• Clinical and Experimental Reproductive Medicine
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• v.35 no.2
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• pp.99-110
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• 2008

Objectives: Preimplantation genetic diagnosis (PGD) has become an assisted reproductive technique for couples carrying genetic conditions that may affect their offspring. Osteogenesis imperfecta (OI) is an autosomal dominant disorder of connective tissue characterized by bone fragility and low bone mass. At least 95% of cases are caused by dominant mutations in the COL1A1 or COL1A2. In this study, we report on our experience clinical outcomes with 5 PGD cycles for OI in two couples. Methods: Before clinical PGD, we assessed the amplification rate and allele drop-out (ADO) rate of alkaline lysis and nested PCR protocol using heterozygous patient's single lymphocytes in the pre-clinical diagnostic tests for OI. We performed 5 cycles of PGD for OI by nested PCR for the causative mutation loci, COL1A1 c.2452G>A and c.3226G>A, in case 1 and case 2, respectively. The PCR products were analyzed by agarose gel electrophoresis, restriction fragment length polymorphism (RFLP) analysis with HaeIII restriction enzyme in the case 1 and direct DNA sequencing. Results: We confirmed the causative mutation loci, COL1A1 c.2452G>A in case 1 and c.3226G>A in case 2. In the pre-clinical tests, the amplification rate was 94.2% and ADO rate was 22.5% in case 1, while 98.1% and 1.9% in case 2, respectively. In case 1, a total of 34 embryos were analyzed and 31 embryos (91.2%) were successfully diagnosed in 3 PGD cycles. Eight out of 19 embryos diagnosed as unaffected embryos were transferred in all 3 cycles, and in the third cycle, pregnancy was achieved and a healthy baby was delivered without any complications in July, 2005. In case 2, all 19 embryos (100.0%) were successfully diagnosed and 4 out of 11 unaffected embryos were transferred in 2 cycles. Pregnancy was achieved in the second cycle and the healthy baby was delivered in March, 2008. The causative locus was confirmed as a normal by amniocentesis and postnatal diagnosis. Conclusions: To our knowledge, these two cases are the first successful PGD for OI in Korea. Our experience provides a further demonstration that PGD is a reliable and effective clinical techniques and a useful option for many couples with a high risk of transmitting a genetic disease.

• Journal of Preventive Medicine and Public Health
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• v.49 no.1
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• pp.23-34
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• 2016

South Korea's state health insurer, the National Health Insurance Service (NHIS), is in the process of a compensation suit against tobacco industry. The tobacco companies have habitually endeavored to ensure favorable outcomes in litigation by misusing scientific evidence or recruiting scientists to support its interests. This study analyzed strategies that tobacco companies have used during the NHIS litigation, which has been receiving world-wide attention. To understand the litigation strategies of tobacco companies, the present study reviewed the existing literature and carried out content analysis of petitions, preparatory documents, and supporting evidence submitted to the court by the NHIS and the tobacco companies during the suit. Tobacco companies misrepresented the World Health Organization (WHO) report's argument and misused scientific evidence, and removed the word "deadly" from the title of the citation. Tobacco companies submitted the research results of scientists who had worked as a consultant for the tobacco industry as evidence. Such litigation strategies employed by the tobacco companies internationally were applied similarly in Korean lawsuits. Results of tobacco litigation have a huge influence on tobacco control policies. For desirable outcomes of the suits, healthcare professionals need to pay a great deal of attention to the enormous volume of written opinions and supporting evidence that tobacco companies submit. They also need to face the fact that the companies engage in recruitment of scientists. Healthcare professionals should refuse to partner with tobacco industry, as recommended by Article 5.3 of the WHO Framework Convention on Tobacco Control.

• Asia pacific journal of information systems
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• v.21 no.3
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• pp.71-96
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• 2011

