• Journal of Gastric Cancer
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• v.21 no.3
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• pp.258-267
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• 2021

Purpose: As the rate of endoscopic resection for early gastric cancer (EGC) has increased in patients with comorbid diseases, it is necessary to elucidate the efficacy of endoscopic submucosal dissection (ESD) for EGC in patients with comorbidities. This study aimed to analyze the clinical outcomes of ESD for EGC in patients with comorbidities. Materials and Methods: A total of 969 patients with 1,015 lesions who underwent ESD for EGC at Seoul National University Hospital between 2010 and 2014 were analyzed. The short- and long-term clinical outcomes were evaluated according to the comorbidity status. Results: Comorbidities were observed in 558 patients (57.6%). The comorbidity group had a higher proportion of patients using antithrombotic agents (29.5% vs. 0.9%; P<0.0001). Although procedure-related complications (bleeding and perforation) were not significantly different between the two groups, the length of hospital stay was significantly longer (1.8 vs. 1.4 days, P=0.023), while survival was significantly shorter in the comorbidity group (5-year overall survival rate: 90.5% vs. 97.2%, P<0.0001; 5-year disease-specific survival rate: 97.9% vs. 100%, P=0.018; 5-year disease-free survival rate: 83.4% vs. 89.2%, P=0.007). Conclusions: Gastric ESD can be performed in patients with comorbidities without increasing the risk of complications.

• Journal of Preventive Medicine and Public Health
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• v.56 no.5
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• pp.458-466
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• 2023

Objectives: The association between long sleep duration and mortality is frequently attributed to the confounding influence of comorbidities. Nevertheless, past efforts to account for comorbidities have yielded inconsistent outcomes. The objective of this study was to evaluate this relationship using a large prospective cohort in Korea. Methods: The study included 114 205 participants from the Health Examinees Study, who were followed for a median of 9.1 years. A composite comorbidity score was developed to summarize the effects of 21 diseases. Using Cox proportional hazards regression, hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause, cancer, and cardiovascular mortality associated with sleep duration were estimated. These estimates were adjusted for socio-demographic factors, lifestyle factors, body mass index, and comorbidity score. Additionally, a stratified analysis by subgroups with and without comorbidities was conducted. Results: Throughout the follow-up period, 2675 deaths were recorded. After all adjustments, an association was observed between a sleep duration of 8 hours or more and all-cause mortality (HR, 1.10; 95% CI, 1.01 to 1.20). However, no such association was detected in the stratified analysis for the subgroups based on comorbidity status. Conclusions: Long sleep duration was found to be associated with all-cause mortality among Koreans, even after adjusting for comorbidities. Additional studies are required to explore the mechanism underlying the association between sleep duration and major causes of mortality.

• The Korean Journal of Pain
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• v.37 no.2
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• pp.91-106
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• 2024

The mechanisms of the chronic pain and depression comorbidity have gained significant attention in recent years. The complement system, widely involved in central nervous system diseases and mediating non-specific immune mechanisms in the body, remains incompletely understood in its involvement in the comorbidity mechanisms of chronic pain and depression. This review aims to consolidate the findings from recent studies on the complement system in chronic pain and depression, proposing that it may serve as a promising shared therapeutic target for both conditions. Complement proteins C1q, C3, C5, as well as their cleavage products C3a and C5a, along with the associated receptors C3aR, CR3, and C5aR, are believed to have significant implications in the comorbid mechanism. The primary potential mechanisms encompass the involvement of the complement cascade C1q/C3-CR3 in the activation of microglia and synaptic pruning in the amygdala and hippocampus, the role of complement cascade C3/C3a-C3aR in the interaction between astrocytes and microglia, leading to synaptic pruning, and the C3a-C3aR axis and C5a-C5aR axis to trigger inflammation within the central nervous system. We focus on studies on the role of the complement system in the comorbid mechanisms of chronic pain and depression.

