| Yoo Seock Cheong | 46 Articles |
Patients' perspectives of family medicine according to the physician's identity and role as a primary-care specialist need to be investigated. This study was conducted to investigate the perceived quality of the primary care of family medicine clinics as assessed by patients in a community setting. Patients (or their guardians) visiting nine community family medicine clinics were surveyed using the Korean Primary Care Assessment Tool from April 2014 to June 2014. The scores of the Korean Primary Care Assessment Tool domains were compared according to the clinics' designation (or not) as 'family medicine' and the patients' recognition (or not) of the physicians as board-certified family medicine specialists. A total of 196 subjects responded to the questionnaire. They assessed the community clinics' quality of primary care as moderate to high. Of the clinics, those that were not designated as family medicine scored higher than those that were designated as family medicine (P<0.05). The group of patients that recognized a clinic as that of a board-certified family medicine specialist awarded higher scores than the non-recognition group in the domains of coordination function and personalized care (P<0.05). The moderate to high scores for the community family medicine clinics' quality of primary care are encouraging. It seems that patients' recognition of the family physician's role and of the physician-patient relationship has a significant influence on their assessment of the quality of primary care. Citations Citations to this article as recorded by
Varenicline is now very useful medication for cessation; however, there is only little result of researches with varenicline for cessation of hospitalized patients. This research attempted to analyze the cessation effect of medication and compliance of hospitalized patients. This research included data for 52 patients who were prescribed varenicline among 280 patients who were consulted for cessation during their admission period. This research checked whether smoking was stopped or not after six months and analyzed their compliance, the factors for succeeding in smoking cessation. One hundred and ninety hospitalized patients participated in smoking cessation counseling among 280 patients who included consultation from their admission departments. And varenicline was prescribed for only 80 patients after counseling. Nineteen smokers were successful in smoking cessation among 52 final participants representing the rating of success of 36.5%. The linkage between compliance of varenicline and rate of smoking successful has no statistical significance. The factors for succeeding in smoking of hospitalized patients are admission departments, diseases, and economic states. Smoking cessation program has low inpatient compliance. Cooperation of each departments is very important for better compliance. Success rate of cessation was relatively high (36.5%). Cessation attempt during hospitalization is very effective strategy. Citations Citations to this article as recorded by
BATHE, the acronym for background, affect, trouble, handling, and empathy, is an interview approach that can be applied in the out-patient setting whereby questions belonging to each of the 5 categories are asked in the above order. As we have been taught to believe that BATHE raises the level of patient satisfaction and the quality of medical treatment overall, this study was designed to test the validity of the claim that applying BATHE heightens patient satisfaction. Each of the 5 doctors was assigned 10 patients (5 in the BATHE group and the other 5 in the control group) with each patient being randomly assigned to either of the groups. The control group was interviewed as usual and the BATHE group was interviewed using BATHE. Immediately after the interview, each patient anonymously filled out a patient satisfaction questionnaire. Whether the questions asked were appropriate for each category of the protocol was evaluated by the researcher through video clips taped during the interviews. On 7 out of 10 items on the patient satisfaction questionnaire, the BATHE group was found to experience higher level of satisfaction than the control group in a statistically significant manner. The questions asked the BATHE group were confirmed to be more appropriate for each category of the protocol except empathy than those asked the control group. As applying the BATHE approach was found to achieve higher level of patient satisfaction, we recommend using it in the out-patient setting. Citations Citations to this article as recorded by
Combined therapy with alendronate and calcitriol may have additive effects on bone density. An observational study was performed to evaluate the efficacy and safety of Maxmarvil, a combinative agent of alendronate (5 mg) and calcitriol (0.5 µg), and to identify factors associated with efficacy. A total of 568 postmenopausal women with osteoporosis were enrolled by family physicians in 12 hospitals. The study subjects took Maxmarvil daily for 12 months. Questionnaires about baseline characteristics, socioeconomic status, and daily calcium intake were completed at the first visit. Adverse events were recorded every 3 months and bone mineral density (BMD) in the lumbar spine was measured using dual-energy X-ray absorptiometry at baseline and after 12 months. We evaluated the efficacy and safety of Maxmarvil, and the factors related to BMD improvement. A total of 370 patients were included in final analysis. The median BMD was 0.81 ± 0.12 g/cm2 at pre-treatment and 0.84 ± 0.13 g/cm2 after one year. The average BMD improvement was 3.4% ± 6.4% (P < 0.05), and 167 (45.1%) patients showed improvement. Factors associated with improved BMD were continuation of treatment (odds ratio [OR], 2.41; 95% confidence interval [CI], 1.15 to 5.07) and good compliance (OR, 2.54; 95% CI, 1.29 to 5.00). Adverse events were reported by 35 of the 568 patients, with the most common being abdominal pain and dyspepsia. Maxmarvil was found to be safe, well tolerated and effective in osteoporosis treatment. Continuation of treatment and good compliance were the factors associated with efficacy. Citations Citations to this article as recorded by
Hemoglobin A1c (HbA1c) was adopted as a new standard criterion for diagnosing diabetes. We investigated the diagnostic utility of HbA1c by comparing the 2003 American Diabetes Association (ADA) diagnostic criteria of diabetes with HbA1c of 6.5%. Furthermore, the cut-off value for HbA1c was investigated using receiver operating characteristic curves. This study included 224 subjects without a history of diabetes that had a fasting plasma glucose level of above 100 mg/dL. The subjects had undergone a 75 g oral glucose tolerance test, and diabetes was defined as according to 2003 ADA criteria. The prevalence of newly diagnosed diabetes was 58.2% by the 2003 ADA criteria, and 47.8% by HbA1c of 6.5%, which underestimated the prevalence of diabetes. Compared with the 2003 ADA criteria, the sensitivity and specificity of HbA1c of 6.5% were 73.5% and 89.1%, respectively. The kappa index of agreement between 2003 ADA and HbA1c criteria was 0.60. The cut-off point of HbA1c for diagnosing diabetes was 6.45% (sensitivity, 73.3%; specificity, 88.2%; area under the curve, 0.85). HbA1c was significantly associated with fasting glucose (r = 0.82, P < 0.01), postprandial glucose (r = 0.78, P < 0.01), and homeostasis model assessment of insulin resistance (r = 0.16, P < 0.05). For high risk patients whose fasting glucose was more than 100 mg/dL, HbA1c criterion underestimated the prevalence of newly diagnosed diabetes compared to the 2003 ADA criteria, and showed moderate agreement. The cut-off value for HbA1c was 6.45%, which was similar to the recommended diagnostic criterion of HbA1c by the 2009 ADA. Citations Citations to this article as recorded by
The family medicine residency program consists mainly of clinical rotations in other specialties and the family medicine-specific training. We conducted this study to investigate how family medicine residents evaluated their training program that include family-oriented medicine, clinical preventive medicine, behavioral science and research in primary care. In 2009, third-year residents of 129 training hospitals in Korea were surveyed to investigate the current state and their expectation of the residency program. The contents of questionnaires included training periods, conferences, procedures, interview techniques, outpatient and inpatient consultations, and written thesis. Total 133 out of 142 residents (93.7%) responded that 3 years of training is ideal or pertinent. Residents responded that the types of conference that they need most are journal review (81%), staff lecture (73.2%), and clinical topic review (73.2%), in that order. Procedures and interview techniques that the residents want to learn most were gastroscopy (72.5%), abdominal ultrasonography (65.2%), and pain management (46.4%). Hospitals where family medicine residents do not see hospitalized patients or patients in the outpatient clinic were 7.9% and 6.5%, respectively, whereas hospitals that maintain continuous family medicine outpatient clinics were only 40.8%. Education in outpatient clinic and articlewriting seminars was done less frequently in the secondary hospitals than in the tertiary hospitals. Evaluation and quality improvement of family medicine training program as well as specialty rotations should be considered in order to foster better family physicians. The efforts have to be made to minimize the difference in quality of each family medicine residency program. Citations Citations to this article as recorded by
Carcinoid is a neuroendocrine tumor and contains many peptide substances and biological active amines, so if it is released, it can cause carcinoid syndrome. However, most carcinoid tumors are unfortunately asymptomatic, and it is difficult to find one smaller than 1 cm because it doesn't have prominent mucosal elevation and change. We can reduce expenses and recovery period of the patient by using a relatively noninvasive endoscopic mucosal resection, unless it has distant organ and lymph node metastasis. Colonoscopy is an optimizing diagnostic tool for early detection of asymptomatic carcinoids. But according to colonoscopic guidelines of many institutes, they recommend to perform a screening colonoscopy in the asymptomatic fifties if there are no risk factors. However, a careful examination of colonoscopy is needed, because possibility of malignant tumor in aymptomatic young age. The authors report four cases of carcinoid tumor in asymptomatic thirties with review of several literatures.
