OBJECTIVE: A reference terminology is essential to achieve semantic interoperability and enhance the quality of health care. Reference terminologies that have achieved common acceptance contain many concepts that clinicians would not want in healthcare, which preclude their practical use in documentation of patient information. To solve the problems, this document proposes a reference terminology model which contains concepts that physicians can use satisfactorily. METHODS: We analyzed the structures of the UMLS and SNOMED CT. We also analyzed health care terms which had been collected by the Korea National Health Information Standard Committee. Based on the results of the analysis, we developed an object-oriented reference terminology model. And, we designed database schema with the model. RESULTS: Eight components of the UMLS and six components of the SNOMED CT were analyzed. The collected terms had various properties and mapping vocabularies according to the characteristics of their respective domains. A reference terminology model was developed from a three-level view using UML. A database schema was developed using ERD. CONCLUSION: This study mainly focuses on reference terminology modeling. It is hoped that this reference terminology modeling helps the semantic interoperable exchange of clinical documents as the basis of common EMR.
Delivery of Health Care* ; Hope ; Humans ; Korea ; Quality of Health Care ; Semantics ; Systematized Nomenclature of Medicine ; Unified Medical Language System ; Vocabulary

PURPOSE: In recent years, obesity in children has become one of the major nutritional problems, and the trend is that number of obese children is increasing. The purpose of this research is to examine the incidence of obesity in pubescent school children in Seoul and Cheju, and to analyze body fat component, complications and eating habits of those obese children in order to obtain basic information for prevention of obesity in children in the future. METHODS: The total number of 4,555 junior high school students from 4 schools consisting of 1,234 boys and 3,321 girls were examined based on their height and weight. For those children, obesity index was calculated based on the 50th percentile obtained from standard weight for height of children proposed by the Korean Pediatric Association in 1985. The body fat component was measured and compared between 275 children of 530 obese children(11.6%) and 275 children from the control group by Futrex-5000 A body fat and fitness computer. Of those children, oral glucose tolerance test, blood pressure, and biochemical studies were performed on 31 children whose follow-up was possible, and their exercise load and eating habits were examined. RESULTS: It was found that 11.6% of the subject children were obese, which consisted of 12.4% in boys and 11.4% in girls. The study showed 11.4% obesity ratio in Seoul and 13.2% obesity ratio in Cheju, but the difference was insignificant. Percents of bodyfat was 25.3+/-5.7% (mean+/-SD) for control group, 32.9+/-4.8% for mild obesity group, 35.6% for moderate obesity group, and 37.2+/-4.0% for severe obesity group. The morbidity of complications of those 31 children whose follow-up was possible showed the highest percentage of 29.0% in hyperlipidemia, and lower percentage in hypertension, elevated AST and/or ALT, glucose intolerance, diabetes, respectively. The eating habit analysis showed the total calorie intake/total energy expenditure ratio of 1.10 which is higher in calories than energy consumption, and the food intake evaluation showed that 23.3% of fat was contained in total calorie intake. CONCLUSIONS: The childhood obesity becomes the primary cause of adult obesity, hypertension and diabetes, and therefore, eating habits and exercise load should be carefully observed in order to prevent childhood obesity. In addition to the health care provided currently by schools, regular physical check-up should undertaken for early diagnosis to conduct appropriate tests and treatment.
Adipose Tissue ; Adult ; Blood Pressure ; Child* ; Delivery of Health Care ; Early Diagnosis ; Eating ; Energy Metabolism ; Female ; Follow-Up Studies ; Glucose Intolerance ; Glucose Tolerance Test ; Humans ; Hyperlipidemias ; Hypertension ; Incidence* ; Jeju-do ; Obesity* ; Obesity, Morbid ; Pediatric Obesity ; Seoul

