As recently as about 50 years ago, hypertension was considered a natural protective mechanism that should not be treated. However, after the completion of the first Multicenter Veterans Administration Cooperative Study proving the benefits of blood pressure-lowering treatment for cardiovascular protection, there has been no more debate regarding the importance of controlling hypertension. Nevertheless, the most appropriate target blood pressure goal has been continuously debated. The recently published Systolic Blood Pressure Intervention Trial has again shifted the balance of consensus towards strict blood pressure control. Herein, I provide a brief summary history of the establishment of target blood pressure goals and current perspectives.
Blood Pressure* ; Consensus ; Hypertension* ; United States Department of Veterans Affairs

PURPOSE: The aim of this study was to evaluate the mediating role of psychological capital (PCP) in the relationship between occupational stress and turnover intention in nurses. METHODS: Data were collected from a sample of 447 nurses working at four Veterans Administration Hospitals throughout South Korea from July 1 to July 31, 2014. We collected data from the nurses using the following surveys: the Short Form Korean-Occupational Stress Scale, the Korean version of the Turnover Intention Scale, and the Korean version of the Psychological Capital Questionnaire. Multiple linear regression analysis was performed to examine the mediating role of PCP. RESULTS: The level of occupational stress was 1.81 ± 0.23, the level of turnover intention was 3.29 ± 0.86, and the PCP level was 3.95 ± 0.52. There were significant correlations among the three variables (occupational stress, turnover intention, and PCP). PCP played a partial mediating role (β=−0.22, p = .008) in the relationship between occupational stress and turnover intention (p < .001) among nurses working at the Veterans Administration Hospitals. CONCLUSION: Based on the findings of this study, we recommend that South Korean hospitals offer occupational stress management programs that incorporate relevant programs in efforts to strengthen the overall components of PCP among nurses to reduce turnover intentions. Further studies are required to determine the most effective intervention programs for hospital settings.
Humans ; Intention* ; Korea* ; Linear Models ; Negotiating* ; Nursing Care ; Personnel Turnover ; United States Department of Veterans Affairs* ; Veterans*

Over the last several decades great strides have been made in the United States to meet the needs of an aging American population. This paper reviews the development of geriatric medicine in the United States, which is cha- racterized by leadership and investment from both the public and private sector. The establishment of the National Institute of Aging, as well as, Centers of Excellence and initiatives from the Veterans Administration supported the development and growth of geriatric medicine training programs. While significant advances have been made, we continue to be faced with the challenge of an aging population and not enough geriatricians to care for them. Current strategies will need to intensify geriatric training at the medical student level and teach all physicians, regardless of specialty, how to take care of older patients.
Aging ; Geriatrics ; Growth and Development ; Humans ; Investments ; Leadership ; Private Sector ; Students, Medical ; United States ; United States Department of Veterans Affairs

BACKGROUNDS: In the absence of distant metastasis, small cell lung cancer (SCLC) patients presenting with supraclavicular lymph node (SCLN) involvement and pleural effusion can benefit from thoracic radiotherapy. But there are some debate as to the prognostic significance of both SCLN involvement and pleural effusion. The purpose of this study was to determine the prognostic significance of SCLN involvement and pleural effusion in SCLC. METHODS: Two Hundred and fifteen patients with histologically confirmed small cell lung cancer, who were treated either at the Keimyung university Dongsan hospital and Kyungpook national university hospital from January 1994 to June 1998, were evaluated retrospectively. The patients were classified as having either limited or extensive stage using the Veterans Administration staging system. RESULTS: SCLN was presented in 10.5% of patients(n=21). The median survival was 247 days for patients with SCLN(n=21) and 264 days for patients without(n=194) (p=0.52). After treatment, the median survival was 298 days for patients with SCLN(n=13) and 348 days for patients without(n=115) (p=0.52). SCLN involvement was not correlated with the presence of distant metastases. Medican survival was 459 days for patients with a limited stage without SCLN(n=66), 650 days for those with a limited stage with SCLN (n=7) (p=0.96). Pleural effusion was presented in 24.7% of patients(n=52). The median survival was 198 days for patients with pleural effusion(n=52) and 275 days for patients without(n=163) (p<0.05). After treatment, the median survival was 294 days for patients with a pleural effusion(n=25) and 286 days for patients without(n=103) (p=0.39). The presence of pleural effusion was not correlated with that of distant metastases. The median survival was 395 days for patients with a limited stage without a pleural effusion(n=63), 451 days for those with a limited stage with pleural effusion(n=10) (p=0.92). CONCLUSIONS: In this study, SCLN involvement does not explain the poor survival rate and the relevance to extensive staged disease. Furthermore, the existence of a pleural effusion did not correlated with the presence of distant metastases. However, the presence of a pleural effusion appears to be a minor prognostic factor in our study. Therefore supraclavicular lymph node justify any amendment to the staging system currently used.
Gyeongsangbuk-do ; Humans ; Lymph Nodes* ; Neoplasm Metastasis ; Pleural Effusion* ; Radiotherapy ; Retrospective Studies ; Small Cell Lung Carcinoma* ; Survival Rate ; United States Department of Veterans Affairs

