Efficacy of Dairy Free Diet and 6-Food Elimination Diet as Initial Therapy for Pediatric Eosinophilic Esophagitis: A Retrospective Single-Center Study / 대한소아소화기영양학회지

12 weeks) were 81.8%, 50.0%, and 55.1% for DFD, and 68.8%, 50.0%, and 40.0% for SFED. Response based on age ( 12 years) were 59.3%, 42.9%, and 67.5% for DFD, and 36.4%, 58.8%, and 72.7% for SFED. In patients treated with DFD, concomitant proton pump inhibitor (PPI) administration resulted in improved outcomes (p=0.0177). Bivariate regression analysis showed that PPI with diet is the only predictor of response (p=0.0491), however, there were no significant predictors on multiple regression analysis.CONCLUSION: DFD and SFED are effective first line therapies for EoE. DFD should be tried first before extensive elimination diets. Concomitant therapy with PPI's may be helpful.

Prognostic factors for outcome of surgical treatment in medication-related osteonecrosis of the jaw

OBJECTIVES: The number of patients with medication-related osteonecrosis of the jaw (MRONJ) is increasing, but treatment remains controversial. Published papers and systematic reviews have suggested that surgical treatment is effective in patients with MRONJ. The purpose of this study was to determine whether preoperative University of Connecticut Osteonecrosis Numerical Scale (UCONNS), other serologic biomarkers, and size of necrosis are prognostic factors for outcome of surgical treatment in MRONJ. MATERIALS AND METHODS: From January 2008 to December 2016, 65 patients diagnosed with MRONJ at the Department of Oral and Maxillofacial Surgery in College of Dentistry, Dankook University who required hospitalization and surgical treatment were investigated. Patient information, systemic factors, and UCONNS were investigated. In addition, several serologic values were examined through blood tests one week before surgery. The size of osteolysis was measured by panoramic view and cone-beam computed tomography in all patients. With this information, multivariate logistic regression analysis with backward elimination was used to examine factors affecting postoperative outcome. RESULTS: In multivariate logistic analysis, higher UCONNS, higher C-reactive protein (CRP), larger size of osteolysis, and lower serum alkaline phosphate were associated with higher incidence of incomplete recovery after operation. This shows that UCONNS, CRP, serum alkaline phosphate, and size of osteolysis were statistically significant as factors for predicting postoperative prognosis. CONCLUSION: This study demonstrated that CRP, UCONNS, serum alkaline phosphate, and size of osteolysis were statistically significant factors in predicting the prognosis of surgical outcome of MRONJ. Among these factors, UCONNS can predict the prognosis of MRONJ surgery as a scale that includes various influencing factors, and UCONNS should be used first as a predictor. More aggressive surgical treatment and more definite surgical margins are needed when the prognosis is poor.

Contemplation of Legal Criteria of Psychiatric Compulsory Admission: Including an Introduction of US Case Which Can be Referred to the Assessment of the Appropriateness of Hospitalization in Korea / 신경정신의학

The Korean Mental Health Act has been radically reformed recently in order to improve psychiatric patients' human rights by regulating the compulsory admission process. However, the expert group brought up questions about difficulties in practice and incoherence in its philosophy before the Act was implemented. There are already discussions concerning the next revision of the Act. In such a situation, lessons can be learned from the experiences of other countries. Articles on psychiatric compulsory admission were comprehensively reviewed with the focus on legal criteria, and found that current trends worldwide include a move towards broad diagnostic criteria, use of capacity and treatability test, and treatment in the interest of health rather than safety. In addition, we introduce the Whittington scale, an assessment tool for the appropriateness of hospitalization used in the Connecticut Mental Health Center, US, as a reference for the similar procedure being implemented soon in Korea.

