• 대한예방의학회:학술대회논문집
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• 대한예방의학회 1994년도 교수 연수회(역학)
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• pp.154-157
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• 1994

The evaluation of diagnostic tests attempts to obtain one or more statistical parameters which can indicate the intrinsic diagnostic utility of a test. Sensitivity. specificity and predictive value are not appropriate for this use. The likelihood ratio has been proposed as a useful measure when using a test to diagnose one of two disease states (e.g. disease present or absent). In this paper, we generalize the likelihood ratio concept to a situation in which the goal is to diagnose one of several non-overlapping disease states. A formula is derived to determine the post-test probability of a specific disease state. The post-test odds are shown to be related to the pre-test odds of a disease and to the usual likelihood ratios derived from considering the diagnosis between the target diagnosis and each alternate in turn. Hence, likelihood ratios derived from comparing pairs of diseases can be used to determine test utility in a multiple disease diagnostic situation.

• Asian Pacific Journal of Cancer Prevention
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• 제13권1호
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• pp.41-48
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• 2012

Introduction: Breast cancer is the second leading cancer in Korean women. To assess potential genetic associations between the prostate stem cell antigen (PSCA) gene in the chromosome 8q24 locus and breast cancer risk in Korean women, 13 SNPs were selected and associations with breast cancer risk were analyzed with reference to hormone receptor (HR) and menopausal status. Methods:We analyzed DNA extracted from buffy coat from 456 patients and 461 control samples, using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) based upon region-specific PCR followed by allelespecific single base primer extension reactions. Risks associated with PSCA genotypes and haplotypes were estimated with chi-square test (${\chi}^2$-test), and polytomous logistic regression models using odds ratios (OR) and 95% confidence intervals (CIs), by HR and menopausal status. Results: In case-control analysis, odds ratios (OR) of rs2294009, rs2294008, rs2978981, rs2920298, rs2976395, and rs2976396 were statistically significant only among women with estrogen receptor (ER) negative cancers, and those of rs2294008, rs2978981, rs2294010, rs2920298, rs2976394, rs10216533, and rs2976396 were statistically significant only in pre-menopausal women, and not in postmenopausal women. Risk with the TTGGCAA haplotype was significantly elevated in ER (-) status (OR= 1.48, 95% CI= 1.03~2.12, p<0.05). Especially risk of allele T of rs2294008 is significantly low in pre-menopausal breast cancer patients and AA genotype of rs2976395 in ER (-) status represents the increase of OR value. Conclusion: This report indicated for the first time that associations exist between PSCA SNPs and breast cancer susceptibility in Korean women, particularly those who are pre-menopausal with an estrogen receptor negative tumor status.

• 사상체질의학회지
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• 제34권1호
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• pp.37-45
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• 2022

Objectives The purpose of this study was to reveal that Sasang constitution(SC) was associated with hypertension and pre-hypertension and could be a risk factor. Methods We introduced this study to educational personnel in D university in Daejeon, and 275 subjects joined this study. The SC classification was conducted with KS 15 questionnaire. The subjected measured the blood pressure with Jawon medical device automatically after 10 minute rest. The hypertension and pre-hypertension was classified by the guide of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The frequency analysis and T-test was used in general characteristics, and chi-square test was also used between SC and pre-hypertension and hypertension. Logistic regression was used to calculate the odds ratios (ORs) and 95% confidence interval (95% CI) for pre-hypertension and hypertension. Results The number of Taeeumin(TE), Soeumin(SE), and Soyangin(SY) was 142, 71, and 61 respectively. There was significantly different in systolic and diastolic blood pressure among SC types(p<.001). The distribution of the normal group, pre-hypertension and hypertension group by SC types was significantly different (p<.001). The ORs of TE was significantly increased (ORs 4.039, 95% CI=2.019-8.082 in pre-hypertension and ORs 4.235, 95% CI=1.581-11.348 in hypertension) compared with SE(p<.001), and after adjusting gender and smoking habit, it was still significantly different(p<.001). Conclusions It is possible that SC, especially TE could be a risk factor both pre-hypertension and hypertension.

