Concept, values, current status and prospect of primary care in Korea

Primary care is an essential part of a whole health system. It is the first contact point for medical care in the community, where many people are likely to obtain their own impression of the health system. Primary care has its own attributes, such as first contact, continuity, comprehensiveness, and coordination, which are yardsticks for measuring its excellence. Regarding the value of primary care, many studies have reported extensive evidence of the advantages of primary care at individual and societal levels. Health systems with strong bases of primary care are better than those with weak ones in terms of cost, health outcomes, and quality of care. However, primary care in South Korea has continuously shrunk or been weakened for several decades. As people age and chronic illnesses become prevalent, more attention is being paid to primary care than ever before, and several policy options have been proposed. Therefore, if the medical community wishes to invigorate primary care, it should play a pivotal role in formulating and implementing primary care policies by envisioning primary care, establishing related data infrastructure, and continuing the discussion on long term goals like training primary care physicians.

Standard model and quality appraisal framework for the organization of primary care

During the past several decades, population aging and chronic diseases have been common burdens to nearly all the world's countries. To meet future health care needs, many countries have tried to improve the efficiency and equity of the health care system by reforming primary care. In the UK, which has already achieved a high level of strength in primary care, the Quality and Outcomes Framework (2004) was introduced and a great deal of the National Health Service (NHS) budget has been invested in primary care. In the US, a country with a low level of strength in primary care, to transform primary care practices to model practices, medical home movements such as the Patient-Centered Medical Home (PCMH) have been initiated after the development of the joint principles of the PCMH (2007) by 4 major societies of primary care. In Australia, despite having achieved high levels of health outcomes among the OECD countries, the Practice Incentives Program (PIP) has been introduced to respond to concerns about quality and coordination of care and prevention in 1998. In South Korea, a country with a very weak infrastructure in primary health care, where primary care has never been explicitly defined at the national level, the government is trying to improve quality in chronic care by using small financial incentives. The authors assert that a standard model and a quality appraisal framework for the organization of primary care are necessary to achieve the goals of primary care reform in this country.

Intraparenchymal Sylvian Fissure Meningioma

Meningiomas arise from meningothelial cells that line the arachnoid membrane. So most meningiomas are dural-based lesion. But meningiomas without dural-attachment do occur and are less common. We report our experience of intraparenchymal sylvian fissure menigioma. A 21-year-old female presented with a one-month history of headache that was associated with long-term intermittent partial seizure. CT revealed about 4.5x4.3x5.5cm sized calcified mass with enhancement in right temporal lobe. On MR imaging, the lesion was observed in the right temporal lobe that was low-signal intensity on T2WI and iso-signal intensity on T1WI with well enhancement. Operation was performed via right orbitocranial approach. The internal surface of dura was intact. Tumor was totally removed except the capsule of tumor adhered to main trunk of middle cerebral artery. The histopathology showed meningioma, psammomatous type. Intraparenchymal meningioma should be considered in the differential diagnosis of intraaxial lesions in patients of any age group.

Posterior Atlantoaxial Transarticular Screw Fixation

OBJECTIVE: Posterior arthrodesis in atlantoaxial instability has been performed using various posterior C1-2 wiring techniques. Recently, transarticular screw fixation (TASF) technique was introduced to achieve significant immediate stability of the C1-2 joint complex. The purpose of this study is to assess the clinical outcomes associated with posterior C1-2 TASF for the patient of atlantoaxial instability. METHODS: We retrospectively reviewed data obtained from 17 patients who underwent C1-2 TASF and supplemented Posterior wiring technique (PWT) with graft between 1994 and 2005. There were 8 men and 9 women with a mean age of 43.5 years (range, 12-65 years). An average follow-up was 26 months (range, 15-108 months). RESULTS: Successful fusions were achieved in 16 of 17 (94%). The pain was improved markedly (3 patients) or resolved completely (14 patients). There was no case of neurological deterioration, hypoglossal nerve injury, or vertebral artery injury. Progression of spinal deformity, screw pullout or breakage, and neurological or vascular complications did not occur. CONCLUSION: The C1-2 TASF with supplemental wiring provided a high fusion rate. Our result demonstrates that C1-2 TASF supplemented by PWT is a safe and effective procedure for atlantoaxial instability. Preoperative evaluation and planning is mandatory for optimal safety.

