Comparison of scaling rate data of Community Health Survey and National Health Insurance Service / 대한구강보건학회지

OBJECTIVES: The purpose of this study was to compare scaling rates in 16 cities and provinces using data from the Community Health Survey (CHS) and National Health Insurance Service (NHIS). METHODS: This study involved cross-sectional secondary data analysis. A total of 16,646,190 subjects who participated in the CHS and 218,184 subjects in the NHIS were included in the final analysis. The dependent variable was the scaling rate, and the independent variables were sex, age, and 16 regions. The study included individuals aged 19 years or older who received scaling between August 2014 and August 2015 in the past year in the CHS and codes U2232 (scaling) and U2233 (scaling before periodontal treatment) in the NHIS. The total scaling rates were compared between the CHS and NHIS. The differences in scaling rates according to sex, age, and 16 regions were analyzed. RESULTS: The CHS (42.6%) scaling rates were 17.5% higher than the NHIS (25.1%) scaling rates in 16 regions in 2015. The median in the CHS data was in Busan (41.5%), while that in the NHIS data was in Jeonbuk (23.5%). There was no significant difference between scaling rates above and below the median region in the CHS and NHIS. CONCLUSIONS: The results suggested that CHS data, which show a higher rate, should be used to assess and monitor the dental needs of community residents. NHIS data should be used to evaluate community oral health projects. It is necessary to develop health indicators for the community oral health project of input, process, and outcome evaluation.

From Visiting a Physician to Expecting Antibiotics: Korean Perspectives and Practices toward Respiratory Tract Infections

Antibiotic resistance is steadily rising worldwide. Respiratory tract infections (RTIs) are common indications, mostly imprudent, for antibiotic prescriptions in outpatient setting. In Korea, antibiotic prescription rate for RTIs is still high. As physician visit and antibiotic prescribing are influenced by patient's perceptions and beliefs, we aimed to explore the general public's perspectives and practices toward RTIs and to develop the ‘RTI clinical iceberg.’ A cross-sectional survey was conducted in Wonju Severance Christian Hospital (WSCH) among 550 adults attending outpatient departments during January 2016. Differences in distributions between groups were examined using two-tailed Pearson χ² test. Using the Andersen's behavioral model as a conceptual framework, we constructed logistic regression models to assess factors associated with physician visit. Of 547 participants with complete questionnaires, 62.9% reported having experienced an RTI in the previous six months; 59.3% visited a physician for the illness, most commonly because the symptoms were severe or prolonged, and approximately 16% of them expected an antibiotic prescription from the visit. Perceptions of symptoms severity, the need factor, most strongly influenced physician visit. Predisposing and enabling factors such as inappropriate expectations for antibiotic for a sore throat or having national health insurance also influenced physician visit. Almost all participants who reported asking for an antibiotic were prescribed one, with a 37.1% non-adherence rate. Conclusively, public education on self-care for RTI symptoms that addresses their main concerns may reduce physician visits. Improving physician-patient relationship and informing patients about the lack of antibiotic benefit for most RTIs may also reduce antibiotic prescriptions.

Induced Abortion Trends and Prevention Strategy Using Social Big-Data / 보건행정학회지

BACKGROUND: The purpose of this study is to investigate the trends on the induced abortion in Korea using social big-data and confirm whether there was time series trends and seasonal characteristics in induced abortion. METHODS: From October 1, 2007 to October 24, 2016, we used Naver's data lab query, and the search word was ‘induced abortion’ in Korean. The average trend of each year was analyzed and the seasonality was analyzed using the cosinor model. RESULTS: There was no significant changes in search volume of abortion during that period. Monthly search volume was the highest in May followed by the order of June and April. On the other hand, the lowest month was December followed by the order of January, and September. The cosinor analysis showed statistically significant seasonal variations (amplitude, 4.46; confidence interval, 1.46–7.47; p<0.0036). The search volume for induced abortion gradually increased to the lowest point at the end of November and was the highest at the end of May and declined again from June. CONCLUSION: There has been no significant changes in induced abortion for the past nine years, and seasonal changes in induced abortion have been identified. Therefore, considering the seasonality of the intervention program for the prevention of induced abortion, it will be effective to concentrate on the induced abortion from March to May.