Background
Varenicline is recently known as smoking cessation medicine has no results of researches conducted in the actual practice settings except for incipient clinical trials. This research attempted to analyze the factors for smoking cessation by using Varenicline prescribed in the family clinic, and the efficacy of Varenicline. Methods: Brief smoking cessation education was conducted on 140 people who visited the Department of Family Medicine at Dankook University and Varenicline was prescribed for them. This research checked whether smoking was stopped or not after six months and analyzed the factors for succeeding in smoking cessation. Results: Varenicline was prescribed for the 140 people. After six months, 46 smokers were successful in smoking cessation, representing the rate of success of 35.4%, and after 12 months, 31 people of 83 people were successful in smoking cessation, representing the rate of success of 37.3%. The group less smoke than 24.3 cigarettes/day (the average daily smoking amount) has higher quit rate than the group more smoke than 24.3 by 4.9 times. The group takes Varenicline longer than 26.7 days (the average Varenicline dosage period) has higher quit rate than the group takes Varenicline shorter than 26.7 by 4 times. Smoking-cessation rate was 4.5 times when trying to stop smoking by the doctor's recommendation. It was higher than when trying to stop smoking by self-determination. In the multivariate analysis, there were significant relationships in daily smoking amount, dosage and period of Varenicline, and motivation of visits.Conclusion: Varenicline is one of the useful medication for quitting smoking in family practice setting. Better compliance of medicine shows better quitting rate. Citations Citations to this article as recorded by
Background
Sleep is an essential restorative physiologic phenomenon. Impaired sleep results in significant negative effect to the health. Symptoms like sleep initiation difficulty, frequent awakening, severe snoring have related to poor sleep quality. We studied frequency and compared the characteristics of common sleep disorders at family practice.Methods: We surveyed patients over 18 years of age and their guardians who visited 16 familial practices for 6 days. We investigated sleep characteristics, frequency of sleep disorder and associated factors by questionnaires and analyzed by frequency analysis, Spearman's correlation coefficient, multiple logistic regression.Results: We enrolled 1,117 participants. Older participants were more likely to report early sleep onset and off time, short sleep duration. Mean number of awakening during a typical night is 1.69. Female complained difficulties in initiation and maintenance of sleep more than male. A total of 32.5% had these insomnia symptoms and related to hypertension, stroke, stress, arthralgia, depression, urological disorder. 31.1% had excessive daytime sleepiness, related to stress, arthralgia, depression. Loud snoring and gasp for breath showed positive correlation between male, high BMI. Disrupted sleep over 3 times was related to old age, female, diabetes, hypertension, stroke, stress, arthralgia, depression. Restless leg syndrome were high in elderly, high BMI, stress, arthralgia and depression.Conclusion: About one in three who visit in primary medical practice have sleep disorder symptoms like insomnia, daytime fatigue, snoring. 3% of them have gasp for breath, 8% have restless leg syndrome. Citations Citations to this article as recorded by
Trichuris trichiura (T. trichiura) is soil-transmitted parasite and widely spreads all over the world. High infection rates occur especially in the poor hygiene area. T. trichiura is transmitted by the water and food contaminated with T. trichiura eggs. Most of mildly infected individuals could be asymptomatic, whereas heavily infected patients manifest with anemia, diarrhea, nausea, vomiting, abdominal pain, and weight loss. Serious manifestations such as intestinal obstruction and perforation were reported to be caused by Trichuriasis. Diagnostic methods are stool examination of T. trichiura eggs and eosinophil count in blood. Sometimes, colonoscopy can be useful diagnostic tool and treatment. We observed that the North Korean refugee with chronic abdominal pain and the patient with abdominal pain and loose stool have been diagnosed as T. trichiura infection confirmed by colonoscopy. After treatment, the patient's symptom has improved. Therefore we report two cases of trichuriasis with literature review.
