• Title/Summary/Keyword: diagnosis model

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Weight Gain and Alcohol Drinking Associations with Breast Cancer Risk in Japanese Postmenopausal Women - Results from the Japan Collaborative Cohort (JACC) Study

  • Nitta, Junichi;Nojima, Masanori;Ohnishi, Hirofumi;Mori, Mitsuru;Wakai, Kenji;Suzuki, Sadao;Fujino, Yoshihisa;Lin, Yingsong;Tamakoshi, Koji;Tamakoshi, Akiko
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.3
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    • pp.1437-1443
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    • 2016
  • Background: We investigated four factors, height, weight gain since age 20, physical activity, and alcohol drinking, for associations with risk of breast cancer (BC) according to menopausal status, using the latest data of the Japan Collaborative Cohort Study (JACC Study). Materials and Methods: We confined the analysis to 24 areas available of cancer incidence information, excluding women with a previous diagnosis of BC. Baseline data were collected from 38,610 (9,367 premenopausal, and 29,243 postmenopausal) women during 1988 and 1990. The study subjects were followed-up at the end of 2009, and 273 (84 premenopausal, and 189 postmenopausal) cases of BC were newly diagnosed in 501,907 person-years. The Cox model was used to estimate a hazards ratio (HR) and its 95% confidence interval (CI) of BC risk. Results: As a result of the multivariate analysis adjusting for age at baseline survey, age at menarche, number of live births, and, age at first delivery, weight gain since age 20 of 6.7 kg-9.9 kg, and ${\geq}10.0kg$ were significantly associated with increased risk for postmenopausal BC (HR=2.48, 95% CI 1.40-4.41, and, HR=2.94, 95% CI 1.84-4.70, respectively). Significantly increased trend of BC risk was also observed in weight gain since age 20 (p for trend, p<0.001). Amount of ethanol intake per day${\geq}15.0g$ was significantly associated with increased risk for postmenopausal BC in the multivariable-adjusted analysis (HR=2.74, 95% CI 1.32-5.70). Conclusions: Higher weight gain in adulthood and larger amounts of ethanol intake were significantly associated with increased risk of BC in Japanese postmenopausal women. None of the investigated factors were significantly associated with BC risk in Japanese premenopausal women.

Distribution of the Population at Risk of Cholangiocarcinoma in Bua Yai District, Nakhon Ratchasima of Thailand Using Google Map

  • Kaewpitoon, Soraya J;Rujirakul, Ratana;Sangkudloa, Amnat;Kaewthani, Sarochinee;Khemplila, Kritsakorn;Cherdjirapong, Karuna;Kujapun, Jirawoot;Norkaew, Jun;Chavengkun, Wasugree;Ponphimai, Sukanya;Polsripradist, Poowadol;Padchasuwan, Natnapa;Joosiri, Apinya;Wakkhuwattapong, Parichart;Loyd, Ryan A;Matrakool, Likit;Tongtawee, Taweesak;Panpimanmas, Sukij;Kaewpitoon, Natthawut
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.3
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    • pp.1433-1436
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    • 2016
  • Background: Cholangiocarcinoma (CCA), a major problem of health in Thailand, particularly in Northeastern and Northern regions, is generally incurable and rapidly lethal because of presentation in stage 3 or 4. Early diagnosis of stage 1 and 2 could allow better survival. Therefore, this study aimed to provide a distribution map of populations at risk for CCA in BuaYai district of Nakhon Ratchasima province, Northeast Thailand. Materials and Methods: A cross-sectional survey was carried out in 10 sub-districts and 122 villages, during June and November 2015. The populations at risk for CCA were screened using the Korat CCA verbal screening test (KCVST) and then risk areas were displayed by using Google map (GM). Results: A total of 11,435 individuals from a 26,198 population completed the KCVST. The majority had a low score of risk for CCA (1-4 points; 93.3%). High scores with 6, 7 and 8 points accounted for 1.20%, 0.13% and 0.02%. The population at risk was found frequently in sub-district municipalities, followed by sub-district administrative organization and town municipalities, (F=396.220, P-value=0.000). Distribution mapping comprised 11 layers: 1, district; 2, local administrative organization; 3, hospital; 4, KCVST opisthorchiasis; 5, KCVST praziquantel used; 6, KCVST cholelithiasis; 7, KCVST raw fish consumption; 8, KCVST alcohol consumption; 9, KCVST pesticide used; 10, KCVST relative family with CCA; and 11, KCVST naive northeastern people. Geovisual display is now available online. Conclusions: This study indicated that the population at high risk of CCA in Bua Yai district is low, therefore setting a zero model project is possible. Key success factors for disease prevention and control need further study. GM production is suitable for further CCA surveillance and monitoring of the population with a high risk score in this area.

