• Journal of Korean Medical Science
• /
• v.33 no.47
• /
• pp.292.1-292.10
• /
• 2018

Background: We investigated the incidence of active tuberculosis among patients with inflammatory bowel disease (IBD) treated with tumor necrosis factor (TNF) inhibitors, with or without latent tuberculosis infection (LTBI). Methods: The study was performed at a Korean tertiary referral center between January 2011 and June 2017. In total, 740 patients with IBD who underwent LTBI screening tests and were followed-up for ${\geq}1$ year after TNF inhibitor treatment initiation were enrolled. LTBI was detected on the basis of tuberculin skin test results, interferon-gamma release assay results, chest X-ray findings, and previous tuberculosis treatment history. The patients were classified into LTBI (n = 84) or non-LTBI (n = 656) group. The risk of developing tuberculosis in each group was assessed on the basis of standardized incidence ratio (SIR) and 95% confidence interval (CI) for active tuberculosis. Results: Mean patient age was 33.1 years, and patients with Crohn's disease were predominant (80.7%). Within 1 year after the initiation of TNF inhibitor treatment, 1 patient in the LTBI group (1/84; 1.2%) and 7 patients in the non-LTBI group (7/656; 1.1%) developed active tuberculosis. The overall 1-year incidence of tuberculosis among the patients was significantly higher than that among the general population (SIR, 14.0; 95% CI, 7.0-28.0), and SIR was not affected by LTBI status (LTBI group: 14.5, 95% CI, 2.0-102.6; non-LTBI group: 14.0, 95% CI, 6.7-29.4). Conclusion: Patients with IBD undergoing TNF inhibitor treatment showed a higher 1-year incidence of tuberculosis than the general population irrespective of LTBI status.

• Journal of Obesity & Metabolic Syndrome
• /
• v.26 no.1
• /
• pp.23-27
• /
• 2017

Background: In Korea, the prevalence of obesity has steadily increased, and the socioeconomic burden of obesity has increased along with it. In 2015, the National Health Insurance Service (NHIS) signed a memorandum of understanding with the Korean Society for the Study of Obesity (KSSO), providing limited open access to its databases so that the status of obesity and obesity management could be investigated. Methods: Using NHIS databases, we analyzed nationwide population-based studies for obesity using the definition of obesity (body mass index ${\geq}25kg/m^2$) in subjects over the age of 20. Age and sex standardization were used for all data. Results: The KSSO released the 'Obesity Fact Sheet 2016' using the 2006-2015 NHIS Health Checkup database. The prevalence of obesity steadily increased from 28.7% in 2006 to 32.4% in 2015, and the prevalence of abdominal obesity also steadily increased from 18.4% in 2009 to 20.8% in 2015. The prevalence of class II obesity steadily increased from 2006 to 2015, such that the total prevalence was 4.8% in 2015 (5.6% in men and 4.0% in women). The highest prevalence of obesity was found in Jeju Island, while the lowest prevalence was found in Daegu City. The highest prevalence of abdominal obesity was also found in Jeju Island, while the lowest prevalence was found in Gwangju City. Conclusion: Based on the Obesity Fact Sheet 2016, a strategy for reducing the prevalence of obesity is needed, especially in Korean men.

• Journal of Korean Medical Science
• /
• v.33 no.43
• /
• pp.277.1-277.10
• /
• 2018

Background: To examine survival rates and renal function after partial nephrectomy (PN) and radical nephrectomy (RN) in patients with chronic kidney disease (CKD). Methods: We studied 4,332 patients who underwent PN or RN for pathological T1a-T2N0M0 renal cell carcinoma from 1988 to 2014. Patients were divided into two subgroups of CKD stage I-II and stage III. Kidney function, and survival outcomes were compared between groups. Results: We included 1,756 patients with CKD I-II and 276 patients with CKD III in the final pair-matched analysis. Kidney function was significantly better preserved in the PN than in the RN group among all patients. However, the beneficial effect of PN on kidney function gradually disappeared over time in CKD III patients. The 5-year overall survival (OS) rates after PN and RN differed in patients with CKD I-II disease (99.4% vs. 96.5%, respectively, P = 0.015). The 5-year OS rates after surgery were not affected by mode of nephrectomy in CKD III patients (97.8% vs. 93.5%, P = 0.103). The 5-year cancer-specific survival rates did not differ between treatment groups in all CKD stage. Cox hazard analysis showed that the operative method was a significant factor for OS in CKD I-II patients (hazard ratio [HR], 0.320; confidence interval [CI], 0.122-0.840; P = 0.021). However, PN was not beneficial in terms of OS in CKD III patients (HR, 0.395; CI, 0.086-1.172; P = 0.117). Conclusion: PN is associated with a higher OS rate and better kidney function in patients with preoperative CKD stage I and II, but not in those with CKD stage III.

