• Title/Summary/Keyword: Predictive Risk Model

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What will be the Proper Criteria for Impaired Fasting Glucose for Korean Men? - Based on Medical Screening Data from a General Hospital - (공복혈당장애의 기준 하한치에 관한 코호트연구 - 일개병원 종합건강자료를 중심으로 -)

  • Ryu, Seung-Ho;Kim, Dong-Il;Suh, Byung-Seong;Kim, Woon-Sool;Chang, Yoo-Soo
    • Journal of Preventive Medicine and Public Health
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    • v.38 no.2
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    • pp.203-207
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    • 2005
  • Objectives: Recently, the American Diabetes Association (ADA) redefined the criteria of prediabetes, which has lowered the diagnostic level of fasting plasma glucose (FPG) from 110 to 125 mg/dl, down to levels between 100 to 125mg/dl. The purpose of this study was to determine the predictive cutoff level of FPG as a risk for the development of diabetes mellitus in Korean men. Methods: A retrospective cohort study was conducted on 11,423 (64.5%) out of 17,696 males $\leq$30 years of age, and who met the FPG of $\leq$125 mg/dl and hemoglobin A1c of $\leq$ 6.4% criteria, without a history of diabetes, and who were enrolled at the screening center of a certain university hospital between January and December 1999. The subjects were followed from January 1999 to December 2002 (mean follow-up duration; 2.3(${\pm}0.7$) years). They were classified as normal (FPG <100mg/dl), high glucose (FPG $\geq$100mg/dl and <110mg/dl) and impaired fasting glucose (FPG $\geq$110mg/dl and $\leq$125mg/dl) on the basis of their fasting plasma glucose level measured in 1999. We compared the incidence of diabetes between the 3 groups by performing Cox proportional hazards model and used receiver operating characteristic analyses of the FPG level, in order to estimate the optimal cut-off values as predictors of incident diabetes. Results: At the baseline, most of the study subjects were in age in their 30s to 40s (mean age, 41.8(${\pm}7.1$) year). The incidence of diabetes mellitus in this study was 1.19 per 1,000 person-years (95% CI=0.68-1.79), which was much lower than the results of a community-based study that was 5.01 per 1,000 person-years. The relative risks of incident diabetes in the high glucose and impaired fasting glucose groups, compared with the normal glucose group, were 10.3 (95% CI=2.58-41.2) and 95.2 (95% CI= 29.3-309.1), respectively. After adjustment for age, body mass index, and log triglyceride, a FPG greater than 100mg/dl remained significant predictors of incident diabetes. Using the receiver operating characteristic (ROC) curve, the optimal cutoff level of FPG as a predictor of incident diabetes was 97.5 mg/dl, with a sensitivity and a specificity of 81.0% and 86.0%, respectively. Conclusion: These results suggest that lowering the criteria of impaired fasting glucose is needed in Korean male adults. Future studies on community-based populations, including women, will be required to determine the optimal cutoff level of FPG as a predictor of incident diabetes.

Multivariate Analysis of Predictive Factors for the Severity in Stable Patients with Severe Injury Mechanism (중증 손상 기전의 안정된 환자에서 중증도 예측 인자들에 대한 다변량 분석)

