• Title/Summary/Keyword: Medical agency

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Effect of Screening on the Risk Estimates of Socio Demographic Factors on Cervical Cancer - A Large Cohort Study from Rural India

  • Thulaseedharan, Jissa Vinoda;Malila, Nea;Hakama, Matti;Esmy, Pulikottil Okuru;Cherian, Mary;Swaminathan, Rajaraman;Muwonge, Richard;Sankaranarayanan, Rengaswami
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.1
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    • pp.589-594
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    • 2013
  • Background: Prospective cohort studies to determine cofactors with oncogenic HPV-infections for cervical cancer are very rare from developing countries and such data are limited to the few screening trials. Large screening trials provide such data as a by product. Some of the cases are prevented by screening and do not surface as invasive cancers at all. Also, pre-invasive lesions are detected almost entirely by screening. Screening causes selection bias if attendance in or effectiveness of screening is correlated with the risk factors. The aim of this study was to quantify the influence of screening on risk factors for cervical cancer. Materials and Methods: Our material stems from a rural cohort of 80,000 women subjected to a randomised screening trial. The effect of screening on the incidence of cervix cancer was estimated with reference to socio-demographic and reproductive risk factors of cervical cancer. We compared these risks with the incidence of cancer in the randomised control population by the same determinants of risk. Results: The results in the screening arm compared to the control arm showed that the women of low SES and young age were benefitting more than those of high SES and old age. The relative risk by age (30-39 vs 50-59) was 0.33 in the control arm and 0.24 in the screening arm. The relative risk by education (not educated vs educated) was 2.8 in the control arm and 1.8 in the screening arm. The previously married women did not benefit (incidence 113 and 115 per 100,000 women years in control vs screening arms) whereas the effect was substantial in those married (86 vs 54). Conclusions: The results in controls were consistent with the general evidence, but results in attenders and nonattenders of the screening arm showed that screening itself and self-selection in attendance and effectiveness can influence the effect estimates of risk factors. The effect of cervical cancer screening programmes on the estimates of incidence of cervical cancer causes bias in the studies on etiology and, therefore, they should be interpreted with caution.

Recruitment and Selection of Police Officials in the United States -the System and it's Implications- (미국 경찰관 모집·선발제도의 특징 및 함의)

  • Park, Dong-Kyun
    • The Journal of the Korea Contents Association
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    • v.11 no.5
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    • pp.384-392
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    • 2011
  • Recruitment and selection are separate but mutually reinforcing processes. The goal of recruitment is to attract the largest number of applicants possible to apply to the agency, and selection is the process of weeding out unqualified candidates and identifying qualified candidates. In this context, the recruitment and selection system of police officials is an important issue because it affects their future performance as police officers on the job, especially their policing skills, perception of society, occupational ethics. This study suggested the characteristics of U. S. recruitment and selection system of police officials. In the U. S, each police agency sets up its own recruitment and selection standards and procedures. However, recruitment and selection process follows a certain sequence : receiving application, psychological examination, background check, polygraph test, drug screening, interview, physical agility, and medical test. Special characteristic of American police system regarding recruitment and selection is that many law enforcement agencies use a polygraph test to ensure the integrity of the candidates. Another interesting screening process is a drug test because many Americans abuse illegal drugs. A candidate officer must submit urine or a hair sample for screening test. Police human resources specialists should continually identify the most innovative tests and approaches recruit and select police officers. Recruitment and selection strategies should increasingly attract and retain those officers who have the attributes to work in a community-oriented policing environment.

Regulations and Guidelines for Planning and Design of Multi-regional Clinical Trials (다지역 임상시험의 계획 및 설계에 대한 국제 제도적 동향 분석)