• Korean Journal of Psychosomatic Medicine
• /
• v.24 no.1
• /
• pp.109-116
• /
• 2016

Objectives : This study aimed to investigate the effects of resilience on posttraumatic stress symptoms and dissociation and whether depression mediates the relationships between resilience and posttraumatic stress symptoms and dissociation. Methods : A total of 115 firefighters participated in the study. Data were collected via the Life Events Checklist, Impact of Event Scale-Revised, Dissociative Experience Scale, Beck Depression Inventory, and Connor-Davidson Resilience Scale. Structural equation modeling and path analysis were applied to estimate the relationships between resilience, depression, posttraumatic stress symptoms, and dissociation. Results : Greater resilience was associated with lower posttraumatic stress symptoms and dissociation, and the relationship between them was fully mediated by depression. Conclusions : Specific aspects of depression may help explain the relationships between resilience and posttraumatic stress symptoms and dissociation. Tailored prevention programs and treatments based on resilience and depression may prevent posttraumatic stress symptoms and dissociation in firefighters and improve treatments outcomes among firefighters with posttraumatic stress symptoms and/or dissociation.

• The Korean Journal of Gastroenterology
• /
• v.72 no.6
• /
• pp.295-303
• /
• 2018

Background/Aims: The primary aims of this study were to evaluate the content quality of YouTube videos on exercises to help relieve constipation and to assess whether the video source, exercise types, and popularity affected their quality. Methods: Eight gastroenterologists independently evaluated the exercises presented in the constipation YouTube videos for seven items: image quality, usefulness in relieving constipation (quality 1), usefulness for general physical health (quality 2), difficulty in following, activity intensity, fun, and overall quality. Raters were asked open-ended questions to evaluate the strengths and weaknesses of the videos. Five-point ordinal scales were used to score each item aforementioned, with the exception of image quality and overall quality that used a six-point Likert scale. Results: The 20 videos had a mean length of 268 seconds and a mean viewership of 32,694. The most common video source was commercial (n=10), and the most common type of physical activity was yoga (n=11). The median values of image quality, quality 1, quality 2, difficulty in following, activity intensity, fun, and overall quality were 3, 2, 2, 2, 2, 2, and 2, respectively. Yoga videos had significantly higher median quality 1 values (3) compared with massage videos (2, adjusted p=0.006) and 'others' videos (2, adjusted p<0.001). A lack of medical evidence was the most common answer to open-ended questions about the weaknesses of each video. Conclusions: Overall, YouTube exercise videos presented a low-quality content. This study highlights the need for evidence-based comprehensive educational videos addressing exercises for treating constipation.

• Journal of Hospice and Palliative Care
• /
• v.21 no.4
• /
• pp.137-143
• /
• 2018

Purpose: The purpose of this study was to investigate the family composition of terminally ill cancer patients admitted to the hospice unit and how it affects their hospice care. Methods: We retrospectively analyzed the medical records of terminal cancer patients who died in one hospice unit between January 2009 and March 2014. The demographic and clinical characteristics of the patients were examined, and any different made by their marital status was evaluated. We calculated the time interval between cancer diagnosis and hospice admission and the survival period from hospice admission to death and analyzed their association with family composition. Results: When divided by the median time of 13 months between diagnosis and admission, Group B (>13 months) had a significantly higher proportion of patients living with their spouses; (P<0.01). The main decision maker was a spouse (52.9%) in Group B; (P=0.04). Conclusion: Among the characteristics of the family composition, the presence of spouse was an important factor associated with admission to a hospice unit. Clinicians need to be aware of the impact of marital status on end-of-life care. This study indicates that it is helpful to understand family composition of terminallyill cancer patients for an effective palliative and hospice care.

• Tuberculosis and Respiratory Diseases
• /
• v.82 no.3
• /
• pp.251-260
• /
• 2019

Background: Beyond its current function as a rescue therapy in acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO) may be applied in ARDS patients with less severe hypoxemia to facilitate lung protective ventilation. The purpose of this study was to evaluate the efficacy of extended ECMO use in ARDS patients. Methods: This study reviewed 223 adult patients who had been admitted to the intensive care units of 11 hospitals in Korea and subsequently treated using ECMO. Among them, the 62 who required ECMO for ARDS were analyzed. The patients were divided into two groups according to pre-ECMO arterial blood gas: an extended group (n=14) and a conventional group (n=48). Results: Baseline characteristics were not different between the groups. The median arterial carbon dioxide tension/fraction of inspired oxygen ($FiO_2$) ratio was higher (97 vs. 61, p<0.001) while the median $FiO_2$ was lower (0.8 vs. 1.0, p<0.001) in the extended compared to the conventional group. The 60-day mortality was 21% in the extended group and 54% in the conventional group (p=0.03). Multivariate analysis indicated that the extended use of ECMO was independently associated with reduced 60-day mortality (odds ratio, 0.10; 95% confidence interval, 0.02-0.64; p=0.02). Lower median peak inspiratory pressure and median dynamic driving pressure were observed in the extended group 24 hours after ECMO support. Conclusion: Extended indications of ECMO implementation coupled with protective ventilator settings may improve the clinical outcome of patients with ARDS.

