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Objective@#Vortioxetine, a new antidepressant, has been demonstrated to have effects on depression and cognitive function. This study aimed to investigate the anti-depressive efficacy of vortioxetine through a well-designed double-blind, placebo-controlled study in Alzheimer’s disease (AD) patients, and to confirm the presence of secondary benefits, including the improvement of cognitive function and activities of daily living (ADL). @*Methods@#The present study included 100 AD patients with depression who were assigned randomly to 12 weeks of daily treatment with either vortioxetine or placebo. The primary efficacy measure was the change in the Cornell Scale for Depression in Dementia score from baseline to 12 weeks. Several secondary efficacy measures were evaluated, including the Korean version of the Short form of Geriatric Depression Scale and several cognitive function domains. The safety and tolerability of vortioxetine were also assessed. We performed modified intention-to-treat analysis using mixed modeling (the Mixed Models for Repeated Measures). @*Results@#There was no statistically significant difference between the two groups in terms of depressive symptoms, cognitive functions, and ADL. Further, the percentage of adverse events and drug discontinuation between the vortioxetine and placebo groups was similar. @*Conclusion@#Our results suggest that vortioxetine might not be effective in reducing depressive symptoms or cognitive impairment in AD patients with depression. However, general drug tolerance and patient safety were similar to those of placebo. Thus, additional studies are needed to replicate the effectiveness and tolerability of vortioxetine in AD patients with depression.
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OBJECTIVE: This study tried to investigate the effects of religiosity on suicide ideation, depression and well-being in older people. METHODS: We analyzed data of 455 subjects over 60-year old who responded to Duke Religion Index, Suicidal Ideation Scale, Short Geriatric Depression Scale of Korean version and WHO-Five Well-Being Index. We compared each score of the scales between religious group and non-religious group and tested the moderating effect of religiosity on the relationship between depression and suicide ideation. RESULTS: Only well-being score of religious group was higher than that of non-religious group. Organizational religious activity had moderating effect on the relationship between depression and suicide ideation. The elderly people who frequently participate in organizational religious activity had low suicide ideation level even if they feel depressed. CONCLUSION: Religiosity can be a protective factor on suicide in elderly people by giving positive effect on well-being and decreasing suicide ideation.
الموضوعات
Aged , Humans , Depression , Suicidal Ideation , Suicide , Weights and Measuresالملخص
BACKGROUND AND OBJECTIVES: Recently the number of geriatric depressed people has been increasing tremendously. Among many factors affecting depression, quality of life seems to be closely related to depression. Thus, a screening tool for assessing both geriatric depression and quality of life is needed. The purpose of this study is to estimate the utility of the Korean version of the WHO-Five Well-Being Index (WHO-5) in evaluating geriatric depression as compared with SGDS-K (Short Geriatric Depression Scale of Korean version) that is being used widely and quality of life. METHODS: A sample of 244 subjects over 65-year old living in Yanggu and Inje area in Gangwon Province, Korea were interviewed and responded to scales, including WHO-5, SGDS-K, MMSE-KC (Mini Mental Status Examination in the Korean version of the CERAD assessment packet) and GQOL-D (Geriatric Quality of Life-Dementia). The total score of WHO-5 below 13 indicates low well-being. RESULTS: The WHO-5 inversely correlated with SGDS-K and positively with GQOL-D, but showed no significant correlation with MMSE-KC. The SGDS-K negatively correlated with WHO-5, MMSE-KC, and GQOL-D. Low well-being group (WHO-5 score<13) had lower GQOL-D score (t=1.9698, p<0.05) and higher SGDS-K score (t=1.9798, p<0.05) than high well-being group. In multiple regression analysis, WHO-5 was significantly associated with GQOL-D and SGDS-K (r2=0.29422, p=0.0000). CONCLUSION: The Korean version of WHO-5 was very useful to evaluate both depressive symptoms and quality of life in the aged dwelling in community.
