The Association between Serum Vitamin D Concentration and Colon Polyp: A Cross-Sectional Study Using Health Care Screening Database in a Tertiary Hospital in Korea / 가정의학회지

Background@#As indoor activity increases with modern lifestyles changes, reduced exposure to sunlight may lead to reduced vitamin D synthesis. Previous studies demonstrated that increased vitamin D level is associated with decreased risk of colon cancer; therefore, this study attempted to determine the association between vitamin D and colon polyps, which may be precancerous lesions, in participants who underwent colonoscopy exams. @*Methods@#A total of 31,004 participants who underwent routine health checkups, including vitamin D level and colonoscopy, at Samsung Medical Center in South Korea from 2010 to 2018 were included in the study. Colorectal polyps were diagnosed through biopsy after performing colonoscopy exams. Participants were categorized into three groups according to level of vitamin D (deficient: <20 ng/mL), insufficient: 20≤ vitamin D <30 ng/mL, and sufficient: ≥30 ng/mL). We analyzed the presence of colorectal polyps according to vitamin D level, and performed multiple logistic regression analyses for the association between vitamin D level and colorectal polyps. @*Results@#About 50% of participants had colorectal polyps (hyperplastic polyp, n=4,864; adenomatous polyp, n=10,470; adenocarcinoma, n=24). There were no significant associations between vitamin D categories and colorectal polyp and colorectal cancer. However, when further analyzing by type of polyp, the risk of hyperplastic polyps significantly decreased with increasing vitamin D levels (P for trend=0.006). @*Conclusion@#We did not find evidence for an association between vitamin D and overall colorectal polyps; however, we observed a trend for decreased odds of hyperplastic polyps with increased vitamin D levels in comparison to vitamin D deficient subjects.

The Association between Serum Vitamin D Concentration and Colon Polyp: A Cross-Sectional Study Using Health Care Screening Database in a Tertiary Hospital in Korea / 가정의학회지

Background@#As indoor activity increases with modern lifestyles changes, reduced exposure to sunlight may lead to reduced vitamin D synthesis. Previous studies demonstrated that increased vitamin D level is associated with decreased risk of colon cancer; therefore, this study attempted to determine the association between vitamin D and colon polyps, which may be precancerous lesions, in participants who underwent colonoscopy exams. @*Methods@#A total of 31,004 participants who underwent routine health checkups, including vitamin D level and colonoscopy, at Samsung Medical Center in South Korea from 2010 to 2018 were included in the study. Colorectal polyps were diagnosed through biopsy after performing colonoscopy exams. Participants were categorized into three groups according to level of vitamin D (deficient: <20 ng/mL), insufficient: 20≤ vitamin D <30 ng/mL, and sufficient: ≥30 ng/mL). We analyzed the presence of colorectal polyps according to vitamin D level, and performed multiple logistic regression analyses for the association between vitamin D level and colorectal polyps. @*Results@#About 50% of participants had colorectal polyps (hyperplastic polyp, n=4,864; adenomatous polyp, n=10,470; adenocarcinoma, n=24). There were no significant associations between vitamin D categories and colorectal polyp and colorectal cancer. However, when further analyzing by type of polyp, the risk of hyperplastic polyps significantly decreased with increasing vitamin D levels (P for trend=0.006). @*Conclusion@#We did not find evidence for an association between vitamin D and overall colorectal polyps; however, we observed a trend for decreased odds of hyperplastic polyps with increased vitamin D levels in comparison to vitamin D deficient subjects.

Doctor's Perception and Referral Barriers toward Palliative Care for Advanced Cancer Patients / 한국호스피스완화의료학회지

PURPOSE: This study was conducted to identify the perception regarding palliative care among Korean doctors and referral barriers toward palliative care for terminal cancer patients. METHODS: Between May and June 2010, 477 specialists mainly caring cancer patients using a web-based, self-administered questionnaire. RESULTS: A total of 128 doctors (26.8%) responded. All respondents (100%) deemed palliative care a necessary service for terminal cancer patients. More than 80% of the respondents agreed to each of the following statements: all cancer centers should provide palliative care service (80.5%); all terminal cancer patients should receive concurrent palliative care along with anti-cancer therapies (89.1%) and caring for terminal cancer patients requires interdisciplinary approach (96.9). While more than 58% of the respondents were satisfied with their performance of physical and psychological symptoms management and emotional support provided by patient's family members, 64% of the responded answered that their general management of the end-of-life care was less than satisfactory. Doctors without prior experience in referring their patients to palliative care specialists accounted for 26.6% of the respondents. The most common barrier to hospice referral, cited by 47.7% of the respondents, was "refusal of patient or family member", followed by "lack of available palliative care resources" (46.1%). CONCLUSION: Although most doctors do recognize the importance of palliative care for advanced cancer patients, comprehensive and sufficient palliative medicine, including interdisciplinary cooperation and end-of-life care, has not been put into practice. Thus, more active palliative consultation or referral is needed for effective care of terminal cancer patients.