The reliability of tablet computers in depicting maxillofacial radiographic landmarks

PURPOSE: This study was performed to evaluate the reliability of the identification of anatomical landmarks in panoramic and lateral cephalometric radiographs on a standard medical grade picture archiving communication system (PACS) monitor and a tablet computer (iPad 5). MATERIALS AND METHODS: A total of 1000 radiographs, including 500 panoramic and 500 lateral cephalometric radiographs, were retrieved from the de-identified dataset of the archive of the Section of Oral and Maxillofacial Radiology of the University Of Connecticut School Of Dental Medicine. Major radiographic anatomical landmarks were independently reviewed by two examiners on both displays. The examiners initially reviewed ten panoramic and ten lateral cephalometric radiographs using each imaging system, in order to verify interoperator agreement in landmark identification. The images were scored on a four-point scale reflecting the diagnostic image quality and exposure level of the images. RESULTS: Statistical analysis showed no significant difference between the two displays regarding the visibility and clarity of the landmarks in either the panoramic or cephalometric radiographs. CONCLUSION: Tablet computers can reliably show anatomical landmarks in panoramic and lateral cephalometric radiographs.

Correlation of burnout syndrome with specific coping strategies, behaviors, and spiritual attitudes among interns at Yale University, New Haven, USA / 보건의료교육평가

PURPOSE: This study aimed to determine the correlation of burnout syndrome with specific coping strategies, behaviors, and spiritual attitudes among interns in internal medicine, primary care, and internal medicine/pediatrics residency programs at two institutions. METHODS: Intern physicians completed anonymous voluntary surveys prior to starting the internship in June 2009 and in the middle of the internship in February 2010. Three validated survey instruments were used to explore burnout, coping, and spiritual attitudes: the Maslach Burnout Inventory, the COPE Inventory, and the Hatch Spiritual Involvement and Beliefs Scale. The interns were in programs at the Yale University School of Medicine and a Yale-affiliated community hospital, New Haven, Connecticut, USA. RESULTS: The prevalence of self-identified burnout prior to starting the internship was 1/66 (1.5%) in June 2009, increasing to 10/53 (18.9%) in February 2010 (P<0.0001). From June 2009 to February 2010, the prevalence of high emotional exhaustion increased from 30/66 (45.5%) to 45/53 (84.9%) (P<0.0001), and that of high depersonalization increased from 42/66 (63.6%) to 45/53 (84.9%) (P=0.01). Interns who employed the strategies of acceptance and active coping were less likely to experience emotional exhaustion and depersonalization (P<0.05). Perceptions of high personal accomplishment was 75.5% and was positively correlated with total scores on the Hatch Spiritual Involvement and Beliefs Scale, as well as the internal/fluid and existential/meditative domains of that instrument. Specific behaviors did not impact burnout. CONCLUSION: Burnout increased during the intern year. Acceptance, active coping, and spirituality were correlated with less burnout. Specific behaviors were not correlated with burnout domains.

Chronic osteitic rhinosinusitis as a manifestation of cystic fibrosis: A case report

A 28-year-old male patient with a history of cystic fibrosis (CF) was referred to the University of Connecticut School of Dental Medicine for an evaluation of a cystic lesion in the right maxilla using cone-beam computed tomography (CBCT). CF is an autosomal recessive disease characterized by an abnormal production of viscous mucus, affecting the mucociliary clearance. The CBCT scan revealed a large cystic lesion in the right maxilla extending from the right maxillary second molar to the midline in the region of the right central incisor with a significant buccal expansion. Further evaluation revealed complete opacification of the paranasal sinuses with medial bulging of the lateral maxillary sinus walls. The maxillary and sphenoid sinuses also appeared hypoplastic. The peculiar finding seen in this case was the presence of marked sclerosis and an increase in the thickness of the adjacent bony framework. This report aimed to describe the common sinonasal findings associated with CF and its underlying pathophysiology.