Among chemical agents in herbicides, dioxin(2,3,7,8-tetrachloro dibenzo-rho-dioxin: a chemical contaminant in herbicides sprayed during the vietnam war has been known to be the major agent causing toxic effects. Approximately 320,000 korean soldiers participated the vietnam war from 1964 to 1974. Although the potential hazards of the herbicides among Korean veterans exposed were implicated, the problem had not been a public issue until 1991 when Korean veterans were informed U. S. companies, the herbicides manufacturer payed fund, from which a trust fund for New Zealand and Australian Class members were established in 1985. After a series of appeals and demonstration by the korean veterans demanding medical care and compensation for their serious health damages, a bill of medical care and compensation for herbicides victims was promulgated in March 1993 and become effective from May 1993. This study was carried out with two major objectives: the first to understand the health problems caused from the herbicides by reviewing literatures published, and the second to examine the nature and extent of health impacts among Korean veterans exposed and to develop valid study methods for the major study by interviewing and reviewing records on a part of veterans (638 persons) registered and completed medical examination in Seoul Veterans Administration Hospital from June to october 1993. The results obtained are as follows: 1. The literature review of 107 papers revealed that: l) Dioxin is teratogenic, carcinogenic and affects almost all organs including nertous, endocrine, and reproductive systems in animal experiments. 2) The diseases showing evidence of causal association were Hodgkin's disease, non-Hodgkin's disease, lung cancer, lymphoma, soft tissue sarcoma, chloroacne and polyneuropathy when judged on the basis of consistency in study results and biological plausibility. 2. Interview and medical record review study on 638 veterans, though limited validity owing to lack of control group, crude estimates of dioxin exposure levels (no biomarkers measurable), and uncertainty of diagnosis, showed that: 1) Most of the study subject's were in their 40's of age and had been dispatched to vietnam during the period from 1965-1970 around one year. 2) Most frequently complained symptoms in medical examination were motor weakness(32%), sensory abnormalities in extremities(23%), skin diseases(22%), and pain in extremities(20%) whereas in interview they were more frequent in order of skin problem(44%), motor weakness (38%), sensory abnormalities and pain in extremities(l7% and 19% each). Kappa indices on the same category of complaints between two sources of information were variable and relatively low. 3) On medical examination, only a part of the 638 subjects had initial impression (442 pts) and final diagnosis (218 pts) suggesting decision making on diagnosis appeared to be difficult even with all available modern medical technologies; in initial impression disorders from peripheral and central neuropathy were predominant whereas in final diagnosis various types of skin disorder were most frequent. 4) when dose-response relationship between several conditions (from questionnaire) and arbitrary exposure scores were examined by CMH linear trend test, spontaneous abortion, sexual problems and health problem of offsprings showed statistically significant linear trends. However, pregnancy, accident and suicidal attempts did not show any relationship in this study capacity. 5) Among complaints, psychosis and neurosis(anxiety, phobia) in interview study, and memory disorder and psychosis in medical record study revealed linear trend. 6) Skin disorder was the only condition showing linear trend in initial impression and none in final diagnosis on medical examination. Even though objective to select out dioxin-related disease or group of diseases from this study was not achieved the research experiences provided firm basis for developing various methodological approaches. 3. From this preliminary study we concluded that a larger scale major epidemiologic study on health impacts of herbicides among Korean veterans exposed is not only indispensible but also well designed study with more valid exposure information and diagnosis may be able to establish causal relationship between certain groups of diseases and exposure to the herbicides among Korean veterans.
Abortion, Spontaneous ; Animal Experimentation ; Biomarkers ; Compensation and Redress ; Decision Making ; Diagnosis ; Epidemiologic Studies* ; Female ; Financial Management ; Herbicides* ; Hodgkin Disease ; Humans ; Lung Diseases ; Lymphoma ; Medical Records ; Memory Disorders ; Military Personnel ; New Zealand ; Polyneuropathies ; Pregnancy ; Psychotic Disorders ; Sarcoma ; Seoul ; Skin ; Uncertainty ; United States Department of Veterans Affairs ; Veterans* ; Vietnam*