| Jae Ho Lee | 21 Articles |
It is important to know the current level of primary care performance in order to evaluate and plan for desirable health policy. We tried to compare patient's assessment of primary (family physician, general practitioner, internist, pediatrician, and general surgeon) and non-primary (the other specialties) care physicians. Study subjects were physicians of primary care clinics in Seoul. The study subject evaluators were Seoul citizens who were selected by a list-assisted random digit dialing sampling method and who had visited their primary care clinic on six or more occasions over a period of more than 6 months as a usual source of care. The modified version of the Korean Primary Care Assessment Tool was used for the evaluation of primary care performance. The data were collected with the aid of a computer-assisted telephone interview system from June 29 to July 22, 2009. The data on 260 individuals were used for analysis. The mean scores of primary and non-primary care physician group were respectively 1.19 and 0.85 in the comprehensiveness domain, 1.00 and 0.83 in the coordination domain, 1.54 and 1.31 in the family/community orientation, and 1.24 and 0.99 as an average of 3 domains above. The scores in the comprehensiveness domain and the average of 3 domains were significantly higher in the primary than in the nonprimary care physician group. Primary care physicians showed superior performance compared to non-primary care physicians in comprehensiveness domain and in the average of comprehensiveness, coordination, and family/community orientation domains. Citations Citations to this article as recorded by
Background
Management of hypertension has been performed mainly in primary care institutions, but hypertension control in population is still unsatisfactory. This study was aimed at finding a strategy to improve health promotion activities in patients with hypertension by exploring the association between health behaviors and quality of primary care.Methods: April to June in 2007, a questionnaire survey of the patients who has a family physician as a usual source of care was conducted for the development of the Korean Primary Care Assessment Tool (KPCAT). In this study, a usual source of care was defined as a physician of the persons who had visited their primary care clinic on six or more occasions over a period of more than 6 months. Of the data collected from 9 private clinics (3 in Seoul and 6 at small cities), cases of the patients who marked on having hypertension were selected. The associations between levels of quality of primary care and socio-demographic characteristics or health behaviors were analysed by Student t-test and chi-square test. Controlling socio-demographic variables, the association between quality of primary care and health behaviors was examined by multiple logistic regression analysis.Results: Among the patients (n = 602) of 9 private clinics who has a family physician as a usual source of care, those who marked on having hypertension were 134. Among 5 domains of the KPCAT, the highest domain in score was personalized care (71.7/100), and the lowest domain in score was coordination function (49.7/100). In patients who gave total average (69.2/100) or more in total primary care score, after adjustment with age, sex, income, education, and duration, odds ratio to have a normal BMI (<25 kg/m2) was 2.53 (P = 0.02), and odds ratio to have a habit drinking an adequate amount of alcohol was 4.32 (P = 0.02). Conclusion: The fact that high-quality primary care was associated with good health behaviors in this study suggests that improving quality of primary care by health care reform can make health behaviors more desirable in patients with essential hypertension. Citations Citations to this article as recorded by
Background
In South Korea, major health care problems have been occurred under the structural background that medical services are mainly provided by private medical institutions. Primary health care, which is very crucial in public health, has been overlooked, and is disorganized and fragmented. In the mean time, health cooperative movement was initiated by local residents and medical doctors to overcome health care problems in 1987. We conducted this study to evaluate the role of health cooperative clinics and obtain lessons for the future primary care policy. Methods: During April to June in 2007, survey was performed by a trained interviewer at the waiting rooms of 3 health cooperative clinics, in the process of development of the Korean Primary Care Assessment Tool (KPCAT). The KPCAT consists of 5 domains (21 items): first contact (5), coordination function (3), comprehensiveness (4), family/community orientation (4), and personalized care (5). Subjects were patients (or guardians) who had visited their health cooperative clinics on six or more occasions over a period of more than 6 months. We compared primary care scores of each domain between members and non-members of health cooperative clinics by student t-test. Effect of having a membership on each primary care domains was examined by multiple regression analysis. Results: Among the participants (N = 100), members of health cooperatives were 48, and non-members 52. Total average scores of 5 primary care domains of the KPCAT were 78.0 ± 13.5 on 100 point scale. (82.0 ± 13.1 in members, and 74.3 ± 13.0 in nonmembers; P = 0.004) Among primary care domains, personalized care was the highest (91.4 ± 11.0), and coordination function the lowest (61.0 ± 33.1) in score. Significant differences between members and nonmembers were noted in coordination function (68.9 vs. 53.7, P = 0.021) and comprehensiveness (78.4 vs. 67.2, P = 0.008). These differences were continued after adjusting by multiple regression analysis for socio-demographic variables including age, sex, income, education, number of disease, and duration since the first visit. Conclusion: In the health cooperative clinics whose primary care performance has been considered exemplary in the context of health care in South Korea, primary care scores assessed by members were higher than those by non-members. The significant differences of scores in coordination function and comprehensiveness between members and non-members suggest that the future primary care policy should be focused to strengthen these two domains of primary care. Citations Citations to this article as recorded by
Background
: Many studies have demonstrated that excessively long or short sleep duration and insomnia are associated with high risk of mortality. We intended to investigate the lifestyle and the state of health in frequently sleep interrupted people. Methods : We have examined 2,540 subjects who visited a comprehensive medical testing center from January 2001 to June 2003. We divided into two groups of sleep disturbance into frequently interrupted group (two or more times per night) and infrequently interrupted group (less than twice per night). After frequency matching by age and sex, 1,900 subjects (each group of 950 subjects) were selected. Lifestyle, self-health perception, symptoms, clinical laboratory data and past history were compared by chi-square test and student's t-test. To identify the factors that influenced on sleep interruption, multiple logistic regression analysis was done. Results : Sleep duration was not significantly different in both groups (P=0.486). The frequently interrupted group were likely to perceive themselves as bad state of health being in a (P=0.008) and to complain of various symptoms, i.e., fatigue (P＜0.001), headache (P= 0.001), etc. Also, they had more incidence of mood disorders (P= 0.002), fatty liver (P=0.008), and arthritis (P=0.001) than the other group. By multiple logistic regression analysis, alcohol consumption (OR: 1.344, P= 0.007), irregular diet (OR: 1.325, P=0.003), and coffee intake (OR: 0.786, P= 0.013) were significantly different between the frequently interrupted group and the other group. Conclusion : Patients who complain of insomnia should be evaluated on both sleep duration and interruption. The evaluation of sleep interruption is needed in patients who perceive themselves as being in a bad state of health, who complain of various symptoms (fatigue, headache, etc.), or have a history of mood disorder, fatty liver, or arthritis.
Background
: A habit of lying-down after eating is known as a risk factor of reflux esophagitis. However the association between gastrointestinal disorders and a postprandial lying-down habit has not yet been identified. Some people believe that lying-down after meals is helpful for their health. We intended to investigate the relationship between such a habit and the health lifestyles, gastrointestinal symptoms, disorders using a questionnaires and gastrofiberscopic results of patients who visited our general health screening center. Methods : We examined 1,030 subjects (the frequent postprandial lying-down group was 576 persons (57.7%), the rare group was 436 persons (42.3%) who visited our general health screening center for a routine check-up including a gastrofiberoscopy during the period between January 2001 to December 2002. After frequency matching by age and sex, health lifestyles (such as smoking, alcohol consumption, exercise, eating habits, night time sleep duration and awakening frequency, nap, and coffee intake), gastrointestinal symptoms (dyspepsia, epigastric pain, heart burn, chest pain, and constipation) and gastrofiberoscopic findings were compared using results from the questionnaires and gastrofiberscopic findings. Factors such as gastritis and reflux esophagitis were set as dependent variables, while postprandial lying-down was set as an independent variable. The frequent postprandial lying-down group and the rare group were analysed through stepwised multiple logistic regression analysis. Results : Subjects with a frequent postprandial lying- down habit showed a significantly greater degree in alcohol consumption (P=0.010), irregular eating habits (P＜0.001), eating between meals (P＜0.001), napping (P＜0.001), and night time awakening frequency (P= 0.016) than the rare group did. In addition, chest pain (P=0.031) and constipation (P=0.010) were more common in the frequent postprandial lying-down group. However, prevalence of dyspepsia (P=0.147), epigastric pain (P=0.085), and heartburn (P=0.700) showed no differences between the two groups. Being controlled with age, sex, education level, body mass index, and life style factors, postprandial lying-down group showed higher prevalence ratios in erythematous gastritis (OR 1.59; P=0.090), atrophic gastritis (OR 1.71; P= 0.059), and reflux esophagitis (OR 1.78; P=0.103). Conclusion : A postprandial lying-down habit is associated with undesirable lifestyles and some gastrointestinal disorders. Therefore, a modification of the postprandial lying-down habit should be recommended. Further investigation is needed to clarify the causal relationships between a postprandial lying down habit and gastrointestinal symptoms and disorders.
