Associated Factors for Target Blood Pressure Achievement after Triple Combination Therapy in Hypertensive Patients

BACKGROUND: The prevalence of hypertension reaches 29% in adults over 30 years of age in the Korean population; however, the control rate is merely 44%. The aim of this study was to investigate the associated factors for target blood pressure achievement after triple combination therapy in hypertensive patients. METHODS: From February 2016 to May 2018, 10 family physicians recruited 348 patients, who newly started a triple combination antihypertensive medication. Target blood pressure was defined as a systolic blood pressure (SBP) <140 mmHg and diastolic blood pressure (DBP) <90 mmHg after 6 months of triple combination therapy. Multivariate logistic regression analyses were performed to analyze the associated factors for target blood pressure achievement. RESULTS: Among the 348 study participants, 317 completed 6 months of treatment. The target achievement rate was 76.3% (242/317). The mean absolute difference and 95% confidence interval (CI) for the SBP and DBP were 10.8 mmHg (8.8 to 12.7) and 6.4 mmHg (5.1 to 7.8), respectively (P<0.05). The odds ratio (OR) for the target blood pressure achievement increased in those with college education or higher (OR, 2.69; 95% CI, 1.22–5.92), those with dyslipidemia (OR, 1.74; 95% CI, 1.01–2.99), and those who were satisfied with the medication (OR, 29.91; 95% CI, 3.70–241.92). CONCLUSIONS: The presence of dyslipidemia and patient's satisfaction with the medication were associated with target blood pressure achievement in our analyses. Our findings suggest the importance of patient's factor in the control of blood pressure.

Associated Factors for Target Blood Pressure Achievement after Triple Combination Therapy in Hypertensive Patients

BACKGROUND@#The prevalence of hypertension reaches 29% in adults over 30 years of age in the Korean population; however, the control rate is merely 44%. The aim of this study was to investigate the associated factors for target blood pressure achievement after triple combination therapy in hypertensive patients.@*METHODS@#From February 2016 to May 2018, 10 family physicians recruited 348 patients, who newly started a triple combination antihypertensive medication. Target blood pressure was defined as a systolic blood pressure (SBP) <140 mmHg and diastolic blood pressure (DBP) <90 mmHg after 6 months of triple combination therapy. Multivariate logistic regression analyses were performed to analyze the associated factors for target blood pressure achievement.@*RESULTS@#Among the 348 study participants, 317 completed 6 months of treatment. The target achievement rate was 76.3% (242/317). The mean absolute difference and 95% confidence interval (CI) for the SBP and DBP were 10.8 mmHg (8.8 to 12.7) and 6.4 mmHg (5.1 to 7.8), respectively (P<0.05). The odds ratio (OR) for the target blood pressure achievement increased in those with college education or higher (OR, 2.69; 95% CI, 1.22–5.92), those with dyslipidemia (OR, 1.74; 95% CI, 1.01–2.99), and those who were satisfied with the medication (OR, 29.91; 95% CI, 3.70–241.92).@*CONCLUSIONS@#The presence of dyslipidemia and patient's satisfaction with the medication were associated with target blood pressure achievement in our analyses. Our findings suggest the importance of patient's factor in the control of blood pressure.

Excessive Sodium Intake and Related Factors According to Energy Intakes Among Korean Elderly: A Nationwide Cross-Sectional Study

BACKGROUND: Few large-scale studies have investigated sodium intake in Korean elderly. We examined excessive sodium intake and related factors according to energy intake in this population. METHODS: We conducted a cross-sectional study using data from the fifth Korea National Health and Nutrition Examination Survey 2012. We analyzed the 24-hour dietary recall data from 1,496 elderly individuals (635 men, 861 women), who were then categorized into three groups according to energy intake-insufficient, appropriate, and excessive. The association between sociodemographic factors and 4 g or more of sodium intake were examined by the multivariable logistic regression model. RESULTS: Mean sodium intake was 4.7 g/day for men and 3.3 g/day for women. Subjects who consumed excessive energy had a higher risk of consuming 4 g or more of sodium in men (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.24-5.08) and women (OR, 3.89; 95% CI, 2.21-6.85) compared with subjects who consumed an appropriate amount of energy. In men, low house income (OR, 2.36; 95% CI, 1.07-5.19) in the group with insufficient energy intake and living alone (OR, 6.30; 95% CI, 2.26-17.54) in the group with excessive energy intake were significantly associated with excessive sodium intake. In women, alcohol use (OR, 4.46; 95% CI, 1.29-15.44) and regular walking (OR, 3.22; 95% CI, 1.15-9.03) in the group with excessive energy intake were significantly associated with excessive sodium intake. CONCLUSION: We observed a significant association between excessive sodium intake with low income and living alone in men. Our findings suggest that dietary support to reduce sodium intake is needed in the elderly.