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Background
Varenicline is known to have higher effect for smoking cessation than existing pharmacotherapies, including Bupropion and Nicotine replacement therapy, however, it can also bring about adverse effects such as problems in compliance due to the complicated dosage, side effects of high frequency, and financial burden resulted from a long term treatment. Moreover, the effect for smoking cessation with group program and non-pharmacotherapy, including financial. incentives, E-mails or SMS is well known, but, the study on their combination is rare. Therefore, in the present study, we tried to evaluate two things; the effect for smoking cessation with multi-modal intervention, and the compliance of Varenicline Methods: From July 2008 to February 2009, we conducted the multi-modal smoking cessation program for 30 volunteers in Dankook university. This program consisted short course of Varenicline, financial incentives, E-mail and short messageservice. Results: The continuous abstinence rate for weeks 9 throught 12 was 76.7% and for weeks 9 through 24 was 43.3%. Multivariate analysis revealed that duration of Varenicline treatment was significant factor affecting 12-week continuous abstinence rate. The average duration of Varenicline treatment was 17.1 (±10.8) days and 54.0% took Varenicline as directed. The most common adverse events were nausea (40.0%) and insomnia (23.3%).Conclusion: Multi-modal intervention (short course of Varenicline, financial incentive, E-mail and short message service) was effective for smoking cessation with high continuous abstinence rates in a university. We suggest multi-modal intervention because compliance of Varenicline seems to be low in real setting. Citations Citations to this article as recorded by
Background
In the primary care setting, compliance with lipid lowering therapy was relatively low. In order to compare the efficacy of a short messaging service (SMS) text messaging and postal reminder as means of improving attendance rates during the first 24 weeks of lipid-lowering therapy, a randomized controlled trial of 918 patients from 19 family practice clinics was conducted between February 2003 and June 2006. Methods: Patients were randomly assigned into 3 groups: SMS (327), postal (294),and control (297) group. To ascertain attendance rates, patients were followed up at 24 weeks after their treatment. Reminders were sent at 16 weeks from the coordinating center. Results: Overall attendance rate was 74.1%. This differed between groups, with 76.1% attendance for the SMS group, 73.5% for the postal group, and 72.4% for the control group. According to a multivariate analysis, the SMS group had a significantly higher attendance rate (Odds ratios [OR] 1.48; 95% confidence interval [CI], 1.01 to 2.16) than the control group, but the postal group (OR, 1.15; 95% CI, 0.79 to 1.69) did not. Moreover, the cost per attendance for the SMS reminder (155 Korean Won [KRW]) was much lower than that for the postal reminder (722 KRW). Conclusion: SMS reminder may be more cost saving method to improve the attendance rate compared with the postal reminder. Citations Citations to this article as recorded by
Background
Throughout the past 20 years in the Korean academy of family medicine seasonal conference, on-going study is done to promote overall development and satisfaction of the conference participants and to overlook the trend of the conference subject, the number of classes, the number of participants, etc. Methods: About 2,132 topics during the conference from the year 1992 to 2007 collected from the Korean academy of family medicine website were categorized by subject based on the standard of the contents of the latest textbook. There were a total of 7 main classifi cations including 5 categories like 'principles of family medicine', 'disease prevention and health promotion', 'symptoms', 'clinical procedures', 'diseases' and adding 2 categories such as each committee' classes and other subjects. The scope of the changes of the main and sub-titles were categorized as in the 1990s and 21 century. Results: The number of attendees has increased during the past 20 years, especially the residents were the main portion of the participants. On the proportion of the clinical topics, there was a remarkable increase of geriatric medicine, palliative medicine, obesity, exercise, nutrition, gastroscopy, and colonoscopy procedure in the later half rather than the former half period. In the fi eld of the main category, the core principle subjects of family medicine seemed to be decreased in contrast to disease category. Conclusion: During the last 20 years, the titles of family medicine conference are changing with the trend of practice. The core knowledge of family medicine should be maintained and balanced for the future of family medicine conference.
Background
Common cold is the most frequently seen ambulatory disease in primary care clinic of Korea. This study investigated the perspectives and expected pattern of health care utilization of patients who visit a primary care clinic in order to understand patients' health care behavior for treating common cold and to consider how to educate them effectively. Methods: We surveyed 570 patients and their accompanying people who visited family medicine clinic and the health promotion center of a university hospital by questionnaire, in which we asked the patients what they think of the cause, symptom, and treatment of common cold and their pattern of health care utilization. Results: The respondents replied that the cause of common cold was a virus (446, 85.3%), a bacteria (58, 11.3%) or others (18, 3.4%). Among the total, 475 respondents (88.6%) replied that they had taken cold medicine before and 264 respondents (55.7%) reported that the symptoms took 1-2 weeks to recover. A total of 285 respondents (58.3%) replied that they prefer red to go to the doctor and 198 (40.5%) replied that they prefer to go to a pharmacy. The respondents who thought that symptoms of common cold takes longer than one week tended to choose to visit a doctor. Patients thought that antibiotics (54.4%) and those that relieved common cold symptoms earlier (30.1%) were 'strong' cold medicine.Conclusion: The results of this survey showed that the difference in patients' perspectives made an effect on the patients' treatment seeking behavior. Even though medicine did not take effect to relieve symptoms, most patients wanted to continue to visit physicians. The family physician should not give only the prescription, but also make an effort to provide pertinent information to patients and educate them to acquire appropriate perspectives. Citations Citations to this article as recorded by
Background: This study reports findings from the ITC Korea Survey, which was conducted to evaluate the characteristics in Korean adult smokers as part of the ITC Project. Methods: Adult male and female smokers were randomly selected using telephone survey from November to December 2005. The ITC Korea Survey contained a wide range of questions on smoking behavior and smoking history. The data reported are weighted on the basis of age and gender, and they are nationally representative of smokers in Korea. Results: A total of 1,002 smokers among the selected 1,402 subjects (71.5%) were interviewed; 96.2% were males. Daily smokers comprised 94.5% of the sample. The mean of cigarettes per day was 17.9. The average minutes after waking before the first cigarette was smoked was lower (50.6 minutes) than it was in other countries of the ITC Project. Over 90% considered themselves addicted to cigarettes and 86.5% expressed regret over smoking. Smokers reported that the norms against smoking in Korea were very strong both personal norms (89.4%) and perceived norms in Korean society (86.3%). Among the smokers, 80.8% had tried to quit smoking, and 76.1% were planning to quit. Only 5.8% of the Korean smokers indicated that the warning labels made them a lot more likely to quit smoking. When the price of cigarettes increased by 500 won (25%) in December 2004, 34.3% reported trying to quit smoking. Only 17.7% supported a complete workplace ban and 15.8% supported a complete ban in restaurants. Although knowledge of the harms of smoking was high, nearly 80% of the Koreans wrongly believed that "nicotine causes most of the cancer in smokers." Finally, the great majority (85.2%) of smokers in Korea believed that "the government should do more to tackle the harm done by smoking" and 62.5% believed that "tobacco products should be more tightly regulated." Conclusion: The results from the baseline wave of the ITC Korea Survey have identified where tobacco control in Korea has been done. Future waves of the ITC Korea Survey will be able to evaluate the impact of important tobacco control policies that Korea will be required to implement over the next few years, as a party to the FCTC. (J Korean Acad Fam Med 2008;29:844-853)
Background