Induced Abortion Trends and Prevention Strategy Using Social Big-Data / 보건행정학회지

BACKGROUND: The purpose of this study is to investigate the trends on the induced abortion in Korea using social big-data and confirm whether there was time series trends and seasonal characteristics in induced abortion. METHODS: From October 1, 2007 to October 24, 2016, we used Naver's data lab query, and the search word was ‘induced abortion’ in Korean. The average trend of each year was analyzed and the seasonality was analyzed using the cosinor model. RESULTS: There was no significant changes in search volume of abortion during that period. Monthly search volume was the highest in May followed by the order of June and April. On the other hand, the lowest month was December followed by the order of January, and September. The cosinor analysis showed statistically significant seasonal variations (amplitude, 4.46; confidence interval, 1.46–7.47; p<0.0036). The search volume for induced abortion gradually increased to the lowest point at the end of November and was the highest at the end of May and declined again from June. CONCLUSION: There has been no significant changes in induced abortion for the past nine years, and seasonal changes in induced abortion have been identified. Therefore, considering the seasonality of the intervention program for the prevention of induced abortion, it will be effective to concentrate on the induced abortion from March to May.

Evaluation of a Community-based participatory professional periodontal care program for hypertension and diabetes patients / 대한구강보건학회지

OBJECTIVES: To evaluate the Community-Based Participatory Research (CBPR) professional periodontal care program model for patients with hypertension and diabetes. METHODS: This descriptive case study included 151 participants of the professional periodontal care program. The CBPR-based professional periodontal care program consists of 5-steps: ‘Issue identification and prioritization’ (Step 1), ‘Strategy development’ (Step 2), ‘Entry into community’ (Step 3), ‘Implementation’ (Step 4), and ‘Transition’ (Step 5). Quantitative data were analyzed using frequency analysis, and descriptive data with PASW 23.0 (SPSS Inc., Chicago, IL, USA). The results of the Focus group interview (FGI) were classified as ‘general opinions regarding the program planning and operation receptiveness’, ‘sustainability’, ‘potential spread of the program’, and ‘improvement of program’. The interviews were qualitative research involving seven people. RESULTS: 1. Participants increased their interest in health and oral health by managing their hypertension, diabetes, and periodontal disease using community resources. Through this, healthy practices and improved awareness helped to prevent complications and manage periodontal diseases. 2. Community organizations actively cooperated, resulting in positive changes in oral health practices (increased registration of patients in education centers for hypertension and diabetes, and increased number of patients visiting the local dental clinic). In the future, it was positive to participate in the program continuously. CONCLUSIONS: The most important step is ‘Entry into community’, which has led to active participation and cooperation of community organizations and participants. Therefore, community organizations and strategy development should be discussed, and the role of community leaders should be emphasized to build cooperative relationships. In addition, participation in and collaboration with health-based projects should be achieved through a search of various community organizations.

A 7-year study of the regional distribution of differences in scaling experience rate among Koreans / 대한구강보건학회지

OBJECTIVES: The aim of this 7-year study was to examine regional differences in scaling experience rate. METHODS: This study used data on scaling experience rate from the Community Health Survey (CHS) obtained between 2008 and 2014. The standardized frequency of scaling experience rate was analyzed using the SPSS 20.0 program, and shown as a Box Plot. Using the Map Wizard for Excel 10.0, the scaling experience rate in each region was illustrated using Geographic Information System (GIS). RESULTS: The scaling experience rate in 2008 was 18.6% and in 2014, was 34.9%. From 2008 to 2014, the annual rate of scaling experience increased approximately 1.8 times. The scaling experience appeared to form clustering on GIS, and there were differences in scaling experience rate between cities, towns, and districts. Although the scaling experience rate increased, the gap between regions seems consistent. CONCLUSIONS: The Scaling Experience rate increased annually, but regional differences did not decrease. Therefore, oral health care professionals in each community should strive to improve the scaling experience rate.

