A Survey on Understanding of Atopic Dermatitis among Korean Patients / 대한피부과학회지

BACKGROUND: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease with genetic and environmental backgrounds. While the prevalence of AD is increasing, many patients lack accurate information and understanding about AD. OBJECTIVE: This study was performed to investigate the understanding of AD among Korean AD patients. METHODS: We developed a survey instrument to assess patient understanding of AD. Surveys were conducted over a 6-month period (from May 2010 to October 2010) among 415 patients with AD who visited 10 dermatology clinics at a university teaching hospital affiliated with the Korean Atopic Dermatitis Association. RESULTS: We identified points of understanding in Korean AD patients, such as knowledge and attitudes about AD, awareness of AD treatment, reliability of health care providers and information sources, and acting with AD treatment. As the results of this survey, it was confirmed that the patients' understanding of the cause and prognosis of AD was relatively inadequate, and it could be seen that the perception of the negative attitude toward the medical treatment of AD and inconveniences caused by AD was high. However, the results of the survey on the perception about the medical treatment methods of AD showed that they perceived medical doctors' treatment and prescriptions to have the best curative value, and as the criteria for choosing the treatment methods for AD, they chose the curative value rather than safety and cost. With regard to the information source for AD, they evaluated the treatment postscript on the internet sites and reliability of news media more highly than other information sources, and they responded that the main channel through which they obtain information related to AD was the medical doctors' explanations. CONCLUSION: We conducted the first systematic questionnaire survey to assess the understanding of AD among Korean AD patients. The results of this survey indicate that in the education and promotion on AD patients, additional education with regard to the cause and prognosis of AD is needed, and it is considered that efforts should be made to reduce the negative perception of AD through smooth communication with the medical team. In education and promotion related to AD, treatment postscripts on news media and the internet sites should also be addressed. Ultimately, the patients' self-discipline capabilities should be reinforced through proper education and development of programs related to AD.

Quality of Life and Disease Severity Are Correlated in Patients with Atopic Dermatitis

Quantification of quality of life (QOL) related to disease severity is important in patients with atopic dermatitis (AD), because the assessment provides additional information to the traditional objective clinical scoring systems. To document the impact of AD on QOL for both children and adults as well as to quantify the relationship with disease severity, QOL assessments were performed over a 6-month period on 415 patients with AD. A questionnaire derived from the Infants' Dermatitis Quality of Life Index (IDQOL), the Children's Dermatology Life Quality Index (CDLQI) and the Dermatology Life Quality Index (DLQI) was used to determine the QOL for 71 infants, 197 children and 147 adults, respectively. To measure AD severity, both the Rajka & Langeland scoring system and the Scoring of Atopic Dermatitis (SCORAD) index were used. The mean scores were as follows: 7.7 +/- 5.5 for IDQOL, 6.6 +/- 6.3 for CDLQI, and 10.7 +/- 7.9 for DLQI. In conclusion, these QOL scores are correlated with AD severity scores as estimated by the Rajka & Langeland severity score and the SCORAD. The outcome of the QOL instruments in this study demonstrates that atopic dermatitis of both children and adults affects their QOL.

Quality of Life and Disease Severity Are Correlated in Patients with Atopic Dermatitis

Quantification of quality of life (QOL) related to disease severity is important in patients with atopic dermatitis (AD), because the assessment provides additional information to the traditional objective clinical scoring systems. To document the impact of AD on QOL for both children and adults as well as to quantify the relationship with disease severity, QOL assessments were performed over a 6-month period on 415 patients with AD. A questionnaire derived from the Infants' Dermatitis Quality of Life Index (IDQOL), the Children's Dermatology Life Quality Index (CDLQI) and the Dermatology Life Quality Index (DLQI) was used to determine the QOL for 71 infants, 197 children and 147 adults, respectively. To measure AD severity, both the Rajka & Langeland scoring system and the Scoring of Atopic Dermatitis (SCORAD) index were used. The mean scores were as follows: 7.7 +/- 5.5 for IDQOL, 6.6 +/- 6.3 for CDLQI, and 10.7 +/- 7.9 for DLQI. In conclusion, these QOL scores are correlated with AD severity scores as estimated by the Rajka & Langeland severity score and the SCORAD. The outcome of the QOL instruments in this study demonstrates that atopic dermatitis of both children and adults affects their QOL.