Results of a Survey of Residents Who Experience Pregnancy and Delivery / 한국의학교육

PURPOSE: A growing number of residents bear children during residency training. This study was conducted to examine the pregnancy and maternity leave experiences of women who delivered infants during their residency training. METHODS: From March 2007 through June 2007, we surveyed 94 women who had given birth during their residency training during the past 5 years from the survey date. Participants were recruited using snowball sampling. RESULTS: Most of the respondents (70.2%) delivered in the 3rd and 4th year of residency. The average length of leave was 68.9 days, and more than half (54.3%) of the women expressed that a maternity leave policy was not formally established in the department. In general, participants believed that having a child during residency was difficult (mean=4.18 in 5-point Likert scale), and this perception was inversely related with systematic departmental support. CONCLUSION: Pregnancy is a special challenge for residents, with regard to not only physical overexertion but also psychosocial impacts on pregnant residents and their colleagues. However, most current residency programs do not have written policies on pregnancy. A formal policy and more flexible curriculum can help both the training program and the pregnant resident.

Detection of Cancer with PET and PET/CT in Asymptomatic Volunteers / 핵의학분자영상

PURPOSE: We retrospectively investigated the diagnostic performance of (18)F-fluorodeoxyglucose positron emission tomography (PET) and PET/CT for cancer detection in asymptomatic health-check examinees. MATERIALS AND METHODS: This study consisted of 5091 PET or PET/CT conducted as part of annual health examination at one hospital from March 1998 to February 2008. To find the incidence of cancers, medical records of the subjects were thoroughly reviewed for a follow-up period of one year. The patterns of formal readings of PET and PET/CT were analyzed to assess the sensitivity and specificity for cancer detection. The histopathology and stage of the cancers were evaluated in relation to the results of PET. RESULTS: Eighty-six cancers (1.7%) were diagnosed within one year after PET or PET/CT. When PET and PET/CT results were combined, the sensitivity was 48.8% and specificity was 81.1% for cancer detection. PET only had a sensitivity of 46.2% and a specificity of 81.4%, and PET/CT only had a sensitivity of 75.0% and a specificity of 78.5% respectively. There were no significant differences in cancer site, stage and histopathology between PET positive and PET negative cancers. In 19.3% of formal readings of PET and PET/CT, further evaluation to exclude malignancy or significant disease was recommended. Head and neck area and upper gastrointestinal tract were commonly recommended sites for further evaluation. CONCLUSIONS: PET and PET/CT showed moderate performance for detecting cancers in asymptomatic adults in this study. More experience and further investigation are needed to overcome limitations of PET and PET/CT for cancer screening.

Association between Obesity in Adolescence and Family Function

BACKGROUND: The association between obesity development and poor family function was controversial in previous studies and has been seldom evaluated in Korean adolescents. METHODS: A questionnaire asking family function (family APGAR, Korean family function assessment tool for adolescents), socioeconomic environment, and behavioral characteristics was self-administered to 1,056 adolescents enrolled in a Korean middle school. A total of 774 adolescents who answered the questionnaire thoroughly and had no diseases influencing family function were included. After calculating body mass index (BMI) using the data of physical measurement at school, we classified participants into overweight-obesity (upper 15%) and normal weight group (lower 85%) based on the reference data of Korean childrens' BMI distribution (Korean pediatric society, 1998). RESULTS: The prevalence of overweight-obesity was 13.0% (14.8% among boys and 10.9% among girls). Multivariable-adjusted logistic regression analysis showed overweight-obesity was associated with better family function, higher school grade, fattier body shape of mother, and lower educational level of mother. Gender- specifically, overweight-obesity was associated with better family functioning and higher school grade with odds ratios (95% confidence interval) of 2.36 (1.13, 5.55) and 2.59 (1.36, 4.93), respectively, in boys, whereas only those who were not living with both parents were 2.67 (1.09~6.54) times more likely to be overweight or obese among girls. CONCLUSION: The factors associated with overweight- obesity differed by gender and the family function of overweight-obesity group was better than normal weight group, especially in boys. These findings suggest poor family function is neither the cause nor the result of obesity development in adolescents.

