Prediction of Survival in Patients with Advanced Cancer: A Narrative Review and Future Research Priorities / 한국호스피스완화의료학회지

This paper aimed to summarize the current situation of prognostication for patients with an expected survival of weeks or months, and to clarify future research priorities. Prognostic information is essential for patients, their families, and medical professionals to make endof-life decisions. The clinician’s prediction of survival is often used, but this may be inaccurate and optimistic. Many prognostic tools, such as the Palliative Performance Scale, Palliative Prognostic Index, Palliative Prognostic Score, and Prognosis in Palliative Care Study, have been developed and validated to reduce the inaccuracy of the clinician’s prediction of survival. To date, there is no consensus on the most appropriate method of comparing tools that use different formats to predict survival. Therefore, the feasibility of using prognostic scales in clinical practice and the information wanted by the end users can determine the appropriate prognostic tool to use. We propose four major themes for further prognostication research: (1) functional prognosis, (2) outcomes of prognostic communication, (3) artificial intelligence, and (4) education for clinicians.

Risk Factors Related to Serious Adverse Drug Reactions Reported through Electronic Submission during Hospitalization in Elderly Patients / 가정의학회지

Background@#Many studies have assessed the risk factors for adverse drug reactions (ADRs) in elderly patients. However, most of these studies have focused on risk factors for ADRs, not serious ADRs (s-ADRs). s-ADRs are commonly found in hospitalized patients. s-ADRs warrant imminent but thorough investigations, given their critical impact on patient health. Therefore, this retrospective study aimed to assess the associated risk factors for s-ADRs in elderly hospitalized patients. @*Methods@#In-patients aged >65 years having ADRs during hospitalization at a university hospital in Korea between 2010 and 2012 were included. Medical professionals spontaneously reported ADRs using an electronic submission system at the study hospital. Further, all descriptions of ADRs were characterized and categorized through the screening of electronic medical records. We compared the characteristics of patients having s-ADRs with those of patients not having s-ADRs. @*Results@#There were 353 cases of ADRs, 67 of which were s-ADRs. Patients taking more than eight concomitant drugs showed the highest odds ratio (OR, 11.99; 95% confidence interval [CI], 3.42–42.03). The ratio of aspartate aminotransferase (AST)/alanine aminotransferase (ALT) was also significantly related to s-ADRs (OR, 2.78; 95% CI, 1.33–5.81). The use of antibiotics (OR, 2.39; 95% CI, 1.13–5.02) and antineoplastics (OR, 4.17; 95% CI, 1.09–15.94) were significant risk factors. @*Conclusion@#Our findings highlight the importance of polypharmacy. Liver function tests (AST/ALT ratio) must be monitored carefully within high-risk groups for ADRs.

A Prognostic Model to Facilitate Palliative Care Referral in Oncology Outpatients / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#We aimed to develop a prognostic model to assist palliative care referral at least 3 months before death in advanced cancer patients treated at an outpatient medical oncology clinic. @*Materials and Methods@#In this prospective cohort study, a total of 200 patients were enrolled at a tertiary cancer center in South Korea. The major eligibility criterion was an expected survival of less than a year as estimated by their oncologists. We analyzed the influences of known prognostic factors along with chemotherapy status, mid-arm circumference, and triceps skinfold thickness on survival time. @*Results@#The mean age of the patients was 64.5 years, 36% were female, and the median survival time was 7.6 months. In the multivariate analysis, we found 6 significant factors related to poor survival: a poor Eastern Cooperative Oncology Group (ECOG) performance status (≥2), not undergoing chemotherapy, anorexia, a low lymphocyte level (<12%), a high lactate dehydrogenase (LDH) level (≥300 IU/L), and a low mid-arm circumference (<23 cm). We developed a prognostic model (score, 0-8.0) to predict 3-month survival based on the multivariate analysis. Patients who scored ≥4.0 points had a short survival of less than 3 months (p<0.001). The discriminating ability of the prognostic model using the area under the receiver operating characteristic curve (AUC) was 0.88. @*Conclusion@#The prognostic model using ECOG performance status, chemotherapy status, anorexia, lymphocytes, LDH, and mid-arm circumference can predict 3-month survival in medical oncology outpatients. It can alert oncologists to refer patients to palliative care specialists before it is too late.

