• Title/Summary/Keyword: Risk Adjustment

Search Result 386, Processing Time 0.021 seconds

A Literature Review on Trauma from Occlusion (교합성 외상에 관한 논쟁의 고찰)

  • Park, Go-Woon;Kim, Dae-Gon;Park, Chan-Jin;Cho, Lee-Ra
    • Journal of Dental Rehabilitation and Applied Science
    • /
    • v.27 no.4
    • /
    • pp.423-436
    • /
    • 2011
  • Trauma from occlusion (TFO) is a pathologic alterations which develop in the periodontium as a result of undue masticatory force. The purpose of this article is to review the controversies about TFO. There are evidences that TFO is a risk factor in the progression of periodontitis. Tooth mobility should be reduced by selective occlusal adjustment. TFO can be developed dependent on the masticatory pattern, occlusion and anterior overbite in sound periodontal conditions. Secondary TFO may aggravate unstable occlusion. If "loss of posterior support" was occur, the problems were worsen. Extrusion, migration, rotation and pathologic deviation can be resulted. Opposite contention is the "shortened dental arch" concept. However, these two concepts persue the occlusal stability together. To treat TFO adequately, exact diagnosis and multi-disciplinary treatment should be needed.

Diagnostic Value of Fecal Calprotectin as a Screening Biomarker for Gastrointestinal Malignancies

  • Khoshbaten, Manouchehr;Pishahang, Parinaz;Nouri, Mohammad;Lashkari, Alireza;Alizadeh, Mahasti;Rostami-Nejad, Mohammad
    • Asian Pacific Journal of Cancer Prevention
    • /
    • v.15 no.4
    • /
    • pp.1667-1670
    • /
    • 2014
  • Background: Calprotectin in feces seems to be a more sensitive marker for gastrointestinal (GI) cancers than fecal occult blood, but its specificity may be too low for screening average risk populations. This study aims at evaluating the diagnostic value of fecal calprotectin as a screening biomarker for GI malignancies. Materials and Methods: In a case-control study, 100 patients with GI malignancies (50 patients with colorectal cancer and 50 patients with gastric cancer) and 50 controls were recruited in Tabriz Imam Reza and Sina hospitals during a 24-month period. One to two weeks after the last endoscopy/colonoscopy, fecal specimens were collected by the patients and examined by ELISA method for quantitative measurement of calprotectin content. The results were compared between the three groups. Results: The mean fecal calprotectin level was $109.1{\pm}105.3$ (2.3-454.3, median:74), $241.1{\pm}205.2$ (3.4-610.0, median:19.3) and $45.9{\pm}55.1{\mu}g/g$ (1.3-257.1, median:19.3) in gastric cancer, colorectal cancer and control group, respectively, the differences being significant (p<0.001) and remaining after adjustment for age. The optimal cut-off point for fecal calprotectin was ${\geq}75.8{\mu}g/g$ for distinguishing colorectal cancer from normal cases (sensitivity and specificity of 80% and 84%, respectively). This value was ${\geq}41.9{\mu}g/g$ for distinguishing gastric cancer from normal cases (sensitivity and specificity of 62%). Conclusions: Our results revealed that fecal calprotectin might be a useful and non-invasive biomarker for distinguishing colorectal cancer from non-malignant GI conditions. However, due to low sensitivity and specificity, this biomarker may not help physicians distinguishing gastric cancer cases from healthy subjects.

Smoking Trajectories among Koreans in Seoul and California: Exemplifying a Common Error in Age Parameterization

  • Allem, Jon-Patrick;Ayers, John W.;Unger, Jennifer B.;Irvin, Veronica L.;Hofstetter, C. Richard;Hovell, Melbourne F.
    • Asian Pacific Journal of Cancer Prevention
    • /
    • v.13 no.5
    • /
    • pp.1851-1856
    • /
    • 2012
  • Immigration to a nation with a stronger anti-smoking environment has been hypothesized to make smoking less common. However, little is known about how environments influence risk of smoking across the lifecourse. Research suggested a linear decline in smoking over the lifecourse but these associations, in fact, might not be linear. This study assessed the possible nonlinear associations between age and smoking and examined how these associations differed by environment through comparing Koreans in Seoul, South Korea and Korean Americans in California, United States. Data were drawn from population based telephone surveys of Korean adults in Seoul (N=500) and California (N=2,830) from 2001-2002. Locally weighted scatterplot smoothing (lowess) was used to approximate the association between age and smoking with multivariable spline logistic regressions, including adjustment for confounds used to draw population inferences. Smoking differed across the lifecourse between Korean and Korean American men. The association between age and smoking peaked around 35 years among Korean and Korean American men. From 18 to 35 the probability of smoking was 57% higher (95%CI, 40 to 71) among Korean men versus 8% (95%CI, 3 to 19) higher among Korean American men. A similar difference in age after 35, from 40 to 57 years of age, was associated with a 2% (95%CI, 0 to 10) and 20% (95%CI, 16 to 25) lower probability of smoking among Korean and Korean American men. A nonlinear pattern was also observed among Korean American women. Social role transitions provide plausible explanations for the decline in smoking after 35. Investigators should be mindful of nonlinearities in age when attempting to understand tobacco use.

