| Chang Won Won | 37 Articles |
Background
Chronic stress is associated with an increased risk of cognitive impairment and Alzheimer’s disease. This study aimed to assess whether better coping with stress, as assessed using the Brief Resilience Scale (BRS), is associated with slower cognitive decline in community-dwelling older adults. Methods This study used 2018/2019 data and 2-year follow-up data from the Korean Frailty and Aging Cohort Study. Of the 3,014 total participants, we included 1,826 participants (mean age, 77.6±3.7 years, 51.9% female) who completed BRS and Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Battery and the Korean version of the Frontal Assessment Battery (FAB). Results Higher BRS score at baseline was associated with a lesser decline in the Mini-Mental State Examination score over 2 years after adjusting for age, sex, years of education, smoking status, hypertension, diabetes, and depression (B, 0.175; 95% confidence interval, 0.025–0.325) for 2 years, which represents global cognitive function. Other cognitive function measurements (Word List Memory, Word List Recall, Word List Recognition, Digit Span, Trail Making Test-A, and FAB) did not change significantly with the BRS score at baseline. Conclusion These findings suggest that better stress-coping ability, meaning faster termination of the stress response, may limit the decline in cognitive function. Citations Citations to this article as recorded by
With aging, loss of skeletal muscle mass and muscle function increases, resulting in an increased risk of falls, fractures, long-term institutional care, cardiovascular and metabolic diseases, and even death. Sarcopenia, which is derived from the Greek words “sarx” or flesh+“penia” or loss, is defined as a condition characterized by low muscle mass and low muscle strength and performance. In 2019, the Asian Working Group for Sarcopenia (AWGS) published a consensus paper on the diagnosis and treatment of sarcopenia. The AWGS 2019 guideline, specifically, presented strategies for case-finding and assessment to help diagnose “possible sarcopenia” in primary care settings. For case finding, the AWGS 2019 guideline proposed an algorithm that recommends calf circumference measurement (cut-off <34 cm in men, <33 cm in women) or the SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls) questionnaire (cut-off ≥4). If this case finding is confirmed, handgrip strength (cutoff <28 kg in men, <18 kg in women) or the 5-time chair stand test (≥12 seconds) should be performed to diagnose “possible sarcopenia.” If an individual is diagnosed as “possible sarcopenia,” AWGS 2019 recommends that the individual should start lifestyle interventions and related health education for primary healthcare users. Because no medication is available to treat sarcopenia, exercise and nutrition is essential for sarcopenia management. Many guidelines, recommend physical activity, with a focus on progressive resistance (strength) training, as a first-line therapy for the management of sarcopenia. It is essential to educate older adults with sarcopenia on the need to increase protein intake. Many guidelines recommended that older people should consume at least 1.2 g of proteins/kg/d. This minimum threshold can be increased in the presence of catabolic or muscle wasting. Previous studies reported that leucine, a branched-chain amino acid, is essential for protein synthesis in muscle, and a stimulator for skeletal muscle synthesis. A guideline conditionally recommends that diet or nutritional supplements should be combined with exercise intervention for older adults with sarcopenia.
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Aging has become a global problem, and the interest in healthy aging is growing. Healthy aging involves a focus on the maintenance of the function and well-being of elderly adults, rather than a specific disease. Thus, the management of frailty, which is an accumulated decline in function, is important for healthy aging. The adaptation method was used to develop clinical practice guidelines on frailty management that are applicable in primary care settings. The guidelines were developed in three phases: preparation (organization of committees and establishment of the scope of development), literature screening and evaluation (selection of the clinical practice guidelines to be adapted and evaluation of the guidelines using the Korean Appraisal of Guidelines for Research and Evaluation II tool), and confirmation of recommendations (three rounds of Delphi consensus and internal and external reviews). A total of 16 recommendations (five recommendations for diagnosis and assessment, 11 recommendations for intervention of frailty) were made through the guideline development process. These clinical practice guidelines provide overall guidance on the identification, evaluation, intervention, and monitoring of frailty, making them applicable in primary care settings. As aging and “healthy aging” become more and more important, these guidelines are also expected to increase in clinical usefulness.
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Background
This study aimed to investigate stress, depression, sleeping time, physical activity, and dietary patterns as factors causing weight gain and investigate which of these factors have a greater effect on weight gain. Methods Data were obtained from the seventh Korea National Health and Nutrition Examination Survey, 2016. Among the respondents, 3,163 adults aged 19–64 years were included in the survey, after excluding non-responders and those with diseases that may affect weight change. The t-test and chi-square test were used to analyze the relationship between weight gain and general characteristics. Logistic regression analysis was performed to evaluate weight changes according to stress, depression, sleep time, physical activity, and dietary patterns and evaluate the odds ratios (ORs) for measuring these associations. Results Participants in the weight gain group were younger and more likely to be obese than those in the control group. Factors that could cause weight gain among women were stress awareness (OR, 1.271; 95% confidence interval [CI], 1.012–1.597), physical inactivity (OR, 1.250; 95% CI, 1.018–1.535), and skipping breakfast (OR, 1.277; 95% CI, 1.028–1.587). Depression was significantly associated with weight gain among women, but not after adjusting for other variables. There were no significant associations with sleeping time. None of these factors in men were significantly associated with weight gain. Conclusion Stress awareness was significantly associated with weight gain among women, while other psychological factors were not significantly associated with weight gain. Citations Citations to this article as recorded by
Disability in older adults has become a significant burden, both individually and socially, due to the rapidly aging population in Korea. It is important to manage both frailty and chronic diseases to delay disability. Frailty, which is considered to be a transition phase between healthy status and disability, is defined as a significant decline in functional reserves of multiple organ systems and the resultant extreme vulnerability to stressors, leading to a higher risk of adverse health-related outcomes. The frailty phenotype and frailty index are the most commonly used methods to diagnose frailty. Frailty is related to physical, psychological, cognitive, and social dysfunction, and is sometimes caused by chronic disease. Therefore, primary care providers are ideally situated to incorporate the concept of frailty into their practice, as they are champions in comprehensive care. Although the identification and treatment of frailty is not yet standard practice in primary care, primary care physicians must use the electronic frailty index to identify frailty in all the patients aged ≥65 years in the United Kingdom. In Canada, some insurance companies and governments are using a similar program, which is called the Community Actions and Resources Empowering Seniors model. The clinical practice guidelines of the International Conference of Frailty and Sarcopenia Research, as well as some additional references, will be introduced. Here, we review the current literature on how to diagnose and manage frailty in primary care.
