Gastric Mucosal Atrophy Impedes Housekeeping Gene Methylation in Gastric Cancer Patients / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Helicobacter pylori infection induces phenotype-stabilizing methylation and promotes gastric mucosal atrophy that can inhibit CpG-island methylation. Relationship between the progression of gastric mucosal atrophy and the initiation of CpG-island methylation was analyzed to delineate epigenetic period for neoplastic transformation. MATERIALS AND METHODS: Normal-appearing gastric mucosa was biopsied from 110 H. pylori–positive controls, 95 H. pylori–negative controls, 99 gastric cancer patients, and 118 gastric dysplasia patients. Gastric atrophy was assessed using endoscopic-atrophic-border score. Methylation-variable sites of eight CpG-island genes adjacent to Alu (CDH1, ARRDC4, PPARG, and TRAPPC2L) or LTR (MMP2, CDKN2A, RUNX2, and RUNX3) retroelements and stomach-specific TFF3 gene were analyzed using radioisotope-labeled methylation-specific polymerase chain reaction. RESULTS: Mean ages of H. pylori–positive controls with mild, moderate, and severe atrophy were 51, 54, and 65 years and those of H. pylori–associated TFF3 overmethylation at the three atrophic levels (51, 58, and 63 years) tended to be periodic. Alu-adjacent overmethylation (50 years) was earlier than TFF3 overmethylation (58 years) in H. pylori–positive controls with moderate atrophy. Cancer patients with moderate atrophy showed late Alu-adjacent (58 years) overmethylation and frequent LTR-adjacent overmethylation. LTR-adjacent overmethylation was frequent in cancer (66 years) and dysplasia (68 years) patients with severe atrophy. CONCLUSION: Atrophic progression is associated with gastric cancer at moderate level by impeding the initiation of Alu-adjacent methylation. LTR-adjacent methylation is increased in cancer patients and subsequently in dysplasia patients.

Clonorchis Sinensis Control Intervention at a Sumjin Riverside Area / 農村醫學 地域保健

OBJECTIVES: This study was performed to investigate the changes in the prevalence and its related factors of the Clonorchis sinensis(C.S.) in the inhabitants at Goksung-Gun along Sum-Jin river after C.S. control intervention. METHODS: The subjects were 416 among 699 in the 8 same villages selected by stratified cluster sampling in 1999. The formalin-esther sedimentaion technic was used for the C.S. egg detection and the questionnare for the related factors. The study was carried on from February, 2005 to March, 2005. RESULTS: The prevalence of C.S. decreased significantly from 19.0% in 1999 to 11.3% in 2005. The signicicant factors in 1999 such as sex, age, area, raw fish eating habit and drink habit were not significant statistically. On the other hand factors such as the awareness of C.S. and the health behavior were changed significantly(p=0.034, p=0.021). CONCLUSIONS: These results suggest that C.S. prevalence became lower than previous study five years ago. But its control intervention should be extened to the general population regardless of sex, age, area, raw fish eating habits, drink habit and we need to make an effort to improve the awareness and the health behavior of C.S..

A Survey on the Development of Database and Network for the Experts in Cancer / 대한의료정보학회지

OBJECTIVE: This research is a basic investigation of collecting experts' opinions for constructing the national cancer expert network. The objective of this research is to evaluate present situation and to use it for the planning of future korean cancer network in the cancer-related area. METHODS: We analyzed the need of the network and degree of information demand for constructing the network from Clinicians and Basic researchers(n=376) who answered themselves 'cancer expert'. The questionnaire consists of 9 questions and it was analyzed by using frequence, t-test and Chi-square. RESULTS: 53.7 percents of respondents answered they are already recognized cancer expert network and 93.5 percents of respondents answered that they need the network. Among the services that would be served by the network, the demand of cancer statistics, development and evaluation of cancer policy, and cancer clinical trials were listed in the high priorities. And recognized societies included in the high priorities were Korean Cancer Study Group, Korean Cancer Association, Korean Association for the Study of Lung Cancer. CONCLUSION: We are going to develop a database and network for the experts to generate, evaluate and verify cancer-related information based on evidence-based cancer information infrastructure. Hence, this research will be contributed to provide fundamental data for activating cancer-related research through joint studies with experts.