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BACKGROUND: Serum gamma-glutamyltransferase (GGT) was reported to be associated with type 2 diabetes, various cardiovascular disease risk factors, and individual components of metabolic syndrome. We performed a cross-sectional study to elucidate the relations between GGT and impaired fasting glucose (IFG). METHODS: The subject of this study included 693 adults (males 272, females 421) aged 45 years or over who have lived in Chuncheon, a suburban small-sized city. IFG was defined as elevated fasting plasma glucose (FPG) concentration of > or = 100 and or = 75th) were 1.0, 0.56, 1.57, and 2.79, respectively (P-value for trend 0.022). In women, the association between the risk of IFG and GGT was not statistically significant. CONCLUSION: This study suggests that elevated level of GGT within the normal range is an independent predictor of impaired fasting glucose in middle-aged or older men but not in women.
الموضوعات
Adult , Aged , Female , Humans , Male , Middle Aged , Aging , Blood Glucose , Body Mass Index , Cardiovascular Diseases , Cross-Sectional Studies , Fasting , gamma-Glutamyltransferase , Glucose , Insulin Resistance , Odds Ratio , Plasma , Reference Values , Risk Factorsالملخص
BACKGROUND: To estimate the prevalence of the metabolic syndrome in Chuncheon city in those ages 45 and over and to evaluate the association between risk factors and the risk of the metabolic syndrome. METHODS: The subject of this study included 662 adults (males 276, females 386) aged 45 years or over who lived in Chuncheon city. The metabolic syndrome was defined as having 3 or more conditions inclnding abdominal obesity, high blood pressure, low HDL cholesterol, high triglyceride, and high fasting glucose. The association between the metabolic syndrome and its life-style related factors, such as smoking, exercise, and drinking, was examined, using multiple logistic regression. RESULTS: The prevalence of the metabolic syndrome from ATP III criteria was 30.1% in men, and 37.9% in women. The prevalence increased with age in women. In men, however, the prevalence increased to 55~64 age group and then it gradually decreased. The prevalence of the metabolic syndrome from Asia-Pacific criteria was 48.2% in men, and 46.6% in women. The prevalence increased with age in men and decreased in women. The highest prevalence among the individual components of diagnostic criteria of the metabolic syndrome in men was hypertension, followed by abdominal obesity, hypertriglyceridemia, low HDL-cholesterolemia, and high fasting blood glucose. And in women, it was abdominal obesity, followed by hypertension, low HDL cholesterolemia, hypertriglyceridemia, and high fasting blood glucose. After adjusting for potential covariates, current smoker was 1.93 times at a greater risk for the metabolic syndrome than non-smokers (95% confidence interval 1.06~3.51). CONCLUSION: The prevalence of the metabolic syndrome was higher than previously reported in Korea. Further studies are strongly needed to elucidate the factors which are related to the syndrome and to develop effective prevention guidelines, especially among the elderly.
الموضوعات
Adult , Aged , Female , Humans , Male , Adenosine Triphosphate , Aging , Blood Glucose , Cholesterol, HDL , Drinking , Fasting , Glucose , Hypertension , Hypertriglyceridemia , Korea , Logistic Models , Obesity, Abdominal , Prevalence , Risk Factors , Smoke , Smoking , Triglyceridesالملخص
BACKGROUND: Increased WBC counts have been associated with different components of metabolic syndrome (MS), accompanied by clustering of a number of risk factors for CHD. Because most individuals have one or more of the risk factors for CHD or a cluster of MS symptoms, it may not be appropriate to look only at isolated components. Therefore, the aim of the present study was to examine the association of WBC counts with clustered features of MS in Korean adults. METHODS: The subject of this study included 593 adults (males 344, females 249) aged 20 years or older. Among the subjects, we excluded those who did not have records of physical parameters and blood test results and those who did not complete the questionnaire. We also excluded acutely ill patients. Logistic regression analyses were used to evaluate the association between WBC counts and features of the MS, with an adjustment for age, smoking and alcohol consumption. RESULTS: The relative risks for obesity, hypertension, hypercholesterolemia, low HDL cholesterol levels, hypertriglyceridemia, high fasting plasma glucose levels and hyperuricemia compared with WBC counts or =1, > or = 2, > or = 3, > or = 4 features of the MS also increased as WBC counts increased. CONCLUSION: An increased, albeit normal, WBC counts associates with the cluster of MS of the so-called "insulin resistance syndrome" and suggest that an increased WBC counts may be yet another feature of this syndrome.
