Effect of Increasing Tobacco Prices on Stages of Smoking Cessation: A Korean Nationwide Data Analysis / 가정의학회지

Background@#In 2015, tobacco prices significantly increased in Korea as part of the government’s smoking cessation policy. This study examined the changes in the stages of smoking cessation among Korean male smokers before and after the implementation of the tobacco price policy, and identified the predictors of such changes. @*Methods@#The study population comprised 3,533 male current smokers (age ≥19 years) who participated in the Korea National Health and Nutrition Survey in 2012, 2013, 2015, and 2016. Current smokers were defined as persons who had smoked ≥100 cigarettes during their lifetime and are continuing to smoke. In accordance with the transtheoretical model, smokers were classified into the precontemplation stage (no plan to quit), contemplation stage, and preparation stage (planning to quit within 6 months). We examined the changes in the smoking cessation stages before and after the implementation of the policy. Multivariate logistic regression analysis was conducted to identify factors related to the likelihood of continuing smoking, after adjustments for potential confounders. @*Results@#Immediately after the policy implementation, the percentage of smokers in the precontemplation stage decreased from 65.6% to 60.8% (P=0.014). However, this effect was temporary. Significant risk factors for remaining in the precontemplation stage were older age (odds ratio [OR], 1.010; 95% confidence interval [CI], 1.002–1.018; P=0.004), being in the lowest income quartile (OR, 1.226; 95% CI, 1.001–1.502; P=0.049), and manual worker or unemployed status (OR, 1.256; 95% CI, 1.036–1523; P=0.020). @*Conclusion@#Increasing tobacco prices only temporarily change the stage of smoking cessation among Korean male smokers.

Cancer Survivors with Low Hand Grip Strength Have Decreased Quality of Life Compared with Healthy Controls: The Korea National Health and Nutrition Examination Survey 2014–2017 / 가정의학회지

Background@#Cancer survivors experience decreased physical function and reduced muscle strength, which leads to lower quality of life (QOL). The hand grip strength (HGS) can be a predictor of poor health-related QOL as a parameter of sarcopenia. The purpose of this study was to investigate the relationship between low HGS and QOL in cancer survivors and healthy controls. @*Methods@#We analyzed 392 cancer survivors and 1,176 healthy controls from the Korea National Health and Nutrition Examination Survey, 2014–2017. We defined low HGS as 2 standard deviation values for healthy young Korean adults from a previous study. QOL was evaluated using the European Quality of Life Scale-Five Dimensions. A complex sample logistic regression model was used to assess the relationship between each dimension of low HGS and QOL. @*Results@#The odds ratios (ORs) for decreased QOL were significantly higher in male cancer survivors with low HGS on self-care (OR, 8.51; 95% confidence interval [CI], 1.69–42.83) and usual activities (OR, 6.63; 95% CI, 1.22–36.03). The ORs for problems in mobility (OR, 5.87; 95% CI, 2.04–16.91), usual activities (OR, 14.46; 95% CI, 3.84–54.44), pain/discomfort (OR, 4.90; 95% CI, 2.00–12.01), and anxiety/depression (OR, 6.43; 95% CI, 2.16–19.12) were significantly high in female cancer survivors with low HGS. However, healthy controls showed no significant relationship between low HGS and QOL. @*Conclusion@#For cancer survivors, low HGS was associated with poor QOL in some domains. Strategies to increase muscle strength must be considered to improve the QOL of cancer survivors.

