Understanding ‘Family’ for Family-Oriented Medical Care

The clinical philosophy of family medicine is to provide warm-hearted health care to every human being as opposed to the modern subspecialized carecalled “inhuman medicine.” One of the strategies to implement this philosophy is comprehensive care. Comprehensive care uses the biopsychosocialmodel approach to health problems. Comprehensive evaluation and management of biopsychosocial dimensions is unique to family medicine, andit is difficult to achieve through subspecialized care. Family-oriented health care is a specific tool to practice comprehensive care based on thebiopsychosocial approach. For family-oriented medical care, the family physician needs to understand “family” from two perspectives: structural anddevelopmental. From the structural perspective, family is a group of small entities called holons. From the developmental perspective, family is anentity that keeps changing and developing through the family life cycle and events. Family-oriented care, in these two contexts, tries to understandand address the communication and behavior patterns of the family members.

Influenza Vaccination and Associated Factors among Korean Cancer Survivors : A Cross-Sectional Analysis of the Fourth & Fifth Korea National Health and Nutrition Examination Surveys

Influenza vaccination is important for cancer survivors, a population with impaired immunity. This study was designed to assess influenza vaccination patterns among Korean cancer survivors. In this cross-sectional analysis, data were obtained from standardized questionnaires from 943 cancer survivors and 41,233 non-cancer survivors who participated in the Fourth and Fifth Korea National Health and Nutrition Examination Surveys (2007-2011). We identified the adjusted influenza vaccination rates and assessed factors associated with influenza vaccination using multivariate logistic regression. Cancer survivors tended to have a higher adjusted influenza vaccination rate than the general population. The rates for influenza vaccination in specific cancer types such as stomach, hepatic, colon, and lung cancers were significantly higher than non-cancer survivors. Among all cancer survivors, those with chronic diseases, elderly subjects, and rural dwellers were more likely to receive influenza vaccination; those with cervical cancer were less likely to receive influenza vaccination. Cancer survivors were more likely to receive influenza vaccinations than non-cancer survivors, but this was not true for particular groups, especially younger cancer survivors. Cancer survivors represent a sharply growing population; therefore, immunization against influenza among cancer survivors should be concerned as their significant preventative healthcare services.

The Adverse Effects of Radiotherapy and Its Management in the Hospice and Palliative Care Patients / 한국호스피스완화의료학회지

Recent advances in techniques and strategies use to detect cancer in its early stages and to treat it effectively has the survival rate of cancer patients and the number of long-term cancer survivors continually increasing. Unfortunately, many cancer survivors are at risk for various late and long-term effects of cancer treatments including the radiotherapy. Long-term cancer survivors can be also seen for a hospice and palliative care because of cancer recurrence and they are at risk of delayed reactions to radiotherapy. So, the understanding and knowledge of radiation reactions is required for the proper medical diagnosis, management, and coordination of the potential reactions that may occur in these care setting. In effort to increase the survival rate in cancer patients and to decrease the adverse effects of cancer treatment, many clinical studies have been and continue to be conducted. The efforts of these studies have thus resulted in the advancement of cancer treatments. Regrettably, the overall interest in how to manage adverse effects of cancer treatment such as radiotherapy appears seemingly low in clinical practice and its advanced studies as a whole are delayed and deficient. It is imperative that the medical community show an enthusiastic interest in the aftercare of cancer patients and cancer survivors in order to create a complementary integrative approach that will eliminate radiotherapy related pain/discomfort or illness in hospice and palliative care settings.