• International Journal of Oral Biology
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• 제45권2호
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• pp.51-57
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• 2020

Thromboelastography or rotational thromboelastometry, is being increasingly utilized in cardiac surgery of late. However, it is an indirect test and is not available in all centers. Low fibrinogen levels before and after cardiopulmonary bypass (CPB) have been described to be associated with postoperative bleeding in cardiac surgery. This study explored the usefulness of reduction ratio of the fibrinogen levels before CPB (preCPB) and after CPB (postCPB) in predicting postoperative hemorrhage. A retrospective, observational study of adult patients who underwent cardiac surgery with CPB between February 2014 and January 2016 was conducted, which included a total of 264 patients. The fibrinogen levels were measured twice, preCPB and postCPB, and the fibrinogen reduction ratio was acquired [(preCPB - postCPB)/preCPB]. Postoperative blood loss, which was defined as the blood collected from the chest drain for 12 hours following arrival at the intensive care unit, was considered severe if it was more than 1,000 mL. A multivariate analysis showed that fibrinogen reduction ratio, sex, and postCPB platelet count were significantly associated with severe postoperative bleeding. However, the pre- and postCPB fibrinogen levels were not significantly associated with severe bleeding. Furthermore, a fibrinogen reduction ratio of > 41.3% was independently associated with postoperative severe bleeding, with an odds ratio of 3.472 (1.483-8.162). These results suggest that the reduction ratio of pre- and postCPB fibrinogen levels may be utilized in predicting postoperative bleeding.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제34권1호
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• pp.37-44
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• 2023

Objectives: Tic disorders are highly heritable; however, growing evidence suggests that environmental factors play a significant role in their pathogenesis. Studies on these factors have been inconsistent, with conflicting results. Therefore, this study aimed to examine the associations of pre- and perinatal exposure to Tourette syndrome (TS) or chronic tic disorders (CTD) in Korean school-aged children. Methods: This case-control study used data from a large prospective cohort study. The primary outcome was TS/CTD diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria and Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean Version. Demographic, pre-, and perinatal information was obtained from the maternal questionnaires. Data between the TS/CTD and control groups were compared using the chi-squared or Student's t-test, as appropriate. Two-step logistic regression analyses were used to test the association between TS/CTD and pre- and perinatal risk factors. Results: We included of 223 children (78 with TS/CTD and 145 controls). Significant differences in the demographic data between the two groups were observed. The male sex ratio, mean parental age, parental final education level, and family history of tics were included as confounders. In the final adjusted multivariable model, TS/CTD was significantly associated with antiemetic exposure during pregnancy (odds ratio [OR]=16.61, 95% confidence interval [CI] 1.49-185.22, p=0.02) and medically assisted reproduction (OR=7.89, 95% CI 2.28-27.28, p=0.01). Conclusion: Antiemetic exposure and medically assisted reproduction are significantly associated with the risk of TS/CTD. These results should be replicated in future prospective and gene-by-environment studies.

• 한국병원경영학회지
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• 제25권3호
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• pp.67-77
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• 2020

Background: As of 2016, average Koreans sleep 7 hours and 42 minutes, the lowest figure among Organization for Economic Cooperation and Development(OECD) countries, and the number of people with sleep disorders reached 561,000. Accordingly, the government has promoted the provision of 'Multiple Sleep Test' to strengthen the diagnosis service for patients with 'sleep disorder' in july 2018. As a result, healthcare costs for patients with sleep disorder is on the rise every year. In this study, we utilized 'Appropriate Sleep' criteria of United States's National Sleep Foundation(NSF) then investigated Korean's sleep pertinence using ｢7th National Health and Nutrition Survey for 2016-2018」 by different occupational type, demographic characteristics, socio-economic characteristics, and health behaviors. Methods: We performed descriptive analysis to examine differences of sleep appropriateness by various sample characteristics. Multivariate logistic regression models were used to examine sleep appropriateness by occupational type and other variables. We also analyzed subgroup models to investigate. Results: As a result, a total of 1,948 (18.37%) study subjects experienced in-appropriate sleep. Results of the Multivariate logistic regression analysis revealed that blue color group had a higher odds ratio (OR) for experiencing in-appropriate sleep (OR=1.179). In addition, the odds ratio of experienced in-appropriate sleep among the elderly aged 70 and over was 2.698, and the odds ratio of the overstressed group was 1.299. Furthermore, sub-group analysis showed that blue color job of female(Or=1.334), high school or below(OR=1.404), divorce/death/separation(OR=2.039), 25%ile-50%lie income group(OR=1.411) more likely experienced in-appropriate sleep. Conclusion: Growing sleep disorder patients and related health care costs are expected. Government should apply detailed 'total periodic sleep disorder management policy' including pre-consultation, examination, diagnosis, treatment, post-consultation, self-management especially to vulnerable population that this study found.

