| Jung Kwon Lee | 35 Articles |
Recent studies suggest that coffee consumption has an influence on kidney function. This study investigated the relationship between habitual coffee consumption and renal impairment in Korean women, in consideration of diabetic status. This study involved 2,673 women aged 35 to 84 years who had participated in the Fourth Korea National Health and Nutrition Examination Surveys, conducted in 2008. Habitual coffee consumption was classified into three categories: less than 1 cup per day, 1 cup per day, and 2 or more cups per day. Renal function impairment was defined as an estimated glomerular filtration rate less than 60 mL/min/1.73 m2 by the Modification of Diet in Renal Disease equation. The prevalence of diabetes and renal function impairment was higher in women who drank < 1 cup of coffee per day. Compared with drinking < 1 cup of coffee per day, the odds ratio (OR) for renal function impairment was significantly lower (OR, 0.59; 95% confidence interval [CI], 0.37 to 0.95; P = 0.03) in those who habitually drank ≥ 2 cups per day after adjusting for multiple confounding factors. When data were stratified according to the presence of diabetes, coffee consumption ≥ 2 cups of coffee per day showed an inverse association with renal function impairment in only diabetic women (OR, 0.14; 95% CI, 0.02 to 0.88; P = 0.04), compared with consumption < 1 cup of coffee per day. In a representative sample of Korean women, coffee consumption was significantly associated with a decreased risk of renal impairment especially in middle and elderly-aged diabetic women. Citations Citations to this article as recorded by
Background
Breast cancer is the second most common cancer in Korean women. As survival years increase, health-related quality of life has become an important issue in breast cancer patients. Sleep problems are common and cause significant disruption in quality of life in breast cancer patients. However, cancer-related sleep disturbance has received little attention. The purpose of this study was to determine the prevalence of poor sleep quality and factors which are associated with poor sleep quality in the breast cancer patients receiving chemotherapy in the outpatients setting. Methods: One hundred and twenty-seven breast cancer patients receiving chemotherapy in a tertiary hospital outpatient were surveyed between February 2009 and July 2009. Among them, 94 (72.8%) patients were finally included in the study. The sleep quality was assessed by the Pittsburg Sleep Quality Index (PSQI). PSQI > 5 indicates clinically significant poor sleep quality. Also the independent factors of sleep quality were assessed using univariable analysis and multiple logistic regression analysis. Results: Seventy-two (76.6%) patients of 94 breast cancer patients undergoing chemotherapy have poor sleep quality. Among of them, 11 (15.3%) patients were actually consulted with doctors. Average PSQI score was 8.8 (± 4.1). Anxiety and employment status were associated with poor sleep quality. Conclusion: A high proportion of breast cancer patients receiving chemotherapy even in the outpatient settings had poor sleep quality. But only small proportion of them consulted doctor. Poor sleep quality during chemotherapy in breast cancer patient was associated with anxiety and employment status. Considering the high prevalence of sleep problem and inadequate management, more adequate attention is needed to manage the sleep problem of breast cancer patients receiving chemotherapy. Citations Citations to this article as recorded by
Background
Smoking is universally recognized as the foremost preventable cause of cancer. And smoking behavior causes many negative effects in cancer patients. Based on the mounting evidence that smoking affects cancer treatment outcomes and survival, we studied whether the cancer diagnosis affects smoking behavior. Methods: During August 2007, 279 patients who were hospitalized with the diagnosis of cancer were surveyed by a questionnaire and a follow up survey was performed at 3 months and 7 months afterwards. Follow up survey was performed via telephone and finally 246 patients were enrolled. Questions in the survey included smoking history, nicotine dependence, stage of change and the reason for quit smoking or keep smoking. In the follow up survey at 7 month, we asked whether they needed smoking cessation interventions. Results: At the end of the study, the subjects who kept smoking were 27 patients, but the degree of nicotine dependence was decreased compared to the preceding 2 surveys and contemplation as well as preparation stage turned out to be the most prevalent stage of change. The main reasons to keep smoking were behavioral habits and stress. Regardless of their smoking history, almost all cancer patients wanted smoking cessation interventions. Conclusion: Smoking is a critical variable that affects cancer treatment and outcome. We surely found there is a smoking subgroup after cancer diagnosis and we should advise them to quit smoking. Citations Citations to this article as recorded by
Background
Menstruation is often regarded as a privilege for women allowing reproductive activity. However, abrupt hormonal fluctuations in menstrual cycle may cause distressing physical and psychological symptoms such as premenstrual syndrome (PMS). PMS is known to have a great impact on daily life activities and social functions, and might result in significantly decreased quality of life (QOL). In this study, we aimed to evaluate a relation between PMS and QOL in young adult Korean women. Methods: Self-administered questionnaires were distributed to a total of 514 women who were aged 16∼35 years and who were employed in an industrial complex located in Gyeonggi-do, Korea. PMS was assessed using diagnostic criteria recommended by the American Psychiatric Association. QOL was assessed using Korean health related Quality of Life Scale. The association between PMS and QOL was examined in 440 women using the two-sample t-test after excluding 74 women who were missing for variables essential for the assessment of PMS and QOL. Results: The prevalence of PMS was 7.3% (32 out of 440 women). Women with PMS had the worse QOL score in almost all domains of QOL except for spiritual health (physical function, psychological health, social function, pain, vitality, role limitation, health status perception, and health status change). Conclusion: There was a significant relation between PMS and QOL. The finding of significantly lower QOL in women with PMS suggests that PMS should be evaluated and treated actively in primary care. (J Korean Acad Fam Med 2008;29:108-113)
