Smoking and tobacco addiction are serious public health problems worldwide. New research reveals that addiction to tobacco can begin very early, with very low levels of smoking. Family physicians are in a unique position to prevent smoking initiation by youths and to diagnose and treat tobacco addiction in young smokers. In this paper we discuss the factors that prompt youths to try smoking, how quickly addiction to tobacco begins after the onset of smoking, how a family physician can determine whether a young patient is addicted, and what the physician can do to prevent adolescent patients from beginning to smoke or to assist them to quit if they already smoke.
Generalized anxiety disorder (GAD) is highly prevalent psychiatric disorder in primary care population and is a source of major morbidity. However, the underawareness and undertreatment of GAD, which is due to insufficient knowledge about the disorder, often hinder the proper management of this chronic condition. Other characteristic features such as chronic course of GAD, frequent comorbidity with other anxiety and depressive disorders, and the controversy regarding the best diagnostic criteria should be fully discussed. First of all, proper and accurate diagnosis is crucial for an appropriate management. Primary care management of GAD and associated comorbidities includes education about the nature of GAD and counseling about treatment alternatives and coping strategies is an important first step. The most effective treatment of GAD is combined psychotherapeutic and pharmacotherapeutic approach. The major psychotherapeutic approaches to GAD are cognitive-behavioral therapy with relaxation techniques. Pharmacological treatment for GAD includes benzodiazepine, buspirone, and antidepressants. In this review, these combined treatment at the view point of primary practitioners was described.
Stress can be defined generally as reponses to stressors on the body or in a definition more focused on the central nervous system, it can be defined as alterations in neuropsychological homeostatic processes. There is a psychological aspect to stress, related to issues such as memory, emotion, arousal, and also a biological aspect which included activation of specific brain and endocrine circuits. This article reviews a series of neurobiological mechanisms aimed at understanding what are pathways by which stress is perceived, processed, and transduced into a neuroendocrine response. Multiple brain structures are involved in the organization of responses to stressful stimuli. Among them the hypothalamus, septohippocampal structures, amygdala, cingulate and prefrontal cortices, hindbrain regions such as the brainstem catecholamine cell body group (A2/C2 cell groups in the nucleus of the tractus solitaris; A1/C1 cell groups in the ventrolateral medulla; A6 cell groups in the locus ceruleus), the parabrachial nucleus, cuneiform nucleus, and dorsal raphe nucleus are prominent structures. We reviewed with the focus on the classic stress circuits: the limbic-hypothalamic-pituitary-adrenal axis (LHPA) and locus ceruleus-norepinephrine (LC-NE) system. Our review indicates that the LHPA stress circuit and LC- NE system are the complex systems with multiple control mechanisms and that these mechanisms are altered in pathological states, such as chronic stress and depression. The holistic features described in this reviews can provide insight into the nature and location of brain circuits and neurotransmitter receptors involved in stress and the treatment of stress-related disorders.
The recent announcement by the Korean Educational Development Institute (KEDI) took many by surprise. According to the KEDI, unlike general literacy rate, reading literacy rate (38%) among Koreans which is an individual's ability to understand the information we face on daily base such as directions on prescribed medication ranked at the bottom of all Organization for Economic Cooperation and Development (OECD) member countries. If we accept it as it is, it raises serious questions about Koreans' abilities to read, comprehend, and process necessary information required of functioning properly in the society. Furthermore since the information we get in the medical settings is usually more difficult to understand than other basic information we face in our daily lives, it may be assumed that health illiteracy among Koreans could be much higher and that the ramifications of it would be very much costly. Despite this seriousness of the reading illiteracy among Koreans, to the best of our knowledge, no attempts have been made to address and determine the prevalence of health illiteracy and relate it to the public health educational issue. More specifically, the effectiveness of health education materials has never been analyzed in this regard for the improvement of health education in Korea. The purpose of this article is to introduce a new concept of health literacy to the Korean public by reviewing the existing studies in the West and encourage researchers in the public health education field to look at the concept of health literacy as one of the possible strategies to design and develop more effective health education campaigns in Korea.
Considering the proportion of the elderly among the total population, prevalence of dementia in the group, and social burden for the management of demented patients, dementia must be a public health problem. Neuroscience, which has made an incredible advance applicable to neuropsychiatry during the last few decades, contributes much to gaining new insight into pathophysiology of dementia as well as to its treatment. The early diagnosis of dementia is increasingly important for these reasons. However, it is controversial which of 1) population screening of the elderly, 2) targeting high risk groups, and 3) identification of the elderly with possible mild cognitive impairment is best one . The screening test on the high risk groups and/or the elderly with possible mild cognitive impairment is recommended for the early identification of dementia, with keeping in mind the dementia prevalence, availability of screening tests, possibility of treatment, and social burden resulting from delayed therapeutic intervention.
It is not uncommon for children and adolescents with learning disabilities to have neurologically based disorders and other associated psychosocial problems. Those children have learning disorder need systematic psychiatric and neuropsychological evaluations for proper managements. Moreover many educational test instruments and special educational literatures use an information processing model for understanding learning and learning disabilities. Any learning disorders can involve more than one area in various dysfunctional processes; input disabilities (visual and auditory perceptions, and other sensory integrations), integration disabilities (sequencing, abstraction, and organization), memory disabilities, and output disabilities (language and motor). Individuals with learning disability require appropriate interventions, whether they are clinical or educational. They must be screened primarily by family physicians, pediatricians, and psychiatrists, and have psychosocial supports for themselves and their family, and then be referred to child and adolescent psychiatrists for optimal treatment planning and multimodal managements.
Obesity is an independent risk factor for cardiovascular disease, hypertension, and diabetes and is associated with several other medical and psychological disorders. Weight loss is known to reduce these risks and to improve or resolve these cormorbid disorders and it is generally assumed that weight loss will improve the health of large people. But there is little research to support this. And no randomized controlled trials have been published to demonstrate that intentional weight loss in the obese actually reduces morbidity or increases longevity. In fact, the large majority of published epidemiological studies show that persons who experience a net loss of weight over time have shorter life spans than those whose body weights remain relatively stable. In addition, many persons who have intentionally lost weight report that they ultimately gain back some or all of the weight they originally lost. For some persons, this pattern of weight loss followed by regain will be repeated over many years of dieting and be exposed to the risk for eating disorders. These findings suggest that our current attitude or assume about weight loss should be challenged or reevaluated. With a culturally determined esthetical ideal and well-documented salutary effects of intentional weight loss on physiological risk factors, dichotomous thinking pattern about weight loss that weight loss is good one but weight gain even weight maintenance above normal is bad one has been prevailing. Therefore, intentional weight loss has been prevalent and intentional weight loss and it's related physical and psychosocial problems may become one of the most common health related issue in Korea. However, the efforts for weight control have been mainly focused on the weight loss rather than weight maintenance without serious consideration about long-term consequences of weight loss. To provide more balanced informations for weight loss and weight control, the authors reviewed the literatures concerning physical and psychosocial effects of weight loss, and effects of weight loss on morbidity and mortality. And we also reviewed the literatures about possible problems that may be resulted by various methods of weight control and discussed what is more appropriate approaches to the weight control.
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