The Frequency and Related Factors of Masked Hypertension among Volunteers

BACKGROUND: 'Masked Hypertension' is a phenomenon of blood pressure that is normotensive by clinic measurement but proves to be hypertensive by 24 hour-AMBP and is associated with many cardiovascular complications and its clinical importance has become the center of public interest. However, in Korea no study concerning masked hypertension has ever been published so far. We investigated the frequency and the related factors of masked hypertension among Koreans. METHODS: Overall, 53 volunteers from Incheon and Seoul, Korea, who were 40 years old and abov were enrolled from August 2003 to August 2004. We checked their blood pressure and pulse rate every hour using an ambulatory blood pressure monitoring device [SpaceLabs 90207] for 24 hours. Masked hypertension was defined as office mean BP less than 140/90 mmHg and daytime mean BP over 135/85 mmHg. RESULTS: Among the total, 15 subjects met the criteria of masked hypertension (28.3%) Current smoking (P=0.021), higher clinic mean SBP (P=0.011) and DBP (P=0.027), and prehypertension (P=0.04) were identified as related factors. And when adjusted for sex by logistic regression, only current smoking was statistically significant (P=0.039) and prehypertension showed borderline significance (P=0.092) (CI=95%). Additionally, mean pulse pressures and mean standard deviation of individual mean SBP were higher in the masked hypertension group. CONCLUSION: The frequency of masked hypertension was 28.3% the and related factors were current smoking and higher office BP, especially prehypertension that was introduced in JNC-7. The fact that the pulse pressure and the variability of individual SBP were higher in the masked hypertension group remains thought-provoking.

The Relation of Health-related Behaviors and Family Function in Adolescents

BACKGROUND: It is well known that family is not only the basis but also one of the major factors for personal health management. In this study, we examined to find out the association of family function with health behavior. METHODS: From June to August, 1999, a total of 800 middle and high school students, selected from several metropolitan, medium and small sized cities and a 'myon', were questionnaired on their health-related behaviors like smoking, alcohol intake, diet, exercise and sleeping by means of 'Korean Family Function Assessment Tool'. RESULTS: Among the total, 599 students gave appropriate answers. They were composed of 323 (53.9%) middle school and 276 (46.1%) high school students. Male to female sex ratio was 307 (51.3%) to 292 (48.7%). In the aspect of smoking, smoking group and non-smoking group showed 127.0 +/- 23.3 and 144.9 +/- 23.6, respectively, in terms of Korean Family Function Assessment Tool and were statistically significant (P<0.01). The students were divided into three groups as heavy alcohol drinkers who consumed alcohol more than 168 g-in case of girls the datum point was 132 g-per week, light drinkers and non-drinkers. Their KFFAT scores were also significantly different from each other (P<0.01). On tukey multiple comparison, there was a significant difference primarily between the drinkers and the non-drinkers (P<0.05). Similer findings were shown between the regular and the irregular diet group (P<0.01). But there as no significance with respect to exercise and sleeping. CONCLUSION: Among the health-related behaviors of adolescents, smoking, alcohol intake and diet habit were significantly associated with family function, but exercise and sleeping were not.

The Relation between Father's and Adolescent's Health Behavior

BACKGROUND: Adolescence is an important period with respect to health promotion, because development of health behavior at this stage is the foundation of health in adalts. Among the social factors, family factor which affects the primary social function can be the most fundamental. We investigated the effects of father's health behavior on the health behavior of their children during adolescence. METHODS: From June to August 1999, 300 adolescent students from middle schools and high schools of areas including four cities (Seoul, Incheon, Anyang, Gunpo) and their fathers were questioned about general characteristics and health behavior such as smoking, alcohol drinking, exercise, duration of sleep, body weight, height and eating habits for breakfast ('Alameda 7'). The relationship between father's health behavior and their adolescents' health behavior was analyzed by chi-squared test. RESULTS: Among 300 adolescents and their fathers, 211 pairs responded appropriately to the questionnaires. Adolescent's smoking was not associated with father's smoking. In drinking there was no significant association between father and adolescent, but in drinking amount, father's high drinking amount was significantly associated in all students, especially in females and high school students. Regular diet, exercise, sleep did not show significant association between father and adolescent. The proportion of obesity in adolescents whose fathers were obese was significantly greater compared to those whose fathers were not. CONCLUSION: High drinking amount and obesity had a statistical significance of association between fathers and adolescents. When we consider adolescents' health behavior, their fathers' health behavior must be considered.