The Utilization of Oral Health Services in Community Health Centers in Korea: A Study Using Data from the 2011-2012 Community Health Survey / 대한구강보건학회지

OBJECTIVES: To determine the utilization of oral health services in community health centers in Korea. METHODS: This cross-sectional study involved secondary analysis of data obtained from the 2011-2012 Community Health Survey. The data were analyzed to determine the utilization of community oral health services. A total of 458,417 people (weighted sample was 80,268,227) were included. A multistage probability proportional systematic sampling method was used. The dependent variable was the utilization of community oral health services. The independent variables were region (city, town, and district), demographic characteristics (gender, age, education, income, occupation, and basic livelihood security), oral health status, and overall health status. The differences in the utilization of community oral health services related to independent variables were analyzed using an independent t-test and ANOVA. Additionally, a Scheffe post-hoc test was performed. Statistical analysis was performed using PASW statistics 20.0 (SPSS Inc., Chicago, IL, USA), at the 5% significance level. RESULTS: The average utilization rate was 26.3% for community health care services and 4.3% for oral health services during the study period in Korea. Utilization was associated with old age and lower education and income levels (P<0.01). Furthermore, residents having poor oral health, chewing discomfort, and unmet dental needs most frequently used the community oral health services. CONCLUSIONS: The utilization of community oral health services was low in Korea. The needs and circumstances of communities should be considered and unique regional structural characteristics should be identified to plan and execute oral health programs and incorporate them with community health care services for overall community health.

Comparison of Health-related Behaviors in Pregnant Women and Breast-feeding Mothers vs Non-pregnant Women

PURPOSE: The aim of this study was to assess health-related behavior of pregnant women and breastfeeding mothers by investigating relevant risk factors. METHODS: Data of 10,396 women (age 19 to 49 years) from the Korea National Health and Nutrition Examination Survey report from 2007 to 2012 was used to analyze factors associated with health-related behavior. The subjects were divided into pregnant women; breastfeeding mothers; and non-pregnant women. Bottle feeding mothers were excluded. RESULTS: Current smoking rate including self-reported smoker and/or positive cotinine urine test were lower for pregnant or breast-feeding group than non-pregnant group. Heavy-drinking was not different among groups while monthly drinking rate was higher in non-pregnant group. Rate of stress recognition was lower in pregnant and breast-feeding group than non-pregnant group. Rate of experience for depressive symptoms and rate of suicidal ideation were not different among groups. CONCLUSION: Pregnant women and breast-feeding mothers maintain a good pattern of health-related behavior compared to non-pregnant women. However, substantial proportion of pregnant women and breast-feeding mothers continue to drink and smoke. This shows the need for a plan that will modify health-related behavior.

The Immunogenicity of a Single Dose of Hepatitis A Virus Vaccines (Havrix(R) and Epaxal(R)) in Korean Young Adults

PURPOSE: Assessing the immunogenicity of a single dose of hepatitis A virus (HAV) vaccines is important because some people receive only a single dose. However, previous studies have shown variable results and have not examined the effects of demographic characteristics other than gender. This study was performed to examine the immunogenicity of a single dose of HAV vaccine according to the vaccine type and demographic characteristics in young adults. MATERIALS AND METHODS: Seronegative medical school students were randomly allocated to receive either Havrix or Epaxal. RESULTS: After approximately 11 months, the seroconversion rate in 451 participants was 80.7%. In men, the Havrix group showed a significantly higher seroconversion rate (81.9%) than the Epaxal group (69.2%), whereas both vaccine groups showed similarly high immunogenicity in women (Havrix: 90.1%, Epaxal: 92.9%; P for interaction=0.062). According to the results of a multivariate analysis, Epaxal showed significantly lower immunogenicity than Havrix only in men. Age, obesity, drinking, smoking, and follow-up time did not significantly affect seroconversion in either gender. CONCLUSION: The seroconversion rate of single-dose HAV vaccines was low in men, particularly in those who received Epaxal. Our results suggest that gender effects should be considered when comparing the immunogenicity of different HAV vaccines.