Pyogenic Liver Abscess Following Acupuncture and Moxibustion Treatment / 가정의학회지

Acupuncture treatment is generally regarded as a relatively safe procedure. However, most procedures have some complications and acupuncture treatment is no exception. Reported complications of acupuncture treatment were mostly mild or temporary symptoms, but certain severe adverse effects were also observed. We report here for the first time a case of liver abscess following acupuncture and moxibustion treatment.

The Impact of Bladder Distension on Blood Pressure in Middle Aged Women / 가정의학회지

BACKGROUND: The purpose of the present study was to investigate the relation between the extent of bladder distention and the rise of blood pressure in middle aged women. METHODS: In a cross-sectional, descriptive observational study, we obtained data from 172 middle aged women at a health promotion center of Pusan National University Hospital. We measured duration of urine-holding as the degree of the extension of bladder distention. Blood pressure was measured twice while holding urine and immediately after urination. Urine holding with full bladder was confirmed by abdominal ultrasound. RESULTS: Difference in systolic blood pressure was 4.2 +/- 10.7 (P < 0.001), and that in diastolic blood pressure was 2.8 +/- 7.7 mm Hg (P < 0.001) between holding urine and immediately after urination. There was no significant correlation between the urine-holding duration and differences in systolic and diastolic blood pressure. CONCLUSION: Our findings suggest that systolic and diastolic blood pressure is increased by urine-holding at least 3 hours after the last urination in middle aged women. Thus in practice, blood pressure should be measured after the bladder is emptied.

Eradication of Helicobacter pylori Increases Ghrelin mRNA Expression in the Gastric Mucosa

It has been suggested that Helicobacter pylori eradication may influence production of some peptides in the stomach, which can affect appetite. This hypothesis is controversial. To verify the hypothesis, we conducted this randomized controlled trial using H. pylori infected subjects without any gastrointestinal symptoms. The treatment group received triple H. pylori eradication therapy for 7 days and the control group received no medication. We measured ghrelin, obestatin and the tumor necrosis factor-alpha (TNF-alpha) mRNA levels in endoscopic biopsy specimens and the changes from baseline to follow-up. The plasma active n-octanoyl ghrelin and obestatin levels were measured in both groups. The ghrelin/obestatin ratios in plasma and gastric mRNA expression were calculated at baseline and follow-up. Ghrelin mRNA expression in the fundic mucosa after H. pylori eradication increased significantly compared to the control group (4.47+/-2.14 vs. 1.79+/-0.96, P=0.009), independent of inflammatory changes. However, obestatin mRNA expression decreased in the antral mucosa (-0.57+/-1.06 vs. 0.41+/-0.72, P=0.028). The treatment group showed a marginal increase (P=0.060) in plasma ghrelin/obestatin ratio. The TNF-alpha mRNA expression also decreased significantly with treatment. This randomized controlled trial demonstrates that H. pylori eradication increases ghrelin mRNA expression, independent of inflammatory cell changes.

