PURPOSE: This study was conducted to determine the effects of a fall prevention program on knowledge, efficacy, and prevention behavior of falls among the low-income elderly. METHODS: This study used a nonequivalent control group pre and post test quasi-experimental research design. The study was conducted from August to October, 2008 with 20 subjects in the experimental group and 22 in the control group who were registered at the public health center of S District in D City. RESULTS: Hypothesis 1 "The experimental group that participated in the fall prevention program will show a higher degree of knowledge about falls than the control group" was supported. Hypothesis 2 "The experimental group will have a higher degree of self-efficacy of falls than the control group" was not supported. Hypothesis 3 "The experimental group will report fall prevention behavior more frequently than the control group" was supported. CONCLUSION: It was verified that the fall prevention program in this study was an effective intervention to improve knowledge about falls and fall prevention behaviors among the low-income elderly. The results can be used as part of an intervention to prevent falls for the vulnerable elderly such as the low-income elderly.
Accidental Falls ; Aged* ; Humans ; Public Health ; Research Design ; Self Efficacy

BACKGROUND: Airway hyperresponsiveness (AHR) to direct stimuli, such as methacholine (MCh), is observed not only in asthma but other diseases. AHR to indirect stimuli is suggested to be more specific for asthma. The purpose of this study was to determine whether asthmatic airway inflammation is more closely related to AHR to hypertonic saline (HS), an indirect stimulus, than to MCh. METHODS: Sixty-four consecutive adult patients with suspected asthma (45 asthma and 19 non-asthma) performed a combined bronchial challenge and sputum induction with 4.5% saline, and MCh challenge on the next day. RESULTS: Both HS-PD15 and MCh-PC20 were significantly lower in asthma patients than in non-asthma patients. However, the sensitivity/ specificity for asthma was 48.9%/100%, respectively, in the HS test and 82.2%/ 84.2%, respectively, in the MCh test. There was a significant relationship between HS-PD15 and MCh-PC20 and only 52.9% of patients with MCh-PC20 < or= 4 mg/mL showed HS-AHR, but 4 patients with HS-AHR showed MCh-PC20 > 4 mg/mL. There were significant correlations between both HS-PD15 and MCh-PC20 and FEV1, or sputum eosinophils, but FEV1 was more closely related to MCh-PC20 (r=0.478, p < 0.01) than to HS-PD15 (r=0.278, p < 0.05), and sputum eosinophils were more closely related to HS-PD15 (r=-0.324, p < 0.01) than to MCh-PC20 (r=-0.317, p < 0.05). Moreover, the IL-5 level (r=-0.285, p < 0.05) and IFN-gamma/IL-5 ratio (r=0.293, p < 0.05) in sputum were significantly related to HS-PD15, but not to MCh-PC20. CONCLUSION: HS-AHR may reflect allergic asthmatic airway inflammation more closely than MCh-AHR.
Asthma/*physiopathology ; Bronchial Hyperreactivity/*physiopathology ; Bronchial Provocation Tests ; Bronchoconstrictor Agents/*diagnostic use ; Comparative Study ; Female ; Human ; Male ; Methacholine Chloride/*diagnostic use ; Saline Solution, Hypertonic/*diagnostic use ; Support, Non-U.S. Gov't

PURPOSE: To evaluate the lung changes in healthy smokers, as seen on inspiratory and expiratoryhigh-resolution computed tomography (HRCT). MATERIAL AND METHODS: Twenty-seven healthy smokers (light smokers,below 20 pack-years, n=16; heavy smokers, above 20 pack-years, n=11) and 25 nonsmokers underwent inspiratory andexpiratory HRCT. All healthy smokers had normal pulmonary function and chest radiography. Parenchymal andsubpleural micronodules, ground-glass attenuation, centrilobular and paraseptal emphysema, bronchial wallthickening, bronchiectasis and septal line were evalvated on inspiratory scan and by air-trapping on expiratoryscan. RESULTS: On inspiratory scan, parenchymal micronodules were observed in one of 25 nonsmokers(4%), two of 16light smokers(13%) and five of 11 heavy smokers(45%); subpleural micronodules in two(8%), four(25%), two(18%);ground-glass attenuation in 0(0%), one(6%), three(27%); centrilobular emphysema in 0(0%), one(6%), three(27%);paraseptal emphysema in three(12%), 0(0%), five(45%); bronchial wall thickening in 0(0%), two(13%), one(9%),bronchiectasis in 0(0%), one(6%) two(18%) and septal line in one(4%), four(25%), two(18%). On expiratory scan,air-trapping was detected in 0 of 15 nonsmokers(0%), two of 17 light smokers(12%), and five of 11 heavysmokers(45%). Statistically significant differences between these three groups were found in parenchymalmicronodules(P=0.006), ground-glass attenuation(P=0.008), centrilobular emphysema(P=0.018), paraseptal emphysema(P=0.005) and air-trapping(P=0.013) between these three groups. CONCLUSION: According to the findings of HRCT,heavy smokers had higher frequency of parenchymal micronodules, ground-glass attenuation, centrilobular andparaseptal emphysema, and air-trapping than nonsmokers and light smokers.
Bronchiectasis ; Bronchiolitis ; Emphysema ; Lung* ; Pulmonary Emphysema ; Radiography ; Thorax

