• Journal of Korean Critical Care Nursing
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• v.12 no.1
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• pp.94-108
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• 2019

Purpose : Heart failure (HF) is considered an important medical burden with rehospitalization and mortality. Anemia is a major risk factor associated with the severity of HF. To improve the understanding of the impact of anemia in the population with HF, we explored the prevalence of anemia, its guidelines, relationship between anemia and mortality or rehospitalization, and limitation of reviewed papers of various populations with HF. Method: We used Whittemore and Knafl's integrative review methodology (2005), and thirty research papers were analyzed. PubMed, CINAHL, Cochrane, PsychInfo, Embase, Web of Science were searched for papers published between January 1960-June 2018. Results: Anemia in individuals with HF was primarily defined using the World Health Organization guideline. The prevalence of anemia in patients with HF varied from 9% to 56.7%. Moreover, such a condition significantly increases the prevalence of mortality or rehospitalization in patients with HF. The analyzed majority were non-prospective cohort study including secondary data analysis. Conclusion: Anemia in individuals with HF is a significant risk factor of mortality and rehospitalization. Prospective cohort studies should be designed to identify the optimal value for screening anemia and the impact of anemia on rehospitalization and mortality among HF patients.

• Safety and Health at Work
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• v.13 no.2
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• pp.201-206
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• 2022

Background: The present objective was to verify whether burnout (emotional exhaustion [EE], depersonalization [DP] and low professional efficacy [PE]) is a risk factor for long-term sickness absence (LTSA; 30 consecutive days) from the teaching role. Methods: This was a prospective cohort study with two years of follow-up that investigated 509 elementary and high-school teachers. Burnout was identified by Maslach Burnout Inventory. Poisson regression with robust variance was used to adjust for possible confounders. Results: The incidence of LTSA was 9.4%. High EE levels were associated with LTSA in the crude analysis, but the association lost statistical significance after adjustments (for sex, age, perception of work-life balance, general self-rated health, chronic pain and depression). High DP levels were associated with this outcome, even after all adjustments (relative risk = 1.80; 95% confidence interval: 1.05-3.09). Low PE levels were not related to LTSA. Conclusion: The results reinforce the need to improve teachers' work conditions to reduce burnout, particularly DP, and its consequences.

• Korean Medical Education Review
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• v.26 no.1
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• pp.5-18
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• 2024

The author recommends the creation of a nationwide career guidance program at the national level through the establishment of a long-term cohort, involving collaboration among medical schools nationwide. This cohort would be constructed for the purpose of analyzing correlations from admission to medical school to post-graduate education, facilitating the development of a career guidance program. This will aid in career development through students' self-analysis and competency building. Each medical school should operate a systematic career guidance program. Career guidance for post-graduate major selection should be included in the regular curriculum. Schools are advised to operate student counseling rooms for various career guidance services. For example, medical schools can operate 1:1 career counseling, academic counseling, career guidance surveys, psychological tests, and counseling. It is advisable to establish a mentor-professor system, connect mentor professors, and build a network of experts related to majors to provide immediate support according to students' needs. Professional mentor training should be provided to mentor professors. To provide opportunities for students to experience their career paths in advance, early clinical exposure, long-term integrated clinical practice, community-based clinical practice, participation in student research programs, career fairs, and student internship programs are recommended. In South Korea, it is necessary to systematically operate the internship system and make improvements to facilitate optical career choices. Additionally, considering the significant influence of social factors on students' career choices in South Korea, efforts should be made to identify and address the issues related to these social factors.

• Safety and Health at Work
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• v.15 no.2
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• pp.147-150
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• 2024

Background: We examined the association between supervisor consultation, as an actual practice representing supervisor support, and work engagement. Methods: This was a prospective cohort study in Japan, involving 14,026 participants who met the requirement for a one-year follow-up. Supervisor consultation was measured using a single question, and work engagement was defined using the Japanese version of the nine-item Utrecht Work Engagement Scale (UWES-9). Associations were examined using linear regression analysis. Results: Supervisor consultation was positively associated with work engagement after adjusting for gender, age, education, income, and industry (𝛽 = 3.474; p < 0.001). The relationship remained significant after adjustment for perceived supervisor support, although the coefficient decreased (𝛽 = 1.315; p < 0.001). Conclusion: Supervisor consultation probably acted on work engagement in different ways than perceived supervisor support.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.3
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• pp.1437-1443
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• 2016

