Cost-Effectiveness Analysis of Immunotherapy in Patient with Allergic Rhinitis / 대한이비인후과학회지

Background and Objectives@#All treatments must be effective and affordable. Although it is clear that immunotherapy is effective in patients with allergic rhinitis, no cost-effectiveness analysis has been conducted in Korea.Subjects and Method We compared 10 years of total treatment costs (medical expense+ transportation cost+time cost) with medications and symptoms scores assuming that adult patients with allergic rhinitis are treated only with symptomatic medication (medication model) or immunotherapy (subcutaneous or sublingual) plus symptomatic medication [subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) models, respectively]. For cost-effectiveness analysis, related papers and domestic medical statistics were used. @*Results@#The total treatment costs for the first 3 years were ₩3330199, ₩6605557, and ₩7130467 for the Medication model, SCIT model and SLIT model, respectively. The total treatment costs for the 10-year period were ₩7996087, ₩8588624, and ₩9113534 for the medication model, SCIT model, and SCIT model, respectively. The cumulative symptoms plus medications scores decreased 0.44 times in both immunotherapy models compared to the medication model. @*Conclusion@#The initial cost of immunotherapy is more expensive than symptomatic medication, but the total cost for 10 years is similar. In addition, immunotherapy can reduce symptoms by more than half. Therefore, it is a cost-effective treatment for allergic rhinitis.

Applicability of the 48/6 Model of Care as a Health Screening Tool, and its Association with Mobility in Community-Dwelling Older Adults

BACKGROUND@#The 48/6 Model of Care is an integrative care initiative for improving the health outcomes of hospitalized older patients; however, its applicability in community-dwelling older adults as a health screening tool has not been investigated. The present study aimed to examine the applicability of this model, prevalence of dysfunction in 6 care areas, and its relationship with self-reported mobility in community-dwelling older adults.@*METHODS@#This was a cross-sectional survey study of community-dwelling adults aged 65 or older. Participants were screened for problems using 9 items corresponding to the 6 care areas of the 48/6 Model of Care (cognitive functioning, functional mobility, pain management, nutrition and hydration, bladder and bowel management, and medication management). Mobility was assessed via the Life-Space Assessment (LSA). We examined the correlation between each screening item and the LSA.@*RESULTS@#A total of 444 older adults (260 women, 58.6%) participated. The mean number of health problems was 2.3 ± 2.1, with the most common being pain, cognitive impairment, and urinary incontinence. These problems and LSA scores were significantly different by age groups. A multiple regression analysis showed that polypharmacy (β = −10.567, P < 0.001), dysphagia (β = −9.610, P = 0.021), and pain (β = −7.369, P = 0.004) were significantly associated with life-space mobility after controlling for age.@*CONCLUSION@#The 48/6 Model of Care is applicable to community-dwelling older adults, who show high prevalence of dysfunction in the 6 care areas. This study supports the role of the model in screening for the health status of older adults living in the community, and in estimating mobility.

Applicability of the 48/6 Model of Care as a Health Screening Tool, and its Association with Mobility in Community-Dwelling Older Adults

BACKGROUND@#The 48/6 Model of Care is an integrative care initiative for improving the health outcomes of hospitalized older patients; however, its applicability in community-dwelling older adults as a health screening tool has not been investigated. The present study aimed to examine the applicability of this model, prevalence of dysfunction in 6 care areas, and its relationship with self-reported mobility in community-dwelling older adults.@*METHODS@#This was a cross-sectional survey study of community-dwelling adults aged 65 or older. Participants were screened for problems using 9 items corresponding to the 6 care areas of the 48/6 Model of Care (cognitive functioning, functional mobility, pain management, nutrition and hydration, bladder and bowel management, and medication management). Mobility was assessed via the Life-Space Assessment (LSA). We examined the correlation between each screening item and the LSA.@*RESULTS@#A total of 444 older adults (260 women, 58.6%) participated. The mean number of health problems was 2.3 ± 2.1, with the most common being pain, cognitive impairment, and urinary incontinence. These problems and LSA scores were significantly different by age groups. A multiple regression analysis showed that polypharmacy (β = −10.567, P < 0.001), dysphagia (β = −9.610, P = 0.021), and pain (β = −7.369, P = 0.004) were significantly associated with life-space mobility after controlling for age.@*CONCLUSION@#The 48/6 Model of Care is applicable to community-dwelling older adults, who show high prevalence of dysfunction in the 6 care areas. This study supports the role of the model in screening for the health status of older adults living in the community, and in estimating mobility.

