Prevalence and Characteristics of Musculoskeletal Pain in Korean Farmers

OBJECTIVE: To investigate the prevalence and characteristics of musculoskeletal pain (MSK) pain in Korean farmers using initial survey data of Farmers' Cohort for Agricultural Work-Related MSK pain (FARM) study. METHODS: Farmers (534 females and 479 males; mean age 57.2±7.5 years) who owned or rented a farm and belonged to an agricultural cooperative unit were recruited. Presence of pain for each body part (neck, shoulder, arm/elbow, wrist/hand/finger, low back, leg/foot), and characteristics of MSK pain (prevalence, location, duration, severity, and frequency) during the last year was assessed. Additionally, demographic data such as farming duration, history of prior injury, and workload (low, moderate, somewhat hard, or hard) were collected using structured questionnaires. RESULTS: Almost all subjects (n=925; 91.3%) complained of pain in more than one body part. The frequency order was low back (63.8%), leg/foot (43.3%), shoulder (42.9%), wrist/hand/finger (26.6%), arm/elbow (25.3%), and neck (21.8%). Low back pain was more frequent in those with over 30 years of farming experience (odds ratio [OR], 1.40; 95% confidence interval, 1.08-1.81). MSK pain was related to history of prior injury (OR, 2.18-5.24; p<0.05) in all body parts except for leg/foot, and very hard workload was associated with low back, leg/foot, neck, shoulder, and wrist/hand/finger pain (OR, 2.88-10.83; p<0.05). CONCLUSION: Most Korean farmers experience MSK pain; furthermore, there is a significant association between pain, history of prior injury, and workload, suggestive of the necessity of coping and preventive strategies to reduce injury or workload.

Health-Promotion and Disease-Prevention Behaviors of Primary-Care Practitioners / 가정의학회지

BACKGROUND: In the 1990s the primary focus of medicine was shifted to disease prevention. Accordingly, it became the responsibility of primary-care physicians to educate and counsel the general population not only on disease prevention specifically but health promotion generally as well. Moreover, it was, and is still today, considered important that physicians provide positive examples of health-promotion behaviors to patients. The purpose of this study was to investigate physicians' health-promotion behaviors and to identify the factors that influence them. METHODS: We conducted a postal and e-mail survey of the 371 members of the Physician Association of Cheonan City between May 16th and June 25th, 2011. The questionnaire consisted of 18 items, including questions relating to sociodemographic factors, screening tests for adult diseases and cancer, and health habits. RESULTS: There were 127 respondents. The gender breakdown was 112 men (88.2%) and 15 women (11.8%), and the mean age was 47.8 years. Fifty-nine (46.4%) were family physicians or interns, and 68 (53.6%) were surgeons. Twenty-six percent (26%) were smokers, and 74.8% were drinkers; 53.5% did exercise; 37% had chronic diseases; 44.9% took periodic cancer screening tests, and 72.4% took periodic screening tests for adult diseases. CONCLUSION: It was found that general characteristics and other health-promotion behaviors of physicians do not affect physicians' practice of undergoing periodic health examination.

Prevalence of Sleep Disorder and Associated Factors in Family Practice / 가정의학회지

BACKGROUND: Sleep is an essential restorative physiologic phenomenon. Impaired sleep results in significant negative effect to the health. Symptoms like sleep initiation difficulty, frequent awakening, severe snoring have related to poor sleep quality. We studied frequency and compared the characteristics of common sleep disorders at family practice. METHODS: We surveyed patients over 18 years of age and their guardians who visited 16 familial practices for 6 days. We investigated sleep characteristics, frequency of sleep disorder and associated factors by questionnaires and analyzed by frequency analysis, Spearman's correlation coefficient, multiple logistic regression. RESULTS: We enrolled 1,117 participants. Older participants were more likely to report early sleep onset and off time, short sleep duration. Mean number of awakening during a typical night is 1.69. Female complained difficulties in initiation and maintenance of sleep more than male. A total of 32.5% had these insomnia symptoms and related to hypertension, stroke, stress, arthralgia, depression, urological disorder. 31.1% had excessive daytime sleepiness, related to stress, arthralgia, depression. Loud snoring and gasp for breath showed positive correlation between male, high BMI. Disrupted sleep over 3 times was related to old age, female, diabetes, hypertension, stroke, stress, arthralgia, depression. Restless leg syndrome were high in elderly, high BMI, stress, arthralgia and depression. CONCLUSION: About one in three who visit in primary medical practice have sleep disorder symptoms like insomnia, daytime fatigue, snoring. 3% of them have gasp for breath, 8% have restless leg syndrome.