Background
: Knee osteoarthritis (OA) is a major cause of disability, particularly in the elderly. The factors determining disability remain unclear and have not been defined in Korea. The aim of this study was to assess the various aspects of the quality of life, and to define the determinant factors of disability in patients with knee OA. Methods : The Korean version of AIMS2 (K-AIMS2) and CMCHS (Catholic Medical Center Health Survey) were administered to a cohort of 239 outpatients with symptomatic OA of the knee who attended 7 participating University Hospitals in Seoul, Ilsan and Taejon. The scores of K-AIMS2 12 subscales by demographic variables and body mass index were compared using Student t-test. And the determinant factors of the lower extremity disability were analysed by stepwise multiple regression method. Results : The study subjects (n=239) were 61.6±9.1 years old, comprised of 197 (82.4%) females and 42 (17.6%) males, had been sick with knee osteoarthritis for 6.2±6.5 years, and had 24.7±3.1 kg/m2 BMI. Among K-AIMS2 12 subscales 'Walking and bending' (5.82±2.17), 'Arthritis pain' (5.19±1.98), 'Social activities' (3.97±2.04), and 'Mobility level' (3.61±1.74) showed high scores, while subscales related with upper extremities function showed low scores, reflecting the costruct validity of K-AIMS2 in patients with symptomatic knee OA. After adjustment for the presence of sociodemographic variables, we found bodily pain (P＜0.001), age (P＜0.001), emotional function (P=0.033), and education level (P=0.099) as determinant factors of K-AIMS2 lower limb function. Conclusion : It is recommendable that the knee OA patients should be treated properly in the emotional aspect as well as the bodily pain aspect. In addition, it is suggested that education level be considered as an important factor when teaching the OA patients about coping with knee disabilities.
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
: A large number of children with psychosocial dysfunction are not recognized within schools or primary care settings. In several research, an incresaing amount of attention has been paid to the importance of low family support as apredictor of psychosocial dysfunction in children. Our study examined the agreement and relationship between the lack of family support as measured by the Family APGAR and child psychosocial dysfunction as screened by the Pediatric Symptom Checklist(PSC). Therefore, We studied the usefulness of Family APGAR as a screening tool of child psychosocial Dysfunction. Methods : We set 643 children that are engaged in elementary school. We gave a questionnaire to their parents and made them record the questionnaire which contained the sociodemographic date, past history of child and parents, the Family APGAR and the translated Pediatric Symptom Checklist(PSC). Finally, we analysed only 506 complete data. We use the SAS/PC 6.12 that is a statistical analysis program. Results : Children with a lack of family support (APGAR+) were 5.1 times as likely to receive scores indicating dysfunction on the PSC(PSC+). Families with a lack of support were significantly more likely to report low parental educational achievement and low income. Sixty percent of children from families with a lack of support were identified as having a psychosocial dysfunction by the PSC rating; however, only 24% percent of the children identified with psychosocial dysfunction by the PSC had scores indicating poor family functioning on the Family APGAR. Families with a lack of support had significantly higher total scores on PSC(mean=20.2) than families with adequate support(mean=11.9) the strength of the agreement between the Family APGAR and the PSC was k=.29. Conclusion : A lack of family support is associated with child psychosocial dysfunction as assessed by the PSC. However, the Family APGAR was not a sensitive measure of child psychosocial dysfunction, and thus it supplements, but does not replace the PSC.
