| Tae Woo Yoo | 14 Articles |
Background
Metabolic indexes (blood pressure, blood glucose, and lipid) differ depending on lower or upper normal value of obesity indexes (weight, percent-body-fat, and waist circumference) despite normal value. Therefore, we examined metabolic indexes changes across obesity indexes changes. Methods: We analyzed 344 adult men who received routine-checkups with normal weight and waist circumference before and after follow-up. We used multiple-linear-regression to examine associations between changes of obesity indexes and metabolic indexes before and after follow-up. We examined differences of metabolic indexes by t-test and odds ratios of normal or abnormal metabolic indexes by multiple-logistic-regression in groups where obesity indexes were increased and decreased.Results: The mean follow-up was 1.38 ± 0.32 years and there were associations between weight change rate and changes in systolic-blood-pressure (SBP), diastolic-blood-pressure (DBP), triglyceride (TG), and high–density-lipoprotein (HDL) (P = 0.001, 0.03, 0.001, 0.01), associations between percent-body-fat change and changes in SBP, DBP, fasting-blood-glucose (FBG) and TG (P = 0.02, 0.002, < 0.001, 0.03), and associations between waist circumference change rate and changes in FBG, TG, HDL (P = 0.01, 0.01, 0.02). There were significant SBP and HDL differences in weight decrease and increase groups (P = 0.04, < 0.001), FBG difference in percent-body-fat decrease and increase groups (P = 0.01), and FBG and TG differences in waist circumference decrease/increase groups (P = 0.03, 0.03). As compared with percent-body-fat decrease group, percent-body-fat increase group had odds ratio of FBG ≥ 100 of 2.98 (95% confidential interval [CI], 1.18 to 7.51) with a significance on only FBG of initially normal metabolic components and conversely percent-body-fat decrease group had odds ratio of FBG < 100 of 3.22 (95% CI, 1.21 to 8.60) with a significance on only FBG of initially abnormal metabolic components. Conclusion: Increased obesity indexes even within normal range, could change metabolic indexes.
Background
Lifestyle is an important risk factor for many diseases. We need to educate medical students for advocating health promoting behaviors to their patients. Teaching knowledge, however, was not enough for medical students to change their health-related lifestyle. In this study, we investigated health promoting behaviors of medical students, and the improvement of their health behaviors after competitive lifestyle modifi cation program.Methods: All sophomores of medical college in Seoul National University were included in this study. We performed lifestyle modifi cation program consisting of lecture, group competition, and feedback. We focused on reforming health behaviors like smoking, drinking, exercise, stress management and eating habits. And we also checked common symptoms of functional diseases, medication frequency for relieving these symptoms and general life satisfaction.Results: After 2 months of lifestyle modifi cation program, the obese (P = 0.0455) and the average value of BMI (P < 0.001) were decreased and two of smokers quitted smoking. Numbers of medical students with health related habits such as regular exerciser (P = 0.027), frequent user of symptom-relief medication (P < 0.001), breakfast skipper (P = 0.005) were signifi cantly changed in positive way, and the average value of general life satisfaction score (P = 0.003) was improved.Conclusion: Lifestyle modification program improved medical students' health habits and enhanced general life satis-faction. Citations Citations to this article as recorded by
Background
: Depression appears by major disease entity itself but also by physical symptoms frequently and often accompanies with many other diseases. Therefore patients who tend to ignore emotional factors visit to primary care only with additional symptoms. Primary physicians recommend to investigate for somatic diseases but the results are not significant because depression os missed. Identification of depression which appears as physical symptoms is a major role for primary physicians, because they can provide adequate medical care and can relieve the additional symptoms. The purposes of this study are measurement of frequency of depression in primary care and investigation of symp-toms this study are measurement of frequency of depression in primary care and investigation of symp-toms and diseases that are correlated with depression. Methods : Study subjects were all of first-visit patients to Department of Family Medicine, Seoul National University Hospital from May 8th to June 10th, 1995. We investigated depression by Beck Depression Inventory and also demographic characteristics(sex, age, education, marital status, occupa-tion) was collected. Medical charts of responders was audited to collect all registered symptoms and diseases, and we investigated correlations with BDI scores. Adjusted correlations of symptoms and diseases with BMI scores were calculated by ANCOVA, Cut-off value of BMI scores was adopted with 16 points which was reported that false negative rate was minimal in clinical setting. Results : The response rate was 77.8%(207/266) and patients who had BDI score 16 or over were 14.4% of men and 38.5% of women. The prevalence of all depressive tendency was 28.0%. Symptoms which had significant demographic characteristics-adjusted correlations with BDI scores were total number of symptoms, anxiety, fatigue, chest discomfort, weight loss, peripheral tingling sense, general weakness, indigestion, skin lesion, multiple pain. Diseases correlated with BDI scores were anxiety disorder, adjustment disorder, tension headache, panic disorder, anxiety/depression, depression, FGID, hypertension and total number of diagnoses. Conclusion : The results of the study were that the rate of diagnosis of depression was relatively low(6.8%) than the higher frequency of depressive tendency and total number of symptoms was significantly correlated with depression(p=0.0001). Theses symptoms and diseases and used as predictors for depression in primary care.
