No abstract available.

No abstract available.
Primary Health Care* ; Telemedicine*

BACKGROUND: Familial aggregation of coronary risk factors is well known, which are hypertension, hyperlipidemia, diabetes mellitus, and obesity. However inter-spouse relation of the risk factors has remained controversial. As spouses are not blood-related, any risk factor relation that exist probably may not reflect genetic factors, but the environmental factors to which the couple is exposed. Moreover, the effect of assortative marriage should be considered. This study is designed to identify inter-spouse relation of coronary risk factors and to document the effects of marriage duration to spouse concordance. METHODS: From May 1995 to March. 1999, we enrolled 1,859 couples who had visited the Health Promotion Center at Seoul National University Hospital. We analysed inter-spouse correlation of body mass index, blood pressure, glucose, serum lipid factors, uric acid, smoking, alcohol drinking, and stress known as coronary risk factors. The correlation coefficients were compared according to marriage duration. RESULTS: There was statistically significant spouse concordance for all risk factors with the exception of smoking. The correlation coefficients of blood pressure, total cholesterol, and triglyceride increased with marriage duration but troughed at 30-39 years of marriage. Those of body mass index and glucose peaked at early and late marriage duration. Those of HDL-cholesterol and uric acid was relatively fixed throughout marriage. CONCLUSION: The presence of significant inter-spouse correlation for most of the coronary risk factors reflect the influence of assortative marriage and environmental factors on spouse concordance. If a spouse has many cardiovascular risk factors, partner should be evaluated for risk factors.
Alcohol Drinking ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Cholesterol ; Diabetes Mellitus ; Family Characteristics ; Glucose ; Health Promotion ; Humans ; Hyperlipidemias ; Hypertension ; Marriage* ; Obesity ; Risk Factors* ; Seoul ; Smoke ; Smoking ; Spouses* ; Triglycerides ; Uric Acid

BACKGROUND: Waist circumferences are widely used to diagnosis and assessment of obesity but various standards of the measuring waist circumference originate the confusion on diagnosis and assessment of obesity. According to this, this study is willing to light up standards of measuring waist circumference what is intimate with body mass index(BMI) and have a precision of intra observer and inter observers in repeated measurements of the waist. METHODS: Measuring of waist circumference by the 4 different standards(anterior superior iliac crest(ASIC), umbilicus, above 3 cm to ASIC, the thinnest area in the waist by the range of seeing) were performed on 102 people visiting Health Promotion Center of one medical collage hospital by two observers in each 2 times, total 16 times. Each data were analyzed by the relativity between the BMI and the each means of measuring waist circumference and by ANOVA test in intra observer and inter observer bias. RESULTS: The relation between BMI and data in measuring standard of ASIC of the waist circumference is the highest. (r=0.900) and the following umbilicus(r=0.896), above 3 cm to the anterior superior iliac crest(r=0.888), the thinnest area in the waist by the range of seeing(r=0.877), It is the lowest in intra observer bias that the thinnest area in the waist by the range of seeing, and ASIC in inter observer. CONCLUSION: It is desirable that ASIC is the standard of measuring waist circumference in the diagnosis of obesity and in measuring that by different two person, because of the highest relativity in BMI and the lowest inter observers bias. But the thinnest area in the waist by the range of seeing is desirable in measuring by same person because of intra observer bias.
Anthropometry ; Bias (Epidemiology) ; Body Constitution ; Body Mass Index ; Diagnosis ; Health Promotion ; Humans ; Obesity ; Observer Variation ; Umbilicus ; Waist Circumference*

No abstract available.
Ear, Middle*

BACKGROUND: ATP is an endogenous nucleotide that has potential electrophysiologic effects. The effects of ATP are largely mediated by its metabolite, adenosine, which acts on A1 receptor in myocardium and mediates negative chronotropic, dromotropic, and inotropic action. The purpose of this study is to determine the efficacy and side effects of ATP in the treatment of paroxymal supraventricular tachycardia(PSVT). METHODS: We analyzed 28 episodes of PSVT in 22 patients(7 men and 15 women, mean age 467.+/-15.9 years), who were selected from Jan. 1992 to Sep. 1992. After measuring blood pressure and obtaining a standard 12 leads electrocardiogram(ECG), we rapidly injected ATP intravenously with dose of 10, 15, 20mg every 1 min, until the termination of PSVT. We recorded peri-injection and post-injection ECG, interval between ATP injection and the termination of PSVT, the pause after termination, side effects and blood pressure immediately after termination. RESULTS: 1) Among 28 episodes of PSVE, 26 episodes(92.9%) were terminated successfully : 21 episodes(75%) with 10mg, 3 episodes(10.7%) with 15mg, and 2 episodes(7.2%) with 20mg of ATP. 2 episodes(7.1%) were failed. 2) The PSVT ended 21.2+/-9.2 seconds after injection of ATP(maximally 40 seconds). 3) The mechanisms of PSVT in 9 patients were atrioventricular nodal reentrant tachycardia(AVNRT), those in 13 patients were atrioventricular reciprocating tachycardia(AVRT). 4) The side effects of ATP included 13 episodes of chest pain(46.6%), 9 episodes of ventricular arrhythmia(32.1%), 6 episodes of sinus pause(21.4%) and 5 episodes of atrioventricular block(17.9%), and these were uncomplicated and short-lasting. CONCLUSION: The ARP is a safe and effective therapy for the conversion of PSVT to sinus rhythm and perhaps more importantly, a valuable new approach to the management and diagnosis of wide-complex tachycardia.
Adenosine Triphosphate ; Adenosine* ; Blood Pressure ; Diagnosis ; Electrocardiography* ; Female ; Humans ; Male ; Myocardium ; Tachycardia ; Tachycardia, Supraventricular* ; Thorax

