Pattern of Hypertensive Management and Usefulness of Treatment Guideline in Primary Care

BACKGROUND: This study aimed at finding out how much the rate of the JNC-7 guideline was carried out, and assessed the degree of evidence based clinical practice patterns and the validity of the new guideline by comparatively analyzing primary care practice patterns in hypertensive patients. METHODS: A questionnaire regarding the management of hypertension was conducted by mail between May 15 and July 15, 2005, to 1,008 of the Korean Association of Family Medicine listed in the address book. There were 195 respondents with a response rate of 19.4%. RESULTS: Among the total respondents, 91.1% were aware of the new guideline and had received information mainly through training lectures and seminars. They said that the biggest difference between the new guideline from the previous one was the inclusion of prehypertension (62.3%), and 61.1% were using the new term prehypertension in their practice. The most frequency advice given to patients related to lifestyle modification were in the order of smoking cessation (44.8%), exercise (41.7%) and weight reduction (38.0%). Calcium channel blocker was the most commonly used (60.9%) as the first-line agent. When physicians failed to control blood pressure with the first medication in cases of stage 1 hypertension, 67.7% added other agents. In treating stage 2 hypertension, 59.9% started with a single agent and gradually added other agents. CONCLUSIONS: Family physicians in primary care clinics had a good understanding of the JNC-7 guideline. However, the rate at which they applied it in treatment was low. To effectively apply the guideline in actual treatments, aggressive education of practitioners and improvement on medical system and treatment guidelines are needed.

Factors Influencing the Impulse of Suicide in Adolescence

BACKGROUND: Suicide is one of the ten largest causes of death in the world. The rate of suicide is recently significantly increasing in Korea and the rate is relatively high, particularly in adolescence. The purpose of this study was to support the establishment of appropriate measures for prevention of suicide through a better recognition of suicide and to investigate the factors that lead to suicide in adolescence with high school students who have large risk factors of suicide due to entrance examination, future courses, etc. METHODS: A questionnaire regarding the factors influencing the impulse of suicide was conducted to 770 high school students in eight high schools in Seoul and local areas between June 1 and July 31, 2005. Suicidal impulses was checked by SSI (scale for suicidal ideation). Depressive mood and internet addiction degrees was evaluated by BDI (Beck's depression inventory) and IAS (internet addiction scale), respectively. RESULTS: The final subjects of the study were 719 (93.3%) high school students among 770 students in eight high schools in Seoul and local areas, excluding 51 (6.6%) students with insufficient response. There were, 362 (50.3%) male students and 357 (49.7%) female students. Among the total 443 (61.6%) of the subjects had a high risk of suicide. The risk was high in subjects whose parents were divorced, who solved their difficulties by themselves, either expressed suicidal ideation to friends or not expressed suicidal ideation, knew an suicidal internet site and had freguent visits to the internet site. And alcohol experience, drug abuse, BDI and IAS were also connected with a high risk of suicide (P<0.05). Marital status of parents, resolution of problems, expression of suicidal ideation, BDI and IAS were independent factors affecting SSI (OR= 3.7, 0.7, 0.8, 2.4, and 1.6, P<0.05) in logistic regression analysis. CONCLUSION: High suicidal risk is associated with complex factors. We have discovered several causes which augment the impulse of suicide in adolescence. They are parent's divorce or separation, an expression of suicidal ideation, depressive mood, and the extent of internet addiction, etc. Therefore in order, to prevent adolescent suicide, a unified personal, family, and social efforts are required.