Consultation and referral are important characteristics of modern medicine which has become more segmented and more specialized. In particular, they give essential value to family practitioners to coordinate patients accordingly for proper care. This study analyzed the referred patients in family practices under Cheonan practice based-research network (CPBRN). Methods: The data was collected via questionnaire in ten family clinics under CPBRN system during the four weeks from June 15, 2006 to July 12, 2006. Results: The total number of referred cases was 103 (0.7%) out of a total of 14,466 office visits. Among the total, 68.9% of referred cases was physician-drived and 31.1% was patient-requested. The reason for referral were 'to get a second opinion of specialist' (34), 'high severity' (20), 'lack of examination tool' (18), 'lack of skill' (10) and 'no response to treatment' (2) in physician-drived cases, whereas in patient-requested cases, they were 'request for advanced hospital' (26) and 'want to meet specialist' (2). The patients were referred to tertiary hospital in 66.7%, secondary hospital in 15.9%, and other specialists of primary setting in 10.1%. Overall, 66.7% of the referred hospital was located in the city area. The main health problems of referred patients was divided into 'gastrointestinal' (17.5%), 'musculoskeletal' (13.6%), 'dermatology' (10.7%) and so on. The speciality consulting physicians were 'internal medicine' (34%), 'pediatrics' (13.6%), and 'orthopedic surgery' (10.7%) specialists. Conclusion: The referral rate of family practice in Korea was 0.7%. The main reason for referral was 'to get a secondary opinion of a specialist'. The most common referral problem was 'gastrointestinal'. 'Internal medicine' was the most frequently consulted specialty. (J Korean Acad Fam Med 2007;28:286-291)
Background
Diabetes mellitus is one of the most common chronic diseases which primary care family physician encounters. This study was performed to describe the medical care for patients with diabetes based on the Cheonan Practice-Based Research Network. Methods: From May 2005 to July 2005, 193 patients with diabetes were assessed among the patients visiting seven family medicine clinics in Cheonan. The data were collected through a questionnaire about patient's socioeconomic characteristics, the details of medical care including screening practices of diabetic complications, self-monitoring of blood glucose and exercise. Results: Among the patients with diabetes, 25.4% reported no exercise and another 29.6% reported regular exercise of more than 4 times a week. The less educated and the more elderly patients reported less exercise. Only 37.3% of patients monitored their blood glucose at home. The more educated, the more likely the patients monitored their blood glucose. Only 18.1% of patients reported having an annual 24-hour urine protein examination. The more educated and the more income they had, the more annual 24-hour urine protein examination was done. Only 32.6% of patients reported having an annual ophthalmologic examination, but there was no associated factors with having an annual ophthalmologic examination. Conclusion: These data indicate that the medical care for diabetic patients, including exercise, self-monitoring of blood glucose, screening of complications, may not be optimal for preventing diabetes complications, and was influenced by demographic characteristics such as age and education level. It is necessary for health care team to provide systematic education for diabetes and ongoing close monitoring of self care practices. (J Korean Acad Fam Med 2007;28:106-113)
Background
: As medical informations are expanded, searching for useful information has become ever more important. Presently, teaching EBM (evidence-based medicine) is emphasiged. The purpose of this study was to survey family medicine residents' knowledge and utilization of EBM. Also, we investigated whether teaching EBM increased the knowledge and use of EBM in family medicine residents. Methods : In July 2005, we sent a questionnaire to family medicine residents in Korea and received 260 answers. The questionnaire concerned education, attitude, utilization and knowledge of EBM. We analyzed the relationship of the level of knowledge and utilization of EBM in practice by using chi-square test. Results : The family medicine residents who hed experienced learning EBM was 61%. Almost half of them were educated during their family medicine training programs (42.2%). Among the total, 33.6% of the respondents had an experience to attend EBM journal club. As for the knowledge of EBM, 59.8% of respondents knew the concept of what is EBM, 36.5% understood PICO question structure, and 28.5% knew how to calculate the NNT value. In the residents who had experienced EBM learning, the level of knowledge (P＜0.001), the frequency of utilization (P＜0.001), and the intention to use EBM in their practice were higher than in those who had not yet experienced EBM learning. Conclusion : Although family medicine residents usually learn EBM in medical school and resident training program, education and utilization of EBM were not organized enough. As can be seen in this study, it is necessary to make an effective education program in medical schools and resident training programs to increase the knowledge and utilization of EBM education.
Background
: Although smoking hazards are acknowledged worldwide, recent study of Korean teenage smokers shows that students' first smoking experiences are occurring at younger ages. Therefore, we have developed an internet-based smoking prevention program, and assessed the effectiveness of the self-administered internet program by comparing with traditional lecture. Methods : Between April and June of 2004, 463 female eighth-grade students at a middle school were divided into two groups. One group (n=252) received the lecture-based smoking prevention education by an expert, while the other group (n=212) learned themselves via the internet program. Prior to both smoking prevention programs, the students filled out questionnaires about their basic information. One month after their education, the students were tested on the information included in the programs without prior notice and filled out another questionnaire on the level of comprehension, satisfaction and other factors. Results : According to the pre-education questionnaire, the percentage of current smoking rate was 2.8%, and the first smoking experience was largely between the sixth and seventh grades. When comparing the scores of self-administered internet education with that of the lecture, the mean scores were 56.7 and 57.8, respectively, which was not significantly different (P=.267). The survey on comprehension, satisfaction, and other factors did not show any significant difference between the two groups. Conclusion : There was no significant difference between the internet-based program and the lecture-based one, in terms of effectiveness as well as comprehension, satisfaction, and other factors. Considering that the internet-based program is not restricted by time or location, it will no doubt be an effective tool in teenage smoking prevention programs.
Background
: The primary concern of a family physician is the healthcare of patients and their families, with the patient's disease itself being secondary. Family physicians should make efforts to discuss personal issues with their patients. This study examined how many patients were counseled about their private problems, especially family or sexual issues in the private clinics of Cheonan. Methods : The subjects were the patients who visited a practice-based network from April to June in 2003. The data were collected through simple questionnaire about sociodemographic features of patients and their family and sexual problems. Results : Eighty eight patients were studied for a total of 107 cases that consisted of 67 cases of family problems (62%) and 40 cases of sexual matters (38%). The common issues about family problems were `the partners' (23 cases, 21%) and `the patients` children' (29 cases, 27 %). The most frequent sexual problems were 'sexually transmitted diseases' (13 cases, 32.5%), `impotence' (7 cases, 17.5%), 'loss of libido, and unsatisfaction' (6 cases, 15.0%). Most physicians were involved in family and sexual issues with medications, and simple counseling with reassurance. Simple counseling was given for 14 cases (21.0%) for family issues and 18 cases (44.0%) for sexual issues. The patients were treated with medications in 47 cases (70.0%) for sexual and 15 cases (38.0%) for family problems. Conclusion : The most common issue for family problems was their partners and for sexual problems was 'sexually transmitted diseases'. Most family physicians were involved with both simple counseling and medications.
Background
: In modern industrial society, the complexity and diversity of social structure has deeply influenced job stress, and thereby threatens mental health of jobholders more than ever. Therefore, the purpose of this study was to examine the effect of job stress in jobholders on propensity of anxiety. Methods : Initially, 235 jobholders living in Cheonan, Asan or Seoul, from May to June 2003, were the subjects of this questionnaire. Only 233 jobholders were evaluated due to inadequate responses from two subjects. The questionnaire was made up of three contents: socio-demographic characteristic, Extended Karasek questionnaire for evaluation of job stress, and the Korean version of Goldberg anxiety scale for evaluation of anxiety. The data were analyzed by chi-square test and multiple logistic regression analysis. Results : Univariate analysis of propensity to anxiety showed a statistical significance on age, monthly income and job characteristics. Moreover, in terms of multivariate analysis, in accordance with age, 40 to 49 (OR: 6.1), showed the highest odds ratio of propensity to anxiety, followed by 30 to 39 (OR: 5.2) and 10 to 29 (OR: 5.4). In job characteristics, high strain group (OR: 3.7) showed highest odds ratio, but neither low strain group nor active group revealed any statistical significance. In monthly income, there was no statistical significance. Conclusion : Job stress in jobholders and propensity to anxiety was positively associated; especially, the more stress jobholders got, the higher propensity to anxiety was.