Effect of Increasing Tobacco Prices on Stages of Smoking Cessation: A Korean Nationwide Data Analysis / 가정의학회지

Background@#In 2015, tobacco prices significantly increased in Korea as part of the government’s smoking cessation policy. This study examined the changes in the stages of smoking cessation among Korean male smokers before and after the implementation of the tobacco price policy, and identified the predictors of such changes. @*Methods@#The study population comprised 3,533 male current smokers (age ≥19 years) who participated in the Korea National Health and Nutrition Survey in 2012, 2013, 2015, and 2016. Current smokers were defined as persons who had smoked ≥100 cigarettes during their lifetime and are continuing to smoke. In accordance with the transtheoretical model, smokers were classified into the precontemplation stage (no plan to quit), contemplation stage, and preparation stage (planning to quit within 6 months). We examined the changes in the smoking cessation stages before and after the implementation of the policy. Multivariate logistic regression analysis was conducted to identify factors related to the likelihood of continuing smoking, after adjustments for potential confounders. @*Results@#Immediately after the policy implementation, the percentage of smokers in the precontemplation stage decreased from 65.6% to 60.8% (P=0.014). However, this effect was temporary. Significant risk factors for remaining in the precontemplation stage were older age (odds ratio [OR], 1.010; 95% confidence interval [CI], 1.002–1.018; P=0.004), being in the lowest income quartile (OR, 1.226; 95% CI, 1.001–1.502; P=0.049), and manual worker or unemployed status (OR, 1.256; 95% CI, 1.036–1523; P=0.020). @*Conclusion@#Increasing tobacco prices only temporarily change the stage of smoking cessation among Korean male smokers.

Cancer Survivors with Low Hand Grip Strength Have Decreased Quality of Life Compared with Healthy Controls: The Korea National Health and Nutrition Examination Survey 2014–2017 / 가정의학회지

Background@#Cancer survivors experience decreased physical function and reduced muscle strength, which leads to lower quality of life (QOL). The hand grip strength (HGS) can be a predictor of poor health-related QOL as a parameter of sarcopenia. The purpose of this study was to investigate the relationship between low HGS and QOL in cancer survivors and healthy controls. @*Methods@#We analyzed 392 cancer survivors and 1,176 healthy controls from the Korea National Health and Nutrition Examination Survey, 2014–2017. We defined low HGS as 2 standard deviation values for healthy young Korean adults from a previous study. QOL was evaluated using the European Quality of Life Scale-Five Dimensions. A complex sample logistic regression model was used to assess the relationship between each dimension of low HGS and QOL. @*Results@#The odds ratios (ORs) for decreased QOL were significantly higher in male cancer survivors with low HGS on self-care (OR, 8.51; 95% confidence interval [CI], 1.69–42.83) and usual activities (OR, 6.63; 95% CI, 1.22–36.03). The ORs for problems in mobility (OR, 5.87; 95% CI, 2.04–16.91), usual activities (OR, 14.46; 95% CI, 3.84–54.44), pain/discomfort (OR, 4.90; 95% CI, 2.00–12.01), and anxiety/depression (OR, 6.43; 95% CI, 2.16–19.12) were significantly high in female cancer survivors with low HGS. However, healthy controls showed no significant relationship between low HGS and QOL. @*Conclusion@#For cancer survivors, low HGS was associated with poor QOL in some domains. Strategies to increase muscle strength must be considered to improve the QOL of cancer survivors.

Age-Group Related Cohort Effects on the Association between Age at Menarche and Metabolic Syndrome among Korean Premenopausal Women / 가정의학회지

No abstract available.

Delphi Survey for Designing a Intervention Research Study on Childhood Obesity Prevention / 가정의학회지

BACKGROUND: The prevalence of childhood obesity in South Korea has increased owing to economic improvement and the prevailing Westernized dietary pattern. As the incidence of chronic diseases caused by obesity is also expected to increase, effective interventions to prevent childhood obesity are needed. Therefore, we conducted a Delphi study to determine the priorities of a potential intervention research on childhood obesity prevention and its adequacy and feasibility. METHODS: The two-round Delphi technique was used with a panel of 10 childhood obesity experts. The panelists were asked to rate “priority populations,”“methods of intervention,”“measurement of outcomes,”“future intervention settings,” and “duration of intervention” by using a structured questionnaire. Finally, a portfolio analysis was performed with the adequacy and feasibility indexes as the two axes. RESULTS: For priority populations, the panel favored “elementary,”“preschool,” and “middle and high school” students in this order. Regarding intervention settings, the panelists assigned high adequacy and feasibility to “childcare centers” and “home” for preschool children, “school” and “home” for elementary school children, and “school” for adolescents in middle and high school. As the age of the target population increased, the panelists scored increasing numbers of anthropometric, clinical, and intermediate outcomes as highly adequate and feasible for assessing the effectiveness of the intervention. CONCLUSION: According to the results of the Delphi survey, the highest-priority population for the research on childhood obesity prevention was that of elementary school students. Various settings, methods, outcome measures, and durations for the different age groups were also suggested.

