• Archives of Plastic Surgery
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• 제51권2호
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• pp.234-250
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• 2024

Background The impact of diabetes on complication rates following free flap (FF), pedicled flap (PF), and amputation (AMP) procedures on the lower extremity (LE) is examined. Methods Patients who underwent LE PF, FF, and AMP procedures were identified from the 2010 to 2020 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP®) database using Current Procedural Terminology and International Classification of Diseases-9/10 codes, excluding cases for non-LE pathologies. The cohort was divided into diabetics and nondiabetics. Univariate and adjusted multivariable logistic regression analyses were performed. Results Among 38,998 patients undergoing LE procedures, 58% were diabetic. Among diabetics, 95% underwent AMP, 5% underwent PF, and <1% underwent FF. Across all procedure types, noninsulin-dependent (NIDDM) and insulin-dependent diabetes mellitus (IDDM) were associated with significantly greater all-cause complication rates compared with absence of diabetes, and IDDM was generally higher risk than NIDDM. Among diabetics, complication rates were not significantly different across procedure types (IDDM: p = 0.5969; NIDDM: p = 0.1902). On adjusted subgroup analysis by diabetic status, flap procedures were not associated with higher odds of complications compared with amputation for IDDM and NIDDM patients. Length of stay > 30 days was statistically associated with IDDM, particularly those undergoing FF (AMP: 5%, PF: 7%, FF: 14%, p = 0.0004). Conclusion Our study highlights the importance of preoperative diabetic optimization prior to LE procedures. For diabetic patients, there were few significant differences in complication rates across procedure type, suggesting that diabetic patients are not at higher risk of complications when attempting limb salvage instead of amputation.

• 농촌의학ㆍ지역보건
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• 제49권1호
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• pp.50-58
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• 2024

본 연구는 2021년 기준 고등학교 1학년생을 대상으로 조사가 진행된 2018년 아동·청소년패널조사 중1 코호트 자료를 활용하여 대도시와 중소도시별 고등학교 1학년생의 여가활동 시간이 건강상태에 미치는 영향 요인을 살펴보는데 있다. 선행연구에서는 여가활동에 관해 삶의 만족도와 사회적 관계에 대해 연구가 이루어져 있다. 그러나 도시규모에 따른 여가활동 시간이 다르고, 전반적인 건강상태에 대한 연구도 나타나지 않았기 때문에 선행연구와의 차별점을 가진다. 건강상태의 영향 요인은 대도시와 중소도시의 평일과 주말 모두 운동 및 신체활동은 정(+), 스마트폰을 가지고 노는 시간은 부(-)의 영향력이 나타났다. 도시규모별로 구분해서 살펴볼 때는 대도시에서는 평일과 주말 모두 이외에 친구들과 노는 시간은 정(+), 중소도시에서는 평일과 주말 모두 TV를 시청하며 노는 시간이 정(+)의 영향으로 나타나 도시규모별로 차이가 있는 요인도 나타났다. 따라서 도시규모에 따라 평일과 주말의 여가시간 건강상태 영향 요인은 동일한 문항도 있었지만, 다른 문항도 나타났다. 대도시의 경우 도시의 발전으로 인해 친구들과 야외에서 여가, 문화생활을 즐길 수 있는 환경이 마련되어 요인의 차이가 발생한 것으로 생각할 수 있다. 도시규모별로 건강상태에 정(+)의 영향이 미치는 여가활동은 여가활동이 보다 활발히 이루어 질 수 있도록 관련 시설의 확대 등의 지원이 필요하고, 부(-)의 영향이 미치는 여가활동은 감소하도록 하고 다른 여가활동을 가질 수 있도록 하는 방안이 고려되어야 할 것으로 사료된다.

