No abstract available.
Geriatrics* ; Primary Health Care*

No abstract available.
Humans

No abstract available.
Career Choice* ; Humans

BACKGROUND: Primary hepatocellular carcinoma(HCC) is the second cause of cancer death in our country. Hepatitis B virus(HBV) and hepatitis C virus(HCV) are important risk factors for hepatocellular carcinoma. The mechanism of HCC development and the epidemiology in HCV infected individuals are still unclear. In this study, we investigated the epidemiolgical and clinical features of HCC in relation to viral infection. METHODS: We reviewed the medical records of 160 HCC patients retrspectively who had been admitted to one University Hospital located in Seoul between January 1991 and December 1995. Among these patients, 113 patients were positive for HBsAg(B group), 24 for anti-HCV(C group). We compared epidemiological and clinical data between B group and C guoup. RESULTS: Anti-HCV positivity was significantly higher in HBsAg negative patients than in HBsAg positive patients(53.3:1.7%, p<0.01). The mean age of patients in B group was significantly lower than that in C group(52:62yr, p<0.01). In C group, the proportion of Child-Pugh class B and C was significantly larger than that of B group(35.4: 75.0%, p<0.01). In C group, the proportion of transfusion history was significantly larger than that in B group(4.4: 16.7%, p<0.05), and the proportion of drug abuse hestory was significantly larger than that in B group (31.0:62.5%, p<0.01). In C group, the albumin, cholesterol, Gamma-glutamyl transferase leves were significantly lower than those in B group. In B group, the proportion of metastasis was significantly larger than that in C group(31.9:4.2%, p<0.01). Alpha fetoprotein levels greater than 400ng/ml are much more prevalent in group B significantly(67:39.1%, p<0.05). No significant differences in cumulative survival rate(1yr, 2yr) and median survival time were observed between the two groups. CONCLUSIONS: We ascertain that the HBV and HCV are inportant factors in HCC. In epidemiology and clinical features of HCC, there were some difference between the HBsAg and anti HCV positive group. Therefore, on primary health care settings, it is necessary to test for hepatitis C as well as hepatitis B in order to prevent and manage HCC and chronic liver desease.
alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Cholesterol ; Epidemiology* ; Hepatitis B ; Hepatitis B Surface Antigens* ; Hepatitis C ; Humans ; Liver ; Medical Records ; Neoplasm Metastasis ; Primary Health Care ; Risk Factors ; Seoul ; Substance-Related Disorders ; Transferases

No abstract available.
Low Back Pain*

OBJECTIVES: To evaluate the consequences of care of a program of preventive in-home comprehensive geriatric assessment(CGA) and determine: 1) if there are major findings in all domains of CGA(medical, functional, mental health and social/environmental), 2) if there is a continued clinical yield when CGA is repeated annually, and 3) factors which affect patient adherence with recommendations from CGA. METHODS: Descriptive prospective study of subjects allocated to the intervention group of a randomized trial of preventive in-home CGA was applied to 202 persons aged 75 years or older and living at home who received the intervention of annual and quarterly home visits by gerontologic nurse practitioners(GNPs) for three years at participants' homes in an urban setting. Detailed data were collected prospectively on clinical problems detected by CGA, specific recommendations made of these problems, and subject adherence with these recommendations. RESULTS: Participants were 80.8 years, 70% of them were female, 95% white, and 64% living alone.4 mean of 17.5 active problems per subject were identified in all domains of CGA, although the most common problems were medical.4 constant number of therapeutic and preventive recommendations was made each year(8.5 per subject annually). Subject adherence varied by type of recommendation(ANOVA, p=.0001); adherence was better for referrals to a physician than for referrals to a non-physician professional or community service or for recommendations involving self-care activities. CONCLUSION: In these community-dwelling older people, there was a continued yield of problems identified and recommendations made when preventive in-home CGA was repeated annually for three years, supporting the practice of repeat CGA in community elders. Subject adherence with recommendations from CGA varied by type of recommendation, but further work is needed to determine additional factors which affect this adherence and to determine the association, if any, between the yield of CGA(i.e., problems identified and recommendations given) and important clinical consequences.
Aged* ; Female ; Geriatric Assessment* ; House Calls ; Humans ; Mental Health ; Patient Compliance ; Prospective Studies ; Referral and Consultation ; Self Care ; Social Welfare