Effects of Aerobic Exercise on Heart Rate Variability(HRV)

BACKGROUND: This study was conducted to find out the difference of heart rate variability between practicing Tai Chi and walking at 6 km/hr. METHODS: Twelve healthy volunteers aged 25 to 35 were recruited through advertisement. All the subjects gave their informed consent, and the study was approved by the Institutional Review Board of the Catholic Medical Center Research Foundation. The subjects either practised Tai Chi or walked at 6 km/ hr on a treadmill machine, maintaining 5-minute rest, 20-minute exercise, and 30-minute rest. After 1 week, they switched and performed the other form of exercise. During the exercise, beat-to-beat HRV data was recorded by Polar S-810. We calculated HRV indices using Matlab software program and analyzed the mean value of HRV indices. RESULTS: The differences of the mean value of HRV indices of pre-exercise resting period were not significant. However, repeated ANOVA revealed that there were significant differences of change in the mean of SDNN (-14.27+/-13.03 ms, -33.67+/-20.23 ms; P=0.023), RMSSD (-10.17+/-9.59 ms, -21.90+/-12.60 ms; P=0.087), and STIDX (171.60+/-196.84, 1003.49+/-812.56; P=0.003) between practising Tai Chi and walking. The differences of change in mean heat rate, LF/HF ratio, LF, HF and TP were not significant. The differences of the mean value of HRV indices of the post-exercise resting period were not significant compared to the pre- exercise period. CONCLUSION: The result of this study suggest that exertional intensity of practising Tai Chi is similar to that of walking. Moreover, practising Tai Chi may be more profitable than walking in the aspect of HRV.

The Relationship between Autonomous Function and Fatigue Rating in Patients with Fatigue

BACKGROUND: This study was conducted to find out the relationship between autonomous function and fatigue rating. The subjects were patients with complaints of fatigue who visited the department of family medicine in a general hospital. METHODS: We conducted this study from April to December 2002 in patients complaining of fatigue. The subjects were categorized into low, intermediate, and high fatigue groups. Heart rate variability was measured for five minutes at rest, followed by a five minute mental arithmetic test. We analyzed the relationship between fatigue ratings and autonomous function with SPSS 10.0. RESULTS: There was a statistically significant increase in the mean heart rate variability in the all three groups at rest and with stress. There was a statistically significant increase in LF norm increase in the low and high fatigue groups. HF norm showed a statistically significant decrease in the intermediate and high fatigue group. The variation in LF norms was highest in the low fatigue group and lowest. With the mental arithmetic test, the low fatigue group showed decreased rMSSD, HF and HF norm values compared to the intermediate group. The above values showed decrease in the high fatigue group compared to the low group. CONCLUSIONS: Overactivity of the sympathetic nervous system was observed as fatigue ratings increased. The cadiovascular autonomic response tended to decrease as fatigue ratings increased.

The Prevelance of Diagnosis as Raynaud's Disease among the People Complaint of Abnormal Sensation on Hands and Feet

BACKGROUND: The previous studies suggested that the rate of the people who reported having sensitivity to cold and Raynaud's disease were 12% and 5~10% of general population respectively. There are surprisingly few data on 'cold hands and feet syndrome', the conventional circulatory disorder in far-eastern Asia in spite of the assumption that it is a common disorder among Korean population. Besides, the prevalence of Raynaud's disease has not been studied for Korean complaint of the syndrome. Therefore, we conducted the survey regarding the frequency of Baynaud's disease and phenomenon among the people appealed abnormal sensory symptoms on hands and feet, and 'cold hands and feet syndrome'. METHODS: The questionnaires were asked to 1,008 out- patients who complained abnormal sensory symptoms on hands and feet. The subjects were screened among the patients who visited the clinics, mainly department of family medicine in Uijongbu St. Mary's hospital from January to July 2003. RESULTS: The most common abnormal sensory symptoms were tingling feeling and coldness, pain in the descending order. The mean age of the patients is 47 years, the average age at the onset of the symptoms is 40 years, and the mean duration they had been suffered by the symptoms is 7 years. During interview, 289 patients voluntarily appealed 'cold hands and feet syndrome' in expression of "I have cold extremities" or "I have the syndrome". Among the screened patients, 510 patients answered, "yes" to the question "Are your fingers unusually sensitive to cold?" Two hundred and nineteen patients (43%) of them showed Raynaud's phenomenon. One hundred and sixty patients were diagnosed as Raynaud's disease among 219 patients who had Raynaud's phenomenon. The rest 59 patients were diagnosed as secondary Raynaud's phenomenon. Eighty-seven patients (30%) of 289 patients who voluntarily reported 'cold hands and feet syndrome' were diagnosed as Raynaud's disease. The average age of Raynaud's disease patients is 37 years old, average first attack age is 24 years, and average suffering period is 14 years. Only 10% of cases experienced the first attacks after 40 years old. The attack rates are different by gender. The ratio is 2.3 and higher in female. Only six patients (4%) of Raynaud's disease had been diagnosed accurately. Fifty-three patients (33%) have family history and 41 of them are the first-degree relatives. The causes of secondary Raynaud's phenomenon (59 patients) are connective tissue disorders, neurologic diseases, carpal tunnel syndrome, hypothyroidism, vascular disorders, etc. The statistically significant factors that influence on Raynaud's disease are female, below 40 years old, stress, family history, hypertension, diabetes, etc. The statistical analysis in this study does not prove the association between the disease and the factors such as physical labor, manual labor using hands heavily, smoking, drinking, thyroid diseases, joint disorders, ischemic heart disease, depression. CONCLUSION: Raynaud's disease has been underlooked even though it is not uncommon and can be easily diagnosed and treated. In conclusion, the result of our study suggests that abnormal sensory symptoms on hands and feet, especially 'cold hands and feet syndrome', the conventional circulatory disorder, are the medical condition where special concern on Raynaud's disease is required.