  • Song, Yun-Kyoung;Sohn, Minji;Jeon, Ah Young;Kim, Jae Hyun;Ji, Eunhee;Oh, Jung Mi;Kim, In-Wha
    • Korean Journal of Clinical Pharmacy
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    • v.28 no.2
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    • pp.146-153
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    • 2018
  • Objective: Multi-regional clinical trials have been widely used for accelerating global drug development by multinational pharmaceutical companies. In this study, we aimed to review and analyze the international trends in regulations and guidelines on multi-regional clinical trials by regulatory authorities and international organizations, such as International Conference on Harmonisation, for referring to policies, including development of domestic guidelines for multi-regional clinical trials. Methods: The policies, regulations, and guidelines published by the US Food and Drug Administration, European Medicines Agency, Pharmaceuticals and Medical Devices Agency (Japan), and China Food and Drug Administration were searched, and the International Conference on Harmonisation E17 draft guideline was reviewed. Results: The regulatory authorities in developed countries have developed and implemented regulations and guidelines on multi-regional clinical trials to promote simultaneous global drug development and evaluate the regional differences in drug safety and efficacy. International Conference on Harmonisation developed the draft guideline for planning/designing of multi-regional clinical trials in 2016, which recommends the general principles for strategy-related issues and design of multi-regional clinical trials, and for protocol-related issues, such as consideration of regional variability, subject selection, dose selection, endpoints, comparators, overall sample size, allocation to regions, collecting information on efficacy and safety, and statistical analysis. Conclusion: It is important to understand the international regulatory requirements for designing and planning of multi-regional clinical trials for global drug development. Moreover, it is necessary to prepare multi-regional clinical trial guidelines in accordance with the Korean regulation for clinical trials and drug administration.

Lagerstroemia ovalifolia Exerts Anti-Inflammatory Effects in Mice of LPS-Induced ALI via Downregulating of MAPK and NF-κB Activation

  • Min, Jae-Hong;Kim, Seong-Man;Park, JI-Won;Kwon, Nam Hoon;Goo, Soo Hyeon;Ngatinem, Ngatinem;Ningsih, Sri;Paik, Jin-Hyub;Choi, Sangho;Oh, Sei-Ryang;Han, Sang-Bae;Ahn, Kyung-Seop;Lee, Jae-Won
    • Journal of Microbiology and Biotechnology
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    • v.31 no.11
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    • pp.1501-1507
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    • 2021
  • Lagerstroemia ovalifolia Teijsm. & Binn. (LO) (crape myrtle) has reportedly been used as traditional herbal medicine (THM) in Java, Indonesia. Our previous study revealed that the LO leaf extract (LOLE) exerted anti-inflammatory effects on lipopolysaccharide (LPS)-stimulated RAW264.7 macrophages. Based on this finding, the current study aimed to evaluate the protective effects of LOLE in a mouse model of LPS-induced acute lung injury (ALI). The results showed that treatment with LPS enhanced the inflammatory cell influx into the lungs and increased the number of macrophages and the secretion of the inflammatory cytokines in the bronchoalveolar lavage fluid (BALF) of mice. However, these effects were notably abrogated with LOLE pretreatment. Furthermore, the increase of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2) and monocyte chemoattractant protein-1 (MCP-1) expression in the lung tissues of mice with ALI was also reversed by LOLE. In addition, LOLE significantly suppressed the LPS-induced activation of the MAPK/NF-κB signaling pathway and led to heme oxygenase-1 (HO-1) induction in the lungs. Additionally, in vitro experiments showed that LOLE enhanced the expression of HO-1 in RAW264.7 macrophages. The aforementioned findings collectively indicate that LOLE exerts an ameliorative effect on inflammatory response in the airway of ALI mice.

Efficacy and Safety of COVID-19 Vaccines in Children Aged 5 to 11 Years: A Systematic Review (5-11세 소아에서 코로나19 백신의 효능 및 안전성에 대한 체계적 문헌고찰)

  • Choi, Miyoung;Yu, Su-Yeon;Cheong, Chelim;Choe, Young June;Choi, Soo-Han
    • Pediatric Infection and Vaccine
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    • v.29 no.1
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    • pp.28-36
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    • 2022
  • Purpose: To evaluate the efficacy and safety of coronavirus disease 2019 (COVID-19) vaccines in children aged 5-11 years, a rapid systematic review was conducted on published clinical trials of COVID-19 vaccines and studies that analyzed real-world data on adverse events after COVID-19 vaccination. Methods: A systematic search was conducted on medical literature in international (Ovid-MEDLINE) and pre-published literature databases (medRxiv), followed by handsearching up to January 4, 2022. We used terms including COVID-19, severe acute respiratory syndrome coronavirus 2, and vaccines, and the certainty of evidence was graded using the GRADE approach. Results: A total of 1,675 studies were identified, of which five were finally selected. Among the five studies, four consisted of data from clinical trials of each of the four types of COVID-19 vaccines (BNT162b2, mRNA-1273, CoronaVac, and BBIBP-CorV). The remaining study consisted of real-world data on the safety of the BNT162b2 vaccine in children aged 5-11 years. This systematic review identified that COVID-19 vaccines in recipients aged 5-11 years produced a favorable immune response, and were vaccines were effective against COVID-19. The safety findings for the BNT162b2 vaccine in children and early adolescents aged 5-11 years were similar to those data noted in the clinical trial. Conclusions: There is limited data on COVID-19 vaccines in children aged 5-11 years. Consequently continuous and comprehensive monitoring is necessary for the evaluation of the safety and effectiveness of the COVID-19 vaccines.

