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Associations between income and survival in cholangiocarcinoma: A comprehensive subtype-based analysis

  • Calvin X. Geng;Anuragh R. Gudur;Jagannath Kadiyala;Daniel S. Strand;Vanessa M. Shami;Andrew Y. Wang;Alexander Podboy;Tri M. Le;Matthew Reilley;Victor Zaydfudim;Ross C. D. Buerlein
    • Annals of Hepato-Biliary-Pancreatic Surgery
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    • v.28 no.2
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    • pp.144-154
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    • 2024
  • Backgrounds/Aims: Socioeconomic determinants of health are incompletely characterized in cholangiocarcinoma (CCA). We assessed how socioeconomic status influences initial treatment decisions and survival outcomes in patients with CCA, additionally performing multiple sub-analyses based on anatomic location of the primary tumor. Methods: Observational study using the 2018 submission of the Surveillance, Epidemiology, and End Results (SEER)-18 Database. In total, 5,476 patients from 2004-2015 with a CCA were separated based on median household income (MHI) into low income (< 25th percentile of MHI) and high income (> 25th percentile of MHI) groups. Seventy-three percent of patients had complete follow up data, and were included in survival analyses. Survival and treatment outcomes were calculated using R-studio. Results: When all cases of CCA were included, the high-income group was more likely than the low-income to receive surgery, chemotherapy, and local tumor destruction modalities. Initial treatment modality based on income differed significantly between tumor locations. Patients of lower income had higher overall and cancer-specific mortality at 2 and 5 years. Non-cancer mortality was similar between the groups. Survival differences identified in the overall cohort were maintained in the intrahepatic CCA subgroup. No differences between income groups were noted in cancer-specific or overall mortality for perihilar tumors, with variable differences in the distal cohort. Conclusions: Lower income was associated with higher rates of cancer-specific mortality and lower rates of surgical resection in CCA. There were significant differences in treatment selection and outcomes between intrahepatic, perihilar, and distal tumors. Population-based strategies aimed at identifying possible etiologies for these disparities are paramount to improving patient outcomes.

The Effect of Grit on Resilience: Multigroup Analysis of Elementary Gifted and Non-Gifted Students in Science (그릿이 회복탄력성에 미치는 영향: 초등 과학영재와 일반학생의 다집단 분석)

  • Kim, Nam Hoon;Yeo, Sang-Ihn
    • Journal of Korean Elementary Science Education
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    • v.43 no.3
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    • pp.365-384
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    • 2024
  • The purpose of this study was to determine the effect of grit on the resilience of elementary science gifted and general students in their daily lives, and to identify the differences between science gifted students in university gifted centers and elementary school gifted classes and normal students. The grit and resilience test was administered to 154 scientifically gifted students and 98 non-gifted students. Based on the collected data, descriptive statistical analysis, measurement model analysis, and multigroup structural model analysis were conducted. The results of the study were as follows: First, across all sub-factors of grit and resilience, the gifted students showed significantly higher levels of resilience than non-gifted students. Second, the path from making perseverance of effort in grit to resilience showed a positive effect, while the path from consistency of interest in grit to resilience showed a negative effect. Third, in all groups, including regular classes, the school for gifted, and the university-affiliated gifted students, the perseverance of effort in grit exhibited a positive effect on resilience, and the consistency of interest in grit showed a negative effect on interpersonal relationship skills in resilience for both the non-gifted and the gifted students. Lastly, gifted students showed a significant difference in the path from perseverance of effort in grit to the sub-factors of resilience, whereas non-gifted students did not.