A Randomized Controlled Trial of SMS Text Messaging versus Postal Reminder to Improve Attendance after Lipid Lowering Therapy in Primary Care / 가정의학회지

BACKGROUND: In the primary care setting, compliance with lipid lowering therapy was relatively low. In order to compare the efficacy of a short messaging service (SMS) text messaging and postal reminder as means of improving attendance rates during the first 24 weeks of lipid-lowering therapy, a randomized controlled trial of 918 patients from 19 family practice clinics was conducted between February 2003 and June 2006. METHODS: Patients were randomly assigned into 3 groups: SMS (327), postal (294),and control (297) group. To ascertain attendance rates, patients were followed up at 24 weeks after their treatment. Reminders were sent at 16 weeks from the coordinating center. RESULTS: Overall attendance rate was 74.1%. This differed between groups, with 76.1% attendance for the SMS group, 73.5% for the postal group, and 72.4% for the control group. According to a multivariate analysis, the SMS group had a significantly higher attendance rate (Odds ratios [OR] 1.48; 95% confidence interval [CI], 1.01 to 2.16) than the control group, but the postal group (OR, 1.15; 95% CI, 0.79 to 1.69) did not. Moreover, the cost per attendance for the SMS reminder (155 Korean Won [KRW]) was much lower than that for the postal reminder (722 KRW). CONCLUSION: SMS reminder may be more cost saving method to improve the attendance rate compared with the postal reminder.

The Relationship between Self-Efficacy and Body Weight Reduction after Educational Program for Health Care / 가정의학회지

BACKGROUND: Obesity is one of the health problems with high risk of metabolic and physiologic morbidity worldwide. Obesity increases cardiovascular disease risk and death as well as psychological and emotional health problems. Self-efficacy and physical self-efficacy are important evaluation tools for successful diet and exercise in obesity diet practice and it is directly associated with health behaviors. This study conducted to evaluate the effect of weight loss on self-efficacy and life quality. METHODS: The 39 adults who joined in weight control program in one public health center were recruited into this study. Quality of life, depression scale, anxiety scale, self-efficacy and physical self-efficacy were examined. Also physical performance ability and weight and lipid profile were examined. Statistical analysis obtained by SPSS. RESULTS: Quality of life and anxiety scale were significantly diminished in obese subjects than non-obese subjects. Quality of life was increased after weight control program in obese subjects. Physical self-efficacy was improved in weight reduction group with much more than 5% of initial weight. CONCLUSION: Weight reduction has positive impact on psychological aspects in obese subjects. Therefore, we should be more concerned about psychological and functional aspect of obese individuals during weight control treatment.

The Role of C-reactive Protein as a Inflammation-related Factor in Metabolic Syndrome / 가정의학회지

BACKGROUND: The metabolic syndrome has been known as the cluster of insulin resistance, dyslipidemia, hypertension, and abdominal obesity. There have been many studies about the inflammatory role in atherosclerosis and cardiovascular diseases, also. We aimed to elucidate the role of high sensitivity C-reactive protein (hs-CRP) as a inflammation-related factor in metabolic syndrome in Korean adults by correlation and factor analysis. METHODS: A cross sectional study was carried out in 1,512 men and 1,836 women (over 20 years old) who had an examination at a center for health promotion of an university hospital from May 2004 through March 2005. The NCEP-ATP III definition and Asian-Pacific adjusted criteria were used to obtain the metabolic syndrome group. And we evaluated the role and gender difference of hs-CRP in metabolic syndrome by correlation and factor analysis. RESULTS: In women, hs-CRP was statistically correlated with most metabolic variables, especially insulin resistance. In factor analysis, 3 factors (obesity, blood pressure, and insulin resistance) were obtained in men and 4 factors (obesity, blood pressure, insulin resistance, and dyslipidemia) in women, respectively. In women, hs-CRP was a part of dyslipidemia factor. CONCLUSION: In factor anaylsis of metabolic syndrome factors with hs-CRP, hs-CRP was not a significant factor in men, but was included as a part of dyslipidemia factor in women.