Influenza Vaccination Coverage Rate according to the Pulmonary Function of Korean Adults Aged 40 Years and Over: Analysis of the Fifth Korean National Health and Nutrition Examination Survey

Influenza vaccination is an effective strategy to reduce morbidity and mortality, particularly for those who have decreased lung functions. This study was to identify the factors that affect vaccination coverage according to the results of pulmonary function tests depending on the age. In this cross-sectional study, data were obtained from 3,224 adults over the age of 40 who participated in the fifth National Health and Nutrition Examination Survey and underwent pulmonary function testing in 2012. To identify the factors that affect vaccination rate, logistic regression analysis was conducted after dividing the subjects into two groups based on the age of 65. Influenza vaccination coverage of the entire subjects was 45.2%, and 76.8% for those aged 65 and over. The group with abnormal pulmonary function had a higher vaccination rate than the normal group, but any pulmonary dysfunction or history of COPD did not affect the vaccination coverage in the multivariate analysis. The subjects who were 40-64 years-old had higher vaccination coverage when they were less educated or with restricted activity level, received health screenings, and had chronic diseases. Those aged 65 and over had significantly higher vaccination coverage only when they received regular health screenings. Any pulmonary dysfunction or having COPD showed no significant correlation with the vaccination coverage in the Korean adult population.

Evidence of Interventions for Preventing Obesity of Children and Adolescents Using Existing Systematic Reviews and Meta-Analyses

BACKGROUND: Pediatric obesity is an important global issue in public health. However, previous efforts for childhood obesity prevention have sporadically been implemented in Korea, neither evidence-based nor with proper evaluation. We aimed to investigate the characteristics of an effective intervention for prevention of pediatric obesity by reviewing previous systematic reviews and Meta-analyses. METHODS: PubMed was searched for articles published frombetween January 2005 to November 2015. Inclusion criteria were as follows: (1) articles published in English; (2) child and/or adolescents (between 2 and 18 years of age) as subjects; and (3) systematic reviews or meta-analyses concerning the preventive intervention of pediatric/adolescent obesity. Each study was evaluated via the Assessment of Multiple Systematic Reviews for quality assessment. We conducted a quantitative analysis to evaluate the implications, strengths, and limitations of each study. RESULTS: Our final analysis included 35 articles, of which 15 were systematic reviews and 20 were meta-analyses. Among these, 24 studies (69%) advocated the efficacy of preventive intervention for pediatric obesity. Multidimensional approach including diet, exercise, and environmental factors conducted in schools with a parent and community involvement wasis more effective at preventing obesity. The efficacy of intervention varied depending on the age, sex, region, and socioeconomic characteristics of participantssubjects. CONCLUSIONS: Preventive intervention of pediatric obesity demonstrated smallminor improvements in body mass index and had positive effects on behavioral and clinical variables, which are associated with obesity. For the efficient prevention of pediatric obesity, it is necessary to consider efforts for developing various intervention programs, with active as well as the participation of school, family, and social community groups.