An Analysis of Determinants of Health Knowledge, Attitude and Practice of Housewives in Korea (한국부인의 보건지식, 태도 및 실천에 영향을 미치는 제요인분석)

  • 남철현
    • Korean Journal of Health Education and Promotion
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    • v.2 no.1
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    • pp.3-50
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    • 1984
  • The levels of health knowledge, attitude and practice of housewives considerably effect to the health of households, communities and the nation. This study was designed to grasp the levels of health knowledge, attitude and practice of houswives and analyse the various factors effecting to health in order to provide health education services as well as materials for effective formulation and implementation of health policy to improve the health of the nation. This study has been conducted through interviews by trained surveyers for 4,281 housewives selected from 4,500 households throughout the country for 40 days during July 11-August 20, 1983. The results of survey were analysed by stepwise multiple regression and path analysis are summarized as follows; 1. Based on the measurement instrument applied to this study, the levels of health knowledge, attitude and practice of housewives were extremely low with 54.5 points out of 100 points in full. Higher level with 72 points and above was approximately 21 percent and lower level with 39 points and below was approx. 24 percent. The middle level was approx. 55 percent. In order to implement health programs successively, health education should be more strengthened and to improve the level of health knowledge, attitude and practice (KAP) of the nation, political consideration as a part of spiritual reformation must be concentrated on health. 2. The level of health knowledge indicated the highest points with 57.3 the level of attitude was the second with 55.0 points and the practice level was the lowest with 50.0 point. Therefore, planning and implementation of health education program must be based on the persuasion and motivation that health knowledge turn into practice. 3. Housewives who had higher level of health knowledge, showed their practice level was relatively lower and those who had middle or low level of it practice level was the reverse. 4. Correlations among health knowledge, attitude and practice (KAP) were generally higher and statistically significant at 0.1 percent level. Correlation between total health KAP level and health knowledge was the highest with r=.8092. 5. Health KAP levels showed significant differences according to the age, number of children, marital status, self-assessed health status and concern on health of the housewives interviewed (p<0.001) 6. Health KAP levels also showed significant differences according to the education level, economic status, employment before marriage and grown-up area of the housewives interviewed. (p<0.001) 7. Heath KAP levels showed significant differences according to health insurance benificiary and the existence of patients in the family. (p<0.001). 8. Health KAP levels showed significant differences according to distance to government organizations, schools, distance to health facilities, telephone possession rate, television possession rate, newspaper reading rate and activities of Ban meeting and Women's club. (p<0.001) 9. Health KAP levels showed significant differences according to electric mass communication media such as television, radio and village broadcasting etc. and printed media such as newspaper, magazine and booklets etc., IEC variables such as individual consultation and husband-wife communication, however, there was no significance with group training. 10. Health KAP of the housewives showed close correlation with personal characteristics variables, i.e., education level (r=.5302), age (r=-.3694) grown-up area (r=.3357) and employment before marriage. In general, correlation of health knowledge level was higher than the levels of attitude or practice. In case of health concern and health insurance, correlation of practice level was higher than health knowledge level. 11. Health KAP levels showed higher correlation with community environmental characteristics, Ban meeting and activity of Women's club, however, no correlation with New-village movement. 12. Among IEC variables, husband-wife communication showed the highest correlation with health KAP levels and printed media, electric mas communication media and health consultation in order. Therefore, encouragement of husband-wife communication and development of training program for men should be included in health education program. 13. Mass media such as electric mass com. and printed media were effective for knowledge transmission and husband-wife communication and individual consultation were effective for health practice. Group training was significant for knowledge transmission, however, but not significant for attitude formation or turning to health practice. To improve health KAP levels, health knowledge should be transmitted via mass media and health consultation with health professionals and field health workers should be strengthened. 14. Correlation of health KAP levels showed that knowledge level was generally higher than that of practice and recognized that knowledge was not linked with attitude or practice. 15. The twenty-five variables effecting health KAP levels of housewives had 41 per cent explanation variances among which education level had great contribution (β=.2309) and electric mass com. media (β=.1778), husband-wife communication (β=.1482), printed media, grown-up area, and distance to government organizations in order. Variances explained (R²) of health KAP were 31%, 15%, and 30% respectively. 16. Principal variables contributed to health KAP were education level (β=.12320, β=.1465), electric mass comm. media (β=.1762, β=.1839), printed media, (β=.1383, β=.1420) husband-wife communication (β=.1004, β=.1067), grown-up area and distance to government organizations, in order. Since education level contributes greatly to health KAP of the housewives, health education including curriculum development in primary, middle and high schools must be emphasized and health science must be selected as one of the basic liberal arts subject in universities. 17. Variences explained of IEC variables to health KAP were 19% in total, 14% in knowledge, 9% in attitude, and 10% in health practice. Contributions of IEC variables to health KAP levels were printed media (β=.3882), electric mass comm media (β=.3165), husb-band wife com. (β=.2095,) and consultation on health (β=.0841) in order, however, group training showed negative effect (β=-.0402). National fund must be invested for the development of Health Program through mass media such as TV and radio etc. and for printed materials such as newspaper, magazines, phamplet etc. needed for transmission of health knowledge. 18. Variables contributed to health KAP levels through IEC variables with indirect effects were education level (Ind E=0.0410), health concern (Ind E=.0161), newspaper reading rate (Ind E=.0137), TV possession rate and activity of Ban meeting in order, however, health facility showed negative effect (Ind E=-.0232) and other variables showed direct effect but not indirect effect. 19. Among the variables effecting health KAP level, education level showed the highest in total effect (TE=.2693) then IEC (TE=.1972), grown-up city (TE=.1237), newspaper reading rate (TE=.1020), distance to government organization (TE=.095) in order. 20. Variables indicating indirect effects to health KAP levels were; at knowledge level with R²=30%, education level (Ind E=.0344), newspaper reading rate (Ind E=.0112), TV possession rate (Ind E=.0689), activity of Ban meeting (Ind E=.0079) in order and at attitude level with R²=13%, education level (Ind E=. 0338), activity of Ban meeting (Ind E=.0079), and at practice level with R²=29%. education level (Ind E=.0268), health facility (Ind E=.0830) and concern on health (Ind E=.0105). 21. Total effect to health KAP levels and IEC by variable characteristics, personal characteristics variables indicated larger than community characteristics variables. 22. Multiple Correlation Coefficient (MCC) expressed by the Personal Characteristic Variable was .5049 and explained approximately 25% of variances. MCC expressed by total Community environment variable was .4283 and explained approx. 18% of variances. MCC expressed by IEC Variables was .4380 and explained approx. 19% of variances. The most important variable effected to health KAP levels was personal characteristic and then IEC variable, Community Environment variable in order. When the IEC effected with personal characteristic or community characteristic, the MCC or the variances were relatively higher than effecting alone. Therefore it was identified that the IEC was one of the important intermediate variable.

