Since its introduction to Korea from Japan at the beginning of the seventeenth century, tobacco became very popular with an amazing rapidity among Koreans. Along with widespread cultivation of tobacco, smoking also became very popular among Koreans, regardless of their classes, ages, and sexes. On the other hand, other imported crops from America via Europe in the sam period, like sweet potato, potato, corn and tomato, did not enjoy such popularity in Korea. A long time after their introduction, Koreans began to cultivate these crops. Why did Koreans respond enthusiastically to the newly-imported tobacco? What kind of factors contributed to the rapid transmission of tobacco in Korea? This study examined the causes of rapid diffusion of the smoking population in three aspects. First was economic aspect. The farming of tobacco yielded a profit by selling it to Chinese. The climate and the soil of Korea fit for farming of tobacco. So the farm land of tobacco expanded gradually since the 18th century. Second was medical aspect. At first, many Koreans believed that smoking was helpful to digestion, expectoration, protecting coldness, and exterminating parasites. Afterwards, they believed smoking could encourage vitality and protect diseases. There was no reason of smoking cessation for the people's health in that the hazards of smoking were not well known to the commonage in those days, though a few intellectuals acknowledge its harm. Third was sociocultural aspect. We could trace the smoking culture of Chosun dynasty through arts, poems, and essays. The making of smoking culture made stable reproduction of smokers generation by generation. Especially, the smoking culture secured juvenile's smoking. Considering the three aspects above, we know that what reason the Decree of Ban of Smoking in Korea was not strict in comparison to that of China (Qing Dynasty), in which the violators were executed. The regulation of smoking by the government failed except controlling in sociocultural aspect. The government reinforced controlling of smoking culture in counteraction to the threat of collapse of the hierarchy of Chosun dynasty in 18th century.
English Abstract ; History of Medicine, 17th Cent. ; History of Medicine, 18th Cent. ; History of Medicine, 19th Cent. ; Korea ; Smoking/*history ; *Tobacco

PURPOSE: An accurate determination of the natural history of a cerebral aneurysm has implications on management. Few risk factors other than female gender and cigarette smoking have been identified to be associated with cerebral aneurysm progression, particularly rapid progression. MATERIALS AND METHODS: This case series and literature review serves to illustrate a relationship between spontaneous carotid occlusion and rapid enlargement of cerebral aneurysms. RESULTS: In our case series, we demonstrated that increased hemodynamic stress on collateral vessels caused by a spontaneous carotid occlusion may contribute to unusually rapid aneurysm growth and/or rupture. CONCLUSION: Spontaneous carotid occlusive disease may be considered a risk factor for rapid cerebral aneurysm progression and/or rupture that may warrant more aggressive management options, including more frequent surveillance imaging in previously treated aneurysms.
Aneurysm ; Carotid Artery, Internal* ; Female ; Hemodynamics ; Humans ; Intracranial Aneurysm* ; Natural History ; Risk Factors ; Rupture ; Smoking

OBJECTIVE: In this study, we aimed to produce basic data on the prenatal environmental risk factors of low birth weight infants at a community level. METHODS: In 2000, we conducted the direct interview using questionnaire about prenatal environmental risk factors with low birth weight infant-delivered mothers and normal weight infant-delivered mothers in Asan-city, Chungcheongnamdo Province, Korea. The questions given to the mothers included past pregnancy history, menstrual status, disease history before and during the pregnancy, family history, environmental risk factors and exposure history. The responses of the two groups were compared to calculate the prenatal environmental risk factors of each group. RESULTS: Mothers' smoking was significantly associated with low birth weight infants (adjusted odds ratio (AOR) 3.27; 95% confidence interval (CI) 1.25-8.56) and preterm baby (AOR 4.20; 95% CI, 1.21-14.61). Other environmental risk factors were not significantly different between the two groups. CONCLUSION: Smoking of mothers can be a risk factor for the delivery of low birth weight infants. These results could provide the basic data on prenatal environmental risk factors of mothers of low birth weight infants and suggest research topics for further community-based evaluation.
Chungcheongnam-do* ; Environmental Exposure ; Female ; Humans ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn ; Korea ; Maternal Exposure ; Mothers* ; Odds Ratio ; Pregnancy ; Reproductive History ; Risk Factors* ; Smoke ; Smoking ; Surveys and Questionnaires