Less Healthy Dietary Pattern is Associated with Smoking in Korean Men According to Nationally Representative Data

The relationship between smoking and nutrient intake has been widely investigated in several countries. However, Korea presents a population with a smoking rate of approximately 50% and dietary consumption of unique foods. Thus, the aim of this study was to evaluate the association of dietary patterns with smoking in Korean men using a nationally representative sample. The study subjects were comprised of 4,851 Korean men over 19 yr of age who participated in the fourth Korean National Health and Nutrition Examination Survey. Dietary data were assessed by the 24-hr recall method. The smoking group comprised 2,136 men (46.6%). Five dietary patterns were derived using factor analysis: 'sugar & fat', 'vegetables & seafood', 'meat & drinks', 'grains & eggs', and 'potatoes, fruits and dairy products.' Current smokers showed a more significant 'sugar & fat' pattern (P = 0.001) while significantly less of the 'vegetables & seafood' and 'potatoes, fruits and dairy products' patterns (P = 0.011, P < 0.001, respectively). As found in similar results from Western studies, Korean male smokers showed less healthy dietary patterns than nonsmokers. Thus, the result of this study underlines the need for health professionals to also provide advice on dietary patterns when counseling patients on smoking cessation.

The Effect of Videotaping Students' Interviews with Patients for Interview Skill Education / 가정의학회지

BACKGROUND: The importance of communication between patients and physicians has been proven in many previous studies. The authors analyzed the effect of interview skill education through videotapes which recorded students' interviews with real patients in the outpatient department of family medicine. METHODS: This study was conducted with all students who chose the elective course of family medicine and one randomly selected student every week from an 'infectious internal medicine' class at Dongguk University Ilsan Hospital during the period from December 2008 to March 2011. All students performed a preliminary examination of a new patient at the outpatient department of family medicine. All consultations were videotaped. Feedback to the student was given on the same day by viewing the videotape together. After feedback, all students performed another preliminary examination of one new patient at the department of family medicine the same week. Three family medicine residents scored all videotapes using 10-item interview skill checklists. Many parts of the checklists were modified using the Arizona Clinical Interview Rating Scales. RESULTS: Thirty-three students participated. Of 10 items, nine showed increased scores after feedback. There was a significant change in four items after feedback: 'type of question' (before 2.36 +/- 0.60, after 2.73 +/- 0.72), 'timeline' (before 2.82 +/- 0.68, after 3.18 +/- 0.73), 'positive verbal reinforcement' (before 2.24 +/- 0.56, after 2.61 +/- 0.90), and the total score (before 21.70 +/- 2.62, after 23.39 +/- 3.13) (P < 0.05). CONCLUSION: Giving feedback to medical school students on medical interview skills using videotapes of students' preliminary consultations with real patients in outpatient settings, was effective in improving the interview areas of 'type of question,' 'timeline,' 'positive verbal reinforcement,' and the total interview scores.

Association between Spiritual Well-Being and Pain, Anxiety and Depression in Terminal Cancer Patients: A Pilot Study / 한국호스피스완화의료학회지

PURPOSE: Spirituality is an important domain and is related with physical and psychological symptoms in terminal cancer patient. The aim of this study is to examine how patients' spirituality is associated with their physical and psychological symptoms as it has been explored by few studies. METHODS: In this cross sectional study, 50 patients in the palliative ward of a tertiary hospital were interviewed. Spiritual well-being, depression, anxiety and pain is measured by Functional Assessment of Chronic-Illness Therapy-Spirituality (FACIT-Sp), hospital anxiety and depression scale (HADS) and the Korean version of the Brief Pain Inventory (BPI-K). The correlations between patients' spiritual well-being and anxiety, depression and pain were analysed. The association between spiritual well-being and age, gender, palliative performance scale (PPS), religion, mean pain intensity, anxiety, depression were assessed by univariate and multivariate regression analyses. RESULTS: Spiritual well-being was negatively correlated with the mean pain intensity (r=-0.283, P<0.05), anxiety (r=-0.613, P<0.05) and depression (r=-0.526, P<0.05). In multivariate regression analysis, spiritual well-being showed negative association with anxiety (OR=-1.03, 95% CI=-1.657~-0.403, P=0.002) and positive association with the existence of religion (OR=9.193, 95% CI=4.158~14.229, P<0.001). CONCLUSION: In this study, patients' anxiety and existence of religion were significantly associated with spiritual well-being after adjusting age, gender, PPS, mean pain intensity, depression. Prospective studies are warranted.