Comparison of Secondary Procedures for Recurrent Stress Urinary Incontinence after a Transobturator Tape Procedure: Shortening of the Tape versus Tension-free Vaginal Tape Redo / 대한비뇨기과학회지

PURPOSE: Although the reported failure rate of the transobturator tape procedure(TOT) is low, recurrence after this procedure have been reported, and no standard treatment has yet been established for the recurrence. We compared a shortening of the previously implanted tape with a repeat tension-free vaginal tape(TVT) procedure after a failed TOT procedure. MATERIALS AND METHODS: We enrolled eighteen women(mean age: 54.38+/-9.15 years, range: 38-72) who underwent shortening of the previously implanted tape or they underwent a repeated TVT procedure due to persistent or recurrent SUI. Of the 18 women, 10 patients underwent shortening of implanted tape and the others underwent repeat TVT. All the patients were evaluated preoperatively with a detailed history, pelvic examination, urinalysis, voiding diary and urodynamic study that included the Valsalva leak point pressure(VLPP). The postoperative outcomes were assessed by a review of admissions and the medical charts. RESULTS: The mean interval from first surgery to recurrence was 6.88+/-2.61 months for Monarc, 12 months for TVT-O and 4.71+/-2.42 months for T-sling. Of the 10 patients who underwent shortening of the implanted tape, 7(70%) patients were cured and the others failed. Of the 8 patients who underwent repeat TVT, 7(87.5%) patients were cured and one was significantly improved. The success rate is significantly higher in the repeated TVT group(p<0.05). CONCLUSIONS: Both a shortening of the previously implanted tape and a repeated TVT procedure are safe, effective, viable options in the event of initial TOT sling failure. However, the success rate of the repeated TVT group is higher than that of the shortening of implanted tape group, especially for patients with an internal sphincteric deficiency. Therefore, a repeated TVT procedure is a first option in the event of initial TOT sling failure.

Effects of Internet-based Diabetic Education on Plasma Glucose and Serum Lipids in Female Type 2 Diabetic Patients / 여성건강간호학회지

PURPOSE: The purpose of this study was to evaluate the effects of Internet education on plasma glucose and serum lipids in female type 2 diabetic patients. METHOD: Control and experimental groups were assessed by a pre-test and at 3 months, 6 months, 9 months, and 12 months. Fourteen patients were assigned randomly to an intervention group and 15 to a control group. Patients in the intervention group were requested to input their blood glucose levels everyday by cellular phone or wire Internet for 1 year. The goal of the intervention was to keep blood glucose concentrations close to the normal range (glycosylated hemoglobin, HbA1c< 7%). An intervention was applied to the intervention group weekly for 1 year. Optimal recommendations were sent weekly by a short message service from a cellular phone and wire Internet. RESULTS: Patients in the intervention group had a significant mean change in HbA1c, from 7.6% at pre-test to 6.9%, at 3 months and equalized at 6.7% at 12 months. There was no significant time and group differences observed in the serum lipids. CONCLUSION: These findings indicate that Internet education would improve and maintain the normal range of HbA1c in female type 2 diabetic patients.

Efficacy of the Merozoite Surface Protein 1 of Plasmodium Vivax as an Antigen for ELISA to Diagnose Malaria

Malaria is still a major health problem in Thailand and its incidence is currently rising in Korea. To identify a useful antigen for the diagnosis of malaria patients, a cDNA expression library from malaria parasites was constructed and screened out immunologically. One clone was selected in view of its predominant reactivity with the patient sera. The recombinant malaria parasite antigen (Pv30) with 27 kDa as a C-terminal His-tag fusion protein that was produced in Escherichia coli was identified through immunoblot analysis. The deduced amino acid sequence had the sequence homology with the merozoite surface protein 1 (MSP1) genes of Plasmodium falciparum and P. yoelii, each by 41% and 42%, respectively. Measurement of serum IgG and IgM antibody to Pv30 by enzyme-linked immunosorbent assay (ELISA) was evaluated as a serodiagnostic test for malaria patients in Thailand (endemic area) and Korea (recently reemerging area). The sensitivity of P. vivax, P. falciparum, and P. malariae was 96.3% (26 /27), 90.6% (29/32), and 100% (6/6), respectively, and the specificity was 63.5% (40/63) in Thailand samples. The sensitivity of P. vivax was 98.8% (88/89), and the specificity was 96.6% (86/89) in Korean samples. Pv30 appears to be a good and reliable recombinant antigen for serodiagonosis of malaria in a nonendemic area.