Within the traditional medical delivery system, patients residing in medically vulnerable areas, those with body movement difficulties, and nursing facility residents have had limited access to good healthcare services. However, Information and Communication Technology (ICT) provides us with a convenient and useful means of overcoming distance and time constraints. ICT is integrated with biomedical science and technology in a way that offers a new high-quality medical service. As a result, rapid technological advancement is expected to play a pivotal role bringing about innovation in a wide range of medical service areas, such as medical management, testing, diagnosis, and treatment; offering new and improved healthcare services; and effecting dramatic changes in current medical services. The increase in aging population and chronic diseases has caused an increase in medical expenses. In response to the increasing demand for efficient healthcare services, a telehealth service based on ICT is being emphasized on a global level. Telehealth services have been implemented especially in pilot projects and system development and technological research. With the service about to be implemented in earnest, it is necessary to study its overall acceptance by consumers, which is expected to contribute to the development and activation of a variety of services. In this sense, the study aims at positively examining the structural relationship among the acceptance factors for telehealth services based on the Technology Acceptance Model (TAM). Data were collected by showing audiovisual material on telehealth services to online panels and requesting them to respond to a structured questionnaire sheet, which is known as the information acceleration method. Among the 1,165 adult respondents, 608 valid samples were finally chosen, while the remaining were excluded because of incomplete answers or allotted time overrun. In order to test the reliability and validity of the assessment scale items, we carried out reliability and factor analyses, and in order to explore the causal relation among potential variables, we conducted a structural equation modeling analysis using AMOS 7.0 and SPSS 17.0. The research outcomes are as follows. First, service quality, innovativeness of medical technology, and social influence were shown to affect perceived ease of use and perceived usefulness of the telehealth service, which was statistically significant, and the two factors had a positive impact on willingness to accept the telehealth service. In addition, social influence had a direct, significant effect on intention to use, which is paralleled by the TAM used in previous research on technology acceptance. This shows that the research model proposed in the study effectively explains the acceptance of the telehealth service. Second, the research model reveals that information privacy concerns had a insignificant impact on perceived ease of use of the telehealth service. From this, it can be gathered that the concerns over information protection and security are reduced further due to advancements in information technology compared to the initial period in the information technology industry, and thus the improvement in quality of medical services appeared to ensure that information privacy concerns did not act as a prohibiting factor in the acceptance of the telehealth service. Thus, if other factors have an enormous impact on ease of use and usefulness, concerns over these results in the initial period of technology acceptance may become irrelevant. However, it is clear that users' information privacy concerns, as other studies have revealed, is a major factor affecting technology acceptance. Thus, caution must be exercised while interpreting the result, and further study is required on the issue. Numerous information technologies with outstanding performance and innovativeness often attract few consumers. A revised bill for those urgently in need of telehealth services is about to be approved in the national assembly. As telemedicine is implemented between doctors and patients, a wide range of systems that will improve the quality of healthcare services will be designed. In this sense, the study on the consumer acceptance of telehealth services is meaningful and offers strong academic evidence. Based on the implications, it can be expected to contribute to the activation of telehealth services. Further study is needed to assess the acceptance factors for telehealth services, such as motivation to remain healthy, health care involvement, knowledge on health, and control of health-related behavior, in order to develop unique services according to the categorization of customers based on health factors. In addition, further study may focus on various theoretical cognitive behavior models other than the TAM, such as the health belief model.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.16 no.1
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• pp.18-23
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• 2016

Objective: Newborn screening leads to improved treatment and disease outcomes, but false-positive newborn screening results may impact include parental stress and anxiety, perception of child as unhealthy, parent-child relationship dysfunction, and increased infant hospitalizations. The purpose of this study was to investigate of the false positive rates and the causative factors of false positive results in Tandem Mass Spectrometry (TMS) in single center. Methods: Records were reviewed for all 18,872 subjects who were born in Cheill General Hospital, during January 1st, 2012 to December 31st, 2014. 17,292 neonates (91.62%) were tested for tandem mass screening almost in 2-5th day of life. Newborn babies whose first results were abnormal had been tested repeatedly by same methods in 7-14 day. If the results were abnormal again, further evaluation was performed. TMS analysis included data for the 43 disorders screened for using TMS broken down into three categories: fatty acid oxidation disorders, organic acidurias, and aminoacidopathies. The impact of several factors on increased false positive rates was analyzed using a multivariate analysis: time from birth to sample collection, birth weight, birth height, BMI, gender, gestational age, delivery type. Results: Males of the subjects were 8942 (51.7%), female 8350 (48.3%), the mean gestational age was $38.6{\pm}1.7$ weeks, the average birth weight $3,155.6{\pm}502.4g$, the average birth height $49.1{\pm}2.9cm$, and the average BMI $13.0{\pm}3.8(kg/m^2)$. Vaginal delivery cases were 9713 (56.2%), caesarean section 7,579 (43.8%). The average date of the inspection was $2.8{\pm}1.1$ days. 224 cases were identified as TMS positive. All the subjects were false positive (222/17,292, 1.30%) except 2 cases (1 male; benign phenylketonuria and 1 female; Short chain acyl-CoA dehydrogenase deficiency). The false positive rates were 0.61% in fatty acid oxidation disorders, 0.25% in organic acidurias, and 0.45% in aminoacidopathies. In our study, the date of inspection got late, the false positive rates got higher. Because almost the cases of late test date were in treatment in neonatal intensive care unit so their test date was affected by their medical conditions. False positive rate was higher in extreme immaturity${\leq}27$ weeks than newborns of gestational age >27 weeks [OR=6.957 (CI=1.273-38.008), p<0.025] and extremely low birth weight<1,000 g than newborns of birthweight ${\geq}1,000g$ [OR=5.616 (CI=1.134-27.820), p<0.035]. Conclusion: False positive rate of TMS was 1.30% in Cheil General Hospital. Lower gestational age and birth weight impacted on increased false positive rates. Better understanding of factors that influence the reporting of screening tests, and the ability to modify these important factors, may improve the screening process and reduce the need for retesting. of screening tests, and the ability to modify these important factors, may improve the screening process and reduce the need for retesting.