Pretreatment Thrombocytosis as a Prognostic Factor in Women with Gynecologic Malignancies: a Meta-analysis

  • Yu, Min;Liu, Lei;Zhang, Bing-Lan;Chen, Qi;Ma, Xue-Lei;Wu, Yu-Ke;Liang, Chun-Shui;Niu, Zhi-Min;Qin, Xin;Niu, Ting
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.12
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    • pp.6077-6081
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    • 2012
  • Background: This study was performed to analyze the prognostic implications of pretreatment or preoperative thrombocytosis in women with gynecologic malignancies. Material and Methods: We surveyed 2 medical databases, PubMed and EMBASE, to identified all relevant studies. A total of 14 (n=3,490) that evaluated the link between thrombocytosis and 5-year survival were included. REVMAN version 5.1 was used for our analysis and publication bias was evaluated using the Begg's funnel plot and tested by STATA 11.0. Risk ratios (RRs) with 95% confidence intervals (CIs) generated by the random effect model were used to assess the strength of any association. Results: 709(20.3%) of the 3,490 patients exhibited thrombocytosis (platelet counts > $400{\times}10^9/L$) at primary diagnosis, and their mortality was 1.62-fold higher compared with the others (RR=1.62, 95%CI=[1.28-2.05], p<0.0001). Thrombocytosis failed to have a stronger effect on the survival of advanced patients of stages III to IV in our study (n=478, RR=1.29, 95% CI=[1.13-1.48], p=0.0003), nor in women with cervical cancer in stage IB (n=1371, RR=1.73, 95% CI=[1.71-2.58], p=0.007). In addition, when adjusted for different carcinoma, it was associated with worse prognosis for all except the ones with vulvar cancer (n=201, RR=0.43, 95% CI=[0.14-1.29], p=0.13). Conclusions: This meta-analysis indicated that thrombocytosis might be associated with a worse prognosis for patients with gynecologic malignancies but without specificity or sensitivity for the ones in advanced stage. When adjusted for different gynecologic malignancies, it showed a significant effect on survival of all except vulvar cancers.

A Survey on the Status of Hospital-Based Early Intensive Intervention for Autism Spectrum Disorder in South Korea (국내 자폐스펙트럼장애 아동의 병원 기반 조기 집중 중재 실태 조사)

  • Lee, Ju Young;Moon, Duk-Soo;Shin, Suk-Ho;Yoo, Hee-Jung;Byun, Hee-Jung;Suh, Dong-Soo
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.28 no.4
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    • pp.213-219
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    • 2017
  • Objectives: Early intensive interventions are very important for children with autism spectrum disorder. We examined the actual conditions of hospital-based early intensive interventions for autism spectrum disorder in Seoul, in order to help develop and implement an evidence-based early intensive intervention model for use in Korea. Methods: Nine hospital-based institutes running an early intensive intervention program for children with autism spectrum disorder responded to a questionnaire in September 2014. They provided a brief introduction to their program, explained its theoretical bases, and reported the number of children, their age, intervention time, duration and so on. Results: In the majority of the institutions, the intervention was provided for over 20 hours every week, and the theoretical bases included various applied behavioral analysis (ABA) methods and other therapies (language and occupational therapy). The therapist-child ratio ranged from 1:1 to 5:3. Various types of therapists were involved, including behavioral analysts, special education teachers and (or) language pathologists. There was only one clinic where the behavioral analyst was the main therapist. Usually, the intervention was terminated just before the child entered elementary school. The main merit of the hospital-based intervention in our survey was the effectiveness of the multi-disciplinary intervention plan and its other merits were the accuracy of the diagnosis, its ability to be combined with medicine, and so on. Conclusion: The current hospital-based early intensive intervention programs provide interventions for over 20 hours per week and employ multidisciplinary approaches. However, there are very few institutes for children with autism and very few intervention specialists and specialist education courses in the country. We need more educational programs for intervention therapists and have to try to develop policies which encourage the implementation of an evidence-based early intensive intervention program nationwide.