  • Lee, Jae Young;Lee, Chang Jae;Lee, Hyoung Ju;Chung, Tae Nyoung;Kim, Eui Chung;Choi, Sung Wook;Kim, Ok Jun;Cho, Yun Kyung
    • Journal of Trauma and Injury
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    • v.25 no.2
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    • pp.49-56
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    • 2012
  • Purpose: For determining the prognosis of critically injured patients, transporting patients to medical facilities capable of providing proper assessment and management, running rapid assessment and making rapid decisions, and providing aggressive resuscitation is vital. Considering the high mortality and morbidity rates in critically injured patients, various studies have been conducted in efforts to reduce those rates. However, studies related to diagnostic factors for predicting severity in critically injured patients are still lacking. Furthermore, patients showing stable vital signs and alert mental status, who are injured via a severe trauma mechanism, may be at a risk of not receiving rapid assessment and management. Thus, this study investigates diagnostic factors, including physical examination and laboratory results, that may help predict severity in trauma patients injured via a severe trauma mechanism, but showing stable vital signs. Methods: From March 2010 to December 2011, all trauma patients who fit into a diagnostic category that activated a major trauma team in CHA Bundang Medical Center were analyzed retrospectively. The retrospective analysis was based on prospective medical records completed at the time of arrival in the emergency department and on sequential laboratory test results. PASW statistics 18(SPSS Inc., Chicago, IL, USA) was used for the statistical analysis. Patients with relatively stable vital signs and alert mental status were selected based on a revised trauma score of more than 7 points. The final diagnosis of major trauma was made based on an injury severity score of greater than 16 points. Diagnostic variables include systolic blood pressure and respiratory rate, glasgow coma scale, initial result from focused abdominal sonography for trauma, and laboratory results from blood tests and urine analyses. To confirm the true significance of the measured values, we applied the Kolmogorov-Smirnov one sample test and the Shapiro-Wilk test. When significance was confirmed, the Student's t-test was used for comparison; when significance was not confirmed, the Mann-Whitney u-test was used. The results of focused abdominal sonography for trauma (FAST) and factors of urine analysis were analyzed using the Chi-square test or Fisher's exact test. Variables with statistical significance were selected as prognostics factors, and they were analyzed using a multivariate logistics regression model. Results: A total of 269 patients activated the major trauma team. Excluding 91 patients who scored a revised trauma score of less than 7 points, 178 patients were subdivided by injury severity score to determine the final major trauma patients. Twenty-one(21) patients from 106 major trauma patients and 9 patients from 72 minor trauma patients were also excluded due to missing medical records or untested blood and urine analysis. The investigated variables with p-values less than 0.05 include the glasgow coma scale, respiratory rate, white blood cell count (WBC), serum AST and ALT, serum creatinine, blood in spot urine, and protein in spot urine. These variables could, thus, be prognostic factors in major trauma patients. A multivariate logistics regression analysis on those 8 variables showed the respiratory rate (p=0.034), WBC (p=0.005) and blood in spot urine (p=0.041) to be independent prognostic factors for predicting the clinical course of major trauma patients. Conclusion: In trauma patients injured via a severe trauma mechanism, but showing stable vital signs and alert mental status, the respiratory rate, WBC count and blood in the urine can be used as predictable factors for severity. Using those laboratory results, rapid assessment of major trauma patients may shorten the time to diagnosis and the time for management.

A Validation Study for the Practical Use of Screening Scale for Potential Drug-use Adolescents(SPDA) (청소년 약물사용 잠재군 선별척도(SPDA) 활용을 위한 타당화 연구)

  • Lee, Ki-Young;Kim, Young-Mi;Im, Hyuk;Park, Mi-Jin;Park, Sun-Hee
    • Korean Journal of Social Welfare
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    • v.57 no.3
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    • pp.305-335
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    • 2005
  • This paper is a result from validation study for SPDA(A Screening Scale For Potential Drug-use Adolescents) created in 2003 and newly developed during 2004. SPDA aims to screen adolescents in their early stage of drug-use and to help practitioners make a preventive approach for the adolescents. 4307 junior and senior high school students were selected as primary research subjects by stratified and quota sampling methods. 305 adolescents on probation were also selected as a comparison group and asked to answer the same questionnaire. Reliability for SPDA recorded 0.914, which proved to be better than previous year's (0.898). Exploratory and confirmatory factor analyses to test construct validity proved that SPDA could be divided into 7 factors and that each factor structure of SPDA could be a proper measurement model with high level of fitness and factor loadings. Discriminant analysis to test predictive validity confirmed that SPDA could classify the adolescents excellently by the frequency of drug-use, with hit ratio of 86.6 percent(78.8% and 87.4% for junior and senior high school students respectively). For concurrent validity test, Hare Home Self-Esteem Scale, Hare School Self-Esteem, Zuckerman-Kuhlman Sensation-seeking Scale were employed to find correlation with SPDA and all the three scales had significant Pearson correlation coefficients with SPDA. Known-groups validity test indicated that SPDA had an adequate power to classify out adolescents on probation from those in schooling, with a hit ratio of 71.8 percent. Cut-off point to detect adolescents with high risk of substance use was 77, which indicated approximately T score, 55 (0.5 SD), satisfying sensitivity, specificity, and efficiency criteria.

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The Suitable Region and Site for 'Fuji' Apple Under the Projected Climate in South Korea (미래 시나리오 기후조건하에서의 사과 '후지' 품종 재배적지 탐색)