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The number of North Korean adolescent defectors entering South Korea has been increasing. The health behavior, including mental health-related behavior, and factors associated with depression in North Korean adolescent defectors residing in South Korea were investigated. Data obtained from the Korea Youth Risk Behavior Web-Based Survey (2011–2014) dataset were utilized. In total, 206 North Korean adolescent defectors were selected, and for the control group, 618 matched South Korean adolescents were selected. Frequency analysis was used to determine the place of birth and nationality of the parents, chi-square tests were used to compare the general characteristics of the North and South Korean subjects, and multivariate logistic regressions were conducted to compare the health behavior of the two sets of subjects. To determine the factors associated with depression in the North Korean subjects, a logistic regression was performed. The North Korean adolescents reported higher current smoking (adjusted odds ratio [aOR], 2.54; 95% confidence interval [CI], 1.48 to 4.35), current drinking (aOR, 1.85; 95% CI, 1.15 to 2.99), and drug use rates (aOR, 10.99; 95% CI, 4.04 to 29.88) than did the South Korean adolescents. The factors associated with depression in the North Korean adolescents were current smoking (aOR, 6.99; 95% CI, 1.62 to 30.06), lifetime drinking experience (aOR, 5.32; 95% CI, 1.51 to 18.75), and perceived stress (aOR, 4.74; 95% CI, 1.74 to 12.90). There were differences in health behavior between the North and South Korean adolescents. A specialized approach for North Korean adolescent defectors is required to promote proper health behavior and adaptation to South Korean society. Citations Citations to this article as recorded by
Body mass index is widely regarded as an important predictor of mortality. The purpose of this study was to investigate the relationship between body mass index and mortality and to compare community-dwelling elderly people in South Korea according to sex. Data were collected from the 2008 and 2011 Living Profiles of Older People Surveys, which comprised 10,613 community-living South Korean men and women aged 65 years or older. The participants were stratified into five groups according to body mass index as defined by the World Health Organization guidelines. The sociodemographic characteristics of participants and mortality rates were compared across the body mass index groups. The highest survival rates were observed in men with a body mass index of 25.0–29.9 kg/m2. A similar trend was observed in women, but it was not statistically significant. After adjusting for covariates, this association was also found in men across all BMI index groups, but not in women. This study supports previous findings that overweight or mild obesity is associated with the lowest mortality and suggests that the current categories of obesity require revision. Furthermore, the absence of statistically significant findings in the female cohort suggests that body mass index is not a suitable predictor of mortality in women and that an alternative is required. Citations Citations to this article as recorded by
The serial 100-7s subtraction, an item on the Mini-Mental State Examination (MMSE), is well known for being difficult for uneducated people. Therefore, we investigated into alternative serial subtractions for serial 100-7s subtraction in uneducated people. One hundred sixty-nine subjects were enrolled by neurologic or neuropsychiatric out-patient clinics in 4 university medical centers. The subjects were divided into two groups: an uneducated group and an educated group (at least primary schooling) by questionnaire. We investigated the correlation between incorrect number of serial subtractions and Global Deterioration Scale (GDS) score in both groups and undertook receiver operating characteristic (ROC) curve analysis. MMSE including serial 40-4s subtraction, serial 20-2s subtraction, and serial 10-1s subtraction instead of serial 100-7s subtraction were arbitrally named MMSE4, MMSE2, and MMSE1. In the educated group, serial 100-7s subtraction showed the highest correlation with GDS score (correlation coefficient, 0.465; P < 0.001). In the uneducated group, serial 40-4s subtraction showed the highest correlation with GDS score (correlation coefficient, 0.608; P < 0.001), and serial 100-7s indicated the lowest correlation (correlation coefficient, 0.378; P = 0.023). In ROC curve analysis for MMSE, MMSE4, MMSE2, and MMSE1 to assess the presence of dementia (GDS score ≥ 3) in uneducated subjects, the area under the curve (AUC) was 0.648, 0.770, 0.758, and 0.711, respectively, and in educated subjects, AUC for MMSE, MMSE4, MMSE2, and MMSE1 was 0.729, 0.719, 0.716, and 0.714, respectively. Out of MMSE items, serial 100-7s is adequate in the educated elderly, but may be less adequate in the uneducated elderly. Serial 40-4s seems to be more appropriate for MMSE in the uneducated elderly. Citations Citations to this article as recorded by
Background
Obesity is known to influence on physical, mental, functional health problems but there have been no study of relationship between body mass index (BMI) and quality of life (QOL) in Korean elderly. Methods: A total of 216 elderly who had been attending two geriatric welfare facilities in Seoul answered the Korean version of obesity-related quality of life (KOQOL) questionnaire. Height, weight, waist circumference were measured. Body fat (%) was measured with HTM20 by impedance technique. Sociodemographic and medical factors were interviewed. QOL was assessed using KOQOL (ver.1) after excluding two sexual life related questions and one work related question. The total score is 48 points. The higher is the score, the poorer is the QOL. Results: In multivariable analysis, BMI, age, history of diabetes mellitus, history of osteoarthritis were associated with KOQOL score. Especially, BMI was significantly associated with KOQOL score after adjusting for waist circumference, body fat (%) (P = 0.002). Conclusion: The more BMI increases, the worse the obesity related QOL is in Korean ambulatory elderly. Citations Citations to this article as recorded by
Various bacteriae, viruses, fungi, parasites may cause community acquired pneumonia and out of them, S. pneumoniae is the most common cause. As finding out causative pathogen in community acquired pneumonia which is common in primary care is often difficult, empiric antibiotic therapy is initiated. For ambulatory patients with community acquired pneumonia: 1) Ղ-lactam alone; 2) combination of Ղ-lactam and macrolides; or 3) respiratory quinolone are recommended. For inpatients without a risk of P. aeruginosa, Ղ-lactam plus macrolide or respiratory fluoroquinolone are recommended. The successful treatment of community-acquired pneumonia requires appropriate, empirical antimicrobial therapy.
