Jungkwon Lee

The effectiveness of an educational intervention on proper analgesic use for dysmenorrhea.

OBJECTIVES Primary dysmenorrhea is a common gynecologic disorder, but is often inappropriately managed due to ignorance and misunderstanding of its pharmacotherapy in many young women. The aim of this study was to assess the effectiveness of an educational intervention on proper analgesic use for dysmenorrhea among Korean female university students. STUDY DESIGN In March 2008, an educational intervention, a 10-min lecture using supplementary educational printed materials, was given to the intervention group (n=98). Two months later, changes and differences in knowledge, actual medication behavior, coping strategies, dysmenorrhea severity (VAS score), and Korean health-related quality of life (KQOLS) were assessed between the intervention and control (n=105) groups. RESULTS The prevalence of dysmenorrhea in the intervention and control groups was 75.1% and 77.1%, respectively. After the educational intervention, the medication rate of the intervention group was significantly increased (from 36.1% to 51.0%, P=0.007), and the knowledge of and actual behavior relating to the proper analgesic use were also significantly improved in this group. The VAS scores were significantly decreased among participants with dysmenorrhea in the intervention group (from 48.6 ± 22.0 to 37.8 ± 22.5, P<0.001). In addition, significant improvements in two domains of the KQOLS, physical function (from 89.3 ± 11.1 to 93.1 ± 8.8, P=0.007) and pain (from 80.4 ± 19.9 to 87.4 ± 14.3, P=0.001), were observed in the intervention group. CONCLUSIONS The findings of this prospective study suggest that a brief educational intervention can improve the severity of dysmenorrhea and the quality of life by enhancing medication knowledge and actual analgesic behavior in Korean female university students.

Evaluation of the Cobra perilaryngeal airway (CPLA) as an airway conduit.

Background and Objective: The effectiveness of the Cobra perilaryngeal airway as a routine airway device and as a conduit for tracheal intubation has not been prospectively studied to date. This study aimed to evaluate the Cobra perilaryngeal airway for its potential role in an emergency airway rescue, by analysing its use as a bridge to blind or fibre‐optic‐guided intubation. Methods: In 49 patients, the procedure was carried out as follows: fibre‐optic view through the Cobra perilaryngeal airway was assessed after the insertion of the Cobra perilaryngeal airway, then blind intubation through the Cobra perilaryngeal airway was attempted. After evaluating the success of blind intubation, fibre‐optic‐guided intubation was performed through the Cobra perilaryngeal airway. The endotracheal tube was removed after evaluating the success of fibre‐optic‐guided intubation, and then conventional laryngoscopy was carried out to evaluate the Cormack & Lehane grade and airway trauma. Results: In all, 95.9% (47/49) of patients had adequate ventilation using the Cobra perilaryngeal airway; the success rates for the blind and fibre‐optic‐guided intubation were 36.2% and 83.0%, respectively. The patients were divided into two groups according to the fibre‐optic view. Group 1 included patients with an obstructed view by an anterior grill of the Cobra perilaryngeal airway head, and a view of the anterior epiglottis (downfolded epiglottis) with or without a visible larynx (16/47, 34.0%). Group 2 included the remaining patients (31/47, 66.0%). The success rates of the blind and fibre‐optic intubations were different between the two groups (blind intubation: 12.5% vs. 48.4%, fibre‐optic intubation: 62.5% vs. 93.6%, P < 0.05). The success rates of blind and fibre‐optic‐guided intubations were not different according to the Cormack & Lehane grading (P > 0.05). 42.6% of patients had blood staining after removing the device and complications such as trauma and oedema were confirmed under direct laryngoscopy. Conclusion: This study suggests that the Cobra perilaryngeal airway could be a useful airway device as a vehicle for fibre‐optic‐guided intubation; however, it needs caution against airway trauma.

Health-Related Quality of Life and Cardiovascular Disease Risk in Korean Adults

Background Health-related quality of life (HRQoL) is considered an important outcome measure in chronic diseases, in particular cardiovascular disease (CVD), which is known to be associated with impaired HRQoL. However, few studies have examined HRQoL in individuals at high risk of CVD. Methods Using the Fifth Korea National Health and Nutrition Examination Survey 2010-2012, we analyzed data from 10,307 adults aged ≥30 years. The study subjects were stratified into 3 groups on the basis of their Framingham risk score-a 10-year estimate of CVD risk: <10.0% (low risk), 10.0%-19.9% (moderate risk), and ≥20.0% (high risk). The EuroQol-5D (EQ-5D) was used to evaluate HRQoL. Results A significantly higher proportion of high-risk subjects than low-risk participants had impaired HRQoL (defined as the lowest quartile of the EQ-5D index); this held true even after adjustment for confounding factors in multivariable logistic regression analysis (men: odds ratio [OR], 1.62; 95% confidence interval [CI], 1.24-2.11; women: OR, 1.46; 95% CI, 1.02-2.08). In terms of the 5 EQ-5D dimensions, a 10-year CVD risk ≥20.0% was significantly associated with self-reported problems of mobility in men (OR, 3.15; 95% CI, 2.02-4.90), and of mobility (OR, 1.56; 95% CI, 1.09-2.24), self-care (OR, 2.14; 95% CI, 1.09-4.22), and usual activity problems (OR, 1.80; 95% CI, 1.17-2.78) in women. Conclusion A high CVD risk is associated with impaired HRQoL. After adjustment for demographic and clinical factors, a 10-year CVD risk ≥20.0% is an independent predictor of impaired HRQoL in the general population; in particular, of mobility problems in men, and of mobility, self-care, and usual activity problems in women.

