Clinical Factors Related to Frailty Estimated by the Korean Frailty Index

BACKGROUND: On the point of entering into the aged society, frailty will be recognized as a new geriatric problem in Korea. This study was conducted to identify clinical factors related to frailty in the community dwelling elderly. METHODS: This was a cross-sectional study comprised of 515 participants among 834 potential subjects who were residents of three towns in Gyeong-ju and had health check-ups at a university hospital in the same region. Using the Korean Frailty Index, those with a total score of 5 or more were considered frail and those with scores 3 to 4 as prefrail. Socio-demographics, anthropometry and laboratory data were the selected clinical factors. Those younger than 65 years or with incomplete data were excluded. Finally, 447 participants were analyzed. RESULTS: Among the participants, those identified as frail were 20 (4.5%), prefrail 72 (16.1%) and robust 355 (79.4%). By gender, the percentage of frail, prefrail and robust individuals were 3.2%, 17.4% and 79.5%, respectively, in men and 5.4, 15.2% and 79.4% in women (p=0.447). On ordinal logistic regression analysis, factors related to frailty were increased age (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.01 to 1.17), functional disability (OR, 8.88; 95% CI, 4.46 to 17.68), chronic disease such as pulmonary disease (OR, 4.69; 95% CI, 1.47 to 14.99) or hypertension (OR, 2.23; 95% CI, 1.15 to 4.32), increased waist circumference (OR, 1.06; 95% CI, 1.01 to 1.11), decreased serum cholesterol (OR, 0.98; 95% CI, 0.97 to 0.99) and elevated blood urea nitrogen (OR, 1.07; 95% CI, 1.01 to 1.14). CONCLUSION: Clinical factors related to frailty were age, functional disability, chronic disease, waist circumference, serum cholesterol and blood urea nitrogen. Primary physicians should assess frailty when seeing elderly patients who have these factors.

The Effect of Videotaping Students' Interviews with Patients for Interview Skill Education / 가정의학회지

BACKGROUND: The importance of communication between patients and physicians has been proven in many previous studies. The authors analyzed the effect of interview skill education through videotapes which recorded students' interviews with real patients in the outpatient department of family medicine. METHODS: This study was conducted with all students who chose the elective course of family medicine and one randomly selected student every week from an 'infectious internal medicine' class at Dongguk University Ilsan Hospital during the period from December 2008 to March 2011. All students performed a preliminary examination of a new patient at the outpatient department of family medicine. All consultations were videotaped. Feedback to the student was given on the same day by viewing the videotape together. After feedback, all students performed another preliminary examination of one new patient at the department of family medicine the same week. Three family medicine residents scored all videotapes using 10-item interview skill checklists. Many parts of the checklists were modified using the Arizona Clinical Interview Rating Scales. RESULTS: Thirty-three students participated. Of 10 items, nine showed increased scores after feedback. There was a significant change in four items after feedback: 'type of question' (before 2.36 +/- 0.60, after 2.73 +/- 0.72), 'timeline' (before 2.82 +/- 0.68, after 3.18 +/- 0.73), 'positive verbal reinforcement' (before 2.24 +/- 0.56, after 2.61 +/- 0.90), and the total score (before 21.70 +/- 2.62, after 23.39 +/- 3.13) (P < 0.05). CONCLUSION: Giving feedback to medical school students on medical interview skills using videotapes of students' preliminary consultations with real patients in outpatient settings, was effective in improving the interview areas of 'type of question,' 'timeline,' 'positive verbal reinforcement,' and the total interview scores.

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

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 patient's 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.

Factors Influencing Willingness for Human Papilloma Virus (HPV) Vaccination in Female Students at One University

BACKGROUND: This study was done to identify factors that influence the willingness to be vaccinated with the human papilloma virus (HPV) vaccine in female college students eligible for a catch-up vaccination program. METHODS: This cross-sectional study included 572 female students aged 18-26 years attending one selected university in the Gyeongbuk Province. From March 2 to 6, 2009, they completed a self-administered questionnaire on their HPV vaccination status. Thereafter, unvaccinated participants were educated about the vaccination program, and each participant's willingness to be vaccinated was assessed. RESULTS: Of the 572 participants, 18 (3.1%) were already vaccinated with the HPV vaccine. The number of participants advised to be vaccinated was 102 (17.8%). Of the 554 unvaccinated participants, 305 (55.1%) were willing to be vaccinated after being educated about the vaccination program. Of the remaining 249 unvaccinated participants, 116 (48.7%) refused the vaccine due to its high cost. Advice by family members was related significantly to the willingness to be vaccinated (odds ratio, 2.37; 95% confidence interval, 1.09-5.14). CONCLUSIONS: The results of this study suggest that the willingness to be vaccinated with the HPV vaccine could be increased in female college students if they are advised to do so by their family members after being educated about the vaccination program.