Bone Acquisition Related Health Behavior Factors and Nutritional Uptake in High School Girl Student

BACKGROUND: The adolescent years are a window of opportunity to influence lifelong bone health. Bone acquisition is accelerated within the genetic potential by lifestyle choices. But some adolescent girls do not care about healthy lifestyle and nutrient uptake. Therefore, we investigated the nutrition and health behavior relating to bone acquisition. METHODS: A cross-sectional study was administered to high school girl students from 4 general and 4 commercial high schools in Uijongbu, Incheon, Suwon, and Yongin. The data was gathered from 378 girls by self-reported questionnaire, which included age, height, weight, health behavior relating to bone acquisition and food-frequency. Nutrient uptake was assessed by DIET PLUS 3.0 program. RESULTS: Girls with bone acquisition inhibiting health habits were reported. Among subjects, 12.2% had regular alcohol intake, 21% smoked daily, 77.7% did not exercise regularly, 58% had light-activity, 42.2% experienced weight reduction trial, 30% had low body weight and 72.8% had less than 2 meals a day. In nutrient uptake, 33.1% of subjects took less calcium uptake and 4% less protein uptake than recommended daily allowance. Comparing general and commercial high schools, commercial students had more bone acquisition inhibiting health habits. CONCLUSION: There were many high school girl students with bone acquisition inhibiting health and eating habits. Family physicians need to promote and educate good health habits with a balanced meal associated with bone acquisition in girls, especially commercial high school students.

The influence of family functioning on psychosocial dysfunction in children

BACKGROUND: A large number of children with psychosocial dysfunction are not recognized within schools or primary care settings. In several research, an increasing amount of attention has been paid to the importance of low family support as a predictor of psychosocial dysfunction in children. Our study examined the agreement and relationship between the lack of family support as measured by the Family APGAR and child psychosocial dysfunction as screened by the Pediatric Symptom Checklist(PSC). Therefore, We studied the usefulness of Family APGAR as a screening tool of child psychosocial dysfunction. METHODS: We set 643 children that are engaged in elementary school. We gave a questionnaire to their parents and made them record the questionnaire which contained the sociodemographic data, past history of child and parents, the Family APGAR and the translated Pediatric Symptom Checklist(PSC). Finally, we analysed only 506 complete data. We use the SAS/PC 6.12 that is a statistical analysis program. RESULTS: Children with a lack of family support(APGAR) were 5.1 times as likely to receive scores indicating dysfunction on the PSC(PSC). Families with a lack of support were significantly more likely to report low parental educational achievement and low income. Sixty percent of children from families with a lack of support were identified as having a psychosocial dysfunction by the PSC rating; however, only 24% percent of the children identified with psychosocial dysfunction by the PSC had scores indicating poor family functioning on the Family APGAR. Families with a lack of support had significantly higher total scores on PSC(mean=20.2) than families with adequate support(mean=11.9). The strength of the agreement between the Family APGAR and the PSC was k=.29. CONCLUSION: A lack of family support is associated with child psychosocial dysfunction as assessed by the PSC. However, the Family APGAR was not a sensitive measure of child psychosocial dysfunction, and thus it supplements, but does not replace the PSC.

Femoral and vertebral bone mineral density and physical fitness factors in postmenopausal women of precticing Tai Chi

BACKGROUND: It is widely accepted tht Tai Chi has been suited for whole aged people, especially old aged women and improves bone mineral density and physical fitness levels. To investigate the efficacy of Tai Chi in postmenopausal women, we compared the bone mineral density and physical fitness levels between Tai Chi and control groups. METHODS: The study subjects were 10 Tai Chi and 18 control group who were postmenopausal women aged 40 years and older. Bone mineral density(BMD) was measured at the lumbar spine and femoral area using dual energy x-ray absorptiometry and maximal O2 intake, flexibility, grip strength, sit up, broad jump, balance, side-to-side step were checked for assessment of fitness levels. Other data was gathered from the questionnaire. RESULTS: The BMD of lumbar spine and Ward's triangle was significantly higher in control group(P<0.05) and the results of maximal O2 intake(P<0.05), grip strength(P<0.05), sit up(P<0.05), balance(P<0.01) were significantly higher in the control group. Logistic regression analysis showed that the results of grip strength, sit up, balance were significantly higher in the control group(P<0.05). CONCLUSIONS: Tai Chi improve physical finess levels and bone mineral density and can be a useful exercise type for menopausal women.