Comprehensive geriatric assessment for the evaluation of the health statuses of elderly patients

For elderly patients with many chronic and degenerative diseases (multiple comorbidities) and geriatric syndromes, chronic and complex problems should be comprehensively evaluated. The comprehensive geriatric assessment (CGA) is an evaluation of elderly patients in which clinical, medical, and functional evaluations are performed together.Current Concepts: Components of CGA include physical, psychological, and socioenvironmental content. In the physical aspect, the presence of various diseases, determination of the severity of each disease, multi-drug intake (polypharmacy), and vaccination records are evaluated. Geriatric syndromes should also be included in the evaluation. The functional evaluation comprises visual acuity, hearing, upper and lower extremity function, gait ability, balance, fall, urinary incontinence, weight change, oral health, nutritional status, and pain. In the psychological aspect, depression and cognitive function status are evaluated. The residential environment, degree of familial and social support, economic status, and advanced medical directives are evaluated in the socioenvironmental aspect.Discussion and Conclusion: Elderly patients with functional disabilities should be screened via the CGA for various problems and geriatric syndromes that the elderly are prone to developing. Problems found require further evaluation, treatment, and management. In this way, the health and quality of life of the elderly can be maintained and improved.

Clinical Practice Guidelines for Managing Frailty in Community-Dwelling Korean Elderly Adults in Primary Care Settings / 가정의학회지

Aging has become a global problem, and the interest in healthy aging is growing. Healthy aging involves a focus on the maintenance of the function and well-being of elderly adults, rather than a specific disease. Thus, the management of frailty, which is an accumulated decline in function, is important for healthy aging. The adaptation method was used to develop clinical practice guidelines on frailty management that are applicable in primary care settings. The guidelines were developed in three phases: preparation (organization of committees and establishment of the scope of development), literature screening and evaluation (selection of the clinical practice guidelines to be adapted and evaluation of the guidelines using the Korean Appraisal of Guidelines for Research and Evaluation II tool), and confirmation of recommendations (three rounds of Delphi consensus and internal and external reviews). A total of 16 recommendations (five recommendations for diagnosis and assessment, 11 recommendations for intervention of frailty) were made through the guideline development process. These clinical practice guidelines provide overall guidance on the identification, evaluation, intervention, and monitoring of frailty, making them applicable in primary care settings. As aging and “healthy aging” become more and more important, these guidelines are also expected to increase in clinical usefulness.

Association between Dietary Protein Intake and Serum High-Sensitivity C-Reactive Protein Level in the Korean Elderly with Diabetes: Based on the Korea National Health and Nutrition Examination Survey 2016–2018

Background@#Studies have shown that adequate protein intake (API) in patients with diabetes is associated with a reduction in cardiovascular risk factors. High-sensitivity C-reactive protein (hs-CRP) has emerged as a new screening test to predict the risk of cardiovascular disease. This study aimed to investigate the association between protein intake and hs-CRP levels in elderly Korean patients with diabetes. @*Methods@#Data were derived from the Seventh Korea National Health and Nutrition Examination Survey (2016–2018). Participants included 889 adults aged 65 years or older with diabetes. They were grouped by dietary protein intake per body weight (g/kg BW) into a low protein intake group (LPI, <1.0 g/kg BW) and adequate protein intake group (API, ≥1.0 g/kg BW). Multiple linear regression analysis was performed to determine the association between protein intake and hs-CRP levels. @*Results@#The mean hs-CRP level was significantly higher in the LPI group than in the API group (1.3±1.6 mg/L vs. 1.0±1.0 mg/L). In model 1, which was adjusted for age, sex, body mass index, and waist circumstance, hs-CRP was decreased by 7.8% (P=0.024) in the API group compared to that in the LPI group. In model 3, which was additionally adjusted for smoking, systolic blood pressure, fasting glucose, total cholesterol, triglyceride, and highdensity lipid cholesterol, hs-CRP was decreased by 7.1% in the API group compared to that in the LPI group (P=0.036). @*Conclusion@#There was a significant negative correlation between protein intake and hs-CRP in elderly Korean patients with diabetes. Therefore, this study provides some evidence that adequate protein intake should be recommended to reduce cardiovascular risk in elderly patients with diabetes.

