• Journal of Chest Surgery
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• 제52권6호
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• pp.400-408
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• 2019

Background: For decades, trauma has been recognized globally as a major cause of death. Reducing the mortality of patients with trauma is an extremely pressing issue, particularly for those with severe trauma. An early and accurate assessment of the risk of mortality among patients with severe trauma is important for improving patient outcomes. Methods: We performed a retrospective medical record review of 582 patients with severe trauma admitted to the emergency department between July 2011 and June 2016. We analyzed the associations of in-hospital mortality with the baseline characteristics and initial biochemical markers of patients with severe trauma on admission. Results: The overall in-hospital mortality rate was 14.9%. Multivariate logistic regression analysis showed that the patient's Rapid Emergency Medicine Score (REMS; odds ratio [OR], 1.186; 95% confidence interval [CI], 1.018-1.383; p=0.029), Emergency Trauma Score (EMTRAS; OR, 2.168; 95% CI, 1.570-2.994; p<0.001), serum lactate levels (SLL; OR, 1.298; 95% CI, 1.118-1.507; p<0.001), and Injury Severity Score (ISS; OR, 1.038; 95% CI, 1.010-1.130; p=0.021) were significantly associated with in-hospital mortality. Conclusion: The REMS, EMTRAS, and SLL can easily and rapidly be used as alternatives to the injury severity score to predict in-hospital mortality for patients who present to the emergency department with severe trauma.

• Tuberculosis and Respiratory Diseases
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• 제73권3호
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• pp.162-168
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• 2012

Background: Idiopathic pulmonary fibrosis (IPF) is a progressive disease. Effective treatment is not currently available and the prognosis is poor. The aim of our study was to identify clinical predictors of survival in patients with IPF. Methods: By using medical record database of a university hospital, we reviewed the records of patients who had been diagnosed as having IPF from January 1996 through December 2007. Results: Among 89 patients considered as having interstitial lung disease (ILD) on computed tomography (CT) of the chest, 22 were excluded because of the diagnosis of other ILDs or connective tissue disease, and finally, 67 met the criteria of IPF. The mean age at the diagnosis of IPF was 70 years (range, 41~87 years) and 43 (64%) were male. The mean survival time following the diagnosis of IPF was 40 months (range, 0~179 months). Among them, 28 cases were diagnosed as the progressive state of IPF on the follow-up CT examination, and the mean duration between diagnosis of IPF and progression was 31 months. Multivariate analysis using Cox regression model revealed that body mass index (BMI) less than 18.5 $kg/m^2$ (p=0.030; hazard ratio [HR], 12.085; 95% confidence interval [CI], 1.277~114.331) and CT progression before 36 months from the diagnosis of IPF (p=0.042; HR, 13.564; 95% CI, 1.101~167.166) were independently associated with mortality. Conclusion: Since low BMI at the diagnosis of IPF and progression on follow-up CT were associated with poor prognosis, IPF patients with low BMI and/or progression before 36 months following the diagnosis should be closely monitored.

• Journal of Preventive Medicine and Public Health
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• 제51권5호
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• pp.227-233
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• 2018

Objectives: Chronic diseases, including back pain, result in significant patient morbidity and societal burden. Overall improvement in physical fitness is recommended for prevention and treatment. Walking is a convenient modality for achieving initial gains. Our objective was to determine whether neighbourhood walkability, acting as a surrogate measure of physical fitness, was associated with the presence of chronic disease. Methods: We conducted a cross-sectional study of prospectively collected data from a prior randomized cohort study of 227 patients referred for tertiary assessment of chronic back pain in Ottawa, ON, Canada. The Charlson Comorbidity Index (CCI) was calculated from patient-completed questionnaires and medical record review. Using patients' postal codes, neighbourhood walkability was determined using the Walk Score, which awards points based on the distance to the closest amenities, yielding a score from 0 to 100 (0-50: car-dependent; 50-100: walkable). Results: Based on the Walk Score, 134 patients lived in car-dependent neighborhoods and 93 lived in walkable neighborhoods. A multivariate logistic regression model, adjusted for age, gender, rural postal code, body mass index, smoking, median household income, percent employment, pain, and disability, demonstrated an adjusted odds ratio of 2.75 (95% confidence interval, 1.16 to 6.53) times higher prevalence for having a chronic disease for patients living in a car-dependent neighborhood. There was also a significant dose-related association (p=0.01; Mantel-Haenszel chi-square=6.4) between living in car-dependent neighbourhoods and more severe CCI scores. Conclusions: Our findings suggest that advocating for improved neighbourhood planning to permit greater walkability may help offset the burden of chronic disease.

