| Jungkwon Lee | 9 Articles |
Background
As indoor activity increases with modern lifestyles changes, reduced exposure to sunlight may lead to reduced vitamin D synthesis. Previous studies demonstrated that increased vitamin D level is associated with decreased risk of colon cancer; therefore, this study attempted to determine the association between vitamin D and colon polyps, which may be precancerous lesions, in participants who underwent colonoscopy exams. Methods A total of 31,004 participants who underwent routine health checkups, including vitamin D level and colonoscopy, at Samsung Medical Center in South Korea from 2010 to 2018 were included in the study. Colorectal polyps were diagnosed through biopsy after performing colonoscopy exams. Participants were categorized into three groups according to level of vitamin D (deficient: <20 ng/mL), insufficient: 20≤ vitamin D <30 ng/mL, and sufficient: ≥30 ng/mL). We analyzed the presence of colorectal polyps according to vitamin D level, and performed multiple logistic regression analyses for the association between vitamin D level and colorectal polyps. Results About 50% of participants had colorectal polyps (hyperplastic polyp, n=4,864; adenomatous polyp, n=10,470; adenocarcinoma, n=24). There were no significant associations between vitamin D categories and colorectal polyp and colorectal cancer. However, when further analyzing by type of polyp, the risk of hyperplastic polyps significantly decreased with increasing vitamin D levels (P for trend=0.006). Conclusion We did not find evidence for an association between vitamin D and overall colorectal polyps; however, we observed a trend for decreased odds of hyperplastic polyps with increased vitamin D levels in comparison to vitamin D deficient subjects. Citations Citations to this article as recorded by
With the early detection of cancer and improvement in cancer therapy, the number of cancer survivors is rapidly increasing. This number is expected to reach 2 million by the end of 2019. Cancer survivors struggle with not only cancer-related health problems but also diverse acute and chronic diseases. These health issues make cancer survivorship more complex, and proper care coordination is necessary. This study aimed to summarize the definition of cancer experience and management of cancer survivors, specifically focused on gastric, colorectal, lung, breast, thyroid, prostate, and cervical cancers. Furthermore, it aimed to discuss the role of primary care in cancer survivorship and survivorship care models and the National Policy for Cancer Survivors and Future Challenges.
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Background
The present study aimed at identifying the difference in the risk of microalbuminuria among individuals with various obesity phenotypes in terms of metabolic health and obesity. Methods This cross-sectional study included 15,268 individuals and used data from the National Health and Nutrition Survey conducted from 2011 to 2014. Obesity was defined as body mass index ≥25 kg/m². Metabolically unhealthy was defined as meeting two or more of the following criteria: systolic and diastolic blood pressure ≥130/85 mm Hg or current use of hypertensive drugs; triglyceride level ≥150 mg/dL; high-density lipoprotein level <40/50 mg/dL (in both men and women); and fasting blood glucose level ≥100 mg/dL or current use of oral antidiabetic medications. The participants were further classified into four subgroups: metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUNO), and metabolically unhealthy obese (MUO). Results A significant difference was observed in the microalbuminuria ratio among the four groups. The MHNO group was considered as the reference group, and the MHO, MUNO, and MUO groups were at an increased risk for microalbuminuria by 1.42 fold (95% confidence interval [95% CI], 1.03–1.96), 2.02 fold (95% CI, 1.61–2.53), and 3.40 fold (95% CI, 2.70–4.26), respectively, after adjusting confounding factors. Conclusion The MUNO group had a higher risk of developing microalbuminuria than the MHNO group. Thus, based on this result, differences were observed in the risk of developing microalbuminuria among individuals with various obesity subtypes. Citations Citations to this article as recorded by
