• Title/Summary/Keyword: Risk Adjustment

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Analysis of dietary behavior and intake related to glycemic control in patients with type 2 diabetes aged 30 years or older in Korea: Utilizing the 8th Korea National Health and Nutrition Examination Survey (2019-2021)

  • Jin-Ah Seok;Yeon-Kyung Lee
    • Nutrition Research and Practice
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    • v.18 no.2
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    • pp.239-256
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    • 2024
  • BACKGROUND/OBJECTIVES: Over the past 10 yrs, the prevalence of diabetes in Korea has continued to incline, and the importance of lifestyle modification to manage diabetes has been highlighted. For patients with diabetes, carbohydrate intake reduction is effective in improving glycemic control; thus, we aimed to analyze the effect of carbohydrate intake ratio and suggest an appropriate carbohydrate intake ratio. SUBJECTS/METHODS: Using the 8th Korea National Health and Nutrition Examination Survey (2019-2021), we analyzed the data including participants aged 30 yrs or older with diabetes, and they were stratified into good and poor glycemic control groups. To analyze the correlation between the dietary behavior characteristics of participants with diabetes and the carbohydrate intake ratio, sociodemographic characteristics, dietary behavior, and health behavior were adjusted, and multivariate logistic regression analysis was conducted to present the adjusted odds ratio and 95% confidence interval (CI). RESULTS: In the unadjusted crude model, when carbohydrate intake ratio in total energy intake increased by 1%, the likelihood of poor glycemic control increased by 1.007-fold (95% CI, 0.998-1.016; P = 0.121). In model 1, which uses age and sex as adjustment variables, an increase of up to 1.011-fold was possible (95% CI, 1.001-1.021; P = 0.008). In model 2, which added variables such as diabetes duration, frequency of fruit consumption, frequency of lunch and, frequency of dinner, the risk of poor glycemic control increased by 1.010-fold as the carbohydrate intake ratio increased (95% CI, 0.998-1.022; P < 0.001). CONCLUSION: This study confirmed that as the ratio of carbohydrate intake to total energy intake increases the likelihood of poor glycemic control also increases in patients with diabetes. Therefore, to improve glycemic control in patients with diabetes, controlling the carbohydrate intake may be helpful.

Comparison of Emotional and Psychological Characteristics between Suicide Attempters and Non-Attempters in Depressed Patients : Using MMPI-2 Profiles (우울장애 환자의 자살 시도 여부에 따른 심리적 특성의 차이 : MMPI-2 프로파일을 중심으로)

  • Lee, Seul-Ah;Kim, Keun-Hyang;Suh, Shin-Young
    • Korean Journal of Psychosomatic Medicine
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    • v.20 no.1
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    • pp.40-49
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    • 2012
  • Objectives : To examine emotional and psychological characteristics associated with suicide attempts in depressed patients. Methods : A sample of 37 inpatients diagnosed with major depressive disorder or depressive disorder NOS was divided into two groups : lifetime suicide attempters(N=15 ; 40.54%), non-attempters(N=22 ; 59.46%). Beck Depression Scale(BDI), Beck Anxiety Scale(BAI), Hamilton Depression Rating Scale(HDRS), Hamilton Anxiety Rating Scale(HARS), and MMPI-2 were used to evaluate symptoms severity and psychological characteristics. Results : Suicide attempters scored higher on the BDI though there were no group differences on the HDRS and on the both anxiety scales. Also they showed higher scores on the F, Fb, Pa, RC1, DEP, HEA, PK, AAS among MMPI-2 subscales. Our findings suggest that suicide attempters among depressed patients undergo more severe subjective distress and difficulties in adjustment than non-attempters. Also they were more hostile to others and showed lower trust. Lastly, they showed more somatic complaints and substance related problems. Conclusion : The present study showed that suicide attempters among depressed patients have distinct emotional and psychological characteristics. MMPI-2 would be helpful to assess suicidal risk of depressed patients.

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Inter-Facility Transport on Extracorporeal Life Support: Clinical Outcomes and Comparative Analysis with In-house Patients

