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Kim HK, Jeon YJ, Um SW, Shin SH, Jeong BH, Lee K, Kim H, Lee HY, Kim TJ, Lee KS, Choi YL, Han J, Ahn YC, Pyo H, Noh JM, Choi JY, Cho JH, Choi YS, Zo JI, Shim YM, Hwang SS, Kim J. Role of invasive mediastinal nodal staging in survival outcomes of patients with non-small cell lung cancer and without radiologic lymph node metastasis: a retrospective cohort study. EClinicalMedicine 2024; 69:102478. [PMID: 38361994 PMCID: PMC10867420 DOI: 10.1016/j.eclinm.2024.102478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 02/17/2024] Open
Abstract
Background Lung cancer diagnostic guidelines advocate for invasive mediastinal nodal staging (IMNS), but the survival benefits of this approach in patients with non-small cell lung cancer (NSCLC) without radiologic evidence of lymph node metastasis (rN0) remain uncertain. We aimed to investigate the impact of IMNS in patients with rN0 NSCLC by comparing the long-term survival between patients who underwent IMNS and those who did not (non-IMNS). Methods In this retrospective cohort study, we included patients with NSCLC but without radiologic evidence of lymph node metastasis from the Registry for Thoracic Cancer Surgery and the clinical data warehouse at the Samsung Medical Centre, Republic of Korea between January 2, 2008 and December 31, 2016. We compared the 5-year overall survival (OS) rate as the primary outcome after propensity score matching between the IMNS and non-IMNS groups. The age, sex, performance statue, tumor size, centrality, solidity, lung function, FDG uptake in PET-CT, and histological examination of the tumor before surgery were matched. Findings A total of 4545 patients (887 in the IMNS group and 3658 in the non-IMNS group) who received curative treatment for NSCLC were included in this study. By the mediastinal node dissection, the overall incidence of unforeseen mediastinal node metastasis (N2) was 7.2% (317/4378 patients). Despite the IMNS, 67% of pathological N2 was missed (61/91 patients with unforeseen N2). Based on propensity score matching, 866 patients each for the IMNS and non-IMNS groups were assigned. There was no significant difference in 5-year OS and recurrence-free survival (RFS) between two groups: 5-year OS was 73.9% (95% confidence interval, CI: 71%-77%) for IMNS and 71.7% (95% CI: 68.6%-74.9%; p = 0.23), for non-IMNS (hazard ratio, HR 0.90, 95% CI: 0.77-1.07), while 5-year RFS was 64.7% (95% CI: 61.5%-68.2%) and 67.5% (95% CI: 64.3%-70.9%; p = 0.35 (HR 1.08, 95% CI: 0.92-1.27), respectively. Moreover, the timing and locations of recurrence were similar in both groups. Interpretation IMNS might not be required before surgery for patients with NSCLC without LN suspicious of metastasis. Further randomised trials are required to validate the findings of the present study. Funding None.
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Affiliation(s)
- Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yeong Jeong Jeon
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyungjong Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ho Yun Lee
- Department of Radiology and Centre for Imaging, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Tae Jung Kim
- Department of Radiology and Centre for Imaging, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Yoon-La Choi
- Department of Pathology and Translational Genomics, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joungho Han
- Department of Pathology and Translational Genomics, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hongryull Pyo
- Department of Radiation Oncology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Ill Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-sik Hwang
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Jeong Y, Kang S, Kim B, Gil YJ, Hwang SS, Cho SI. Utilization of the Unlinked Case Proportion to Control COVID-19: A Focus on the Non-pharmaceutical Interventional Policies of the Korea and Japan. J Prev Med Public Health 2023; 56:377-383. [PMID: 37551076 PMCID: PMC10415646 DOI: 10.3961/jpmph.23.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/11/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVES Korea and Japan have managed the spread of coronavirus disease 2019 (COVID-19) using markedly different policies, referred to as the "3T" and "3C" strategies, respectively. This study examined these differences to assess the roles of active testing and contact tracing as non-pharmaceutical interventions (NPIs). We compared the proportion of unlinked cases (UCs) and test positivity rate (TPR) as indicators of tracing and testing capacities. METHODS We outlined the evolution of NPI policies and investigated temporal trends in their correlations with UCs, confirmed cases, and TPR prior to the Omicron peak. Spearman correlation coefficients were reported between the proportion of UCs, confirmed cases, and TPR. The Fisher r-to-z transformation was employed to examine the significance of differences between correlation coefficients. RESULTS The proportion of UCs was significantly correlated with confirmed cases (r=0.995, p<0.001) and TPR (r=0.659, p<0.001) in Korea and with confirmed cases (r=0.437, p<0.001) and TPR (r=0.429, p<0.001) in Japan. The Fisher r-to-z test revealed significant differences in correlation coefficients between the proportion of UCs and confirmed cases (z=16.07, p<0.001) and between the proportion of UCs and TPR (z=2.12, p=0.034) in Korea and Japan. CONCLUSIONS Higher UCs were associated with increases in confirmed cases and TPR, indicating the importance of combining testing and contact tracing in controlling COVID-19. The implementation of stricter policies led to stronger correlations between these indicators. The proportion of UCs and TPR effectively indicated the effectiveness of NPIs. If the proportion of UCs shows an upward trend, more testing and contact tracing may be required.
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Affiliation(s)
- Yeri Jeong
- Department of Preventive Medicine, Graduate School of Public Health, Seoul National University, Seoul,
Korea
| | - Sanggu Kang
- Department of Preventive Medicine, Graduate School of Public Health, Seoul National University, Seoul,
Korea
| | - Boeun Kim
- Graduate School of Public Health, Seoul National University, Seoul,
Korea
| | - Yong Jin Gil
- Department of Preventive Medicine, Graduate School of Public Health, Seoul National University, Seoul,
Korea
| | - Seung-sik Hwang
- Department of Preventive Medicine, Graduate School of Public Health, Seoul National University, Seoul,
Korea
| | - Sung-il Cho
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul,
Korea
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Park EH, Hwang SS, Oh J, Kim BJ, Bae HJ, Yang KH, Choi AR, Kang MY, Subramanian S. Annual Endovascular Thrombectomy Case Volume and Thrombectomy-capable Hospitals of Korea in Acute Stroke Care. J Prev Med Public Health 2023; 56:145-153. [PMID: 37055356 PMCID: PMC10111097 DOI: 10.3961/jpmph.22.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/31/2023] [Indexed: 04/03/2023] Open
Abstract
Objectives: Although it is difficult to define the quality of stroke care, acute ischemic stroke (AIS) patients with moderate-to-severe neurological deficits may benefit from thrombectomy-capable hospitals (TCHs) that have a stroke unit, stroke specialists, and a substantial endovascular thrombectomy (EVT) case volume.Methods: From national audit data collected between 2013 and 2016, potential EVT candidates arriving within 24 hours with a baseline National Institutes of Health Stroke Scale score ≥6 were identified. Hospitals were classified as TCHs (≥15 EVT case/y, stroke unit, and stroke specialists), primary stroke hospitals (PSHs) without EVT (PSHs-without-EVT, 0 case/y), and PSHs-with-EVT. Thirty-day and 1-year case-fatality rates (CFRs) were analyzed using random intercept multilevel logistic regression.Results: Out of 35 004 AIS patients, 7954 (22.7%) EVT candidates were included in this study. The average 30-day CFR was 16.3% in PSHs-without-EVT, 14.8% in PSHs-with-EVT, and 11.0% in TCHs. The average 1-year CFR was 37.5% in PSHs-without-EVT, 31.3% in PSHs-with-EVT, and 26.2% in TCHs. In TCHs, a significant reduction was not found in the 30-day CFR (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.76 to 1.12), but was found in the 1-year CFR (OR, 0.84; 95% CI, 0.73 to 0.96).Conclusions: The 1-year CFR was significantly reduced when EVT candidates were treated at TCHs. TCHs are not defined based solely on the number of EVTs, but also based on the presence of a stroke unit and stroke specialists. This supports the need for TCH certification in Korea and suggests that annual EVT case volume could be used to qualify TCHs.
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Affiliation(s)
- Eun Hye Park
- Graduate School of Public Health, Seoul National University, Seoul,
Korea
| | - Seung-sik Hwang
- Department of Preventive Medicine, Graduate School of Public Health, Seoul National University, Seoul,
Korea
| | - Juhwan Oh
- Department of Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Beom-Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Ki-Hwa Yang
- Health Insurance Review and Assessment Service, Wonju,
Korea
| | - Ah-Rum Choi
- Health Insurance Review and Assessment Service, Wonju,
Korea
| | - Mi-Yeon Kang
- Health Insurance Review and Assessment Service, Wonju,
Korea
| | - S.V. Subramanian
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, MA,
USA
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Oh SW, Wood AC, Hwang SS, Allison M. Racial and Ethnic Differences in the Association of Low-Carbohydrate Diet With Mortality in the Multi-Ethnic Study of Atherosclerosis. JAMA Netw Open 2022; 5:e2237552. [PMID: 36264576 PMCID: PMC9585425 DOI: 10.1001/jamanetworkopen.2022.37552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Evidence linking low-carbohydrate diets (LCDs) to mortality is limited among multiethnic populations. OBJECTIVE To evaluate the association between LCDs and mortality by race and ethnicity. DESIGN, SETTING, AND PARTICIPANTS The Multi-Ethnic Study of Atherosclerosis is a large, population-based prospective cohort study of adults aged 45 to 84 years recruited from 6 US communities. A total of 6109 participants without baseline cardiovascular disease were included in this analysis. Baseline data were collected from July 2000 to August 2002, with follow-up completed by December 2017. The data were analyzed between May 2021 and April 2022. EXPOSURES Food frequency questionnaires were used to assess dietary intake. From these data, overall LCD scores were calculated from the percentages of energy intake from carbohydrates, fats, and proteins. Animal-based (emphasizing saturated fat and animal protein) and vegetable-based (emphasizing monounsaturated fat and vegetable protein) LCD scores were also calculated. MAIN OUTCOMES AND MEASURES All-cause and cause-specific mortality over a median follow-up of 15.9 years (IQR, 14.3-16.6 years). RESULTS Among the 6109 participants (mean [SD] age, 62.3 [10.3] years; 3190 women [52.2%]; 1623 African American [26.6%], 701 Chinese American [11.5%], 1350 Hispanic [22.1%], and 2435 non-Hispanic White [39.8%]), there were 1391 deaths. Overall, LCD scores were not associated with mortality, but when analyses were stratified by race and ethnicity, a lower risk of all-cause and non-CV mortality was observed among Hispanic participants with moderate carbohydrate intake. Specifically, the hazard ratios for total mortality for overall LCD scores were 0.58 (95% CI, 0.40-0.84) for quintile 2, 0.67 (95% CI, 0.45-0.98) for quintile 3, 0.60 (95% CI, 0.41-0.87) for quintile 4, and 0.83 (95% CI, 0.57-1.21) for quintile 5, with quintile 1 as the reference group. A similar association was observed for animal-based (but not vegetable-based) LCD scores. In contrast, no significant associations were found between LCD scores and mortality risk in the other racial and ethnic groups. CONCLUSIONS AND RELEVANCE In this cohort study of multiethnic US adults, LCD score was not associated with mortality in the whole population. However, moderate carbohydrate intake was associated with a lower risk of mortality among Hispanic participants. These findings suggest that the association between carbohydrate intake and mortality may differ according to race and ethnicity. Dietary guidelines considering these differences may be necessary.
