ABSTRACT
BACKGROUND: Posttraumatic stress symptoms (PTSS) in patients with psychological trauma lead to poor health-related quality of life. Understanding of the relationships among PTSS, anxiety, depression, and illness intrusiveness will guide the development of efficient approaches to enhance subjective well-being in patients with psychological trauma. This study investigated whether anxiety and depression mediate the relationship between PTSS and illness intrusiveness in the hope of providing more comprehensive and effective trauma treatment. METHODS: Psychiatric outpatients who visited the trauma clinic of a university hospital (n = 260) participated in this study. Assessments were conducted for PTSS, anxiety, depression, and illness intrusiveness. Structural equation modeling and path analysis were performed to analyze the mediating effects of anxiety and depression on the relationship between PTSS and illness intrusiveness. RESULTS: PTSS had both direct and indirect exacerbating effects on illness intrusiveness. Anxiety exhibited the largest direct exacerbating effect on illness intrusiveness. The indirect effects of PTSS on illness intrusiveness through anxiety alone and through a depression-to-anxiety pathway were significant, but the indirect effect through depression alone was not. CONCLUSION: The findings demonstrate that anxiety, both independently and as part of an interrelated pathway with depression, partially mediates the relationship between PTSS and illness intrusiveness. Appropriate interventions and a comprehensive approach to alleviate anxiety and depression could mitigate the negative effects of PTSS on illness intrusiveness in patients with psychological trauma.
Subject(s)
Humans , Anxiety , Depression , Hope , Negotiating , Outpatients , Psychological Trauma , Quality of LifeABSTRACT
BACKGROUND: Proper education regarding inhaler usage and optimal management of chronic obstructive pulmonary disease (COPD) is essential for effectively treating patients with COPD. This study was conducted to evaluate the effects of a comprehensive education program including inhaler training and COPD management. METHODS: We enlisted 127 patients with COPD on an outpatient basis at 43 private clinics in Korea. The patients were educated on inhaler usage and disease management for three visits across 2 weeks. Physicians and patients were administered a COPD assessment test (CAT) and questionnaires about the correct usage of inhalers and management of COPD before commencement of this program and after their third visit. RESULTS: The outcomes of 127 COPD patients were analyzed. CAT scores (19.6±12.5 vs. 15.1±12.3) improved significantly after this program (p<0.05). Patients with improved CAT scores of 4 points or more had a better understanding of COPD management and the correct technique for using inhalers than those who did not have improved CAT scores (p<0.05). CONCLUSION: A comprehensive education program including inhaler training and COPD management at a primary care setting improved CAT scores and led to patients' better understanding of COPD management.
Subject(s)
Animals , Cats , Humans , Disease Management , Dry Powder Inhalers , Education , Korea , Metered Dose Inhalers , Nebulizers and Vaporizers , Outpatients , Primary Health Care , Pulmonary Disease, Chronic ObstructiveABSTRACT
Menopause is the time at which menstruation stops in women. After menopause, women are more susceptible to some diseases, especially osteoporosis and cardiovascular disease. Vitamin D has a protective effect against osteoporosis by facilitating the absorption of calcium and affecting parathyroid hormone. Vitamin D also affects cardiovascular function by lowering the blood pressure, which affects the renin–angiotensin system and alters the low-density lipoprotein receptor activity. This paper discusses supplemental vitamin D in postmenopausal women with osteoporosis and cardiovascular disease.
Subject(s)
Female , Humans , Absorption , Blood Pressure , Calcium , Cardiovascular Diseases , Menopause , Menstruation , Osteoporosis , Parathyroid Hormone , Receptors, Lipoprotein , Vitamin D , VitaminsABSTRACT
Cerebellar degeneration is a group of diseases that manifests as progressive ataxia, that finally led to death without specific treatment. We report here two patients with cerebellar degeneration, who had shown an improvement and less progressive course, which is associated with panax ginseng intake. Patient 1 was a 60-year-old woman with multisystem atrophy (MSA) type C with 5 year history of ginseng ingestion. Patient 2 was a 54-year-old woman with spinocerebellar ataxia (SCA) type 6, who had a history of ginseng intake for 30 months. Both the patients showed atrophic change in the cerebellum by brain magnetic resonance imaging. Cerebellar functions had been semi-quantified by International Cooperative Ataxia Rating Scale (ICARS) and monitored before and after the ginseng ingestion every 6 to 12 months. In Patient 1 with MSA type C, ICARS had improved from 21 to 17.5 ± 1.8 in the following 5 years. In Patient 2 with SCA, ICARS also showed an improvement from 22 to 6.0 ± 1.0 over 30 months. However, when she stopped taking ginseng, it progressed up to 13 points in two years. These observations provide a potential disease-modifying effect of ginseng on patients with cerebellar degeneration.
