Causes and Predictive Factors Associated with “Diagnosis Changed” Outcomes in Patients Notified as Tuberculosis Cases in a Private Tertiary Hospital

( Byung Ju Kang ),( Kyung Wook Jo ),( Tai Sun Park ),( Jung Wan Yoo ),( Sei Won Lee ),( Chang Min Choi ),( Yeon Mok Oh ),( Sang Do Lee ),( Woo Sung Kim ),( Dong Soon Kim ),( Tae Sun Shim ) 대한결핵 및 호흡기학회 2013 Tuberculosis and Respiratory Diseases Vol.75 No.6

Background: The aim of our study was to evaluate the “diagnosis changed” rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS). Methods: A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: “diagnosis maintained”, “diagnosis changed” (initially notified as TB, but ultimately diagnosed as non-TB), and “administrative error” (notified as TB due to administrative errors). Results: Excluding 17 patients in the “administrative error” group, the “diagnosis maintained” and “diagnosis changed” groups included 1,097 (87.3%) and 159 patients (12.7%), respectively. Common causes of “diagnosis changed” were nontuberculous mycobacterial (NTM) disease (51.7%, 61/118), and pneumonia (17.8%) in cases notified as pulmonary TB, and meningitis (19.5%, 8/41) and Crohn`s disease (12.2%) in cases notified as extrapulmonary TB. Being older than 35 years of age (odds ratio [OR], 2.18) and a positive acid-fast bacilli stain (OR, 1.58) were positive predictors and a TB-related radiological finding (OR, 0.42) was a negative predictor for a “diagnosis changed” result via multivariate logistic regression analysis in pulmonary TB cases. Conclusion: Because of a high “diagnosis changed” rate in TB notifications to the KTBS, the TB incidence rate measured by the KTBS may be overestimated. Considering the worldwide trend toward increased NTM disease, the “diagnosis changed” rate may increase over time. Thus, when reporting the annual TB notification rate in Korea, the exclusion of “diagnosis changed” cases is desirable.

Causes and Predictive Factors Associated with "Diagnosis Changed" Outcomes in Patients Notified as Tuberculosis Cases in a Private Tertiary Hospital

Kang, Byung Ju,Jo, Kyung-Wook,Park, Tai Sun,Yoo, Jung-Wan,Lee, Sei Won,Choi, Chang-Min,Oh, Yeon-Mok,Lee, Sang-Do,Kim, Woo Sung,Kim, Dong Soon,Shim, Tae Sun The Korean Academy of Tuberculosis and Respiratory 2013 Tuberculosis and Respiratory Diseases Vol.75 No.6

Background: The aim of our study was to evaluate the "diagnosis changed" rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS). Methods: A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: "diagnosis maintained", "diagnosis changed" (initially notified as TB, but ultimately diagnosed as non-TB), and "administrative error" (notified as TB due to administrative errors). Results: Excluding 17 patients in the "administrative error" group, the "diagnosis maintained" and "diagnosis changed" groups included 1,097 (87.3%) and 159 patients (12.7%), respectively. Common causes of "diagnosis changed" were nontuberculous mycobacterial (NTM) disease (51.7%, 61/118), and pneumonia (17.8%) in cases notified as pulmonary TB, and meningitis (19.5%, 8/41) and Crohn's disease (12.2%) in cases notified as extrapulmonary TB. Being older than 35 years of age (odds ratio [OR], 2.18) and a positive acid-fast bacilli stain (OR, 1.58) were positive predictors and a TB-related radiological finding (OR, 0.42) was a negative predictor for a "diagnosis changed" result via multivariate logistic regression analysis in pulmonary TB cases. Conclusion: Because of a high "diagnosis changed" rate in TB notifications to the KTBS, the TB incidence rate measured by the KTBS may be overestimated. Considering the worldwide trend toward increased NTM disease, the "diagnosis changed" rate may increase over time. Thus, when reporting the annual TB notification rate in Korea, the exclusion of "diagnosis changed" cases is desirable.