The Influence of the Sick House Syndrome on Nasal Mucosa and Nasal Symptoms / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Concerns about the quality of indoor air have increased recently. However, there has not been any significant research conducted concerning the patterns of histologic and organic changes induced in humans by indoor air pollution. The aim of the study is to investigate the organic changes of nasal mucosa and nasal symptoms due to exposed concentrations of indoor air pollution. SUBJECTS AND METHOD: We studied fourteen people from four families, all of whom had plans to move into new apartments. We measured the quantities of indoor air pollution before their move, one week after moving in, and then one month after the move. Other clinical tests such as an acoustic rhinometry, olfactory tests and nasal smears were performed. RESULTS: Mean concentrations of Total Volatile Organic Chemicals (TVOCs) and aldehydes showed an increase after moving into the new apartments. Post-move acoustic rhinometry, Connecticut Chemosensory Clinical Research Center (CCCRC) test and endoscopic findings showed a decrease in nasal function and patency. Additionally, in nasal smears, eosinophils with bilobulated nuclei were observed, and eosinophil count showed a pattern of increase. CONCLUSION: High concentrations of indoor air pollutants could induce organic changes of the nasal cavities and cause the recession of olfactory function. Due to indoor air pollutants, hypersensitivity of nasal mucosa was induced, and histological changes of nasal mucosa as well as hematological changes were observed. These indicate that indoor air pollution impinges on the nasal mucosa and cause nasal symptoms.

Trends in outpatient breast cancer surgery among Medicare fee-for-service patients in the United States from 1993 to 2002 / 癌症

The practice of outpatient breast cancer surgery has been controversial in the United States. This study aimed to update time trends and geographic variation in outpatient breast cancer surgery among elderly Medicare fee-for-service women in the United States. Using the 1993-2002 linked Surveillance, Epidemiology and End Results (SEER)-Medicare claims data and the Area Resource Files, we identified 2 study samples, including the women whose breast cancers were the first-ever-diagnosed cancer at age 65 years or older from 9 regions continuously covered by the SEER registries since 1993. The first sample included the women receiving unilateral mastectomy for stage 0-IV cancer; the second included the women receiving the breast-conserving surgery with lymph node dissection (BCS/LND) for stage 0-II cancer. The proportions of patients receiving outpatient surgery increased from 3.2% to 19.4% for mastectomy and from 48.9% to 77.8% for BCS/LND from 1993 to 2002. We observed substantial geographic variation in the average proportion of the patients receiving outpatient surgery in the studied areas across the 10-year period, ranging from 3.9% in Connecticut to 27.2% in Utah for mastectomy and from 54.7% in Hawaii to 78.1% in Seattle, Washington, for BCS/LND. As the popularity of outpatient breast cancer surgery continues to grow, more evidence-based analyses related to quality and outcomes of outpatient breast cancer surgery among various populations are needed in order to facilitate the public debates about state and federal mandated health benefit legislations.

Alteration of Olfactory Function in Chronic Viral Hepatitis Patients

BACKGROUND AND OBJECTIVES: Alterations of olfactory function among patients with cirrhosis of the liver, acute viral hepatitis or alcoholic liver disease have been reported. The goal of this study is to evaluate the alteration of olfactory function among chronic viral hepatitis patients. MATERIALS AND METHODS: The study group consisted of 21 patients with chronic active viral hepatitis and 32 normal subjects. Between December 2006 and January 2008, olfactory function among the study groups was evaluated using the Connecticut Chemosensory Clinical Research Center and the Cross Cultural Smell Identification Test. Then, correlations between the olfactory function test scores and serological data were analyzed. RESULTS: Hepatitis patients had significantly lower smell identification test scores. Only serum total bilirubin level had negative correlation with smell identification test scores. CONCLUSION: Chronic viral hepatitis appears to influence olfactory function.