Background
: Among the various brands of herbal cigarettes currently available in Korea, Kumyeoncho is the most popular. However, there is no clinical evidence that these herbal cigarettes are effective in helping smokers quit smoking. This study was performed to determine the long term effectiveness of Kumyeoncho herbal cigarettes. Methods : Two hundred smokers, all employees of the same company in Cheonan city, voluntarily participated in this study. They were divided into two random groups: 100 smokers used Kumyencho (herbal cigarettes), and the other 100 smokers used nicotine patches. Between July 2002 and February 2003, the smoking status of all participants was evaluated at one month, three months, and six months, after they stopped using regular cigarettes. Results : The success rates at 1 month were 54.5% for the Kumyeoncho group and 50.7% for the nicotine patch group (P=0.643). The success rates at 3 month were 41.4% and 39.4%, respectively (P=0.875). And the success rates at 6 month were 38.8% and 35.2%, respectively (P=0.747). Statistical analysis showed that the success rate for the Kumyeoncho group was not less than that for the nicotine patch group in all periods. Thirty-seven cases of adverse effects were reported in the Kumyeoncho group: 25 (25.5%) of nausea, 6 (6.1%) of coughing, 5 (5.1%) of dizziness, and 1 (1.0%) of palpitation; thirty-nine cases of adverse effects were reported for nicotine patch users: 18 (25.4%) of itching, 15 (21.1%) of skin irritation and erythema, 2 (2.8%) of dizziness and headache each, and 1 (1.4%) of nausea and palpitation each. Conclusion : With respect to the short and long term effects of herbal cigarettes, Kumyeoncho is considered similarly effective to nicotine patches.
Background
: According to recent studies of smoking rates among adolescents, the age at which young people begin to smoke is decreasing. The present study reports the results of a survey, conducted by the Korean National Tuberculosis Association (KNTA) in 2002, of the smoking status of Korean middle school students. Methods : From April to November 2002, the KNTA surveyed the present smoking status of middle school students (total 14,296: boys-8,697, girls-5,599) according to sex and grade in 125 schools in 12 provinces during a smoking cessation education program. Results : The survey showed that 18.4% of the males (7th grade-15.8%, 8th grade-17.6%, 9th grade-21.8%) and 8.3% of the females (7th grade-6.2%, 8th grade-9.3%, 9th grade-9.5%) had smoking experience. Approximately 2.5% of the males (7th grade-1.2%, 8th grade-1.8%, 9th grade-4.6%) and 1.0% of the females (7th grade- 0.3%, 8th grade-1.2%, 9th grade-1.5%) smoked regularly. The boys' smoking rate was higher than that of the girls in all grades. Smoking rates varied among the provinces, with Chungbuk having the highest rate (2.8%) and Jeonbuk having the lowest (0.9%). The time when most smokers began to smoke was in 6th grade of elementary school for the boys (15.9%) and 7th grade of middle school for the girls (28.6%). Approximately 69.4% of smokers answered that "curiosity" was the most important motivational factor. Statistical analysis indicated that smoking rates were positively correlated with alcohol use and height of students, but were negatively correlated with parents' level of education. At the end of the smoking cessation education program, the number of smokers had reduced for the boys (from 2.6% to 2.2%), but had increased for the girls (from 1.8% to 2.0%). The pre- program survey on the trans-theoretical stage of smoking cessation revealed that 34.2% fell into a pre- contemplation stage, 34.2% into a contemplation stage, and 31.6% into a preparation stage. The post-education survey showed remarkable changes: 24.0% were in the pre-contemplations stage, 40.0% in the contemplation stage, and 36.0% were in the preparation stage. Conclusion : This study reports the results of a survey, conducted by the KNTA in 2002, concerning the national smoking status of middle school students, relating factors, and levels of motivation for quitting smoking. The smoking cessation education program run by the KNTA had an impact on the motivational stage of smoking cessation.
Background
: Recently, the number of internet users is rapidly increasing and internet medical counseling for medical information is also becoming frequent. The aim of this study was to assess the responses and accuracy of internet medical counseling, and compare the responses according to years and operating groups. Methods : The subject websites were 79 websites in August, 2000, and 88 in May, 2002, which operated board-type medical counseling. We questioned a simulated case of an acute dermatologic disease. Then we analysed the response rate, the time taken to reply and the accuracy of reponses. Results : The number of websites that answered the question was 38 (48.1%) in 2000, and 73 (83.0%) in 2002. The response rate was significantly higher in 2002 than 2000. Time to reply was significantly shorter in 2002 than 2000. The response rate in hospital or clinic groups was higher than in other groups. The rate to make a correct diagnosis was significantly higher in 2002 than 2000. The rate to mention prognosis and necessity of intensive treatment was significantly higher in 2002 than 2000. Conclusion : The response rate was higher 2002 than 2000. Time to reply and the accuracy of answer improved in 2002. The response rate was higher in hospital or clinic group than in other groups.
Background
: In spite of the harmfulness of smoking, the smoking rate of adult males is high in Korea and those of adolescents and women have risen recently. Although the number of smoking-cessation clinic has risen year by year in Korea, it is not easy for a smoker to attend because of time and economic constraints. This project was performed to allow easy access to on-line smoking counselling center on the internet. Methods : Smoking cessation homepage (www.xsmoke. net) containing smoking counselling and e-mailing services was developed by Namo web editor, Photoshop 7.0, and MySQL database program. Results : This program was divided into two major categories: part one was a library of various kind of information on smoking such as articles, lecture notes, pictures, slides, mp3 and motion files. The other part was an autonomous smoking cessation prescription program. This program analyzed smokers' smoking pattern (using WHY test), nicotine addiction level (using Fagerstrom score), stress level (using BEPSI test), and smokers' confidence level. After the input of smoker's history by the applicant, the program showed its smoking cessation prescription automatically and required to give and decide on a quitting day. The next step was automatic e-mailing service containing information on smoking cessation methods. Conclusion : Internet smoking cessation center that provides a library of smoking cessation materials, automatic prescription and e-mailing program has been developed for Korean smokers.
Background
: After amendment of the national health insurance law to enforce and reform primary health care, the number of family medicine out-patients was increased. Some patients requested referral. Therefore, this study was made to reveal family medicine residents' perception of attitude towards request for referral. Methods : The self-administered questionnaires were collected by post mailing (July 1 to July 30, 2002) and by e-mailing (July 25 to August 10, 2002). The questionnaire contained the followings: general characteristics, issues of referral request, influence of referral request in training, and influence in private family clinics. Results : The overall response rate was 22.2% (93/418). Patients need was the most common cause of referral (62.0%). Among the total, 46.2% of respondents gave answers that increasing number of patients at the family medicine out-patient clinic was beneficial in increasing their experience. Also, 55% of respondents replied that the present state of family medicine out-patient system influenced lowering of motivation in training. Overall, 63.4% of respondents replied that the present state of family medicine out-patient system led a trend of distrust to private family clinics. Conclusion : Patients request was the most common cause of referral in family medicine out-patient clinic. The present state of referral system in family medicine out- patient clinic influenced lowering of motivation in training and a trend of distrust to private family clinics.
