This study investigates birth cohort and educational differences in the marital and fertility life course using the Hernes model. First, lifetime marriage rates remain high across birth cohorts but men in the youngest birth cohort(1965-74) experience a somewhat significant reduction in ever-marriage rates. Second, this study also finds educational differences in lifetime marriage rates across birth cohorts. The likelihood of being never married is particularly high for poorly educated men in the youngest birth cohort but women show the opposite pattern. Third, quantum changes in the fertility transition are more likely to be the changes in higher-order births, while the changes in first and second births are mainly tempo changes. Fourth, the negative association between education and fertility is significantly larger for higher-order births. Finally, marriage and fertility show the opposite pattern in their association with education. Overall, educational differences in lifetime marriage rates become stronger across birth cohorts but the association between education and higher-order births shows the opposite pattern.
Background: Associations between elevated C-reactive protein (CRP) and cancer risk have been reported for many years, but the results from prospective cohort studies remains controversial. A meta-analysis of prospective cohort studies was therefore conducted to address this issue. Methods: Eligible studies were identified by searching the PubMed and EMBASE up to October 2012. Pooled hazard ratios (HR) was calculated by using random effects model. Results: Eleven prospective cohort studies involving a total of 194,796 participants and 11,459 cancer cases were included in this meta-analysis. The pooled HR per natural log unit change in CRP was 1.105 (95% confidence interval (CI): 1.033-1.178) for all-cancer, 1.308 (95% CI: 1.097-1.519) for lung cancer, 1.040 (95% CI: 0.910-1.170) for breast cancer, 1.063 (95% CI: 0.965-1.161) for prostate cancer, and 1.055 (95% CI: 0.925-1.184) for colorectal cancer. Dose-response analysis showed that the exponentiated linear trend for a change of one natural log unit in CRP was 1.012 (95% CI: 1.006-1.018) for all-cancer. No evidence of publication bias was observed. Conclusions: The results of this meta-analysis showed that the elevated levels of CRP are associated with an increased risk of all-cancer, lung cancer, and possibly breast, prostate and colorectal cancer. The result supports a role of chronic inflammation in carcinogenesis. Further research effort should be performed to identify whether CRP, as a marker of inflammation, has a direct role in carcinogenesis.
Objectives : We examined the association between alcohol consumption and incidence of colorectal cancer in elderly Koreans. Methods : The cohort members (n=14,304) consisted of 4,834 males and 9,470 females derived from the Korea Elderly Pharmacoepidemiologic Cohort (KEPEC), a population-based dynamic cohort. They were aged 65 years old or older and lived in Busan between 1993-1998; they were beneficiaries of the Korean Medical Insurance Corporation (KMIC). Baseline information was surveyed by a self-administered, mailed questionnaire. This study population was restricted to 14,304 participants who reported alcohol drinking habits on the questionnaire and had not been diagnosed with colorectal cancer at baseline. The adjusted hazard ratios (aHR) of status, type, frequency and daily average amount of alcohol consumption were computed with Cox's proportional hazard model, with the never-drinkers as a reference group and controlling for age and gender. Results : After 4.82 person-years of mean follow-up 112 cases of colorectal cancer occurred. The incidence densities of colorectal cancer were 161 (95% CI=123-200) for never-drinkers, 219 (95% CI=125-339) for ex-drinkers, and 137 (95% CI=84-189) for current-drinkers per 100,000 person-year. The status, type, frequency, and daily average amount of alcohol consumption were not significantly related to the incidence of colorectal cancer after controlling for age and gender. Conclusions : There was no significant association between alcohol consumption and colorectal cancer among elderly people after controlling for age and gender.