• Journal of the Institute of Electronics Engineers of Korea CI
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• v.46 no.6
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• pp.7-17
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• 2009

The precise analysis of exercise data for designing an effective rehabilitation system is very important as a feedback for planing the next exercising step. Many subjective and reliable research outcomes that were obtained by analysis and evaluation for the human motor ability by various methods of biomechanical experiments have been introduced. Most of them include quantitative analysis based on basic statistical methods, which are not practical enough for application to real clinical problems. In this situation, data mining technology can be a promising approach for clinical decision support system by discovering meaningful hidden rules and patterns from large volume of data obtained from the problem domain. In this research, in order to find relational rules between posture training type and muscle activation pattern, we investigated an application of the WAR(Weishted Association Rule) to the biomechanical data obtained mainly for evaluation of postural control ability. The discovered rules can be used as a quantitative prior knowledge for expert's decision making for rehabilitation plan. The discovered rules can be used as a more qualitative and useful priori knowledge for the rehabilitation and clinical expert's decision-making, and as a index for planning an optimal rehabilitation exercise model for a patient.

• Korean Journal of Psychosomatic Medicine
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• v.17 no.2
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• pp.62-67
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• 2009

Objectives : The aim of this study was to evaluate the effect of sociodrama for reducing burnout among health care workers and to investigate relationship between the job satisfaction, conflict with other professions, and burnout. Methods：15 nurses in general hospital participated in sociodrama directed by psychiatrist. One week after acting sociodrama, they were requested to complete ward organizational feature scale(WOFS) and maslach burnout inventory(MBI). The other twenty nurses in same ward requested to complete questionnaire without participating in sociodrama at the same time. Results : Sociodrama group(N=15) showed significantly lower score in burnout when compared to control group(N=17). Nurse/physician relationship was significantly correlated with job satisfaction and burnout. After controlling for interaction between variables by multivariate regression analysis, only job satisfaction was significant predictive factor to burnout. Conclusion : Our result suggests that the sociodrama can be effective in reducing burnout of health care workers in general hospital. These finding also underline the importance of relationship with physicians in job satisfaction and burnout of healthcare workers in general hospital.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.12
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• pp.7143-7147
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• 2013

Background: The survival outcomes for women presenting with early breast cancer are influenced by treatment decisions. In Malaysia, survival outcome is generally poor due to late presentation. Of those who present early, many refuse treatment for complementary therapy. Objective: This study aimed to explore the decision making experiences of women with early breast cancer. Materials and Methods: A qualitative study using individual in-depth interviews was conducted to capture the decision making process of women with early breast cancer in Malaysia. We used purposive sampling to recruit women yet to undergo surgical treatment. A total of eight participants consented and were interviewed using a semi-structured interview guide. These women were recruited from a period of one week after they were informed of their diagnoses. A topic guide, based on the Ottawa decision support framework (ODSF), was used to facilitate the interviews, which were audio recorded, transcribed and analysed using a thematic approach. Results: We identified four phases in the decision-making process of women with early breast cancer: discovery (pre-diagnosis); confirmatory ('receiving bad news'); deliberation; and decision (making a decision). These phases ranged from when women first discovered abnormalities in their breasts to them making final surgical treatment decisions. Information was vital in guiding these women. Support from family members, friends, healthcare professionals as well as survivors also has an influencing role. However, the final say on treatment decision was from themselves. Conclusions: The treatment decision for women with early breast cancer in Malaysia is a result of information they gather on their decision making journey. This journey starts with diagnosis. The women's spouses, friends, family members and healthcare professionals play different roles as information providers and supporters at different stages of treatment decisions. However, the final treatment decision is influenced mainly by women's own experiences, knowledge and understanding.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.12
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• pp.581-588
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• 2017