• Journal of Preventive Medicine and Public Health
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• 제45권1호
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• pp.37-46
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• 2012

Objectives: This study was performed to consider the association between Internet using time for non-educational purposes and adolescent health, and to examine how health status differs between Internet users and non-users. Methods: We analyzed 2009 data from the Korea Adolescent Risk Behavior Web-Based Survey, conducted on a nationally representative sample of students in grades 7 to 12. A total of 75 066 adolescents were categorized into four groups according to their Internet using time excluding using for educational purposes: non-Internet users (NIUs), occasional Internet users (OIUs) (<1 h/d), moderate Internet users (MIUs) (${\geq}1$ and <2 h/d), and heavy Internet users (HIUs) (${\geq}2$ h/d). Health factors included eight health risk behavior indices, four mental health indices and six physical health indices. Results: The distribution of Internet use was as follows: NIUs 17.4%, OIUs 68.1%, MIUs 12.7%, and HIUs 1.7%. In multivariate analysis, using OIUs as a reference, U- or J-shaped associations were observed for five health risk behavior indices (current smoking, current drinking, drug abuse, sexual intercourse, sedentary behavior on weekdays) and four mental health indices (stressed, depressed, suicidal ideation, attempted suicide) in both genders. After removing confounding effects, including age, region, school type, subjective school record, subjective economic status, presence of parents, living with family, and sedentary behavior, these associations were still observed. Conclusions: Health professionals should consider both Internet non-users (for non-educational purposes) and heavy users to be high-risk groups in terms of health status. Also, more well-designed studies are needed to clarify what factors are working in these nonlinear associations.

• 한국임상약학회지
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• 제31권3호
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• pp.237-246
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• 2021

Background: Pembrolizumab, an anti-cancer drug, is known to increase the activity of the immune system, leading to side effects called immune-related adverse events (irAE), including type 1 diabetes. This study analyzed the correlation between blood glucose level and pembrolizumab administration and investigated the covariates that affect those changes in cancer treatment. Methods: The information of 133 adult cancer patients was obtained from the electronic medical record (EMR) to identify the changes in random blood glucose (RBG) levels during the pembrolizumab treatment. Subjects were classified into subgroups according to their baseline RBG level, history of diabetes, and the use of steroids, and linear regression analysis was conducted. In addition, a secondary analysis was performed within the group of subjects having a strong correlation to glycemic change, which was based on the Pearson correlation coefficient being less than -0.7 or greater than +0.7. Univariate and multivariate logistic regressions were conducted to identify the risk factors to glycemic increase. Results: The RBG level tended to descend without significant differences in total patients during the administration period of pembrolizumab. Despite the insignificance, the logistic regression analysis presents that the odds ratios of baseline RBG less than 130 mg/dL, prophylactic steroid use, and higher dose of pembrolizumab per cycle (mg/kg/cycle) were greater than 1. Conclusions: Prophylactic administration of steroids and a higher dose of pembrolizumab per cycle may increase the blood glucose level as irAE in cancer patients with a strong tendency to glycemic change.

