be predicted by the patient's clinical features in most of cases and the scoring system may help the predictability.
Sampling of appropriate specimen at or near the squamocolumnar junction is necessary to increase sensitivity of cervical smear. The presence of endocervical cells or squamous metaplasia is currently considered to be an important factor in assessing the adequacy of a cervical smear. One of the purposes of this study is to assess capture rate of endocervical element of the current Pap smear method in Korea which is performed by using only dry cotton swab. The other purpose is to compare effectiveness of two combinations of instrument when performing Pap smear, (Milex spatula+moistened cotton swab, Milex spatula+Cytobrush) This study was performed for 277 patients visiting family practice clinic at Seoul National University Hospital to take Pap smear test form Nov 1, 1991 to Jan 25, 1992. For 114 patients (group C) only dry cotton swabs were used to collect specimen. 78 patients' specimens were taken by combination instrument of Milex spatula and moistened cotton swab. (group A) Combination instrument of Milex spatula and Cytobrush were used for 85 patients. (group B) The endocervical cell capture rate was 62.8% for group A, 80.0% for group B, 56.5% for group C. The difference of endocervical cell capture rates among groups was significant statistically (X²=13.2, p<0.05). This difference among groups was more marked in the older age group over 45. In conclusion, combination instrument of Milex spatula and Cytobrush is considered as a more effective method for collection of endocervical cells compared with other two methods.
Physicians should take more active role in extending cervical screening corverage.
Background
: In order to make accurate diagnosis and to avoid unnecessary use of medications in UTI, family physicians require sensitive & rapid diagnostic methods. In this study we analyzed the relationship between symptoms and the results of microscopic examination of urine with the results of urine cultures in order to identify predictors of cultures result in the diagnosis of UTI. Methods : Usual symptoms, signs, and urinalysis (including microscopy of urinary sediment) as predictors of UTPs in patients were evaluated in 65 primary care visits in two community based hospitals, using a positive urine culture as gold standard (which was defined by colony count≥10). Results : 1) The overall culture positivity rate was 26.2%(17 out of 65 cases). The 17 isolated was 26.2%(17 out of 65 cases). The 17 isolated bacteria were E.coli (11), Serratia species(4), G(+) Bacilli(1), Acinetobacter species(1), in order of decreasing frequency. 2) A difference was not found between sexes(p=,206), but was among age groups(p=.046). 3) The presenting features with the higher efficacy were dysuria, frequency, generalized symptoms, and no history of previous antibiotic use. A positive nitrite test, albuminuria, and ketonuria had relatively high specificities, but relatively low sensitivities. 4) The sensitivity and specificity of microscopic bacteriuria were 41.2% and 85.4%, respectively. At the maximal cutoff point for microscopic leukocytes(10/HPF) and erythrocyte(2/HPF), the sensitivity and specificity were 94.1% and 64.6%, 70.6% and 54.2%, respectively. 5) In cases of symptoms and signs consisting of dysuria, urgency, abdominal pain, or costovertebral angle tenderness, and microscopic findings of WBC≥(10/HPF), the sensitivity and the specificity were 94.1% and 64.6%, and the positive and negative predictive values were 48.5% and 96.9%, respectively. 6) In cases of any symptoms and signs consisting of dysuria, urgency, abdominal pain, or costovertebral angle tenderness, and urine tests consisting of a positive nitrite test, microscopic bacteriuria, microscopic WBC≥20/HPF, the sensitivity, specificity, positive and negative predictive values were 88.2%, 70.8%, 51.4%, and 91.4%, respectively, and were the most predictive values in our study. Conclusion : Among some diagnostic methods, the finding of at least 10 WBC/HPF was found to have the highest correlation with positive urine culture. Specificity of WBC result is increased by symptoms & signs of patients and microscopic examinations of organism & RBC. This is further enhanced by addition of a nitrite test. The combination of these diagnostic methods yield the highest validity in the prediction of urine culture result.