Background
: Recently, many countries including Korea have been trying to enforce and reform their primary care system. The Family Doctor Registration Program(FDRP) which Korean government had tried and failed in 1996. continuously has been being highlighted because of it's importance. Several private family practitioners started grass root movement for conduction FDRP voluntarily. This survey aimed to know the willingness for private family practitioners to participate in voluntary FDRP and it's major services. Methods : By mailing, the self-administered questionnaire were collected two times during May 20 to June 30 in 1998. The questionnaire contained following : demographic and practice related factors, willingness to participate FDRP, factors related to it's major services. Subjects were 496 private family physicians who had acquired the certification since 1989. Analyses were made by the Chi-square test, t-test, and multiple logistic regression analysis. Results : Though overall response rate was only 44.8%(222/496), but age and sex distributions of respondents were similar to those of the total study subjects. The percentage of those having a willingness to participate in voluntary FDRP('Y' group) was 58.6%. The 'Y' group showed phone counseling frequence of 3.2(±2.6) times per day. They had much more home visiting experience than 'N' group(62.2% vs 44.9%, P=0.0019). After the conduction of FDRP. the frequency of possible night-time phone duty per month was 3.5(±2.6) times, and the frequency of possible home visiting per week was 1.9(±1.4) times in 'Y' group. After multiple logistic regression analysis on the meaningful variables, male(OR=2.25, P=0.027) rather than female, percentage of child patients<40%(OR=2.526, P=0.0149) rather than that>60%, and having home-visiting experience(OR=1.8, P=0.1131) rather than no experience showed relatively higher tendency of participation in voluntary FDRP. Conclusion : The results of this survey should be reflected into the health care policy when retrying to implement FDRP in Korea.
Background
: The role and future of family physician are not yet clearly determined even when 20 years lapsed since its introduction to korea. This study was conducted to establish identity of family physician, to develop pragmatic. curriculum of training, and to sort out frame of certification exam by analysing the job of family physicians who were practicing in community. Methods : We analysed the job of practicing family physician by using DACUM(Development of Curriculum) method from March 11, 2000 through March 12. Job analysis team was composed of five practitioners, four professors, one facilitator, and one scriber. Six sessions of 2 hours were mainly devoted to brain storming of the idea related to family physician. Results : Job analysis results are as follows. Family physician was defined as "primary care physician who provides primary medical service continuously and comprehensively by offering individual patient and/or family health promotion, disease prevention, and treatment of common illness". Family physician had seven duties and 129 tasks. The duty of physical exam had 18 tasks, duty of test, 21 tasks, duty of treatment, 40 tasks, duty of health promotion and disease prevention, 15 tasks, duty of patient/client, management, 12 tasks, duty of clinic management, 15 tasks, and self-development, 8 tasks respectively. Number of tasks whose impotance was classified as 'A'(very important) were 43 as total, 3 in physical exam, 7 in test, 9 in treatment, 11 in health promotion and disease prevention, 2 in patient/client management, 9 in clinic management, and 2 in self-development respectively. Number of tasks whose difficulty was classified as 'A'(very dif-ficult) were 19 as total. 2 in physical exam, 7 in test, 7 in treatment, 1 in clinic management, and 2 in self-development respectively. Number of tasks whose frequency was classified as 'A'(very frequent) were 22 as total, 6 in physical exam, 1 in test 8 in treatment, 3 in health promotion and disease prevention, 3 in patient/client management, and 1 in clinic management respectively. Number of tasks which were required for entry level were 74 as total, 18 in physical exam, 14 in test, 29 in treatment, 9 in health promotion and disease prevention, 3 in patient/client management, and 1 in clinic management respectively. Conclusion : Family physicians in Korea perform 7 duties and 129 tasks. Seventy four tasks are required to enter into the job.