The Relation between Father's and Adolescent's Health Behavior

BACKGROUND: Adolescence is an important period with respect to health promotion, because development of health behavior at this stage is the foundation of health in adalts. Among the social factors, family factor which affects the primary social function can be the most fundamental. We investigated the effects of father's health behavior on the health behavior of their children during adolescence. METHODS: From June to August 1999, 300 adolescent students from middle schools and high schools of areas including four cities (Seoul, Incheon, Anyang, Gunpo) and their fathers were questioned about general characteristics and health behavior such as smoking, alcohol drinking, exercise, duration of sleep, body weight, height and eating habits for breakfast ('Alameda 7'). The relationship between father's health behavior and their adolescents' health behavior was analyzed by chi-squared test. RESULTS: Among 300 adolescents and their fathers, 211 pairs responded appropriately to the questionnaires. Adolescent's smoking was not associated with father's smoking. In drinking there was no significant association between father and adolescent, but in drinking amount, father's high drinking amount was significantly associated in all students, especially in females and high school students. Regular diet, exercise, sleep did not show significant association between father and adolescent. The proportion of obesity in adolescents whose fathers were obese was significantly greater compared to those whose fathers were not. CONCLUSION: High drinking amount and obesity had a statistical significance of association between fathers and adolescents. When we consider adolescents' health behavior, their fathers' health behavior must be considered.

Immune Response to Hepatitis B Vaccination for Adults with Isolated Antibody to Hepatitis B Core Antigen in the Hepatitis B Endemic Area

BACKGROUND: Korea is a highly prevalent area of isolated anti-HBc with a rate of 15%, but there is neither vaccination nor management guideline agreed. To know the management for Hepatitis B Vaccination for adults with isolated anti-HBc, we investigated immune response to hepatitis B vaccination in adults with isolated anti-HBc. METHODS: The 23 adults with persistent isolated anti-HBc, who visited a health promotion center from Dec. 1998 to Aug. 1999, were vaccinated with Hepavax?-B by the standard schedule (0, 1, 6 month) and anti-HBs titers were measured 1 month after 1st and 3rd vaccinations (1, 7 month). RESULTS: After the 1st vaccination, 18 (78.26%) developed anti-HBs seroconversion. Among them, 4 (17.39%) had titers of 10~49 mIU/ml, 8 (34.78%) 50~99 mIU/ml, and 6 (26.09%) more than 100 mIU/ml. All non-responders after the 1st vaccination remained as such even with 3 doses of complete vaccination. The majority of seroconverted group did not show more anti-HBs response with further vaccination. CONCLUSIONS: Since none of adults with isolated anti-HBc had a primary response, which indicated few false positive results. Therefore they should be excluded on vaccination programs in Korea. To differentiate between immunity and occult infections, a single dose of vaccine with a follow-up anti-HBs test is preferable for adults with isolated anti-HBc. If the test shows a seroconversion it would indicate protective immunity, if not, then occult infection may be suspected.