Background: This paper describes the relationship and effect of health examination on personal medical cost by identifying the difference of the cost for medical care in physician visit between the population without and with health examination. Methods: After classifying into three cohorts in which, independent variables were designed according to the Andersen's behavioral model, the association of personal medical cost for medical care and prescription drugs which is dependent variable was analyzed by t-test and Mann-Whitney test for description and gamma regression model for inference. Results: In personal average medical cost, the population with health examination paid significantly more than without health examination, 11.6% more in cohort 2008, 26.6% more in cohort 2009, and 48.0% more in combined cohort. The odds ratio on medical expenditure of outpatients with health examination was 1.067, 1.126, 1.398 significantly in cohort 2008, 2009, and combined cohort respectively, comparing to the group without health examination. In independent variables, that is female, the elderly, never married, non-working, non-metropolitan, the higher family income, the smaller family size, people with disability, the people with chronic disease, and people with health examination have significantly being paid more tendency showing positive association with medical cost. Conclusion: This result showed that medical expenditure in physician visit has been increased after taking a health examination. Therefore reasonable limitation of getting preventive medical service is suggested to avoid medical shopping around and reduce being repeated health examination by unifying control to find out easily the clinical results from various medical facilities.
Background: The purpose of our study was to elucidate the joint effects of combined smoking and alcohol intake on esophageal cancer mortality in Japanese men through a large cohort study with a 20-year follow-up period. Materials and Methods: The Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study) was established in the late 1980s, including 46,395 men and 64,190 women aged 40 years and older and younger than 80. Follow-up of these participants was conducted until 2009. We used the Cox proportional hazards model to analyze data for 42,408 people excluding female participants, 411 people with histories of malignant neoplasms, and 3,576 with unclear smoking and drinking data. Results: The joint effects of age at start of smoking and amount of alcohol consumed per day were compared with non-smokers and non-drinkers or those consuming less than one unit of alcohol per day. The mortality risk was 9.33 (95% confidence interval, 2.55-34.2) for those who started smoking between ages 10 and 19 years and drinking at least three units of alcohol per day. Regarding the joint effects of cumulative amount of smoking and alcohol intake, the risk was high when both smoking and alcohol intake were above a certain level. Conclusions: In this Japanese cohort study, increased cancer mortality risks were observed, especially for people who both started smoking early and drank alcohol. Quitting smoking or not starting to smoke at any age and reducing alcohol consumption are important for preventing esophageal cancer in Japan.
Although multilayer perceptrons (MLPs) present several advantages against other pattern recognition methods, MLP-based speaker verification systems suffer from slow enrollment speed caused by many background speakers to achieve a low verification error. To solve this problem, the quantitative discriminative cohort speakers (QnDCS) method, by introducing the cohort speakers method into the systems, reduced the number of background speakers required to enroll speakers. Although the QnDCS achieved the goal to some extent, the improvement rate for the enrolling speed was still unsatisfactory. To improve the enrolling speed, this paper proposes the qualitative DCS (QlDCS) by introducing a qualitative criterion to select less background speakers. An experiment for both methods is conducted to use the speaker verification system based on MLPs and continuants, and speech database. The results of the experiment show that the proposed QlDCS method enrolls speakers in two times shorter time than the QnDCS does over the online error backpropagation(EBP) method.
Objectives: Outbreaks of scarlet fever in Mexico in 1999, Hong Kong and mainland China in 2011, and England in 2014-2016 have received global attention, and the number of notified cases in Korean children, including in Jeju Province, has also increased since 2010. To identify relevant hypotheses regarding this emerging outbreak, an age-period-cohort (APC) analysis of scarlet fever incidence was conducted among children in Jeju Province, Korea. Methods: This study analyzed data from the nationwide insurance claims database administered by the Korean National Health Insurance Service. The inclusion criteria were children aged ${\leq}14years$ residing in Jeju Province, Korea who received any form of healthcare for scarlet fever from 2002 to 2016. The age and year variables were categorized into 5 groups, respectively. After calculating the crude incidence rate (CIR) for age and calendar year groups, the intrinsic estimator (IE) method was applied to conduct the APC analysis. Results: In total, 2345 cases were identified from 2002 to 2016. Scarlet fever was most common in the 0-2 age group, and boys presented more cases than girls. Since the CIR decreased with age between 2002 and 2016, the age and period effect decreased in all observed years. The IE coefficients suggesting a cohort effect shifted from negative to positive in 2009. Conclusions: The results suggest that the recent outbreak of scarlet fever among children in Jeju Province might be explained through the cohort effect. As children born after 2009 showed a higher risk of scarlet fever, further descriptive epidemiological studies are needed.