Internet Healthcare Delivery System

The healthcare laws and healthcare system, which includes healthcare delivery system and network hospital and attending hospital system etc., have much influence on the application of Internet. Whereas government-driven healthcare delivery system had little desirable effects including increased efficiency in patient care and balanced development of various types of medical service facilities, the private hospital network was successful with the help of information interchange. The network hospital is a kind of private hospital network for patient delivery preparing for the current healthcare management issues such as the separation of pharmacy and clinic and expansion of DRG. Network hospitals has been used the internet to transfer the information of patients. Internet is not the main success factor of the network, but the it may not be successful without Internet. The attending hospital system is in it's early stage in Korea. As the number of participating physician increases, the need of information interchange will be increased. The future of the internet healthcare delivery system would be composed of web application and databases, ASP, team approach to assist physicians. The major obstacle of the system is the technical level of information system in medium and small sized hospitals. The governmental financial assistance is needed in that hospitals. The most important issue is the standardization of information. The participation of KMA in standardization is needed.

Two human cases of tick bite caused by Ixodes nipponensis

We report two human cases of tick bite. A 63-year-old male had a pruritic pea-sized brownish nodule on the left popliteal area. Another 41-year-old male had an asymptomatic bean-sized black nodule in the pubic area. The ticks were identified as Ixodes nipponensis, which are the 18th and the 19th cases in Korea.

The Relationship between Alcohol Use and Job Stress among Firemen / 대한산업의학회지

OBJECTIVES: To establish the relationship between alcohol use and job stress among firemen, and to develop a comprehensive health promotion program including stress management and the prevention of problem drinking. METHODS: Data was collected from July to August, 2000. Study subjects included 97 rescue workers, 97 emergency medical personnel, 179 fire extinguishers, 116 administrators and 49 others. RESULTS: The firemen displayed higher scores of stress due to promotion-related pressures and salary. We found significant differences in job internal factors, job role, interpersonal relationship, organizational norm, work environment and stress outcome among the various jobs. Job internal factors, job stress factors, personal characteristics, coping skills, and stress outcome were higher in heavy drinkers compared with the light and moderate drinkers. Job internal factors and smoking habit showed a positive correlation with the amount of drinking, although coping skill, exercise frequency and monthly income showed a negative relation with the amount consumed. CONCLUSION: This study suggested that alcohol drinking is associated with job stress. This suggests that a comprehensive health promotion program including stress management and problem drinking prevention and control should be developed.

Twelve-year tracking of blood pressure in Korean school children: the Kangwha Study

Longitudinal data from different populations have shown different degrees of tracking of blood pressure (BP). To examine BP tracking in Korean school children, 219 of 430 children (100 males, 119 females) who were 6 years old in 1986 in Kangwha County, Korea have been examined annually up to 1997 in the Kangwha Study. BP was measured twice with standard mercury sphygmomanometers and the average of the two measurements was used for the level of BP. Diastolic BP were measured at the fourth Korotkoff sound. Tracking was examined using a time-lag correlation analysis and McMahan's tracking index tau, which indicates the proportion of variation attributable to tracking apart from the natural growth component. As well the jackknife method was used to obtain the confidence interval of tau. Correlation coefficients between systolic BP from age 6 to 17 ranged from 0.39-0.54 for males and 0.44-0.57 for females. Taus for systolic BP were 0.875 (95% CI: 0.803-0.947) and 0.900 (95% CI: 0.809-0.991) in males and females, respectively. Correlation coefficients between diastolic BP from age 6 to 17 ranged from 0.28-0.47 for males and 0.14-0.47 for females. Taus for diastolic BP were 0.983 (95% CI: 0.897-1.000) and 0.800 (95% CI: 0.717-0.883) in males and females, respectively. These findings showed strong evidence for BP tracking in Korean school children from childhood to late adolescence.