Acculturation, socioeconomic status, obesity and lifestyle factors among low-income Puerto Rican women in Connecticut, U.S., 1998-1999

OBJETIVOS: Examinar las asociaciones entre el estado socioeconómico y la aculturación con las características del estilo de vida que podrían constituir factores de riesgo de diabetes y de enfermedades cardiovasculares en mujeres puertorriqueñas de bajos ingresos. MÉTODOS: Este estudio transversal se llevó a cabo entre 1998 y 1999 mediante entrevistas a una muestra de conveniencia compuesta de 200 mujeres puertorriqueñas de bajos ingresos que cuidaban a niños pequeños en Hartford, Connecticut, Estados Unidos de América. Se usaron diversas formas de reclutamiento para conseguir que hubiera una buena representación de la comunidad blanco. Las asociaciones entre la obesidad (índice de masa corporal > 30,0) y factores propios del estilo de vida (actividad física, tabaquismo, consumo de alcohol, alimentación) por un lado y la clase social (escolaridad, empleo, tenencia de un automóvil), aculturación, edad y estado civil por el otro se examinaron mediante la prueba de rho de Spearman, la de ji al cuadrado y la de la U de Mann-Whitney y análisis de regresión logística.RESULTADOS: La edad promedio fue de 29 años. La obesidad (40%), inactividad física (47%) y el tabaquismo (32%) fueron comunes. Las participantes con menos grado de aculturación fueron 57% menos propensas a ser fumadoras y 54% menos propensas a ser obesas que las que estaban más aculturadas. Pertenecer a una clase social más baja (no haber terminado la secundaria o no tener automóvil) se asoció con una mayor probabilidad de ser obesa, pero las mujeres sin trabajo (por oposición a las que sí lo tenían) mostraron menor propensión a ser obesas (P < 0,05). Las mujeres que no tenían automóvil consumían carne, huevos y pescado con menos frecuencia que las que sí lo tenían. Las fumadoras tenían más probabilidad de tener una alimentación malsana que las que no fumaban.CONCLUSIONES: Las asociaciones entre el grado de aculturación y el estado socioeconómico con algunas características del estilo de vida apuntan a la necesidad de crear programas apropiados desde el punto de vista cultural para promover conductas sanas en esta comunidad de bajos ingresos.

An overview of reported youth violence in Puerto Rico

OBJECTIVES: The purpose of this paper is to describe the prevalence of school and youth violence in Puerto Rico based on several representative samples surveyed in the Island during the 1990's. BACKGROUND: Reviewing the available data on youth violence is necessary in order to decide the best strategies to follow in developing new ways to prevent and monitor it. METHODS: Three surveys were reviewed in this paper: The Youth Risk Behavior Survey conducted by the Center for Disease Control (1991, 1995, 1997); The Methods for the Epidemiology of Child and Adolescent Mental Disorders Study (1991); and the Youth Survey (1997-98). RESULTS: It was found that the prevalence of reported school violence in Puerto Rico tends to be somewhat lower than the prevalence reported in other sites of the U.S.A. Age and gender has a dramatic influence in the reports of youth violence in Puerto Rico. Male students are three times as likely to carry weapons than females and almost twice as likely to report hurting someone than females. Less than 10 per cent of the male students ages 12-13 report carrying a weapon while fully 30 per cent of those 18 year olds reported carrying a weapon. Being arrested also increases from only 3 per cent in the youngest students surveyed to 10 per cent on the oldest group (18 or older). CONCLUSION: The CDC has recently reported that since the early 90's there has been a decrease in reported school violence in the U.S.A. This analysis of youth surveys replicated a similar tendency for Puerto Rican youngsters. Implications for prevention programs are discussed.

Olfactory Lateralization in Humans / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aimed to investigate differences in olfactory thresholds and odor discrimination between the two sides of the nose in relation to the right hand and the right eye. MATERIALS AND METHOD: Eighty subjects (40 women, 40 men) participated in this study. All were in excellent health without any nasal or health problems. The olfactory function tests designed by Connecticut Chemosensory Clinical Reserch Center (CCCRC) were performed. RESULTS: We found a slight tendency for lower thresholds and better discrimination on the right nostril; this phenomenon was not influenced by the subjects' handedness. However, the left-handers performed better at the right side compared with the left nostril than right-handers and the differences between the two sides of the nose were larger in the left-handers. There were no relationships between the ocular and nasal dominance. CONCLUSION: The data indicate that olfactory functions exhibit a certain degree of lateralization to the right side.

