A Web-Based Decision Aid for Informed Prostate Cancer Screening:Development and Pilot Evaluation

Background@#Prostate-specific antigen-based routine screening is not recommended for the general population due to conflicting results with mortality reduction. We aimed to develop a web-based decision aid (DA) for informed decision making for prostate cancer screening. @*Methods@#Using the International Patient Decision Aid Standards (IPDAS) development process model, we developed our DA based on patient and clinician interviews and multidisciplinary expert discussions. The prototype consisted of predicting individual prostate cancer risk and informed decision-making, including knowledge, risk and benefit, cost, personal value, and decision making. We conducted a pilot study on 101 healthy men, evaluating the effectiveness of DA by measuring knowledge, attitude, and intention to screen before and after using the DA, as well as decisional conflict and usefulness after using the DA. @*Results@#Of the 101 participants (median age 60 [50–69] years), 84% had not undergone screening for prostate cancer in the past two years. After using the DA, knowledge on prostate cancer screening increased (mean score [of 10] before versus after: 6.85 ± 1.03 versus 7.57 ± 1.25; P < 0.001), and intention to not screen increased from 27.7% to 51.5% (P < 0.001), but attitude toward screening did not change (P = 0.564). After use of the DA, 79 participants reported no decisional conflict, and the usefulness score was high (mean score [of 100] 77.35 ± 7.69), with 85% of participants reporting that the DA helped with decision making. @*Conclusion@#Our web-based DA yielded increased knowledge, decreased screening intention, and high perceived usefulness. These findings indicate potential clinical relevance, especially among younger individuals.

The Association between Serum Vitamin D Concentration and Colon Polyp: A Cross-Sectional Study Using Health Care Screening Database in a Tertiary Hospital in Korea / 가정의학회지

Background@#As indoor activity increases with modern lifestyles changes, reduced exposure to sunlight may lead to reduced vitamin D synthesis. Previous studies demonstrated that increased vitamin D level is associated with decreased risk of colon cancer; therefore, this study attempted to determine the association between vitamin D and colon polyps, which may be precancerous lesions, in participants who underwent colonoscopy exams. @*Methods@#A total of 31,004 participants who underwent routine health checkups, including vitamin D level and colonoscopy, at Samsung Medical Center in South Korea from 2010 to 2018 were included in the study. Colorectal polyps were diagnosed through biopsy after performing colonoscopy exams. Participants were categorized into three groups according to level of vitamin D (deficient: <20 ng/mL), insufficient: 20≤ vitamin D <30 ng/mL, and sufficient: ≥30 ng/mL). We analyzed the presence of colorectal polyps according to vitamin D level, and performed multiple logistic regression analyses for the association between vitamin D level and colorectal polyps. @*Results@#About 50% of participants had colorectal polyps (hyperplastic polyp, n=4,864; adenomatous polyp, n=10,470; adenocarcinoma, n=24). There were no significant associations between vitamin D categories and colorectal polyp and colorectal cancer. However, when further analyzing by type of polyp, the risk of hyperplastic polyps significantly decreased with increasing vitamin D levels (P for trend=0.006). @*Conclusion@#We did not find evidence for an association between vitamin D and overall colorectal polyps; however, we observed a trend for decreased odds of hyperplastic polyps with increased vitamin D levels in comparison to vitamin D deficient subjects.

The Association between Serum Vitamin D Concentration and Colon Polyp: A Cross-Sectional Study Using Health Care Screening Database in a Tertiary Hospital in Korea / 가정의학회지