Neutrophil to Lymphocyte Ratio - Not an Independent Prognostic Factor in Patients with the Myelodysplastic Syndrome

  • Akinci, Sema;Silay, Kamile;Ulas, Arife;Guney, Tekin;Hacibekiroglu, Tuba;Basturk, Abdulkadir;Akinci, Muhammed Bulent;Alkan, Afra;Dilek, Imdat
    • Asian Pacific Journal of Cancer Prevention
    • /
    • v.15 no.24
    • /
    • pp.10883-10885
    • /
    • 2015
  • Purpose: Neutrophil-to-lymphocyte ratio (NLR) was evaluated as a potential prognostic factor in patients with myelodysplastic syndrome (MDS). Materials and Methods: Between December 2009 and April 2014, 14 female (35%) and 26 male (65%) MDS patients who were followed up in our hematology clinic were included in the study for NLR during diagnosis. Division was into two groups according to the NLR, and the correlation with mortality was evaluated. The prognostic significance of NLR regarding treatment outcome was also evaluated with adjustment for known confounding risk factors. Results: The mortality rate of the patient group was 55%, and median survival was 18 months. There was no significant correlation between mortality and NLR at a median value of 1.8 (p=0.75). Thrombocytopenia was observed to increase mortality (p=0.027), and there was a significant correlation between mortality and pancytopenia (p=0.017). Conclusions: This first study of NLR and mortality did not show any significant correlation. In centres with limited access to genetic evaluation for the presence of pancytopenia and/or thrombocytopenia at the time of diagnosis, a platelet level less than $50{\times}10^9/l$ may be poor prognostic markers in MDS patients.

A Comparative Study on Comorbidity Measurements with Lookback Period using Health Insurance Database: Focused on Patients Who Underwent Percutaneous Coronary Intervention (건강보험 청구자료에서 동반질환 보정방법과 관찰기관 비교 연구: 경피적 관상동맥 중재술을 받은 환자를 대상으로)

  • Kim, Kyoung-Hoon;Ahn, Lee-Su
    • Journal of Preventive Medicine and Public Health
    • /
    • v.42 no.4
    • /
    • pp.267-273
    • /
    • 2009
  • Objectives : To compare the performance of three comorbidity measurements (Charlson comorbidity index, Elixhauser s comorbidity and comorbidity selection) with the effect of different comorbidity lookback periods when predicting in-hospital mortality for patients who underwent percutaneous coronary intervention. Methods : This was a retrospective study on patients aged 40 years and older who underwent percutaneous coronary intervention. To distinguish comorbidity from complications, the records of diagnosis were drawn from the National Health Insurance Database excluding diagnosis that admitted to the hospital. C-statistic values were used as measures for in comparing the predictability of comorbidity measures with lookback period, and a bootstrapping procedure with 1,000 replications was done to determine approximate 95% confidence interval. Results : Of the 61,815 patients included in this study, the mean age was 63.3 years (standard deviation: ${\pm}$10.2) and 64.8% of the population was male. Among them, 1,598 2.6%) had died in hospital. While the predictive ability of the Elixhauser's comorbidity and comorbidity selection was better than that of the Charlson comorbidity index, there was no significant difference among the three comorbidity measurements. Although the prevalence of comorbidity increased in 3 years of lookback periods, there was no significant improvement compared to 1 year of a lookback period. Conclusions : In a health outcome study for patients who underwent percutaneous coronary intervention using National Health Insurance Database, the Charlson comorbidity index was easy to apply without significant difference in predictability compared to the other methods. The one year of observation period was adequate to adjust the comorbidity. Further work to select adequate comorbidity measurements and lookback periods on other diseases and procedures are needed.

