PURPOSE: This study compared the functional fitness and brake response of elderly and young drivers to confirm the correlation between the functional fitness and brake response. METHODS: This study was a cross sectional observational design. Older drivers (>65age, n=21) and young adult drivers (20–40aged, n=20) were enrolled as subjects. The functional fitness of the subjects was measured using a senior fitness test consisting of a back scratch (BS), chair sit and reach (CSR), arm curl (AC), chair stand up (CSU), foot up and go (8-FUG), and 2-minute step (2-MS). The brake response used the virtual driving simulator to measure the brake reaction time (BRT) and braking distance (BD) according to the pedestrian protection and traffic signal compliance. RESULTS: The older drivers had a lower BS (p < 0.000), CSU (p=0.040), and 8-FUG (p=0.011) than the young adult drivers. BS and 8-FUG showed a significant positive correlation with the BRT and BD of pedestrian protection and traffic signal compliance. CSU showed a significant negative correlation with the BRT of pedestrian protection and traffic signal compliance. CONCLUSION: These findings suggest that the flexibility of the upper extremity, lower extremity strength, and agility are strongly correlated with the driving performance of elderly drivers.
Aged* ; Arm ; Compliance ; Foot ; Humans ; Lower Extremity ; Pliability ; Reaction Time ; Upper Extremity ; Young Adult

BACKGROUND: Smoking is a high risk factor for various chronic diseases. Therefore, physicians are expected to play a critical role in patients smoking cessation. There have been a number of studies which show that cessation recommendation by physicians is effective for patients to stop smoking. The purpose of this study is to assess physicians smoking status and its effect on physicians attitude for their advice to patients to quit smoking. METHODS: During August and September in 1995, self-report questionnaire was distributed to doctors in Jin-Gu, Pusan. It consisted of inquiries on their demographic features, their smoking status, whether physicians ask patients their smoking status or not, whether physicians advise patients to quit smoking or not, and whether physicians confirm patients smoking cessation. Among 203 responses returned, 193 cases was analyzed. RESULTS: Among the total 193 persons, 60 persons are smoking now(31.4%, Men 34.5%, women 0%), and 88 persons(67.2%) are ex-smoker. 84.1% of smokers have tried to quit smoking, and stress was the most common reason for failure. Smoking rate and experience rate were higher in men than in women(P<0.001), but there were no significant differences in smoking rate and experience rate according to ages, religions, specialties, hospital types, and positions. Among responders 144 cases(75.0%) asked smoking status of patients. 21.4% of them asked smoking status of all patients who may smoke, and 25.0% of them hardly ask smoking status of patients. For question about patients' smoking status, the younger physicians were more active in asking smoking status of patients(p=0.038), and the physicians in hospital did much more than physicians in university hospital and private clinics(p=0.015). Among responders, 161 persons(84.7%) advised patients to quit smoking, and 19.5% of them advised to quit smoking for all patients who smoked. However, 15.3% of them hardly gave patients such suggestion. It was found that there was no significant relationship between physicians smoking status and attitudes toward giving patients suggestion to quit smoking. CONCLUSIONS: This study revealed that there was no significant relationship between physicians smoking status and their attitudes toward giving patients suggestion to quit smoking, and physicians smoking status did not have any effect on smoking cessation advice. However, this study does not exclude the possibility that the results might be reversed, if the census would be extended to broader area. Physicians should take an active role against smoking.
Busan ; Censuses ; Chronic Disease ; Female ; Humans ; Male ; Risk Factors ; Smoke* ; Smoking Cessation* ; Smoking* ; Surveys and Questionnaires

BACKGROUND: Continuity is very important in primary care, and in most studies continuous care has been reported to have a good effect on the result of care. So we studied the factors influencing the continuity of patient care by physician in charge, especially in case of out-patient department in a university hospital. METHODS: We posed questionnaires to 55 persons who had visited continually to Paik Hospital in Pusan for at least 6 months. We classified them into three groups according to the degree of continuity using 'Modified Continuity Index', and compared the lower group (18 patients) with the higher group(18 patients). RESULTS: The incame of the higher continuity group was significantly less than that of the lower continuity group(P=0.042). But there were no significant differences between the two groups according to sex, age, the type of family, marital status, job and the level of education. The higher continuity group agreed more significantly than the lower continuity group with the question whether it is important to be treated continually from physician in charge(P=0.005). About the reasons for visiting to other doctors instead of the physician in charge, most of them in both group replied that they could not keep appointment. And there were no significant differences in the care pattern of disease between the groups. CONCLUSIONS: To improve the continuity of patient care by physician in charge, it is necessary to instruct the importance of continuous care to the patients and to motivate them through various methods.
Busan ; Continuity of Patient Care* ; Education ; Family Practice* ; Humans ; Marital Status ; Outpatients ; Primary Health Care ; Surveys and Questionnaires