Association between Metabolic Components and Subclinical Atherosclerosis in Korean Adults / 가정의학회지

BACKGROUND: Many studies have attempted to develop relatively simple and easy noninvasive measurements of atherosclerosis (NIMA), and each NIMA assesses different atherosclerotic properties. We, therefore, investigated the association between metabolic syndrome (MetS) components and different NIMAs. METHODS: This study included 1,132 Korean subjects over 20 years of age who had visited a Health Promotion Center in Korea. Carotid injury (increased carotid intima-media thickness or plaques) was evaluated by ultrasonography and arterial stiffness by brachial-ankle pulse wave velocity. The MetS components were assessed according to the Asian criteria of the American Heart Association/National Heart, Lung, and Blood Institute. RESULTS: Both arterial stiffness and carotid injury gradually deteriorated with increase in the number of MetS components. Arterial stiffness and carotid injury were associated with different MetS components, each of which had varying impact. After adjustment for all possible confounders such as age, sex, and lifestyle, elevated blood pressure (BP) was found to have the strongest association with arterial stiffness, whereas central obesity, impaired fasting plasma glucose, and elevated BP had comparable connection with carotid atherosclerosis. CONCLUSION: Individual MetS components were related with subclinical atherosclerosis in different ways. Elevated BP showed the strongest association with arterial stiffness, while central obesity, impaired fasting plasma glucose, and elevated BP showed good correlation with carotid atherosclerosis.

The Changes of Confidence, Accuracy and Knowledge of Medical Professionals after the Education for Survival Predictionin Terminally Ill Cancer Patients / 한국호스피스완화의료학회지

PURPOSE: In this study, we evaluated the effects of training for survival prediction of terminally ill patients in terms of medical professionals' confidence, accuracy and knowledge of survival prediction. METHODS: Twenty-nine participants completed a self-administered questionnaire where they scored their confidence, accuracy and knowledge of survival prediction before and after the training session. The training was provided in July 2009 at a university hospital located in Gyeonggi province, Republic of Korea. The participants were instructed by a professor of family medicine specialized in hospice palliative medicine to predict survival of a case using the palliative prognostic score and objective prognostic score. The training was provided in the form of a PowerPoint presentation for 40 minutes. RESULTS: Participants' confidence in survival prediction significantly increased from 4.00+/-1.73 (mean+/-SD) (0~10, visual analogue scale) to 5.83+/-1.71 after the training (P<0.001). Before training, participant's level of confidence significantly correlated with their age (P=0.04). The training significantly improved the correlation between the confidence level and the number of terminal cancer patients whom they have experienced (P=0.005 before training, P=0.017 after training). Participant's accuracy in survival prediction also significantly improved from 14 of 29 (48%) to 27 of 29 (93.1%) (P<0.001). The change in knowledge of survival prediction was too small to be statistically analyzed. CONCLUSION: After training, the confidence and accuracy scores significantly improved. Further study with a greater number of participants is needed to generalize this finding.