Analyzing Cancer Incidence among Korean Workers and Public Officials Using Big Data from National Health Insurance Service (건강보험 빅데이터를 통한 전체 근로자 및 공무원 근로자의 암 발생률 분석)

  • Baek, Seong-Uk;Lee, Wanhyung;Yoo, Ki-Bong;Lee, Woo-Ri;Lee, Won-Tae;Kim, Min-Seok;Lim, Sung-Shil;Kim, Jihyun;Choi, Jun-Hyeok;Lee, Kyung-Eun;Yoon, Jin-Ha
    • Journal of Korean Society of Occupational and Environmental Hygiene
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    • v.32 no.3
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    • pp.268-278
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    • 2022
  • Objectives: This study aimed to establish a control group based on the big data from National Health Insurance Service. We also presented presented the number of incidences for each cancer, and analyzed the cancer incidence rate among Korean workers. Methods: The cohort definition was separated by 'baseline cohort', 'dynamic cohort', and 'fixed- industry cohort' according to the definition. Cancer incidence was calculated based on the Korean Standard Classification of Disease code. Incidence rate was calculated among the group of all workers and public officials. Based on the study subjects and each cohort definition, the number of observations, incidences, and the incidence rate according to sex and age groups was calculated. The incidence rate was estimated based on the incidence per 100,000 person-year, and 95% confidence intervals calculated according to the Poisson distribution. Results: The result shows that the number of cancer cases in the all-worker group decreases after the age of 55, but the incidence rate tends to increase, which is attributed to the retirement of workers over 55 years old. Despite the specific characteristics of the workers, the trend and figures of cancer incidence revealed in this study are similar to those reported in previous studies of the overall South Korean population. When comparing the incidence rates of all workers and the control group of public officials, the incidence rate of public officials is generally observed to be higher in the age group under the age of 55. On the other hand, for workers aged 60 or older, the incidence rates were 1,065.4 per 100,000 person-year for all workers and 1,023.7 per 100,000 person-year for civil servants. Conclusions: This study analyzed through health insurance data including all workers in Korea, and analyzed the incidence of cancer of workers by sex and age. In addition, further in-depth researches are needed to determine the incidence of cancer by industry.

Epidemiological Aspects and Trends of the Extensive Eradication Programs for Bovine Brucellosis Outbreaks-Associated Human Brucellosis in Korea, 2002~2013

  • Lee, Won-Chang;Yoon, Hachung;Lee, Myeong-Jin;Kwon, Young Hwan
    • Korean journal of aerospace and environmental medicine
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    • v.29 no.2
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    • pp.72-76
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    • 2019
  • Over the last decade, human brucellosis (HB) has become a principal zoonosis in Korea. The objective of this study was observing the epidemiological trends of the extensive eradication programs for bovine brucellosis (BB) outbreaks-associated HB in Korea from 2002 to 2013. The raw data analysis in this study was obtained from the website of brucellosis outbreaks by Korea Center for Disease Control and Prevention (KCDC) and Animal and Plant Quarantine Agency (QIA), Korea, 2002~2013. The number of cases of BB outbreaks-associated HB in Korea was increased after 2003 and peaked in 2006 before decreasing thereafter. There were a total of 89,240 infected BB in domestic cattle with a cumulative incidence rate (CIR) of 611.8 per 100,000 cattle; during the same period there were a total of 703 cases of HB with a CIR of 0.12 per 100,000 persons. Moreover, the correlation coefficient of brucellosis outbreaks between cattle and human was highly significant (r=+0.985). The attack ratio of HB was 7.88 per 1,000 BB cases. All of the control measures of HB were applied in the extensive eradication programs for brucellosis outbreaks of infection source in domestic animals and contributed significantly to the reduction in the outbreaks of HB in Korea.