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Background: Dementia is the most important factor affecting everyday life of the elderly and there have been studies on the relationship between dementia and social withdrawal or loneliness. However, there is a lack of investigations on the relationship between loneliness and cognitive function in the elderly living alone. Methods: Ninety five community-dwelling elderly people registered to Sungbook elderly welfare center in Seoul, who were living alone, were enrolled in the study. Personal visits by three pre-trained researchers were made during April 2006. One year later, 11 elderly dropped out, and 84 elderly were interviewed in the same way. They were interviewed based on loneliness scale, social support, Hasegawa dementia scale, instrumental activities of daily living, and depression. Results: The mean age of the subjects was 78.3 years. Most of them were women (90.5%) and education level was low (no schooling in 69%). The loneliness scale did not change much during one year (P=0.63), but the instrumental activities of daily living (IADL) score had worsened from 10.5 to 11.2 (P=0.002) The mean Hasegawa dementia scale score decreased from 23.2 to 21.0 during one year (P<0.001). Multivariate regression analysis for the one-year difference in Hasegawa Dementia Scale revealed loneliness was a significant factor after adjusting for age, the level of education, social support, IADL score, and depression (regression coefficient=−0.712, P=0.02). Conclusion: Loneliness was associated with a decline in cognitive function in the elderly people living alone. In contrast, social withdrawal and depression had no effect on changes of cognitive function during one year. (J Korean Acad Fam Med 2008;29:695-702)
Background: With the number of geriatric population on a steep increase, the roles of family physicians broaden to give comprehensive medical care to the elderly. Therefore, geriatrics is becoming increasingly more important for the residents of family medicine. The authors have surveyed and researched on resident's current attention, actual training conditions, and future needs on geriatrics. Methods: Family medicine residents in 79 hospitals registered to Korean Family Medicine Resident Union were enrolled. By means of electronic and postage mail surveys, informations were gathered; including demographics, the order of importance of nine training curricula, the necessity of training itself, the facility and academic conference of geriatrics training. Results: A total of 173 residents in 45 hospitals replied with return rates of 51.9%. Among the total, 169 (97.7%) of the answered agreed on the necessity of geriatrics training. Of the nine curricula, geriatrics was considered the most important. And residents considered family medicine outpatient department and inpatient ward to be the most important place for geriatrics training. Furthermore, the residents considered elderly's diseases or symptoms as more important conference title, but the parameters such as the quality of life, physiology of aging, care in nursing home were considered less important. Conclusion: The geriatrics training program is not up to the standards of residents' satisfaction. This is considered to be due to the absence of a formal training program. To provide a better care for the elderly, it is compulsory to gain broad knowledge of geriatrics and actual experience out in the field. (J Korean Acad Fam Med 2008;29:687-694)
Background
It has been reported that H.pylori causes changes in fundic leptin levels and plasma levels of ghrelin, and that eradication of H.pylori infection can increase appetite. There is also a report that showed changes of appetite between before and after eradication of H.pylori in peritoneal dialysis patients. Our study investigated the degree of appetite between H.pylori negative group and H.pylori positive group in adults. Methods: The subjects included those without appetite- related diseases. We carried out gastroscopy and then performed CLO test in subjects who had no gastric lesions. We interviewed the study subjects about appetite related behavior (three items: desire to eat, hunger before meal, deliciousness) using visual analogue scale. We examined the appetite related behavior between CLO (-) group and CLO (+) group. Results: The difference of age, sex, height, weight, body mass index, alcohol con sumption, blood pressure, hemoglobin, fasting blood sugar, AST, ALT, GGT between CLO (-) group and CLO (+) group were not statistically significant. The difference of appetite related behavior (three items) between CLO (-) group and CLO (+) group was not statistically significant. Conclusion: The degree of appetite between CLO (-) group and CLO (+) group was not different. (J Korean Acad Fam Med 2007;28:909-915)
Background
: Gastrointestinal (GI) symptoms are believed to be common in the general population, and constipation is one of the most representative GI symptoms. However, the prevalence and risk factors of functional constipation are not well known in Korea. We aimed to study the prevalence of, and risk factors for, constipation in the elderly. Methods : We randomly selected 852 among 854 (excluded by cancer and dementia) subjects, ages 65 yr and older, in three different geriatric welfare facilities in December, 2003. The prevalence of functional constipation was based on the Rome II criteria and the survey on risk factors for constipation was performed. Results : Functional constipation had a prevalence of 26.6% and there was no difference between men and women. Exercise, fluid·fruit·vegetable intake, anal diseases and age related risk factors were associated with constipation. Conclusion : In the elderly, constipation is a common complaint. Further studies are now required for risk factors of constipation.