아세틸 콜린 유발 검사시 허혈성 심전도 변화와 흉통의 발생이 내피세포 기능장애에 미치는 영향

최철웅(Cheol Ung Choi),나승운(Seung-Woon Rha),김선원(Sun Won Kim),나진오(Jin Oh Na),임홍의(Hong Euy Lim),김진원(Jin Won Kim),김응주(Eung Ju Kim),한성우(Seong Woo Han),박창규(Chang Gyu Park),서홍석(Hong Seog Seo),오동주(Dong Joo Oh) 대한임상노인의학회 2010 대한임상노인의학회지 Vol.11 No.4

연구배경: 아세틸 콜린 유발 검사시 발생하는 흉통과 허혈성 심전도 변화가 아세틸 콜린에 의해 발생하는 관상동맥의 내피세포 기능에 어떤 영향을 주는지 알아보고자 했다. 방법: 흉통으로 내원하여 관상동맥 조영술과 아세틸 콜린 유발검사를 시행받은 1,085명의 환자를 대상으로 하였다. 아세틸 콜린 유발 검사를 하는 동안 허혈성 심전도 변화 및 흉통의 발생 유무에 따른 관상동맥 내피세포 기능의 특징을 비교하였다. 결과: 539명의 환자에서 아세틸 콜린 검사시 내피세포 기능 장애가 발생 하였다. 허혈성 심전도 변화가 있었던 그룹이 심전도 변화가 없었던 그룹보다 흉통이 더 많았고(78.1% vs. 60.8%, P=0.007), 관상동맥 조영술상 다발성 관상동맥 경련이 빈번하였고(59.4% vs. 40.6%, P=0.004), 관상동맥의 경련 정도도 더 심하였다(64.1% vs. 46.5%, P=0.006). 흉통이 있었던 그룹이 흉통이 없었던 그룹보다 허혈성 심전도 변화의 빈도가 더 높았다(14.7% vs. 7.5%, P=0.007). 또한 흉통이 있었던 그룹이 관상동맥 경련이 다발성으로 발생하는 경우가 많았고 (50.7% vs. 29.5%, P<0.001), 미만성으로 발생하는 경우가 많았고(87.1% vs. 75%, P<0.001), 관상동맥의 경련의 정도도 더 심하였다(51.6% vs. 43.5%, P=0.041). 결론: 아세틸 콜린 유발검사시 발생하는 허혈성 심전도 변화와 흉통은 관상동맥 경련의 정도와 경련이 발생하는 관상동맥 개수와 연관이 있다. Background: ECG changes and chest pain during acetylcholine (Ach) provocation tests may constitute important clinical parameters for Ach-induced endothelial dysfunction. We investigated the association between ischemic ECG changes and chest pain during the Ach-provocation test and angiographic characteristics of Ach-induced endothelial dysfunction. Methods: A total of 1,085 patients with anginal symptoms underwent diagnostic coronary angiography (CAG) and Ach-provocation tests. We compared angiographic characteristics of Ach-induced endothelial dysfunction according to the presence of ECG change and chest pain. Results: A total of 539 patients experienced Ach-induced endothelial dysfunction. Patients who experienced ECG change group suffered more frequent chest pain (78.1% vs. 60.8%, P=0.007), angiographically more frequent multiple coronary artery spasm (59.4% vs. 40.6%, P=0.004), and more severe coronary artery spasm (64.1% vs. 46.5%, P=0.006) than patients without ECG change. However, there was no difference in the length of endothelial dysfunction between the groups. The incidence of ischemic ECG changes in patients with chest pain was higher than in patients without chest pain (14.7% vs. 7.5%, P=0.007). Patients who experienced chest pain more often experienced multiple (50.7% vs. 29.5%, P<0.001), diffuse (87.1% vs. 75%, P<0.001), and severe coronary artery spasm (51.6% vs. 43.5%, P=0.041) than patients without chest pain. Conclusion: Ischemic ECG changes and chest pain during the Ach-provocation test are associated with multi-vessel involvement and severe coronary artery spasm. Chest pain is associated with the length of endothelial dysfunction, but ischemic ECG change is not.