Technical Competency of the Esophgogastroduodenoscopy (EGD) during the First 50 EGDs: The Training Result of Family Medicine Residents in a University Hospital / 가정의학회지

BACKGROUND: A previous Korean study recommended minimal 50 cases of Esophgogastroduodenoscopy (EGD) to achieve technical competency, based on director's opinion. Therefore, this study was conducted to evaluate the achievement of EGD's technical skills during the first 50 EGD cases. METHODS: The data were collected from the first 50 EGDs consecutively performed by six family medicine residents trained the EGD procedure in one residency program from 2004 to 2006. Technical competency of the EGD procedure was evaluated in 4 steps divided with anatomical landmarks (the gastroesophageal junction, the antrum, the fundus of the stomach, and the second portion of the duodenum). Authors measured the procedure time of EGDs performed by residents in 4 steps and calculated the rate of success cases satisfied with author's own criteria made by procedure time. RESULTS: The success rate of EGD procedure in all steps was 26.7% at 10 EGDs, but sharply increased to 80.0% at 30 EGDs, reached 88.0% at 50 EGDs. Fail to perform esophageal intubation and retroversion to the fundus of the stomach was none after 30 EGDs. However, in steps from gastroesphageal junction to the antrum of the stomach and from the antrum of the stomach to the second portion of the duodenum, the failure rate kept up less than 10% during the first 50 EGDs. A statistically significant reduction of the procedure time in success cases was observed between 20 and 30 EGDs in all steps. CONCLUSION: The technical competency of EGD was achieved approximately 90% during the first consecutive 50 EGDs.

Factors Related to Pre-Procedural Anxiety for Gastroscopy in Health Check Examinee / 가정의학회지

BACKGROUND: Gastroscopy is the useful method to detect the upper gastrointestinal condition, but examinee have recognized it as the procedure causing the discomfort and anxiety. This study was conducted to identify the factors related to pre-procedural anxiety for gastroscopy . METHODS: From 9th March to 12th June 2009, Data were collected from 463 examinee undergone gastroscopy at a health promotion center of a university hospital by self-administered questionnaires about general characteristics (age, sex, education state, economic state, family history of gastric cancer), gastrointestinal symptom, histroy of gastrointestinal disease, sedated gastroscopy and previous experience of gastroscopy. Before gastroscopy procedure, pre-procedural anxiety was assessed using 20-items by Korean version of Spielberger State Triat Anxiety Inventory Form-Y (STAI-Y). RESULTS: The mean score of pre-procedural state anxiety was 38.1 +/- 10.2 in all participants. The mean score was the most highest in participants who had no previous experience of gastroscopy and would perform non-sedated gastroscopy as 42.1 +/- 10.3. Factors related to pre-procedural anxiety were female (odds ratio [OR], 3.00; 95% confidence interval [CI], 1.94 to 4.64), low education state (OR, 1.68; 95% CI, 1.05 to 2.71) and the previous experience of gastroscopy (OR, 0.46; 95% CI, 0.24 to 0.88). Among participants who had the previous experienced gastroscopy, female (OR, 3.20; 95% CI, 1.97 to 5.22), low education state (OR, 1.79; 95% CI, 1.06 to 3.02) and the good tolerance at previous gastroscopy (OR, 0.35; 95% CI 0.21 to 0.59) were related to pre-procedural anxiety. CONCLUSION: In health check examinee, female, low education state and the no previous experience of gastroscopy were related to pre-procedural anxiety. Endoscopists should be provide efforts to lower pre-procedural anxiety in those subjects as to increase effectiveness of interventions.