Background
: New educational objectives and evaluation methods in Korean medical schools have been suggested recently to cope with health care related environmental changes. Current status of family medicine clinical clerkships in Korean medical schools is to be known before establishing standards. Methods : Educational Committee of Korean Academy of Family Medicine surveyed the family medicine clerkship in Korean medical school (about educational environment, subjects and evaluation methods) using structured questionnaires by e-mail and Fax from February through March in 2004. Results : Family medicine clinical clerkship was run by 25 of 41 medical schools (65.9%). Educational subject areas included communication skill, observation in hospital based ambulatory office, primary care and family medicine, medical recording, diagnosis and treatment of common problems, residential out-hospital ambulatory programs, presentation of hospital based ambulatory programs, procedure skill, lifelong heath management plan, and health promotion, in descending order. Faculties of family medicine were directly in charge of educational subjects. However, educational methods were mainly composed of lectures and indirect observation. It should be noted that concrete and precise evaluation methods in the family medicine clerkship program had been lacking due to insufficient and obscure evaluation strategies. Conclusion : Clerkship period, educational environment, and number of class were variable among medical schools in Korea. Educational format needs to be standardized in terms of common educational subjects such as communication skill education, patient education, and ambulatory care clerkship. More valid methods are to be introduced for family medicine clerkship evaluation.
Background
: The functional status of elderly has been measured by many different methods including Karz ADL index, Bathel ADL index and physical self- maintenance scale. Among them, Bathel ADL index has been widely used in many countries because of easiness to scoring and administration. Therefore, we translated the Bathel ADL index and tested the translation validity and psychometric properties (validity and reliability) of Korean version of Bathel ADL index. Methods : The Bathel ADL index was translated by multidisciplinary committee members. The quality of translation was rated by committee members using three criteria (clarity, use of common language, conceptual equivalence). Reliability was tested by internal consistency (Cronbach's alpha), two weeks test-retest reliability, and intraobserver agreement. Clinical validity and construct validity comparison with brain disability grade were tested for validity testing. Results : Cronbach's alpha was 0.97. Two weeks test-retest correlations coefficient was 0.95 (P=0.00). Interrator agreements were high in all 10 items (κ=0.82∼1.0). Normal control group had lower scores than the patient group (P=0.000). Correlation coefficients between the Korean version of Bathel ADL index score and brain- disability grade was -0.58 (P=0.000). Conclusion : The Korean version of Bathel ADL index is a valid and reliable instrument for measuring functional status of the elderly.
Background
: Since March 1, 1989, a new health care system has been introduced. But the departments of ENT, ophthalmology, dermatology and PMR (rehabilitation medicine) in tertiary health care hospitals were exempted from the new system and were allowed to see patients directly. Thereafter, the Ministry of Health revised the National Health Insurance regulation, and required the above departments to see patients only with referral. This study was done to analyze whether the revision has contributed to providing adequate specialized medical services and to know what role family physicians can assume under revision by analyzing the referred patients. Methods : From November 1998 to June 2000 and from July 2000 to February 2002, both 20 months, we reviewed the charts of 331 patients who were referred from family medicine department of KHMC (Kyung Hee Medical Center) to the above four departments and analysis has done. Results : During both periods, the number of cases increased from 94 to 237, and the patients group had no significant difference in age and sex. Reviewing the number of referred cases, before revision, cases were concentrated to the department of ENT and to PMR. After revision, cases were evenly distributed in three departments. except for PMR. Reviewing referral contents, the three departments except for dermatology showed no significant difference. Conclusion : The sum of cases increased by 2.5 times, but the three departments except for dermatology showed no significant difference in referral and diagnosis content. In dermatology, the majority of the patients wanted a referral with the objective of obtaining a referral paper. Therefore, we can consider that the revision didnot contribute to specialized medical services. But after revision, referral cases to ophthalmology and dermatology increased by 4 and 6 times. We recommend that family physicians know and experience more about these.
In early May 2003, a small group of four, including three family physicians and a media person, visited various family medicine education and training facilities in Edmonton, Alberta, Canada. This paper is a brief discussion of what knowledge and insight was gained during this trip.