The Prevalence of Cancer in Kangwha County / 예방의학회지

OBJECTIVES: Most descriptive studies of cancer have focused either on cancer incidence or mortality. Cancer prevalence has rarely been estimated. Cancer prevalence data can be used as a measure of the economic and social burden of cancer and are also useful for health care planning. This study attempts to estimate cancer prevalence in Kangwha county. METHODS: This investigation is based on data of Kangwha cancer registry. The data include all cases of cancer diagnosed from 1983 through 1992. We define "prevalent cases" as cancer patients who is alive as of January 1, 1993. For each five-year age group, the number of "known prevalent cases" is added to the number of "estimated prevalent cases". Prevalence is calculated by dividing these sums by the populations of Kangwha County on December 31, 1992(derived from Kangwha Statistics Annual). RESULTS: Crude prevalence of cancer among males and females are 536.7 and 601.1 per 100,000 respectively. Gastric cancer is the most common malignant neoplasm(213.2 per 100,000, crude prevalence) among males. It is followed by lung cancer(45.1 per 100,000), liver cancer(32.8 per 100,000), rectal cancer(25.4 per 100,000) and colon cancer(25.4 per 100,000). Cervical cancer is the most common cancer(201.9 per 100,000, crude prevalence) and is followed by gastric cancer(91.5 per 100,000), thyroid cancer(64.8 per 100,000), breast cancer(57.2 per 100,000) and rectal cancer(32.7 per 100,000) among females. CONCLUSIONS: We tried to estimate cancer prevalence based on the Kangwha cancer registry for the first time in Korea. The estimation of cancer prevalence based on a population-based cancer registry will be more correct and useful as the data accumulate. We will make another estimation in the near future.

Relation between Body Size and Body Mass Index and Breast Cancer by Menopausal Status in Korea / 대한암학회지

PURPOSE: Because the breast cancer is one of the major causes of mortality among women, it is important to identify modifiable risk factors for this disease. Some reported that overweight/obesity is a risk factor for breast cancer, but the results are not consistent. Human breast cancer has different characteristics according to the status of menopause (premenopause and postmenopause). For the premenopaused women, the majority of the relevant prospective studies support an inverse relationship between body mass index and the development of breast cancer. In contrast, for the postmenopaused women, a positive relationship between body mass index and development of breast cancer has been reported in only half of prospective studies on this topic. This study was undertaken to determine the role of body size and body mass index by status of menopause in development of breast cancer in Korea using retrospective case-control study. MATERIALS AND METHODS: The breast cancer cases (n=683) and controls (n=501) were recruited from January 1993 to April 1998 at the Asan Medical Center. The authors collected information on demographic, reproductive and anthropometric characteristics by interviews. Quetelets index was calculated using height and weight. Multiple logistic regression was done to estimate adjusted odds ratios (ORs) by menopausal status, controlling age, age at first full-tenn pregnancy, age at menarche, number of parity, family history of breast cancer. RESULTS: Overall, there was a moderate, but significant association between obesity and breast cancer. Among premenopausal women, in comparison with women whose weights were less than 50 kg, the ORs for the upper quintile group of weight was 1.71 (95% confidence interval (CI), 1.01~2.89). The heaviest premenopausal women had a higher risk (OR=1.16, 95% CI, 1.05~1.29, P=0.005). The adjusted OR for the highest quintile of BMI relative to the lowest was 2.02 (95% CI, 1.18~3.45). Higher body mass index was significantly associated with increased risk of premenopausal breast cancer (OR=1.08, 95% CI, 1.02~1.15, P=0.006). Among postmenopausal women, higher body mass index and weight were associated with increased risk of breast cancer. In comparison with women whose weights were less than 50 kg, the OR for the upper quintile group of weight was 2.08 (95% CI, 1.064.08). The adjusted OR for the highest quintile of BMI relative to the lowest was 2.02 (95% CI, 1.02~4.01). CONCLUSION: Our findings suggest that overweight/obesity may play an important role in the incidence of premenopausal and postmenopausal breast cancer in Korea.