BACKGROUND/AIMS: Dyslipidemia is one of the major causes of cardiovascular disease in end-stage renal disease (ESRD) patients. Most of them are dyslipidemic despite the use of lipid-lowering agents. Ezetimibe is a novel chemical entity that inhibits the intestinal absorption of dietary and biliary cholesterol. This study evaluated the effects of ezetimibe on the lipid profile, inflammation markers, endothelial injury, and thrombogenesis in ESRD patients. METHODS: Sixty-five patients with serum low-density lipoprotein (LDL)-cholesterol levels > or =100 mg/d were recruited: 33 patients were on hemodialysis and 32 patients were on peritoneal dialysis. They were assigned randomly to the ezetimibe (10 mg) monotherapy group and the ezetimibe (10 mg) plus simvastatin (10 mg) combination therapy group. Both drugs were administered for 8 weeks. RESULTS: There were no significant differences in the baseline demographic and laboratory characteristics between the two groups. In the monotherapy group, the total and LDL-cholesterol levels were reduced by 14.7 and 21.9%, respectively. There were no changes in the high-density lipoprotein (HDL)-cholesterol or triglyceride levels. Fibrinogen increased significantly (p=0.04). In the combination therapy group, the total and LDL-cholesterol levels were reduced by 29.8 and 42.4%, respectively. There was an additional 15.1% reduction in total cholesterol and an additional 20.5% reduction in LDL cholesterol compared with monotherapy. Several patients complained of minor adverse effects and only one patient in the ezetimibe monotherapy group discontinued medication, because of diarrhea. CONCLUSIONS: In ESRD patients, ezetimibe used as combination therapy with a statin is more effective than ezetimibe monotherapy in ESRD patients.
Azetidines ; Cardiovascular Diseases ; Cholesterol ; Cholesterol, LDL ; Dyslipidemias ; Fibrinogen ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Inflammation ; Intestinal Absorption ; Kidney Failure, Chronic ; Lipoproteins ; Peritoneal Dialysis ; Renal Dialysis ; Simvastatin ; Ezetimibe

BACKGROUND: The epidemiology of tuberculosis (TB) has been assessed based on the data of the analysis of TB patients notified to the surveillance system in Korea. However, the national status of TB is not validated through this surveillance system. The objective is to determine the epidemiology of TB and to understand the accurate status of TB patients treated in private institutions. METHODS: Medical records of 53,579 patients who had been diagnosed with TB in 2008 were analyzed. RESULTS: Among 53,579 patients, the number of sputum smear positive cases was 15,639(29.2%) and the number of new cases was 39,191 (73.1%). The drug resistance rate of new cases was 5.3%, while the rate stood at 13.3% for TB patients with treatment history. The number of multi-drug resistant TB (MDR-TB) patients was 2,472 (4.6%), which consists of 2.9% of new cases and 9.3% of TB patients with prior treatment history. The number of extensively drug-resistant TB patients was 749 (1.4%), consisting of 1.1% of new cases and 2.2% of TB patients with prior treatment history. In terms of treatment outcomes, 66.4% of all TB patients, 70.5% of new cases, 64.4% of relapse cases, and 46.8% of MDR-TB cases were cured or completed. It was inferred that in 2008, the total number of TB patients reached 70,767, 145.6 per 100,000 people (95% confidence interval, 145.5~145.7). CONCLUSION: We conclude that the medical records review of the Health Insurance Review and Assessment Service (HIRA) data can be very effective in promoting the understanding of the current status of TB in private institutions.
Data Collection ; Disease Notification ; Drug Resistance ; Humans ; Insurance, Health ; Korea ; Medical Records ; Recurrence ; Sputum ; Tuberculosis ; Tuberculosis, Multidrug-Resistant

BACKGROUND: The epidemiology of tuberculosis (TB) has been assessed based on the data of the analysis of TB patients notified to the surveillance system in Korea. However, the national status of TB is not validated through this surveillance system. The objective is to determine the epidemiology of TB and to understand the accurate status of TB patients treated in private institutions. METHODS: Medical records of 53,579 patients who had been diagnosed with TB in 2008 were analyzed. RESULTS: Among 53,579 patients, the number of sputum smear positive cases was 15,639(29.2%) and the number of new cases was 39,191 (73.1%). The drug resistance rate of new cases was 5.3%, while the rate stood at 13.3% for TB patients with treatment history. The number of multi-drug resistant TB (MDR-TB) patients was 2,472 (4.6%), which consists of 2.9% of new cases and 9.3% of TB patients with prior treatment history. The number of extensively drug-resistant TB patients was 749 (1.4%), consisting of 1.1% of new cases and 2.2% of TB patients with prior treatment history. In terms of treatment outcomes, 66.4% of all TB patients, 70.5% of new cases, 64.4% of relapse cases, and 46.8% of MDR-TB cases were cured or completed. It was inferred that in 2008, the total number of TB patients reached 70,767, 145.6 per 100,000 people (95% confidence interval, 145.5~145.7). CONCLUSION: We conclude that the medical records review of the Health Insurance Review and Assessment Service (HIRA) data can be very effective in promoting the understanding of the current status of TB in private institutions.
Data Collection ; Disease Notification ; Drug Resistance ; Humans ; Insurance, Health ; Korea ; Medical Records ; Recurrence ; Sputum ; Tuberculosis ; Tuberculosis, Multidrug-Resistant