Background
: Hypertension is a main cause of heart blood vessel disease. To diagnose and treat hypertension, it is necessary to measure blood pressure accurately. There are various factors that influence blood pressure. According to real clinical demonstrators and some recent studies, blood pressure differences between right and left arms are often observed. This study was intended to know whether the differences are really found and wheather the correlation exists between mid-arm circumferences and the blood pressure differences according to right-handed or left-handed which were considered as an important factor in affecting blood pressures. Methods : One hundred sixty nine college freshmen of year 2001 were chosen. Among them, 103 were right- handed and 66 left-handed. Which arms to be checked first were determined randomly. This sequence was repeated two times on each person. Their mid-arm circumferences were measured, also. Results : For right-handed persons, systolic blood pressure in right arm (119.2±12.3 mmHg) was significantly higher than in left arm (118.0±12.0 mmHg) (P＜0.005). But diastolic blood pressure differences between right arm (75.3±10.0 mmHg) and left arm (75.0±9.5 mmHg) was not significant statistically. For left-handed persons, systolic blood pressure was 120.3±9.9 mmHg in right arm and 120.0±10.3 mmHg in left arm. However, diastolic blood pressure in right arm (76.7±9.4 mmHg) was significantly higher than in left arm (75.0±8.6 mmHg) (P＜0.005). For right handed persons, their arm circumferences (26.2±2.8 cm) were significantly thicker than left ones (25.9±2.9 cm). For left-handed, left arm circumference (25.9±2.7 cm) was significantly thicker than right one (25.5±2.6 cm). As for the blood pressure difference in arm tested order, the first measured systolic blood pressure (right arm; 120.9±11.7 mmHg, left arm; 120.0±11.9 mmHg) was significantly higher than the second measured one (right arm; 118.3±11.8 mmHg, left arm; 117.8±11.6 mmHg) (P＜0.005). However, the first measured diastolic blood pressure (right arm; 76.3±10.5 mmHg, left arm; 75.5±9.4 mmHg) did not have more significance than the second measured one (right arm; 75.4±9.9 mmHg, left arm; 74.6±10.8 mmHg). Conclusion : The right-handed person's blood pressure was higher in the right arm, but for the left-handed persons it was not significantly different in both arms. The second measurement of blood pressure was lower than the first measurement in both arms. The arm circumference depending on the right/left-handedness influenced the blood pressure, but clear correlation between them was not observed. Therefore, if possible, when the blood pressure is measured, it is advised to check blood pressure in both arms before diagnosing hypertension.
Background
: The second version of the Arthritis Impact Measurement Scales (AIMS2) is an improvement on an evaluation instrument that was developed to measure patient outcome in the rheumatic diseases. The goal of this study was to validate a translated version of the revised and expanded Arthritis Impact Measurement Scales (AIMS2) to be used by Korean patients with osteoarthritis (OA) of the knee. Methods : The AIMS2 was translated into Korean according to a recommended translation guideline. The Korean version of AIMS2 (K-AIMS2) was administered to a cohort of 239 outpatients with symptomatic OA of the knee who attended 7 participating University Hospitals in Seoul, Ilsan and Taejon. Forty eight patients readministered the K-AIMS2, 7 days after the first visit, to evaluate the instrument's test-retest reliability. After 6 weeks of NS AIDs therapy, 79 subjects were asked to complete a second survey of the questionnaire. Results : The internal consistency reliability of each scale score, as estimated by Cronbach's alpha coefficient, was high and indicated that the components of the scale measured the same construct. The items were all correlated with each other, but there was no redundancy; this indicated that each domain addressed a somewhat different aspect of functional disability. The test-retest reliability equalled or exceeded 0.86 for 12 scales. Factor analysis provided a three-factor health status model explaining 58.2% of the variance. The upper limb function scales formed the first factor. Psycho-social scale were loaded on the second factor. Arthritis pain together with physical scales for mobility level and walking and bending were loaded on the third factor (the lower limb function). The scale for support from family and friends was not loaded on any factors. These results demonstrate that the physical health status scales of the K-AIMS2 are valid, as shown by the significant, moderate to high correlations between the K-AIMS2 subscales and the majority of the clinical measures. Conclusion : Our data suggest that, like the original questionnaire, the Korean version of AIMS2 is a reliable, consistent and valid instrument for measuring health status and physical functioning in patients with OA of the knee.
Background
: Hearing impairment is one of the most common physical handicaps of the aged. This diseases has recently attracted such amount of social attention and understanding as never attracted several years age, and high degree of achievement was made with regard to screening test method, diagnosis, treatment and rehabilitation. However, unfortunately, even now, not enough attention is being paid upon early discovery hearing handicap for patients frequently encountered in clinics. Therefore, as a screening test method of senile hypacusis, we were to apply "Hearing Handicap Inventory for the Elderly - Screening Version" (HHIE-S) inquiries in Korea and studied the usabulity, sensitivity, specificity, positive predictive value and negative predictive value and cutoff point of this method. Methods : This study was performed for 120 persons over the age of 60, who visited general health screening centers of one university hospital located in Seou, during the period of October 1996 through to March 1999. HHIE-S questionnaires were used and pure tone audiometry was performed to generate gold standard. Results : Only 119 out of 120 initial subjects were included in the study because of incomplete questionnaire answers by excluded 10 subject. We defined gold standard of hearing handicap to be ⑴ lower than 30 dB of hearing capability of both ears to frequency between 1000 Hz and 2000 Hz or ⑵ lower than 40 dB of hearing capability of an ear to frequency between 1000 Hz and 2000 Hz, as determined by pure tone audiometry. Assuming cutoff point of HHIE-S as 4 points, the sensitivity and specificity resulted to bo 80%, and 67% each. Assuming cutoff point of HHIE-S as 6 points, the sensitivity and specificity were 76% and 78% each. At 8 points, the percentages were 64%, and 80%, At 10 points, the percentages were 64% and 85%. As a result of this study, the appropriate cutoff point is 6 points. In order to specify the correlation between questionnaire result and pure tone audiometry, we performed 500 Hz, 100 Hz and 200 Hz audi-ometry which are within conversational range, calculated arithmetic mean from the results, and inspected correlation between the resultant mean of the better performing ear and questionnaire resultant points. The correlation coefficient was 0.612 and Chronbach's alpha, as a measurement of internal consistency of the questionnaire was 0.9044. Conclusion : HHIE-S proved to be useful in screening hearing handicap in the Korean elderly.