Comprehension of Lung Sounds for Family Medicine Residents in Daegu, Gyeongbuk / 가정의학회지

BACKGROUND: Understanding lung sound is important physical examination of chest. We studied to identify the state of the understanding, the education and the self-learning experience for lung sound's interpretation during the residentship training period. METHODS: Data were collected from 45 family medicine residents who had trained in Daegu and Gyeongbuk from April 1st to May 31th 2008. Residents completed self-administered questionnaire about the education and the self-learning experience for lung sound's interpretation and had been estimated the understanding of lung sound by using the audio file of five lung sounds. RESULTS: The median score (inter-quartile range, IQR) of lung sound's interpretation was 2 (1, 3) between 0 and 5 range. The number of residents who were educated for the interpretation of lung sounds during the training period were 10 (22.2%). Twenty-four (53.3%) had the self-learning experience for lung sounds. CONCLUSION: The understanding for lung sounds of family medicine residents in Daegu, Gyeungbuk was not high and the majority of residents were not educated the interpretation of lung sounds during the training period. Directors of family medicine should consider to make the regular education program for interpretation of lung sound during the training period.

The Effect of Relaxation Music on Anxiety in Subjects Performed Unsedated Esophagogastroduodenoscopy / 가정의학회지

BACKGROUND: Esophagogastroduodenoscopy is a very important method to detect gastroduodenal lesions. But the investigation might be delayed due to its own discomfort and anxiety. This study was performed to evaluate the effect of relaxation music on relief of anxiety and physical discomfort during unsedated esophagogastroduodenoscopy. METHODS: From March 3 to May 14 2009, 104 clients who have undergone unsedated esophagogastroduodenoscopy more than once in the past were enrolled in this study. The subjects were randomly assigned to receive either relaxation music (music, N = 52) or no music (control, N = 52) before esophagogastroduodenoscopy. The subjects recorded their anxiety and physical discomfort about latest and today endoscopy by visual analogue scale (VAS). At pre and post music listening, systolic, diastolic blood pressure and heart rate were measured. RESULTS: There was a significant difference of anxiety VAS between music and control group (music, decrease 1.1 +/- 2.1; control, increase 0.0 +/- 1.9; P = 0.008). Throat discomfort VAS was not significant (music, decrease 0.9 +/- 1.8; control, decrease 0.5 +/- 2.7; P = 0.33). Dyspnea VAS decreased in both groups (music, 0.6 +/- 2.2; control, 0.4 +/- 2.5; P = 0.68). Nausea & vomitting VAS also decreased in both group (music, 0.9 +/- 2.2; control, 1.1 +/- 2.1, P = 0.71). There were no significant vital sign changes premusic and postmusic, In both group vital signs increased. Mean differences of systolic pressure(1.0 +/- 11.4 vs. 1.6 +/- 11.1) and diastolic pressure (0.7 +/- 7.3 vs. 1.3 +/- 5.7) were lower in music group, and mean difference of heart rate (1.8 +/- 9.5 vs. 1.5 +/- 8.0) was lower in control group. But There were no significant vital sign changes premusic and postmusic (each P = 0.8, P = 0.62, P = 0.89). CONCLUSION: Listening relaxation music before unsedated esophagogastroduodenoscopy may reduced anxiety.

A Case of Myofascial Pain Syndrome of the Iliopsoas Muscle Undiagnosed for 3 Years with Chronic Abdominal Pain / 가정의학회지

Abdominal pain is one of the most common symptoms we encounter in primary care clinics, and the patients being hospitalized for abdominal pain account for 5-6% of all the inpatients. Careful history taking and physical exams are always necessary for the diagnosis of patients having abdominal pain, because their problems may be transient and insignificant but also can be severe. For the elderly patients, common causes of abdominal pain are unspecific abdominal pain, functional disease, constipation, kidney stone, urinary tract infection, inflammatory bowel disease, biliary tract disease, acute appendicitis, diverticulitis, abdominal aortic aneurysm, peptic ulcer, intestinal obstruction, mesenteric ischemia, malignant tumor, gastroenteritis, etc. and myofacscial pain can also be the cause. We treated an elderly female patient who had suffered severe abdominal pain due to myofascial pain syndrome of the iliopsoas muscle undiagnosed for over 3 years. Therefore we report this case with review of several literatures.