사염화탄소 투여 흰쥐에서 간섬유화 진행에 따른 Propranolol 의 약동학적 지표들의 변화

이민호,강주섭,강문수,윤병철,이오영,함준수,변재원,윤창옥 대한간학회 2001 Clinical and Molecular Hepatology(대한간학회지) Vol.7 No.2

Background/Aims : This study was designed to determine the effect of hepatic fibrotic severity on pharmacokinetics of propranolol in CC1q - treated rats. Methods - 1 mL/kg of 10% CC14 in olive oil was injected intramuscularly to rats twice weekly for 4, 6, 8 and 10 weeks, respectively (n=6). Control (n=6) was a sham - injected equal dose of olive oil for 10 weeks. After intravenous bolus injection of 2 mg/kg propranolol to rats, the serum propranolol concentrations were analyzed for 4 hours at various time points by a HPLC - fluorimetric system, and pharmacokinetic parameters such as Co, MRT, AUC, Vdss, tl/2(p) and CLp were determined. Then, a small amount of hepatic tissue was obtained and subjected to determination of the hepatic 4 - hydroxyproline content, which confirmed the hepatic fibrotic severity. Results : The serum concentrations of propranolol at 0.5, 1, 2 and 4 hours were significantly increased in CC1q-treated rats (p$lt;0.01). In proportion to the duration of CC4 treatment, Co and AUC were significantly increased, and Vdss and CLp were significantly decreased (p$lt;0.001). But MRT and t1/2(β) were not significantly changed. The hepatic 4 -hydroxyproline content was gradually increased in CC4-treated rats (p$lt;0.001). Conclusion - Gradual changes in pharmacokinetic parameters of propranolol were seen to be dependent on the hepatic fibrotic severity. We suggest that gradual dosage modification, according to their hepatic fibrotic severity, is necessary for many drugs administered to patients with chronic liver disease.(Korean J Hepatol 2001;7:181-188)

한국인 A 형 간염 환자에서 A 형 간염 바이러스의 유전자형에 관한 연구

권오상,송기준,박상훈,송진원,김재선,김종헌,변관수,이창홍,연종은,백락주,박영태 대한간학회 2000 Clinical and Molecular Hepatology(대한간학회지) Vol.6 No.3

$quot;목적: 한국에서 과거 A형 간염은 낙후된 개인위생 및 자연환경으로 유소아기에 불현성 감염으로 앓고 지나가게 되어 청소년 및 성인에서 HAV에 대한 항체 보유율이 매우 높고 성인에서의 급성 A형 간염은 매우 드물게 보고되었다. 그러나 고도의 경제성장과 더불어 식생활, 위생상태의 개선, 상하수도의 보급 등으로 유소아기의 A형 간염 이환율이 현격히 감소하면서 청소년 및 성인에서 HAV 항체가 없는 인구집단 즉 HAV에 감염되면 현증 간염이 발생할 수 있는 인구 집단이 증가되어 최근 수 년 사이에 현증 A형 간염이 폭발적으로 증가하게 되었다. 이에 저자는 HAV의 유전자형을 알아보고 이미 보고된 각국의 HAV와 연관성을 알아보고자 본 연구를 시행하였다. 대상과 방법: 1994년부터 1998년까지 한국에서 산발적으로 발생한 18예의 A형 간염 환자의 혈청에서 HAV RNA를 추출, 역전사-중화효소 연쇄반응법(RT-PCR)으로 증폭하여 직접 염기서열의 분석을 통해 국내 HAV 사이에 염기서열, 아미노산의 차이 등을 알아보고 세계 각국에서 보고되었던 HAV 분리주들과 비교하였다. 결과: HAV 게놈의 특정부위인 VP1/2A 연결부위 168 bp 길이에서 시행한 염기서열 분석 결과 한국에서 분리된 18예의 HA이러스는 최근 해외에서 유입된 바이러스일 가능성은 적으며 따라서 장기간 국내에서 토착화된 바이러스일 것으로 생각된다. $quot;Background/Aims: Studies of genotypes and changes in nucleotide and amino acid sequences of hepatitis A virus (HAV) may provide valuable information on the epidemiological aspects of a particular region. In Korea the prevalence of anti-HAV in the 1 - 20 year age group declined from 60% in 1980 to 9% in 1995. As a result this age group has a high risk of HAV infection. Actually over 1,500 cases of clinically overt hepatitis A occurred in 1998 while few cases of clinical hepatitis A had been reported until the early 1990s. The aims of this study are to determine the genotypes of HAV which have been circulating in Korea and to define the phylogenetic relationships of geographically defined isolates. Method: From 1994 - 1998 a total of 18 serum specimens was obtained from patients in Korea with sporadic form acute hepatitis A. The HAV nucleic acid from serum specimens was subjected to genomic sequence analysis following viral RNA extraction, reverse transcription and amplification of the cDNA by PCR. DNA sequencing was performed in both directions of each PCR product. Results: All isolates clustered within the subgenotype IA irrespective of the geographic locations and timing of the clinical hepatitis. Among 18 Korean isolates, 9 isolates had 2 amino acid sequence changes and 2 isolates had 1 amino acid sequence change. These changes in the amino acid sequences are unique and have never been reported in HAV subgenotype IA. Conclusions: All isolated HAV had genotype (IA). Eleven of 18 isolates had unique changes in amino acid sequences. These data indicate that the endemic HAV has been circulating in Korea over a long period of time.