Objective: To investigate molecular and functional consequences of additional exposures to iodine- or gadolinium-based contrast agents within 24 hours from the initial intravenous administration of iodine-based contrast agents through an animal study. Materials and Methods: Fifty-six Sprague–Dawley male rats were equally divided into eight groups: negative control, positive control (PC) with single-dose administration of CT contrast agent, and additional administration of either CT or MR contrast agents 2, 4, or 24 hours from initial CT contrast agent injection. A 12 µL/g of iodinated contrast agent or a 0.47 µL/g of gadoliniumbased contrast agent were injected into the tail vein. Serum levels of blood urea nitrogen, creatinine, cystatin C (Cys C), and malondialdehyde (MDA) were measured. mRNA and protein levels of kidney injury molecule-1 (KIM-1) and neutrophil gelatinaseassociated lipocalin (NGAL) were evaluated. Results: Levels of serum creatinine (SCr) were significantly higher in repeated CT contrast agent injection groups than in PC (0.21 ± 0.02 mg/dL for PC; 0.40 ± 0.02, 0.34 ± 0.03, and 0.41 ± 0.10 mg/dL for 2-, 4-, and 24-hour interval groups, respectively; P < 0.001). There was no significant difference in the average Cys C and MDA levels between PC and repeated CT contrast agent injection groups (Cys C, P = 0.256–0.362; MDA, P > 0.99). Additional doses of MR contrast agent did not make significant changes compared to PC in SCr (P > 0.99), Cys C (P = 0.262), and MDA (P = 0.139–0.771) levels. mRNA and protein levels of KIM-1 and NGAL were not significantly different among additional CT or MR contrast agent groups (P > 0.05). Conclusion A sufficient time interval, probably more than 24 hours, between repeated contrast-enhanced CT examinations may be necessary to avoid deterioration in renal function. However, conducting contrast-enhanced MRI on the same day as contrast-enhanced CT may not induce clinically significant kidney injury.

PURPOSE: The aim of this study was to investigate the incidence and associated clinical factors of delayed absorption of subretinal fluid (SRF) after surgery for rhegmatogenous retinal detachment. METHODS: This study involved 36 eyes of 36 consecutive patients who underwent successful surgery for rhegmatogenous retinal detachment. A complete ophthalmologic evaluation, including clinical fundus examination, optical coherence tomography, and indocyanine green angiography, was conducted before and after surgery. Delayed absorption was defined as the presence of residual concave SRF or an SRF bleb at 6 months after surgery. Clinical factors and choroidal features on indocyanine green angiography were compared according to the presence and absence of delayed absorption. RESULTS: Eighteen of 36 eyes (50%) showed delayed absorption. Macular involvement and worse preoperative visual acuity were significantly related to the presence of delayed absorption (p = 0.001 and p = 0.034, respectively). On indocyanine green angiography, preoperative choroidal vascular hyperpermeability was noted in 70% of eyes with delayed absorption and in 14% of eyes without it (p = 0.010). CONCLUSIONS: Delayed absorption of SRF after retinal reattachment surgery was not rare, with a 50% of incidence in this study. Macula-off status was significantly related to the incidence of delayed SRF absorption, and choroidal features such as choroidal vascular hyperpermeability might be responsible in part, possibly through the resultant exudative property of choroid.
Absorption* ; Angiography ; Blister ; Choroid* ; Humans ; Incidence ; Indocyanine Green ; Retinal Detachment ; Retinaldehyde* ; Subretinal Fluid* ; Tomography, Optical Coherence ; Visual Acuity

