Background : Osteoporosis is chronic disease, therefore education about osteoporosis is very important in patients and high risk groups. The objective of this study is to assess the effect of audiovisual instruction about osteoporosis in perimenopausal women. Methods : We educated perimepopausal women who lived in Ulsan about lifestyle behavior related to osteoporosis from July.1999 to Dec.1999 and assessed improvements of lifestyle behaviors related to osteoporosis and evaluated factors that influence hormone replacement therapy uptake. Results : After the audiovisual instruction, hormone replacement therapy uptake, milk intake and exercise were significantly increased in only experimental group. But, smoking and coffee intake were not significantly decreased in both control group and experimental group. After the audiovisual instruction, the factor that significantly influenced hormone replacement therapy uptake was type of education and osteoporosis of participants and also it were significant after adjustment of multiple comparison. Menopause of participants influenced hormone replacement therapy but it was not significant after adjustment. Conclusion : Our study suggests that community intervention trial against osteoporosis improves lifestyle behaviors in perimenopausal women. Longer term studies are needed to determine the relationship between improvements in lifestyle behaviors and osteoporosis.
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 : The purpose of this study was to examine relationship between stress and health behaviors practice. Method: Health behaviors were investigated about ‘Alameda 7’ such as smoking, alcohol drinking, exercise, duration of sleep, body weight, eating habit of breakfast and snack. Stress was measured by Psychosocial Well-being Index(PWI). The data consisted of 2 stage cluster sample of 1,308 individuals who live a district.
Results : There ere significant differences in health behaviors of smoking, body weight, eating habit of breakfast and health practice index according to stress perception (p<0.05). But there were no difference in health behaviors of smoking, alcohol drinking, duration of sleep, eating habit of snack according to stress perception.
Conclusion : Therefore, it is likely that there were associations between stress and health behaviors practice. These findings indicate that appropriate management of stress might bring a good life style and might be effective for health promotion and disease prevention. Prospective studies are needed to find a causal relationship between health behaviors and stress.
Background : Early detection and treatment for depression are very important. But because of several factors such as practice time etc, primary care physician missed potential depression patients. The Korean version Beck Depression Inventory (BDI) is useful for the detection of depression but the validation study of this tool is not confirmed yet. And so we conducted the validation study of BDI.
Methods : From July 1999 to October 1999, 259 patients who visited five family practice center in tertiary or secondary hospital were the study subjects. They have experienced depressive symptoms or had past history of depression during recent one year. The subjects were responded to the questionnaire including BDI, and diagnosed with depression or nondepression according to DSM-IV-PC(interview). The depression patients were retested with BDI. Cronbach α were estimated for internal consistency, and factor analysis were done for validation. Kappa statistics were estimated according to the consistency between BDI and DSM-IV-PC(interview). Using ROC curve, optimal cut-off point were estimated.
Results : Depression ad nondepression patients were 205(79.2%), 54(20.8%) each. Cronbach α (total items of BDI) was 0.87. Factor analysis resulted that two factors explained 90.7% of total variance. BDI score of depression, mild depression and nondepression groups were 22.29(±9.68), 14.43(±8.44), 11.68(±6.42) each (F=29.77, df=2, P=0.001). At 13 BDI score on ROC curve, we have known the results of sensitivity 78.3%, specificity 76.5% and positive predictive value 94.2%.
Conclusion : We concluded BDI was very useful and convenient easy screening tool for depression in primary care.
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