Purpose: The aim of this study was to compare the characteristic expression patterns of advanced periodontitis in 2 cohort data sets analyzed using different microarray platforms, and to identify differentially expressed genes (DEGs) through a meta-analysis of both data sets. Methods: Twenty-two patients for cohort 1 and 40 patients for cohort 2 were recruited with the same inclusion criteria. The 2 cohort groups were analyzed using different platforms: Illumina and Agilent. A meta-analysis was performed to increase reliability by removing statistical differences between platforms. An integrative meta-analysis based on an empirical Bayesian methodology (ComBat) was conducted. DEGs for the integrated data sets were identified using the limma package to adjust for age, sex, and platform and compared with the results for cohorts 1 and 2. Clustering and pathway analyses were also performed. Results: This study detected 557 and 246 DEGs in cohorts 1 and 2, respectively, with 146 and 42 significantly enriched gene ontology (GO) terms. Overlapping between cohorts 1 and 2 was present in 59 DEGs and 18 GO terms. However, only 6 genes from the top 30 enriched DEGs overlapped, and there were no overlapping GO terms in the top 30 enriched pathways. The integrative meta-analysis detected 34 DEGs, of which 10 overlapped in all the integrated data sets of cohorts 1 and 2. Conclusions: The characteristic expression pattern differed between periodontitis and the healthy periodontium, but the consistency between the data sets from different cohorts and metadata was too low to suggest specific biomarkers for identifying periodontitis.
The KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) was launched in 2011 with the support of the Korea Disease Control and Prevention Agency. The study was designed with the aim of exploring the various clinical features and characteristics of chronic kidney disease (CKD) in Koreans, and elucidating the risk factors for CKD progression and adverse outcomes of CKD. For the cohort study, nephrologists at 9 tertiary university-affiliated hospitals participated in patient recruitment and follow-up. Biostatisticians and epidemiologists also participated in the basic design and structuring of the study. From 2011 until 2016, the KNOW-CKD Phase I recruited 2238 adult patients with CKD from stages G1 to G5, who were not receiving renal replacement therapy. The KNOW-CKD Phase II recruitment was started in 2019, with an enrollment target of 1500 subjects, focused on diabetic nephropathy and hypertensive kidney diseases in patients with reduced kidney function who are presumed to be at a higher risk of adverse outcomes. As of 2021, the KNOW-CKD investigators have published articles in the fields of socioeconomics, quality of life, nutrition, physical activity, renal progression, cardiovascular disease and outcomes, anemia, mineral bone disease, serum and urine biomarkers, and international and inter-ethnic comparisons. The KNOW-CKD researchers will elaborate a prediction model for various outcomes of CKD such as the development of end-stage kidney disease, major adverse cardiovascular events, and death.
Oh, Minkyung;Ju, Hyunjung;Yoon, Bo Young;Lee, Jong-Tae
Korean Medical Education Review
/
v.24
no.3
/
pp.250-260
/
2022
Evaluating the effectiveness of educational programs involves measuring learning processes as well as outcomes. It is essential to study cohorts of students and graduates to evaluate the long-term effects of educational programs with data generated both during education and after graduation. The purpose of this study was to establish cohorts of students and graduates to evaluate their performance, thereby providing a basis for evaluating the social accountability of medical education. In this study, student and graduate cohorts were built for both students currently enrolled and graduates at Inje University College of Medicine (IUCM). A model involving the process of cohort establishment and an evaluation indicator framework was developed. In the process of cohort establishment, the following steps were conducted: defining the goals and objectives of the student and graduate cohorts, organizing a cohort committee, developing regulations, registering cohorts, acquiring consent, and building a database. A framework of evaluation indicators according to the graduate roles of IUCM was developed by adapting Kirkpatrick's evaluation model. Next, items to be collected in student and graduate cohorts were selected, and the current status of existing data was analyzed. Moreover, a preliminary analysis was conducted, including analyses of the evaluation indicators and graduates' performance. This study suggests that it is necessary to include additional evaluation indicators considering students' learning environment and well-being in student cohorts and to develop strategies or methods for graduates to continue participating in data collection for a long-term study.
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