Posterior Atlantoaxial Transarticular Screw Fixation

OBJECTIVE: Posterior arthrodesis in atlantoaxial instability has been performed using various posterior C1-2 wiring techniques. Recently, transarticular screw fixation (TASF) technique was introduced to achieve significant immediate stability of the C1-2 joint complex. The purpose of this study is to assess the clinical outcomes associated with posterior C1-2 TASF for the patient of atlantoaxial instability. METHODS: We retrospectively reviewed data obtained from 17 patients who underwent C1-2 TASF and supplemented Posterior wiring technique (PWT) with graft between 1994 and 2005. There were 8 men and 9 women with a mean age of 43.5 years (range, 12-65 years). An average follow-up was 26 months (range, 15-108 months). RESULTS: Successful fusions were achieved in 16 of 17 (94%). The pain was improved markedly (3 patients) or resolved completely (14 patients). There was no case of neurological deterioration, hypoglossal nerve injury, or vertebral artery injury. Progression of spinal deformity, screw pullout or breakage, and neurological or vascular complications did not occur. CONCLUSION: The C1-2 TASF with supplemental wiring provided a high fusion rate. Our result demonstrates that C1-2 TASF supplemented by PWT is a safe and effective procedure for atlantoaxial instability. Preoperative evaluation and planning is mandatory for optimal safety.

FACES III in the Korean adolescents

BACKGROUND: This study was intended to look into the characteristics and problems when FACES III are used as tools to evaluate family function of adolescents. METHODS: From May to June 1996, self-reported questionnaires for FACES III were conducted on 2,430 middle school and high school students (males:1,190, females:1,240) in Seoul and Yangpyung, Kyunggi-Do. There were eight schools (four middle schools, four high schools) in Seoul and two schools (one middle school, one high school) in Yangpyung, Kyunggi-Do in this study. Also, educational level of parents, occupational status of parents, family types (extended/nuclear), number of family member and numbers of siblings were assessed. RESULTS: The mean values of adaptability were significantly higher in Seoul students, in females, and in nuclear families. The mean values were higher in single sibling than two or more and in parents with higher education. The mean values of cohesion were significantly higher in Seoul students, in middle school students and in family members of 5 and under. The mean values were higher in those without a sibling and in those with above college education. In stepwise regression analysis, educational level of parents, gender, area, occupational status of mother and grade were associated significantly with the mean values of adaptability and educational level of parents, grade and numbers of siblings were significantly associated with the mean values of cohesion. CONCLUSIONS: We consider that there are problems in deciding the cut-off point and in the questionnaires of survey when the FACES III is used as a tool for evaluating family function of adolescents. Trials of combining other tools of family function or consideration of lower concepts are needed in other to be applicable to the individual conversation and the clinical surroundings.

Reliability and validity of Korean templer's death anxiety scale, death depression scale and sense of symbolic immortality scale

BACKGROUND: Means to measure death anxiety, death depression and sense of symbolic immortality with approved validity and reliability does not yet exist in Korea. METHODS: Existing English questionnaires such as Templer Death Anxiety Scale (TDAS), Death Depression Scale (DDS), Sense of Symbolic Immortaligy Scale (SSIS) were translated into Korean by 5 translators, and then reviewed by 3 non-participants of translation for collegial summary and this summary was counter-translated again by another 2 non-participants. Another 3 non-participants of translation and counter-translation were chosen to examine the two sentences of each item. Then reexamination was done by retranslating and counter-translating the parts with errors. Aftr pretest on ordinary people. the completed questionnaires were given to medical students, residents and nurses of a university hospital. Pastors and missionaries were selected as comparison group. RESULTS: Kuder-Richardson or Cronbach-alpha that represent internal consistency of TDAS, DDS and SSIs was 0.69, 0.84 and 0.78. The three sentences that lowered internal consistency of SSIS was deleted. BDI and DDS showed a positive correlation (0.32, P=0.02), suggesting proved construct validity. Correlation coefficient that proves construct validity of TDAS and DDS was 0.54 (P<0.01), of SSIS and TDAS -0.23(P=0.04), of SSIS and DDS -0.29(P=0.01). The TDAS and DDS(P<0.01), DDS and BDI(P=0.02) have shown a positive correlation were shown. There was significant difference in the score of SSIS(P<0.01). The same results in cases where the 3 sentences was deleted. CONCLUSION: Korean versions of TDAS, DDS and SSIS were reliable and valid.