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Affiliation(s)
- Seung-Won Oh
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Alexis C. Wood
- Department of Pediatrics, US Department of Agriculture/Agricultural Research Service Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - Seung-sik Hwang
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Matthew Allison
- Department of Family Medicine, University of California, San Diego
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Kang S, Jeong Y, Park EH, Hwang SS. The Impact of Household Economic Deterioration Caused by the COVID-19 Pandemic and Socioeconomic Status on Suicidal Behaviors in Adolescents: A Cross-sectional Study Using 2020 Korea Youth Risk Behavior Web-based Survey Data. J Prev Med Public Health 2022; 55:455-463. [PMID: 36229908 PMCID: PMC9561140 DOI: 10.3961/jpmph.22.241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/19/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Economic hardship has a serious impact on adolescents' mental health. The financial impact of the coronavirus disease 2019 (COVID-19) pandemic was more severe for low-income families, and this also impacted adolescents. This study aimed to examine the associations of economic deterioration (ED) caused by the COVID-19 pandemic and low socioeconomic status (SES) with adolescents' suicidal behaviors. METHODS This study analyzed data from the 2020 Korea Youth Risk Behavior Web-based Survey, which included 54 948 middle and high school students. Odds ratios (ORs) of suicidal ideation, suicidal planning, and suicide attempts related to ED and SES were calculated using multivariable logistic regression. We calculated relative excess risks due to interaction to assess additive interactions. RESULTS The ORs for suicidal ideation, suicidal planning, and suicide attempts related to combined severe ED and low SES were 3.64 (95% confidence interval [CI], 3.13 to 4.23), 3.88 (95% CI, 3.09 to 4.88), and 4.27 (95% CI, 3.21 to 5.69), respectively. CONCLUSIONS ED and low SES were significantly associated with suicidal behaviors in adolescents. Although no significant additive interaction was found, the ORs related to suicidal ideation, suicidal planning, and suicide attempts were highest among adolescents from low-income families with severe ED. Special attention is needed for this group, considering the increased impact of economic inequality due to the COVID-19 pandemic.
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Affiliation(s)
- Sanggu Kang
- Department of Preventive Medicine, Graduate School of Public Health, Seoul National University, Seoul,
Korea
| | - Yeri Jeong
- Department of Preventive Medicine, Graduate School of Public Health, Seoul National University, Seoul,
Korea
| | - Eun Hye Park
- Graduate School of Public Health, Seoul National University, Seoul,
Korea
| | - Seung-sik Hwang
- Department of Preventive Medicine, Graduate School of Public Health, Seoul National University, Seoul,
Korea
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Hong SB, Hwang S. Resting-State Brain Variability in Youth With Attention-Deficit/Hyperactivity Disorder. Front Psychiatry 2022; 13:918700. [PMID: 35903637 PMCID: PMC9322108 DOI: 10.3389/fpsyt.2022.918700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/09/2022] [Indexed: 11/19/2022] Open
Abstract
In this study, we sought to determine the nature of the abnormality in resting-state default mode network (DMN) activation and explore its correlation with functional connectivity in attention-deficit/hyperactivity disorder (ADHD). We obtained resting-state functional magnetic resonance images of youth with ADHD and typically developing counterparts from the publicly available ADHD-200 database. We used data from Peking University (232 scans) and New York University (172 scans); the scan repetition time was 2 s for both data collection sites. We applied generalized estimating equations to estimate the variability of the averaged blood-oxygen-level-dependent (BOLD) time series extracted from the DMN at rest. We performed network-based statistics to determine the association between the observed differences in BOLD signal variability and altered functional connectivity. We analyzed data from 105 youth with ADHD (age: mean 12.17, standard deviation 2.31, median 12.25; 15.2% female, 84.8% male) and 140 typically developing youth (age: mean 11.99, standard deviation 2.28, median 11.85; 47.1% female, 52.9% male), who aged 7-17 years. The imaging data were cross-sectionally collected for each participant at one time point. We observed a greater number of significant BOLD signal changes and higher-order polynomial significant associations in youth with ADHD. Moreover, there were significant between-group differences in BOLD signal change after the first 140 s, which coincided with decreased resting-state functional connectivity within the DMN in youth with ADHD. Increased variability of neural signaling was intermittently observed in the brains of youth with ADHD at rest, thereby indicating their default mode state was more unstable than that of typically developing youth.
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Affiliation(s)
- Soon-Beom Hong
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, College of Medicine, Seoul National University, Seoul, South Korea.,Institute of Human Behavioral Medicine, Medical Research Center, Seoul National University, Seoul, South Korea
| | - Seungsik Hwang
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
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Benimana TD, Lee N, Jung S, Lee W, Hwang SS. Epidemiological and spatio-temporal characteristics of COVID-19 in Rwanda. Glob Epidemiol 2021; 3:100058. [PMID: 34368752 PMCID: PMC8333025 DOI: 10.1016/j.gloepi.2021.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) has taken millions of lives and disrupted living standards at individual, societal, and worldwide levels, causing serious consequences globally. Understanding its epidemic curve and spatio-temporal dynamics is crucial for the development of effective public health plans and responses and the allocation of resources. Thus, we conducted this study to assess the epidemiological dynamics and spatio-temporal patterns of the COVID-19 pandemic in Rwanda. METHODS Using the surveillance package in R software version 4.0.2, we implemented endemic-epidemic multivariate time series models for infectious diseases to analyze COVID-19 data reported by Rwanda Biomedical Center under the Ministry of Health from March 15, 2020 to January 15, 2021. RESULTS The COVID-19 pandemic occurred in two waves in Rwanda and showed a heterogenous spatial distribution across districts. The Rwandan government responded effectively and efficiently through the implementation of various health measures and intervention policies to drastically reduce the transmission of the disease. Analysis of the three components of the model showed that the most affected districts displayed epidemic components within the area, whereas the effect of epidemic components from spatial neighbors were experienced by the districts that surround the most affected districts. The infection followed the disease endemic trend in other districts. CONCLUSION The epidemiological and spatio-temporal dynamics of COVID-19 in Rwanda show that the implementation of measures and interventions contributed significantly to the decrease in COVID-19 transmission within and between districts. This accentuates the critical call for continued intra- and inter- organization and community engagement nationwide to ensure effective and efficient response to the pandemic.
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Affiliation(s)
| | | | - Seungpil Jung
- Department of Public Health Science, Seoul National University, Seoul, Republic of Korea
| | - Woojoo Lee
- Department of Public Health Science, Seoul National University, Seoul, Republic of Korea
| | - Seung-sik Hwang
- Department of Public Health Science, Seoul National University, Seoul, Republic of Korea
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Kim WH, Park JH, Jeong J, Ro YS, Hong KJ, Song KJ, Shin SD, Hwang S. Intensity of physical activity for out-of-hospital cardiac arrests during exercise and survival outcomes. Am J Emerg Med 2021; 55:221-223. [PMID: 34412902 DOI: 10.1016/j.ajem.2021.07.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Woo Hyung Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Joo Jeong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine and Bundang Hospital, Gyeonggi, Republic of Korea
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine and Boramae Medical Centre, Seoul, Republic of Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Seungsik Hwang
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
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Hwang SS, Ahn KO, Shin SD, Ro YS, Lee SY, Park JO, Suh J. Temporal trends in out-of-hospital cardiac arrest outcomes in men and women from 2008 to 2015: A national observational study. Am J Emerg Med 2021; 41:174-178. [DOI: 10.1016/j.ajem.2020.01.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/07/2020] [Accepted: 01/28/2020] [Indexed: 01/05/2023] Open
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Lee N, Kang S, Lee W, Hwang SS. The Association between Community Water Fluoridation and Bone Diseases: A Natural Experiment in Cheongju, Korea. Int J Environ Res Public Health 2020; 17:ijerph17249170. [PMID: 33316869 PMCID: PMC7764285 DOI: 10.3390/ijerph17249170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 11/16/2022]
Abstract
The present study aimed to investigate the association between bone diseases and community water fluoridation (CWF). An ecological study with a natural experiment design was conducted in Cheongju, South Korea, from 1 January 2004 to 31 December 2013. The community water fluoridation program was implemented in Cheongju and divided into CWF and non-CWF areas. To observe adverse health effects related to bone diseases, we conducted a spatio-temporal analysis of the prevalence of hip fracture, osteoporosis, and bone cancer in residents who have lived in CWF and non-CWF areas using National Health Insurance Service data. First, we used standardized incidence ratios to estimate the disease risk. Second, the hierarchical Bayesian Poisson spatio-temporal regression model was used to investigate the association between the selected bone diseases and CWF considering space and time interaction. The method for Bayesian estimation was based on the R-integrated nested Laplace approximation (INLA). Comparing the CWF area with the non-CWF area, there was no clear evidence that exposure to CWF increased health risks at the town level in Cheongju since CWF was terminated after 2004. The posterior relative risks (RR) of hip fracture was 0.95 (95% confidence intervals 0.87, 1.05) and osteoporosis was 0.94 (0.87, 1.02). The RR in bone cancer was a little high because the sample size very small compared to the other bone diseases (RR = 1.20 (0.89, 1.61)). The relative risk of selected bone diseases (hip fractures, osteoporosis, and bone cancer) increased over time but did not increase in the CWF area compared to non-CWF areas. CWF has been used to reduce dental caries in all population groups and is known for its cost-effectiveness. These findings suggest that CWF is not associated with adverse health risks related to bone diseases. This study provides scientific evidence based on a natural experiment design. It is necessary to continue research on the well-designed epidemiological studies and develop public health prevention programs to help in make suitable polices.
