Journal of Preventive Medicine and Public Health

Brief Report

Impact of Admission Diagnosis on the Smoking Cessation Rate: A Brief Report From a Multi-centre Inpatient Smoking Cessation Programme in Singapore: Jason Jia Hao See, Kay Choong See; J Prev Med Public Health. 2020;53(5):381-386. Published online July 17, 2020; DOI: https://doi.org/10.3961/jpmph.20.134

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Abstract PDF: Objectives
Few studies have been published regarding the relevance of the admission diagnosis to the smoking cessation rate. We studied smoking cessation rates in relation to admission diagnoses in our inpatient smoking cessation programmes.
Methods
This retrospective study included all patients recruited into our inpatient smoking cessation programmes at 2 institutions in Singapore between June 2008 and December 2016. Patients were given individualized intensive counselling and were followed up via phone interviews for up to 6-month to assess their smoking status. Multivariable logistic regression was used to analyse potential associations between admission diagnoses and 6-month abstinence.
Results
A total of 7194 patients were included in this study. The mean age was 54.1 years, and 93.2% were male. In total, 1778 patients (24.7%) were abstinent at the 6-month follow-up call. Patients who quit smoking tended to be of Chinese ethnicity, have initiated smoking at a later age, be better educated, and have lower Fagerström Test of Nicotine Dependence scores. After adjusting for these factors, patients with a cardiovascular admission diagnosis had a significantly higher probability of quitting tobacco use than patients with a respiratory or other diagnosis.
Conclusions
In patients acutely admitted to the hospital, a diagnosis of cardiovascular disease was associated with the highest quit rate. Smoking cessation interventions need to be incorporated into all cardiovascular disease treatment pathways to leverage the patient’s motivation and to improve the quit rate. In addition, patients in groups with lower quit rates may benefit from more intensive programmes to increase the rate of successful cessation.; Summary

Original Article

Upper Endoscopy up to 3 Years Prior to a Diagnosis of Gastric Cancer Is Associated With Lower Stage of Disease in a USA Multiethnic Urban Population, a Retrospective Study: Shailja C. Shah, Chiaki Nakata, Alexandros D. Polydorides, Richard M. Peek, Steven H. Itzkowitz; J Prev Med Public Health. 2019;52(3):179-187. Published online April 26, 2019; DOI: https://doi.org/10.3961/jpmph.18.262

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Objectives
In the USA, certain races and ethnicities have a disproportionately higher gastric cancer burden. Selective screening might allow for earlier detection and curative resection. Among a USA-based multiracial and ethnic cohort diagnosed with non-cardia gastric cancer (NCGC), we aimed to identify factors associated with curable stage disease at diagnosis.
Methods
We retrospectively identified endoscopically diagnosed and histologically confirmed cases of NCGC at Mount Sinai Hospital in New York City. Demographic, clinical, endoscopic and histologic factors, as well as grade/stage of NCGC at diagnosis were documented. The primary outcome was the frequency of curable-stage NCGC (stage 0-1a) at diagnosis in patients with versus without an endoscopy negative for malignancy prior to their index exam diagnosing NCGC. Additional factors associated with curable-stage disease at diagnosis were determined.
Results
A total of 103 racially and ethnically diverse patients were included. Nearly 38% of NCGC were stage 0-Ia, 34% stage Ib-III, and 20.3% stage IV at diagnosis. A significantly higher frequency of NCGC was diagnosed in curable stages among patients who had undergone an endoscopy that was negative for malignancy prior to their index endoscopy that diagnosed NCGC, compared to patients without a negative endoscopy prior to their index exam (69.6% vs. 28.6%, p=0.003). A prior negative endoscopy was associated with 94.0% higher likelihood of diagnosing curable-stage NCGC (p=0.003). No other factors analyzed were associated with curable-stage NCGC at diagnosis.
Conclusions
Endoscopic screening and surveillance in select high-risk populations might increase diagnoses of curable-stage NCGC. These findings warrant confirmation in larger, prospective studies.

