| Hwan Sik Hwang | 17 Articles |
The clinical practice examination (CPX) was introduced in 2010, and the Seoul-Gyeonggi CPX Consortium developed the patient-physician interaction (PPI) assessment tool in 2004. Both institutions use rating scales on classified sections of PPI but differ in their scoring of key components. This study investigated the accuracy of standardized patient scores across rating scales by comparing checklist methods and verified the concurrent validity of two comparable PPI rating tools. An educational CPX module dyspepsia case was administered to 116 fourth-year medical students at Hanyang University College of Medicine. One experienced standardized patient rated exams using two different PPI scales. She scored checklists composed of 43 items related to the two original PPI scales through video clips of the same students. From these checklists, we calculated Pearson's correlation coefficient. The correlations of total PPI score between the checklist and rating scale methods were 0.29 for the Korean Medical Licensing Examination (KMLE) tool and 0.30 for the consortium tool. The correlations between the KMLE and consortium tools were 0.74 for checklists and 0.83 for rating scales. In terms of section scores, the consortium tool showed only three significant correlations between the two methods out of seven sections and the KMLE tool showed only two statistically significant correlations out of five sections. The rating scale and checklist methods exhibited a weak relationship in the PPI assessment, but a high correlation between assessment tools using the same method. However, the current rating scale requires modification by reorganizing key scoring components through factor analysis. Citations Citations to this article as recorded by
Frailty and cognitive impairment are considered the most common and yet least understood conditions in older adults. This study was conducted to investigate the correlation between frailty and cognitive function in non-demented older Koreans. Korean Mini-Mental Status Examination (K-MMSE) scores and Cardiovascular Health Study Frailty Indices were obtained for 486 older adults aged 65 and over who registered at six senior welfare centers in Seoul and Gyeonggi province. Multiple linear regression was performed to identify the association between frailty and K-MMSE scores. Of the 486 older adults, 206 (42.4%) were robust, 244 (50.2%) were prefrail, and 36 (7.4%) were frail. Prevalence of cognitive impairment (K-MMSE ≤ 23) was 6.3% in the robust group, 16.8% in the prefrail group, and 30.6% in the frail group (P < 0.001), and mean K-MMSE score was 27.5 ± 2.2, 26.5 ± 3.1, and 23.7 ± 5.3, respectively (P < 0.001). Frailty tended to be associated with lower MMSE scores (B = -1.92, standard error, 0.52; P < 0.001). Frailty was found to be correlated with cognitive impairment in non-demented older Koreans. However, further cohort studies are required to determine the association between frailty and cognitive function. Citations Citations to this article as recorded by
Background
Platelet has been known as an implicating factor in the pathophysiology of atherosclerotic disease. Larger platelets are more reactive and produce more prothrombotic factors. Several studies have shown relationship between mean platelet volume (MPV) and coronary artery disease. The present study has been designed to investigate association of MPV and subclinical CAD (coronary artery disease; abnormal finding in coronary multidetector computed tomo-graphy [MDCT] in asymptomatic individual). Methods: This cross sectional study was carried out in 103 men and 72 women (over 40 years old) who underwent coronary MDCT as screening test for disease prevention in the health examination center of Hanyang University Medical Center in Korea from January 1 to April 30, 2009. Subclinical CAD was defined when either of the following findings are present in asymptomatic patients: 1) plaque or calcification, 2) stenosis of any level. After adjustment for age, gender, hypertension, diabetes, BMI, smoking (pack-years), LDL cholesterol, odds ratios (ORs) for the prevalence of the subclinical CAD were calculated for quintiles of MPV using logistic regression analysis. Results: After adjustment for age, gender, hypertension, diabetes, BMI, smoking (pack-years), LDL cholesterol, the OR for subclinical CAD, comparing the fifth quintile of MPV with the first quintile, was 5.83 (95% confidence interval, 1.51 to 22.42; P = 0.010). Conclusion: Highest level of MPV is independently associated with the prevalence of the subclinical CAD after adjusting for other risk factors. Citations Citations to this article as recorded by
Background
Aging population correspond with an increase in the numbers of dementia patients. Dementia decreases the quality of life of patients and care-givers. However, current pharmacological treatment is limited by modest efficacy and adverse effect. Nonpharmacological treatment for dementia has been considered to be a substitute treatment. Recently we developed a special planned program for dementia with depression. The aim of this study was to evaluate therapeutic effect of this program. Methods: We included patients aged 65 and older who diagnosed dementia with depression in a geriatric institution from April to June, 2006. We surveyed their sex, age, education period, and histories of hypertension, smoking, and alcohol intake. Patients in experimental group carried out our program, including cooking, painting, recreation, and activity, 9 times for 60 minutes a session. All included patients were checked Korean Mini-Mental State Examination (K-MMSE) and Korean Form of Geriatric Depression Scale (KGDS) before starting program and after 3 months when programs finished. Results: There was no difference in demographic factors between two groups. K-MMSE was significantly improved in experimental group compared with control group (P = 0.01). And, the KGDS was significantly improved in experimental group compared with control group (P = 0.00). Conclusion: Multidivisional program for social skill improvement was effective on treatment for patients of dementia with depression. Nonpharmacological treatment for dementia with depression would be developed and studied to enhance the qualities of life of patients and care of dementia. Citations Citations to this article as recorded by
