BACKGROUND: To analyze the patterns of medical care utilization and its related factors in hypertensive patients during 19 years (1990-2008), utilizing national patient survey in Korea. METHODS: Using seven surveyed data, age-standardized medical care utilization increasing ratios for the inpatients and outpatients compared to the year of 1990 were calculated, respectively. Changes of medical facilities (%) of patients used in 1990, 1999, and 2008 were compared. For the outpatients, median length of stay and discharge mortality rate per 1,000 persons were calculated. Multivariate logistic regression methods were used to identify related factors of the resident patients and the comparison characteristics between hypertensives and the others of all subjects. Sample weights were used. RESULTS: The medical care utilization of hypertensives were increased for both inpatients and outpatients. However, the ratios were dramatically diminished after the standardization. Age-standardized ratios were 3.6 in outpatients and 5.9 in inpatients compared to 1990. For the outpatients, mainly used medical facilities were changed from general hospital to convalescent hospital. Also, median length of stay and discharge mortality rate were increased up to 5 times and 4 times compared to 1990. The odds of being resident patients were related with discharge as death and using oriental medical center convalescent hospital in 2008. Hypertensive patients were older than the others. Confined to hypertensive patients, member of National Health Insurance was more tend to be outpatients but less inpatients. CONCLUSIONS: Aging population and long-term care Act were presumed as the main reason for the increasing of medical care utilization in 1990 to 2008.
Aging ; Health Care Surveys ; Hospitals, Convalescent ; Hospitals, General ; Humans ; Hypertension ; Inpatients ; Korea ; Length of Stay ; Logistic Models ; Long-Term Care ; Mortality ; National Health Programs ; Outpatients ; Utilization Review ; Weights and Measures

OBJECTIVE: To investigate the buffering effects of social support as an effects modifier in the association between depression and inflammation in the elderly. METHODS: We analyzed the Korean Social Life, Health, and Aging Project (KSHAP) for questionnaire, clinical, and laboratory data of 530 older adults living in a rural community. Multivariate regression models were used to investigate the association between depressive symptoms and C-reactive protein level (CRP), a marker of inflammation, at varying levels of social support. RESULTS: Social support affected the association between depressive symptoms and CRP level in both sexes. However, the direction of effects modification was different for men and women. In men, a higher CRP level was significantly associated with depressive symptoms only among those with lower support from a spouse or family members. By contrast, in women, the association was significant only among subgroups with higher spousal or family support. Social support from neighbors or friends did not affect the depression-inflammation relationship in men but modestly affected the relationship in women. CONCLUSION: Our findings suggest that social support may have a buffering effect in the relationship between depression and inflammation in elderly Koreans. But the influence of social support may run in different directions for men and women.
Adult ; Aged ; Aging ; C-Reactive Protein ; Depression ; Female ; Friends ; Humans ; Inflammation ; Male ; Rural Population ; Spouses

The acknowledgements was incorrect in the original publication of this article.

OBJECTIVES: The aim of this study is to investigate the association between obesity indices (body mass index, weight, waist-hip ratio and waist circumference) in adolescents and the carotid intima-media thickness (C-IMT) in early adulthood. We also wanted to identify the best predictor for C-IMT among these obesity indices. METHODS: This study used community-based prospective cohort study, known as the Kangwha Study, and the data we used were from subjects who were 16-years old in 1996 (defined as "adolescencec") and 25 years-old in 2005 (defined as "early adulthoodc"). The 256 subjects (113 men and 143 women) who were used for analysis participated in both follow-ups, and they underwent B-mode ultrasonography of the carotid arteries at the early adulthood follow-up. Obesity indices were defined as the body mass index, weight, waist-hip ratio and waist circumference. The C-IMT was defined as the mean of the maximal IMT of each common carotid artery. The C-IMT and obesity indices associations were evaluated via multivariable regression, logistic regression and the receiver-operator characteristic curve analyses. RESULTS: In men, all the obesity indices in adolescence were showed to have statistically significant positive association with C-IMT in early adulthood. However, no such relationship was showed in women. On multiple regression and logistic regression analysis, the waist-hip ratio showed the biggest relationship with the C-IMT among the 4 obesity indices. However, there were no statistical significant differences and no best predictor was found. For the women, the obesity incidences and C-IMT showed no relationships. CONCLUSIONS: This study suggested that obesity in adolescence was related to an increase C-IMT in healthy young Korean men.
Adolescent ; Adult ; Blood Glucose/analysis ; Blood Pressure ; Carotid Arteries/*pathology ; Female ; Humans ; Korea/epidemiology ; Lipids/blood ; Male ; Obesity/*pathology/physiopathology ; Prospective Studies ; Sex Factors ; Tunica Intima/*pathology ; Waist-Hip Ratio