Health Behavior and Metabolic Syndrome / 가정의학회지

BACKGROUND: Life style has been shown to improve risk factors comprising the metabolic syndrome. Metabolic syndrome is a prime candidate for lifestyle modification utilizing the tools of exercise, nutritional therapy and so on. Therefore, we examined the prevalence of metabolic syndrome according to health behaviors. METHODS: A total of 1,240 adults were recruited into this cross-sectional study. The subjects were examined on body mass index, waist circumference, blood pressure, and lipid profile. Medical history was reviewed and daily calorie intake was examined by food frequency questionnaire. Six healthy behaviors, sleeping hours, smoking, drinking, exercise, calorie intake and body weight of subjects, were examined. Each healthy behaviors were categorized into three groups. Metabolic syndrome as diagnosed by ATP III criteria. RESULTS: The study subjects consisted of 57.1% men and 42.9% women. The prevalence of metabolic syndrome was 14.3%. The prevalence of metabolic syndrome was lower in the group with good healthy behaviors. The subjects with more good healthy behaviors had a lower prevalence of metabolic syndrome than those with less good healthy behaviors (0, 50.0%; 1, 41.0%; 2, 30.6%; 3, 13.8%; 4, 8.5%; 5, 5.3%; and 6, 4.3%). Relative to the subjects with high good health behavior score, those with low good health behavior score were at significantly increased risk of metabolic syndrome (odds ratio = 4.25, 95% CI 2.97-6.08). CONCLUSION: The subjects with much more good healthy behaviors had a substantially lower risk of being diagnosed with the metabolic syndrome compared to those with lesser good healthy behaviors. This finding suggests that lifestyle modification may be appropriate as the first-line intervention to metabolic syndrome.

Regional Fat Measured by DEXA and Metabolic Risk Factors among Women with Central Obesity

BACKGROUND: This study was carried out to determine the usefulness of regional body fat measured by dual energy X-ray absorptiometry (DEXA) by examining the relationship between regional body fat and metabolic risk factors. METHODS: A total of 98 women aged 18~65 years with central obesity (waist circumference > or =80 cm) took the evaluation for metabolic risk factors (blood pressure, fasting glucose, insulin, high sensitive c-reactive protein (hs-CRP), lipid profile, homeostasis model assessment of insulin resistance (HOMA-IR)) and the anthropometric measurement, and regional body fat measurement using DEXA. The relationship of regional body fat with the metabolic risk factors, the metabolic syndrome (MS) defined by the International Diabetes Federation and insulin resistance (IR, defined by HOMA-IR> or =2.48) were assessed. The analyses were conducted using regression and logistic regression analyses. RESULTS: After adjustment for age and total body fat (%), legs fat (%) was significantly and negatively associated with LDL-C, triglyceride, HOMA-IR, and hs-CRP, while positively with HDL-C. The 1% increase of legs fat was associated with the MS by odds ratio of 0.82 (95% C.I 0.71~0.96) and with the IR by odds ratio of 0.80 (95% C.I. 0.67~0.95). Trunk fat (%) was significantly and positively associated with LDL-C, triglycerides, and HOMA-IR. The 1% increase of trunk fat was associated with the MS by odds ratio of 1.32 (95% C.I. 1.03~1.71) and with the IR by odds ratio of 1.33 (95% C.I. 1.01~1.77). The ratio of android fat to gynoid fat was significantly and positively associated with LDL-C, triglycerides, glucose, and HOMA- IR, while negatively with HDL-C. The 0.1 increase of the ratio was associated with the MS by odds ratio of 1.66 (95% C.I. 1.07~2.60). CONCLUSION: The trunk fat, and legs fat, the ratio of android fat to gynoid fat assessed by DEXA seemed to be useful indicators to predict the metabolic risk factors in women with central obesity.

Relations of Serum gamma-glutamyltransferase Levels to Incidence of the Metabolic Syndrome

BACKGROUND: The metabolic syndrome is a cluster of risk factors for cardiovascular diseases. Recently, serum gamma-glutamyltransferase (GGT) has been suggested as a predictor for development of the metabolic syndrome. Therefore, we investigated the association between serum GGT levels and the incidence of the metabolic syndrome in the Korean healthy adults with normal serum GGT with a 3 year follow-up. METHODS: The study subjects consisted of 741 individuals who visited the Center for Health Promotion in Pusan National University Hospital for a medical checkup in 2002 to 2005. Among 741 subjects, 312 were excluded: 71 were positive for HBsAg, 17 were positive for Anti-HCV Ab, 40 showed GGT higher levels than limit of reference range, and 224 had metabolic syndrome. The final subjects were 429 individuals. We measured serum GGT levels, lipid profiles, fasting glucose, blood pressure and their metabolic components. RESULTS: As the quartile of serum GGT increased, 3 year follow-up incidence of the metabolic syndrome was increased. Logistic regression analysis adjusting for sex, age, and alcohol drinking status showed that the odds ratio (95% confidence Interval, P-value) of each GGT quartile was 2.28 (0.58~9.01, P=0.240), 1.53 (0.36~6.66, P=0.564), 4.56 (1.08~19.32, P=0.040), respectively. CONCLUSION: These results showed that the serum GGT was closely related to the metabolic syndrome. In Korean adults without the metabolic syndrome, the serum GGT levels within normal limit were associated with an increased risk of incident, metabolic syndrome.