Factors Related to Substantial Pain in Terminally Ill Cancer Patients / 한국호스피스완화의료학회지

PURPOSE: Pain is the most common and influential symptom in cancer patients. Few studies concerning pain intensity in the terminally ill cancer patients have been done. This study aimed to identify factors related with more than moderate pain. METHODS: This study used secondary data of 162 terminal cancer inpatients at the palliative ward of six training hospitals in Korea. Physician-assessed pain assessment was by 10 point numeric rating scale. Substantial pain was defined more than moderate intensity by the Korean National Guideline for cancer pain. The Korean version of the MD Anderson Symptom Inventory was self-administered to assess symptoms. Survival prediction was estimated by the attending physicians at the time of admission. RESULTS: Less than six weeks of predicted survival and more than numeric rating of six for worst drowsiness in the previous 24 h were significantly related to substantial pain (P=0.012 and P=0.046, respectively). The dose of opioid analgesics was positively related to substantial pain (P=0.004). CONCLUSION: Factors positively related to substantial pain were less than six weeks of predicted survival and considerable drowsiness. Careful monitoring and active preparation for pain are required in terminal cancer patients having those factors.

The Relationship between Normal Serum Uric Acid and Nonalcoholic Fatty Liver Disease

The objective of the present study was to determine the relationship between serum uric acid (SUA) level and the presence of nonalcoholic fatty liver disease (NAFLD). We analyzed data of 9,019 Koreans who visited a health check up center. The SUA levels of all of these subjects were within the normal range. The participants were divided into 4 groups according to the quartiles of the SUA levels for both sexes. Hepatic steatosis was diagnosed on the basis of ultrasonographic findings. Multivariate logistic regression modeling was performed across the SUA quartiles. The presence of NAFLD and metabolic abnormalities were found significantly in subjects with high-normal SUA levels. After adjustment for age, metabolic components, and the liver-function test, the adjusted odds ratio (OR, 95% CIs) for the presence of NAFLD in the subjects with the highest SUA level was 1.46 (1.17-1.82) for men and 2.13 (1.42-3.18) for women, as compared to the subjects with the lowest SUA level. Our results suggest that increased SUA concentrations, even within the normal range, are independently associated with the presence of NAFLD.

Delirium in the Final Weeks of Terminally Ill Cancer Patients / 가정의학회지

BACKGROUNDS: In terminally ill cancer patients, delirium must be considered to be important clinically and for the quality of life. We reviewed cases of delirium in hospitalized cancer patients with the aim to recognize and treat delirium. METHODS: We reviewed retrospectively the medical records of patients admitted with terminal cancer from April 2003 to April 2004 in the department of family medicine, National Health Insurance Corporation Ilsan Hospital. A total of 71 patients were evaluated with age, sex, oncological diagnosis, metastases, morphine (oral morphine equivalents/day, OME) use and amount, sedatives use, duration from delirium to death, and laboratory fi ndings. Analysis was conducted to fi nd the characteristics of delirium patients and to quantify the relationship between delirium and predicting factors. RESULTS: Among 71 cases, those patients who developed delirium were 41 (57.7%). Among them, gastric cancer was the most common diagnosis with 10 patients (24.4%), followed by colon and lung cancers (9: 22%, 5: 12.2%). The patients receiving sedatives or morphines were 24 (58.5%) and 28 (68.3%), respectively. The mean amount of morphine was 168.6 +/- 125.5 mg OME/day. Hyperbilirubinemia (4.2 +/- 9.2 mg/dL) and hyponatremia (132.5 +/- 4.5 mM/L) were found. Not only bone metastasis and the use of morphine or sedatives but serum Na were significant (P = 0.047; P < 0.001; P = 0.069; P = 0.029). By logistic regression analyses, the occurrence of delirium was increased with decreased serum Na (odds ratio [95% CI] 0.798 [0.649-0.981]) and increased use of sedatives (5.955 [1.080-32.835]). CONCLUSION: In terminally ill cancer patients, the risk factors of delirium were bone metastasis, the use of morphine or sedatives, and serum Na level. Among these, the use of sedatives and serum Na level were independent risk factors.

