• Journal of Preventive Medicine and Public Health
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• 제53권1호
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• pp.56-63
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• 2020

Objectives: The objective of this study was to determine the effect of atrial fibrillation (AF) on the risk of dementia in the Korean elderly. Methods: A 10-year retrospective cohort study was conducted using the National Health Insurance Service-Senior Cohort database. We excluded those who were under 65 years of age as of January 2006 (n=46 113), those who were diagnosed with dementia between 2002 and 2005 (n=9086), and those with a history of stroke prior to AF diagnosis (n=8392). We used a Cox proportional hazards model with a time-varying covariate to determine whether AF is associated with the risk of dementia after adjusting for potential confounders. Results: In univariable Cox regression, the hazard ratio (HR) of dementia according to AF status was 1.28 (95% confidence interval [CI], 1.23 to 1.33). After adjusting for potential confounders, AF was found to increase the risk of dementia (HR, 1.12; 95% CI, 1.07 to 1.17), Alzheimer dementia (HR, 1.12; 95% CI, 1.07 to 1.17), and vascular dementia (HR, 1.10; 95% CI, 1.03 to 1.18). In patients diagnosed with AF, the incidence of dementia was lower (HR, 0.50; 95% CI, 0.47 to 0.52) in patients who were treated with oral anticoagulants. Conclusions: Investigating the potential risk factors of dementia in an aged society is important. We found a slightly higher risk of dementia in those with AF than in those without AF, and we therefore concluded that AF is a potential risk factor for dementia.

• 한국임상약학회지
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• 제26권3호
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• pp.195-200
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• 2016

Background: Venous thromboembolism (VTE) is a common and life-threating condition in cancer patients. Low molecular weight heparins (LMWH), such as dalteparin, are recommended in the treatment of VTE. Also, rivaroxaban, an orally administered direct factor Xa inhibitor, was approved for the treatment of VTE. It showed similar efficacy to standard therapy (LMWH or warfarin) and was associated with significantly lower rates of major bleedings. However, in the real world, bleeding has been reported to occur frequently in cancer patient receiving rivaroxaban. The goal of this research was to analyze bleeding risks between rivaroxaban and dalteparin for treatment of VTE in cancer patients. Methods: Medical records of oncology patients who were treated with rivaroxaban or dalteparin for VTE from July 2012 to June 2014 were retrospectively reviewed. Data collected were as follows: age, sex, weight, height, cancer types and stages, ECOG (eastern cooperative oncology group) PS (performance score), VTE types, concurrently used medications, study drug information (dose and duration of therapy), INR (international normalized ratio), PT (prothrombin time), and platelet counts. Bleeding was classified into major bleedings, clinically relevant non-major bleedings, and minor bleedings. Results: A total of 399 patients were included in the study. Of these patients, 246 were treated with rivaroxaban and 153 with dalteparin. Bleeding rates were significantly higher in the rivaroxaban group than in the dalteparin group (adjusted odds ratio (AOR) 2.09, 95% CI 1.22-3.60) after adjusting for confounders. In addition, rivaroxaban remained independently associated with 1.78-fold (95% CI 1.14-2.76) shorter time to bleeding compared to dalteparin after adjusting other factors known to be associated with poor outcomes. Conclusion: This study suggested that rivaroxaban was associated with an increased risk of bleedings in cancer patients.

• 대한간호학회지
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• 제50권4호
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• pp.621-630
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• 2020