Variabilities in Weight and Waist Circumference and Risk of Myocardial Infarction, Stroke, and Mortality: A Nationwide Cohort Study

Background@#Evidence regarding the association between variabilities in obesity measures and health outcomes is limited. We aimed to examine the association between variabilities in obesity measures and cardiovascular outcomes and all-cause mortality. @*Methods@#We identified 4,244,460 individuals who underwent health examination conducted by the Korean National Health Insurance Service during 2012, with ≥3 anthropometric measurements between 2009 and 2012. Variabilities in body weight (BW) and waist circumference (WC) were assessed using four indices including variability independent of the mean (VIM). We performed multivariable Cox proportional hazards regression analyses. @*Results@#During follow-up of 4.4 years, 16,095, 18,957, and 30,200 cases of myocardial infarction (MI), stroke, and all-cause mortality were recorded. Compared to individuals with the lowest quartiles, incrementally higher risks of study outcomes and those of stroke and all-cause mortality were observed among individuals in higher quartiles of VIM for BW and VIM for WC, respectively. The multivariable adjusted hazard ratios and 95% confidence intervals comparing the highest versus lowest quartile groups of VIM for BW were 1.17 (1.12 to 1.22) for MI, 1.20 (1.16 to 1.25) for stroke, and 1.66 (1.60 to 1.71) for all-cause mortality; 1.07 (1.03 to 1.12) for stroke and 1.29 (1.25 to 1.33) for all-cause mortality regarding VIM for WC. These associations were similar with respect to the other indices for variability. @*Conclusion@#This study revealed positive associations between variabilities in BW and WC and cardiovascular outcomes and allcause mortality. Our findings suggest that variabilities in obesity measures are associated with adverse health outcomes in the general population.

Variabilities in Weight and Waist Circumference and Risk of Myocardial Infarction, Stroke, and Mortality: A Nationwide Cohort Study

Background@#Evidence regarding the association between variabilities in obesity measures and health outcomes is limited. We aimed to examine the association between variabilities in obesity measures and cardiovascular outcomes and all-cause mortality. @*Methods@#We identified 4,244,460 individuals who underwent health examination conducted by the Korean National Health Insurance Service during 2012, with ≥3 anthropometric measurements between 2009 and 2012. Variabilities in body weight (BW) and waist circumference (WC) were assessed using four indices including variability independent of the mean (VIM). We performed multivariable Cox proportional hazards regression analyses. @*Results@#During follow-up of 4.4 years, 16,095, 18,957, and 30,200 cases of myocardial infarction (MI), stroke, and all-cause mortality were recorded. Compared to individuals with the lowest quartiles, incrementally higher risks of study outcomes and those of stroke and all-cause mortality were observed among individuals in higher quartiles of VIM for BW and VIM for WC, respectively. The multivariable adjusted hazard ratios and 95% confidence intervals comparing the highest versus lowest quartile groups of VIM for BW were 1.17 (1.12 to 1.22) for MI, 1.20 (1.16 to 1.25) for stroke, and 1.66 (1.60 to 1.71) for all-cause mortality; 1.07 (1.03 to 1.12) for stroke and 1.29 (1.25 to 1.33) for all-cause mortality regarding VIM for WC. These associations were similar with respect to the other indices for variability. @*Conclusion@#This study revealed positive associations between variabilities in BW and WC and cardiovascular outcomes and allcause mortality. Our findings suggest that variabilities in obesity measures are associated with adverse health outcomes in the general population.

Association between Body Fat and Bone Mineral Density in Normal-Weight Middle-Aged Koreans / 가정의학회지

BACKGROUND: Osteoporosis and osteopenia are characterized by reduced bone mineral density (BMD) and increased fracture risk. Although the risk of fractures is higher in underweight people than in overweight people, the accumulation of body fat (especially abdominal fat) can increase the risk of bone loss. This study aimed to evaluate the association between body fat percentage and BMD in normal-weight middle-aged Koreans. METHODS: This study included 1,992 adults (mean age, 48.7 years; 52.9% women). BMD and body fat were measured using dual-energy X-ray absorptiometry. Multiple linear regression analyses and analysis of covariance were used to assess the association between BMD and body fat. Body fat percentage was grouped by cut-off values. The cut-off values were 20.6% and 25.7% for men with a body mass index of 18.5–22.9 kg/m2, while the cut-off values were 33.4% and 36% for women. RESULTS: Body fat percentage tended to be negatively associated with BMD. Increased body fat percentage was associated with reduced BMD in normal-weight middle-aged adults. The effects of body fat percentage on BMD in normal-weight individuals were more pronounced in men than in women. CONCLUSION: There was a negative correlation between BMD and body fat percentage in middle-aged Korean men and women with normal body weight. This association was stronger in men than in women.