Anterior cervical fusion has become a standard of care for numerous pathologic conditions of the cervical spine. However, subsequent development of clinically significant disc disease at levels adjacent to fused discs is a serious long-term complication of this procedure. As more patients live longer after surgery, it is foreseeable that adjacent segment pathology (ASP) will develop in increasing numbers of patients. Also, ASP has been studied more intensively with the recent popularity of motion preservation technologies like total disc arthroplasty. The true nature and scope of ASP remains poorly understood. The etiology of ASP is most likely multifactorial. Various factors including altered biomechanical stresses, surgical disruption of soft tissue and the natural history of cervical disc disease contribute to the development of ASP. General factors associated with disc degeneration including gender, age, smoking and sports may play a role in the development of ASP. Postoperative sagittal alignment and type of surgery are also considered potential causes of ASP. Therefore, a spine surgeon must be particularly careful to avoid unnecessary disruption of the musculoligamentous structures, reduced risk of direct injury to the disc during dissection and maintain a safe margin between the plate edge and adjacent vertebrae during anterior cervical fusion.
Humans ; Intervertebral Disc Degeneration ; Natural History ; Pathology* ; Reoperation ; Risk Factors ; Smoke ; Smoking ; Spinal Fusion ; Spine ; Sports ; Standard of Care ; Total Disc Replacement ; Viperidae

OBJECTIVE: Due to longer life spans, patients newly diagnosed with unruptured intracranial aneurysms (UIAs) are increasing in number. This study aimed to evaluate how management of UIAs in patients age 65 years and older affects the clinical outcomes and post-procedural morbidity rates in these patients. METHODS: We retrospectively reviewed 109 patients harboring 136 aneurysms across 12 years, between 1997 and 2009, at our institute. We obtained the following data from all patients : age, sex, location and size of the aneurysm(s), presence of symptoms, risk factors for stroke, treatment modality, and postoperative 1-year morbidity and mortality. We classified these patients into three groups : Group A (surgical clipping), Group B (coil embolization), and Group C (observation only). RESULTS: Among the 109 patients, 56 (51.4%) underwent clipping treatment, 25 (23%) patients were treated with coiling, and 28 observation only. The overall morbidity and mortality rates were 2.46% and 0%, respectively. The morbidity rate was 1.78% for clipping and 4% for coiling. Factors such as hypertension, diabetes mellitus, hypercholesterolemia, smoking, and family history of stroke were correlated with unfavorable outcomes. Two in the observation group refused follow-up and died of intracranial ruptured aneurysms. The observation group had a 7% mortality rate. CONCLUSION: Our results show acceptable favorable outcome of treatment-related morbidity comparing with the natural history of unruptured cerebral aneurysm. Surgical clipping did not lead to inferior outcomes in our study, although coil embolization is generally more popular for treating elderly patients. In the treatment of patients more than 65 years old, age is not the limiting factor.
Aged ; Aneurysm ; Aneurysm, Ruptured ; Diabetes Mellitus ; Follow-Up Studies ; Humans ; Hypercholesterolemia ; Hypertension ; Intracranial Aneurysm ; Natural History ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking ; Stroke ; Surgical Instruments

BACKGROUND/AIMS: This study was performed to evaluate the relationship between family history of gastrointestinal (GI) cancers and incidence of any GI cancer in the Korean population. METHODS: Between January 2015 and July 2016, 711 GI cancer patients and 849 controls in 16 hospitals in Korea were enrolled. Personal medical histories, life styles, and family history of GI cancers were collected via questionnaire. RESULTS: There was a significant difference in the incidence of family history of GI cancer between GI cancer patients and controls (p=0.002). Patients with family history of GI cancer tended to be diagnosed as GI cancer at younger age than those without family history (p=0.016). The family members of GI cancer patients who were diagnosed before 50 years of age were more frequently diagnosed as GI cancer before the age of 50 years (p=0.017). After adjusting for major confounding factors, age (adjusted odds ratio [AOR] 1.065, 95% confidence interval [CI]; 1.053–1.076), male gender (AOR 2.270, 95% CI; 1.618–3.184), smoking (AOR 1.570, 95% CI; 1.130–2.182), and sibling's history of GI cancer (AOR 1.973, 95% CI; 1.246–3.126) remained independently associated with GI cancers. CONCLUSIONS: GI cancer patients tended to have a first relative with a history of concordant GI cancer. Personal factors (old age and male) and lifestyle (smoking) contribute to the development of GI cancer, independently. Individuals with high risk for GI cancers may be advised to undergo screening at an earlier age.
Age Factors ; Gastrointestinal Neoplasms* ; Humans ; Incidence ; Korea ; Life Style ; Male ; Mass Screening ; Medical History Taking ; Odds Ratio ; Risk Factors ; Smoke ; Smoking

