Patient knowledge of upper respiratory infections an unnecessary utilization of antibiotics

BACKGROUND: Upper respiratory infections account for many of the visits in primary care. As most URIs are caused by viruses, antibiotic therapy is not desirable. However, for URI treatment antibiotic therapy is commonly used, which causes many public health problems such as drug resistant bacteria and high medical cost. This paper examines patient knowledge of the normal presentation of a URI, beliefs in the effectiveness of antibiotics and health care utilization. METHODS: A survey of 200 outpatients or their families was conducted in one university hospital from March to April, 1998. Two URI conditions were given for the survey:(1) a condition of 5 days' duration with a cough, sore throat, and clear nasal discharge (question 1), (2) a condition of the same symptom as (1) except a discolored nasal discharge (question 2). For various questions in each of these conditions they were to answer in 5 point Likert type scale. Statistical softwares of SAS 8.0 and GAUSS 3.21 were used for analyzing the survey data. RESULTS: For question 1, 61 % of the sample reported that they would seek care from a physician while for question 2, 75 % of the sample reported that they would do so (p<.01). The health service suppliers, in the order of visiting frequencies, were pharmacy (58 %), hospital (38 %), no visit (2.5 %), public health center (0.5 %), and Chinese medicine clinic (0.5 %) for question 1 and pharmacy (54 %), hospital (42 %), no visit (2 %), Chinese medicine clinic (0.5 %) and public health center (0.0 %) for question 2. For question 1, 54 % of the sample and for question 2, 63 % reported that they believe antibiotics were effective (p=.068). For question 1, 79.5 % and for question 2, 89.5 % of the subjects reported that they had complied to prescriptions of doctors or pharmacists (p<0.05). Out of those subjects, only 19.5 % for question 1 and 21.2 % for question 2 reported that they checked the presence of antibiotics in the prescriptions. A multivariate analysis shows that older people, normally used antibiotics and current smokers had higher tendency of seeking care and stronger beliefs in the effectiveness of antibiotics. CONCLUSION: There is a lack in patient understanding of normal presentation of a URI and the effectiveness of antibiotics as a treatment. A confusion about the meaning ofa discolored nasal discharge is particularly evident. The patients visited pharmacies more often than hospitals, and majority of them (80 %) did not know the details of their prescriptions.

The usefulness of single question for problem drinker

BACKGROUND: Brief intervention with problem drinkers have been shown to be effective, but physicians often do not ask about alcohol use because of time constraints and lack of knowledge. If a sin gle question can be used to screening for problem drinker effectively, primary care physicians could detect problem drinker earlier and reduce future complication and morbidity. The purpose of this study was to evaluate the usefulness of single question. METHODS: One family medicine's resident interviewed 163 patients who visited Dongdaemun Hospital's Health care management center of Ewha Woman's university from January 27th 1999 to February 26th 1999, and the patients answered the written forms of questionnares. This written forms contained the followings: (1) age, sex, education, income level, occupation, smoking, drunken driving, (2) "On any single occasion during the past 3 months have you had more than a bottle of Soju or three bottles of beer or five glasses of whisky?" (3) CAGE, NAST test. Quantity of alcohol was determined by the calendar based review in the past 4 weeks. At risk drinker defined as drinking more than 56 g on one occasion, or more than 196 g of pure alcohol during a week for men ; more than 42 g on one occasion, or more than 98 g of pure alcohol during a week for women. Also alcohol use disorder was defined by the DSM IV criteria and problem drinker was defined as either at risk drinker or a alcohol use disorder. RESULTS: The single question had a positive predictive value of 82.2%, and negative predictive value of 95.5% with a sensitivity of 93.8% and a specificity of 86.9% for problem drinkers. CONCLUSION: A single question about alcohol use would be a effective tool for detecting problem drinker.

The role of lipid peroxidation and glutathione on the glycochenodeoxycholic acid-induced cell death in primary cultured rat hepatocytes

Intracellular accumulation of bile acids in the hepatocytes during cholestasis is thought to be pathogenic in cholestatic liver diseases. The objective of this study was to determine the role of lipid peroxidation and glutathione on the bile acid-induced hepatic cell death mechanism in primary cultured rat hepatocytes. To induce hepatic cell death, we incubated primary cultured rat hepatocytes with glycochenodeoxycholic acid (GCDC; 0~400 micrometer) for 3 hours. In electron microscopic examination and agarose gel electrophoresis, low concentration of GCDC treatment mainly induced apoptotic feature. Whereas 400 micrometer GCDC treated cells demonstrated both apoptosis and necrosis. Lipid peroxidation was increased dose-dependently in GCDC treated hepatocyte. And this was also accompanied by decreased glutathione. Therefore, oxygen free radical damage may play a partial role in GCDC-induced hepatic cell death.

