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Analysis of Continuity of Care and Its Related Factors in Diabetic Patients: A Cross-Sectional Study
Ji Yeh Shin,Ha Jin Kim,BeLong Cho,Yun Jun Yang,Jae Moon Yun 대한가정의학회 2022 Korean Journal of Family Medicine Vol.43 No.4
Background: Continuity of care in primary care settings is crucial for managing diabetes. We aimed to statistically define and analyze continuity factors associated with demographics, clinical workforce, and geographical relation-ships.Methods: We used 2014–2015 National Health Insurance Service claims data from the Korean registry, with 39,096 eligible outpatient attendance. We applied multivariable logistic regression to analyze factors that may affect the continuity of care indices for each patient: the most frequent provider continuity index (MFPCI), modified-modi-fied continuity index (MMCI), and continuity of care index (COCI).Results: The mean continuity of care indices were 0.90, 0.96, and 0.85 for MFPCI, MMCI and COCI, respectively. Among patient factors, old age >80 years (MFPCI: odds ratio [OR], 0.81; 95% confidence interval [CI], 0.74–0.89; MMCI: OR, 0.84; 95% CI, 0.76–0.92; and COCI: OR, 0.81; 95% CI, 0.74–0.89) and mild disability were strongly associ-ated with lower continuity of care. Another significant factor was the residential area: the farther the patients lived from their primary care clinic, the lower the continuity of diabetes care (MFPCI: OR, 0.74; 95% CI, 0.70–0.78; MMCI: OR, 0.70; 95% CI, 0.66–0.73; and COCI: OR, 0.74; 95% CI, 0.70–0.78).Conclusion: The geographical proximity of patients’ residential areas and clinic locations showed the strongest correlation as a continuity factor. Further efforts are needed to improve continuity of care to address the geographi-cal imbalance in diabetic care.
Ji, Chang-Jun,Kim, Jung-Hoon,Won, Young-Bin,Lee, Yeh-Eun,Choi, Tae-Woo,Ju, Shin-Yeong,Youn, Hwan,Helmann, John D.,Lee, Jin-Won American Society for Biochemistry and Molecular Bi 2015 The Journal of biological chemistry Vol.290 No.33
<P>In many Gram-positive bacteria PerR is a major peroxide sensor whose repressor activity is dependent on a bound metal cofactor. The prototype for PerR sensors, the Bacillus subtilis PerRBS protein, represses target genes when bound to either Mn2+ or Fe2+ as corepressor, but only the Fe2+-bound form responds to H2O2. The orthologous protein in the human pathogen Staphylococcus aureus, PerR(SA), plays important roles in H2O2 resistance and virulence. However, PerR(SA) is reported to only respond to Mn2+ as corepressor, which suggests that it might rely on a distinct, iron-independent mechanism for H2O2 sensing. Here we demonstrate that PerR(SA) uses either Fe2+ or Mn2+ as corepressor, and that, like PerRBS, the Fe2+-bound form of PerR(SA) senses physiological levels of H2O2 by iron-mediated histidine oxidation. Moreover, we show that PerR(SA) is poised to sense very low levels of endogenous H2O2, which normally cannot be sensed by B. subtilis PerRBS. This hypersensitivity of PerR(SA) accounts for the apparent lack of Fe2+-dependent repressor activity and consequent Mn2+-specific repressor activity under aerobic conditions. We also provide evidence that the activity of PerR(SA) is directly correlated with virulence, whereas it is inversely correlated with H2O2 resistance, suggesting that PerR(SA) may be an attractive target for the control of S. aureus pathogenesis.</P>
Analysis of the Comprehensiveness of Primary Care Clinics in Korea
김하진,Ji Yeh Shin,양윤준,Belong Cho,윤재문 대한가정의학회 2021 Korean Journal of Family Medicine Vol.42 No.1
Background: In the Republic of Korea, which medical specialties should take the responsibility for primary care and what the role of primary care should be are still unclear. In this study, we focused on the comprehensiveness of primary care to identify related factors. Methods: The National Health Insurance Service (NHIS)-National Sample Cohort is a population-based cohort, sampled in the 2002 NHIS database and followed up until 2015. We used data collected from January 2014 to December 2015, including 20,423,832 outpatient visits in 19,557 office-based clinics. The Korean government has designated 52 simple or minor disease groups (SMDGs) to enhance the experience of patients who attend primary care for managing those diseases. We assessed comprehensiveness for each clinic as the number of SMDGs treated in each clinic for 2 years. We also identified the factors related to higher comprehensiveness, using logistic regression for analysis. Results: The clinics included in the study had provided treatment for an average of 14 SMDGs during a 2-year period. Compared to general practitioners, internal medicine physicians presented higher comprehensiveness with an odds ratio (OR) of 2.29 (95% confidence interval [CI], 2.03–2.59), and family medicine physicians illustrated higher comprehensiveness (OR, 4.96; 95% CI, 3.59–6.83). Other specialties showed lower comprehensiveness than general practitioners. Clinics located in the capital city and metropolitan area tended to have lower comprehensiveness. Clinics hiring more doctors and having hospitalization facility showed higher comprehensiveness. Conclusion: General physician, internal medicine, and family medicine are the fields providing comprehensive medical care in Korea. Clinics located in metropolitan area and capital city show lower comprehensiveness. The number of physicians is related to higher comprehensiveness of clinics.