Peer assessment of small-group presentations by medical students and its implications / 한국의학교육

PURPOSE: The purpose of this study was to explore the relationships among medical students' assessments on peers' group presentations, instructors' assessments of those presentations, and students' educational achievements in other assignments and tests. METHODS: A total of 101 first-year students from a medical school participated in the study. The students' educational achievements in a 4-week long integrated curriculum were analyzed. Student's final grades were comprised of the following education criteria: two written tests (60%), 15 group reports (25%), one individual report (7%), and four group presentations (15%). We compared scores of the group presentation assessed by the peers and the two instructors. Furthermore, we compared peers' assessment scores with each component of the evaluation criteria. RESULTS: Pearson correlation analysis showed significant correlaton for the assessments between peers and instructors (r=0.775, p<0.001). Peer assessment scores also correlated significantly with scores for the group assignments (r=0.777, p<0.001), final grades on the curriculum (r=0.345, p<0.001), and scores for individual assignments (r=0.334, p<0.001); however, no significant correlation was observed between the peer-assessed group presentation scores and the two written test scores. CONCLUSION: Peer assessments may be a reliable and valid method for evaluating medical students' performances in an integrated curriculum, especially if the assessments are used to academic processes, such as presentations, with explicit evaluation and judgment criteria. Peer assessments on group presentations might assess different learning domains compared to written tests that primarily evaluate limited medical knowledge and clinical reasoning.

General Recommendations and Recent Update in Adult Immunization

BACKGROUNDS: Vaccination is the primary prevention strategy which aims to prevent various vaccine-preventable diseases and its complications. Although immunization practice had been centered on children in Korea, recent epidemic of several vaccine-preventable diseases such as hepatitis A and novel influenza H1N1 made people pay more attention on adult immunization since 2000. METHODS: This article reviews the general recommendations of adult immunization based on the recent report from the US Advisory Committee on Immunization Practices in 2011. New vaccines which have been introduced or will be introduced are briefly reviewed. RESULTS: Following topics are included: 1) principles for vaccine scheduling, 2) spacing of vaccines and antibody-containing products, 3) vaccination in altered immunocompetence, 4) vaccination in special situations, 5) contraindications and precautions, and 6) preventing and managing adverse reactions. Brief information on various influenza vaccines, adult pertussis vaccine, meningococcal vaccine, and zoster vaccine are reviewed and provided. CONCLUSIONS: Updated general recommendations and information on the new vaccines are intended for clinicians and other health-care providers who vaccinate patients.

Recent Update in Adult Immunization / 가정의학회지

Immunization is the most effective and cost-beneficial means to prevent infectious diseases in adults as well as in children. However, adult immunization has been beyond the center of attention relatively to children's immunization in Korea. Since the Korean Academy of Family Medicine had published "Vaccination for Adults" in 1994, a recent update was done in this field by the Korean Centers for Disease Control and Prevention and the Korean Society of Infectious Diseases. This paper reviews standard immunization for healthy persons and supplementary immunization for persons with underlying diseases based on those recent recommendations. General information, indications, dosage, route of administration, efficacy and safety were reviewed for vaccination of influenza, pneumococcal infection, tetanus, hepatitis A, hepatitis B, human papilloma virus, varicella and measles/mumps/rubella.

Recent Update in Adult Immunization / 가정의학회지

Immunization is the most effective and cost-beneficial means to prevent infectious diseases in adults as well as in children. However, adult immunization has been beyond the center of attention relatively to children's immunization in Korea. Since the Korean Academy of Family Medicine had published "Vaccination for Adults" in 1994, a recent update was done in this field by the Korean Centers for Disease Control and Prevention and the Korean Society of Infectious Diseases. This paper reviews standard immunization for healthy persons and supplementary immunization for persons with underlying diseases based on those recent recommendations. General information, indications, dosage, route of administration, efficacy and safety were reviewed for vaccination of influenza, pneumococcal infection, tetanus, hepatitis A, hepatitis B, human papilloma virus, varicella and measles/mumps/rubella.