Development and Performance Test of Preamplifier and Amplifier for Gamma Probe / 대한핵의학회잡지

PURPOSE: Preamplifier and amplifier are very important parts for developing a portable counting or imaging gamma probe. They can be used for analyzing pulses containing energy and position information for the emitted radiations. The commercial Nuclear Instrument Modules (NIMs) can be used for processing these pulses. However, it may be improper to use NIMs in developing a portable gamma probe, because of its size and high price. The purpose of this study was to develop both preamplifier and amplifier and measure their performance characteristics. MATERIALS and Methodes: The preamplifier and amplifier were designed as a charge sensitive device and a capacitor resistor-rsistor capacitor (CR-RC) electronic circuit, respectively, and they were mounted on a print circuit board (PCB). We acquired and analyzed energy spectra for Tc-99m and Cs-137 using both PCB and NIMs. Multichannel analyzer (Accuspec/A, Caberra Industries Inc., Meriden Connecticut, U.S.A) and scintillation detectors (EP-047 (Bicron Saint-Gobain/Norton Industrial EP-047 (Ceramics Co., Ohio, U.S.A) with 2"x2" NaI (T1) crystal and R1535 (Hamamatsu Photonics K.K., Electron Tube Center, Shizuoka-ken, Japan) with 1"x1"NaI (T1) crystal) were used for acquiring the energy spectra. RESULTS: Using PCB, energy resolutions or EP-047 detectors for Tc-99m and Cs-137 were 12.92% and 5.01%, respectively, whereas R1535 showed 13.75% and 5.19% of energy resolution. Using the NIM devices, energy resolutions of EP-047 detector for Tc-99m and Cs-137 were measured as 14.6% and 7.58%, respectively. However, reliable energy spectrum of R1535 detector could not be acquired, since its photomultiplier tube (PMT) requires a specific type of preamplifier. CONCLUSION: We developed a special preamplifier and amplifier suitable for a small sized gamma probe that showed good energy resolutions independent of PMT types. The RESULTS indicate that the PCB can be used in developing both counting and imaging gamma probe.

Nosocomial sepsis in neonates with single lumen vascular catheters.

Catheter-related sepsis is commonly encountered in the neonatal intensive care unit. We retrospectively studied infants with vascular catheters at 2 NICUs. Data were obtained from the computerised admission records available at both the hospitals. Our aims were to describe the clinical and microbial profile of nosocomial sepsis in infants with vascular catheters [umbilical artery (UA), umbilical venous (UV), central venous Broviac (CV), percutaneously placed central venous (PC), peripheral artery (PA)], and to determine the association between catheter type, duration and sepsis in a subset of the population. Nosocomial sepsis (positive blood culture after the 3rd postnatal day) occurred in 217 of 2091 (10.4%) infants. Infected infants, in contrast to non-infected, had a significantly (P < 0.001) greater number of multiple catheters (2.3 vs 1.4) had lower birth weights (1.2 vs 2.1 kg), were younger (28 vs 33 weeks) and had lower 1 and 5 minute Apgar scores (4.3 and 6.7 vs 5.5 and 7.4). The most common organism was coagulase negative Staphylococcus. In a subset population as analyses revealed, longer duration of UA use was associated with higher infection rates [13.6% with UA use for > or = 8 days vs 1.3% for < or = 7 days (P < 0.0001)]. PC use had a lower rate of sepsis than CV use (5.1% vs 15.2%; P < 0.05). Use of intravascular catheters should be balanced between the need for vascular access and the risk of sepsis.