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Adult , Female , Humans , Alcohol Drinking , Blood Glucose , Cholesterol, HDL , Cluster Analysis , Fasting , Hematologic Tests , Hypercholesterolemia , Hypertension , Hypertriglyceridemia , Hyperuricemia , Leukocyte Count , Logistic Models , Obesity , Risk Factors , Smoke , Smokingالملخص
BACKGROUND: One method for achieving medical practice to be more evident, especially in the field of primary care, is to encourage the use of clinical guidelines. If development of guidelines is difficult because of time and cost, an evidence based foreign guidelines can be selected and translated into Korean for application. METHODS: A team was formed, consisting of 11 family physician experts on evidence based medicine and clinical practice guidelines. We selected six respiratory diseases requiring clinical guidelines because of variability in practice. We searched several clinical practice guideline databases and selected one guideline according to currency, scope of guideline, whether it was evidence based, and its feasibility in the field of primay care. We translated selected guideline's full-texts or summaries which were done by authorized organization into Korean. RESULTS: The selected respiratory diseases were chronic obstructive pulmonary disease, asthma, pneumonia, sinusitis, rhinitis, and influenza. According to criterion, we selected GOLD (Global Initiative for Chronic Obstructive Lung Disease) for chronic obstructive lung disease, GINA (Global initiative for asthma) for asthma, CDC (Center for disease control) guideline for influenza, IDSA (Infectious Diseases Society of America) guideline for pneumonia, AAP (American Academy of Pediatrics) guideline for sinusitis, and JCAAI (Joint Council of Allergy, Asthma and Immunology) for rhinitis. CONCLUSION: We selected six common respiratory diseases and the most appropriate evidence based guidelines for those particular diseases.
الموضوعات
Humans , Asthma , Evidence-Based Medicine , Hypersensitivity , Influenza, Human , Lung , Physicians, Family , Physicians, Primary Care , Pneumonia , Primary Health Care , Pulmonary Disease, Chronic Obstructive , Rhinitis , Sinusitisالملخص
OBJECTIVES: The cerebrovascular diseases including stroke have become prevalent in Korea, ranking first as the cause of death in the aged. The quality of life (QOL) in stroke patients has been studied with growing interest since every aspect of life after stroke is influenced by the sequelae of this illness. This study aimed at 1) describing QOL of stroke patients and 2) identifying predictors of two month QOL after the event in stroke survivors. METHOD: WHO QOL scale was used to evaluate two month QOL after the stroke in 69 ischemic stroke patients. Data on age at the stroke event, sex, education level, brain MRI (magnetic resonance imaging) findings, symptoms of depression and anxiety, and neurologic disabilities were collected. Analyses were performed to explore the predictors of two month QOL. RESULTS: Stroke survivors with higher number and volume of frontal cortex lesions had lower two month QOL. Also, patients with more severe subcortical gray matter lesions had significantly lower two month QOL. Stroke patients with depression at the event had lower two month QOL than patients without depression. CONCLUSION: Lesions in frontal cortex and subcortical gray matter hyperintensities on MRI T2 images and depression in acute phase were of paramount importance in predicting two month QOL. Accurate and prompt neurologic and psychiatric interventions are required to improve QOL after stroke.
الموضوعات
Humans , Anxiety , Brain , Cause of Death , Depression , Education , Frontal Lobe , Korea , Magnetic Resonance Imaging , Quality of Life , Stroke , Survivorsالملخص
BACKGROUND: This study is aimed at the pathoanatomic correlates of depression and anxiety in acute stroke patients including subcortical lesion(periventricular hyperintensity, deep white matter hyperintensity, subcortical gray matter hyperintensity). METHODS: Sixty nine patients with acute stoke were recruited. Their brain lesions were measured using Brain MRI. Depressive or anxiety symptoms were rated by Beck depression inventory(BDI) or Beck anxiety inventory, respectively. RESULTS: There were significant correlation between depression and periventricular hyperintensity and deep white matter hyperintensity in acute stroke patients. There are no significant pathoanatomic correla- tions between anxiety and brain lesions on MRI. CONCLUSION: Our findings suggest that the white matter lesion may increase the risk of depression after stroke. Prevention of asymptomatic cerebrovascular lesion could decrease the risk of depression in acute stroke patients as well as the risk of stroke.
