Background : Recently, many countries including Korea have been trying to enforce and reform their primary care system. The Family Doctor Registration Program(FDRP) which Korean government had tried and failed in 1996. continuously has been being highlighted because of it's importance. Several private family practitioners started grass root movement for conduction FDRP voluntarily. This survey aimed to know the willingness for private family practitioners to participate in voluntary FDRP and it's major services.
Methods : By mailing, the self-administered questionnaire were collected two times during May 20 to June 30 in 1998. The questionnaire contained following : demographic and practice related factors, willingness to participate FDRP, factors related to it's major services. Subjects were 496 private family physicians who had acquired the certification since 1989. Analyses were made by the Chi-square test, t-test, and multiple logistic regression analysis.
Results : Though overall response rate was only 44.8%(222/496), but age and sex distributions of respondents were similar to those of the total study subjects. The percentage of those having a willingness to participate in voluntary FDRP('Y' group) was 58.6%. The 'Y' group showed phone counseling frequence of 3.2(±2.6) times per day. They had much more home visiting experience than 'N' group(62.2% vs 44.9%, P=0.0019). After the conduction of FDRP. the frequency of possible night-time phone duty per month was 3.5(±2.6) times, and the frequency of possible home visiting per week was 1.9(±1.4) times in 'Y' group. After multiple logistic regression analysis on the meaningful variables, male(OR=2.25, P=0.027) rather than female, percentage of child patients<40%(OR=2.526, P=0.0149) rather than that>60%, and having home-visiting experience(OR=1.8, P=0.1131) rather than no experience showed relatively higher tendency of participation in voluntary FDRP.
Conclusion : The results of this survey should be reflected into the health care policy when retrying to implement FDRP in Korea.
Background : Stress can be induced from minor daily life event, and it is widely accepted that this daily minor stress is better predictive factor for relationship between disease and stress. In a number of laboratory studies, investigator reported that perception of stress can be reduced by physical exercise. So in this study, we observed relationship between exercise and stress from minor daily life event, and tried to clarify the effect of exercise on daily stress.
Methods : Volunteer was recruited from health promotion center of one university hospital. and they were doing regular exercise in more than three days per week. Participants completed measures of daily stress inventory and amount of daily exercise for seven days. To compare the daily stress amount between exercise day and no exercise day, we used repeated measures analysis of variance. We used the Wilcoxon sighed-rank test to compare difference of stress in different sex and different trait anxiety group.
Results : There was significant difference in appraisal of daily stress between exercise days and no exercise days. The amount of daily stress was significantly reduced in continuous low level of anxiety group and male by exercise.
Conclusion : Exercise is associated with a reduction of daily stress appraisal from minor life event. And there is different effect of exercise on daily minor stress in the different anxiety level group and different sex group.
Background : Osteoporosis is becoming major health problem in old age and menopausal women, and osteoarthritis is most common joint disease in both ages. The inverse relationship between osteoporosis and osteoarthritis was first noticed 20years ago. However the subject had not been studied in korea. Thus, our objectives is to examine the influence of osteoarthritis on bone density measurements.
Methods : The study group consisted of 120 women, aged over 40 years, who visited for health examination in Health Center of Poondang-Jesaeng general hospital from October 1998 to April 1999. Bone mineral density(BMD) of the lumar spine was measured, using dual energy X-ray absorptiometry(Lunar, Expert XL), and lateal lumbar spine radiograph was taken. Severity of osteoarthritis were scored on osteophytes, disk space narrowing and vertebral body sclerosis.
Results : Postmenopausal women had significantly lower BMD than premenopausal women(P<0.001). Age(r=-0.545,p<0.001), body mass index(r=0.264,p<0.01) and education(r=0.284, p<0.001) were significantly correlated with BMD, but smoking, exercise, radiogrphic OA variables not correlated. However, stepwise multiple regression analysis using osteoporosis related variables and OA variables is indicated that menopausal status, body mass index, age, osteophytes were significantly associated factor with BMD, and lumbar osteophytes explained 2.7% of variation in lumbar spine BMD.
Conclusion : We conclude that, among women, lumbar BMD is higher in those with osteophytosis of the lumbar spine. The effect is largely directed by osteophytes being included in the BMD measurement.