Association of Body Fat and Body Mass Index with Pulmonary Function in Women in Their Forties

BACKGROUND: Obesity and decreased pulmonary function increase mortality and morbidity of diseases. Obesity is a major factor of decreased pulmonary function. There are variable results of how much body mass index (BMI) and body fat percent influence pulmonary function. There arefew data between obesity and pulmonary function in Korea. This study observed the association of BMI, body fat percent and pulmonary function, and quantified the impact of obesity to pulmonary function. METHODS: 603, non-smoking women in their forbles visited the Health Promotion Center of Inha University Hospital from January 3, 2000 to December 31 2000. Questions concerning smoking, exercise, and past medical history were made. Body fat percent and pulmonary function were measured. Correlation, simple linear regression and multiple linear regression between obesity indices and pulmonary function were used executed. RESULTS: BMI has no correlation with FVC, FEV1 and FEV1/FVC ratio. Body fat percent was negatively correlated with FVC and FEV1 (r=-0.162; P<0.01, r= -0.195; P<0.01), and was not correlated with FEV1/FVC ratio. In a multiple linar regression, body fat percent was inversely related to FVC and FEV1 (beta=-10.380; P<0.01, beta=-11.379; P<0.01). CONCLUSION: Increased body fat percent has association with decreased pulmonary function and has more impact on FEV1 than FVC. FVC was decreased by 10.380 mL and FEV1 was decreased by 11.379 mL when body fat percent increased by 1%.

Tele-Primary Care and Patient Satisfaction in Korea / 대한의료정보학회지

Korea has a unique feature for telemedicine, including geographical mal-distribution of medical resources, immature health care delivery and heavy traffic in metropolitan areas. As one solution for these issues, we developed a tele-primary care system and tested its feasibility and user satisfaction. The tele-primary care system is based on PC's with videoconferencing hardware. The patient PC equipped with diagnostic peripherals such as blood pressure, stethoscope, magnifying camera, and so on. There are two remote clinics and 4 homes which are connected to the telecare center through leased lines or fast internet. Three hundred ninety eight patients were seen during the period of one year and each made about 2 visits on an average. The health problems seen through tele-primary care were not different from ones in primary care clinics. Drugs were prescribed over the half of the visits and labs were used only infrequently. Most users were satisfied and felt comfortable with this new type of medicine. We found tele-primary care system would be one solution for health delivery issues in Korea.

Comparison of usefulness in the variable standards of waist circumference measurement

BACKGROUND: Waist circumferences are widely used to diagnosis and assessment of obesity but various standards of the measuring waist circumference originate the confusion on diagnosis and assessment of obesity. According to this, this study is willing to light up standards of measuring waist circumference what is intimate with body mass index(BMI) and have a precision of intra observer and inter observers in repeated measurements of the waist. METHODS: Measuring of waist circumference by the 4 different standards(anterior superior iliac crest(ASIC), umbilicus, above 3 cm to ASIC, the thinnest area in the waist by the range of seeing) were performed on 102 people visiting Health Promotion Center of one medical collage hospital by two observers in each 2 times, total 16 times. Each data were analyzed by the relativity between the BMI and the each means of measuring waist circumference and by ANOVA test in intra observer and inter observer bias. RESULTS: The relation between BMI and data in measuring standard of ASIC of the waist circumference is the highest. (r=0.900) and the following umbilicus(r=0.896), above 3 cm to the anterior superior iliac crest(r=0.888), the thinnest area in the waist by the range of seeing(r=0.877), It is the lowest in intra observer bias that the thinnest area in the waist by the range of seeing, and ASIC in inter observer. CONCLUSION: It is desirable that ASIC is the standard of measuring waist circumference in the diagnosis of obesity and in measuring that by different two person, because of the highest relativity in BMI and the lowest inter observers bias. But the thinnest area in the waist by the range of seeing is desirable in measuring by same person because of intra observer bias.

Prevention and treatment of traveler'sdiarrhea

No abstract available.

Factors associated with the place of death in Korea; a population based study

BACKGROUND: In western countries the proportion of deaths in the hospital has somewhat decreased. While that of Korea has continuously increased, it is interesting things that the hospital death rate in Korea is less than that in western countries. Therefore we tried to find the factors associated with the place of death in Korea. METHODS: We obtained the data from the National Statistical Office. They are composed of address, occupation, cause of death, marital status, and level of education. Causes of death were classified by ICD 10. Univariate and Mutivariate analysis were done to find the effect of each variable for the place of death. RESULTS: Total number of the study population was 242,362 (male;136,063, female;106,299). Female died more in the hospital. The younger are more likely to die in the hospital. People having lived in metropolitan, having educated to higher level and professionals died more in the hospital. And the people having had ischemic heart disease and cancer death were more likely to die in the hospital. The single(unmarried, divorced) died more in the hospital. In multivariate analysis, the place of death was significantly different by sex, age, address, occupation, cause of death, and level of education. CONCLUSION: In Korea sex, age, address, occupation, cause of death, and level of education are helpful in predicting the palce of death.