Background
PAP smear has been highly appraised for screening cervical cancer. Generally regarded is that women physicians regularly screen for PAP would promote patients' early detection and treatment rate by their strong recommendation. Hereby we investigated PAP-screening in primary care women physicians, recommending proportion and associated factors. Methods: Questionnaires were sent to 981 members of the Korean Academy of Family Medicine, Korean Association of Family Practitioners, Korean Medical Women's Association, and Songpa-gu and Kangdong-gu family practitioners. a total of 193 respondents was analyzed. Results: Among the total 55.4% of the respondents screened for PAP smear regularly, either annually (23.9%), or from their treating gynecologists (61.6%) or through routine check-up (81.1%). Common reasons for not screening were lack of time (40.7%) and forgetfulness (38.4%). Recommending proportion for PAP to patients was 49.2%. Reasons for not recommending were lack of equipment, forgetfulness (18.8% each). Confidence of PAP as a screening test was very high (71.5%); significantly related to PAP-screening and to recommending proportion (P=0.033, P=0.005, respectively). Many of the respondents thought physician's own PAP-screening affected its recommendation (45.3%), whereas significant relation to their actual PAP-screening was not found (P=0.845). PAP-screening in physicians showed no significant relationship with recommending proportion (P=0.053). Internal disease history had meaningful relation only with recommending proportion (P=0.001). Conclusion: Though physicians show strong confidence in PAP and undergo more than the general public, most do not screen for it regularly and the recommending proportion was low. To improve physician's PAP-screening and recommending proportion, re-education of physicians and provision of proper clinical equipment are required. (J Korean Acad Fam Med 2007;28:589-598)
Background
: Although caffeine is commonly consumed substance and not seriously harmful as compared to alcohol and nicotine, Korea is planning to mark on the products which contain caffeine above a definite level with "containing large amounts caffeine". At this point in time, the study concerning caffeine related symptoms is in need. Methods : After surveying university students by using self-administered questionnaires based on DSM-IV substance related disorder, healthy 810 subjects were assessed for socio-demographic characteristics and features of caffeine intake and its dependence, withdrawal, and intoxication. Results : The mean amount of caffeine consumption in 810 subjects was 120.49 mg (median=93.0) per day. The major features of caffeine dependence were as follows: tolerance (61.1%), withdrawal (46.3%), using more or longer than intended (46.0%), and unsuccessful attempt to cut down or control use (12.6%). The prevalence was increased by daily caffeine consumption. Among 711 subjects who had experienced no caffeine consumption over 24 hours {amount of daily caffeine consumption was 116.0 mg (median=86.5)}, 6.19% showed significant distress in usual activity, and 22.1% used caffeine contents to avoid withdrawal symptoms. The prevalence of caffeine withdrawal based on DSM-IV research criteria was 2.67% and the frequency for symptoms were as follows: fatigue (37.7%), drowsiness (17.6%), headache (14.5%), an anxiety (8.3%). In addition, the prevalence of caffeine intoxication was 2.1% and the frequency for symptoms were as follows: insomnia (41.9%), diuresis (35.8%), tachycardia (26.7%), and gastrointestinal disturbance (23.3%). Conclusion : The unwanted symptoms related to caffeine withdrawal or intoxication were common in students using caffeine. Therefore, major features of caffeine-related symptoms should be considered in primary care practice.
Background
: Systematic care is not well provided in patients with terminal cancer and their families in Korea. Unnecessary hospitalization, multiple emergency room visits for controlling acute symptoms and the use of unqualified alternative care services are typical health care utilization patterns in such patients. We operated home-based hospice-palliative care services to help these patients and their families at a university-based family practice setting. Our experience is presented for the development of care model of hospice-palliative care services. Methods : We investigated the demographic characteristics, the clinical findings and the utilization of medical care services of 72 terminally ill cancer patients before and after enrollment to hospice-palliative care unit from April 25, 2003 to April 21, 2005. Results : The frequency of emergency room visits and the number of hospitalizations were decreased by Wicoxon Signed Ranks Test after the enrollment to home-based hospice-palliative care service unit. The duration of emergency room visits decreased from 7.7 hours to 0.3 hours and the duration of hospitalization decreased from 6.5 days to 0.0 days in median. The cost per emergency room visits decreased from 268,801 won to 153,816 won and the cost per hospitalization decreased from 285,491 won to 106,294 won in median. Conclusion : Home-based hospice-palliative care services can be an efficient and effective model for the care of terminally ill cancer patients at a low cost.