The Experience of Providing Older Adult Patients with Transitional Care from an Acute Care Hospital to Home in Cooperation with a Public Health Center

Background@#This study aimed to describe the experience of providing older adult patients with transitional care from an acute care hospital to home in cooperation with a public health center, in order to present the barriers to that care and suggest better organizational methods. @*Methods@#This was a cross-sectional study to show the results of the Geriatric Screening for Care-10 (GSC-10) and outcomes of transitional care. Among 659 hospitalized patients aged 65 years or above who lived in an administrative district, forty-five subjects were enrolled between June 24, 2019 and January 23, 2020. Within 48 hours of admission, using the 10 areas of GSC-10, they were assessed for cognitive impairment, depression, polypharmacy (5 or more medications), functional mobility, dysphagia, malnutrition, pain, and incontinence, and were reassessed before discharge. The transitional care plan (containing the treatment summary, the results of the GSC-10 assessment, and the post-discharge plan) was forwarded to a representative of the public health center, who provided continued disease management and various health care services, such as chronic disease and frailty care, and physical rehabilitation. @*Results@#Of all the participants, 64.4% had more than 1 GSC-10 concern. The most prevalent concerns were functional immobility (35.6%) and polypharmacy (22.2%). About 15.6% of the participants were readmitted to a nursing home or hospital. A total of 38 participants received the transitional care intervention. They received an average of 2.7 administered interventions. However, the rate of rejection was high (30.1%) and patients were visited an average of 16.5 days after discharge. @*Conclusion@#Through our experience of providing transitional care from an acute care hospital to home in cooperation with a public health center, we expect that the transitional care suitable for the Korean medical situation could be established and successful.

Applicability of the 48/6 Model of Care as a Health Screening Tool, and its Association with Mobility in Community-Dwelling Older Adults

BACKGROUND: The 48/6 Model of Care is an integrative care initiative for improving the health outcomes of hospitalized older patients; however, its applicability in community-dwelling older adults as a health screening tool has not been investigated. The present study aimed to examine the applicability of this model, prevalence of dysfunction in 6 care areas, and its relationship with self-reported mobility in community-dwelling older adults.METHODS: This was a cross-sectional survey study of community-dwelling adults aged 65 or older. Participants were screened for problems using 9 items corresponding to the 6 care areas of the 48/6 Model of Care (cognitive functioning, functional mobility, pain management, nutrition and hydration, bladder and bowel management, and medication management). Mobility was assessed via the Life-Space Assessment (LSA). We examined the correlation between each screening item and the LSA.RESULTS: A total of 444 older adults (260 women, 58.6%) participated. The mean number of health problems was 2.3 ± 2.1, with the most common being pain, cognitive impairment, and urinary incontinence. These problems and LSA scores were significantly different by age groups. A multiple regression analysis showed that polypharmacy (β = −10.567, P < 0.001), dysphagia (β = −9.610, P = 0.021), and pain (β = −7.369, P = 0.004) were significantly associated with life-space mobility after controlling for age.CONCLUSION: The 48/6 Model of Care is applicable to community-dwelling older adults, who show high prevalence of dysfunction in the 6 care areas. This study supports the role of the model in screening for the health status of older adults living in the community, and in estimating mobility.