The hospital standardized mortality ratio (HSMR) is a widely used generic measure for assessing quality of hospital care in many countries. However, the validity of HSMR as a quality indicator is still controversial. We critically reviewed characteristics of HSMR and suggested how to use HSMR as a quality indicator in the Korean setting. The association between HSMR and other quality measures of hospital care is inconclusive. In addition current HSMR model has shortcomings in risk adjustment because of the lack of clinical data, accuracy of disease coding, coding variation among hospitals, end-of-life care issues, and so on. Therefore, HSMR should be used as an indicator for improvement, not for judgement such as public reporting and pay-for-performance. More efforts will be needed to tackle practical and methodological weaknesses of HSMR in the Korean setting.
Clinical Coding ; Korea* ; Mortality* ; Quality of Health Care ; Risk Adjustment

PURPOSE: We examined the effect of lowering prostate-specific antigen (PSA) threshold on the number of Korean men requiring a prostate biopsy. MATERIALS AND METHODS: We evaluated men who had serum PSA levels tested at routine physical check-ups between 1999 and 2005 at 11 domestic hospitals. Men with PSA> or =10ng/ml or patients with prostate cancer were excluded. A total of 45,074 men(aged 50 to 79 years) were enrolled and split into three age groups: 50-59 years, 60-69 years, and 70-79 years. For each age group, we calculated the number and proportion of men whose PSA level exceeded potential biopsy thresholds: 2.5ng/ml, 3.0ng/ml, and 4.0ng/ml. Results were extrapolated to the 4.992 million men older than 50 years old, or 21.3% of the Korean male population in 2005. RESULTS: The number of biopsy candidates at the threshold of 4.0ng/ml, 3.0ng/ml, and 2.5ng/ml were 1,321(2.9%), 2,248(5.4%), and 3,577(7.9%), respectively. Extrapolating to the male population in Korea, lowering the PSA threshold from 4.0ng/ml to 3.0 or 2.5ng/ml would increase the number of men needing biopsy by 1.75 and 2.49 times, respectively. CONCLUSIONS: Lowering the PSA threshold would increase the number of men receiving prostate biopsy despite the low reference age for PSA in Korea. Considering the low incidence of prostate cancer, physicians should be careful in altering the PSA threshold.
Biopsy ; Humans ; Incidence ; Korea ; Male ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms

PURPOSE: We retrospectively investigated how patients age and prostate volume influence on the cancer detection rate in Korean men with prostate-specific antigen (PSA) levels of 4.0 to 10.0ng/ml. MATERIALS AND METHODS: 791 Korean men who underwent transrectal ultrasound guided prostate biopsies (TRBx) at 12 medical centers were analyzed retrospectively during the previous 10 years. TRBx were performed in cases with PSA levels of 4.0 to 10.0ng/ml. The biopsy-proven cancer patient group was compared to the non-cancer patient group according to age, PSA, prostate volume and PSAD. RESULTS: Among the 791 patients who underwent TRBx, prostate cancer was detected in 123 patients (15.5%). The mean age (cancer group vs non-cancer group=69.1 vs 63.8 year-old), prostate volume (38.0 vs 42.5ml, respectively) and PSAD (0.21 vs 0.18ng/ml/ml, respectively) were found in statistically significant between the two groups. The cancer detection rate (20.1%) in the small prostate (less than 40ml) was significantly higher than that (10.3%) of the large prostate. The cancer detection rate was significantly increased with age: from 14.4% for the 50 to 59 year-old patients to 31.6% for the 80 or more year-old patients. CONCLUSIONS: The cancer detection rate in Korean men with a gray zone PSA level is lower than that of Caucasians. However, regarding the detection of prostate cancer in Korean men, the older age group and the patients with less than 40ml of prostate volume among the patients with gray zone PSA levels are considered as the important factors to decide whether biopsy of prostate is needed.
Biopsy ; Humans ; Male ; Middle Aged ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Retrospective Studies* ; Ultrasonography