الموضوعات
Humans , Anxiety , Brain , Depression , Magnetic Resonance Imaging , Strokeالملخص
BACKGROUND: This study is aimed at the pathoanatomic correlates of depression and anxiety in acute stroke patients including subcortical lesion(periventricular hyperintensity, deep white matter hyperintensity, subcortical gray matter hyperintensity). METHODS: Sixty nine patients with acute stoke were recruited. Their brain lesions were measured using Brain MRI. Depressive or anxiety symptoms were rated by Beck depression inventory(BDI) or Beck anxiety inventory, respectively. RESULTS: There were significant correlation between depression and periventricular hyperintensity and deep white matter hyperintensity in acute stroke patients. There are no significant pathoanatomic correla- tions between anxiety and brain lesions on MRI. CONCLUSION: Our findings suggest that the white matter lesion may increase the risk of depression after stroke. Prevention of asymptomatic cerebrovascular lesion could decrease the risk of depression in acute stroke patients as well as the risk of stroke.
الموضوعات
Humans , Anxiety , Brain , Depression , Magnetic Resonance Imaging , Strokeالملخص
BACKGROUND: The brain imaging techniques have developed to detect silent brain lesion in healthy elderly, including white matter changes. These silent brain lesions implicate the possibility of brain cerebrovasculopathy, which are also suggestive of having risk factors for geriatric depression, decrease in cognitive function, cerebral infarction and vascular dementia. This study investigated prevalence and clinical characteristics of patients with hyperintesities on MRI (Magnetic Resonance Imaging) T2 image in normal healthy adults. METHOD: Eighty-nine adults above age of 20 were studies who took health examinations including brain MRI. Hyperintensities on brain MRI were categorized by a neuroradiologist according to Fazekas classification. All subjects filled out Zung's depression scale (SDS) and Brief Encounter Psychosocial Instrument (BEPSI). Past histories of hypertension and diabetes mellitus, antihypertensive drug medication history, smoking, alcohol drinking, and height, body weight, BMI (body mass index), systolic and diastolic blood pressure, fasting blood sugar, serum lipids (cholesterol, triglyceride, HDL-C, LDL-C) were evaluated in all subjects. The subjects were divided into three group according to the evaluation scores of hyperintensities on MRI (control group with 0 score, hyperintensity 1 group with evaluation score of 1, hyperintesity 2 group with evaluation score of 2 or 3). ANOVA (Post Hoc test;Scheffe) or chi2 tests were carried out in three groups with the significance level of 0.05. RESULTS: Hyperintensities on MRI T2 image were found in relatively old age groups, and systolic blood pressures were higher in these groups. Serum cholesterol and triglycerides were higher in hyperintensity 1 and 2 group than normal control group, but there was no statistical significance. The amount of alcohol drinking and smoking were not significantly different in three groups. CONCLUSION: Normal healthy subjects with hyperintensities on MRI T2 image in normal healthy people would need to be treated if they have concurrent risk factors of cerebrovascular disease such as hypertension. Normal healthy adults with hyperintensities on MRI should be followed up for long-term to investigate incidence of clinical infarct and depressive symptoms, change in cognitive function.
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Adult , Aged , Humans , Alcohol Drinking , Blood Glucose , Blood Pressure , Body Height , Brain , Cerebral Infarction , Cholesterol , Classification , Dementia, Vascular , Depression , Diabetes Mellitus , Fasting , Hypertension , Incidence , Magnetic Resonance Imaging , Neuroimaging , Prevalence , Risk Factors , Smoke , Smoking , Triglyceridesالملخص
BACKGROUND: The hemoglobin is a basic tool in diagnosing anemia. Not many studies compared hemoglobin between non-smokers and smokers in Korea and they did not differentiate hemoglobin between males and females. This study was conducted to show the difference of hemoglobin between non-smokers and smokers in male population and factors affecting hemoglobin. METHODS: We gathered 313 men who underwent periodic health examination from May to July 2001 in a general hospital. The relationship between cigarette smoking and hemoglobin concentration was examined by comparing the means of hemoglobin between two groups and through multiple regression analysis. RESULTS: The mean of hemoglobin was significantly higher in smokers than in non -smokers, especially in smokers with more than 1 pack per day. The factors that influence the hemoglobin level were age, the amount per day, and the total amount they smoked in the past (pack -year). Daily cigarette smoking seemed to cause a general upward shift of hemoglobin distribution curve, while age and pack - year on the opposite. CONCLUSION: This study suggests that hemoglobin cutoff values should be adjusted for smoke and one must consider the patient's age to compensate for masking effect of smoking and aging on detection of anemia.
