Current Status of Korean Alcohol Drinking in Accordance with the Korean Alcohol Guidelines for Moderate Drinking Based on Facial Flushing / 가정의학회지

Since each person has a different ability to break down alcohol, it is inappropriate to apply a uniform standard to everyone when evaluating drinking status. In Korea, there has been a guideline for moderate drinking based not only on sex and age but Koreans’ alcohol metabolism capabilities that can be predicted by presence of facial flushing response. So far, there have been no studies that have investigated drinking habits of Koreans in accordance with the guideline. This study tried to identify the current drinking status of Koreans according to the guideline. As a result, it was confirmed that about 1/3 of the total population was accompanied by facial flushing when drinking alcohol, and it was found that different drinking habits were shown even in the same age and gender groups according to the presence of facial flushing. It is difficult to accurately evaluate drinking habits because facial flushing has not yet been investigated in some large data or various medical examinations. In the future, it is necessary to ensure that the presence of facial flushing can be confirmed at the medical treatment or examination site so that accurate drinking habit evaluation and prevention and resolution of drinking problems can be achieved.

Impact of a Doctor's Verbal Recommendation on Pneumococcal 13-Valent Conjugate Vaccine among High-Risk Patients for Pneumonia in a Primary Care Setting

Background@#Streptococcus pneumoniae is the main bacterial pathogen of community-acquired pneumonia in Korea. This study aimed to enhance the vaccination rate by evaluating the effectiveness of current methods of recommendation. @*Methods@#A retrospective analysis of the medical records of 143 patients with high risk of pneumonia among first-visit outpatients was conducted. High-risk patients for pneumonia are defined by the U.S. Advisory Committee on Immunization Practices. One hundred and twenty-seven patients, excluding 16 with pneumococcal 13-valent conjugate vaccination (PCV13) history prior to the first visit, were divided into three groups according to the method of vaccination recommendation: banner (B) group; banner+brochure (B+Br) group; banner+brochure+doctor's recommendation (B+Br+DR) group. The vaccination rates among patients in each group were compared. @*Results@#Patients with high risk of pneumonia showed 11.2% rate for PCV13 vaccination upon their first visit;however, this rate increased to 39.2% following counseling (P<0.001). Variation among the three groups was as follows: 9.0% in the B group, 20.0% in the B+Br group, and 75.0% in the B+Br+DR group (P<0.001). After adjusting for age, sex, high-risk group, occupation, and residence, a regression analysis was carried out. The odds ratio for the PCV13 vaccination rate compared to the B group was 2.49 (95% confidence interval [CI], 0.55-11.34) for the B+Br group and 43.72 (95% CI, 11.52-165.96) for the B+Br+DR group. @*Conclusions@#Among the available methods, we are thought to be more effective to add doctor's verbal recommendation in a clinical setting.

Validation of the Simplified Palliative Prognostic Index to Predict Survival for Advanced Cancer Patients in Home Hospice Setting / 가정의학회지

Background@#The simplified Palliative Prognostic Index (sPPI) substitutes a single item from the Communication Capacity Scale (CCS) for the delirium item of the original PPI. This study aimed to examine the validity of the sPPI for patients with advanced cancer in a home-based hospice care setting. @*Methods@#This study included 75 patients with advanced cancer who received home-based hospice care. We used medical records maintained by professional hospice nurses who had visited the patients in their homes. Based on their sPPI score, patients were divided into three groups—A (<4), B (≥4 and <6), and C (≥6)—to compare survival. Further, we investigated the sPPI’s accuracy using the area under the receiver operating characteristic curve (AUC) and sensitivity and specificity for 3- and 6-week survival. We used three sPPIs including different substitutions for the delirium item (two methods using the CCS and one using the Korean Nursing Delirium Screening Scale). @*Results@#The median survival was 60–61 days for group A, 27–30 days for group B, and 12–16 days for group C. The difference in survival was significant (P<0.05). The AUC was 0.814–0.867 for 3-week survival and 0.736–0.779 for 6-week survival. For 3- and 6-week survival, prognostic prediction showed sensitivities of 76.2%–90.9% and 76.3%–86.8%, and specificities of 64.2%–88.7% and 51.4%–70.3%, respectively. @*Conclusion@#The sPPI, which is measured by professional hospice nurses, has acceptable validity to predict survival for patients with advanced cancer in a home hospice setting in South Korea.

Validation of the Simplified Palliative Prognostic Index to Predict Survival for Advanced Cancer Patients in Home Hospice Setting / 가정의학회지

Background@#The simplified Palliative Prognostic Index (sPPI) substitutes a single item from the Communication Capacity Scale (CCS) for the delirium item of the original PPI. This study aimed to examine the validity of the sPPI for patients with advanced cancer in a home-based hospice care setting. @*Methods@#This study included 75 patients with advanced cancer who received home-based hospice care. We used medical records maintained by professional hospice nurses who had visited the patients in their homes. Based on their sPPI score, patients were divided into three groups—A (<4), B (≥4 and <6), and C (≥6)—to compare survival. Further, we investigated the sPPI’s accuracy using the area under the receiver operating characteristic curve (AUC) and sensitivity and specificity for 3- and 6-week survival. We used three sPPIs including different substitutions for the delirium item (two methods using the CCS and one using the Korean Nursing Delirium Screening Scale). @*Results@#The median survival was 60–61 days for group A, 27–30 days for group B, and 12–16 days for group C. The difference in survival was significant (P<0.05). The AUC was 0.814–0.867 for 3-week survival and 0.736–0.779 for 6-week survival. For 3- and 6-week survival, prognostic prediction showed sensitivities of 76.2%–90.9% and 76.3%–86.8%, and specificities of 64.2%–88.7% and 51.4%–70.3%, respectively. @*Conclusion@#The sPPI, which is measured by professional hospice nurses, has acceptable validity to predict survival for patients with advanced cancer in a home hospice setting in South Korea.