Background@#As indoor activity increases with modern lifestyles changes, reduced exposure to sunlight may lead to reduced vitamin D synthesis. Previous studies demonstrated that increased vitamin D level is associated with decreased risk of colon cancer; therefore, this study attempted to determine the association between vitamin D and colon polyps, which may be precancerous lesions, in participants who underwent colonoscopy exams. @*Methods@#A total of 31,004 participants who underwent routine health checkups, including vitamin D level and colonoscopy, at Samsung Medical Center in South Korea from 2010 to 2018 were included in the study. Colorectal polyps were diagnosed through biopsy after performing colonoscopy exams. Participants were categorized into three groups according to level of vitamin D (deficient: <20 ng/mL), insufficient: 20≤ vitamin D <30 ng/mL, and sufficient: ≥30 ng/mL). We analyzed the presence of colorectal polyps according to vitamin D level, and performed multiple logistic regression analyses for the association between vitamin D level and colorectal polyps. @*Results@#About 50% of participants had colorectal polyps (hyperplastic polyp, n=4,864; adenomatous polyp, n=10,470; adenocarcinoma, n=24). There were no significant associations between vitamin D categories and colorectal polyp and colorectal cancer. However, when further analyzing by type of polyp, the risk of hyperplastic polyps significantly decreased with increasing vitamin D levels (P for trend=0.006). @*Conclusion@#We did not find evidence for an association between vitamin D and overall colorectal polyps; however, we observed a trend for decreased odds of hyperplastic polyps with increased vitamin D levels in comparison to vitamin D deficient subjects.

National Lung Cancer Screening Program in Korea: More Harm Than Good

Although the result of low dose computed tomography (LDCT) screening for high risk smoker for lung cancer (National Lung Screening Trial, NLST) showed 20% of lower lung cancer death compare to chest X-ray screening, which published in 2011, after more than 8 years passed, no European or Asian country has implemented organized lung cancer screening with LDCT, and there are no National Lung Cancer Screening Program globally. In United States, where LDCT lung screening has become standard procedure, the screening rate is extremely low, less than 5%. That is because in spite of the considerable the benefit of the screening, the harms of screening; specifically, most notably due to the high level of false positives, and physical, psychological, and economical burdens. Recently the controversies regarding the harms of LDCT lung screening has been increasingly debated. Also, the novel strategies, such as artificial intelligence and volumetric measurement of suspicious nodules has been adopted for recently launched lung cancer screening clinical trials. However, amid of skeptical opinions increasing globally, Korean Government recently decided to include LDCT lung cancer screening as national cancer screening program, becoming Korea as the first and the only national lung cancer screening program worldwide. Without randomized trial proven to be effective for Korea population, hurried implementation of national lung cancer screening program could have more harmful effect than benefit in terms of public health perspectives.

National Lung Cancer Screening Program in Korea: More Harm Than Good

Although the result of low dose computed tomography (LDCT) screening for high risk smoker for lung cancer (National Lung Screening Trial, NLST) showed 20% of lower lung cancer death compare to chest X-ray screening, which published in 2011, after more than 8 years passed, no European or Asian country has implemented organized lung cancer screening with LDCT, and there are no National Lung Cancer Screening Program globally. In United States, where LDCT lung screening has become standard procedure, the screening rate is extremely low, less than 5%. That is because in spite of the considerable the benefit of the screening, the harms of screening; specifically, most notably due to the high level of false positives, and physical, psychological, and economical burdens. Recently the controversies regarding the harms of LDCT lung screening has been increasingly debated. Also, the novel strategies, such as artificial intelligence and volumetric measurement of suspicious nodules has been adopted for recently launched lung cancer screening clinical trials. However, amid of skeptical opinions increasing globally, Korean Government recently decided to include LDCT lung cancer screening as national cancer screening program, becoming Korea as the first and the only national lung cancer screening program worldwide. Without randomized trial proven to be effective for Korea population, hurried implementation of national lung cancer screening program could have more harmful effect than benefit in terms of public health perspectives.

Association of Grip Strength with All-Cause Mortality and Cause-Specific Mortality: Analysis of the Korean Longitudinal Study of Ageing (2006–2016)