Summary

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Cáncer gástrico de intervalo: un llamado a la atención y a la acción
R. Castaño-Llano, A. Piñeres, R. Jaramillo, S. Molina, F. Aristizábal, J.E. Puerta
Revista de Gastroenterología de México.2023; 88(2): 91. CrossRef
Interval gastric cancer: A call to attentiveness and action
R. Castaño-Llano, A. Piñeres, R. Jaramillo, S. Molina, F. Aristizábal, J.E. Puerta
Revista de Gastroenterología de México (English Edition).2023; 88(2): 91. CrossRef

Special Article

Primary Care Physicians’ Action Plans for Responding to Results of Screening Tests Based on the Concept of Quaternary Prevention: Jong-Myon Bae, Marc Jamoulle; J Prev Med Public Health. 2016;49(6):343-348. Published online October 13, 2016; DOI: https://doi.org/10.3961/jpmph.16.059

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Abstract PDF

Since noncommunicable diseases (NCDs) are generally controllable rather than curable, more emphasis is placed on prevention than on treatment. For the early detection of diseases, primary care physicians (PCPs), as well as general practitioners and family physicians, should interpret screening results accurately and provide screenees with appropriate information about prevention and treatment, including potential harms. The concept of quaternary prevention (QP), which was introduced by Jamoulle and Roland in 1995, has been applied to screening results. This article summarizes situations that PCPs encounter during screening tests according to the concept of QP, and suggests measures to face such situations. It is suggested that screening tests be customized to fit individual characteristics instead of being performed based on general guidelines. Since screening tests should not be carried out in some circumstances, further studies based on the concept of prevention levels proposed by Jamoulle and Roland are required for the development of strategies to prevent NCDs, including cancers. Thus, applying the concept of QP helps PCPs gain better insights into screening tests aimed at preventing NCDs and also helps improve the doctor-patient relationship by helping screenees understand medical uncertainties.

Summary

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Healthy lifestyle status related to alcohol and food addiction risk among college students: a logistic regression analysis
Cheong Hoon Kim, Kyung-Ah Kang, Sunhwa Shin
Journal of American College Health.2023; 71(3): 775. CrossRef
Quaternary prevention: reviewing the concept
Carlos Martins, Maciek Godycki-Cwirko, Bruno Heleno, John Brodersen
European Journal of General Practice.2018; 24(1): 106. CrossRef
Ethical, pedagogical, socio-political and anthropological implications of quaternary prevention
Marc Jamoulle, Michel Roland, Jong-Myon Bae, Bruno Heleno, Giorgio Visentin, Gustavo Diniz Ferreira Gusso, Maciek Godycki-Ćwirko, Miguel Pizzanell, Patrick Ouvrard, Ricardo La Valle, Luis Filipe Gomes, Daniel Widmer, Jorge Bernstein, Mariana Mariño, Hamil
Revista Brasileira de Medicina de Família e Comunidade.2018; 13(40): 1. CrossRef
National health examination expansion policy
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Journal of the Korean Medical Association.2017; 60(2): 104. CrossRef
Shared decision making: relevant concepts and facilitating strategies
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Epidemiology and Health.2017; 39: e2017048. CrossRef

Original Article

The Association Between Smoking Tobacco After a Diagnosis of Diabetes and the Prevalence of Diabetic Nephropathy in the Korean Male Population: Hyungseon Yeom, Jung Hyun Lee, Hyeon Chang Kim, Il Suh; J Prev Med Public Health. 2016;49(2):108-117. Published online March 23, 2016; DOI: https://doi.org/10.3961/jpmph.15.062

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Abstract PDF Supplementary Material

Objectives
Smoking is known to be associated with nephropathy in patients with diabetes. The distinct effects of smoking before and after diabetes has been diagnosed, however, are not well characterized. We evaluated the association of cigarette smoking before and after a diagnosis of diabetes with the presence of diabetic nephropathy.
Methods
We analyzed data from the 2011-2013 editions of the Korea National Health and Nutrition Examination Survey. A total of 629 male patients diagnosed with diabetes were classified as non-smokers (90 patients), former smokers (225 patients), or continuing smokers (314 patients). A “former smoker” was a patient who smoked only before receiving his diagnosis of diabetes. A “continuing smoker” was a patient who smoked at any time after his diabetes had been diagnosed. Diabetic nephropathy was defined as the presence of albuminuria (spot urine albumin/creatinine ratio ≥30 mg/g) or low estimated glomerular filtration rate (<60 mL/min/1.73 m²). Multiple logistic regression models were used to assess the independent association after adjusting for age, duration of diabetes, hemoglobin A1c, body mass index, systolic blood pressure, medication for hypertension, and medication for dyslipidemia. Female patients were excluded from the study due to the small proportion of females in the survey who smoked.
Results
Compared to non-smokers, continuing smokers had significantly higher odds ratio ([OR], 2.17; 95% confidence interval [CI], 1.23 to 3.83) of suffering from diabetic nephropathy. The corresponding OR (95% CI) for former smokers was 1.26 (0.70 to 2.29).
Conclusions
Smoking after diagnosis of diabetes is significantly associated with the presence of diabetic nephropathy in the Korean male population.

