Age-related Injury Profile in Childhood

PURPOSE: Injuries are the most important cause of morbidity and mortality in the childhood population worldwide. Thus, this study was down to investigate the type and the severity of injuries according to the age group in childhood. METHODS: A survey of injury information and a chart review were done on 378 children (257 boys, 121 girls) who visited the Emergency Departments of Asan Medical Center from March 1, 2009, to March 31, 2009. To determine differences in injury mechanism, accident place, injury site, New Injury Severity Score (NISS) and Pediatric Trauma Score (PTS), we divided the 378 patients into 4 group: under 1 year, 1 to 4 years, 5 to 9 years, and 10 to 15 years. RESULTS: The mean (+/-SD) age of the study group was 5.1 (+/-4.4) years. Two year olds formed the largest group of injured children, with 77 cases (20.4% of the total). The most common cause of injury in childhood was being hit by an object (26.2%). Falls were frequent in the under-1-year group (22.2%) and slip downs (30.1%) were more frequent in 1-to-4-year group. More than half (53.4%) of the injuries occurred in the home, and the most common places of home-related injuries were the living room (41.1%) and the bedroom (31.2%). The mean (+/-SD) NISS was 1.5 (+/-1.8), and traffic accidents had the highest NISS (2.8+/-5.1). Injuries occurred most frequently during the evening. The peak period was 4:00 PM to 8:00 PM (33.7%). CONCLUSION: Patterns of childhood injury by age group were considerably different, and less severe and nonhospitalized injuries were common. Thus, need to improve surveillance of a variety of injuries, promote intersectional collaboration, build institutional capacities and mobilize community support and policy as an investment in prevention.

The association between insulin resistance and Framingham risk score among type 2 diabetes / 한국역학회지

BACKGROUND AND PURPOSE: Insulin resistance has been known to be associated with the risk of cardiovascular diseases. However, the relationship with Framingham risk score among type 2 diabetes has not been well known. We investigated the relationship between insulin resistance (IR) and the Framingham risk score(FRS) among type 2 diabetes in Korea. METHODS: We estimated the 5-year risk of ischemic heart disease(IHD) based on Framingham equation among 1,941 diabetes patients(1,294 men and 647 women), who visited Huh's clinic, enrolled from January 2003 to June 2006. IR, which was measured by insulin tolerance test (ITT), was divided into five groups(Q1 to Q5). High risk of IHD was defined as upper 10 percentile of FRS. Multivariate regression and logistic regression models were used to see independent association of higher quintiles of IR level, compared with lowest quintile(Q1) for the risk of IHD. RESULTS: Mean (+/-standard deviation) 5-year FRS of study subjects were 8.40%(+/-6.89) for men and 5.92%(+/-5.23) for women. There were significant correlation between IR, body mass index, HbA1C, fasting glucose, triglyceride, LDL-cholesterol, C-peptide and FRS in both men and women. After adjusting for triglyceride, LDL-cholesterol, C-peptide, multivariate regression model analysis showed that IR was independently associated with the FRS. A positive association between IR and high risk of IHD was observed in men: highest versus lowest quintile of IR (odds ratio 5.45 in men and 4.71 in women). CONCLUSION: Increased IR level was independently associated with risk of IHD measured by FRS among type 2 diabetes in Korea.

Framingham Equation Model Overestimates Risk of Ischemic Heart Disease in Korean Men and Women / 한국역학회지

BACKGROUND: The prediction of the absolute risk of ischemic heart disease (IHD) is commonly based on the risk prediction equations, originated from the Framingham Heart Study. METHOD: Framingham equation model was applied to participants from 2001 Korean National Health and Nutrition Examination Survey (KNHNES) to estimate the 5 year risk of IHD among Koreans ranging from 30 to 74 year-olds. The estimated risks were compared to the incidence and admission rates from two statistical reports among Koreans. Five year admission rate was estimated by the annual report from National Health Insurance Corporation (NHIC). RESULTS: The average ages (standard deviation) were 34.31(27.23) year-old for KNHNES and 48.26(12.87) year-old for Framingham population used in this study. The risk of IHD predicted by the Framingham equation model substantially exceeded the risks actually reported in Korea. Five-year predicted risks by Framingham equation model were 4.86% for men and 1.93% for women; whereas from incidence data in Korea, five-year risks for acute myocardial infarction (AMI) were for 0.47% for men and 0.18% for women. These AMI incidence was similar to the admission rate (0.34 for men and 0.15 for women) estimated by NHIC. Also, 5-year admission rate of IHD were 1.16 for men and 0.78 for women. The magnitude of risk overestimation by Framingham mode is approximately at least 150 to 320%. CONCLUSION: Korean guidelines for the management for high risk group of IHD need to develop and correct for overestimation to avoid inflation of costs in primary prevention.