OBJECTIVE: Self-report questionnaires are frequently used to obtain information in epidemiological research. However, information reported by patients are sometimes inconsistent with medical records. This study compared self-reported major rheumatologic diagnoses and co-morbid conditions with those from a medical record review. METHODS: A cross-sectional survey was conducted at two tertiary academic hospitals. All patients who visited the rheumatology department from September 2, 2009 to September 13, 2009 were enrolled in this survey. Structured patient questionnaires and medical record reviews were performed in each hospital. We evaluated agreement with kappa statistics (κ) between these two data sources for major rheumatologic diagnosis and Charlson Comorbidity Index (CCI) score. Multiple logistic regression models were used to investigate factors associated with disagreement. RESULTS: A total of 369 patients were interviewed at clinic exit. Of them, 302 patients (81.8%) were female, and the average age was 52.1 years. The agreement for major rheumatologic diagnosis between the questionnaire and patient chart was good (κ=0.763). The agreement rate for all rheumatic diseases was 81.8%; rheumatoid arthritis with 94.9%, systemic lupus erythematosus with 96.3%, and ankylosing spondylopathy with 100%. Higher educational level and longer attendance at our clinic were associated with agreement between major rheumatologic diagnoses. The agreement rate for CCI score between the data sources was 76.1%. CONCLUSION: In patients with rheumatologic diseases, the agreement for major diagnoses between self-reports and the medical record review was good, although it varied with the specific disease and patient characteristics. Comparing major rheumatologic diagnoses, the agreement rate for CCI was low.
Arthritis, Rheumatoid ; Comorbidity* ; Cross-Sectional Studies ; Diagnosis* ; Female ; Humans ; Information Storage and Retrieval ; Logistic Models ; Lupus Erythematosus, Systemic ; Medical Records* ; Rheumatic Diseases* ; Rheumatology ; Self Report

OBJECTIVE: To investigate the factors influencing the quiet standing balance of patients with incomplete cervical spinal cord injuries. Also to find the correlations between posturographic parameters and clinical balance tests as well as to find the correlation between posturographic parameters and functional independence. METHOD: We conducted a tetra-ataxiometric posturography, lower extremity motor score (LEMS), Korean version of the Berg Balance Scale (K-BBS), Timed Up and Go test (TUG), and Korean Version of the Modified Barthel Index (K-MBI) of 10 patients. 10 healthy adults carried out the posturography. We checked stability, weight distribution, Fourier and synchronization indices of eight positions, and the fall index of the posturography. RESULTS: The patient group showed significantly higher stability and weight distribution indices in all eight positions. Stability indices significantly increased with eyes closed or standing on pillows. Weight distribution indices were significantly higher with eyes closed or the head bent backwards. The patient group showed significantly higher Fourier indices of low, low-medium, and high frequency in eight positions. The Fourier indices at high-medium frequency were significantly higher with eyes closed on pillows or in variable head positions. There were no significant differences of synchronization indices between the patient and the control group. The falling index of the patient group significantly correlated with K-BBS, TUG, and K-MBI. LEMS had significant correlation with some synchronization indices, but not with the falling index. CONCLUSION: The quiet standing balance of the patients was influenced by somatosensory limitations or insufficient visual compensation. We should try to improve the postural balance and functional independence of patients through proper proprioceptive and lower extremity strength training for better postural and pedal control, and to make efforts to minimize environmental hazards.
Adult ; Compensation and Redress ; Eye ; Hazardous Substances ; Head ; Humans ; Lower Extremity ; Postural Balance ; Posture ; Resistance Training ; Spinal Cord ; Spinal Cord Injuries

PURPOSE: To evaluate the prevalence of anterior type diabetic retinopathy (DR) using ultra-widefield fluorescein angiography and to identify the factors associated with anterior type DR incidence. METHODS: A retrospective case review was used in this study. Patients with non-proliferative diabetic retinopathy (NPDR) underwent examination by ultra-widefield fluorescein angiography, and were classified into anterior, posterior, or diffuse DR groups. Anterior DR was defined if diabetic retinal changes were noted only at the location anterior to the imaginary circle bordered by the Early Treatment Diabetic Retinopathy Study seven-standard fields. Correlations between demographic data, as well as systemic and ocular factors, and the incidence of NPDR types were evaluated. RESULTS: Among the 234 eyes of 234 patients with NPDR, 25 eyes (10.7%) demonstrated anterior DR. Anterior DR was observed in 10 eyes (30.3%) of patients having mild NPDR, three eyes (4.8%) of moderate NPDR patients, and in 12 eyes (7.1%) of severe NPDR patients (p < 0.001). The incidence of anterior DR positively correlated with lower hemoglobin A1c levels and with greater high-density lipoprotein levels following multiple logistic regression analysis (p < 0.001). The mean hemoglobin A1c level was 7.03 ± 0.99% in anterior DR, 7.99 ± 1.74% in posterior DR, and 7.94 ± 1.39% in diffuse DR patients (p = 0.003). The mean high-density lipoprotein level was 51.2 ± 12.5 mg/dL in anterior, 49.7 ± 15.2 mg/dL in posterior, and 45.2 ± 13.1 mg/dL in diffuse DR patients (p = 0.010). CONCLUSIONS: Diabetic retinal changes confined to an anterior location were more frequently noted in earlier stages of NPDR. The incidence of DR sparing posterior retinal involvement was related to favorable blood sugar and lipid profiles.
Angiography* ; Blood Glucose ; Diabetic Retinopathy* ; Fluorescein Angiography ; Humans ; Incidence ; Lipoproteins ; Logistic Models ; Prevalence ; Retinaldehyde ; Retrospective Studies