BACKGROUND: Grip strength has been found to be closely related to mortality and disease morbidity. In this study, we aimed to evaluate the relationship between grip strength and mortality in middle aged and elderly Koreans.METHODS: Study subjects were selected from the participants of the Korean Longitudinal Study of Ageing from 2006 to 2016. The Cox proportional hazards model was used to analyze the association between grip strength, all-cause mortality, and cause-specific mortality according to age and sex, after adjusting for covariates.RESULTS: The adjusted hazard ratio (HR) for all-cause mortality was decreased in the high grip strength group (male: HR=0.580, 95% confidence interval [CI]=0.478–0.704; female: HR=0.601, 95% CI=0.483–0.747) compared to the low grip strength group in both sexes. In male, cardiovascular mortality (middle group: HR=0.453, 95% CI=0.278–0.738; high group: HR=0.538, 95% CI=0.332–0.871) and cancer mortality (middle group: HR=0.697, 95% CI=0.514–0.945; high group: HR=0.589, 95% CI=0.427–0.812) were significantly lower in the middle and high grip strength groups compared to the low grip strength group. The HR for mortality due to stroke in male decreased significantly according to grip strength, but this became nonsignificant after adjusting for covariates. No association between cause-specific mortality and grip strength was found in female.CONCLUSION: In this study, grip strength was inversely associated with all-cause mortality, with similar effects on cause-specific mortality due to heart disease and cancer in male. Grip strength is a useful predictor of health status, and further studies are needed to evaluate its clinical relevance in Koreans.

Cancer Survivorship in Primary Care / 가정의학회지

With the early detection of cancer and improvement in cancer therapy, the number of cancer survivors is rapidly increasing. This number is expected to reach 2 million by the end of 2019. Cancer survivors struggle with not only cancer-related health problems but also diverse acute and chronic diseases. These health issues make cancer survivorship more complex, and proper care coordination is necessary. This study aimed to summarize the definition of cancer experience and management of cancer survivors, specifically focused on gastric, colorectal, lung, breast, thyroid, prostate, and cervical cancers. Furthermore, it aimed to discuss the role of primary care in cancer survivorship and survivorship care models and the National Policy for Cancer Survivors and Future Challenges.

The Risk of Microalbuminuria by Obesity Phenotypes according to Metabolic Health and Obesity: The Korean National Health and Nutrition Examination Survey 2011–2014 / 가정의학회지

BACKGROUND: The present study aimed at identifying the difference in the risk of microalbuminuria among individuals with various obesity phenotypes in terms of metabolic health and obesity. METHODS: This cross-sectional study included 15,268 individuals and used data from the National Health and Nutrition Survey conducted from 2011 to 2014. Obesity was defined as body mass index ≥25 kg/m2. Metabolically unhealthy was defined as meeting two or more of the following criteria: systolic and diastolic blood pressure ≥130/85 mm Hg or current use of hypertensive drugs; triglyceride level ≥150 mg/dL; high-density lipoprotein level < 40/50 mg/dL (in both men and women); and fasting blood glucose level ≥100 mg/dL or current use of oral antidiabetic medications. The participants were further classified into four subgroups: metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUNO), and metabolically unhealthy obese (MUO). RESULTS: A significant difference was observed in the microalbuminuria ratio among the four groups. The MHNO group was considered as the reference group, and the MHO, MUNO, and MUO groups were at an increased risk for microalbuminuria by 1.42 fold (95% confidence interval [95% CI], 1.03–1.96), 2.02 fold (95% CI, 1.61–2.53), and 3.40 fold (95% CI, 2.70–4.26), respectively, after adjusting confounding factors. CONCLUSION: The MUNO group had a higher risk of developing microalbuminuria than the MHNO group. Thus, based on this result, differences were observed in the risk of developing microalbuminuria among individuals with various obesity subtypes.

Association between Female Urinary Incontinence and Geriatric Health Problems: Results from Korean Longitudinal Study of Ageing (2006) / 가정의학회지

BACKGROUND: Urinary incontinence (UI) is highly prevalent in the aging population. UI is one of the most common geriatric syndromes and affects overall health, quality of life, and economical burden in patients. The aims of this study were to investigate the characteristics of patients with UI and to assess its association with other geriatric health problems. METHODS: We used data from the Korean Longitudinal Study of Ageing obtained in 2006. Among the 10,254 individuals aged 45 years and older, we analyzed data from 2,418 women aged 65 years and older. Data were obtained using questionnaires for UI, comorbidities, and lifestyle factors. RESULTS: Among the 2,418 women aged 65 years and older, 506 (20.9%) had UI. Cerebrovascular disease (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.26 to 3.23), arthritis (OR, 1.44; 95% CI, 1.18 to 1.77), and fear of falling (OR, 1.62; 95% CI, 1.18 to 2.22) were significantly associated with UI, while chronic lung disease, psychiatric disease, difficulty in daily living due to visual and hearing problems, and experiencing a fall in the last 2 years were not associated with UI. CONCLUSION: Cerebrovascular disease, arthritis, and especially fear of falls were significantly associated with UI in elderly Korean women.