Purpose: Prostate volume (PV) is a key predictor of both the progression and response to medical therapy in patients with benign prostatic hyperplasia (BPH). Prostate-specific antigen (PSA) has been studied as a proxy marker for the estimation of the total PV in a predominantly Caucasian patient population. If the PV of Korean men is smaller than that of Caucasian men, the PSA-PV of Korean men may be different from those of the other races. The relationship between the PSA and PV was evaluated in Korean men. Materials and Methods: Patients with lower urinary tract symptoms and BPH, aged between 50 and 79 years, between 1999 and 2004, were enrolled in this multicentered study. IPSS, PSA, uroflowmetry and TRUS measurements were performed on all patients. Men with a PSA greater than 10ng/ml were excluded to reduce the likelihood of including occult prostate cancer cases. Those with suspicious findings on digital rectal examination and serum PSA were biopsied to rule out prostate cancer. Results: The analysis included 5,716 patients, with a mean age 64.3 years, and mean baseline PV and PSA of 36.9ml and 2.4ng/ml, respectively. The PV and serum PSA have an age-dependent log-linear relationship. Older men tend to have a steeper rate of increase in their PV with increasing serum PSA. Receiver operating characteristic (ROC) curves were constructed to evaluate the ability of the serum PSA to predict the threshold of the PV in men with BPH. The ROC curve analysis revealed that the PSA had good predictive value for various PV cutoff points (30, 40 and 50ml). Conclusions: The PSA-PV relationship in Korean men was similar to that in Caucasians. However, Korean men have a lower PSA and smaller PV than Caucasians. Approximate age-specific criteria for detecting Korean men with PV exceeding 40ml are: PSA >1.3ng/ml, >1.7ng/ml and >2.0 ng/ml for men with BPH in their 50s, 60s and 70s, respectively.
Continental Population Groups ; Digital Rectal Examination ; Humans ; Lower Urinary Tract Symptoms ; Male ; Multiple Endocrine Neoplasia Type 1 ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Hyperplasia* ; Prostatic Neoplasms ; Proxy ; ROC Curve

PURPOSE: The incidence of prostate cancer is increasing in Korea, but compared with western counties, the incidence is relatively low. The detection rate of prostate cancer, according to the serum prostate-specific antigen (PSA) level, is reportedly different in Korean men, but this remains to be confirmed. We retrospectively reviewed the data of prostate biopsies, and evaluated the detection rate of prostate cancer from biopsies, according to the serum PSA level in Korean men. MATERIALS AND METHODS: We retrospectively reviewed the results of 2,422 Korean men who had undergone prostate biopsies at 12 medical centers. Prostate biopsies were performed in cases of high PSA levels, greater than 4ng/ml, or abnormal findings on digital rectal examination. RESULTS: Of the 2,422 men, 39.7% had a positive biopsy. With PSA levels between 4 and 10ng/ml, the detection rate of prostate cancer was 15.9%. This rate was similar to that of the Japanese (15.8%), but quite different from that of American men (25%). With PSA levels above 10ng/ml, 59.5% of men had a positive biopsy. For PSA levels > or= 4ng/ml and > or= 10ng/ml, the detection rates were 42.1 and 59.5%, respectively. CONCLUSIONS: When the serum PSA levels were divided into 4 subdivisions (4.0-10.0, 10.0-20.0 and 20.0-100.0ng/ml and more than 100.0ng/ml), the detection rates were 15.9, 34.1, 66.2 and 93.8%, respectively.
Asian Continental Ancestry Group ; Biopsy ; Digital Rectal Examination ; Humans ; Incidence ; Korea ; Male ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Neoplasms* ; Retrospective Studies