Glycochenodeoxycholic acid induces cell death in primary cultured rat hepatocyte: Apoptosis and necrosis

Intracellular accumulation of bile acids in the hepatocytes during cholestasis is thought to be pathogenic in cholestatic liver injury. Due to the detergent-like effect of the hydrophobic bile acids, hepatocellular injury has been attributed to direct membrane damage. However histological findings of cholestatic liver diseases suggest apoptosis can be a mechanism of cell death during cholestatic liver diseases instead of necrosis. To determine the pattern of hepatocellular toxicity induced by bile acid, we incubated primary cultured rat hepatocytes with a hydrophobic bile acid, Glycochenodeoxycholate (GCDC), up to 5 hours. After 5 hours incubation with 400 muM GCDC, lactate dehydrogenase released significantly. Cell viability, quantitated in propidium iodide stained cells concomitant with fluoresceindiacetate was decreased time-and dose-dependently. Most nuclei with condensed chromatin and shrunk cytoplasm were heavily labelled time- and dose-dependently by a positive TUNEL reaction. These findings suggest that both apoptosis and necrosis are involved in hepatocytes injury caused by GCDC.

Drugs and pregnancy

No abstract available.

The usefulness of wrist/height ratio as a predictor for the risk factors of coronary artery disease

BACKGROUND: The waist/hip ratio in an useful index of abodominal obesity, but it includes two variables which may result in a false interpretation. The purpose of this study is to evaluate the usefulness of waist/height ratio as a predictor for the risk factors of coronary artery disease(CAD). METHODS: 1,395 persons(818 men & 577 women) were selected as subjects who visited the Health Examination Center at Ewha Mokdong Hospital from October 1998 to March 1997. Waist circumference was measured at the level of umblicus with standing position. Hip circumference was measured at the level of the largest circumference of the hip. We set the criteria if the risk factors as hypertension(systolic BP > OR = 140mmHg and/or diastolic BP > OR = 90mmHg), glucose intolence (fastng blood glucose > OR = 115mg/dl) hypertriglyceridemia(>160mg/dl), hypercholesterolemia(> OR = 200mg/dl), and low HDL-cholesterol level(<35mg/dl). The morbidity index of CAD was calculated by the sim if the risk factor scores(one point per item if present). RESULTS: There was significant correlation between waist/height ratio, waist/hip ratio and body mass index(BMI)(p=0.0001). BMI had more strong correlation with waist/height ratio(r=0.81) than waist/hip ratio(r=0.48). According to the simple regression analysis, BMI, waist/hip ratio and waist/height ratio had significant correlation with all of the risk factors and the morbidity index, According to the multiple regression analysis, waist/height ratio had significant correlation with age, weight, height, systolic BP, triglyceride, cholesterol and HDL-cholesterol. The risk factor morbidity index of the groups with waist/height ratio over 0.45 was significantly more higher than the group of the lowest risk factor morbidity index(waist/height ratio under 0.4) in men(p=0.01). for women, 0.46 was the level which the risk factor morbidity index increased significantly (p<0.01). CONCLUSIONS: Waist/height ratio can be a useful index of abdominal obesity. And it may be used as a more easier and better predictor of multiple CAD risk factors than waist/hip ratio. We can predict that waist/height ratio over 0.45 in men and over 0.46 in women may have more higher coronary artery disease risk.

The risk factors of the nonresponders after hepatitis B vaceinatio and the immunogenecity after a double-dose revaccination in the nonresponders

BACKGROUND: Korea is an endemic area of viral hepatitis B with a rate of 5~10% carrier state. Therefore, hepatitis B vaccination is performed nationwide. But 5~15% of healthy individuals fail to respond adequately to the vaccine and an approved guideline for the nonresponders has not been developed yet. This study is designed to identify risk factors for those who lack anti-HBs after hepatitis B vaccination and to document the results of a double-dose revaccination in such nonresponders to the primary vaccination. METHODS: From Feb. 1996 to Aug, 1997, we assessed 51 healthy subjects(HBs Ag negative, anti-HBs negative, anti-HBc negative and a normal LFT). All subjects were vaccinated with Hepavax- B, 1.0ml, 24 by a rapid schedule(0, 1, and 2 months) and 27 by a standard schedule(0, 1, and 6 months). Anti-HBs titers were evaluated 3 months after the third vaccine and assessed the nonre-sponders (anti-HBs titer<2mIu/ml) and the hyporesponders(2~10mK/ml). All 13 nonresponders were revaccinated with 2ml of Hepavax-B 3 months after the primary vaccination. Anti-HBs titers were evaluated 1 month later. RESULTS: The differences in age(p<0.01) and smoking amount(p<0.05) between the responders and the hypo and the nonresponders were statistically significant. There were more males and higher body mass index in the hypo and the nonresponders but not statistically significant. The seroconversion rate after the double-dose vaccination was 92.3%(12/13) with an average titer of 5K08mlU/ ml(1-132.4mIU/ml). CONCLUSIONS: Increase in age and smoking amount were the risk factors of the nonresponders after the primary vaccination. Most of the hypo and the nonresponders to the primary vaccination responded adequately to the double-dose revaccination.