Referral Pattern of Family Practitioners : Cheonan Practice-Based Research Network Study

BACKGROUND: Consultation and referral are important characteristics of modern medicine which has become more segmented and more specialized. In particular, they give essential value to family practitioners to coordinate patients accordingly for proper care. This study analyzed the referred patients in family practices under Cheonan practice based-research network (CPBRN). METHODS: The data was collected via questionnaire in ten family clinics under CPBRN system during the four weeks from June 15, 2006 to July 12, 2006. RESULTS: The total number of referred cases was 103 (0.7%) out of a total of 14,466 office visits. Among the total, 68.9% of referred cases was physician-drived and 31.1% was patient-requested. The reason for referral were 'to get a second opinion of specialist' (34), 'high severity' (20), 'lack of examination tool' (18), 'lack of skill' (10) and 'no response to treatment' (2) in physician-drived cases, whereas in patient-requested cases, they were 'request for advanced hospital' (26) and 'want to meet specialist' (2). The patients were referred to tertiary hospital in 66.7%, secondary hospital in 15.9%, and other specialists of primary setting in 10.1%. Overall, 66.7% of the referred hospital was located in the city area. The main health problems of referred patients was divided into 'gastrointestinal' (17.5%), 'musculoskeletal' (13.6%), 'dermatology' (10.7%) and so on. The speciality consulting physicians were 'internal medicine' (34%), 'pediatrics' (13.6%), and 'orthopedic surgery' (10.7%) specialists. CONCLUSION: The referral rate of family practice in Korea was 0.7%. The main reason for referral was 'to get a secondary opinion of a specialist'. The most common referral problem was 'gastrointestinal'. 'Internal medicine' was the most frequently consulted specialty.

Referral Pattern of Family Practitioners : Cheonan Practice-Based Research Network Study

BACKGROUND: Consultation and referral are important characteristics of modern medicine which has become more segmented and more specialized. In particular, they give essential value to family practitioners to coordinate patients accordingly for proper care. This study analyzed the referred patients in family practices under Cheonan practice based-research network (CPBRN). METHODS: The data was collected via questionnaire in ten family clinics under CPBRN system during the four weeks from June 15, 2006 to July 12, 2006. RESULTS: The total number of referred cases was 103 (0.7%) out of a total of 14,466 office visits. Among the total, 68.9% of referred cases was physician-drived and 31.1% was patient-requested. The reason for referral were 'to get a second opinion of specialist' (34), 'high severity' (20), 'lack of examination tool' (18), 'lack of skill' (10) and 'no response to treatment' (2) in physician-drived cases, whereas in patient-requested cases, they were 'request for advanced hospital' (26) and 'want to meet specialist' (2). The patients were referred to tertiary hospital in 66.7%, secondary hospital in 15.9%, and other specialists of primary setting in 10.1%. Overall, 66.7% of the referred hospital was located in the city area. The main health problems of referred patients was divided into 'gastrointestinal' (17.5%), 'musculoskeletal' (13.6%), 'dermatology' (10.7%) and so on. The speciality consulting physicians were 'internal medicine' (34%), 'pediatrics' (13.6%), and 'orthopedic surgery' (10.7%) specialists. CONCLUSION: The referral rate of family practice in Korea was 0.7%. The main reason for referral was 'to get a secondary opinion of a specialist'. The most common referral problem was 'gastrointestinal'. 'Internal medicine' was the most frequently consulted specialty.