Korea has a unique feature for telemedicine, including geographical mal-distribution of medical resources, immature health care delivery and heavy traffic in metropolitan areas. As one solution for these issues, we developed a tele-primary care system and tested its feasibility and user satisfaction. The tele-primary care system is based on PC's with videoconferencing hardware. The patient PC equipped with diagnostic peripherals such as blood pressure, stethoscope, magnifying camera, and so on. There are two remote clinics and 4 homes which are connected to the telecare center through leased lines or fast internet. Three hundred ninety eight patients were seen during the period of one year and each made about 2 visits on an average. The health problems seen through tele-primary care were not different from ones in primary care clinics. Drugs were prescribed over the half of the visits and labs were used only infrequently. Most users were satisfied and felt comfortable with this new type of medicine. We found tele-primary care system would be one solution for health delivery issues in Korea.
Blood Pressure ; Delivery of Health Care ; Humans ; Internet ; Korea* ; Patient Satisfaction* ; Primary Health Care ; Stethoscopes ; Telemedicine ; Videoconferencing

BACKGROUND: Korea is an endemic area of viral hepatitis B with a rate of 5~10% carrier state. Therefore, hepatitis B vaccination is performed nationwide. But 5~15% of healthy individuals fail to respond adequately to the vaccine and an approved guideline for the nonresponders has not been developed yet. This study is designed to identify risk factors for those who lack anti-HBs after hepatitis B vaccination and to document the results of a double-dose revaccination in such nonresponders to the primary vaccination. METHODS: From Feb. 1996 to Aug, 1997, we assessed 51 healthy subjects(HBs Ag negative, anti-HBs negative, anti-HBc negative and a normal LFT). All subjects were vaccinated with Hepavax- B, 1.0ml, 24 by a rapid schedule(0, 1, and 2 months) and 27 by a standard schedule(0, 1, and 6 months). Anti-HBs titers were evaluated 3 months after the third vaccine and assessed the nonre-sponders (anti-HBs titer<2mIu/ml) and the hyporesponders(2~10mK/ml). All 13 nonresponders were revaccinated with 2ml of Hepavax-B 3 months after the primary vaccination. Anti-HBs titers were evaluated 1 month later. RESULTS: The differences in age(p<0.01) and smoking amount(p<0.05) between the responders and the hypo and the nonresponders were statistically significant. There were more males and higher body mass index in the hypo and the nonresponders but not statistically significant. The seroconversion rate after the double-dose vaccination was 92.3%(12/13) with an average titer of 5K08mlU/ ml(1-132.4mIU/ml). CONCLUSIONS: Increase in age and smoking amount were the risk factors of the nonresponders after the primary vaccination. Most of the hypo and the nonresponders to the primary vaccination responded adequately to the double-dose revaccination.
Body Mass Index ; Carrier State ; Hepatitis B* ; Hepatitis* ; Humans ; Immunization, Secondary* ; Korea ; Male ; Risk Factors* ; Smoke ; Smoking ; Vaccination

PURPOSE: The purpose of this study was to describe the experience of hospice nurses on spiritual care. METHODS: Data was collected from 9 hospice nurses by using in-depth interview. The main questions include what they understand as spiritual care, when they feel the needs of spiritual care, how they perform spiritual care, and what is the outcome of spiritual care. The data was analyzed by grounded theory methodology developed by Strauss and Corbin. RESULTS: The core category of experience of hospice nurses on spiritual care was identified as "Untie a knot of mind". In the process of spiritual care in hospice nurses was consisted of soothing, dwelling with, releasing, giving meaning, plunging, and going beyond a life. CONCLUSION: The result of this study was expected to give useful information to nurses and nursing managers about the real situation of performance of spiritual care. The findings of this study contributes to developing programs and supportive policies for encouraging spiritual care.
Hospices

OBJECTIVE: The presence of an intracerebral hematoma from a ruptured aneurysm is a negative predictive factor and it is associated with high morbidity and mortality rates even though clot evacuation followed by the neck clipping is performed. Endovascular coil embolization is a useful alternative procedure to reduce the surgical morbidity and mortality rates. We report here on our experiences with the alternative option of endovascular coil placement followed by craniotomy for clot evacuation. MATERIALS AND METHODS: Among 312 patients who were admitted with intracerebral subarachnoid hemorrhage during the recent three years, 119 cases were treated via the endovascular approach. Nine cases were suspected to show aneurysmal intracerebral hemorrhage (ICH) on CT scan and they underwent emergency cerebral angiograms. We performed immediate coil embolization at the same session of angiographic examination, and this was followed by clot evacuation. RESULTS: Seven cases showed to have ruptured middle cerebral artery (MCA) aneurysms and two cases had internal carotid artery aneurysms. The clinical status on admission was Hunt-Hess grade (HHG) IV in seven patients and HHG III in two. Surgical evacuation of the clot was done immediately after the endovascular coil placement. The treatment results were a Glasgow Outcome Scale score of good recovery and moderate disability in six patients (66.7%). No mortality was recorded and no procedural morbidity was incurred by both the endovascular and direct craniotomy procedures. CONCLUSION: The results indicate that the coil embolization followed by clot evacuation for the patients with aneurysmal ICH may be a less invasive and quite a valuable alternative treatment for this patient group, and this warrants further investigation.
Treatment Outcome ; Tomography, X-Ray Computed ; Retrospective Studies ; Middle Aged ; Male ; Intracranial Aneurysm/radiography/*therapy ; Humans ; Hematoma/radiography/*therapy ; Female ; Embolization, Therapeutic/*methods ; Drainage/*methods ; Cerebral Angiography ; Aneurysm, Ruptured/radiography/*therapy ; Adult