Effects of tibolone on postmenopausal osteoporosis, lipid, mammograph compared with continuous combined hormone replacement therapy

BACKGROUNDS: Hormone replacement therapy is effective for improvement of climacteric symptoms, and prevention of postmenopausal osteoporosis but patient compliance is very low. The aim of the study was to assess the comprarative effects on bone mineral density(BMD), lipid, mammographic finding, biochemical bone markers of tibolone and continuous combined hormone replacement therapy in postemeopusal women. METHODS: Body mass index, BMD in the spine and femur neck. lipid, alkaline phosphatase, serum osteocalcin, urine deoxypyridinolone were measured before and after 1 year therapy in 88 postmenopausal subjects. Of these, 54 women received CEE 0.625 mg and MPA 2.5 mg (CEE/MPA) per oral, 34 tibolone alone for 1 year. RESULTS: Body mass index didn't changed in both groups. Significantly increased mammographic density in CEE/MPA groups(p<0.05). Total cholesterol was decreased in both group, but no significant differences between the different treatment groups. Triglyceride decreased in tibolone group and there are significant difference between the two groups(P<0.01). HDL cholesterol increased in CEE/MPA group(p<0.01) but decreased in tibolone group(p<0.01). There are significant difference in HDL cholesterol response between two groups(p<0.01). LDL cholesterol decreased in CEE/MPA group(p<0.01) and significant difference in LDL cholesterol response between two groups(p<0.05). Total alkaline phosphatase(TALP) and serum osteocalcin decreased in both groups(p<0.01) but no differences between two groups. Urine deoxypyridinoline was not decreased in both groups and no differences between two groups. Spine bone mineral density(BMD) increased in both groups(p=0.0001) but no differences in treatment response between two groups. Femur neck BMD didn't not increased in both groups and no differenced of treatment responses between two groups. CONCLUSION: Tibolone was effective on BMD of lumbar spine as much as CEE/MPA and may be safe in terms of mammographic changes in postmenopausal women.

Factors associated with fetal losses after mid-trimester amniocentesis / 대한산부인과학회잡지

OBJECTIVE: To evaluate factors associated with fetal losses following mid-trimester diagnostic amniocentesis. METHODS: 412 pregnancy outcomes following amniocentesis were analyzed for each variables(maternal age, gestational age, indication for the amniocentesis, placental penetration by aspiration needle, needle touch by the fetus, color of amniotic fluid) with statistical methods(student t-test, chi-square test and multiple logistic regression test). RESULTS: Mean maternal age was 31.8+/-4.9 years, fetal loss rate was increased slightly with the age of the mother. If the indications were abnormally high maternal serum alpha-fetoprotein level, the pregnancy courses after the procedure were worse than other indication groups. In cases of discolored amniotic fluid, the dark brown discoloration made the pregnancy outcome poor. Gestational age at the time of the procedure, penetration of the placenta by the aspirating needle, needle touch during the procedure by the fetus, did not influence the outcomes after the procedure. CONCLUSION: Maternal age, indication as neural tube defect in triple test and dark brown discoloration of amniotic fluid are associated with fetal losses following mid-trimester diagnostic amniocentesis.

