Medical nutrition therapy (MNT) is considered a keystone of medical treatment of chronic diseases. However, only few studies have evaluated medical and economical outcome of MNT. The study was performed on the patient with type 2 diabetes mellitus to evaluate the effect of clinical and cost-effective outcomes of MNT. Subjects from two general hospitals were randomly assigned to two different groups; One receiving basic nutritional education (BE) (n = 35), and the other receiving intensive nutritional education (IE) (n = 32) for a 6-month clinical trial. The group which received BE had a single visit with a dietitian, while the other group which received IE had an initial visit with a dietitian addition to two visits during the first 4 weeks of the study periods. Anthropometric parameters, blood components, and dietary intake were measures at the beginning of study period and after 6 month. Cost-effective analysis included direct labor costs, educational materials and medication cost difference during 6 months. After 6 month, subjects from IE group showed significant reduction of body weight (p <0.05) and systolic blood pressure (p <0.05), whereas BE group did not show any significant changes. Result from biochemical indices showed glycated hemoglobin concentration was significantly reduced by 0.7% (p <0.05) only in the IE group. The ratio of energy intake to prescribed energy intake decreased significantly in both groups (p <0.05). Mean time taken for a dietitian to educate the subject was 67.9 ${\pm}$ 9.3 min/person for BE group, while 96.4 ${\pm}$ 12.2 min/person for IE group. Mean number of educational materials was 1.9 ${\pm}$ 0.7/person for BE group and 2.5 ${\pm}$ 0.7/person for IE group. Change in glycated hemoglobin level along the 6 month period of study can be achieved with an investment of \88,510/% by implementing BE and \53,691/% by implementing IE. Considering the net cost-effect of blood glucose control and HbA Ic, IE which provides MNT by dietitian had a cost efficiency advantage than that of BE. According to this study, MNT provided by dietitian had a significant improvements in medical and clinical outcomes compared to that of BE intervention. Therefore, MNT protocol should be performed by systemic intensive nutrition care by dietitian in clinical setting to achieve good therapeutic results of DM with lower cost.
Yeo Jin Yoo;Bo-Kyung Je;Ga Young Choi;Jee Hyun Lee;Sunkyu Choi;Ji Young Lee
Journal of the Korean Society of Radiology
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v.83
no.2
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pp.304-316
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2022
Purpose To evaluate the effect of the emergence of coronavirus disease-19 (COVID-19) on pediatric intussusception. Materials and Methods Patients (< 18 years) who were diagnosed with intussusception and received enema reduction from 2011 to 2020 were included. We reviewed the demographics, yearly/monthly/seasonal incidence of intussusception, method and failure rate of enema reduction, recurrence rate of intussusception, surgical record, and pathologic report. Subsequently, we investigated the differences in mean age, failure rate of enema reduction, and recurrence rate of intussusception between the cases in 2020 and those in the period from 2011 to 2019. Results A total of 859 enema reductions were performed during the past decade, more in males and in the age < 1 year (mean age, 22.2 months). The yearly incidence was highest in 2014 and lowest in 2020, and the monthly incidence was highest on December and September. The cases in 2020 (n = 27) had a lower mean age (18.1 months vs. 22.8 months), higher failure rate of enema reduction (7.4% vs. 2.4%), and higher recurrence rate of intussusception (14.8% vs 7.3%) compared with those that occurred between 2011 and 2019 (n = 832). However, these results did not show statistical significance (p = 0.07, p = 0.15, p = 0.14, respectively). Conclusion With the emergence of COVID-19, the number of enema reductions was remarkably decreased with a lower mean age, higher failure rate, and higher recurrence rate.
In this study, we investigated factors for affecting pneumothorax in percutaneous needle aspiration biopsy of lung lesions. This research were conducted at University Hospital in Daejeon from August 2007 to May 2008. Total 104 patients between the ages of 25~85 who had focal lung lesions were grouped in terms of the tumor location, tumor size, depth of lesion, gender, age, biopsy time, and the number of biopsies. Then, their correlations with pneumothorax were studied. The incidence of pneumothorax according to the positions showed 27.3% in the right lower lobe, 24.3% in the right upper lobe, 15% in the left lower lobe and 12% in the left upper, respectively. In addition, the incidence by lesion size showed 24.0% in 0~2.0 cm, 18.2% in 2.1~4.0 cm, above 20.0% in 4.1 cm respectively. The probabilities of pneumothorax was 6.7% at 0 cm depth of lesion, 24.2% at 0.1~2.0 cm and greater than 26.8% at 2.1 cm. By gender differences, we found that probability of incidence of pneumothrax is 21.7% for male and 17.1% for female. According to age, pneumothorax occurred in 25% in the group of less than 40-years-old, 11.7% in 41~50 years, 14.3% in 51~60 years, 24.1% in 61~70 years old and 24.1% in over 70 years. According to the time of biopsy, the incidence of pneumothorax was 3.8% from 0 to 10.0 minutes, 18.9% from 10.1 to 20.0 minutes and 40% more than 21 minutes.