Influence of Stomach Cancer Risk Factors on the Development of Gastric Dysplasia

BACKGROUND: Both atrophic gastritis and intestinal metaplasia may progress to gastric dysplasia. This study aimed to analyze the factors influencing progression of atrophic gastritis and intestinal metaplasia to dysplasia. METHODS: People diagnosed with atrophic gastritis and intestinal metaplasia for the first time received a follow-up endoscopy and were investigated for the cumulative incidence rate of gastric dysplasia by age, gender, smoking habit, alcohol intake, rice consumption and family history of stomach cancer. RESULTS: The cumulative incidence rate increased with age, consuming > or =3 bowls of rice per day and family history of stomach cancer. Multivariate analysis showed that the cumulative incidence rate of gastric dysplasia increased in subjects >61 years (RR=2.54, P=0.014), in those consuming > or =3 bowls of rice per day (RR=1.46, P=0.021) and in those with a family history of stomach cancer (RR=1.31, P=0.037). CONCLUSIONS: More active management, such as intensive endoscopic follow-up examinations, lifestyle change and education regarding gastric dysplasia, are required in those older than 61 years, having a higher intake of grain or with a family history of stomach cancer.

Clinical Application of Family-Centered Health Care / 가정의학회지

For practicing comprehensive approach to health problems, family physicians should see both biomedical aspects and psychosocial aspects of each patient at the same time. Family physicians can hypothesize and intervene effectively the psychosocial aspects of patients through family-centered health care. Genogram, family life cycle, family's resources for stressful life events, and adaptability and cohesiveness of patients' family are the four eyes of family physicians, those enable family physicians to see the family of patients in their health care practice. Family-centered health care in family practice can be achieved by applications of family-related questions to routine health care practice, approaches to the family dynamics in patients with red flags, and family conferences for inpatients and patients with more difficult problems. Family-centered health care is the core practice of comprehensive approach to health problems and an important identity of family medicine.

Effect of 8-week Therapy with Rabeprazole on Presenting Symptoms in Korean Patients with Gastroesophageal Reflux Disease

BACKGROUND: Gastroesophageal reflux diease (GERD) is common in Western civilization and comprise 75% of esophageal diseases. However, there are only few studies of GERD in Korea. The aim of the study was to evaluate the clinical symptoms of GERD in Koreans and the effect of rabeprazole on the symptoms. METHODS: The study subjects were included 353 patients who were diagnosed endoscopically with reflux esophagitis (316) or non-erosive reflux disease who have complained of intermittent heartburn during the past 3 months or more. All patients received rabeprazole 20 mg daily for 8 weeks. Symptoms according to 8 symptom categories of GERD were evaluated. Patients recorded the severity of GERD associated symptoms at baseline, 4 weeks and 8 weeks after treatment. Presenting symptoms in Korean, frequency and severity of each symptom was evaluated. Efficacy of Rabeprazole treatment was analysed. RESULTS: The most common symptoms of GERD were regurgitation (60.9%), heartburn (52.7%), epigastric pain/ soreness (49.6%) and other epigastric discomfort (47.0%). Symptom severity was rated in order of epigastric pain/ soreness, epigastric discomfort, and heartburn. The proportion of all symptoms, except for heart burn and cough, increased in relation to the severity of endoscopic grading, but the severity of symptoms was not significantly different between subgroups according to endoscopic findings. Symptoms, except for hoarseness, globus sensation and cough, significantly improved in 4 weeks after treatment. Cough did not improve after 4 weeks irrespective of smoking status, All symptoms significantly improved after 8 weeks. CONCLUSION: Regurgitation was more common, and epigastric symptoms were more severe than heartburn in Koreans. The 8-week rabeprazole treatment was effective on all symptoms associated with GERD.

Mondor's Disease of the Breast: Clinical Manifestations and Imaging Findings

Mondor's disease or thrombophlebitis of the superficial veins of the breast is a rare benign condition and a self-limiting disease. The combination of the clinical manifestations and the imaging (mammographic & sonographic) findings is the typical sign of Mondor's disease of the breast. Therefore, an understanding of such an entity and knowledge of the clinical and imaging findings will make it possible to avoid the unnecessary biopsy or surgery. We report the case of a 53-year-old woman diagnosing as Mondor's diasease, who underwent evaluation of a tender, papable cord- like mass in her left breast associated with discoloration of the overlying skin.

