Dialysis specialist care and patient survival in hemodialysis facilities: a Korean nationwide cohort study

It is important for the dialysis specialist to provide essential and safe care to hemodialysis (HD) patients. However, little is known about the actual effect of dialysis specialist care on the survival of HD patients. We therefore investigated the influence of dialysis specialist care on patient mortality in a nationwide Korean dialysis cohort. Methods: We used an HD quality assessment and National Health Insurance Service claims data from October to December 2015. A total of 34,408 patients were divided into two groups according to the proportion of dialysis specialists in their HD unit, as follows: 0%, no dialysis specialist care group, and ≥50%, dialysis specialist care group. We analyzed the mortality risk of these groups using the Cox proportional hazards model after matching propensity scores. Results: After propensity score matching, 18,344 patients were enrolled. The ratio of patients from the groups with and without dialysis specialist care was 86.7% to 13.3%. The dialysis specialist care group showed a shorter dialysis vintage, higher levels of hemoglobin, higher single-pool Kt/V values, lower levels of phosphorus, and lower systolic and diastolic blood pressures than the no dialysis specialist care group. After adjusting demographic and clinical parameters, the absence of dialysis specialist care was a significant independent risk factor for all-cause mortality (hazard ratio, 1.10; 95% confidence interval, 1.03–1.18; p = 0.004). Conclusion: Dialysis specialist care is an important determinant of overall patient survival among HD patients. Appropriate care given by dialysis specialists may improve clinical outcomes of patients undergoing HD.

Evaluation of elementary school lunch menus (1) : based on food diversity

The sound dietary habit is formed in childhood, which is basic foundation for keeping health. The school foodservice is practiced to provide proper nutritions, to establish the sound dietary habit. Continuous evaluation and improvement are necessary to operate school foodservice effectively. This study was conducted to evaluate the quality of meals served in elementary school based on nutrient content, food diversity. A questionnaire was mailed to dietitian of each school requested for menus of one week. Menus served in 77 schools from each province and major cities in Korea were analyzed. The results of this study were summarized as follows; Compared to 1/3 of RDA for children, many schools provide lower amounts of energy, calcium and Vitamin A. Proportions of energy from carbohydrate, protein and fat were 59.64%, 17.43% and 20.11%, respectively and were not significantly different by the area, the foodservice system, and the number of persons served. NAR(nutrient adequacy ratio) were lowest for calcium(0.67) and Vitamin A(0.65). MAR(mean adequacy ratio) was 0.83. The results of comparison of NAR and MAR by the area, the foodservice system, and the number of persons served were similar to those of nutrient contents. Comparing foods served by the nutrient density were different by nutrient contents, NAR and MAR. Mean nutrient density per meal were higher in large cities than in small cities and rural area, in conventional than in commissary foodservice system. Mean number of dishes and food items per meal were 5.86 and 19.87, respectively. The mean of total quantity of each food group per meal was 352g. The mean of total quantity of each food group per meal were higher in small cities and rural area than in large cities, in commissary than in conventional foodservice system. This study is based only on served menus, and the evaluations of meals based on actual consumption of children are needed. These results suggest that in order to improve the quality of school food service, realistic standard should be suggested and basic study should be done continuously.

The Relationship of Nutritional Satus to the Degree of Hypertension in Residents of Kangbuk-gu, Seoul / 대한지역사회영양학회지

The purpose of this study was to relate the degree of hypertension to nutritional status, in order to prepare basic data for a nutrition program. The study using the WHO standard divided the residents in Kangbuk-gu into a normal group (NG) of 254 adults with systolic blood pressure (SBP) 140 or DBP > 90. The mean age of HG was older than the other groups (p 0.05) for all three groups. The Dietary Variety Score (DVS) of the NG was 22.7, and higher than those of the other groups (p > 0.05). The fasting blood sugar (p < 0.001), total cholesterol (p < 0.001), protein (p < 0.001), albumin (p < 0.01), hemoglobin (Hb) (p < 0.001), alkaline phosphatase (ALP) (p < 0.001), and creatinine (p < 0.05) values of the HG were higher than those of the other groups. The Body Mass Index (BMI) and the waist-hip ratio (WHR) of the HG were higher than those of the other groups (p < 0.001). In conclusion, these results showed that there tended to be differences among the three groups. For effective nutritional education and counseling of each group, we should further study the differences and understand their characteristics of each group in order to provide nutritional education for controling and preventing hypertension.