Background
: In spite of worldwide recognition of the hazardous effects of smoking, the adolescent smoking rate in Korea continues to increase. This study was performed to determine the smoking statistics for the Chonan area, and to evaluate the effectiveness of mass smoking cessation education based on Prochaska's trans-theoretical model in adolescents. Methods : To obtain the smoking statistics, an on-site questionnaire survey was performed on 7,373 students from 5 middle and 6 high schools in the Chonan area from May to July, 2001. A logistic regression analysis was done on the variables in order to determine the factors related to smoking. Immediately after completing smoking cessation education, the second questionnaire, which included questions on the effectiveness and satisfaction of the education, was conducted in one high school. Results : The smoking rates were 18.0% in males, 8.8% in females; 4.3% in middle school students, and 21.1% in high school students. The smoking rate in vocational high schools (30.7%) was higher than in general high schools (11.9%)(P＜0.001). Multiple logistic regression analyses indicated that the smoking rate increased in males (OR= 2.28), father's smoking status (OR=1.55), mother's smoking status (OR=2.98), and sibling's smoking status (OR=3.57). Approximately 47% of smokers answered that "curiosity" was their most important motivational factor; 29.1% of smokers started smoking in second grade of middle school. The pre-education survey on the trans-theoretical stage of smoking cessation revealed that 38.1% fell into pre-contemplation stage, 36.8% into contemplation stage, and 25.1% into preparation stage. The post-education survey showed remarkable change to 20.8% of pre-contemplations stage, 47.6% of contemplation stage, and 31.6% of preparation stage. Conclusion : The mass smoking cessation education run by doctors did have an impact on the motivational stage of smoking cessation. Therefore, to improve adolescents' health, an active non-smoking campaign and education should be continued in various ways.
Background
: No-show is a major obstacle for proper management in outpatient clinic. This study was performed to evaluate the effectiveness of a reminding telephone call on the compliance after no-show patients in family practice. Methods : A nurse in family practice called to 590 non-compliant patients who did not visit on the appointment day within 80 days. A single telephone call attempt was directed primarily to the patient or family members for them to make another appointment. The outcome measure was an increased attendance rate within 3 months after telephone calling. Results : The completed telephone contacted group (N=242) and failed group (N=348) were well balanced for all study variables except age. The attendance rate of 60.7% in the completed group, regardless of who was contacted by telephone, was 40.7% greater than 23.0% attendance rate in the failed group. In the univariate analysis, attendance for patients who lived near the clinic (within 1 hour) was better (45.3%) than that for any other group (P=.02). In the logistic regression analysis, only the telephone call reminder was an independent predictor of attendance (Adjusted OR=5.03, P<.001). Conclusion : Telephone reminder is a very effective method of increasing attendance in a hospital-based family clinic. The reminder is a consistenly effective intervention whether the message is delivered to the patient or the family member.
Background
: In spite of harmfulness of smoking, the rate of adult man's smoking is high in Korea and that of young people and women has risen recently. Although the number of hospitals operating smoking-cessation clinic has risen year by year, there is little research on smoking cessation. In this study, we tried to find the factors associated with successful smoking cessation and have attempted to contribute to developing effective smoking cessation strategy and help to continue cessation state. Methods : Three hundred smokers, who had visited the Dankook Univ. Hospital from May 1999 to December 1999, were consulted. After doing a survey with a basic questionnaire and smoking cessation consultation, we asked them to revisit on the date of appointment with continued use of nicotine patch as much possible. Six months later, we selected 272 people and analyzed the factors of difference between the two group; one is the successful group and the other is the failure group. Results : The success group included 77 people (28.3%), and the failure group 195 people (71.7%). In view of demographic profiles such as age, sex, marital status, education, and job, there was no significant difference between the two groups. In view of smoking pattern and factors that can influence them such as age of starting to smoke, duration of smoking, motive of smoking, reason of failure to stop smoking, reason of trying to stop smoking, the presence of smoking family member, confidence in smoking cessation, dependence on nicotine and the number of alcohol drinking, there was no significant difference between the two groups. In the results of univariate analysis, daily mean smoking amount, the presence of smoking-associated disease, expiratory CO level at initial visit to hospital, period of using nicotine patch and total times of visiting clinic were significant difference between the two groups. Therefore, the total number of visits to the clinic was the only significant factor according t multivariate analysis. Conclusion : The results of multivariate analysis has shown that the factor that is most associated with success of smoking cessation is the total number of visits to smoking-cessation clinic. This means that the more people who smoke consult with doctor and the longer the period of utilizing the smoking-cessation clinic is, the more successful they are in smoking cessation.
Background
: Recently, childhood obesity has increased and became a major health concern in Korea. The aim of this study is to measure the prevalence of childhood obesity in rural city and to explore the risk factors of obesity including obesity of parents. Methods : We made 13 convenience samples of elementary school and attached kindergarten located in Asan-city, ChungNam, in 2001. We surveyed children's height, weight, and risk factors of childhood with a self-recorded questionnaire answered by parents. Children's obesity was evaluated by ideal body weight which is defined as the 50th percentile of weight for Korean children of the same height and sex in 1998. The criteria of parents' obesity was over 25of BMI. Results : The subjects were 1,558 children among 1870 respondents. The prevalence of childhood obesity was 9.4% and that of male children was 11.0% and that of female children was 7.9%. The older in both male and female, the higher the obesity prevalence was. Mother's age were significantly higher in obese children. Birth weight and family income were also significantly higher in obese children. Birth weight and family income were also significantly higher in obese children. There was a higher family history of obesity in obese children. Risk factors associated with childhood obesity were gender, age of child, mother's age, birth weight, number of siblings, family income, and family history of obesity. Conclusion : The prevalence of childhood obesity in Asan-city was 9.4%. Children whose father, mother, or parents were obese tended to be obese.
Background
: The harmfulness of cigarette smoking is widely known, as a result the interest of smoking cessation is increasing. Some smoking cessation methods have tried at clinical setting, but with exception of nicotine replacement therapy, the long-term result is not satisfactory. The objective of this study is to determine of smoking cessation effectiveness of aromatherapy, which one of the alternative medicine, attracted public attention recently. Methods : All participants of this study used nicotine patch, and as a double-blind randomized control study with use of natural herb aroma which is known to have tranquility effect and placebo(artificial lemon perfume). The subjects consist of Dankook University Hospital workers who volunteered as smoking cessation. 6 weeks of smoking cessation program was conducted using nicotine patch and aroma or nicotine patch and placebo, and the result were verified 6 weeks and 6 month after the start of smoking cessation. Result : Fifty-three male persons(27 in aroma, 26 in placebo) paricipated and three subjects(2 in aroma, one in placebo) were dropped out. In two groups, participants with successful results were 13 persons in aroma group, and 14 persons in placebo group at 6 week later, and 6 persons and 7 persons respective at 6 month later. There was no statistical difference in two groups. Conclusion : There was no statistical difference between the herb aroma and placebo with smoking cessation effect.