Subject(s)
Cerebellar Ataxia , Cerebellar DiseasesABSTRACT
BACKGROUND: The aim of this study was to evaluate the quality of the Second Korean Working Conditions Survey (KWCS), focusing on its validity and reliability. METHODS: The external validity was evaluated by the assessment of sampling procedures and the response rate, in order to investigate the representativeness of the sample. The content validity was evaluated by the assessment of the development of the questionnaire, and the consistency of questions for the selected construct. The test-retest method was used to evaluate the reliability by means of a phone call survey of 30% of the respondents, who were randomly selected. The respondents' satisfaction regarding the survey procedures and interview time were analyzed to evaluate the quality of survey data. RESULTS: The external validity was assured by an acceptable sampling procedure, rigid multi-stage stratified cluster random sampling. The content validity was also guaranteed by a reasonable procedure for the development of the questionnaire with a pretest. The internal consistency of the questions for work autonomy was maintained, with 0.738 of Cronbach's alpha. The response rate of 36% was lower than that of the European Working Conditions Survey (EWCS), with a contact rate of 66%, compared to 76% for the EWCS. The matching rates of the five retested questions were more than 98% reliable. CONCLUSION: The quality of the second KWCS was assured by the high external and content validity and reliability. The rigid sampling procedure and development of the questionnaire contributed to quality assurance. The high level of reliability may be guaranteed by the sophisticated field survey procedures and the development of a technical manual for interviewers. The technical strategies for a high response rate should be developed for future surveys.
Subject(s)
Surveys and Questionnaires , Reproducibility of ResultsABSTRACT
Fibroepithelial polyps are benign soft tissue tumors that occur in a wide variety of sites, including the lower female genital tract. They exhibit a wide range of morphologic appearances and can be misinterpreted as malignant. A 16-year-old woman presented with a 28x27 cm polypoid lesion localized on the right labium. The labial lesion was resected and recurred 6 years following the initial treatment. The histologic findings of the initial and recurrent lesions were consistent with fibroepithelial polyps. We present a case of a fibroepithelial polyp that is larger than any previously described lesion and recurred lesion with a brief review of the literature.
Subject(s)
Adolescent , Female , Humans , Polyps , VulvaABSTRACT
OBJECTIVE: The aim of the present study was to investigate the clinical usefulness of serum CA 125 and CA 19-9 levels for diagnosing and determining the severity of endometriosis. METHODS: A total of 112 women who underwent gynecologic surgery between January 1998 and August 2004 were selected in this study. 81 patients had histologically confirmed endometriosis and the remaining 31 had benign ovarian tumor but no obvious evidence of endometriosis. Blood samples were collected in all patients before the operation and the mean values and standard deviations of both serum CA 125 and CA 19-9 levels were measured in various stages of disease. Both tumor markers were also measured in the control group. The results were compared to determine the usefulness of CA 125 and CA 19-9 in diagnosing and predicting the severity of endometriosis. As a results, new cutoff values of serum CA 125 and CA 19-9 in endometriosis were obtained. RESULTS: The mean levels of serum CA 125 and CA 19-9 in patients at stage III and IV of endometriosis were significantly higher than in patients without endometriosis, and increased in accordance with the advancement of the clinical stage. Statistically appropriate cutoff values of CA 125 and CA 19-9 were calculated to be 20 IU/mL and 10 IU/mL, respectively. The sensitivity and specificity of CA 125 at this cutoff value for endometriosis were 72% and 71%, respectively. The sensitivity and specificity were 59% and 55% respectively in the case of CA 19-9. CONCLUSION: CA 125 is a useful marker for diagnosing and determining the severity of endometriosis. CA 19-9 shows limitation in diagnosing endometriosis, but is indeed a potential marker in predicting the severity of disease.