Summary

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The hidden impact: the rate of nicotine metabolism and kidney health
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Relating Onset of Health Conditions to Changes in Tobacco/Nicotine Use — Analyses based on the U.S. PATH Study *
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Nicotine promotes renal interstitial fibrosis via upregulation of XIAP in an alpha7-nAChR-dependent manner
Lili Guo, Yue Zhang, Jian Lu, Xiaoyang Li, Chao Zhang, Wenzhu Song, Yafang Dong, Xiangyang Zhou, Rongshan Li
Molecular and Cellular Endocrinology.2023; 576: 111989. CrossRef
Lifestyle factors associated with a rapid decline in the estimated glomerular filtration rate over two years in older adults with type 2 diabetes–Evidence from a large national database in Japan
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Development of a Risk Model for Predicting Microalbuminuria in the Chinese Population Using Machine Learning Algorithms
Wei Lin, Songchang Shi, Huibin Huang, Nengying Wang, Junping Wen, Gang Chen
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The Global Burden of Type 2 Diabetes Attributable to Tobacco: A Secondary Analysis From the Global Burden of Disease Study 2019
Jianjun Bai, Fang Shi, Yudiyang Ma, Donghui Yang, Chuanhua Yu, Jinhong Cao
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ASIAN PACIFIC SOCIETY OF NEPHROLOGY CLINICAL PRACTICE GUIDELINE ON DIABETIC KIDNEY DISEASE
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Impacts of Preoperative Smoking and Smoking Cessation Time on Preoperative Peripheral Blood Inflammatory Indexes and Postoperative Hospitalization Outcome in Male Patients with Lung Cancer and Surgery Treatment
Xu Longming, Dai Shuiping, Zuo Yunxia
Chinese Medical Sciences Journal.2020; 35(2): 170. CrossRef
Interaction of MTHFR C677T polymorphism with smoking in susceptibility to diabetic nephropathy in Chinese men with type 2 diabetes
Liang Ma, Yongwei Jiang, Xiaomu Kong, Qian Liu, Hailing Zhao, Tingting Zhao, Yongtong Cao, Ping Li
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H. Ben Ayed, M. Ben Hmida, M. Ben Jemaa, M. Trigui, J. Jedidi, R. Karray, Y. Mejdoub, M. Kassis, H. Feki, S. Yaich, J. Damak
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Association of smoking and cardiometabolic parameters with albuminuria in people with type 2 diabetes mellitus: a systematic review and meta-analysis
Debasish Kar, Clare Gillies, Mintu Nath, Kamlesh Khunti, Melanie J. Davies, Samuel Seidu
Acta Diabetologica.2019; 56(8): 839. CrossRef
The global prevalence of tobacco use in type 2 diabetes mellitus patients: A systematic review and meta-analysis
Peter Roderick, Victoria Turner, Anne Readshaw, Omara Dogar, Kamran Siddiqi
Diabetes Research and Clinical Practice.2019; 154: 52. CrossRef
Cigarette smoking and risk of albuminuria in patients with type 2 diabetes: a systematic review and meta-analysis of observational studies
Haili Xu, Jinliu Suo, Jing Lian
International Urology and Nephrology.2018; 50(5): 911. CrossRef
Cigarette smoking and chronic kidney disease in the general population: a systematic review and meta-analysis of prospective cohort studies
Jia Xia, Lin Wang, Zhiheng Ma, Liping Zhong, Ying Wang, Yachan Gao, Liqun He, Xiao Su
Nephrology Dialysis Transplantation.2017; 32(3): 475. CrossRef
Smoking and the risk of diabetic nephropathy in patients with type 1 and type 2 diabetes: a meta-analysis of observational studies
Ning Jiang, Feng Huang, Xiurong Zhang
Oncotarget.2017; 8(54): 93209. CrossRef
Association of single-nucleotide polymorphisms in the RAGE gene and its gene- environment interactions with diabetic nephropathy in Chinese patients with type 2 diabetes
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Brief Communication

