The Association between Hand Grip Strength and Cardiovascular Disease Risk: The 2016 Korea National Health and Nutrition Examination Survey

BACKGROUND: The measurement of grip strength is a simple and inexpensive method to assess all-cause and cardiovascular mortality, as well as the risk of cardiovascular disease. We investigated the association between handgrip strength and the risk of cardiovascular disease in a nationally representative sample.METHODS: Using the Seventh Korea National Health and Nutrition Examination Survey 2016, we analyzed data obtained from 3,266 adults aged 40–79 years, without cardiovascular disease at their baseline examination (1,421 men and 1,845 women). Relative handgrip strength was used for analysis and was calculated as the sum of the maximal absolute handgrip strength of both hands divided by the body mass index. We performed multivariate linear regression analysis to assess the association between handgrip strength and the 10-year risk of cardiovascular disease. The 10-year risk of cardiovascular disease was calculated using the American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort atherosclerotic cardiovascular disease (ASCVD) Risk Estimator.RESULTS: Multivariate linear regression analysis showed a significant association between handgrip strength and the 10-year risk of cardiovascular disease (%). After adjusting for confounders, an inverse association was observed between handgrip strength and the 10-year risk of cardiovascular disease in adults of both sexes (men: −1.29, women: −0.58).CONCLUSION: This study investigated the association between relative handgrip strength and the risk of ASCVD using ACC/AHA guidelines. We observed that increased relative handgrip strength may be associated with a better cardiovascular disease risk profile and lower 10-year cardiovascular risk among Korean adults aged 40–79 years.

Association between Smoking and Periodontal Disease in Korean Adults: The Fifth Korea National Health and Nutrition Examination Survey (2010 and 2012) / 가정의학회지

BACKGROUND: This study aimed to evaluate an association between smoking, smoking cessation, and periodontal disease in Korean adults. METHODS: The data were collected from 8,336 participants, aged between 20 and 64 years, who participated in the fifth Korea National Health and Nutrition Examination (2010 and 2012). Smoking status was assessed using self-administered questionnaires. Periodontal disease was defined as a community periodontal index ≥3 points. Logistic regression analysis was used to evaluate an association between smoking, smoking cessation, and periodontal disease after adjusting for age, sex, education, monthly income, diabetes, obesity, alcohol intake, and frequency of tooth brushing. RESULTS: The risk of periodontal disease was higher among current smokers (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.21-1.83) than never smokers. Among current smokers, the risk of periodontal disease was increased in smokers of ≥10 cigarettes/d, ≥20 years duration, and >10 pack-years compared with never smokers (P<0.05). Among former smokers, the risk of periodontal disease after 10 years since cessation declined to 0.56 (95% CI, 0.42-0.75) compared with current smokers and was indistinguishable statistically from never smokers. CONCLUSION: Periodontal disease is significantly associated with smoking status in Korean adults.

Risk of Cardiovascular Disease Using Framingham Risk Score in Korean Cancer Survivors / 가정의학회지

BACKGROUND: Cardiovascular disease is an important cause of morbidity and mortality in cancer survivors. The aim of this study was to investigate the modifiable cardiovascular disease risk factors and 10-year probability of the disease based on the Framingham risk score in cancer survivors, compared with the general population. METHODS: A total of 1,225 cancer survivors and 5,196 non-cancer controls who participated in the 2007-2013 Korea National Health and Nutrition Examination Surveys were enrolled. We assessed modifiable cardiovascular disease risk factors including smoking, body mass index, physical inactivity, high blood pressure, high cholesterol, and elevated blood glucose level. The 10-year probability of cardiovascular disease was determined by applying the Framingham cardiovascular disease risk equation among cancer survivors and non-cancer controls, ranging from 30 to 74 years old who had no overt cardiovascular diseases. RESULTS: The proportion of subjects who had higher fasting glucose levels, hemoglobin A1c levels, systolic blood pressure, and low density lipoprotein cholesterol levels, and those who had lower high density lipoprotein cholesterol levels was significantly higher in the cancer survivors than in the non-cancer controls. The average 10-year probability of cardiovascular disease among the cancer survivors was higher than that in the non-cancer controls in both men and women. The average 10-year probability of cardiovascular disease in relation to the cancer type was significantly higher in patients with hepatic, colon, lung, breast, and gastric cancer. CONCLUSION: Cancer survivors have a higher cardiovascular disease risk and 10-year probability of cardiovascular disease than non-cancer controls. Control of cardiovascular disease risk factors and implementation of a well-defined cardiovascular disease prevention program are needed for treating cancer survivors.