The Assessment Tools in Palliative Medicine / 한국호스피스완화의료학회지

The assessment of patient status in palliative medicine is essential for determining treatments and for clinical outcomes. The objective of assessment tools is to raise the quality of care for individual patients and their families. There are a number of tools available to assess pain, non-pain symptoms and quality of life. The tools are either uni-dimensional or multi-dimensional measures. Unfortunately, however, no single tool is recommended to be a superior to others in symptoms or quality of life assessment. Therefore, to select an appropriate assessment tool, one should consider the time frame and unique characteristics of tools depending on purpose and setting. The combination of prognostic index is highly recommended in prognostication, and web-based prognostic tools are available. Recently, a new objective prognostic score has been constructed through multicenter study in Korea. It does not include clinicalestimates of survival, but includes new objective prognostic factors, therefore, anyone can easily use it. For beginners in palliative medicine, relatively easy-to-use tools would be convenient. We recommend Eastern Cooperative Oncology Group performance status to assess functional status, numeric rating scale for pain assessment and the Korean version of brief pain inventory for initial pain assessment. Asking directly with numeric rating scale or the Korean version of MD Anderson Symptom Inventory would be desirable to assess various symptoms together. We think that European Organization Research and Treatment Quality of Life Questionnaire Core 15 for Palliative Care is good to assess the quality of life, while Objective Prognostic Score is convenient as prognostic index for beginners.

Validation of Scoring System for Survival Prediction in Terminal Cancer Patients in Korea

BACKGROUND: Accurate prediction of survival in terminal cancer patients is important for planning effective palliative care. But, the prediction of survival most often relies on the physicians' prediction. Recently, simple prognostic scores such as Palliative Prognostic Index and Palliative Prognostic Score have been developed to estimate duration of survival. The aim of this study was to validate these prognostic scores and physicians' prediction for terminally ill cancer patients in Korea to determine its value in clinical practice. METHODS: The subjects of this study were 40 terminal cancer inpatients of one hospital who died between March to May 2005. All patients' Palliative Prognostic Index, Palliative Prognostic Score, and physicians' prediction were recorded on admission by a physician. RESULTS: When a Palliative Prognostic Index of more than 6 was adopted as a cut-off point 3 weeks' survival was predicted with a sensitivity of 90% and a specificity of 60%. When the three groups were grouped by Palliative Prognostic Scores (group A: 11), the 30 day survival probability were 60% for group A, 16.7% for group B, and 4.3% for group C, respectively. Physicians' prediction showed moderate correlation (correlation coefficient=0.604) with actual survival and had a tendency to overestimate survival. CONCLUSION: Palliative Prognostic Index was proved to be a reliable survival prediction tool in Korea. Palliative Prognostic Score had a tendency to overestimate survival as compared with other studies. Physicians' prediction had a correlation with actual survival, and it was presumed to be more accurate when combined with other prognostic score.

Association of Smoking Status and Dietary Pattern -A Data of Male Screeners at a Health Promotion Center-

BACKGROUND: Smoking greatly increases the risk of cancer, cardiovascular diseases and osteoporosis. Besides direct harm from smoking, some dietary pattern of smokers have been reported to increase such risk. This study aimed to analyze various nutrients by smoking status, and to find out whether smokers maintain harmful dietary patterns. METHODS: One thousand and six hundred fourteen men were selected who visited the health promotion center of an university hospital in Seoul. The inclusion criteria was the completion of dietary survey. Dietary analysis was done by calculation of amounts of each nutrients from 24-hour recall method. We compared total intake of each nutrients and total calories by smoking status with analysis of variance (ANOVA). Then we adjusted the results for exercise and education level by ANCOVA (analysis of covariance). RESULTS: The study subjects were 840 current smokers (52.0%), 479 ex-smokers (29.7%) and 295 non-smokers (18.3%). The consumption of total fat and cholesterol was significantly high in smokers than non-smokers (P=0.012, P=0.005). The alcohol intake was higher in smokers and ex-smokers than non-smokers (P <0.001, P=0.007). The smokers and ex-smokers had less calcium than non- smokers (P=0.001, P=0.044). Furthermore, the smokers exercised less than ex-smokers and non-smokers (P <0.001). CONCLUSIONS: The smokers consumed more total fat and cholesterol which increases the risk of cardiovascular diseases. They also had less calcium and drank more alcohol. Comprehensive approach which includes intervention for dietary intakes in addition to smoking cessation is desirable to decrease health risk for smokers.