Background
: Hospitals provide programs for routine screening health examination to meet the needs of people who take keen interest in the prevention of cancer and chronic diseases. But current programs do not reflect individual characteristics such as age, sex, occupation, and risk factors. Expensive diagnostic tests not based on evidence raise a continued issue of controversy. We evaluated on the scientific evidence of screening tests in these programs. Methods : Internet home pages were searched for screening test provided by 6 major hospitals and by National Health Insurance Corporation. Screening tests were arranged by target diseases which were chosen by the authors. We reviewed the guidelines of several organizations and compared the scientific evidence of each test by the recommended guidelines. Results : Excessive investigation, such as tumor markers, abdominal ultrasonography, anti-HCV Ab, and VDRL were routinely administered against recommended guidelines. Screening tests lacking sufficient evidence for recommendation were included. Furthermore, selection of the screening tests options and time interval was based on the clients' economic state and non-expert preference. Conclusion : Screening tests were uniformly administered in excess with insufficient evidence. Tailored screening program should be administered considering individual characteristics and risk factors.
Background
: Since the Women's Health Initiative (WHI) study indicated that the significant risks are associated with hormone replacement therapy (HRT), it has been highly expected that postmenopausal women have decisional conflict about HRT. We investigated how much decisional conflict women have in taking HRT and what factors were associated with this conflict. Methods : A total of 312 postmenopausal women, who had been on HRT or just began, were surveyed from May 10 to June 27, 2005. The subjects were asked by questionnaire that included demographic characteristics and factors related to decisional conflict. Decisional conflict was assessed using the Decisional Conflict Scale (DCS) composed of 16 items. Results : The mean score of DCS was 2.61, which was severe and lack of support from friends and relatives was the most common major conflicting factor. Forty-five percent of the participants started HRT by doctor's recommendation, but had a higher decisional conflict compared to those who started on their own or by encouragement from family and friends. Women who were exposed to mass-media or who had discontinued HRT previously had a lower conflict. Higher the educational level and longer the duration of HRT before stopping lowered decisional conflict. DCS was not significantly influenced by age, income, menopausal symptoms, duration of HRT and the history of hysterectomy. Conclusion : Postmenopausal women when making a decision to begin HRT had high conflict. The factors related to conflict were educational level, exposure to mass-media, and motivation to begin therapy. Therefore, adequate and continued counseling with doctors may reduce women's decisional conflict about HRT.
Background
: The primary physician may be the first or the only professional who may come in contact with victims of spouse abuse. But little is known about family physician's knowledge of and attitude towards spouse abuse in Korea. Therefore, this study was conducted. Methods : We selected 191 doctors from the participants of the 2003 annual meeting of the Korean Academy of Family Medicine (KAFM). We distributed a 5 paged questionnaire them to fill out and analyzed 125 cases among them. The questionnaire included social demographic characteristics, individual knowledge of and attitudes toward spouse abuse, individual practice experience, education and training experience, and others. Results : We found a significant relationship between doctor's knowledge of spouse abuse and intervention after coming in contact with the victim. Also, this study showed that 31.8% of doctors intervened and traced the spouse abuse cases actively after physical treatment of victims, but none of the cases were reported to the police. Among the total 64.7% of the doctors explained that they did not want to intervene because they were afraid of getting involved in a legal situation. Some of the doctors who had prior educational experience concerning spouse abuse showed very significant high rate of actual intervention (P=0.0112). Conclusion : The more educational experience on spouse violence the doctors had, the more active intervention they showed. Therefore, we need to intensify the practical educational program along with the training medical program targeting medical practitioners. Of course we need to request sacrifice from doctors based on moral principles, but we also need systemic aid and reform to legal system to minimize burden to doctors.
