Nak Jin Sung

Adipokines, insulin resistance, metabolic syndrome, and breast cancer recurrence: a cohort study.

IntroductionSeveral in vitro studies have suggested the effects of adipokines and insulin resistance on breast cancer cell proliferation and survival. However, little is known about the clinical significance of these findings.MethodsWe examined associations between breast cancer recurrence and adiponectin, leptin, insulin resistance, and metabolic syndrome (MetS) in a cohort of 747 patients from 2001 to 2004.ResultsAdjusted hazard ratios showed an inverse trend across the quartiles for serum adiponectin concentration in estrogen receptor (ER)/progesterone receptor (PR) -negative patients (P for trend = 0.027) but not in ER/PR-positive patients. Compared to the highest quartile for adiponectin level, the lowest quartile showed a hazard ratio of 2.82 (1.03 to 7.68). Homeostasis model assessment for insulin resistance (HOMA-IR) showed a positive trend for recurrence in the ER/PR-negative group (P for trend = 0.087) and a negative trend in the ER/PR-positive group (P for trend = 0.081). Leptin did not show any associations (P for trend >0.05). A linear trend was observed with the number of components of MetS in ER/PR-negative patients (P for trend = 0.044). This association disappeared when adjusted for adiponectin and HOMA-IR.ConclusionsAdiponectin and HOMA-IR have prognostic significance in breast cancer recurrence and interventions related to these factors may protect against recurrence in ER/PR-negative patients. These findings were not observed in the case of ER/PR-positive patients. Further evaluation of these insignificant associations is needed because it might be biased by adjuvant chemotherapy or other confounders.

Patient's assessment of primary care of medical institutions in South Korea by structural type

OBJECTIVE To compare patients assessment of primary care of medical institutions by structural type. DESIGN Cross-sectional study. SETTING Primary care clinics where family physicians work in South Korea (nine private clinics, three health cooperative clinics, three public health center clinics and five teaching hospital clinics). We collected data by questionnaire survey from April 2007 to June 2007. PARTICIPANTS Study subjects were patients who had visited their primary care clinic on six or more occasions over a period of more than 6 months as a usual source of care. MAIN OUTCOME MEASURES Scores in each domain of primary care, evaluated by the Korean Primary Care Assessment Tool. RESULTS A total of 968 subjects were surveyed. The median of primary care average scores was the highest (78) in health cooperative clinics, the second in teaching hospitals clinics, the third in private clinics and the lowest (62) in public health center clinics. When compared with private clinics, the odds ratio for having a high primary care average score was 2.1 (95% confidence interval 1.3-3.3) for health cooperative clinics, and 0.55 (95% confidence interval 0.34-0.88) for public health center clinics. CONCLUSION Among medical institutions where family physicians work in South Korea, health cooperative clinics showed the highest primary care average score, and public health center clinics the lowest. To reinforce primary care in South Korea, where medical service delivery systems are only loosely established, health cooperative clinics could serve as an alternative.

Association of the Length of Doctor-Patient Relationship with Primary Care Quality in Seven Family Practices in Korea

Countries with historically unlimited patient choice of medical provider, such as Korea, have been promoting rational health care pathways. Factors related to the length of doctor-patient relationship (DPR) for enhancing primary care in those countries should be studied. Participants were patients who had visited their family practices on six or more occasions over a period of more than 6 months. Five domains (21 items) of the Korean Primary Care Assessment Tool (first contact, coordination function, comprehensiveness, family/community orientation, and personalized care) and general questions were administered in the waiting rooms. From seven practices, the response rate was 83.7% (495/591). The older the age, the lower the income, the shorter the duration of education, the more the number of diseases the patients had, and in provincial cities rather than in Seoul, the longer length of DPR ( ≥ 4 yr) was shown. The long-term DPR was associated with total primary care quality score (upper [ ≥ 71.4] vs lower [ < 71.4], OR, 1.74; 95% CI, 1.10-2.76), especially with coordination function (OR, 1.01; 95% CI, 1.00-1.02), being adjusted for confounding variables. Strengthening the coordination function may have to be the first consideration in primary care policy in countries like Korea.

Higher quality primary care is associated with good self-rated health status

OBJECTIVE To ascertain the association between primary care quality and self-rated health status. METHODS A cross-sectional study using the Korean primary care assessment tool (K-PCAT). The K-PCAT is a validated tool based on the definition of primary care in Korea, consisting of 5 domains and 21 items providing a total primary care quality score. Data were collected from patients of family physicians working at nine private clinics as their usual source of care. The main outcome measure was self-rated health status. RESULTS Data were analyzed for 531 study participants. Bivariate analysis of socio-demographic variables of patients, who participated in this study as primary care quality assessors, revealed that those with high self-ratings of health tended to have higher household incomes and more frequent exercise. Those with high self-ratings of health had higher total primary care scores than those with low self-ratings of health, as determined through bivariate analysis (P < 0.01). After being adjusted for age, sex, the number of diseases being treated, education years, household income, smoking status, alcohol intake and the frequency of regular exercise, the total primary care score was found to be positively associated with good health. CONCLUSIONS Primary care quality, as assessed by the K-PCAT, was positively associated with good self-rated health status.

Patients' Assessment of Community Primary and Non-primary Care Physicians in Seoul City of South Korea

Background It is important to know the current level of primary care performance in order to evaluate and plan for desirable health policy. We tried to compare patients assessment of primary (family physician, general practitioner, internist, pediatrician, and general surgeon) and non-primary (the other specialties) care physicians. Methods Study subjects were physicians of primary care clinics in Seoul. The study subject evaluators were Seoul citizens who were selected by a list-assisted random digit dialing sampling method and who had visited their primary care clinic on six or more occasions over a period of more than 6 months as a usual source of care. The modified version of the Korean Primary Care Assessment Tool was used for the evaluation of primary care performance. The data were collected with the aid of a computer-assisted telephone interview system from June 29 to July 22, 2009. Results The data on 260 individuals were used for analysis. The mean scores of primary and non-primary care physician group were respectively 1.19 and 0.85 in the comprehensiveness domain, 1.00 and 0.83 in the coordination domain, 1.54 and 1.31 in the family/community orientation, and 1.24 and 0.99 as an average of 3 domains above. The scores in the comprehensiveness domain and the average of 3 domains were significantly higher in the primary than in the nonprimary care physician group. Conclusion Primary care physicians showed superior performance compared to non-primary care physicians in comprehensiveness domain and in the average of comprehensiveness, coordination, and family/community orientation domains.