Interdisciplinary treatment of Class III malocclusion using mini-implant: problem-oriented orthodontic treatment / 대한치과교정학회지

Interdisciplinary treatment of Class III malocclusion with congenital missing of unilateral maxillary canine and anterior crossbite is discussed focusing on a problem-oriented treatment planning, treatment progress, and treatment result. Maxillary mini-implant provided anchorage for distalization of the maxillary right porsterior dentition. Mandibular mini-implants were used to distalize the whole mandibular dentition. Total treatment time was 17 months to achieve a successful treatment goal. Stable occlusion was maintained after 12 months of retention.

Self-care for Diabetic Patients in Primary Care

BACKGROUND: Diabetes mellitus is one of the most common chronic diseases which primary care family physician encounters. This study was performed to describe the medical care for patients with diabetes based on the Cheonan Practice-Based Research Network. METHODS: From May 2005 to July 2005, 193 patients with diabetes were assessed among the patients visiting seven family medicine clinics in Cheonan. The data were collected through a questionnaire about patient's socioeconomic characteristics, the details of medical care including screening practices of diabetic complications, self-monitoring of blood glucose and exercise. RESULTS: Among the patients with diabetes, 25.4% reported no exercise and another 29.6% reported regular exercise of more than 4 times a week. The less educated and the more elderly patients reported less exercise. Only 37.3% of patients monitored their blood glucose at home. The more educated, the more likely the patients monitored their blood glucose. Only 18.1% of patients reported having an annual 24-hour urine protein examination. The more educated and the more income they had, the more annual 24-hour urine protein examination was done. Only 32.6% of patients reported having an annual ophthalmologic examination, but there was no associated factors with having an annual ophthalmologic examination. CONCLUSION: These data indicate that the medical care for diabetic patients, including exercise, self-monitoring of blood glucose, screening of complications, may not be optimal for preventing diabetes complications, and was influenced by demographic characteristics such as age and education level. It is necessary for health care team to provide systematic education for diabetes and ongoing close monitoring of self care practices.

Initial Experience with Large Jostent in the Treatment of Pulmonary Artery Stenosis with Congenital Heart Disease: Comparison of Clinical Results with Palmaz Stent

PURPOSE: The aim of this study was to assess the efficacy of Jostent (peripheral, large; JS) in the treatment of pulmonary artery stenosis with congenital heart disease (CHD) and report our initial experience with JS. METHODS: Seventy four large-sized stents in 70 patients with CHD were implanted from June 1996 to July 2004. Thirty eight Palmaz stent (large; PS) in 36 patients (PS group) and 36 JS in 34 patients (JS group) were used. Immediate and follow-up results were compared. RESULTS: All stent placements were successful except 1 procedure with long PS (P308) due to acute angle of passage to the lesion. In both groups, stenosis diameters increased (PS group; 4.1+/-1.3 to 10.3+/-2.0 mm, JS group; 4.2+/-1.9 to 9.9+/-2.9 mm), pressure gradients decreased (PS group; 23.7+/-13.9 to 2.6+/-4.5 mmHg, JS group; 23.8+/-20.8 to 2.6+/-4.5 mmHg) and perfusions to the affected lung improved significantly (PS group; 20.2+/-9.7 to 38.5+/-9.7%, JS group; 16.6+/-8.5 to 36.4+/-10.2%). Redilatation of the implanted stents were feasible and effective except 3 stents in PS group and 1 stent in JS group. There was no significant stenosis or thrombus formation caused by the protruded stents, but failure to get access into the stent for redilatation due to protruded stent orifice was occurred in 1 patient. No significant stent recoil or distortion was observed. CONCLUSION: The efficacy and safety of JS in the treatment of pulmonary artery stenosis with CHD is comparable with those of PS. The smooth tip design and flexibility of JS enhances feasibility of the procedure.