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Female , Humans , Male , Aging , Anemia , Hospitals, General , Korea , Masks , Smoke , Smokingالملخص
BACKGROUND: The prevalence of hepatitis C in blood donors have been reported to be 1.5% to 2.0% and 85 90% of post transfusion hepatitis patients show anti HCV positive results. Most agree that hepatitis C is readily spread by way of contact with blood, but a discernible history of parenteral exposure is identified in only 40% to 50% of cases. Thus other possible nonparenteral routes of transmission such as vertical, sexual and intrafamilial contact transmission need to be explored. In this study, we investigated the clinical characteristics of anti HCV seropositives and the infection patterns of hepatitis C in their families not only by anti HCV but also by HCV PCR to explore the possibility of HCV infection through nonparenteral household contact. METHODS: Past history, physical examination, liver function tests, HCV PCR, hepatitis B viral markers, abdominal ultrasonography and liver biopsy were done in 161 anti HCV seropositives from May, 1991 to August, 1996. Of the 161 seropositives, 42 seropositives' family members, 98 subjects, were available for investigation by anti HCV, HCV PCR and liver function tests to document intrafamilial HCV infection;their respective relationships to the index seropositive were noted. RESULTS: The 161 anti HCV seropositives were classified as follows:34 in the carrier group(21.1%), 41 in the acute hepatitis group (25.5%), 32 in the chronic hepatitis group(19.9%), 24 in the liver cirrhosis group(14.9%) and 30 in the hepatoma group(18.6%). The positive rates of HCV PCR were 55.2% in total, 46.1% in the carrier group, 55.0% in the acute hepatitis group, 76.4% in the chronic hepatitis group, 40.0% in the liver cirrhosis group, and 42.8% in the hepatoma group. The 98 family members were all anti HCV seronegative. The positive rates of HCV PCR in these family members were 10.2% in total, 7.1% in spouses, 28.6% in siblings, and 8.3% in children. CONCLUSION: Anti HCV seropositives were in various clinical states of liver disease due to HCV infecton. Although none of the family members showed anti HCV positive results, HCV PCR was positive in 10.2% of the family members indicating the need to perform HCV PCR to detect HCV infection.
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Child , Humans , Biomarkers , Biopsy , Blood Donors , Carcinoma, Hepatocellular , Family Characteristics , Hepatitis B , Hepatitis C , Hepatitis , Hepatitis, Chronic , Liver , Liver Cirrhosis , Liver Diseases , Liver Function Tests , Physical Examination , Polymerase Chain Reaction , Prevalence , Siblings , Spouses , Ultrasonographyالملخص
BACKGROUND: The positive effects of hormone replacement therapy (HRT) on the skeleton in postmenopausal women are well defined. However, the effects of vitamin D supplementation on BMD in postmenopausal women are controversial. But many women, who are contraindicated to HRT or afraid of side effects of HRT or are already on HRT regimen, take calcium plus vitamin D supplement for prevention of osteoporosis. Therefore, this study was designed to examine the effect of vitamin D supplementation on BMD in postmenopausal women and to determine whether vitamin D supplementation can give additional benefit to HRT. METHODS: Subjects were 109 postmenopausal women out of total 213, who visited the Sacred Heart Hostpital, Chuncheon and had follow up BMD study one year after druing January, 1996 to May, 1999. The study group was as follows: No treatment (n=31) ; Vit D (n=11) ; HRT (n=50) ; HRT+Vit D (n=17). We compared and analyzed the changes of BMD in the region of lumbar spine (L2-4) and femur (femoral neck, trochanter, Ward's triangle). SPSSWIN 7.5 was used for statistical procedure. RESULTS: Subject had a mean age of 54.4+/-5.7 years, mean menopausal age of 48.4+/-2.4 years, mean postmenopausal duration of 6.1+/-4.1 years, and mean body mass index of 24.1+/-2.8 kg/m2. No correlation was observed between