Students' Opinions on the Experience of Objective Structured Clinical Examination at Pusan National University School of Medicine / 한국의학교육

PURPOSE: The purpose of this study is to report the opinions of the students on the OSCE and how to improve this exam. METHODS: 135 students at Pusan National University School of Medicine were asked to perform the OSCE. Data were collected through a questionnaire (Cronbach's alpha = .965). Analysis was done using SPSS statistics program. RESULTS: In summary, the students thought the content of the OSCE was all very important but practically, it was difficult to perform due to a lack of practice. Through this exam, thestudents said that they realized their insufficiencies, and they felt more motivated to learn. The BLS station scored very high in the 'validity of contents', 'validity of difficulty', 'validity of time limit', and 'fostering learning motivation'. The opinions of the students on the areas requiring improvement were: the control of information exchange among them, the connection with training, the establishment of a permanent training space, and increasing exposure to the exam. CONCLUSION: The OSCE, now more than ever, definitely has an educating role in preparing physicians for clinical practice.

Social Support, Self-concept and Self-efficacy as Correlates of Adolescents' Physical Activity and Eating Habits

BACKGROUND: Despite growing knowledge of the importance of the management of diet and physical activity in the prevention of obesity in adolescence, a better understanding of social psychological influences could assist efforts in family, school and community settings. METHODS: Among the 3,653 adolescents who were randomly selected from seven separate school districts in Busan, 2,938 (83.9%) completed the questionnaire. The students who agreed to participate in this study were given a questionnaire which included social support as the Child and Adolescent Social Support Scale, self-efficacy as the physical self-efficacy questionnaire, self-concept as the Song and Hattie Test, physical activity as a Leisure-Time Exercise Questionnaire and eating habits as the Harris questionnaire. RESULTS: The support from parents, teachers, classmates, close friends and other people in the community predicted the level of adolescents' self-concept and physical activity, while only the support from teachers and other people in the community predicted adolescents' dietary self-efficacy. Adolescents' self-concept and physical activity self-efficacy significantly predicted the level of physical activity. Self-concept and dietary self-efficacy also predicted healthier eating habits. Only the support from close friends predicted adolescents' healthy eating habits. The support from parents, teachers, close friends, classmates and other people in the community predicted the level of physical activity through increasing the level of self- concept or physical activity self-concept. CONCLUSION: Although adolescents' behavior are ultimately individualized, they are formed through cognitive processes which are affected by social support. These social levels, therefore, should be supportive of adolescents' physical activity and healthier eating habits by providing frequent support and encouragement to establish positive self-concept and self-efficacy.

Social Support, Self-concept and Self-efficacy as Correlates of Adolescents' Physical Activity and Eating Habits

BACKGROUND: Despite growing knowledge of the importance of the management of diet and physical activity in the prevention of obesity in adolescence, a better understanding of social psychological influences could assist efforts in family, school and community settings. METHODS: Among the 3,653 adolescents who were randomly selected from seven separate school districts in Busan, 2,938 (83.9%) completed the questionnaire. The students who agreed to participate in this study were given a questionnaire which included social support as the Child and Adolescent Social Support Scale, self-efficacy as the physical self-efficacy questionnaire, self-concept as the Song and Hattie Test, physical activity as a Leisure-Time Exercise Questionnaire and eating habits as the Harris questionnaire. RESULTS: The support from parents, teachers, classmates, close friends and other people in the community predicted the level of adolescents' self-concept and physical activity, while only the support from teachers and other people in the community predicted adolescents' dietary self-efficacy. Adolescents' self-concept and physical activity self-efficacy significantly predicted the level of physical activity. Self-concept and dietary self-efficacy also predicted healthier eating habits. Only the support from close friends predicted adolescents' healthy eating habits. The support from parents, teachers, close friends, classmates and other people in the community predicted the level of physical activity through increasing the level of self- concept or physical activity self-concept. CONCLUSION: Although adolescents' behavior are ultimately individualized, they are formed through cognitive processes which are affected by social support. These social levels, therefore, should be supportive of adolescents' physical activity and healthier eating habits by providing frequent support and encouragement to establish positive self-concept and self-efficacy.