Influence of Anxiety, Depression and Stress on Adjustment to College in Freshmen of a University / 가정의학회지

BACKGROUND: Freshmen maladaptation to university life has brought a lot of attention recently. Therefore, we intended to investigate about the relationship between anxiety, depression, stress and freshmen adaptation to university life. METHODS: We recruited 861 freshmen of a university located in Gyeongju, Gyeongbuk, and measured their degree of anxiety, depression, and stress by questionnaire from March 10 to 14, 2008. After 8 weeks, we examined their adaptation to university life by questionnaire and finally, analyzed the data of 600 freshmen. RESULTS: Among the freshmen, 285 (47.5%) had anxiety, 95 (15.8%) depression, and 70 (11.7%) stress. Adaptation to university life significantly associated with college-entrance exam experience, the number of close friends in class, willingness to join the club, major satisfaction and distance from the university to hometown, in addition to anxiety, depression, and stress. Risk factors of maladaptation to university life were stress (odds ratio: 2.66, 95% confidence interval: 1.60 to 4.45), depression (2.45; 1.56 to 3.84), one experience of college entrance exam (1.83; 1.24 to 2.69), anxiety (1.73; 1.27 to 2.37) and fewer than 5 close friends (1.60; 1.17 to 2.20). Short distance from the university to hometown (0.72; 0.53 to 0.98), willingness to join the club (0.60; 0.41 to 0.87) and major satisfaction (0.42; 0.29 to 0.61) were identified as lowering the risk of maladaptation to university life. CONCLUSION: Anxiety, depression, and stress closely related to freshmen adaptation to university life. During freshmen's health examination, we need to identify the degree of anxiety, depression and stress in order to predict maladaptation to university life.

Sexual Desire and Behavior of Residents at Nursing Homes

BACKGROUND: Sexual Problems of the elderly carry weight with the quality of life. Sexual desire and behavior among the aged in the community are well known, but not at nursing homes. METHODS: The study subjects were 131 residents at two nursing homes in Po-hang and Gyeong-ju city from May 1st 2007 to May 22nd 2007. We interviewed the residents using 10-items which were made by investigators. 31 subjects were excluded due to impossible interview. We analyzed 100 subjects. RESULTS: Subjects were 45% men and 55% women, aged 63 to 92 and the mean age was 77 years old. Men and Women felt sexual desires in 64.4% and 18.2%, performed sexual activity in 35.6% and 5.5%. Obscene jokes and patting were common among sexual behaviors. CONCLUSION: Men's sexual desire was much higher than women, but sexual behaviors were rare in all subjects except obscene jokes.

Experience of Internet-based Video Conferences for Residency Training in Rotation Location

Residents in family medicine often have difficulty of gathering to have a conference when they are sent to different hospitals according to training programs. From 2001, for resident conference of family medicine in pohang hospital and gyeongju hospital, dongguk university medical center, an Internet-based video conference system was used for video conferences. The Internet-based video conferences for the members who work at difference hospitals had the same effects as they gather at one place. In addition, the participants could lower the burden of preparing the presentation, listen to the presentation lively, and have a discussion with questions and answers immediately, enhancing the efficiency of conferences. They also could have a sense of affinity as they talk face to face. We reported this case as the application cases and effects of Internet-based video conferences.

Experience of Internet-based Video Conferences for Residency Training in Rotation Location

Residents in family medicine often have difficulty of gathering to have a conference when they are sent to different hospitals according to training programs. From 2001, for resident conference of family medicine in pohang hospital and gyeongju hospital, dongguk university medical center, an Internet-based video conference system was used for video conferences. The Internet-based video conferences for the members who work at difference hospitals had the same effects as they gather at one place. In addition, the participants could lower the burden of preparing the presentation, listen to the presentation lively, and have a discussion with questions and answers immediately, enhancing the efficiency of conferences. They also could have a sense of affinity as they talk face to face. We reported this case as the application cases and effects of Internet-based video conferences.

Alteration of Circadian Diurnal Rhythms of Cardiovascular Parameters by Night Shift Work in 3 Shift Nurses