Cancer Incidence in Kangwha County(1986 - 1992) / 예방의학회지

OBJECTIVES: This paper presents the information on the incidence of cancer from the population-based cancer resistry in Kangwha County. Material and METHODS: This investigation is based on Kangwha cancer registry. The data included cases of cancer diagnosed from 1986 through 1992. The diagnosis of cancer was confirmed by a team of physicians and nurses with the medical records kept in the clinics and hospitals based on the diagnostic criteria recommended by WHO. Home visitings were also made to cancer patients confirmed in every 6 months for the follow up and for the collection of relevant information directly from the patients. RESULTS: A total of 992 cancer cases were registered during 1986 - 1992. The age-adjusted cancer incidence rate of all site is 201.7 in men and 110.7 in women. The most common cancer is the stomach cancer in both sexes. The age-adjusted incidence rate of the stomach cancer is 65.9 in men and 25.0 in women per 100,000 population. The lung cancer(33.8) and liver cancer(27.7) are next common cancers in men. The cervical cancer(21.8) and lung cancer(8.4) are next in women. CONCLUSION: The most common cancer is the stomach cancer in both sexes. The annual age-adjusted incidence rate of the stomach cancer is 65.9 in men and 25.0 in women per 100,000 population.

The effect of sodium and potassium intake on blood pressure change in Korean adolescents / 예방의학회지

In order to investigate the effect of the urinary excretion of sodium and potassium on the change on blood pressure over 3 years, 668 adolescents aged 13 years living in Kangwha area were investigated in a longitudinal follow-up study. Two measurements were taken on each blood pressure (diastolic, systolic) and the average of the two readings was used in the analysis. Sodium and potassium intake were estimated by the determination of those electrolytes in 24hr urine. The mixed model regression analysis was used to identify the effect of urinary sodium and potassium on the change of blood pressure after controlling for BMI of each age. On simple bivariate analysis no relationship was found between urinary sodium excretion and systolic or diastolic blood pressure among both male and female, however, a significant positive association between urinary potassium excretion and systolic blood pressure among male. The results of mixed regression analysis showed that the body mass index (BMI) were more influential that urinary electrolytes among this study subjects. It suggested that risk factors observed from the adults, may not be identical with that of the growing aged population. After control of the BMI and age, significant association between sodium and diastolic BP among male, and association between potassium and systolic BP among female, were found. In summary, the results indicate that growth has been more influential than dietary factor on blood pressure for growing aged population.

A Case-Control Study on Risk Factors of CHD: Vegetable consumption and risk for CHD in Korean men / 한국역학회지

The purpose of this study was to investigate the association of vegetable consumption with the incidence of CHD in Korean men by a case-control study. The case group consisted of 108 patients with EKG-confirmed myocardial infarct or angiographically-confirmed(>or=50% stenosis) angina pectoris admitted to a university teaching hospital in Seoul, Korea. Controls were 142 age-matched patients admitted to the departments of ophthalmology and orthopedic surgery at the same hospital. Dietary intake was assessed by a nutritionist using a semiquantitative food frequency method, while body mass index (BMI), tobacco use, and past history of cardiovascular disease were determined during an interview and examination. The consumption of vegetables was classified by the average frequency of intake(less than 3 times/week, 3~4 times/week, 5~6 times/week, more than once/day). The percentage of subjects who consumed vegetables less than 3 times per week was 29.6% for cases and 17.6% for controls; while men who consumed vegetavle more than once per day were 16.7% for cases and 32.4% for controls. After the adjustment for age, body mass index, and tobacco use, the odds ratio of men who consumed vegetables at least once per day was 0.38(95% confidence interval, 0.18-0.85) compared with men who consumed vegetables less than three times per week. These results suggested that in a population with a relatively low fat intake, consumption of vegetables at least once per day may reduce the risk of CHD in men.

Changes in blood pressure and determinants of blood pressure level and change in Korean adolescents / 예방의학회지