Background
: Chest P-A interpretation is very important because chest P-A is one of the important diagnostic tools in primary care. Primary care physicians often make decision of patient management based on clinical impression and radiologic findings. This study assessed the accuracy of family physicians in interpretationg radiographs taken in the seven family practice offices. Methods : This study compared the interpretation of family physicians with those of one radiologist on 183 office radiographs using a uniform protocol. Nine family physicians participated in the study along with one radiologist. A total of 183 chest P-Ad were evaluated. Results : The results were as follows 1) the family physicians' discordancy rate with the radiologist was 19.6% 2) 80% of the discordant films were clinically significant misses of those were read as "normal" by one radiologist 4) only 5% of chest P-As which were read as "normal" by family physicians were read as "abnormal" by radiologist 5) The sensitivity of family physician's interpretation compared with radiologist was 90%, the specificity was 86%, and the positive predictability was 71%. Conclusion : This result suggest that it is not necessary to consult radiologist for interpretation of Chest PAs which were read as "normal" by family physician, because 95% of Chest PAs which were read as "normal" by family physicians were read as "normal" by radiologist. Radiologically abnormal films may need to be consulted with clinical information. Physicians should take more active role in extending cervical screening corverage.
Background
: The causative effect of cigarette smoking on pulmonary diseases, coronary heart diseases and much variety of cancers is evident. But the rate of cigarette smoking in Korea is increasing and adequate smoking cessation intervention has not been done yet. this clinical trial evaluated the effect of antismoking intervention done by primary care physicians. Methods : The subjects were 145 smokers who visited SNUH Family Medicine Model Clinic from April to early July, 1991. We randomized subjects by their chart number. We educated all smokers about the adverse effect of cigarette smoking with self-help material and recommended to quit smoking. We reeducated the intervention group every 3rd, 5th and 7th week by face-to-face interview or telephone call. Twelve weeks after the intervention, we attempted to contact every smoker for the number of cigarettes per day currently smoked. Results : The rates of smoking cessation and reduction for control group and intervention group were 7.7% and 38.5% vs. 19.7% and 47.99%, respectively. They were statistically significant(P<0.05). Statistically significant differences between the case and control groups were in their change of smoking habit in the following subgroups ; greater than 40 years of age, greater than 12 years of education and having diseases associated to smoking. Conclusion : In conclusion, personal intervention carried out by primary care physicians resulted in significant smoking reduction and cessation. history.
Background
: Death certificates are important data about death, which represent the changing pattern of disease and make it possible to compare the health status among other groups. But often there are error occurring tendencies which are due to the inaccuracy of diagnosis and inaccuracy of filling up death certificates, and which reduce the validity of death statistics. We reviewed the death certificates for the purpose of getting information about the incidence and the types of errors. Methods : we reviewed a sample of 1047 death certificates collected at the Department of Statistics in Feb 1991. Seven items based upon WHO criteria were checked in the review, and we compared the error rate among to geographical districts, medical specialties, hospital size and year in which the physician who completed the death certificate obtain his/her medical license. Results : One or more errors were found in 56.4% of death certificates. Of the total number of errors, 39% were due to listing the mechanism of death(such as cardiac arrest or respiratory arrest) as the immediate cause of death, 18.2% due to failing to state the immediate cause of death, 9.2% due to listing nonspecific disease entities instead of specific medical diagnosis, 8.3% due to listing illogical relationship between causes, 7.4% due to failing to state the underlying cause of death, 7.1% due to reversing the immediate and underlying cause of death, 5.6% due to part I containing conditions not or mannerly contributing to death in addition to the underlying cause of death, 2.5% to failing to certain information about E codes, 1.3% to part II containing either an underlying cause of death or a complication of the cause of death, and 1.5% to contain only the mechanism of death. We could not determine the precise underlying cause of death in 10.8%. Furthermore, up to 13.2% of death certificates may have involved inappropriate selection for the underlying cause of death. There are no differences in errors among districts, specialties, and hospital size. There are slightly more errors of death certificates recorded by the physician who obtains their licenses before 1960. Conclusion : The accuracy of death certificates was low. So we need more attention in filling up death certificates.