Validity of the Korean Version of the Face, Legs, Activity, Cry, and Consolability Scale for Assessment of Pain in Dementia Patients

Pain is often associated with a more rapid progression of cognitive and functional decline, and behavioral disturbance in dementia. Therefore, it is essential to accurately assesses pain for proper intervention in patients with dementia. The Face, Legs, Activity, Cry, and Consolability (FLACC) scale is an excellent behaviour scale which includes most of the domains that are recommended by the American Geriatrics Society to evaluate when assessing pain in patients with dementia. The purpose of this study was to develop the Korean version of the FLACC (K-FLACC) and to verify its reliability and validity in assessing pain of elderly patients with dementia. We developed the K-FLACC to consist of the five domains (face, legs, activity, cry, and consolability) with scores of 0, 1, and 2 for each domain and a total score ranging from 0 to 10 as in the original FLACC. Eighty-eight patients with dementia who visited Konkuk University Medical Center were evaluated. The K-FLACC revealed good validity as compared to the Numeric Rating Scale (NRS; r = 0.617, P < 0.001) and the Face Pain Scale (FPS; r = 0.350, P = 0.001). All of the five domains of the K-FLACC were related to the NRS and FPS, in which the activity domain showed the highest correlation. Test-retest reliability was excellent, as the intra-class correlation coefficient comparing the retest to test was 0.73 (95% confidence interval, 0.59–0.82). Our results show that the K-FLACC is a suitable and valuable scale to assess pain in patients with dementia in Korea.

Difference in Volume Perception of Cooked White Rice according to Size and Color of Rice Bowl in Normal and Obese Women

To examine the effect of obesity on volume perception according to size and color of rice bowl, we divided female college students into a normal weight group ( or =30% fat mass, n=83) and then measured perceived volume of rice bowls of various sizes (general size; 350 ml vs. small size; 188 ml) and color (yellow, white, blue, and black) containing the same amount of cooked white rice (210 g). Normal weight group perceived that the general rice bowl contained significantly more cooked white rice compared to the small rice bowl. In contrast, the obese group perceived that the general rice bowl contained significantly less cooked white rice than the small rice bowl. The estimated variance in perceived volume of both bowls was significantly bigger in the obese group compared to the normal group. There were no differences in perceived volume among any of the subjects (both normal and obese groups) according to rice bowl color. However, the estimated variance in perceived volume in the obese group was significantly larger than that in the normal group for all of the rice bowls. In conclusion, rice bowl size and color might affect volume perception, and volume perception in obese people may be different from that of normal weight people.

Ethanol down regulates the expression of myelin proteolipid protein in the rat hippocampus / 대한해부학회지

It is well known that chronic ethanol treatment affects the synthesis of RNA and protein in the brain and the maintenance and function of nervous system. The changes in myelination-related genes are most prominent in human alcoholics. Previously, our cDNA microarray study showed altered Proteolipid protein (PLP), a major protein of central myelin. The present study aimed to gain more understanding of the expression of PLP after chronic ethanol treatment. Male Sprague-Dawley rats were daily treated with ethanol (15% in saline, 3 g/kg, i.p.) or saline for 14 days. Messenger RNAs from hippocampus of each group were subjected to cDNA expression array hybridization to determine the differential gene expressions. Among many ethanol responsive genes, PLP was negatively regulated by ethanol treatment, which is one of the most abundant proteins in the CNS and has an important role in the stabilization of myelin sheath. Using northern blot and immunohistochemical analysis, we showed the change in expression level of PLP mRNA and protein after ethanol treatment. PLP mRNA and protein were decreased in hippocampus of rat with chronic ethanol exposure, suggesting that ethanol may affect the stabilization of myelin sheath through the modulation of PLP expression and induce the pathophysiology of alcoholic brain.