• Journal of Korean Academy of Nursing
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• v.41 no.3
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• pp.411-422
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• 2011

Purpose: The aim of this study was to clarify the actual condition of elders with dementia who were registered in the Seoul Dementia Management Project. Methods: Data were collected from 5,312 elderly patients with dementia. Demographic included characteristics, comorbidity, and healthy lifestyle habits; data from the Seoul Dementia Management Project. Results: First, demographic characteristics were as follows; mean age at the time of definite diagnosis was 78.0 yr. There were slightly more women (69.3%), and 4.55 yr was the average length of education with 41.4% being illiterate or uneducated patients. Second, there were several comorbidities including hypertension (61.7%), diabetes mellitus (31.8%), hypercholesterolemia (10.2%), heart disease (11.1%), obesity (4.2%), and stroke (21.4%). Third, alcoholic history was found in 11.8% of the patients, and smoking in 9.8%. Regular exercise was done by only 29.1% of the patients with dementia. Finally, significant differences between men and women were found for the following; age, education, medical security, hypertension, diabetes mellitus, stroke, alcoholic consumption, smoking, and regular exercise. Conclusion: Authors expect that the present data will be used for establishment of dementia associated projects and policies.

• Tuberculosis and Respiratory Diseases
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• v.80 no.2
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• pp.113-135
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• 2017

Asthma is traditionally regarded as a chronic airway disease, and recent literature proves its heterogeneity, based on distinctive clusters or phenotypes of asthma. In defining such asthma clusters, the nature of comorbidity among patients with asthma is poorly understood, by assuming no causal relationship between asthma and other comorbid conditions, including both communicable and noncommunicable diseases. However, emerging evidence suggests that the status of asthma significantly affects the increased susceptibility of the patient to both communicable and noncommunicable diseases. Specifically, the impact of asthma on susceptibility to noncommunicable diseases such as chronic systemic inflammatory diseases (e.g., rheumatoid arthritis), may provide an important insight into asthma as a disease with systemic inflammatory features, a conceptual understanding between asthma and asthma-related comorbidity, and the potential implications on the therapeutic and preventive interventions for patients with asthma. This review discusses the currently under-recognized clinical and immunological phenotypes of asthma; specifically, a higher risk of developing a systemic inflammatory disease such as rheumatoid arthritis and their implications, on the conceptual understanding and management of asthma. Our discussion is divided into three parts: literature summary on the relationship between asthma and the risk of rheumatoid arthritis; potential mechanisms underlying the association; and implications on asthma management and research.

• Perspectives in Nursing Science
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• v.10 no.1
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• pp.52-64
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• 2013

Purpose: The purpose of this study was to explore the utilization of health care of patients with lung cancer in Korea and identify determinants of these patients' health care utilization. Methods: This was a descriptive analytical study. The national medical fees claims data of patients with lung cancer were used. Using SPSS Statistics 20, the ${\chi}^2$-test and logistic regression were performed to determine the factors influencing health care utilization. Results: There were significant differences by sex, age, disease type, stage, comorbidity index, region of institutions, and type of institutions in the utilization of surgical procedures; by age, disease type, stage, comorbidity index, region of institutions, and type of institutions in the utilization of chemotherapy; and by age, stage, comorbidity index, region of institutions, and type of institutions in the utilization of radiotherapy. Conclusion: The findings of this study suggest that democratic and clinical characteristics of patients as well as institutional characteristics affect health care utilization of patients with lung cancer. Additional research is needed to determine the factors influencing health care utilization of patients with lung cancer.

