• Title/Summary/Keyword: Risk Adjustment

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Lack of Associations between Vitamin D Metabolism-Related Gene Variants and Risk of Colorectal Cancer

  • Mahmoudi, Touraj;Karimi, Khatoon;Arkani, Maral;Farahani, Hamid;Nobakht, Hossein;Dabiri, Reza;Asadi, Asadollah;Vahedi, Mohsen;Zali, Mohammad Reza
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.2
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    • pp.957-961
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    • 2014
  • Purpose: With regard to the protective effect of vitamin D against colorectal cancer (CRC), we evaluated genetic variants that might influence vitamin D metabolism: vitamin D receptor (VDR), vitamin D binding protein (GC), vitamin D 25-hydroxylase (CYP2R1), and vitamin D 25-hydroxy 1-alpha hydroxylase (CYP27B1). Materials and Methods: A total of 657 subjects, including 303 cases with CRC and 354 controls were enrolled in this case-control study. All 657 were genotyped for the four gene variants using PCR-RFLP methods. Results: In this study, no significant difference was observed for VDR (rs2238136), GC (rs4588), CYP2R1 (rs12794714), and CYP27B1 (rs3782130) gene variants in either genotype or allele frequencies between the cases with CRC and the controls and this lack of difference remained even after adjustment for age, BMI, sex, smoking status, NSAID use, and family history of CRC. Furthermore, no evidence for effect modification of the variants and CRC by BMI, sex, or tumor site was observed. Conclusions: Our findings do not support a role for VDR, GC, and CYP27B1 genes in CRC risk in our Iranian population. Another interesting finding, which to our knowledge has not been reported previously, was the lack of association with the CYP2R1 gene polymorphism. Nonetheless, our findings require confirmation and possible roles of vitamin D metabolism-related genes in carcinogenesis need to be further investigated.

Mental Health Problems in Child and Adolescent Obesity (비만에 이환된 아동청소년에서 보이는 정신건강문제)

  • Kang, Na Ri;Lee, Ji Sun;Kang, Ki Soo;Kwack, Young Sook
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.27 no.2
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    • pp.119-129
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    • 2016
  • Objectives: The purpose of this study was to investigate mental health problems in obese child and adolescent patients. We assess the frequency of mental health problems and their differences according to sex, school grade and severity of obesity. Methods: The sample consisted of 106 children and adolescents aged 8-16 years (61 boys with mean age $10.98{\pm}2.26$, 45 girls with mean age $9.74{\pm}1.96$, p=.004) who were diagnosed with obesity and recruited at the Department of Pediatrics of Jeju National University Hospital. The participants completed the Korean-Child Behavior Checklist (K-CBCL), Children's Depression Inventory (CDI), Korean version of the Eating Attitude Test-26 (KEAT-26), and somatotype drawings. Results: The percentage of participants having a T-score in clinical range on one or more CBCL subscale was 37.7%. The percentage of participants in the high risk group for depression (CDI score above 17) was 20.8% and that in the high risk group for eating disorder (EAT-26 score above 20) was 6%. The girls showed significantly lower CBCL T-scores in social competence ($48.39{\pm}15.66$ vs. $38.91{\pm}22.04$, p=.011), adjustment function ($49.51{\pm}17.35$ vs. $40.38{\pm}22.58$, p=.020) and school competence ($53.34{\pm}10.47$ vs. $48.22{\pm}15.11$, p=.042) than the boys, but the percentages of boys and girls in clinical range were not significantly different. The middle school students showed (significantly) higher CBCL T-scores in somatic symptoms ($60.86{\pm}9.44$ vs. $55.74{\pm}6.76$, p=.005), aggressive behavior ($58.81{\pm}6.74$ vs. $54.68{\pm}6.22$, p=.009), total problems ($59.86{\pm}9.91$ vs. $54.88{\pm}9.76$, p=.039) and externalizing problems ($57.90{\pm}10.57$ vs. $52.44{\pm}9.38$, p=.022) than the elementary school students. The severe obesity group showed significantly higher CBCL T-scores in attention problems ($59.18{\pm}9.45$ vs. $54.15{\pm}5.34$, p=.001), social problems ($59.25{\pm}8.59$ vs. $55.96{\pm}6.50$, p=.038), delinquent behavior ($58.07{\pm}6.97$ vs. $54.73{\pm}6.00$, p=.017) and total problems ($59.21{\pm}11.65$ vs. $54.67{\pm}9.03$, p=.037) than the mild to moderate obesity group. Conclusion: Significant proportions of obese children and adolescents suffer from mental health problems. Clinicians need to pay attention to the mental health risk, especially in obese adolescents and severely obese children and adolescents.