PURPOSE: The aim of this study was to compare the short-term operative outcomes of laparoscopy-assisted total gastrectomy (LATG) with those of open total gastrectomy (OTG) for patients suffering with advanced upper gastric cancer. MATERIALS AND METHODS: Of the 47 patients who underwent LATG with D1+beta or D2 lymphadenectomy from July 2004 to March 2008, 29 patients with pathologically proven advanced gastric cancer were compared with 35 patients who underwent conventional OTG during the same time period. The comparison was based on the clinicopathological characteristics, the surgical outcome, the follow-up survival and tumor recurrence. RESULTS: The patients' age, gender and body mass index were similar between the two groups. However, there were statistically differences in tumor size (9.2+/-3.9 vs 6.1+/-3.6 cm, P=0.002) and the proximal resected margin (2.1+/-2.0 vs 3.6+/-2.1 cm P=0.004). There was no significant difference in most of the peri- and post-operative courses such as the time to first flatus, the time to starting a solid diet and the length of the hospital stay, except for a longer operating time (289.0 vs. 361.3 minutes, P<0.001) in the LATG group. The complication rate was higher in the LATG group (13.8%) than that in the OTG group (5.7%). The mean overall survival and disease free survival times were 32 and 31 months, and 24 and 28 months, respectively, with an average 18.8 months follow-up duration. The main recurrent sites were peritoneum and lymph node in both groups. CONCLUSION: The early results of the current study suggest that LATG for AGC is technically feasible and it does not show any inferiorities of the postoperative outcomes as compared to those of conventional open total gastrectomy.
Body Mass Index ; Diet ; Disease-Free Survival ; Flatulence ; Follow-Up Studies ; Gastrectomy ; Humans ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Peritoneum ; Stomach Neoplasms ; Stress, Psychological

OBJECTIVES: Although risk factors for coronary artery disease are also associated with increased carotid intima-media thickness (IMT), there is little information available on the asymptomatic, young adult population. We examined the association between multiple cardiovascular risk factors and the common carotid IMT in 280 young Korean adults. METHODS: The data used for this study was obtained from 280 subjects (130 men and 150 women) aged 25 years who participated in the Kangwha Study follow-up examination in 2005. We measured cardiovascular risk factors, including anthropometrics, blood pressure, blood chemistry, carotid ultrasonography, and reviewed questionnaires on health behaviors. Risk factors were defined as values above the sex-specific 75th percentile of systolic blood pressure, body mass index, total cholesterol/high-density lipoprotein cholesterol ratio, fasting blood glucose and smoking status. RESULTS: The mean carotid IMT+/-standard deviation observed was 0.683+/-0.079 mm in men and 0.678+/-0.067 mm in women (p=0.567) and the evidence of plaque was not observed in any individuals. Mean carotid IMT increased with an increasing number of risk factors(p for trend <0.001) and carotid IMT values were 0.665 mm, 0.674 mm, 0.686 mm, 0.702 mm, and 0.748 mm for 0, 1, 2, 3, and 4 to 5 risk factors, respectively. The odds ratio for having the top quartile carotid IMT in men with 3 or more risk factors versus 0-2 risk factors was 5.09 (95% CI, 2.05-12.64). CONCLUSIONS: Current findings indicate the need for prevention and control of cardiovascular risk factors in young adults and more focus on those with multiple cardiovascular risk factors.
Adult ; Blood Pressure ; Body Weights and Measures ; Cardiovascular Diseases/*epidemiology ; Carotid Arteries/*physiopathology/ultrasonography ; Female ; Health Behavior ; Hematologic Tests ; Humans ; Korea/epidemiology ; Male ; Risk Factors ; Tunica Intima/*physiopathology