Does propofol and alfentanil‐induced sedation cause periodic apnoea in chronic renal failure patients?

Aims:  There is evidence suggesting that the respiratory response to sedation is different in patients with sleep apnoea, which is common in patients with chronic renal failure (CRF). This study examined the respiratory response of sedation with propofol and alfentanil, whose pharmacokinetics are not affected by the renal function, in CRF patients.

Association between Smoking and Periodontal Disease in Korean Adults: The Fifth Korea National Health and Nutrition Examination Survey (2010 and 2012)

Background This study aimed to evaluate an association between smoking, smoking cessation, and periodontal disease in Korean adults. Methods The data were collected from 8,336 participants, aged between 20 and 64 years, who participated in the fifth Korea National Health and Nutrition Examination (2010 and 2012). Smoking status was assessed using self-administered questionnaires. Periodontal disease was defined as a community periodontal index ≥3 points. Logistic regression analysis was used to evaluate an association between smoking, smoking cessation, and periodontal disease after adjusting for age, sex, education, monthly income, diabetes, obesity, alcohol intake, and frequency of tooth brushing. Results The risk of periodontal disease was higher among current smokers (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.21-1.83) than never smokers. Among current smokers, the risk of periodontal disease was increased in smokers of ≥10 cigarettes/d, ≥20 years duration, and >10 pack-years compared with never smokers (P<0.05). Among former smokers, the risk of periodontal disease after 10 years since cessation declined to 0.56 (95% CI, 0.42-0.75) compared with current smokers and was indistinguishable statistically from never smokers. Conclusion Periodontal disease is significantly associated with smoking status in Korean adults.

Factors Associated with Fatigue in Korean Gastric Cancer Survivors

Background Gastric cancer is the second most common cancer in Korea. Fatigue is a common symptom among cancer survivors. The aim of this study was to identify factors associated with fatigue in gastric cancer survivors. Methods Data were analyzed from 199 gastric cancer survivors who visited a cancer survivor outpatient clinic from July 2013 to June 2014. Patients were surveyed using a questionnaire containing a fatigue severity scale (FSS) and questions regarding associated symptoms. Participants were divided into fatigue (FSS) and non-fatigue groups based on FSS scores (≥4 and <4, respectively). Age, sex, weight, body mass index, cancer stage, pathology, surgery type, chemotherapy, radiotherapy, comorbid disease, family history of cancer, smoking, alcohol consumption, exercise, and laboratory results were investigated. Results The fatigue and non-fatigue groups contained 42 and 157 survivors, respectively. Their mean age was 58 years, and the mean post-operative period was 6.58 years. Arthralgia (odds ratio [OR], 12.95; 95% confidence interval [CI], 3.21-52.34), dyspnea (OR, 10.54; 95% CI, 2.94-37.80), dyspepsia (OR, 8.26; 95% CI, 2.63-25.96), changed bowel habits (OR, 4.56; 95% CI, 1.09-19.11), anemia (OR, 3.18; 95% CI, 1.26-8.05), and regular exercise (OR, 0.31; 95% CI, 0.12-0.77) were significantly associated with fatigue in gastric cancer survivors, while weight, treatment, and depressive mood were not. Conclusion Arthralgia, dyspnea, dyspepsia, bowel habit change, anemia, and regular exercise are associated with fatigue in gastric cancer survivors.

Suicidal ideation in underweight adults who attempt to lose weight: Korea national health and nutrition examination survey, 2007-2012.