The hierarchical structures of cause-and-effect relationships on the profit factors in overseas construction projects (해외건설공사 수익성 영향인자의 계층구조 및 사레적용에 관한 연구)

  • Han, Seung-Heon;Sun, Seung-Min;Park, Sang-Hyuk;Jung, Do-Young
    • Korean Journal of Construction Engineering and Management
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    • v.7 no.5
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    • pp.64-76
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    • 2006
  • Korea's overseas construction industry has been rather depressed by the weakened profitability as well as the sharp decrease of the market shares due to the lack of international competitiveness and the declined international market. There exist a lot of various risks in performing the overseas construction, and especially EPC projects, which entail complicated process from different parts, also require a sophisticated procurement and management skill. Subsequently, to survive in the competitive international market, we need to establish strategies to select potentially profitable projects at the initial stage of bidding process and to mitigate the high degree of risk exposure through contract negotiation and its adjustment. This research discusses the trend of environment in international construction markets. Then, it identifies the key factors that affect the profitability significantly through the structured surveys from 59 actual overseas projects, and it analyzes the key factors by using statistical methods. This research provides the profitability evaluation bases, with which overseas construction participants can forecast and analyze the risk more systematically, by eliciting profit-influencing factors using the result of statistical analysis, literature review and structuring their cause-and-effect relationships. The profitability casual hierarchy structure describes the profitability factors' hierarchy in details and their interrelationships. It also enables us to find out critical factors directly related to profitability aggravation through a qualitative and quantitative analysis. Ultimately, with this hierarchy structure as the base, the research will suggest how to develop the quantitative profitability forecasting model.

Comparison of Meta-analysis Results with and Without Adjustment for Healthy Worker Effect on the Association Between Occupational Exposure to Trichloroethylene and Cancer Risk (건강근로자효과 보정 전후의 메타 분석 결과 비교 -직업적 트리클로로에틸렌 노출과 암의 연관성-)

  • Park, Tae Won;Hwang, Sung Ho;Lee, Kyoung-Mu
    • Journal of Environmental Health Sciences
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    • v.40 no.5
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    • pp.385-396
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    • 2014
  • Objectives: By conducting a meta-analysis of cohort studies reporting standardized mortality ratios (SMRs) for workers exposed to trichloroethylene, we attempted to adjust for healthy hired effect by applying the same methods as described in a recent report from the Agricultural Health Study. Methods: Among all cohort studies that evaluated the association between all cancer, non-Hodgkin's lymphoma (NHL), kidney cancer, liver cancer and occupational exposure to trichloroethylene, a total of 10 studies reporting SMR values were selected. A random-effects model was used to estimate the summary SMRs or rSMRs and 95% confidence intervals. Relative SMR ($rSMR=SMR_x/SMR_{not\;x}$) was calculated comparing observed and expected counts for all cancer, NHL, kidney cancer, and liver cancer with an independent referent set of values consisting of the observed and expected counts for other causes. Results: The SMR values for all causes ranged from 0.68 to 1.03, suggesting moderate to weak healthy worker effect for the selected studies. When the healthy worker hire effect was taken into account, the summarized risk became statistically significant; the summary SMR of all cancer was 0.95 (0.91-1.00) and the summary rSMR of all cancer was 1.10 (1.04-1.15). The summary SMR of NHL was 1.04 (0.93-1.14) and the summary rSMR of NHL was 1.23 (1.04-1.46). The summary SMR of kidney cancer was 1.08 (0.88-1.33) and the summary rSMR of kidney cancer was 1.23 (1.02-1.49). The summary SMR of liver cancer was 0.88 (0.78-0.99), and the summary rSMR of liver cancer was 0.95 (0.84-1.07). Conclusion: The rSMR method is useful to determine summary risk adjusted for healthy worker effect through meta-analysis.