With recent advancement of the medical imaging systems and picture archiving and communication system (PACS), installation of digital radiography has been accelerated over past few years. Moreover, Computed Radiography (CR) which was well established for the foundation of digital x-ray imaging systems at low cost was widely used for clinical applications. This study analyzes imaging characteristics for two systems with different pixel sizes through the Modulation Transfer Function (MTF), Noise Power Spectrum (NPS) and Detective Quantum Efficiency (DQE). In addition, influence of radiation dose to the imaging characteristics was also measured by quantitative assessment. A standard beam quality RQA5 based on an international electro-technical commission (IEC) standard was used to perform the x-ray imaging studies. For the results, the spatial resolution based on MTF at 10% for Agfa CR system with I.P size of $8{\times}10$ inches and $14{\times}17$ inches was measured as 3.9 cycles/mm and 2.8 cycles/mm, respectively. The spatial resolution based on MTF at 10% for Fuji CR system with I.P size of $8{\times}10$ inches and $14{\times}17$ inches was measured as 3.4 cycles/mm and 3.2 cycles/mm, respectively. There was difference in the spatial resolution for $14{\times}17$ inches, although radiation dose does not effect to the MTF. The NPS of the Agfa CR system shows similar results for different pixel size between $100{\mu}m$ for $8{\times}10$ inch I.P and $150{\mu}m$ for $14{\times}17$ inch I.P. For both systems, the results show better NPS for increased radiation dose due to increasing number of photons. DQE of the Agfa CR system for $8{\times}10$ inch I.P and $14{\times}17$ inch I.P resulted in 11% and 8.8% at 1.5 cycles/mm, respectively. Both systems show that the higher level of radiation dose would lead to the worse DQE efficiency. Measuring DQE for multiple factors of imaging characteristics plays very important role in determining efficiency of equipment and reducing radiation dose for the patients. In conclusion, the results of this study could be used as a baseline to optimize imaging systems and their imaging characteristics by measuring MTF, NPS, and DQE for different level of radiation dose.
Lee, Chul-Ho;Lee, Kye Young;Hong, Yun-Chul;Choe, Kang-Hyeon;Kim, Yong-Dae;Kang, Jong-Won;Kim, Heon;Hong, Jang Soo
Tuberculosis and Respiratory Diseases
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v.58
no.5
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pp.490-497
/
2005
Background : The paraoxonase enzyme plays a significant role in the detoxification of various organophosphorous compounds in mammals, and paraoxonase (PON) 1 is one of the endogenous free-radical scavenging systems in the human body. In this study, we investigated the interaction between cigarette smoking and the genetic polymorphism of PON1 with lung cancer in Korean males. Methods : Three hundred thirty five patients with lung cancer and an equal number of age-matched controls were enrolled in this study. Every subject was asked to complete a questionnaire concerning their smoking habits and alcohol drinking habits. A 5' exonuclease assay (TaqMan) was used to genotype the PON1 Q192R polymorphism. The effects of smoking habits and drinking habits, the PON1 Q192R polymorphism and their interactions were statistically analyzed. Results : Cigarette smoking and the Q/Q genotype of PON1 were significant risk factors for lung cancer. Individuals carrying the Q/Q genotype of PON1 were at a higher risk for lung cancer as compared with those individuals carrying the Q/R or R/R genotype (odds ratio, 2.84; 95% confidence interval, 1.69 - 4.79). When the groups were further stratified by the smoking status, the Q/Q PON1 was associated with lung cancer among the current or ex-smokers (odds ratio, 2.56; 95% confidence interval, 1.52 - 4.31). Current smokers or ex-smokers who had the Q/Q genotype showed an elevated risk for lung cancer (odds ratio: 15.50, 95% confidence interval: 6.76 - 35.54) as compared with the group of subjects who never smoked, and had the Q/R or R/R genotype. The odds ratios (95% confidence interval) of smokers with the PON1 Q/Q type compared to the nonsmokers with the PON1 Q/R or R/R type were 53.77 (6.55 - 441.14) for squamous cell carcinoma, 6.25 (1.38 - 28.32) for adenocarcinoma, and 59.94 (4.66 - 770.39) for small cell carcinoma, and these results were statistically significant. Conclusion : These results suggest that cigarette smoking and the PON1 Q/Q genotype are risk factors for lung cancer. The combination of cigarette smoking and the PON1 Q/Q genotype significantly increased the lung cancer risk irrespective of the histologic type of cancer.
