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.

The Validity and Reliability of Korean Fall Efficacy Scale(FES) and Activities-specific Balance Confidence Scale(ABC)

BACKGROUND: The purpose of this study was to evaluate the applicability of the Korean version of Fall Efficacy scale(FES) and Activities-specific Balance Confidence Scale(ABC) to Korean older adult through an examination of instrument`s internal consistency and validity METHOD: A sample of 90 Korean older adults who lived in a community completed a survey instrument which included Korean version of FES and ABC. Because of comparable data derived from each scale, fear of falling and quality of life, activity daily living were included. Concurrent validity, criterion validity and correlational validity were tested. Reliability was tested by internal consistency, test-retest method. RESULTS: Cronbach`s alpha was 0.9043 in FES, and 0.99623 in ABC. Test-retest correlations in all scales were higher than 7.0. Statistically significant association was found between fear of falling and both scales. Correlation coefficient between Quality of life(SF-8) and ABC was -0.142(p=0.049). Both FES and ABC are correlated significantly each other. CONCLUSION: The Korean version of FES and ABC appears to be a reliable and valid method for meas- uring fear of falling. These instruments may be useful in assessing the independent contribution of fear of falling. ABC scale may be more useful to detect loss of balance confidence in more highly functioning seniors.

The Comparison of Body Fat Rate and Body Mass Index through the Relationship with Cardiovascular Risk Factors

BACKGROUND: Obesity has been generally diagnosed by 'Body Mass Index (BMI)' in primary care. Recently the use of Bioelectrical Impedance Analyzer' has become popular in Korea to evaluate body fat rate (BFR), as cost is inexpensive and the method to use is simple. As a result, the opposed finding of normal BMI and elevated BFR vice versa in same individuals are being encountered frequently. We designed this study to find out the characteristics and cardiovascular risk of people in these groups. METHODS: The medical records of health promotion center were obtained and 22,704 applicants visitor who undeerwent health risk questionnaire, screening tests and physical examination for cardiovascular disease were reviewed. RESULTS: After adjusting for age, sex, exercise and education level, cardiovascular risk such as hypertension, DM, and hypercholesterolemia, LDL tended to increase linearly and HDL tended to decrease linearly with increase of BFR or BMI. In comparison with normal BMI and BFR group, the odds ratios of normal BMI and elevated BFR group or vice versa were increased. CONCLUSION: If either one of BMI or BFR of a person was elevated, even though the other was within normal range, the cardiovascular risk of that person was shown to be high.

Medical Consultation and Telemedicine Using the Internet

The number of Internet users is rapidly increasing in Korea. Because of the busy modern life style, demands for the convenient medical services using the Internet are also increased. There are about 10,000 medical Internet sites in Korea. However, several surveys on the Internet medical information in Korea have shown disapointing results. As in other nations medical information is often inappropriate for the questions and some might be even harmful. Somewhat insufficient role of the Internet medical consultation do not satisfy the people' needs. There are eseveral movements for the improving medical Internet information system in Korea but are still at the beginning state. By using the Internet technology, telemedicne for the remote area, for the dementia patients, for the emergency care, and for the elderaly have been tried in Korea. But legal problems, insufficient evidence for its efficiency, and several other drawback make telemedicine be still remaining at the experimental state. However, increasing demands for the better medical services, developing inforamtion technology, expanding high-velocity network system, and fucure capacity mobile communication systems will obviate these problems in the near future.

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.

Associated factor of prevalence of asymptomatic gallstone

BACKGROUND: Because of improvement of economic state and eating habit changes in Korea, 60-70% of gallbladder stones are cholesterol stones. As ultrasonography was used increasingly, detection of asymptomatic gallstone were increased. There has been few studies about asymptomatic gallstone in Korea. So, this study was designed to obtain associated factor of prevalence of asymptomatic gallstone. METHODS: We screened adults over 20 years who were visited the health Promotion Center in a university hospital from May 1995 to May 1999. Subjects were defined as case group(584 subjects) who were diagnosed gallstone by abdominal ultrasonogaphy by radiologist. Control group(1153 subjects) were selected by random sampling from visitors of the Health Promotion Center. Every subjects were assessed with respect to gender, age, height, weight, fasting blood glucose, serum total cholesterol, high density lipoprotein-cholesterol, triglyceride. Social-Economic state, smoking were assessed by self-administered questionnaires. Associated factor of prevalence of asymptomatic gallstone were analyzed by Chi-square test and multiple logistic regression. RESULTS: Age, BMI(Body Mass Index), fasting blood glucose were associated with gallstone by Chi-square test(P40 years old) and were associated with BMI(>25 kg/m2), fasting blood glucose. CONCLUSION: Associated factors of prevalence of asymptomatic gallstone were increased by age(>40 years old) and were associated with BMI(>25 kg/m2), fasting blood glucose, and were not different from those in West countries. further studies will be needed about associated factors according to the composition of gallstone and developing from asymptomatic gallstone to asymptomatic gallstone.

Validity of beck depression inventory(BDI): detection of depressio in primary care

No Abstract Available.