Relationship Between Fatty Liver and Coronary Risk Factors among Health Examined Adult Women in an University Hospital (한 대학병원 건강검진센터에 내원한 성인 여성의 지방간과 관상동맥질환위험인자와의 관련성)

  • Lee, Kwang-Sung;Park, Jae-Young;Cho, Young-Chae
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.12 no.7
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    • pp.3130-3137
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    • 2011
  • The present study was to elucidate such a relationship by comparing the coronary risk factors with and without fatty liver adjusted for age and/or BMI. Study subjects were 665 women of 30 years and over, who underwent health package check-up at the health promotion center of an university hospital from July, 2009 to June, 2010. As a results, the prevalence rates of fatty liver of study subjects were 11.6%, and the rates were significantly higher in older age group, in the group of higher level of BMI. The group of subjects with fatty liver had significantly lower mean HDL-cholesterol and higher levels of body fat rate, TG, TC, LDL-cholesterol, FBS and ALT, then those parameters in subjects without fatty liver, even after adjustment for age and/or BMI. In age and BMI adjusted logistic regressions, The odds ratio of fatty liver was increased significantly as there is an increase in the abnormal group with TG, TC, LDL-C and ALT.

The Association Between Apolipoprotein E Genotype and Lipid Profiles in Healthy Woman Workers (건강한 여성 근로자에서 Apolipoprotein E와 혈중 지질 농도와의 관련성)

  • Moon, Gi-Eun;Sung, Sook-Hee;Chang, Youn-Koun;Park, Il-Keun;Paek, Yun-Mi;Kim, Soo-Geun;Choi, Tae-In;Jin, Young-Woo
    • Journal of Preventive Medicine and Public Health
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    • v.43 no.3
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    • pp.213-221
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    • 2010
  • Objectives: Plasma lipid profiles and Apolipoprotein E (ApoE) are established risk factors for cardiovascular disease (CVD). The knowledge of lipid profile may estimate the potential victims of cardiovascular disease before its initiation and progression and offers the opportunity for primary prevention. The most common ApoE polymorphism has been found to influence plasma lipid concentrations and its correlation with CVD has been extensively investigated in the last decade. Methods: The ApoE polymorphism and its influence on plasma lipid were investigated in healthy woman workers. The information on confounding factors was obtained through a self-administered questionnaire and ApoE polymorphism was investigated using PCR. Results: The relative frequencies of alleles E2, E3 and E4 for the study population (n = 305) were 0.127, 0.750 and 0.121, respectively. ApoE polymorphism was associated with variations in plasma HDL-cholesterol lipid profile. In order to estimate the independent effects of alleles E2 and E4, as compared with E3, on lipid profile, multiple regression was performed after adjustment for confounding variables such as age, BMI, blood pressure, education status, insulin, fasting glucose, HOMA-IR, menopause. ApoE2 had a negative association with HDL cholesterol and ApoE4 had a positive association with LDL cholesterol. Conclusions: This study identified that the ApoE and CVD risk factors contribute to the lipid profiles, similar to other studies. The analysis including dietary intake and other gene in further studies may help to identify clear effects on lipid profiles as risk factor for CVD.

Liver-to-Spleen Volume Ratio Automatically Measured on CT Predicts Decompensation in Patients with B Viral Compensated Cirrhosis