캘리그래피(Calligraphy) 수업에 있어 재료의 활용이 수업성과에 미치는 영향

이범주 ( Beom Ju Lee ),오해춘 ( Hai Choon Oh ),장광집 ( Kwang Chip Chang ) 한국기초조형학회 2011 기초조형학연구 Vol.12 No.5

현대 사회는 빠르게 변화하고 있다. 이러한 변화와 더불어 디자인도 다양한 분야에서 변화되고 있다. 최근에 볼 수 있는 디자인의 경향중 하나는 감성디자인으로 과거의 디자인접근방법에 비하여 인간의 감성을 디자인에 충실히 담으려는 노력이다. 이러한 변화는 학교교육에서도 마찬가지로 나타나고 있는데 현재 디자인교육의 중요성과 필요성이 높아지고 있는 것이 이를 설명하고 있다. 이에 따라 전문계고등학교에서 디자인과의 신설 및 디자인특성화고등학교가 늘어나고 있다. 그러므로 디자인교육의 양적 성장과 더불어 디자인교육 또한 변화되고 발전되어야 할 것이다. 최근 디자인분야의 대표적인 추세중의 하나인 감성디자인을 디자인교육에 접목하는 것은 큰 의미가 있다 하겠다. 이에 본 연구에서는 현대 디자인에서 쉽게 접할 수 있는 캘리그래피(Calligraphy)에 관한 것으로, 동일하게 주어진 재료가 아니라 다양한 재료를 사용하게 하는 것이 학생들의 흥미도 높이고 이에 따른 수업의 집중도도 높아질 것이라는 가설을 세우고, 이를 실험을 통해 검증하는 연구를 실시하였다. 이 연구를 위하여 4차시의 수업지도안을 작성하여 2개의 학급을 대상으로 실시하였으며, 실험집단과 통제집단으로 모형을 설계하였다. 실험집단에는 재료의 다양성을 제공하고, 통제집단에는 일반재료의 사용을 통한 수업을 적용하였다. 실험적용 결과 연구를 통해 얻어지는 결론은 다음과 같다. 다양한 재료의 선택이 집중도에 큰 영향을 미치지 않으며, 다양한 재료를 학습할 때에는 재료의 특성과 성향에 대한 사전교육이 중요하며, 수업을 진행할 때에는 재료의 특성과 성향에 대한 사전교육의 중요성에 대해 알 수 있었다. The modern society is rapidly changing. Along with such changes, design in mane areas is changing. One of the recent trends that can be seen is emotion design, an effort to put human sensibility into design compared to the design approach of the past. Such changes can be also seen in school education in that the importance and necessity of design education is increasing. As a result vocational high schools are establishing new departments for design and special high schools for design are increasing. Here as well as the quantitative growth of design education, the education itself should change and improve. Adding emotion design, one of the representative trends recently in the design field, can be very meaningful. Therefore, this study regarding Calligraphy, verifies the hypothesis, using various materials rather than same materials can increase students` interest and concentration to the class, by experiments. For the research, teaching plans for 4 lessons were written and the subjects of the experiment were 2 classes. The model was designed to have experimental group and control group. The experimental group was provided with various materials and in the control group`s lessons, normal materials were used. The results of the experiment are as follows. Using various materials does not have a significant effect to concentration, the orientation process regarding the characteristics of materials is important when studying with various materials, and to run the class, orientation process about property of materials is important.

