Risk Factors of Nosocomial Sepsis in Very Low Birth Weight Infants

PURPOSE: This study was performed to estimate the incidence of nosocomial sepsis and to identify the most relevant risk factors for nosocomial sepsis in high-risk very low birth weight (VLBW) infants. METHODS: A retrospective review of 341 VLBW infants, admitted to the Neonatal Intensive Care Unit of the Eulji University Hospital (Daejeon & Seoul) between January 2002 and June 2009, who survived more than 72 hours was performed. The incidence, causative organisms, risk factors and prognosis of nosocomial sepsis in VLBW infants were analyzed. RESULTS: The incidence of nosocomial sepsis was 16.1% and the onset date of nosocomial sepsis was 21.5+/-15.9 days (mean+/-SD) after delivery. Staphylococcus aureus (21.3%) was the most common organism in the patients with nosocomial sepsis in VLBW infants. The multiple logistic regression analysis showed that, gestational age [odds ratio (OR), 0.87; 95% CI, 0.83-0.91], umbilical artery catheter use for more than 5 days (OR, 2.2; 95% CI, 1.15-4.46), umbilical venous catheter use for more than 5 days (OR, 2.1; 95% CI, 1.11-4.16), peripheral arterial line use (OR, 2.1; 95% CI, 1.14-4.04) and intravenous intralipids (OR, 4.3; 95% CI, 1.13-14.32) were identified as risk factors. CONCLUSION: The limited usage of intravascular catheter related procedures and the short providence of intravenous nutrition may decrease the incidence of nosocomial sepsis in VLBW infants.

Outbreak of Scabies at Geriatric Long-Term Care Facilities in Korea / 한국역학회지

OBJECTIVES: To investigate an outbreak of scabies that occurred in geriatricfacilities located in Kyounggi-province, Korea, between September 2004 and September 2005. METHODS: We carried out an epidemiologic investigation on the scabies outbreak. All workers except two were interviewed and the charts of the patients were reviewed. RESULTS: Among workers, the attack rate was 58.6% (17/29). The rate was 86.0%(37/43) in patients. Secondary cases also occurred among the family members of workers, with a secondary attack rate of 15.8%. The 95% confidence interval was 6%~31.3%. The transmission of scabies began from one index case who had scabies and moved from another facility. She was hospitalized on the 4th floor of this facilitywhere dependent patients resided. After the activities (picnic and yard sale) in May 2005, and the ward rotation of care givers between the 3rd and 4th floor in July 2005, the incidence of scabies increased. The last cases occurred in Sep. 2005. CONCLUSIONS: This outbreak investigation has importance because it is the first report of ascabies outbreak in geriatric long-term care facilities in Korea. Recently, the reports on a scabies epidemic are increasing with the augmentation of geriatric long-term care facilities. It is important to educate and inform workers and staff in long-term care facilities about scabies and other contagious skin diseases. More facilities for senility and dementia will be opened and we need to lookinto contagious diseases in long-term care facilities.

Modeling and Simulations for Infectious Diseases / 한국역학회지

Modeling and simulations of infectious diseases are useful tools to estimate epidemic size and determine effective intervention methods. Models are idealized, simplified representations of reality. Therefore, a simple model should be the first design, with complex models always able to be added later to better represent reality. The following recommendations are made to ensure accurate simulations: (1) minimal feasible complexity, (2) mathematically well-defined, models should be constructed with well characterized stochastic processes rather than 'ad-hoc'behavioral models, (3) if predictions are being made, unknown parameters need to be robustly estimated using the model from epidemiological data, (4) where data is unavailable, a detailed sensitivity analysis needs to be undertaken, and (5) even if models are only being used to explore dynamics, sensitivity analysis is important to understand mechanisms. For the effective control of infectious diseases with models and simulations, we need effective information systems (laboratory and clinical data) for communicable disease control as a permanent infrastructure, closer collaboration between academic and service providers on new developments in communicable disease control, and enhanced monitoring of veterinary infections and 'minor' zoonoses, particularly in resources poor settings.

Clinical Prognostic Factors and Treatment Outcome of Aggressive Non-Hodgkin's Lymphoma in Elderly Patients / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The aim of this study was to determine the prognostic factors and treatment outcome of for elderly patients (age>or=60 at time of diagnosis) with aggressive non-Hodgkin's lymphoma (NHL). MATERIALS AND METHODS: We analyzed 52 patients diagnosed with aggressive NHL between January 1990 and May 2000. RESULTS: The patient's median age was 69 years (range: 60~92). Thirty-two (61.5%) patients were male. Patients included those with diffuse large B cell (53.8%), peripheral T cell (23.1%), AILD-like T-cell (3.8%), angiocentric (3.8%), mantle cell (3.8%), Burkitt's lymphoma (3.8%), and others (7.9%). International prognostic index (IPI) parameters were as follows: elevated LDH (60.8%), ECOG performance status>or=2 (32.7%), advanced stage (III/IV, 62.7%), and extranodal site>or=2 (11.5%). Twenty-six (50.0%) patients demonstrated a high and high-intermediate IPI. The median follow-up for surviving patients was 26.6 months. The overall median survival was 22.7 months and the 2-year survival rate was 46.9%. Among the 49 patientstreated with chemotherapy, 28 (57.1%) patients achieved complete remission (CR). Univariate analysis identified 8 prognostic factors for overall survival: ageor=60 years) with aggressive NHL can be successfully treated with conventional chemotherapy and the important prognostic factors for survival are age, IPI, initial WBC, and CR on first line treatment.