Identification of Related Factors of Female Sexual Function in Family Medicine Outpatients

BACKGROUND: Female sexual function is influenced by much more factors than that of male and has a close relationship with psychosocial factors. A satisfying sex life has a high correlation to a happy married life. A questionnaire provides easy access to private matters and in a multidimensional manner. The objective of this study was to identify the factors related to female sexual function to help sexual adjustment in marriage. METHODS: A hundred married women living with their spouses, who visited an outpatient clinic of family medicine department of a university hospital in Seoul were studied. After filling out the self-administered questionnaire, a face-to-face interview was done on all study subjects. For multivariate analysis of the related factors, the outcome variables were a binary response of the normal female sexual cycle ?drive, lubrication, orgasm, and satisfaction. RESULTS: The multivariate analysis showed that the household income was a significant factor related to Drive (Odds Ratio: OR=0.6, 95% Confidence Interval: CI 0.4~0.9). Age was a significant factor related to Insufficient Lubrication (OR=1.1, 95% CI 1.0~1.3). Insufficient foreplay was a risk factor for Insufficient Lubrication (OR= 2.4, P=0.052). In multivariate analysis of the Orgasm related factors, the perceived health status showed an OR of 7.1 (95% CI 1.5~32.6) and both marital satisfaction and open communication showed an OR of 6.0 (95% CI 1.3~26.8) and an OR of 5.8 (95% CI 1.2~28.2), respectively. The significant related factors to Satisfaction were in order of importance of sex life, education, and open communication, with an OR of 3.6 (95% CI 1.7~7.6), 2.5 (95% CI 1.1~5.9), and 2.0 (95% CI 1.0~3.8), respectively. CONCLUSION: The positively related factors to female sexual function were good perceived health status, high marital satisfaction, placing importance in sex life, and open communication regarding sexual matters. Increasing age and household income were found to be factors adverse to female sexual function.

The Development of Female Sexual Function Questionnaire in Family Medicine Outpatients

BACKGROUND: Currently, the high quality of life associated with women's rights is strongly supported and has become an important social issue. As a result, there is an increasing need for studies concerning female sexual function. The objectives of this study was to develop a questionnaire to evaluate sexual function evaluation in Korean women. METHODS: A total of 100 married women, who visited an outpatient clinic of family medicine department of a university hospital in Seoul, were studied. After filling out the self-administered questionnaire, a face-to- face interview was done on all study subjects. The items of this questionnaire were adopted from questionnaires with proven validity and reliability. Factor analysis was done and Crohnbach's alpha was calculated. RESULTS: The items of this questionnaire were classified into 5 parts: Drive, Excitement, Sexual activity, Satisfaction, and Spouse. The total variance was 51.5%. The total Crohnbach's alpha was 0.82. The internal consistency was high. Study subjects were able to complete this questionnaire within 10 minutes. CONCLUSION: The validity and reliability of this female sexual function questionnaire was found to be acceptable. This questionnaire can be utilized as a diagnostic adjunctive tool and feedback for treatment through further studies.

The Impact of the Change of Leisure Time Physical Activities on Body Weight

BACKGROUND: The risk of overweight and obesity to health is well known. Physical activity is important in the treatment of obesity in terms of healthy body composition and maintenance of body function. This study is a follow-up study to identify the impact of changes of leisure time physical activities on body weight. METHODS: The study subjects were people who visited a health examination center in Seoul at least twice between 1995 and 2000. Seven hundred people who completed physical activity questionnaires each time they visited were included. Three hundred eighty two of them were men, and 318 were women. The questionnaire was Baecke physical activity questionnaire, consisted of items for work activities, sports activities, and non-sports leisure activities. Each index of activities was calculated. RESULTS: Ninety seven people (13.9%) reduced their weights more than 5% of initial body weights. Twenty eight people (4.0%) gained their weights more than 5% of initial body weights. In five hundred and seventy five people (82.1%) their body weights were changed within 5% of initial body weights. Non-sports leisure time indices increased greatly and were significantly more than sports indices in reduced weight group. Non-sports leisure time indices were not changed significantly in gained weight group. The dose-response relationship existed between changed body weight (kg) and difference of leisure time indices. The multivariate analysis showed that female was a significant factor related to reducing weight (odds ratio=4.5, 95% confidence interval 2.7-7.5). Increase of non-sports leisure indices showed borderline significance (odds ratio=1.4, 95% confidence interval 0.9-2.0). CONCLUSION: To increase non-sports leisure activities for the purpose of reducing body weight is actively recommendable. Such activities performed on a daily basis may have impact on reducing weight through repeatability and ease of access.