  • Kim, Soo-Ock;Chung, U-Ran;Kim, Seung-Heui;Choi, In-Myung;Yun, Jin-I.
    • Korean Journal of Agricultural and Forest Meteorology
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    • v.11 no.4
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    • pp.162-173
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    • 2009
  • Information on the expected geographical shift of suitable zones for growing crops under future climate is a starting point of adaptation planning in agriculture and is attracting much concern from policy makers as well as researchers. Few practical schemes have been developed, however, because of the difficulty in implementing the site-selection concept at an analytical level. In this study, we suggest site-selection criteria for quality Fuji apple production and integrate geospatial data and information available in public domains (e.g., digital elevation model, digital soil maps, digital climate maps, and predictive models for agroclimate and fruit quality) to implement this concept on a GIS platform. Primary criterion for selecting sites suitable for Fuji apple production includes land cover, topography, and soil texture. When the primary criterion is satisfied, climatic conditions such as the length of frost free season, freezing risk during the overwintering period, and the late frost risk in spring are tested as the secondary criterion. Finally, the third criterion checks for fruit quality such as color and shape. Land attributes related to these factors in each criterion were implemented in ArcGIS environment as relevant raster layers for spatial analysis, and retrieval procedures were automated by writing programs compatible with ArcGIS. This scheme was applied to the A1B projected climates for South Korea in the future normal years (2011-2040, 2041-2070, and 2071-2100) as well as the current climate condition observed in 1971-2000 for selecting the sites suitable for quality Fuji apple production in each period. Results showed that this scheme can figure out the geographical shift of suitable zones at landscape scales as well as the latitudinal shift of northern limit for cultivation at national or regional scales.

Delirium after Head Trauma at Psychiatric Consultation (두부 외상 후 섬망의 자문 정신 의학적 고찰)

  • Kim, Hyon-Chul;Lee, Sang-Chul;Kim, Do-Hoon;Lee, Sang-Kyu;Hong, Seung-Gwan;Son, Bong-Ki
    • Korean Journal of Psychosomatic Medicine
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    • v.12 no.1
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    • pp.15-22
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    • 2004
  • Objectives: Delirium after head trauma results in various cognitive and behavioral dysfunction. This study aimed at developing and validating a predicitive model for clinical improvement after delirium based on precipitating factors during hospitalization Method: Data were collected on 45 patients who developed delirium after head trauma using 5 year retrospective design, based on reviews of medical charts including psychiatric consultation reports. The differences of the group who sustained residual symptoms of delirium(The RS group) and the group of full recovery(The FR group) at 4 week follow-up visits were compared by motoric type of delirium, socio-demographic variables, neuroimaging variables and clinical variables of interest. Result: There was significant difference in reason for initial consultation between two groups, in terms of hyperactivity(p<.01). The presence of compensation claim, subcortical gray matter lesion was significantly associated with the RS group(p<.05). Total length of intensive care unit(ICU) admission and of hospital stay were significantly longer in RS group than FR group(p<.01). Conclusion: This study shows that hyperactivity on initial consultation, compensation claims, specific brain lesion were altogether significant factors in explaining prolonged duration of delirium after head trauma. A simple predictive model based on the presence of precipitating factors might be used to identify delirious patients at high risk for prolonged cognitive dysfunction. Early psychiatric intervention would be required for evaluating efficacious management and shortening admission period.

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Prediction of Species Distribution Changes for Key Fish Species in Fishing Activity Protected Areas in Korea (국내 어업활동보호구역 주요 어종의 종분포 변화 예측)

  • Hyeong Ju Seok;Chang Hun Lee;Choul-Hee Hwang;Young Ryun Kim;Daesun Kim;Moon Suk Lee
    • Journal of the Korean Society of Marine Environment & Safety
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    • v.29 no.7
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    • pp.802-811
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    • 2023
  • Marine spatial planning (MSP) is a crucial element for rational allocation and sustainable use of marine areas. Particularly, Fishing Activity Protected Areas constitute essential zones accounting for 45.6% designated for sustainable fishing activities. However, the current assessment of these zones does not adequately consider future demands and potential values, necessitating appropriate evaluation methods and predictive tools for long-term planning. In this study, we selected key fish species (Scomber japonicus, Trichiurus lepturus, Engraulis japonicus, and Larimichthys polyactis) within the Fishing Activity Protected Area to predict their distribution and compare it with the current designated zones for evaluating the ability of the prediction tool. Employing the Intergovernmental Panel on Climate Change (IPCC) 6th Assessment Report scenarios (SSP1-2.6 and SSP5-8.5), we used species distribution models (such as MaxEnt) to assess the movement and distribution changes of these species owing to future variations. The results indicated a 30-50% increase in the distribution area of S. japonicus, T. lepturus, and L. polyactis, whereas the distribution area of E. japonicus decreased by approximately 6-11%. Based on these results, a species richness map for the four key species was created. Within the marine spatial planning boundaries, the overlap between areas rated "high" in species richness and the Fishing Activity Protected Area was approximately 15%, increasing to 21% under the RCP 2.6 scenario and 34% under the RCP 8.5 scenario. These findings can serve as scientific evidence for future evaluations of use zones or changes in reserve areas. The current and predicted distributions of species owing to climate change can address the limitations of current use zone evaluations and contribute to the development of plans for sustainable and beneficial use of marine resources.