The necessary role of genital infection by specific types of human papillomavirus (HPV) in cervical cancer development provides an opportunity to reduce the risk of cervical cancer, a second leading cancer in women, through prophylactic vaccination. Two types of vaccines targeting HPV 16 and 18 which are responsible for about 70% of all cervical cancer worldwide have been developed: a quadrivalent vaccine (GardasilⰒ) and a bivalent vaccine (CervarixⰒ). Gardasil also targets HPV 6 and 11 causing 90% of genital wart. Both two vaccines contain virus-like particles composed of L1 protein of viral capsid and do not exert infectivity. HPV vaccines were highly effective in preventing persistent infection by vaccine specific type HPV in young women who have not been previously exposed to them. Randomized double- blind placebo-controlled clinical trials have provided evidence that HPV vaccines have high efficacy against cervical precancerous lesion in young women irrespective of baseline HPV infection status. However, HPV vaccines neither treat existing HPV infections nor provide protection against all types of HPV related with cervical cancer. Therefore, even vaccinated females should take cervical cancer screening as recommended. Gardasil has been tested mainly in 9∼26 years old females and Cervarix in 15∼25 years old. Current recommendation for vaccination age is 9∼26 years for Gardasil and 10∼25 years for Cervarix, considering sexual debut and previous clinical trials. There are plenty of remaining issues regarding HPV vaccination such as vaccine efficacy in older women and in males, cost-effectiveness, duration of protection, cross-protection, potential replacement infection, and vaccine compatibility. (J Korean Acad Fam Med 2008;29:821-830)
Background: There have been very few studies on the relationship between obesity and dense breast as risk factors of breast cancer in Korean women. Therefore, we evaluated the relationship between BMI and mammographic density in Korean women. Methods: We recruited 332 women without prior history of breast cancer, breast surgery, radiotherapy, hormone replacement therapy, and family history of breast cancer who underwent screening for mammography and completed a self-administered questionnaire in one general hospital. On the basis of ACR BI-RADS breast composition, four density patterns were classified repeatedly by a radiologist. Results: The mean age, Body Mass Index (BMI), the proportion of postmenopausal women of the study population were 50.4 years, 23.2 kg/m2, and 29.8%, respectively. The proportion of extremely dense breast women was 100% in the underweight group, 77.3% in the normal weight group, 41.4% in class 1 obesity group, and 25% in class 2 obesity group, decreased with increasing BMI. The odds Ratio of BMI to extremely dense breast was 0.82 (95% CI: 0.72∼0.93, P value=0.002) after adjustment for age, menache, menopause, and BI-RADS assessment category in logistic regression. Conclusion: Our findings showed that the BMI was negatively correlated with mammographic density as well in Korea. Therefore, primary physicians should consider sensitive additional method for breast cancer screening especially in underweight and normal weight Korean women. (J Korean Acad Fam Med 2008;29:831-837)
Background: The metabolic syndrome is a cluster of risk factors for cardiovascular diseases. Recently, serum gamma-glutamyltransferase (GGT) has been suggested as a predictor for development of the metabolic syndrome. Therefore, we investigated the association between serum GGT levels and the incidence of the metabolic syndrome in the Korean healthy adults with normal serum GGT with a 3 year follow-up. Methods: The study subjects consisted of 741 individuals who visited the Center for Health Promotion in Pusan National University Hospital for a medical checkup in 2002 to 2005. Among 741 subjects, 312 were excluded: 71 were positive for HBsAg, 17 were positive for Anti-HCV Ab, 40 showed GGT higher levels than limit of reference range, and 224 had metabolic syndrome. The final subjects were 429 individuals. We measured serum GGT levels, lipid profiles, fasting glucose, blood pressure and their metabolic components. Results: As the quartile of serum GGT increased, 3 year follow-up incidence of the metabolic syndrome was increased. Logistic regression analysis adjusting for sex, age, and alcohol drinking status showed that the odds ratio (95% confidence Interval, P-value) of each GGT quartile was 2.28 (0.58∼9.01, P=0.240), 1.53 (0.36∼6.66, P=0.564), 4.56 (1.08∼19.32, P=0.040), respectively. Conclusion: These results showed that the serum GGT was closely related to the metabolic syndrome. In Korean adults without the metabolic syndrome, the serum GGT levels within normal limit were associated with an increased risk of incident, metabolic syndrome. (J Korean Acad Fam Med 2008;29:838-843)
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: Worry, a core feature of anxiety disorder, is shown in not only children with anxiety disorder but also normal children. This study was conducted to determine the relationship between worry and family environment factors, especially, perceived parental rearing and attachment styles among children. Methods: Five hundred and nine children participated in this study among 549 children in third, fourth, fifth and sixth grades in two primary schools located in Seoul and Seongnam from October 2007 to December 2007. Forty children did not agree with participation (rejection rate: 7.3%). Their degrees of worry, attachment styles and perceived parental rearing were investigated with questionnaires. Results: The reliability of a questionnaire asking children's worry, PSWQ-C and a questionnaire asking perceived parental rearing, modified EMBU-C was appropriate with internal consistency (Cronbach's Ձ of PSWQ- C: 0.92, Cronbach's Ձ of modified EMBU-C: 0.68∼0.89). Around 22.4% of children had insecure attachment (avoidant or ambivalent attachment) and scores of worry were high in both girls and boys. When children perceived their parental rearing behavior as anxious rearing, they were classified to have ambivalent attachment in many cases by themselves. And when they perceived the rearing as rejection many of them were classified to have avoidant or ambivalent attachment by themselves. Worry showed a significantly negative correlation in the cases where children answered their perceived parental rearing as emotional warmth and showed a significantly positive correlation with rejective and anxious rearing. Conclusion: This study found that children's worry was closely related with their perceived parental rearing and attachment styles. If the children's attachment, which has been developed while they have grown up, was insecure and they did not perceive parental rearing as emotional warmth, the intensity of worry, a core symptom of anxiety disorder, increased. (J Korean Acad Fam Med 2008;29:854-866)
Background: A curriculum in medical school should help doctors achieve professional attitude, ethics and values by socialization process. However, existing knowledge- based curriculum has lots of shortcomings to reach these ideal goals. This study was operated to investigate the effect of a 'service-learning program' for premedical students in medical college of Korea University. Methods: The survey was conducted from July 3 2006 to 5 at Chungbuk Eumsung Kkottongnae. A total of 99 students completed surveys; before and after the intervention. The questionnaire was consisting of necessity and goal of the program and it also include assessment of students' attitude and contents of the program. Each item was assessed by using 5-Likert scale. For comparing the items, we practiced paired t-test. Results: 97 (response rate 97.9%) students completed survey. 53 students (54.6%) agreed 'the program is really needed.' About the questions: 'self-development from program', 'the program will be helpful for medical activity in the future.' students gave positive answers. The participants' attitude, interest was significantly increased. Also 'the motivation', 'appropriation of the program and time allocation', 'general satisfaction' were all increased. Conclusion: 54.6% of participants thought a service- learning program was necessary for a medical curriculum and this program would be helpful to get self-development and professionalism. Active attending for a service-learning program increased interest and motivation. It will be needed further study about the long-term effect of a service-learning program. (J Korean Acad Fam Med 2008;29:867-871)
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