Probably because the Renaissance period tended to be overglorified, people have even come to equate the "Middle Ages" with the "Dark Ages". But some writings have recently expressed positive views on the "Middle Ages" in history. The Christian teachings from the Middle Ages concerning the sick and the poor have undoubtedly contributed to forming the ideals of modern medical care. Today's medical facilities run especially by churches are expected to continue their services based on a biopsychosociomedical model rather than on a biomedical mode.
*Altruism ; Christianity/*history ; English Abstract ; History of Medicine, Early Modern ; History of Medicine, Medieval ; History of Medicine, Modern ; Primary Health Care/*history ; Religion and Medicine

OBJECTIVES: The purpose of this study is to examine the modern history of public health(PH) and suggest a way forward for PH nursing(PHN). METHODS: This paper is a review article that derives results from literature review. RESULTS: In the period of beginning (up to 1944), PHN began as the PH Department was created in the Hygiene Bureau in 1908 and tasks about nurses were legislated. PHN was limited to infectious disease tasks and performed mostly by missionaries. In the period of foundation formation (1945 to 1961), the Republic of Korea was founded, and PH policies and tasks were defined with the establishment of the central government organization and the applicable laws. In the period of foundation establishment (1962 to 1979), the Regional PH Act was amended, and as a result, PH Centers(PHCs) spread across the country. In the period of foundation expansion (1980 to 1994), the PH referral system of PHCs, PH Units, and Primary Health Care Post was established. In the period of organization in each area (1995 to 2005), PH programs reflecting changes in disease structure and public needs for the quality of life. A regional health care plan was launched. In the period of funtion expansion (2006 to present day), Centers for support health living were established. CONCLUSIONS: In the future, PH nurses need to have a macroscopic perspective that views PH through the overall PH system, and to expand from the existing healthcare concept to the national and global healthcare one.
Communicable Diseases ; Delivery of Health Care ; History, Modern 1601- ; Hydrogen-Ion Concentration ; Hygiene ; Jurisprudence ; Missionaries ; Primary Health Care ; Public Health Nursing* ; Public Health* ; Quality of Life ; Referral and Consultation ; Republic of Korea

Drug-induced autoimmune hepatitis (DIAIH) is an increasingly recognized form of drug-induced liver injury that leads to a condition similar to idiopathic autoimmune hepatitis. A number of drugs have been associated with DIAIH, minocycline is one of the most well characterized. Minocycline is a semisynthetic tetracycline antibiotic used in the treatment of acne vulgaris. Minocycline-induced autoimmune hepatitis presents with serologic and histologic features similar to idiopathic autoimmune hepatitis. However, the natural history and outcomes of these two conditions differ significantly. The majority of patients with minocycline-induced autoimmune hepatitis experience complete resolution of symptoms after withdrawal of the medication. Some patients may require a short course of steroids and rarely use of an immunomodulator to achieve resolution of disease. Recurrence of symptoms is rare and typically only occurs with reintroduction of minocycline. It is important for primary care providers to consider minocycline-induced autoimmune hepatitis when liver injury develops during minocycline therapy.
Acne Vulgaris ; Drug-Induced Liver Injury ; Hepatitis, Autoimmune* ; Humans ; Liver ; Minocycline ; Natural History ; Primary Health Care ; Recurrence ; Steroids ; Tetracycline

Roughly one third of medical problems in children are related to the musculoskeletal system. Most of these problems are common and can be precisely diagnosed. For these problems, nonoperative treatment or reassurance can be given by the pediatrician. Occasionally, a problem needs surgical treatment, but a precise diagnosis must be made. There is little agreement about what types of orthopedic problems a primary care pediatrician should understand in order to effectively care for children. Many pediatric residencies lack an organized teaching curriculum that effectively covers these topics or that includes a required pediatric orthopedic rotation. In this article the authors delineate pediatric orthopedic problems that require recognition and urgent surgical treatment and are relatively common, but have different treatment options (observation, conservative treatment, and surgery) depending on their natural history. Whenever possible, the diagnosis should be made before a decision to refer is made. An accurate diagnosis allows the pediatrician to discuss the natural history of the condition properly. Referral to the wrong specialty can needlessly generate expensive tests and further delay in treatment or generate inappropriate treatment. The parents can be reassured rather than waiting to hear the same information from another physician. In particular, orthopedic problems are known to generate pressure from the parents to seek specialty consultation for reassurance. It is important to communicate to the specialist that the reason for the referral is for parental reassurance rather than for further work-up or treatment. After a proper diagnosis, communication directly between the pediatrician and the appropriate specialist can often avoid an unnecessary referral, and avoid unnecessary tests. The authors reviewed our experience at our outpatient clinic over last 1 year and found that it is useful to classify conditions as common or uncommon, and whether they require surgical or nonsurgical treatment. Many conditions fall in between. The following is a discussion of some of these more important or common conditions.
Ambulatory Care Facilities ; Child ; Curriculum ; Humans ; Internship and Residency ; Musculoskeletal System ; Natural History ; Orthopedics ; Outpatients ; Parents ; Primary Health Care ; Referral and Consultation ; Specialization