Purpose: This study was aimed to evaluate the external validity of a carbapenem-resistant Enterobacteriaceae (CRE) acquisition risk prediction model (the CREP-model) in a medium-sized hospital. Methods: This retrospective cohort study included 613 patients (CRE group: 69, no-CRE group: 544) admitted to the intensive care units of a 453-beds secondary referral general hospital from March 1, 2017 to September 30, 2019 in South Korea. The performance of the CREP-model was analyzed with calibration, discrimination, and clinical usefulness. Results: The results showed that those higher in age had lower presence of multidrug resistant organisms (MDROs), cephalosporin use ≥ 15 days, Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥ 21 points, and lower CRE acquisition rates than those of CREP-model development subjects. The calibration-in-the-large was 0.12 (95% CI: - 0.16~0.39), while the calibration slope was 0.87 (95% CI: 0.63~1.12), and the concordance statistic was .71 (95% CI: .63~.78). At the predicted risk of .10, the sensitivity, specificity, and correct classification rates were 43.5%, 84.2%, and 79.6%, respectively. The net true positive according to the CREP-model were 3 per 100 subjects. After adjusting the predictors' cutting points, the concordance statistic increased to .84 (95% CI: .79~.89), and the sensitivity and net true positive was improved to 75.4%. and 6 per 100 subjects, respectively. Conclusion: The CREP-model's discrimination and clinical usefulness are low in a medium sized general hospital but are improved after adjusting for the predictors. Therefore, we suggest that institutions should only use the CREP-model after assessing the distribution of the predictors and adjusting their cutting points.

• 한국치위생학회지
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• 제11권5호
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• pp.707-715
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• 2011

Objectives : The objective of this study was to assess a level of oral health related quality of life(OHRQoL) for rural communities elderly and to determine the association between OHRQoL and socio-economic position. Methods : The study population was elderly(60+year-old) residents of PyeongChang county, Jeongseon county, Yeongwol county, Gangwon province. A total of 171 people were invited to participate. Oral health related quality of life was measured using the GOHAI. The data were analyzed with Mann-Whitney U test or Kruskal-Wallis test and to assess socio-economic inequalities in OHRQoL(GOHAI), we used multi-variable logistic regression models. We used models adjusting for age, sex, family status factors(Model I) and compared them to models additionally adjusting for stress level(Model II). Results : There were significant differences in lower score of GOHAI at lower age group and live alone group. And we found that lower SES was significantly associated with lower score of OHRQoL. Social gradient in the score of OHRQoL persisted when adjusted for age, sex, family status, stress level. Conclusions : We recommend that oral health promotion program should be developed after due consideration SES for rural communities elderly because OHRQoL of rural communities elderly was low and association between SES and OHRQoL for rural communities elderly.

• 한국병원경영학회지
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• 제27권1호
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• pp.1-10
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• 2022

Background: This study aims to empirically compare and evaluate the current status of medical accessibility and health inequality between people with disabilities and without. We calculated the ACSC hospitalization rate, which is a medical accessibility index, for hypertension, a major risk factor for cardiovascular disease that accounts for more than 20% of deaths among people with disabilities using the 2016 National Health Insurance Big Data. Methods: The subjects of the study were a total of 601,520, including 64,018 people with disabilities and 537,501 people without. Logistic regression was performed to analyze the differences in hypertension hospitalization rates adjusted for demographic and sociological characteristics and disease characteristics using SAS 9.4 program. Results: Before adjusting for the characteristics, the hypertension hospitalization rate of people with disabilities was 1.55%, and the people without disabilities were 0.49%. After adjusting, it was found that people with disabilities were 2.11 times higher than people without disabilities, and it was statistically significant. Conclusion: The preventable hospitalization rate of people with disabilities is higher than that of people without, suggesting that the disabled have problems with access to medical care and health inequality. Therefore, the government's policy improvement is required to close the medical gap for the disabled.

• Clinical and Experimental Pediatrics
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• 제51권3호
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• pp.256-261
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• 2008