Factors Associated with Fatigue in Korean Gastric Cancer Survivors / 가정의학회지

BACKGROUND: Gastric cancer is the second most common cancer in Korea. Fatigue is a common symptom among cancer survivors. The aim of this study was to identify factors associated with fatigue in gastric cancer survivors. METHODS: Data were analyzed from 199 gastric cancer survivors who visited a cancer survivor outpatient clinic from July 2013 to June 2014. Patients were surveyed using a questionnaire containing a fatigue severity scale (FSS) and questions regarding associated symptoms. Participants were divided into fatigue (FSS) and non-fatigue groups based on FSS scores (> or =4 and <4, respectively). Age, sex, weight, body mass index, cancer stage, pathology, surgery type, chemotherapy, radiotherapy, comorbid disease, family history of cancer, smoking, alcohol consumption, exercise, and laboratory results were investigated. RESULTS: The fatigue and non-fatigue groups contained 42 and 157 survivors, respectively. Their mean age was 58 years, and the mean post-operative period was 6.58 years. Arthralgia (odds ratio [OR], 12.95; 95% confidence interval [CI], 3.21-52.34), dyspnea (OR, 10.54; 95% CI, 2.94-37.80), dyspepsia (OR, 8.26; 95% CI, 2.63-25.96), changed bowel habits (OR, 4.56; 95% CI, 1.09-19.11), anemia (OR, 3.18; 95% CI, 1.26-8.05), and regular exercise (OR, 0.31; 95% CI, 0.12-0.77) were significantly associated with fatigue in gastric cancer survivors, while weight, treatment, and depressive mood were not. CONCLUSION: Arthralgia, dyspnea, dyspepsia, bowel habit change, anemia, and regular exercise are associated with fatigue in gastric cancer survivors.

Health-Related Quality of Life and Cardiovascular Disease Risk in Korean Adults / 가정의학회지

BACKGROUND: Health-related quality of life (HRQoL) is considered an important outcome measure in chronic diseases, in particular cardiovascular disease (CVD), which is known to be associated with impaired HRQoL. However, few studies have examined HRQoL in individuals at high risk of CVD. METHODS: Using the Fifth Korea National Health and Nutrition Examination Survey 2010-2012, we analyzed data from 10,307 adults aged > or =30 years. The study subjects were stratified into 3 groups on the basis of their Framingham risk score-a 10-year estimate of CVD risk: or =20.0% (high risk). The EuroQol-5D (EQ-5D) was used to evaluate HRQoL. RESULTS: A significantly higher proportion of high-risk subjects than low-risk participants had impaired HRQoL (defined as the lowest quartile of the EQ-5D index); this held true even after adjustment for confounding factors in multivariable logistic regression analysis (men: odds ratio [OR], 1.62; 95% confidence interval [CI], 1.24-2.11; women: OR, 1.46; 95% CI, 1.02-2.08). In terms of the 5 EQ-5D dimensions, a 10-year CVD risk > or =20.0% was significantly associated with self-reported problems of mobility in men (OR, 3.15; 95% CI, 2.02-4.90), and of mobility (OR, 1.56; 95% CI, 1.09-2.24), self-care (OR, 2.14; 95% CI, 1.09-4.22), and usual activity problems (OR, 1.80; 95% CI, 1.17-2.78) in women. CONCLUSION: A high CVD risk is associated with impaired HRQoL. After adjustment for demographic and clinical factors, a 10-year CVD risk > or =20.0% is an independent predictor of impaired HRQoL in the general population; in particular, of mobility problems in men, and of mobility, self-care, and usual activity problems in women.