Factors related to depression of elderly in a Korean rural community

BACKGROUND: Depression is prevalent and a serious disorder in the elderly that interferes with social and physical function. It is associated with significant morbidity and a high mortality rate from suicide. Depression is highly treatable disease, but it remain largely unrecognized and untreated among the elderly. This study evaluate the factors related to depression of elderly, to be used as basic reference for management program in the community. METHODS: The cross-sectional study evaluates the depression of community-living elderly, aged 60 and older, in a Korean rural community. The subject were selected from a two stage cluster sampling. Questionnaire contained demographics, Geriatric Depression Scale (GDS), Mini-Nutritional Assessment (MNA), Mini-Mental Status Exam-Korean (MMSE-K), IADL, Social support network. T-test and multiple stepwise regression were constructed to explore the factors related to depression. RESULTS: Mean age was 71.22+/-7.1 with 101 male subjects and 200 female subjects. The mean GDS score was 6.9+/-3.7 and 56.5% of subjects were suggested depression (above 5 point on GDS). The mean score from the GDS showed significant differences in terms of following factors: gender, age, education, marital status, income, expenditures, type of residency, cognitive function, presence of disease, number of medications, stress, subjective self perception of health, IADL, nutrition, emotional support, social activity support, instrumental support (p0.05). These variables explained 34.2% of depression. CONCLUSION: Nutritional status, cognitive function, physical state, functional state, social support network demographic characteristics were related to depression in the elderly.

Factors affecting the settlement amount of medical malpractice claims

BACKGROUND: The purpose of this study was to investigate the characteristics of and to analyze the factors re-lated to the cost of the resolution of a medical dispute. METHODS: We have reviewed 2,346 cases reported to the Korean Medical Association(KMA)mutual-aid association from Nov. 1. 1981 to Oct. 31. 1994. RESULTS: The percentage rate of reported cases of were related field as follows .' obstetric gynecology(OBGYN) 31.9%, general practitice 28.1%, general surgery 13.3%, orthopedics 6.9% and internal medicine 6.4% 1,829 cases (80.0%) were settled out of court and without public intervention. 310 cases(13.2%) were settled by the police, the public procurators office or the court. The mean settlement amount per case was 9,340,000 won with annual growth rate 10.8%, and median settlement amount was 5,890,000 won. The mean settlement amount for OBGYN was 930,000 won, surgical group 8,900,000 won, medical group 7,710,000 won, and general practitice 7,490,000 won. The cases of medical dispute according to the types of medical care were : operation 21.1%, injection 18.0%, treat-ment and care 18.0%, delivery 13.0%, artificial abortion 10.3%, Cesarian section 7.2% and anesthesia 2.5%. The mean settlement amount according to the types of medical care were: delivery and Cesarian section 15,190,000 won, operation and anesthesia 9,500,000 won, others 6,610,000 won, and injection and medication 6,230,000 won. The mean settlement amount that was settled out of court without public intervention was 7,940,000 won. The mean settlement with public intervention in the court was 17,290,000 won. The cases of medical dispute according to the patients status were .' death 37.5%, complications 20.8%, disability 12.2% and others 28.9%. The mean settlement amout for death was 16,150,000 won, disability 9,430,000 won, others 4,850,000 won and complications 3,550,000 won. The mean settlement amount where doctors have asserted that the outcome was inevitable or have not agreed that it was their fault was higher than the cost of cases where they had admitted responsibility. The settlement amout where there was a misdiagnosis present had not shown to be higher than when the misdiagnosis was absent. The mean settlement amount for cases where multiple doctors were involved was higher than for cases of a single doctor. The mean settlement amount for disturbing the medical practice and suspension of are high. The mean settlement amount for complications was lower than others, and the mean settlement amount for disability and death presented were high. Concerning the types of care, the mean settlement amount for operation/anesthesia, delivery/ Cesarian sections were higher than for injection/medication. Concerning the type of settlement, the mean settlement amount in the police and public procurators office was higher than in out of court without public intervention. CONCLUSIONS: The mean settlement amount depended on the patient's status, the type of settlement, and the disturbance of medical practice regardless of the doctors misdiagnosis, fault, and standard care. Therefore, a reason-able method of resolution for medical dispute is needed.