  • Hong, Tae Hee;Lee, Heemoon;Jung, Jae Jun;Cho, Yang Hyun;Sung, Kiick;Yang, Ji-Hyuk;Lee, Young-Tak;Cho, Su Hyun
    • Journal of Chest Surgery
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    • v.50 no.5
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    • pp.363-370
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    • 2017
  • Background: Extracorporeal life support (ECLS) is widely used in refractory heart or lung failure, and the demand for inter-facility transportation on ECLS is expanding. However, little is known about post-transportation outcomes, the clinical safety of such transportation, or the characteristics of the transported patients. Methods: This was a retrospective review of a 3-year, single-institution experience with inter-facility ECLS transport, as well as a comparative analysis of clinical outcomes with those of in-house patients. We also analyzed the risk factors for hospital mortality in the entire ECLS population using univariate and multivariate analyses to investigate the effects of transport. Results: All 44 patients were safely transported without adverse events. The average travel distance was 178.7 km, with an average travel time of 74.0 minutes. Early survival of the transported group seemed to be better than that of the in-house group, but the difference was not statistically significant (70.5% vs. 56.6%, p=0.096). The incidence of complications was similar between the 2 groups, except for critical limb ischemia, which was significantly more common in the transported group than in the in-house group (25.0% vs. 8.1%, p=0.017). After adjusting for confounders, being part of the transported group was not a predictor of early death (adjusted odds ratio, 0.689; p=0.397). Conclusion: Transportation of patients on ECLS is relatively safe, and the clinical outcomes of transported patients are comparable to those of in-house ECLS patients. Although matched studies are required, our study demonstrates that transporting patients on ECLS did not increase their risk of hospital mortality after adjustment for other factors.

Feasibility study of the beating cancellation during the satellite vibration test

  • Bettacchioli, Alain
    • Advances in aircraft and spacecraft science
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    • v.5 no.2
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    • pp.225-237
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    • 2018
  • The difficulties of satellite vibration testing are due to the commonly expressed qualification requirements being incompatible with the limited performance of the entire controlled system (satellite + interface + shaker + controller). Two features cause the problem: firstly, the main satellite modes (i.e., the first structural mode and the high and low tank modes) are very weakly damped; secondly, the controller is just too basic to achieve the expected performance in such cases. The combination of these two issues results in oscillations around the notching levels and high amplitude beating immediately after the mode. The beating overshoots are a major risk source because they can result in the test being aborted if the qualification upper limit is exceeded. Although the abort is, in itself, a safety measure protecting the tested satellite, it increases the risk of structural fatigue, firstly because the abort threshold has been already reached, and secondly, because the test must restart at the same close-resonance frequency and remain there until the qualification level is reached and the sweep frequency can continue. The beat minimum relates only to small successive frequency ranges in which the qualification level is not reached. Although they are less problematic because they do not cause an inadvertent test shutdown, such situations inevitably result in waiver requests from the client. A controlled-system analysis indicates an operating principle that cannot provide sufficient stability: the drive calculation (which controls the process) simply multiplies the frequency reference (usually called cola) and a function of the following setpoint, the ratio between the amplitude already reached and the previous setpoint, and the compression factor. This function value changes at each cola interval, but it never takes into account the sensor signal phase. Because of these limitations, we firstly examined whether it was possible to empirically determine, using a series of tests with a very simple dummy, a controller setting process that significantly improves the results. As the attempt failed, we have performed simulations seeking an optimum adjustment by finding the Least Mean Square of the difference between the reference and response signal. The simulations showed a significant improvement during the notch beat and a small reduction in the beat amplitude. However, the small improvement in this process was not useful because it highlighted the need to change the reference at each cola interval, sometimes with instructions almost twice the qualification level. Another uncertainty regarding the consequences of such an approach involves the impact of differences between the estimated model (used in the simulation) and the actual system. As limitations in the current controller were identified in different approaches, we considered the feasibility of a new controller that takes into account an estimated single-input multi-output (SIMO) model. Its parameters were estimated from a very low-level throughput. Against this backdrop, we analyzed the feasibility of an LQG control in cancelling beating, and this article highlights the relevance of such an approach.

A Study on Cause-and-Effect Hierarchy of Profit Factors for the Feasibility Evaluation of Overseas Construction Projects (해외건설공사의 타당성 평가를 위한 수익성 영향인자의 인과관계 계층구조 구축에 관한 연구)

  • Sun Seung-Min;Kim Han-Him;Han Seung-Heon
    • Proceedings of the Korean Institute Of Construction Engineering and Management
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    • autumn
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    • pp.373-378
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    • 2003
  • 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 following the outbreak of Iraq war. 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 exposures through contract negotiation and its adjustment. 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 from real overseas construction projects and structuring their cause-and-effect relationships. The profitability causal 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 analysis. Ultimately, with this hierarchy structure as the base, the research will suggest how to develop the quantitative profitability forecasting model.