Immediate Improvement of Chaotic Atrial Tachycardia after Ligation of Patent Ductus Arteriosus

Chaotic or multifocal atrial tachycardia is very rare abnormality in cardiac rhythm for pediatric patients. A newborn female baby was brought to the hospital for tachycardia and showed heart failure symptoms such as poor oral intake, tachypnea, and chest wall retraction. Electrocardiogram and 24-hour holter monitoring revealed chaotic atrial tachycardia and echocardiogram revealed large patent ductus arteriosus and small secundum atrial septal defect associated with pulmonary hypertension. Medical treatment had been unsuccessful and large patent ductus arteriosus was ligated with subsequent improvement of chaotic atrial tachycardia.

The Clinical Characteristics and the Usefulness of the Ocular Compression Test in Syncope of Children Test / 대한소아신경학회지

PURPOSE:Nevertheless that syncope of children is a relatively common disease which occurs during adolescence, diagnostic yield rate of syncope of children is far below than that of adults. Some reports indicate that the diagnostic rate could be increased up to 70% by using the head-up tilt test(HUT). However, HUT is relatively invasive and harmful to be used for children. The purpose of this study is to analyze the etiology of syncope in children and investigate whether the ocular compression test(OCT), which is not invasive and relatively safe, could substitute the HUT for vasovagal syncope. METHODS:Children who visited NHIC Ilsan Hospital for syncope from January 2004 to July 2006 were retrospectively analyzed. We examined the medical records of the patients and performed the basic diagnostic tests including EEG as well as HUT. OCT was performed during EEG to find check out the presence and the duration of asystole. We classified the patients into 3 groups according to the etiology, such as neurally-mediated(vasovagal), cardiovascular and non- cardiovascular syncopes and comparatively analyzed the clinical characteristics of each group. In addition, in case the asystole duration of OCT is prolonged, we performed cross-table analysis to know whether it matches the positive result of HUT in order to confirm the availability of OCT. RESULTS:55 patients were included in the study and the rate of males to female was 1: 2.4. The causes of syncope were identified in 43 cases(78.2%) and half of which was neurally- mediated type. In detail, 24(43.6%) patients were neurally-mediated, 5(9.1%) were cardiovascular, 14(25.5%) non-cardiovascular and 12(21.8%) unidentified. There was no significant difference regarding the clinical characteristics among diagnostic groups. However, the neurally- mediated syncope group showed statistically significant difference in the duration of asystole. Therefore, when we make a point over 3 seconds of asystole in OCT, it will produce the most similar result with the HUT in neurally-mediated(vasovagal) syncope(specificity 94.4%). CONCLUSION:Generally, syncope in children peaks during adolescence and it is more common among girls than boys. The etiologic diagnostic rate was 78.2% and the neurally-mediated syncope was the most common type. The cardiovascular syncope of children was much less in contrast to that of adults. There was no statistically significant difference in the clinical characteristics among the three diagnostic groups. It is concluded that OCT, a non-invasive and relatively safe test, could substitute the invasive, and harmful HUT for vasovagal syncope of children.

A Case of Spontaneous Intracranial Hypotension presented as Bilateral Abducens Nerve Palsy without Postural Headache

No abstract available.

Loss of Striatal Dopamine Transporter Binding in Patients and a Family Member with Familial Parkinsonism with Parkin Gene Mutation

No abstract available.