The factors related to serum total cholesterol high\density lipoprotein (HDL)cholesterol ratio in healthy adults

BACKGROUND: Recently, many large epidemiological studies revealed that total cholesterol (TC)/high density lipoprotein-cholesterol (HDL-C) ratio is a better predictor of risk for coronary heart disease than total cholesterol, high density lipoprotein-cholesterol, or low density lipoprotein-cholesterol as a single factor. Our study is designed to examine the factors associated with TC/HDL-C ratio in healthy Korean adults. METHODS: The study involved 6,584 adults who visited the SNUH Health Promotion Center from March 1997 to February 1998. We examined their demographic data, past medical history, smoking habits, alcohol intake and exercise through a questionnaire. Serum lipid levels were checked after 14 hours of fasting. We analyzed the data by analysis of covariance and multiple regression analysis. RESULTS: 3,774 healthy adults (men 1,976, women 1,798) were statistically analyzed. The average TC/HDL-C ratio was 4.2+/-1.2 in men, 3.6+/-1.0 in women. TC/HDL-C ratio was highest in over age 70(4.4+/-1.3), and was increased as BMI, the amount of smoking increased, and was decreased as alcohol intake increased in men. In women, TC/HDL-C ratio was increased as BMI increased, and was lower in exercise groups(3.5+/-1.0) than inactive group(3.7+/-1.0), but there was no difference according to the smoking amount. Regression analyses revealed a positive correlation between TC/HDL-C ratio and BMI, smoking(P<0.05, respectively), and a negative correlation between TC/HDL-C ratio and alcohol intake(P<0.05) in men. In women, there was a positive correlation between TC/HDL-C ratio and BMI, age(P<0.05, respectively), and a negative correlation between TC/HDL-C ratio and exercise amount and alcohol intake(P<0.05, respectively). In both men and women, BMI showed the highest correlation with TC/HDL-C ratio. CONCLUSIONS: BMI, smoking, exercise as well as sex and age are related to TC/HDL-C ratio. Thus, primary physicians should consider correction of these factors.

A study of medical utilization and health status for migrant workers in Korea

BACKGROUND: The number of illegal migrant workers has been increasing in Korea since late 1997 in what was called the IMF era. This study was conducted to evaluate and to recognize the medical utilization and health Status for migrant workers in Korea. The goal of this study was to understand the epidemiological characteristics of the migrant workers and family physician's role as a health provider and gate keeper to them and to provide basic data for public health policy. METHODS: In September 1999, self-administered questionnaires were distributed to the migrant workers in Seoul, Sung-Nam, Pucheon and An-Yang. We classified the reasons for clinical encounters and the prescribed drugs by reviewing the medical records of all patients who visited a clinic of shelter for migrant workers in Sung-Nam from January to December 1998 and analysed the report according to death certification of the shelter for migrant workers in Sung Nam from 1994 to September 1999 RESULTS: The major distribution of nationality were from China, Mongo, and Bangladesh (86.9 %). They were mostly between 30 and 39 years old, males are, and unmarried. Most had high school education. The average income was 756,700 won and the average working hours were 11.5 hours per day in migrant workers being in worse condition than those of Korean workers. Classified according to systems, the respiratory(21.2%), musculoskeletal (20.6%), digestive(15.8%), and cardiovascular(12.5%) symptoms were common. Repayment for death was different between before (87.7%) and after IMF era (13.0%), in late 1997. Average medical expenditure was 43,552 won comprising 5% of the total income of subjects only. Most of them did not benefit from medical insurance. CONCLUSION: Migrant workers' situation seemed poor. The patterns of the disease' were similar to those who visit family medicine clinics in general. Family physicians should take more interest in providing a more effective and better care to migrant workers.

Validity of zung's self-rating depression scale : Detection of depression in primary care

No Abstract Available.

Smoking patterns and factors associated with smoking in Korean adult women

BACKGROUND: Women smoker faces increased risk for heart disease, stroke, cancers, and respiratory diseases as well as a number of gender specific risks. Maternal smoking has been linked to harmful effects on their offspring such as increased incidence of premature, stillbirth and sudden infant death syndrome, etc. Recently, the rate of female adolescent smoking in Korea is increasing, and the rate of adult woman is expected to increase. This study is aimed at obtaining basic information about smoking patterns and factors associated with smoking in Korean adult women. METHODS: From May 1995 to April 1999, a self-administered questionnaire was distributed to the female visitors of Health Promotion Center in Seoul National University Hospital. The number of smokers was 492. The control group(984 nonsmokers) was selected by 1:2 age group matched random sampling. Smokers and control group were divided into three age groups-young age(20-39 years), middle age(40-59 years), old age(60 years and over)-and analysed the resalts using SPSS and EpiInfo software. RESULTS: The most frequent amount of cigarette smoking was below 10 cigarettes in all age groups. The duration of smoking was below 10 years in most young and middle age groups. In the old age group the duration of smoking was longer than others. Variables positively associated with smoking included alcohol drinking, being engaged in trade service, being unmarried or divorced or separated or parted for ever, high stress status, dissatisfation of life in young age group. The variable of no exercise was added to them in middle age group. In old age group alcohol drinking, no exercise, no school education were the positive meaningful factors associated with smoking in multivariant logistic regression analysis. CONCLUSIONS: The modifiable variables associated with smoking in Korean adult women included alcohol drinking, high stress status, dissatisfation of life and no exercise.