Subject(s)
Female , Humans , Endometriosis , Gynecologic Surgical Procedures , Sensitivity and Specificity , Biomarkers, TumorABSTRACT
OBJECTIVE: Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders complicating pregnancy. It is associated with adverse outcomes of pregnancy including obstetrical complications such as increased rate of cesarean section, preeclampsia, and birth trauma, and perinatal morbidities, such as macrosomia, hypoglycemia, hypocalcemia, and hyperbilirubinemia. Therefore, screening for gestational diabetes mellitus and early diagnosis of this condition allows intervention to be carried out, thereby, the reduction of the untoward effects mentioned above can be minimized. But selective screening based on clinical or historic risk factors has been reported ineffective to identify the women with GDM. BACKGROUND: Circulating sex hormones have a role in the development of insulin resistance associated with certain physiological states including hyperandrogenism and polycystic ovary syndrome. Throughout pregnancy, normal human pregnancy is a hyperestrogenic state of major proportions. To evaluate the clinical correlation between Gestational diabetes mellitus and unconjugated estriol, we used it to screening protocol using three biochemical markers for unconjugated estriol levels. METHODS: In our retrospective between January 2002 and December 2003 at Korea university medical center, 137 women were screened for three biochemical tests and 50 gm Glucose challenge test at second trimester of pregnancy. The 50 gm GCT positive (n=56) women were performed 100 gm oral glucose tolerance test and by NDDG diagnosic criteria, women were diagnosed as Gestational diabetes mellitus (n=42). RESULTS: With logistic regression analysis, the significant risk factors were family history of DM (odd ration 16.59 95% CI 2.66-103.52), previous macrosomia birth (odd ratio 9.02 95% CI 1.98-41.6), maternal BMI (odd ratio 1.29 95% CI 1.09-1.49), parity (odd ratio 0.31 95% CI 0.11-0.83), glucosuria (odd ratio 0.68 95% CI 0.26-1.76) and among three biochemical test, estriol (odd ratio 1.60 95% CI 0.49-5.27), AFP (odd ratio 1.35 95% CI 0.35-5.28), hCG (odd ratio 0.59 95% CI 0.27-1.28). CONCLUSION: The screening test of GDM would be preferable and intensified management approach needed for patients with obesity, previous macrosomia birth. In three biochemical test, estriol and AFP levels were elevated in GDM but these odd ratio were not statistically significant.
Subject(s)
Female , Humans , Pregnancy , Academic Medical Centers , Biomarkers , Cesarean Section , Diabetes, Gestational , Early Diagnosis , Estriol , Glucose , Glucose Tolerance Test , Gonadal Steroid Hormones , Hyperandrogenism , Hyperbilirubinemia , Hypocalcemia , Hypoglycemia , Insulin Resistance , Korea , Logistic Models , Mass Screening , Obesity , Parity , Parturition , Polycystic Ovary Syndrome , Pre-Eclampsia , Pregnancy Trimester, Second , Retrospective Studies , Risk FactorsABSTRACT
OBJECTIVE: The aim of this study was to evaluate the predictive factors of residual disease for positive conization margins. METHODS: Retrospective study was performed in 735 patients treated with bovie electroknife conization at the University Hospital of Kuro between January, 1988 and December, 2003. Of the 735 patients, 81 patients (11.0%) had positive margins after conization. 58 of these 81 patients underwent either immediate reoperation or monitoring with a Pap smear, HPV test, endocervical curettage and colposcopy. Fisher exact test, Trend test were used for statistical analysis. RESULTS: The mean age of the patients was 44.5 years. 27 of 58 patients (46.6%) undergoing conization followed by reoperation had residual lesion in the specimen obtained by reoperation. Severity of lesion was associated with the predictive factors of residual disease (p<0.05). Age of patients, site of resection margins were not associated with the predictive factors of residual disease. But more sufficient number of cases of Pap smear, HPV test, endocervical curettage and colposcopy directed biopsy are thought to be needed for stastistical analysis. CONCLUSION: Severity of lesion is useful in predicting residual disease for positive conization margins.
Subject(s)
Humans , Biopsy , Colposcopy , Conization , Curettage , Reoperation , Retrospective StudiesABSTRACT
Uterine artery ligation or embolization is a minimally invasive alternative for treatment of symptomatic leiomyoma. However, the experience with pregnancy management and outcome after ablating uterine blood flow is still unknown. We have recently experienced a case of a woman who had two successful spontaneous intrauterine pregnancies after laparoscopic uterine artery ligation to treat uterine myoma for dysmenorrhea and menometrorrhagia.