This study was conducted to determine which factors would predict metabolic syndrome (MetS) perception and exercise by applying a machine learning classifier, or Extreme Gradient Boosting algorithm (XGBoost) from July 2014 to December 2015. Data were obtained from the Korean Community Health Survey (KCHS), representing different community-dwelling Korean adults 19 years and older, from 2009 to 2013. The dataset includes 370,430 adults. Outcomes were categorized as follows based on the perception of MetS and physical activity (PA): Stage 1 (no perception, no PA), Stage 2 (perception, no PA), and Stage 3 (perception, PA). Features common to all questionnaires for the last 5 years were selected for modeling. Overall, there were 161 features, categorical except for age and the visual analogue scale (EQ-VAS). We used the Extreme Boosting algorithm in R programming for a model to predict factors and achieved prediction accuracy in 0.735 submissions. The top 10 predictive factors in Stage 3 were: age, education level, attempt to control weight, EQ mobility, nutrition label checks, private health insurance, EQ-5D usual activities, anti-smoking advertising, EQ-VAS, education in health centers for diabetes, and dental care. In conclusion, the results showed that XGBoost can be used to identify factors influencing disease prevention and management using healthcare bigdata.

• Korean Journal of Clinical Laboratory Science
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• v.49 no.4
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• pp.345-349
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• 2017

Diabetes mellitus is associated with a variety of adverse health outcomes, including metabolic syndrome and cardiovascular diseases. Recently, diabetes has been receiving increased scientific attention because of the rapid increase in the diabetic population. One of the features of type-2 diabetes mellitus is an elevated glucose level in blood. Fasting glucose level, which is the most basic test, is widely used as a diagnostic indicator of diabetes. Several previous studies reported that TLR4 expression is relatively high in the heart. However, few studies have investigated the association between TLR4 variants and fasting blood glucose to date. Thus, this study tested the association between single nucleotide polymorphisms (SNPs) in the TLR4 gene and fasting glucose in the Korean population. A total of 994 subjects recruited from Seoul were used for the present study. When compared to fasting blood glucose, the TLR4 gene region was shown as a linkage disequilibrium owing to the relatively large gene range. This region also presented as several LD blocks. We found that specific SNPs in the TLR4 gene were associated with the mean fasting glucose (p<0.01). The minor allele frequency of rs1329067 was 16.4%, and individuals with the AA genotype had a higher fasting blood glucose level than those with the GG genotype, suggesting that genetic variants in TLR4 influence glucose levels in Korean adults.

• Journal of Digital Convergence
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• v.14 no.6
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• pp.325-333
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• 2016

This study was conducted to provide the base line for the use of prophylactic antibiotics and the standard of antibiotic use and the evaluation based on analysis of current use, quality assessment and periodic changes of prophylactic antibiotics in a university hospital. We chose the year 2008, 2009, 2010, 2012, and 2014 as the study periods since the primary evaluation on the first year of implementation in 2007. For this study, healthcare benefit quality assessment data from the Health Insurance Review and Assessment Service was used. We analyzed the differences each year of treatment period; one category for initial treatment timing, three categories for selecting antibiotics, and two categories for the length of treatment from multiple evaluation indices of gastric surgeries, colorectal surgeries, and cholecystectomy. The analysis revealed the followings: Regarding length of antibiotics treatment, total days of treatment decreased down to 1.5, 1.5, and 0.6 days in the year 2014, from 13.5, 12.8, and 6.9 days in the year 2007, for gastric surgeries, colorectal surgeries, and cholecystectomy. Based on these outcomes, the efforts to devise efficient delivery and distribution of the recommendations or indices which medical staff could adhere for quality improvement of the prophylactic antibiotics would be necessary. Also implementing monitoring system to help the hospitals to acknowledge their own faults may be helpful.