Background: There are incoherent studies about the effect of night shift work on circadian diurnal rhythms of cardiovascular parameters. Our study aimed to assess the alteration of circadian diurnal rhythms of cardiovascular parameters by night shift work. Methods: We studied 26 healthy nurse volunteers engaged in 3 shift work. From March 16 to April 30, 2006, ABPM (ambulatory blood pressure monitoring) was performed to each nurse two times during the day and night shift. Three nurses were excluded due to pain omdiced by ABPM. Blood pressure and heart rate was monitored every 30 minutes. Paired T-test was used for statistical analysis. Results: The mean arterial pressure, the mean systolic pressure, the mean heart rate and the mean pulse pressure during the overall period were significantly higher in the night shift than the day shift (P-value: <0.05, <0.001, <0.05, and <0.001, respectively). The mean arterial pressure, the mean diastolic pressure and the mean heart rate during in-hospital working period were significantly higher in the day shift (P-value: <0.05, <0.001, and <0.05, respectively). All parameters during the daytime sleep period after the night shift were significantly higher than during the nighttime sleep period after the day shift (P-values: <0.001). Proportional percentile falls of 3 parameters (systolic pressure, diastolic pressure, and heart rate) during the daytime sleep period after the night shift were significantly less than during the nighttime sleep period after the day shift (P-values: <0.001). Conclusion: The night shift work caused significant alteration in homeostasis of autonomic nervous system associated with circadian diurnal rhythms of cardiovascular parameters.

Analysis of Family Practice Academic Dissertations

BACKGROUND: Family practice academic dissertations are the product of family practice research in the school of medicine. This paper was intended to evaluate the status of family practice academic dissertations, analyze the basic data and suggest directions for family practice research in the school of medicine. METHODS: The total number of masters' and doctoral dissertations from 1992 to February, 2005 was 124. of those, 120 were collected. They were analyzed in terms of research area, subjects, collected data, methodology, and statistical methods. RESULTS: In terms of research area, health promotion/ disease prevention was the most common (42.5%). For study subjects, out-patients and in-hospital patients were the most prevalent (38.0%), followed by health promotion center visitors and community residents (28.7%). When it came to research methodology, analytic study was the most common by a wide margin (70.8%). Among analytic studies, cross-sectional studies were the most frequent, followed by case-control studies and cohort studies. The most commonly-used data were medical records and questionnaires. CONCLUSION: Many advances have been made in research methodology and academic dissertation numbers since 1992. Many research topics, however, were not relevant to primary care. Much research was done in general hospital instead of primary-care facilities. These results must improve in the future.

Difficult Problems for Family Physicians in Clinical Practice

BACKGROUND: Real performance in practice is one of the criteria by which residency training program can be evaluated. We surveyed the difficult problems in which family physicians underwent in their practices after a university hospital training program to evaluate our family physician training program. METHODS: The study subjects were all physicians who fulfilled our family physician residency training program in a university hospital from February 1993 to February 1999. Data on facing difficult problems were collected via questionnaire which was distributed in advance and answered by practicing physicians. The study period was the first week of each month from March 1999 to December 1999. RESULTS: The participating physicians were 13 among 20. Total collected cases were 179. The reasons why family physicians faced difficulty in their practices were persistent symptoms of patients, lack of knowledge, lack of skills and facilities, vague symptoms, multiple symptoms of patients, low compliance, negative feelings, and patients' economic problems. Common difficult problems were abdominal pain (15), low back pain (14), cough (14), arthralgia and myalgia (12), skin rash (11), dyspnea (8), multiple somatic complaints (8), otitis media (7), nasal stuffiness (6), and dizziness (6) among 179 cases. Rare diseases comprised 22.2% of difficult problems. CONCLUSION: The problems of difficulty that family physicians faced in their practices were persistent symptoms of chronic diseases despite active treatment, lack of knowledge and skills in differential diagnosis of acute illness, and rare diseases in the communities.

Senior Medical Students' Gastrofibroscopy Experience to Understand Patients' Discomfort / 한국의학교육

PURPOSE: Senior medical students agreed to undergo gastrofibroscopy testing in the same manner as patients would in order to assess if the experience affects their understanding of patients' discomfort and their recommendation of this test. METHODS: 27 senior medical students rotating through family medicine underwent gastrofiberscopy. The level of discomfort experienced by these students was evaluated by using the Visual Analogue Scale(VAS). Each student's recommendation of gastrofibroscopy or upper gastrointestinal series to asymptomatic and symptomatic adults with upper GI complaint was recorded. And we assessed the need of patient experience for recommendation of gastrofibroscopy. RESULTS: Before having experienced a gastrofibroscopy, 21 students recommended gastrofibroscopy (21 cases, 77.8%) and 6 recommended upper gastrointestinal series(6 cases, 22.2%) as screening tests in asymptomatic adults. After having had a gastrofibroscopy, gastrofibroscopy was recommended in 16 cases(59.3%) and the upper gastrointestinal series in 11(40.7%), again in asymptomatic adults. However in symptomatic adults, there was no change. The degree of discomfort after having had a gastroscopy was less than they thought(5 cases, 18.5%), the same (5 cases, 18.5%), and more than they thought(17 cases, 63.0%), 25(92.5%) students thought experiencing gastrofibroscopy would help them explain the procedure to patients in the future. 26(96.3%) students expressed that doctors who recommend gastrofibroscopies should experience having the test so that they can better empatize and understand patients' discomfort. CONCLUSION: Senior medical students' experience being a patient is a significant learning opportunity for understanding the patient discomfort. This experience will help doctors understand patient's discomfort.