Utilization Behaviour and Influencing Factors of Complementary and Alternative Medicine Therapies Among the Elderly / 農村醫學 地域保健

OBJECTIVES: The aim of this study is to analyze the utilization behaviour and influencing factors of complementary and alternative medicine (CAM) therapies among elderly people with chronic diseases. METHODS: The study population was selected among 9 welfare facilities for the aged in 2 cities among Daegu Metropolitan City & Gyeongsangnam Province by two-stage cluster sampling. 250 senior citizens participated in a face-to-face interview using a structured questionnaire. Logistic regression analysis was performed to examine the association between the utilization of CAM therapies and various characteristics of the elderly. All statistics were analyzed using the PASW (ver 18.0). RESULTS: Among 233 elderly peoples, 70.4% (164 persons) had used various kinds of CAM therapies (including nutritional methods, pharmacologic and biologic treatments, etc.) more than once during the last year. 48.8% (64 persons) ~ 60.7% (88 persons) of the elderly used CAM therapies without health and medical experts' counsel. The elderly with perceptions of CAM therapy used it 2 times more than those without knowledge of CAM therapies. The number of chronic diseases was more likely to increase the usage of nutritional methods (OR=2.92, 95% CI: 1.07-7.97), manipulative and body-based practices (OR=5.85, 95% CI: 1.97-17.34), pharmacologic and biologic treatments (OR=2.92, 95% CI: 1.49-8.17). Elderly with diabetes used nutritional methods 3.76 (95% CI: 1.49-9.47) more than elderly without diabetes. CONCLUSIONS: CAM therapies use in the aged with chronic diseases appears common. The findings suggest that the clinical efficacy and safety of CAM therapies on medical management of chronic disease may be investigated and that patient-physician communication need to be strengthened.

Current status and new policy direction of healthcare personnel in Korea

The health insurance financial crisis and the aging population have overshadowed the South Korean healthcare market. Reforming healthcare has become a major policy issue in the upcoming presidential election on December 19, 2012. It is hard to imagine a time when expectations have been higher and the challenges have been greater for the next administration to create a sustainable healthcare system. Among healthcare policy problems, the new administration must keep in mind reforms for healthcare personnel. Accordingly, several intermediate and long-term actions and initiations for healthcare personnel can help lay the groundwork for sustainable development of Korea's healthcare system. Possible examples include balancing the supply plan of physicians and nurses according to the finances of the National Health Insurance, controlling the number of dentists, oriental medical doctors, and pharmacists, while enhancing health education specialists, and complementary and alternative medical therapists.

Analysis on the difference between needs and recipients for scaling and its trend in Korea (2000-2009) / 대한구강보건학회지

OBJECTIVES: This study aimed to identify the trend regarding the difference between needs and recipients for scaling in the period from 2000 to 2009, and to analyze the differences by gender and age. METHODS: This study was a follow-up study that analyzed the secondary data. The analysis was done in those > or =19 years old who were included in the data obtained from KNOHS (2000, 2003), KNHANES, and CHS (2008, 2009). The dependent variables were needs and recipients for scaling, and the rate of the difference. Independent variables were the year, gender, and age. By performing the gender-age specific directly standardized the rates, independent t-test and one-way ANOVA. For statistical analysis, the study used MS Office Excel 2010 and PASW statistics 18.0. RESULTS: The rate regarding the needs for scaling has been steadily decreased, but the rate of recipients for scaling was increased, since 2000. The difference rate was reduced from 85.6% in 2000 down to 62.3% in 2009. Men showed a higher rate of needs for scaling compared to women (P or =55 years old) groups with preference, when setting the priority to mitigate the unmet needs for scaling.