PURPOSE: Prostate volume (PV) is a key predictor of both the progression and response to medical therapy for the patients suffering with benign prostatic hyperplasia (BPH). 5 alpha reductase inhibitors are effective for the patients with a large PV. Prostate-specific antigen (PSA) has been predominantly studied as a proxy marker to estimate the PV in a Caucasian patient population. If the PV of Korean men is smaller than that of Caucasian men, then the PSA-PV may be different for Korean men as compared with the other races. We evaluated the optimal PSA cut-off point to predict the response to 5 alpha reductase inhibitors with using Korean PSA-PV equations. MATERIALS AND METHODS: Patients aged between 50 and 79 years with lower urinary tract symptoms and BPH were enrolled in this multicenter study from 1999 to 2004. IPSS, PSA, uroflowmetry and TRUS measurements were performed on all the patients. We performed the computations using the logarithms of the PSA and PV. PV and PSA have an age-dependent log-linear relationship. The prediction curve was given by PV(55)=28.84 x PSA(0.208), PV(65)=30.36xPSA(0.245), and PV(75)=30.23xPSA(0.280). If a PV of 40ml was applied to these equations, then the PSA values were obtained for men in their 50s, 60s and 70s, respectively. If these PSA values were again applied to the Roehrborn's equations, then the PVs of Korean men were obtained. Receiver operating characteristic (ROC) curves were constructed to evaluate the ability of the serum PSA to predict the threshold PV in the men suffering with BPH. RESULTS: The analysis included 5,716 patients with a mean age of 64.3 years, a mean baseline PV of 36.9ml and a baseline PSA value of 2.4ng/ml. The approximate cut-off PV for the Korean men was 35ml. The ROC curve analysis revealed that PSA had good predictive value for the PV cut-off point (35ml) from the Korean PSA-PV equations. The approximate age- specific criteria for detecting Korean men with a PV exceeding 35ml are a PSA >1.2ng/ml, >1.6ng/m, and >2.0ng/ml for the men with BPH who are in their 50s, 60s and 70s, respectively. CONCLUSIONS: The PSA-PV relationship in Korean men shows that Korean men have a lower PSA and a smaller PV than Caucasians. The PV of Korean men corresponding to a PV of 40ml for Caucasians was approximately 35ml.
5-alpha Reductase Inhibitors ; Continental Population Groups ; Humans ; Lower Urinary Tract Symptoms ; Male ; Multiple Endocrine Neoplasia Type 1 ; Prostate* ; Prostate-Specific Antigen ; Prostatic Hyperplasia* ; Proxy ; ROC Curve

PURPOSE: The incidence of accidentally detected small renal tumors is increasing throughout the world. In this multi-institutional study performed in Korea, histopathological characteristics of contemporarily surgically removed renal tumors were reviewed with emphasis on tumor size. MATERIALS and METHODS: Between January 1995 and May 2005, 1,702 patients with a mean age of 55 years underwent surgical treatment at 14 training hospitals in Korea for radiologically suspected malignant renal tumors. Clinicopathological factors and patient survival were analyzed. RESULTS: Of the 1,702 tumors, 91.7% were malignant and 8.3% were benign. The percentage of benign tumors was significantly greater among those < or = 4cm (13.2%) than those > 4cm (4.5%) (p < 0.001). Among renal cell carcinoma patients, the percentage of tumors classed as stage > or = T3 was significantly less among tumors < or = 4cm (5.2%) than those > 4cm (26.8%) (p < 0.001). The percentage of tumors classed as Fuhrman's nuclear grades > or = 3 was also significantly less among tumors < or = 4cm (27.3%) than tumors > 4cm (50.9%) (p < 0.001). The 5-year cancer-specific survival rate was 82.7%, and T stage (p < 0.001), N stage (p < 0.001), M stage (p = 0.025), and Fuhrman's nuclear (p < 0.001) grade were the only independent predictors of cancer-specific survival. CONCLUSION: In renal tumors, small tumor size is prognostic for favorable postsurgical histopathologies such as benign tumors, low T stages, and low Fuhrman's nuclear grades. Our observations are expected to facilitate urologists to adopt function-preserving approach in the planning of surgery for small renal tumors with favorable predicted outcomes.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Kidney Neoplasms/classification/*pathology/*surgery ; Male ; Middle Aged ; Neoplasm Staging