Background : This study was intended to present the importance of insight status concerning the abstinence of alcoholics.
Methods : The 214 subjects, who participated in insight-improving programs during hospitalization in an alcohol treatment center, were followed up for their abstinent status during the 12month period after discharge, The relation between their abstinence results and insight status was investigated. To find out the influence of other factors upon abstinence. stepwise multiple regression was performed over variables including disease severity, sociodemographic, therapeutic and familial features.
Results : The 73 individuals (34.1%) had 'no remission', 110 (51.4%) 'early full remission', and 31 (14.5%) 'sustained full remission'. The insight degree was significantly correlated with both 'initial consecutive months of sobriety'(IMS) after discharge and 'total months of sobriety'(TMS) during the follow-up. The 153 subjects (71.5%) relapsed within four months after discharge, and the rage of continuous abstinence at each month differed significantly among three insight groups. On the inter-group shifts during hospitalization, the abstinent months were greater in the group whose insight changed from 'poor-' to 'good-insight' than the one from 'fair-' to 'good-insight'. By stepwise multiple regression analysis, the higher insight scores, older age and shorter hospital days, in a decreasing order of association, the longer IMS and TMS, while absence of religion and lower MAST scores was associated only with IMS, with their overall R2 value of 18.5% and 20.8%, respectively.
Conclusion : The insight degree was related to the length of abstinence and thus it is necessary to develop insight-improving programs which can be of help to recovering patients.
Background : According as people have an increased interest in early detection of disease and health promotion, people who take health examinations are increased. So this study is aimed to survey common problems about health in community and their frequency by way of investigation on diagnosis in health examination data and to evaluate the effects of risk factors on each disease patterns.
Methods : The medical records of the clients who have taken health examinations for the first time from March 1995 to February 2000 at a health examination center of a university hospital in Seoul were reviewed. The category and number of judged diagnosis, sociodemographic factors are compared and analyzed.
Results : The selected medical records accounted to 22,393. The study subjects consist of 11,544(51.6%) male. Mean age is 52.0±105 years(range 16~90). Mean number of judged diagnosis is 4.04±2.13(range 0~9) per one person and female took more diagnosis than male on an average(4.09±2.17 Vs 3.99±20.9). The organic diagnosis(56.4%) is most in total and other diagnosis is 35.7%, functional diagnosis is 7.9%. The common diagnoses are liver disease(7.17%), decreased physical strength(6.68), hyperlipidemia(6.53%), obesity(5.90%), osteoporosis or postmenopausal syndrome(4.72%), need for immunization against viral hepatitis(4.69%), hypertension(4.20%), functional gastrointestinal disease(3.93%). The number of total diagnosis and organic diagnosis is larger in older age, no exercise, female, smoker, no-spouse, lower education(p<0.05). The number of functional diagnosis is larger in female, younger age, non-smoker, lower education(p<0.05). The number of other diagnosis is larger in no exercise, smoker, female, younger age(p<0.05).
Conclusion : According to health examination, total diagnosis and organic diagnosis are influenced by age, exercise, sex, smoking, spouse, education, functional diagnosis is influenced by sex, age, smoking, education and other diagnosis is influenced by exercise, smoking, sex, age.
Background : In western countries the proportion of deaths in the hospital has somewhat decreased. While that of Korea has continuously increased, it is interesting things that the hospital death rate in Korea is less than that in western countries. Therefore we tried to find the factors associated with the place of death in Korea.
Methods : We obtained the data from the National Statistical Office. They are composed of classified by ICD-10. Univariate and Mutivariate analysis were done to find the effect of each variable for the place of death.
Results : Total number of the study population was 242,362 (male:136,063, female:106,299). Female died more in the hospital. The younger are more likely to die in the hospital. People having lived in metropolitan, having educated to higher level and professionals died more in the hospital. And the people having had ischemic heart disease and cancer death were more likely to die in the hospital. The single (unmarried, divorced) died more in the hospital. In multivariate analysis, the place of death was significantly different by sex, age, address, occupation, cause of death, and level of education
Conclusion : In Korea sex, age, address, occupation, cause of death, and level of education are helpful in predicting the palce of death.
Background : This is a cross-sectional study to assess the effect of BMI (body mass index) on blood pressure and to get the appropriate BMI range for the prevention and control of hypertension in old men and women.