• Korean Circulation Journal
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• 제54권6호
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• pp.311-322
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• 2024

Background and Objectives: Early diastolic mitral annular tissue (e') velocity is a commonly used marker of left ventricular (LV) diastolic function. This study aimed to investigate the prognostic implications of e' velocity in patients with mitral regurgitation (MR). Methods: This retrospective cohort study included 1,536 consecutive patients aged <65 years with moderate or severe chronic primary MR diagnosed between 2009 and 2018. The primary and secondary outcomes were all-cause and cardiovascular mortality, respectively. According to the current guidelines, the cut-off value of e' velocity was defined as 7 cm/s. Results: A total of 404 individuals were enrolled (median age, 51.0 years; 64.1% male; 47.8% severe MR). During a median 6.0-year follow-up, there were 40 all-cause mortality and 16 cardiovascular deaths. Multivariate analysis revealed a significant association between e' velocity and all-cause death (adjusted hazard ratio [aHR], 0.770; 95% confidence interval [CI], 0.634-0.935; p=0.008) and cardiovascular death (aHR, 0.690; 95% CI, 0.477-0.998; p=0.049). Abnormal e' velocity (≤7 cm/s) independently predicted all-cause death (aHR, 2.467; 95% CI, 1.170-5.200; p=0.018) and cardiovascular death (aHR, 5.021; 95% CI, 1.189-21.211; p=0.028), regardless of symptoms, LV dimension and ejection fraction. Subgroup analysis according to sex, MR severity, mitral valve replacement/repair, and symptoms, showed no significant interactions. Including e' velocity in the 10-year risk score improved reclassification for mortality (net reclassification improvement [NRI], 0.154; 95% CI, 0.308-0.910; p<0.001) and cardiovascular death (NRI, 1.018; 95% CI, 0.680-1.356; p<0.001). Conclusions: In patients aged <65 years with primary MR, e' velocity served as an independent predictor of all-cause and cardiovascular deaths.

• Asian Pacific Journal of Cancer Prevention
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• 제14권12호
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• pp.7509-7515
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• 2013

To assess the risk of cancers associated with sleep duration using meta-analysis of published cohort studies, we performed a comprehensive search using PubMed, Embase and Web of Science through October 2013. We combined hazard ratios (HRs) from individual studies using meta-analysis approaches. A random effect dose-response analysis was used to evaluate the relationship between sleep duration and cancer risk. Subgroup analyses and sensitivity analyses were also performed. Publication bias was evaluated using Funnel plots and Begg's test. A total of 13 cohorts from 12 studies were included in this meta-analysis, which included 723, 337 participants with 15, 156 reported cancer outcomes during a follow-up period ranging from 7.5 to 22 years. The pooled adjusted HRs were 1.06 (95% CI: 0.92, 1.23; P for heterogeneity =0.003) for short sleep duration, 0.91 (95% CI: 0.78, 1.07; P for heterogeneity <0.0001) for long sleep duration. In subgroup analyses stratified by cancer type, long duration of sleep showed an inverse relation with hormone-related cancer (HR=0.79; 95% CI: 0.65, 0.97; P for heterogeneity =0.009) and a greater risk of colorectal cancer (HR=1.29; 95% CI: 1.09, 1.52; P for heterogeneity =0.346). Further meta-analysis on dose-response relationships showed that the relative risks of cancer were 1.00 (95% CI: 0.99, 1.01; P for linear trend=0.9151) for one hour of sleep increment per day, and 1.00 (95% CI: 0.98, 1.01; P for linear trend=0.7749) for one hour of sleep increment per night. No significant dose-response relationship between sleep duration and cancer was found on non-linearity testing (P=0.5053). Our meta-analysis suggests a positive association between long sleep duration and colorectal cancer, and an inverse association with incidence of hormone related cancers like those in the breast. Studies with larger sample size, longer follow-up times, more cancer types and detailed measure of sleep duration are warranted to confirm these results.

• 대한임상독성학회지
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• 제15권1호
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• pp.11-16
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• 2017

Purpose: The association of hypoalbuminemia with 30-day in-hospital mortality in patients with organophosphate insecticide poisoning (OPI) was studied. Methods: This retrospective cohort study was conducted between January 2006 and November 2013 in the emergency department (ED) after OPI poisoning. A Kaplan-Meier 30-day survival curve and the log-rank test were used to analyze patients stratified according to serum albumin levels on ED admission (hypoalbuminemia or normo-albuminemia). Independent risk factors including hypoalbuminemia for 30-day mortality were determined by multivariate Cox regression analysis. Results: A total of 135 patients were included. Eighty-eight (65%) patients were male and the mean age was $57.3{\pm}17.0$ years. Serum albumin, mean arterial pressure, and Glasgow coma scale score were significantly higher in the survival group than the non-survival group. APACHE II score was significantly lower in the non-survival group than the survival group. The mortality of the hypoalbuminemia group (serum albumin <3.5 g/dl) was 68.8%, while that of the normo-albuminemia group (serum albumin ${\geq}3.5g/dl$) was 15.1%. The area under the ROC curve of the serum albumin level was 0.786 (95% CI, 0.690-0.881) and the APACHE II score was 0.840 (95% CI, 0.770-0.910). Conclusion: Hypoalbuminemia is associated with 30-day mortality in patients with OPI poisoning.