Compilation of 104 Experimental Theses on the Antitumor and Immuno-activating therapies of Oriental Medicine (한의학의 항종양 면역치료에 관한 연구 -1990년 이후 발표된 실험논문을 중심으로-)

  • Kang Yeon Yee;Kim Tai Im;Park Jong Ho;Kim Sung Hoon;Park Jong Dai;Kim Dong Hee
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.17 no.1
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    • pp.1-24
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    • 2003
  • This study was done to compile 104 experimental theses which are related to the antitumor and immuno-activating therapies between February 1990 through February 2002. Master's and doctoral theses were dassified by schools, degrees, materials, effects, experimental methods of antitumor and immunoactivity, and results. The following results were obtained from this study : 1. Classifying the theses by the school, 34.6% were presented by Daejeon University, 29.8% by Kyung-hee University and 11.5% by Won-kwang University. Of all theses, 51.0% were aimed for the doctoral degree and 43.3% were for the master's degree. All of three universities have their own cancer centers. 2. Classifying the theses by herb materials, complex prescription accounted for 60.3%, single herb accounted for 24.8% and herbal acupuncture accounted for 14.2%. Considering the key principles of the traditional medicine, complex prescription was much more thoroughly studied than single herb prescription. The results showed that the complex prescription had both antitumor activity and immuno-activating activity, which might reflects on multi-activation mechanisms by complex components. 3. Classifying the theses by the efficacy of herbs examined, in single herb, invigorating spleen and supplementing was 35.5%, expelling toxin and cooling was 29.0%, activating blood flow and removing blood stasis was 12.9%. In herbal acupuncture, invigorating spleen and supplementing was 52.9%, expelling toxin and cooling was 29.4%. In complex prescription, pathogen-free status was 41.9%, strengthening healthy qi to eliminate pathogen was 35.5%, strengthening healthy qi was 22.6%. It is presumed that the antitumor and immunoactivating therapy based on syndrome differentiation is the best way to develop oriental oncology. 4. Classifying the theses by antitumor experiments, cytotoxic effect was 48.1 %, survival time was 48.1 % and change of tumor size was 42.3%. Survival rate was not necessarily correlated with cytotoxicity. These data reflect the characteristic, wholistic nature of the oriental medicine which is based on BRM (biological response modifier). 5. Classifying the theses by immunoactivating experiments, hemolysin titer was 51.0%, hemagglutinin titer was 46.2% and NK cell's activity was 44.2%. In the future studies, an effort to elucidate specific molecular and cellular mechanisms of cytokine production in the body would be crucial. 6. Classifying the theses according to the data in terms of antitumor activity, 50% was evaluated good, 24.0% was excellent, and 15.5% have no effect. In an evaluation of immuno-activating activity, 35.9% was excellent and 18.0% showed a little effect. The index point, as described here, may helps to use experimental data for clinical trials. Changes in index points by varying dosage implicate the importance of oriental medical theory for prescription. 7. In 167 materials, IIP (immunoactivating index point, mean : 3.12±0.07) was significantly higher than AIP(antitumor index point, mean : 2.83±0.07). These data demonstrate that the effect of herb medicine on tumor activity depends more on immunoactivating activity than antitumor activity. This further implies that the development of herbal antitumor drugs must be preceded by the mechanistic understanding of immunoactivating effect. 8. After medline-searching tumor and herb-related articles from NCBI web site, we conclude that most of the studies are primarily focused on biomolecular mechanisms and/or pathways. Henceforth, we need to define the biomolecular mechanisms and/or pathways affected by herbs or complicated prescriptions. 9. Therefore, the most important point of oriental medical oncology is to conned between experimental results and clinical trials. For the public application of herbal therapy to cancer, it is critical to present the data to mass media. 10. To develop the relationship of experimental results and clinical trials, university's cancer clinic must have a long-range plan related to the university laboratories and, at the same time, a regular consortium for this relationship is imperative. 11. After all these efforts, a new type herbal medicine for cancer therapy which is to take care of the long-term administering and safety problem must be developed. Then, it would be expected that anti-tumor herbal acupuncture can improve clinical symptoms and quality of life (QOL) for cancer patients. 12. Finally, oriental medical cancer center must be constructed in NCC (National Cancer Center) or government agency for the development of oriental medical oncology which has international competitive power.

