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 evaluate the complication and recurrence rates in patients undergoing trocar-guided mesh implant for pelvic organ prolapse (POP) treatment. METHODS: A retrospective study was performed based on the medical records of patients who had undergone mesh implant by one surgeon from May 2006 to August 2013 at the Presbyterian Medical Center in Korea. We evaluated perioperative complications such as bladder injury, mesh exposure, urinary symptoms, infections, and chronic pelvic pain. Recurrence was defined as a POP-quantification system stage ≥II or any symptomatic prolapse. RESULTS: Sixty-seven patients were evaluated, and the mean age of patients was 65.4±7.2 years. Stage ≥III POP-quantification Ba was noted in 61 patients (91%). Intraoperative complications included three cases of bladder injury (4.5%). The mean follow-up period was 44.1±7.9 months. Postoperative complications occurred in seven women (10.5%): four cases of urinary symptoms (6%), two cases of infections (3%), and one case of chronic pelvic pain (1.5%). Mesh exposure did not occur (0%). Prolapse recurrence was reported in five patients (7.5%). CONCLUSION: Based on our operational result, the trocar-guided mesh implant seems to provide safe and effective outcomes.
Female ; Follow-Up Studies ; Humans ; Intraoperative Complications ; Korea ; Medical Records ; Pelvic Organ Prolapse* ; Pelvic Pain ; Postoperative Complications ; Prolapse ; Protestantism ; Recurrence ; Retrospective Studies ; Surgical Mesh ; Urinary Bladder

BACKGROUND: We conducted a population-based cross-sectional study of Korean adults to evaluate the association between metabolic syndrome and microalbuminuria as a marker for early-stage chronic kidney disease. METHODS: A total of 8,497 adults (3,625 men and 4,872 women) who participated in the Korea National Health and Nutrition Examination Survey between 2011 and 2012 were included. Metabolic syndrome was defined according to recommendation from a joint interim statement of international organizations published in 2009. Microalbuminuria was defined as a urinary albumin-to-creatinine ratio of 30 to 300 mg/g. The association between metabolic syndrome and microalbuminuria was evaluated using logistic regression analysis with adjustment for covariates while considering sampling weights and the complex survey design. RESULTS: The prevalence of microalbuminuriain subjects with metabolic syndrome was 11% for men and 14.4% for women, whereas the prevalence in subjects without metabolic syndrome was 3.1% for men and 6.7% for women. Metabolic syndrome was significantly associated with an increased risk of microalbuminuriain both women (odds ratio, 2.79; 95% confidence interval, 2.01 to 3.88) and men (odds ratio, 3.00; 95% confidence interval, 2.11 to 4.27). All components of the metabolic syndrome were associated with a significantly increased risk of microalbuminuria with the strongest association for high blood pressure. The risk of microalbuminuria increased in a dose-dependent manner (P-value for trend < 0.001) with the number of metabolic syndrome components observed for both sexes. CONCLUSION: These findings suggest that metabolic syndrome is a risk factor for chronic kidney disease from an early stage.
Adult* ; Albuminuria ; Cross-Sectional Studies ; Dyslipidemias ; Female ; Humans ; Hypertension ; Joints ; Korea ; Logistic Models ; Male ; Nutrition Surveys ; Obesity ; Prevalence ; Renal Insufficiency, Chronic ; Risk Factors ; Weights and Measures

OBJECTIVES: To evaluate the degree of adolescent internet addiction, and investigate its relationship to the general characteristics, internet environments, and contents, especially the stress measured by the psychosocial wellbeing index-short form (PWI-SF). METHODS: The data was obtained from self-administered questionnaires from 886 11th grade urban area students. The questionnaires consisted of general characteristics, internet user's environments, frequencies by internet contents, internet addiction test and PWI-SF. RESULTS: The possible rate of internet use at home was 95.1%, and the area of most internet use was the home. The frequencies of internet game and porno site use were higher in males, with web searching and community uses higher in females. The total mean of internet addiction score was 56.8, and was higher for male than for female students. From multiple regression, as analyzed by the internet addiction score as a dependent variable, on-line friends, internet use times, years of internet use, frequencies of internet game & porno site use, and PWI-SF scores were significant in male. Internet use times, the frequencies of internet game, chatting, community use, and PWI-SF score were significant in female. Four PWI-SF subscales (social role & self reliability, depression, general health & vitality, and sleep disturbance & anxiety) and internet addiction were significantly correlated in both male and female students, with depression having the most correlation. CONCLUSION: The results of this study suggest that intervention should be provided to prevent internet addiction, especially for coping with stress in Korean teenage students.
Adolescent ; Depression ; Female ; Friends ; Humans ; Internet* ; Male

