Difficult patients who meet in the clinic may have a negative effect on the patient’s clinical outcomes by leading to difficulties in history taking, relationship building, diagnosis and treatment. Factors that contribute to non-cooperative patients include physician factors, patient factors, environmental factors, and communication factors. In order to communicate with non-cooperative patients, efforts to prepare for interviews and build relationships, self-reflective attitudes, empathic listening, the use of preceptors or reflective teams, and the maintenance of identity as medical professionals should be emphasized. Multi-party conversations, including family members, may be difficult in patient interviews, and physician should check the emotional responses and expectations that families feel about patient care. Within a family, there are many hidden strengths that could become valuable resources for healing the patient. But they will most likely to come out when families are faced with challenges for which their present repertoire of responses seems inadequate. Health care providers can become a significant part of this process that can result in better patient care and rewarding relationships with families.

Background: The prevalence of impaired fasting glucose (IFG) in Korea is increasing. Few studies have investigated the relationship between handgrip strength (HGS) and type 2 diabetes among Koreans; however, no study has investigated the relationship between IFG and HGS among Koreans. Therefore, we examined the relationship between relative IFG and HGS to evaluate HGS as a marker of prediabetes. Methods: This cross-sectional study analyzed data from participants aged 20 years or older (n=9,190) who did not have diabetes and had had their body mass index, fasting plasma glucose (FPG), and HGS measured in the 2016–2017 Korea National Health and Nutrition Examination Survey. The association between relative HGS and IFG was analyzed using complex sample logistic regression analyses after adjusting for age, education, strengthening exercise, aerobic exercise, smoking, excessive drinking, and chronic diseases. Results: The prevalence of IFG was 31.5 (0.9)% and 19.6 (0.7)% for men and women, respectively. According to the increase in quartile of relative HGS, FPG and HbA1c significantly decreased in both men and women (Ptrend<0.001). In multivariate logistic regression, the odds of IFG significantly decreased with the increase in quartile of relative HGS in both men and women (Ptrend=0.001 for men, Ptrend=0.002 for women). Conclusion This population-based, nationally representative study suggests that higher relative HGS is associated with a decreased risk of IFG for both men and women.

BACKGROUND: Online health information can influence consumers to make informed decisions. There are conflicting messages online about health concerns on the use of e-cigarettes. We aimed to investigate differences in those messages through Naver and Google's English versions, which are the most representative portal sites in Korea and in the world. METHODS: We reviewed the top 100 web pages related to health effects of e-cigarettes on Naver and Google in May 2018. Two medical doctors sorted the web pages into three groups as positive, negative, and mixed messages for e-cigarettes, as well as two groups based on the relative safety of conventional smoking versus e-cigarettes. RESULTS: There were 10 and 27 positive, 65 and 45 negative, and 25 and 28 mixed messages on Naver and Google, respectively. There were 15 messages on Naver and 53 on Google that considered e-cigarettes safer than conventional cigarettes. The most frequent topics were toxicity (71%) and diseases (22%) on Naver. Google provides topics of health concerns for young people, including gateway effect (47%), diseases (35%), and toxicity (25%). Particularly, harm reduction which was not present on Naver, came up on Google as 24%. CONCLUSIONS: We found that Naver provides more negative messages on e-cigarettes than does Google, which means that Koreans are exposed more to negative information on e-cigarettes than are foreign people who use Google. In future, more open discussions about harm reduction should be conducted to resolve the imbalance in information regarding health effects of e-cigarettes in Korea.
Electronic Cigarettes ; Harm Reduction ; Internet ; Korea ; Smoke ; Smoking ; Smoking Cessation ; Tobacco Products

BACKGROUND: Online health information can influence consumers to make informed decisions. There are conflicting messages online about health concerns on the use of e-cigarettes. We aimed to investigate differences in those messages through Naver and Google's English versions, which are the most representative portal sites in Korea and in the world. METHODS: We reviewed the top 100 web pages related to health effects of e-cigarettes on Naver and Google in May 2018. Two medical doctors sorted the web pages into three groups as positive, negative, and mixed messages for e-cigarettes, as well as two groups based on the relative safety of conventional smoking versus e-cigarettes. RESULTS: There were 10 and 27 positive, 65 and 45 negative, and 25 and 28 mixed messages on Naver and Google, respectively. There were 15 messages on Naver and 53 on Google that considered e-cigarettes safer than conventional cigarettes. The most frequent topics were toxicity (71%) and diseases (22%) on Naver. Google provides topics of health concerns for young people, including gateway effect (47%), diseases (35%), and toxicity (25%). Particularly, harm reduction which was not present on Naver, came up on Google as 24%. CONCLUSIONS We found that Naver provides more negative messages on e-cigarettes than does Google, which means that Koreans are exposed more to negative information on e-cigarettes than are foreign people who use Google. In future, more open discussions about harm reduction should be conducted to resolve the imbalance in information regarding health effects of e-cigarettes in Korea.