Validation of the Prognosis in Palliative Care Study Predictor Models in Terminal Cancer Patients / 가정의학회지

BACKGROUND: Prognosis in Palliative Care Study (PiPS) predictor models were developed in 2011 to estimate the survival of terminal cancer patients in the United Kingdom. The aim of this study was to validate the PiPS model for terminal cancer patients in Korea, and evaluate its value in clinical practice. METHODS: This study included 202 advanced cancer patients who were admitted to the cancer hospital's palliative care ward from November 2011 to February 2013. On admission, physicians recorded the PiPS-A, PiPS-B, and doctor's survival estimates in inpatients. RESULTS: The median survival across PiPS-A categories was 9, 28, and 33 days, and the median survival across PiPS-B was 9.5, 27, and 43 days. The median actual survival was 25 days; overall accuracy between the PiPS-A, PiPS-B, doctor's estimates of survival, and actual survival was 52.0%, 49.5%, and 46.5%, respectively. The PiPS-A and PiPS-B groups for survival in 'days' showed a sensitivity of 48.4% and 64.1%, and specificity of 87.7%, and 77.5%, respectively. The PiPS-A and PiPS-B groups for survival in 'weeks' showed a sensitivity of 59.2%, and 44.7%, and specificity of 61.6%, and 64.7%, respectively. The PiPS-A and PiPS-B 'months' group showed a sensitivity of 37.1% and 37.1%, and specificity of 74.9% and 78.4%, respectively. The 'weeks' and 'months' groups showed significantly prolonged survival rates than 'days' group did in both PiPS-A and PiPS-B, by the Kaplan-Meier method. CONCLUSION: The PiPS predictor models effectively predicted the survival > or =14 days in terminal cancer patients, and were superior to doctor's estimates.

Association between Coffee Consumption and Renal Impairment in Korean Women with and without Diabetes: Analysis of the Fourth Korea National Health and Nutrition Examination Survey in 2008 / 가정의학회지

BACKGROUND: Recent studies suggest that coffee consumption has an influence on kidney function. This study investigated the relationship between habitual coffee consumption and renal impairment in Korean women, in consideration of diabetic status. METHODS: This study involved 2,673 women aged 35 to 84 years who had participated in the Fourth Korea National Health and Nutrition Examination Surveys, conducted in 2008. Habitual coffee consumption was classified into three categories: less than 1 cup per day, 1 cup per day, and 2 or more cups per day. Renal function impairment was defined as an estimated glomerular filtration rate less than 60 mL/min/1.73 m2 by the Modification of Diet in Renal Disease equation. RESULTS: The prevalence of diabetes and renal function impairment was higher in women who drank or = 2 cups per day after adjusting for multiple confounding factors. When data were stratified according to the presence of diabetes, coffee consumption > or = 2 cups of coffee per day showed an inverse association with renal function impairment in only diabetic women (OR, 0.14; 95% CI, 0.02 to 0.88; P = 0.04), compared with consumption < 1 cup of coffee per day. CONCLUSION: In a representative sample of Korean women, coffee consumption was significantly associated with a decreased risk of renal impairment especially in middle and elderly-aged diabetic women.

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.