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Effect of water storage on the fracture toughness of dental resin cement used for zirconia restoration (수분이 지르코니아 수복물 전용 레진시멘트의 파괴인성에 미치는 영향에 관한 연구)

  • Goo, Bon-Wook;Kim, Sung-Hun;Lee, Jai-Bong;Han, Jung-Suk;Yeo, In-Sung;Ha, Seung-Ryong;Kim, Hee-Kyung
    • The Journal of Korean Academy of Prosthodontics
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    • v.52 no.4
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    • pp.312-316
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    • 2014
  • Purpose: The aim of this study was to compare the fracture toughness of currently available resin cements for zirconia restorations and evaluate the effect of water storage on fracture toughness of those resin cements. Materials and methods: Single-edge notched specimens ($3mm{\times}6mm{\times}25mm$) were prepared from three currently available dual cure resin cements for zirconia restorations (Panavia F 2.0, Clearfil SA luting and Zirconite). Each resin cement was divided into four groups: immersed in distilled water at $37^{\circ}C$ for 1 (Control group), 30, 90, or 180 days (n=5). Specimens were loaded in three point bending at a cross-head speed of 0.1 mm/s. The maximum load at specimen failure was recorded and the fracture toughness ($K_{IC}$) was calculated. Data were analyzed using one-way ANOVA and multiple comparison $Scheff{\acute{e}}$ test (${\alpha}$=.05). Results: In control group, the mean $K_{IC}$ was $3.41{\pm}0.64MN{\cdot}m^{-1.5}$ for Panavia F, 2.0, $3.07{\pm}0.41MN{\cdot}m^{-1.5}$ for Zirconite, $2.58{\pm}0.30MN{\cdot}m^{-1.5}$ for Clearfil SA luting respectively, but statistical analysis revealed no significant difference between them. Although a gradual decrease of $K_{IC}$ in Panavia F 2.0 and gradual increases of KIC in Clearfil SA luting and Zirconite were observed with storage time, there were no significant differences between immersion time for each cement. Conclusion: The resin cements for zirconia restorations exhibit much higher $K_{IC}$ values than conventional resin cements. The fracture toughness of resin cement for zirconia restoration would not be affected by water storage.