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Risk Factors and Effects of Severe Late-Onset Hyponatremia on Long-Term Growth of Prematurely Born Infants

  • Park, Ji Sook;Jeong, Seul-Ah;Cho, Jae Young;Seo, Ji-Hyun;Lim, Jae Young;Woo, Hyang Ok;Youn, Hee-Shang;Park, Chan-Hoo
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.23 no.5
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    • pp.472-483
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    • 2020
  • Purpose: Sodium is an essential nutritional electrolyte that affects growth. A low serum sodium concentration in healthy premature infants beyond 2 weeks of life is called late-onset hyponatremia (LOH). Here, we investigated the association between LOH severity and growth outcomes in premature infants. Methods: Medical records of premature infants born at ≤32 weeks of gestation were reviewed. LOH was defined as a serum sodium level <135 mEq/L regardless of sodium replacement after 14 days of life. Cases were divided into two groups, <130 mEq/L (severe) and ≥130 mEq/L (mild). Characteristics and growth parameters were compared between the two groups. Results: A total of 102 premature infants with LOH were included. Gestational age ([GA] 27.7 vs. 29.5 weeks, p<0.001) and birth weight (1.04 vs. 1.34 kg, p<0.001) were significantly lower in the severe group. GA was a risk factor of severe LOH (odds ratio [OR], 1.328, p=0.022), and severe LOH affected the development of bronchopulmonary dysplasia (OR, 2.950, p=0.039) and led to a poor developmental outcome (OR, 9.339, p=0.049). Growth parameters at birth were lower in the severe group, and a lower GA and sepsis negatively affected changes in growth for 3 years after adjustment for time. However, severe LOH was not related to growth changes in premature infants. Conclusion: Severe LOH influenced the development of bronchopulmonary dysplasia and developmental outcomes. However, LOH severity did not affect the growth of premature infants beyond the neonatal period.

Comparison of Safety Level between Driver's Ages by Threshold Zone Luminance Level of Vehicular Traffic Tunnel (터널 경계부 휘도수준에 따른 운전자 연령대별 안전수준 비교)

  • Cho, Won Bum;Jeong, Jun Hwa;Kim, Do Gyeong;Park, Won Il
    • International Journal of Highway Engineering
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    • v.17 no.1
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    • pp.129-142
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    • 2015
  • PURPOSES : The purpose of this study is to suggest a basis for setting appropriate safety goals specifically related to the threshold zone luminance in a vehicular traffic tunnel. METHODS : In the test, drivers were divided into two groups. One group consisted of all drivers (average drivers) group with an age ratio of drivers holding domestic driver's license and driver group by age to produce threshold zone luminance in the tunnel. The threshold zone luminance produced as a result was used to analyze how it affects the safety level of each driver group and provide a basis for setting an appropriate safety criterion that can be used to determine threshold zone luminance. We used test equipment, test conditions, and ananalysis of threshold zone luminance identical to that reported by ChoandJung(2014) but the values of adaptation luminance in our analys is were expanded to range from100 to $10,000cd/m^2$. RESULTS : Adaptation luminance and threshold zone luminance are found to be related by a quadratic function. The threshold zone luminance needed by older drivers to ensure a certain safety level is significantly higher than that for drivers of other age brackets when adaptation luminance increases. 56% of older drivers are at an increased risk of an accident at the same luminance for which the safety level of average drivers is 75%. The safety level that can be achieved for older drivers increases to above 60% when threshold zone luminance level is set with the goal of attaining a safety level of more than 85% for average drivers. The safety level that can be attained for average drivers is above 90% when the threshold zone luminance is high enough to ensure over 75% in the safety level of older drivers. Results of this study are applicable to highways and others whose designed speed is 100 km/h. CONCLUSIONS : Threshold zone luminance determined on the basis of drivers having average visual ability is of limited value as a performance standard for ensuring the safety of older drivers. Hence, safety level for older drivers should be considered separately from safety levels for drivers with an average ability to avoid risk. Upward adjustment of older drivers' safety level in the process of determining appropriate threshold zone luminance in a vehicular traffic tunnel may bring both tangible and intangible benefit as a result of reducing accidents. However, there is an associated dollar cost arising from installing and operating lights. As a result, the economic impact of these trade-offs should also be considered.

Fire District Adjustment for Improving Fire Service Vulnerable Areas in Jinju (진주시 소방서비스 취약지역 개선을 위한 소방권역 조정)

  • Yoo, Hwan Hee;Koo, Seul
    • Journal of Korean Society for Geospatial Information Science
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    • v.21 no.1
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    • pp.19-26
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    • 2013
  • This study analyzed the vulnerable areas to the fire service in regard to 119 safety centers, currently established in Jinju city. In this study, the district of fire was examined through the analysis of the OD cost matrix to find the transference or increase methods of the existing centers for improving the fire services. The study results demonstrate that the numbers of 119 safety centers were lacking in comparison with the areas of the administrative district in Jinju. In particular, relocation and the transference or increase of centers were required for the Cheonjeon 119 safety centers, which is the creation area of the National Industrial Complex among five 119 safety centers located in Jinju, and the fire service jurisdiction of Munsan 119 safety centers (including Banseong 119 regional unit), which is the location of a big fire risk due to the increase of population according to the development of the new town. In addition, the OD cost matrix analysis in this study reveals the fact that the time of fire service in the Jeonchon Industrial Complex, which is the significantly vulnerable area, will be reduced from 8 minutes to 3.3 minutes if the current Cheonjeon 119 safety center is moved to Gaho-dong. It indicates that the increase of safety centers in Geumsan-myeon areas, where the population has increased rapidly in recent days due to the development of the new town, is keenly needed.