  • Ji Hye Kwon;Seung Soo Lee;Jee Seok Yoon;Heung-Il Suk;Yu Sub Sung;Ho Sung Kim;Chul-min Lee;Kang Mo Kim;So Jung Lee;So Yeon Kim
    • Korean Journal of Radiology
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    • v.22 no.12
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    • pp.1985-1995
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    • 2021
  • Objective: Although the liver-to-spleen volume ratio (LSVR) based on CT reflects portal hypertension, its prognostic role in cirrhotic patients has not been proven. We evaluated the utility of LSVR, automatically measured from CT images using a deep learning algorithm, as a predictor of hepatic decompensation and transplantation-free survival in patients with hepatitis B viral (HBV)-compensated cirrhosis. Materials and Methods: A deep learning algorithm was used to measure the LSVR in a cohort of 1027 consecutive patients (mean age, 50.5 years; 675 male and 352 female) with HBV-compensated cirrhosis who underwent liver CT (2007-2010). Associations of LSVR with hepatic decompensation and transplantation-free survival were evaluated using multivariable Cox proportional hazards and competing risk analyses, accounting for either the Child-Pugh score (CPS) or Model for End Stage Liver Disease (MELD) score and other variables. The risk of the liver-related events was estimated using Kaplan-Meier analysis and the Aalen-Johansen estimator. Results: After adjustment for either CPS or MELD and other variables, LSVR was identified as a significant independent predictor of hepatic decompensation (hazard ratio for LSVR increase by 1, 0.71 and 0.68 for CPS and MELD models, respectively; p < 0.001) and transplantation-free survival (hazard ratio for LSVR increase by 1, 0.8 and 0.77, respectively; p < 0.001). Patients with an LSVR of < 2.9 (n = 381) had significantly higher 3-year risks of hepatic decompensation (16.7% vs. 2.5%, p < 0.001) and liver-related death or transplantation (10.0% vs. 1.1%, p < 0.001) than those with an LSVR ≥ 2.9 (n = 646). When patients were stratified according to CPS (Child-Pugh A vs. B-C) and MELD (< 10 vs. ≥ 10), an LSVR of < 2.9 was still associated with a higher risk of liver-related events than an LSVR of ≥ 2.9 for all Child-Pugh (p ≤ 0.045) and MELD (p ≤ 0.009) stratifications. Conclusion: The LSVR measured on CT can predict hepatic decompensation and transplantation-free survival in patients with HBV-compensated cirrhosis.

A Study on the Effects of Risk Factors and Protection Factors of Care givers on Job Change Intention: Focused on the Mediation Effect of Occupational Adaptation (요양보호사의 위험요인과 보호요인이 이직의도에 미치는 영향 연구: 직업적응의 매개효과 중심으로)

  • Park, Su Jan;Kim, Youn Jae
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.13 no.2
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    • pp.159-175
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    • 2018
  • The purpose of this study was to identify the factors that could overcome the crisis and adversity of the nursing care provider through understanding the effect of job adaptation on the turnover intention of the nursing care provider and to contribute to the various problems of the nursing care provider in the long term. In order to confirm this as an empirical research task, risk factors and protection factors, general characteristics of the survey subjects, job adaptation and turnover intention were selected, and the risk factors and protective factors of caregivers' As a mediator. So Seoul. The results of the questionnaire survey were as follows: 291 caregivers in the elderly medical welfare facilities in Gyeonggi area. First, as the relationship between the risk factors and protective factors of occupational caregivers and occupational adaptation were more severe, the higher the maladjustment of the workplace culture, the more the job satisfaction and organizational commitment were adversely affected. The emotional support, The higher the information support, the more satisfied and satisfied the job. Second, the relationship between the risk factors of the caregiver and the protective factors and the turnover intention, the higher the conflict of caregivers, the more unstable the workplace, the more difficult it is to adapt to work culture, Respectively. Finally, as a result of verifying the mediating effect of occupational adaptation on the relationship between risk factors and protective factors and turnover intention of caregivers, job satisfaction, which is a sub-factor of job adaptation, It is shown that they play mediating roles only in the relationship between stress and turnover intention, and do not play a mediating role in the relationship between protective factor self - efficacy and social support and turnover intention. In other words, if caregivers feel satisfaction about their job, they can be less stressed on their jobs, improve their self-efficacy, and have a positive attitude toward social support. Also, it was found that the more the caregiver 's immersion into the organization, the less job stress and turnover intention decreased, but the self - efficacy and social support perception were not influenced. Based on this, the director of the facility should strive to stabilize the operation of the facility and provide high-quality services by seeking ways to improve conflict resolution and adaptation to the workplace culture so that nursing care workers can adapt to their work. And it is required to develop active management strategies and institutional support for improving job satisfaction and organizational commitment of caregivers.