The Prognostic Role of B-type Natriuretic Peptide in Acute Exacerbation of Chronic Obstructive Pulmonary Disease (만성폐쇄성폐질환의 급성 악화시 예후 인자로서의 혈중 B-type Natriuretic Peptide의 역할)

  • Lee, Ji Hyun;Oh, So Yeon;Hwang, Iljun;Kim, Okjun;Kim, Hyun Kuk;Kim, Eun Kyung;Lee, Ji-Hyun
    • Tuberculosis and Respiratory Diseases
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    • v.56 no.6
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    • pp.600-610
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    • 2004
  • Background : The plasma B-type natriuretic peptide(BNP) concentration increases with the degree of pulmonary hypertension in patients with chronic respiratory disease. The aim of this study was to examine the prognostic role of BNP in the acute exacerbation of chronic obstructive lung disease (COPD). Method : We selected 67 patients who were admitted our hospital because of an acute exacerbation of COPD. Their BNP levels were checked on admission at the Emergency Department. Their medical records were analyzed retrospectively. The patients were divided into two groups according to their in-hospital mortality. The patients' medical history, comobidity, exacerbation type, blood gas analysis, pulmonary function, APACHE II severity score and plasma BNP level were compared. Results : Multiple logistic regression analysis identified three independent predictors of mortality: $FEV_1$, APACHE II score and plasma BNP level. The decedents group showed a lower $FEV_1$($28{\pm}7$ vs. $37{\pm}15%$, p=0.005), a higher APACHE II score($22.4{\pm}6.1$ vs. $15.8{\pm}4.7$, p=0.000) and a higher BNP level ($201{\pm}116$ vs. $77{\pm}80pg/mL$, p=0.000) than the sSurvivors group. When the BNP cut-off level was set to 88pg/mL using the receiver operating characteristic curve, the sensitivity was 90% and the specificity was 75% in differentiating between the survivors and decedents. On Fisher's exact test, the odds ratio for mortality was 21.2 (95% CI 2.49 to 180.4) in the patients with a BNP level > 88pg/mL. Conclusion : The plasma BNP level might be a predictor of mortality in an acute exacerbation of COPD as well as the $FEV_1$ and APACHE II score.

Relationships between Dietary Behaviors with Smoking, Drinking Situations and Subjective Health Status of University Students (대학생의 식행동, 흡연, 음주실태와 주관적 건강상태와의 관련성)

  • Kwon, Soo-Jin;Kang, Ji-Hea;Kim, Na-Jung;Kim, Rye-Jin;Kim, Suhn-young;Kim, Si-Il;Han, Gyeong-Soon
    • Journal of dental hygiene science
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    • v.12 no.2
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    • pp.145-153
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    • 2012
  • This study aims at investigate dietary behaviors, smoking and drinking status of university students depending on their gender and residential patterns, and analyzing relationships with their subjective health status. The subjects of this study was 538 university students in Metropolitan areas from May 10-31, 2010. Data were analyzed with chi-square test, fisher's exact test, t-test and stepwise multiple regression SPSS 12.0. Male students higher frequency on the intake of eggs, meats and carbonated drinks than female students. The group residing at one's own house showed higher frequency on the intake of beans, fruits and milk than the self-boarding group or other groups(p<0.05), while preferring sweet taste the most. Male students were significantly higher than female students in the amount of smoking and drinking(p<0.05). They had positive recognition on their health conditions as they have higher frequency on the intake of potatoes, seaweeds, green tea and milk with less frequency on the intake of eggs, fast foods and drinking amount. Accordingly, it was considered necessary to have continuous education on nutrition and social supports to prevent their dietary behaviors from leaning on convenience or preference.