Prevalence and Associated Factors of Neck Shoulder Pain in High School Students

BACKGROUND: Neck shoulder pain (NSP) was highly prevalent even among the adolescents in previous Western studies. However, the prevalence among Korean adolescents was seldom studied and the factors associated with NSP were controversial. METHODS: A self-administered questionnaire asking the presence of NSP, restriction in daily activities due to NSP, behavioral characteristics, and psychological factors was given to 1,232 adolescent enrolled in high schools. Finally, 1,194 providing adequate responses to the questionnaire were included. NSP occurring once a week or more over the last 6 months was defined as a significant NSP and the association between the significant NSP and the studied variables was estimated using multiple logistic regression analysis. RESULTS: The prevalence of NSP and the significant NSP were 82.9% and 33.4%, respectively. The girls (40.6%) were experiencing the significant NSP more than the boys (26.0%). Restriction in daily activities due to NSP was very common and 74.8% of the girls and 65.2% of the boys reported study disturbance. The factors associated with higher risk significant NSP in the boys were higher BMI (25> or =kg/m2), moderate stress, and fairly poor or poor self-assessed physical condition with odds ratios (95% confidence intervals) of 1.86 (1.02~3.40), 1.74 (1.03~2.97), and 2.30 (1.26~4.19), respectively. In the girls, a longer (<75% of total sitting time) time of sitting in desk/chair of the inadequate height was associated with a higher risk of the significant NSP (odds ratio: 1.59, 95% confidence interval: 1.05~2.39). CONCLUSION: The prevalence of NSP in Korean adolescents was very high, suggesting that active efforts to prevent NSP in Korean adolescents would be needed with a consideration of different risk factors between girls and boys.

Trends in Avoidable Death over 20 Years in Korea

To evaluate the achievement of health care services in Korea independent of other socioeconomic factors, we observed the time trend of avoidable death between 1983 and 2004. A list of avoidable causes of death was constructed based on the European Community Atlas of ''Avoidable Death''. We calculated sex- and agestandardized mortality rates of Korean aged 1-64 yr using data of the Korea National Statistical Office. The avoidable mortality rate (per 100,000 persons) decreased from 225 to 84 in men and from 122 to 41 in women. Accordingly, the proportion of avoidable deaths among all classifiable deaths was reduced by 8.1% in men and 6.4% in women. However, mortality rates from some preventable causes such as ischemic heart disease and malignant neoplasms of lung, breast, cervix, and colorectum have been on the rise. Mortality preventable by appropriate medical care showed the greatest reduction (by 77.8%), while the mortality preventable by primary prevention showed the least reduction (by 50.0%). These findings suggest that health care service has significantly contributed to the improvement of health in Korea. However, more effective intervention programs would be needed given the less reduction in mortality avoidable by primary or secondary prevention than expected and unexpectedly increasing mortality from several preventable causes.

Comparison of Quality of Life between Medical Students and General College Students / 신경정신의학

OBJECTIVES: The quality of life of medical students was investigated and compared with that of general college students to identify what kind of problems medical students are suffering from. METHOD: Korean version of WHOQOL-BREF was administered to 317 medical students and 150 general college students of Yonsei University in 1999. Collected data were analyzed with t-test and multiple regression analysis RESULTS: There was no significant difference in the total scores of WHOQOL-BREF between medical students and general college students. However, the scores of facets of sleep and rest, sexual activity, and participation and opportunities for recreation/leisure were significantly lower in medical students than in general college students, while the scores of facets of dependency on medication and treatment, financial resources, opportunities for acquiring new information and skills, and transport were significantly higher in medical students than in general college students. The score of social relationships domain was significantly lower in medical students than in general college students, while, the score of environmental domain was significantly higher in medical students than in general college students. Physical, environmental and social relationships domains contributed more to the quality of life of medical students than psychological domain while psychological and environmental domains contributed more to the quality of life of general college students than physical and social relationships domains. CONCLUSION: The result suggests that it is necessary to improve the quality of life of medical students in social relationships domain and in the facets of sleep and rest, sexual activity, participation and opportunities for recreation/leisure.