The Positive Rate of Serum Rheumatoid Factor in Health Screening Subjects and Related Factors

BACKGROUND: This study was done to estimate the prevalence of Rheumatoid Factor (RF) positive rate in adult Korean population and to investigate the association between rheumatoid factor positive rate and related factors. METHODS: The database from 4,678 subjects, who visited a general health screening center of an university hospital during 1 year period were surveyed. RF was tested using a commercial latex test kit, HBsAg by RIA of 3rd generation, anti-HCV by EIA of 3rd generation and serum AST, ALT by enzyme kinetic method. Syphilis was checked using RPR test and TPHA. Lung diseases (tuberculosis, IPF) were screened using chest X-ray. Flukes was checked by sedimentation method and cestodes was by direct method in stool tests. Smokers were based on history on health screening. RESULTS: 1) The positive rate of RF was 4.4%, HBsAg was 5.9%, anti-HCV was 1.5% and ALT>35 IU/L was 18.4%. The number of syphilis subjects was 19, lung diseases was 119, parasitic diseases was 43, and smokers was 1,299. 2) RF positive rate of males was 4.0%, females was 5.3%. Therefore, the positivity of females was higher than males and RF positivite rate was increased in the higher age groups. 3) RF positive rate in HBsAg (+) subjects was 18.1% and HBsAg (-) was 3.6% and in anti-HCV (+) subjects was 10.3% and anti-HCV (-) was 4.3%. 4) RF positive rate of subjection both positive reactions of RPR test and TPHA, namely, syphilis tests was 21.1%. 5) RF positive rate of parasitic diseases was 4.7%, lung diseases was 2.5% and smokers was 4.2%. 6) RF positive rate was highly associated with HBsAg, syphilis, anti-HCV, female sex, age in order of sequence. CONCLUSION: The positive rate of RF in healthy Korean adults can be estimated to be 4.5% and shows high association with hepatitis B and C virus infection in addition to syphilis, age and sex.

Synthetic CDCA Derivatives-Induced Apoptosis of Stomach Cancer Cell Line SNU-1 Cells / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study was conducted to explore whether CDCA derivatives induce apoptosis in a stomach cancer cell line, and to dissect the detailed mechanism underlying apoptosis. MATERIALS AND METHODS: The human stomach cancer cell line, SNU-1, cells were treated with the synthetic CDCA derivatives, HS-1199 and HS-1200. DNA and mitochondrial stains were used to detect apoptotic cells by fluorescence imaging or flow cytometry. The caspase-3 activity was measured by Western blotting. RESULTS: Both the HS-1199 and HS-1200 induced decreased viabilities of the SNU-1 cells, in time-dependent manners. The CDCA derivatives demonstrated various apoptosis hallmarks, such as mitochondrial changes reduction of MMP, cytochrome c release, and Smac/ DIABLO translocation), activation of caspase-3 (resulting in the degradation of PARP and DFF45), DNA fragmentation and nuclear condensation. CONCLUSION: The CDCA derivatives, HS-1199 and HS- 1200, both induced apoptosis of the SNU-1 gastric cancer cells in caspase- and mitochondria-dependent fashions. Many important issues relating to their therapeutic applications remain to be elucidated.

The multi-center study of the comprehensive geriatric assessment in the Korean elderly