Background: We investigated four factors, height, weight gain since age 20, physical activity, and alcohol drinking, for associations with risk of breast cancer (BC) according to menopausal status, using the latest data of the Japan Collaborative Cohort Study (JACC Study). Materials and Methods: We confined the analysis to 24 areas available of cancer incidence information, excluding women with a previous diagnosis of BC. Baseline data were collected from 38,610 (9,367 premenopausal, and 29,243 postmenopausal) women during 1988 and 1990. The study subjects were followed-up at the end of 2009, and 273 (84 premenopausal, and 189 postmenopausal) cases of BC were newly diagnosed in 501,907 person-years. The Cox model was used to estimate a hazards ratio (HR) and its 95% confidence interval (CI) of BC risk. Results: As a result of the multivariate analysis adjusting for age at baseline survey, age at menarche, number of live births, and, age at first delivery, weight gain since age 20 of 6.7 kg-9.9 kg, and ${\geq}10.0kg$ were significantly associated with increased risk for postmenopausal BC (HR=2.48, 95% CI 1.40-4.41, and, HR=2.94, 95% CI 1.84-4.70, respectively). Significantly increased trend of BC risk was also observed in weight gain since age 20 (p for trend, p<0.001). Amount of ethanol intake per day${\geq}15.0g$ was significantly associated with increased risk for postmenopausal BC in the multivariable-adjusted analysis (HR=2.74, 95% CI 1.32-5.70). Conclusions: Higher weight gain in adulthood and larger amounts of ethanol intake were significantly associated with increased risk of BC in Japanese postmenopausal women. None of the investigated factors were significantly associated with BC risk in Japanese premenopausal women.

• Journal of dental hygiene science
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• v.17 no.2
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• pp.160-167
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• 2017

The purpose of this systematic review was to investigate the association between periodontal disease and chronic kidney disease. A search of Embase, PubMed and The Cochrane Library databases was performed up to April 17, 2016. Article selection was based on cohort study design and the study subjects were patients with periodontal disease or severe periodontal disease. The final result was development of chronic kidney disease and kidney function decrease based on the estimated glomerular filtration rate values. The quantitative synthesis of the final selected articles was assessed using Review Manager statistical analysis software. A fixed-effects model meta-analysis was performed to estimate the degree of association between periodontal disease and chronic kidney disease. The search strategy identified 3,018 potentially eligible articles, of these, four studies were finally selected for meta-analysis, revealing that periodontal disease was significantly associated with the risk of developing chronic kidney disease (odds ratio, 1.65; 95% confidence interval, 1.44~1.90; p<0.001). In order to prevent the development of chronic kidney disease and kidney function decrease it is important to prevent periodontal disease, as well as minimizing the traditional risk factors known to reduce the quality of life of patients and increase disease burden.

• Korean Journal of Radiology
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• v.23 no.4
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• pp.466-478
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• 2022

Objective: ¹⁸F-fluorodeoxyglucose (FDG) PET/CT is often used for detecting malignancy in patients with newly diagnosed hemophagocytic lymphohistiocytosis (HLH), with acceptable sensitivity but relatively low specificity. The aim of this study was to improve the diagnostic ability of ¹⁸F-FDG PET/CT in identifying malignancy in patients with HLH by combining ¹⁸F-FDG PET/CT and clinical parameters. Materials and Methods: Ninety-seven patients (age ≥ 14 years) with secondary HLH were retrospectively reviewed and divided into the derivation (n = 71) and validation (n = 26) cohorts according to admission time. In the derivation cohort, 22 patients had malignancy-associated HLH (M-HLH) and 49 patients had non-malignancy-associated HLH (NM-HLH). Data on pretreatment ¹⁸F-FDG PET/CT and laboratory results were collected. The variables were analyzed using the Mann-Whitney U test or Pearson's chi-square test, and a nomogram for predicting M-HLH was constructed using multivariable binary logistic regression. The predictors were also ranked using decision-tree analysis. The nomogram and decision tree were validated in the validation cohort (10 patients with M-HLH and 16 patients with NM-HLH). Results: The ratio of the maximal standardized uptake value (SUVmax) of the lymph nodes to that of the mediastinum, the ratio of the SUVmax of bone lesions or bone marrow to that of the mediastinum, and age were selected for constructing the model. The nomogram showed good performance in predicting M-HLH in the validation cohort, with an area under the receiver operating characteristic curve of 0.875 (95% confidence interval, 0.686-0.971). At an appropriate cutoff value, the sensitivity and specificity for identifying M-HLH were 90% (9/10) and 68.8% (11/16), respectively. The decision tree integrating the same variables showed 70% (7/10) sensitivity and 93.8% (15/16) specificity for identifying M-HLH. In comparison, visual analysis of ¹⁸F-FDG PET/CT images demonstrated 100% (10/10) sensitivity and 12.5% (2/16) specificity. Conclusion: ¹⁸F-FDG PET/CT may be a practical technique for identifying M-HLH. The model constructed using ¹⁸F-FDG PET/CT features and age was able to detect malignancy with better accuracy than visual analysis of ¹⁸F-FDG PET/CT images.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.6
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• pp.2245-2250
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• 2015