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Ro H, Jeong JC, Kong JM, Min JW, Park SK, Lee J, Koo TY, Yang J, Kim MS, Hwang S, Ahn C. The tacrolimus metabolism affect post‐transplant outcome mediating acute rejection and delayed graft function: analysis from Korean Organ Transplantation Registry data. Transpl Int 2020; 34:163-174. [DOI: 10.1111/tri.13777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/14/2020] [Accepted: 10/21/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Han Ro
- Department of Internal Medicine Gil Hospital Gachon University Incheon Korea
| | - Jong Cheol Jeong
- Department of Internal Medicine Seoul National University Bundang Hospital Seongnam Korea
| | - Jin Min Kong
- Department of Internal Medicine BHS Hanseo Hospital Busan Korea
| | - Ji Won Min
- Department of Internal Medicine Bucheon St. Mary’s Hospital The Catholic University of Korea Bucheon Korea
| | - Sung Kwang Park
- Department of Internal Medicine Chonbuk National University Medical School Jeonju Korea
| | - Joongyub Lee
- Department of Prevention and Management School of Medicine Inha University Hospital Inha University Incheon Korea
| | - Tai Yeon Koo
- Transplantation Research Institute Seoul National University Hospital Seoul Korea
| | - Jaeseok Yang
- Department of Surgery Transplantation Center Seoul National University Hospital Seoul Korea
| | - Myoung Soo Kim
- Department of Surgery Yonsei University College of Medicine Seoul Korea
| | - Seungsik Hwang
- Department of Public Health Sciences Graduate School of Public Health Seoul National University Seoul Korea
| | - Curie Ahn
- Department of Internal Medicine Seoul National University Hospital Seoul National University College of Medicine Seoul Korea
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Moja TN, Bunekar N, Mishra SB, Tsai TY, Hwang SS, Mishra AK. Melt processing of polypropylene-grafted-maleic anhydride/Chitosan polymer blend functionalized with montmorillonite for the removal of lead ions from aqueous solutions. Sci Rep 2020; 10:217. [PMID: 31937796 PMCID: PMC6959273 DOI: 10.1038/s41598-019-57079-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/16/2019] [Indexed: 11/12/2022] Open
Abstract
Heavy metals such as lead ions Pb (II) are a primary concern in the aquatic environment. These is because Pb (II) is poisonous at a threshold limit above 0.01 mg/L, when consumed over a long period of time. Pb (II) poisoning is very harmful to various organs viz. heart, intestine and kidneys. Besides, it affects bones, tissues, nervous and reproductive systems. Hence, it is important to remove Pb (II) from aquatic environment. Polypropylene (PP) and polypropylene grafted-maleic-anhydride (PP-g-MA) based nanocomposites reinforced with Chitosan (CS) and modified montmorillonite clay nanofiller (CL120DT) were successfully fabricated using twin screw melt extrusion for adsorption of Pb (II). The resulting nanocomposites were characterized by XRD to analyze the dispersion properties of the material, TEM and SEM for surface morphology, FTIR analysis for the functional groups and TGA for thermal stability. Pure PP showed two sharp peaks, but there was decreased in the intensity upon adding of CS and CL120DT. Among series of nanocomposites 2.0 phr and 4.0 phr loaded samples shows better storage module than that of pure PP. The uptake of Pb (II) from lead nitrate aqueous solution by PP + PP-g-MA/CL120DT-CS 2.0 phr nanocomposites followed the Langmuir isotherm model, with a remediation of 90.9% at pH 8 and was verified by pseudo-second order kinetic model. These results indicate that PP + PP-g-MA//CL120DT-CS 2.0 phr nanocomposites performed as a superabsorbent for the Pb (II) ion removal from aqueous solution.
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Affiliation(s)
- T N Moja
- Nanotechnology and Water Sustainability Research Unit, College of Science, Engineering and Technology, University of South Africa, Florida Campus, Johannesburg, South Africa
| | - N Bunekar
- Department of Chemistry, Master Program in Nanotechnology & Center for Nanotechnology, Chung Yuan Christian University, Chung-Li, 32023, Taiwan, ROC
| | - S B Mishra
- Nanotechnology and Water Sustainability Research Unit, College of Science, Engineering and Technology, University of South Africa, Florida Campus, Johannesburg, South Africa.
| | - T-Y Tsai
- Department of Chemistry, Master Program in Nanotechnology & Center for Nanotechnology, Chung Yuan Christian University, Chung-Li, 32023, Taiwan, ROC.
| | - S S Hwang
- Department of Mechanical Engineering, Chien-Hsin University of Science and Technology, Chung-Li, 32097, Taiwan, ROC
| | - A K Mishra
- Nanotechnology and Water Sustainability Research Unit, College of Science, Engineering and Technology, University of South Africa, Florida Campus, Johannesburg, South Africa.
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13
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Kim HJ, Park JI, Yoo KD, Kim Y, Baek H, Kim SH, Chang T, Kim HH, Lee KH, Hwang S, Kim CT, Koo H, Kim JH. Real-world treatment patterns of renal anemia in hemodialysis patients: A multicenter cohort study performed using DialysisNet (RRAHD study). Medicine (Baltimore) 2020; 99:e18749. [PMID: 31914095 PMCID: PMC6959890 DOI: 10.1097/md.0000000000018749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A multicenter cohort study.The DialysisNet was previously developed for the management of hemodialysis (HD) patients based on the American Society for Testing and Materials Continuity of Care Records by metadata transformation. DialysisNet is a dialysis patient management program created by using the personal health record care platform to overcome the problems of registry studies, in real-time.Here, we aimed to investigate the pattern of treatment for renal anemia in HD patients using DialysisNet.We performed a multicenter cohort study among HD patients who were treated at one of the three Korean university-affiliated hospitals from January 2016 to December 2016. Subjects were divided into 4 hemoglobin variability groups by quartiles. The variable anemia treatment pattern was reviewed. To determine renal anemia treatment patterns, we automatically collected information on the practice of anemia treatment patterns such as erythropoietin stimulating agent (ESA) doses and administration frequencies, and targeted hemoglobin maintenance rate. Individual hemoglobin variabilities were expressed as (standard deviations)/(√(n/[n-1]).The records of 159 patients were analyzed (Hospital A: 35, Hospital B: 21, Hospital C: 103). Mean patients' age was 65.6 ± 12.8 years, and 61.6% were men. Overall, hemoglobin level was 10.5[7.43;13.93] g/dL. 158 (99.3%) patients were using ESA; and overall, the epoetin alfa dose was 33,000[4000;136,800] U per week. Hemoglobin levels (P = .206) and epoetin alfa doses were similar (P = .924) for patients with different hemoglobin variabilities. The hemoglobin target maintenance rate was lower in the highest hemoglobin variability group than in the lowest variability group (P = .045).In this study, detailed information on the actual anemia treatment patterns were obtained using the DialysisNet. We expect that DialysisNet will simplify and improve the renal anemia management for both dialysis patients and health care providers.
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Affiliation(s)
- Hyo Jin Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan
| | - Ji In Park
- Department of Internal Medicine, Kangwon National University School of Medicine
- Department of Internal Medicine, Kangwon National University Hospital
| | - Kyung Don Yoo
- Division of Nephrology, Department of Internal Medicine, Ulsan University Hospital, Ulsan
| | - Yunmi Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital
| | - Hyunjeong Baek
- Department of Internal Medicine, Kangwon National University School of Medicine
- Department of Internal Medicine, Kangwon National University Hospital
| | - Sung Ho Kim
- Seoul National University Biomedical Informatics (SNUBI), Division of Biomedical Informatics, Seoul National University College of Medicine
| | - Taehoon Chang
- Seoul National University Biomedical Informatics (SNUBI), Division of Biomedical Informatics, Seoul National University College of Medicine
| | - Hye Hyeon Kim
- Seoul National University Biomedical Informatics (SNUBI), Division of Biomedical Informatics, Seoul National University College of Medicine
| | - Kye Hwa Lee
- Center for Precision Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seungsik Hwang
- Department of Public Health Science, Graduate School of Public Health, Seoul National University
| | - Clara Tammy Kim
- Institute of Life and Death Studies, Hallym University, Chuncheon
| | - Hoseok Koo
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine
| | - Ju Han Kim
- Seoul National University Biomedical Informatics (SNUBI), Division of Biomedical Informatics, Seoul National University College of Medicine
- Systems Biomedical Informatics Research Center, Seoul National University
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14
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Lee YJ, Hwang SS, Shin SD, Lee SC, Song KJ. Effect of National Implementation of Telephone CPR Program to Improve Outcomes from Out-of-Hospital Cardiac Arrest: an Interrupted Time-Series Analysis. J Korean Med Sci 2018; 33:e328. [PMID: 30546282 PMCID: PMC6291408 DOI: 10.3346/jkms.2018.33.e328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/02/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND In cardiac arrest, the survival rate increases with the provision of bystander cardiopulmonary resuscitation (CPR), of which the initial response and treatment are critical. Telephone CPR is among the effective methods that might increase the provision of bystander CPR. This study aimed to describe and examine the improvement of neurological outcomes in individuals with out-of-hospital acute cardiac arrest by implementing the nationwide, standardized telephone CPR program. METHODS Data from the emergency medical service-based cardiac arrest registry that were collected between 2009 and 2014 were used. The effectiveness of the intervention in the interrupted time-series study was determined via a segmented regression analysis, which showed the risk ratio and risk difference in good neurological outcomes before and after the intervention. RESULTS Of 164,221 patients, 148,403 were analyzed. However, patients with unknown sex and limited data on treatment outcomes were excluded. Approximately 64.3% patients were men, with an average age of 63.7 years. The number of bystander CPR increased by 3.3 times (95% confidence interval [CI], 3.1-3.5) after the intervention, whereas the rate of good neurological outcomes increased by 2.6 times (95% CI, 2.3-2.9 [1.6%]; 1.4-1.7). The excess number was identified based on the differences between the observed and predicted trends. In total, 2,127 cases of out-of-hospital cardiac arrest (OHCA) after the intervention period received additional bystander CPR, and 339 cases of OHCA had good neurological outcomes. CONCLUSION The nationwide implementation of the standardized telephone CPR program increased the number of bystander CPR and improved good neurological outcomes.
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Affiliation(s)
- Yu Jin Lee
- Department of Emergency Medicine, Inha University Hospital, Incheon, Korea
| | - Seung-sik Hwang
- Department of Public Health Sciences, Seoul National University Graduate School of Public Health, Seoul, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Chul Lee
- Department of Emergency Medicine, Dongkuk University Ilsan Hospital, Goyang, Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
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Abstract
OBJECTIVES The work of public officers involves repeated and long-term exposure to heavy workloads, high job strain and workplace violence, all of which negatively impact physical and mental health. This study aimed to evaluate and compare the incidences of diseases among different categories of public officers in Korea, in order to further understand the health risks associated with these occupations. DESIGN A cohort study using the National Health Insurance data. PARTICIPANTS We collated claims data between 2002 and 2014 for 860 221 public officers. PRIMARY AND SECONDARY OUTCOME MEASURES Age-standardised rates were calculated using the direct standardisation method, and HRs were calculated using the Cox proportional hazard regression models. RESULTS Overall, we found that police officers and firefighters had a higher incidence of a range of diseases when compared with national and regional government officers (NRG). The most prominent HRs were observed among police officers for angina pectoris (HR: 1.52, 95% CI 1.49 to 1.54), acute myocardial infarction (HR: 1.84, 95% CI 1.77 to 1.92) and cerebrovascular disease (HR: 1.36, 95% CI 1.31 to 1.40). Firefighters were more susceptible to physical ailments and were at a significantly higher risk for traumatic stress disorders (HR: 1.40, 95% CI 1.26 to 1.56) than NRGs. CONCLUSION Compared withNRGs, police officers had higher HRs for all measured diseases, except for traumatic stress disorders. While firefighters had higher HRs for almost all diseases examined, public education officers had a higher HR for traumatic stress disorders, when compared with NRGs.
