OBJECTIVES: The purpose of this study is to investigate the characteristics of drinking patterns and the prevalence of hazardous drinking and alcohol use disorder with the assessment of alcohol policy needs in community population of urban city in Korea. METHODS: Data was collected from 1,000 residents in a single urban city in Korea, from June 1 to July 31, 2011 by a questionnaire. As research tools, socio-demographic characteristics composed of variables based on study purpose, alcohol problems and alcohol use disorder state scales composed with Alcohol Use Disorder Identification Test(AUDIT) and Cut down, Annoyed, Guilty, Eye-opener(CAGE), and the assessment of alcohol policy needs in community population questions were used. RESULTS: The lifetime experience of alcohol drinking was 97.4%. For the frequency of drinking, 21.9% of population responded 2 to 4 times per weekly. 24.4% of male had one time or more high risk drinking, defined as having four or more drinks in a sitting, per week. 51.6% experienced the first time drinking of alcohol in adolescence. The lifetime prevalence of hazardous drinking and alcohol use disorder were 14.9% and 3.3%, respectively using AUDIT. Alcohol use disorder were 9.6% with the CAGE scale. Problem drinking were 8.4% in this study. They requested the program such as prevention education(57.2%), construction of liaison system to treatment facilities( 50.1%), alcohol counseling and intervention(41.7%), and rehabilitation program(39.8%). CONCLUSIONS: These results demonstrate that alcohol problem and alcohol use disorder were much prevalent, and these problem started in the earlier age. It is necessary to develop an effective alcohol prevention program or policy with considering the needs in community population.
Adolescent ; Alcohol Drinking ; Counseling ; Drinking ; Humans ; Korea ; Male ; Prevalence ; Questionnaires ; Weights and Measures

The aim of this study was to understand the roles of Sonic Hedgehog (SHH) signaling during tooth root and periodontium formation. In this study, we generated the dental mesenchyme-specific Smoothened (Smo) activated/inactivated mice with the activity of Cre recombinase under the control of osteocalcin promoter.In the Smo activated mutant molar sections at the postnatal 28 days, we found extremely thin root dentin and widened pulp chamber. Picrosirius red staining showed loosely arranged fibers in the periodontal space and decreased cellular cementum with some root resorption. Immunohistochemical staining showed less localization of matrix proteins such as Bsp, Dmp1, Pstn, and Ank in the cementum, periodontal ligament, and/or cementoblast.In the Smo inactivated mutant mouse, there was not any remarkable differences in the localization of these matrix proteins compared with the wild type. These findings suggest that adequate suppressing regulation of SHH signaling is required in the development of tooth root and periodontium.
Animals ; Dental Cementum ; Dental Pulp Cavity ; Dentin ; Hedgehogs ; Mice ; Molar ; Osteocalcin ; Periodontal Ligament ; Periodontium ; Recombinases ; Root Resorption ; Tooth Root ; Tooth

We evaluated the prevalence and risk factors for early age-related macular degeneration (AMD) in Koreans 50 yr of age or older who were examined at a single health promotion center. We retrospectively reviewed the records of 10,449 subjects who visited the center over a 6-month period. Fundus photography was performed on all subjects, and systematic risk factor analysis was conducted using a structured questionnaire. All patients (n = 322) were initially diagnosed with drusen or early AMD using fundoscopy; the control group (n = 10,127) were those yielding normal fundoscopy findings. The age- and gender-adjusted prevalence of early AMD was 3.08%. Advanced age, male gender, smoking status, hyperlipidemia, working outdoors, and residence in rural areas were all significantly associated with an increased risk for development of early AMD. Higher-level ingestion of fruit or herbal medication and an increased amount of exercise were associated with a lower risk of early AMD development. In our Korean cohort, consisting principally of relatively healthy, middle-class urban adults, the prevalence of early AMD was 3.08% that is similar to that reported in earlier epidemiological studies. Several modifiable risk factors such as smoking and hyperlipidemia are associated with the prevalence of early AMD in our cohort.
Age Factors ; Cohort Studies ; Community Health Centers ; Female ; Humans ; Hyperlipidemias/complications ; Macular Degeneration/complications/diagnosis/*epidemiology ; Male ; Middle Aged ; Odds Ratio ; Prevalence ; Questionnaires ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Sex Factors ; Smoking

OBJECTIVE: This study examined the efficacy and safety of memantine-an uncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist-in the treatment of moderate-to-severe dementia. METHODS: Forty-four patients with moderate-to-severe dementia received 20 mg of memantine daily for 24 weeks. The primary efficacy variable was measured by the Korean version of Severe Impairment Battery(K-SIB), and the secondary efficacy variables were measured using the Seoul-Activites of Daily Living(S-ADL) and Neuropsychiatric Inventory-Questionnaire(NPI-Q). Neuropsychological assessments were administrated at baseline, 12 weeks, and 24 weeks. Safety parameters were monitored. RESULTS: Of 44 patients recruited, 30 completed the study and 14 dropped out. Memantine-treated patients showed a therapeutic benefit in all efficacy variables ; the K-SIB, S-ADL, and NPI-Q total scores were not significantly different from baseline either at the endpoint(in the analysis of intention-to-treat, with the last observation carried forward, ITT-LOCF) or at week 24(in the analysis of observed cases, OC). The response rates, when "response" was defined as improved or unchanged in the K-SIB or the S-ADL scores, were 43.3 and 50%, respectively(in the analysis of OC). The responders showed significant improvement in the cognitive subdomain of memory function, praxis, visuospatial ability, and orienting to name. Memantine was shown to be tolerable and safe. CONCLUSIONS: Memantine treatment reduced or delayed clinical deterioration in cognition, function, and behavior in patients with moderate-to-severe dementia.
Cognition ; Dementia* ; Humans ; Memantine* ; Memory ; N-Methylaspartate

