The Validity of Michigan Neuropathy Screening Instrument as a Screening Test and Risk Factors for Diabetic Peripheral Neuropathy

BACKGROUND: Diabetic neuropathy is a common complication of diabetes. Since neuropathy leads to ulceration and amputation, efforts to detect early and to elucidate its risk factors are ongoing. The goal of this study was to check the validity of Michigan neuropathy screening instrument (MNSI) as a screening test and its risk factors for diabetic neuropathy. METHODS: A total of 75 subjects with type II diabetes mellitus, who visited a university hospital, were investigated. We measured their duration of diabetes, height, weight, systolic blood pressure, diastolic blood pressure, fasting glucose, glycosylated hemoglobin, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total cholesterol, serum creatinine, and 24-h urine albumin. MNSI tested and electrophysiological test were performed. RESULTS: The sensitivity, specificity, positive predictive value, and negative predictive value of MNSI was 63.5%, 78.3%, 86.8%, and 48.6%, respectively. Statistically significant relationships were found between neuropathy and the duration of diabetes and total cholesterol. CONCLUSION: MNSI seemed to be an appropriate screening test for diabetic neuropathy. More attention must be paid to the duration of diabetes and the total cholesterol of type 2 diabetic patients with peripheral neuropathy.

Factors associated with Receiving Rescreening in High Risk Group Diagnosed by Endoscopic Screening of Stomach Cancer

BACKGROUND: Stomach cancer is the most common cancer in Korea. Lifelong health management program recommends that males over 40 years and women over 50 years should undergo stomach cancer screening by endoscopy or upper gastrointestinal series every two years. The importance of re-screening of stomach cancer in a high risk group is emphasized. METHODS: A telephone questionnaire was done one year after to 123 patients over 40 years old considered as a high risk group with either chronic atropic gastritis, intestinal metaplasia, gastric ulcer, gastric adenoma among 804 subjects who had undergone anendoscopic examination from February 2002 to June 2003 at a university hospital health promotion center. RESULTS: The number of patients who responded were 109. The average recognition rate of high risk group was 53.2%. The rate of recognition of high risk group was lower in good subjective health estimation group and in less educated group, in old age group, and in chronic atrophic gastritis and intestinal metaplasia group. The rate of not receiving re-screening after 1 year was 48 (44.0%). Re-screening rate in patients with intestinal metaplasia (35.3%) and chronic atropic gastritis (39.1%) compared to gastric ulcer (77.8%) and gastric polyp (90.0%), in those not recognizing themselves as high risk group, in low education group, in old age, was lower. CONCLUSION: In patients with chronic atropic gastritis and intestinal metaplasia, in those not recognizing themselves as high risk group, in old age and in good subjective health state. We need to educate the importance for regular screening of stomach cancer more intensively.

Factors Influencing the Impulse of Suicide in Adolescence

BACKGROUND: Suicide is one of the ten largest causes of death in the world. The rate of suicide is recently significantly increasing in Korea and the rate is relatively high, particularly in adolescence. The purpose of this study was to support the establishment of appropriate measures for prevention of suicide through a better recognition of suicide and to investigate the factors that lead to suicide in adolescence with high school students who have large risk factors of suicide due to entrance examination, future courses, etc. METHODS: A questionnaire regarding the factors influencing the impulse of suicide was conducted to 770 high school students in eight high schools in Seoul and local areas between June 1 and July 31, 2005. Suicidal impulses was checked by SSI (scale for suicidal ideation). Depressive mood and internet addiction degrees was evaluated by BDI (Beck's depression inventory) and IAS (internet addiction scale), respectively. RESULTS: The final subjects of the study were 719 (93.3%) high school students among 770 students in eight high schools in Seoul and local areas, excluding 51 (6.6%) students with insufficient response. There were, 362 (50.3%) male students and 357 (49.7%) female students. Among the total 443 (61.6%) of the subjects had a high risk of suicide. The risk was high in subjects whose parents were divorced, who solved their difficulties by themselves, either expressed suicidal ideation to friends or not expressed suicidal ideation, knew an suicidal internet site and had freguent visits to the internet site. And alcohol experience, drug abuse, BDI and IAS were also connected with a high risk of suicide (P<0.05). Marital status of parents, resolution of problems, expression of suicidal ideation, BDI and IAS were independent factors affecting SSI (OR= 3.7, 0.7, 0.8, 2.4, and 1.6, P<0.05) in logistic regression analysis. CONCLUSION: High suicidal risk is associated with complex factors. We have discovered several causes which augment the impulse of suicide in adolescence. They are parent's divorce or separation, an expression of suicidal ideation, depressive mood, and the extent of internet addiction, etc. Therefore in order, to prevent adolescent suicide, a unified personal, family, and social efforts are required.