BACKGROUND AND OBJECTIVES: The optimal AV delay should allow for the completion of the atrial contraction prior to the ventricular contraction, and provide for the longest diastolic filling and maximal stroke volume. This study evaluated the effects of the AV delay on the changes in heart functions, in patients with a DDD pacemaker and normal systolic function. SUBJECTS AND METHODS: Nineteen patients were enrolled. The pacing rate was set at 70 beats/min. The AV delay was lengthened in 20-25 msec step, from 100 to 250 msec. The stroke volume and diastolic parameters were measured by echocardiography for each AV delay. RESULTS: The changes in the stroke volume associated with the changes in the AV delay were not statistically significant. However, when viewing each individual patient, the optimal AV delay for each patient could be found. When comparing the stoke volumes obtained just before, just after, and during the maximal AV delay, a statistically significant difference was found (p< 0.05). The absolute value of the E/A ratio was less than 1. The pulmonic vein flow pattern was dominated by the systolic flow, but the changes were not statistically significant. There was a tendency for the E wave propagation slope to decrease. However, the absolute value was less than 40 cm/s, and the E/E' absolute ratio was more than 8, but neither showed any significant differences. CONCLUSION: In patients with a DDD pacemaker and normal systolic function, the diastolic parameters were abnormal, and the stroke volume affected by the change in the AV delay.
Diastole ; Dichlorodiphenyldichloroethane* ; Echocardiography ; Heart ; Humans ; Stroke Volume ; Veins

No abstract available.
Tomography, Optical Coherence*

BACKGROUND AND OBJECTIVES: Coffee is one of the most popular beverages in the world. Caffeine is one of the substances contained in coffee and it is well known to increase blood pressure and the peripheral vascular resistance, in part because it stimulates the sympathetic nervous system. Arterial stiffness is an important factor for the performance of the cardiovascular system and it is an independent prognosticator of cardiovascular disease. We investigated the acute effect of caffeine on arterial stiffness in young healthy subjects. SUBJECTS AND METHODS: We enrolled 20 young healthy subjects, who were randomly divided two groups. The caffeine group (10 subjects, 4 males, mean age: 23.3+/-1.1 years) received 520 mL caffeinated coffee and the control group (10 subjects, 4 males, mean age: 23.1+/-1.3 years) received 520 mL water. The arterial stiffness was evaluated by the carotid-radial pulse wave velocity and the augmentation index as corrected by heart rate (75 bpm), and all the hemodynamic measurements were obtained at baseline, 30, 60, 120 and 180 minutes after ingestion of the coffee or water. RESULTS: Arterial stiffness measured by carotid-radial pulse wave velocity increased progressively from 9.4+/-1.2 m/sec at baseline to 11.5+/-1.6 m/sec (p<0.05) at 30 minutes after the coffee intake. In addition, peripheral systolic pressure increased progressively from 107.1+/-10.2 mmHg at baseline to 114.4+/-12.9 mmHg (p<0.05) at 60 minutes after the coffee intake. Such changes were not seen in control group. CONCLUSION: Caffeine affects increased the pulse wave velocity and systolic blood pressure. This means that coffee might have an adverse effect on arterial stiffness.
Arteries ; Beverages ; Blood Pressure ; Caffeine* ; Cardiovascular Diseases ; Cardiovascular System ; Coffee ; Eating ; Heart Rate ; Hemodynamics ; Humans ; Male ; Pulse Wave Analysis ; Sympathetic Nervous System ; Vascular Resistance ; Vascular Stiffness* ; Water

Aortoesophageal fistula secondary to thoracic aortic aneurysm is an uncommon cause of gastrointestinal bleeding and is uniformly fatal without surgical intervention. We report a case of aortoesophageal fistula in an 83-year-old male who presented with massive hematemesis after 4 days of NSAID use. Endoscopy showed a kissing esophageal ulcer with a pulsating mass lesion in the mid esophagus. HRCT showed a fusiform aortic aneurysm in the descending aorta that was affecting the mid esophagus.
Aged, 80 and over ; Aorta, Thoracic ; Aortic Aneurysm ; Aortic Aneurysm, Thoracic ; Endoscopy ; Esophageal Fistula ; Esophagus ; Fistula ; Hematemesis ; Hemorrhage ; Humans ; Male ; Ulcer