• Proceedings of the Korea Inteligent Information System Society Conference
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• 2000.11a
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• pp.289-299
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• 2000

This study provides an application of datamining approach to CQI(Continuous Quality Improvement) using the discharge summary. First, we found a process variation in hospital infection rate by SPC (Statistical Process Control) technique. Second, importance of factors influencing hospital infection was inferred through the decision tree analysis which is a classification method in data-mining approach. The most important factor was surgery followed by comorbidity and length of operation. Comorbidity was further divided into age and principal diagnosis and the length of operation was further divided into age and chief complaint. 24 rules of hospital infection were generated by the decision tree analysis. Of these, 9 rules with predictive prover greater than 50% were suggested as guidelines for hospital infection control. The optimum range of target group in hospital infection control were Identified through the information gain summary. Association rule, which is another kind of datamining method, was performed to analyze the relationship between principal diagnosis and comorbidity. The confidence score, which measures the decree of association, between urinary tract infection and causal bacillus was the highest, followed by the score between postoperative wound disruption find postoperative wound infection. This study demonstrated how datamining approach could be used to provide information to support prospective surveillance of hospital infection. The datamining technique can also be applied to various areas fur CQI using other hospital databases.

• Anxiety and mood
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• v.5 no.1
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• pp.29-35
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• 2009

Background : In spite of the worldwide relevance of obsessive-compulsive disorder Ed-highlight : Unclear. Perhaps consider changing word choice. (OCD), there are considerable differences in prevalence, sex ratio, comorbidity patterns, and sociodemographic correlates. Data on subclinical OCD have been sparse to date. Methods : Data stemmed from the Korea Epidemiologic Catchment Area (KECA) study which had been carried out from April to December 2001. Korean versions of DSM-IV adapted Composite International Diagnostic Interview were administered to a representative sample of 6275 persons aged 18-64 living in the community. DSM-IV based criteria for subclinical OCD were applied. Results : The lifetime prevalence rates for OCD and subclinical OCD were 0.8% and 6.6%, respectively. In both OCD and subclinical OCD, the rates for males and females were not statistically different. OCD was demonstrated to be associated with depressive disorder, bipolar disorder, social phobia, generalized anxiety disorder, and alcohol and nicotine dependence. Additionally, subclinical OCD was associated with posttraumatic stress and somatoform disorders. Comorbidity rates in subclinical OCD were lower than those in OCD. Conclusions : The lifetime prevalence rate for OCD was less than 1% in the Korean general population. Age distribution and comorbidity patterns suggest that subclinical OCD represents a broad and heterogeneous syndrome and not simply a milder form of OCD.

• Journal of Digital Convergence
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• v.17 no.2
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• pp.217-230
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• 2019

This study was conducted to develop a customized severity-adjustment method and to evaluate their validity for acute myocardial infarction(AMI) patients to complement the limitations of the existing severity-adjustment method for comorbidities. For this purpose, the subjects of KCD-7 code I20.0 ~ I20.9, which is the main diagnosis of acute myocardial infarction were extracted using the Korean National Hospital Discharge In-depth Injury survey data from 2006 to 2015. Three tools were used for severity-adjustment method of comorbidities : CCI (charlson comorbidity index), ECI (Elixhauser comorbidity index) and the newly proposed CCS (Clinical Classification Software). The results showed that CCS was the best tool for the severity correction, and that support vector machine model was the most predictable. Therefore, we propose the use of the customized method of severity correction and machine learning techniques from this study for the future research on severity adjustment such as assessment of results of medical service.

• Journal of Korean Critical Care Nursing
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• v.4 no.1
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• pp.1-10
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• 2011

Purpose: The study was conducted to find out clinical characteristics for coronary artery disease patients with diabetes mellitus. Methods: We retrospectively reviewed the electronic medical records which included the data of 6,792 patients, who had been diagnosed coronary artery disease (CAD) such as angina or acute myocardial infarction and admitted to a university hospital in Seoul from January, 2005 to November, 2010. Results: Of the 6,792 patients, 43% had been diagnosed diabetes as comorbidity. The CAD patients with diabetes had lower left ventricular ejection fraction, stayed longer at hospital, and spent on more time from the first symptom to hospital visit than those without diabetes. In addition, they were more likely to have multi vessel coronary artery disease. Conclusion: The CAD patients with diabetes lay on the various factors which can make more worsen condition. Hence, we need to pay attention to specialized nursing care and patient education for the CAD patients with diabetes.