Hospice and Palliative Care in Chronic Obstructive Pulmonary Disease / 한국호스피스완화의료학회지

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation that is usually progressive. It is a major cause of morbidity and mortality worldwide, leading to substantial and increasing economic and social burden. Palliative care for COPD patients aims to reduce symptoms and exacerbations and improve exercise tolerance and quality of life. It is difficult to make a prognosis for COPD patients due to the variable illness trajectory and advanced care of patients. However, severity of breathlessness, assessment of lung function impairment, and frequency of exacerbations can help to identify palliative care needs and determine effective methods to mitigate symptoms, which is discussed in this paper. In these patients, it is recommended to provide individualized palliative care along with curative/restorative care at the onset of COPD symptoms. Before launching a palliative care system in Korea, it is necessary to prepare pulmonary rehabilitation resources, patient-centered communication, timely palliative responsiveness, and a program for effective advanced care planning. A multidisciplinary approach involving collaboration with not only the respiratory and palliative care teams but also primary care offers a new model of care for these patients and should be considered with a priority.

Management of long-term cancer survivors in primary care

No abstract available.

Management of long-term lung cancer survivors in Korea

Lung cancer survivors need to undergo continuous care by primary care physicians after acute treatment. The health problems of lung cancer survivors are associated with their treatment: for example, severe pain, respiratory difficulty, poor quality of life, or pneumonitis. They also have various comorbidities, such as stroke, myocardial infarction, arrhythmia, chronic obstructive pulmonary disease, or psychological problems. Surveillance of lung cancer survivors is based on an annual chest CT with routine physical examination. Incidence of second primary cancer in lung cancer survivors is reported to increase in the remnant lung, head and neck, kidney, bladder, thyroid, stomach, and breast. Therefore, lung cancer survivors need to undergo regular health examination for early detection of cancer. Smoking status, weight change, drinking behavior, and vaccination, especially influenza and pneumococcal vaccination, should be assessed whenever the patient meets a clinician. The primary care physician would be expected to take on the role of managing the health problems of Korean lung cancer survivors comprehensively, including physical and psychosocial problems, from screening to survivorship care.

Suicidal Ideation in Underweight Adults Who Attempt to Lose Weight: Korea National Health and Nutrition Examination Survey, 2007-2012 / 가정의학회지

BACKGROUND: Being underweight has been related to health risks. However, little is known about the relationship between suicidal ideation and attempting to lose weight. This study was conducted to examine if there is an association between suicidal ideation and attempting to lose weight among underweight adults. METHODS: A cross-sectional study of 1,122 underweight adults (range, 19 to 69 years) was conducted based on the Korea National Health and Nutrition Examination Survey, 2007-2012. We examined suicidal ideation, doctor-diagnosed depression, depressive mood, stress, physical activity, health-related behavior, comorbidity, and socioeconomic status by weight loss attempts. Logistic regression analysis was performed to examine the association between suicidal ideation and weight loss attempts. The following covariates were controlled for: age, sex, physical activity, alcohol problem, marital status, education, income, occupation, self-perception of body image, chronic disease, and body mass index. RESULTS: There were 101 subjects in the weight loss attempt group and 1,021 in the non-attempt group. The attempt group had a higher risk of suicidal ideation (odds ratio [OR], 2.47; 95% confidence interval [CI], 1.35 to 4.53) and depressive symptoms (OR, 2.17; 95% CI, 1.19 to 3.98). After depressive symptoms were added to the covariates, the risk of suicidal ideation was also significant (OR 2.11, 95% CI: 1.03 to 4.35). The two groups did not significantly differ in doctor-diagnosed depression and stress. CONCLUSION: Weight loss attempts were associated with suicidal ideation in underweight Korean adults.