• Journal of Korean Dental Science
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• 제3권1호
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• pp.17-24
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• 2010

Objective : To investigate the prevalence of dental anomalies and to determine the associations between dental anomalies in permanent teeth Materials and methods : The samples were 1,240 patients (760 females and 480 males, mean age=15.1 years) who visited the Samsung Medical Center. Dental anomalies were diagnosed using pre-treatment dental casts, radiographs, clinical examinations, and medical/dental histories. Prevalence and association were investigated according to gender and sidedness. The Chi-square test was performed for statistical analysis. Results : The most common missing tooth was the lower lateral incisor, followed by the lower and upper second premolars. This particular dental anomaly is characteristic of the East Asian population (prevalence of congenital missing tooth=12.3%). The upper anterior area was the most frequently affected area (prevalence of supernumerary tooth was 1.5%). The presence of a supernumerary tooth was more prevalent in males than in females (p<.05, odds ratio=3.2). The most frequently affected tooth was the upper canine (prevalence of impacted tooth=4.3%). Unilateral impaction of the upper canine occurred significantly more often compared to bilateral impaction (p<.001). The prevalence of peg lateralis was 2.7%. The presence of congenital missing tooth was closely associated with peg lateralis (p<.01). If children aged 7~8 years have peg lateralis, the rest of the teeth should be checked for congenital absences. Conclusion : The early detection of dental anomalies and understanding of their associations help clinicians determine the appropriate treatment timing and methods of dealing with these anomalies.

• Journal of Preventive Medicine and Public Health
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• 제44권5호
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• pp.210-217
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• 2011

Objectives: The rising burden of preventable risk factors for non-communicable diseases (NCDs) among adolescents is a major public health challenge worldwide. We identified the preventable risk factors for NCDs in adolescents. Methods: In a school-based study, pre-tested structured questionnaires were completed by 414 adolescents (14 to 17 years) at six schools in three cities in Pakistan. The chi-squared test and adjusted odds ratio (aOR) with 95% confidence interval (CI) were calculated in a multinomial logistic regression analysis. Results: Over 80% of the adolescents had unhealthy diets, and 54% were physically inactive. Most adolescents were exposed to passive smoking, and 14% were also current smokers. More than one-third of participants chewed betel nut, and one-quarter used oral tobacco. More girls were physically inactive (OR, 4.07; 95% CI, 2.69 to 6.17), whereas a greater proportion of boys were current smokers (OR, 2.17; 95% CI, 1.19 to 3.91), exposed to passive smoking (OR, 2.57; 95% CI, 1.72 to 3.83), and using betel nut (OR, 2.03; 95% CI, 1.34 to 3.06). Only 3.1% of the participants were without any preventable lifestyle risk factor for NCDs, and over 80% had ${\geq}$2 factors. Co-existence of risk factors was independently associated with fathers being blue-collar workers (aOR, 3.57; 95% CI, 1.07 to 11.92) and parents not treating their child fairly (aOR, 5.05; 95% CI, 1.29 to 19.78). Conclusions: Most of the adolescents studied had preventable risk factors for NCDs. These results warrant comprehensive and integrated interventions to prevent lifestyle risk factors, and parents are front-line stakeholders.

• Journal of Preventive Medicine and Public Health
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• 제24권3호
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• pp.363-372
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• 1991