Evaluation of the Completeness of Case Reporting during the 1998 Cheju-do Mumps Epidemic, Using Capture-recapture Methods / 예방의학회지

OBJECTIVES: To estimate mumps incidence during the study period and to evaluate the completeness of case reporting. METHODS: Capture-recapture methods, originally developed for counting wildlife animals, were used. The data sources were 1) the National Notifiable Communicable Disease Reporting System (NNCDRS; 848 cases), 2) the School Health Reporting System, temporarily administered by the Division of Education (SHRS; 1,026 cases), and 3) a survey of students (785 cases). We estimated the number of unobserved mumps cases by matching the three data sources and fitting loglinear models to the data. We then determined the estimated total number of mumps cases by adding this to the number of observed cases. Completeness was defined as the proportion of observed cases from each source to the total of estimated cases. RESULTS: The total number of observed cases was 1,844 and the total number of estimated cases was 1,935 (95% CI: 1,878-2,070). The overall completeness was 43.8% of the NNCDRS, 53.0% of the SHRS, and 40.6% of the survey. However, completeness varied by area and age. CONCLUSION: Although the completeness of NNCDRS data appeared higher than in the past, it is difficult to generalize this result. In Korea, it is possible to estimate the size of health hazards relatively cheaply and quickly, by applying capture-recapture methods to various data using a multiple data collection system.

p53 protein expression and its prognostic importance in patients with nodal non-Hodgkin's lymphoma

To determine whether the p53 expression might be a predictor for treatment sponse and overall survival in nodal non-Hodgkin's lymphoma (NHL), we analyzed e expression of p53 in 69 NHL patients. p53 protein expression was analyzed by munohistochemistry with long-term follow up (1-148 months: median 12.2). p53 pression was noted in 23/69 (33.3%) patients. Complete response (CR) rate to stemic chemotherapy was correlated with stage (I/II) (p=0.038), but not with 3 expression (p=0.2856). Poor overall survival was associated with stage =0.0010) or IPI score (p=0.0076), but not with p53 expression (p=0.8601). From ratification analysis by stage, in stage III/IV patients, the p53 positive oup had a trend to be associated with poor overall survival than the p53 gative group. Multivariate analysis revealed that p53 positive group was sociated with less CR rate compared to the p53 negative group (p=0.046), ereas overall survival was correlated with stage (p=0.0320), not with p53 atus. p53 expression was associated with less CR rate in patients with DLBL. rther studies with large numbers of samples and homogenous group of NHL are eded to determine the prognostic value of cell cycle regulator, p53 in NHL.

Association between Musculoskeletal Subjective Symptoms and the MMPI (Minnesota Multiphasic Personality Inventory) Profile of Female VDT Operators / 대한산업의학회지

A study was conducted to assess the association between musculoskeletal subjective symptoms and the MMPI(Minnesota Multiphasic Personality Inventory) profile. The study subjects were 539 female operators of telecommunication company in Seoul, and were interviewed with subjective symptom questionnaire and MMPI. Results were as follows 1. 77.5% of the study subjects complained subjective symptoms on the shoulder, 73.8% on the neck, 71.8% on the lower back, 67.5% on the arm, 67.2% on the hand, 39.8% on the elbow, respectively. According to NIOSH symptom criteria, 63% complained on the shoulder, 57.4%, 54.6% on the lower back, 53.2% on the hand, 45.9% on the arm, 29.8% on the elbow, respectively. 2. Among the MMPI clinical scales, Hs(Hypochondriasis), Hy(Hystria) and Dep (Depression) scales showed significant differences according to the numbers of subjective symptom(NIOSH criteria), VAS(Visual Analogue Scale), and the experience of sick leave (each by ANOVA, p<0.05). 3. The association between the numbers of subjective symptom site for NIOSH symptom criteria, the personal history of sick leave and the MMPI profile that has more than 70 points in anything of Hs, Dep and Hy scales was showed significantly (each by x(2)-test, p<0.05).

Epidemiological Study on the Mumps Epidemic: In one Primary School in Hwasung-Kun, Kyonggi-Do / 한국역학회지

In the last years, according to the increasing incidence of measles and other viral diseases, it have been needed to study on not only the fundamental epidemiological characteristics of mumps and measles but also judgement on the effectiveness of vaccine that meet our domestic situation. The author carried out questionnaire to obtain epidemiological characteristics and vaccine efficacy of mumps on epidemics of mumps in one primary school in Hwasung-kun, Kyonggi Do from Feb. to July, 1994. The results are summarized as follows: 1. Total students was 556, but 446(78.4%) responded to the questionnaire. Among that 446,130(29. 1%) have suffered from mumps. From 9 to 10 year old students had the high attack rates, especially 10 year olds has the highest(39. 7%). 2. From Feb. 2, 1994, first case was on, to July 6, 1994, the epidemic was continues, and attack rate was higest in May(50. 5%). 3. Among the 130 mumps patients, 5 have suffered from complication(3.8%) : encephalitis 3(2 in male, 1 in female). 4. Vaccination rate was 91%, and as ages were lowered, the rates were higher. 5. Attack rate was higher in group who had time interval after vaccination less than 5 years than total attack rate, and was higher in group who had been vaccined after 5 year old. 6. Attack rate in vaccinated group was 27.3%. 7. Vaccine efficacies, be judged by three methods of analysis according to case definition and vaccination status, were 37.4 39. 2%. 8. Factors that have significantly affected the mumps epidemic were vaccination status and vaccination age.