Management of cancer survivors in Korea

With the early detection of cancer and advances in cancer treatment, the number of cancer survivors is increasing dramatically and is currently over 1 million. Many cancer survivors face lifetime risks associated with their cancer therapy, with a significant proportion at risk for serious morbidity and premature mortality. The long-term physical and psychosocial effects of cancer treatment on cancer survivors and their families are increasingly being recognized as emerging problems from both clinical and public health perspectives. This article summarizes the core principles of management of cancer survivors: follow-up of primary cancer; screening and prevention of a second primary cancer; management of late effects of cancer treatment and comorbid conditions; promotion of healthy behaviors such as smoking cessation, exercise and physical activity, nutrition, and weight management; management of psychosocial problems; and support for family caregivers. Finally, we discuss the way forward for improving survivorship care: shared care between oncologists and primary care physicians; a comprehensive cancer support program; and further research to generate relevant evidence regarding these management principles.

Management of cancer survivors in Korea

With the early detection of cancer and advances in cancer treatment, the number of cancer survivors is increasing dramatically and is currently over 1 million. Many cancer survivors face lifetime risks associated with their cancer therapy, with a significant proportion at risk for serious morbidity and premature mortality. The long-term physical and psychosocial effects of cancer treatment on cancer survivors and their families are increasingly being recognized as emerging problems from both clinical and public health perspectives. This article summarizes the core principles of management of cancer survivors: follow-up of primary cancer; screening and prevention of a second primary cancer; management of late effects of cancer treatment and comorbid conditions; promotion of healthy behaviors such as smoking cessation, exercise and physical activity, nutrition, and weight management; management of psychosocial problems; and support for family caregivers. Finally, we discuss the way forward for improving survivorship care: shared care between oncologists and primary care physicians; a comprehensive cancer support program; and further research to generate relevant evidence regarding these management principles.

Associations between the Risk of Internet Addiction and Problem Behaviors among Korean Adolescents / 가정의학회지

BACKGROUND: The number of internet users is increasing rapidly and internet addiction among adolescents has become a serious public health problem in Korea. In the light of behavioral addiction, this study was aimed to identify the associations between the risk of internet addiction and other problem behaviors which can lead to addiction, such as cigarette smoking, alcohol drinking, drug abuse, and sexual intercourse among a nationally representative sample of Korean adolescents. METHODS: Data from the 2010 Korean Youth Risk Behavior Web-based Survey (respondents, 73,238) were analyzed. Risk of internet addiction was assessed by the 'Korean Internet Addiction Proneness Scale for Youth-Short Form: Self Report' which was developed by the Korean National Information Society Agency in 2008. Multiple logistic regression analysis was used to calculate the odds ratios of problem behaviors among adolescents at high risk for internet addiction and adolescents at low risk for internet addiction. RESULTS: The odds of smoking experience, drug abuse experience, and sexual intercourse experience were significantly higher among boys at high risk for internet addiction compared to boys at low risk for internet addiction. Among girls at high risk of internet addiction, the odds of smoking experience, drinking experience, and drug abuse experience were significantly higher compared with girls at low risk of internet addiction. CONCLUSION: The risk of internet addiction was associated with cigarette smoking, alcohol drinking, drug abuse, and sexual intercourse experience among Korean adolescents.

Metastatic Hepatocellular Carcinoma to the Distal Phalanx: a Case Report and Review of Literature / 한국호스피스완화의료학회지

Metastatic tumors to the hand are rare and often overlooked by clinicians. Here, we report a rare case of phalangeal metastasis of right 4th finger in a patient with hepatocellular carcinoma. Treatment was given with right 4th finger disarticulation. This report suggests that physicians must take consideration into the possibility of metastatic tumors in patients with bone lesions on hands and a history of malignancy.