백혈구수와 고혈압과의 관계를 알아보기 위해 1985년에 일부 농촌 거주자와 1986년에 일부 도시 거주자를 대상으로 혈액학적인 검사와 장기별로 기능검사를 통해서 건강선별조사를 했던 자료를 이용했다. 농촌거주자는 1985년에 경상북도 경산군에서 남자 206명, 여자 203명을 마을, 통, 반을 기준으로 다단계 집락추출법으로 추출했다. 도시 거주 대상자는 1985년 12월에 대구시에 거주하고 있는 20세 이상의 주민의 성별, 연령별 구성비율에 부합되게 농촌과 같은 표본추출방법으로 600명을 선정했으나 600명중 384명만이 본 조사에 응해주어서 나머지 인원은 피보험대상자들의 정기 신체검사를 위해 대학병원 건강관리과에 내원한 사람들 중에서 성, 연령을 짝지어서 추출했다. 이들 자료에서 백혈구수 측정이 빠진 사람, 고혈압력을 포함한 질병 유소견자와 검사상 극도의 비정상적인 수치를 보이는 자들을 농촌 거주자에서 36명 (8.8%), 도시 거주자에서 29명 (4.8%)을 제외시켜서 최종분석에 이용된 자는 도시가 571명, 농촌이 373명이었다. 백혈구수 측정은 ELT-8 Laser shadow method 를 이용했으며 단위는 $cells/mm^3$ 였다. 혈압 측정은 Aneroid 혈압계를 사용해서 표준화한 후 측정했다. 고혈압자의 정의는 수축기혈압 140 mmHg/확장기혈압이 90 mmHg 이상인 자로 했다. 농촌과 도시를 합한 총대상자에대해 고혈압자와 정상 혈압자간의 백혈구수의 평균을 비교하면 정상 혈압자에서 $6490.61{\pm}1941.32$, 고혈압에서 $6965.93{\pm}1997.01$로서 고혈압자에서 백혈구수의 평균이 통계적으로 유의하게 더 높았으며 (P=0.00), 농촌에서 동일한 방향의 유의한 차이를 보였다 (P=0.03). 그 외의 거주지와 성별로 층화한 각 층에서는 유의한 평균차이를 보이는 결과는 없었다. 총대상자에서 백혈구수 1/5분위수를 기준으로 했을 때 2/5분위수의 비차비가 0.99 (95% confidence interval, CI 0.62-1.59), 3/5분위수가 1.41 (95% CI 0.90-2.21), 4/5분위수가 1.76(95% CI 1.14-2.72), 5/5분위수가 1.80 (95% CI 1.15-2.82)로서 백혈구수가 증가 함에따라 고혈압의 유병율이 일정하게 상승하는 것을 알 수 있었으며 경향분석에서도 유의한 경향($X^2_{trend}=5.53,\;df=1,\;P<0.05$)을 나타내었다. 나머지 층에서는 유의한 비차비도 없었으며 유의한 경향 역시 보이지 않았다. 그러나 거주지와 성별로 층화한 각 층에서 연령, 흡연과 음주량을 다중지수회귀분석으로 통제를 했을 때 단일분석시 통계적인 유의성을 보였던 전체 대상자의 비차비는 통계적으로 유의하지 않게 되었고 그 크기 역시 작아지고 불안정해졌다. 전체적으로 비차비의 크기가 조금씩 줄었으며 경향분석에서도 유의한 경향을 보인 층은 없었다. 이러한 사실은 백혈구수와 고혈압과의 가설을 처음으로 제시했던 Friedman등의 연구가 고혈압의 예측변수를 찾기위해 800여개의 변수와 고혈압발생과의 관계를 보는 과정에서 우연히 발견된 통계적인 1종오차의 결과 일지도 모른다는 것을 시사해주는 결과이다.

• 농촌의학ㆍ지역보건
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• 제49권1호
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• pp.37-49
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• 2024

이 연구는 강원도 원주시와 춘천시에 거주하고 있는 만 19세 이상 성인 600명을 대상으로 두 지역 간 흡연 상태에 차이가 있는지를 탐색하고, 지역 내 금연프로그램 경험이 금연 시도에 영향을 미치는지를 평가하였다. 연구결과 원주시는 춘천시보다 현재흡연율이 더 높고, 흡연기간은 더 길었으며, 흡연 시작 연령은 춘천시보다 더 낮았다. 원주시의 현재흡연율이 춘천시보다 더 높았음에도 불구하고 관할지역 내 보건소 등에서 운영하는 금연 교육프로그램의 이수 경험률이 원주지역에서 더 낮았고(OR=0.52, 95% CI=0.33~0.81), 금연클리닉의 이용률도 더 낮았지만 유의하지는 않았다. 지역 내 금연프로그램 경험이 금연 시도에 미치는 영향을 분석한 결과, 원주시는 금연교육 이수자와 금연클리닉 이용자가 그렇지 않은 대상자에 비해 각각 OR=2.31, OR=2.29로서 금연 시도 경험이 더 높았고, 춘천시의 경우도 금연지원서비스를 인지하고 있는 대상자의 금연 시도 경험이 그렇지 않은 대상자에 비해 OR=2.26배 더 높았다. 하지만 두 지역 모두 적은 표본수로 인하여 통계적 유의수준에 도달하지는 못하였다. 이 연구결과를 바탕으로 해당보건의료기관은 지역주민의 금연지원서비스에 대한 인식 제고와 흡연자의 금연 시도를 높이기 위한 지역 내 보다 실용성 있는 금연 교육프로그램을 개발하고 지역-밀착형 홍보로 접근성을 제고하여 현재흡연율의 지역 격차를 해소할 수 있는 중재전략을 마련할 필요가 있다.