Association between Serum Selenium Level and the Presence of Diabetes Mellitus: A Meta-Analysis of Observational Studies

BACKGROUND: Epidemiological studies have suggested an association between selenium (Se) and diabetes mellitus (DM). However, different studies have reported conflicting results. Therefore, we performed a comprehensive meta-analysis to clarify the impact of Se on DM. METHODS: We searched the PubMed database for studies on the association between Se and DM from inception to June 2018. RESULTS: Twenty articles evaluating 47,930 participants were included in the analysis. The meta-analysis found that high levels of Se were significantly associated with the presence of DM (pooled odds ratios [ORs], 1.88; 95% confidence interval [CI], 1.44 to 2.45). However, significant heterogeneity was found (I2 =82%). Subgroup analyses were performed based on the Se measurement methods used in each study. A significant association was found between high Se levels and the presence of DM in the studies that used blood (OR, 2.17; 95% CI, 1.60 to 2.93; I2 =77%), diet (OR, 1.61; 95% CI, 1.10 to 2.36; I2 =0%), and urine (OR, 1.49; 95% CI, 1.02 to 2.17; I2 =0%) as samples to estimate Se levels, but not in studies on nails (OR, 1.24; 95% CI, 0.52 to 2.98; I2 =91%). Because of significant heterogeneity in the studies with blood, we conducted a sensitivity analysis and tested the publication bias. The results were consistent after adjustment based on the sensitivity analysis as well as the trim and fill analysis for publication bias. CONCLUSION: This meta-analysis demonstrates that high levels of Se are associated with the presence of DM. Further prospective and randomized controlled trials are warranted to elucidate the link better.

The Relationship between Hyperuricemia and Triglyceride Glucose Index: Based on 2016 Korean National Health and Nutrition Examination Survey

BACKGROUND: Hyperuricemia refers to an excess of uric acid in the blood and is associated with gouty arthritis, hypertension, metabolic syndrome, atrial fibrillation, kidney stones, insulin resistance (IR), and type 2 diabetes mellitus. Previous studies have used the homeostatic model assessment of IR (HOMA-IR), a well-known index of IR, to investigation the correlation between serum uric acid levels and IR. However, difficulty with measuring insulin levels limits the clinical applicability of the HOMA-IR index. This study investigated the correlation between hyperuricemia and the triglyceride glucose (TyG) index.METHODS: We used data from the Seventh Korea National Health and Nutrition Examination Survey, 2016. The study population included adults without diabetes aged >19 years. The TyG index, which serves as an indicator of IR, was calculated using fasting serum glucose and triglyceride levels to investigate the correlation between the TyG index and hyperuricemia. Pearson's correlation coefficient and analysis of covariance were used for statistical analysis, which was performed using IBM SPSS software.RESULTS: A statistically significant correlation was observed between serum uric acid levels and the TyG index. After adjustment for factors that may affect IR (age, body mass index, waist circumference, and systolic and diastolic blood pressures), we observed that the TyG index was significantly higher in the hyperuricemia than in the non-hyperuricemia group (8.96 vs. 8.54, P < 0.001).CONCLUSION: Serum uric acid levels were significantly correlated with IR assessed using the TyG index in adults without diabetes aged >19 years.