A case of cystic change of adenomyosis in adolescent girl complaining acute pelvic pain / 대한산부인과학회지

Cystic adenomyosis is a rare form of adenomyosis of the uterine myometrium that has been described in older adults. This condition has not frequently been reported in the adolescent girl. The adenomyotic cyst was located within the myometrium of a 15-year-old adolescent girl suffering from acute lower abdominal pain, not dysmenorrhea. After laparoscopic operation, patients's symptoms improved. On pathology finding, the cyst diagnosed adenomyotic cyst. We report a case of adenomyotic cyst of the uterus in adolescent girl with a brief review of literatures.

The Subjectivity of Attitudes Toward Life Support Care / 간호학회지

PURPOSE: The purpose of this study was to categorize adult's subjectivity of their attitudes towards life sustaining treatment, and thereby understand the differences among these life sustaining treatment types using Q methodology. METHODS: Q-methodology, which provides a method of analyzing the subjectivity of each item, was used. Thirty selected Q-statements received from 52 adults were classified into a shape of normal distribution using a 7 point scale. The collected data was analyzed using a QUANL pc program. RESULT: Four types of attitudes toward life sustaining treatment were identified. Type I is called one's autonomy type. Type II is called potentiality of resuscitation type. Type III is called DNR (Do not resuscitation) type. Type IV is calledone's effort type. CONCLUSION: The results of the study indicate that different approaches of life support care programs are recommended based on the four types of life sustaining treatment attitudes among Korean adults.

A Study of the Subjectivity of Quality of Life in Elderly Women / 성인간호학회지

PURPOSE: The purpose of the study were to categorize the subjectivity of the quality of life in elderly women and to thereby understand the differences regarding quality of life desires. METHODS: This study used a Q-methodology to measure the quality of life in elderly women. A Q sample was collected from in-depth and objective interviews and WHOQLO. Fourteen participants rated 28 selected Q-statements on a scale of 1-7. The collected data was analyzed using PC Quanl. RESULTS: The principal component analysis identified 4 factors regarding the quality of life of elderly women. These categories were labeled 'hopelessness-oriented', 'relationship/adaptation-oriented', 'physical suffering-oriented', and 'self satisfaction-orientated'. CONCLUSION: Some of the factors regarding the quality of life of elderly women were determined through this research. Further research is necessary to set up and apply different the quality of life between men and women based on this result. The results of this study indicate that different approaches toward quality of life promotion programs are recommended based on the four factors of quality of life among elderly women.

Involvement of VEGF in both Cell Apoptosis and Survival in the Retina of Type 2 Diabetic OLETF Rats / 대한해부학회지

Vascular endothelial growth factor (VEGF) is closely involved in early retinal pathology of diabetes, including blood-retinal barrier breakdown, pericyte loss, neuro-retinal apoptosis, and cell proliferation. This study examines the involvement of VEGF in cell apoptosis and survival in the retina of animals with type 2 diabetes. We used retinas from 28-week-old Otsuka Long-Evans Tokushima Fatty (OLETF) rats, a model of spontaneous type 2 diabetes, and Long-Evans Tokushima Otsuka (LETO) rats as controls. In parallel with evidence for pericyte loss, we found cell proliferation, apoptosis, and endothelial nitric oxide synthase (eNOS) (an indicator of endothelial cell proliferation/survival) and VEGF overexpression in the OLETF-retina, compared to control LETO. Furthermore, apoptotic signals were partly co-localized to only VEGF-positive cells in the OLETF-retina, but no apoptotic signals were found in VEGF- and eNOS-double-positive cells. These results suggest that upregulated VEGF is involved in apoptosis and eNOS-dependent cell survival in the retinas of type 2 diabetic rats.