Many studies have led to the notion that essential hypertension in adults is the result of a process that starts early in life: investigation of blood pressure(BP) in children and adolescents can therefore contribute to knowledge of the etiology of the condition. a A unique longitudinal study on BP in Korea, known as Kangwha Children's Blood Pressure(KCBP) Study was initiated in 1986 to investigate changes in BP in children. This study is a part of the KCBP study. The purposes of this study are to show changes in BP and to determine factors affecting to BP level and change in Korean adolescents during age period 12 to 16 years. A total of 710 students(335 males, 375 females) who were in the first grade at junior high school(12 years old) in 1992 in Kangwha County, Korea have been followed to measure BP and related factors(anthropometric, serologic and dietary factors) annually up to 1996. A total of 562 students(242 males, 320 females) completed all five annual examinations. The main results are as follows: 1. For males, mean systolic diastolic BP at age 12 and 16 years old were 108.7 mmHg & 118.1 mmHg(systolic), and 69.5 mmHg & 73.4 mmHg(diastolic), respectively. BP level was the highest when students were at 15 years old. For females, mean systolic and diastolic BP at age 12 and 16 years were 114.4 mmHg & 113.5 mmHg(systolic) and 75.2 mmHg & 72.1 mmHg(diastolic), respectively. BP level reached the highest point when they were 13-14 years old. 2. Anthropometric variables(height, weight and body mass index etc) increased consitantly during the study period for males. However, the rate of increase was decreased for females after age 15 years. Serum total cholesterol decreased and triglyceride increased according to age for males, but they did not show any significant trend for females. Total fat intake increased at age 16 years compared with that at age 14 years. Composition of carbohydrate, protein and fat among total energy intake was 65:15:20 at age 14 and 16 years. 3. Most of anthropometric measures, especially, height, body mass index(BMI) and triceps skinfold thickness, showed a significant correlation with BP level in both sexes. When BMI was adjusted, serum total cholesterol showed a significant negative correlation with systolic BP at age 12 years in males, but at age 14 years the direction of correlation changed to positive. In females serum total cholesterol was negatively correlated with diastolic BP at age 15 and 16 years. Triglyceride and creatine showed positive correlation with systolic and diastolic BP in males, but they did not show any correlation in females. There was no consistent findings between nutrient intake and BP level. However, protein intake correlated positively with diastolic BP level in males. 4. Blood pressure change was positively associated with changes in BMI and serum total cholesterol in both sexes. Change in creatine was associated with BP change positively in males and negatively in females. Students whose sodium intake was high showed higher systolic and diastolic BP in males, and students whose total fat intake was high maintained lower level of BP in females. The major determinants on BP change was BMI in both sexes.

Four-year change and tracking of serum lipids in Korean adolescents / 예방의학회지

It has been known that there is a tracking phenomenon in the level of serum lipids. However, no study has been performed to examine the change and tracking of serum lipids in Korean adolescents. The purpose of this study is to examine the changes of serum lipids in Korean adolescents from 12 to 16 years of age, and to examine whether or not there is a tracking phenomenon in serum lipids level during the period. In 1992 serum lipids(total cholesterol(TC), triglyceride(TG), LDL cholesterol(LDL-C), HDL cholesterol(HDL-C)) were measured in 318 males, 365 females who were 12 years of age in Kangwha county, Korea. These participants have been followed up to 1996 and serum lipids level were examined in 1994 and 1996. Among the participants 162 males and 147 females completed all three examinations in fasting state. To examine the effect of eliminating adolescents with incomplete data, we compared serum lipids, blood pressure and anthropometric measures at baseline between adolescents with complete follow-up and adolescents who were withdrawn. To examine the change of serum lipids we compared mean values of serum lipids according to age in males and females. Repeated analysis of variance was used to test the change according to age. We used three methods to examine the existence of tracking. First, we analyzed the trends in serum lipids over 4-year period within quartile groups formed on the basis of the first-year serum lipids level to see whether or not the relative ranking of the mean serum lipids among the quartile groups remained in the same group for 4-year period. Second, we quantified the degree of tracking by calculating Spearman's rank correlation coefficient between every tests. Third, the persistence extreme quartile method was used. This method divides the population into quartile groups according to the initial level of blood lipids and then calculates the percent of the subjects who stayed in the same group at follow-up measurement. The decreases in levels were noted during 4 years for TC, LDL-C, primarily for boys. The level of HDL-C decreased between baseline and first follow-up for both sexes and girls. Tracking, as measured by both correlation coefficients and persistence extreme quartiles, was evident for all of the lipids. The correlation coefficients of TC between baseline and 4 years later in boys and girls were 0.55 and 0.68, respectively. And the corresponding values for HDL-C were 0.58 and 0.69. More than 50% of adolescents who belonged to the highest quartile group in TC, HDL-C and LDL-C at the baseline were remained at the same group at the examination performed 2 years later for both sexes. The probability of remaining at the same group was more than 35% when examined 4 years later. The tracking phenomenon of TG was less evident compared with the other lipids. Percents of girls who stayed at the same group 2 years later and 4 years later were 42.9% and 25.7%, respectively. It was evident that serum lipid levels tracked in Korean adolescents. Researches with longer follow-up would be needed in he future to investigate the long-term change of lipids from adolescents to adults.