Relationship between Abdominal Obesity and Proportion of Supper and Late-night Meals

BACKGROUND: Obesity is a serious problem, and there have been various studies to elucidate its causes. This study aims to evaluate the relationship between obesity and proportion of supper and late-night meals among the Korean general population. METHODS: The total analyzed population was 15,757 people (mean age 44.6 years). The criterion for abdominal obesity as defined by waist circumference was follows: men ≥90 cm, women ≥85 cm. Supper and late-night meals are defined as meals eaten between 6:00 p.m. and 2:00 a.m. Calories of supper and late-night meal were divided by the total calorie intake of the day and categorized into quintiles. Various variables that can affect obesity were corrected for in the model, and logistic regression models were used to confirm the relationship between supper and late-night meals and waist circumference. RESULTS: Comparing the first quintile to the second, the third, and the fifth showed statistically significant results (Odds ratio: 1.19, 1.25, and 1.21, respectively). We also compared the breakfast group and the no breakfast group. Only the breakfast group showed statistically significant results (Odds ratio: 1.28, 1.30, 1.22, and 1.21, respectively). CONCLUSION: Risk of abdominal obesity will be decreased if one reduces the proportion of supper and late-night meals to half of the recommended calorie intake.

Beta-glucan for Glycemic Control Effects in Adults: a Meta-analysis

BACKGROUND: Recently, there has been an increase of emerging concerns between dietary fiber and diabetics. Increasing intake of dietary fiber leads to delaying absorption of glucose, and lowering of serum insulin levels. In the past studies, there were inconsistent glycemic control effect of beta-glucan. Our purpose was to assess the glycemic control effect of beta-glucan in adults. METHODS: Electronic searches (Cochrane, PubMed, EMBase), hand-searching and review of reference were done. The search term for beta-glucans [mh], "Avena sativa" [mh], "Hordeum" [mh], beta glucan* [tw], oat [tw], barley [tw], with no language restriction were used. All RCT that included available data of beta-glucan or that could impute dose of beta-glucan, at least one relevant outcome of glycemic control, run-in period more than 2 weeks, and intervention period of more than 2 weeks or greater were selected. A fixed-effect model was used to assess the summary effect of studies. RESULTS: A total of 43 articles were identified, 4 studies met our inclusion criteria and then analyzed. In pooled analysis, the effect size of fasting glucose level was 0.13 (95%CI: -1.25 to 1.51), and serum insulin level was -0.95 (95%CI, -2.37 to 0.47). It was impossible to adjust for sex and age owing to the lack of raw data. CONCLUSION: In this review, the results suggested that there were negative impacts of beta-glucan on fasting glucose and serum insulin level in adults, but we concluded that there was insufficient evidence to confirm about glycemic control effect. More powerful and well-designed RCT were required to confirm about glycemic control effect of beta-glucan.

Preferences for Addressing Title to Patients and Physicians' Attire in a Medical Office

BACKGROUND: Most patients feel uneasy about visiting a clinic and thus the trust on their physicians can be affected by the physicians' attire, attitude and greeting. We aimed to investigate the difference between patients' and physicians' preferences to attires and greetings in clinics. METHODS: We conducted a questionnaire survey on 394 outpatients in a university hospital and on 169 doctors from five university hospitals. We questioned to the outpatients about their preference for physicians' dress style, how to address them and the method of greeting. We also questioned to the doctors about their own attire, attitude and etiquette. RESULTS: The patients preferred to be called 'OOO Nim' (54.0%), 'OOO Ssi' (29.2%), 'Hwanjabun' (16.2%) and 'Sunsaengnim' (2.5%). However, the physicians were used to calling patients 'Hwanjabun' (39.2%), 'OOO Nim' (29.6%), 'OOO Ssi' (24.5%) and 'Sunsaengnim' (1.2%) (P<0.001). Both the patients and the physicians preferred physicians'to wear white-gown (70.3% vs 78.7%) in a medical office. Inside the gown, a shirt and a necktie (66.2% vs 71.6%) were favored in both groups. Compared to the patients, the physicians thought that their attitude (23.1% vs 45.6%) and their attire (49.7% vs 55.6%) had a great effect on their professionalism. CONCLUSION: We found that the patients wanted to be called 'OOO Nim', but 'Hwanjabun' was most commonly used by the physicians. Both the patients and the physicians preferred white-gown. We also found that the physicians' attire and attitude were strongly associated with their professionalism.

