OBJECTIVES: This review strives to look through the reality of school situation in Korea which gives the most severe burden of conflict to adolescents nowadays, for the purpose of better understanding of them. METHODS: Followings comprised of the summary of the materials from the published articles and books, and from mass media regarding 'school collapse' phenomenon in Korea, and also include materials regarding school non-attenders. And discussion was done with developmental and psychiatric perspectives on the phenomenon along with on school non-attenders. CONCLUSION: School non-attenders nowadays with the issue of 'school collapse' have different characteristics from the dropouts reported in many previous studies. Psychiatrists need to accommodate their previous view on adolescents as the way of adolescents' coping has rapidly changed. It is noted that there are few researches regarding school non-attenders, as well as regarding school factors associated with non-attending in Korea. This review was done to call for future studies focused on the interdependent relationship between school processes and the individual characteristics of non-attenders, so that enable us to capture the complexity of how adolescents make their decision of hangingin or droppingout of school.
Adolescent ; Humans ; Korea* ; Mass Media ; Patient Dropouts ; Psychiatry

BACKGROUND AND PURPOSE: A carboxy-O-methyl transferase inhibitor entacapone has been introduced as an adjuvant drug for Parkinson disease (PD) patients. Although clinical trials reported beneficial role of entacapone, a long-term trial over 3 years failed to show significant effect. The goals of this study were to evaluate the clinical benefit and the efficacy of entacapone in an open clinical practice. METHODS: After the completion of a double-blind placebo-controlled entacapone study, 149 patients from 4 centers were included. Antiparkinsonian medications were optimized by the judgment of the neurologists in charge. The clinical global impression (CGI) scale was obtained at 6 months and 1 year after the initiation of entacapone treatment. RESULTS: Of the 149 patients, 117 patients chose to try entacapone in an open-label fashion. Sixty-nine (59%) patients completed the 1-year trial. Twenty-nine patients discontinued entacpaone before 6 months, and 19 between 6 months and 1 year during trial. Twelve patients out of 48 patients discontinued entacapone because of its poor efficacy. The CGI scale was 3.9 (+/-1.5) at the beginning of the trial, 4.3 (+/-1.1) at 6 month, and 3.8 (+/-1.3) at 1 year, respectively. The CGI scale of those who discontinued between 6 month and 1 year was 3.4 (+/-1.7), which was worse, but insignificantly, than that of the continuer. CONCLUSIONS: The dropout at 1 year of our study was very high at 41%. Even though entacapone is indicated for advanced PD patients with motor fluctuation, the fluctuators commonly have dyskinesia and mental symptoms, which can become more troublesome with entacapone. In the patients with advanced PD, the clinical efficacy and side effects should be carefully considered in a long-term use of entacapone.
Dyskinesias ; Humans ; Judgment ; Parkinson Disease* ; Patient Dropouts ; Transferases

One of the true success stories in clinical neurosciences over the last 30 or so years has been the development of effective drug therapies of several psychiatric disorders including schizophrenia. It is true that the effects of drug are not disease-specific. However, it if logical to find medications that will be effective in eating disorders. In spite of many limitations, some tentative conclusions regarding the role of medications in the treatment of eating disorders can now be drawn. These conclusions as a whole revealed the following ; 1) There were no clear difference in efficacy among the various drugs used. 2) Short-term abstinence rates are about 30%, and overall reductions in bulimic behavior are about 70%. 3) A significant relapse rate(30-45%) is observed if patients are followed for 4-6 months. 4) There are few predictors of who will respond to these medications. 5) Dropout rates tend to be high, in part because of side effects and in part because of some patients' attitudes toward medication use. 6) The doses used in these treatment studies have generally been similar to those employed in the treatment of depression, and with a single exception which the high-dose regimen (60 mg of fluoxetine) was clearly superior to the loll dose (20 mg of fluoxetine). However, Wakeling(1995) suggested that the pharmacotherapy for eating disorders clearly had some limited beneficial effects, at least in the short term and that many unanswered questions remained related to the acceptability of this form of treatment, the unwanted effects of drugs and the longer-term efficacy. He also insisted that at the present level of knowledge, pharmacotherapy should not be used as a sole treatment approach but only within an overall treatment programme. In clinical practice, pharmacotherapy is frequently used in the treatment of eating disorders in combination with various psychotherapuetic approaches. Therefore, the clinicians, who engage in the treatment of patients with eating disorders, should be able to identify the patients for whom drug therapy is desirable and be accustomed to the differences with the pharmacotherapy of other psychiatric patients. The author will review the results of previous studies on pharmacotherapy for eating disorders and demonstrate several important issues in the practice of pharmacotherapy for the patients with eating disorders.
Depression ; Drug Therapy* ; Feeding and Eating Disorders* ; Eating* ; Humans ; Logic ; Neurosciences ; Patient Dropouts ; Recurrence ; Schizophrenia