Background
: This study is to investigate on how much the dysmenorrheal and lower abdominal pain(LAP)/back pain are improved by the aromatherapy which is emerging as an alternative therapy. Methods : In order to get the data by questionnaire, 245 subject was selected from women student class of a high school at rural area from June 2000 to August 2000. 125 subject, aroma was given to 69 subject and placebo was given to 56 subject. The subject was investigated how the dysmenorrhea was improved by using the aroma and placebo. Results : After the aromatherapy, severities of dysmenorrheal and LAP/back pain improved in aroma group and placebo group. Therefore, there is not statistical difference between both groupts. Conclusion : The herbal aroma is not effective more than placebo aroma to relieve dysmenorrhea.
Background
: There are very few cohort studies on the hypertension in family practice. In order to investigate epidemiological characteristics of hypertensive patients and assess the safety and tolerabiliy of newly prescribed antihypertensive monotherapies in Korean patients, a prospective study was carried out. Methods : A total of 1,181 patients were observed from July 1997 to August 1999. At 2,4,8 and 12 weeks after initiation of antihypertensive monotherapy, the patients were evaluated for whether treatment is continued and development of any adverse reactions. Results : Calcium channel blockers(CCBs) were the most commonly prescribed initial drug class(44.2%) in family practice, followed by angiotensin converting enzyme inhibitors(ACEI) (21.0%), angiotensin II receptor antagonists(ARA) (11.8%), B-blockers(9.6%), a-blockers(3.9%), and diuretics(3.6%), During the first 12 weeks, the percentage of subjects continuing their initial ACEIs(40.7%) was substantially lower than the percentages that of subjects continuing ARAs(66.2%), a- blockers*(63.0%), CCBs(61.3%), B-blockers(55.8%), and diuretics(53.5%), respectively(P<0.001), The following adverse reactions were detected: cough(7.5%), headache(6.1%), dizziness(3.9%), flushing(3.7%), and impotence(2.4%). The incidence of cough associated with ACEI(27.9%), was higher than those of other classes(P<0.01) Conclusion : CCBs were the most commonly prescribed initial drug class in family practice, followed by ACEIs, ARAs, B-blockers, a-blockers, and diuretics. The tolerability of antihypertensive medication was the highest in Korean patients treated with ARAs, followed by CCBs, B-blockers, diuretic, a-blocker, and ACEIs.
Background
: Obesity is a risk factor of hyperlipidemia, DM, hypertension and cardiovascular deseases. In clinical practice the evaluation of obesity has been done indirectly by anthropometric indices such as BMI, waist to hip ratio, waist and hip circumference. This study was attempted to show whetjer waist circumference is better simple anthropometric index of abdominal obesity and has better correlation of metabolic profile than waist to hip ratio which has been commonly used. Methods : We gathered 286 cases who have taken medical examination from May 1997 to July 1997 at Dankook University Hospital and measured BMI, relative ideal body weight by Modified Broca method, waist circumference, waist to hip ratio, metabolic profiles, fasting blood sugar, systolic and diastolic blood pressure. Results : Waist to hip ratio and waist circumference showed high correlation with BMI and Modified Broca index. In men, correlation coefficient of waist circumference and waist to hip ratio with BMI was r=0.761, r=0.467, and correlation coefficient of waist circumference and waist to hip ratio with Modified Broca index was r=0.726, r=0.458. In women, correlation coefficient of waist circumference and waist to hip ratio with BMI was r=0.791, r=0.628, and correlation coefficient of waist circumference and waist to hip ratio with Modified Broca index was r=0.769 r=0.660. This finding shows waist to hip ratio and waist circumference are more closely related to BMI and Modified Broca index in women than men and showed higher correlation with waist circumference than waist to hip ratio. There were significant differences of correlation coefficient of obesity indices between waist circumference and waist to hip ratio(p<0.00001). Waist circumference showed relatively significant correlation with metalbolic profiles but we could not notice high correlation coeffience. But there was sighificant difference of distribution between normal group and obese group defined as BMI>25, modified Broca index>120%. Conclusion : Waist circumference, index of abdominal obesity has better correlation with obesity indices than waist to hip ratio and is more simple method.
Background
: Fasting blood sugar and urine glucose are measured as screening tests of diabetes in the workers' periodic health examination. but of the casual glucose is measured and the basis of the cut-off values of screening tests is not clear. Therefore, we investigated the accuracy of screening test of diabetes in periodic health examination. Methods : One hundred and eighty two men were selected for this study in 1997-1998. They performed a second confirmatory test for diabetes because their initial screening test results showed 'suspicious diabetes'. The gold standard was a fasting blood glucose for the second test. We analyzed the sensitivity and the specificity of each cut-off values of initial fasting blood glucose and urine glucose, and constructed the receiver operator characteristic (ROC) curve. Results : The correlation coefficient between initial blood glucose and second fasting glucose was 0.562, and that between initial glucose and 2nd post-prandial glucose was 0.551. The false positive rate of initial screening test was 62.1%. When the cut-off value of initial blood glucose was 144.98mg/dl, the sensitivity was 0.79 and the specificity was 0.97. Using the current cut-off value of 121 mg/dl, the sensitivity was 0.11 and the specificity was 1.0. The best cut-off value of urine glucose test was trace on the basis of ROC curve. Conclusion : The problem of diabetic screening test was high false positive rate and the low correlation coefficient between screening test and the gold standard. It is necessary to control the test condition and to reset cut-off value up, to make the screening test accurate.
Background
: Overt hyperthyroidism is a well-known cause of secondary hyperlipidemia and atherosclerosis. However, there have been some dissenting report of abnormalities and in serum lipid concentration in patients with subclinical hypothyroidism. We have attempted to analyze serum lipid concentrations to investigate whether they are increased in patients with subclinical hypothyroidism and to see if there is a correlation between serum LDL-C and TSH concentrations. Methods : Serum lipid profiles(total cholesterol, triglycerides, LDL-C, HDL-C) of patients with subclinical hypothyroidism (M/F=7/119) compared with age, sex and body mass index matched control subject(M/F=14/239) from Jan. 1. 1996. to Dec. 30. 1997. Results : There were no significant differences of serum total cholesterol, LDL cholesterol, TG, and HDL concentrations in 126 patients with subclinical hypothyroidism and 253 control subjects(178.47±35.76mg/Dl vs. 173.05±35.963mg/Dl ; 113.33±52.89mg/Dl vs.117.64±68.70mg/Dl ; 112.89±33.25mg/dL vs 109.65±29.02mg/Dl ; 48.60±11.34mg/Dl vs 46.51±11.73mg/Dl). There was no correlation between LDL cholesterol and TSH concentrations in subclinical hypothyroidism(r=0.29, p<0.05). Conclusion : Serum lipid concentration(total cholesterol, LDL cholesterol, and TG, HDL) was not increased in patients with subclinical hypothyroidism. There was no correlation between serum LDL and TSH levels in patients with subclinical hypothyroidism.