Variation of Hospital Costs and Product Heterogeneity / 예방의학회지

The major objective of this research is to identify those hospital characteristics that best explain cost variation among hospitals and to formulate linear models that can predict hospital costs. Specific emphasis is placed on hospital output, that is, the identification of diagnosis related patient groups (DRGs) which are medically meaningful and demonstrate similar patterns of hospital resource consumption. A casemix index is developed based on the DRGs identified. Considering the common problems encountered in previous hospital cost research, the following study requirements are established for fulfilling the objectives of this research: 1. Selection of hospitals that exercise similar medical and fiscal practices. 2. Identification of an appropriate data collection mechanism in which demographic and medical characteristics of individual patients as well as accurate and comparable cost information can be derived. 3. Development of a patient classification system in which all the patients treated in hospitals are able to be split into mutually exclusive categories with consistent and stable patterns of resource consumption. 4. Development of a cost finding mechanism through which patient groups' costs can be made comparable across hospitals. A data set of Medicare patients prepared by the Social Security Administration was selected for the study analysis. The data set contained 27,229 record abstracts of Medicare patients discharged from all but one short-term general hospital in Connecticut during the period from January 1, 1971, to December 31, 1972. Each record abstract contained demographic and diagnostic information, as well as charges for specific medical services received. The "AUTOGRP System" was used to generate 198 DRGs in which the entire range of Medicare patients were split into mutually exclusive categories, each of which shows a consistent and stable pattern of resource consumption. The "Departmental Method" was used to generate cost information for the groups of Medicare patients that would be comparable across hospitals. To fulfill the study objectives, an extensive analysis was conducted in the following areas: 1. Analysis of DRGs: in which the level of resource use of each DRG was determined, the length of stay or death rate of each DRG in relation to resource use was characterized, and underlying pattern of the relationships among DRG costs were explained. 2. Exploration of resource use profiles of hospitals; in which the magnitude of differences in the resource uses or death rates incurred in the treatment of Medicare patients among this study hospitals was explored. 3. Casemix analysis; in which four types of casemix-related indices were generated, and the significance of these indices in the explanation of hospital costs was examined. 4. Formulation of linear models to predict hospital costs of Medicare patients; in which nine independent variables(i.e., casemix index, hospital size, complexity of service, teaching activity, location, casemix-adjusted death rate index, occupancy rate, and casemix-adjusted length of stay index) were used for determining factors in hospital costs. Results from the study analysis indicated that: 1. The system of 198 DRGs for Medicare patient classification was demonstrated not only as a strong tool for determining the pattern of hospital resource utilization of Medicare patients, but also for categorizing patients by their severity of illness. 2. The weighted mean total case cost(TOTC) of the study hospitals for Medicare patients during the study years was $1127.02 with a standard deviation of $117.20. The hospital with the highest average TOTC ($1538.15) was 2.08 times more expensive than the hospital with the lowest average TOTC ($745.45). The weighted mean per total cost (DTOC) of the study hospitals for Medicare patients during the study years was $107.98 with a standard deviation of $15.18. The hospital with the highest average DTOC ($147.23) was 1.87 times more expensive than the lowest average DTOC($78.49). 3. The linear models for each of the six types of hospital costs were formulated using the casemix index and the eight other hospital variables as the determinants. These models explained variable to the extent of 68.7 percent of total case cost (TOTC), 63.5 percent of room and board cost (RMC), 66.2 percent of total ancillary service cost (TANC), 66.3 percent of per diem total cost (DTOC), 56.9 percent of per diem room and board cost (DRMC), and 65.5 percent of per diem ancillary service cost (DTANC). The casemix index alone explained approximately one half of inter-hospital cost variation; 59.1 percent for TOTC and 44.3 percent for DTOC. These results demonstrate that the casemix index is the most important determinant of inter-hospital cost variation. Future research and policy implications in regard to the results of this study is envisioned in the following three areas: 1. Utilization of casemix-related indices in the Medicare data systems. 2. Refinement of data for hospital cost evaluation. 3. Development of a system for reimbursement and cost control in hospitals.