Selection of Antihypertensive Drugs in Hypertensive Patients with Diabetes Mellitus: In Pohang-Gyeongju Primary Care Research Network

BACKGROUND: Angiotensin converting enzyme inhibitor or Angiotensin II type 1 receptor blocker is usually recommended for hypertensive patients with diabetes mellitus. No reports have been made on antihypertensive agents prescribed for these patients in private practice. METHODS: During a one month period of December 2004, 169 hypertensive patients with diabetes mellitus on their prescribed antihypertensive agents by ten family physicians were analyzed. The influencing factors for such prescriptions were analyzed by directly visiting each physicians who prescribed them. RESULTS: A total of 21 antihypertensive agents were prescribed by these family physicians. Single calcium channel blocker therapy was the most common with 55 cases (32.5%), followed by 20 cases (11.8%) of single angiotensin converting enzyme inhibitor therapy and 16 cases of single therapy of Angiotensin II type 1 receptor blocker. The low frequency of prescribing the Angiotensin II type 1 receptor blocker was due to insufficient effect (7), lack of information (5), resistance from the patients from changing the medications (4) and expensive costs (4). CONCLUSION: In prescribing antihypertensive agents for patients with diabetes mellitus, angiotensin converting enzyme inhibitor or Angiotensin II type 1 receptor blocker were chosen less. In order to decrease the incidence of complications in these patients, such agents should be prescribed more.

Asymptomatic Duodenal Ulcer Patient with Candidiasis due to Medical Treatment

Candida was found in the oral cavity, jejunum, and ileum of the healthy population. In case of alimentary tract, the factors of favorable to candida colonization include old age, malnutrition, diabetes, burns, trauma, surgical operations, parenteral nutrition, intravascular or bladder catheterization, H2-blocker therapy, steroid therapy, immunosuppresive treatment and the use of wide spectrum antibiotics: however, gastrointestinal candida colonization is rarely found in the healthy adult. No case of duodenal ulcer with candidiasis has been reported in healthy people. Recently we experienced a case of asymptomatic duodenal ulcer with candidiasis in a healthy male, who had taken H2-blocker and proton pump inhibitor for 3 months after primary closure of duodenal ulcer perforation. Therefore we report this case with review of several literatures.

Suitability Assessment of Patients' Education Materials Made by Korean Academy of Family Medicine

BACKGROUND: We assessed the suitability of patients' education materials made by KAFM (Korean Academy of Family Medicine) to suggest guidelines for making more efficient education materials. METHODS: The Korean version of SAM (Suitability Assessment of Materials) was used to evaluate patients' education materials of KAFM. The Korean version was modified within the centext of Korean language and culture by 3 family medicine specialists. We evaluated all materials which had been made up to October, 2003. Each item of evaluation criteria was assessed and agreed by 3 family medicine specialists. RESULTS: The total number of evaluated materials as 51. The average SAM score was 40.2% and its range was 22~78%. The materials on 'Early detection and self examination of breast cancer', 'Back muscle exercise for back pain patients', and 'Treatment and management of hypertension' received high scores. The materials on 'TIA', 'Alcohol and liver', and 'Children's constipation' received low scores. Two materials (3.9%) were judged excellent, 18 (35.3%) adequate, and 31 (60.8%) not adequate. The criteria for each item such as learning aids via road signs, layout factors, and typography received high scores. The criteria for each item such as summary or review included, 'context is given first', 'cover graphic shows purpose', relevance of illustrations, and 'caption used for graphics' received low scores. CONCLUSION: The items such as 'learning aids via road signs', 'layout factors', and 'typography' received high scores in the evaluation of patients' education materials by SAM criteria. There were also weak points noted about unclear purpose, less description about behavior change, irrelevance of illustrations, and lack of learning stimulation and motivation.