general characteristics (age, menopausal age, postmenopausal duration, and body mass index) and changing rate of BMD. Lumbar BMD had increased by 1.83% in the Vit D group, by 1.95% in the HRT group and by 3.15% in the HRT+Vit D group, whereas it had decreased by 1.99% in the no treatment group. The increase of femoral neck BMD in the Vit D group was 1.5%, in the HRT group 0.66% and in the HRT+Vit D group 2.09%, but the loss in the no treatment group was 1.65%. The changes of trochanteric BMD were as follows: No treatment group (-2.49%), Vit D group (0.04%), HRT group (1.48%), and HRT+Vit D group (1.81%). In Ward's triangle BMD the changes were as follows : No treatment group (-4.09%), Vit D group (1.17%), HRT group (-0.01%), HRT+Vit D group (0.16%). In the Vit D group, except for the trochanteric area (P>0.05), there was a significant increase in BMD of L2-4, femoral neck, and Ward's triangle (P<0.05), whereas in the HRT group and HRT+Vit D group significant increases were observed in all areas (P<0.05). But there was no significance among Vit D group, HRT group and HRT+Vit D group. CONCLUSION: This study confirmed the beneficial effect of HRT on lumbar and femoral BMD. It also showed that low dose Vitamin D supplementation had effect in the prevention of osteoporosis in postmenopausal women. In the HRT+Vit D group, BMD had increased more than HRT alone, but does not give any benefit additional to that of HRT alone.
الموضوعات
Female , Humans , Body Mass Index , Calcium , Cholecalciferol , Femur , Femur Neck , Follow-Up Studies , Heart , Hormone Replacement Therapy , Neck , Osteoporosis , Skeleton , Spine , Vitamin D , Vitaminsالملخص
BACKGROUND: Osteoporosis after menopause is known as a disease that needs preventive measures before medical treatment. Many patients, however, do not undergo hormone therapy to prevent it. This paper investigates some obstacles to hormone replacement therapy (HRT). METHOD: A total of 85 menopausal women who under went bone-mineralodensitometry (BMD) examination at Chuncheon Sungshim Hospital Health Care Clinic from May, 1995 to April, 1997 were the subjects of our study. We interviewed them by telephone, examined their medical records including their BMD results. We also examined what the obstacles were for them to receive HRT for osteoporosis. RESULTS: The average age of the subjects was 55.8years. Only 40 women (47%) replied that they knew beforehand the purpose of the BMD examination. The rest of the subjects replied that they simply went through the examination because it was inclusive to health items. Those who had heard of HRT for osteoporosis were only 43 people because(50.1%), and those who did not currently receive HRT amounted to 32 (74.4%). The reasons why they do not undergo the therapy were fear of cancer, no symptoms related to osteoporosis, financial difficulty, and weight gain. Among the 32 subjects, only 1 person replied that she would not receive the HRT even if the above obstacles were removed. Therefore, it seems that most of our subjects would receive HRT if such obstacles removed. Those who were currently receiving HRT were 11 people(12.9%). According to the open questionnaire, many of them replied that they do not feel any inconvenience while receiving the HRT, but some of them complained of epigastric pain, dysmenorrhea, or mastalgia. They replied that after the HRT they felt no arthralgia and felt far better in body and mind than before treatment. All the 11 people replied that they will continue to receive the HRT. CONCLUSION: The main reason why so few people received HRT for osteoporosis proved to be the lack of knowledge of the therapy. Even those who had heard of HRT complained about the negative aspects, which in fact can be overcome, and as a result a considerable number of them do not receive HRT. Therefore we conclude that in order to increase the number of patients who will undergo HRT for osteoporosis after menopause we need to strengthen education about the merits of this therapy rather than just performing BMD examination.