Analysis of Papers Published in Journal of the Korean Academy of Family Medicine

BACKGROUND: Research is essential for the development of family medicine as a professional field in primary care. Since information is available through the articles in the Journals of Family Medicine which contains subjects such as disease mechanism, pathophysiology, drug or new treatment method, and it is necessary to evaluate the contribution of recent researches in this field. This paper is intended to evaluate the current status of the quality of papers published in the Journal of the Korea Academy of Family Medicine (below JKAFM) and provide statistical data & direction of studies in the future. METHODS: 1218 articles in 185 editions of JKAFM were analyzed among 188 editions published from Nov. 1980 to Dec. 1996. The papers were classified into Case Report, Original Article, Review Article by the type of papers, and then categorized Into descriptive studies, analytic studies, and clinical trials by its methodology. In each category, the papers were stratified by the topic. Also, the analysis was conducted according to the authors, research subjects, sampling methods and the statistical methods, and observed the changes each year through 1980s to 1990s. RESULTS: The portion of original articles has increased from 18.6% in 1980s to 73.9% in 1990s. In terms of research methodology, the portions of analytical studies and clinical trials occupy 28.8% and 2.1% in 1990's respectively, compared with those of 1.8% and 0.6% in 1980's. When the papers were stratified by study topics, topics on family medicine showed the highest of 34.9% of the total. According to the detailed stratification, the principle of family medicine recorded 24.2%. In terms of sampling method, 89% and above was from the clinical data when current data were used, and 69.1% was by questionnaires when the data were newly collected. The most of the study subjects were outpatients of family medicine departments. The portion of papers in which the statistical analysis was not included was 29.9% in 1980s which decreased to 15.7% in 1990s. In terms of the statistical analysis methodology, the Chi-square test was the most frequently used(26.2%), followed by Descriptive(19.6%),1-test(18.2% ) and ANOVA(8.7%) were the next. CONCLUSIONS: The academic performance of family medicine can be most effectively measured by the analysis of the journals on family medicine. According to the analysis, the papers based on clinical activity is increasing in recent years with substantial contribution, which means that the field of family medicine has found its own position in medical science and is developing actively. In terms of study methodology, the portion of analytical study is getting larger, and the various method are being tried. The application of statistical methods is being developed in its quality and quantity. It should be noted that research on family medicine should provide the basis for new knowledge and promote public health by the integrated and intensive efforts.

The Usefulness of Clock Drawing Test as Screening for Dementia On the basis of the correlation between clock drawing and MMSE-K

BACKGROUND: The prevalence of dementia is estimated to be as high as 11.3% among coummunity-dwelling persons over 65 years of age in Korea. The fear of dementia for both patients and families is growing because of the chronicity and progressiveness of the disease. Though the recognition, evaluation, and management of patients with dementia are important for the care of older pateint, unfortunately, MMSE takes 5 to 10 minutes to administer and is cumbersome to carry for all elderly patients in busy office. The Clock Drawing Test has been known as valid, easily administered and low cost screening procedure for the congnitive impaiment associated with dementia in general geriatric clinic population. In this study, we assessed the usefulness of this measure as a screening test for dementia, on the basis of the correlation between clock drawing and MMSE-K. METHODS: The subjects for this study consisted of 47 elderly who visited to two elderly clubs in Seoul from April 1996 through June 1996 or the outpatient department of Family medicine of the Ehwa Mok-dong hospital. They received the Mini-Mental Status Exam and the Clock Drawing test. Three observers evaluated them by ratings from 10(best) to 1(worst). Inter-rater reliability of scores from the Clock Drawing Test was assessed and Pearson correlation coefficients were used to examine the relationships between scores from the Clock Drawing Test and MMSE-K. RESULTS: Their mean age was 75.4 years with range of 65 to 91 years. There were 34 women and 13 men. Correlations between individual raters was highly significant(y=0.8939, 0.8552, and 0.8698, respectively ; P<0.01). Compared to scores on MMSE-K, rating from clock drawings by each of 3 raters revealed statistically significant correlations(y=0.7164, 0.7398, and 0.6884, respectively ; P<0.01). CONCLUSIONS: The clock drawings can be rated reliably by even untrained observers and performance on this task relates significantly to performance on MMSE-K of severity. We confirmed the usefulness of clock drawings as a simple, easily administered, low cost, and reliable general screening tool for dementia in a general geriatric clinic population.