• 한국과학교육학회지
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• 제37권1호
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• pp.135-142
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• 2017

4년 주기로 반복되는 TIMSS 연구에서는 2016년 말에 TIMSS 2015 결과를 발표하였다. 본 연구에서는 TIMSS 2015 결과 중에서, 학생들의 설문 응답 결과를 토대로 우리나라 학생들의 과학에 대한 태도와 성취도의 관계를 살펴보고, TIMSS 평가주기별 공통문항을 중심으로 학생들의 응답 변화추이와, 학교급 변화에 따른 학생들의 태도 변화추이를 살펴보았다. 연구결과에 따르면 우리나라 중학교 2학년 학생들은 과학 성취도 상위 15개국은 물론 전체 참여국 중 과학에 대한 자신감, 과학 학습에 대한 흥미, 과학에 대한 가치인식 등에서 최하위 수준을 나타내었다. 또한, TIMSS 평가주기별 공통문항을 중심으로 과학에 대한 태도를 분석한 결과, 우리나라 학생들은 과학에 대한 자신감과 과학 학습에 대한 흥미는 TIMSS 2011에 비해 TIMSS 2015에서 모두 낮아졌다. 반면에 과학에 대한 도구적 가치인식의 경우 TIMSS 2011에 비해 TIMSS 2015에서 모두 상승하였다. 또한, 우리나라 학생들은 초등학교 4학년에서 중학교 2학년으로 진학함에 따라 과학에 대한 자신감과 흥미가 감소하는 것으로 나타났다. 연구결과를 토대로, 우리나라 중학생들의 과학에 대한 정의적 태도 개선을 위한 후속연구와 과학과 교수학습 개선 방안을 제안하였다.

• Tuberculosis and Respiratory Diseases
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• 제83권1호
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• pp.81-88
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• 2020

Background: Use of appropriate antibiotics for the treatment of pneumonia is integral in patients admitted to intensive care units (ICUs). Although it is recommended that empirical treatment regimens should be based on the local distribution of pathogens in patients with suspected hospital-acquired pneumonia, few studies observe patients admitted to ICUs with nursing home-acquired pneumonia (NHAP). We found factors associated with the use of inappropriate antibiotics in patients with pneumonia admitted to the ICU via the emergency room (ER). Methods: We performed a retrospective cohort study of 83 pneumonia patients with confirmed causative bacteria admitted to ICUs via ER March 2015-May 2017. We compared clinical parameters, between patients who received appropriate or inappropriate antibiotics using the Mann-Whitney U, Pearson's chi-square, and Fisher's exact tests. We investigated independent factors associated with inappropriate antibiotic use in patients using multivariate logistic regression. Results: Among 83 patients, 30 patients (36.1%) received inappropriate antibiotics. NHAP patients were more frequently treated with inappropriate antibiotics than with appropriate antibiotics (47.2% vs. 96.7%, p<0.001). Methicillin-resistant Staphylococcus aureus was more frequently isolated from individuals in the inappropriate antibiotics-treated group than in the appropriate antibiotics-treated group (7.5% vs. 70.0%, p<0.001). In multivariate analysis, NHAP was independently associated with the use of inappropriate antibiotics in patients with pneumonia admitted to the ICU via ER. Conclusion: NHAP is a risk factor associated with the use of inappropriate antibiotics in patients with pneumonia admitted to the ICU via the ER.