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.

Influence of Facial Flushing on Pre- or Type 2 Diabetes Risk according to Alcohol Consumption in Korean Male / 가정의학회지

Background@#This study aims to examine the association between alcohol consumption and the risk of pre- or type 2 diabetes mellitus (T2DM) by alcohol-induced flushing response in Korean male adults, particularly based on their body mass index (BMI). @*Methods@#This study selected 1,030 (158 non-drinkers, 364 flushers, and 508 non-flushers) male adults who had medical checkups. A logistic regression analysis was used to compare the association between alcohol consumption and the risk of pre- or T2DM. @*Results@#In both the normal-weight group (BMI 4 and ≤8 drinks: 2.64, 1.10–6.36; >8 drinks: 2.42, 1.11–5.27). However, obese non-flushers had only a significant higher risk of pre- or T2DM when consuming more than 8 drinks of alcohol per week than the non-drinkers (2.72, 1.39–5.30) @*Conclusion@#These results suggest that obese flushers have an increased risk of developing pre- or T2DM even with less alcohol consumption.

Relationship between Alcohol Consumption and Ocular Pressure according to Facial Flushing in Korean Men with Obesity / 가정의학회지

BACKGROUND: This study aimed to examine the relationship between alcohol consumption and intraocular pressure (IOP) according to facial flushing in Korean men with obesity. METHODS: The study included 479 Korean men with a body mass index of ≥25 kg/m² (75 non-drinkers, 174 with drinking-related facial flushing, and 230 without facial flushing) who underwent health check-ups between October 1, 2016 and March 31, 2017. Multivariate logistic regression was used to assess the relationship between alcohol consumption and high IOP (≥21 mm Hg). RESULTS: Flushers consuming ≤16 drinks per week had a significantly higher risk of high IOP than non-drinkers, depending on alcohol consumption (≤8 standard drinks: odds ratio [OR], 4.49; 95% confidence interval [CI], 1.05–19.25; >8 but ≤16 standard drinks: OR, 8.14; 95% CI, 1.37–48.45). However, when the consumption was >16 drinks per week, the high IOP risk did not significantly increase (OR, 0.71; 95% CI, 0.05–10.69). In addition, there was no significant relationship between alcohol consumption and high IOP among non-flushers consuming ≤8 drinks per week (OR, 2.07; 95% CI, 0.52–8.19). However, a significantly increased risk of high IOP was observed among non-flushers consuming >8 drinks per week, depending on alcohol consumption (>8 but ≤16 standard drinks: OR, 4.84; 95% CI, 1.14–20.61; >16 standard drinks: OR, 4.08; 95% CI, 1.02–16.26). CONCLUSION: This study suggests that obese men with alcohol flush reactions may have an increased risk of high IOP with the consumption of smaller amounts of alcohol than non-flushers.

Korean Alcohol Guidelines for Moderate Drinking Based on Facial Flushing / 가정의학회지

This study investigated advantages and potential risks associated with drinking alcohol in Koreans based on the alcohol flush reaction. Our investigation reviewed published studies and examined moderate-drinking levels for Koreans based on modified National Institute on Alcohol Abuse and Alcoholism guidelines. Fourteen articles out of a total 198 publications were searched using PubMed, EMBASE, KoreaMed, and RISS (Research Information Sharing Service) databases and selected for review. Individuals without alcohol flush reaction (non-flushers) exhibited lower risks associated with insulin resistance, metabolic syndrome, and hyperhomocysteinemia and their 10-year cardiovascular disease risk when alcohol consumption was ≤8 drinks/wk. Conversely, risks associated with insulin resistance, metabolic syndrome, high blood pressure, prediabetes or type-2 diabetes, and high intraocular pressure and increases in carbohydrate-deficient transferrin, gamma glutamyl transferase, and blood glucose levels were present when >8 drinks were consumed. For individuals with flushing reaction (flushers), advantages were reported in relation to risks of hyperhomocysteinemia when alcohol consumption was ≤4 drinks/wk, whereas consumption of >4 drinks/wk increased the risk of insulin resistance, metabolic syndrome, high blood pressure, pre-diabetes or type-2 diabetes, high-risk colorectal adenoma, and high intraocular pressure and increased carbohydrate-deficient transferrin, gamma glutamyl transferase, and blood glucose levels. The moderate drinking level for Koreans is ≤8 drinks/wk for men aged ≤65 years and ≤4 drinks/wk for men aged over 65. For women, these limits should be half of those for men. Furthermore, individuals with flushing reaction should maintain an alcohol consumption level half of that for non-flushers.