A Comparison of Fasting Glucose and HbA1c for the Diagnosis of Diabetes Mellitus Among Korean Adults.: Woo Jun Yun, Min Ho Shin, Sun Seong Kweon, Kyeong Soo Park, Young Hoon Lee, Hae Sung Nam, Seul Ki Jeong, Yong Woon Yun, Jin Su Choi; J Prev Med Public Health. 2010;43(5):451-454.; DOI: https://doi.org/10.3961/jpmph.2010.43.5.451

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Abstract PDF

OBJECTIVES
The American Diabetes Association (ADA) has recently recommended the HbA1c assay as one of four options for making the diagnosis of diabetes mellitus, with a cut-point of > or =6.5%. We compared the HbA1c assay and the fasting plasma glucose level for making the diagnosis of diabetes among Korean adults. METHODS: We analyzed 8710 adults (age 45-74 years), who were not diagnosed as having diabetes mellitus, from the Namwon study population. A fasting plasma glucose level of > or =126 mg/dL and an A1c of > or =6.5% were used for the diagnosis of diabetes. The kappa index of agreement was calculated to measure the agreement between the diagnosis based on the fasting plasma glucose level and the HbA1c. RESULTS: The kappa index of agreement between the fasting plasma glucose level and HbA1c was 0.50. CONCLUSIONS: The agreement between the fasting plasma glucose and HbA1c for the diagnosis of diabetes was moderate for Korean adults.

Summary

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Analytical Performance of Bio-Rad D-100 on a Hemoglobin A1c Assay
Changseung Liu, Eunhye Choi, In Cheol Bae, Sang-Guk Lee, Jeong-Ho Kim
Laboratory Medicine Online.2017; 7(2): 59. CrossRef
Epidemiological ramifications of diagnosing diabetes with HbA1c levels
Mayer B. Davidson, Deyu Pan
Journal of Diabetes and its Complications.2014; 28(4): 464. CrossRef
COMPARATIVE STUDY OF GLYCOSYLATED HAEMOGLOBIN WITH BLOOD GLUCOSE LEVELS IN THE DIAGNOSIS OF DIABETES MELLITUS
Kavya S T, Nagaraja B S, Akila V, Chandra Mohan G, Prakash Kikker Gowdaiah
Journal of Evolution of Medical and Dental Sciences.2014; 3(23): 6435. CrossRef
An Emerging Diabetes Mellitus Diagnosis Modality: HbA1c
Hyun-Ae Seo, In-Kyu Lee
The Korean Journal of Internal Medicine.2012; 27(1): 39. CrossRef
Evaluation of the Performance of ARKRAY ADAMS HA-8180 HbA1cAnalyzer
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Laboratory Medicine Online.2012; 2(3): 126. CrossRef
Discordance between HbA1c and fasting plasma glucose criteria for diabetes screening is associated with obesity and old age in Korean individuals
Jin Hwa Kim, Ji Hye Shin, Hae Jung Lee, Sang Yong Kim, Hak Yeon Bae
Diabetes Research and Clinical Practice.2011; 94(2): e27. CrossRef
Relationship between Glycemic Control and Diabetic Retinopathy
Woo-Jun Yun
Journal of the Korean Geriatrics Society.2010; 14(4): 234. CrossRef

English Abstract

Medical Care Utilization Status and Associated Factors with Extended Hospitalization of Psychiatric Patients in Korea.: Soo Kyung Suh, Yoon Kim, Jong Ik Park, Myung Soo Lee, Hong Suk Jang, Sun Young Lee, Jin Seok Lee; J Prev Med Public Health. 2009;42(6):416-423.; DOI: https://doi.org/10.3961/jpmph.2009.42.6.416