BACKGROUND: Alternative medicine is defined as a non-orthodox therapeutic practices including chiropractic, acupunture, herbal medicine, faith, spiritual therapy or as all sorts of medical care that do not follow the medical community standards. Patients do not think of modern medicine as the absolute solution to their health problems and they will sometimes ask for complementary therapy and in want of referral to alternative practitioner. We have investigated the primary physicians' attitude and behavior towards alternative medicine. METHODS: Randomly selected 770 practitioners, in primary care practice in Seoul, were questioned from July to September in 1996 about the attitude to wards alternative medicine, the reasons and symptoms when referring, and experience in alternative medicine practice. RESULTS: 150 questionnaires were returned and among them 139 completed ones (18.1%) were analyzed. Among 770 doctors, 35 (25.2%) have referred patients to alternative practitioner before and more referrals were made when they worked together closely or had some prior training. The belief of special effect of alternative medicine on certain disease was the first reason to refer. Other reasons were for herbal medicine, acupunture, and chiropractice in the order of seguence. The standard way to learn alternative medicine was to attend seminars available through certain institutions. On referral either chronic pain or musculoskeletal disease were the most chief complaints or main diseases of patients. 15 doctors (10.8% ) had some experience in practicing an alternative approach and the patient subjeccts were more likely to be women, and there was increased tendency to be working with another doctor, and to have been trained for such practice. The items used by alternative practitioners were acupunture, herbs in the order of seguence. CONCLUSIONS: Alternative medicine is accepted somewhat by primary physicians in Seoul although the rate of referral and practice is lower than 54% compared to 16% in Canada.
Canada ; Chiropractic ; Chronic Pain ; Complementary Therapies* ; Female ; Herbal Medicine ; History, Modern 1601- ; Humans ; Musculoskeletal Diseases ; Primary Health Care ; Referral and Consultation ; Seoul* ; Surveys and Questionnaires

Urinary incontinence is the involuntary loss of urine. There are many types of incontinence and different management options available, ranging from lifestyle modifications, medication to surgical intervention. Untreated urinary incontinence can result in a myriad of problems, including skin irritations, infections, social phobia, major depression and premature institutionalisation of elderly family members. Common barriers to optimal management include the socially embarrassing nature of the condition, which impedes open discussion, as well as the misperceptions that management must be invasive and the condition cannot be adequately managed within the community. We discuss the common types of incontinence encountered in the community and their management in the primary care setting.
Cholinergic Antagonists ; therapeutic use ; Diagnosis, Differential ; Exercise Therapy ; Female ; Humans ; Male ; Medical History Taking ; Primary Health Care ; Urinalysis ; Urinary Incontinence ; diagnosis ; etiology ; therapy

Haemoptysis is commonly seen in the healthcare setting. It can lead to life-threatening complications and therefore requires careful evaluation of the severity and status of the patient. Common causes of haemoptysis can be broadly grouped into five main categories: infective, neoplastic, vascular, autoimmune and drug-related. Detailed history-taking and careful physical examination are necessary to provide a diagnosis and assess the patient's haemodynamic status. Physicians must have a clear understanding of the criteria for further investigations and the need for a specialist or inpatient referral for management.
Diagnosis, Differential ; Female ; Hemodynamics ; Hemoptysis ; diagnosis ; diagnostic imaging ; therapy ; Hemorrhage ; Humans ; Medical History Taking ; Middle Aged ; Primary Health Care ; Referral and Consultation ; Tomography, X-Ray Computed