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Affiliation(s)
- Minkyung Han
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Sohee Park
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Jong Heon Park
- Big Data Steering Department, National Health Insurance Service, Gangwon-do, Republic of Korea
| | - Seung-sik Hwang
- Department of Public Health Science, Seoul National University Graduate School of Public Health, Seoul, Republic of Korea
| | - Inah Kim
- Department of Occupational and Environmental Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
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Kwak KM, Paek D, Hwang SS, Ju YS. Estimated future incidence of malignant mesothelioma in South Korea: Projection from 2014 to 2033. PLoS One 2017; 12:e0183404. [PMID: 28817672 PMCID: PMC5560642 DOI: 10.1371/journal.pone.0183404] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 08/03/2017] [Indexed: 01/26/2023] Open
Abstract
Malignant mesothelioma is a malignant tumor on the pleura or the peritoneum caused mostly by asbestos. Although asbestos is not currently used in South Korea, the incidence of mesothelioma is increasing due to its long latent period. This study predicted the incidence of malignant mesothelioma in South Korea over the next 20 years using an age-period-cohort (APC) model. Data regarding mesothelioma incidence from 1994–2013 were acquired from the Korea Central Cancer Registry (KCCR). Demographic data, including prospective resident data, were acquired from the Korean Statistical Information Service (KOSIS) for 1994–2033. An APC model with Møller’s power-link function was utilized to predict the incidence of mesothelioma. It was predicted that 2,380 and 1,199 new cases of mesothelioma in men and women, respectively, would occur over the next 20 years. For both sexes, the mesothelioma incidence rate was predicted to be greater in 2029–2033 compared to that in 2009–2013 (men, 0.282 vs 0.563; women, 0.155 vs 0.217). For men, the age-standardized incidence rate was predicted to be slightly greater in 2029–2033 relative to the rate in 2009–2013 (0.228 vs 0.235), while the age-standardized incidence rate in women decreased within the same timeframe (0.113 vs 0.109). The changes in mesothelioma incidence were mostly caused by changes in the population structure due to aging and not by changes in the mesothelioma risk ratio. The results of this study project a continuous increase in mesothelioma incidence in South Korea over the next 20 years. Although the projected increase in mesothelioma incidence was not related to an increase in the mesothelioma risk ratio, continuous preventive efforts are necessary to reduce the exposure to asbestos and prevent the trend from worsening.
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Affiliation(s)
- Kyeong Min Kwak
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Department of Occupational and Environmental Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Domyung Paek
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Seung-sik Hwang
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Young-Su Ju
- Department of Occupational and Environmental Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
- * E-mail:
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17
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Hwang SS, Smith RA, Barfield WD, Smith VC, McCormick MC, Williams MA. Supine sleep positioning in preterm and term infants after hospital discharge from 2000 to 2011. J Perinatol 2016; 36:787-93. [PMID: 27171759 DOI: 10.1038/jp.2016.80] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/10/2016] [Accepted: 04/01/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Supine sleep positioning (SSP) has been shown to reduce the risk of sudden infant death syndrome (SIDS) and preterm infants are at higher risk for SIDS. Population-based estimates of SSP are lacking for the preterm population. The objectives of this study are: (1) compare the prevalence of SSP after hospital discharge for preterm and term infants in the United States; and (2) assess racial/ethnic disparities in SSP for preterm and term infants. STUDY DESIGN We analyzed the 2000 to 2011 data from the Pregnancy Risk Assessment Monitoring System of Centers for Disease Control and Prevention from 35 states. We measured prevalence of SSP by preterm and term gestational age (GA) categories. We calculated adjusted prevalence ratios (APR) to evaluate the likelihood of SSP for each GA category compared with term infants and the likelihood of SSP for non-Hispanic black (NHB) and Hispanic infants compared with non-Hispanic white (NHW) infants. RESULTS Prevalence of SSP varied by GA: ⩽27, 59.7%; 28 0/7 to 33 6/7, 63.7%; 34 0/7 to 36 6/7 (late preterm), 63.6%; and 37 0/7 to 42 6/7 (term) weeks, 66.8% (P<0.001). In the adjusted analyses, late preterm infants were slightly less likely to be placed in SSP compared with term infants (APR: 0.96, confidence interval: 0.95 to 0.98). There were racial/ethnic disparities in SSP for all GA categories when NHB and Hispanic infants were compared with NHW infants. CONCLUSIONS All infants had suboptimal adherence to SSP indicating a continued need to better engage families about SSP. Parents of late preterm infants and families of NHB and Hispanic infants will also require greater attention given their decreased likelihood of SSP.
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Affiliation(s)
- S S Hwang
- Section of Neonatology, Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - R A Smith
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - W D Barfield
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - V C Smith
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - M C McCormick
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard School of Public Health, Boston, MA, USA
| | - M A Williams
- Harvard School of Public Health, Boston, MA, USA
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Affiliation(s)
- Alex Broadbent
- Department of Philosophy, University of Johannesburg, Auckland Park, Gauteng, South Africa
| | - Seung-sik Hwang
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, South Korea
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Ryu WS, Park JB, Ko SB, Hwang SS, Kim YJ, Kim DE, Lee SH, Yoon BW. Diastolic Dysfunction and Outcome in Acute Ischemic Stroke. Cerebrovasc Dis 2016; 41:148-55. [DOI: 10.1159/000442006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 10/27/2015] [Indexed: 11/19/2022] Open
Abstract
Background: Left ventricular diastolic dysfunction (DD) is associated with an increased mortality in general population and patients with myocardial infarct. In the present study, we investigated whether DD is associated with outcomes after ischemic stroke. Methods: Five hundred and three acute ischemic stroke patients with normal left ventricular ejection fraction (≥50%) were retrospectively included. Echocardiography and tissue Doppler imaging were used to evaluate and grade diastolic function. Ordinal logistic and Cox regression analyses were used to examine relations between DD and modified Rankin Scale (mRS) score at 3 months and mortality after stroke, respectively. Results: Mean age was 67.2 ± 11.8 years and 63% were men. Among parameters of diastolic function, early mitral inflow velocity/early diastolic mitral annulus velocity (E/e') was independently related with higher mRS score at 3 months and mortality after ischemic stroke. The highest quartile of E/e' (>14) was independently associated with higher mRS score (adjusted OR 3.86, 95% CI 2.27-6.54) as well as with mortality (hazards ratio [HR] 2.87, 95% CI 1.17-7.04) as compared to the lowest quartile of E/e' (<8.8). In addition, moderate-to-severe DD grade was related to higher mRS score (adjusted OR 2.41, 95% CI 1.15-5.06) and mortality (HR 6.63, 95% CI 1.80-24.43) compared to the normal diastolic function. Conclusion: In patients with ischemic stroke, DD is associated with functional outcome at 3 months and mortality. Our data suggest that more attention should be given to DD in patients with ischemic stroke.
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Rim TH, Han J, Choi YS, Hwang SS, Lee CS, Lee SC, Kim SS. Retinal Artery Occlusion and the Risk of Stroke Development: Twelve-Year Nationwide Cohort Study. Stroke 2016; 47:376-82. [PMID: 26742801 DOI: 10.1161/strokeaha.115.010828] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 12/08/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to evaluate the risk of subsequent stroke development after retinal artery occlusion (RAO). METHODS National registry data were collected from the Korean National Health Insurance Service, comprised 1 025 340 random subjects. Patients diagnosed with RAO in 2002 and 2003 were excluded. The RAO group was composed of patients with an initial diagnosis of either central or other RAO between January 2004 and December 2013 (n=401). The comparison group was composed of randomly selected patients (5 per RAO patient; n=2003) who were matched to the RAO group according to sociodemographic factors and year of RAO diagnosis. Each sampled patient was tracked until 2013. Cox proportional hazard regression was used. RESULTS Stroke occurred in 15.0% of the RAO group and in 8.0% of the comparison group (P < 0.001). RAO was associated with an increased risk of stroke occurrence (hazard ratio, 1.78; 95% confidence interval, 1.32-2.41). The magnitude of the RAO effect for stroke was larger among younger adults aged <65 years (hazard ratio, 3.11) than older adults aged ≥65 years (hazard ratio, 1.26). However, the risk of subsequent stroke was significantly increased in older adults aged ≥65 years at the 4-year follow-up (hazard ratio, 1.58; 95% confidence interval, 1.01-2.48). CONCLUSIONS RAO was significantly associated with subsequent stroke after adjusting for comorbidities and sociodemographic factors. These findings are limited by uncontrolled confounding factors and need to be replicated by other observational studies.
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Affiliation(s)
- Tyler Hyungtaek Rim
- From the Department of Ophthalmology, Severance Hospital, Institute of Vision Research (T.H.R., J.H., C.S.L., S.C.L., S.S.K.), Department of Radiology, Severance Hospital (Y.S.C.), and Yonsei Healthcare Big Data Based Knowledge Integration System Research Center and Institute of Convergence Science (S.S.K.), Yonsei University College of Medicine, Seoul, Korea; and Department of Social and Preventive Medicine, Inha University School of Medicine, Epidemiology, Incheon, South Korea (S.-s.H.)
| | - Jinu Han
- From the Department of Ophthalmology, Severance Hospital, Institute of Vision Research (T.H.R., J.H., C.S.L., S.C.L., S.S.K.), Department of Radiology, Severance Hospital (Y.S.C.), and Yonsei Healthcare Big Data Based Knowledge Integration System Research Center and Institute of Convergence Science (S.S.K.), Yonsei University College of Medicine, Seoul, Korea; and Department of Social and Preventive Medicine, Inha University School of Medicine, Epidemiology, Incheon, South Korea (S.-s.H.)
| | - Yoon Seong Choi
- From the Department of Ophthalmology, Severance Hospital, Institute of Vision Research (T.H.R., J.H., C.S.L., S.C.L., S.S.K.), Department of Radiology, Severance Hospital (Y.S.C.), and Yonsei Healthcare Big Data Based Knowledge Integration System Research Center and Institute of Convergence Science (S.S.K.), Yonsei University College of Medicine, Seoul, Korea; and Department of Social and Preventive Medicine, Inha University School of Medicine, Epidemiology, Incheon, South Korea (S.-s.H.)
| | - Seung-sik Hwang
- From the Department of Ophthalmology, Severance Hospital, Institute of Vision Research (T.H.R., J.H., C.S.L., S.C.L., S.S.K.), Department of Radiology, Severance Hospital (Y.S.C.), and Yonsei Healthcare Big Data Based Knowledge Integration System Research Center and Institute of Convergence Science (S.S.K.), Yonsei University College of Medicine, Seoul, Korea; and Department of Social and Preventive Medicine, Inha University School of Medicine, Epidemiology, Incheon, South Korea (S.-s.H.)
| | - Christopher Seungkyu Lee
- From the Department of Ophthalmology, Severance Hospital, Institute of Vision Research (T.H.R., J.H., C.S.L., S.C.L., S.S.K.), Department of Radiology, Severance Hospital (Y.S.C.), and Yonsei Healthcare Big Data Based Knowledge Integration System Research Center and Institute of Convergence Science (S.S.K.), Yonsei University College of Medicine, Seoul, Korea; and Department of Social and Preventive Medicine, Inha University School of Medicine, Epidemiology, Incheon, South Korea (S.-s.H.)
| | - Sung Chul Lee
- From the Department of Ophthalmology, Severance Hospital, Institute of Vision Research (T.H.R., J.H., C.S.L., S.C.L., S.S.K.), Department of Radiology, Severance Hospital (Y.S.C.), and Yonsei Healthcare Big Data Based Knowledge Integration System Research Center and Institute of Convergence Science (S.S.K.), Yonsei University College of Medicine, Seoul, Korea; and Department of Social and Preventive Medicine, Inha University School of Medicine, Epidemiology, Incheon, South Korea (S.-s.H.)
| | - Sung Soo Kim
- From the Department of Ophthalmology, Severance Hospital, Institute of Vision Research (T.H.R., J.H., C.S.L., S.C.L., S.S.K.), Department of Radiology, Severance Hospital (Y.S.C.), and Yonsei Healthcare Big Data Based Knowledge Integration System Research Center and Institute of Convergence Science (S.S.K.), Yonsei University College of Medicine, Seoul, Korea; and Department of Social and Preventive Medicine, Inha University School of Medicine, Epidemiology, Incheon, South Korea (S.-s.H.).