Intracavernous injection of prostaglandin E1 as a treatment for erectile dysfunction has achieved widespread acceptance due to low rates of drug induced priapism and penile fibrosis. We assessed the efficacy and side effects through our experience in a pharmacologic erection program using prostaglandin E1 only. A total of 79 impotent patients received a prostaglandin E1 monotherapy as a first-line pharmacological erection program for more than 2 months. Suspecting etiologies were non-vasculogenic non-neurogenic in 39, vasculogenic in 38 and neurogenic in 2 patients. The average duration using prostaglandin E1 was 4.6 months with a range of 2 to 14 months and the mean frequency of drug use was 4.9 per week. The average prostaglandin E1 dose used by patients in the program was 7.4Hg(0.37ml). No one had any side effects such as prolonged erection or fibrotic curvature. Dropout rate from prostaglandin E1 monotherapy after using for more than 2 months was 49%(39 patients) and reasons were penile pain in 7, drug expense in 4, inadequate response in 3, recovery of spontaneous erection in 2 and unclear in 23 patients. Among these dropout patients, 14 received Trimix(the mixture of 15mg of papaverine, 1. 25mg of phentolamine and 5ug of prostaglandin E1 per 1ml of solution) injection as a second- line pharmacological erection program with a good erectile response. We conclude that the prostaglandin E1 monotherapy represents a safe and efficacious method for the first-line selfinjection therapy.
Alprostadil* ; Erectile Dysfunction* ; Fibrosis ; Humans ; Male ; Papaverine ; Patient Dropouts ; Phentolamine ; Priapism

PURPOSE: Sildenafil citrate(Viagra(R)) has been accepted as a primary treatment of erectile dysfunction(ED). We performed this study to assess the determinants of sildenafil failure and the status of secondary treatment in sildenafil failure patients. MATERIALS AND METHODS: We reviewed the medical records of 1,023 erectile dysfunction patients who were prescribed sildenafil from September 2001 to June 2003. A specially designed sildenafil failure questionnaire was asked in 236 patients of sildenafil failure(Group I) and 127 of 787 patients with sildenafil success as a control(Group II). RESULTS: Sildenafil failure rate was 23%(236/1023). In Group I, the etiology of ED was psychogenic in 14%, organic in 36%, mixed in 32% and un-classified in 18%. Number of total medication(more than 6 times) was 47% in Group I and 61.4% in Group II. Presence of sexual stimulation after medication was 47% in Group I and 61.4% in Group II. There was no difference in time to intercourse after medication and interval of meal to medication between both groups(p>0.05). The secondary treatment in Group I was intracavernous injection(11.3%), vacuum device(7.2%), penile prosthesis(1.3%) and 81.2% of no further treatment. CONCLUSIONS: Although precise education of taking sildenafil may enhance the response rate, the best predictors for long-term use of sildenafil are the severity and cause of ED and the effectiveness of sildenafil. Due to the high dropout rate of patients who suffer sildenafil failure, precise public education and secondary treatment options should be recommended.
Education ; Erectile Dysfunction* ; Humans ; Male ; Meals ; Medical Records ; Patient Dropouts ; Sildenafil Citrate ; Vacuum