Background
: Categorial rating scale about pain intensity has been used in many studies without any validation. So we tried to score the pain intensity of phrases which Koreans commonly use for description of pain intensity, and developed categorial rating scale about pain intensity. Methods : After gathering the phrases which Koreans commonly use for description of pain intensity, the authors selected 23 common phrases. For the each 23 phrase, we asked 69 outpatients at a family Medicine clinic and 76 hospital employee to check on the visual analogue scale according to the intensity. To estimate the reliability of the answers, we asked them to respond to the same questionnaire two weeks later. Results : Of 145 people interviewed, 63 were male and 82 were female. We found out the absolute pain intensity of 23 phrases. Then we could present 5 point categorial rating scale and 4 point categorial rating scale. Correlation coefficients of two weeks test-retest were from 0.355 to 0.570, which were all statistically significant. Conclusion : We developed 5 point categorial rating scale and 4 point categorial rating scale which can be used for evaluation of Korean's pain intensity.
Background
: Accidental fall is a major risk factor of hip fractures in the aged. Recently Tai chi exercise is reported to reduce the frequency of falls in the American elderly. This study was to evaluate the effects of Tai Chi exercise on equilibrium in the Koreas elderly. Methods : we selected 4 clubs for the elderly in the same district. The elderly(11 men, 9 women) who attended two of the clubs were offered Tai Chi(9 basic forms) exercise and the elderly(4 men , 21 women) who attended the other two of them were offered regular medical examination. Intervention length was 12 weeks, with outcomes measured before and after intervention. Results : In men, single left leg standing with eyes open improved in Tai chi group as compared with non-Tai chi group(p=0.026). In women, single right leg standing with eyes open improved in Tai Chi group as compared with non-Tai Chi group(p=0.023), and single left leg standing with eyes open showed improvement in Tai Chi group as compared with non-Tai Chi group(p=0.085). MMSE-K showed improvement in Tai Chi group as compared with non-Tai Chi group, but it was not significant(p>0.05). Those who said these 9 basic forms were not difficult were 81.8% in men, 77.8% in women. Conclusion : '9 basic forms of Tai Chi' is easy to practice and helpful for equilibrium in the aged. The effect of 9 basic forms of Tai Chi on cognition of the aged needs further studies.
Background
: Hypertension is an important as well as common disease in primary practice, so family physicians should concern about it. It is well known that if hypertension were well controlled, it could lower cardiovascular complications. However, there are few studies on the impact of hypertension affecting the quality of life. Therefore, we carried out this study to compare the quality of life in the hypertensive patients by whether it is well controlled or not. Methods : The authors surveyed the quality of life using the questionnaire named as CMC Health Survey Version 1.0 for the hypertensive patients. The subjects had no complications and no other diseases, and aged 40 or more, and visited doctors at the Department of Family Medicine, Kyung-Hee University Hospital or the Department of Internal Medicine, Sungmin Hospital from May 1 to Aug 31, 1998. We categorized the subjects into the two groups of the well-controlled group(SBP<140mmHg and DBP<90 mmHg) and the uncontrolled group(SBP≥140mmHg or DBP ≥ 90mmHg) and compared the quality of life and lifestyle. Results : The total number of subjects was 119, that of well-controlled group was 69, and that of the uncontrolled group was 50. Mean systolic and diastolic blood pressure was 133.1±7.5mmHg and 85.3±5.2 mmHg in the well-controlled group, 159.2±7.4 mmHg and 100.2±5.5 mmHg in the uncontrolled group. The comparison of the distribution of age, sex, education, occupation, and monthly income between the two groups showed no difference. The comparision of the lifestyle between two groups by Alameda-7 questionnaire showed no difference, too. As for the comparison of quality of life between two groups, the well-controlled group had significantly higher scores in the domain of physical function, social function, general health, vitality(above P<0.01), emotional function, role limitation, and health perception(above P<0.05) than uncontrolled group. However, the scores of the domain of change in health, satisfaction, bodily pain were not significantly different between two groups. After covariated by obesity, the comparison of quality of life between two groups showed similar results. Conclusion : We confirmed that the well-controlled group had better quality of life than the uncontrolled group. So family physicians should consider the quality of life when they consult the patients with hypertension.
Background
: Though many adolescents are suffering from depression in Korea, there have been few studies about the prevalence of it and depressive adolescents are not managed appropriately yet because of ignorance of the society and family. This study was intended to find out college freshmen's prevalence of depression, and the relationship between family function and depression. Methods : The subjects were college freshmen of one university both in Seoul and Suwon and the study period was from January to February, 1999. Family APGAR was used as a family function index Beck's Depression Inventory (BDI) was used to measure the degree of depres-sion. Chi square tests and logistic regression were done for analysis using SPSS 8.0/PC program. Results : The prevalence of depression among college freshmen was 1.5% (37 out of 2465) as of BDI score 21 or more. Depression was more common in the families with low Family APGAR score and those in Suwon campus. No significant differences were found in gender, age, blood pressuere, blood type, BMI, present illness, number of families, marital status of parents or siblings. Relative risks of depression were 4.5 times for family dysfunction group and 2.6 times for Suwon campus group. Conclusion : Depression is not a rare disease among college freshmen. Therefore, family physician as a primary care physician should consider the possibility of depression among adolescence and screen depression using BDI for adolescents in dysfunctional family particularly.
