This longitudinal study examines the burdens and related factors for stroke patient's primary family caregivers. Sixty-one patients treated for stroke at a general hospital in Chung-nam province and family member caregivers participated in this study from July 28, 1998 to August 1, 1999. Family caregivers' burdens were assessed by the burden scale originally developed by Zarit(1980) and Novak &Geust(1989) and modified by Oh's(1993) for use in Korea. The burden scale instrument consists of five subscales.: financial burden, social burden, physical burden, dependency burden, and emotional burden. Repeated ANOVA and Stepwise multiple regression were used in the data analyses. The results were as follows: The burden mean score was 3.23 in the hospital, 3.26 after hospital release, and 3.27 in the home environment. In the hospital, a patient's degree of cognition, and social support for family caregivers were significant factors affecting the sense of burden felt by family caregivers. After hospital release, the significant factors affecting the sense of burden were the degree to which stroke patients could participate in daily living activities, social support for family caregivers, and changing to a second caregiver. In the home environment, the most significant factor affecting the sense of burden was social support for family caregivers.
Activities of Daily Living ; Caregivers* ; Cognition ; Dependency (Psychology) ; Hospitals, General ; Humans ; Korea ; Longitudinal Studies* ; Statistics as Topic ; Stroke*

During acute stages of hospitalized stroke patients, family caregivers face many challenges. They often experience emotional distress. social isolation. and financial constraints. However. the burden of caregiving of stroke patients in acute stages has never been studied properly. The purpose of this study was to investigate the factors related to the caregivers' burden with acute stroke. The subjects were 123 acute stroke patients and their caregivers who were admitted to neurology and neurosurgery units at Dan Kook University Hospital in Chung-Nam area. An interview was performed with the use of standardized questionnaire which included data pertaining to the patients/caregivers characteristics, caregiver burden (Modified Zarit's Burden Scale), and social support (Fersonal Resource Questionnaire). Our results showed that the mean burden score was 3,11. indicating high level of burden, Among the sub-domain scores, financial burder was the highest, In univariate analysis, the factors related to caregiver burdens were: inability to communicate between patients and caregiver (p<.001): low cognitive function of the patients(p<.001): low level of ADL(p<.001), the gender of caregiver(p<.001) the current employment status of caregivers(p<.01) the presence of social support for caregiver(p<.001), and the availability of alternative caregivers (p<.001). In multiple regression analysis, social support for family caregivers (87%), low level of patient's cognition (2%), availability of 2nd caregiver (1%). and gender of caregiver (female, 0,4%) were significant explanatory factors of overall burden, The caregivers' burden in acute stages during hospitalization following stroke was high, Recognition of high levels of caregivers' burden and those relating factors affecting caregiver burden may allow us to develop different nursing strategies to unload the level of burden for caregivers in acute stages of stroke.
Caregivers ; Cognition ; Employment ; Hospitalization ; Humans ; Neurology ; Neurosurgery ; Nursing ; Surveys and Questionnaires ; Social Isolation ; Stroke*

PURPOSE: We studied the value of clinical signs, laboratory findings and (99m)technetium dimercaptosuccinic acid(DMSA) scan in predicting the presence of vesicoureteral reflux(VUR) in children with first febrile urinary tract infection(UTI). METHODS: A retrospective analysis of 84 hospitalized children with first febrile UTI was performed. They underwent DMSA scan and voiding cystourethrography(VCUG) during the acute phase, and were divided into three groups according to the results of the VCUG: absence of VUR, mild(grade I-II) and severe VUR(grade III-V). We studied the relation of VUR to age, gender, fever duration, causative organism, white blood cell count, serum C-reactive protein and result of DMSA scan. RESULTS: Among 84 patients, 6 had mild and 17 had severe VUR. Thirty-eight had abnormal DMSA scan. results Patients with VUR were older than those without VUR(P<0.01). There was a lower probability of infection with Escherichia coli in patients with severe VUR than in those with mild and absent VUR(P<0.01). An abnormal DMSA scan correlated with the presence and severity of VUR(P<0.05). Severe VUR was present in 10.9% of patients with normal DMSA scan. The sensitivity, specificity, positive and negative predictive values of the DMSA scan in predicting the presence of VUR were 69.6%, 63.9%, 42.1%, and 84.8%, respectively. CONCLUSION: An abnormal DMSA scan correlated to the presence and severity of VUR, but the sensitivity, specificity and positive predictive value of the DMSA scan were low. Therefore, patient with an abnormal DMSA scan requires a VCUG. In order to prevent missing the 10.9% of patients with severe VUR but normal DMSA scans, a VCUG should be performed in patient with normal DMSA scan.
C-Reactive Protein ; Child* ; Child, Hospitalized ; Escherichia coli ; Fever ; Humans ; Leukocyte Count ; Retrospective Studies ; Sensitivity and Specificity ; Succimer ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux

No abstract available.
Alzheimer Disease* ; Dementia*

BACKGROUND: It is not uncommon to misdiagnose frontotemporal dementia (FTD) because it presents with alterations in personality and behavior rather than cognitive decline. Since compulsive behavior is one of the common early manifestations of FTD, analysis of compulsive behaviors, together with presenting symptoms, would help diagnose FTD in its early stage. METHODS: Subjects consisted of 25 patients (5 men and 20 women with mean age of 56 +/-9 years) who met the FTD criteria proposed by the Lund and Manchester group. We analyzed their presenting symptoms and compulsive behaviors retrospectively. RESULTS: The presenting symptoms were variable, including inappropriate judgement, loss of spontaneity, memory disturbance, personality change, apathy, repetitive movements, hypersexuality, and parsimony. Twenty-two out of the 25 patients (88%) showed compulsive behaviors. They included reading signboards, stereotypy of speech, ordering, hoarding, washing, checking, counting, singing, and wandering a fixed route. CONCLUSIONS: Compulsive behaviors are commonly associated with FTD and thereby understanding of these symptoms together with presenting symptoms may help diagnose FTD early and minimize the misdiagnosis of FTD for Alzheimer's disease or other psychiatric illnesses.
Alzheimer Disease ; Apathy ; Compulsive Behavior* ; Diagnostic Errors ; Female ; Frontotemporal Dementia* ; Humans ; Male ; Memory ; Obsessive Hoarding ; Retrospective Studies ; Singing

No abstract available.

PURPOSE: The aims were to evaluate the main risk factors (RFs) of breast cancer and to estimate the individual disease-probability from combinations of RFs in Korean female. MATERIALS AND METHODS: We conducted case-control study of 1, 687 incident cases of invasive carcinoma and 1, 238 controls during 1996~2000. A breast cancer disease-probability model was established by a general modeling process using a multivariate logistic regression model, which included the main Korean RFs and synergistic interaction-terms. RESULTS: The main Korean RFs selected were age, family history of second relatives, BMI, age at first full term pregnancy, breast-feeding, and a special test on the breasts. Two synergisms were observed between age and breast-feeding, and between special test and age at first fullterm pregnancy. The disease-probability and model are shown in Table 4, and Appendix 1. CONCLUSION: The availability of previous Western models was limited for Korean female due to the differences inhazard-rates and the characteristics of breast cancer between Asian and Western females. Due to limited basic data, i.e. incidence, hazard-rate and cancer-cohorts, the developing-probability of breast cancer for Korean females was not calculated. Therefore, the disease-probability was calculated instead. This approach might be more beneficial for Koreans, and help in the decision- making for regular screening or hospital visit-interval, counseling in breast-cancer clinics, prescribing high-risk population, and in educating for primary prevention, although it over-estimates the relative probability compared to the developing-probability and the 65% predictive validity.
Appendix ; Asian Continental Ancestry Group ; Breast Neoplasms* ; Breast* ; Case-Control Studies ; Counseling ; Female ; Humans ; Incidence ; Logistic Models ; Mass Screening ; Pregnancy ; Primary Prevention ; Risk Factors

Lipocortin 1 has been proposed as a putative mediator of anti-inflammatory actions of glucocorticoids. We investigated the role of lipocortin 1 in the effect of dexamethasone using rat splenic leukocytes. Concanavalin A(ConA; 1-microgram/ml) increased the leukocyte proliferation and nitric oxide(NO) generation, which were measured as (3H)-thymidine uptake by the cells and nitrite accumulation in the culture media, respectively. Dexamethasone suppressed CoNinduced cell proliferation, in a concentration-dependent manner with EC-50 around 50nM. The addition of anti-lipocortin 1 (Anti-LC1) reversed dexamethasone effects: 0.24, 1.2, 6 microgram/ml of Anti-LC1 reversed dexamethasone(50nM)-induced suppression of thymidine uptake by 9+/-3%, 16+/-3%, 36+/-5%, respectively; 0.24, 1.2, and 6-microgram/ml of Anti-LC1 reversed dexamethasone-induced decrease of nitrite concentration by 49 +/- 16%, 61 +/- 20%, 77 +/- 19 %, respectively. The present data indicate that lipocortin 1 mediates, at least in part, glucocorticoids-induced suppression of leukocyte proliferation and blockade of NO generation.
Animals ; Annexin A1* ; Annexins* ; Cell Proliferation ; Culture Media ; Dexamethasone* ; Glucocorticoids ; Leukocytes* ; Nitric Oxide* ; Rats* ; Thymidine