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
: This study was conducted to survey current status of research and scholarly activity of residency programs and to evaluate quality of education. Methods : Questionnaire on research and scholarly activity were sent to all residency training programs by regular mail on May 2003. The questionnaire included detailed characteristics of residency programs, current status of conferences, educations for research activities, degree of faculty involvement, and numbers of published papers and presentations for past year. Results : A total of 103 residency programs answered the questionnaire. Most of the programs held journal review, book review, and clinical review in regular bases as scholarly activities. Smaller than 50% of the programs held case review, chart review, and psycho- social conference in regular bases. As research activity, 40 programs offered educations on epidemiology and statistics, and 55 programs held critical review of the literatures. Faculties involve actively in residents' research project in the process of designing research questions and selecting the subjects, but less actively in the process of gathering informations, completing manuscripts, and preparing presentations. Degrees of faculty involvement were smaller in the programs which are connected with medical school, had only 1 faculty, and educational experiences of the faculty were insufficient. Conclusion : Current scholarly activities were active in various aspects, but psychosocial conference and chart audit should be encouraged. Special efforts are required in the research activities, especially in programs which were not connected with medical school and had only one faculty.
Background
: Nowadays the addictive use of internet is becoming a serious social and health problem. The authors performed a study in PC bang users to evaluate the prevalence of addictive internet use and the association between addictive internet use and behavioral and psychological factors. Methods : A face-to-face interview survey of 900 Korean internet users at six PC-bangs was performed between 11th and 19th of December, 2002, using standardized questionnaires composed of Young's internet addiction scale, scale of unwillingness to communicate, patient problem questionnaire for screening depression and anxiety, and questions asking internet using patterns and socio- demographic factors. Results : Of the final 888 participants, 3.4% were identified as addictive users and 41.3% as over-users of internet service. The subjects who were male, unemployed, less educated, using internet mainly at PC bang, using internet more frequently, starting or finishing off internet use usually in the morning, using internet service usually for doing games tended to be more addictive users of internet (P＜0.05). In proportional odds model analysis, increasing duration of internet use (OR=1.22; 95% CI, 1.16∼1.30), daily use of internet (OR=2.06; 95% CI, 1.21∼3.51), finishing off internet use between midnight and 6 a.m. (OR=2.00; 95% CI, 1.30∼3.07), anxiety (OR=5.38; 95% CI, 2.86∼10.1), and increasing approach avoidance (OR=1.05; 95% CI, 1.03∼1.08) were significantly associated with a higher degree of internet addiction. Conclusion : Addictive use of internet should be suspected in a person who uses internet for long time, daily, and over midnight. An active evaluation and management for anxiety are needed among addictive internet users.
Background
: Smoking is well known as an important preventable risk factor contributing to mortality and morbidity. Telephone counseling might be one of adjunctive interventions for smoking cessation. We evaluated whether telephone counseling performed by a nurse could improve smoking cessation rate. Methods : Study subjects were 152 male smokers who visited family practice in one tertiary hospital between November 2001 and January 2002 and agreed to participate in this study. After completing a self- administered questionnaire, the subjects received self-help materials and were randomly assigned into either an intervention or control group. A well-trained nurse provided telephone counseling only to experimental group at 8th and 17th week of follow-up. The 25-week smoking cessation rates were checked in both groups by telephone call. Results : There were no significant differences in socio- demographic and smoking-related characteristics between intervention, control, and non-participants groups. Intention-to-treat smoking cessation rate at 25th-week of follow- up was 21.1% in control, 25.0% in intervention group and was not statistically different from each other. Smoking cessation rate according to the baseline stage of change toward quit smoking was not statistically different from each other. Conclusion : The telephone counseling performed by a nurse was not significantly effective for improving smoking cessation rate in this study.
Background
: Hormone replacement therapy (HRT) is the most effective treatment for climacteric symptoms. It also has definitive role in reducing or preventing the risk of osteoporosis. However, compliance with HRT is very poor. This study was conducted to know the compliance of hormone replacement therapy and investigate the determining factors for compliance. Methods : Review of charts and telephone questionnaires were completed among 107 women who had received HRT in a family medicine clinic at a university hospital. Compliance was determined by the medication availability ratio (MAR): (HRT treated days)/(total number of observed days). An individual with MAR less than 0.75 was considered as partial compliance, and more than 0.75 was considered as complete compliance group. Results : The average age of 107 subjects was 57.4 years. Among the 107 study subjects, 59 persons (55.1%) were compliant with HRT. Mean observation period was 17.6 months. The compliance with HRT was 60.9%, 55.1%, 49.6% at 12, 24, 36 months, respectively. The compliance was higher in high-perception group compared to low- perception group (P=0.01). Education level, presence of osteoporosis, hysterectomised state, difference in doctor and past fracture history were not associated with compliance. The reasons for starting HRT were physician's recommendation, osteoporosis prevention, treatment of menopausal symptoms, and influence of mass media, in descending order. Conclusion : The compliance with HRT was 61% at one- year treatment and 50% at three-year teatment period. Positive attitude for HRT was related to higher compliance with HRT. Patient education on HRT is essential for successful compliance of HRT.