Background
Sexual dysfunction such as erectile dysfunction (ED) may be a hidden agenda, but, it should be dealt with by family physicians in primary care. We investigated the prevalence of ED and utilization of sexual consultation practice among community family physicians. Methods: We analyzed the subjects who were males aged over 30 and married who visited 10 community family clinics around Seoul, Korea and completed questionnaires related to erectile function and utilization of sexual consultation service from May 9 to 28 2009. ED was designated if the 5-item version of international index of erectile dysfunction (IIEF-5) scores were less than 17. Results: The average age of the responders was 45.6 years. The prevalence of ED was 43.3% and increased according to age, chronic disease, low educational history and low family income. Almost all of the mild ED patients answered that they needed sexual consultation. But, half of them had no plan to have a sexual consultation. Odds ratios (ORs) with 95% confi dence intervals (CIs) for having a sexual consultation or not according to variables were calculated with logistic regression. More severe ED (OR = 0.875; 95% CI, 0.827 to 0.926), existence of chronic disease (OR = 1.828; 95% CI, 1.026 to 3.260), inferior education (OR = 0.395; 95% CI, 0.196 to 0.796), and lower income (OR = 0.326; 95% CI, 0.124 to 0.857) were the factors which infl uenced to have a sexual consultation with a family physician.Conclusion: The prevalence of ED in family clinic was over 40%, but the utilization of sexual consultations was under 50%. We need to develop intervention strategies for more sexual counseling practice according to educational history, family incomes and status of ED in community family medicine clinics. Citations Citations to this article as recorded by
Background
Within a recent few years, the number multicultural families had been increasing rapidly in Korea. This study was conducted to investigate the characteristics of the function of multicultural families and its determining factors.Methods: The study subjects were 68 foreign women who had been married to Korean men and immigrated to Korea. All participants were registered in one of the three migration support centers in South Jeolla Province. They completed a self-administered questionnaire which evaluated the demographic information, FACES III, and the family APGAR scores. We compared their family function with that of the typical Korean families reported in previous articles.Results: Multicultural families were prone to be an extreme family according to the FACES III. Their family APGAR scores were lower compared to those of ordinary Korean families. Family dysfunction of multicultural families as signifi cantly associated with women's age, hometown, education level, the number of family members, and her religion.Conclusion: Multicultural families may show different features compared to typical Korean families. Family physicians needs to be concerned with functional patterns of multicultural families. Further studies should be followed to understand modifi able factors for fi xing dysfunction of multicultural families. Citations Citations to this article as recorded by
Background
After referral system had been established, patients wishing to consult with a specialist with 'self- referral' in mind is increasing in university hospital family medicine clinics. This study was conducted to know whether those by self-referral to a specialist in a university hospital could benefit from family physician's consultation or not. Methods: Three hundred and sixty patients were serially assigned to either 'simple referral' group provided with a referral note without consultation or 'referral after consultation' group with consultation from a family physician. Patient satisfaction was rated by using questionnaires with 5-point Likert scale. Results: Patients in the 'simple referral' group were more satisfied with the whole process of family physicians' consultation compared to the 'referral after practice' group in both the appropriateness and patient satisfaction of the consultation (both, P＜0.001). Males, longer encounter time, and shorter waiting time were significantly influenced patient satisfaction compared to each counterpart. Conclusion: Patients who want only a referral note from a family physician in a university hospital may received some benefit from the coordination and comprehensive care by a family physician. Health delivery system should be rectified according to the consideration of the role of the primary care physician such as a family physician. (J Korean Acad Fam Med 2008;29:325-329)
Amiodarone is a potent antiarrhythmic agent that is used to treat ventricular arrhythmias and atrial fibrillation. But it has a wide range of adverse effects, including pulmonary toxicity, thyroid dysfunction, liver toxicity, gastrointestinal events, corneal deposits, peripheral neuropathy and so on. Patients treated with amiodarone should be followed regularly to assess ongoing need for amiodarone, efficacy of the drug, appropriateness of dosage, adverse effects, and potential drug interactions. We experienced a case of severe weight loss due to amiodarone-induced multiple toxicity after a long course of a low dose therapy. So we report this unusual case with literature review.