BACKGROUND: Smoking cessation services for inpatients can be provided effectively through interdisciplinary collaborations. Physicians could play a central role in smoking cessation counseling and treatment for recovery from illness and health promotion of the inpatient. This study aimed to investigate the perspectives of physicians on inpatient smoking cessation services. METHODS: We conducted one personal and two focus group interviews with clinical faculties at a university hospital in Seoul and a university hospital in Chungnam using semi-structured questionnaires. Interviews were recorded, and the transcribed verbatim was analyzed qualitatively. RESULTS: The physicians recognized the need for inpatient smoking cessation services and recognized that smoking cessation was effective when the patient had a smoking-related illness such as respiratory or cardiovascular disease Additionally, the physicians recognized the need for hospital management to support smoking cessation in hospitalized patients and recognized that it was effective to have a dedicated workforce with a smoking cessation coordinator. There was support from four types of physicians in the smoking cessation program: active participant, passive supporter, passive ignorer, and active refuser. CONCLUSIONS The physician is important for the effective implementation of inpatient smoking cessation services. A dedicated team for the smoking cessation of the inpatient, the establishment of evidence-based data on the effectiveness of the inpatient smoking cessation services, and development of customized smoking cessation services will be necessary to strengthen the role of physicians.

BACKGROUND: Smoking cessation services for inpatients can be provided effectively through interdisciplinary collaborations. Physicians could play a central role in smoking cessation counseling and treatment for recovery from illness and health promotion of the inpatient. This study aimed to investigate the perspectives of physicians on inpatient smoking cessation services. METHODS: We conducted one personal and two focus group interviews with clinical faculties at a university hospital in Seoul and a university hospital in Chungnam using semi-structured questionnaires. Interviews were recorded, and the transcribed verbatim was analyzed qualitatively. RESULTS: The physicians recognized the need for inpatient smoking cessation services and recognized that smoking cessation was effective when the patient had a smoking-related illness such as respiratory or cardiovascular disease Additionally, the physicians recognized the need for hospital management to support smoking cessation in hospitalized patients and recognized that it was effective to have a dedicated workforce with a smoking cessation coordinator. There was support from four types of physicians in the smoking cessation program: active participant, passive supporter, passive ignorer, and active refuser. CONCLUSIONS: The physician is important for the effective implementation of inpatient smoking cessation services. A dedicated team for the smoking cessation of the inpatient, the establishment of evidence-based data on the effectiveness of the inpatient smoking cessation services, and development of customized smoking cessation services will be necessary to strengthen the role of physicians.
Cardiovascular Diseases ; Chungcheongnam-do ; Cooperative Behavior ; Counseling ; Focus Groups ; Health Promotion ; Humans ; Inpatients ; Seoul ; Smoke ; Smoking Cessation ; Smoking

BACKGROUND: The prevalence of childhood obesity in South Korea has increased owing to economic improvement and the prevailing Westernized dietary pattern. As the incidence of chronic diseases caused by obesity is also expected to increase, effective interventions to prevent childhood obesity are needed. Therefore, we conducted a Delphi study to determine the priorities of a potential intervention research on childhood obesity prevention and its adequacy and feasibility. METHODS: The two-round Delphi technique was used with a panel of 10 childhood obesity experts. The panelists were asked to rate “priority populations,”“methods of intervention,”“measurement of outcomes,”“future intervention settings,” and “duration of intervention” by using a structured questionnaire. Finally, a portfolio analysis was performed with the adequacy and feasibility indexes as the two axes. RESULTS: For priority populations, the panel favored “elementary,”“preschool,” and “middle and high school” students in this order. Regarding intervention settings, the panelists assigned high adequacy and feasibility to “childcare centers” and “home” for preschool children, “school” and “home” for elementary school children, and “school” for adolescents in middle and high school. As the age of the target population increased, the panelists scored increasing numbers of anthropometric, clinical, and intermediate outcomes as highly adequate and feasible for assessing the effectiveness of the intervention. CONCLUSION: According to the results of the Delphi survey, the highest-priority population for the research on childhood obesity prevention was that of elementary school students. Various settings, methods, outcome measures, and durations for the different age groups were also suggested.
Adolescent ; Child ; Child, Preschool ; Chronic Disease ; Delphi Technique ; Health Services Needs and Demand ; Humans ; Incidence ; Korea ; Obesity ; Outcome Assessment (Health Care) ; Pediatric Obesity* ; Prevalence