Sleep Quality of Breast Cancer Patients Receiving Chemotherapy in the Outpatients Setting / 가정의학회지

BACKGROUND: Breast cancer is the second most common cancer in Korean women. As survival years increase, health-related quality of life has become an important issue in breast cancer patients. Sleep problems are common and cause significant disruption in quality of life in breast cancer patients. However, cancer-related sleep disturbance has received little attention. The purpose of this study was to determine the prevalence of poor sleep quality and factors which are associated with poor sleep quality in the breast cancer patients receiving chemotherapy in the outpatients setting. METHODS: One hundred and twenty-seven breast cancer patients receiving chemotherapy in a tertiary hospital outpatient were surveyed between February 2009 and July 2009. Among them, 94 (72.8%) patients were finally included in the study. The sleep quality was assessed by the Pittsburg Sleep Quality Index (PSQI). PSQI > 5 indicates clinically significant poor sleep quality. Also the independent factors of sleep quality were assessed using univariable analysis and multiple logistic regression analysis. RESULTS: Seventy-two (76.6%) patients of 94 breast cancer patients undergoing chemotherapy have poor sleep quality. Among of them, 11 (15.3%) patients were actually consulted with doctors. Average PSQI score was 8.8 (+/- 4.1). Anxiety and employment status were associated with poor sleep quality. CONCLUSION: A high proportion of breast cancer patients receiving chemotherapy even in the outpatient settings had poor sleep quality. But only small proportion of them consulted doctor. Poor sleep quality during chemotherapy in breast cancer patient was associated with anxiety and employment status. Considering the high prevalence of sleep problem and inadequate management, more adequate attention is needed to manage the sleep problem of breast cancer patients receiving chemotherapy.

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.

Effect of Cancer Diagnosis on Smoking Behavior / 가정의학회지

BACKGROUND: Smoking is universally recognized as the foremost preventable cause of cancer. And smoking behavior causes many negative effects in cancer patients. Based on the mounting evidence that smoking affects cancer treatment outcomes and survival, we studied whether the cancer diagnosis affects smoking behavior. METHODS: During August 2007, 279 patients who were hospitalized with the diagnosis of cancer were surveyed by a questionnaire and a follow up survey was performed at 3 months and 7 months afterwards. Follow up survey was performed via telephone and finally 246 patients were enrolled. Questions in the survey included smoking history, nicotine dependence, stage of change and the reason for quit smoking or keep smoking. In the follow up survey at 7 month, we asked whether they needed smoking cessation interventions. RESULTS: At the end of the study, the subjects who kept smoking were 27 patients, but the degree of nicotine dependence was decreased compared to the preceding 2 surveys and contemplation as well as preparation stage turned out to be the most prevalent stage of change. The main reasons to keep smoking were behavioral habits and stress. Regardless of their smoking history, almost all cancer patients wanted smoking cessation interventions. CONCLUSION: Smoking is a critical variable that affects cancer treatment and outcome. We surely found there is a smoking subgroup after cancer diagnosis and we should advise them to quit smoking.

Association of Premenstrual Syndrome with Quality of Life in Young Korean Women

BACKGROUND: Menstruation is often regarded as a privilege for women allowing reproductive activity. However, abrupt hormonal fluctuations in menstrual cycle may cause distressing physical and psychological symptoms such as premenstrual syndrome (PMS). PMS is known to have a great impact on daily life activities and social functions, and might result in significantly decreased quality of life (QOL). In this study, we aimed to evaluate a relation between PMS and QOL in young adult Korean women. METHODS: Self-administered questionnaires were distributed to a total of 514 women who were aged 16~35 years and who were employed in an industrial complex located in Gyeonggi-do, Korea. PMS was assessed using diagnostic criteria recommended by the American Psychiatric Association. QOL was assessed using Korean health related Quality of Life Scale. The association between PMS and QOL was examined in 440 women using the two-sample t-test after excluding 74 women who were missing for variables essential for the assessment of PMS and QOL. RESULTS: The prevalence of PMS was 7.3% (32 out of 440 women). Women with PMS had the worse QOL score in almost all domains of QOL except for spiritual health (physical function, psychological health, social function, pain, vitality, role limitation, health status perception, and health status change). CONCLUSION: There was a significant relation between PMS and QOL. The finding of significantly lower QOL in women with PMS suggests that PMS should be evaluated and treated actively in primary care.