• 대한간호학회지
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• 제49권3호
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• pp.329-339
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• 2019

Purpose: The purpose of this study was to investigate the frequency, patterns, and factors of reversals in decisions about life-sustaining treatment (LST) among older patients with terminal-stage chronic cardiopulmonary disease. Methods: This was a retrospective correlational descriptive study based on medical chart review. De-identified patient electronic medical record data were collected from 124 deceased older patients with terminal-stage cardiopulmonary disease who had made reversals of LST decisions in an academic tertiary hospital in 2015. Data were extracted about the reversed LST decisions, LST treatments applied before death, and patients' demographic and clinical factors. Multivariate logistic regression analysis was used to identify the factors associated with the reversal to higher intensity of LST treatment. Results: The use of inotropic agents was the most frequently reversed LST treatment, followed by cardiopulmonary resuscitation, intubation, ventilator therapy, and hemodialysis. Inconsistency between the last LST decisions and actual treatments occurred most often in hemodialysis. One-third of the reversals in LST decisions were made toward higher intensity of LST treatment. Patients who had lung diseases (vs. heart diseases); were single, divorced, or bereaved (vs. married); and had an acquaintance as a primary decision maker (vs. the patients themselves) were significantly more likely to reverse the LST decisions to higher intensity of LST treatment. Conclusion: This study demonstrated the complex and turmoil situation of the LST decision-making process among older patients with terminal-stage cardiopulmonary disease and suggests the importance of support for patients and families in their LST decision-making process.

• 대기
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• 제33권3호
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• pp.307-317
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• 2023

This study investigates the physical mechanisms that contributed to the 2022 European record-breaking heatwave throughout May-August (MJJA). The European climate has experienced surface warming and drying in the recent decade (1979~2022) which influences the development of the 2022 European heatwave. Since its spatial pattern resembles the 2003 European heatwave which is a well-known case developed by the strong coupling of near-surface conditions to land surface processes, the 2022 heatwave is compared with the 2003 case. Understanding heatwave development is carried out by the European Centre for Medium-Range Weather Forecasts (ECMWF) Reanalysis version 5 (ERA5) and daily maximum surface temperature released by NCEP (National Centers for Environmental Prediction) CPC (Climate Prediction Center). The results suggest that the persistent high pressure along with clear sky tends to increase the downward shortwave radiation which leads to enhanced sensible heat flux with the land surface dryness. Terrestrial Coupling Index (TCI), a process-based multivariate metric, is employed to quantitatively measure segmented feedback processes, separately for the land, atmosphere, and two-legged couplings, which appears to the development of the 2022 heatwave, can be viewed as an expression of the recent trends, amplified by internal land-atmosphere interactions.

• Radiation Oncology Journal
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• 제8권1호
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• pp.65-71
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• 1990

유방암의 일차 치료후 흉벽이나 국소임파절에 국한된 재발은 비교적 흔하게 관찰된다. 방사선치료는 이러한 국소재발유암 환자에게 효과적인 치료법으로 사용되어 왔으나 국소병변의 관해에도 불구하고 많은 경우에서 이차개발 또는 원격전이로 인해 불량한 예후를 보이므로 최근에는 다방면 병용요법을 시도하여 환자의 수명을 연장시키고 관해율을 증가시켰다는 고들이 있다. 이에 저자들은 국소 재발유암 환자의 특성과 치료결과, 치료후 실패양상, 생존율에 영향을 미치는 예후인자를 분석하여 향후치료의 지침으로 삼고자, 1974년 부터 1986년까지 연세대학교 의과대학 치료방사선과에서 방사선치료를 받은 53명을 대상으로 후향적분석을 통해 다음과 같은 결과를 얻었다. 32예 ($60.4\%$)가 단일 병소에, 21예 ($39.4\%$)가 다발병소에 재발하였다. 방사선치료후 31예 ($58.4\%$)에서 완전관해를 보였으나 그 중 7예는 치료부위에 다시 재발하였다. 전체환자의 5년 생존율과 무병생존율은 각각 $27\%,\;15\%$였다. 각각의 예후인자에 대한 단일변량분석에서는 최초 수술당시의 액와임파절전이 숫자, 보조적 화학요법의 시행 유무, 경도의 유무 등이 통계적 유의성을 보였고, 다변량분석법을 통한 분석에서는 최초수술당시의 액와임파절전이의 수, 경도의 유무, 재발시 병변의 크기, 치료후 관해기간 등이 생존율에 통계적으로 유의한 영향을 끼치는 예후인자였다.

