• 의학교육논단
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• 제25권2호
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• pp.102-108
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• 2023

This study shares details on the operating process and results of the cohort of students and graduates that was designed and implemented at Konyang University College of Medicine in Daejeon and discusses future directions for cohort establishment and improvement. First, Konyang University College of Medicine established the necessity and defined the purpose of cohort design and implementation. A task force was formed to establish guidelines for analysis targets, procedures, reports, and data management, and cohort operation was classified as a quality control activity. Data were collected through surveys of current students and graduates, and data generated during the curriculum were collected, analyzed, and reported every 2 years. The cohort data collection and analysis methods are designed by the Department of Medical Education, and data collection is carried out by the administrative team and each committee. Data management and analysis are handled by the Center for Medical Education Support, and analysis and reporting are conducted by the Department of Medical Education. Various members of the medical school are working to collect and analyze data, report findings, provide feedback, and improve. In the future, we plan to advance database computerization and work toward more effective data analysis. Cohort operation should not be another burden for medical schools; instead, it is hoped that operating cohorts will be a meaningful activity to increase the effectiveness of medical education and help in the operation and policy decisions of medical schools.

• 한국임상약학회지
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• 제29권3호
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• pp.147-155
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• 2019

Objectives: The purpose of this study was to investigate the association between fracture risk and proton pump inhibitor (PPI) use to establish evidence for defining high-risk groups of fracture among PPI users. Methods: A case-control study was performed using the National Health Insurance Sample Cohort Database from January 2002 to December 2013. The cases included all incidences of major fractures identified from January 2011 to December 2013, and up to four controls were matched to each case by age, gender, osteoporosis, and Charlson comorbidity index. Conditional logistic regression was used to calculate the adjusted odds ratio (aOR) and associated 95% confidence interval (CI). Results: Overall, 14,295 cases were identified, and 63,435 controls were matched to the cases. The aOR of fractures related to the use of PPIs was 1.06 (95% CI: 1.01-1.11). There was a statistically significant association between fracture and PPI use within 3 months of the last dose, and a trend of increasing fracture risk with increasing cumulative PPI dose. The risk of fracture was significantly higher in patients who took PPIs for more than 1 year during the 2-year observation period. Conclusion: Patients who have been using PPIs for more than 1 year should be warned about the risk of fracture during or at least 3 months after discontinuing the PPI.

• 의학교육논단
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• 제25권2호
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• pp.84-101
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• 2023

Longitudinal data can provide important evidence with the potential to stimulate innovation and affect policies in medical education and can serve as a driving force for further developments in medical education through evidence-based decisions. Tracking and observing cohorts of students and graduates using longitudinal data can be a way to link the past, present, and future of medical education. This study reviewed practical methods and technical, administrative, and ethical considerations for the establishment and operation of a longitudinal database and presented examples of longitudinal databases. Cohort study design methods and previous examples of research using longitudinal databases to explore major topics in medical education were also reviewed. The implications of this study are as follows: (1) a systematic design process is required to establish longitudinal data, and each university should engage in ongoing deliberation about this issue; (2) efforts are needed to alleviate "survey fatigue" among respondents and reduce the administrative burden of those conducting data collection and analysis; (3) it is necessary to regularly review issues of personal information protection, data security, and ethics regarding the survey respondents; and (4) a system should be established that integrates and manages a longitudinal database of medical education at the national level. The hope is that establishing longitudinal data and cohorts at individual medical schools will not be a temporary phenomenon, but rather that they will be well utilized at the national level to innovate and implement ongoing changes in medical education.

• Hip & pelvis
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• 제34권3호
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• pp.150-160
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• 2022

Purpose: The purpose of this study is to determine risk factors that affect mortality following osteoporotic hip fracture in patients 50 years or older using the National Health Insurance Service (NHIS) sample cohort 2.0 database. Materials and Methods: Data from 2,533 patients who satisfied the inclusion criteria for the NHIS sample cohort 2.0 database were used in this study. Data from patients who suffered osteoporotic hip fractures between 2002-2015 were used. An analysis of correlations between the incidence of osteoporotic hip fractures and various factors (sex, age, underlying diseases, etc.) was performed. Analysis of the associations between the mortality of osteoporotic hip fracture and the various factors with hazard ratio (HR) was performed using Cox regression models. Results: Patient observation continued for an average of 38.12±32.09 months. During the observation period, a higher incidence of hip fracture was observed in women; however, higher mortality following the fracture was observed in men (HR=0.728; 95% confidence interval [CI], 0.635-0.836). The incidence and mortality of fractures increased when there were increasing age, more than three underlying diseases (HR=1.945; 95% CI, 1.284-2.945), cerebrovascular diseases (HR=1.429; 95% CI, 1.232-1.657), and renal diseases (HR=1.248; 95% CI, 1.040-1.497). Also, higher mortality was observed in patients who were underweight (HR=1.342; 95% CI, 1.079-1.669), current smokers (HR=1.338; 95% CI, 1.104-1.621), and inactivity (HR=1.379; 95% CI, 1.189-1.601). Conclusion: Male gender, the presence of cerebrovascular or kidney disease, a more than three underlying diseases, underweight, a current smoker, and inactivity were risk factors that increased mortality.

