BACKGROUND: Hypertension is a major contributor to the global disease burden of cardiovascular and cerebrovascular disease. The aim of this study was to determine demographic and clinical factors associated with adherence to antihypertensive medication. METHODS: From August 2012 to February 2015, we recruited 1,523 Korean patients with hypertension who visited family physicians. The study was conducted in 24 facilities located in urban and metropolitan areas. Of these facilities, two were primary care clinics and 22 were level 2 or 3 hospitals. Adherence was assessed using the pill count method; a cut-off value of 80% was used as the criterion for good adherence. Sociodemographic and lifestyle factors were compared between the adherent and nonadherent groups using the chi-square test for categorical variables and t-test for continuous variables. Binary logistic regression analysis was performed with medication adherence as the outcome variable. RESULTS: Of the 1,523 patients, 1,245 (81.7%) showed good adherence to antihypertensive medication. In the multivariate logistic analysis, age ≥65 years, exercise, treatment in a metropolitan-located hospital, being on ≥2 classes of antihypertensive medication and concomitant medication for diabetes, and a family history of hypertension or cardiovascular diseases were associated with good adherence. Patients who had a habit of high salt intake were less adherent to medication. CONCLUSION: Multiple classes of antihypertensive medications, concomitant medication, and exercise were associated with good adherence to antihypertensive medication, and high salt intake was associated with poor adherence to antihypertensive medication. These factors should be considered to improve hypertension control.
Cardiovascular Diseases ; Cerebrovascular Disorders ; Humans ; Hypertension ; Life Style ; Logistic Models ; Medication Adherence ; Methods ; Patient Compliance ; Physicians, Family ; Primary Health Care

BACKGROUND/AIMS: For evaluation of anemia, esophagogastroduodenoscopy (EGD) is widely used. However, there is no sufficient information on the efficiency and role of colonoscopic evaluation for these anemia patients. We aimed to evaluate the diagnostic yield of colonoscopy in anemia patients with nonactive rectal bleeding. METHODS: This was a retrospective study from January 2001 to December 2002. We reviewed 147 patients who underwent colonoscopy for anemia evaluation. RESULTS: The mean age was 48+/-17 years (range 15~90), and male to female ratio was 1:4.3. Ninety-four patients (63.9%) had iron deficiency anemia and 21.8% of them have less than 7 g/dL of hemoglobin. Abnormal colonoscopic findings were observed in 84 patients (57.1%) including hemorrhoid (35), polyp (31), tuberculosis (9), cancer (8), diverticulum (8), endometriosis (1), angiodysplasia (1), and ulcerative colitis (1). The presence of abnormal colonoscopic findings was more frequently observed in older population (> or =55 years old, p=0.034). Intestinal tuberculosis, endometriosis, and ulcerative colitis were observed only in younger population (<55 years old), and 2 of 8 cancer patients were 39 and 49 years old males. CONCLUSIONS: Although the diagnostic yield of colonoscopy is relatively higher in older population, colonoscopy is one of the valuable tools in anemia evaluation of both older and younger populations.
Anemia* ; Anemia, Iron-Deficiency ; Angiodysplasia ; Colitis, Ulcerative ; Colonoscopy ; Diverticulum ; Endometriosis ; Endoscopy, Digestive System ; Female ; Hemorrhage* ; Hemorrhoids ; Humans ; Male ; Middle Aged ; Polyps ; Retrospective Studies ; Tuberculosis