Methods : From 1996 to 1998 we obtained data for anthropometrics, blood pressure, serum blood profiles and health behaviors about 418 out of 668 old people having visited a charge-free clinic in rural areas. First we tried to figure out the relationship between BMI and systolic or diastolic blood pressure in old men and women separately. After adjusting age, smoking , alcohol, blood glucose, total cholesterol, we checked the linear relationship between each quintile BMI group and prevalence of hypertension in old men and women and obtained prevalence odds ratio (POR) for hypertension in each the 2nd to the 5th quintile BMI group compared to the baseline hypertension- prevalence of the1st quintile BMI group.
Results : Regardless of sex, there was significant correlations between BMI and systolic blood pressure (in men r=0.257, p=0.002;in women r=0.182 p=0.005) or diastolic blood pressure (in men r=0.204, p=0.014;in women r=0.256 p<0.001). The prevalence of hypertension in men and women increased 1.37 and 1.41 times respectively by each quintile BMI increase. According to each BMI group in men (median BMI value of each quintile group:18.2, 20.4, 21.8, 23.3, 26.6 kg/㎡), PORs for hypertension were 1.0, 3.7(95% C.I;1.05-12.68), 3.6(95% C.I;1.03-12.59), 6.5(95% C.I;1.89-22.29), 4.0 (95% C.I;1.11-14.36). In women, (median BMI value of each quintile group;18.6, 21.3, 22.9, 25.1, 28.3 kg/㎡), PORs for hypertension were 1.0, 1.6(95% C.I;0.62-3.82), 2.9(95% C.I;1.22-6.99), 2.9(95% C.I;1.28-6.68), 4.2(95% C.I;1.73-9.98).
Conclusion : Regardless of sex, there was a significant positive association between BMI and prevalence of hypertension in the old and the risk of hypertension increased even in normal weight group compared to the underweight group. Further studies on the appropriate to prevent and control hypertension in old people will be needed.
BACKGROUND The students who had traveled in Jeju island developed symptoms of diarrhea at a girls' high school in Busan, June 2000. The goals of this study are to investigate the pattern of shigellosis and to compare drug resistance to S. sonnei with recent studies by reference reports. METHODS Through epidemiological investigation and stool test of new patients, 993 students were registered from Jun.12 to 17, 2000 in a girls' high school, Busan. 2nd grade students(N=355) who had traveled in Jeju island described a questionnaire of the source of infection. Clinical and bacteriological studies were carried out on 6 cases of patients with S. sonnei. RESULTS Among total 993 students, 79 patients were considered to have diarrhea. But 54 patients of 2nd grade students developed symptoms of diarrhea(14.7%) and the analysis of associative symptoms showed that it contained abdominal pain(72.2%), headache(61.6%), tenesmus(57.4%). 43 students of 2nd grade students who had traveled in Jeju ate chinese foods. Of them, 40 students showed diarrhea(93.0%) confirmed shigellosis(6 students), probable shigellosis(34 students). S. sonnei was isolated from 6 patients(14.0%).
The attack rate of diarrhea was 20.7 times more in the group eating chinese foods than in the group not eating chinese foods(p<0.001). After the 2nd grade students ate chinese foods in Jeju, diarrhea attack day distribution was first day(23.2%), second day(39.7%), and third day(16.3%). The result of drug resistance test to S. sonnei(ampicillin, amoxicillin/clavulanic acid, tetracycline, sulfamethoxazole trimethoprim, and streptomycin) was 100%. CONCLUSION The 2nd grade patients with shigellosis ate chinese foods in a restaurant, Jeju. The pattern of antibiotic resistance to S. sonnei was different from that of several previous cases of shigellosis in Busan.
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 : Many studies have shown that obesity is associated with sexual dysfunction and causes erectile dysfunction particularly, but these studies are mainly about chronic diseases caused by obesity. Therefore, we conducted a study to evaluate the association of obesity in itself with erectile dysfuntion.
