Is the Use of Physician Reminder Sticker on Medical Records Effective for Improving the Rate of Recommending Influenza Vaccination?

BACKGROUND: For people who have high risk diseases or who are aged 65 years or more, routine influenza vaccination is required. However, in Korea, influenza vaccination rate of such people is low. We performed a study to assess the effectiveness of physician reminder in improving the rate of recommending influenza vaccination. METHODS: Among the patients who registered to tertiary care hospital family clinic center, 305 patients with diabetes mellitus or aged 65 years or more were randomly assigned into physician reminder group and control group. After excluding the patients who were vaccinated before the medical consultation or who did not attend the clinic, remaining 253 patients were included as final study subjects. For the physician reminder group, a sticker showing that influenza vaccination was needed was placed on each medical record. Demographic and clinical characteristics, recommendation of vaccination by physician, and the receipt of vaccination were checked through self-administered questionnaires, review of medical chart and order communication system, and telephone interview. RESULTS: The rates of recommending vaccination in the physician reminder group and the control group were 36% and 29.7%, respectively. The difference between the two groups was not significant. Vaccination rate in patients for whom influenza vaccination was recommended by their physician was 87.0%, whereas those for whom vaccination was not recommended was only 41.2%. CONCLUSION: Physician reminder for influenza vaccination was not effective in this study. However, the physician's recommendation was effective in improving the influenza vaccination rate. Effective strategies will be needed to encourage physicians to recommend influenza vaccination.

Lifestyle Factors Related to Constipation in Working Women

BACKGROUND: While woman, old age, insufficent fiber and water supplement are well known risk factors of constipation, the relationships between constipation and stress, irregular diet and other lifestyle factors have not been well documented. We examined the relationship between constipation and those lifestyle factors in working women. METHODS: The study design was a cross-sectional study. The study subjects were 911 women who underwent health examination between May 30th, 2002 and June 30th, 2002 and completed the questionnaires relating to bowel movement. The information on bowel movement, demographic and lifestyle factors acquired through self-administered questionnaires were used for analysis. Chi-square test, t-test, and multiple logistic regression analysis were used. RESULTS: The prevalence rate of constipation defined by Rome II criteria among study subjects was 48.6%. The most frequent abnormal symptom occurring in more than 25% of abnormal bowel movement was straining (50.0%). Fewer than three bowel movements per week was observed only in 16.1% of the subjects. Among the subjects with self-reported constipation, only 66% had constipation defined by Rome II criteria. High degree of stress was the strongest independent risk factor (odds ratio[OR]:3.02, 95% confidence interval[CI]:1.68-5.41). Low intake of fiber and dieting were significantly related with increased risk of constipation and the OR was 2.08 (95%CI: 1.13-3.81), 1.92 (95%CI: 1.12-3.27), respectively. CONCLUSION: The significant relationship between constipation and stress, fiber intake, and dieting suggest that they are the risk factors of constipation. The possibility of disagreement between self-reported and objective constipation should be considered during medical consultation of patient with abnormal bowel habit.

Preferred place of death of elderly women in seoul

BACKGROUND: The present it is getting to be on aged society there is increasing that hospital has higher rate for place of death than home. Because we can expect that many patients who are faced with death come to hospital or hospice in the future, we have studied preferred place of death with an old women in seoul to have essential material of plan to understand asking for medical service of death, to divide medical manpowers and equipments and to supplement and to revise of medical educations. METHODS: Through the internet, 71 schools for the elderly. Of 277 an old woman who attending the schools out of 7 schools. We research into preferred place of death by self answering way through the June to July in 2000. RESULTS: The average age was 72.4 years. Of 277 respondents, 87 respondents(32.46%) reply their homes as a place of death and 166(61.94%) reply hospital, 15(5.6%) reply hospice, missing is 9. Statistical significance has connections with only level of education. The highest reason(47.5%) why respondents choose the hospital or hospice is only to reduce their children's burdens. Unlike respondents that education attending period is below 6 year, the relative risk of choosing the hospital or hospice between respondents who are 6 9year and above 9 year is each of 3.66, 5.58. CONCLUSION: This research shows that an elderly women in seoul prefer hospitals or hospice to homes as their place of death.

Diabetes mellius and serum ferrtin concentration

BACKGROUND: A prospective study about the association between serum ferritin concentration and diabetes mellitus showed that higher risk of diabetes was found in men in higher concentration of serum ferritin. The aims of this study is to examine the association between serum ferritin concentration and the risk of diabetes mellitus in healthy Korean in hospital-based samples. METHODS: In a volunterred healthy population(n=14,782), who underwent health examination in Samsung Medical Center, from January to December 1997, serum ferritin and glucose were determined. RESULTS: After adjusting for age, BMI, serum triglyceride concentration, and multiple logistic regression analysis showed that those in the highest quartile had increased risk of diabetes mellitus (OR: men 2.26(95% CI 2.41-2.95, p=0.0001), women 3.03(95% CI 2.51-3.67, p=0.0001), compared with those in the lowest quartile. CONCLUSION: In studied population, elevated serum ferrtin concentration was associated with an increaed risk of diabetes.

Effectiveness of Telephone and Postcard Reminders for the Influenza Vaccination: A Study in the Elderly Who Have Visited a Family Practice Center in a Tertiary Care Hospital / 예방의학회지

OBJECTIVES: Routine vaccination against influenza is recommended for all people aged 65 years or more. Without active encouragement to receive the vaccine, the rate of compliance is generally low. A study was undertaken to assess and compare the effectiveness of two reminder systems in improving the influenza vaccination rate. METHODS: A total of 2,017 patients aged 65 or over in a tertiary care hospital family practice center were randomly assigned to a control, a telephone reminder, or a postcard reminder group before the influenza season in 1998. The outcome measure, receipt of vaccination, was determined by telephone interview. Demographic and clinical characteristics were checked through the medical chart review. RESULTS: Among the 1,312 patients who actually received reminders and interviewed, the vaccination rate was 46.7% in the control group, 56.3% in the postcard reminder group, and 63.3% in the telephone reminder group. Vaccination compliance was significantly higher in people reminded by telephone (Odds ratio [OR], 2.00; 95% confidence interval [CI], 1.52-2.64) and postcard (OR, 1.55; 95% CI, 1.18-2.02) compared to that in the control group. Of the characteristics investigated, number of high risk co-morbidity was positively associated with vaccination compliance while current smoking was negatively associated. CONCLUSIONS: This result suggests that telephone and postcard reminders can significantly improve compliance with influenza vaccination in this group of Korean elderly. However, additional strategies need to be developed to encourage vaccination among noncompliant.