A study on the change of hepatitis B markers with the passage of time in nonvaccinees-A follow-up data of visitors in a health examination center for three years

BACKGROUND: Korea is an epidemic area of hepatitis B. There are needs for longitudinal study to measure quantity of hepatitis B infection status in Korea. This study was designed to observe natural course of hepatitis B markers in the same person for three years. The objective of this study was to investigate incidence of new infection and persistence of previous infection. METHODS: The study subjects were clients who visited a health examination center in Seoul twice with an interval of three years, from 1995 to 2000. They replied as nonvaccinee on both occasions for hepatitis B by self-administered questionnaire. Hepatits B markers were measured by radioimmunoassay on all visits. There were 103 subjects with 61 men and 42 women. RESULTS: The positive rate of hepatitis B surface antigen was 20.4% initially, which changed to 18.5% after three years. The positive rate of hepatitis B surface antigen was 20.4% initially, that was changed as 18.5% after three years. The positive rate of hepatitis B surface antibody was 61.2% initially, which increased to 66.0% after three years. The positive rates of hepatitis B surface antibody in men were 63.9% initially and 68.9% after three years, which showed statistically significant trend. (P=0.08). The positive rate of hepatitis B core antibody was 89.3%, which remained the same after three years. There was no positive conversion case of hepatitis B surface antigen. The negative conversion rate of hepatitis B surface antigen was 2/63(3.2%). The positive conversion rate of hepatitis B surface antibody was 7/40(17.5%), and negative conversion rate of that was 2/63(3.2%). The positive conversion rate of hepatitis B core antibody was 3/11(27.3%), and negative conversion rate of that was 3/92(3.3%). CONCLUSION: Hepatitis B markers changed in the direction of increase of infection incidence, rather than natural disappearance of markers in nonvaccinees. The mechanism was postulated as occurrence of new infection mainly, but the possibility of double infection by variants of hepatitis B virus could not be ruled out. We confirmed that positive rate of hepatitis B marker in males was not only higher cross-sectionally, but also increased higher longitudinally. We suggest a follow-up study of hepatits B markers to be performed because hepatits B markers showed dynamic changes. We think the high risk groups of hepatitis B infection have a priority in follow-up study.

Nausea and vomiting

No abstract available.

Relationship of serum lipid profile and the degree of depressive symptoms in Korean adults

BACKGROUND: An inverse relationship between cholesterol level and the degree of depressive symptoms was found in several studies targeted to Westerners. But, other studies failed to replicate this finding, giving diverse opinion on this matter. The objective of this study was to investigate the association between the degree of depressive symptomps and lipid level, total calorie intake and fat intake respectively in adults screened in a health promotion center in Korea. METHOD: The study group consisted of 352 men and women who visited the Health Promotion Center of Seoul National University Hospital from June to August in 1998. Their depressive symptoms were measured by Korean version of the Center for Epidemiologic Studies Depression Scale(CES-D). Lipid level was measured by enzymatic methods with fasting blood specimen. Total calorie and fat intake were calculated from a self-reported questionnaire on the types and amount of food. RESULTS: Depressive symptoms were not significantly related to lipid levels, total calorie intake, fat intake, age, exercise, BMI, smoking or alcohol consumption(p>0.05). But sex(P0.05). CONCLUSION: In contrast to the results of previous studies, no significant association between the degree of depressive symptoms and lipid levels, total calorie intake and fat intake respectively were found in Korean adults after adjusting for several factors related to health.