Background
: Patients known as 'difficult' who make doctors get negative fillings can be products of 'difficult' doctor-patient relationship. This study describes the reasons for difficulty, demographic characteristics, and contents of medical care of 'difficult' patients as compared with control patients of nine third-year residents in hospital-based family practice center. Methods : Fifty-nine difficult patient sample was generated by asking residents to indicate patients whose care they considered difficult. And control sample was generated by random sampling after matching about duty doctor and being registered to Lifetime Health Maintenance Program in department of Family Medicine, Seoul National University Hospital. The control and difficult patient charts were audited and we compared two groups about various medical and demographic characteristics. Results : Thirty-nine percent of difficult patients were selected due to medical problems and the others were selected due to psychosocial problems. There were no differences in demographic characteristics such as age, sex, marital status, educational level, and number of adults and children in family. Difficult patient group had more chronic problems, psychotropic drug use, provider continuity, and less total duration of care than control group. Two patient groups did not differ significantly in acute problems, chronic medications, samplings, radiological examinations, special tests, referrals, total visits to family practice center, and total duty doctors. After covariance analysis adjusting for total duration of care, significant differences remained between the two groups for chronic problems, psychotropic drug use. Also, after the covariance analysis the differences between difficult patient group and control group in number of acute problems and referrals became significant with the patient group having more acute problems and more referrals. Conclusion : This study result suggest that residents experience a lots of difficulties in medical work-up and therapeutic plan of certain conditions, and that demographic characteristics and contents of medical care of difficult patients differ from previous studies.
Background
: This study was designed to analyze the pattern and appropriateness of the choice of antigypertensive drug and laboratory tests in hypertension by comparison between residents in family medicine before and after 1988, and between residents in family medicine and in internal medicine after 1988. Methods : We reviewed medical records in Seoul National University Hospital and evaluated the age, past medical history, initial BP of the patients, the items of laboratory tests, the timing of medication, and drugs prescribed for 48 and 51 hypertensive patients prescribed by residents in family medicine from 1985 to 1987(Group 1) and from 1989 to 1991 (Group 2) respectively, and 38 hypertensive patients prescribed by residents in internal medicine from 1989 to 1991(Group 3). Results : 1) The drugs mainly prescribed were diuretics and adrenergic blockers in group 1, ACE inhibitors, adrenergic blockers, and diuretics in group 2, and adrenergic blockers, calcium antagonists, and diuretics in group 3 in order of frequency. The prescribing pattern made little difference according to age except that diuretics were not prescribed for patients under 50 years old in group 2 and group 3. 2) In group 1, diuretics and adrenergic blockers were mainly prescribed irrespective of past medical history, but various drugs were prescribed according to past medical history in group 2 and 3. 3) Antihypertensive drugs were prescribed at first visit in above 40% of hypertensive patients irrespective of the degree of hypertension. 4) Among 10 laboratory tests, there were statistically significant differences in fasting glucose(P<0.001) and serum calcium(P<0.001) between group 1 and 2, and serum potassium(P<0.05) between group 2 and 3. 5) The funduscopic examination was ordered more frequently in group 1 than in group 2, and in group 3 than in group 2. The differences were statistically significant(P<0.001). Conclusion : After introducing the individualized-care approach for hypertensive patients, the initial prescribing pattern for hypertensive patient was individualized according to the patient's age, past medical history.
Background
: The Urinalysis is useful laboratory test in the diagnosis of various diseases. But in many cases, the urine specimen is delayed in room temperature. There are some studies how the result changes with delayed specimen, but there are few study how much change occurs. So this study was carried out to determine the extent of change of delayed urinalysis. Methods : During July and September 1991, the each urine specimen from medical outpatient department of Incheon Hospital was divided in equal amount and one was examined within 1 hour in fresh state and the other was examined about 4 to 6 hours after collection. The delayed urinalysis results were compared with fresh urinalysis results. Considering fresh urinalysis results as gold standard, the sensitivity and specificity of delayed urinalysis were calculated. Results : Comparison of dipstick results showed no difference in specific gravity, protein, glucose and occult blood between the delayed specimens and the fresh specimens, but pH was increased significantly(p=0.001). The number of RBC(p=0.03), WBC(p=0.01), and epithelial cell(p=0.001) decreased significantly. The specificity of dipstick and microscopic examination results were above 90%, but sensitivity of all item below 90%. With the specimens resulted positive, there was no significant difference in glucose, protein, occult blood and WBC. But the number of RBC(p=0.012), and the number of epithelial cell(p=0.006) decreased significantly. Conclusion : In some items, there was no significant difference statistically. But because the pH and the microscopic examination results changed significantly and sensitivity was below 90%, delayed urinalysis can lead to incorrect clinical decision-making. So we reaffirm that the urinalysis must be done with fresh urine specimen. physicians should take more active role in extending cervical screening corverage.