Pattern of Hypertensive Management and Usefulness of Treatment Guideline in Primary Care

BACKGROUND: This study aimed at finding out how much the rate of the JNC-7 guideline was carried out, and assessed the degree of evidence based clinical practice patterns and the validity of the new guideline by comparatively analyzing primary care practice patterns in hypertensive patients. METHODS: A questionnaire regarding the management of hypertension was conducted by mail between May 15 and July 15, 2005, to 1,008 of the Korean Association of Family Medicine listed in the address book. There were 195 respondents with a response rate of 19.4%. RESULTS: Among the total respondents, 91.1% were aware of the new guideline and had received information mainly through training lectures and seminars. They said that the biggest difference between the new guideline from the previous one was the inclusion of prehypertension (62.3%), and 61.1% were using the new term prehypertension in their practice. The most frequency advice given to patients related to lifestyle modification were in the order of smoking cessation (44.8%), exercise (41.7%) and weight reduction (38.0%). Calcium channel blocker was the most commonly used (60.9%) as the first-line agent. When physicians failed to control blood pressure with the first medication in cases of stage 1 hypertension, 67.7% added other agents. In treating stage 2 hypertension, 59.9% started with a single agent and gradually added other agents. CONCLUSIONS: Family physicians in primary care clinics had a good understanding of the JNC-7 guideline. However, the rate at which they applied it in treatment was low. To effectively apply the guideline in actual treatments, aggressive education of practitioners and improvement on medical system and treatment guidelines are needed.

Prevalence of Renal Diseases and Its Related Risk Factors in Patients Undergoing Comprehensive Medical Examination in a University-based Hospital

BACKGROUND: Renal function in patients, who undergo medical examination, is usually evaluated by the serum creatinine level. However this numerical value does not always represent the entire renal function because the values increases only when the renal function has decreased more than 50%. The purpose of this study was to find the prevalence of renal diseases through the GFR (Glomerular filtration rate) using MDRD (Modification of Diet in Renal Disease) equation and to analyze the risk factors related to renal diseases. METHODS: We reviewed all the clinical records of 440 patients who had visited for medical examination between January 1, 2004 and December 31, 2004. We have calculated the GFR for each group using the MDRD equation and then figured out the correlation between the GFR and its risk factors. RESULTS: Patients haing GFR of less than 60 mL/min/1.73 m2 were 19 (7.2%), 60~90 mL/min/1.73 m2 were 123 (46.4%) and more than 90 mL/min/1.73 m2 were 123 (46.2%). The correlation between the GFR and age, obesity, hypertension and diabetes melitus were observed as negative results in univariate analysis of variance (P<0.05). Age and diabetes melitus were independent factors affecting the GFR (OR=3.1, 2.2 respectively, P<0.05) in multiple logistic regression analysis. CONCLUSION: It is a well known fact that the declined renal function is related to the aging process and diabetes melitus. Therefore, the mortality rate caused by renal failure and its complications should be decreased through the control of diabetes melitus, aging process and other risk factors.

Health Behaviors and Health Perceptions among Medical and Law Students

BACKGROUND: Modern physicians' role as a model is very important in advocating health promoting behaviors for their patients. In this study, we compared health promoting behaviors and corresponding health perceptions between law students and medical students with evaluation of the association between health promoting behaviors and corresponding health perceptions. METHODS: The data of this survey, conducted among law students and medical students attending a university in a metropolitan city in June, 2004, were collected by self-administered questionnaire based on FANTASTIC lifestyle checklist adjusted to reflect Korean circumstances. RESULTS: Qestionnaires from 74 law students and 136 medical students were analysed. The medical students showed better health behaviors in terms of fastening seatbelt, leisure time, sleep, and salt intake reduction. The medical students showed better health perceptions in terms of exercise, activity, body weight, animal fat and salt intake reduction, smoking cessation. The law students showed better perceptions in being impatient. Significant association between health behavior and health perception was observed in relationship with family and friends, exercise, activity, breakfast, reduced intake animal fat, smoking cessation, reduced drug and drinking habits, sleep, fastening seatbelt, regular physical exam, positive thought, and school satisfaction in the law students. In the medical students, significant association was observed in relationship with family and friends, exercise, breakfast, reduced drinking, sleep, fastening seatbelt, coping skills for stress, regular physical exam, and positive thought. CONCLUSION: Even though the medical students were more concerned about and engaged in some health promoting behaviors, other factors affecting medical students' health promoting behaviors than health perception should be addressed further.

Treatment of Chronic Cough in Primary Care

No abstract available.

Recognition of Osteoporosis and Analysis of Influencing Factors

BACKGROUND: As the average lifespan of human increases, osteoporosis and osteoporosis-related fractures have become major health care problems. Despite recent advances in medical treatment, few studies have assessed the recognition of osteoporosis in general adults. This study examined the recognition of osteoporosis and analysed the relating factors. METHODS: We made a survey in a rural area called Chunjunlee in Chunchon city. The questionnaire contained general characteristics of people, sociocultural factors, questions constructed to know the recognition of osteoporosis and factors that were presumed to influence people's recognition of osteoporosis. DEXA was performed on those who visited our medical office free of charge. RESULTS: The total number of people who responded to the questionnaire was 204. They were composed of 81 men and 123 women. Among the total, 83% of women and 72.8% of men said that they had heard about osteoporosis. There was no significant recognition score difference between men and women. In the items of recognition, wrong answer rate concerning the association between osteoporosis and musculoskeletal disorders such as osteoarthritis and low back pain was above 90%. The significant factors that influenced its recognition were age, education level, menopause state and newspaper/ magazine subscription. All men who were diagnosed with osteoporosis on DEXA initially said that they did not have osteoporosis. CONCLUSION: Many people had a conceptual confusion between osteoporosis and other muscular skeletal disorders such as osteoarthritis and low back pain. Physicians played no significant role in improvement of people's recognition of osteoporosis. Generally, men thought that osteoporosis was a problem in women only.