Background
: Use of Complementary and Alternative Medicine(CAM) is common among patients with chronic conditions such as rheumatic disorder. This study was conducted to know rate and behavior of using CAM and to improve doctor-patient relationship in rheumatic patients. Methods : Among patients visiting a tertiary hospital rheumatology clinic, 867 persons (15.8% of total) were selected conveniently and interviewed by a trained nurse according to structured questionnaire from July 1st through July 31st 1999. Three hundred and sixty two CAM users completed the interview. Results : Among 867 persons interviewed, 372 persons had used CAM (use rate 44%). Use rate of Chinese medicine was 26%, CAM except Chinese medicine 21%. Herb medicine(49.4%) was the commonest single category of all CAM. Twenty four percents of users had used two or more types of CAM, 6.8% had experienced adverse effects. The average yearly cost for CAM was 704,000 won/person, 64% of the one for hospital use, 1,100,000 won/person. The subjectively rated degree of effectiveness was 6.3 points which was significantly higher when compared with 5.9 points for hospital services. The degree of satisfaction with CAM was 5.6 points which was higher than that of hospital services, 4.8 points. The most frequently reported reason for using CAM was the hope for synergistic treatment effect(32%). The proportion of experiencing adverse effects from CAM was 7% of all users. Only one fourth of the users had discussed on the CAM use with the western doctors. The commonest reason for not discussing CAM was that the respondents had no need to discuss about it (40%). Among doctor's attitudes when discussing CAM with patient, limited aproval was most common(40%). Conclusion : Among patients with rheumatic conditions, 44% use CAM. Herb medicine was most commonly used CAM. Comparing with hospital services, cost for CAM is 2/3 but its subjective effectiveness and satisfaction are higher. Western doctors must consider appropriately the need from users of alternative medicine.
Background
: A discharge against medical advice(AMA discharge) means a critical failure of doctor-patient relationship and noncompliance. Most AMA discharge studies had been limited to psychiatric patients. This study was conducted to determine the factors associated with AMA discharge, especially focused on appropriateness of admission and hospital days. Methods : From January 1998 to June 1998, there were 366 AMA discharges of total 11,716 discharges. We selected 132 AMA discharge patients as cases. Controls were selected by individual matching by sex, age(±2 years), and length of stay(5 days). Medical records were reviewed by a doctor. Appropriateness of admission and hospital days were assessed by an experienced quality assurance nurse according to the appropriate evaluation protocol & delay tool. Results : Sixty one percent of the 132 cases was male. Mean age of case group was 53.9 years, and mean hospital day was 8.3 days, which was not significantly different from those of control group. Less patients had graduated high school in cases when compared with controls (37.9% vs 56.8%). More patients had been admitted via emergency room in cases compared with controls (53.0% vs 33.3%). More patients had been admitted to the department of internal medicine, neurology, or neurosurgery room in cases compared with controls. Neoplasms, disease of circulatory system were more frequent primary diagnosis in cases than those in controls. Appropriateness in both admission and hospital stay higher in cases than those of controls and those effect persisted even after controlling hospital days. Department of admission, patient’s status at discharge, and primary diagnosis at discharge remained as significant factors associated with AMA discharge after adjustment for other potential risk factors. The reasons for 120 AMA discharge were “personal obligations” (20%), “felt better” (14.6%), “financial obligations” (12.3%), and “hopeless” (10.8%), in order. Conclusion : Department of admission, primary diagnosis, and patient’s status at discharge were associated with AMA discharge. Appropriateness in both admission and hospital stay was higher in cases than that of controls.
BACKGROUND
Establishing effective communication between doctor and patient help doctors treat their patients easily and influence patient's compliance with medical regimen and treatment outcome. The objective of this study was to evaluate common characteristic of third-year medical student's behavior in their patient interview and apply these results to medical education of communication. METHODS Ninety-one third-year medical students in Hanyang University College of Medicine through their clerkship in family medicine had been instructed to perform medical interviews of patients who visited the Department of Family Medicine of Hanyang University Hospital. Video-taped records of the interviews using CCTV were done. The evaluation was done with a rating scale table consisting of 20 items. The rating scale was categorized in to 5 areas: beginning the interviews, collection of information, doctor-patient relationship, structure of interview and ending the interview. RESULTS Among the 62 students who were enrolled in the study, 55 students were males(84%). In the process of collecting information 33 students(53%) applied open-ended question at least once. Eighteen students(29%) used leading question. In the doctor-patient relationship, 3 students gave empathic verbal response among 58 records which were applicable. In the structure of interview, 25 students(40%) appropriately avoided to shift abruptly the focus of discussion. When ending their interviews, 6 students(10%) clarified the interview in whole. CONCLUSIONS We conclude that there are several deficiencies in medical students' communication skills during their process of interviews that might influence information gathering and doctor-patient relation ship.