Cerebral aneurysms are common lesions. In most populations, the incidence of subarachnoid hemorrhage (SAH) is 10 per 100,000 personyears. The case fatality rate of SAH is about 50 percent in population-based studies, with a trend toward gradual improvement. Associated conditions include autosomal dominant polycystic kidney disease, fibromuscular dysplasia, Marfan's syndrome, Ehlers-Danlos syndrome, and arteriovenous malformations of the brain. The risk factors for the rupture of cerebral aneurysms include increasing size, specific site, smoking, and hypertension. Cerebral aneurysms can be divided into two different categories: saccular (atherosclerotic) and dissecting (nonatherosclerotic). The most common histologic finding in saccular aneurysms is a decrease in the tunica media, the middle muscular layer of the artery, causing structural defects. These defects combined with hemodynamic factors, lead to aneurysmal outpouchings at arterial branch points in the subarachnoid space at the base of the brain. Dissecting aneurysms are characterized by widespread disruption of the internal elastic lamina that leads to mural thrombus formation and causes ischemic or hemorrhagic symptoms. Ultimately, therapeutic strategies should be based on the epidemiology, natural history, and pathogenesis of the cerebral aneurysms.
Aneurysm ; Aneurysm, Dissecting ; Arteries ; Arteriovenous Malformations ; Brain ; Ehlers-Danlos Syndrome ; Fibromuscular Dysplasia ; Hemodynamics ; Hypertension ; Incidence ; Intracranial Aneurysm ; Marfan Syndrome ; Natural History ; Polycystic Kidney, Autosomal Dominant ; Risk Factors ; Rupture ; Smoke ; Smoking ; Subarachnoid Hemorrhage ; Subarachnoid Space ; Thrombosis ; Tunica Media

BACKGROUND/AIMS: The natural history of severe erosive reflux disease in Korea remains uncertain. We aimed to evaluate endoscopic follow-up results in subjects with severe reflux esophagitis under routine clinical care. MATERIALS AND METHODS: A total 61,891 subjects underwent an upper endoscopic examination in the health check-up program from January 2007 to December 2013. We reviewed medical charts of patients who had been diagnosed with severe reflux esophagitis. The severity of reflux esophagitis was determined by the Los Angeles (LA) classification system. Patients underwent at least one follow up endoscopy after diagnosis of severe reflux esophagitis. We classified the patients into two groups; regressed in severity and remained unchanged, according to follow up endoscopic status. RESULTS: Based on endoscopic findings, 5,938 subjects (9.6%) were found to have reflux esopohagitis: 121 subjects (0.2%) in LA-C; 39 subjects (0.06%) in LA-D. Among 31 patients who had endoscopic follow-up, 23 patients (74.2%) showed regression from LA C/D to LA A/B or minimal change disease or normal. The mean follow up duration was 42.2 months in regression group and 53.2 months in no change group. All patients had been treated with proton pump inhibitors (PPIs) on a regular or on-demand basis. Age, sex, smoking, alcohol, exercise, hypertension, diabetes mellitus, dyslipidemia, sliding hiatal hernia, body mass index, waist circumference and duration of PPIs therapy did not significantly influence regression of severe reflux esophagitis. CONCLUSIONS: The majority of severe reflux esophagitis patients under routine clinical care showed improvement on endoscopic follow-up.
Body Mass Index ; Classification ; Diabetes Mellitus ; Diagnosis ; Dyslipidemias ; Endoscopy* ; Esophagitis ; Esophagitis, Peptic* ; Follow-Up Studies* ; Gastroesophageal Reflux ; Hernia, Hiatal ; Humans ; Hypertension ; Korea* ; Natural History ; Nephrosis, Lipoid ; Proton Pump Inhibitors ; Smoke ; Smoking ; Waist Circumference