The overexpression of X-linked inhibitor of apoptosis protein (XIAP), a member of IAP family protein, is intuitively expected to be associated with unfavorable clinical features in malignancies; however, there have been only a very limited number of studies reporting the clinical relevance of XIAP expression. This study was performed to investigate the prognostic relevance of XIAP expression in childhood acute myeloid leukemia (AML). In 53 children with de novo AML, the level of XIAP expression was determined by using quantitative reverse transcriptase-polymerase chain reaction and was analyzed with respect to the clinical characteristics at diagnosis and treatment outcomes. As a result, the XIAP expression was found to be higher in patients with extramedullary disease than in those without (P=0.014). In addition, XIAP overexpression (> or =median expression) was associated with an unfavorable day 7 response to induction chemotherapy and also associated with a worse 3-yr relapsefree survival rate (52.7+/-20.9% vs. 85.9+/-14.8%, P=0.014). Multivariate analyses revealed that XIAP overexpression was an independent unfavorable prognostic factor for relapse-free survival (hazard ratio, 6.16; 95% confidence interval, 1.48-25.74; P=0.013). Collectively, XIAP overexpression may be used as an unfavorable prognostic marker in childhood AML.
Adolescent ; Child ; Child, Preschool ; Female ; Gene Expression Regulation, Leukemic ; Humans ; Infant ; Leukemia, Myeloid, Acute/*diagnosis/drug therapy/mortality ; Male ; Prognosis ; Reverse Transcriptase Polymerase Chain Reaction ; Survival Rate ; X-Linked Inhibitor of Apoptosis Protein/*metabolism

Background: Cardiac resynchronization therapy (CRT) is an effective treatment option for patients with heart failure (HF) and left ventricular (LV) dyssynchrony. However, the problem of some patients not responding to CRT remains unresolved. This study aimed to propose a novel in silico method for CRT simulation. Methods: Three-dimensional heart geometry was constructed from computed tomography images. The finite ele‑ ment method was used to elucidate the electric wave propagation in the heart. The electric excitation and mechani‑ cal contraction were coupled with vascular hemodynamics by the lumped parameter model. The model parameters for three-dimensional (3D) heart and vascular mechanics were estimated by matching computed variables with measured physiological parameters. CRT effects were simulated in a patient with HF and left bundle branch block (LBBB). LV end-diastolic (LVEDV) and end-systolic volumes (LVESV), LV ejection fraction (LVEF), and CRT responsiveness measured from the in silico simulation model were compared with those from clinical observation. A CRT responder was defined as absolute increase in LVEF ≥ 5% or relative increase in LVEF ≥ 15%. Results: A 68-year-old female with nonischemic HF and LBBB was retrospectively included. The in silico CRT simu‑ lation modeling revealed that changes in LVEDV, LVESV, and LVEF by CRT were from 174 to 173 mL, 116 to 104 mL, and 33 to 40%, respectively. Absolute and relative ΔLVEF were 7% and 18%, respectively, signifying a CRT responder.In clinical observation, echocardiography showed that changes in LVEDV, LVESV, and LVEF by CRT were from 162 to 119 mL, 114 to 69 mL, and 29 to 42%, respectively. Absolute and relative ΔLVESV were 13% and 31%, respectively, also signifying a CRT responder. CRT responsiveness from the in silico CRT simulation model was concordant with that in the clinical observation. Conclusion This in silico CRT simulation method is a feasible technique to screen for CRT non-responders in patients with HF and LBBB.