Background
: Korean health related Quality of Life Scale(KQOLS) was developed to measure the quality of life reflecting Korean’s own language expression and culture. In order to confide in the results of KQOLS, it is necessary to establish verification of the psychometric properties(reliability, validity, responsiveness). Methods : KQOLS’s final 46 items and item option responses were established by expert panels. Reliability was tested by 2 weeks test-retest method and internal consistency methods. Validity was tested by factor analysis and clinical validity. Sensitivity and specificity for detecting treatment-related changes were also tested. Results : A high degree of internal consistency was observed for each of domains(Cronbach’s alpha value of 0.77 or higher). Two weeks test-retest reliability correlation coefficients scores were highly significant except health perception domain. A principal components analysis identified 9 factors with eight values greater than 1.0 which were approximately the same as intended domains. Normal control group had statistically significant higher scores than patients group except in spiritual health and social function domains. Improved group of patients had statistically significant higher scores than non-improve group of patients after treatment except in spiritual health and health status perception domains. Conclusion : Korean health related Quality of Life Scale(KQOLS) is both a valid and a reliable instrument, but fine refinements such as items revision and item response options modification will be needed.
Background
: This study was performed to understand medical student’s feelings and difficulties in the first clinical through student’s perspective. Methods : The essays of 128 medical students submitted after the first clinical interview were analyzed using qualitative methodology and the results were validated by questionnaire survey. Results : The author found 5 major categories with 23 themes. In the first clinical interview students showed various emotions that changed during the interview. Difficulties perceived in the interview skill were questioning, judging clinical importance of patient’s story, applying medical knowledge, and eliciting family and social history. Defects in interview behavior were a lock of confidence and overstrain, immature doctor-patient relationship ad a lack of empathic empathic expression. The first clinical interview was appreciated positively by the students. Conclusion : Medical student’s emotions during the first interview with real patients were well understood as well as defects in the interview skill. This understanding will contribute further to the development of medical interview curriculum.( J Korean Acad Fam Med 1999;20:1721-1731)
Background
: The status of development of instruments to asses the health related quality of life' reflecting Korean's own language expression and culture is still far from satisfaction, despite their importance in building basic date for health promotion, evaluation of effectiveness of treatment, health policy and so on. Methods : Symptom descriptions in both ill and healthy conditions were collected from 292 Koreans based on definition and domains of 'health related quality of life' which was established by 7 family physicians. The collected results were categorized into each domain and edited to be used as questions. Questions of health change and spiritual health domains were added. A selection of most pertinent items were pursued through the internal consistency analysis on 417 patients. Pretest was performed on 20 ordinary people to see if they think selected questions were understandable and related to their quality of life. Results : A total of 1934 symptom descriptions were collected and categorized into 44 of 7 domains including physical function, mental health, social function, pain, role, vitality, and health perception. Two items of health change and 3 items of spiritual health domain were added. Among those 49 items, 45 items of 9 domains were selected after discarding 4 items lowering internal consistency coefficient. Some items were corrected for more precise meaning, concise meaning, concise sentence, proper expression and word order, and nuance after pretest. Conclusion : We developed a Korean health related Quality of Life Scale(KoQoLS) reflecting Korean's own language expression and culture.
Background
: Fatigue is one of the most common problems encountered in family practice but its diagnosis and management are neither standardized nor simplified. This baseline study was conducted to find out the clinical characteristics. clinical courses, and outcomes of fatigued patients. Methods : This study included 163 fatigued patients who visited a department of a university hospital based family practice due to fatigue as their prima교 or secondary complaint. We classified fatigue which persisted for more than 6 months as chronic fatigue, less than 6 months as acute fatigue. Retrospective review of medical record was used to collect all related clinical all related clinical characteristics and telephone interview was done to follow the course and outcomes of fatigue. Results : Of the total 163 fatigued patients, 105 patients(64.4%) were men. Fifty two patients(31.9%) visited the clinic for complete health check-up due to fatigue. The rate of response to telephone interview was 62.6%. Fifty five patients(33.7%) were acute fatigue, 75 patients(46.0%) chronic fatigue, and 33 patients(20.2%) unknown duration of fatigue. According to the causes of fatigue, 11.7% of patients corresponded to organic cause, 60.7% psychiatric cause, 27.6% unknown cause. Specified organic causes of fatigue, chronic hepatitis was the most common disease followed by alcohol liver disease, most common disease followed by alcohol liver disease, arthritis, anemia, viral syndrome and hyperthyroidism. As psychiatric causes of fatigue, stress was the most common cause followed by overwork, alcohol abuse, depression, and anxiety. Reassurance and observation(71.8%), drug therapy(17.8%) were the most common treatments. These who felt their function decreased below 50% were 7.6% of total 102 patients. On the survival analysis, 58.2% of acute fatigue patients, 62.4% of chronic fatigue patients, 67.0% of unknown patients had fatigue for 2 years since the initial visit. Conclusion : As the cause of fatigue in a family practice, psychiatric causes were more frequent than organic causes. As psychiatric causes of fatigue, stress was the most common cause followed by overwork and alcohol abuse. Only one third of the third of the fatigued patients had improved two years later.