Methods : The study sample consisted of men, aged over 20 who visited in a university hospital in Pusan from December 1999 to March 2000, who responded to the Korean version of the international index of erectile function(IIEF). The patients having obesity-related diseases were excluded from the subject group. The subjects were classified into 'obese', 'normal' group according to body mass index(BMI) and erectile function was classified into 'erectile dysfunction', 'normal' according to IIEF-5 score. Chi-square test and Fisher's exact test were performed for statistic analysis.
Results : The mean age was 42.1. In total 160 subjects. 109 men(68.1%)belonged to the normal group and 51(31.9%) to the obese group. and 100 men(62.5) had erectile dysfunction. In normal group, 43(39.4%) had normal erectile function and 66(60.6%) and erectile dysfunction. In obese group, 17(3.3%) were normal and 34(66.7%) had erectile dysfunction. No significant difference between two groups was noted in erectile function (P>0.05).
Conclusion : There was no significant association of obesity in itself with erectile dysfunction in this study after excluding effects of other obesity-related problems.
Background : The most frequent disease seen in the anal area is hemorrhoid. The main therapeutic approach has been surgical treatment. However, in case of first degree and second degree hemorroids, the high frequency therapy is available. It can be applied on the OPD basis by the family pratitioners.
Methods : The data have been collected between Nov. 1997 and Apr. 1999, 464 cases are surveyed on the basis of sex, age, symptom duration, main symptom, location and duration of hemorrhoid, associated anal disease, therapeutic complication, and patients subjective satisfaction. Only 220 out of the 464 cases were available for the patients satisfaction study because of limited follow-up study.
Results : The sex ratio is 1.18:1 (252 in male, 212 in female). Age distribution shows a clustering pattern around the middle age(158 cases in the 30s, and 142 in the 40s respectively). Symptom duration before their first hospital visit reveals 118 cases(25.4%). under 5 years, 105 cases (22.6%) over 10 years, 102 cases (22.1%) 5 to 10 years orderly. The main symptom includes hemorrhoidal mass, bleeding, and pain. 146 cases (31.5%) had all the symptom descrived above. Patients with mass and bleeding were 122 patients(26.3%). In case of the degee of internal hemorrhoid, the second degree of hemorrhoid was the most common (386 cases: 83.2%) followed by the first degree(43 cases: 9.3%), the third degree (24 cases: 5.1%) and the forth degree(11 cases:2.4%). Total number of the patients with therapeutic complication were 99 cases. The complications were acute urinary retension (46cases: 46.5%), perianal edema (30 cases: 30.3%), bleeding (18cases: 18.2%) and anal stricture (5 cases: 5.0%). Satisfaction survey was based on the 220 follow-up case study. 125 cases revealed very satisfied. (56.8%), 66 slightly satisfied (30.0%) and 29 unsatisfied(13.2%).
Conclusion : As shown in the study above, the high frequency therapy provided the patients with the high level of satisfaction. Based on the this fact, it is suggested to the family practitioners.
Background : The prevalance of coronary heat disease is significantly higher in men than in premenopausal women of the same age. Impact that endogenous androgens have on serum lipid has many arguments and few researches were made in Korea. So this study was made to investigate correlation between total testosterone and serum lipid known as effect on cardiovascular disease.
Methods : This was a cross-sectional study on 560 middle aged men undertaken health screening program in Pundang General Hospital. Korea for June 1999 to June 2000. We surveyed informations concerning exercise, consumption of alcohol and smoking by means of self questionnaire records and total testosterone and serum lipid were measured at fasting state.
Results : Body mass index was positively correlated with total cholesterol and triglycerides(r=2.023;P<0.01, r=0.229;P<0.01) but negatively correlated with HDL-cholesterol (r=-0.284;P<0.001). Total testosterone concentrations were negatively correlated with total cholesterol and triglyceride(r=-0.096; P<0.05, r=-0.145; P<0.01) but positively correlated with HDL-cholesterol(r=0.155; P<0.001). Total testosterone concentrations were independently correlated with HDL-cholesterol after age and body mass index were adjusted(B=0.734; P<0.05). And after statistical adjustment for age, body mass index, exercise, smoking and alcohol, total, testosterone concentrations were significantly correlated with triglyceride(B=-10.467; P<0.05).
Conclusion : The result indicate that total testosterone can be a independent determinant of HDL-cholesterol and we expect that appropriate maintenance of total tetosterone concentrations will have a protective effect for cardiovascular disease.
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