Background
: The elderly is known to have many different clinical laboratory data compared with the young adults. There have been rare studies comparing tumor markers and rheumatoid factors between young adults and the elderly in Korea. This study was conducted to evaluate the differences in tumor markers and rheumatoid factor between elderly and young adults. Methods : We gathered 94 healthy elderly cases and 91 healthy young adults who have taken periodic health examination from November 1996 to February 1997 at one hospital. We compared the mean of rheumatoid factor and tumor markers between two groups and took multiple regression analysis. Results : In the elderly, the mean of CEA and AFP are significantly higher than young adults. The number of abnormally elevated rheumatoid factor is significantly higher in elderly group, but in case of CEA the number of abnormal data is not significantly different. The CEA level is significantly high in smoker group than non-smoker group. The factors that increase the CEA level are old age, smoking amount, albumin level. The factors that increase the AFP level are old age, hemoglobin level. The factor that increase the rheumatoid factor is old age only. Conciusions: When we interpret the level of tumor markers and rheumatoid factor, we must consider the patient's age. Aging is a factor that is associated with CEA, AFP, rheumatoid factor.
Background
: Hepatitis B is a world widely distributed disease. The hepatitis B prevalence of South East nations is reported to be higher than that of America or Europe. Korea is known to be one of high prevalent nation among Asia-Pacific nations. But hepatitis B prevalence in North Korea, separate from South Korea due to politics and ideology, is not reported. This study was performed using the data of North Korean defectors to estimate the prevalence of hepatitis B in North Korea. Methods : We analyzed the data of 107 persons (98, males, 9 females) who defected from North Korea and underwent screening examination in a general hospital from July 1987 to March 1996. Twenty nine persons(25 males, 4 females) were excluded because of incomplete data. The HBsAg test was carried out by reversed passive hemagglutination(RPHA) and the anti-HBs test was carried out by passive hemagglutination(PHA). The liver function tests were carried out by biochemical quantitative analysis method of Dimension. Results : The study group was 73 males(93.6%) and 5 females(6.4%). Mean age was 33.0±8.4 years and third decade was the largest as 35 persons(44.9%). The overall HBsAg positive rate was 15.4% and anti-HBs positive rate was 33.3%. Those who need vaccination were 51.4%. The only item among liver function tests which was statistically different by the hepatitis B viral marker groups was alkaline phosphatase. Mean total cholesterol was 176.4±38.0mg/dL. But no other item of liver function tests was statistically different in abnormal value by the hepatitis B viral marker groups. Conclusion : The overall HBsAg positive rate of North Korean defects was much higher than that of South Korean and anti-HBs positive rate was much lower. So HBsAg positive rate of North Korean seems to be higher than that of South Korean. We think that a large study of hepatitis B for North Korean should be performed at y opportunity and take a measure to meet the situations. ( J Korean Acad Fam Med 1999;20:1778-1783)
Background
: The purpose of this study is to investigate the correlations between distal radius BMD and other skeletal site(L2-L4, Femoral neck, Ward's triangle, Trochanter) BMD's, and to find out the usefulness of DTX-200. Methods : The authors surveyed the subjects of 76 perimenopausal women who had visited Kyu-nghee Medical Center and measured their bone mineral densities(BMDs) from February, 1997 to July, 1997. Measurements were done for distal radius, ultradistal-8mm radius BMD using DTX-200(OSTEOMETER, Denmark), and other skeletal sites(L2-L4, Femoral neck, Ward's triangle, Trochanter) BMDs using EXPERT(Lunar, USA). Using SPSS for windows, the correlation coefficients of the BMDs of both instruments were calculated. Results : The total number of subjects were 76 (average age:54.8 years, range 32~78years). Among them, 67 were postmenopausal women. The BMD measurements of various skeletal sites were as follows : distal radius, 0.41±0.07(g/cm²), ultradistal-8mm radius 0.34±0.07(g/cm²), femoral neck 0.82±0.18(g/cm²), trochanter 0.72±0.17(g/cm²), Ward's triangle 0.59±0.22(g/cm²), L2-L4 0.98±0.16(g/cm²). The correlations of BMDs between distal radius and femoral neck, trochanter, Ward's triangle, and L2-L4 were 0.44, 0.35, 0.47, and 0.63, respectively. The correlations of BMDs between ultradistal-8mm radius and femoral neck, trochanter, Ward's triangle, and L2-L4 were 0.64, 0.34, 0.41, and 0.69 respectively. Conclusion : The correlations of BMDs between distal radius and those of femoral neck, trochanter, Ward's triangle, L2-L4 were moderately high.
Background
: The elderly is known to have physiologic electrocardiographic changes with aging. But in Korea, such study is rare. Methods : We investigated the residents in a community about past history of disease and current medications. Also we checked electrocardiography for those who were thought to be healthy. Results : The elderly(≥60 year old) were 66 persons, and the young adults(<40 year old) were 8 persons. Mean QRS axis in the elderly was 37.7°, and it was significantly deviated to the left compared with that(63.8°) in the young adults(P<0.05). Mean T amplitude of V6 in the elderly was 3.47mm, and it was to some degree shorter than that(4.81mm) in the young adults(P=0.063). But pulse rate, PR interval, QRS duration, amplitude of R1, R6, S1 were not different between the elderly and the young adults. Conclusion : Mean QRS axis in the elderly was significantly deviated to the left compared with in the young adults. And the mean T amplitude of V6 in the elderly was to some degree shorter than in the young adults.