Cardiac Intracoronary Stenting vs CABG: Prevention of Medical Accident (심장 스텐트 시술과 의료사고 예방)

  • Kim, Kyoung Reay;Park, Kook Yang
    • The Korean Society of Law and Medicine
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    • v.18 no.2
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    • pp.163-194
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    • 2017
  • Coronary artery disease has increased in Korea as the country enters the aged society. It is well known that the incidence of coronary artery disease is related to aging, hypertension, diabetes, hyperlipidemia, and dietary habit. For effective treatment of significant coronary stenosis, close coordination between cardiac surgery and cardiology team is essential. Especially cardiologists' decision whether to do the stent placement or CABG is very important because the cardiologists usually start to consult the patients for their treatment. Recently, non-surgical interventions(that is stent placement) in cardiology field have dramatically increased as the national insurance system removed the limitation of the number of stents deployed. However, accidents are often caused by inappropriate use of stents, especially in patients with triple coronary disease or left main disease with heavy coronary calcifications. Another aspect of stent placement is to cope with an emergency case in the event of coronary rupture or pericardial tamponade during coronary interventions without cardiac surgeons. In the past two years, the Korea Consumer Agency (Consumer Dispute Coordination Committee) analyzed eight cases of medical dispute settlement. Only two hospitals were manned with both cardiologists and cardiac surgeons. Seven patients died of procedures of stenting and five patients died on the day of the procedure. Among the 8 cases, 5 cases showed 3 vessel disease and the rest of the cases had either severe calcification, complete occlusion or poor coronary antomies for stenting According to a 2017 national data registry of coronary stenting, less than 3 drug-eluting stents were implanted in 98% of all patients. In 2015, the number of stent procedures was 38,922, and approximately in 800 (2%) cases, more than four stents were used per patient. We emphasize that it is necessary to seriously consider the cost-benefit analysis between stent and CABG. The patient has the right to choose the right procedure by asking the liability of 'instruction explanation obligation'. He should be well informed of the pros and cons of both procedures to avoid overuse of stent. It can be solved by intimate discussion of individual cases with the cardiac surgeon and the patient. Unilateral dialogue with the patient, forceful restriction on the number of stenting, lack of surgeon's backup in difficult cases should all be avoided. It is also necessary to solve the problem not only at the hospital level, such as multidisciplinary integrated medical care, but also a nationwide solution such as expanding cardiac surgeons as essential personnel to public officials.

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Evaluation and Verification of the Attenuation Rate of Lead Sheets by Tube Voltage for Reference to Radiation Shielding Facilities (방사선 방어시설 구축 시 활용 가능한 관전압별 납 시트 차폐율 성능평가 및 실측 검증)

  • Ki-Yoon Lee;Kyung-Hwan Jung;Dong-Hee Han;Jang-Oh Kim;Man-Seok Han;Jong-Won Gil;Cheol-Ha Baek
    • Journal of the Korean Society of Radiology
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    • v.17 no.4
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    • pp.489-495
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    • 2023
  • Radiation shielding facilities are constructed in locations where diagnostic radiation generators are installed, with the aim of preventing exposure for patients and radiation workers. The purpose of this study is seek to compare and validate the trend of attenuation thickness of lead, the primary material in these radiation shielding facilities, at different maximum tube voltages by Monte Carlo simulations and measurement. We employed the Monte Carlo N-Particle 6 simulation code. Within this simulation, we set a lead shielding arrangement, where the distance between the source and the lead sheet was set at 100 cm and the field of view was set at 10 × 10 cm2. Additionally, we varied the tube voltages to encompass 80, 100, 120, and 140 kVp. We calculated energy spectra for each respective tube voltage and applied them in the simulations. Lead thicknesses corresponding to attenuation rates of 50, 70, 90, and 95% were determined for tube voltages of 80, 100, 120, and 140 kVp. For 80 kVp, the calculated thicknesses for these attenuation rates were 0.03, 0.08, 0.21, and 0.33 mm, respectively. For 100 kVp, the values were 0.05, 0.12, 0.30, and 0.50 mm. Similarly, for 120 kVp, they were 0.06, 0.14, 0.38, and 0.56 mm. Lastly, at 140 kVp, the corresponding thicknesses were 0.08, 0.16, 0.42, and 0.61 mm. Measurements were conducted to validate the calculated lead thicknesses. The radiation generator employed was the GE Healthcare Discovery XR 656, and the dosimeter used was the IBA MagicMax. The experimental results showed that at 80 kVp, the attenuation rates for different thicknesses were 43.56, 70.33, 89.85, and 93.05%, respectively. Similarly, at 100 kVp, the rates were 52.49, 72.26, 86.31, and 92.17%. For 120 kVp, the attenuation rates were 48.26, 71.18, 87.30, and 91.56%. Lastly, at 140 kVp, they were measured 50.45, 68.75, 89.95, and 91.65%. Upon comparing the simulation and experimental results, it was confirmed that the differences between the two values were within an average of approximately 3%. These research findings serve to validate the reliability of Monte Carlo simulations and could be employed as fundamental data for future radiation shielding facility construction.