Subject(s)
Female , Humans , Pregnancy , Dysmenorrhea , Leiomyoma , Ligation , Myoma , Uterine ArteryABSTRACT
OBJECTIVE: It is widely believed that pregnancy accounts for a significant impact upon maternal as well as fetal health. Nevertheless, the correlation between pregnancy and cerebrovasular disease has not been fully understood due to few data available in Republic of Korea. METHODS: We have reviewed clinical diagnosis and impressions of 7,879 patients who were admitted inpatients to the Korea University Anam Hospital either for delivery or for pregnancy between 1995 and 2000, retrospectively. Four identified as patients with cerebrovascular disease were analyzed with medical records, results of blood tests and radiologic tests, as well as neurologic findings. RESULTS: In 4 patients with cerebrovascular diseases, we found 2 subarachnoid hemorrhages, 1 intracranial hemorrhage, and 1 cerebral infarction. Among 7,879 inpatients, the incidences of subarachnoid hemorrhage, intracranial hemorrhage, and cerebral infarction were 0.03%, 0.01%, and 0.01% respectively. CONCLUSION: In our study, the incidence of cerebrovascular disease during pregnancy was as low as 0.05%. But cerebrovascular disease was related to maternal and fetal health, therefore much attention should be focused on the precise evaluation of the pregnancy with cerebrovascular disease.
Subject(s)
Humans , Pregnancy , Cerebral Infarction , Diagnosis , Hematologic Tests , Hemorrhage , Incidence , Inpatients , Intracranial Hemorrhages , Korea , Medical Records , Neurologic Manifestations , Republic of Korea , Retrospective Studies , Subarachnoid HemorrhageABSTRACT
OBJECTIVE: To determine whether gene expressions of VEGF and PlGF are different between the human placenta of normal and abnormal pregnancy. METHODS: Placenta was collected at each trimester of normal pregnancy, missed abortion, intrauterine growth retardation and pre-eclampsia. Total RNA was extracted from placenta. Reverse transcription-polymerase chain reaction(RT-PCR) was performed using VEGF and PlGF primer. RESULTS: VEGF121, VEGF165 and VEGF189 were identified in normal pregnancy and missed abortion. In two cases of four IUGR and one case of three pre-eclampsia, four of isoforms (VEGF121, VEGF145, VEGF165, and VEGF189) were identified. The intensity of signal was strongest for VEGF165 in all cases. PlGF131 and PlGF152 were identified in all cases. However, the signal intensities of VEGF121, VEGF165, VEGF189, PlGF131 and PlGF152 were not different according to the gestational age. They were also not different between normal pregnancy and abnormal pregnancy. CONCLUSION: VEGF and PlGF were not only expressed at placenta but also overexpressed in part of IUGR and pre-eclampsia. The results suggest that VEGF may play a role in the induction of angiogenesis of placenta in normal pregnancy and its production may be increased under the hypoxic condition.
Subject(s)
Female , Humans , Pregnancy , Abortion, Missed , Fetal Growth Retardation , Gene Expression , Gestational Age , Placenta , Pre-Eclampsia , Protein Isoforms , RNA , Vascular Endothelial Growth Factor AABSTRACT
The purpose of this study was to investigate pregnancy, abortion and delivery rates among Korean teenagers. The subjects of this study were 11,433 teenagers aged 13-19 year in Seoul, Pusan, Taegu, Kwangju, Insheon, Taejeon and Ansan, Korea. Data were collected from Feb. 1994 to May 1995, 16 months, by schoolnurses or the researchers. The results showed pregnancy rate was 7.2 per 1,000 teenagers, the abortion rate was 4.3 per 1,000 teenagers, and delivery rate was 1.2 per 1,000 teenagers. In the pregnancy experience, the main factors related to teenage pregnancy were love or marriage engagement. In the abortion experience, 53.9% of teenagers had more than two abortion experiences, 38.1% midtrimester abortion, 22% complications after abortion. In the delivery experience, 64.3% of teenagers delivered with no prenatal care and 42.9% had a delay in realizing they were pregnant. Fifty percent were delivered by non-professionals in non-medical institutions.
Subject(s)
Adolescent , Female , Humans , Pregnancy , Abortion, Induced , Birth Rate , Korea , Love , Marriage , Pregnancy in Adolescence , Pregnancy Rate , Pregnancy Trimester, Second , Prenatal Care , SeoulABSTRACT
Acute fatty metamorphosis is a rare but potentially fatal complication of the third trimester of pregnancy. In 20~40% of cases, acute fatty metamorphosis is associated with preeclampsia and may be difficult to distinguish from preeclamptic liver involvement. Recent reports suggest that the mortality has decreased to 25% fo both mother and fetus, due to largely to early delivery and to the recognition of a higher proportion of mild and nonfatal cases. We experienced one case of acute fatty liver metamorphosis that caused fulminant hepatitis and complete resolution, so we report the case and review of literature briefly.