Prevalence of Dyslipidemic hypertension

BACKGROUND: The studies about that hypertension commonly associated with dyslipidemia and that dyslipidemic hypertension increased mortality compared with hypertension only and dyslipidemia only, suggests an important clinical entity. Therefore, this study aimed to identify prevalence and describe potential insulin resistance of dyslipidemic hypertension, and compare about them with two other groups(dyslipidemia only, hypertension only). METHODS: The data in this study was analyzed from 1,296 persons who had visited Health examination center in Ewha Womans University Mok-dong Hospital from Jan. to April, 1996. Prevalence of dylipidemia, hypertension and dislipidemic hypertension were measured. Average age, and frequency of male, obesity and NIDDM in three groups were measured. Odds ratios of sex, obesity, smoking, and DM according to two age group consisting of persons before and after 50 years were calculated for three groups. RESULTS: Frequency of dyslipidemia only was 27% and of hypertension only was 8%.; conjoint frequency(dyslipidemic hypertension) was 7%, which is 1.5 times greater than expected value(4.7%) if the two diseases were independent. In characteristics for age, sex, obesity and NIDDM, All three groups(dyslipidemic hypertension, dyslipidemia only, hypertension only) w-normal subjects. Dyslipidemic hypertension was more likely to be obese and had a greater frequency of NIDDM than two other group(dyslipidemia only, hypertension only). Odds ratio was contrasted with three groups for sex, smoking, obesity, NIDDM stratified by age to more indentify association with insulin resistance. Sex was associated with male in two groups(dyslipidemia only, dyslipidemic hypertension) of younger group and dyslipudemia only group of older group, but associated with female in hypertension only and dyslipidemic hypertension of older group. Smoking was associated with dyslipidemia only group of younger group. Obesity was associated with increased odds of dyslipidemia only(2.03) and hypertension only(2.02), dyslipidemic hypertension (4.38) in younger group, and dyslipidemic hypertension(2.24) in older group, but associated with decreased odds with dyslipidemia only(0.56). NIDDM was associated with increased odds of dyslipidemia only(2.39) and dyslipidemic hypertension(3.32) in youger group. CONCLUSIONS: Dyslipidemic hypertension is common and more often than would be dictated by chance alone, which is consistent with a distinct syndrome. Dyslipidemia and hypertension were associated with potential insulin resistant states of obesity and DM in this study. So, treatment of dislipidemic hypertension should focus on weight control and exercise, which increase insulin sensitivity.

Prevalence of Dyslipidemic hypertension

BACKGROUND: The studies about that hypertension commonly associated with dyslipidemia and that dyslipidemic hypertension increased mortality compared with hypertension only and dyslipidemia only, suggests an important clinical entity. Therefore, this study aimed to identify prevalence and describe potential insulin resistance of dyslipidemic hypertension, and compare about them with two other groups(dyslipidemia only, hypertension only). METHODS: The data in this study was analyzed from 1,296 persons who had visited Health examination center in Ewha Womans University Mok-dong Hospital from Jan. to April, 1996. Prevalence of dylipidemia, hypertension and dislipidemic hypertension were measured. Average age, and frequency of male, obesity and NIDDM in three groups were measured. Odds ratios of sex, obesity, smoking, and DM according to two age group consisting of persons before and after 50 years were calculated for three groups. RESULTS: Frequency of dyslipidemia only was 27% and of hypertension only was 8%.; conjoint frequency(dyslipidemic hypertension) was 7%, which is 1.5 times greater than expected value(4.7%) if the two diseases were independent. In characteristics for age, sex, obesity and NIDDM, All three groups(dyslipidemic hypertension, dyslipidemia only, hypertension only) w-normal subjects. Dyslipidemic hypertension was more likely to be obese and had a greater frequency of NIDDM than two other group(dyslipidemia only, hypertension only). Odds ratio was contrasted with three groups for sex, smoking, obesity, NIDDM stratified by age to more indentify association with insulin resistance. Sex was associated with male in two groups(dyslipidemia only, dyslipidemic hypertension) of younger group and dyslipudemia only group of older group, but associated with female in hypertension only and dyslipidemic hypertension of older group. Smoking was associated with dyslipidemia only group of younger group. Obesity was associated with increased odds of dyslipidemia only(2.03) and hypertension only(2.02), dyslipidemic hypertension (4.38) in younger group, and dyslipidemic hypertension(2.24) in older group, but associated with decreased odds with dyslipidemia only(0.56). NIDDM was associated with increased odds of dyslipidemia only(2.39) and dyslipidemic hypertension(3.32) in youger group. CONCLUSIONS: Dyslipidemic hypertension is common and more often than would be dictated by chance alone, which is consistent with a distinct syndrome. Dyslipidemia and hypertension were associated with potential insulin resistant states of obesity and DM in this study. So, treatment of dislipidemic hypertension should focus on weight control and exercise, which increase insulin sensitivity.

The clinical investigation of the femoral shaft fracture in children

No abstract available.