No abstract available.
Humans

BACKGROUND: In Korea before the enforcement of the medical reform in July 2000, it was generally difficult to analyze the conditions of prescriptions in hospitals and clinics. It was true that the circulation process of prescribed medicine was unclear and that there was no support between medical and pharmaceutical industries with the government. Also with the reality of high rate of pharmaceutical expenses among medical costs in Korea, it was necessary to enforce reform of medical and pharmaceutical industries and for our citizens to follow the new reform as well in order to prevent drug abuse and reduce medical costs. This research was to provide basis for future studies on prescription conditions and related factors through compared analysis of before and after the medical reform by analyzing university hospital prescriptions. METHODS: A comparison and analysis of patients, who visited a university hospital for medical treatment, was dpme. There were 23,974 patients in March 2000, and 22,550 patients in March 2001. During these periods 16,870, 12,919 prescriptions were each issued, respectively. RESULTS: There was a total of 46,524 outpatients with 29,789 prescription issued. There were 23,974 outpatients in March 2000 and 22,550 in March 2001 with 16,870 and 12,919 prescriptions, respectively. Among the outpatients, there were 20,769 men (44.6%) and 24,471 women (52.6%) with 13,527 and 16,209 prescriptions, respectively. In comparing the outpatients and prescription issued patients in March 2000 and in March 2001, both men and women showed decrease in the number of prescriptions (P <.001). Also in the ages between 0-15, 16-40 and 41-65, there was a clear evidence of decrease in the number of both outpatients and prescription issued patients (P<0.001). However in the age group of 65 and over there was an increase of 4,453 patients from 3,956 outpatients. The patient analysis in March 2000 and March 2001 excluding the outpatients in emergency, urology, dentistry and radiology shows a decrease in the number of patients in medical departments in general. Also except for the increase of prescription authorized patients in dentistry, urology and family health, it showed a decrease. In general, there was a decrease in the number of cases in the issuance of prescriptions excluding few item changes in the upper 1st to 10th medicine categories in prescribed frequencies. For prescribed medicine categories no vast difference existed. In total medicine categories, there was a decrease in injections from 24.5% to 12.3% and increase of oral medications from 64.5% to 73.8%. Also there was a significant decrease of prescriptions in injections for antibiotics and significant increase of prescription for anti-hypertensive agents such as Angiotensin Converting Enzyme inhibitors. CONCLUSION: This study involved before and after the reform of prescription conditions and obtained related factor information. The results may differ depending on the type of a hospital, patient distribution and local area, but has provided valuable basic research information which did not exist in previous university hospital unit. Hence in relation to the before and after the medical reform, future studies on diseases and on significant changes in elderly patient care, antibiotic usage and in categories of anti-hypertensive agents may be necessary.
Aged ; Angiotensin-Converting Enzyme Inhibitors ; Anti-Bacterial Agents ; Antihypertensive Agents ; Dentistry ; Drug Industry ; Emergencies ; Family Health ; Female ; Hospital Units ; Humans ; Korea ; Male ; Outpatients* ; Patient Care ; Prescriptions* ; Substance-Related Disorders ; Urology

BACKGROUND: The aim of this study was to elucidate the relationship between nonalcoholic fatty liver disease diagnosed by ultrasonography and the metabolic syndrome defined by NCEP-ATP III criteria. METHODS: Sixty-nine adult male subjects with negligible alcohol consumption underwent an anthropometric and laboratory investigation. The ultrasound scan of the liver was performed to determine the presence and the severity of nonalcoholic fatty liver disease. RESULTS: Nonalcoholic fatty liver disease was diagnosed in 36 cases by ultrasound scan. According to the severity of nonalcoholic fatty liver, triglyceride, HDL- cholesterol, alanine aminotransferase, aspartate aminotrasnferase, fasting insulin level, HOMA-IR, and obesity related variables (body mass index, percent body fat, waist circumference) showed a significant difference. The independent variables which account for the severity of nonalcoholic fatty liver disease was waist circumference, and alanine aminotransferase which is a predictor of nonalcoholic steatohepatitis. The prevalence of metabolic syndrome was 41% vs 6.1% in nonalcoholic fatty liver group vs control group, respectively, and the odds ratio was 11.1 (95% CI 2.29~53.6). The prevalence of nonalcoholic fatty liver was increased with increasing the number of features of metabolic syndrome. CONCLUSION: Nonalcoholic fatty liver disease was closely related to the metabolic syndrome and the severity classification of nonalcoholic fatty liver by ultrasound scan could be useful to predict of the severity of insulin resistance, and the risk of nonalcoholic steatohepatitis.
Adipose Tissue ; Adult ; Alanine Transaminase ; Alcohol Drinking ; Aspartic Acid ; Cholesterol ; Classification ; Fasting ; Fatty Liver* ; Humans ; Insulin ; Insulin Resistance ; Liver ; Male ; Obesity ; Odds Ratio ; Prevalence ; Triglycerides ; Ultrasonography ; Waist Circumference

PURPOSE: We tried to identify the overall incidence of microsatellite instability (MSI) and the utility of mismatch repair (MMR) protein expression in sporadic colorectal cancers in Korean. We also investigate the role of angiogenesis in colorectal cancers by MSI status. METHODS: A total 85 resected colorectal cancers were submitted for MSI study using PCR methods with 5 markers and immunohistochemistry (IHS) for hMLH1 and hMSH2. Expression of COX-2 and iNOS and microvessel density by IHS were correlated with various clinicopathologic prognostic factors. RESULTS: Among 85 cases of sporadic colorectal cancers, MSI was observed in 11 cases (12.9%) including 10 MSI-H and 1 MSI-L cases. Patients with MSI (+) showed female prevalence (1.75 : 1), low Dukes stage, mucinous histologic type, and Crohn-like lymphoid reaction than those with MSS. Overall sensitivity of hMLH1 and/or hMSH2 expression was 98.6% and specificity was 72.7%. iNOS expression was significantly correlated with COX-2 expression in tumor cells (P=0.006), however, they were not correlated with MSI status. High microvessel density was correlated with hMLH1 expression (P=0.025), COX-2 expression (P= 0.05), and Crohn-like lymphoid reaction (P=0.041). CONCLUSIONS: IHS for MMR proteins is a valuable substitute of MSI status and COX-2 related neoangiogenesis is thought to be related to inhibition of microsatellite unstable colorectal cancer progression via decreased microvessel density.
Colorectal Neoplasms* ; DNA Mismatch Repair ; Female ; Humans ; Immunohistochemistry ; Incidence ; Microsatellite Instability* ; Microsatellite Repeats* ; Microvessels* ; Mucins ; Polymerase Chain Reaction ; Prevalence ; Sensitivity and Specificity