Hospital Employees' Awareness about Medical Student's Clerkship / 한국의학교육

PURPOSE: With our medical school accepting graduate level students, there may be more conflicts between the older students and hospital employees. These issues need to be dealt with in order to improve the quality of education of medical students during clerkship. This study aims to improve the setting of clerkship by analysing how knowledgeable hospital employees are about medical school clerkship. METHODS: Study subjects included 206 hospital employees working at a university hospital in Pusan. Subjects completed a self-reported questionnaires on the hospital employees' knowledge about medical student's clerkship. Means and standard deviations were based on a five point scale, and data were analyzed using statistical methods including chi-square-test, two-sample t-test, ANOVA, and partial correlation. RESULTS: Opinions about the awareness of educational role of the university hospital, necessity of clerkship, influence that clerkship has on doctor's careers, necessity for clerkship students to understand roles of other hospital employees, and degree to which hospital employee explain their roles to clerkship students, were positive, but opinions about the attitudes of clerkship students were neutral, and opinions about attachment to clerkship students, clerkship students' efforts to understand the roles of hospital employees were negative. Opinions about the necessity of clerkship, influence that clerkship had on doctor's careers, clerkship students' efforts to understand roles of hospital employees showed significantly positive correlations with opinions about the attitude of clerkship students, attachment to clerkship students and the degree of explaining hospital employee's roles to clerkship students. CONCLUSION: To increase attentiveness in hospital employees towards medical clerkships, it seems necessary both to educate hospital employees on the clerkship itself and on working together with medical students, and to have clerkship students continue to be taught on the roles of other employees of the hospital.

Application of Abdominal Circumference Presented by Body Composition Analyzer according to Gender and Body Mass Index

BACKGROUND: Recently, body composition analyzer has been used widely clinically. Various indirectly measured values of body are calculated without direct measuring. The abdominal circumference that is presented by such instrument may be used for diagnosing abdominal obesity, but the reliable evidence of the accuracy and the validity may be not be enough for application to general population. For this reason, the author investigated the usefulness of automatically produced abdominal circumference for diagnosing abdominal obesity. METHODS: The medical records of 5,555 outpatients who had undergone body composition analysis in a tertiary hospital was collected. The usefulness of the automatically presented abdominal circumference for diagnosing abdominal obesity among general population was investigated. RESULTS: There was a significant positive correlation between abdominal circumference measured by body composition analyzer and measuring tape in the normal, the overweight, and the obese groups of both gender. But, the results were the same only in females in the underweight group. The most significant difference between the two values were 4.8+/-5.0 cm in normal male group and -5.7+/-5.5 cm in female obese group. The difference of the male obese group was lesser than that of the overweight, the normal and the underweight groups. The difference of the male overweight group was lesser than that of the normal group. The difference of the female obese group was lesser than that of the overweight, the normal and the underweight groups. The sensitivity and specificity to detect abdominal obese person among the total subjects was 76.3% and 79.1%, respectively. The specificity was higher in all male and the normal female groups, wheras the sensitivity was higher in the obese and the overweight female groups. CONCLUSION: Physicians should confirm the accuracy of abdominal circumference, especially in normal males and obese female group, although the automatically presented value is convenient and reflects the manually measured one very well which is useful to diagnose abdominal obesity.