Evaluation of Clinical Usefulness of EIS(Electro Interstitial Scan) (EIS(Electro Interstitial Scan) 방법의 임상적 유효성 연구)

  • Kim, Soochan;Bae, Jang-Han;Jun, Min-Ho;Kim, Jaeuk U.
    • Journal of the Institute of Electronics and Information Engineers
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    • v.52 no.12
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    • pp.124-133
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    • 2015
  • Electro interstitial scan shows potential as a non-invasive screening method. It can discriminate some diseases based on electric current response to induce low intensity direct current to limbs or local area of body. DDFAO was invented in France and it is claimed that multi-channel EIS(Electro Interstitial Scan) is useful for various diseases, especially, diagnoses of endocrine system such as diabetics are very effective. In this study, we verified the repeatability and sensitivity of DDFAO by using a RC phantom model and its clinical usefulness using data obtained from normal and diabetes subject groups. As a result, it showed the repeatability and the output change according to change of phantom characteristic, but it was hard to distinguish normal and patient groups non-invasively with just six surface electrodes of DDFAO. The repeatability and the clinical accuracy was not sufficient for screening or diagnostic purposes, as well. In spite of the results with low repeatability and accuracy conducted in this study, we still need further investigations to improve the EIS-based measurement method; EIS is very convenient and simple and it shows potential as a screening tool of the whole body health conditions rather than localized disease diagnosis.

A Study on Cooperative Medical Treatment System between Oriental and Western Medical Practitioners (한.양방 협진체계 개발에 관한 연구)

  • Yi, Dong-Heui;Yoo, Kyu-Soo
    • Korea Journal of Hospital Management
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    • v.3 no.1
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    • pp.34-61
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    • 1998
  • A study on cooperative medical treatment system between oriental and western medical practitioners was conducted from March through August 1997 in order to determine a productive model of cooperation of two medical parts for treatment of patients. Questionnaires were distributed to 195 medical doctors(M.D.) and 195 doctors of oriental medicine(O.M.D.) working in clinics and hospitals in six major cities. Statistical analysis tools used for this study were frequency, t-test and multiple regression by using SPSS/P.C package. The results are summarized as follows: 1. The respondents were composed of male docotors(78%) and female doctors(22%) and 68.2% of M.D. and 97% of O.M.D. were interested in the other medical part. The doctors of both disciplines had some limitation on treatment of patients but they were reluctant to refer their patients to other doctors in different discipline. 2. M.D assumed that oriental medicine was more effective for chronic diseases, and O.M.D. thought that western medicine was more effective for acute diseases. 92.3% of O.M.D.s responded that even though they do not utilize western medical technology for diagnosis, they believed the results of diagnoses by western medical technology. 3. 60.5% of O.M. and 93.3% of O.M.D. said that cooperative medical treatment system could be necessary for patients and it would be effective for control of diseases and 69% of western medical doctors and 99% of oriental medical doctors agreed that oriental medical practice would be more effective for cerebellar vascular accidents than other diseases. 77.4% of western medical doctors and 92.3% of oriental medical doctors responded that the students of two different disciplines have to be taught on the other disciplines. 82.6% of western medical doctors and 83.3% oriental medical doctors agreed that it would be necessary to have collaborative research between scientists in two disciplines. 81.5% of M.D.s and 93.3% of O.M.D.s believed that they had prejudice and distrust on other discipline 4.90% of the doctors were not satisfied with the government medical policies on health insurance, legal matters, and health delivery system. 5. 75.4% of M.D.s and 50.2% of O.M.D.s said that two medical disciplines should be integrated, but they were skeptical on that. 75.3% of M.D.s thought that western hospitals should employ O.M.D.s Finally this study recommended that western medical students study oriental medicine and the vice versa, and M.D.s and O.M.D.s should have seminars and workshops to exchange knowledge, and experiences. It is also recommended that medical laws be revised to allow medical doctors refer the patients whom they can not handle to oriental medical doctors and the vice versa.