Obesity management and scientific evidence

Obesity is now recognized as a critical target for public health intervention in many parts of the world, affecting virtually all age and socio-economic groups within both developed and developing countries. This study's objective is to provide an overview of the full range of methods and models available for weight loss, including some methods used by overweight and obese people without medical supervision. Many diverse approaches for achieving weight loss and weight maintenance have been evaluated. According to some evidence-based guidelines, in order to achieve the best treatment outcomes, it is recommended that a combination of dietary therapy with low-calorie diet, increased physical activity, and behavioral therapy be incorporated. Advances in treatment and innovative policy initiatives focusing on prevention could reverse the global problem of obesity and overweight. The most effective forms of treatment require collaboration among health care providers in primary care settings, including nurses, dietitians, psychologists, physicians, and psychiatrists. Effective strategies for weight loss require management strategies that combine dietary therapy and physical activity by using behavioral interventions. Thus, in the near future, the Korean government must develop evidence-based (clinical or community) guidelines for obesity management. Also, due to the lack of high quality primary studies on obesity management in Korea, future randomized clinical or community trials are recommended in this area.

Factors Influencing Utilization of Medical Care Among Osteoarthritis Patients in Korea: Using 2005 Korean National Health and Nutrition Survey Data / 예방의학회지

OBJECTIVES: The purpose of this study was to define the association between the medical utilization of osteoarthritis patient and its related factors. METHODS: We used the 2005 Korean National Health and Nutrition Survey data and we enrolled 2833 participants who were forty or older and who were diagnosed as having osteoarthritis by a doctor within 1 year and who had suffered from osteoarthritis for more than 3 months. The Andersen behavioral model was used as the analytic framework, and the variables were categorized into predisposing, enabling, and need factors. To determine the influence of each variable on the medical utilization of osteoarthritis patient, we applied hierarchical logistic regression analysis with two stages: the first stage included the predisposing and enabling factors and the second stage included the need factors. RESULTS: On the hierarchical logistic analysis, the variables of personal income, the type of medical security, the duration of arthritis related symptoms within 1 month, the subjective health status and the duration of osteoarthritis showed a statistically significant difference between whether the medical utilization in men patients. And the variables of age, limitation activity due to osteoarthritis, arthritis related symptoms within 1 month, and the subjective health status had a statistically significant difference between whether the medical utilization in women patients. CONCLUSIONS: The patients who tend to receive less care are those suffer less from symptoms of osteoarthritis, those who are within the initial phase, or those with a low-level severity of osteoarthritis. It is necessary to encourage patients to receive the treatment in the initial phase.

The Medical Doctors' Opinion of Public Health Center on the Development and Supply of Medical Doctor for Public Health Sector / 農村醫學 地域保健

OBJECTIVES: This study, as for activating measures for capable medical physicians to penetrate into the public health sector, is to provide a basic informations which are used for the enlargement of human resources of physicians in the public health sector, by investigating the perception of physicians, who are now working in the public health center, on the training and development of physicians in the public health sector. METHODS: The subjects of this study were 126 individuals. The data was analyzed by frequency analysis using SPSS ver. 17.0K. RESULTS: According to the investigation of 'how to support physicians in public health sector', the necessity of almost questions is considered to be important. Especially, regarding to investigation on 'obstacles of physicians' entrance to public health sector', 'relatively low salary' and 'lack of promotion chances' were thought to be considerable. The most significant education programs to work for public health sector is to improve the ability of health administration planning and service performance. CONCLUSIONS: The important methods to reinforce and easily obtain the human resources of physicians in public health sector are not only to improve the penetration of physicians to public health sector, but also to enhance the ability of present physicians, even though sufficient recruitment of physicians is essential.

Need of Health Center-based Integrated Healthcare Services for the Elderly in Rural Area / 農村醫學 地域保健

OBJECTIVES: The challenge of an increasing elderly population has coupled with everpresent social concerns in Korea. A major problem in health center for the frail older people is that medical, healthcare, and welfare services are often fragmented in terms of providers and settings without appropriate coordination. The purpose of this study was to investigate the need of health center-based integrated healthcare services and its related factors for the elderly. METHODS: A total of 110 elderly people who had visited at a county Health Center were interviewed using a self-administered questionnaire from November to December, 2005. The questionnaire consists of five domains according to the Program of All-inclusive Care for the Elderly. RESULTS: Respondents had high need (total mean score with the 5-point Likert-type sacle: 3.67) of health center-based integrated healthcare services including home visiting service (mean: 4.08), chronic disease care service (mean: 4.06), and transportation service (mean 4.05). According to the results of hierarchical multiple regression analysis, among three regression models the magnititude of the variance of full model that is explained by the need of welfare-domain service was significantly larger than two reduced model. Income was a significant variable in increasing the need of health care and welfare services. CONCLUSIONS: This study suggests that the health center-based integrated healthcare services for the elderly must be continuously developed and provided for the health promotion and improved the quality of life of the elderly who live in rural area in Korea.