A FRAM-based Systemic Investigation of a Rail Accident Involving Human Errors (인적오류가 관여된 철도 사고의 체계적 분석을 위한 FRAM의 활용)

  • Choi, Eun-Bi;Ham, Dong-Han
    • Journal of the Korea Safety Management & Science
    • /
    • v.22 no.1
    • /
    • pp.23-32
    • /
    • 2020
  • There has been a significant decline in the number of rail accidents in Korea since system safety management activities were introduced. Nonetheless, analyzing and preventing human error-related accidents is still an important issue in railway industry. As a railway system is increasingly automated and intelligent, the mechanism and process of an accident occurrence are more and more complicated. It is now essential to consider a variety of factors and their intricate interactions in the analysis of rail accidents. However, it has proved that traditional accident models and methods based on a linear cause-effect relationship are inadequate to analyze and to assess accidents in complex systems such as railway systems. In order to supplement the limitations of traditional safety methods, recently some systemic safety models and methods have been developed. Of those, FRAM(Functional Resonance Analysis Method) has been recognized as one of the most useful methods for analyzing accidents in complex systems. It reflects the concepts of performance adjustment and performance variability in a system, which are fundamental to understanding the processes of an accident in complex systems. This study aims to apply FRAM to the analysis of a rail accident involving human errors, which occurred recently in South Korea. Through the application of FRAM, we found that it can be a useful alternative to traditional methods in the analysis and assessment of accidents in complex systems. In addition, it was also found that FRAM can help analysts understand the interactions between functional elements of a system in a systematic manner.

Comparison of Nutrient Intake between Hypercholesterolemic and Normal groups based on the 6th Korea National Health and Nutrition Examination Survey (고콜레스테롤혈증군과 정상군의 영양소 섭취량 비교: 제6기 국민건강영양조사 자료 활용)

  • Lee, Hyun-A;Kim, Hyung-Sook
    • Korean Journal of Community Nutrition
    • /
    • v.25 no.5
    • /
    • pp.396-405
    • /
    • 2020
  • Objectives: This study was conducted to compare the nutrient intake of normal healthy adults with those having hypercholesterolemia. Methods: We analyzed data from the 6th Korea National Health and Nutrition Examination Survey (KNHANES VI). A total of 12,636 adults (5,223 males and 7,413 females) aged 19 or older were included in the study. Results: Males with hypercholesterolemia were older and had a higher waist circumference, body mass index, fasting blood sugar levels (FBS) and serum triglyceride (TG) concentrations compared to the normal group. Females with hypercholesterolemia were older and had higher FBS levels and serum TG concentrations compared to the normal group. While comparing nutrient intake by the 24-hour recall method, the male normal group showed a higher intake of fat, saturated fatty acid (SFA), monounsaturated fatty acid (MUFA), vitamin A and thiamin compared to the hypercholesterolemic group. However, the male normal group had a lower intake of iron and vitamin C compared to the hypercholesterolemic group. The female normal group had a higher intake of energy, protein, fat, SFA, MUFA, polyunsaturated fatty acids, cholesterol, riboflavin, and niacin compared to the hypercholesterolemic group, but had a lower intake of iron compared to the hypercholesterolemic group. A comparison of nutrient intake by food frequency questionnaire (FFQ) showed the following: There was no significant difference in nutrient intake between the normal men and women and those with hypercholesterolemia. After adjustment for confounding factors, nutrient intake by FFQ of the male normal group showed higher levels of n-3 fatty acid and vitamin C compared to the group with hypercholesterolemia. However, there was no significant difference in nutrient intake between the two groups of women. Conclusions: The average intake of n-3 fatty acids and vitamin C of the male group with hypercholesterolemia was lower than that of the normal group. However, since KNHANES is a cross-sectional study, prospective cohort studies are required to analyze the risk factors of hypercholesterolemia.