在日韓國人의 生活文化의 異質化와 適應過程에 關한 保健學的 硏究

金正根(Jong-Kun Kim),張昌谷(Chang-Gok Chang),林達旿(Dar-Oh Lim),金武采(Mu-Chae Kim),李州烈(Ju-Yul Lee) 한국인구학회 1992 한국인구학 Vol.15 No.2

After world war Ⅱ Japanese life expectancy has been improved remarkably, and reached the highest level in the world around late 1970's. The life expectancy of Korean has also shown tremendous improvement in recent years with about 20 year's gap from the Japanese. The reason of rapid improvement of life expectancy can be explained by changes in the structure of cause of death due to health system, living standard, social welfare, health behavior of individuals and so on. Korean in Japan is placed under different situations from both Korean in Korea and Japanese in these regards, and expected to show different picture of cause of death pattern. The objective of this study is the comparision of changing patterns of cause of death of three population groups, Korean in Japan, Korean in Korea and Japanese, and to investigate the reasons which effect to the structural difference of mortality cause with special emphasis on health ecological aspects. One of the major limitations of the Korean causes of death statistics is the under-registration which ranges about 10% of the total events, and inaccuracy of the exact cause of death. Some 20% of registered deaths were unable to classify by ICD. However, it is concluded that the Korean data are evaluated as sufficient to stand for over-viewing of trends of cause of death pattern. The evaluation is done by comparing data from registration and field survey over the same population sample. Population data of Korean in Japan differ between two sources of data; census and foreigner's registration. Correction is done by life table method under the assumption that age-specific mortality pattern would accord with that of the Japanese. The crude death rate was lowest among Korean in Japan, 5.7 deaths per 1,000 population in 1965. The crude death rates of Korean in Japan and Japanese are increasing recently influenced by age structure while Korean in Korea still shows decreasing tendency. The adjusted death rate is lowest among Japnaese, followed by Korean in Japan, and Korean in Korea. The leading causes of death of Korean in Korea until 1960's was infectious diseases including pneumonia and tuberculosis. The causes of death structure changed gradually to accidents, neoplasm, hypertensive disease, cerebro-vascular disease in order. The main difference in cause of death between Korean and Japanese is high rate of liver diseases and diabetes for both Korean in Japan and Korea. A special feature of cause of death among Korean in Korea is remakably high rate of hypertensive disease, which is assumed to be caused by physicians tendency in choosing diagnostic categories. The low ischemic heart disease and high vasculo-cerebral disease are the distinctive characteristic of the three population groups compared to western countries. Specific causes of death were selected for detailed sex, age and ethnic group comparisons based on their high death rates. Cancer is the cause of death which showed most drama tical increase in all three population groups. In Korea 20.1% of all death were caused by cancer in 1990 compared with 10.5% in 1981. Cancer of the liver is the leading cause of cancer death among Korean in Japan for both sexes, followed by cancer of the lung and cancer of the stomach, while that of Korean in Korea is cancer of the stomach, followed by cancer of the liver and cancer of the lung for male. Causes of infant mortality were examined among the three population groups since 1980 on yearly bases. For both Japanese and Korean in Japan, leading cause of death ranks as conditions originating in the perinatal period, congenital anomalies, accidents and other violent causes. Trends since 1980 for these two population groups in the leading cause of infant mortality showed no changes. On the contrary, significant changes in leading cause of death structure in Korea were observed : The ranking of leading cause of death in 1981 were congenital asnomali

Finding key vulnerable areas by a climate change vulnerability assessment

Kim, Ho Gul,Lee, Dong Kun,Jung, Huicheul,Kil, Sung-Ho,Park, Jin Han,Park, Chan,Tanaka, Riwako,Seo, Changwan,Kim, Ho,Kong, Wooseok,Oh, Kyusik,Choi, Jinyong,Oh, Young-Ju,Hwang, Gangseok,Song, Chang-Keun Springer Netherlands 2016 Natural hazards Vol.81 No.3