PURPOSE: Traditionally vascular reconstruction has been reserved for patients with limb threatening ischemia. So, the surgery for claudication has been discouraged by the fear of bypass graft failure, limb loss, and significant perioperative complication that may be worse than the natural history of the disease. However, in a minority of patients with claudication, the symptoms progress and a severe disability can result, which limit normal daily activities. In these patients intervention may be regarded as worthwhile. METHODS: To evaluate the benefit or risk of revascularization that performed in patients with disabling or incapacitating intermittent claudication, the clinical data of patients who underwent the revascularization for disabling claudication at Yeungnam University hospital were collected and analyzed retrospectively. RESULTS: From January 1990 to June 1999, 98 patients with disabling claudication were performed the surgical or interventional management (13.7% of all lower limb arterial disease registration in our unit). The patients were 93 males and 5 females ranging from 35 to 76 years of age. The mean age was 59, with the highest incidence among people in their 50s, followed by those in their 60s and then in their 70s. History of smoking was noted in 82.7% of the cases. The major arterial occlusive site were aortoiliac artery in 42 cases (42.9%), femoral artery in 23 cases (23.5%), iliofemoral artery in 13 cases (13.3%), popliteal artery in 4 cases (4.1%), tibial artery in 5 cases (5.1%) and multi-level occlusion in 11 cases (11.2%). The operative procedures for disabling claudication were bypass graft operation in 70 cases, thromboembolectomy in 5 cases, endarterectomy in 4 cases and percutaneous transluminal angioplasty (PTA) in 19 cases. Arterial bypass operations were aortobifemoral or aortobipopliteal bypass in 17 cases, iliofemoral bypass in 8 cases, femoropopliteal bypass in 16 cases, femorotibial bypass in 3 cases, popliteotibial bypass in 6 cases, axillobifemoral bypass in 7 cases and femorofemoral bypass in 13 cases. In 98.4% of the operative cases, the early outcome was good with 3 to 2 rating according to Rutherford criteria and cumulative 12, 24, 60-month primary and secondary patency rates were 83.3%, 76.4%, 71.3% and 87.8%, 86.3%, 81.8%. The operative mortality rates were 0% and no limb loss was noted in this series. CONCLUSION: In summary, arterial reconstruction for disabling claudication is noted as safe and durable procedure in some selective patients. Therefore, surgical intervention are valid treatment option in selected patients with disabling claudication.
Angioplasty ; Arteries ; Endarterectomy ; Extremities ; Female ; Femoral Artery ; Humans ; Incidence ; Intermittent Claudication* ; Ischemia ; Lower Extremity ; Male ; Mortality ; Natural History ; Popliteal Artery ; Retrospective Studies ; Smoke ; Smoking ; Surgical Procedures, Operative ; Tibial Arteries ; Transplants

OBJECTIVE: This study was aimed to evaluate the age at natural menopause and related factors among women in a population based study in 2015 in Isfahan, Islamic Republic of Iran. METHODS: In this cross-sectional study 960 menopausal women were selected by cluster sampling. Demographic, socioeconomic, lifestyle behavior and reproductive history aspects were collected using a structured questionnaire. Woman and her husband's educational level and occupation with family income were the variables to construct socioeconomic status using principal component analysis. RESULTS: Mean and median of natural menopause age were 48.66 and 48 years, respectively. Women body mass index (BMI) more than 30 kg/m2 had significantly higher menopausal age than women with lower BMI (P value = 0.022). The mean of menopausal age was not statistically significant in regard to marital status, physical activity, smoking status, menarche age, age at first pregnancy and history of abortion. Menopause age with pregnancy numbers and age at last pregnancy had a significant positive association. Women with better socioeconomic status had significantly higher natural menopause age. Multiple linear regression shows significant relationship between lower age at menopause with higher age at marriage, higher number of pregnancy and lower socioeconomic status. CONCLUSION: Age at menopause in our studied sample is similar to previous estimates reported for other Iranian populations. Age at marriage, higher number of pregnancy and lower socioeconomic status were the significant factors in relations to age at menopause.
Age Factors ; Body Mass Index ; Cross-Sectional Studies ; Female ; Humans ; Iran* ; Islam ; Life Style ; Linear Models ; Marital Status ; Marriage ; Menarche ; Menopause* ; Motor Activity ; Occupations ; Pregnancy ; Principal Component Analysis ; Reproductive History ; Smoke ; Smoking ; Social Class ; Socioeconomic Factors