BACKGROUND: Comprehensive geriatric assessment is identified as a dynamic process responsive to the changes on health status that occurs over time in the context of extremely increasing trend in the numbers of the elderly people, their office visit, and the medical cost universally. We completed the comprehensive geriatric assessment and applied it to the Korean elderly through the multi-center trials. METHODS: We performed studies variables using questionnaires, with interviewing, physical examination to the number of total 312 elderly people who visited the department of family medicine or physical medicine and rehabilitation of the 11 university hospital or general hospital in Korea from July 1, 1999 through October 31, 1999. We, the geriatrician, met and discussed 3 times to complete the comprehensive geriatric assessment through the consensus panel. RESULTS: We found the sex ratio of 312 subjects was 1 to 2 (104 males and 208 females) and the average age was 73.2 years old. The orders of more frequency of self-reported health status of the respondents were hypertension, arthritis, cataract, gastrointestinal disturbance, diabetes mellitus, urinary/fecal incontinence, depression, cerebrovascular accident, anemia, and heart disease. Nearly 15% of those showed depression, 41.6% of those were in the status of socially isolation. We found 43.1% of those showed hypertension, 3.7% isolated systolic hypertension, and 20.2% orthostatic hypotension. Of those, cognitive impairment were measured in 37.1%, gait disturbance 13.0%, and the risk of malnutrition 39.6%. Geriatrician spent 21.1 minutes per person during the process of comprehensive geriatric assessment. CONCLUSION: We realized we could diagnose and intervene effectively certain hidden conditions/diseases, particularly urinary incontinence, falls, visual impairment, hearing impairment, pain, depression, social isolation, cognitive impairment, and orthostatic hypotension, with using the comprehensive geriatric assessment. These results reflected the fact that the comprehensive geriatric assessment might be necessary for the care of the elderly.

The relationship between test anxiety and family adaptability, cohesion of high school students

BACKGROUND: As Koreans have had great enthusiasm for education traditionally, most students have excessive anxiety about tests and such anxiety may cause several physical and psychological problems. But there are few studies on the relationship between test anxiety and family function. Therefore, in this study, we tried to figure out the relationship between test anxiety and family function in order to treat and educate patients who have excessive test anxiety. METHODS: In a survey study, the Korean Version of Test Anxiety Inventory and Olson's FACES III was administered to the 220 second year high school students of a single high school who live in Pusan. Two groups of students with high and low test anxiety levels (52 in each group) were selected based on the test anxiety scale ratings and analysis of their family adaptability and cohesion. RESULTS: In FACES III adaptability of high test anxiety group, there were 15 cases (28.8%) for rigid, 23 cases (44.2%) for structured, 11 cases (21.2%) for flexible and 3 cases (5.8%) for chaotic familes. In that of low test anxiety group, 2 cases (3.8%) for rigid, 16 cases (30.8%) for structured, 24 cases (46.2%) for flexible and 10 cases (19.2%) for chaotic familes. In FACES III cohesion of high test anxiety group, there were 2 cases (3.8%) for disengaged, 14 cases (26.9%) for separated, 20 cases (38.5%) for connected and 16 cases (30.8%) for enmeshed familes. In that of low test anxiety group 18 cases (34.6%) for disengaged, 22 cases (42.3%) for separated, 8 cases (15.4%) for connected and 4 cases (7.7%) for enmeshed familes. In FACES III family type of high test anxiety group, there were 24 cases (46.2%) for balanced, 20 cases (38.4%) for mid range and 8 cases (15.4%) for extreme familes. In that of low test anxiety group 24 cases (46.2%) for balanced, and 22 cases (42.3%) for mid range and 6 cases (11.5%) for extreme familes. CONCLUSION: Cohesion scale of high test anxiety group was higher than that of low test anxiety group and adaptability scale of low test anxiety group was higher than that of high test anxiety group.

Hemangioma of Scrotum: A Report of 3 Cases / 대한비뇨기과학회지

Hemangioma of the scrotum is a rare and benign tumor and complete surgical excision is the preferred treatment. Magnetic resonance imaging (MRI) may be useful for the evaluation of these lesions particularly when determining the extent or depth of involvement would affect management decisions. Herein, we report 3 cases of scrotal hemangioma, and the usefulness of MRI in the evaluation of these lesions is discussed.