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Effects of Family Value on Family Adaptation in Family Who has a Child with Cancer (가족 가치관이 암환아 가족의 적응에 미치는 영향)

  • Park In-Sook;Tak Young-Ran;Lee Jung-Aee
    • Child Health Nursing Research
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    • v.7 no.4
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    • pp.494-510
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    • 2001
  • As a family respond to any stressful situation as a whole system, cancer diagnosis of a child, as a serious life event, could be emotional shock to destroy homeostasis of the family system. A family has a resilient capacity to adjust and adapt to stressful events. Previous studies have been focused on family stress and adaptation, but little attention has been given to family value as one of resilient factors. The data for model testing were collected from July 18, 2000 to August 30, 2000 and the analysis included 309 parents of children who are diagnosed as cancer, 18 or less years of age, and treated either hospitalized or at the outpatient clinics. The data analysis utilized SAS 6.12 and LISREL 8 for descriptive statistics, correlation, cluster analysis, factor analysis, and LISREL. The study findings are as follows. 1) Monthly income (γ=-0.28, t=-5.81) was the most important factor to explain family strain along with family support (γ=-0.11, t=-2.43), severity of children's illness (γ=0.26, t=5.22), and family stressor (γ=0.22, t=4.62). All of these factors together explained 40% of variance in family strain. 2) Among general family value, the relationship with the parents (γ=0.28, t=4.89) and relationship with the children (γ=0.20, t=3.60) showed positive effects to family value for cancer children, while relationship with the spouse (γ=-0.19, t=-3.22) and the age of the cancer children (γ=-0.11, t=-2.21) showed negative effects. These predictors together explained 22% of variance in family value for cancer children. 3) Family hardiness was explained mostly by family strain (γ=-0.53, t=-8.65) along with direct negative effects of family persistency and indirect negative effects of severity of children's illness, family stressor, relationship with the spouse, and the children's age. Family value for cancer children was the most important predictor with positive effect (γ=0.44, t=6.76) along with indirect effects of monthly income, relationship with the parents, relationship with the children, support from family and significant others, and confidence with the health professionals. 51% of variance in family hardiness was explained by all of these predictors. 4) The most important predictor for family adaptation was family stressor (γ=-0.50, t=-6.85) with direct and indirect negative effects along with the severity of children's illness (γ=-0.27, t=-5.21). However, family value for cancer children showed compromised total effect (γ=-0.13, t=-1.99) with negative direct effects (γ=-0.28, t=-3.43) and positive indirect effects (γ=0.14, t=3.01). Similarly, confidence with the health professionals also showed compromised total effect (γ=0.09, t=1.99) with positive direct effects and negative indirect effects. Family hardiness showed the biggest positive direct effects while other factors such as monthly income, family stressor, family persistence, support of family and significant others, relationship with the parents, relationship with the children, and relationship with the spouse, and children's age showed indirect effects only. 39% of variance in family adaptation was explained by all of these predictors.

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Modification of Cutoff Values for HE4, CA125, the Risk of Malignancy Index, and the Risk of Malignancy Algorithm for Ovarian Cancer Detection in Jakarta, Indonesia

  • Winarto, Hariyono;Laihad, Bismarck Joel;Nuranna, Laila
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.5
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    • pp.1949-1953
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    • 2014
  • Background: CA125 and HE4 are used in calculating Risk of Malignancy Algorithm (ROMA); and Risk of Malignancy Index (RMI). However, studies showed that normal levels of CA125, and HE4 differ among ethnicities such as between Asians and Caucasians, thus affecting the accuracy of the RMI score and ROMA in predicting ovarian malignancy. This study aimed to determine whether new or modified cutoff values for Ca125, HE4, the RMI score, and ROMA resulted in a better prediction of malignancy compared with the previous or standard ones. Materials and Methods: Serum level of CA125 and HE4 from 128 patients with diagnosis of ovarian tumor that had been collected before surgery at Cipto Mangunkusumo General Hospital (CMH) in Jakarta from November 2010 until May 2011 were reviewed and analysed. The standard cutoff values of these biomarkers, RMI, and ROMA were modified by using logistic regression model. The modified cutoff values were compared to the standard cutoff values in terms of sensitivity, specificity, and accuracy. Results: The modified cutoff value of CA125, HE4, RMI score and ROMA were 165.2 U/mL, 103.4 pM, 368.7, 28/54. The sensitivity and specificity of the modified cutoff values CA125, HE 4, RMI score and ROMA in differentiating benign from malignant and borderline were 67% and 75,4%; 73.1% and 85.2%; 73.1% and 80.3%; and 77.6% and 86.9%. While the sensitivity and specificity of the standard cutoff value of CA125; HE4; RMI score; and ROMA were 91% and 24.6%; 83.6% and 65%; 80.6% and 65.6%; and 91.0% and 42.6%. The accuracy of modified cutoff values compared with standard cutoff values were: 71.2% vs 59.3%, 78.9% vs 75% vs, 76.5% vs 73.4%, and 82% vs 67.9%. Conclusions: The new or modified cutoff values of Ca125, HE4, RMI score and ROMA resulted in higher accuracy compared to the previous or standard ones, at the cost of reduced sensitivity.