The rising incidence and prevalence of diabetes along with its complications have become a global concern. The necessity for a comprehensive model-targeting primary, secondary and tertiary prevention as well as all levels of care has become apparent. Staged Diabetes Management (SDM) was developed over a decade ago by the International Diabetes Centers, Minneapolis, Minnesota, U.S.A.. SDM was founded on the principle that a detailed understanding of the natural history of diabetes and the underlying defects responsible for the development of hyperglycemia and its associated complications should be the basis of sound clinical decision-making. It relies on clinical pathways to guide the clinicians though the detection, treatment and follow up of each type. Unique to SMD is that each pathway is customized for utilization in collaboration with local physicians and allied heath professionals. Thus far clinicians from 22 countries, using 11 translated versions of SDM, have participated in this process. In Korea, SDM was introduced in 1999 with the foundation of the committee in Korean Diabetes Association (KDA). Taking into account the regional difference in medical practice, resource allocation, availability of pharmacological agents and access to care, this Korean version of SDM was developed to reduce variation in practice, improve screening and detection, tighten glycemic control and to increase surveillance of complications. It has been noted that diabetes contributes to the cost of medical services. One way of reducing the financial burden is to find cost-effective approaches to prevention, detection and treatment of diabetes and its complications. The SDM model directly addresses this issue by seeking ways to optimize the limited resources available for diabetes care, prioritizing treatment, reducing medical error and expanding the role of allied health professionals. As SDM moves into the 21st century, its mission has expanded to encompass the principles of primary and secondary prevention.
Cooperative Behavior ; Critical Pathways ; Diabetes Mellitus ; Follow-Up Studies ; Health Occupations ; Humans ; Hyperglycemia ; Incidence ; Korea ; Mass Screening ; Medical Errors ; Minnesota ; Missions and Missionaries ; Natural History ; Prevalence ; Primary Health Care ; Resource Allocation ; Secondary Prevention ; Tertiary Prevention

BACKGROUND: A considerable portion of patients in primary care are thought to have mental disorders in Korea. But they are not easily noticed and are thus underdiagnosed and approached improperly. This study was done to assess the prevalence of common mental disorders in a hospital-based family practice and to evaluate the utility of a diagnostic tool, the Patient Health Questionnaire (PHQ). METHODS: Ten or more patients each day were systematically selected in family practice clinics for two weeks in a university and a community hospital-based family practice clinics in Seoul, Korea. Routine care was delivered as a control during the first week and the PHQ was administered to patients during the second week and the physicians were allowed to review the PHQ just before making clinical decisions. Physicians were asked to answer whether they recognized patients' with mental disorders before reviewing the PHQ. RESULTS: The prevalence of mental disorders was higher in the test group than the control except for eating disorders and other anxiety disorders (P <0.05)(test vs. control group): major depressive disorders 1.75% vs. 3.8%, other depressive disorders 6.8% vs. 11.4%, panic disorders 0.6% vs. 2.3, somatoform disorders 3% vs. 5%, alcohol abuse 2.2% vs. 8.7%, and any mental disorders 20.9% vs. 29.4%. In the test group, the percentage (95% confidence interval in parenthesis) of newly diagnosed mental disorders after physicians' review of the PHQ were 66% (49~82) in major depressive disorders, 70% (50~90) in panic disorders, 70% (56~83) in somatoform disorders, 84% (75~92) in alcohol abuse, and 68% (62~74) in any mental disorders. Patients' response to the PHQ was overall very receptive. CONCLUSION: One-week prevalence of common mental disorders in the hospital-based family practice was 29.4% and the PHQ tool was efficient to help the family physicians recognize hidden mental disorders.
Alcoholism ; Anxiety Disorders ; Confidence Intervals ; Depressive Disorder ; Depressive Disorder, Major ; Diagnosis ; Eating Disorders ; Family Practice* ; Humans ; Korea* ; Medical History Taking ; Mental Disorders* ; Panic Disorder ; Physicians, Family ; Prevalence* ; Primary Health Care ; Seoul ; Somatoform Disorders ; Surveys and Questionnaires