목 적 : 렙틴과 아디포넥틴은 대표적인 adipocytokine으로 비만도 및 인슐린 저항성이 증가함에 따라 혈중 렙틴은 증가하고 아디포넥틴은 감소하는 것으로 알려져 있다. 본 연구에서는 건강한 소아에서 렙틴/아디포넥틴 비와 인슐린 저항성 사이에 어떠한 연관성이 있는지 알아보고자 하였다. 방 법 : 7-15세의 건강한 소아 77명(남아 36명, 여아 41명)을 대상으로 하여 신체계측을 하고 공복 후 채혈하여 혈당, 인슐린, 렙틴, 아디포넥틴, 총 테스토스테론, 에스트라디올 및 SHBG를 측정하였다. 활성 남성호르몬 농도로는 FAI를, 인슐린 저항성의 척도로는 HOMA-IR을 사용하였다. 결 과 : 남아에서 HOMA-IR은 연령, 사춘기 단계, FAI, 렙틴 및 렙틴/아디포넥틴 비와 의미있는 양의 상관관계를 보였다. 여아에서는 HOMA-IR과 연령, %WFH, 사춘기 단계, 에스트라디올, 렙틴, 그리고 렙틴/아디포넥틴 비 사이에 의미있는 양의 상관성이 관찰되었다. 다중회귀분석 결과, 남아에서 렙틴/아디포넥틴 비는 연령, %WFH, 및 FAI로 보정한 후에도 HOMA-IR과 독립적인 연관성을 보였다(P=0.010). 여아에서는 렙틴/아디포넥틴 비와 HOMA-IR 사이에 독립적인 연관성을 보이지 못하였다. 결 론 : 비만하지 않은 건강한 소아에서도 렙틴/아디포넥틴 비는 인슐린 저항성과 의미있는 연관성을 보였으며, 남아에서는 연령, 비만도 및 남성호르몬 농도로 보정한 후에도 렙틴/아디포넥틴 비와 인슐린 저항성 사이에 독립적인 연관성이 있었다.

• Neonatal Medicine
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• 제25권4호
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• pp.161-169
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• 2018

Purpose: We assessed the influence of antenatal corticosteroid (ACS) on the inhospital outcomes of intrauterine growth restriction (IUGR) infants. Methods: A retrospective study was conducted with singletons born at $23^{+0}$ to $33^{+6}weeks$ of gestation at Seoul National University Hospital from 2007 to 2014. We compared clinical outcomes between infants who received ACS 2 to 7 days before birth (complete ACS), at <2 or >7 days (incomplete ACS), and those who did not receive ACS in IUGR and AGA infants. Multivariate logistic regression using Firth's penalized likelihood was performed. Results: 304 neonates with 91 IUGR neonates were eligible. Among AGA neonates, mortality (adjusted odds ratio [aOR], 0.13; 95% confidence interval [CI], 0.02 to 0.78), hypotension within 7 postnatal days (aOR, 0.20; 95% CI, 0.06 to 0.64), and severe bronchopulmonary dysplasia (BPD) or death (aOR, 0.24; 95% CI, 0.07 to 0.77) were lower in complete ACS group after adjusting for pregnancy induced hypertension and uncontrolled preterm labor. Mortality (aOR, 0.18; 95% CI, 0.04 to 0.78), hypotension (aOR, 0.26; 95% CI, 0.09 to 0.70), and severe BPD or death (aOR, 0.33; 95% CI, 0.12 to 0.92) were also lower in the incomplete ACS group. Among IUGR infants, after adjusting for birth weight and 5-minute Apgar score, inhaled nitric oxide use within 14 postnatal days was lower in both complete ACS (aOR, 0.07; 95% CI, 0.01 to 0.67) and incomplete ACS (aOR, 0.04; 95% CI, 0.01 to 0.37) groups. Conclusion: ACS was not effective in reducing morbidities in IUGR preterm infants.

• 한국보건간호학회지
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• 제29권3호
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• pp.426-440
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• 2015

Purpose: This qualitative study aimed to understand older adults' perspectives on successful aging and develop a model of a successful aging process, within the Korean socio-cultural context. Methods: This study used a Grounded Theory approach. Through theoretical sampling, 14 participants were selected from older adults at a public health center and a volunteer institution in Gyeonggi Province, South Korea. Results: The basic social process identified was "expanding the aging self", which was preceded by three phases, namely, adjusting to the changes, developing the valuable self, and embracing the environment. Participants used 2-3 strategies for successful aging in each phase. For adjusting to the changes, participants used strategies such as "adopting a positive attitude", "accepting the changes", and "being at the center of life". To develop the valuable self, "re-identifying capacities", "having something to do", and "advancing to a healthy lifestyle" were used. Participants embraced their environments with "sharing with others" and "embracing younger generations". The causal condition for expanding the aging self was the changes in participants' physical, mental, or psychosocial situations. Conclusion: These findings suggest a theoretical foundation for the development of potential nursing interventions to promote self-care management and the interpersonal relationship for successful aging among Korean elderly individuals.