Clinical Studies on 56 Cases of Having Treated patients suffering from Ischemic Stroke through both Urokinase and Therapeutics of Oriental Medicine (Urokinase와 동의학적요법(東醫學的療法)으로 동시치료(同時治療)한 허혈성뇌졸중환자(虛血性腦卒中患者) 56례(例)에 대(對)한 임상적(臨床的) 연구(硏究))

  • Kim, In-Sup
    • The Journal of Korean Medicine
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    • v.15 no.2 s.28
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    • pp.46-91
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    • 1994
  • l. Backgrounds of Studies Cerebrovascular accident. one of the three major causes of death among audults with cardiopathy and malignancy, has been on the increase in korea while it is on the decrease in European countries and Japan. Types of stroke undergo changes caused by prolongment of life expectancy. and social and economic variety. More patients of ischemic stroke show a tendency to increase now than those of hemorrhagic stroke in the past. Many clinical studies on medical cerebrovascular and oriental stroke of paralysis have been published. but few clinical studies on therapeutics of integrated oriental and western medicine are to be found. So I have made an attempt to study clinical observations and therapeutic responses of ischemic stroke under integrated oriental and western medicine. 2.Methods. Among the patients admitted into the clinic of Joong-Poong, Woo-Suk University Hospital from May 1. 1993 until April 30. 1994 those 56 patients who were diagnosed as ischemic stroke on Computed Tomography(CT) and showed no dubious symptom after examination of coagulation and bleeding time were classified into the following six steps and treated: l)diagnosis 2)emergency treatment 3)basic treatment 4)treatment of risk and provoking factors. and preceeding disease 5)complications and conservative therapy 6)rehabilitation. For a period of basic treatment both herb medication and urokinase therapy were applied at the same time. Intravenous injection has been given at a unit of 300.000 dosage a day as urokinase therapy during basic treatment. If they showed any dubious symptom in glucose tolerance test. fructose 500ml and urokinase 300.000 dosage were mixed and injected. In case of no symptom 5% DW 500ml was mixed with urokinase 300.000 unit. and injected at a speed of 15gtt per minute. 3. Results and Conclusions 1) The level of ambulation has been improved from 42.9% when admitted to 73.2% when discharged in the degree of recovery. The level of severe function disorder has been remarkably decreased from 55.4% when admitted to 19.6% when discharged. 2) The treatment effect on the basis of therapeutic response of clinical and subjective symptom shows as follows: 7.1% Excellent. 35.7% Good. 37.5% Effective. 10.7% Stationary. and 8.9% Aggravated. The total recovery above effective shows 80.3%. Judging from the above results I think it proper to develop the model of better preventing and treating ischemic stroke through effective therapeutic and clinical studies of integrated oriental and western medicine.

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A Hippocampus Segmentation in Brain MR Images using Level-Set Method (레벨 셋 방법을 이용한 뇌 MR 영상에서 해마영역 분할)

  • Lee, Young-Seung;Choi, Heung-Kook
    • Journal of Korea Multimedia Society
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    • v.15 no.9
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    • pp.1075-1085
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    • 2012
  • In clinical research using medical images, the image segmentation is one of the most important processes. Especially, the hippocampal atrophy is helpful for the clinical Alzheimer diagnosis as a specific marker of the progress of Alzheimer. In order to measure hippocampus volume exactly, segmentation of the hippocampus is essential. However, the hippocampus has some features like relatively low contrast, low signal-to-noise ratio, discreted boundary in MRI images, and these features make it difficult to segment hippocampus. To solve this problem, firstly, We selected region of interest from an experiment image, subtracted a original image from the negative image of the original image, enhanced contrast, and applied anisotropic diffusion filtering and gaussian filtering as preprocessing. Finally, We performed an image segmentation using two level set methods. Through a variety of approaches for the validation of proposed hippocampus segmentation method, We confirmed that our proposed method improved the rate and accuracy of the segmentation. Consequently, the proposed method is suitable for segmentation of the area which has similar features with the hippocampus. We believe that our method has great potential if successfully combined with other research findings.