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Abstract PDF

OBJECTIVES
This study was performed to examine medical care utilization of psychiatric patients and to explore patients' characteristics associated with extended hospitalization. METHODS: Data were extracted from information of Korean Health Insurance Review and Assessment Service. All data associated with admission and outpatient clinic visit were analysed by patient characteristics. We selected first psychiatric admission patients who diagnosed mental and behavioral disorders due to use of alcohol (main disease code: F10), schizophrenia and related disorders (F20-29) and mood disorders (F30~33) from January to June 2005. We analysed status of admission, mean length of stay, regular access to outpatient clinic and rates of extended hospitalization during 3 years. Bivariate and multivariate analyses were conducted to identify factors associated with extended hospitalization. RESULTS: The number of psychiatric patients during the first six month of 2005 was 30,678. The mean length of stay was longest for schizophrenia and related disorders but shortest for mood disorders. Patients who experienced an extended hospitalization were 18.8% of total subjects. An extended hospitalization was more common in schizophrenia and related disorders than other diagnostic groups. The factors associated with the extended hospitalization were age, sex, diagnostic group, type of insurance and medical care utilization groups. CONCLUSIONS: The study indicates the problem of an extended hospitalization for psychiatric patients in Korea. It is suggested that variations in rates of extended hospitalization among medical care utilization group may need an active early intervention system in psychiatric treatment service. Particular attention needs to be devoted to planning and funding for reducing extended hospitalization.

Summary

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European Neuropsychopharmacology.2019; 29(9): 1051. CrossRef
The Significance and Limitations of Korean Diagnosis-Related Groups in Psychiatric Inpatients' Hospital Charges
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Journal of Korean Neuropsychiatric Association.2017; 56(1): 10. CrossRef
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Factors Affecting the Downward Mobility of Psychiatric Patients: A Korean Study of National Health Insurance Beneficiaries
Un-Na Kim, Yeon-Yong Kim, Jin-Seok Lee
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The Current Situation of Treatment Systems for Alcoholism in Korea
Jee Wook Kim, Boung Chul Lee, Tae-Cheon Kang, Ihn-Geun Choi
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Original Articles

Efficient DRG Fraud Candidate Detection Method Using Data Mining Techniques.: Duho Hong, Jung Kyu Lee, Min Woo Jo, Kidong Park, Sang Il Lee, Moo Song Lee, Chang Yup Kim, Yong Ik Kim; Korean J Prev Med. 2003;36(2):147-152.

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Abstract PDF: OBJECTIVES
To develop a Diagnosis-Related Group (DRG) fraud candidate detection method, using data mining techniques, and to examine the efficiency of the developed method. METHODS: The study included 79, 790 DRGs and their related claims of 8 disease groups (Lens procedures, with or without, vitrectomy, tonsillectomy and/or adenoidectomy only, appendectomy, Cesarean section, vaginal delivery, anal and/or perianal procedures, inguinal and/or femoral hernia procedures, uterine and/or adnexa procedures for nonmalignancy), which were examined manually during a 32 months period. To construct an optimal prediction model, 38 variables were applied, and the correction rate and lift value of 3 models (decision tree, logistic regression, neural network) compared. The analyses were performed separately by disease group. RESULTS: The correction rates of the developed method, using data mining techniques, were 15.4 to 81.9%, according to disease groups, with an overall correction rate of 60.7%. The lift values were 1.9 to 7.3 according to disease groups, with an overall lift value of 4.1. CONCLUSIONS: The above findings suggested that the applying of data mining techniques is necessary to improve the efficiency of DRG fraud candidate detection.; Summary

Changes in Quality of Care for Cesarean Section after Implementation of Diagnosis-Related Groups/Prospective Payment System.: Jun Yim, Young Hun Kwon, Du Ho Hong, Chang Yup Kim, Yong Ik Kim, Young Soo Shin; Korean J Prev Med. 2001;34(4):347-353.

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Abstract PDF: OBJECTIVES
To determine the impacts of Diagnosis-Related Groups/Prospective Payment System (DRG/PPS) on the quality of care in cases of Cesarean section and to describe the policy implications for the early stabilization of DRG/PPS in Korea. METHODS: Data was collected from the medical records of 380 patients who had undergone Cesarean sections in 40 hospitals participating in the DRG/PPS Demonstration Program since 1999. Cesarean sections were performed in 122 patients of the FFS(Fee-For-Service) group and 258 patients of the DRG/PPS group. Measurements of quality used included essential tests of pre- and post-operation, and the PPI(Physician Performance Index) score. The PPI was developed by two obstetricians. RESULTS: Univariate analysis demonstrated significant differences in PPI scores according to the payment systems. With respect to the mean of PPI scores, a higher score was found in the DRG/PPS group than in the FFS group. However, the adjusted effect did not show significant differences between the FFS group and the DRG/PPS group. CONCLUSION: This study suggested that the problem of poor quality may not be related to the implementation of DRG/PPS in Cesarean section. However, this study did not consider the validity and reliability of the process measurement, and it did not exclude the possibility of data omission in medical records.; Summary

A Study on the Nutritional Knowledge, Nutritional Attitude, Eating Practice and Food Intake of Womans University Students.: Eun Hee Ha, Sun Hee Kim, Ji Yong Kang; Korean J Prev Med. 1990;23(4):404-415.