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Hwang SS, O'Sullivan A, Fitzgerald E, Melvin P, Gorman T, Fiascone JM. Implementation of safe sleep practices in the neonatal intensive care unit. J Perinatol 2015; 35:862-6. [PMID: 26156063 DOI: 10.1038/jp.2015.79] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/18/2015] [Accepted: 05/18/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To increase the percentage of eligible infants engaging in safe sleep practices (SSP) in two level III neonatal intensive care units (NICUs) in the Boston, Massachusetts area. STUDY DESIGN On the basis of eligibility criteria (⩾34 weeks or ⩾1800 g without acute medical conditions), all infants were eligible for two sleep practices: SSP or NICU therapeutic positioning (NTP) depending on their gestational age, weight, clinical illness and need for therapeutic interventions. Compliance with SSP was defined as: (1) supine positioning, (2) in a flat crib with no incline, (3) without positioning devices and (4) without toys, comforters or fluffy blankets. NTP comprised usual NICU care. Nursing education was comprised of a web-based learning module and in-person teaching sessions with a study team member. Double-sided crib cards (SSP one side and NTP on the other) were attached to the bedside of every infant. Pre- and postintervention audits of all infants were carried out at both study sites. We compared compliance across all time points using generalized estimating equations to account for correlated data (SAS v9.3, Cary, NC, USA). RESULT Of 755 cases, 395 (52.3%) were assessed to be eligible for SSP. From the pre- to post-intervention period, there was a significant improvement in overall compliance with SSP (25.9 to 79.7%; P-value<0.001). Adherence to each component of SSP also improved significantly following the intervention. CONCLUSION Safe infant sleep practices can be integrated into the routine care of preterm infants in the NICU. Modeling SSP to families far in advance of hospital discharge may improve adherence to SSP at home and reduce the risk of sleep-related morbidity and mortality in this vulnerable population of infants.
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Affiliation(s)
- S S Hwang
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Department of Neonatology, South Shore Hospital, South Weymouth, MA, USA
| | - A O'Sullivan
- Department of Neonatology, South Shore Hospital, South Weymouth, MA, USA
| | - E Fitzgerald
- Department of Neonatology, South Shore Hospital, South Weymouth, MA, USA
| | - P Melvin
- Center for Patient Safety and Quality Research, Boston Children's Hospital, Boston, MA, USA
| | - T Gorman
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,St Elizabeth's Medical Center, Boston, MA, USA
| | - J M Fiascone
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Department of Neonatology, South Shore Hospital, South Weymouth, MA, USA
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22
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Ro YS, Hwang SS, Shin SD, Han D, Kang S, Song KJ, Cho SI. Presumed Regional Incidence Rate of Out-of-Hospital Cardiac Arrest in Korea. J Korean Med Sci 2015; 30:1396-404. [PMID: 26425035 PMCID: PMC4575927 DOI: 10.3346/jkms.2015.30.10.1396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/23/2015] [Indexed: 01/06/2023] Open
Abstract
The regional incidence rates of out-of-hospital cardiac arrest (OHCA) were traditionally calculated with the residential population as the denominator. The aim of this study was to estimate the true incidence rate of OHCA and to investigate characteristics of regions with overestimated and underestimated OHCA incidence rates. We used the national OHCA database from 2006 to 2010. The nighttime residential and daytime transient populations were investigated from the 2010 Census. The daytime population was calculated by adding the daytime influx of population to, and subtracting the daytime outflow from, the nighttime residential population. Conventional age-standardized incidence rates (CASRs) and daytime corrected age-standardized incidence rates (DASRs) for OHCA per 100,000 person-years were calculated in each county. A total of 97,291 OHCAs were eligible. The age-standardized incidence rates of OHCAs per 100,000 person-years were 34.6 (95% CI: 34.3-35.0) in the daytime and 24.8 (95% CI: 24.5-25.1) in the nighttime among males, and 14.9 (95% CI: 14.7-15.1) in the daytime, and 10.4 (95% CI: 10.2-10.6) in the nighttime among females. The difference between the CASR and DASR ranged from 35.4 to -11.6 in males and from 6.1 to -1.0 in females. Through the Bland-Altman plot analysis, we found the difference between the CASR and DASR increased as the average CASR and DASR increased as well as with the larger daytime transient population. The conventional incidence rate was overestimated in counties with many OHCA cases and in metropolitan cities with large daytime population influx and nighttime outflow, while it was underestimated in residential counties around metropolitan cities.
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Affiliation(s)
- Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Seung-sik Hwang
- Department of Social & Preventive Medicine, Inha University School of Medicine, Incheon, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Daikwon Han
- Department of Epidemiology & Biostatistics, Texas A&M University, College Station, TX, USA
| | - Sungchan Kang
- Department of Social & Preventive Medicine, Inha University School of Medicine, Incheon, Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-il Cho
- Department of Preventive Medicine, Graduate School of Public Health, Seoul National University, Seoul, Korea
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23
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Kim SH, Cho BL, Shin DW, Hwang SS, Lee H, Ahn EM, Yun JM, Chung YH, Nam YS. The Effect of Asthma Clinical Guideline for Adults on Inhaled Corticosteroids PrescriptionTrend: A Quasi-Experimental Study. J Korean Med Sci 2015; 30:1048-54. [PMID: 26240481 PMCID: PMC4520934 DOI: 10.3346/jkms.2015.30.8.1048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 04/09/2015] [Indexed: 12/15/2022] Open
Abstract
In order to increase inhaled corticosteroid (ICS) use and to reduce hospitalization, emergency department visits and ultimately the economic burden of asthma, "Korean Asthma Management Guideline for Adults 2007" was developed. To assess the guideline effects on physician's ICS prescription for asthma, we conducted segmented regression and multilevel logistic regression using National Health Insurance claims database of outpatient visits from 2003 to 2010. We set each quarter of a year as a time unit and compared ICS prescription between before and after guideline dissemination. A total of 624,309 quarterly visits for asthma was observed. The ICS prescription rate before and after guideline dissemination was 13.3% and 16.4% respectively (P < 0.001). In the segmented regression, there was no significant guideline effect on overall ICS prescription rate. In multilevel logistic regression analyses, the effect of guideline on overall ICS prescription was not significant (odds ratio, 1.03; 95% CI, 1.00-1.06). In subgroup analysis, ICS prescription increased in secondary care hospitals (odds ratio, 1.15; 95% CI, 1.02-1.30) and in general hospitals (odds ratio, 1.10; 95% CI, 1.04-1.16). However, in primary clinics, which covered 81.7% of asthma cases, there was no significant change (odds ratio, 0.98; 95% CI, 0.94-1.02). From the in-depth interview, we could identify that the reimbursement criteria of the Health Insurance Review and Assessment Service and patient's preference for oral drug were barriers for the ICS prescription. The domestic asthma clinical guideline have no significant effect on ICS prescription, especially in primary clinics.
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Affiliation(s)
- Sang Hyuck Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
- College of Medicine, Kyung Hee University, Seoul, Korea
| | - Be Long Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
- Advanced Institutes of Convergence Technology, Seoul National University, Suwon, Korea
- Institute on Aging, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Wook Shin
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung-sik Hwang
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea
| | - Hyejin Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun Mi Ahn
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae Moon Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yun Hee Chung
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - You Seon Nam
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
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Lee WK, Lee HA, Hwang SS, Kim H, Lim YH, Hong YC, Ha EH, Park H. Does Temperature Modify the Effects of Rain and Snow Precipitation on Road Traffic Injuries? J Epidemiol 2015; 25:544-52. [PMID: 26073021 PMCID: PMC4517993 DOI: 10.2188/jea.je20140244] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There are few data on the interaction between temperature and snow and rain precipitation, although they could interact in their effects on road traffic injuries. METHODS The integrated database of the Korea Road Traffic Authority was used to calculate the daily frequency of road traffic injuries in Seoul. Weather data included rain and snow precipitation, temperature, pressure, and fog from May 2007 to December 2011. Precipitation of rain and snow were divided into nine and six temperature range categories, respectively. The interactive effects of temperature and rain and snow precipitation on road traffic injuries were analyzed using a generalized additive model with a Poisson distribution. RESULTS The risk of road traffic injuries during snow increased when the temperature was below freezing. Road traffic injuries increased by 6.6% when it was snowing and above 0 °C, whereas they increased by 15% when it was snowing and at or below 0 °C. In terms of heavy rain precipitation, moderate temperatures were related to an increased prevalence of injuries. When the temperature was 0-20 °C, we found a 12% increase in road traffic injuries, whereas it increased by 8.5% and 6.8% when it was <0 °C and >20 °C, respectively. The interactive effect was consistent across the traffic accident subtypes. CONCLUSIONS The effect of adverse weather conditions on road traffic injuries differed depending on the temperature. More road traffic injuries were related to rain precipitation when the temperature was moderate and to snow when it was below freezing.