Prevalence and Risk Factors of Gallstones in Adult Health Screening Population (건강한 성인의 담석 유병률과 위험인자)

  • Lee, Mi-Hwa;Kwon, Duck-Moon;Cho, Pyong-Kon
    • Journal of radiological science and technology
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    • v.37 no.4
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    • pp.287-294
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    • 2014
  • Gallstone is the most common disease of the biliary system. Korean has experienced an increase in the percentage of cholesterol gallstones. The major risk factors associated with cholesterol gallstones are age, gender as well as obesity. This study was designed to determine the prevalence of gallstones in the last three years and evaluate the associated risk factors in the population who underwent health screening. The study population consisted of 2,484 males and 2,212 females who visited the health promotion center in Dalseogu, Daegu in Korea from January 2011 to December 2013. Each participant in the study had their biliary system gallbladder examined using ultrasonography. Classified as underweight, normal weight or overweight using the population of obese according to the body mass index, and classified according to mood diagnosis of diabetes presented by the American Diabetes Association. Fasting blood glucose and number of liver function, the divided the control group by referring to the normal liver function values used herein. The geological map, I was classified as NCEP APT III. A showed of total 148 people were found to have gallstones. The prevalence of sex among 148 patients (3.15%) 84 men (1.79%) and 64 women 1.36%) which shows significantly there is little difference. 1.84% 40 years and below, 3.38% 40's showed age prevalence was 4.66% in 50's and above. In addition, Total-cholesterol was at the most in 52 people, LDL-cholesterol in 398 people, Triglyceride in 36 people, HDL-cholesterol in 19 people. The abnormal group, was created from the total-cholesterol categories from a physical examination of a subject that has been found to be gallstones in the gallbladder. A result of conducting the univariate analysis shows the prevalence of gallstones, a correlation that is meaningful. The logistic regression analysis of multiple ages was chosen to show risk factors age independent cholelithiasis. In spite of the conclusion, gallstones are not displayed in relation to the metabolic syndrome but in order to clarify this, not only the subject of a health examination is needed but, a further study of the general public when possible.

The Usefulness of Spot Urine Protein/Creatinine Ratio in Evaluating Proteinuria in Children and the Correlation between 24-hour Urinary Protein Amount and Spot Urine Protein/Creatinine Ratio (소아 단백뇨 검사에 있어서 단회뇨 단백/크레아티닌 비의 유용성 및 일일 요단백량과의 연관성)

  • Hong, Seon Young;Kim, Ji Young;Chung, Woo Yeong
    • Clinical and Experimental Pediatrics
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    • v.46 no.2
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    • pp.173-177
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    • 2003
  • Purpose : Recently, different results about factors affecting accurate quantitation of 24-hr urinary protein(24UP) amount using spot urine protein/creatinine ratio(PCR) have been reported. The current study was designed to evaluate correlation between 24UP amounts and PCR in children, and the effect of 24UP amounts, age, sex, and glomerular filtration rate(GFR) on this correlation. Methods : Among 94 patients who visited the department of pediatrics in Busan Paik Hospital from March 2002 to August 2002, 68 patients whose urinary creatinine excretion was ${\geq}15mg/kg/day$ were included in this study. All the patients were divided into I, II/A, B group(I : 24UP<500 mg/day, II : $24UP{\geq}500mg/day$, A : <10 years of age, B : ${\geq}10years$ of age). Pearson correlation analysis was performed between 24UP and PCR to evaluate the relationship. We defined fractional difference between 24UP and PCR, and then performed multiple regression analysis with 24UP amount, age, GFR and fractional difference. Results : There was a strong positive linear correlation between 24UP and PCR(R=0.936, P<0.0001) in all patients, and the correlation was also good in each group. Using PCR cutoff values of 0.5, the PCR provided high sensitivity, specificity, positive and negative predictive value in predicting 24UP amount ${\geq}500mg$. The factors affecting accurate quantitation of proteinuria using spot urine PCR was age, not 24UP amount, GFR or sex. Conclusion : Spot urine PCR is a useful test but has limitations in predicting 24UP amount. Therefore, it should be used only as screening method. Age-adjusted PCR cutoff values may be necessary to predict 24UP amount in children with proteinuria.