BACKGROUND/AIMS: Spontaneous HBeAg seroconversion occurs frequently in the immune reactive phase in HBeAg-positive chronic hepatitis B (CHB). Therefore, observation for 3-6 months before commencing antiviral therapy is recommended in patients with alanine aminotransferase (ALT) levels that exceed twice the upper limit of normal (ULN). However, HBeAg seroconversion occurs infrequently in patients infected with hepatitis B virus (HBV) genotype C. The aim of the present study was to determine whether the waiting policy is necessary in endemic areas of HBV genotype C infection. METHODS: Ninety patients with HBeAg-positive CHB were followed prospectively without administering antiviral therapy for 6 months. Antiviral therapy was initiated promptly at any time if there was any evidence of biochemical (i.e., acute exacerbation of HBV infection or aggravation of jaundice) or symptomatic deterioration. After 6 months of observation, antiviral therapy was initiated according to the patient's ALT and HBV DNA levels. RESULTS: Only one patient (1.1%) achieved spontaneous HBeAg seroconversion. Biochemical and symptomatic deterioration occurred before 6 months in 17 patients (18.9%) and 5 patients, respectively. High ALT and HBV DNA levels were both independent risk factors for biochemical deterioration. Of 15 patients with HBV DNA > or =5.1x107 IU/mL and ALT > or =5xULN, biochemical deterioration occurred in 7 (46.7%), including 1 patient receiving liver transplantation due to liver failure. CONCLUSIONS: Spontaneous HBeAg seroconversion in patients with HBeAg-positive CHB is rare within 6 months. Biochemical deterioration was common and may lead to liver failure. Immediate antiviral therapy should be considered, especially in patients with high ALT and HBV DNA levels in endemic areas of genotype C infection.
Adult ; Alanine Transaminase/blood ; Antiviral Agents/*therapeutic use ; DNA, Viral/blood ; Female ; Follow-Up Studies ; Genotype ; Guanine/analogs & derivatives/therapeutic use ; Hepatitis B e Antigens/*blood ; Hepatitis B virus/*genetics ; Hepatitis B, Chronic/*drug therapy ; Humans ; Male ; Middle Aged ; Prospective Studies ; Risk Factors

BACKGROUND: Early recognition of thoracic aortic disease is critical for managing the patients to reduce morbidity and mortality. In emergency department(ED), transesophageal echocadiography(TEE) has recently challenged traditional diagnostic modality for assessing thoracic aortic disease such as computed tomogram(CT) scan, aortography and magnetic resonance imaging(MRI) because of it's safety, rapid acquisition time, high sensitivity and portability. The purpose of this study was to evaluate the diagnostic role of TEE as the first imaging modality in nontraumatic and traumatic thoracic aortic disease in emergency department. METHODS: From May 1993 to Feburary 1995, twenty six patients(nontrauma : 13 cases, trauma : 13 cases) who were suspicious of thoracic aortic disease and received tee as the first diagnostic tool in emergency department were enrolledd. Indications of emergency TEE in the suspicious thoracic aortic disease were typical chest pain, mediastinal widening or massive left side hemothorax. RESULTS: Of the 26 patients undergoing TE, CT scan were performed sequentially in patients(except 4 patients who died immediately in ED). Aortic pathology was detected in 18 patients (65%). Aortic pathology of nontraumatic patients were as followings : DeBakey type I dissction was in 4 cases(36%), type II dissection in 3 cases (28%), and type III dissection in 4 cases(36%). Six of 13 traumatic patients (46%) had thoracic aortic injury. Findings of aortic injury were aortic tear(2 cases), aortic aneurysm and aortic dissection in each. Of six traumatic thoracic aortic lesions which were detected by TEE, 4 lesions (2 aortic tear, subintimal hematoma, and aortic aneurysm) were not detected dby CT scan. Only 4 cases(15%) underwent emergency operation after TEE. There was no significant hemodynamic deterioration or procedure-related dddeath during TEE. CONCLUSION: In emergency department, TEE may be considered as the first diagnostic tool in detecting acute thoracic aortic disease. In considering of it's high sensitivity, no contrast injection, short procedure time and portability at bedside, TEE should be prefered in patients with suspected thoracic aortic disease from trauma.
Aortic Aneurysm ; Aortic Diseases* ; Aortography ; Chest Pain ; Diagnosis* ; Echocardiography, Transesophageal* ; Emergencies* ; Emergency Service, Hospital ; Hematoma ; Hemodynamics ; Hemothorax ; Humans ; Mortality ; Pathology ; Tomography, X-Ray Computed