Experience of Development of Cataract Clinical Practice Guideline in Korea; Focus on Meta-analysis and Questionnaire Survey

Background: By reviewing experiences and lessons from results of main studies such as systematic review of articles and meta- analysis, and the current situation and trend in the field of cataract and refractive surgery, we proposed practical cases about objective and scientifically evident approaches in process of developing cataract clinical practice guideline in Korea. Methods: Development of cataract clinical practice guideline composed of constructing development team, reviewing guideline- associated articles, conducting meta-analysis and survey about practice behaviors, and having workshop and council. Meta-analysis composed of search and collection of article published within current five years, selection of review principles, development of article assessment form, and investigation of practical variation by qualitative and quantitative meta-analysis. Based on Medline, Meta-analysis was conducted about three topics of IOP (Intra-ocular pressure) changes after inserting each healon, and comparison results after cataract surgery by incision point and occurrence patterns of acquired cataract by types of intraocular lens. Questionnaire survey was conducted about practice behaviors focused on main procedures and surgeries related to cataract. For developing and using clinical practice guideline, we developed a draft which was reviewed by each sub-ophthalmology society, opened symposiums and workshop, and developed final draft. Results: There was no significant difference between IOP (Intra-ocular pressure) changes after inserting each healon. After reviewing article about results after cataract surgery by incision point, we found that we couldn't conduct quantitative meta-analysis because surgeries method, incision lengths, measuring methods, and points at measuring showed different pattern. Occurrences of cataract in 24 months after cataract surgery between 'PMMA', 'Silicone', and 'Acrylic' group showed significant difference. Result of questionnaire survey showed that there was many variations on cataract clinical practice behaviors. Conclusions: Although we were lacking in articles, we could propose partial objective evidences for development of cataract clinical practice guideline. And we found that systematic researches and surveys should be conducted for more objective evidences.

Prostate-Specific Antigen, Digital Rectal Examination and Transrectal Ultrasonography: A Meta-Analysis for This Diagnostic Triad of Prostate Cancer in Symptomatic Korean Men

We conducted a meta-analysis using results from the Korean literature to determine whether prostate-specific antigen (PSA) or digital rectal examination (DRE) or transrectal ultrasonography (TRUS) provides a better diagnostic outcome for possible prostate cancer patients. An extensive literature search of MedRIC database et al. (1980 to 2003) was performed using the medical subject headings "PSA", "DRE", "TRUS" and "prostate cancer". Of the 108 articles that we retrieved, 13 studies (2, 029 subjects) were selected for this meta-analysis. The criteria for quality evaluation were as follows: the study subjects must have been compared clinically for suspected prostate cancer, and the articles must have included individual data about sensitivity and specificity for this diagnostic triad based on the biopsy results as a reference standard. For the quantitative meta-analysis process the Hasselblad method was utilized. The pooled sensitivity and specificity for a PSA level greater than 4ng/mL were 91.3% and 35.9%, respectively; and those for a PSA level greater than 10ng/mL were 77.3% and 67.5%, respectively; and those for DRE were 68.4% and 71.5%, respectively; and those for TRUS were 73.6% and 61.3%, respectively. According to the results in a fixed effect model for PSA criteria, the estimates of d for PSA4 and PSA10 were 0.8517 [95% confidence interval (CI) : 0.6694, 1.0340] and 1.0996 (95% CI: 0.9459, 1.2534), respectively. Also, according to the results using a random effect model for both DRE and TRUS criteria, the estimates of d for DRE and TRUS were 0.8398 (95% CI: 0.7169, 0.9627) and 0.8002 (95% CI: 0.6714, 0.9289), respectively. The detection rate for combination testing of PSA, DRE and TRUS for the diagnosis of prostate cancer jumped further to 68.3% or to 76.8%. In conclusion, this study suggests that this diagnostic triad for prostate cancer was noneffective when they were used separately. Therefore, we recommend that the urologists should use PSA together with DRE and TRUS for the primary diagnosis of prostate cancer in men with lower urological symptoms.