BACKGROUND: The purpose of this study was to find out whether primary physicians know the new guidelines (JNC VII) of target BP (blood pressure) and whether they educate their patients properly or not. METHODS: We made calls to local clinicians (family medicine (FM), internal medicine (IM), oriental medicine (OM)) under the disguise of the patient's caretaker and asked them the target BP for patients with hypertension without any cardiovascular disease and those with hypertension and DM (diabetes mellitus). We categorized the participants according to sex, age and departments. RESULTS: Out of the 145 clinics, 88 clinics responded (28 clinicians of FM, 30 clinicians of IM, 30 clinicians of OM). Questions on systolic target BP for patients with hypertension without cardiovascular disease, 87 clinicians answered. Among them, 64 clinicians (73.6%) answered correctly to the target BP (< or =140 mmHg), in the order of FM, IM, and OM. Questions on the diastolic pressure (< or =90 mmHg), 78 clinicians answered and all of them answered correctly. On the question of the target BP for the patients and hypertension and DM, 55 clinicians (63.2%) answered correctly to the systolic target BP (< or =130 mmHg) in the order of IM, FM, and OM. Only 19 clinicians (32.4%) answered correctly to the diastolic target BP (< or =90 mmHg) in the order of FM, IM, and OM. CONCLUSION: The clinicians have given less correct answers on the target BP in the patients and hypertension and DM than those with only essential hypertension. In conclusion, local clinicians should be fully aware of the target BP in patients with hypertension associated with cardiovascular disease or other complications. Also they should educate their patients properly.
Blood Pressure* ; Cardiovascular Diseases ; Humans ; Hypertension ; Internal Medicine ; Medicine, East Asian Traditional

BACKGROUND: Throughout the past 20 years in the Korean academy of family medicine seasonal conference, on-going study is done to promote overall development and satisfaction of the conference participants and to overlook the trend of the conference subject, the number of classes, the number of participants, etc. METHODS: About 2,132 topics during the conference from the year 1992 to 2007 collected from the Korean academy of family medicine website were categorized by subject based on the standard of the contents of the latest textbook. There were a total of 7 main classifications including 5 categories like 'principles of family medicine', 'disease prevention and health promotion', 'symptoms', 'clinical procedures', 'diseases' and adding 2 categories such as each committee's classes and other subjects. The scope of the changes of the main and sub-titles were categorized as in the 1990s and 21 century. RESULTS: The number of attendees has increased during the past 20 years, especially the residents were the main portion of the participants. On the proportion of the clinical topics, there was a remarkable increase of geriatric medicine, palliative medicine, obesity, exercise, nutrition, gastroscopy, and colonoscopy procedure in the later half rather than the former half period. In the field of the main category, the core principle subjects of family medicine seemed to be decreased in contrast to disease category. CONCLUSION: During the last 20 years, the titles of family medicine conference are changing with the trend of practice. The core knowledge of family medicine should be maintained and balanced for the future of family medicine conference.
Colonoscopy ; Gastroscopy ; Humans ; Obesity ; Palliative Care ; Seasons

PURPOSE: Laparoscopic radical nephrectomy (LRN) is more challenging with increases in body mass index (BMI). Several recent studies have shown, however, that LRN can be safely performed even in obese patients. The influence of obesity on the perioperative outcomes of LRN has not been well elucidated for large renal tumors (>7 cm), however. We estimated the impact of obesity on LRN for stage T1 and T2 renal cell carcinoma (RCC). MATERIALS AND METHODS: From January 2004 to March 2011, 266 patients underwent LRN (T1: 195, T2: 71). These patients were subdivided into the following two groups according to BMI: the nonobese group (BMI less than 25 kg/m2) and the obese group (BMI greater than 25 kg/m2). Perioperative outcomes were retrospectively compared between these two groups in T1 and T2 RCC patients. RESULTS: There were no significant differences in perioperative outcomes between the obese and nonobese groups of T1 RCC patients. However, in T2 RCC patients, operative time and complication rate were significantly increased in the obese group. CONCLUSIONS: Our results suggest that LRN can be safely performed in Korean patients with T1 RCC regardless of obesity. In T2 RCC patients, however, LRN may become more difficult with increasing BMI considering a longer operation time as well as a higher complication rate. We suggest that LRN for obese patients with T2 RCC be carefully considered.
Body Mass Index ; Carcinoma, Renal Cell ; Humans ; Nephrectomy ; Obesity ; Operative Time ; Retrospective Studies