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Abstract PDF: This study was conducted to analyze the relations among nutritional knowledge, nutritional attitude eating practice and total nutritional diagnosis and also to find the influencing factors of them. The survey was done during the period from April 1990 to June 1990 and the target population were Ewha Woman's University students (freshmen and senior) of whom 1,354 peoples were surveyed. The summarized results are as follows ; 1. For the learning environment, the percentage of completion on nutritional knowledge course was 28.6% and among them the department of foods and nutrition had the highest score(100.0%) and the next was dept. of medicine(53.4%). 2. To find the relation which the nutritional knowledge, nutritional attitude, eating practice and the total nutritional diagnosis influence on one another, the multiple correlation analysis was done. The attitude the practice were highly correlated with total nutritional diagnosis, but the correlation between nutritional knowledge and total nutritional diagnosis was not significant. The correlation between the practice and nutritional knowledge which were positively and significantly correlated with attitude respectively was positive but not significant. 3. The difference which were analyzed by department, grade and completion on knowledge course on the nutritional knowledge, attitude, eating practice were significant (p<0.01) by ANOVA. 4. The significant variables on nutritional diagnosis are the eating practice points, the grade, the knowledge course, the breakfast and the attitude (r2=10.3%) by multiple regression analysis. This study has the limitation that it did not consider the environmental factors of dietary life such as dietary culture, family environment, cultural habit. Therefore important points of these dietary studies are to extend to the practical nutritional education and dietary improvement for the national health not restricted to the local area or local population.; Summary

A Study on the Early Diagnosis of Pneumoconiosis.: Young Lim, Im Goung Yun; Korean J Prev Med. 1990;23(3):262-273.

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Abstract PDF: In order to assess the method which is more sensitive one to detect the early change of lung tissue by the inhaled dust, we have performed the various medical examinations such as chest radiography, pulmonary function test, high resolution chest CT, bronchoalveolar lavage and lung biopsy used bronchoscope and ultrathin bronchoscopy examination to 48 persons. The control group were 8 persons who did not exposed to dust, 40 cases of the experimental group have professionally exposed to the mineral dust. The results were as follows ; 1. The total number of cells in bronchoalveolar lavage was significantly increased in all of the pneumoconiosis group classified by chest and high resolution chest CT. 2. The composition rate of macrophage to the total number of cells in bronchoalveolar lavage fluid was significantly decreased in all of the pneumoconiosis group compared with the control group. 3. The composition rate of neutophils and lymphocytes to the total number of cells in bronchoalveolar lavage fluid was significantly increased in all of the pneumoconiosis group compared with the control group. 4. The forced expiratory volume in one second (FEV1.0), maximal mid-expiratory flow (MMF), and maximal voluntary ventilation (MVV) were significantly increased only in the group of the progressed pneumoconiosis relatively. 5. We observed submocosal edema, anthracotic pigmentation and granuloma formation in transbronchial lung biopsy of the suspected pneumoconiosis (category 0/1) case which is thought to the early change of coal workers' pneumoconiosis.; Summary

A Study on the Regional Function of Health Care by the Disease Pattern of the Inpatients.: Huyn Rim Choi, Sang Il Lee, Young Soo Shin, Yong Ik Kim; Korean J Prev Med. 1988;21(2):390-403.

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Abstract PDF: The objectives of the study were to provide the basic informations needed in the development of balanced medical services throughout the nation. As the national health care system was expanding rapidly along with the economic growth, quantitative re-evaluation of the system is of great need. For that reason, characteristics of the admitted patients were analyzed for the case-mix and patients' flow within and through regions. Materials were 421,530 cases of inpatients, who were reported through Medical Insurance Corporation(KMIC) for insurance claim, during the period of March 1, 1985 through February 28, 1987. Korean Diagnosis Related Groups(K-DRGs) classification system was adopted for the study of case-mix and 189 cities and countries were classified into 5 district groups by factor analysis results of K-DRGs. The major findings of this study were as follows ; 1) Factor analysis of case-mix, employing K-DRG system, revealed 5 distinct functional district groups. Group A(18 district) was prominent for tertiary medical care. In group B(36 districts), rather simple procedures were prevalent. Group C(26 districts) was distinctive for the medical care of well organized internal medicine practices with qualified clinical laboratories. Group D(17 districts) was characterized by relatively high balanced medical care. Group E (92 districts) was with very low level of medical care. 2) Analysis of the case-flow through the districts showed 3 types of flow patterns ; inflow, outflow, and balanced types. Inflow type of case-flow was found in Group A, C and D while Group B and E showed outflow type. Inflow was most prominent in Group A and Group E was of typical outflow type. Group B was consistently the outflow type except for Major Diagnostic Category XX regardless of the disease treaders, but Group C and D were inflow or outflow types according to the disease tracers.; Summary