Family Physician as a Counsellor Focused on Sexual and Family Problems: Cheonan Practice-Based Research Network Study

BACKGROUND: The primary concern of a family physician is the healthcare of patients and their families, with the patient's disease itself being secondary. Family physicians should make efforts to discuss personal issues with their patients. This study examined how many patients were counseled about their private problems, especially family or sexual issues in the private clinics of Cheonan. METHODS: The subjects were the patients who visited a practice-based network from April to June in 2003. The data were collected through simple questionnaire about sociodemographic features of patients and their family and sexual problems. RESULTS: Eighty eight patients were studied for a total of 107 cases that consisted of 67 cases of family problems (62%) and 40 cases of sexual matters (38%). The common issues about family problems were `the partners' (23 cases, 21%) and `the patients` children' (29 cases, 27 %). The most frequent sexual problems were 'sexually transmitted diseases' (13 cases, 32.5%), `impotence' (7 cases, 17.5%), 'loss of libido, and unsatisfaction' (6 cases, 15.0%). Most physicians were involved in family and sexual issues with medications, and simple counseling with reassurance. Simple counseling was given for 14 cases (21.0%) for family issues and 18 cases (44.0%) for sexual issues. The patients were treated with medications in 47 cases (70.0%) for sexual and 15 cases (38.0%) for family problems. CONCLUSION: The most common issue for family problems was their partners and for sexual problems was 'sexually transmitted diseases'. Most family physicians were involved with both simple counseling and medications.

Enhancement of radiosensitivity by combined ceramide and dimethylsphingosine treatment in lung cancer cells

Ceramide generated from sphingomyelin in response to ionizing radiation has been implicated as a second messenger to induce cellular proapoptotic signals. Both ceramide and its metabolic inhibitor, N, N-dimethyl-D-erythro-sphingosine (DMS), might lead to sustained ceramide accumulation in cells more efficiently, thereby sensitizing them to gamma-radiation-induced cell death. To delineate this problem, the clonogenic survival of Lewis lung carcinoma (LLC) cells was evaluated following exposure to radiation together with or without C2-ceramide, DMS, or both. The treatment of ceramide/DMS synergistically decreased the survival of the irradiated cells compared with treatment with ceramide or DMS alone. Ceramide/DMS-treated cells displayed several apoptotic features after gamma-irradiation, including increased sub G1 population, TUNEL-positive fraction, and poly-(ADP-ribose) polymerase (PARP) cleavage. We also observed ceramide/ DMS induced disruption of mitochondrial membrane potential (MMP) and activation of caspase- 9 and -3 in a radiation-dose-dependent manner. Furthermore, pretreatment of LLC cells with ceramide/DMS not only increased the protein expression level of Bax, but also decreased Bcl-2 after gamma-irradiation. Taken together, the present study indicates that the radiosensitizing activity of ceramide/DMS on LLC cells most likely reflects the dominance of pro-apoptotic signals related to the mitochondria-dependent pathway.

Two Cases of Pancreatitis in Children with Hemolytic Uremic Syndrome

An epidemic outbreak of food poisoning due to enterohemorrhagic Escherichia coli(EHEC) occurred throughout Korea from May to September, 2003. Patients infected via contaminated school lunch foods were found mainly in Seoul and Gyeonggi province. As a result of this food poisoning, 36 patients were diagnosed as hemolytic uremic syndrome(HUS) up to mid- September, 2003 and five of them visited our hospital. Before the outbreak this year, we had experienced only 23 cases of HUS, including diarrhea associated (D+) and atypical (D-) forms, for the last 14 years, and there had been no case with pancreatic enzyme elevation. Unlike the past HUS cases, those of this year presented with severe abdominal pain and spiking elevation of pancreatic enzyme levels in 2 cases. We report 2 cases of transient pancreatitis combined with HUS in children during the epidemic outbreak in 2003 with a brief review of related literatures.