Primary Pulmonary Ewing's Sarcoma/Primitive Neuroectodermal Tumor in a 67-year-old Man

Extraskeletal Ewing's sarcoma (EES) is a branch of neuroectodermal tumor (PNET), which is very rare soft tissue sarcoma. We report a case of EES/PNET arising is the lung of a 67-yr-old man. Computed tomography, bone scintigraphy, and positron emission tomography confirmed the mass to have a primary pulmonary origin. The mass showed positive reactivity in the Periodic Acid Schiff (PAS) stain and MIC-2 immunoreactivity in immunohistochemical stain. Fluorescence in situ hybridization (FISH) was performed, which revealed an EWSR1 (Ewing sarcoma breakpoint region 1) 22q12 rearrangement. The diagnosis was confirmed both pathologically and genetically. The mass lesion was resected, and the patient is currently undergoing chemotherapy.

Clinical Assessment of Aging

There are two ways to assess aging: to evaluate the function and to estimate the biological age. The biological age is estimated objectively by measuring the level of biological aging, taking apart with disease. It is measured with some biomarkers, which reflect the change of organ function and body with aging. It is, however, difficult to use in clinical practice. The evaluation of function is more practical and easier to clinicians. The parameters used include Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), and Mini-Mental Status Examination (MMSE) to evaluate the level of cognitive function. Balance test, standing up from chair, and walking pace can be checked to evaluate the physical function. Each method has its own limitations in evaluating the degree of aging precisely.

Biomedical Issues of Dietary fiber beta-Glucan

beta-Glucan is a polysaccharide in the form of fiber and the main element of fiber in grains such as barley, oats, yeast and mushrooms. Many studies have examined the efficacy of beta-Glucan in terms of the lipid lowering effects, blood sugar reduction, weight reduction, immune modulator, and anticarcinogenic effect. However, there is no comprehensive review article on the biomedical issues regarding beta-Glucan. The authors searched for systematic reviews and clinical experiments for each relevant topic and reviewed the biomedical effects of beta-Glucan, for the purpose of developing research strategies for the future.

The Analysis of the Articles Published in Journal of the Korean Geriatrics Society

Background: We thought that it is needed to look over the past issues in the Korean Geriatrics Society Articles, in order to assure that it is proper as an academic journal of geriatrics. We scrutinized the articles published in the Journal of the Korean Geriatrics Society. Methods: We analyzed 20 volumes of Journal of the Korean Geriatrics Society, published from 2001 to 2005. We counted the number of review articles, original articles and case reports by year. We classified articles as geriatric principles, basic sciences, and clinical studies, which were classified again by subjects as understanding of geriatrics and elderly patients, problem common in elderly people, and clinical trial. We stratified articles by the research methods, such as descriptive, analytical(cross-sectional, case-control, and cohort study), and investigational study. Results: Journal of the Korean Geriatrics Society was published in every three months. For 5 years, 191 articles were published, which included 27 review articles(14.1%), 130 original articles(68.1%), and 34 case reports(17.8%). They were dealing with the geriatric principles in 51, basic science in 13, and clinical study in 93 articles respectively. By subjects, 64 articles(33.4%) worked on understanding of geriatrics and elderly patients, and many original articles were related with the cardiovascular and neurological system. Neurological diseases were most common in case reports. There were 40 descriptive(30.8%), 82 analytical(64.0%: cross-sectional 43.1%, casecontrol 19.2%, cohort 0.7%), and 8 investigational studies(6.2%). Conclusion: The proportion of original articles was highest in Journal of the Korean Geriatrics Society. A third of all articles were relevant to geriatrics original, and two thirds were analytical, which were thought to be proper as an academic journal of geriatrics.

