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The subject of the cost and value of medical education is becoming increasingly important. However, this subject is not a new one. Fifty years ago, Mr. DH Patey, Dr. OF Davies, and Dr. John Ellis published a report on the state of postgraduate medical education in the UK. The report was wide-ranging, but it made a considerable mention of cost. In this short article, I have presented the documentary research that I conducted on their report. I have analyzed it from a positivist perspective and have concentrated on the subject of cost, as it appears in their report. The authors describe reforms within postgraduate medical education; however, they are clear from the start that the issue of cost can often be a barrier to such reforms. They state the need for basic facilities for medical education, but then outline the financial barriers to their development. The authors then discuss the costs of library services for education. They state that the "annual spending on libraries varies considerably throughout the country." The authors also describe the educational experiences of newly graduated doctors. According to them, the main problem is that these doctors do not have time to attend formal educational events, and that this will not be possible until there is "a more graduated approach to responsible clinical work," something which is not possible without financial investment. While concluding their report, the authors state that the limited money invested in postgraduate medical education and continuing medical education has been well spent, and that this has had a dual effect on improving medical education as well as the standards of medical care.
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Hospitalization presents smokers with an opportunity to initiate smoking cessation. We studied the effect of inpatient counseling and follow-up after discharge on smoking cessation and assessed predictors of successful cessation.
This study included a total of 125 patients (118 male and 7 female) who were admitted to departments of neurology, cardiology, and pulmonology. They were referred to the smoking cessation clinic, and participated between September 2011 and February 2013. A counseling service lasting about thirty minutes was provided by the third-year family medicine residents during hospitalization. The follow-up counseling services, which were either by telephone or in-person physician counseling were provided at 1 week, 4 weeks, and 3 months. Smoking habits and nicotine dependency data were gathered using questionnaires, and patient information was collected from electronic medical records.
The average age in the study was 57.9 ± 10.2 years and duration of smoking was 35.9 ± 11.7 years. Daily tobacco consumption was 23.5 ± 13.2 cigarettes. The smoking cessation rate after 3 months was 42.4%. The only differences between patients in the successful cessation and failed groups were cause of admission (P = 0.039) and total number of counseling sessions after discharge (P < 0.001). In a multivariate analysis, smoking cessation was more likely when patients experienced more instances of follow-up after discharge (1-2 visits: odds ratio [OR], 8.186; 95% confidence interval [CI], 1.060 to 63.239; ≥3 visits: OR, 121.873; 95% CI, 14.462 to 1,027.055).
Smoking cessation counseling during hospitalization and further follow-up by telephone or outpatient counseling after discharge contributed to an increased smoking cessation rate. The smoking cessation rate also tended to increase with total counseling numbers.
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We conducted a population-based cross-sectional study of Korean adults to evaluate the association between metabolic syndrome and microalbuminuria as a marker for early-stage chronic kidney disease.
A total of 8,497 adults (3,625 men and 4,872 women) who participated in the Korea National Health and Nutrition Examination Survey between 2011 and 2012 were included. Metabolic syndrome was defined according to recommendation from a joint interim statement of international organizations published in 2009. Microalbuminuria was defined as a urinary albumin-to-creatinine ratio of 30 to 300 mg/g. The association between metabolic syndrome and microalbuminuria was evaluated using logistic regression analysis with adjustment for covariates while considering sampling weights and the complex survey design.
The prevalence of microalbuminuriain subjects with metabolic syndrome was 11% for men and 14.4% for women, whereas the prevalence in subjects without metabolic syndrome was 3.1% for men and 6.7% for women. Metabolic syndrome was significantly associated with an increased risk of microalbuminuriain both women (odds ratio, 2.79; 95% confidence interval, 2.01 to 3.88) and men (odds ratio, 3.00; 95% confidence interval, 2.11 to 4.27). All components of the metabolic syndrome were associated with a significantly increased risk of microalbuminuria with the strongest association for high blood pressure. The risk of microalbuminuria increased in a dose-dependent manner (P-value for trend < 0.001) with the number of metabolic syndrome components observed for both sexes.
These findings suggest that metabolic syndrome is a risk factor for chronic kidney disease from an early stage.
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Korean women are known to have a very low smoking rate. However, the actual smoking rate among Korean women is higher than 10% and may continue to increase gradually. In addition, some Korean women use extreme weight control methods that have potentially harmful effects. This study was conducted to elucidate weight control methods related to cotinine-verified smoking among Korean adult women.
This cross-sectional study involved 4,189 women aged ≥19 years who had attempted weight control during the past 1 year from the Korea National Health and Nutrition Examination Survey, 2008-2011. Smoking status was assessed using both self-report questionnaires and assays of urinary cotinine, and weight control methods were investigated using self-report questionnaires.
The smoking rate based on the measurement of urinary cotinine was 12.4% ± 0.8% among Korean women. Cotinine-verified smokers were more likely to attempt fasting (odds ratio, 2.19; 95% confidence intervals, 1.03 to 4.67), taking prescription diet-pills (odds ratio, 2.37; 95% confidence intervals, 1.47 to 3.82), and taking nonprescription diet-pills (odds ratio, 3.46; 95% confidence intervals, 1.71 to 6.98), and were less likely to attempt eating less food or modifying dietary patterns (odds ratio, 0.71; 95% confidence intervals, 0.51 to 0.99) compared to non-smokers.