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Affiliation(s)
- Won-Kyung Lee
- Department of Social and Preventive Medicine, Inha University School of Medicine
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25
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Jang SH, Sheen S, Kim HY, Yim HW, Park BY, Kim JW, Park IK, Kim YW, Lee KY, Lee KS, Lee JM, Hwangbo B, Paik SH, Kim JH, Sung NJ, Lee SH, Hwang SS, Kim SY, Kim Y, Lee WC, Sung SW. The Korean guideline for lung cancer screening. J Korean Med Assoc 2015. [DOI: 10.5124/jkma.2015.58.4.291] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Seung Hun Jang
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Seungsoo Sheen
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Hyae Young Kim
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Hyeon Woo Yim
- Department of Preventive Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Bo Young Park
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Jae Woo Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Whan Kim
- Division of Pulmonary and Critical Care Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kye Young Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Chungju, Korea
| | - Kyung Soo Lee
- Department of Radiology, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Jong Mog Lee
- Department of Thoracic and Cardiovascular Surgery, National Cancer Center, Goyang, Korea
| | - Bin Hwangbo
- Department of Pulmonology, National Cancer Center, Goyang, Korea
| | - Sang Hyun Paik
- Department of Radiology, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea
| | - Jin-Hwan Kim
- Department of Radiology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Nak Jin Sung
- Department of Family Medicine, Dongguk University College of Medicine, Goyang, Korea
| | - Sang-hyun Lee
- Department of Family Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Seung-sik Hwang
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea
| | - Soo Young Kim
- Department of Family Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Won-Chul Lee
- Department of Preventive Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sook-Whan Sung
- Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea
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Kim JM, Kim MH, Ju YS, Hwang SS, Ha M, Paek D. Rebuttal to authors' reply, re: cancer risk in adult residents near nuclear power plants in Korea: a cohort study of 1992-2010. J Korean Med Sci 2015; 30:115-6; discussion 116. [PMID: 25552892 PMCID: PMC4278018 DOI: 10.3346/jkms.2015.30.1.115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Jeong-Min Kim
- Department of Occupational and Environmental Medicine, Cheongju Medical Center, Cheongju, Korea
| | | | - Young-Su Ju
- Department of Occupational & Environmental Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Seung-sik Hwang
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea
| | - Mina Ha
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Domyung Paek
- Department of Occupational and Environmental Medicine, School of Public Health, Seoul National University, Seoul, Korea
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Cho H, Moon S, Park SJ, Han G, Park JH, Lee H, Choi J, Hwang S, Bobrow BJ. Out-of-hospital cardiac arrest: incidence, process of care, and outcomes in an urban city, Korea. Clin Exp Emerg Med 2014; 1:94-100. [PMID: 27752559 PMCID: PMC5052837 DOI: 10.15441/ceem.14.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 08/12/2014] [Accepted: 08/12/2014] [Indexed: 01/14/2023] Open
Abstract
Objective We aimed to determine the incidence, processes of care, and outcomes in out-of-hospital cardiac arrests (OHCA) in Ansan, South Korea. Methods From the Ansan Fire Department’s (1-1-9 emergency call number) Emergency Medical Services (EMS) database, we obtained a list of adult cardiac arrest cases occurring between January 2008 and December 2011. We excluded cases with obvious non-cardiac causes, such as trauma, drowning, hanging, and asphyxia. We matched the EMS data with in-hospital care and outcome data. We analyzed basic demographic variables (age and gender), the time and place of incidence, witnesses, bystander cardiopulmonary resuscitation (CPR), major time variables, CPR instructions during transport, initial cardiac rhythm at the scene, and automated defibrillator use. Results The overall incidence of OHCA in Ansan was 33.1/100,000 persons per year. Out of 778 adult OHCAs in our study population, bystander CPR was provided in 103 cases (13.2%). Of the 517 OHCAs whose initial rhythms were confirmed, 85 (16.4%) showed shockable rhythms, but only 23 (27.1%) received defibrillation at the scene or during transportation. Of the 106 patients whose spontaneous circulation returned at the hospital, only 6 (5.7%) received mild therapeutic hypothermia. During the study period, 31 patients (4%) survived to discharge from hospitals, and 6 of these discharged patients (19.4%) showed favorable neurologic outcomes. Conclusion While the survival rate from OHCA in Ansan is very low, this study provides basic information needed to create improvements. Our analysis suggests that multiple variables contribute to the low OHCA survival rate. Several of these variables are modifiable; addressing them is a clear first step toward strengthening the chain of survival from OCHA in Ansan.
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Affiliation(s)
- Hanjin Cho
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Sungwoo Moon
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Sung Joon Park
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Gapsu Han
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Jong-Hak Park
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea
| | | | | | - Seungsik Hwang
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea
| | - Bentley J Bobrow
- Arizona Emergency Medicine Research Center, University of Arizona College of Medicine, Phoenix, AZ, USA; Arizona Department of Health Services, Bureau of EMS and Trauma Systems, Phoenix, AZ, USA
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28
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Lee WJ, Ha M, Hwang SS, Lee KM, Jin YW, Jeong M, Jun JK, Cha ES, Ko Y, Choi KH, Lee JE. The radiologic technologists' health study in South Korea: study design and baseline results. Int Arch Occup Environ Health 2014; 88:759-68. [PMID: 25408461 DOI: 10.1007/s00420-014-1002-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 11/10/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe the study design, methods, and baseline results of a prospective cohort of radiologic technologists which we have initiated in South Korea. METHODS The cohort participants were enrolled through a self-administered questionnaire survey administered from April 2012 to May 2013. Survey data were linked with radiation dosimetry, a cancer registry, and health insurance data by personal identification numbers. A nationwide representative survey was also conducted using a stratified random sampling design with face-to-face interviews. RESULTS A total of 12,387 radiologic technologists were enrolled, which accounted for approximately 63% of all diagnostic radiologic technologists working in South Korea. For nationwide survey, 585 workers were interviewed using the detailed questionnaire, and buccal cells were also collected by scraping the inside of the cheek. The majority of study subjects were under 50-year-old and male workers. The average annual effective dose of radiation declined both men (from 2.75 to 1.43 mSv) and women (from 1.34 to 0.95 mSv) over the period of 1996-2011. A total of 99 cancers (66 cancers in men and 33 in women) were reported from 1992 to 2010. The standardized incidence ratio of all cancer combined was significantly lower in men (SIR = 0.75, 95% CI 0.58-0.96) than general population, but the ratios for thyroid cancer were significantly higher than expected among both men and women. CONCLUSIONS This cohort provides comprehensive information on work activities and health status of diagnostic radiologic technologists. In addition, the nationwide representative sample provides unique opportunities compared with previous radiologic technologist studies.
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Affiliation(s)
- Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea,
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Suh B, Shin DW, Hwang SS, Choi HC, Kwon H, Cho B, Park JH. Alcohol is longitudinally associated with lower urinary tract symptoms partially via high-density lipoprotein. Alcohol Clin Exp Res 2014; 38:2878-83. [PMID: 25399519 DOI: 10.1111/acer.12564] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 08/31/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies on the association of alcohol consumption with lower urinary tract symptoms (LUTS) have been inconsistent, and none took into account the dynamic nature of LUTS, fluctuating over time. The purpose of the study was to determine the longitudinal association of alcohol consumption with LUTS. METHODS We used generalized estimating equations to analyze the longitudinal association of alcohol consumption with LUTS in a longitudinal study of 9,712 healthy men 30 years or older who visited our institution multiple times for routine comprehensive health evaluations, with an average follow-up period of 27.9 months. RESULTS Light-moderate alcohol consumption (0.1 to 29 g/d) was associated with decreased likelihood of moderate-severe LUTS, whereas heavy alcohol consumption (≥30 g/d) was associated with increased likelihood of moderate-severe LUTS in a dose-dependent manner. Compared to those with 0 g/d alcohol intake, subjects who drank 0.1 to 9.9, 10 to 19.9, 20 to 29.9, 30 to 39.9, or ≥40 g/d of alcohol were in general significantly associated with moderate-severe LUTS with adjusted odds ratio (95% confidence interval) as follows respectively: 0.94 (0.87 to 1.02), 1.00 (0.91 to 1.09), 0.85 (0.77 to 0.93), 1.08 (0.98 to 1.19), and 1.31 (1.19 to 1.44). However, the protective association of light-moderate alcohol consumption with LUTS was greatly attenuated when serum high-density lipoprotein (HDL) was added to the analysis, specifically for voiding symptoms. CONCLUSIONS We show strong evidence there is longitudinal association of alcohol consumption with LUTS. The protective effect of light-moderate alcohol consumption on LUTS is in part modulated by HDL as a confounder, similar to its effect on coronary heart disease.
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Affiliation(s)
- Beomseok Suh
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Korea
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Koo BK, Lee CH, Yang BR, Hwang SS, Choi NK. The incidence and prevalence of diabetes mellitus and related atherosclerotic complications in Korea: a National Health Insurance Database Study. PLoS One 2014; 9:e110650. [PMID: 25329714 PMCID: PMC4199756 DOI: 10.1371/journal.pone.0110650] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 09/20/2014] [Indexed: 11/19/2022] Open
Abstract
AIMS/INTRODUCTION The incidence and prevalence of type 2 diabetes mellitus (T2DM) and related macrovascular complications in Korea were estimated using the Health Insurance Review and Assessment (HIRA) database from 2007-2011, which covers the claim data of 97.0% of the Korean population. MATERIALS AND METHODS T2DM, coronary artery disease (CAD), cerebrovascular disease (CVD), and peripheral artery disease (PAD) were defined according to ICD-10 codes. We used the Healthcare Common Procedure Coding System codes provided by HIRA to identify associated procedures or surgeries. When calculating incidence, we excluded cases with preexisting T2DM within two years before the index year. A Poisson distribution was assumed when calculating 95% confidence intervals for prevalence and incidence rates. RESULTS The prevalence of T2DM in Korean adults aged 20-89 years was 6.1-6.9% and the annual incidence rates of T2DM ranged from 9.5-9.8/1,000 person-year (PY) during the study period. The incidence rates of T2DM in men and women aged 20-49 years showed decreasing patterns from 2009 to 2011 (P<0.001); by contrast, the incidence in subjects aged 70-79 years showed increased patterns from 2009 to 2011 (P<0.001). The incidence rates of CAD and CVD in patients newly diagnosed with T2DM were 18.84/1,000 PY and 11.32/1,000 PY, respectively, in the year of diagnosis. Among newly diagnosed individuals with T2DM who were undergoing treatment for PAD, 14.6% underwent angioplasty for CAD during the same period. CONCLUSIONS Our study measured the national incidences of T2DM, CAD, CVD, and PAD, which are of great concern for public health. We also confirmed the relatively higher risk of CAD and CVD newly detected T2DM patients compared to the general population in Korea.
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Affiliation(s)
- Bo Kyung Koo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Chang-Hoon Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bo Ram Yang
- Division of Clinical Epidemiology, Medical Research Collaborating Center, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung-sik Hwang
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Nam-Kyong Choi
- Division of Clinical Epidemiology, Medical Research Collaborating Center, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
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Affiliation(s)
- Jeong-Min Kim
- Department of Occupational and Environmental Medicine, Cheongju Medical Center, Cheongju, Korea
| | | | - Young-Su Ju
- Department of Occupational & Environmental Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Seung-sik Hwang
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea
| | - Mina Ha
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Domyung Paek
- Department of Occupational and Environmental Medicine, School of Public Health, Seoul National University, Seoul, Korea
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Song E, Choi H, Hwang S, Lee W. Spatial Clustering Method Via Generalized Lasso. Korean Journal of Applied Statistics 2014. [DOI: 10.5351/kjas.2014.27.4.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lee WK, Lee HA, Hwang SS, Kim H, Lim YH, Hong YC, Ha EH, Park H. A time series study on the effects of cold temperature on road traffic injuries in Seoul, Korea. Environ Res 2014; 132:290-6. [PMID: 24834824 DOI: 10.1016/j.envres.2014.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 04/14/2014] [Accepted: 04/17/2014] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Although traffic accidents are associated with weather, the influence of temperature on injuries from traffic accidents has not been evaluated sufficiently. The objective of this study was to evaluate the effect of temperature, especially cold temperatures, on injuries from traffic accidents in Seoul, Korea. We also explored the relationship of temperature with different types of traffic accident. METHODS The daily frequencies of injuries from traffic accidents in Seoul were summarized from the integrated database established by the Korea Road Traffic Authority. Weather data included temperature, barometric pressure, rainfall, snow, and fog from May 2007 to December 2011. The qualitative relationship between daily mean temperature and injuries from traffic accidents was evaluated using a generalized additive model with Poisson distribution. Further analysis was performed using piecewise linear regression if graph the showed non-linearity with threshold. RESULTS The incidence of injuries was 216 per 100,000 person-months in Seoul. The effect of temperature on injuries from traffic accidents was minimal during spring and summer. However, injuries showed a more striking relationship with temperature in winter than in other seasons. In winter, the number of injuries increased as the temperature decreased to <0°C. The injuries increased by 2.1% per 1°C decrease under the threshold of the daily average temperature -5.7°C, which is 10-fold greater than the effect of temperature above the threshold. Some groups were more susceptible to injuries, such as young and male drivers, according to the types of traffic accident when the temperature decreased to below the freezing temperature. CONCLUSIONS The incidence of injuries increased sharply when the temperature decreased below freezing temperature in winter. Temperature can be effectively used to inform high risk of road traffic injuries, thus helping to prevent road traffic injuries.