OBJECTIVE: To examine the impact of patient education (PE) on patients' satisfaction in rheumatoid arthritis (RA) and to compare nurse-led education with medical doctor (MD)-led education. METHODS: Patients were enrolled by categorizing in two groups, nurse-led and MD-led education, randomization was performed. Face-to-face education was conducted two times, and changes in patient satisfaction before and after PE were assessed using the visual analogue scale (VAS; 0 to100 mm) and patients' satisfaction questionnaire (PSQ). Changes in patients' reported outcomes (PRO) were measured using disease activity score with 28 joint-erythrocyte sedimentation rate (DAS28-ESR), health assessment questionnaire (HAQ), and European quality of life-5 dimension (EQ-5D). Changes in patients' satisfaction and PRO between before and after PE were compared using paired t-test, and the comparison between nurse-led and MD-led education was analyzed using independent t-test. RESULTS: A total of 120 patients, 60 patients from each group, were randomized to receive either nurse-led or MD-led education. Among them, 113 patients completely received education and final assessment. In total patients, patients' satisfaction was significantly increased from 87.8±13.1 mm to 92.3±8.8 mm in VAS (p<0.01), and from 3.7±0.4 to 4.0±0.4 in PSQ (p<0.01). There was no improvement in DAS28-ESR, HAQ, but there was mild improvement in quality of life (QOL) after PE. Improvement of patients' satisfaction by PSQ after nurse-led education was 0.4±0.4 and it was higher than 0.3±0.5 after MD-led education, but it was not statistically different (p=0.25). CONCLUSION: PE for RA patients improved patients' satisfaction and QOL. Nurse-led education showed comparable improvement in patients' satisfaction with MD-led education.
Arthritis, Rheumatoid* ; Education* ; Humans ; Patient Education as Topic* ; Patient Satisfaction ; Quality of Life ; Random Allocation

Antipsychotic poisoning may cause significant adverse effects, su-ch as a change in consciousness and extrapyramidal symptoms (EPS), in infants and toddlers. We report the sibling cases of a 33-month-old sister and 11-month-old brother who both presented with altered states of consciousness and cervical rigidity after acute haloperidol poisoning. Initially, the pediatrician suspected a central nervous system infection, as the patients exhibited confused mental states, cervical rigidity, and ataxia in the emergency room. Various laboratory and imaging tests, including cerebrospinal fluid examinations, electroencephalograms, and brain computerized tomography did not show any particular abnormalities. After 1 day, the patients' mother reported that she had a current haloperidol prescription, for the treatment of schizophrenia. After 3 days of symptomatic treatment, the two siblings recovered completely, without significant sequelae. Haloperidol was detected in their plasma, at concentrations of 2.1 ng/mL in the sister and 2.5 ng/mL in the brother. We emphasize that, when administering antipsychotics to patients living with young children, family education to prevent unintentional antipsychotic poisoning is essential. Clinicians must take account of the possibility of antipsychotics poisoning when a child suddenly presents an altered state of consciousness and/or suspicious EPS with no clear reason.
Antipsychotic Agents ; Ataxia ; Brain ; Central Nervous System Infections ; Child ; Consciousness ; Electroencephalography ; Emergencies ; Haloperidol ; Humans ; Infant ; Mothers ; Plasma ; Preschool Child ; Prescriptions ; Schizophrenia ; Siblings