• 한국환경보건학회지
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• 제38권3호
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• pp.184-194
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• 2012

Objectives: We investigated the effects of air pollution on allergic diseases (allergic rhinitis, asthma, atopic dermatitis) in metropolitan cities in Korea, adjusting for meteorological factors. Methods: Data on daily hospital visits and hospital admissions for 2003-2010 was obtained from the National Health Insurance Cooperation. Meteorological data was obtained from the Korea Meteorological Administration. We then calculated daily mean temperature, daily mean humidity, daily mean air pressure at sea level, and diurnal temperature range. We used data on air pollution provided by the National Institute of Environmental Research. Maximum daily eight-hour average ozone concentrations and the daily mean $PM_{10}$ were used. We estimated excess risk and 95% confidence interval for the increasing interquatile range (IQR) of each air pollutant using Generalized Additive Models (GAM) that appropriate for time series analysis. Results: In this study, we observed an association between ozone and hospital visits for allergic rhinitis, asthma, and atopic dermatitis in all metropolitan cities, adjusting for temperature, humidity, air pressure at sea level, diurnal temperature range, and day of the week. Ozone was associated with hospital visits for allergic rhinitis, asthma, and atopic dermatitis across all metropolitan cities. However $PM_{10}$ was associated with allergic-related diseases in only select cities. Also, ozone and $PM_{10}$ were associated with hospital admission for asthma in all cities except Gwangju. Hospitalization for the other diseases failed to show consistent association with air pollutants. Conclusion: In the findings of this study, there was a significant association between air pollutants and allergic-related diseases. More detailed research subdivided age group or conducting meta-analyses combining data of all cities is required.

• Parasites, Hosts and Diseases
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• 제60권5호
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• pp.327-338
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• 2022

This study determined the recent status and trend of Pneumocystis jirovecii pneumonia (PcP) in the non-human immunodeficiency virus (HIV) (non-HIV-PcP) and HIV (HIV-PcP) infected populations using data from the Health Insurance Review & Assessment Service (HIRA) and the Korea Disease Control and Prevention Agency (KDCA). SaTScan and Join-point were used for statistical analyses. Non-HIV-PcP cases showed an upward trend during the study period from 2010 to 2021, with the largest number in 2021 (551 cases). The upward trend was similar until 2020 after adjusting for the population. Seoul had the highest number of cases (1,597) in the non-HIV-PcP group, which was the same after adjusting for the population (162 cases/1,000,000). It was followed by Jeju-do (89 cases/1,000,000). The most likely cluster (MLC) for the non-HIV-PCP group was Seoul (Relative Risk (RR)=4.59, Log Likelihood Ratio (LLR)=825.531), followed by Jeju-do (RR=1.59, LLR=5.431). An upward trend was observed among the non-HIV-PcP group in the Jeju-do/Jeollanam-do/Jeollabuk-do/Gyeongsangnam-do/Busan/Daejeon/Daegu/Ulsan joint cluster (29.02%, LLR=11.638, P<0.001) located in the southern part of Korea. Both women and men in the non-HIV groups showed an overall upward trend of PcP during the study period. Men in the 60-69 age group had the highest annual percentage change (APC 41.8) during 2014-2019. In contrast, the HIV groups showed a falling trend of PcP recently. Men in the 60-69 age group had the most decrease (APC -17.6) during 2018-2021. This study provides an analytic basis for health measures and a nationwide epidemiological surveillance system for the management of PcP.