BACKGROUND: The pain caused by injection of propofol is known to be related to the concentration of aqueous free propofol. Microemulsion propofol can cause a serious pain because it has 7 times higher concentration of aqueous free propofol. We used ondansetron, lidocaine, ondansetron lidocaine as pretreatment to compare the effect for injection pain of microemulsion propofol. METHODS: 75 patients, ASA physical status I or II were enrolled. We randomly allocated into Group L (n = 25) received 2% lidocaine 40 mg, group O (n = 25) received ondansetron 4 mg and group M (n = 25) received ondansetron 4 mg plus 2% lidocaine 40 mg as pretreatment. After instituting standard monitoring, the venous drainage was occluded using a pneumatic tourniquet at 25 cm proximal to venous line. The patients were pretreated over a period of 15 seconds with one of the pretreatment drug. After releasing the tourniquet, microemulsion propofol was injected. We asked the patient about degree of injection pain until loss of consciousness, by using 0-100 point pain intensity numerical rating scale (PI-NRS). In the recovery room, we asked the patient whether they recall injection pain. RESULTS: There were significant differences in the group L and the group M compared with group O on PI-NRS (P < 0.05). The incidence of injection pain was significantly lower in group L and group M than group O. CONCLUSIONS: Pretreatment of lidocaine and lidocaine + ondansetron is more effective than ondansetron alone for reducing pain on injection of microemulsion propofol.
Drainage ; Humans ; Incidence ; Lidocaine ; Ondansetron ; Propofol ; Recovery Room ; Tourniquets ; Unconsciousness

BACKGROUND: The purpose of this study was to assess the quality of primary care by patient-completed questionnaire, and to investigate whether the results of the assessment were different among the specialties of doctors (especially family medicine) and according to the existence of a family doctor. METHODS: The questionnaire, which covers 7 components of primary care (accessibility, continuity, accountability, comprehensiveness, integration, sustained partnership with patients, whole person orientation), was administered to the applicants of health screening center of a university hospital, and factory workers in Cheonan, and residents living in Seoul. Statistic analysis was performed through the collected samples. RESULTS: Total of 574 subjects were analyzed. The mean score (%) of each component of the total sample was as follows; accessibility 45.8, continuity 47.8, comprehensiveness 22.5, accountability 55.5, integration 41.8, sustained partnership with patients 48.9, and whole person orientation 31.8. The mean score (%) of all components were 42.0. Doctors were classified into internists, general surgeons, family physicians, general physicians, and others. Family physicians had the best score in accessibility (P=0.01). The mean score of all components of family physicians was better than that of internists and the other specialties (P<0.05). The respondents who had a family doctor was 129 (22.5%). The mean score of each component was higher than those without a family doctor (P<0.05). CONCLUSION: Family physicians are providing high quality primary care compared to internists and other specialists. Patients who have a family doctor are provided with higher quality primary care than those who do not. Especially, comprehensiveness and whole person orientation need to be improved.
Chungcheongnam-do ; Surveys and Questionnaires ; Humans ; Mass Screening ; Physicians, Family ; Primary Health Care* ; Seoul ; Social Responsibility ; Specialization

BACKGROUND: Hemoglobin A1c (HbA1c) was adopted as a new standard criterion for diagnosing diabetes. We investigated the diagnostic utility of HbA1c by comparing the 2003 American Diabetes Association (ADA) diagnostic criteria of diabetes with HbA1c of 6.5%. Furthermore, the cut-off value for HbA1c was investigated using receiver operating characteristic curves. METHODS: This study included 224 subjects without a history of diabetes that had a fasting plasma glucose level of above 100 mg/dL. The subjects had undergone a 75 g oral glucose tolerance test, and diabetes was defined as according to 2003 ADA criteria. RESULTS: The prevalence of newly diagnosed diabetes was 58.2% by the 2003 ADA criteria, and 47.8% by HbA1c of 6.5%, which underestimated the prevalence of diabetes. Compared with the 2003 ADA criteria, the sensitivity and specificity of HbA1c of 6.5% were 73.5% and 89.1%, respectively. The kappa index of agreement between 2003 ADA and HbA1c criteria was 0.60. The cut-off point of HbA1c for diagnosing diabetes was 6.45% (sensitivity, 73.3%; specificity, 88.2%; area under the curve, 0.85). HbA1c was significantly associated with fasting glucose (r = 0.82, P < 0.01), postprandial glucose (r = 0.78, P < 0.01), and homeostasis model assessment of insulin resistance (r = 0.16, P < 0.05). CONCLUSION: For high risk patients whose fasting glucose was more than 100 mg/dL, HbA1c criterion underestimated the prevalence of newly diagnosed diabetes compared to the 2003 ADA criteria, and showed moderate agreement. The cut-off value for HbA1c was 6.45%, which was similar to the recommended diagnostic criterion of HbA1c by the 2009 ADA.
Fasting ; Glucose ; Glucose Tolerance Test ; Hemoglobin A, Glycosylated ; Hemoglobins ; Homeostasis ; Humans ; Insulin Resistance ; Plasma ; Prevalence ; ROC Curve ; Sensitivity and Specificity