Reasons Why Patients and Families Choose Medical Dispute

BACKGROUND: Medical dispute is increasing and its effect on society is serious, but reasonable settlement system is absent. Nevertheless patients and families choose medical dispute. But there is little research on patients and their families who choose to settle by medical dispute. Therefore this study examines the impact of medical malpractice to patients and their families and their reasons for choosing medical dispute after mishap. METHODS: Data were collected from 234 subjects who inquired of Medical Malpractice Family Association about malpractice suit. Questionnaire was composed of demographic characteristics, characteristics of hospital, characteristics of medical malpractice, degree of satisfaction with explanation and attitude of the treating doctor, effect of medical malpractice on patients' life and reasons patients and their families choose to settle by medical dispute. Factor analysis with varimax rotation was carried out to reduce the reasons to a smaller number of clearly interpretable factors. Multiple regression analysis was carried out to identify the variables relevant to these main themes. RESULTS: Degree of satisfaction with doctor's explanation and attitude was less than 10%. Over 60% of respondents stated that medical malpractice seriously affected their lives. Four main themes emerged from the factor analysis of reasons for dispute which includes dissatisfaction with doctor's attitude, wanting to prevent similar incident in the future, call t? account, and compensation. The relative importance in the order of frequency was wanting to prevent similar incident in the future, dissatisfaction with doctor's attitude, call to account, followed by compensation. Multiple regression analysis was used to identify the variables relevant to these four main themes. Clinical speciality group and degree of satisfaction on attitude were signi(icantly associated with the dissatisfaction with doctor's attitude. Clinical speciality group, patient's condition, effect of medical malpractiee on life and degree of satisfaction on attitude were significantly associated with the call to account. Academic carrier, clinical speciality group, patient's condition, effect of medical malpractice on life and degree of satisfaction on attitude were significantly associated with the compensation. CONCLUSIONS: From the above results, the reasons patients and their families cheese to settle by medical dispute were diverse and associated with demographic characteristics, doctor's attitude, effect of mishap on life, et. at.

Associated Diseases in Inpatients with Dementia

OBJECTIVES: Patients with dementia are accompanied with poor autonomy and multiple disability. Therefore moer cost and medical service are required than non-dementia patients. In order to insure comprehensive, systematic care for dementia patients, knowledge of the associated disease of different types of dementia is warranted. This study evaluate the characteristics of associated disease in inpatients with dementia, to be used as basic reference for effective treatment. METHODS: The study popultion consist of 92 patients with dementia admitted between January 1, 1996 and September 30, 1997 to geriatric department, Yosei University Kwangju Severance Psychiatric Hospital. Diagnoses were based on DSM-IV and NINCDS. Severity of dementia was evaluated by GDS (Global Deterioration Scale). Associated diseases was recorded in separated checklist. chi-test, Fisher's exact test, ANOVA, T-test, Wilcoxon rank sum test, Kruskal-Wallis test were used to determine statistical differences among the dementia subgroup. RESULTS: The mean age was 71.8+/-9.2 with 31 male (33.7%) subjects and 61 female subject (66.3%). The types of dementia among the 92 demented patients were as follows:50 (54%) with Alzheimer's disease, 30 (33%) with vascular dementia, 12 (13%) with unclassified dementia. Mean GDS score was 5.4+/-1.1. The mean duration of admission was 66.9+/-88.9 days. Types of discharge were normal discharge 33 (35.9%), discharge against doctors' advice 28 (30.4%), transfer 23 (25.0%). The average number of diagnoses was 4.9+/-2.4. (4.5+/-2.4 in Alzheimer's disease, 6.1+/-2.4 in vascular dementia, 5.3+/-2.1 in unclassified dementia in respectively (p<0.05). The most common associated disease were gastrointestinal disorders (24.8%), cardiovascular disorders (11.8%), urinary tract infection (6.8%), musculoskeletal disorder (6.6%), diabetes mellitus (4.5%). Associated diseases that their frequency showed significant differences in different types of dementia were hypertension, diabetes mellitus, urinary incontinence, oral cavity disease, anemia (p<0.01). CONCLUSIONS: Associated disease are different in different type of dementia. Patients with vascular dementia had more associated disease and received more drugs for associated disease than Alzheimer's disease. Our data emphasize comprehensive and systematic treatment plan according to type of dementia.