Background
: Antibiotics are often indiscriminately prescribed for respiratory tract infections. This study was conducted to describe the prescription pattern of family physicians for respiratory tract infections. Methods : In each clinic of 50 representative family practitioners, about 20 consecutive patients with diagnosis of respiratory tract infection were enrolled into the study. The data were collected by questionnaire to physicians just after patient interview. Results : The number of study subjects was 1020, of which 55.7% was less than 15 year old. Antibiotics were prescribed to 73.9% of total subjects. According to diagnosis, the antibiotic prescription rate was 51.5% in common cold, 86.0% in pharyngitis, 88.6% in bronchitis, 98.9% in sinusitis, and 100% in otitis media. In common cold, the factors which significantly increased the antibiotic prescription were 1)patient age less than 15 year old (OR=1.70, CI= 1.06-2.73), 2)more than two visits during the same episode(OR=1.95, CI=1.27-2.99), 3)yellow and thick rhinorrhea(OR=2.22, CI=1.16-4.25), 4)yellow and thick sputum(OR=3.31, CI=1.34-8.19), and 5)throat injection(OR=2.50, CI=1.42-4.39). Among patients to whom antibiotics were prescribed, 48.7% of patients were given the antibiotics by intramuscular injection. The most frequently prescribed antibiotics were penicillin and macroride among per-oral medicine and ribostamycin and lincomycin among intramuscular medicine. The reason for antibiotic prescription were 1)possibility of bacterial infection(43.4%), 2)prevention of bacterial complication(23.7%), and 3)definite evidence of bacterial infection(22.5%). Conclusion : Family practitioners prescribe antibiotics indiscriminately for the respiratory tract infection. The prescription was influenced by patient's age, number of clinic-visit, and clinical symptoms and signs.
Background
: Physicians’ satisfaction with their professional life influences the quality of patient care they provide and helps to determine the number and type of students attracted to the various fields of medicine. In South Korea, two decades have passed already since the introduction of family medicine. But, S. Korean health policy has not developed a strong plan a strong plan to control a high medical cost and ineffective utilization of medical resources. Additionally, the number of students applying for family medicine is less than that for internal medicine or pediatrics. The purpose of this study was to de-lineate factors relation to professional satisfaction among family physicians in South Korea. Methods : The subjects were 840 family physicians who had been trained formally and registered to the Korean Academy of Family Physicians. The self-administered questionnaires were collected by three mailings during March 18 to May 24 in 1998. Results : Completed questionnaires were received from 292 South Korean family physicians. With respect to income, there showed ‘satisfaction in 31.4%, ‘middle’ 47%, and ‘dissatisfaction’ 20.5%(no response 1.0%). Three periods of certification acquisition(P=0.001), four practice types(P=0.005), and three degrees of training satisfactioni(P=0.003) had significantly different degrees of satisfaction. In the aspect of pride as a family physician, there showed ‘high’ in 42.1%, ‘middle’ 45.8%, and ‘low’ 10.9%(no response 1.2%). In the aspect of future view as a family physician, there showed ‘bright‘ in 40.6%, ‘middle’ 40.6%, and ‘dark’ 17.6%(no response 1.2%). After confounding variables were controlled, practice types(faculty family physicians rather than private practitioners) (P=0.003), the degree of training satisfaction(P=0.001, positive relationship), and the number of patients encountered per an hour(P-0.0098, positive relationship) were significant variables of the degree of general professional satisfaction. Conclusion : Though standard measure of professional satisfaction have not been developed, this survey result seems to help understand factors relating to professional satisfaction of S. Korean family physicians. This information may be useful in the development of policy to structure a primary care oriented health care system in S. Korea.( J Korean Acad Fam Med 1999;20:1697-1708)
Background