Background: The interaction between tumor cells and inflammatory cells has not been systematically investigated in esophageal squamous cell carcinoma (ESCC). The aim of the present study was to evaluate whether preoperative the lymphocyte-monocyte ratio (LMR), the neutrophil-lymphocyte ratio (NLR), and the platelet-lymphocyte ratio (PLR) could predict the prognosis of ESCC patients undergoing esophagectomy. Materials and Methods: Records from 218 patients with histologically diagnosed ESCC who underwent attempted curative surgery from January 2007 to December 2008 were retrospectively reviewed. Besides clinicopathological prognostic factors, we evaluated the prognostic value of the LMR, the NLR, and the PLR using Kaplan-Meier curves and Cox regression models. Results: The median follow-up was 38.6 months (range 3-71 months). The cut-off values of 2.57 for the LMR, 2.60 for the NLR and 244 for the PLR were chosen as optimal to discriminate between survival and death by applying receiver operating curve (ROC) analysis. Kaplan-Meier survival analysis of patients with low preoperative LMR demonstrated a significant worse prognosis for DFS (p=0.004) and OS (p=0.002) than those with high preoperative LMR. The high NLR cohort had lower DFS (p=0.004) and OS (p=0.011). Marginally reduced DFS (p=0.068) and lower OS (p=0.039) were found in the high PLR cohort. On multivariate analysis, only preoperative LMR was an independent prognostic factor for both DFS (p=0.009, HR=1.639, 95% CI 1.129-2.381) and OS (p=0.004, HR=1.759, 95% CI 1.201-2.576) in ESCC patients. Conclusions: Preoperative LMR better predicts cancer survival compared with the cellular components of systemic inflammation in patients with ESCC undergoing esophagectomy.

• Archives of Plastic Surgery
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• v.44 no.2
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• pp.124-135
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• 2017

Background In cases of total knee arthroplasty (TKA) threatened by potential hardware exposure, flap-based reconstruction is indicated to provide durable coverage. Historically, muscle flaps were favored as they provide vascular tissue to an infected wound bed. However, data comparing the performance of muscle versus fasciocutaneous flaps are limited and reflect a lack of consensus regarding the optimal management of these wounds. The aim of this study was to compare the outcomes of muscle versus fasciocutaneous flaps following the salvage of compromised TKA. Methods A systematic search and meta-analysis were performed to identify patients with TKA who underwent either pedicled muscle or fasciocutaneous flap coverage of periprosthetic knee defects. Studies evaluating implant/limb salvage rates, ambulatory function, complications, and donor-site morbidity were included in the comparative analysis. Results A total of 18 articles, corresponding to 172 flaps (119 muscle flaps and 53 fasciocutaneous flaps) were reviewed. Rates of implant salvage (88.8% vs. 90.1%, P=0.05) and limb salvage (89.8% vs. 100%, P=0.14) were comparable in each cohort. While overall complication rates were similar (47.3% vs. 44%, P=0.78), the rates of persistent infection (16.4% vs. 0%, P=0.14) and recurrent infection (9.1% vs. 4%, P=0.94) tended to be higher in the muscle flap cohort. Notably, functional outcomes and ambulation rates were sparingly reported. Conclusions Rates of limb and prosthetic salvage were comparable following muscle or fasciocutaneous flap coverage of compromised TKA. The functional morbidity associated with muscle flap harvest, however, may support the use of fasciocutaneous flaps for coverage of these defects, particularly in young patients and/or high-performance athletes.

• Asian-Australasian Journal of Animal Sciences
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• v.33 no.9
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• pp.1369-1377
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• 2020

Objective: The main objectives of the present study were to assess the genetic diversity, population structure and to appraise the efficiency of ongoing selective breeding program in the closed nucleus herd of Nellore sheep through pedigree analysis. Methods: Information utilized in the study was collected from the pedigree records of Livestock Research Station, Palamaner during the period from 1989 to 2016. Genealogical parameters like generation interval, pedigree completeness, inbreeding level, average relatedness among the animals and genetic conservation index were estimated based on gene origin probabilities. Lambs born during 2012 and 2016 were considered as reference population. Two animal models either with the use of F_i or ΔF_i as linear co-variables were evaluated to know the effects of inbreeding on the growth traits of Nellore sheep. Results: Average generation interval and realized effective population size for the reference cohort were estimated as 3.38±0.10 and 91.56±1.58, respectively and the average inbreeding coefficient for reference population was 3.32%. Similarly, the effective number of founders, ancestors and founder genome equivalent of the reference population were observed as 47, 37, and 22.48, respectively. Fifty per cent of the genetic variability was explained by 14 influential ancestors in the reference cohort. The ratio f_e/f_a obtained in the study was 1.21, which is an indicator of bottlenecks in the population. The number of equivalent generations obtained in the study was 4.23 and this estimate suggested the fair depth of the pedigree. Conclusion: Study suggested that the population had decent levels of genetic diversity and a non-significant influence of inbreeding coefficient on growth traits of Nellore lambs. However, small portion of genetic diversity was lost due to a disproportionate contribution of founders and bottlenecks. Hence, breeding strategies which improve the genetic gain, widens the selection process and with optimum levels of inbreeding are recommended for the herd.