The Realities and Associated Factors of Palliative Chemotherapy Near the End of Life in the Patients Enrolled in Palliative Care Unit / 가정의학회지

BACKGROUND: It is important to know and decide when to end regimen for the quality of life of the patients. However, there is currently no clear agreement on when to terminate palliative chemotherapy. We investigated the duration between the last chemotherapy and death, and associated factors affecting patients receiving palliative care after the last chemotherapy. METHODS: We studied 242 patients who were put into palliative care ward after receiving chemotherapy and died during hospitalization from 2008 to 2009. Electronic medical records were used to gather information on demographic characteristics, types of primary cancer, and palliative chemotherapy. Then we analyzed the relationship between the clinical characteristics of patients and interval between last chemotherapy and death. RESULTS: The average survival time of patients after referral to palliative care was 17.5 days; survival time after discontinuation of chemotherapy was 103 days. Also, 104 (43.0%) patients died within 3 months and 14 (5.8%) patients died within 1 month of persistent palliative chemotherapy. Chemotherapy on patients within 3 months from their death was not associated with the social characteristics of the population. CONCLUSION: The patients who were referred to palliative care were found to have continued to receive chemotherapy within 3 months before death. However, only a small number of patients received chemotherapy within 1 month before death, which confirms that futile chemotherapy that extends to the end of life was less frequent. Doctors should be able to recognize the implications of excessive and aggressive use of chemotherapy and should actively communicate with patients about therapeutic choices.

Design and Implementation of a Web-based Portfolio Assessment System for a Family Medicine Residency Program in Korea / 한국의학교육

PURPOSE: Evaluation and feedback are fundamental components in a residency program. A portfolio assessment system is an appropriate option for making formative assessments, particularly for a family medicine resident whose training includes rotations through various disciplines at multiple locations. However, a paper-based portfolio assessment system has limitations when applied to a clinical environment due to how it is managed and cared. This study assessed the satisfaction and utility of a paper-based portfolio assessment system, and then designed and implemented a web-based portfolio assessment system for family medicine residents. METHODS: A self-administered questionnaire focusing on the satisfaction and utility of a paperbased portfolio assessment system was given to 23 family medicine residents. A web-based portfolio assessment system was then designed using the component-based development approach. RESULTS: The overall satisfaction and utility with the paper-based portfolio assessment system were low. Fifteen residents (62.5%) reported that following a paper-based portfolio assessment system was sometimes a waste of time and only three (13.0%) reported having no problems. The web-based portfolio assessment system was successfully designed to be easy to implement and user-friendly. CONCLUSION: The web-based portfolio assessment system is expected to overcome the shortcomings of a paper-based portfolio assessment system and improve the level of satisfaction of medical residents. It is expected that the web-based portfolio assessment system designed in this study will be an additional tool for family medicine residencies.

Prevalence of Mental Disorders in Family Practice Centers in Korea and the Utility of a Diagnostic Tool

BACKGROUND: A considerable portion of patients in primary care are thought to have mental disorders in Korea. But they are not easily noticed and are thus underdiagnosed and approached improperly. This study was done to assess the prevalence of common mental disorders in a hospital-based family practice and to evaluate the utility of a diagnostic tool, the Patient Health Questionnaire (PHQ). METHODS: Ten or more patients each day were systematically selected in family practice clinics for two weeks in a university and a community hospital-based family practice clinics in Seoul, Korea. Routine care was delivered as a control during the first week and the PHQ was administered to patients during the second week and the physicians were allowed to review the PHQ just before making clinical decisions. Physicians were asked to answer whether they recognized patients' with mental disorders before reviewing the PHQ. RESULTS: The prevalence of mental disorders was higher in the test group than the control except for eating disorders and other anxiety disorders (P <0.05)(test vs. control group): major depressive disorders 1.75% vs. 3.8%, other depressive disorders 6.8% vs. 11.4%, panic disorders 0.6% vs. 2.3, somatoform disorders 3% vs. 5%, alcohol abuse 2.2% vs. 8.7%, and any mental disorders 20.9% vs. 29.4%. In the test group, the percentage (95% confidence interval in parenthesis) of newly diagnosed mental disorders after physicians' review of the PHQ were 66% (49~82) in major depressive disorders, 70% (50~90) in panic disorders, 70% (56~83) in somatoform disorders, 84% (75~92) in alcohol abuse, and 68% (62~74) in any mental disorders. Patients' response to the PHQ was overall very receptive. CONCLUSION: One-week prevalence of common mental disorders in the hospital-based family practice was 29.4% and the PHQ tool was efficient to help the family physicians recognize hidden mental disorders.