Background
: Stroke is the second common cause of death in Korea. It may cause severe and irreversible damages to human health. Risk factors and prevention of stroke have been interested by many physicians and patients. There are many studies about rick factors of stroke in the world. but there are no reliable epidemiologic studies abut risk factors of stroke in Korea. So this study was designed to investigate the risk factors of cerebral infarction. Especially, we focused on the lipid profile in cerebral infarction. Methods : 102 cases were selected among patients who confirmend by Brain CT of MRI as cerebral infarction at one University Hospital and one City Hospital. Age-sex matched 102 patients, who were not diagnosed as stroke by CT or MRI, were selected as a contral group. Information was taken by charts review. Adjusted odds ratios for individual risk factors were calculated by multiple logistics regression anaysis. Results : Average total cholesterol level was 216.1mg/dl in the case group and 190.7mg/dl in the control group. A patient who had cerebral infarction had almost 2.5 times more likely to have hypercho-lesterolemia(cholesterol>200mg/dl) than a patient who did not have a stroke(adjusted odds ratio is 2.48, 95% confidence interval, CI : 1.27~4.8, p<0.01). HDL-cholesterol average was 39.4mg/dl in the case group and 46.6mg/dl in the control group. A patient who had cerebral infarction had almost 0.5 times more likely to have not hypoHDL-cholesterolemia(HDL-cholesterol<35mg/dl in male, HDL-cholesterol<45mg/dl in female) than a patient who did not have a stroke(adjusted odds ratio is 0.46, 95% CI:0.23~0.92, p<0.05). LDL-cholesterol average was 147.8mg/dl in the case group and 114.5mg/dl in the control group. A patient who had cerebral infarction had almost 3.1 times more likely to hane hyperLDL-cholesterolemia(cholesterol>130mg/dl) than a patient who did not have a stroke(adjusted odds ratio is 3.07, 95% CI:1.59~5.96, p<0.01). Triglyceride average was 144.4mg/dl in the case group and 149.0mg/dl in the control group. There was not statistically significant diference between two groups. In concerning with other risk factors, obesity was not statistically significant risk factor. Hypertension and Diabetes Mellitus were statistically significant(two p-value are all less than 0.01). Its adjusted odds ratio were 5.24(95% CI:2.8~10.22) and 5.32(95% CI:2.14~13.21) Conclusion : Hypercholesterolemia, HypoHDL-cholesterolemia, hyperLDL-cholesterolemia, Hyper-tension, and Diabets Mellitus were significant risk factors for cerebral infaction. But Triglyceride and Obesity were not statistically signficant risk factors.
Background
: Non-compliance with long-term pharmacologic treatment is an important cause of inadequately controlled high blood pressure. A self-reported questionnaire on medication compliance has already been tested in two specialized outpatient clinics in USA and validated. However, a method of identifying noncompliant patients that is easy to apply has not been in practical use in our country. The purpose of this study was to test and validate a Korean version of the questionnaire in a family pracice setting. Methods : We recreited a sample of diagnosed hypertensive outpatients receiving care in a family medicine unit July and september 1994(N=108). After measuring the blood pressure and administering the questionnaire, we tested the questionnaire against blood pressure control for which JNC V criteria was used. Results : Fifty-five subjects give an affirmative answer to the first question, about forgetting medication, while a much smaller number of subjects to the 2nd, 3rd, and 4th questions. Fortyfour patients answered no to all four questions. About sixty percent answered yes to one or more questions. The questionnaire's reliability was tested with Cronbach's alpha (0.18) Concurrent validity of the questionnaire is followed: sensitivity=76%. The sensitivity for the first question is 63% and the specificity is 67%. Conclusion : The self-reported quesionnaire of korean version has been shown to be useful in monitoring compliance to hypertension drug treatment. In the clinical setting, asking patients only the first question instead of all four questions will produce similar results. But further studies will be needed because the questionnaire's reliability was too low.
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
: 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
: 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
: 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
: Recent studies reported that doctors of different specialty use different diagnostic and therapeutic methods to the same clinical conditions. Though this difference has significant influence on the quality and cost of medical care, study about this problem was never been done in Korea. Methods : The diagnostic methods of third year residents in family practice(N=6) and internal medicine(N=6) were compared with respect to "functional gastrointestinal disorder(FGID)", common ambulatory patient problem. One "standardized patient" was presented. Results : Analysis of the recorded interviews showed that family practice residents took more medical history(p<0.05), ordered more laboratory investigations(p<0.05). There was no difference in the selection of physical examination items. There was difference in the diagnosis reached by these two groups. Six family practice residents diagnosed FGID. In an analysis of the "commonness" of questions asked by internal medicine residents and family practice residents, it was found that internal medicine residents used more common questions. Conclusion : There were some significant differences in diagnostic and therapeutic strategies between internal medicine and family medicine residents. These findings have implications for the future training of primary care physicians.
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.
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