PURPOSE: Because low-quality trials may lead to erroneous conclusions, quality assessments are necessary. Thus, in this study, we scrutinized randomized controlled trials (RCTs) published in the Korean Journal of Urology (KJU) to assess their quantity and quality. MATERIALS AND METHODS: Upon extracting RCTs from all articles published in the KJU from 1991 to 2010, assessments were made on the basis of the Jadad scale and the adequacy of allocation concealment. The selections and assessments were performed independently by two researchers, and adjustment of the differences was done by a third-party researcher. In addition, the factors that may affect quality were analyzed. RESULTS: A total of 3,516 original articles were searched and 28 RCTs were extracted. In the 1990s, RCTs constituted only 0.27% of the total original articles, but in the 2000s, RCTs constituted 1.34%. The mean total Jadad score increased from 1.6 points in the 1990s to 1.65 points in the 2000s. However, the percentage of "good quality" trials also increased from 20% to 30.43%. As for adequate allocation concealment, one study was observed in the 2000s. The aspect most lacking was appropriate dropout and double-blinding. Studies with medical interventions or funded or examined by institutional review boards tended to receive higher quality assessments. CONCLUSIONS: Although RCTs consistently increased in both quantity and quality, in future studies, researchers should continue to strive toward achieving adequate allocation concealment and appropriate double-blinding. In addition, researchers must become more interested in receiving external funding and undergoing examination by institutional review boards.
Ethics Committees, Research ; Financial Management ; Humans ; Korea ; Patient Dropouts ; Prospective Studies ; Random Allocation ; Urology

BACKGROUND: Although expert panels and guidelines recommend that 5~10% weight reductions of initial body weight have beneficial effects for decreasing obesity-related complications, obese persons tend to desire greater weight losses. Little is known about the patients' expectations and the disparity of goal weight between physicians and patients. The aim of this study was to evaluate the patients' weight loss expectation, and the association between the degree of desired weight losses and treatment outcomes. METHODS: A total of 283 obese subjects (84 men, 199 women), aged > or =20 years with body mass index (BMI) over 25 kg/m2 from 19 obesity clinics were included. Patients' desired weight as evaluated using modified GRWQ (Goals and Relative Weight Questionnaire) which included goal weight, ideal weight, satisfactory weight, acceptable weight, and disappointed weight. After 12 weeks, subsequent weight changes and treatment adherence were investigated. RESULTS: Mean BMI of men and women were 30.9+/-4.2 kg/m2 and 29.1+/- 3.8 kg/m2, respectively. Men expected 13.2 kg (14.0%) mean weight reductions and women expected 10.8 kg (15.7%) mean reductions during the 3 months. The heavier the patient's weight, the greater the reduction amount was desired in both men and women. During the 3 months, the dropout rates of men and women were 40.1% and 46.2%, respectively. In women, the amount of desired weight reduction as significantly higher in the dropout group compared to the non-dropout group. Those who attained pre-determined goal weight after 3 months were 6% for men and 4% for women. After 3 months, 81% of male subjects and 80% of female subjects had not achieved even their predefined disappointed weight. CONCLUSION: Obese patients seeking treatment expected average of 15% weight reduction, greater than 'medically reasonable or successful' weight reductions. The disparities between patients' expectations and physicians' recommendations could influence treatment adherence.
Body Mass Index ; Body Weight ; Female ; Humans ; Male ; Obesity* ; Patient Dropouts ; Weight Loss

PURPOSE: Alarm interventions are effective and safe treatments for nocturnal enuresis when compared with the other treatments. However, the rate of doctors prescribing enuresis alarms is quite low in Korea. This study evaluated the application conditions and treatment results of an enuresis alarm in children with enuresis in Korea. MATERIALS AND METHODS: 147 out of 316 patients who purchased an enuresis alarm through a alarm sales agency in Korea were evaluated retrospectively. The questionnaire had two main categories: items of enuresis(number of episodes during the night, enuresis frequency during a week, etc.) and the items of the enuresis alarm(previous treatment history, a motivation of using enuresis alarm treatment, the period of using the enuresis alarm, initial success, continued success, dropout of using enuresis alarm, nocturia after treatment, etc.). RESULTS: A total 147 children participated in this study. The initial success rate was 30.6% whereas the continued success rate was 34.0%. In addition, the dropout rate was 27.2%. 46.2% of patients purchased the enuresis alarm with a doctor's prescription and 53.8% purchased the alarm without a prescription. Among the factors, the success and dropout rate were affected by only whether the patient visited the hospital. Thirty five patients who took combination therapy with medicine had a significantly lower initial success rate. CONCLUSIONS: In Korea, without a doctor's prescription, 53.7% patients attempt to treat enuresis alarm directly. The initial and continued success rate with the enuresis alarm was approximately 30% and the dropout rate was approximately 30%.
Child ; Commerce ; Enuresis ; Humans ; Korea ; Motivation ; Nocturia ; Nocturnal Enuresis ; Patient Dropouts ; Prescriptions ; Retrospective Studies