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Affiliation(s)
- Won-Kyung Lee
- Department of Social and Preventive Medicine, Inha University School of Medicine, Republic of Korea; Department of Preventive Medicine, School of Medicine, Ewha Womans University, 071, Anyangcheon-ro, Yangcheon-ku, Seoul 158-710, Republic of Korea
| | - Hye-Ah Lee
- Department of Preventive Medicine, School of Medicine, Ewha Womans University, 071, Anyangcheon-ro, Yangcheon-ku, Seoul 158-710, Republic of Korea
| | - Seung-sik Hwang
- Department of Social and Preventive Medicine, Inha University School of Medicine, Republic of Korea
| | - Ho Kim
- Department of Epidemiology and Biostatistics, Seoul National University, Seoul, Republic of Korea
| | - Youn-Hee Lim
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Yun-Chul Hong
- Department of Preventive Medicine, School of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Eun-Hee Ha
- Department of Preventive Medicine, School of Medicine, Ewha Womans University, 071, Anyangcheon-ro, Yangcheon-ku, Seoul 158-710, Republic of Korea
| | - Hyesook Park
- Department of Preventive Medicine, School of Medicine, Ewha Womans University, 071, Anyangcheon-ro, Yangcheon-ku, Seoul 158-710, Republic of Korea.
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Park YS, Bae IK, Kim J, Jeong SH, Hwang SS, Seo YH, Cho YK, Lee K, Kim JM. Risk factors and molecular epidemiology of community-onset extended-spectrum β-lactamase-producing Escherichia coli bacteremia. Yonsei Med J 2014; 55:467-75. [PMID: 24532519 PMCID: PMC3936615 DOI: 10.3349/ymj.2014.55.2.467] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Inadequate empirical therapy for severe infections caused by extended-spectrum β-lactamase-producing Escherichia coli (ESBLEC) is associated with poor outcomes. This study was designed to investigate risk factors for community-onset ESBLEC bacteremia at admission to a tertiary care hospital. MATERIALS AND METHODS A case-control study was performed that included all episodes of ESBLEC bacteremia in the outpatient department or within 48 hours of admission from January 2005 to March 2009. Data on predisposing factors were collected. The molecular epidemiology of ESBLEC clinical isolates was also determined. RESULTS Among 25281 blood cultures, 60 episodes of ESBLEC bacteremia were studied, which accounted for 7% of all E. coli bacteremia at admission. Healthcare-associated infection [odds ratio (OR), 8.3; 95% confidence interval (CI), 2.4-28.7; p=0.001], malignancy (OR, 4.6; 95% CI, 1.3-16.3; p=0.018), urinary tract infection (OR, 139.1; 95% CI, 24.6-788.2; p<0.001), hepatobiliary infection (OR, 79.1; 95% CI, 13.5-463.8; p<0.001), third generation cephalosporin usage during preceding 3 months (OR, 16.4; 95% CI, 2.0-131.8; p=0.008), and severe sepsis/septic shock (OR, 73.7; 95% CI, 12.4-438.5; p<0.001) were determined as independent risk factors for community-onset ESBLEC bacteremia. The most common extended-spectrum β-lactamase (ESBL) gene identified was blaCTX-M-15 (n=31) followed by blaCTX-M-14 (n=23). CONCLUSION The most common types of ESBLs in E. coli causing community-onset bacteremia were CTX-M-15 and CTX-M-14 in Korea. By result of decision tree analysis, the empirical use of carbapenems is suggested only for patients with severe sepsis/septic shock, hepatobiliary infection, or healthcare-associated urinary tract infection.
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Affiliation(s)
- Yoon Soo Park
- Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, Korea
| | - Il Kwon Bae
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Juwon Kim
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seok Hoon Jeong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-sik Hwang
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea
| | - Yiel-Hea Seo
- Department of Laboratory Medicine, Gachon University, Gil Medical Center, Incheon, Korea
| | - Yong Kyun Cho
- Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, Korea
| | - Kyungwon Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - June Myung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Hwang SS, Kang S, Lee JY, Lee JS, Kim HJ, Han SK, Yim JJ. Impact of outdoor air pollution on the incidence of tuberculosis in the Seoul metropolitan area, South Korea. Korean J Intern Med 2014; 29:183-90. [PMID: 24648801 PMCID: PMC3956988 DOI: 10.3904/kjim.2014.29.2.183] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 07/22/2013] [Accepted: 08/27/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Although indoor air pollution is a well-known risk factor for tuberculosis (TB), the possible link between outdoor air pollution and TB development has not been examined fully. We assessed the impact of outdoor air pollution on TB development in the Seoul metropolitan area, South Korea. METHODS The mean concentrations of ambient particulate matter (PM) with an aerodynamic diameter ≤ 10 µm (PM10), O3, CO, NO2, and SO2 levels in Seoul, between January 1, 1997 and December 31, 2006, were determined. Furthermore, their association with the risk of developing TB after adjusting for socioeconomic status, between January 1, 2002 and December 31, 2006, was investigated. RESULTS Between January 1, 2002 and December 31, 2006, a total of 41,185 TB cases were reported in Seoul. Concentrations of PM10, O3, CO, and NO2 were not associated with TB incidence in males or females. However, the interquartile increase in SO2 concentration was associated with a 7% increment in TB incidence (relative risk [RR], 1.07; 95% credible interval [CrI], 1.03 to 1.12) in males but not in females (RR, 1.02; 95% CrI, 0.98 to 1.07). CONCLUSIONS Long-term exposure to ambient SO2 increased the risk of TB in males.
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Affiliation(s)
- Seung-sik Hwang
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea
| | - Sungchan Kang
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea
| | - Ji-Young Lee
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea
| | - Ji Sun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Jin Kim
- Korean Institute of Tuberculosis, Osong, Korea
| | - Sung Koo Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Kim JH, Chin HM, Hwang SS, Jun KH. Impact of intra-abdominal fat on surgical outcome and overall survival of patients with gastric cancer. Int J Surg 2014; 12:346-52. [PMID: 24468645 DOI: 10.1016/j.ijsu.2014.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 09/23/2013] [Accepted: 01/16/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of obesity on surgical outcome and prognosis in patients with gastric cancer. METHODS A total of 304 patients who underwent curative gastrectomy for gastric adenocarcinoma between January 2005 and March 2008were enrolled. Body mass index (BMI) was calculated before the operation and visceral fat area (VFA) was measured by abdominal computed tomography (CT). The patients were divided according to BMI class and VFA quartile. The influence of BMI and VFA on surgical outcome and survival was evaluated. RESULTS The median BMI was 23.3 kg/m(2) and the median VFA was 103 cm(2). There was a significant positive correlation between BMI and VFA. According to BMI class and VFA quartile, there were no significant differences in patients' characteristics or surgical outcome, with the exception of a significantly longer operation time and fewer retrieved lymph nodes in patients with a high BMI and VFA. The unadjusted overall and disease free survival were not significantly different between BMI classes or VFA quartiles. CONCLUSIONS Obesity, as represented by BMI and VFA, may not be a poor prognostic factor in patients with gastric cancer.
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Affiliation(s)
- J H Kim
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - H M Chin
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - S S Hwang
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - K H Jun
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea.
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Park SH, Ahn S, Hong N, Park JH, Hwang SS, Lee KH. Quality of Reporting Noninferiority/Similarity in Research Studies of Diagnostic Imaging. Radiology 2014; 270:241-247. [DOI: 10.1148/radiol.13130967] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Park SH, Ahn S, Hong N, Park JH, Hwang SS, Lee KH. Quality of Reporting Noninferiority/Similarity in Research Studies of Diagnostic Imaging. Radiology 2013. [DOI: 10.1148/radiology.13130967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Smith VC, Hwang SS, Dukhovny D, Young S, Pursley DM. Neonatal intensive care unit discharge preparation, family readiness and infant outcomes: connecting the dots. J Perinatol 2013; 33:415-21. [PMID: 23492936 DOI: 10.1038/jp.2013.23] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Neonatal intensive care unit (NICU) discharge readiness is defined as the masterful attainment of technical skills and knowledge, emotional comfort, and confidence with infant care by the primary caregivers at the time of discharge. NICU discharge preparation is the process of facilitating comfort and confidence as well as the acquisition of knowledge and skills to successfully make the transition from the NICU to home. In this paper, we first review the literature about discharge readiness as it relates to the NICU population. Understanding that discharge readiness is achieved, in part, through successful discharge preparation, we then outline an approach to NICU discharge preparation.
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Affiliation(s)
- V C Smith
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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Lim I, Kim SK, Hwang SS, Kim SW, Chung KW, Kang HS, Lee ES. Prognostic implication of thyroglobulin and quantified whole body scan after initial radioiodine therapy on early prediction of ablation and clinical response for the patients with differentiated thyroid cancer. Ann Nucl Med 2012; 26:777-86. [DOI: 10.1007/s12149-012-0640-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 07/23/2012] [Indexed: 11/29/2022]
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Kim K, Kim YH, Kim SY, Kim S, Lee YJ, Kim KP, Lee HS, Ahn S, Kim T, Hwang SS, Song KJ, Kang SB, Kim DW, Park SH, Lee KH. Low-dose abdominal CT for evaluating suspected appendicitis. N Engl J Med 2012; 366:1596-605. [PMID: 22533576 DOI: 10.1056/nejmoa1110734] [Citation(s) in RCA: 227] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Computed tomography (CT) has become the predominant test for diagnosing acute appendicitis in adults. In children and young adults, exposure to CT radiation is of particular concern. We evaluated the rate of negative (unnecessary) appendectomy after low-dose versus standard-dose abdominal CT in young adults with suspected appendicitis. METHODS In this single-institution, single-blind, noninferiority trial, we randomly assigned 891 patients with suspected appendicitis to either low-dose CT (444 patients) or standard-dose CT (447 patients). The median radiation dose in terms of dose-length product was 116 mGy·cm in the low-dose group and 521 mGy·cm in the standard-dose group. The primary end point was the percentage of negative appendectomies among all nonincidental appendectomies, with a noninferiority margin of 5.5 percentage points. Secondary end points included the appendiceal perforation rate and the proportion of patients with suspected appendicitis who required additional imaging. RESULTS The negative appendectomy rate was 3.5% (6 of 172 patients) in the low-dose CT group and 3.2% (6 of 186 patients) in the standard-dose CT group (difference, 0.3 percentage points; 95% confidence interval, -3.8 to 4.6). The two groups did not differ significantly in terms of the appendiceal perforation rate (26.5% with low-dose CT and 23.3% with standard-dose CT, P=0.46) or the proportion of patients who needed additional imaging tests (3.2% and 1.6%, respectively; P=0.09). CONCLUSIONS Low-dose CT was noninferior to standard-dose CT with respect to negative appendectomy rates in young adults with suspected appendicitis. (Funded by GE Healthcare Medical Diagnostics and others; ClinicalTrials.gov number, NCT00913380.).