Background
: Recently, adolescent smoking has become one of the most serious problems in our society. In this study, we surveyed smoking status, family function by Korean family function assessment tool, history of abuse, and others to know the factors associated with smoking for high school students. Methods : In May 2001, a total of 1,033 students from 2 male and 2 female general high schools located in Seoul were assessed with self-completing questionnaire. Among the total, there were 502 male and 533 female students. Results : The percentage of male smokers was 27.7% and that of female smokers was 14.5%. The percentage of smokers was significantly higher in students with a history of physical abuse, psychological abuse or negligence (only in males) than in students without them. The family function score of the smokers was 127.3±20.3 and that of the non-smokers was 140.3±21.0 in males. The family function score of the smokers was 121.5±17.45 and that of the non-smokers was 140.9±22.1 in females. The family function score of the smokers was significantly lower than that of the non-smokers in males and females. In 6 factors (supportiveness, alienation, closeness, roles, sociality, authority (only in males)) each family function score of the smokers was significantly lower than that of the non-smokers in males and females. Conclusion : Adolescent smoking was associated with family function and history of abuse (physical, psychological and negligence (only in males)).
Background
: Recently, physicians have been challenged to see more patients per office session while maintaining patient satisfaction. We examined the variables related to patient satisfaction with the time spent with physician during office visit. Methods : In the department of family medicine of an university hospital, a trained researcher observed patient visits by VTR and collected additional data using medical record reviews and patient exit questionnaires from July 1 to July 31, 2002 The data was analyzed statistically by SPSS ver11.0/PC+. Results : Visits by 103 patients were observed in this study. Age, functional health status, time of Dr.'s talking to patients and the ratio of Dr.'s talking time to visit length were significantly associated with patient satisfaction (P＜0.05). Sex, marital status, education level, new vs. established patient, reason for visit, visit length, number of problems, number of medications, body mass index, and satisfaction for time spent were not significantly associated with patient satisfaction. According to logistic regression analysis, greater patient satisfaction were associated with better perceived health status, with more ratio of Dr.'s talking time to visit length and with age younger than 40 years. Conclusion : Physician can enhance patient satisfaction during an office visit by spending sufficient time to talk with patients during each visit and should take an interest in elderly patients and patients with multiple problems.
Background
: The study was done to examine the role of long-term diving(5-20m depth) on regional bone mineral density(BMD) in women. Methods : We compared woman divers(n=38) with matched non-diver controls(n=38) according to age, weight, and duration of menopause. BMD(g/cm2)of the proximal femur (femoral neck, trochanter, Wards’s triangle) was assessed by dual-energy X-ray absorptiometry (DEXA, Hologic QDR-1500). Results : There was no significant difference between groups for proximal femur BMD. But in premenopausal group, BMD of divers was higher than controls in femur neck and trochanter (P<0.05). Correlations analysis revealed that body weight of divers was significantly correlated to femoral neck BMD (P<0.05). In multiple regression analysis, menopause and age of postmenopausal divers was a predictors of femoral neck BMD in divers. Conclusion : These result suggest that diving is has osteogenic effect on women.
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
: 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
: 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.
|
|