Background
: Hypertension is one of the frequent problems for which family physicians are well encountered to manage. Nonpharmacologic measures-which include stress relaxation, low salt diet, weight reduction, moderation of alcohol intake, physical activity, tobacco avoidance-are used as definitive or adjuvant therapy for hypertension. Family physicians should vigorously encourage their patients to adopt these life-style modifications. This study was conducted to know how many nonpharmacologic treatment modalities are adopted by hypertensives and to find predicting factors. Methods : A total of 100 of the hypertensive patients who are followed up via the department of family medicine, Hanyang University Hospital, from September 1995 through November 1995 are included in this study. A trained nurse interviewed patients according to the previously designed structured questionnaire. The overall response rate was 90% and the fill-up rate of the questionnaire was 100%. Results : Sixty three patients were women. The mean age was 57.4 years(range, 20 to 84). Sixty one percent accompanied one or more other diseases, of which diabetes mellitus was the most common disorder. The mean systolic pressure was 143.9 mmHg and the mean diastolic blood pressure was 89.3%mmHg. Ninty-three percent of patient received antihypertensives with compliance of 81 to 100%. Twenty four percent of patients adhered to regular exercise, 36 percent weight reduction, 48 percent low salt diet, 79 percent moderate drinking, 81 percent stress relaxation, and 87 percent no smoking. Of those six non-pharmacological treatment, 3.6 behaviors were adhered. Male patients were more attended with the low salt diet. Eleven patients of 25 alcoholics(44.0%) reduced their amount of alcohol intake and 8 of 17 smokers quitted smoking(47.1%) after they were diagnosed as hypertension. The mean BEPSI score was 1.5. Fifty one percent of patients has stress within the last three months, 32 percent has cumulative fatigue. The occupational stress was the most common one. All exercise which patients reported were isotonic. Seventeen percent of the patients took certain herb medicine or folk medicine. Conclusion : Of those 100 hypertensives who were treated at the department of family medicine, Hanyang University hospital, 24% adhered to regular exercise, 36 percent weight reduction, 48 percent low salt diet, 79 percent moderate drinking, 81 percent stress relaxation, and 87 percent quit smoking in order. Of those six non-pharmacological treatments, 3.6 behaviors were adhered on the average. Nonpharmacologic treatment should be promoted by family physician as an important strategy for treatment of hypertension.
Background
: Blood pressures measured by a nurse at reception room as a part of routine physical examination are often used as a indicator of medical care. Blood pressure at reception room and consultation room are, however, often different to each other and these differences are caused by various factors including difference of white coat effect by nurse and doctor. Thus, this study was performed in order to know whether blood pressure difference really exit, and its associated factors. Methods : Two hundred ninety one patients who visited to one university hospital family practice were enrolled in this study. Blood pressure and pulse rate at reception room and consultation room, waiting time, time interval between reception and consultation, smoking status, and intake of coffee and food were collected. Nine patients were excluded, because blood pressure either at reception room or at consulation room was not recorded. This study was performed by one nurse and two doctors. They defined the guideline for method of blood pressure measurement before the study, and used the same kind of indirect cuff sphygmomanometer. Results : Two hundred eighty two patients were analyzed. The number of men was one hundred twenty five. Systolic blood pressure at consultation room was higher than that at reception room by 1.6±11.9mmHg(P<0.05). Sixty five cases(65%) in systolic blood pressure and 111 cases(40%) in diastolic blood pressure showed blood pressure differences more than 5mmHg. The group with systolic blood pressure difference between reception room and consultation room(Δ SBP) in more than 5mmHg is more likely to be hypertensive than the group with ΔSBP in less than 5mmHg(P<0.01). More female patients(66%) and hypertensive patients(59%) were belong to the group whose systolic blood pressure at consultation room were 5mmHg higher than at reception room(P<0.01). Twenty four patients(30%) of the group whose systolic blood pressure at reception room were 5mmHg higher than at consultation room had cigarette smoking within 1 hour, and this ratio was significantly higher than the other groups whose systolic blood pressure difference was less than 5mmHg or systolic blood pressure at consultation room were 5mmHg higher than at reception room(P<0.01). There was relatively good concordance room were 5mmHg higher than at reception room(P<0.01). There was relatively good concordance in classifying hypertension and normal blood pressure according to measurement site(Overall kappa ; 0.747, P<0.01). Conclusion : Many patients showed blood pressure differences more than 5mmHg between reception room and consultation room. Systolic blood pressure at consultation room was higher than that at reception room, and there was relatively good concordance in classifying hypertension and normal blood pressure according to measurement site, but the adverse effect by misclassification should not be neglected. The importance as well as the limitation of blood pressure measurement at reception room should be considered in screening and treating hypertensive patient. Every time when blood pressure is taken, physicians should keep in mind to consider patient's factors which may influence blood pressure level.