Identification of Characteristics and Risk Factors Associated with Mortality in Hydrops Fetalis (태아수종의 특성 및 사망률과 연관된 위험인자)

  • Ko, Hoon;Lee, Byong-Sop;Kim, Ki-Soo;Won, Hye-Sung;Lee, Pil-Ryang;Shim, Jae-Yoon;Kim, Ahm;Kim, Ai-Rhan
    • Neonatal Medicine
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    • v.18 no.2
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    • pp.221-227
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    • 2011
  • Purpose: The objectives were to identify the characteristics of neonates with hydrops fetalis, and to identify the risk factors associated with mortality. Methods: A retrospective review of AMC (Asan Medical Center) dataset was performed from January 1990 to June 2009. The characteristics of 71 patients with hydrops fetalis were investigated and they were divided into two groups: the survived group and the expired group. Various perinatal and neonatal factors in two groups were compared to find out risk factors associated with mortality based on univariate analysis, followed by multiple regression analyses (SPSS version 18.0). Results: Of those 71 neonates (average gestational age: 33 weeks, birth weight: 2.6 kg), 38 survived, 33 died, resulting in overall mortality rate of 46.5%. The most common etiology was idiopathic followed by chylothorax, cardiac anomalies, twin-to-twin transfusion, meconium peritonitis, cardiac arrythmias, and congenital infections. Factors that were associated independently with mortality in logistic regression analyses were low 5-minutes Apgar score, hyaline membrane disease and delayed in achieving 50th percentile ideal body weight for appropriate gestational age by 10 days. Conclusion: In this study, 5-minutes Apgar score, hyaline membrane disease and delayed in achieving 50th percentile ideal body weight for appropriate gestational age by 10 days were significant risk factors associated with mortality in hydrops fetalis. Therefore, the risk of death among neonates with hydrops fetalis depends on the illness immediately after birth and severity of hydrops fetalis. Informations from this study may prove useful in prediction of prognosis to neonates with hydrops fetalis.

A Comprehensive Approach to Model Development -The Effect of U.S. Retail Employees' Work Experiences on Job Performance, Job Satisfaction, and Retail Career Intention- (연구모델 개발의 포괄적 접근 -미국 소매업 종사자의 직무 경험이 소매업 직업 성과와 직업 만족 그리고 소매업 직업 선택의도에 미치는 영향-)

  • Kim, Hae-Jung;Crutsinger, Christy;Knight, Dee
    • Journal of the Korean Society of Clothing and Textiles
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    • v.29 no.12 s.148
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    • pp.1571-1581
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    • 2005
  • In a highly competitive marketplace, U.S. retailers are challenged to attract, recruit, and retain a skilled workforce. The purpose of our research was to examine the impact of young retail employees' work experiences on their job performance, job satisfaction, and career intention using a comprehensive approach to model development. The model was developed in three phases over a four-year period using both qualitative and quantitative methodologies. During Phase 1, we conducted focus group interviews to guide the development of the questionnaire. Work experience was initially operationalized as role conflict, role ambiguity, supervisory support, and work involvement. Using a student sample(n=470) from U.S. universities, we employed multiple regression to determine the significance of relationships between their work experience, job satisfaction, and retail career intention. During Phase 2, we expanded our investigation to include retail work experiences of teens employed while they were in high school. The teen sample(n=898) was drawn from students enrolled in work-study programs in 16 U.S. high schools, and data were analyzed using structural equation modeling (hereafter SEM). During Phase 3, we expanded our model to include two new variables, job characteristics and job performance. Based on a national sample(n=803) of U.S. university students, we employed SEM to holistically determine if retail employees' work experience impacted their job performance, job satisfaction, and retail career intention. During each phase, job satisfaction consistently was the superior antecedent of retail career intention. Among the work experience variables, supervisory support had a positive impact on job satisfaction, while role conflict, role ambiguity, and work involvement exhibited inconsistent effects on job outcomes. The strong relationship between job satisfaction and retail career intention should make job satisfaction a priority for retailers.