Background
: It is necessary for most effective treatment of neoplasms to detect it in early stage. For the purpose we use many screening tests currently, however, the tumor marker have many limitations as a screening test for neoplasm. Nevertheless most of Hea-lth screening centers are using CEA as a screening test for neoplasm. So, we began this study for the assessment of validity of CEA as a screening test for neoplasm. Methods : The subjects were 4265 persons who visited Health screening center of Kyung-hee Medical Center from July 1995 to June 1996. The number of elevated CEA among the subjects was 156. We evaluated the frequencies of factors known as etiologies of in-creased CEA. We followed up whether neoplasms were developed in normal CEA group. Through the random sampling of normal CEA group, 391 subjects were obtained for statis-tical analysis by SPSS/PC+. Immunoradiometric assay kit of Eiken company was used for gauging CEA level and normal level was less than 2.4ng/ml according to manual of manu-facturer. Results : There was no significant difference of CEA according to sex, age. The factors that significantly affect CEA were neoplasms, chronic lung disease, liver cirrhosis. In this study, smoking, hypertension, diabetes mellitus, fibrocystic disease, chronic renal failure, al-cohol drinking, hepatitis, peptic ulcer disease known as etiologies of elevated CEA in other studies did not show statistical significance. 9 cases of neoplasms were developed in both elevated CEA and normal CEA group during follow up. In former, 4 cases of 9 neoplasms were early stage. In latter, all cases were stage IV and inoperable. Specificity and sensitiv-ity of CEA were each 96.5%, 50.0%. Positive & negative predictive value of CEA were each 5.8%, 99.8%. Conclusion : CEA was increased in various benign conditions and even if any neoplasm exists, CEA was not elevated in most of all in early stage. Is showed high false positive rate and low sensitivity. Thus, this study showed that it was not valid to use CEA as a screening test for early detection of neoplasms.
Background
: The elderly is known to have many different clinical laboratory data compared with the young adults. But, in Korea, such study is lacking. Methods : We gathered 98 healthy elderly cases and 98 healthy young adult controls who have taken periodic heath examination from January 1993 to May 1996 at one hospital and we compared the mean of various clinical laboratory data between the two groups. Results : In both sexes, cholesterol, ESR, glucose were significantly higher in the elderly than in the controls and direct bilirubin was significantly lower in the elderly than in the controls(P<0.05). In men, albumin, calcium, hemoglobin were significantly lower in the elderly than in the controls and MCV was significantly higher in the elderly than in the controls(P<0.05). In women, alkaline phosphatase, LDH, triglyceride, GOT, GPT, T₃, TSH, phosphate were significantly higher in the elderly than in the controls and total bilirubin, protein, uric acid were significantly lover in the elderly than in the controls(P<0.05). WBC count, platelet count, neutrophil count(%), lymphocyte count(%), eosinohpil count(%), monocyte count(%), MCH, MCHC, BUN, creatinine, HDL were not significantly different between two groups. Conclusion : Many clinical laboratory data are different between the elderly and the young adults, and some clinical laboratory data have sexual differences.
Background
: In recent years, the issue of body image merger because of need for detail approach to managing obesity. Body image is the mental image one gas of one's body and studies suggets that perceptual distortions may result in wrong health behavior such as over-dieting and over-dieting and over-exercise. This cross-sectional study was attempted to find factors affecting body image distrotion. Methods : From July 1995 to December 1995, data were collected from 332 subjects who visited two university hospitals for medical examination. Educational level and Zung's self depression scale data were collected by questionnaire and body image was assessed by asking subjects' perceived actual body somatotypes. Results : When body image was stratified with sex, age, educational level, height, weight, BMI, SDS score, weight, BMI and SDS score were significantyly associated with body image distortion. When body image distortion group was sepatated into negative body image group and positive body image group, negative group subjects were significantly lighter than normal body image group subjects and positive group subjects were significantly heavier than normal body image group subjects. Odds ratios of BMI, SDS, weight for body image distrotion were 2.45(2.08-2.80), 0.45(0.30-0.88), 0.97(0.58-1.36). Conclusion : Body image distortion was significantly associated with BMI and SDS score. but the clinical implication must be validated.
Background
: As modern epidemiologic studies began to identify obesity as a risk factor for cardio-vascular disease diabetes, hypertension, and cancer, measuring the degree of excess body fat s important on primary health care. The evaluation of obesity level in outpatient clinic setting has been mostly done by measuring patient's height and weight. But, the anthropomentry could not be done to all visitors of clinics as well as to responders of epidemiologic survey. This study was attempted to develop a new instrument for evaluating the level individual obesity in outpatient clini setting in Korea. Method: For assessing validity of the instrument, questionnaire study and measurement of sta-tus/weight was done to new visitors of clinic. Two weeks later, questionnaire retest was done by using same instrument for assessing reliability. Results : The data were collected from 140 subjects of 20 years of age and older. When the validity was measured through correlation with Body Mass index(kg/M²), Spearman's correlation coefficient(r) was 0.79(P<0.001), that reliability of instrument using test-retest method was demonstra-ted(r=0.905). Conclusion : Quick instrument using somatotype drawing are applicable to screen degree of body fat in outpatient clinic setting in Korea.
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
: 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.
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