PAP Smear-screening in Primary Care Women Physicians and Its Influence on Patients

BACKGROUND: PAP smear has been highly appraised for screening cervical cancer. Generally regarded is that women physicians regularly screen for PAP would promote patients' early detection and treatment rate by their strong recommendation. Hereby we investigated PAP-screening in primary care women physicians, recommending proportion and associated factors. METHODS: Questionnaires were sent to 981 members of the Korean Academy of Family Medicine, Korean Association of Family Practitioners, Korean Medical Women's Association, and Songpa-gu and Kangdong-gu family practitioners. a total of 193 respondents was analyzed. RESULTS: Among the total 55.4% of the respondents screened for PAP smear regularly, either annually (23.9%), or from their treating gynecologists (61.6%) or through routine check-up (81.1%). Common reasons for not screening were lack of time (40.7%) and forgetfulness (38.4%). Recommending proportion for PAP to patients was 49.2%. Reasons for not recommending were lack of equipment, forgetfulness (18.8% each). Confidence of PAP as a screening test was very high (71.5%); significantly related to PAP-screening and to recommending proportion (P=0.033, P=0.005, respectively). Many of the respondents thought physician's own PAP-screening affected its recommendation (45.3%), whereas significant relation to their actual PAP-screening was not found (P=0.845). PAP-screening in physicians showed no significant relationship with recommending proportion (P=0.053). Internal disease history had meaningful relation only with recommending proportion (P=0.001). CONCLUSION: Though physicians show strong confidence in PAP and undergo more than the general public, most do not screen for it regularly and the recommending proportion was low. To improve physician's PAP-screening and recommending proportion, re-education of physicians and provision of proper clinical equipment are required.

Caffeine Consumption and Its Related Symptoms in University Students

BACKGROUND: Although caffeine is commonly consumed substance and not seriously harmful as compared to alcohol and nicotine, Korea is planning to mark on the products which contain caffeine above a definite level with "containing large amounts caffeine". At this point in time, the study concerning caffeine related symptoms is in need. METHODS: After surveying university students by using self-administered questionnaires based on DSM-IV substance related disorder, healthy 810 subjects were assessed for socio-demographic characteristics and features of caffeine intake and its dependence, withdrawal, and intoxication. RESULTS: The mean amount of caffeine consumption in 810 subjects was 120.49 mg (median=93.0) per day. The major features of caffeine dependence were as follows: tolerance (61.1%), withdrawal (46.3%), using more or longer than intended (46.0%), and unsuccessful attempt to cut down or control use (12.6%). The prevalence was increased by daily caffeine consumption. Among 711 subjects who had experienced no caffeine consumption over 24 hours {amount of daily caffeine consumption was 116.0 mg (median=86.5)}, 6.19% showed significant distress in usual activity, and 22.1% used caffeine contents to avoid withdrawal symptoms. The prevalence of caffeine withdrawal based on DSM-IV research criteria was 2.67% and the frequency for symptoms were as follows: fatigue (37.7%), drowsiness (17.6%), headache (14.5%), an anxiety (8.3%). In addition, the prevalence of caffeine intoxication was 2.1% and the frequency for symptoms were as follows: insomnia (41.9%), diuresis (35.8%), tachycardia (26.7%), and gastrointestinal disturbance (23.3%). CONCLUSION: The unwanted symptoms related to caffeine withdrawal or intoxication were common in students using caffeine. Therefore, major features of caffeine-related symptoms should be considered in primary care practice.