BACKGROUND: Varenicline is now very useful medication for cessation; however, there is only little result of researches with varenicline for cessation of hospitalized patients. This research attempted to analyze the cessation effect of medication and compliance of hospitalized patients. METHODS: This research included data for 52 patients who were prescribed varenicline among 280 patients who were consulted for cessation during their admission period. This research checked whether smoking was stopped or not after six months and analyzed their compliance, the factors for succeeding in smoking cessation. RESULTS: One hundred and ninety hospitalized patients participated in smoking cessation counseling among 280 patients who included consultation from their admission departments. And varenicline was prescribed for only 80 patients after counseling. Nineteen smokers were successful in smoking cessation among 52 final participants representing the rating of success of 36.5%. The linkage between compliance of varenicline and rate of smoking successful has no statistical significance. The factors for succeeding in smoking of hospitalized patients are admission departments, diseases, and economic states. CONCLUSION: Smoking cessation program has low inpatient compliance. Cooperation of each departments is very important for better compliance. Success rate of cessation was relatively high (36.5%). Cessation attempt during hospitalization is very effective strategy.
Compliance* ; Counseling ; Hospitalization ; Humans ; Inpatients ; Smoke* ; Smoking Cessation* ; Smoking* ; Varenicline

BACKGROUND: Patients' perspectives of family medicine according to the physician's identity and role as a primary-care specialist need to be investigated. This study was conducted to investigate the perceived quality of the primary care of family medicine clinics as assessed by patients in a community setting. METHODS: Patients (or their guardians) visiting nine community family medicine clinics were surveyed using the Korean Primary Care Assessment Tool from April 2014 to June 2014. The scores of the Korean Primary Care Assessment Tool domains were compared according to the clinics' designation (or not) as 'family medicine' and the patients' recognition (or not) of the physicians as board-certified family medicine specialists. RESULTS: A total of 196 subjects responded to the questionnaire. They assessed the community clinics' quality of primary care as moderate to high. Of the clinics, those that were not designated as family medicine scored higher than those that were designated as family medicine (P<0.05). The group of patients that recognized a clinic as that of a board-certified family medicine specialist awarded higher scores than the non-recognition group in the domains of coordination function and personalized care (P<0.05). CONCLUSION: The moderate to high scores for the community family medicine clinics' quality of primary care are encouraging. It seems that patients' recognition of the family physician's role and of the physician-patient relationship has a significant influence on their assessment of the quality of primary care.
Awards and Prizes ; Family Practice ; Humans ; Physician's Role ; Primary Health Care* ; Quality of Health Care ; Specialization

BACKGROUND: The purpose of this study was to compare students' awareness of and satisfaction with clerkships in family medicine between a university hospital and a community hospital or clinic. METHODS: Thirty-eight 4th year medical students who were undergoing a clerkship in family medicine in the 1st semester of 2012 were surveyed via questionnaire. The questionnaire was administered both before and after the clerkship. RESULTS: External clerkships were completed in eight family medicine clinics and two regional hospitals. At preclerkship, participants showed strong expectation for understanding primary care and recognition of the need for community clerkship, mean scores of 4.3±0.5 and 4.1±0.7, respectively. At post-clerkship, participants showed a significant increase in recognition of the need for community clerkship (4.7±0.5, P<0.001). The pre-clerkship recognition of differences in patient characteristics between university hospitals and community hospitals or clinics was 4.1±0.7; at post-clerkship, it was 3.9±0.7. Students' confidence in their ability to see a first-visit patient and their expectation of improved interviewing skills both significantly increased at post-clerkship (P<0.01). Satisfaction with feedback from preceptors and overall satisfaction with the clerkship also significantly increased, but only for the university hospital clerkship (P<0.01). CONCLUSION: Students' post-clerkship satisfaction was uniformly high for both clerkships. At pre-clerkship, students were aware of the differences in patient characteristics between university hospitals and community hospitals or clinics, and this awareness did not change by the end of the clerkship.
Clinical Clerkship ; Community Medicine ; Hospitals, Community* ; Hospitals, University* ; Humans ; Primary Health Care ; Students, Medical