Association of Visceral Fat Area Measured by InBody 720 with the Results Measured by CT, DEXA and Anthropometric Measurement / 가정의학회지

BACKGROUND: Obesity is associated with various chronic diseases, especially abdominal fat affect cardiovascular disease, metabolic disease, diabetes mellitus and mortality. The aim of this study was to estimate the accuracy of the visceral fat area measured by bioelectric impedence analysis (BIA) that easily used in many clinical settings, and to compare with the visceral fat area measured by CT and other abdominal obesity measures. METHODS: Participants were 71 premenopausal adult women whose BMI was over 23 kg/m2. BMI, waist circumference, total abdominal fat area, visceral fat area, subcutaneous fat area by CT and truncal fat by dual-energy X-ray absorptiometry (DEXA) were measured. Visceral fat area measured by Inbody 720 were compared with variables examining abdominal obesity using partial correlation analysis and Bland-Altman analysis. The accuracy of the visceral obesity by BIA was compared with that diagnosed by CT as gold standard. RESULTS: There was significant difference between visceral fat area measured by CT and BIA in women below BMI 30 kg/m2, whereas the difference was not significant in women with BMI > or = kg/m2. Visceral fat area measured by BIA was significantly correlated with visceral fat area measured by CT only in subjects with BMI less than 30 kg/m2 after adjusting for age (r = 0.495, P or = 30 kg/m2. CONCLUSION: BIA is not appropriate for evaluation of abdominal visceral obesity.

Interventions to Prevent Catheter-Associated Blood-stream Infections: A Multicenter Study in Korea / 감염과화학요법

BACKGROUND: The purpose of this study was to determine the efficacy of infection-control interventions to decrease the incidence of catheter-associated bloodstream infections (CA-BSI) and to examine the sustainability of its effect during and after the intervention in Korea. MATERIALS AND METHODS: We conducted a prospective multi-strategy intervention in intensive care units (ICUs) at 3 university hospitals in Korea. The intervention consisted of education and on-site training for medical personnel involved in catheter care, active surveillance, and reinforcement of current intervention in each unit. After the intervention of 3 months, we identified CA-BSI cases of each hospital using the electronic database for 6 months. RESULTS: During the intervention, the number of CA-BSI decreased significantly compared to pre-interventional period (8.7 vs. 2.3 per 1,000 catheter days; rate ratio 0.28; 95% CI, 0.13-0.61). After the intervention, CA-BSI rate increased slightly, but was still significantly lower than that of pre-interventional period (4.3 per 1,000 catheter days; rate ratio, 0.49; 95% CI, 0.31-0.78). Reduction of gram-negative bacterial infections was noted during and after the intervention. CONCLUSIONS: A multi-strategy approach to reduce CA-BSI could be implemented in diverse settings of medical and surgical units in Korea and decreased CA-BSI rates during the intervention.

Epidemiology of Salmonella enterica Serotype Typhi Infections in Korea for Recent 9 Years: Trends of Antimicrobial Resistance

The aim of this study is to characterize the epidemiological features of typhoid fever, categorized as class 1 notifiable disease in Korea and to analyze the recent change of antimicrobial resistance of Salmonella enterica serotype Typhi isolated nationwide. We retrospectively analyzed the 1,692 culture-proven cases from 1992 to 2000, using the data of the Korean National Institute of Health. The overall incidence of culture-proven typhoid fever was 0.41 per 100,000 population. It occurred all over the country, but the southeastern part of Korean peninsula had the higher incidence rate than other areas. There were several outbreaks suspected, of which two outbreaks were confirmed. The resistance rate against chloramphenicol showed mild increase, but the ampicillin, trimethoprim/sulfamethoxazole, kanamycin, or nalidixic acid resistance remained at the similar levels for the past 9 yr. There were 21 (1.3%) multidrug-resistant (MDR) strains isolated since 1992, and the number of those has increased. Two strains resistant to ciprofloxacin were first identified in Korea.

The Development of Case-Bank of Problem-Based Learning Program via the Internet for Medical Education / 대한의료정보학회지

Problem-based Learning challenges students to be more actively involved in defining what they learn and solving the problem. When it proceeds with the Internet, the Internet program will provide learning materials and guide the clinical reasoning process. We developed the PBL casebank database on the web to facilitate development and maintenance of PBL case modules. The database has the 3-tier structure according to the form of the preexistent Internet program, and possible record forms are text, sound files, and image files. This database system is connected with web using ODBC(Qpen DataBase Connectivity) and ASP(Active Server Pages) technology on the Microsoft Windows NT server. With this PBL casebank system, we are hoping for owning medical education materials in common between universities and distance learning in medicine.