Maxillary Sinus Mucocele as a Late Complication in a Patient Underwent Lefort I Procedure

PURPOSE: The authors report unusual one case of a patient presenting with maxillary sinus mucocele who had underwent Lefort I procedure 7 years ago. METHODS: Case report and literature review RESULTS: A 25 year old man came to us with fullness, pain and nasal obstruction on his left cheek area. He had a history of multiple operations due to cleft lip and palate since birth. Two jaw surgery was performed for correcting class III malocclusion 7 years ago. Computed tomography showed haziness, and fluid filled cystic mass on left maxillary sinus. Nasoendoscopy revealed the bulging of inferior turbinate and mucosa coincided in medial wall of maxillary sinus. Antrostomy with Caldwell-Luc approach was performed. Mucin contaning brownish exudate was leaked out. Severe inflammation of maxillary inner wall and exposure of 2 screws fixed previously were noticed. The curettage and marsupialization were accomplished. The symptoms of patient were improved after that procedure. CONCLUSION: Maxillary sinus mucocele is related with Lefort I procedure and it may occur even long after that procedure.

Family Physician's Knowledge of and Attitude towards Spouse Abuse in Korea

BACKGROUND: The primary physician may be the first or the only professional who may come in contact with victims of spouse abuse. But little is known about family physician's knowledge of and attitude towards spouse abuse in Korea. Therefore, this study was conducted. METHODS: We selected 191 doctors from the participants of the 2003 annual meeting of the Korean Academy of Family Medicine (KAFM). We distributed a 5 paged questionnaire them to fillout and analyzed 125 cases among them. The questionnaire included social demographic characteristics, individual knowledge of and attitudes toword spouse abuse, individual practice experience, education and training experience, and others. RESULTS: We found a significant relationship between doctor's knowledge of spouse abuse and intervention after coming in contact with the victim. Also, this study showed that 31.8% of doctors intervened and traced the spouse abuse cases actively after physical treatment of victims, but none of the cases were reported to the police. Among the total 64.7% of the doctors explained that they did not want to intervene because they were afraid of getting involved in a legal situation. Some of the doctors who had prior educational experience concerning spouse abuse showed very significant high rate of actual intervention (P=0.0112). CONCLUSION: The more educational experience on spouse violence the doctors had, the more active intervention they showed. Therefore, we need to intensify the practical educational program along with the training medical program targeting medical practitioners. Of course we need to reguest sacrifice from doctors based on moral principles, but we also need systemic aid and reform to legal system to minimize burden to doctors.

Decisional Conflict about Hormone Replacement Therapy in Postmenopausal Women and Its Related Factors

BACKGROUND: Since the Women's Health Initiative (WHI) study indicated that the significant risks are associated with hormone replacement therapy (HRT), it has been highly expected that postmenopausal women have decisional conflict about HRT. We investigated how much decisional conflict women have in taking HRT and what factors were associated with this conflict. METHODS: A total of 312 postmenopausal women, who had been on HRT or just began, were surveyed from May 10 to June 27, 2005. The subjects were asked by questionnaire that included demographic characteristics and factors related to decisional conflict. Decisional conflict was assessed using the Decisional Conflict Scale (DCS) composed of 16 items. RESULTS: The mean score of DCS was 2.61, which was severe and lack of support from friends and relatives was the most common major conflicting factor. Forty-five percent of the participants started HRT by doctor's recommendation, but had a higher decisional conflict compared to those who started on their own or by encouragement from family and friends. Women who were exposed to mass-media or who had discontinued HRT previously had a lower conflict. Higher the educational level and longer the duration of HRT before stopping lowered decisional conflict. DCS was not significantly influenced by age, income, menopausal symptoms, duration of HRT and the history of hysterectomy. CONCLUSION: Postmenopausal women when making a decision to begin HRT had high conflict. The factors related to conflict were educational level, exposure to mass-media, and motivation to begin therapy. Therefore, adequate and continued counseling with doctors may reduce women's decisional conflict about HRT.