The Factors Associated with the Selection of a Regular Doctor

BACKGROUND: The rapid increase in population of old people has been emphasized as a serious social problem even in medical world. Geriatric disease has special characters that can be mentioned as a non-contagious chronic degenerative disease. 'Regular Doctor System' can be considered as one of the efficient ways to care for it continuously. The purpose of this study was to promote the introduction of family doctor system gradually and care of geriatric disease through examination of old people's thinking about 'Regular Doctor System'. METHODS: The result of this study was based on the questionnaire survey on 292 old people(aged 65 and more, response rate 73%) at 2 welfare centers in Seoul, located at Yeongdeungpo-gu and Guro-gu, and 1 college for old people, for 2 weeks from May, 2003. The contents of surveywere consisted of many questions for understanding of old people's thinking about 'Regular Doctor System'. The response method was self-reported. RESULTS: Comparing with other age group surveys, this old people's survey has special character that it has higher affirmative answer rate for the question of 'Do you have a regular doctor?'. The old people's favorite natures of regular doctor were considerateness( 26.9%) and kindness(26.2%). And the most desirable service from their regular doctor was comprehensive health examination( 45.2%). The factors reflecting on selecting of doctor were separately questioned into two aspects, as factors related to doctor's behavior and the others. Among the factors related to doctor's behavior, the effect of medical treatment(22.7%) was top ranked and 'being aware of my disease'(17.3%), 'easy explanation'(15.5%) were followed. The other factors were medical specialty(24,1%), easy access(19.3%) and short waiting time(10.5%). The reasons for changing of doctor were 'to receive specialist's medical treatment'( 37.2%), 'no improvement of patient's condition'(13.1%) and 'distrust of diagnosis'(9.0%). CONCLUSION: The old people wanted considerate and kind attitude from their doctors. The factors, related to doctor's behavior that the old people wanted, were 'good effect of medical treatment', 'being aware of my disease well' and 'easy explanation'. The other factors they wanted were medical specialty, easy accessibility and short waiting time.

QTc Interval Prolongation with Increasing Body Mass Index

BACKGROUND: Prolongation of the QTc interval is a risk factor for ventricular tachycardia, ventricular fibrillation, especially torsades de pointes, and sudden death. It is associated with increasing age, female sex, some of antiarrhythmic drugs, tricyclic antidepressants, and conditions such as hypokalemia, hypothermia, subarachnoid hemorrhage, congenital long QT syndrome. Earlier studies reported lengthening of the QTc interval with increasing body mass index (BMI) and intra-abdominal fat. But no such reports exist in Korea. Therefore, we determined the relationship between BMI and the QTc interval. METHODS: The study population consisted of 372 persons who undertook periodic health examination in a university hospital between September and December 1998. BMI and standard 12-lead electrocardiogram were measured in all subjects. Excluding 4 patients who had arrhythmia where QTc interval could not be calculated, the QT interval was measured in the electrocardiogram of 368 subjects. The QT interval was measured in the leads that showed the longest interval for three consecutive beats and then were averaged. Correlation between the calculated QTc interval and BMI was examined. The QTc interval difference according to sex and obesity was also analyzed. RESULTS: Among 368 subjects, there were 197 men (54%) and 171 women (46%). The mean ages were 44.5 years for men and 47.6 for women. The BMI was 23.8 3.13 (mean SD). Obese subjects with BMI above 27 kg/m2 totalled 61 (17%), including 31 men and 30 women. The QTc interval was 399 25 msec (mean SD), and the subjects showed prolonged QTc intervals of 24 (12 men and 12 women). There was a statistically significant correlation between BMI and QTc interval (r=0.135, P=0.0094), and the obese subjects were found to have a longer QTc interval than the nonobese controls. Women also had a longer QTc interval than men. CONCLUSION: There was a significant correlation between BMI and QTc interval, and longer QTc interval was observed in obese patients. The QTc interval should be considered when analyzing electrocardiogram of obese patients.

Factors related to the follow-up of class II patients on the pap smear

BACKGROUND: Cervical cancer is the second most commonly diagnosed cancers in women and is responsible for about 14 percent of all female cancer found in Korean women. Early detection is very important because the likelihood of a complete cure is greater, and among the early screen only tools to detect cervical cancers, a Pap smear is most widely used. It has the clinical significance to follow - up patients whose results are classified as class II in their Pap smear. Thereto we tried to find the factors associated with follow-up in class II patients. METHODS: On Pap smear practiced from Jan. 1, 2000 to Dec. 31 in a University Hospital, 159 patients Pap smear results were categorized as class II, and among the 159 patients, we were able to collect data from 107 patients who voluntarily answered a phone survey. The categories in the survey were the followings : follow- up for the Pap smear, age, age of marriage, presence of menopause, age of menopause, occupation, family history of chronic diseases or cancers, educational level, presence of concomittant diseases, income, average hospital visit frequency in a year, belief of general health, and reason for doing follow- up and reason for not doing it. RESULTS: Among 107 patients, only 62 patients (57.9 Percent) did follow-up for their Pap smear results. The reasons were doctors follow-up recommendation for Pap smear results and regular health check-up, and the two main reasons not doing follow-up were nonexistence of further symptom and financial distress. In a single variable analysis, the higher educational level, individual income, and hospital visit frequency, the more People had follow-up. But in multiple logistic anarsis, only individual income was statistically significant. CONCLUSION: The follow-up rate was as low as 57.9 percent, and the reasons why they did not follow-up were mainly the lack of understanding about the clinical significance of class II result on the Pap smear. Therefore, an advertisement and public education Programs to general public about cervical cancer will make more patients follow up their result on the Pap smear, especially to the low income and low education class people.