• Neonatal Medicine
• /
• v.25 no.4
• /
• pp.161-169
• /
• 2018

Purpose: We assessed the influence of antenatal corticosteroid (ACS) on the inhospital outcomes of intrauterine growth restriction (IUGR) infants. Methods: A retrospective study was conducted with singletons born at $23^{+0}$ to $33^{+6}weeks$ of gestation at Seoul National University Hospital from 2007 to 2014. We compared clinical outcomes between infants who received ACS 2 to 7 days before birth (complete ACS), at <2 or >7 days (incomplete ACS), and those who did not receive ACS in IUGR and AGA infants. Multivariate logistic regression using Firth's penalized likelihood was performed. Results: 304 neonates with 91 IUGR neonates were eligible. Among AGA neonates, mortality (adjusted odds ratio [aOR], 0.13; 95% confidence interval [CI], 0.02 to 0.78), hypotension within 7 postnatal days (aOR, 0.20; 95% CI, 0.06 to 0.64), and severe bronchopulmonary dysplasia (BPD) or death (aOR, 0.24; 95% CI, 0.07 to 0.77) were lower in complete ACS group after adjusting for pregnancy induced hypertension and uncontrolled preterm labor. Mortality (aOR, 0.18; 95% CI, 0.04 to 0.78), hypotension (aOR, 0.26; 95% CI, 0.09 to 0.70), and severe BPD or death (aOR, 0.33; 95% CI, 0.12 to 0.92) were also lower in the incomplete ACS group. Among IUGR infants, after adjusting for birth weight and 5-minute Apgar score, inhaled nitric oxide use within 14 postnatal days was lower in both complete ACS (aOR, 0.07; 95% CI, 0.01 to 0.67) and incomplete ACS (aOR, 0.04; 95% CI, 0.01 to 0.37) groups. Conclusion: ACS was not effective in reducing morbidities in IUGR preterm infants.

• The Korean Journal of Applied Statistics
• /
• v.34 no.5
• /
• pp.795-806
• /
• 2021

Recently, as text data through online channels have become vast, there is a growing interest in research that summarizes and analyzes them. One of the fundamental analyses of text data is to extract potential topics. Although the researcher may read all the data and summarize the contents one by one, it is not easy to deal with large amounts of data. Blei and Lafferty (2007) and Blei et al. (2003) proposed topic modeling methods for extracting topics using a statistical model. Since the text data is generally collected over time, it is worthwhile to monitor the topic's changes. In this study, we propose a topic index based on the results of the topic model. In addition, a control chart, a representative tool for statistical process management, is applied to monitor the topic index over time. As a practical example, we use text data collected from Blue House National Petition boards between March 5, 2018, and March 5, 2020.

• Health Policy and Management
• /
• v.30 no.4
• /
• pp.493-504
• /
• 2020

Background: There have been many studies on the associations between body mass index (BMI) and cognitive function. However, no study has ever compared the associations across the methods of categorizing BMI. In this study, we aimed to fill the gap in the previous studies and examine whether the obesity paradox is valid in the risk of cognitive function. Methods: Of the 10,254 people aged 45 and older from the Korean Longitudinal Study of Ageing from 2006 to 2016, 8,970 people were finalized as the study population. The dependent variable was whether a person has a normal cognitive function or not, and the independent variables of interest were BMI categorized by the World Health Organization Western Pacific Regional Office (WHO-WPRO) method, the WHO method, and a 10-group method. Covariates included sociodemographic factors, health behavior factors, and health status factors. A generalized linear mixed model analysis with a logit link was used. Results: In the adjusted model with all covariates, first, in the case of BMI categories of the WHO-WPRO method, underweight (odds ratio [OR], 1.16; 95% confidence interval [CI], 1.15-1.17), overweight (OR, 1.36; 95% CI, 1.35-1.36), and obese (OR, 1.34; 95% CI, 1.33-1.34) groups were more likely to have a normal cognitive function than a normal-weight group. Next, in the case of BMI categories of the WHO method, compared to a normal-weight group, underweight (OR, 1.15; 95% CI, 1.14-1.16) and overweight (OR, 1.06; 95% CI, 1.06-1.07) groups were more likely to have a normal cognitive function; however, obese (OR, 0.62; 95% CI, 0.61-0.63) group was less likely to have it. Lastly, in the case of the 10-group method, as BMI increased, the likelihood to have a normal cognitive function changed like a wave, reaching a global top at group-7 (26.5 kg/㎡ ≤ BMI <28.0 kg/㎡). Conclusion: The associations between BMI and cognitive function differed according to how BMI was categorized among people aged 45 and older in Korea, which suggests that cognitive function may be positively associated with BMI in some categories of BMI but negatively in its other categories. Health policies to reduce cognitive impairment need to consider this association between BMI and cognitive function.