PURPOSE: A hospital-based case-control study was conducted to evaluate the role of glutathione-S-transferase (GST) Ml and Tl genetic polymorphism for developing breast cancer in Korea. MATERIALS AND METHODS: Histologically confirmed incident cases of breast cancer (n=176) were selected from inpatients at the Department of General Surgery, Seoul National University Hospital (SNUH), Borame hospital, and Asan Medical Center from 1994 to 1998. Women with no self-reporting past history of any malignancies who were selected from the inpatients at the same department at three hospitals during the same period served as controls (n 118). Information on the life-styles including reproductive factors were obtained by interview using questionnaire. Age and education adjusted odds ratio and 95% confidence interval were estimated by unconditional linear logistic regression. RESULTS: These subjects had similar risk factors for developing breast cancer to general Korean population based on other epidetniologic studies previously performed in Korea. GSTI1 null type showed a borderline significance relation in the breast cancer risk (adjusted OR=1.6, 95% CI=0.96-2.62), however, GSTM1 null type was not significant (adjusted OR=1.1, 95% CI=0.67-1.80). Particularly noteworthy was an borderline increasing tendency (p<0.1) of the breast cancer risk with the risk null genotypes assessed by multivariate logistic regression model after adjusting age and education: the putative low-risk genotype with both GSTM1 & GSTT1 wild type, OR=1.0; one putative high risk genotype with GSTM1 null or GSTMl null type, OR=1.9 (95% CI=0.92-3.74); all two putative high risk genotype with both GSTM1 & GSTT1 null type, OR=2.0 (95% CI=0.89-4.68). CONCLUSIONS: These findings suggest that both GSTMl and GSTT1 null type might be the risk factor of developing breast cancer in Korean women. Further investigation with larger sample size should be needed to provide more concrete information on the role of GST genetic polymorphism in breast cancer.
Breast Neoplasms* ; Breast* ; Case-Control Studies* ; Chungcheongnam-do ; Education ; Female ; Genotype ; Glutathione Transferase* ; Glutathione* ; Humans ; Inpatients ; Korea ; Logistic Models ; Odds Ratio ; Polymorphism, Genetic* ; Surveys and Questionnaires ; Risk Factors ; Sample Size ; Seoul

PURPOSE: A hospital-based case-control study was conducted to figure out the risk factors for benign breast disorders in Korea. MATERIALS AND METHODS: Histologically confirmed incident cases of benign breast disorders(n=54) were selected from inpatients with life-style information at the Department of General Surgery, Seoul National University Hospital during 1994 to 1997. Women with free of self-reporting past history of any malignancies were regarded as controls who were selected from the inpatients at the same department of the same hospital(n=180). Information on life-styles including reproductive factors were obtained by direct interview using questionnaire. Adjusted odds ratios and 95% confidence intervals were estimated by multivariate logistic regression model with matching variables. RESULTS: Overall, higher educational level, family history of breast cancer, alcohol drinking, and older age at first fullterm pregnancy related to the risk of benign breast disorders. For premenopausal women, older age, higher educational level, and family history of breast cancer increased the risk of benign breast disorders. For postmenopausal women, alcohol drinking, older age at first fullterm pregnancy, and more frequent experiences of fullterm pregnancy increased the risk. Elder age in postmenopausal women and the experience of breast feeding had, however, protective effect against benign breast disorders. CONCLUSIONS: Although the risk factors for benign breast disease may differ from those for breast cancer, these findings are consistent with the hypothesis of excessive circulating estrogen. The present data indicate some risk factors of benign breast disorders are confirmed as risk factors for breast cancer though a substantial agreement between the risk factors for (pathologically confirmed) benign and malignant breast disease.
Alcohol Drinking ; Breast Diseases ; Breast Feeding ; Breast Neoplasms ; Breast* ; Case-Control Studies* ; Estrogens ; Female ; Humans ; Inpatients ; Korea* ; Logistic Models ; Odds Ratio ; Pregnancy ; Reproduction ; Risk Factors* ; Seoul ; Surveys and Questionnaires