• 한국환경보건학회지
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• 제34권1호
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• pp.12-19
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• 2008

We evaluated the relationship between birth weight and mercury exposure levels in Seoul, Korea, by following a cohort of pregnant women and the outcomes of their pregnancies between 2001-2005. Eighty-five pregnant women were recruited into this study after obtaining informed consent. Samples were collected at delivery from normal pregnant women who were living in the city of Seoul, Korea. Mercury concentrations in 85 sets of maternal and cord blood samples were measured using a gold-amalgam collection method. We used multiple regression analysis to analyze the effect of mercury exposure on birth weight. The mean levels of total mercury concentrations were 5.41(ppb) in maternal blood of pregnant women and 3.58(ppb) in umbilical cord blood. The mean concentration of umbilical cord blood mercury exposures was higher than the level recommended by WHO. There was a significant correlation between maternal and cord blood mercury concentrations. Mercury concentrations of umbilical cord blood was associated with birth weight. In addition, after adjusting for potential confounding factors, we found that mercury exposure may reduce the birth weight. This study suggests that exposure to mercury concentration during pregnancy contributes to the risk of low birth weight. Therefore, prenatal and environmental education for various and possible sources of mercury exposure might be necessary for the good health of babies. The finding of this study supports the construction of national policy for environmental health management.

• Journal of Preventive Medicine and Public Health
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• 제41권2호
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• pp.115-120
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• 2008

Objectives : The purpose of this study was to examine the relationship between serum ferritin and the metabolic syndrome (MS). Methods : We conducted a cross-sectional study of 1,444 adults over age 40 and under age 70 that lived in a rural area and participated in a survey conducted as part of the Korean Rural Genomic Cohort Study (KRGCS). The MS was defined as the presence of at least three of the followings : elevated blood pressure, low high density lipoprotein cholesterol, elevated serum triglycerides, elevated plasma glucose, or abdominal obesity. After adjustment for age, alcohol intake, menopausal status, body mass index (BMI), high sensitivity C-reactive protein (hs-CRP), and alanine aminotransferase (ALT), odds ratios (ORs) for the prevalence of the MS by sex were calculated for quartiles of serum ferritin using logistic regression analysis. Results : The MS was more common in those persons , with the highest levels of serum ferritin, compared to persons with the lowest levels, in men (37.1% vs. 22.4%, p=0.006) and women (58.8% vs. 34.8, p<0.001). In both sexes, the greater the number of MS components presents, the greater the serum ferritin levels. After adjustment for age, alcohol intake, and menopausal status, the OR for metabolic syndrome, comparing the fourth quartile of ferritin with the first quartile, was 2.21 (95% confidence interval; CI=1.26-3.87; p-trend=0.024) in men and 2.10 (95% CI=1.40-3.17; p-trend=0.001) in women. However, after further adjustment for BMI, hs-CRP, and ALT, the ORs were statistically attenuated in both sexes. Conclusions : Moderately elevated serum ferritin levels were not independently associated with the prevalence of the MS after adjusting for other risk factors. Further studies are needed to obtain evidence concerning the association between serum ferritin levels and the MS.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권6호
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• pp.504-508
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• 2004

Surgical process of oral and maxillofacial area as well as dental treatment are stressful situations to the patients. It is well known that serum level of stress hormones including adrenocorticotropic hormone(ACTH) and cortisol increase when the body is exposed to stress. However, there have been few studies on demographic and clinical factors related with stress. Therefore, the purpose of this study was to supply data to cope with stress more comprehensively and efficiently by analyzing the effect of factors related with stress in addition to surgical procedure. Prospective cohort study method was selected. Serum levels of ACTH and cortisol were measured by sampling bloods pre-operatively and post-operatively from 45 patients who had been operated at the Bundang Jesaeng Hospital department of oral and maxillofacial surgery. To evaluate factors associated with stress, patients were classified according to gender, age, method of payment(insurance or self), experiences of operation, kind of operations(expected operations or unexpected operations). Relative risk was calculated to assess relationships between changes of serum level of ACTH and cortisol and factors related with stress, whereas Chi-square analysis was executed to evaluate statistical significance. With regard to serum level of ACTH, relative risk was 1.3 in the group of the patients who were less than 40 years old. With regard to serum level of cortisol, relative risk was 1.8 for women compared with men, 1.4 in the group of the patients who were less than 40 years old and 1.6 in the group of the patients who had not experienced any other operations. In addition to surgical procedure, factors related with stress included gender, age, method of payments, experiences of operation and kind of operations. Therefore, we should provide comprehensive schemes to reduce stress of the patients going through oral and maxillofacial surgery.