Development of Problem-based medical education program using the Internet / 대한의료정보학회지

Medicine in the twenty-first century will be different from the medicine of today. Recent changes in medical environment, such as changes in disease and mortality pattern and rapid increase in medical knowledge, require change and adaptation of medical education. The task of medical education is to help people entering medicine to prepare to meet their professional obligations in this new context. So we tried to join Problem-base learning(PBL), which challenges students to be more actively involved in defining what they learn and how they learn, and Computer-assisted learning(CAL), which uses multimedia and medical informatics as learning tools. Finally we developed Problem-oriented medical education program using the Internet. First, using simulated patient cases, we built clinical database with patients' history, physical examinations, and various laboratory findings. To provide PBL program through the Internet, we constructed client-server system using IJS(Internet Information Server) on Windows-NT settings, and made user-friendly dynamic interface with HTML, JAVA, JAVA Script and so on. PBL on the Web will make students learn effectively and actively, and offer vivid multimedia environment for medical education. We expect this PBL program to be used as an effective learning tool for residents or doctors as well as for medical students in the near future. The Internet

Trends of Sexually Transmitted Diseases during recent three years: among users of 11 Public Health Centers in Seoul

BACKGROUND: STDs are major communicable disease group in Korea. This study was carried out to evaluate the current status of sexually transmitted diseases in Seoul. METHODS: We collected the laboratory data of those who visited 11 Public Health Centers in Seoul for venereal disease examination and analyzed abnormal results from Jan 1, 1993 to Dec 31, 1995. The diagnoses of STDs were made by VDRL quantification, TPHA test, Gram's stain, and culture of urine or urethral discharge. RESULTS: There were total of 10,302 patients. There were 7,836 male cases(76.1%) and 2,466 female cases (23.9%). Mean age was 30.6+/-9.7, and the most common age group was 25-34 yearn of age(42.1%). Diagnoses were as follows ; syphilis 2,036 cases(19.8%), gonorrhea 2,249 cases(21.8%), nongonococcal urethritis 4,973 cases(48.3%), vaginitis 954 cases(9.3%), mixed infection of syphilis and gonorrhea 13 cases(0.1% ), mixed infection of syphilis and NGU 50 cases(0.5%), mixed infection of syphilis and vaginitis 27 cases(0.3%). The proportion of PPNG among gonorrhea was as follows ; 43.4% in 1993, 55.1% in 1994, 43.8% in 1995. There were more WBCs on Gram's staining in gonorrhea cases than in NGU cases. CONCLUSIONS: The STD patients seen in 11 Public Health Centers in Seoul were mainly young men. Common diagnoses were as follows ; NGU, gonorrhea, syphilis, vaginitis. The proportion of PPNG increased at first and then decreased.

Medical Counseling by Internet / 대한의료정보학회지

Recent progress in medical informatics enables us to use medical information regardless of time or place, to make a diagnostic and therapeutic plan, according to increasing need about health of general population. There are many homepages on the web, which provides medical common senses, hospital information, and medical counselling on the web. Virtual Hospital, which offers comprehensive media information, has medical counselling program with various programs such as self-diagnosis, emergency information, drug information, Q and A, and so on. The aim of this study is to examine the content and purpose of medical counselling on the web. The subjects consisted of 150 counselings which were called 'Medical Counselling' in the Virtual Hospital for December 1996 through March 1997. Many questioners wanted to know treatment principles. to make a diagnosis, and to know specific medical knowledge, The most common questions are as follows; general and unspecified, digestive, skin, musculoskeletal problems. These findings suggests that medical counselling may be used to supplement the lack of direct medical interviews with doctors.