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Affiliation(s)
- Kyuseok Kim
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
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Kim SY, Lee KH, Kim K, Kim TY, Lee HS, Hwang SS, Song KJ, Kang HS, Kim YH, Rhee JE. Acute appendicitis in young adults: low- versus standard-radiation-dose contrast-enhanced abdominal CT for diagnosis. Radiology 2011; 260:437-45. [PMID: 21633052 DOI: 10.1148/radiol.11102247] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To compare low and standard radiation doses in intravenous contrast material-enhanced abdominal computed tomography (CT) for the diagnosis of acute appendicitis in young adults. MATERIALS AND METHODS The institutional review board approved this retrospective study and waived informed consent. The study included 257 patients (age range, 15-40 years) who underwent CT for suspected appendicitis performed by using a low radiation dose (n = 125) or a standard radiation dose (n = 132). Receiver operating characteristic (ROC) analysis, Fisher exact tests, and Mann-Whitney U tests were used to compare the diagnosis of appendicitis and diagnostic confidence as recorded in prospective CT reports between the two groups. RESULTS For 55 low-radiation-dose (median dose-length product, 122 mGy · cm) and 44 standard-dose (median dose-length product, 544 mGy · cm) examinations, one of two abdominal radiologists made primary reports that served as final reports. For the remaining examinations, on-call radiologists with differing levels of experience issued preliminary reports and the two abdominal radiologists then provided final reports. In the primary reports, the low- and standard-dose CT groups did not significantly differ in area under the ROC curve (0.96 vs 0.97, P = .76), sensitivity (90% [38 of 42] vs 89% [47 of 53], P > .99), or specificity (92% [76 of 83] vs 94% [74 of 79], P = .74) in the diagnosis of appendicitis. There was also no significant difference between the two groups in the confidence level when diagnosing (P = .71) or excluding (P = .20) appendicitis in the primary reports. Similar results were observed for the final reports. The two dose groups also did not significantly differ in terms of appendiceal visualization, diagnosis of appendiceal perforation, or sensitivity for alternative diagnoses. CONCLUSION Low-dose CT may have comparable diagnostic performance to standard-dose CT for the diagnosis of appendicitis in young adults.
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Affiliation(s)
- So Yeon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
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Kim JJ, Choi YM, Hwang SS, Yoon SH, Lee GH, Chae SJ, Hwang KR, Moon SY. Association of the interferon-γ gene (CA)n repeat polymorphism with endometriosis. BJOG 2011; 118:1061-6. [PMID: 21477169 DOI: 10.1111/j.1471-0528.2011.02963.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate whether the interferon-γ (IFN-γ) gene (CA)(n) repeat polymorphism is associated with susceptibility to endometriosis. DESIGN Case-control study. SETTING University Department of Obstetrics and Gynaecology. POPULATION Women with (n = 622) and without (n = 442) endometriosis. METHODS Genotyping was performed by fluorescent polymerase chain reaction (PCR) and gene-scan analysis. MAIN OUTCOME MEASURES Genotype distribution and allele frequency of the dinucleotide (CA)(n) repeat polymorphism in the IFN-γ gene. RESULTS Seven alleles (12-18 repeats) of the IFN-γ gene (CA)(n) repeat polymorphism were found. In both patients with endometriosis and controls the most common allele was composed of 13 repeats, followed by an allele of 15 repeats, and then by an allele of 12 repeats. Patients with endometriosis had a significantly higher incidence of genotypes with alleles composed of fewer repeats (12-13 repeats), compared with the controls (92.0 versus 84.4%, respectively, P < 001). CONCLUSIONS Our results suggest that the (CA)(n) repeat polymorphism in the IFN-γ gene may be associated with a risk of endometriosis in the South Korean population.
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Affiliation(s)
- J J Kim
- Department of Obstetrics and Gynaecology, Seoul National University College of Medicine, Seoul, South Korea
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Abstract
Renal malignant fibrous histiocytoma (MFH) is a rare, primary renal tumour. Imaging findings of renal MFH, including ultrasound, CT and MRI, have, however, been reported. As to the best of our knowledge (18)F-FDG PET/CT imaging of renal MFH has not been previously reported, we present the CT and (18)F-FDG PET/CT appearance of a pathologically proven primary renal MFH.
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Affiliation(s)
- S S Hwang
- Department of Radiology, College of Medicine, The Catholic University of Korea, Korea
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Kim HR, Hwang SS, Kim EC, Lee SM, Yang SC, Yoo CG, Kim YW, Han SK, Shim YS, Yim JJ. Risk factors for multidrug-resistant bacterial infection among patients with tuberculosis. J Hosp Infect 2010; 77:134-7. [PMID: 20850896 DOI: 10.1016/j.jhin.2010.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Accepted: 07/02/2010] [Indexed: 10/19/2022]
Abstract
Given that anti-tuberculosis medication itself has antibacterial activity and that broad-spectrum antibiotics are frequently used, the emergence of multidrug-resistant (MDR) bacteria among patients being treated for tuberculosis (TB) is likely. We used a case-control design to study the clinical predictors of MDR bacterial infection among TB patients. Both cases and controls were selected from among patients who were diagnosed and treated as having TB between 1 January 1996 and 31 August 2006. TB patients with MDR bacterial infection were included as cases and those with non-MDR bacterial infection were included as controls. Multiple logistic regression analysis was performed to elucidate the risk factors for MDR bacterial infection. During the study period 3667 patients were diagnosed with, and treated for, TB. A total of 123 experienced episodes of bacterial infection, of whom 59 (48.0%) were infected by an MDR strain at least once. The presence of chronic renal failure [adjusted odds ratio (OR): 4.96; 95% confidence interval (CI): 1.37-18.01] and the use of antimicrobials other than typical anti-TB drugs within three months (adjusted OR: 4.37; 95% CI: 1.74-10.95) were independent risk factors for MDR bacterial infection. Bacterial infection in TB patients is commonly multidrug resistant. Clinicians should be aware of the possibility of MDR bacterial infection among TB patients with chronic renal failure or recent use of other antimicrobials.
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Affiliation(s)
- H-R Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Lung Institute of Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea
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Abstract
Metanephric adenoma is an extremely rare, epithelial, renal tumor with characteristic histology. This tumor is invariably benign. We report a case of metanephric adenoma diagnosed by ultrasound-guided needle biopsy.
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Affiliation(s)
- S S Hwang
- Department of Radiology, St Vincent's Hospital, The Catholic University of Korea, 93 Chi-dong, Paldal-ku, Suwon, Gyeonggi-do 442-723, Korea.
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Hwang SS, Kim HH, Park SH, Kim SE, Jung JI, Ahn BY, Kim SH, Chung SK, Park YH, Choi KH. N-butyl-2-cyanoacrylate pulmonary embolism after endoscopic injection sclerotherapy for gastric variceal bleeding. J Comput Assist Tomogr 2001; 25:16-22. [PMID: 11176287 DOI: 10.1097/00004728-200101000-00003] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this work was to describe the radiologic and clinical manifestations of n-butyl-2-cyanoacrylate pulmonary embolism (PE) after endoscopic injection sclerotherapy (EIS) for gastric variceal bleeding. METHOD From 1992 to 1999, the medical records of 140 patients who had undergone EIS using n-butyl-2-cyanoacrylate were reviewed for identification of respiratory symptoms and amount of injection, and their pre- and postprocedure chest radiographs were reviewed to identify PE. In patients with PE, pre- and postprocedure chest radiographs (6/6), chest CT scans (3/6), lung perfusion scans (3/6), and follow-up chest radiographs (6/6) were analyzed retrospectively. RESULTS Radiographically evident PE was observed in 6 (4.3%) of 140 patients. In comparison with patients without emboli, these patients received a higher mean volume of injection (4.2 vs. 1.8 ml) (p = 0.0011). Four of the six patients with pulmonary emboli had respiratory symptoms. Chest radiographs and CT scans showed unusual tubular or nodular, radiopaque pulmonary emboli along the pulmonary vessels. Multiple peripheral, wedge-shaped, subsegmental perfusion defects were seen on perfusion lung scans. In five of six patients, the radiographic abnormalities showed complete or partial resolution. There were no fatalities directly associated with PE. CONCLUSION Radiographically evident PEs are uncommonly observed following EIS and appear to be more common in patients receiving a higher volume of liquid acrylate. Affected patients were either mildly symptomatic or asymptomatic, and there were no direct fatalities of this complication.
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Affiliation(s)
- S S Hwang
- Department of Radiology, St. Vincent's Hospital, Catholic University of Korea, Seoul
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Abstract
Hydronephrosis during pregnancy is common but rarely results in renal rupture. We report an unusual case of spontaneous rupture of a hydronephrotic kidney during pregnancy. Although we could not predict the renal rupture on the basis of sonographic findings, serial sonography was useful in the early detection and management of the rupture.
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Affiliation(s)
- S S Hwang
- Department of Radiology, St. Vincent's Hospital, The Catholic University of Korea, 93 Chi-dong, Paldal-ku, Suwon, Gyeonggi-do 442-723, South Korea
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Abstract
BACKGROUND The Memorial Symptom Assessment Scale Short Form (MSAS-SF), an abbreviated version of the Memorial Symptom Assessment Scale, measures each of 32 symptoms with respect to distress or frequency alone. A physical symptom subscale (PHYS), psychologic symptom subscale (PSYCH), and global distress index (GDI) can be derived from the Short Form. We validated the MSAS-SF in a population of cancer patients. METHODS Two hundred ninety-nine cancer patients examined at the Section of Hematology/Oncology completed the MSAS-SF and the Functional Assessment Cancer Therapy (FACT-G). The Karnofsky performance status (KPS), extent of disease (EOD), and demographic data were assessed. The Cronbach alpha coefficient was used to assess internal reliability. MSAS-SF subscales were assessed against subscales of the FACT-G, the KPS, and EOD to determine criterion validity. Test-retest analysis was performed at 1 day and at 1 week. RESULTS The Cronbach alpha coefficients for the MSAS-SF subscales ranged from 0.76 to 0.87. The MSAS-SF subscales showed convergent validity with FACT subscales. Correlation coefficients were -0.74 (P < 0.001) for the PHYS and FACT-G physical well-being subscales, -0.68 (P < 0.001) for the PSYCH and FACT emotional well-being subscales, and -0.70 (P < 0.001) for GDI and FACT summary of quality-of-life subscales. The MSAS-SF subscales demonstrated convergent validity with performance status, inpatient status, and extent of disease. The test-retest correlation coefficients for the MSAS-SF subscales ranged from 0.86 to 0.94 at 1 day and from 0.40 to 0.84 for the 1 week group. CONCLUSIONS The MSAS-SF is a valid and easy to use instrument for symptom assessment.
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Affiliation(s)
- V T Chang
- University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Section Hematology/Oncology, VA New Jersey Health Care System at East Orange, 07018, USA.
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