English Abstracts

One Year Follow-up Study of Symptomatic Cases of Ulnar Neuropathy at the Elbow in a Rural Population.: Young Joo Sim, Hyun Sul Lim; J Prev Med Public Health. 2006;39(5):404-410.

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Abstract PDF: OBJECTIVES
This study examined the natural history of symptomatic patients who did or did not display abnormal results on nerve conduction studies (NCS). METHODS: Forty hundred fifty adults were selected among a total of 578 residents who participated in the health examination in a rural Korean district. A symptom questionnaire and NCS were used to diagnose ulnar neuropathy at the elbow (UNE). There were 6.4% of the subjects with UNE, 5.1% of the subjects showed symptoms without a NCS, and 84.2% of the subjects who were asymptomatic. One year later, 20 symptomatic limbs with an abnormality on the ulnar NCS and 22 symptomatic limbs without any abnormality in the ulnar NCS were enrolled in a follow-up study. The natural history of UNE was evaluated by examining the changes in the clinical and electrodiagnostic examinations. RESULTS: The 1-year follow-up of the enrolled limbs found that for the symptomatic limbs with an abnormality on the NCS, the degree of severe of the clinical grade changed from 20% to 10%. In contrast, for the symptomatic limbs that were without any abnormality in the NCS, the change of the severe degree of the clinical grade was from 0% to 18.2%. Also, for the electrodiagnostic change, only symptomatic limbs without NCS abnormalities showed significant changes in motor latency, amplitude and conduction velocity at the 1-year follow-up. CONCLUSIONS: The 1-year follow-up study revealed symptomatic limbs that were without any abnormality on the ulnar NCS were more likely to progress than the symptomatic limbs with an abnormality on the ulnar NCS.; Summary

A Study on Scheduling Periodic Examinations for the Early Detection of Breast Cancer in Korea.: Seong Hwa Jeong, Dae Ryong Kang, Nam Wook Hur, Jinheum Kim, Soon Young Lee, Sang Hyuk Jung, Chung Mo Nam; J Prev Med Public Health. 2006;39(4):346-352.

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Abstract PDF: OBJECTIVES
The purposes of this study were to propose a screening schedule for the early detection of breast cancer among Korean women, as based on the statistical model, and to compare the efficacy of the proposed screening schedule with the current recommendations. METHODS: The development of the screening schedule for breast cancer closely followed the work of Lee and Zelen (1998). We calculated the age-specific breast cancer incidence rate from the Korea Central Cancer Registry (2003), and then we estimated the scheduling of periodic examinations for the early detection of breast cancer, using mammography, and based on the threshold method. The efficacy of the derived screening schedule was evaluated by the schedule sensitivity. RESULTS: For estimating the screening schedule threshold method, we set the threshold value as the probability of being in the preclinical stage at age 35, the sensitivity of mammography as 0.9 and the mean sojourn time in the preclinical stage as 4 years. This method generated 14 examinations within the age interval [40, 69] of 40.0, 41.3, 42.7, 44.1, 45.4, 46.7, 48.0, 49.3, 51.0, 53.2, 55.3, 57.1, 59.0 and 63.6 years, and the schedule sensitivity was 75.4%. The proposed screening schedule detected 85.2% (74.5/87.4) of the cases that could have been detected by annual screening, but it required only about 48.7% (14.0/30.0) of the total number of examinations. We also examined the threshold screening schedules for a range of sensitivities of mammography and the mean sojourn time in the preclinical stage. CONCLUSIONS: The proposed screening schedule for breast cancer with using the threshold method will be helpful to provide guidelines for a public health program for choosing an effective screening schedule for breast cancer among Korean women.; Summary

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