The Association of Obesity and Left Colonic Adenomatous Polyps in Korean Adult Men (성인 남자에서 대장경 검사로 확인된 하부대장 선종성 용종과 비만의 관련성)

  • Kim, Chang-Sup;Cheong, Hae-Kwan;Jeong, Tae-Heum;Kim, Moon-Chan
    • Journal of Preventive Medicine and Public Health
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    • v.38 no.4
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    • pp.415-419
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    • 2005
  • Objectives : We wanted to evaluate the relationship between obesity and left colonic adenomatous polyps in Korean adult men. Methods : This study was conducted among 575 adults men (aged between 40 and 69), who had colonoscopy done from January to December 2002 during a routine health examination at Health Promotion Center, Ulsan University Hospital. The patients' colons were examined up to splenic flexure by using fiberoptic colonoscopy. A questionnaire survey on behavioral factors and physical measurements were also done. The body mass index (BMI) and waist-hip ratio (WHR) were used as the indices of obesity. The BMI was categorized into three levels: normal ($BMI{\leq}22.9$), overweight ($23{\leq}BMI{\leq}24.9$), and obese ($BMI{\geq}25.0$). The WHR was categorized into four levels with cutoff points at the 30th, 60th, and 90th percentile of the control group. Age, education, smoking, alcohol use and exercise were controlled for by performing multiple logistic regression analysis. Results : There were 99 cases of colonic adenomatous polyps. Four hundred seventy six subjects with normal colonoscopy findings served as the control. The BMI and WHR were associated with the adenomatous polyps (odds ratio, 1.81 [95% CI=1.02-3.19] for a $BMI{\geq}25.0$ as compared with a $BMI{\leq}22.9$, odds ratio, 3.94 [95% CI=1.77-8.77] for a $WHR{\geq}0.95$ as compared with a $WHR{\leq}0.86$). The BMI was not associated with the risk of adenomatous polyps after additional adjustment was made for the WHR, but the association between the WHR and adenomatous polyps was still positive and independent of the BMI (odds ratio, 4.15 [95% CI=1.63-10.59]). Conclusions : The results support that obesity, and particularly abdominal obesity, can be associated with an increased risk of incurring colonic adenomatous polyps.

Association of Current and Past Smoking with Metabolic Syndrome in Men (성인남성에서 현재 및 과거 흡연과 대사증후군의 관련성)

  • Hong, A-Rum;Lee, Kang-Sook;Lee, Seon-Young;Yu, Jae-Hee
    • Journal of Preventive Medicine and Public Health
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    • v.42 no.3
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    • pp.160-164
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    • 2009
  • Objectives : The objective of this study was to determine the relationship between past smoking and the risk factors for metabolic syndrome. Methods : From January 2007 to December 2007, a total of 3,916 over thirty years old male health screen examinees were divided into the nonsmoking, smoking, ex-smoking groups. The diagnosis of metabolic syndrome was based on the criteria of the NCEP ATP III(Executive Summary of The Third Report of The National Cholesterol Education Program). Metabolic syndrome was defined as the presence of three or more of the following: a blood pressure $\geq$ 130/85 mmHg, a fasting glucose level $\geq$ 110 mg/dL, a HDL-C (High Density Lipoprotein Cholesterol) level < 40 mg/dL, a triglyceride level $\geq$ 150 mg/dL and, a waist circumference men $\geq$ 102 cm, but a waist to hip ratio > 0.90 was used as a surrogate for the waist circumference. Results : After adjustment for age, alcohol consumption and, exercise in the smokers, for the ex-smokers compared with the nonsmokers, the odds ratio (OR) of a lower HDL cholesterol level (<40 mg/dL) was 1.29 (95% CI=1.03-1.61) in the smokers, the ORs of a higher triglyceride level were 1.35 (95% CI=1.09-1.66) in the ex-smokers and, 2.12 (95% CI=1.75-2.57) in the smokers, and the OR of a waist to hip ratio was 1.25 (95% CI=1.03-1.52) in the ex-smokers. When there were over three components of metabolic syndrome in the ex-smokers and smokers as compared with the nonsmokers, the odds ratio against the risk of metabolic syndrome were 2.39 (95% CI=1.00-6.63) and 2.37 (95% CI=1.02-6.46), respectively. Conclusions : The present study suggested that there is an association of smoking with metabolic syndrome in men.