• 대한치과보철학회지
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• 제58권3호
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• pp.193-200
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• 2020

목적: 대규모 인구집단데이터를 사용하여 양측 또는 편측 완전 무치악 여부와 치매와의 관련성에 대하여 알아본다. 재료 및 방법: 만 60세 이상을 대상으로 구축된 건강보험공단 노인 코호트 데이터베이스를 사용하여 후향적 코호트 연구를 설계하였다. 실험군은 완전 무치악 코호트로 2012년 7월 1일부터 2013년 12월 31일 까지 1개 이상의 상악 또는 하악 레진상 완전의치 보험 처방 이력이 있는 사람을 대상으로 하였고, 대조군은 유치악 코호트로 같은 기간 동안 잔존치아에 대한 보존적 치아 처치 이력이 있는 사람을 대상으로 하였다. 모든 대상자들은 이 기간 동안 치매로 진단 또는 치료 받은 기록이 없었다. 성향점수매칭법에 따라 연령과 성별, 그리고 거주지역을 고려하여 실험군과 대조군을 1:1 동수로 매칭하였고, 두 코호트 집단간 2년 동안 치매로 이환된 비율을 비교하였다. 결과: 실험군과 대조군을 비교했을 때, 실험군인 양측 또는 편측 완전 무치악 환자에서 치매 발병률(12.13%)은 대조군인 유치악 환자의 치매 발병률(9.74%) 보다 유의미하게 높다는 것을 확인할 수 있었다 (P < .05). 다른 요인들과 치매와의 명확한 관련성은 확인되지 않았다. 결론: 대규모 인구집단데이터 분석을 통해 양측 또는 편측 완전 무치악 환자에서 치매 발병률이 높다는 것을 확인할 수 있었다.

• 의학교육논단
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• 제25권2호
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• pp.132-138
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• 2023

Cohorts are established and operated at medical schools as part of efforts to improve the quality of education. Chosun University College of Medicine clarified the purpose of establishing three cohorts in light of its core values and developed criteria and indicators for each purpose. An organization focusing on cohort construction and operation was established as the Cohort Committee under the Quality Improvement Committee, and guidelines were proposed. In addition, a database and system were developed to handle primary data efficiently, and tools for measuring psychological variables were created. The data collected by establishing a cohort, regions, and admission types of graduates were first analyzed for the following projects: (1) an analysis of the educational process and quality improvement to educate medical professionals who contribute to the community after graduation, and (2) an analysis of the educational process and quality improvement to secure excellence in the medical field (e.g., knowledge and clinical reasoning), using information on the academic achievements of students and graduates as primary data. Chosun University College of Medicine is conducting cohorts and longitudinal studies gradually, starting with a simple, practically feasible system to solve the difficulties faced in cohort establishment and operation. Medical educators hope that future data collection and analysis will improve the quality of medical school education and have practical implications.

• Environmental Analysis Health and Toxicology
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• 제30권
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• pp.10.1-10.14
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• 2015

Recent cohort studies have relied on exposure prediction models to estimate individual-level air pollution concentrations because individual air pollution measurements are not available for cohort locations. For such prediction models, geographic variables related to pollution sources are important inputs. We demonstrated the computation process of geographic variables mostly recorded in 2010 at regulatory air pollution monitoring sites in South Korea. On the basis of previous studies, we finalized a list of 313 geographic variables related to air pollution sources in eight categories including traffic, demographic characteristics, land use, transportation facilities, physical geography, emissions, vegetation, and altitude. We then obtained data from different sources such as the Statistics Geographic Information Service and Korean Transport Database. After integrating all available data to a single database by matching coordinate systems and converting non-spatial data to spatial data, we computed geographic variables at 294 regulatory monitoring sites in South Korea. The data integration and variable computation were performed by using ArcGIS version 10.2 (ESRI Inc., Redlands, CA, USA). For traffic, we computed the distances to the nearest roads and the sums of road lengths within different sizes of circular buffers. In addition, we calculated the numbers of residents, households, housing buildings, companies, and employees within the buffers. The percentages of areas for different types of land use compared to total areas were calculated within the buffers. For transportation facilities and physical geography, we computed the distances to the closest public transportation depots and the boundary lines. The vegetation index and altitude were estimated at a given location by using satellite data. The summary statistics of geographic variables in Seoul across monitoring sites showed different patterns between urban background and urban roadside sites. This study provided practical knowledge on the computation process of geographic variables in South Korea, which will improve air pollution prediction models and contribute to subsequent health analyses.