The Korean Mental Health Act was amended 2016 overall. This paper examines and evaluates the old Korean Mental Health Act since 1995 and the new Korean Mental Health Promotion Act 2016 from the Perspective of Human Rights and Inclusion of Persons with Psychosocial Disabilities. The persons with mental disabilities was separated and ruled out from society by the enactment of the Mental Health Act in 1995 and five times amendment. That has been justified and institutionally supported by medical viewpoint. The medical approach which reconsider the persons with mental disabilities as patients conceal that the aims of the involuntary admission in Mental Hospital are protection of society and the relief of the family member's duty of support for person with mental disabilities. This is institutionally supported in the 1995 Korean Mental Health Act by involuntary admission through the consent of family members as protectors. According to the old Act, the family members as protectors are authorized to consent to involuntary admission of persons with mental disabilities. Also, the psychiatrist that diagnoses the person with mental disabilities and evaluates the need for treatment by admission is not impartial in this decision. Family members as protectors may want to lighten their burden of support for the person with mental disabilities in their home by admitting them into a mental hospital, and the psychiatrist in the mental hospital can be improperly influenced by demand of hospital management. Additionally, Article 24 of the Korean Mental Health Act for the Involuntary Admission by the Consent of Family Members as Protector might violate personal liberty, as guaranteed in the Korean Constitution. The Mental Health Promotion Law was amended to reduce the scope of the persons with mental illness which are subject to forced hospitalization and to demand that a second diagnosis is made by another psychiatrist and screening by the committee concerning the legitimacy of admission in the process of the involuntary admission by the consent of family members as a method of protection. The amended Mental Health Promotion Law will contribute to reducing the number of the involuntary admissions and the inclusion of persons with mental disabilities. But if persons with mental disabilities are not providing some kind of service to the community, the amended Mental Health Promotion Law does not work for Inclusion of them.
Background: We evaluated a sensitive and quantitative method utilizing fragment analysis of the fms-like tyrosine kinase 3-internal tandem duplication (FLT3-ITD), simultaneously measuring mutant allele burden and length, and verified the analytical performance. Methods: The number and allelic burden of FLT3-ITD mutations was determined by fragment analysis. Serial mixtures of mutant and wild-type plasmid DNA were used to calculate the limit of detection of fragment analysis, conventional PCR, and Sanger sequencing. Specificity was evaluated using DNA samples derived from 50 normal donors. Results of fragment analysis were compared to those of conventional PCR, using 481 AML specimens. Results: Defined mixtures were consistently and accurately identified by fragment analysis at a 5% relative concentration of mutant to wild-type, and at 10% and 20% ratios by conventional PCR and direct sequencing, respectively. No false positivity was identified. Among 481 AML specimens, 40.1% (193/481) had FLT3-ITD mutations. The mutant allele burden (1.7-94.1%; median, 28.2%) and repeated length of the mutation (14-153 bp; median, 49 bp) were variable. The concordance rate between fragment analysis and conventional PCR was 97.7% (470/481). Fragment analysis was more sensitive than conventional PCR and detected 11 additional cases: seven had mutations below 10%, three cases represented conventional PCR failure, and one case showed false negativity because of short ITD length (14 bp). Conclusions: The new fragment analysis method proved to be sensitive and reliable for the detection and monitoring of FLT3-ITD in patients with AML. This could be used to simultaneously assess ITD mutant allele burden and length.