Background/Aims: This study evaluated the long-term cardiovascular complications among Korean patients with hypertension and compared them with that of controls without hypertension. Methods: The Korean Hypertension Cohort (KHC) enrolled 11,043 patients with hypertension and followed them for more than 10 years. Age- and sex-matched controls without hypertension were enrolled at a 1:10 ratio. We compared the incidence of cardiovascular events and death among patients and controls without hypertension. Results: The mean age was 59 years, and 34.8% and 16.5% of the patients belonged to the high and moderate cardiovascular risk groups, respectively. During the 10-year follow-up, 1,591 cardiovascular events (14.4%) with 588 deaths (5.3%) occurred among patients with hypertension and 7,635 cardiovascular events (6.9%) with 4,826 deaths (4.4%) occurred among controls. Even the low-risk population with hypertension showed a higher cardiovascular event rate than the population without hypertension. Although blood pressure measurements in the clinic showed remarkable inaccuracy compared with those measured in the national health examinations, systolic blood pressure (SBP) ≥ 150 mmHg was significantly associated with a higher risk of cardiovascular events. Conclusions This long-term follow-up study confirmed the cardiovascular event rates among Korean hypertensive patients were substantial, reaching 15% in 10 years. SBP levels ≥ 150 mmHg were highly associated with occurrence of cardiovascular event rates.

Background/Aims: Cardiorespiratory fitness (CRF), as measured by maximal oxygen consumption (VO2max), is an important independent predictive factor of cardiovascular outcomes in patients with heart failure (HF). However, it is unclear whether conventional equations for estimating CRF are applicable to patients with HF with preserved ejection fraction (HFpEF). Methods: This study included 521 patients with HFpEF (EF ≥ 50%) whose CRF was directly measured by cardiopulmonary exercise test using a treadmill. We developed a new equation (Kor-HFpEF) for half of the patients in the HFpEF cohort (group A, n = 253) and validated it for the remaining half (group B, n = 268). The accuracy of the Kor-HFpEF equation was compared to that of the other equations in the validation group. Results: In the total HFpEF cohort, the directly measured VO2max was significantly overestimated by the FRIEND and ACSM equations (p < 0.001) and underestimated by the FRIEND-HF equation (p <0.001) (direct 21.2 ± 5.9 mL/kg/min; FRIEND 29.1 ± 11.8 mL/kg/min; ACSM 32.5 ± 13.4 mL/kg/min; FRIEND-HF 14.1 ± 4.9 mL/kg/min). However, the VO2max estimated by the Kor-HFpEF equation (21.3 ± 4.6 mL/kg/min) was similar to the directly measured VO2max (21.7 ± 5.9 mL/kg/min, p = 0.124), whereas the VO2max estimated by the other three equations was still significantly different from the directly measured VO2max in group B (all p < 0.001). Conclusions Traditional equations used to estimate VO2max were not applicable to patients with HFpEF. We developed and validated a new Kor-HFpEF equation for these patients, which had a high accuracy.

BACKGROUND/AIMS: In spite of various diagnostic modalites, biliary cystic neoplasms (biliary cystadenoma and cystadenocarcinoma) remain to be difficult to diagnose preoperatively. Recently, there are some reports that elevated CA19-9 level in serum and/or cystic fluid could be a useful finding in the differential diagnosis of biliary cystic neoplasm. This study aimed to evaluate the expression of CA19-9 and to elucidate its significances in intrahepatic biliary cystic neoplasms and simple hepatic cysts. METHODS: In 8 patients with biliary cystic neoplasms and 6 simple hepatic cysts, symptoms, radiologic and laboratory findings were reviewed retrospectively. In 5 biliary cystic neoplasms (4 bililary cystadenomas, 1 biliary cystadenocarcinoma) and 5 simple hepatic cysts, immunohistochemical stainings for CA19-9 were performed with formalin-fixed, paraffin-embedded tissues. RESULTS: In 8 biliary cystic neoplasms, two cases were suspected as biliary cystadenoma preoperatively and 6 cases could not be distinguished from simple cysts or cholangiocarcinoma preoperatively. In 6 simple hepatic cysts, 3 cases were diagnosed preoperatively and 3 cases could not be distinguished from biliary cystadenoma or pancreatic pseudocyst preoperatively. Expression of CA19-9 in simple hepatic cysts and biliary cystic neoplasms were 80% in both groups. Expression of CA19-9 is not related to the elevated level of CA19-9 in serum. CONCLUSINOS: Our data suggests that the elevated level of CA19-9 in serum may not be helpful in the preoprative diagnosis of biliary cystic neoplasm.
Adult ; Aged ; Biliary Tract Neoplasms/*diagnosis ; CA-19-9 Antigen/*analysis/blood ; Cystadenocarcinoma/*diagnosis ; Cystadenoma/*diagnosis ; Cysts/*diagnosis ; Diagnosis, Differential ; Female ; Humans ; Immunohistochemistry ; Liver Diseases/*diagnosis ; Male ; Middle Aged