The periodic health examination is an essential part in Family Medicine for health promotion and disease prevention. The patients' compliance for the health exams is required basically for the efficacy of those health exams. 150 patients were selected randomly among 1962 patients who visited an urban health exam center from May to August in 1990 to investigate the patients' thoughts about health screening examinations. 136 patients responded to 3-paged structured questionnaire in the half of which the typical health exam costs were noticed for each health exam item. It was suggested that the patients should select the health exam items among the 10 laboratory procedure items. (Pap smear exam was excluded for men.)
58% of those patients had got health examinations at least once before that time. New problems which were previously unknown were found in 14% of them by health examinations. Listing typical health exam costs did not alter the selection rates of the patients. Who paid health examination costs for them did not also alter the selection rates of the patients. Patients wanted to get health exams more frequently than they were generally recommended.
Background
: Cervix cancer is the most common cancer in women. The incidence and the number of deaths from cervical cancer were reduced by the effective screening test-Pap smear. Therefore we carried out this study to determine the most effective way for increasing the rate of cervical cancer screening. Methods : We tried four compliance enhancing intervention strategies (group I -reminder postcard/group Ⅱ-reminder phone call/group Ⅲ-postcard and education material/group Ⅳ-postcard and education material and phone) to 224 female patients who visited previously family medical center, and compliance predictors were examined by questionnaires. Results : Total compliance rate was 35.8% and compliance rates of each group were 32.5%, 34.9%, 31.8%, 44.7%. Difference among the four groups was not statistically significant (X²=1.7087 P=0.6084). The likelihood of obtaining the cervical cancer screening test were linked to the number of Pap smears the previous years, education level, the number of visit to hospital the previous year, family history of cervical cancer(P<0.05). Conclusion : Postcard reminder is the simple and cost-effective measure. To increase the compliance of cervix cancer screening test, primary care physicians should take more active role in extending cervical screening coverage.
The purpose of this study is to find out the better Body Mass Index for Korean children.
We surveyed 737 students in a primary school in Seoul. Among them, 373 were boys. Using the records of the physical examination done for the children every last 5 years, the data of the children's weights and heights for last 5 years were obtained. From these data, we calculated 6 Body Mass Indices(Quetelet Index, Modified Quetelet Index, Rohrer Index, Ponderal Index, Weight for lenght Index, and Body Surface Area Index). We analysed the trends of indices by age and by sex. The results were as follows ; 1. In boys, Quetelet, Modified Quetelet, and Body Surface Area Indices increased as the age. The Ponderal Index increased till the second year and then remained unchanged. The change of the Weight for Lenght Index were unnoticeable for the the firs year, but the Index increased for next two years, and then there was no change. The Rohrer Index changed insignificantly all the years. 2. The trends of girls' indices were very similar to those of boys except the Weight for Length Index, which decreased slightly for the second year and increased till the fourth year for girls while never decreased for boys. 3. The Quetelet Index were significantly larger for boys than for girls in the first and second year(p<0.05). The Weight for Lenght Index was significantly larger for girls in the first and the second year, while it was opposite in the third and fourth year(p<0.05). The Body Surface Area Index was significantly larger for girls all the years but the fifth year(p<0.05).
To know whether computerized EKG system improves the accuracy of family practitioner's EKG interpretation and, if so, whether this improvement brings considerable acquirement of clinically significant informations, we collected all EKGs(total 207 cases) processed by computerized EKG machine from April 1,1989 until March 31,1990 in the outpatient department of Family Medicine, Seoul National University Hospital.