Urinary incontinence (UI) is highly prevalent in the aging population. UI is one of the most common geriatric syndromes and affects overall health, quality of life, and economical burden in patients. The aims of this study were to investigate the characteristics of patients with UI and to assess its association with other geriatric health problems. We used data from the Korean Longitudinal Study of Ageing obtained in 2006. Among the 10,254 individuals aged 45 years and older, we analyzed data from 2,418 women aged 65 years and older. Data were obtained using questionnaires for UI, comorbidities, and lifestyle factors. Among the 2,418 women aged 65 years and older, 506 (20.9%) had UI. Cerebrovascular disease (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.26 to 3.23), arthritis (OR, 1.44; 95% CI, 1.18 to 1.77), and fear of falling (OR, 1.62; 95% CI, 1.18 to 2.22) were significantly associated with UI, while chronic lung disease, psychiatric disease, difficulty in daily living due to visual and hearing problems, and experiencing a fall in the last 2 years were not associated with UI. Cerebrovascular disease, arthritis, and especially fear of falls were significantly associated with UI in elderly Korean women. Citations Citations to this article as recorded by
Being underweight has been related to health risks. However, little is known about the relationship between suicidal ideation and attempting to lose weight. This study was conducted to examine if there is an association between suicidal ideation and attempting to lose weight among underweight adults. A cross-sectional study of 1,122 underweight adults (range, 19 to 69 years) was conducted based on the Korea National Health and Nutrition Examination Survey, 2007-2012. We examined suicidal ideation, doctor-diagnosed depression, depressive mood, stress, physical activity, health-related behavior, comorbidity, and socioeconomic status by weight loss attempts. Logistic regression analysis was performed to examine the association between suicidal ideation and weight loss attempts. The following covariates were controlled for: age, sex, physical activity, alcohol problem, marital status, education, income, occupation, self-perception of body image, chronic disease, and body mass index. There were 101 subjects in the weight loss attempt group and 1,021 in the non-attempt group. The attempt group had a higher risk of suicidal ideation (odds ratio [OR], 2.47; 95% confidence interval [CI], 1.35 to 4.53) and depressive symptoms (OR, 2.17; 95% CI, 1.19 to 3.98). After depressive symptoms were added to the covariates, the risk of suicidal ideation was also significant (OR 2.11, 95% CI: 1.03 to 4.35). The two groups did not significantly differ in doctor-diagnosed depression and stress. Weight loss attempts were associated with suicidal ideation in underweight Korean adults. Citations Citations to this article as recorded by
The number of internet users is increasing rapidly and internet addiction among adolescents has become a serious public health problem in Korea. In the light of behavioral addiction, this study was aimed to identify the associations between the risk of internet addiction and other problem behaviors which can lead to addiction, such as cigarette smoking, alcohol drinking, drug abuse, and sexual intercourse among a nationally representative sample of Korean adolescents. Data from the 2010 Korean Youth Risk Behavior Web-based Survey (respondents, 73,238) were analyzed. Risk of internet addiction was assessed by the 'Korean Internet Addiction Proneness Scale for Youth-Short Form: Self Report' which was developed by the Korean National Information Society Agency in 2008. Multiple logistic regression analysis was used to calculate the odds ratios of problem behaviors among adolescents at high risk for internet addiction and adolescents at low risk for internet addiction. The odds of smoking experience, drug abuse experience, and sexual intercourse experience were significantly higher among boys at high risk for internet addiction compared to boys at low risk for internet addiction. Among girls at high risk of internet addiction, the odds of smoking experience, drinking experience, and drug abuse experience were significantly higher compared with girls at low risk of internet addiction. The risk of internet addiction was associated with cigarette smoking, alcohol drinking, drug abuse, and sexual intercourse experience among Korean adolescents. Citations Citations to this article as recorded by
It is important to know and decide when to end regimen for the quality of life of the patients. However, there is currently no clear agreement on when to terminate palliative chemotherapy. We investigated the duration between the last chemotherapy and death, and associated factors affecting patients receiving palliative care after the last chemotherapy. We studied 242 patients who were put into palliative care ward after receiving chemotherapy and died during hospitalization from 2008 to 2009. Electronic medical records were used to gather information on demographic characteristics, types of primary cancer, and palliative chemotherapy. Then we analyzed the relationship between the clinical characteristics of patients and interval between last chemotherapy and death. The average survival time of patients after referral to palliative care was 17.5 days; survival time after discontinuation