Background
: The lack of standardization in measuring bone mineral density(BMD) is generally recognized as an important and unresolved issue. The National Health Insurance System in Korea covers the cost of osteoporosis treatment according to the relative value(T score < -1.0) of normal BMD. We analyzed numerous research papers published in Korea which related to BMD, and calculated the normal BMD of Korean women using cross0calibration equipment on three different DEXA scanners(Lunar/Norland/Hologic). Methods : We searched for key words such as 'osteoporosis' and 'bone mineral density' in the Korean Medical Journal CD-ROM from 1987 to 1988. we received 145 full texts, and analyzed 114 original articles all of which used one of the above three scanners, over 100 normal Korean women as subjects and focused on the lumber spine. We found five articles that fit the criteria. Among the scanners used in the five articles are three were Lunar, one Hologic and one Norland. We substituted the results of Norland and Hologic with Lunar's using a cross-calibration equation, and calculated the mean BMD according to age by using a weighted average. Standard deviations of the calibrated data were calculated by using pooled estimates of variance equation. Results : The lumbar spine BMD values of normal Korean women were 1.181±0.683(g/cm2) in their thirties, forties, sixties were 1.128±0.144, 0.989±0.161, 0.862±0.162, respectively in Lunar scanner, 1.020±0.568, 0.974±0.124,0.854±0.138, 0.746±0.139, respectively in Norland seanner. Conclusion : we calculated the lumbar spine BMD values for normal Korean women among three major companies using DEXA scanners. Further studies on BMD in randomly selected healthy adult women are needed.
Background
: Although urinary incontinence is a common problem, its prevalence and severity in community is not well established. The main objects of this study were to define the prevalence in adult men and women who came to a primary care office for health care. Methods : Men and women aged 20 years and over who came to family physician's offices seeking health care for any reason during an 2-week period were the subjects of a survey by anonymous questionnaire. Ten family practice offices in Cheonan Practice-Based Research Network parti-cipated. We defined "current significant urinary incontinence' as over any degree of annoying incontinence in the past 12 months. Results : Of the 1,130 responders, 46.3% experienced urinary incontinence. Incontinence was experienced by 26.7% of the men and 50.2% of the women. 'Current significant urinary incontinence' was experienced by 3.7% of the men and 10.12% of the women. Conclusion : Urinary incontinence as a common problem among those seen in primary care settings, and patients hesitate to seek consultation of their problems with physicians. Therefore, family physicians should deal with the symptoms of incontinence more attentively during history taking.(J Korean Acad Fam Med 1999;20:55~61)
Background
: This study was designed to evaluate medical instruments purchases by Korean family practitioners in private practice. We then proposed guidelines for purchasing equipments for new physicians who are just beginning their private practice. Methods : A questionnaire was sent to 646 family practitioners managing their private clinics. The questionnaire assessed current medical equipments purchases. They were then asked which instruments they would recommend or discourage others form purchasing. We analysed 123 returned questionnaires(19%). Results : The number of instruments they have was between 4 to 26, and the average was 13. The most frequently owned items included in descending order: otoscope (89.9%), electrocardiograph(82.5%), ophthalmoscope(78.9%), ultrasound(78%), ultraviolet sterilizer(73.2%) and microscope(69.9%). The instruments they recommended avoiding were sigmoidoscope(27.3%), cryotherapy kit(25%), laser therapy kit(21.1%), thermo-hemorrhoidectomy instrument(20%), and defibrillator (20%). Instruments they recommended purchasing were otoscope(87.0%), elctrocardiograph(83.0%), ultrasound(74.8%), gastrofiberscope(65.9%), ultraviolet sterilizer(63.4%), microscope(57.7%), and plain radiographic unit(<100mA, 56.1%). The most frequent advice given in purchasing medical instruments was "Avoid over(purchasing) at the beginning". Some instruments were different in possession rate according to sex, age, and practice patterns. Conclusion : This study evaluated medical instruments purchases of Korean family practitioners in private practice. This compiled list may be of benefit to new physicians who are just opening their own clinic.
Background
: Rubella is a viral infection of childhood. Its clinical manifestations are not serious, but rubella in early pregnancy can result in congenital rubella syndrome. In Korea, there have been several rubella outbreaks in 1996. We performed an epidemiological study about a rubella outbreak in middle and high school students in an isolated small town. Methods : This study was carried out from March 22, 1996 to April 29, 1996. The target populations were middle and high school students(middle school-1,269, high school-966 students) in Namseonri. They were given a questionnaire containing sociodemographic characteristics, past vaccination history and rubella-like symptoms. We selected 70 clinically diagnosed patients and 233 students with rubella-like symptoms from the questionnaires. Through IgM and IgG ELISA, we analyzed the serum of selected students. All of the middle and high school students except those with clinical rubella were vaccinated on March 27. Results : 1) The number of IgM positive students was 65 among 303 selected students. 58 students among the IgM positive group were diagnosed clinically, and 7 patients had subclinical infection. 2) Male patients were more predominant than female, especially in high school(M:F, 2:1 in middle school, 7:1 in high school). 3) Positive rates of IgG gradually increased by grade from 58.3% to 92.9%(1st grade of middle school to 3rd grade of high school). 4) IgG titer of the booster vaccinees(2nd and 3rd grade female, high school) was significantly higher than younger female students(p<.05). 5) After mass vaccination, 3 more patients caught rubella in high school during 1 month follow-up. Conclusion : Among 2335 students, IgM positive patients were 65 with incidence rate of 2.8%. Mass vaccination of the students is an effective preventive method in a rubella outbreak.
Background
: Hypertension is a chronic disorder that causes various complications. It needs proper pharmacologic and non-pharmacologic treatment. But, other studies show there are many traditional and folk remedies about hypertension in Korean. This study was designed to show behavioral patterns of outcomes and side effects of folk remedies in practice-based network. Methods : The study subjects were hypertensive patients visited practice-based network from September to December in 1996. Data were collected through questionnaire about sociodemographic features of patients and types, effect, frequency, and side effects of folk remedies. Results : The responders totalled 160 patients, and those who have tried traditional medicine or folk remedies were 65 patients(27 men and 38 women cases). Information source about remedies were 'family members or friends' in 53.8%, 'TV, magazines, and newspapers' in 13.8%, and 'books that deal with health information' in 3.1%. There were 22 experienced remedies ; the most common remedy was herb medicine. In subjective judgement about anti-hypertensive effect, 6 cases described as 'very effective', 21 as ' somewhat effective', 14 as 'not effective', 17 as 'not sure'. Ten(15.3%) of 65 cases experienced side effects. Conclusion : 40.6% of total responders used traditional or folk remedies, and 15.3% of them experienced side effects, 9.2% of them told that their remedies were 'very effective'. Physicians need to inform patients of side effects of folk remedies and adequate management of hypertension.
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