Firstly, these 207 EKGs were evenly and randomly distributed to the 10 family medicine residents and we requested them to interpret each EKG unaided by computerized EKG system. Secondly, these 207 EKGs were evenly and randomly reassigned to the previous 10 family medicine residents and we requested them to interpret each EKG with the aid of computerized EKG system. Cardiologist's interpretation aided with computerized EKG system was used as a standard interpretation and evaluation of accuracy of residents' interpretation was done according to it. 1. Degree of agreement with cardiologist's interpretation increased from 72.9%(precomputer interpretation) to 76.3%(postcomputer interpretation). 2. Sensitivity of the residents' interpretation on the normal EKGs increased from 0.80(precomputer interpretation) to 0.85(postcomputer interpretation). 3. Specificity of the residents' interpretation on the normal EKGs increased from 0.80(precomputer interpretation) to 0.82(precomputer interpretation). 4. When compared with postcomputer interpretation, precomputer interpretation was changed in the 60 cases out of 207 cases. In the normal EKGs(total 123 cases), 22 cases(17.9%) were changed. In the abnormal EKGs(total 64 cases), 38 cases(43.0%) were changed. 5. Analysis of postcomputer interpretation was as followed; more agreements with cardiologist's interpretation were in 38 cases(60.3%), less agreements were in 20 cases(33.3%) and unchanged cases were 2(6.4%) 6. More agreement brought clinically significant informations in 17 cases(44.7%) out of more agreed EKGs (38 cases). We concluded that postcomputer interpretation made the family medicine residents' interpretation more agreed with cardiologist interpretation and this increased agreement brought clinically significant informations. Thus this result suggested that computerized EKG system serve as a useful teaching tool for educating EKG interpretation and increase the quality of practice by acting as a backup opinion for more accurate interpretation.
In order to elucidate the relationship between low visual acuity and environmental factors including the video display terminal usage among school children, we measured the visual acuity of the 557 elementary school children and analysed the data from questionnaire about life pattern pertaining to video display terminal usage. The results were as follows;
1. There was a tendency of gradual increase of low visual acuity with grade(p<0.01). 2. The low visual acuity in female was higher than that in male. (p<0.01). 3. It is statistically significant that low visual acuity was related with glasses wearing of parents(p<0.05). 4. It is statistically significant that the time of watching TV, computer operation and duration of computer education were related with low visual acuity respectively(p<0.05). From the above results, we have got a conclusion that low visual acuity was related not only with hereditary factors, but also with environmental factors including the video display terminal usage. So it is conceived that the instructions for proper usage of video display terminal are required for prevention of low visual acuity among school children. And further studies on causal relation between low visual acuity and video display terminal usage are required.
We already know how important the adequate prenatal care is & it's positive effects to birth outcomes. In KOREA, nevertheless, the proportion of pregnant women who receives adequate prenatal care is still low. This study was performed to detect any obstacles in receiving adequate prenatal care. As many as 141 out of 257 women who gave birth at Puchun Sejong hospital from June to July 1990 were selected & paper-interviews with chart reviews were performed.
The results were as follows : 1. Mean age of 145 women was 27.3 years & 82(56.6%) of them were primipara & 63(43.4%) were multipara. 2. The mean number of prenatal visit was 8.1, and the numbers of women who received adequate prenatal care were 65(37.2%), intermediate prenatal care were 55(37.2%), and inadequate prenatal care were 25(17.2%). 3. Adequacy of prenatal care had no effect to birth outcomes. 4. Age group, economic status, educational level, type of health insurance, family structure, previous illness, illness during this pregnancy were not significantly related to adequacy of prenatal care. 5. In multiparous women, the proportion of inadequate prenatal care was higher than primiparas & it's difference was statistically significant. 6. The proportion of inadequate prenatal care was higher in women who had negative attitude to prenatal care than those who had positive attitude, & it's difference was statistically significant. 7. The majority(86.7%) of women who did not received adequate prenatal care said,"I didn't have to, because I had no problem". We concluded that the education about the significance and the practical method of adequate prenatal care was very important, and it should be especially stressed to multiparas.