: Since the Independence in 1945, the Republic of Korea(ROK) has maintained fundamentally the liberal health care system by the influence of U.S.A. Therefore, as in the case of U.S.A., the primary health care system of ROK has fallen in the chaos. Recently, the new government of ROK seems to retry the introduction of 'Family Doctor Registration System(FDRS)' in spite of the 1996's failure. In order to conduct FDRS efficiently, there should be a thorough investigation on the opinions of doctors and people in the community. This study was conducted with a view to collecting necessary information regarding the implementation of FDRS. Methods : By mailing, the self-administered questionnaires were collected twice during March 18 to May 12 in 1998. The questionnaire had been prepared trough several discussions, pretest, and final correction by five family physicians and two health care policy professors. The subjects consisted of 2,093 family physicians. Results : Though the overall response rate was only 28.2%(591) subjects, age distribution for the study subjects was similar to that of average family physicians. The subjects consisted of 451 males and 138 females. The number of those whose age was less than 40 was 49.9%(195). 'The group that agrees with the introduction of FDRS' was 58.5% of all respondents; 'the group that objects' 14.4%; and 'the group undetermined' 24.7%. The 73.6% of all respondents had negative opinion on increased administrative work. Only 21.3% expected their net income to increase. On multiple logistic regression analysis, relatively large city rather than metropolitan Seoul, the smaller number of visiting patients a month, regular resident training experience, and male sex resulted in having a significant positive relationship with the introduction of FDRS. Further analyses are called for to identify differences of opinions between family physicians and single specialty medical practitioners Conclusion : The results of this survey should be reflected into the health care policy when retrying to implement FDRS in Korea.
Background
: Family physicians in their on primary practice frequently encounters patients with fever, which is one of the common symptoms. Fever is an important symptom and can occur in mild disease, common cold, influenza, acute pharyngotonsillitis or can originate from a particular severe disease, such as bacterial endocarditis, malignant lymphoma and SLE, which need more aggressive management. Therefore, we studied patients who were admitted with short-term fever or long-term fever to find out their causes of febrile diseases and to compare the differences with previous other studies. Methods : 601 patients with fever above 37.2 degree centigrade or those who were transferred from other hospitals due to long-term fever were enrolled from Jan. 1991 to Jun. 1997. Patients' medical records were reviewed and classified according to disease, sex, age. Srandardization of Petersdorf's rule for F.U.O. was used. Results : 601 patients were randomly selected among which 301 were males and 300 females. Males were 147 and females 147 young adult patients as compared to 154 males and 153 females were elderly patients. According to disease category, the number of infections, connective tissue diseases, neoplastic diseases and other diseases were 442(73.5%), 14(2.3%), 87(14.5%) and 21(3.5%), respectively. The number of diseases of undetermined case was 37(6.2%). The most frequent disease was pneumonia with 103(31.1%). UTI and tuberculosis were the 2nd and 3rd most common diseases. The total number of F.U.O. patients was 82(13.6%). According to the disease categories there were 29(35.4%) in infections, 2(2.4%) in connective tissue diseases, 12(14.6%) in neoplasms, 2(2.4%) in others and 37(45.2%) in unknown origin. The most common disease in the classification of sex and age of F.U.O. was infections and tubrculosis. Conclusion : In the clinical study of febrile patients admitted from Jan. 1991 to Jun. 1997 through medical record review, the disease category in the order of frequency was infection, neoplasm, connective tissue disease and the distribution of F.U.O was same result. In comparison with other study, the order of connective tissue disease and neoplasm was different in other hospital study but same result was taken in comparison with Petersdorf's study.