Effect of 8-week Therapy with Rabeprazole on Presenting Symptoms in Korean Patients with Gastroesophageal Reflux Disease

BACKGROUND: Gastroesophageal reflux diease (GERD) is common in Western civilization and comprise 75% of esophageal diseases. However, there are only few studies of GERD in Korea. The aim of the study was to evaluate the clinical symptoms of GERD in Koreans and the effect of rabeprazole on the symptoms. METHODS: The study subjects were included 353 patients who were diagnosed endoscopically with reflux esophagitis (316) or non-erosive reflux disease who have complained of intermittent heartburn during the past 3 months or more. All patients received rabeprazole 20 mg daily for 8 weeks. Symptoms according to 8 symptom categories of GERD were evaluated. Patients recorded the severity of GERD associated symptoms at baseline, 4 weeks and 8 weeks after treatment. Presenting symptoms in Korean, frequency and severity of each symptom was evaluated. Efficacy of Rabeprazole treatment was analysed. RESULTS: The most common symptoms of GERD were regurgitation (60.9%), heartburn (52.7%), epigastric pain/ soreness (49.6%) and other epigastric discomfort (47.0%). Symptom severity was rated in order of epigastric pain/ soreness, epigastric discomfort, and heartburn. The proportion of all symptoms, except for heart burn and cough, increased in relation to the severity of endoscopic grading, but the severity of symptoms was not significantly different between subgroups according to endoscopic findings. Symptoms, except for hoarseness, globus sensation and cough, significantly improved in 4 weeks after treatment. Cough did not improve after 4 weeks irrespective of smoking status, All symptoms significantly improved after 8 weeks. CONCLUSION: Regurgitation was more common, and epigastric symptoms were more severe than heartburn in Koreans. The 8-week rabeprazole treatment was effective on all symptoms associated with GERD.

Diagnosis-related Characteristics of Microvascular Complications among Patients with Type 2 Diabetes Mellitus

BACKGROUND: This study was aimed to investigate the diagnosis-related characteristics of the microvascular complications among patients with type 2 diabetes mellitus and to identify the relationship ship between regular check-up and detection of complications of diabetes. METHODS: The study subjects were 63 patients with diabetic microvascular complications. The data were collected with self-administered questionnaire and analyzed with descriptive statistics. RESULTS: The main motive to identify retinopathy was through 'visiting hospital after having symptoms (58.9%)', and not through regular checkup. The most common symptom of retinopathy was dim dye (84.3%) and the mean duration after diabetes mellitus diagnosis was 6.8 years. The main motive to identify renal complications was through 'visiting hospital after having symptoms and checking for other complications (28.0%)'. The most common symptom of renal complications was edema of face and hands (72.0%) and the mean duration following diabetes mellitus diagnosis was 8.4 years. The main motive to identify neuropathy was through 'visiting hospital after having symptoms (34.8%)', and not regular checkup. The most common symptom of neuropathy was tingling sensation of feet (100.0%) and the mean duration following diabetes mellitus diagnosis was 7.4 years. CONCLUSION: Based on the results, we suggest that diabetes complications check-up should be performed simultaneously to make the diagnosis of diabetes mellitus, and that the health care providers could provide them with more opportunities to have such check-ups with standardized complications care guidelines.

Validity and Reliability of Self-Report in Cancer Screening

BACKGROUND: The study was aimed to examine the validity and the reliability of self-report of gastric cancer screening (endoscopy or upper GI), mammography, and Pap smear. METHODS: The study subjects for validity included those who had undergone 276 endoscopies or UGIs, 127 mammograms, and 125 Pap smears performed at a health promotion center of P and I university hospital during January 1, 1999 to June 30, 1999 and January 1, 2002 to June 30, 2002. The study subjects for reliability included those who had undergone 86 endoscopies or UGIs, 31 mammograms, and 33 Pap smears who went through two surveys. The data was collected by mail or telephone interview. We calculated the sensitivity of self-reports by comparing the self-report and the laboratory results as a gold standard, and the agreement between repeateds reportings. RESULTS: The sensitivities based on the test year were 49.3% for gastric cancer screening, 56.7% for mammography, and 53.6% Pap smear, and the sensitivities on the test month were 39.1%, 45.7%, and 46.4%, respectively. The agreement between the two self-reporting on the test year were 59.6% for gastric cancer screening, 67.7% for mammography, and 63.6% Pap smear, and the agreement on the test month were 82.3% for gastric cancer screening, 74.2% for mammography, and 72.7% for Pap smear. CONCLUSION: Self-report alone may not provide accurate or reliable data on the cancer screening compliance. It is recommended to utilize other objective data for cancer screening. And it would be helpful to utilize a memo-book as a reminder to screen for cancer in order to enhance the validity and the reliability of self-report.