The blood pressure level and several selected variables were studied in 485 female adolescents (15 to 18 years of age) for the purpose of knowing the distribution of blood pressure and the factors associated with blood pressure. The level of systolic and diastolic blood pressure did not change with the increase of the age, height and pulse rate. But the level of systolic and diastolic blood pressure elevated with the increase in body weight and variable weight-height ratios. The level of systolic and diastolic blood pressure was not associated with the family history of hypertension and blood type. So this data suggests that for Korean female adolescents, body weight and variable weight-height ratios correlate with blood pressure significantly.
To assess the injection preference of patients and its related factors, 332 patients who visited Yeoncheon Health Center Hospital during the preiod of 16th June through 30th June 1990 were studied by means of questionnaire and review of medical records.
The results were as follows. 1. Of total 332 patients, the proportion of injection preference group was 226(68.1%). 2. The proportion of injection preference group according to disease group was 26(86.7%) in sensorineuro-psychiatric diseases, 49(81.7%) in musculoskeletal diseases, 46(69.7%) in gastrointestinal diseases, 52(65.0%) in respiratory diseases, and 8(47.1%) in cardiovascular diseases. 3. There was a tendency that injection preference was higher in patients who were older, who were low-educated and who had no history of side effect of injection. Age, education level and history of side effect of injection were significantly related to injection preference.(P<0.01) 4. The beliefs that 'Injection makes faster recovery from illness than p.o. medications.','Illness that was not recovered by p.o. medications had better be treated with injection.' and 'Side effect of injection is more dangerous than that of p.o. medications.' were significantly related to injection preference.(P<0.01) In conclusion, in order to induce the injection preference to favorable direction, health education is necessary to change the patients' beliefs about injection and this effort is more important in patients who are older, who are low-educated, and who have no histroy of side effect of injection.
The methodological and statistical validity of 382 original articles published in the Journal of the Korean Medical Association, from January 1980 to December 1989 was reviewed by the author devised checklist consisting of 21 items(14 items for methodological validity and 7 items for statistical validity). Results show that 379 articles(99.2%) have one or more invalid items for methodology, and of 297 articles using statistical analyses a total of 290 articles (97.6%) were found to contain at least on error in statistical methods used. The mean and standard deviation of 'validity score of one article', defined as the total number of valid items divided by the total number of applicable items and then multiplied by 100, were 43,8 and 15.2, respectively. The distribution of validity score was as follows; over 60(57 articles, 14.9%), 30 to 59(266 articles, 69.6%), and under 30(59 articles, 15.5%). The proportion of articles, of which validity score was over 60, was significantly higher in descriptive study(19.4%) than in analytic study(8.4%, p=0.003). Also the articles of over-60 in validity sectional study(16.8%) than in logitudinal study(10.6%), but this finding was not statistically significant. The average validity score of two year period was highest in 1984-1985(50.24), and lowest in 1986-1987(38.85). There was no signicant time trend of the averaged validity score over 10 years.(0.1
143 elderly who are staying in nursing home in Gyounggi-do are studied in terms of nutrional evaluation.
1. The proportion of smaller diet is higher in the age of 85 and more than any other age group. 2. The values of measurement of obesity index, BMI, and thickness of mid upperarm are significantly higher in female(P<0.50) 3. The prevalences of anemia according to hemoglobin level are 33.3% in men and 20.9% in female. However hemoglobin level less than 10.0g/dl are observed only in female. 4. Hypocalcemia are identified among 37.3% in male and 50% in female. 5. The levels of phosphorus are not significantly different in terms of age and sex. 6. hypoalbuminemia are identified among 17.6% in men and 27.2% in female. This difference is statistically significant(P<0.05) and the level of albumin is inversely correlated with age. 7. means of cholesterol level are 184.7 mg/dl in female and 152.1mg/dl in men. The higher level in female may be related with the higher obesity rate.
During 4 weeks (1990.5.21-6.18), ninety-two patients' medical interviews were reviewed after recording by the use of audiovisual system for analysing their terms containing medical meanings. Medical intervews were done at OPD of Department of Family Medicine, Seoul, Seoul National University Hospital.