Background
: It is very important aspect in primary care to control life style factors related to diseases. But it seems that primary care doctors have difficulties to appraise biopsycosocially the patient's life style and apply the results into the the daily outpatient managements in Korea, where the medical surroundings confind the interview time with patient's life style easily, bio-psychosocially, and objectively, especially during managing in the office. Method: From June to August in 1995, among the encounters of outpatient clinic of the de-partment of Family Medicine, Saint Mary Hospital, 203 subjects were recommended to check their life styles on checklists. This checklist is the one which Dr.Lee modified to be compatible with Korean culture out of Wilson's Fantastic life styles, which is consisted of 25 items each of that we allocated 0-4 points to. So total life style score of this checklist is 100. Among the subje-cts 22 subjects, sampled randomly, were retested 1 week after the 1st test for reliability test by phone interview. The patients who had been diagnosed as adult disease, were allocated into mor-bid group(77 subjects), and the others into healthy group(77 subjects). Cross sectional study was performed. And the data were analyzed through correlation analysis, student, t-test, and Chi-square test using MINITAB 7.1 package program. Results : The checklist used in this study showed an acceptible correlation coefficient(r=0.879) on test-retest. The mean life style score was 65.7(SD 0.75, 41-87)in total group, 63.3(SD 10.37, 41-87)in morbid group, and 68.2(SD 8.48, 53-87)in healthy group. The mean score of morbid group was significantly lower than the one of healthy group(p=0.0016). Among the 25 total life style items, 10 items showed significantly lower scores in morbid group than in healthy group such as 'positive thinking(p=0.0002)', 'anxiety and worry(p=0.003).', 'anger(p=0.0006)', etc. When life style score was divided into 5 classes by 90% and 70% of sensitivity and specificity, odds ratio between excellent and dangerous groups was 3.56. The post-intervention reappraisal for knowing the short term effect, tried at 3 weeks after the pre-intervention test, showed a rise of mean life score by 4.1(p=0.026). Conclusion : The checklist, used in this study is agreed as a useful method to assess and ap-praise patient's life style, acceptible in reliability and validity, adaptible in outpatient primary care medicine, and applicable in self-assessment by patients.
Background
: It is suggested that the protection of the cardiovascular disease, including Myocardial infarction, in danger group is also important as well as the treatment of the disease after its attack. The rick factor of myocardial infarction, the most critical disease among cardiovascular disease, is well known and a lot of research papers are reported in Korea. But there are a few case studies on the behavior type and cardiovascular disease. Thus this study is intended to promoted the early detection and treatment of Myocardial infarction in primary care stage by surveying the influential behavior pastern to cardiovascular, especially the relation of Type A personality pattern. Method: We set the 117 patients who came to six university hospitals in the vicinity of Seoul and Kyung-ki Province from April to August in 1995, as the patient group, and set 113 patients without cardiovascular disease who came to the same hospitals as the control group. The information on the disease and sociocultural elements of the 230 patients is obtained by questionnaire and medical records. As a method of behavior patten survey, the Danakawa. Type A behavior questionnaire of Tokai University in Japan is adopted This questionnaire is based on the Jenkins Activity Survey. We use the T-test and Chi-square test, CATMOD test in statistical correlation, and use th linear model in multivarient analysis. Results : In the sociocultural aspects of the research object, there is no noticeable difference. Howe-ver, the patient group shows significantly high frequency in high blood pressure, DM, cholesterol, smoking and myocardial infarction family history. There play the role to cause Myocardial infarction. Type A behavior patten shows 81 patients(69.2%) in patient group,46 patients(40.7%) in control group. Accordingly the patients with Type A behavior pattern shows noticeably higher level than the control(x²=18.912, DF=1, P=0.000). Cholesterol(P=0.0001) and smoking(P=0.01), the major risk factors of Myocardial infarction, seem to be significantly related to the Type A behavior pattern, And factor of Myocardial infarction, seem to be significantly related to the Type A behavior pattern. And even though we exclude each factro of critical factors of Myocardial infarction and other variables, the Type A behavior pattern shows high influence on Myocardial infarction. Conclusion : It is surveyed that Myocardial infarction, the most critical cardiovascular disease, and the Type A behavior pattern is deeply related as a cause and effect. In the exammination on the relations of serum cholesterol, smoking, the main risk factors of cardiovascular disease, the result shows thers is meaningful relations between them. Therefore we can conclude that the Type A behavior pattern plays the causative role to Myocardial infarction. Thus we can conclude that it is recommended to educaste the patients on the basis of the behavior-scientific approaching method of Type A behavior pattern for the better treatment, prevention and prohibition of recurrence of the Myocardial infarction as well as the interception of the direct factor. And more studies are required
Most recent data revealed that mortality rate of liver cirrhosis had been increased significantly in this society. And the mortality rate of hepatic cancer of Korean males was highest in the world last year. In the past, we did not give attention to the many alcoholics. So we need more considerable concerns about alcoholics and chronic hepatitis patients. Especially, death rate in fourth decade due to liver cirrhosis was significantly increased. Therefore, we studied retrospectively eighty liver cirrhosis patients admitted at Buchun Jeil Hospital from January 1989 to August 1990 located near Seoul city
The results obtained were as follows; 1. Male to female ratio was 8:1, and the age showed high incidence in 5th and 6th decades. Patients who were hired and had low education and did not have religion were contributed with the most of the cases. 2. 85% of patients were alcohol drinkers and has been drinking over 20 years. 3. The amount of alcohol consumption most patients was more than 1 bottle of 2 hop-Soju. 4. Most often chief complaints when admitted were ascites. 5. α-fetoprotein was positive in 78.8%. 6. Serum HBs Ag is positive in 32.5% of cases and HBe Ag is positive in 30.8%. 7. Hepatoma was combined with liver cirrosis in 18.8% of cases.
