Five-year Survival and Prognostic Factors after Kasai Portoenterostomy for Biliary Atresia

PURPOSE: Long-term survival of biliary atresia patients after Kasai's portoenterostomy is being increasingly reported. Although extended survival has been achieved for many patients, factors influencing outcome have not been defined clearly. The authors investigated 5-year survival rates and prognostic factors for survival after Kasai's portoenterostomy using univariate and multivariable methods. METHODS: The authors analyzed 5-year survival rates and prognostic factors in 56 patients who underwent Kasai's portoenterostomy during the period from 1991 to 2005 by the Kaplan-Meier model and Cox proportional hazards model, respectively. Both clinical factors and histological features of the liver and periportal fibrous mass were analyzed as prognostic factors. RESULTS: Younger ages of less than 90 days at surgery, clearance of jaundice and absence of post-Kasai cholangitis in 6 months were predictive of a favorable outcome. A significant difference between the live and the dead was found with regard to an average of 7 or more bile ductules in periportal fibrous mass in 200 HPF (P=0.013). The external diameter of the longest bile ductule in the periportal fibrous mass is not correlated to the prognosis (P=0.49). Independent factors for good prognosis were jaundice-free in 6 months and over 7 bile ductules density in periportal fibrous mass. CONCLUSION: Favorable outcome after Kasai's portoenterostomy for biliary atresia is determined by bilirubin clearance in 6 months after Kasai operation and seven or more bile ductules in periportal fibrous mass. The 5-year post-Kasai survival rate is 77.2%.

The Effectiveness of an Intervention Program for Subway Operators for Symptoms of Post-traumatic Stress Disorder After the Persons Had Fallen Under a Train / 대한산업의학회지

OBJECTIVE: The aims of this study were to evaluate the level of job stress in subway workers and to determine the main factors that aggravated their PTSD(Post-Traumatic Stress Disorder) symptom, which were due to having fallen under a train, and to verify the effectiveness of the intervention program. METHODS: The questionnaires utilized in the survey were composed of the Korean Occupational Stress Scale (the short form, 24 items), the depression scale, the coping scale II, the PTSD scale and the life style, health status and occupational properties. The intervention program for PTSD symptoms was executed for 18 subway operators who had experienced deadly accidents in their service from June 2004 to May 2006. The intervention programs included exercise, meditation and deep breathing for 8 weeks and a written message was sent twice per week. RESULTS: Compared with pre-intervention, the post-intervention group showed significantly lower scores for the KOSS, depressive symptom and the PTSD. CONCLUSION: This study showed the intervention program was effective to lower the job stress, the PTSD symptoms and depressive symptoms, and to improve the coping skills. It was suggested that the mental health promotion program should be implemented for subway workers to prevent occupational mental diseases.

The Relationship Between Job Stress and Quality of Life for Hospital Workers by Type of Employment / 대한산업의학회지

OBJECTIVE: This study was conducted to evaluate the relationship between job stress and quality of life for hospital workers by type of employment. METHODS: Data were obtained for 361 workers in a large hospital 172 of whom were categorized as typical workers defined by permanent employee and 189 of whom were categorized as atypical workers defined by fixed-term contraction. Job stress was assessed using the Korean Occupational Stress Scale-Short Form and the World Health Organization Quality of Life-BREF Questionnaire RESULTS: Atypical workers had significantly higher scores for job-related stress in the domains of insufficient control, over work, job insecurity, and lack of reward in the workplace compared with typical workers, who had higher scores for stress in the domains of job demands and occupational climate. Test scores also indicated that typical workers had a significantly better quality of life than atypical workers, especially in terms of mental health, social relationships and environment. CONCLUSION: These findings suggested that factors contributing to job-related stress were different between typical and atypical hospital and typical workers are likely to have a better quality of life.