Evaluation of Scientific Evidence for Health Screening Tests Provided by Some Hospitals in Korea

BACKGROUND: Hospitals provide programs for routine screening health examination to meet the needs of people who take keen interest in the prevention of cancer and chronic diseases. But current programs do not reflect individual characteristics such as age, sex, occupation, and risk factors. Expensive diagnostic tests not based on evidence raise a continued issue of controversy. We evaluated on the scientific evidence of screening tests in these programs. METHODS: Internet home pages were searched for screening test provided by 6 major hospitals and by National Health Insurance Corporation. Screening tests were arranged by target diseases which were chosen by the authors. We reviewed the guidelines of several organizations and compared the scientific evidence of each test by the recommended guidelines. RESULTS: Excessive investigation, such as tumor markers, abdominal ultrasonography, anti-HCV Ab, and VDRL were routinely administered against recommended guidelines. Screening tests lacking sufficient evidence for recommendation were included. Furthermore, selection of the screening tests options and time interval was based on the clients' economic state and non-expert preference. CONCLUSION: Screening tests were uniformly administered in excess with insufficient evidence. Tailored screening program should be administered considering individual characteristics and risk factors.

Home-based Hospice-palliative Care Service Administered by University-based Family Practice

BACKGROUND: Systematic care is not well provided in patients with terminal cancer and their families in Korea. Unnecessary hospitalization, multiple emergency room visits for controlling acute symptoms and the use of unqualified alternative care services are typical health care utilization patterns in such patients. We operated home-based hospice-palliative care services to help these patients and their families at a university-based family practice setting. Our experience is presented for the development of care model of hospice-palliative care services. METHODS: We investigated the demographic characteristics, the clinical findings and the utilization of medical care services of 72 terminally ill cancer patients before and after enrollment to hospice-palliative care unit from April 25, 2003 to April 21, 2005. RESULTS: The frequency of emergency room visits and the number of hospitalizations were decreased by Wicoxon Signed Ranks Test after the enrollment to home-based hospice-palliative care service unit. The duration of emergency room visits decreased from 7.7 hours to 0.3 hours and the duration of hospitalization decreased from 6.5 days to 0.0 days in median. The cost per emergency room visits decreased from 268,801 won to 153,816 won and the cost per hospitalization decreased from 285,491 won to 106,294 won in median. CONCLUSION: Home-based hospice-palliative care services can be an efficient and effective model for the care of terminally ill cancer patients at a low cost.

The Effects of Depressive Symptoms to Metabolic and Glycemic Control among Type 2 Diabetes Patients

BACKGROUND: Depression is common among type 2 diabetic patients. To determine the relationship between depressive symptoms and metabolic control, we evaluated the risk factors that are related to metabolic control in diabetic patients. METHODS: This study was performed among 356 type 2 diabetic outpatients, who visited the Department of Family Medicine and Endocrinology, Samsung Medical Center, from November 2003 to January 2004. The data were collected through questionnaire about sociodemographic features diabetes-related factors and health behaviors. Beck Depression Inventory (BDI) was administered to measure depressive symptoms. The medical records were reviewed to confirm metabolic controls including HbA1c, lipids, blood pressure, body mass index (BMI), past medical history, and prescriptions. RESULTS: The prevalence of depressive symptoms (BDI> or =11) was 35.4%, including severe symptoms (BDI> or =21) 6.8%. There were significant graded relationships between greater depressive symptoms and higher serum level of HbA1c (P=0.000) and LDL-cholesterol (P=0.046). In binary logistic regression analysis, low level of exercise (OR=1.97; 95% CI=1.18~3.28), lack of exercise (OR= 2.94; 95% CI=1.28~6.77), poor LDL-cholesterol control (OR=1.94; 95% CI=1.19~3.18), and depressed group (OR=2.20; 95% CI=1.35~3.60) were significantly associated with poor glycemic control. CONCLUSION: There is a significant association between depressive symptoms and glycemic control of type 2 diabetes. Therefore, family physicians who provide continuous and comprehensive primary care should be more concerned for depressive symptoms in type 2 diabetes patients.