Korean adult women's smoking is independently related to a high likelihood of using weight control methods with potentially harmful effects, such as fasting and taking diet-pills, and a low likelihood of choosing weight control methods, including dietary modification, that require constant effort for a prolonged time.
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Being underweight has been related to health risks. However, little is known about the relationship between suicidal ideation and attempting to lose weight. This study was conducted to examine if there is an association between suicidal ideation and attempting to lose weight among underweight adults.
A cross-sectional study of 1,122 underweight adults (range, 19 to 69 years) was conducted based on the Korea National Health and Nutrition Examination Survey, 2007-2012. We examined suicidal ideation, doctor-diagnosed depression, depressive mood, stress, physical activity, health-related behavior, comorbidity, and socioeconomic status by weight loss attempts. Logistic regression analysis was performed to examine the association between suicidal ideation and weight loss attempts. The following covariates were controlled for: age, sex, physical activity, alcohol problem, marital status, education, income, occupation, self-perception of body image, chronic disease, and body mass index.
There were 101 subjects in the weight loss attempt group and 1,021 in the non-attempt group. The attempt group had a higher risk of suicidal ideation (odds ratio [OR], 2.47; 95% confidence interval [CI], 1.35 to 4.53) and depressive symptoms (OR, 2.17; 95% CI, 1.19 to 3.98). After depressive symptoms were added to the covariates, the risk of suicidal ideation was also significant (OR 2.11, 95% CI: 1.03 to 4.35). The two groups did not significantly differ in doctor-diagnosed depression and stress.
Weight loss attempts were associated with suicidal ideation in underweight Korean adults.
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Alcohol use disorder (AUD) affects not only an individual's health but also their family. This study was conducted to examine effects of a spouse's AUD on family functioning and family communication.
We conducted a cross-sectional study using data from 890 participants (445 couples) in a Korean family cohort in primary care. Participants with Alcohol Use Disorders Identification Test in Korea scores of 8 or greater were classified into an AUD group. Family functioning was classified into three groups (balanced, midrange, and extreme) using the Family Adaptability and Cohesion Scale (FACES)-III questionnaire, and then reclassified into two groups (appropriate and extreme groups) for binominal analyses. Family communication was classified into three groups (high, moderate, and low) using the Family Communication Scale, FACES-IV, and also reclassified into two groups (good and poor).
There was no significant difference in adaptability and cohesion between both male and female participants with a spouse with AUD and participants with a spouse without AUD. Using multivariate logistic regression to adjust for potential confounders, there was no significant difference in family type and communication between the two groups in males. However, there was a significant decrease in family communication (odds ratio, 2.14; 95% confidence interval, 1.29 to 3.58) in females with a spouse with AUD compared to females with a spouse without AUD, even after adjusting for the participant's own AUD.
In females, family communication is significantly worse when spouses have AUD. This suggests that a husband's alcohol consumption has negative effects on his wife's family communication.
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To date, the medical environment has been undergoing continual changes. It is therefore imperative that clinicians recognize the changing trends in the degree of patient expectations for patient-centered care. We conducted this study to examine changes in the degree of patient expectations for patient-centered care and the related socio-demographic factors in a primary care setting over a 5-year period.
We evaluated patients' attitudes toward patient-centered care using the Patient-Practitioner Orientation Scale, which provides 'sharing' and 'caring' scores. The study included 359 and 468 patients in phase I (March-July, 2005) and II (March-July, 2010). We also examined the relationship of their changes to their socio-demographic factors.
In phase II, as compared with phase I, the 'sharing' score was higher (3.67 ± 0.68 vs. 3.82 ± 0.44; P < 0.001) and 'caring' one was lower (4.01 ± 0.57 vs. 3.67 ± 0.58; P = 0.001). Further, 'sharing' and 'caring' scores were associated with age, monthly income, education level, marital status, and the functional health status of patients.
These results would be of help for providing patient-centered care for patients because it makes clinicians are aware of the degree to which patients' expect it.
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There have been a few reported cases of congenital great toenail dystrophy (GTND), described as a congenital malalignment of the great toenails. However, acquired GTDN is rare, and has not been documented extensively. This study aimed to describe the clinical features of 21 patients with acquired GTND.
Twenty-one patients with acquired GTND who visited Yeouido St. Mary's Hospital between June 2005 and August 2012 were retrospectively reviewed.
The mean patient age was 43.1 years (range, 17 to 88 years), and the cohort predominantly comprised women (18/21). In our experience, all acquired GTND patients presented with yellow or yellow-brownish chromonychia, onychotrophy, and onycholysis. Conservative treatment with tape methods and grinding, as well as nail extraction, was provided and yielded little improvement in any case.
This study provides initial data on the nail changes affecting the great toenail, such as yellowish chromonychia, onychomadesis, and onycholysis. These data may help physicians to distinguish various nail disorders, including onychomycosis, congenital malalignment of the great toenails, and yellow nail syndrome.
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