Showing papers in "Journal of The Korean Medical Association in 2006"

Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease

Abstract: With an ever-expanding understanding about chronic obstructive pulmonary disease (COPD), it has been realized that it is a respiratory disease with systemic manifestations. Systemic effects of COPD lead to cardiovascular co-morbidities, muscle wasting and osteoporosis that in turn lead to inactivity and physical deconditioning. This development has a direct impact on the health-related quality of life (HRQoL) of patients suffering from this respiratory disease. Pharmacological therapy leads to improvement in shortness of breath and has limited effect on the physical deconditioning. Latest research has shown an additive effect of pulmonary rehabilitation on improving the inactivity and overall HRQoL in COPD patients. Pulmonary rehabilitation (PR) is a comprehensive multimodality program that includes strength and endurance training, nutritional education and psychosocial support. This leads to a holistic approach to management of COPD which results in symptom improvement in patients and decreased utilization of heath care resources. There are several barriers to widespread adoption of pulmonary rehabilitation as a standard treatment. This includes availability, insurance coverage and patient compliance. With inclusion of pulmonary rehabilitation in respiratory society guidelines, there has been a renewed interest among both pulmonary specialist and community physicians. This chapter aims to provide exhaustive evidence based knowledge regarding pulmonary rehabilitation and its beneficial effect on COPD patients.

The Changes in the Birth and Mortality Rates of Newborn in Korea

Abstract: 한 JKMA Special Issue 한국에서 미숙아 신생아 관리의 현재와 미래

Climacteric Symptoms & Hormone Therapy

Abstract: After menopause, estrogen deficiency from the loss of ovarian function results in various symptoms and metabolic changes, which lead to an increased risk of chronic diseases. Troublesome menopausal symptoms, vasomotor and/or psychological, are the first to develop, and various kinds of disorders related to estrogen deficiency such as genitourinary atrophy, involutional osteoporosis, cardiovascular, and Alzheimer's diseases follow. Among these, two major long-term consequences of ovarian failure are osteoporosis and cardiovascular disease, which are also the major causes of morbidity, mortality and financial costs. Hormone therapy by using estrogen with or without progesterone, is most consistently effective for the treatment of acute and some intermediate menopause-related symptoms such as vasomotor symptoms and vaginal dryness, and therefore has been recommended as the first-line measure to prevent and treat the acute symptoms of estrogen deficiency. It also has been reported that hormone therapy reduces the risks of some long-term sequelaes, suggesting both therapeutic and preventive roles in postmenopausal women. However, it is clear that hormone therapy is not a panacea and is not suitable for all postmenopausal women because of side effects and some concerns about cancer risks. The rate of long-term compliance is also low at present. Recent RCTs showed that hormone therapy does not seem to be effective in improving cognition and preventing CHD and dementia. However, there is a growing consensus that the early initiation of hormone therapy provides protection from CVS and CNS, the two most important areas, whereas RCTs have disagreed with observational data. This means that in young women at early menopause, \"a window of therapeutic opportunity\" exists for hormone therapy, since treatment during this period may provide cardioand neuroprotection. More studies are urgently needed on this controversy. Current recommendations suggest treatment with the lowest effective dose for the shortest period of time and individualized treatment based on patient’s risk and benefit ratio.