Spouse concordance of coronary risk factors and the effect of marriage duration

BACKGROUND: Familial aggregation of coronary risk factors is well known, which are hypertension, hyperlipidemia, diabetes mellitus, and obesity. However inter-spouse relation of the risk factors has remained controversial. As spouses are not blood-related, any risk factor relation that exist probably may not reflect genetic factors, but the environmental factors to which the couple is exposed. Moreover, the effect of assortative marriage should be considered. This study is designed to identify inter-spouse relation of coronary risk factors and to document the effects of marriage duration to spouse concordance. METHODS: From May 1995 to March. 1999, we enrolled 1,859 couples who had visited the Health Promotion Center at Seoul National University Hospital. We analysed inter-spouse correlation of body mass index, blood pressure, glucose, serum lipid factors, uric acid, smoking, alcohol drinking, and stress known as coronary risk factors. The correlation coefficients were compared according to marriage duration. RESULTS: There was statistically significant spouse concordance for all risk factors with the exception of smoking. The correlation coefficients of blood pressure, total cholesterol, and triglyceride increased with marriage duration but troughed at 30-39 years of marriage. Those of body mass index and glucose peaked at early and late marriage duration. Those of HDL-cholesterol and uric acid was relatively fixed throughout marriage. CONCLUSION: The presence of significant inter-spouse correlation for most of the coronary risk factors reflect the influence of assortative marriage and environmental factors on spouse concordance. If a spouse has many cardiovascular risk factors, partner should be evaluated for risk factors.

Clinical efficacy of the 7-Minute Screen at primary care setting

BACKGROUND: Because dementia tends to be underdiagnosed, Solomon PR developed a brief neurocognitive screening battery to identify Alzheimer's dementia. The 7-Minute Screen consists of four individual tests(orientation, memory, clock drawing, verbal fluency). It can be rapidly administered and it may be appropriately used in the primary care setting. We attempted to develop a screening tool of dementia based on the 7-Minute Screen at primary care setting in Korea. METHODS: We adapted the 7 Minute Screen to the Korean version of 7 Minute Screen(7 MS-K). 7 MS-K and MMSE-K were administered to 61 elderly people who visited the Sungbuk Public Health Center. Inter-rater reliability and test-retest reliability were evaluated. RESULTS: The 7 MS-K has a sensitivity of 92% and a specificity of 90% for cutoff point of MMSE-K 23/24. Inter-rater reliability and test-retest reliability for the entire battery was very high(both r=1). Mean time of administration was 10 minutes. CONCLUSION: 7 MS-K has a reasonable validity, reliability and can be administered in a brief period, and requires no clinical judgement and minimal training. It may be a useful tool for screening dementias in primary care setting.

The Clinical study for Efficacy and Safety of Amezinium methylsulfate

BACKGROUND: Amezinium methylsulfate(Risumic) is the useful drug in the treatment of essential hypotension. This drug elevate blood pressure by stimulating sympathetic nervous system and improve symptoms related hypotension. This study was designed to evaluate efficacy and safety of Risumic for patients with essential hypotension. METHODS: This study was performed in patients with systolic blood pressure less than 100mmHg from June, 1999 to December, 1999. Risumic blood pressure response, improvement of symptom and side effect were examined in a double-blind, placebo-controlled, crossover trial. RESULTS: Total of 54 patients participated in this study and only 55.6% of them were finished and the rest of them(44.4%) was stopped. 6 patients of this patients were stopped because of side effects. But there was no difference in side effects in Risumic and placebo periods. In diastolic BP, Risumic group is 5mmHg higher than placebo group. And then there was significant difference in statistics. CONCLUSIONS: In essential hypotensive patients, Risumic is elevater DBP than SBP, side effects frequency was no significance difference in Risumic and placebo group.