Ultrasonography in the Diagnosis of Appendicitis: Evaluation by Meta-analysis

OBJECTIVE: We wanted to review the usefulness of ultrasonography (US) for the diagnosis of appendicitis and to evaluate the diagnostic accuracy of US according to patients' and researchers' characteristics. MATERIALS AND METHODS: The relevant Korean articles published between 1985 and 2003 were included in this study if the patients had clinical symptoms of acute appendicitis. The histopathologic findings were the reference standard and the data were presented for 2x2 tables. Articles were excluded if patients had no sonographic signs of appendicitis according to graded-compression US. Two reviewers independently extracted the data on study characteristics. The Hasselblad method was used to obtain the combined estimates of sensitivity and specificity for the performance of US. RESULTS: Twenty-two articles (2, 643 patients) fulfilled all inclusion criteria. The estimate of d calculated by combining the sensitivity and specificity was 2.0054 (95% confidence interval [CI]: 1.8553, 2.1554) by a random effects model. The overall sensitivity and specificity (95% CI) were 86.7% (85.4 to 88.0), and 90.0% (88.9 to 91.2), respectively. According to the subgroup meta-analysis by patients' characteristics, the d estimate (95% CI) of dominantly younger age, male, and highly clinical suggestive group for US was 2.2388 (1.8758 to 2.6019), 2.7131 (2.2493 to 3.1770), and 2.4582 (1.7387 to 3.1777), respectively. Also, according to subgroup meta-analysis by researchers' characteristics, the d value (95% CI) for US done by diagnostic radiologists and gray-scale was 2.0195 (1.7942 to 2.2447) and 2.2630 (1.8444 to 2.6815). CONCLUSION: This evidence suggests that US may be useful for the diagnosis of acute appendicitis, especially when patients are younger age, male, and highly clinical suggestive.

Is Laparoscopic Appendectomy Useful for the Treatment of Acute Appendicitis in Korea?: A Meta-Analysis

We performed a meta-analysis using results in the Korean literatures to determine whether laparoscopic appendectomy (LA) or open appendectomy (OA) provide the better outcome in possible acute appendicitis patients. To perform the meta-analysis, an extensive literature search was conducted, giving priority to the Journal of the Korean Surgical Society, and domestic literature in its search database, published since January 1993, to ascertain the usefulness of LA in the treatment of acute appendicitis. The criteria used for the quality evaluation were as follows: 1) study subjects must have been evaluated clinically for suspected acute appendicitis, and 2) articles were included only if sufficient data (e.g. patient number, mean and standard deviation of patient outcome variables) were available regarding patient outcomes for LA or OA treated appendicitis. Of the 136 articles retrieved, 8 studies (1, 258 patients) were selected for quantitative meta-analysis. Because insufficient data was available in some studies, operating time and hospitalization days were assessed for all 8 studies, but the time required to return to full functioning was assessed for only 3 studies. Overall effect size estimates were calculated using a random effect model for four patient outcomes (operating time, Q=38.6699, p < 0.001; length of stay, Q=19.3876, p < 0.001; postoperative hospital stay, Q=20.9164, p < 0.001; and return time to full functioning, Q=41.5061, p < 0.001). Because the overall effect size for operating time was -0.3218 (95% confidence interval [CI] -0.6108 to -0.0328), LA operating time was significantly greater than that of OA. In addition, a significant difference was found between the two modalities in terms of the length of hospital stay. Overall effect size in terms of the time required to return to full functioning was 1.9757 (95% CI 1.0066 to 2.9448), and LA reduced the time required by about 2 days versus OA. Considering the overall odds ratio (0.33) and 95% CI (0.20 to 0.55) the incidence of wound infection was significantly lower in LA than in OA. This review of the published evidence suggests that LA is more useful for treating acute appendicitis, especially when perforated appendicitis is suspected.