<P>Extreme climate events such as typhoons, heat waves, and floods have increased in frequency with climate change. Many municipalities within the Republic of Korea (ROK) have experienced damage from these events, necessitating countermeasures. Vulnerability assessment has been suggested in the implementation of a national plan for reducing damage resulting from climate change. Thus, in this study, we assess the vulnerability of the ROK and identify key vulnerable municipalities in support of the national adaptation plan. We create a framework for assessing the vulnerability of all 232 municipalities of the ROK with respect to 32 items in 7 fields. The framework regards decision makers' comprehension and availability of data as important factors. We assess the vulnerability index of each municipality by using variables of climate exposure, sensitivity, and adaptation capacity. The weights of variables are determined by the Delphi method. We used the representative concentration pathways 8.5 climate scenario to reflect future climate exposure for the vulnerability assessment. From the analysis, vulnerability maps are prepared for the 32 items of 7 fields, and key vulnerable municipalities are identified by aggregating the maps. The distribution of vulnerable municipalities changes with the future climate conditions. These maps provide a scientific and objective basis for the ROK government to establish adaptation plans and allocate resources. The ROK government can utilize the results to identify the characteristics of highly vulnerable areas, and municipalities can use the results as a basis for requesting support from the national government.</P>

고령 작업자를 위한 농작업 편이장비의 인간공학적 개선에 관한 연구

이창민,오연주,김대웅,유중현,신광현 東義大學校産業技術開發硏究所 2009 産業技術硏究誌 Vol.23 No.-

우리나라의 농업은 작업자의 고령화와 여성작업자의 증가 그리고 비정형화로 구성된 작업형태로 인해 근골격계질환의 위험성이 매우 높은 업종이다. 특히 과수업은 작업점이 작업자의 머리위에서 형성되어 지속적으로 이루어지고, 수확기에는 작업량이 집중되어 농업분야 중에서도 근골격계질환의 유병율이 가장 높게 나타난다. 본 연구에서는 고령농작업자에게 집중적으로 발생되는 근골격계질환을 예방하기 위해 수확기에 집중되는 대표작업 세 가지 운반 작업, 선별작업 그리고 포장작업을 선정하여 유해요인을 분석하고 공학적 개선책을 제시하고자 한다. 배농업의 수확기 작업에서 근골격계질환 유해요인으로 나타나는 중량물 운반 작업과 불필요한 작업 자세를 개선할 수 있는 자바라 컨베이어 벨트와 높이조절식 작업대의 도입을 통하여 고령 작업자뿐만 아니라 여성 작업자들이 효율적인 시스템에서 안전하게 작업할 수 있기를 기대하며 근골격계질환 발생으로 인한 사회․경제적 손실도 감소시킬 수 있을 것이다.

시판 된장 첨가가 스폰지 케이크 제조에 미치는 영향

오현주,김창순 한국조리과학회 2004 한국식품조리과학회지 Vol.20 No.4

The effect of commercial Doenjangs (Korean soybean pastes) on sponge cake making was studied. When Doenjang was added to egg foams at levels of 5, 10, 15 and 20%, there were no big differences in viscosity or stability of egg foams up to 15%, and thus in cake volume index, compared to those of control (without Doenjang). In the results of preference rank test, cake with 10% Doenjang was preferred to the other cakes. Therefore, it was decided that the addition of 10% Doenjang was suitable for sponge cake making. When seven commercial Doenjang products were used at 10%, there were differences in physical and sensory properties. The decreased viscosity of egg foams reduced their stability and so decreased the quality of the sponge cakes with low volume index and low texture scores. The use of Doenjangs improved the flavor of sponge cake and so countervailed the undesirable egg flavor. Especially, "C" Doenjang product, which increased the viscosity and stability of egg foams, produced good foaming ability and the highest physical and sensory quality, thus the higher overall acceptable scores than the control. It was probably due to its high amount of protein hydrolysate above 10-KDa. Consequently, the suitable amount of Doenjang was fixed at 10% and "C" Doenjang product was chosen as the best among the commercial products for sponge cake making.