• Journal of Preventive Medicine and Public Health
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• 제49권3호
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• pp.165-175
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• 2016

Objectives: The present study was undertaken to study the maternal risk factors for preterm birth (PTB) and low birth weight (LBW) with a special emphasis on assessing the proportions of maternal genitourinary and periodontal infections among Indian women and their association with adverse pregnancy outcomes. Methods: A hospital-based prospective study comprising 790 pregnant women visiting the obstetrics clinic for a routine antenatal check-up was undertaken. Once recruited, all study participants underwent clinical and microbiological investigations for genitourinary infections followed by a dental check-up for the presence of periodontitis. The study participants were followed up until their delivery to record the pregnancy outcomes. Infectious and non-infectious risk factors for PTB and LBW were assessed using univariate and multivariate Cox regression analysis. Independent risk factors for PTB and LBW were reported in terms of adjusted relative risk (ARR) with the 95% confidence interval (CI). Results: Rates of PTB and LBW in the study population were 7.6% and 11.4%, respectively. Previous preterm delivery (ARR, 5.37; 95% CI, 1.5 to 19.1), periodontitis (ARR, 2.39; 95% CI, 1.1 to 4.9), Oligohydramnios (ARR, 5.23; 95% CI, 2.4 to 11.5), presence of Nugent's intermediate vaginal flora (ARR, 2.75; 95% CI, 1.4 to 5.1), gestational diabetes mellitus (ARR, 2.91; 95% CI, 1.0 to 8.3), and maternal height <1.50 m (ARR, 2.21; 95% CI, 1.1 to 4.1) were risk factors for PTB, while periodontitis (ARR, 3.38; 95% CI, 1.6 to 6.9), gestational hypertension (ARR, 3.70; 95% CI, 1.3 to 10.8), maternal height <1.50 m (ARR, 2.66; 95% CI, 1.3 to 5.1) and genital infection during later stages of pregnancy (ARR, 2.79; 95% CI, 1.2 to 6.1) were independent risk factors for LBW. Conclusions: Our study findings underscore the need to consider screening for potential genitourinary and periodontal infections during routine antenatal care in developing countries.

• 한국임상수의학회지
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• 제34권2호
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• pp.140-145
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• 2017

The goal of this study was to investigate risk factors associated with porcine reproductive and respiratory syndrome (PRRS) in pig farms in the Republic of Korea using logistic regression and a multilevel model. A cross-sectional study was applied to 305 pig farms with a questionnaire-based interview by veterinarians between March 2014 and February 2015. The questionnaire comprised eight categories: proximity to neighbors, disinfection, visitors, vehicles, insecticides, wild animals, gilts, and feeding. In total, 61 questions in eight categories related to pig farm biosecurity were investigated. Farms were classified as PRRS stable or unstable based on the results of an antibody test and PCR. For univariate analysis, keeping production records with computers (OR = 0.283, 95% CI = 0.056 - 1.425), accredited farm with no use of antibiotics (OR = 0.412, 95% CI = 0.134 - 1.269), reviewing health record of semen prior to purchasing (OR = 0.492, 95% CI = 0.152 - 1.589), complete isolation of runt pigs (OR = 0.264, 95% CI = 0.084 - 0.829), compulsory registering for visitors (OR = 0.424, 95% CI = 0.111 - 1.612), keeping records of insecticide history (OR = 0.406, 95% CI = 0.089 - 1.846), routine on-farm monitoring by veterinarians (OR = 0.314, 95% CI = 0.069 - 1.423), and use of on-farm checklist for biosecurity monitoring (OR = 0.313, 95% CI = 0.063 - 1.553) were found to decrease the probability of PRRS infection. Multivariate and multilevel analysis revealed only two factors, complete isolation of runt pigs (OR = 0.165, 95% CI = 0.045 - 0.602 and OR = 0.208, 95% CI = 0.055 - 0.782) and compulsory registering for visitors (OR = 0.106, 95% CI = 0.017 - 0.655 and OR = 0.119, 95% CI = 0.017 - 0.809) were found to decrease the probability of PRRS infection. The intracluster correlation coefficient of a province for multilevel model was 0.05. The results of this study might facilitate biosecurity measures for individual farms to reduce the probability of PRRS infection.