Association of Current and Past Smoking with Metabolic Syndrome in Men / 예방의학회지

OBJECTIVES: The objective of this study was to determine the relationship between past smoking and the risk factors for metabolic syndrome. METHODS: From January 2007 to December 2007, a total of 3,916 over thirty years old male health screen examinees were divided into the nonsmoking, smoking, ex-smoking groups. The diagnosis of metabolic syndrome was based on the criteria of the NCEP ATP (Executive Summary of The Third Report of The National Cholesterol Education Program). Metabolic syndrome was defined as the presence of three or more of the following: a blood pressure > or = 130/85 mmHg, a fasting glucose level > or = 110 mg/dL, a HDL-C (High Density Lipoprotein Cholesterol) level or = 150 mg/dL and, a waist circumference men > or = 102 cm, but a waist to hip ratio > 0.90 was used as a surrogate for the waist circumference. RESULTS: After adjustment for age, alcohol consumption and, exercise in the smokers, for the ex-smokers compared with the nonsmokers, the odds ratio (OR) of a lower HDL cholesterol level (< 40 mg/dL) was 1.29 (95% CI=1.03-1.61) in the smokers, the ORs of a higher triglyceride level were 1.35 (95% CI=1.09-1.66) in the ex-smokers and, 2.12 (95% CI=1.75-2.57) in the smokers, and the OR of a waist to hip ratio was 1.25 (95% CI=1.03-1.52) in the ex-smokers. When there were over three components of metabolic syndrome in the ex-smokers and smokers as compared with the nonsmokers, the odds ratio against the risk of metabolic syndrome were 2.39 (95% CI=1.00-6.63) and 2.37 (95% CI=1.02-6.46), respectively. CONCLUSIONS: The present study suggested that there is an association of smoking with metabolic syndrome in men.

Awareness and Attitude Toward Suicide in Community Mental Health Professionals and Hospital Workers / 예방의학회지

OBJECTIVES: The purpose of this study was to evaluate community mental health professionals and hospital workers attitude and awareness towards suicide. METHODS: This study investigated 264 community mental health professionals and 228 hospital workers. SOQs (Suicidal Opinion Questionnaires) were used from July 2007 to September 2007. After a factor analysis for the attitude towards suicide, the items on ethics, mental illness, religion, risk, and motivation were included in the subsequent analysis. RESULTS: There were significant differences in the attitude towards suicide according to religion, age, educational background, the marriage status, the economic position, and different professional licenses. Hospital workers' view was different from the community workers'. The hospital workers judged that suicide was due to mental illness, and suicide was high for the people in a special environment and who lacked motivation, which caused them to fall in a dangerous situation. For the lower educational group, they thought that suicide was attributable to mental illness. The awareness for suicide was significantly higher in the group with a postgraduate education, unmarried people, mental health professionals and the persons who had concern and experience with suicide. The factors that had an influence on the awareness of suicide were the items of mental illness, religion, risk and motivational factors. CONCLUSIONS: This study suggested that the factors to increase the awareness and attitude for suicide were the experience of increased education and case management of suicide. Therefore, education dealing with suicide and reinforcement of crisis management programs should be developed.

The Association of Cardiovascular Risk Factors with Nonalcoholic Fatty Liver Disease in Health Checkup Examinees / 예방의학회지

OBJECTIVES: The purpose of this study was to evaluate the relationship of nonalcoholic fatty liver and cardiovascular risk factors. METHODS: This study was conducted to investigate the association of nonalcoholic fatty liver and cardiovascular risk factors for adult men (n=2976) and women (n=2442) who were over 19 years old, after excluding the HBsAg(+) or anti-HCV(+) patients and the men and women with increased alcohol intake (men: 40 g/week, women: 20 g/week). RESULTS: Compared with the normal liver subjects, the nonalcoholic fatty liver subjects showed a significantly increased frequency of abnormal systolic blood pressure (> or =120 mmHg), fasting blood sugar (> or =100 mg/dL), total cholesterol (> or =200 mg/dL), triglyceride (> or =150 mg/dL), high density lipoprotein cholesterol ( or =130g m/dL) and abdominal obesity in men, and all these measures were significantly increased in the women except for abnormal HDL cholesterol. After adjusting for the body mass index, age, smoking, exercise and a nonalcoholic liver, the odds ratios of an abnormal waist hip ratio were 1.35(95% Confidence Interval=1.05-4.72) in the mild fatty liver, 1.61(1.19-2.18) in the moderate fatty liver, 2.77(1.57-4.92) in the severe fatty liver compared with a normal liver. The adjusted odds ratios for abnormal fasting blood sugar were 1.26(1.03-1.53) in the mild fatty liver, 1.62(1.27-2.06) in the moderate fatty lliver and 1.77(1.12-2.78) in the severe fatty liver. The adjusted odds ratios for abnormal triglyceride were 1.38(1.11-1.72) in the mild fatty liver, 1.73(0.33-2.24) in the moderate fatty liver and 1.91(1.17-3.10) in the severe fatty liver of men. Adjusted odds ratios for abnormal triglyceride were 1.50(1.04-2.15) in mild, 1.71(1.07-2.68) in moderate, 1.81(0.69-4.38) in severe fatty liver of women. CONCLUSIONS: The nonalcoholic fatty liver subjects had more cardiovascular risk factors compared with the normal liver subjects. Thus, prevention and treatment of the nonalcoholic fatty liver is necessary by lifestyle modifications such as restriction of alcohol intake, no smoking, exercise and adequate eating habits.