Objective: To develop a deep-learning-based bone age prediction model optimized for Korean children and adolescents and evaluate its feasibility by comparing it with a Greulich-Pyle-based deep-learning model. Materials and Methods: A convolutional neural network was trained to predict age according to the bone development shown on a hand radiograph (bone age) using 21036 hand radiographs of Korean children and adolescents without known bone development-affecting diseases/conditions obtained between 1998 and 2019 (median age [interquartile range {IQR}], 9 [7–12] years; male:female, 11794:9242) and their chronological ages as labels (Korean model). We constructed 2 separate external datasets consisting of Korean children and adolescents with healthy bone development (Institution 1: n = 343;median age [IQR], 10 [4–15] years; male: female, 183:160; Institution 2: n = 321; median age [IQR], 9 [5–14] years; male:female, 164:157) to test the model performance. The mean absolute error (MAE), root mean square error (RMSE), and proportions of bone age predictions within 6, 12, 18, and 24 months of the reference age (chronological age) were compared between the Korean model and a commercial model (VUNO Med-BoneAge version 1.1; VUNO) trained with Greulich-Pyle-based age as the label (GP-based model). Results: Compared with the GP-based model, the Korean model showed a lower RMSE (11.2 vs. 13.8 months; P = 0.004) and MAE (8.2 vs. 10.5 months; P = 0.002), a higher proportion of bone age predictions within 18 months of chronological age (88.3% vs. 82.2%; P = 0.031) for Institution 1, and a lower MAE (9.5 vs. 11.0 months; P = 0.022) and higher proportion of bone age predictions within 6 months (44.5% vs. 36.4%; P = 0.044) for Institution 2. Conclusion The Korean model trained using the chronological ages of Korean children and adolescents without known bone development-affecting diseases/conditions as labels performed better in bone age assessment than the GP-based model in the Korean pediatric population. Further validation is required to confirm its accuracy.

In order to resolve the decline in population due to low birthrates, the South Korean government is expanding its free child care policies with an increased budget. In anticipating the effects and problems of our system, it will be worthy of attention to refer to the child care systems of other countries. In this paper, we reviewed the past and present policies and the current situation of the child care system in North Korea. North Korea started its free child care system earlier than that of South Korea, for the purpose of utilizing the women's labor force and rearing children to be revolutionary men of Juche type (Kimilsungism), in order to construct a communistic society. 'Child Care Education Law', which is the legal foundation of the child care system, regulates institutions for nursery schools and kindergarten and informs people that the country is responsible for support of child care. Despite their interest and progress in both quantity and quality in the child care system until the 1980s, the free child care system was partially disrupted, and discrepancies between ideology and actual situation were revealed due to economic difficulties from the 1990s. Because people's survival and physical health have been threatened, it is barely possible to find any study investigating the effect of institutional child care from early childhood and the instillation of unique ideology by group education from the preschool period on mental health.
Budgets ; Child ; Child Care ; Child Day Care Centers ; Democratic People's Republic of Korea* ; Education* ; Employment ; Humans ; Korea ; Male ; Mental Health ; Schools, Nursery

BACKGROUND/AIMS: Accurately diagnosing inflammatory bowel disease (IBD) remains a challenge, but is crucial for providing proper management for affected patients. The aim of the present study was to evaluate the frequency of change in diagnosis in Korean patients who were referred to our institution with a diagnosis of IBD. METHODS: We enrolled 1,444 patients diagnosed with ulcerative colitis (UC) and 1,452 diagnosed with Crohn's disease (CD), who had been referred to the Asan Medical Center between January 2010 and December 2014. These patients were assessed and subsequently classified as having UC, CD, indeterminate colitis, possible IBD, or non-IBD. RESULTS: During a median follow-up of 15.9 months, 400 of the 2,896 patients (13.8%) analyzed in this study experienced a change in diagnosis. A change in diagnosis from UC to CD, or vice-versa, was made in 24 of 1,444 patients (1.7%) and 23 of 1,452 patients (1.6%), respectively. A change to a non-IBD diagnosis was the most common modification; 7.5% (108 of 1444) and 12.7% (184 of 1452) of the patients with a referral diagnosis of UC and CD, respectively, were reclassified as having non-IBD. Among the 292 patients who were ultimately determined not to have IBD, 135 (55 UC and 80 CD cases) had received IBD-related medication. CONCLUSIONS: There are diagnostic uncertainties and difficulties in relation to IBD. Therefore, precise assessment and systematic follow-up are essential in the management of this condition.
Chungcheongnam-do ; Cohort Studies* ; Colitis ; Colitis, Ulcerative ; Crohn Disease ; Diagnosis* ; Follow-Up Studies ; Humans ; Inflammatory Bowel Diseases* ; Korea* ; Referral and Consultation

Most preschool children in Korea attend kindergarten (KG) or a child care center (CCC). CCCs, which focus on caring for the child, belong to the ministry of health and welfare. On the other hand, KGs are responsible for education, and belong to the ministry of education, science and technology. In order to resolve the decline in population due to low birthrates, the government is expanding the free child care and education policies. CCCs and KGs are combined together to form the 'NURI curriculum' and supporting funds have been increased in both governmental departments. In addition, economic support is provided for homeschooling households. Because this is a nationwide policy and applies to every single household, thorough preparation regarding the effect and side effects must be made. This policy is currently being implemented, and as child and adolescent psychiatrists, great consideration should be given to the influence on the population. Therefore, the Korean Academy of Child and Adolescent Psychiatry intends to investigate the effects and problems of the nationwide policy by analyzing the current condition of Korea's free child care and education and foreign policies. In the current paper, we reviewed the developmental process of Korea's free child care and education policy, as well as suggested future directions.
Adolescent ; Adolescent Psychiatry ; Child ; Child Care ; Child, Preschool ; Chlormequat ; Family Characteristics ; Financial Management ; Hand ; Humans ; Korea ; Mental Health ; Psychiatry