Standardization of The Two-question Case-finding Instrument As A Screening Instrument for The Adolescent's Depression

BACKGROUND: The current various case-finding instruments for detecting depression in Korea are too cucumbersome and time-consuming for routine use in primary care or student and soldier groups because of too many questions. We carried out this study in order to investigate the validity of the two-question case-finding instrument for detecting depression easily in the primary care or the mentioned groups. METHODS: We selected one boy high school in Seoul and 155 sophomer students answered the questionnaire by self-report. The questionnaire included two questions about depressed mood and anhedonia: (1) "During the past month, have you often been bothered by feeling down, depressed or hopeless?" (2) "During the past month, have you often been bothered by little interest or pleasure in doing things(e.g., studying, playing or talking with friends) ?". And then a resident of family medicine interviewed them and made a diagnosis for depression using the diagnostic criteria of DSM-IV. Simultaneously we compared the test characteristics of a two-question case-finding instrument with those of a previously validated Beck Depression Inventory as a currently world-wide used screening instrument for depression. RESULTS: The prevalence of major depression as determined by the interview was 6.6%(10 of 151). The two-question case finding instrument had a Cronbach's alpha of 0.663-internal consistency, a sensitivity of 100%, a specificity of 54.6%, a positive likelihood ratio of 2.20 and a negative predictive value of 1.00.(A "yes" answer to either of the two questions was considered a positive test.) And the BDI had a sensitivity of 90%, a specificity of 68.1%, a positive likelihood ratio of 3.63 and a negative predictive value of 0.99(cut-off point=15). Area under the ROC curves of the two-question case-finding instrument was 0.882, greater than that of the BDI, 0.834. CONCLUSIONS: The test characteristics of a two-question case-finding instrument were higher compared to those of BDI for major depression. Therefore, the two-question case-finding instrument is a useful measure for detecting depression and less time-consuming in primary care and certain groups.

Primary Care Oriented Telemedicine

No abstract available.

The risk factors of the nonresponders after hepatitis B vaceinatio and the immunogenecity after a double-dose revaccination in the nonresponders

BACKGROUND: Korea is an endemic area of viral hepatitis B with a rate of 5~10% carrier state. Therefore, hepatitis B vaccination is performed nationwide. But 5~15% of healthy individuals fail to respond adequately to the vaccine and an approved guideline for the nonresponders has not been developed yet. This study is designed to identify risk factors for those who lack anti-HBs after hepatitis B vaccination and to document the results of a double-dose revaccination in such nonresponders to the primary vaccination. METHODS: From Feb. 1996 to Aug, 1997, we assessed 51 healthy subjects(HBs Ag negative, anti-HBs negative, anti-HBc negative and a normal LFT). All subjects were vaccinated with Hepavax- B, 1.0ml, 24 by a rapid schedule(0, 1, and 2 months) and 27 by a standard schedule(0, 1, and 6 months). Anti-HBs titers were evaluated 3 months after the third vaccine and assessed the nonre-sponders (anti-HBs titer<2mIu/ml) and the hyporesponders(2~10mK/ml). All 13 nonresponders were revaccinated with 2ml of Hepavax-B 3 months after the primary vaccination. Anti-HBs titers were evaluated 1 month later. RESULTS: The differences in age(p<0.01) and smoking amount(p<0.05) between the responders and the hypo and the nonresponders were statistically significant. There were more males and higher body mass index in the hypo and the nonresponders but not statistically significant. The seroconversion rate after the double-dose vaccination was 92.3%(12/13) with an average titer of 5K08mlU/ ml(1-132.4mIU/ml). CONCLUSIONS: Increase in age and smoking amount were the risk factors of the nonresponders after the primary vaccination. Most of the hypo and the nonresponders to the primary vaccination responded adequately to the double-dose revaccination.