الموضوعات
Female , Humans , Arthralgia , Delivery of Health Care , Dysmenorrhea , Education , Hormone Replacement Therapy , Mastodynia , Medical Records , Menopause , Osteoporosis , Osteoporosis, Postmenopausal , Telephone , Weight Gain , Surveys and Questionnairesالملخص
BACKGROUND: Family physicians help the patients to be adapted to a new life cycle with anticipatory guidance. But the later life of empty nest stage seems to be the most stressful since during this time is made preparation of his/her own death. Anticipatory guidance in later life for death is not encouraged because after death, the patient no longer exists. METHODS: From August 1, 1995 to August 31,1995, we gathered the data by the means of questionnaire to persons aged over 60 who visited the department of family medicine and geriatric center in Yong-dong Severance Hospital. The questionnaire was consisted of demographic factors, attitude toward death, fear of death, preparation of death in aspect of his/her own and also in his/her family. RESULTS: The total 104 subjects responded to the questionnaire, consisting of 58 males and 46 females. To the question asking the attitude tpward death, 71(67.6%)answered death as a spiritually new life, 39(37.1%)as an end of life and 11(10.5%)as just and event in life. 75(72.1%)persons insisted the need of preparation of death, and the content of the preparation were consideration of the family 35(33.3%), preparation of mind 34(32.4%), devotion to religion 33(31.4%), arrangement of fortune 19(18.1%). The answer about the fear of death was 42(40.0%)and the reasons for fear were pain of death 26(24.8%), separation from the family 19(18.1%), uncertainty of the nature after death 17(16.2%), suffering of the family 10(9.5% ) in rank order. The contents of preparation of death as family were being together with dying person 57(45.7%), evangelizm 32(30.5%), helping arrangement of life 30(28.6%), and the answer about fear of death of family were pain of death 40(37.1%), regret 31(26.5%), lack of preparation of after death 22(21.1%), loneliness after separation 14(13.3%). CONCLUSIONS: Family physicians should recognize death as one of the life cycles because the most persons insist of the need of preparation of death. So family physician can help the the patient prone to death by anticipatory guidance with stimulation of performance of developmental tasks.
الموضوعات
Female , Humans , Male , Demography , Life Cycle Stages , Loneliness , Physicians, Family , Uncertainty , Surveys and Questionnairesالملخص
PURPOSE: The development of new therapeutic modalities such as gene therapy, which still requires further investigation, is clearly important to improve the prognosis of gastric cancer. This study was conducted to evaluate the effect on the growth and the tumorigenicity of retrovirus-mediated p53 gene transduction into gastric cancer cells. MATERIALS AND METHODS: Human gastric cancer cell lines were cultured and their DNAs were analyzed to evaluate the p53 status with PCR-SSCP (polymerase chain reaction-single strand conformation polymorphism) and DNA sequencing. Retroviral supernatants were obtained from each producer cell line, PA317/LNCX and PA317/LNC/p53, after construction of retroviral vector LNC/p53 containing human p53 cDNA and producer cell line PA 317/ LNC/p53. To investigate the effect of retrovirus-mediated p53 gene transduction in human gastric cancer cell lines, the in vitro growth rates and in vivo tumorigenicities of the N-87 cell line having mutant p53 and the YCC-S-2 cell line having wild-type p53 were compared before and after infection with LNC/p53 retrovirus. RESULTS: The following results were obtained: 1) The growth inhibition of N-87 cells after p53 transduction was signficant when compared to that of the parent N-87 cells. The growth of the p53 transduced YCC-S-2 cells and the parent YCC-S-2 cells was not different. 2) In nude mice, the growth of tumors formed by N-87 cells was modestly inhibited after retrovirus-mediated wild-type p53 gene transduction. However, the growth of tumors formed by YCC-S-2 cells was not inhibited by retrovirus-mediated p53 gene transduction. 3) The expression rate of p53 protein after p53-containing retroviral infection in the KATO-III cell lines, which have no p53 gene, was dose-dependent on the m.o.i. of retrovirus, although it was not more than 15% with the m.o.i. of 100 upon immunohistochemical analysis. CONCLUSION: The growth inhibition by retrovirus-mediated p53 transduction in human gastric cancer cells was significant in a gastric cancer cell line having mutant p53 in vitro, and the growth of tumor masses formed by a gastric cancer cell line having mutant p53 was modestly inhibited after p53 transduction using retroviral vector in nude mice, although it was not statistically significant. Only modest inhibition of tumor growth using retrovirus-mediated p53 gene transduction in vivo is most likely to be due to low transduction efficiency.