82,104 cases of general health people were obtained from Jan. 1986 to Dec. 1989 at Korea Medical Insitiute(KMI) and an immunological studies for rheumatoid arthritis have been performed by using Latex agglutination method(RA 80 'Eiken, Eiken Chemical Co., Ltd.)
The results were as follows: 1.The sera of positive rate of qualitative test were 4,921 cases(8.2%) in male (60,204), 1,569 cases(7.2%) in female (21,900)(average 7.9%) 2. Age distribution of positive rheumatoid factor showed 119 cases(5.1%) in 10~19 year old group, 1,192 cases(5.5%) in 20~29 year old group, 2,230(7.5%) in 30~39 year old group, 1,780(9.5%) in 40~49 year old group, 906(11.5%) in 50~59 year olf group, 224(14.1%) in 60~69 year old group, 39(17.5%) in over 70 year old group. The positive rate of qualitative RF test increased with age. 3. The sera of significant titer(1 : 80 or higher) by quantitative RF test were revealed only in 1.2% among the positive sera of qualitative RF test. From the above results, we concluded that rheumatoid factor seems to be not a good index for screening test of rheumatoid arthritis.
A clinical study was performed on 67 cases of pulmonary tuberculosis patients who were treated as intractable patients at Inchon Red Cross Tuberculosis Sanatorium in past 18 months, from July 1987 through December 1988.
1. Intractable patients occupied 27.3% of total inpatients. 2. The ratio of male to female was 56.7% vs 43.3% and 51% of patients were the group between second and third decades. 3. Patients who have disease period over 3 years was 77.6% of patients have the disease for have than 3 years. 4. 64.2% was administrated the anti-tuberculosis drugs from 6 months to 2 years. 6. Kinds of drugs which were used before admission were reviewed as follows : INH 100%, EMB 82%, RFP 82%, SM 39.7%, PAS 42.6%, PZA 39.3%, KM 29.9%, PTA 26.4%, CS 19.7%. 7. Drug resistance rate were 86.2% to INH, 75.9% to RFP, 55.1% to EMB, 46.5% to SM, 31.0% to PAS, 27.6% to KM, 39.6% to PTA 24.1% to CS. 8. Resistance rate to more the 5 drugs 33.7% of patients showed resistance to more than 5 drugs. 9. Bacteriologic examination of sputum presented improvement in 54.7%(35/67), 72% of these patients changed into negative conversion from 2 months to 6 months after chemotherapy. 10. Chest X-ray on admission showed minimal pulmonary tuberculosis(Tb) or degree in 4.5%, moderate pulmonary Tb in 22.4%, far advanced pulmonary Tb in 73.1%. 11. Chest X-ray changes after chemotherapy showed mild improvement in 35.8%, moderate improvement in 19.4%, no change in 35.8%, aggravation in 7.5%. Intractable tuberculosis due to initial resistant infection and acquired resistance was major source of disease transmission and increasing resistance of recent short-course drugs of chemotherapy were problem of tuberculosis management. In primary care family physician, proper and active management was necessary for improvement of intractable tuberculosis control in our country, in the medical, social and personal aspects in initial treatment.
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