The usefulness of ovarian volume using 3D VOCAL transvaginal ultrasound, antral follicle count and age as predictors of menopause in pre- and postmenopausal women / 대한산부인과학회지

OBJECTIVE: To evaluate the sensitivity and specificity of ovarian volume using 3D VOCAL and 2D ultrasound, antral follicle count, and age as predictors of menopausal status in pre- and postmenopausal women. METHODS: The subjects of this study were premenopausal (n=38) and postmenopausal (n=23) healthy women aged between 35 and 57 years of age who were interviewed about social, demographic, and medical conditions. These women underwent transvaginal ultrasound using 3D VOCAL and 2D probe to determine ovarian volume. Chi-square test was applied to evaluate the correlation between ovarian volume, antral follicle count, age and menopausal status. Receiver operating Characteristic (ROC) curves were elaborated to evaluate the sensitivity, specificity and positive and negative predictive values. RESULTS: Premenopausal women presented larger ovaries than postmenopausal women (p<0.01). Premenopausal women had a higher number of antral follicles than postmenopausal women (p<0.01). ROC curves showed that antral follicle count and ovarian volume using 3D VOCAL transvaginal probe were more sensitive and specific markers of menopausal status than age or ovarian volume using 2D transvaginal probe. CONCLUSIONS: Ovarian volume and antral follicle count differ according to age in pre- and postmenopausal women. The data suggest that antral follicle count and ovarian volume using 3D VOCAL transvaginal probe are quite useful in predicting menopausal status.

A case report of Pseudo-Meigs' syndrome associated with ovarian serous cystadenocarcinoma / 부인종양

Pseudo-Meigs' syndrome is a rare condition that includes hydrothorax and/or ascites secondary to ovarian neoplasms other than benign primary tumors. A 67-year-old woman presented with ascites, hydrothorax, left ovarian mass and elevated CA-125 level. The mass was removed and revealed serous cystadenocarcinoma. The immediate and complete resolution of symptoms and rapid decline of CA-125 level to normal value was achieved post-operatively. One month after surgery, she had no evidence of ascites or pleural effusion. We report Pseudo-Meigs' syndrome associated with ovarian serous cystadenocarcinoma and elevated CA-125 level.

A case report of Pseudo-Meigs' syndrome associated with ovarian serous cystadenocarcinoma / 부인종양

Pseudo-Meigs' syndrome is a rare condition that includes hydrothorax and/or ascites secondary to ovarian neoplasms other than benign primary tumors. A 67-year-old woman presented with ascites, hydrothorax, left ovarian mass and elevated CA-125 level. The mass was removed and revealed serous cystadenocarcinoma. The immediate and complete resolution of symptoms and rapid decline of CA-125 level to normal value was achieved post-operatively. One month after surgery, she had no evidence of ascites or pleural effusion. We report Pseudo-Meigs' syndrome associated with ovarian serous cystadenocarcinoma and elevated CA-125 level.

A Case of the Broad Ligamentary Angiomyoma / 대한산부인과학회지

Angiomyoma is a rare, benign, mesenchymal tumor occurring mainly in the female genital tract and higher incidence in the fourth to sixth decades of life. It is originated from smooth muscle cells and contains thick-walled vessels. The most satisfactory treatment is complete excision. We experienced a case of the broad ligamentary angiomyoma that was treated by complete excision with a brief review of literature.

Alterations of Tyrosine Hydroxylase and Choline Acetyltransferase in the Retina of the Diabetic Rat / 대한해부학회지

To investigate the effect of hyperglycemia on the visual system, we investigated the retinal dopaminergic and cholinergic systems using tyrosine hydroxylase (TH) and choline acetyltransferase (ChAT) in the rat retinas of streptozotocin (STZ)-induced diabetes. Diabetes was induced by a single intraperitoneal injection of STZ (50 mg/kg) to Sprague-Dawley rats (250~300 g). We first analyzed morphologic thickness changes in the several retinal layers of 6-week-old control and STZ-diabetic rats after H & E staining. To confirm whether TH and ChAT protein expressions changed, we carried out immunohistochemistry analysis and Western blotting. After induction of diabetes, significant changes were not shown in the retinal thickness at 6 weeks. TH and ChAT immunoreactivities were clearly detected in amacrine cells and sublaminas in the inner retina of both control and diabetic rats, showing continuously reduced positive amacrine cells in the retinas during diabetes. In addition, the decline in TH and ChAT protein expression was already present to a significant extent in the retina at 6 weeks in early diabetes. Our present study demonstrates the possibility that the observed alterations in TH and ChAT in the diabetic retina may cause the visual system changes in the retinal pathophysiology associated with diabetes mellitus.