Irreversible Response of the Intertropical Convergence Zone (ITCZ) to CO₂ Forcing
Jong-Seong Kug,Ji-Hoon Oh,Soon-Il An,Sang-Wook Yeh,Seung-Ki Min,Seok-Woo Son,Jong-Hoon Kam,Yoo-Geun Ham,Jongsoo Shin 한국기상학회 2021 한국기상학회 학술대회 논문집 Vol.2021 No.10
With the unprecedented rate of global warming in this century, whether or not human-made climate change is irreversible is the most critical question. Based on idealized CO₂ ramp-up and -down experiments, we show here that the intertropical convergence zone (ITCZ) exhibits irreversible changes. While the ITCZ location does not change much during the CO₂ increasing period, the ITCZ sharply moves south as soon as CO₂ begins to decrease, and its center eventually resides in the Southern Hemisphere. The pattern of the irreversible precipitation changes manifests a permanent extreme El Nino-like pattern, which has distinctive impacts on the global hydrological cycle. It was revealed that the hysteresis behavior of the Atlantic meridional overturning circulation and the delayed energy exchanges between the tropics and extratropics are responsible for the peculiar evolution of the hemispheric temperature contrast, leading to irreversible ITCZ changes
Kim, Jung-Hoon,Won, Young-Bin,Ji, Chang-Jun,Yang, Yoon-Mo,Ryu, Su-Hyun,Ju, Shin-Yeong,Kwon, Yumi,Lee, Yeh-Eun,Lee, Jin-Won Elsevier 2017 Biochemical and biophysical research communication Vol.484 No.1
<P><B>Abstract</B></P> <P>PerR, a member of Fur family of metal-dependent regulators, is a major peroxide sensor in many Gram positive bacteria, and controls the expression of genes involved in peroxide resistance. <I>Bacillus licheniformis</I>, a close relative to the well-studied model organism <I>Bacillus subtilis</I>, contains three PerR-like proteins (PerR<SUB>BL</SUB>, PerR2 and PerR3) in addition to Fur and Zur. In the present study, we characterized the role of PerR<SUB>BL</SUB> in <I>B. licheniformis</I>. <I>In vitro</I> and <I>in vivo</I> studies indicate that PerR<SUB>BL</SUB>, like PerR<SUB>BS</SUB>, uses either Fe<SUP>2+</SUP> or Mn<SUP>2+</SUP> as a corepressor and only the Fe<SUP>2+</SUP>-bound form of PerR<SUB>BL</SUB> senses low levels of H<SUB>2</SUB>O<SUB>2</SUB> by iron-mediated histidine oxidation. Interestingly, regardless of the difference in H<SUB>2</SUB>O<SUB>2</SUB> sensitivity, if any, between PerR<SUB>BL</SUB> and PerR<SUB>BS</SUB>, <I>B. licheniformis</I> expressing PerR<SUB>BL</SUB> or PerR<SUB>BS</SUB> could sense lower levels of H<SUB>2</SUB>O<SUB>2</SUB> and was more sensitive to H<SUB>2</SUB>O<SUB>2</SUB> than <I>B. subtilis</I> expressing PerR<SUB>BL</SUB> or PerR<SUB>BS</SUB>. This result suggests that the differences in cellular milieu between <I>B. subtilis</I> and <I>B. licheniformis</I>, rather than the intrinsic differences in PerR<SUB>BS</SUB> and PerR<SUB>BL</SUB> <I>per se</I>, affect the H<SUB>2</SUB>O<SUB>2</SUB> sensing ability of PerR inside the cell and the H<SUB>2</SUB>O<SUB>2</SUB> resistance of cell. In contrast, <I>B. licheniformis</I> and <I>B. subtilis</I> expressing <I>Staphylococcus aureus</I> PerR (PerR<SUB>SA</SUB>), which is more sensitive to H<SUB>2</SUB>O<SUB>2</SUB> than PerR<SUB>BL</SUB> and PerR<SUB>BS</SUB>, were more resistant to H<SUB>2</SUB>O<SUB>2</SUB> than those expressing either PerR<SUB>BL</SUB> or PerR<SUB>BS</SUB>. This result indicates that the sufficient difference in H<SUB>2</SUB>O<SUB>2</SUB> susceptibility of PerR proteins can override the difference in cellular environment and affect the resistance of cell to H<SUB>2</SUB>O<SUB>2</SUB>.</P> <P><B>Highlights</B></P> <P> <UL> <LI> <I>Bacillus licheniformis</I> PerR senses H<SUB>2</SUB>O<SUB>2</SUB> by Fe-mediated histidine oxidation. </LI> <LI> The <I>in vivo</I> H<SUB>2</SUB>O<SUB>2</SUB>-sensing ability of PerR can be modulated by cellular environments. </LI> <LI> The H<SUB>2</SUB>O<SUB>2</SUB>-sensitivity of PerR can affect the resistance of cells to H<SUB>2</SUB>O<SUB>2</SUB>. </LI> </UL> </P>