The relationship between socio-economic factors and self-rated health among older people (노인의 사회 경제적 수준과 주관적 건강수준과의 관계)

  • Lee Hoo Yeon;Kim Sung A;Lee Hye Jean;Jung Sang Hyuk
    • Health Policy and Management
    • /
    • v.15 no.2
    • /
    • pp.70-83
    • /
    • 2005
  • The purpose of this paper is to examine the relationship between socio-economic factors and self-rated health among older people living in the community. In addition, the study tries to determine whether risk differentials by these socio-economic factors can be explained by other demographic factors, chronic diseases, and functional status. We surveyed to investigate the self-rated health of 397 study samples which had been selected by stratified randomized sampling, $2.7\%$ by each Dong (district) of S-city in Gyeonggi-do. Our study found that the socioeconomic factors such as income, occupation, and insurance were significantly associated with self-rated health. The level of social economic status was positively associated with the level of self-rated health. Two-staged multivariate analysis demonstrated that this relationship was still significant even after adjustment for demographic factors, chronic diseases, and functional status. In conclusion, there are wide socio-economic disparities in self-rated health of older people in this community. It is important that government should know not only health status but also the health-associated factors in order to prepare for the aged society and improve the health status of the elderly. Further researches should uncover causality and mechanism by which SES affects changes in functional health among the elderly.

Analysis of Direct Nursing Activity and Patient Outcomes Related to Graded Fee of Nursing Management for Inpatient (입원환자 간호관리료 차등제에 따른 직접간호활동 및 환자결과 비교)

  • 박성희
    • Journal of Korean Academy of Nursing
    • /
    • v.33 no.1
    • /
    • pp.122-129
    • /
    • 2003
  • Purpose: The purpose of this study is to examine the difference of direct nursing activity and patient outcomes as mortality rate, complication rate, readmission rate and length of stay related to graded fee of nursing management for inpatient. Method: The subjects of this study were 44 general hospitals with more than 500 beds. Data totaled to 86,044 claims provided to inpatients in Jan. 2001 requested by an electronic data interchange from a Health Insurance Review Agency. The data was analyzed by SPSS win(ver.10.0) and statistical methods used were frequency, one-way ANOVA, $X^2$-Test and regression. Result: Synthetic judgment through performance index and 95% confidence interval, direct nursing activity showed to provided adequate quality of nursing care on 2nd, 3rd, 4th and 6th nursing degree. Also, patient outcomes showed difference by graded fee of nursing management for inpatient. Mortality rate of 2nd was the lowest with P.I. 67.9, 3rd, 5th, 6th, 4th in order. In case of complication rate, 2nd, 3rd and 4th were lower than other nursing degree. Readmission rate of 4th and 5th was the lowest. Length of stay of 2nd was the shortest with P.I. 88.3, 3rd, 4th, 5th, 4th, 6th in order. Conclusion: The findings from this study showed that, the higher nurse-to-patient ratio, the greater amount of direct nursing care activity for the patient. Also, the more direct nursing activities influenced a lower mortality rate, complication rate and readmission rate, shorter length of stay.

A study about the Life Expectancy, Quality of Life and QALYs of Stroke patients (뇌졸중 환자의 기대여명과 삶의 질, QALY에 대한 연구)

  • Kim, Nam-Kwen;Lee, Dong-Hyo;Jo, Ga-Won;Seo, Eun-Sung
    • Journal of Society of Preventive Korean Medicine
    • /
    • v.16 no.3
    • /
    • pp.15-26
    • /
    • 2012
  • Objective : Only a few studies have investigated the life expectance and health related quality of life (HRQOL) about stroke patients. The purpose of this study is to analyze the life expectancy, preference based quality of life(QOL) and quality adjusted life years(QALYs) of stroke patients. Methods : We used data of 10,533 adults from 4th Korean national health and nutritional examination survey 2009 for evaluating HRQOL of stroke patients. We also analyzed the life expectancy for stroke patients using life table from national public health data. Finally we calculated the QALYs with and without stroke conditions and assumed the difference of QALYs. Results : The mean age of stroke patients was assumed to be 65. Lower income and less educated groups were prone to be exposed to the stroke conditions. Common comorbidities of stroke patients were ischemic heart attack, hypertension, diabetes and hyperlipidemia. The proportions of participants who reported problems in each of the five EQ-5D dimensions increased significantly at chronic stroke group. Participants with chronic stroke conditions had an almost 6-fold higher risk of impaired health utility(the lowest quartile of EQ-5D utility score) compared with non stroke participants, after adjustment of age, gender, income, education, comorbidity variables. The differences of life expectancy and QALYs between non-stroke and stroke group from the age of 65 till death were assumed to be 0.767 year and 3.103 QALYs. Conclusions : Although the authors analyzed the affecting factors of QOL and assumed the differences of life expectance and QALYs about stroke patients using domestic national data and statistic references, well designed cohort studies should be needed to prove the causal effects of affecting factors and to assume more correct QALY differences.