A Comparison of Laparoscopic Cholecystectomy with Open Cholecystectomy in a Korean Hospital / 예방의학회지

Laparoscopic cholecystectomy was introduced into Korea in 1990 and has been rapidly replacing open cholecystectomy when the indications were met. In this study a medical utilization and technology was assessed on the selected hospitalized patients with cholelithiasis who underwent open or laparoscopic cholecystectomy from April 1, 1991 to March 31, 1994. The results are as follows. Despite the low reimbursement rate by the health insurance, the number of laparoscopic cases have been steadily increased. The post-operative days before health insurance coverage were significantly shortened from 8.4 days to 4.6 days. The preoperative days before health insurance coverage were significantly shorted from 8.4 days to 4.0 days. The total length-of-stays in the hospital were also significantly shortened from 15.2 days to 10.7 and 9.8 days in laparoscopic cholecystectomy. The laparoscopic cholecystectomy showed low expenses in all aspects expect the average hospital charges per day. For the hospital to have cost containment, it is more effective if length-of-stay is shorter because of high daily inpatient hospital charge. The laparoscopic cholecystectomy also showed shortened anesthesia time and operation time compared with open cholecystectomy that were statistically significant. The mean anesthesia and operation time for open cholecystectomy were 113.2 and 90.2 minutes but those of laparoscopic cholecystectomy were 105.7 and 68.6 minutes. According to this study the laparoscopic cholecystectomy has reduced the medical expenditure and we recommend this procedure over open cholecystectomy. The further discussion on the different morbidity rate between two types of procedure is essential in providing quality medical care, and to educate specialist.

A methodological study on simplifying claims review system in medical insurance / 예방의학회지

After the introduction of National Medical Insurance in 1989, the medical demand has rapidly increased. The impact of increased medical demand was followed by an increase in the number of claims in need of review. We studied a new, fair method for reducing the number of claims reviewed. we analysed 90,583 outpatient claims submitted between september and october; claims were made for services given August of 1994. We finally suggested a screening system for claims review using a statistical method of discriminant analysis of the medical costs. The results were as follows. 1. In the cut-off group, age, days of medication, number of hospital or clinic visits, and total change were significantly high The cut-off rates according to the hospital-type and existence of accompanied disease were significantly different. 2. According to ICD, the cut-off rate was highest in peripheral enthesopathies and allied syndromes(20.76%), lowest in acute sinusitis(0.93%). The mean charges were significantly different according to ICD and existence of cut-off. 3. we build discriminant functions by ICD with such discriminant variables as patient age, sex, existence of accompanied disease, number of hospital or clinic visits, and 9 detailed hospital or clinic charges included in claim. 4. we applied the discriminant function for screening those claims that were expected to be cut-off. The sensitivities comprised from 40% to 70%, and specificities from 70% to 95% by ICD. Acute rhinitis had highest sensitivity(100.00%)and other local infections of skin and subcutaneous tissue had highest specificity(98.45%). The excepted number of cut-off was 17,762(19.61%). The total sensitivity was 49.62%, the total specificity was 82.57% and the error rate was 19.66%. We lacked economic analysis such as cost-benefit analysis. But, if the few method of screening claims using discriminant analysis were applied, the number of claims in need of review will reduce considerably.

Cohort analysis on academic achievement of medical students / 한국의학교육

In order to analyze academic achievement of medical students and its related factors, a total of 2,371 students who entered the premedical course of O university from 1987 were reviewed based on cohor t of their admission year. Those who did not promoted to medical college from premedical course in two years were 15% and those who did not graduate medical school in four years were 21%. The percentage of female students and outside Seoul residents has been growing. The percentage that students parents' occupation is medical profession has been decreasing. Those who failed during premedical course have higher conditional probability to fail during the medical studies. The results suggest that medical educators pay more attention to those who failed during the premedical course. Also the criteria whether students are failed or promoted to next grade is reasonable should be studied in depth.