Breast Screening and Breast Cancer Survival in Aboriginal and Torres Strait Islander Women of Australia

  • Roder, David;Webster, Fleur;Zorbas, Helen;Sinclair, Sue
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.1
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    • pp.147-155
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    • 2012
  • Aboriginal and Torres Strait Islander people comprise about 2.5% of the Australian population. Cancer registry data indicate that their breast cancer survivals are lower than for other women but the completeness and accuracy of Indigenous descriptors on registries are uncertain. We followed women receiving mammography screening in BreastScreen to determine differences in screening experiences and survivals from breast cancer by Aboriginal and Torres Strait Islander status, as recorded by BreastScreen. This status is self-reported and used in BreastScreen accreditation, and is considered to be more accurate. The study included breast cancers diagnosed during the period of screening and after leaving the screening program. Design: Least square regression models were used to compare screening experiences and outcomes adjusted for age, geographic remoteness, socio-economic disadvantage, screening period and round during 1996-2005. Survival of breast cancer patients from all causes and from breast cancer specifically was compared for the 1991-2006 diagnostic period using linked cancer-registry data. Cox proportional hazards regression was used to adjust for socio-demographic differences, screening period, and where available, tumour size, nodal status and proximity of diagnosis to time of screen. Results: After adjustment for socio-demographic differences and screening period, Aboriginal and Torres Strait Islander women participated less frequently than other women in screening and re-screening although this difference appeared to be diminishing; were less likely to attend post-screening assessment within the recommended 28 days if recalled for assessment; had an elevated ductal carcinoma in situ but not invasive cancer detection rate; had larger breast cancers; and were more likely than other women to be treated by mastectomy than complete local excision. Linked cancer registry data indicated that five-year year survivals of breast cancer cases from all causes of death were 81% for Aboriginal and Torres Strait Islander women, compared with 90% for other women, and that the former had larger breast cancers that were more likely to have nodal spread at diagnosis. After adjusting for socio-demographic factors, tumour size, nodal spread and time from last screen to diagnosis, Aboriginal and Torres Strait Islander women had approximately twice the risk of death from breast cancer as other women. Conclusions: Aboriginal and Torres Strait Islander women have less favourable screening experiences and those diagnosed with breast cancer (either during the screening period or after leaving the screening program) have lower survivals that persist after adjustment for socio-demographic differences, tumour size and nodal status.

The Effect of Gender Difference in Injury Experience on Biomechanical Variables of Lower Extremity during Two Leg Drop Landing (양발 착지 시 성별에 따른 상해 경험이 하지관절의 운동역학적 변인에 미치는 영향)

  • Lee, Seong-Yeol;Kwon, Moon-Seok
    • Journal of the Korean Applied Science and Technology
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    • v.36 no.2
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    • pp.424-433
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    • 2019
  • The purpose of this study was to investigate the effects of gender difference in injury experience on biomechanical variables of lower extremity during two leg drop landing. 20 male(injury experience=8, non-injury experience=12) and 20 female(injury experience=11, non-Injury Experience=9) in their 20's were selected as subjects. Two-way mixed ANOVA was performed on the biomechanical variables obtained from the two leg drop landing in a 45cm height box and post-test was performed with bonferroni adjustment(p <.05). The results of this study suggest that the group of female who injury experience could induce the reduction of the peak vertical ground reaction force by increasing the valgus and internal rotation of the knee joint and flexion and internal rotation of the hip joint. In the INE(injury non-experienced) female group, the peak knee flexion angle was the smallest, as well as the flexion of the hip joint and the external rotation angle, and the peak vertical ground reaction force was the highest. On the other hand, the INE female group showed high vertical ground reaction force because they did not utilize the knee and hip joints relatively than the IE(injury experienced) female group, this means that it is relatively exposed to the risk of injury. Therefore, it was found that gender difference in injury experience is a factor affecting factors of knee and hip joint movement and peak vertical GRF(ground reaction force).