Prostatodynia: Characteristics of Uroflowmetries / 대한비뇨기과학회지

PURPOSE: Prostatodynia (PD) is a kind of syndrome by many causes and many patients with PD Are refractory to treatments of prostatitis. Considering a large part of complaints of PD patients are involving voiding symptoms, screening for voiding difficulty in patients with PD using uroflowmetry can be useful for selecting the following diagnostic method and choice of treatment. But characteristics of uroflowmetries in PD patients are not clarified. In this study, we analyzed data and types of curves from uroflowmetries in patients with PD to clarify and evaluate the characteristics of their voiding patterns. MATERIALS AND METHODS: Patients (n=48) and 11 healthy men under age 40 were selected. All the patients and controls underwent uroflowmetries. According to 5 types of uroflow curves by Jphirgensen et at, all the uroflow curves were classified, and maximum flow rate (Qmax; ml/sec) and average flow rate (Qave; ml/sec) were compared. RESULTS: Qmax (15.9 ml/sec) and Qave (9.0 ml/sec) in PD patients were all lower than those (24.5 ml/sec, 15.5 ml/sec) in controls (p<0.001, <0.001). By the classification of uroflow curves, uroflow curves of controls were all type 1. In PD patients, 12 (25%) were type 1, 6 (12.5%) were type 2, 13 (27.1%) were type 3, 17 (35.4%) were type 5, and none of them was type 4. Comparing RESULTS of each type PD patients with those of controls shows that there was no statistically significant difference between type 1 PD patients and controls, while Qmax and Qave of type 2, type 3, and type 5 PD patients were all lower than those of controls (statistically significant). Qmax and Qave were the lowest in type 5 (12.0 ml/sec, 7.2 ml/sec). CONCLUSION: From the RESULTS of our investigations, we suggest that a large part of PD patients have voiding problems and the uroflowmetry deserves to be a screening test for them. We think further studies are necessary to clarify the exact causes involving voiding symptoms in patients with PD.

Ureteroscopic Treatment for Lower Ureteral Calculi / 대한비뇨기과학회지

Ureteroscopic management as a primary treatment for lower ureteral calculi was assessed. From August 1994 through December 1995, 62 cases treated ureteroscopically in 60 consecutive patients with lower urethral stones were evaluated. Complete stone removal was achieved in 58 cases (93.5%). In 50 cases treated with Swiss Lithoclast lithotriptor, stones were well fragmented and extracted without difficulties. Either size or shape of stone seldom had influence on success rate. In 8 cases, stones were relatively small and able to be removed only with stone grasping forceps or Dormia stone baskets. There were five complications which were minor and treated conservatively. These observations show that ureteroscopic stone manipulation with lithotriptor deserves to be a primary treatment modality for lower ureteral stones in view of remarkable efficacy, negligible complication rate.

Effects of Thoracentesis on Thoracic Impedance and Cardiac Performance

Effects of thoracentesis on thoracic impedance and cardiac performance were studied in patients with uncomplicated unilateral tuberculous pleural effusion. The speed of the removal of the pleural effusion in thoracentesis was essentially similar to that of a generally used for therapeutic purpose in daily practice. Thoracic impedance was measured in 23 cases before, 4 and 10 minutes after thoracentesis to the amount of pleural effusion aspirated was observed. In 11 cases out of 23, the changes in cardiac performance as assessed by stroke volume, cardiac output, heart rate, heather index and ratio of pre-ejection period to left ventricular ejection time(PEP/LVET) were observed 4 minutes after 150 ml to 1,000 ml of thoracentesis. In these cases, stroke volume, cardiac output, and Heather index were determined from impedance cardiograms, and PEP/LVET from mechanocardiograms recorded simultaneously with the former. A significant increase in thoracic impedance was observed both 4 and 10 minutes after thoracentesis. There was a slight but a significant correlation between the changes in thoracic impedance and the amount of pleural fluid aspirated only 4 minutes after thoracentesis. Thoracentesis showed no consistent influence on cardiac performance as reflected to stroke volume, cardiac output, heart rate, heart index and PEP/LVET. These facts suggest that measurement of thoracic impedance may be a useful method reflecting alterations in pleural fluid volumes, particularly when it occurs in a relatively short period of time, and the effects of thoracentesis of less than one liter on the cardiac functions as determined by the above-mentioned parameters were variable.