The results were as follow; 1. Total time of medical interviews was 1,021 minutes. 2. For hundred five words or sentences were presented and used 831 times. 3. Patients used 298 words or sentences 685 times to complain their symptoms. 4. Everyday languages and well-known medical languages were used as meidcally meaning full terms. 5. There were many words or sentences containing similar medical meaning. 6. There were some words containing two or more meanings concomitantly.
Most primary care physicians are faced with continuous health care and this access is accomplished through the telephone because on-call arrangement is the traditional solution to patient care demands outside scheduled hours and provides a means by which the patient may interact with a health care provider at all times of day or night. For this purpose, we have given 24 hour telephone call service at Dept. of Family medicine, Seoul National University Hospital.
We analysed the contents of 108 calls for 5 months(90.5.1~9.30) from the family members who are registered in the same department in terms of age, sex, chief complaint and counselling. Followings are the result of the study ; 1. A total of 108 calls were received during the study period and an average of 0.7 call day were received. 2. Of the patients who called, 61.8% was female and 38.2% was male. 3. According to patient's age, divided into age groups of 0-19, 20-29, 30-39, 40-49, 50-59 and 60-69year of age, the heighest number of patients were observed in age of 0-19 in male and in age of 30-49 in female. 4. When analysed by the type of caller, call from the patient was 51.4%, that from their relatives was 48.6%. 5. On weekdays, 76 calls were received and none on weekend, 32 calls were distributed throughout the day as follows; 40 calls(37.0%) were received by the physicians during daytime hours of 9AM to 3PM and 68 calls(63.0%) were received on after-hours. 6. The majority of the contents of calls were about the medical problems and diagnoses related to medical problems are recorded in the general categories of the international classification. The most common diagnoses are Gastrointestinal tract and Nervous and sense organ disease. 7. Most calls did not require a face to face visit as judged by the physician. So, of the calls, 44.8% were handled by the physicians with only information.
This study was performed in order to assess the factors influencing pregnant women's behavior in oral iron supplement and to document the reasons to stop oral iron supplement.
The 260 women's data which were collected by chart review and the responses to the prepared questionnaire in Bucheon Se Jong Hospital during 4 months(May, June, July, August) in 1990, were as analyzed. The results were as follows : 1. The percentage of the women who took oral iron pill was 56.2%. 2. There was significant increase in the oral iron supplement if the pregnant women had higher education or the more income or antenatal care or the knowledge for iron supplement during pregnancy. 3. The most common reason for iron supplement during pregnancy was the knowledge for iron supplement. Then the doctor's advice was the second and the husband's advice was the third. 4. They discontinued iron supplement during pregnancy due to the side effects(32.9%), annoying continuous use(25.7%), forgetting the use(18.6%) and satisfying to herself(5.7%). 5. The mean values of hemoglobin and hematocrit were 11.8gm/dl and 35.3% in adequate supplement group, 11.0gm/dl and 33.3% in inadequate supplement group, and 10.0gm/dl and 30.9% in non-supplement group.
Hyperlipidemia has long been associated with cardiovascular disorders by increased incidence of artherosclerosis. So it remains one of the chief risk factors accociated with coronary artery disease and cerebrovascular accidents.
In Korea, there is a increased tendency of hyperlipidemia because of increased ingestion of animal fat, which may account for increased incidence of cardiovascular disease. It was revealed that the low prevalence of artherosclerosis and cardiovascular disease among Eskimos in Greenland despite a diet as high in fat and cholesterol as that of the Danes or American resulted from different composition of fat consumed, which contained much higher proportion of omege-3 polyunsaturated fatty acids in the fish diet. The omega-3 fatty acids have lowering effect of serum lipid level. Among the 44 hypercholesterolemic patients who visited Family Practice Center, the randomly selected 26 patients took 650mg omega-3 fatty acid daily and their serum lipid levels were compared with those of the control group. In the case group. omega-3 fatty acids led to decrease in plasma cholesterol (8.2per cent), triglyceride (18.2 per cent), and low density lipoprotein (9.8 per cent). There was no side effect. In the control group. it had much less effect. We conclude that omega-3 fatty acids have lipid lowering effect in hyperlipidemic patients, especially with hypertriglyceridemia.
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