PURPOSE: Since the induction of the residency program in the surgical departments, more than 200 residents now enter postgraduate year-1 (PGY-1) every year. This number has been declining in recent years while the dropout has been on the rise. To suggest a solution to this problem, we evaluated the current status of residency education and proposed an improved method for postgraduate surgical education. METHODS: We analyzed the responses from mailed questionnaires sent to the 789 residents in 123 different training hospitals in April 2001. Twenty-five questions were analyzed according to PGY, working conditions, and other variables. RESULTS: The response rate was 40.8% (322/789). The mean age of the residents was 30 years, and there were 28 (9%) female residents. The number of married residents were 137 (42.5%), and there were 91 1st year PGYs, 77 2nd year, 82 3rd year and 70 4th year. Most of them were being trained in university based hospitals (89.8%). The residents felt that their number was insufficient (70.8%), and that their work load was greater than that of other residents (92.9%). Their greatest stress was physical exhaustion (64.3%). Most residents discussed their problems with the senior residents (78%). They needed standardized training programs (62.1%). A majority (77.7%) responded that they did not have enough opportunities to perform surgical procedures. The single most important problem in PGY education was perceived to be the excessive work load (75.8%), which could be improved by specialized educational programs (64.6%). CONCLUSION: The absences of both educational programs and supporting manpower are the major problems facing surgical residents. Adequate stipend would be also beneficial, and increased attention and demonstrations of experience should be offered by the staff physicians.
Education* ; Female ; Humans ; Internship and Residency* ; Patient Dropouts ; Postal Service ; Surveys and Questionnaires

PURPOSE: To evaluate the efficacy and safety of an intracavernous injection of lyophilized papaverine/phentolamine/alprostadil (Standro(R)) for the treatment of erectile dysfunction (ED) in Koreans. MATERIALS AND METHODS: 249 men (>20 years old), with ED (>6 month duration), were enrolled from 14 clinical centers. The intracavernous 'TMs' were titrated in a stepwise fashion at the clinic, from 0.05-0.25ml (17.64mg papaverine, 0.6mg phentolamine, and 6mug alprostadil per ml), with increment of 0.02-0.05ml, according to the etiology and severity of the ED and the patients' ages. RESULTS: Of the 249 men, 238 completed the dose titration, and progressed to home treatment of 3 months duration. Of these 238, 193 (psychogenic 13.0%, organic 75.5%, mixed 11.5%) completed the home treatment (4 or more self-injections), with the other 45 dropping out (lost to follow-up in 24, patient refusal in 9, no chance to have intercourse in 7 and omitted recording of patient diary in 2). The success rate per trial (a total number of sufficient erection for vaginal intromission/a total number of injections) and per patient (number of patients who had one or more sufficient erections for vaginal intromission/the enrolled patients at beginning or 193 patients), and the satisfaction rate per patient (number of patients who had both patient and partner satisfaction with erection/193 patients) were 74.1, or 91.2 and 75.1%, respectively. The adverse reactions were prolonged erections in 3, urethral pain in 1 and penile skin edema in 2. Three patients complained of penile pain during an erection, but there was no dropout due to the pain. No significant changes in laboratory tests were found after the home treatment. CONCLUSIONS: A 'TM' seems to be effective and safe for an intracavernous injection for the treatment of men with erectile dysfunction.
Alprostadil ; Disulfiram ; Edema ; Erectile Dysfunction* ; Follow-Up Studies ; Humans ; Male ; Papaverine ; Patient Dropouts ; Phentolamine ; Skin