• Journal of Periodontal and Implant Science
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• 제50권5호
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• pp.303-312
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• 2020

Purpose: The purpose of this study was to evaluate severe periodontitis with tooth loss as a modifiable risk factor for Alzheimer dementia (AD), vascular dementia (VaD), and mixed dementia (MD) using the National Health Insurance Service-National Health Screening Retrospective Cohort database with long-term follow-up over 14 years. Methods: Multivariate Cox hazards regression analysis was applied to a longitudinal retrospective database, which was updated in 2018, to evaluate the association between severe periodontitis with few remaining teeth and dementia after adjusting for potential risk factors, including sociodemographic factors and comorbid diseases. Results: Among 514,866 individuals in South Korea, 237,940 (46.2%) participants satisfying the inclusion criteria were selected. A total of 10,115 age- and sex-matched participants with severe periodontitis and 10,115 periodontally healthy participants were randomly selected and evenly assigned. The results showed that the risks of AD (hazard ratio [HR], 1.08), VaD (HR, 1.24), and MD (HR, 1.16) were significantly higher in patients with severe periodontitis with 1-9 remaining teeth after adjustment for sociodemographic factors, anthropomorphic measurements, lifestyle factors, and comorbidities. Conclusions: Severe periodontitis with few remaining teeth (1-9) may be considered a modifiable risk factor for the development of AD, VaD, and MD in Korean adults.

• 대한예방한의학회지
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• 제25권3호
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• pp.25-37
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• 2021

Objectives : To investigate the effectiveness of Korean Medicine services use on the all-cause mortality and incidence of Parkinson's disease(PD) in elderly patients with chronic disease based on the National Health Insurance Service Corhort Database (elderly), called as the NHIS-senior. Methods : This study was a retrospective cohort analysis conducted using the NHIS-senior. Patients with chronic diseases over 65 years old who were not diagnosed PD during 2007-2009 were identified. The case group was defined as patients who used both Korean Medicine and Western Medicine services and the control group consisted of patients who used Western Medicine service only. The all-cause mortality and incidence of PD was analyzed using the Cox proportional hazard model after a propensity score matching(PSM) with a 1:1 ratio. Results : After PSM, the cohort included 47,546 subjects (23,773 in the case group, 23,773 in the control group). Sex, age, comorbidity, severity of disability, and neurology medical service utilization were adjusted in both groups. The mortality was 0.668 times (95% C.I.: 0.646-0.690) lower in the case group than the control group, which was statistically significant (p<0.001). The incidence of PD was 1.051 times (95% C.I.: 0.962-1.148) higher in the case group than the control group, which was not statistically significant(p=0.272). Conclusion : It was not obvious that the use of both Korean Medicine service and Western Medicine services for prevention of PD is benefitial than using only Western Medicine. But it would be possible that using both Korean Medicine and Western Medicine services decreases the mortality than using Western Medicine alone.

• Korean Journal of Radiology
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• 제24권4호
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• pp.274-283
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• 2023

Objective: To compare the outcomes of digital breast tomosynthesis (DBT) screening combined with ultrasound (US) with those of digital mammography (DM) combined with US in women with dense breasts. Materials and Methods: A retrospective database search identified consecutive asymptomatic women with dense breasts who underwent breast cancer screening with DBT or DM and whole-breast US simultaneously between June 2016 and July 2019. Women who underwent DBT + US (DBT cohort) and DM + US (DM cohort) were matched using 1:2 ratio according to mammographic density, age, menopausal status, hormone replacement therapy, and a family history of breast cancer. The cancer detection rate (CDR) per 1000 screening examinations, abnormal interpretation rate (AIR), sensitivity, and specificity were compared. Results: A total of 863 women in the DBT cohort were matched with 1726 women in the DM cohort (median age, 53 years; interquartile range, 40-78 years) and 26 breast cancers (9 in the DBT cohort and 17 in the DM cohort) were identified. The DBT and DM cohorts showed comparable CDR (10.4 [9 of 863; 95% confidence interval {CI}: 4.8-19.7] vs. 9.8 [17 of 1726; 95% CI: 5.7-15.7] per 1000 examinations, respectively; P = 0.889). DBT cohort showed a higher AIR than the DM cohort (31.6% [273 of 863; 95% CI: 28.5%-34.9%] vs. 22.4% [387 of 1726; 95% CI: 20.5%-24.5%]; P < 0.001). The sensitivity for both cohorts was 100%. In women with negative findings on DBT or DM, supplemental US yielded similar CDRs in both DBT and DM cohorts (4.0 vs. 3.3 per 1000 examinations, respectively; P = 0.803) and higher AIR in the DBT cohort (24.8% [188 of 758; 95% CI: 21.8%-28.0%] vs. 16.9% [257 of 1516; 95% CI: 15.1%-18.9%; P < 0.001). Conclusion: DBT screening combined with US showed comparable CDR but lower specificity than DM screening combined with US in women with dense breasts.