BACKGROUND: Chronic Myelogenous Leukemia (CML) is the first proven disease in which gene abnormality, t(9;22)(q34;q11) can cause the disease to occur in humans. Recently, targeted therapy with STI571 (GleevecTM), signal transduction inhibitor for BCR-ABL kinase was developed and can induce cytogenetic remission in patients with CML. Hypermetaphase-FISH (HMF)/Interphase-FISH (I-FISH, Fluorescence in situ hybridization) aiming specific chromosomal abnormalities are unambiguous quantitative molecular genetic methods for individual Philadelphia (Ph1) chromosome positive cells. We evaluated the change of Ph1 chromosome in CML patients during STI571 therapy using HMF/I- FISH. METHODS: Twenty one patients with CML were treated with STI571 which was provided from Norvatis pharmaceutical company as Expanded Access Program for Compassionate Use from May 2001 at the doses of 200-600 mg/day orally. Median age of this cohort was 37 years old and median follow up duration was 113 days (48~165 days). HMF or I-FISH using bone marrow or peripheral blood were performed on the sample at baseline, day 14, day 28 and then monthly. RESULTS: Complete cytogenetic responses which were assessed by HMF/I-FISH counting several hundreds cells were found in 8 of 21 patients. Among them, 4 of 10 chronic phase, 2 of 2 accelerate phase and 2 of 8 blastic crisis patients achieved cytogenetic complete response. One patient with blastic crisis was relapsed after achieving cytogenetic complete response. Grade III-IV thrombocytopenia and neutropenia were noticed in 8 and in 7 patients respectively, but there were no major bleeding episodes nor neutropenic fever. CONCLUSION: BCR-ABL tyrosine kinase inhibitor, STI571 was tolerable for patients with CML. The majority of patients achieved hematologic remission and 8 out of 21 patients achieved complete cytogenetic response regardless of their disease stage. Cytogenetic response of Ph1 chromosome can be quantified accurately with HMF/I-FISH.
Adult ; Bone Marrow ; Chromosome Aberrations ; Cohort Studies ; Compassionate Use Trials ; Cytogenetics ; Fever ; Fluorescence ; Follow-Up Studies ; Fusion Proteins, bcr-abl ; Hemorrhage ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Molecular Biology ; Neutropenia ; Philadelphia Chromosome* ; Phosphotransferases ; Signal Transduction ; Thrombocytopenia ; Imatinib Mesylate

BACKGROUND: Although urinary incontinence is a common problem, its prevalence and severity in community is not well established. The main objects of this study were to define the prevalence in adult men and women who came to a primary care office for health care. METHODS: Men and women aged 20 years and over who came to family physician's offices seeking health care for any reason during an 2-week period were the subjects of a survey by anonymous questionnaire. Ten family practice offices in Cheonan Practice-Based Research Network participated. We defined "current significant urinary incontinence" as aver any degree of annoying incontinence in the past 12 months. RESULTS: Of the 1,130 responders, 46.3% experienced urinary incontinence. Incontinence was experienced by 26.7% of the men and 50.2% of the women. 'Current significant urinary incontinence' was experienced by 3.7% of the men and 10.12% of the women. CONCLUSIONS: Urinary incontinence is a common problem among those seen in primary care settings, and patients hesitate to seek cansultation of their problems with physicians. Therefore, family physicians should deal with the symptoms of incontinence more attentively during history taking.
Adult* ; Anonyms and Pseudonyms ; Chungcheongnam-do* ; Delivery of Health Care ; Family Practice* ; Female ; Humans ; Male ; Physicians' Offices ; Physicians, Family ; Prevalence* ; Primary Health Care ; Urinary Incontinence* ; Surveys and Questionnaires