The Association between Stress Level in Daily Life and Age at Natural Menopause in Korean Women: Outcomes of the Korean National Health and Nutrition Examination Survey in 2010-2012 / 가정의학회지

BACKGROUND: Although several risk factors associated with reduced age at natural menopause (ANM) have been investigated, the results are inconsistent. Excessive stress, which leads to elevation of stress hormones, can also negatively affect reproductive ability, including by accelerating menopause. However, a direct association between stress level and ANM has not yet been demonstrated. Therefore, the object of this study was to investigate the association between stress level and ANM in Korean women. METHODS: Study participants were Korean women between 40 and 70 years old who were in natural menopause during the 5th Korean National Health and Nutrition Examination Survey (n=3,176). The level of stress in daily life was estimated based on data from the mental health topics of the survey. We used the t-test and one-way analysis of variance to analyze the correlation between stress level and ANM. Regression (beta) coefficients calculated by multiple regression analysis were used to estimate various factors affecting ANM. RESULTS: Women who experienced a high level of stress in daily life had a lower mean ANM than women with a low stress level (50.17+/-3.7 and 50.58+/-3.5 years, respectively), with a statistically significant correlation (P<0.05). This correlation was still observed after adjusting for age, body mass index, menstrual regularity, and personal income (P<0.05 for variables). CONCLUSION: In Korean women between 40 and 70 years of age who are in natural menopause, there is a statistically significant correlation between stress level and ANM. In particular, women who experience a high level of stress in daily life have reduced ANM.

Comprehension of Patient-Physician Interaction through Analysis of Relationships between Domains in Clinical Performance Examination / 한국의학교육

PURPOSE: This research investigated the psychometric properties of the patient-physician interaction (PPI) domain in the clinical performance examination (CPX). This research aimed to understand the PPI domain in the CPX through a psychometric and relationship analysis between the domains. METHODS: Data were drawn from 1,302 examinees on a set of 6 common CPX cases and 1,066 on a 'bad news delivery' case. All cases included 7 PPI items, among which we calculated internal consistency reliability. Correlations were made between PPI and the other domains. Analyses using the structural equation model (SEM) were conducted to assess the relationships between latent factors and controlled measurement errors. To calculate the disparity between colleges, we performed a multi-level analysis. Also, we conducted t-tests to investigate the consistency of the PPI and information sharing (IS) scores in the 'bad news delivery' case. RESULTS: Correlation between the mean PPI score and the total CPX score was high (0.707). The correlations between PPI and other domains were; 0.904 for the patient's overall satisfaction, 0.41 for history taking, and 0.327 for patient education. In SEM, these correlations between latent variables increased. The proportion of level-2 (between-school component) variance in PPI was 4.1%. For 'bad news delivery', the group that checked 'yes' on the IS items had higher PPI scores (mostly p<0.01). CONCLUSION: PPI is an influential domain of the CPX and is highly related with the patient's overall satisfaction, clinical courtesy, and history taking. Disparities between schools in PPI are relatively small, such that the PPI could be due to individual factors rather than the school.

The Comparison of Backgrounds and Characteristics of Students in Medical College and Graduate Medical School: A Case Study of One Medical School / 한국의학교육

PURPOSE: Information about students is important not only in developing curriculum and teaching strategies, but also in providing support to them. We surveyed students in 2004 (Medical collage) and 2007 (Graduate Medical School) to change our educational system to the GMS. By comparing the characteristics of these students, we expected the new curriculum to be more appropriate for the GMS students. METHODS: Our survey tool was a modified version of the matriculating student questionnaires used by the American Association of Medical Colleges. 60 (80.2%) matriculating students in 2004 (MC), and 71 (93.4%) in 2007 (GMS) responded to the survey. A total of 101 items were asked in 5 areas- 1) Demographic Data, 2) Pre-medical school experience, 3) Medical school application, 4) Career plans and interests, and 5) Perceptions of Medicine and Medical Service. RESULTS: Graduate Medical School matriculates have more diverse backgrounds and experiences before entrance than MC matriculates. GMS students are more sensitive to social issues and accountabilities of medicine and have a higher interest in working with other professionals. Both groups of students were similar in ranking medical professionalism higher than occupational stability or social economic compensation. CONCLUSION: We can use this information about students for curriculum development and, in particular, the differences seen between MC and GMS students could be helpful in improving medical education. If the survey were collected longitudinally and nation-wide, the results could be valuable for policy making not only in medical education but also in medical care and health of the nation.

Clinical Trial of Vaginal Approach in Gynecologic Pelvic Surgery / 대한산부인과학회잡지

OBJECTIVE: To analyse the clinical aspects of vaginal approach for gynecologic pelvic surgery, we evaluated age distribution, parity, indications for hysterectomy, postoperative pathology, operating time, bleeding amount, weight of uterus, postoperative complications. resected uterus weight, operating time and bleeding amount based on operative procedure type. METHODS: We reviewed the medical records of the 136 patients who underwent vaginal approach for gynecologic pelvic surgery for the indications other than uterine prolapse from Jan. 1998 to April. 1998, and from July. 1999 to Sep. 2001 at Chosun University Hospital. RESULTS: We performed 136 cases of vaginal approach for gynecologic pelvic surgery. We performed 132 cases of total vaginal hysterectomy, 4 cases of transvaginal ovarian cystectomy, a high increased rate of vaginal approach for gynecologic pelvic surgery significantly. The most common indication for vaginal approach for gynecologic pelvic surgery was uterine leiomyoma (63.2%), followed by HSIL, adenomyosis, MIC of the cervix, and ovarian cyst. The operating time was within 90 min in almost cases (47.1%). The most common postoperaive pathologic finding was uterine leiomyoma (47.1%), followed by adenomyosis, uterine leiomyoma with adenomyosis, MIC of the cervix, HSIL, LSIL, ovarian serouscys- tadenoma, and endometrioma. There were 4 cases (2.9%) of cuff cellulitis, 2 cases of pelvic cellulitis (1.5%), 3 cases of hematoma formation (2.2%), 1 case of laparatomy (0.7%) as postoperative complications. etc. CONCLUSION: Vaginal approach for hysterectomy and ovarian cystectomy is a safe method for removing uterus even in the absence of prolapse. Recently it's indication is widened to the patient who has larger uterus and history of previous pelvic surgery. Because of it's advantage, Vaginal approach for hysterectomy and ovarian cystectomy would be the preferred method of gynecologic pelvic surgery in the future.