Antibiotics prescription pattern of family practitioners for respiratory tract infections

BACKGROUND: Antibiotics are often indiscriminately prescribed for respiratory tract infections. This study was conducted to describe the prescription pattern of family physicians for respiratory tract infections. METHODS: In each clinic of 50 representative family practitioners, about 20 consecutive patients with diagnosis of respiratory tract infection were enrolled into the study. The data were collected by questionnaire to physicians just after patient interview. RESULTS: The number of study subjects was 1020, of which 55.7% was less than 15 year old. Antibiotics were prescribed to 73.9% of total subjects. According to diagnosis, the antibiotic prescription rate was 51.5% in common cold, 86.0% in pharyngitis, 88.6% in bronchitis, 98.9% in sinusitis, and 100% in otitis media. In common cold, the factors which significantly increased the antibiotic prescription were 1)patient age less than 15 year old (OR=1.70, CI=1.06-2.73), 2)more than two visits during the same episode(OR=1.95, CI=1.27-2.99), 3)yellow and thick rhinorrhea(OR=2.22, CI=1.16-4.25), 4)yellow and thick sputum(OR=3.31, CI=1.34-8.19), and 5)throat injection(OR=2.50, CI=1.42-4.39). Among patients to whom antibiotics were prescribed, 48.7% of patients were given the antibiotics by intramuscular injection. The most frequently prescribed antibiotics were penicillin and macroride among per-oral medicine and ribostamycin and lincomycin among intramuscular medicine. The reason for antibiotic prescription were 1)posssibility of bacterial infection(43.4%), 2)prevention of bacterial complication(23.7%), and 3)definite evidence of bacterial infection(22.5%). CONCLUSION: Family practitioners prescribe antibiotics indiscriminately for the respiratory tract infection. The prescription was influence by patient's age, number of clinic-visit, and clinical symptoms and signs.

Diagnostic Utility of a Rapid ICT Tuberculosis Assay for the Diagnosis of Pulmonary Tuberculosis / 대한임상미생물학회지

BACKGROUND: Diagnosis of tuberculosis is more complicated because of low sensitivity and time consuming procedures of the conventional diagnostic methods as well as nonspecific clinical features. Recently the serologic diagnosis of tuberculosis has been reported as one of rapid sensitive and specific methods. We evaluated the ability of a rapid ICT Tuberculosis assay(AMRAD/ICT Diagnostics, Syndey, Australia) to detect pulmonary tuberculosis. METHODS: ICT Tuberculosis assay was performed to the sera from 50 patients with pulmonary tuberculosis (24 patients with smear positive, 26 patients with smear negative) and 105 controls (48 patients without tuberculosis, 57 healthy controls). RESULTS: Antibodies were detected in 22 of 24 (92%) smear positive patients and 22 of 26 (85%) smear negative patients who had been clinically diagnosed as having active pulmonary tuberculosis. Two (4.2%) out of 48 patients without tuberculosis and 1 (1.8%) out of 57 healthy controls had a positive antibody response. The overall sensitivity, specificity, and positive and negative predictive value of the ICT Tuberculosis assay were 88%, 97%, 94%, and 94%, respectively. CONCLUSIONS: The ICT Tuberculosis assay was not only sensitive and specific but also rapid and simple. This assay will be useful as a diagnostic method of pulmonary tuberculosis in combination with sputum smear and X-ray.