Background Being underweight has been related to health risks. However, little is known about the relationship between suicidal ideation and attempting to lose weight. This study was conducted to examine if there is an association between suicidal ideation and attempting to lose weight among underweight adults. Methods A cross-sectional study of 1,122 underweight adults (range, 19 to 69 years) was conducted based on the Korea National Health and Nutrition Examination Survey, 2007-2012. We examined suicidal ideation, doctor-diagnosed depression, depressive mood, stress, physical activity, health-related behavior, comorbidity, and socioeconomic status by weight loss attempts. Logistic regression analysis was performed to examine the association between suicidal ideation and weight loss attempts. The following covariates were controlled for: age, sex, physical activity, alcohol problem, marital status, education, income, occupation, self-perception of body image, chronic disease, and body mass index. Results There were 101 subjects in the weight loss attempt group and 1,021 in the non-attempt group. The attempt group had a higher risk of suicidal ideation (odds ratio [OR], 2.47; 95% confidence interval [CI], 1.35 to 4.53) and depressive symptoms (OR, 2.17; 95% CI, 1.19 to 3.98). After depressive symptoms were added to the covariates, the risk of suicidal ideation was also significant (OR 2.11, 95% CI: 1.03 to 4.35). The two groups did not significantly differ in doctor-diagnosed depression and stress. Conclusion Weight loss attempts were associated with suicidal ideation in underweight Korean adults.

Association between Female Urinary Incontinence and Geriatric Health Problems: Results from Korean Longitudinal Study of Ageing (2006)

Background Urinary incontinence (UI) is highly prevalent in the aging population. UI is one of the most common geriatric syndromes and affects overall health, quality of life, and economical burden in patients. The aims of this study were to investigate the characteristics of patients with UI and to assess its association with other geriatric health problems. Methods We used data from the Korean Longitudinal Study of Ageing obtained in 2006. Among the 10,254 individuals aged 45 years and older, we analyzed data from 2,418 women aged 65 years and older. Data were obtained using questionnaires for UI, comorbidities, and lifestyle factors. Results Among the 2,418 women aged 65 years and older, 506 (20.9%) had UI. Cerebrovascular disease (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.26 to 3.23), arthritis (OR, 1.44; 95% CI, 1.18 to 1.77), and fear of falling (OR, 1.62; 95% CI, 1.18 to 2.22) were significantly associated with UI, while chronic lung disease, psychiatric disease, difficulty in daily living due to visual and hearing problems, and experiencing a fall in the last 2 years were not associated with UI. Conclusion Cerebrovascular disease, arthritis, and especially fear of falls were significantly associated with UI in elderly Korean women.

The Risk of Microalbuminuria by Obesity Phenotypes according to Metabolic Health and Obesity: The Korean National Health and Nutrition Examination Survey 2011–2014

Background The present study aimed at identifying the difference in the risk of microalbuminuria among individuals with various obesity phenotypes in terms of metabolic health and obesity. Methods This cross-sectional study included 15,268 individuals and used data from the National Health and Nutrition Survey conducted from 2011 to 2014. Obesity was defined as body mass index ≥25 kg/m². Metabolically unhealthy was defined as meeting two or more of the following criteria: systolic and diastolic blood pressure ≥130/85 mm Hg or current use of hypertensive drugs; triglyceride level ≥150 mg/dL; high-density lipoprotein level <40/50 mg/dL (in both men and women); and fasting blood glucose level ≥100 mg/dL or current use of oral antidiabetic medications. The participants were further classified into four subgroups: metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUNO), and metabolically unhealthy obese (MUO). Results A significant difference was observed in the microalbuminuria ratio among the four groups. The MHNO group was considered as the reference group, and the MHO, MUNO, and MUO groups were at an increased risk for microalbuminuria by 1.42 fold (95% confidence interval [95% CI], 1.03–1.96), 2.02 fold (95% CI, 1.61–2.53), and 3.40 fold (95% CI, 2.70–4.26), respectively, after adjusting confounding factors. Conclusion The MUNO group had a higher risk of developing microalbuminuria than the MHNO group. Thus, based on this result, differences were observed in the risk of developing microalbuminuria among individuals with various obesity subtypes.

The Realities and Associated Factors of Palliative Chemotherapy Near the End of Life in the Patients Enrolled in Palliative Care Unit

Background It is important to know and decide when to end regimen for the quality of life of the patients. However, there is currently no clear agreement on when to terminate palliative chemotherapy. We investigated the duration between the last chemotherapy and death, and associated factors affecting patients receiving palliative care after the last chemotherapy. Methods We studied 242 patients who were put into palliative care ward after receiving chemotherapy and died during hospitalization from 2008 to 2009. Electronic medical records were used to gather information on demographic characteristics, types of primary cancer, and palliative chemotherapy. Then we analyzed the relationship between the clinical characteristics of patients and interval between last chemotherapy and death. Results The average survival time of patients after referral to palliative care was 17.5 days; survival time after discontinuation of chemotherapy was 103 days. Also, 104 (43.0%) patients died within 3 months and 14 (5.8%) patients died within 1 month of persistent palliative chemotherapy. Chemotherapy on patients within 3 months from their death was not associated with the social characteristics of the population. Conclusion The patients who were referred to palliative care were found to have continued to receive chemotherapy within 3 months before death. However, only a small number of patients received chemotherapy within 1 month before death, which confirms that futile chemotherapy that extends to the end of life was less frequent. Doctors should be able to recognize the implications of excessive and aggressive use of chemotherapy and should actively communicate with patients about therapeutic choices.