People with obesity maintain low levels of inflammation; therefore, their exposure to foreign antigens can trigger an excessive immune response. In people with obesity or allergic contact dermatitis (ACD), symptoms are exacerbated by a reduction in the number of regulatory T cells (Tregs) and IL-10/TGF-β–modified macrophages (M2 macrophages) at the inflammatory site. Benefits of intermittent fasting (IF) have been demonstrated for many diseases; however, the immune responses regulated by macrophages and CD4+ T cells in obese ACD animal models are poorly understood. Therefore, we investigated whether IF suppresses inflammatory responses and upregulates the generation of Tregs and M2 macrophages in experimental ACD animal models of obese mice. The IF regimen relieved various ACD symptoms in inflamed and adipose tissues. We showed that the IF regimen upregulates Treg generation in a TGF-β-dependent manner and induces CD4+ T cell hypo-responsiveness. IF-M2 macrophages, which strongly express TGF-β and inhibit CD4+ T cell proliferation, directly regulated Treg differentiation from CD4+ T cells. These results indicate that the IF regimen enhances the TGF-β-producing ability of M2 macrophages and that the development of Tregs keeps mice healthy against ACD exacerbated by obesity. Therefore, the IF regimen may ameliorate inflammatory immune disorders caused by obesity.

BACKGROUND/AIMS: Colorectal cancer is the third most common cancer and the fourth leading cause of cancer death in Korea. Colonoscopic screening with removal of adenomas is an effective strategy for reducing the incidence and mortality of colorectal cancer. This study was conducted to investigate predictable factors of early colorectal cancer (ECC) in patients with advanced adenoma (AA), tumor in situ (Tis), and submucosal (SM) cancer diagnosed after colonoscopic polypectomy. METHODS: Between August 2003 and June 2012, a total of 1,001 patients who underwent colonoscopic polypectomy in Jeju National University Hospital were enrolled in this study. RESULTS: Patients were classified into four groups; non-AA, AA, Tis, and SM cancer. Compared to the AA group, the ECC group (n=50) had large adenoma size (12.2+/-5.9 mm vs. 15.3+/-6.5 mm, P<0.01), distal location (39.3% vs. 52.0%, P=0.05) and diabetes mellitus (13.1% vs. 25.0%, P=0.04). However, age, sex, body mass index, the mean number of polyps, and morphological features (polypoid vs. nonpolypoid lesions) were not significantly different between the AA and ECC groups. In multivariate analysis, adenoma size >15 mm (odds ratio [OR], 4.49; 95% confidence interval [CI] 2.40-8.38), distal location (OR, 2.59; 95% CI, 1.33-5.05), and diabetes mellitus (OR, 2.10; 95% CI, 1.07-4.43) were significantly associated with ECC. Of the 12 patients with SM cancer, 5 underwent additional operations and had no remnant carcinoma. CONCLUSIONS: Predictable factors of ECC after colonoscopic polypectomy may be adenoma size >15 mm, distal location and diabetes mellitus.
Adenoma ; Body Mass Index ; Colonoscopy ; Colorectal Neoplasms ; Diabetes Mellitus ; Humans ; Incidence ; Korea ; Mass Screening ; Multivariate Analysis ; Polyps

BACKGROUND/AIMS: The point mutations in 23S rRNA gene accounts for the majority of the clarithromycin resistance of Helicobacter pylori. This study aimed to investigate the association between the clarithromycin-resistance of H. pylori and the failure of primary H. pylori eradication therapy in Jeju Island. METHODS: Between April 2011 and October 2012, 6,937 patients underwent endoscopy, and H. pylori infection was evaluated in 2,287 patients (33.0%). Total of 110 patients with H. pylori infection were treated with proton pump inhibitor (PPI)-based triple therapy. The result of eradication was evaluated with urea breath test, histology and PCR which were conducted 4 weeks from the last dose of medicine. RESULTS: The patients who had point mutations were 33 (26.0%). A2142G and A2143G mutations were observed in 10 patients (7.9%) and 23 patients (18.1%). Among 110 patients treated with PPI-based triple therapy, the success rate of the eradication therapy was 52.7% (58/110) and 70.7% (58/82) by intention-to-treat and per-protocol analysis, respectively. Fifteen of the 24 patients who failed the eradication therapy showed point mutations; 1 patient (4.2%) showed A2142G mutation and 14 patients (58.3%) showed A2143G mutation. Patients with A2143G mutation H. pylori showed higher failure rate of 87.5%. Patients with A2142G mutation H. pylori showed similar failure rate compared to those of the patients with wild type H. pylori. CONCLUSIONS: In Jeju Island, the frequency of 23S rRNA point mutations is similar (26.0%) with other regions of Korea (15.8-31.3%). A2143G mutation is associated with the failure of H. pylori eradication.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/*therapeutic use ; Clarithromycin/*therapeutic use ; DNA, Bacterial/analysis ; Drug Resistance, Bacterial ; Female ; Gastroscopy ; Helicobacter Infections/*drug therapy ; Helicobacter pylori/drug effects/*genetics ; Humans ; Islands ; Male ; Middle Aged ; Point Mutation ; Polymerase Chain Reaction ; Proton Pump Inhibitors/therapeutic use ; RNA, Ribosomal, 23S/*genetics ; Republic of Korea ; Young Adult