Two Cases of Pancreatitis in Children with Hemolytic Uremic Syndrome

An epidemic outbreak of food poisoning due to enterohemorrhagic Escherichia coli(EHEC) occurred throughout Korea from May to September, 2003. Patients infected via contaminated school lunch foods were found mainly in Seoul and Gyeonggi province. As a result of this food poisoning, 36 patients were diagnosed as hemolytic uremic syndrome(HUS) up to mid- September, 2003 and five of them visited our hospital. Before the outbreak this year, we had experienced only 23 cases of HUS, including diarrhea associated (D+) and atypical (D-) forms, for the last 14 years, and there had been no case with pancreatic enzyme elevation. Unlike the past HUS cases, those of this year presented with severe abdominal pain and spiking elevation of pancreatic enzyme levels in 2 cases. We report 2 cases of transient pancreatitis combined with HUS in children during the epidemic outbreak in 2003 with a brief review of related literatures.

A Case of Localized Follicular Hamartoma with Pili Multigemini / 대한피부과학회지

Follicular hamartoma is a rare, benign adnexal tumor with varieties of clinical diversity. But, Histological feature is characterized by a proliferation of immature hair follicle in the dermis with multifocal islands and thickened perifollicular sheath. Pili multigemini is also a rare, developmental anomaly of hair growth with multiple hairs from two or more matrices and papillae in a single pilosebaceous unit. Its prevalence and pathogenesis are unknown. We describe herein a rare case of localized follicular hamartoma with pili multigemini suggesting the possibility of association on pathogenesis between them.

A Case of Clear Cell Syringoma / 대한피부과학회지

Ansan, KoreaClear cell syringoma is a rare variant type of syringoma. It has two noteworthy features: histologic preponderance of clear cells and frequent coexistence with diabetes mellitus. There is no difference between clear cell syringoma and typical syringoma with respect to age, sex, and clinical features. We report a 48-year-old woman who presented with clear cell syringoma concomitant with diabetes mellitus. Histopathologic findings showed numerous various-sized, well-defined tumor cell nests composed largely of clear cells.

Clinical Analysis on the Therapeutic Efficacy of 20% Aluminum Chloride Solution in Primary Hyperhidrosis / 대한피부과학회지

BACKGROUND: A large number of therapeutic options are used for the treatment of primary hyperhidrosis. These include application of topical agents, iontophoresis, sympathectomy and recently botulium toxin injection. But, It should be desirable as first treatment to choice a simple, safe, and less expensive method that also proved to be effective. OBJECTIVE: The aim of this study was to clinically prove 20% aluminum chloride solution to deserve to be the initial choice of treatment modality for primary hyperhidrosis. METHODS: A total of 22 patients(mean age 24.1, male 3, female 19) with clinical diagnosis of primary hyperhidrosis were treated by 20% aluminum chloride solution. Until the desired degree of dryness was obtained, they were educated to apply everyday and thereafter, the agent would be applided as often as is necessary. By regular meeting including telephone interview, we analyzed patient satisfaction and other clinical parameters such as application time at onset of desired dryness, applicaton interval to maintain the relief of symptoms, and side effects during various follow-up periods. RESULT: Aluminum chloride solution was effective not only in axillary hyperhidrosis but also in palmoplantar hyperhidrosis(patient satisfaction, axillae:excellent, 12 of 16(75%); good, 4(25%), palms or soles:excellent, 3 of 6(50%); good, 2(33%)). Applicaton interval to maintain the relief of symptoms ranged from 5 to 60 days with mean 10 days. There were no significant complications(mild irritation 50%). CONCLUSION: Aluminum chloride solwtion is the simplest, safest and least expensive method for initial treatment of primary hyperhidrosis. And its effect could be maintainable for a relatively long-term period.

A Case of Darier's disease with preceding lesions of palm and sole / 대한피부과학회지

Darier's disease is an autosomal dominant disorder with altered keratinization of the epidermis, but many cases are sporadic and presumably represent new mutation. Multiple discrete, keratotic, asymptomatic or mild pruritic papules are present at not only the seborrheic areas but also oral mucosa, palm and sole. The histologic characteristic changes in Darier's disease are formation of corps ronds and grains, suprabasal acantholysis and villi. We experienced a case of Darier's disease with preceding lesions of palm and sole, so reported this case with literature review.