of chemotherapy was 103 days. Also, 104 (43.0%) patients died within 3 months and 14 (5.8%) patients died within 1 month of persistent palliative chemotherapy. Chemotherapy on patients within 3 months from their death was not associated with the social characteristics of the population. The patients who were referred to palliative care were found to have continued to receive chemotherapy within 3 months before death. However, only a small number of patients received chemotherapy within 1 month before death, which confirms that futile chemotherapy that extends to the end of life was less frequent. Doctors should be able to recognize the implications of excessive and aggressive use of chemotherapy and should actively communicate with patients about therapeutic choices. Citations Citations to this article as recorded by
Background
: A considerable portion of patients in primary care are thought to have mental disorders in Korea. But they are not easily noticed and are thus underdiagnosed and approached improperly. This study was done to assess the prevalence of common mental disorders in a hospital-based family practice and to evaluate the utility of a diagnostic tool, the Patient Health Questionnaire (PHQ). Methods : Ten or more patients each day were systematically selected in family practice clinics for two weeks in a university and a community hospital-based family practice clinics in Seoul, Korea. Routine care was delivered as a control during the first week and the PHQ was administered to patients during the second week and the physicians were allowed to review the PHQ just before making clinical decisions. Physicians were asked to answer whether they recognized patients' with mental disorders before reviewing the PHQ. Results : The prevalence of mental disorders was higher in the test group than the control except for eating disorders and other anxiety disorders (P＜0.05)(test vs. control group): major depressive disorders 1.75% vs. 3.8%, other depressive disorders 6.8% vs. 11.4%, panic disorders 0.6% vs. 2.3, somatoform disorders 3% vs. 5%, alcohol abuse 2.2% vs. 8.7%, and any mental disorders 20.9% vs. 29.4%. In the test group, the percentage (95% confidence interval in parenthesis) of newly diagnosed mental disorders after physicians' review of the PHQ were 66% (49∼82) in major depressive disorders, 70% (50∼90) in panic disorders, 70% (56∼83) in somatoform disorders, 84% (75∼92) in alcohol abuse, and 68% (62∼74) in any mental disorders. Patients' response to the PHQ was overall very receptive. Conclusion : One-week prevalence of common mental disorders in the hospital-based family practice was 29.4% and the PHQ tool was efficient to help the family physicians recognize hidden mental disorders.
Background
: One of the main objectives of medical school is to provide high-quality primary care physicians. To fulfill this objective it is increasingly important to utilize ambulatory care setting, particularly community private practice clinic for medical students' clerkship. But program evaluation of this type of clerkship is lacking. The authors intended to evaluate th e community primary care clerkship with a view to students' perspective. Methods : We used students' and preceptors' evaluation forms with semi-structured questionnaires using 5-point Likert scale and students' essays for program evaluation. We analyzed 76 students' and 89 preceptors' evaluation forms by description, and categorized emergent themes from 89 students' essays using qualitative method. Results : Over seventy percent of students rated overall satisfaction, achievement of knowledge, preceptors' educational effort, and practical application as excellent on the 5-point Likert scale. In the evaluation of the discussion topics with preceptors, they rated medical insurance and health care delivery system as relatively poor compared to other topics such as realities of private practice, management of private practice and equipments necessary in primary care. They understood positively the importance of patient characteristics and good patient-physician relationship in primary care, and the realities of private practice. They were also concerned about the problems of health care system and assumed a sound suspicion whether the education in medical school was practical in primary care. On the other hand, they showed ambivalence towards expressing the negative aspect of primary care in terms of the repetition of simple cases and lack of stimulation to achieve sophisticated medical knowledge. Conclusion : Community primary care clerkship was generally satisfactory in the students' perspective, which is necessary to standardize preceptor education and establish a role model of primary care in order to provide the soil for high-quality primary care physician.
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