PURPOSE: The aim of this study is to investigate anti-arthritis activity using natural eggshell membrane (NEM). METHODS: NEM was administered at 52 mg/kg, 200 mg/kg, and 400 mg/kg to SD-Rat, where arthritis was induced by monosodium iodoacetate (MIA) at 3 mg. NO production in serum was measured using Griess reagent. Cytokines including IL-1beta, and IL-6 were measured by Luminex and PGE2, MMP-2, MMP-9, TIMP-1, LTB4, and hs-CRP were measured by ELISA. The cartilage of patella volume was examined and 3-D high-resolution reconstructions of the cartilage of patella were obtained using a Micro-CT system. RESULTS: Production of NO, IL-1beta, IL-6, PGE2, MMP-2, MMP-9, TIMP-1, LTB4, and hs-CRP in serum was decreased, respectively, in comparison with control. The cartilage of patella volume increased significantly. In addition, the NEM group showed a decrease in the cartilage of patella, synovial membrane, and transformation of fibrous tissue. CONCLUSION: The results for NEM showed significant anti-arthritis activity. These results may be developed as a raw material for new health food to ease the symptoms mentioned above.
Animals ; Arthritis* ; Cartilage ; Cytokines ; Dinoprostone ; Enzyme-Linked Immunosorbent Assay ; Food, Organic ; Interleukin-6 ; Leukotriene B4 ; Membranes* ; Osteoarthritis ; Patella ; Rats* ; Synovial Membrane ; Tissue Inhibitor of Metalloproteinase-1

BACKGROUND/AIMS: Studies of genotypes and changes in nucleotide and amino acid sequences of hepatitis A virus (HAV) may provide valuable information on the epidemiological aspects of a particular region. In Korea the prevalence of anti-HAV in the 1 - 20 year age group declined from 60% in 1980 to 9% in 1995. As a result this age group has a high risk of HAV infection. Actually over 1,500 cases of clinically overt hepatitis A occurred in 1998 while few cases of clinical hepatitis A had been reported until the early 1990s. The aims of this study are to determine the genotypes of HAV which have been circulating in Korea and to define the phylogenetic relationships of geographically defined isolates. METHOD: From 1994 - 1998 a total of 18 serum specimens was obtained from patients in Korea with sporadic form acute hepatitis A. The HAV nucleic acid from serum specimens was subjected to genomic sequence analysis following viral RNA extraction, reverse transcription and amplification of the cDNA by PCR. DNA sequencing was performed in both directions of each PCR product. RESULTS: All isolates clustered within the subgenotype IA irrespective of the geographic locations and timing of the clinical hepatitis. Among 18 Korean isolates, 9 isolates had 2 amino acid sequence changes and 2 isolates had 1 amino acid sequence change. These changes in the amino acid sequences are unique and have never been reported in HAV subgenotype IA. CONCLUSIONS: All isolated HAV had genotype (IA). Eleven of 18 isolates had unique changes in amino acid sequences. These data indicate that the endemic HAV has been circulating in Korea over a long period of time.
Amino Acid Sequence ; DNA, Complementary ; Epidemiology ; Genotype ; Geographic Locations ; Hepatitis A Antibodies ; Hepatitis A virus* ; Hepatitis A* ; Hepatitis* ; Humans ; Korea ; Molecular Epidemiology* ; Polymerase Chain Reaction ; Prevalence ; Reverse Transcription ; RNA, Viral ; Sequence Analysis ; Sequence Analysis, DNA

We made a mistake in presenting abstract & figure correction.