Background
: Noncompliance is a important problem in the management of hypertension, which causes major morbidity and mortality among Korean people. The purpose of this study is the assessment of drop-out rate of hypertensive patients in university-based family practice setting. Methods : The medical records of hypertensive patients for 2 years(July 1, 1991 August 30, 1993) were reviewed. 207 patients visited during this period. Six cases of referral and 45 cases of non-pharmacologic treatment group were excluded. A total of 156 patients were under reivew about the date of the first visit, the date of the last visit, and frequency of visit during study period. We analysed several factors by adherent group, irregular visiting group, and drop-out group according to arbitrary criteria. Results : Among 156 patients, 33 patients(21%) were compliant, 46 patients (29.5%) were visited irregularly and 77 patients(49.3%) were dropped-out. Patient's compliance in keeping appointment was not related with age, sex, presence of target organ damage and previous awareness of morbid state, except presence of comorbid disease. Patients with several degenerative diseases were keeping appointment better than patients without these comorbid diseased.(P<0.05) 39.5% of hypertensive patients were lost to follow-up after 1 year, and 45.3% remained in antihypertensive therapy after 3 years. Conclusion : There is a increase in drop-out rate with duration of antihypertensive therapy. 45.3% of hypertensive patients remained in antihypertensive therapy after 3 years of treatment and 12% of patients were dropped out immediately after the first visit. Presence of comorbid diseases was associated with patient's compliance. Strategies improving compliance and decreasing early drop-out rate are needed.
Background
: Fine needle aspiration biopsy is useful method to evaluate the mass lesion in primary care. But false negative result and insufficient specimen make it difficult to interpret the result and to manage the patients. Therefore, we should effort to decrease the frequency of false negative result and insurfficient specimen. Methods : The medical records of twenty one patients were reviewed who had been examined with fine needle aspiration biopsy for the evaluation of thyroid nodule, cervical lymph node swelling and breast mass from January 1992 to October 1993 in the family practice outpatient department. Results : Among 8 cases of the thyroid nodules, insufficient specimens were 3 cases, benign 4 and malignancy 1. Among 8 cases of the cervical lymph node swellings, insufficients 3, benign 4 and malignancy 1. Among 5 cases of the breast masses, insufficient 2 and benign 3. Total number of insufficient specimens were 8 cases(38% of all case), benign 10 and malignancy 2. Among the 8 cases of insufficient specimens, one thyroid nodule and two lymph node swellings were confirmed to adenomatous hyperplasia and tuberculosis, respectively by excisional biopsy. Another five cases were followed up and the lesion was reducted in size without any management in the cases of two thyroid nodules, the other was dropped out. One lymph node swelling was treated by anti-tuberculosis medication because chest film showed pulmonary tuberculosis concurrently. Two breast masses were not changed in size. Conclusion : Our study had more insufficient speciment than others, but they are diagnosed by exicional biopsy or follow-up. We should improve the skill of fine needle aspiration biopsy to decrease the insurfficient specimen.
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
: Physician's role to reduce smoking-related mortality and morbidity is receiving increased attention. But many physicians in busy practice are reluctant to do smoking cessation counseling because of time pressure and lack of belief in efficacy. If brief counseling requiring minimum time can be effective in motivating smoking patients, it is of great help in preventive practice of primary care physician. Methods : Cigarette-smoking male patients in university hospital family practice were randomly assigned to either a control group receiving routine care or an intervention group receiving. In addition to routine care, 3-munites brief smoking cessation counseling from their physician. Both groups were followed up with telephone interview at 3 months. Counseling were individualized according to the patient's health problem and physician's own style and consisted of smoking history, hazards of smoking and benefit of quitting, emphasis of cold-turkdy method, and searching for motivation based on the patients' life style. Results : Fifty-seven patients from intervention group and sixty-nine patients from control group were interviewed. 74% of intervention group and 74% of control group attempted to quit. Quit rate for some duration was 49% in intervention group and 42% in control group. Two patients from intervention group and 5 patients from control group were non-smokers at interview. All the difference between two groups was not significant statistically. Characteristics such as age and baseline smoking status of smokers and non-smokers were similar to each other. Conclusion : Brief smoking cessation counseling in this study showed negative results. Development of smoking counseling skills and other effective strategy are required.
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