Aging population is a global trend and Korea is no exception. Due to the progress of the medical and scientific sectors, increase in the average lifetime incurred increase in the number of elderly people. Meanwhile, the family function of supporting the elderly has become a major issue in a society due to the changes in the society's structure and increased entry of the women into the workforce. As a means to substitute the protection of the elderly who are not protected at their respective homes and to replace the tending needs, weekly protection centers and short-stay centers for the elderly were established and operated in Seoul since 1992. However, structured and satisfactory services are not yet to be provided, thus this research intends to understand the current situation at the short-stay centers for the elderly, to identify users' characteristics and to conduct study on nursing need for the health reasons so that the results of the research can be utilized as basic data for the development of nursing care program. Towards this end, this research targeted 142 elderly people who were undergoing treatment at the 11 short-stay centers for the elderly out of total of 13 located in Seoul that were willing to cooperate. The research was conducted from April to May 2002, with the measurement tool developed by Rhee, Seon-ja (2001) to measure the level of nursing need. Then data was collected and analyzed using SPSS program. The results are as follows. The general characteristics of users of the short-stay centers for the elderly were: 123 females $(86.6\%)$, 19 males $(13.4\%)$ and 72 elderly were over the age of 80 $(50.7\%)$. Among these, 24$(16.9\%)$ were living by themselves. Among the illnesses that the subjects were inflicted with were: dementia $(54.2\%)$, stroke $(54.1\%)$ and high blood pressure $(50.7\%)$, in the respective order. Despite the fact that they were diagnosed with illnesses, $47.2\%$ responded that they do not undergo special treatment due to financial reasons. When the level of needs for nursing care among the elderly who use the short-stay centers is divided into informational. physical. and emotional need levels and scored between zero to two, the level of emotional need is the highest with 1.80, followed by physical (1.45) and informational (1.44) need levels. As for the realities of services at the centers and improvement areas, restriction on term was cited as the greatest inconvenience with $38.7\%$, followed by lack of budget (24 respondents, $16.9\%$). Wishful services were financial assistance $(46.5\%)$, medical and nursing services $(40.1\%)$, meal provision service $(8.5\%)$ and counseling service $(4.9\%)$, in the respective order. Based on the above mentioned results, the research identified the need to develop nursing program for the patients of dementia that can be applied onto the short-stay centers and the need to develop volunteer service, backed by societal support. Also, placement of specialized cadre of professionals is needed so that medical and nursing service functions can be provided in a complementary manner.
Multiple 15-hue tests were designed and implemented on a PC in the study so as to quickly and quantitatively evaluate color vision acuity. Difficulty of the test was control)ed by the value of CDBACC (color difference between adjacent color chips) calculated using a CIELAB formula. The multiple 15-hue tests consist of eight of the hue tests (test 3-10) and three of the basic color (red, green, blue) tests (test 11-13). The 15 colors used for the hue tests were specified by the 15 color coordinates that were located at a constant distance (d = 2. 3. 5. 7, 10, 20, 30. 40) from white reference in the CIE chromaticity coordinate system and were separated by a constant color difference (CDBACC = 0.75, 1.1, 1.8. 2.5. 3.5. 7.5. 11, 14) from the adjacent chips. The color coordinates for the 15 chips for the basic color tests were the same as those of the 15 points spaced equally by a constant color difference (6.87 for the green color test. 7.27 for the red color test, 7.86 for the blue color test) from the white reference along the axis of red, green and blue. Thirty normal subjects who were not color blind were taken to undergo the multiple 15-hue tests. It was observed that most of the subjects correctly arranged color chips for the tests with CDBACC greater than 5, whereas no one correctly answered for those with CDBACC less than 2. Rapid changes in the number of the subjects correctly arranged took place when CDBACC of the tests was between 2 and 4.5. In the basic color tests, unlike the hue tests having similar values of CDBACC, it was seen that the subjects arranged color chips even less correctly. It was found that JNCD (just noticeable color difference) - a measure of color vision acuity was about 3 in average for the subjects. The JNCD was chosen as the value of the CDBACC of the test for which about $50\%$ of the subjects failed to successfully arrange color chips. ERCCA (error rate of color chips arrangement) for the test with CDBACC the same as the JNCD was shown to be about $20\%$. It is expected that the multi 15-hue tests implemented on a PC in the study will be an economical tool to quickly and quantitatively evaluate color vision acuity and, accordingly, the tests can be used for early diagnosis to massive potential patients suffering from diseases (ex. diabetes, glaucoma) which may induce changes in color vision acuity.
The purpose of this study is to analyze the dental service system in correctional institutions and 10 find the factors for improving inmates' oral health. This study is comprised of document review, telephone and questionnaire survey. The subjects of questionnaire survey are public health dentists and doctors in correctional institutions. They responded to questionnaire and the survey was collected from previous research and selected information about the dental service system. The findings of the study were as follow : Documentary survey 1. According to 2004's study, there are 42 dental offices in 46 all correctional institutions. 2. Criminals who took an health examination occupied 69.0% when committed to a jail in 2002's study. Majorities of them(81.5%) responded that they didn't take any oral examination. Telephone & Questionnaire survey 1. Full-time public health dentists are 26 in 2009. There is no correctional institution having oral health providers in 26 correctional institutions surveyed. 2 About 10 patients use the dental services in a day. Part-time dentists visit 4 times a month as average in 80% of institutions. 40% of institutions responded dental treatments can't be progressed conveniently because of the lack of oral health providers. 3. 80% of respondents answered that it is hard to cure prisoners, and that's because they are forbidden to get out of the institutions. 4. Only 20% of correctional institutions offered the oral hygiene instructions. There is no regular oral hygiene education for all inmates. 5. They need to increase the number of oral health providers.
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