A study of the effect of low dose recombinant human growth hormone replacement therapy on bone mineral density, IGF-1, hand grip strength, body fat and serum lipid compositions in postmenopausal women / 대한산부인과학회지

OBJECTIVE: To determine the effect of low-dose growth hormone (GH) replacement therapy on bone mineral density at the lumbar spine and femur, IGF-1, hand grip, body fat and serum lipid compositions in postmenopausal women. METHODS: A total of 9 postmenopausal women were assigned to receive growth hormone with a daily dose 0.0095 IU/kg, six times a week. We compared the change of bone marrow density (BMD), bone marker (osteocalcin), IGF-1, hand grip strength, body fat and serum lipid compositions during therapy. Repeated measure ANOVA test was used for statistical analysis. RESULTS: The results were as follows. 1. Mean age of the patients was 62.2 +/- 2.7 years. 2. The bone marker, osteocalcin level at 3 and 6 months were increased by 28% and 35% respectively, compared to baseline (p0.05). 5. Hand grip strength at 6 months was increased by 7.8% compared to baseline (p0.05). 7. The total cholesterol, triglyceride and LDL cholesterol were decreased during GH treament, but not significance (p>0.05). The HDL cholesterol was increased with no statistical significance (p>0.05). CONCLUSION: Our study results suggest that low-dose GH replacement therapy in postmenopausal women have beneficial effect on increased BMD, hand grip strength and HDL cholesterol. The present findings provide useful information regarding the use of low-dose GH treament in elderly women with osteoporosis.

Differential Effects of Antipsychotic Drugs on Dopamine D1 and D2 Receptor mRNAs in the Rat Brain / 대한해부학회지

The principal aim of this study was to determine the effects of antipsychotics (haloperidol, sulpiride, and clozapine) on regulating dopamine (DA) D1 and D2 receptor mRNA levels in the rat caudate putamen (CPu), nucleus accumbens (NAc), and olfactory tubercle (OTu). Twenty male Sprague-Dawley rats (250 g) were treated with haloperidol (1mg/mL), sulpiride (40 mg/mL), clozapine (20 mg/mL), and the control group received only water. Drugs were administered orally for 4 weeks. Antipsychotic drugs had differential effects on DA D1 and D2 receptor gene expression. Haloperidol and sulpiride induced an increase of DA D1 and D2 receptor mRNA levels in the rat CPu, OTu, and NAc; haloperidol caused a greater increase than sulpiride. However, clozapine treatment had less effect on DA receptor mRNAs levels in the same area. Antipsychotic drugs differentially upregulated the expression of DA D1 and D2 receptor mRNAs in the rat brain. These changes may be related, at least in part, to changes of DA concentration following antipsychotics treatment.

A Case of Iniencephaly Diagnosed by Prenatal Ultrasonography / 대한산부인과학회지

Iniencephaly is an abnormality in cervical vertebra associated with an excessive lordosis of the cervicothoracic spine and neural tube closure defects. The incidence is one of 1,000 to 10,000 live birth. The pathogenesis is unknown. It is possible that iniencephaly is a primary defects in fetal cervical development and the resulting lordosis cause a failure of neural tube closure. Specific sonographic findings are over extended fetal head, very short and modified thorax, generally shortened fetal long bones and frequent associating anencephaly and meningomyelocele. Fetal alpha-fetoprotein elevation may be present. Iniencephaly, when diagnosed in utero, is almost always lethal. We experienced a case of iniencephaly in a fetus of intrauterine pregnancy at 17 weeks diagnosed by prenatal ultrasonography who was terminated because of ultrasonic demonstration of other multiple anomalies. Thus, we report a case with brief review of the literature.