PURPOSE: Pancreaticoduodenectomy (PD) is a complex surgery associated with high morbidity, mortality, and cost. Municipal hospitals have their important role in the public health and welfare system. The purpose of this study was to identify the feasibility as well as the cost-effectiveness of performing PD in a mid-volume municipal hospital based on 13 years of experience with PD. METHODS: From March 2003 to November 2015, 183 patients underwent PD at Seoul Metropolitan Government - Seoul National University Boramae Medical Center.. Retrospectively collected data were analyzed, with a particular focus on complications. Hospital costs were analyzed and compared with a national database, with patients divided into 2 groups on the basis of medical insurance status. RESULTS: The percentage of medical aid was significantly higher than the average in Korean hospitals. (19.1% vs. 5.8%, P = 0.002). Complications occurred in 88 patients (44.3%). Postoperative pancreatic fistula (POPF) occurred in 113 cases (61.7%), but the clinically relevant POPF was 24.6% (grade B: 23.5% and grade C: 1.1%). The median hospital stay after surgery was 20 days (range, 6–137 days). In-hospital mortality was 3.8% (n = 7), with pulmonary complications being the leading cause. During the study period, improvements were observed in POPF rate, operation time, and hospital stay. The mean total hospital cost was 13,819 United States dollar (USD) per patient, and the mean reimbursement from the National Health Insurance Service (NHIS) to health care providers was 10,341 USD (74.8%). The patient copayment portion of the NHIS payment was 5%. CONCLUSION: Performing PD in a mid-volume municipal hospital is feasible, with comparable results and cost-effectiveness.
Health Personnel ; Hospital Costs ; Hospital Mortality ; Hospitals, Municipal* ; Humans ; Insurance Coverage ; Length of Stay ; Local Government ; Mortality ; National Health Programs ; Pancreatic Fistula ; Pancreaticoduodenectomy* ; Postoperative Complications ; Public Health ; Retrospective Studies ; Seoul ; United States

OBJECTIVE: Most BRCA1/2 carriers do not undergo risk-reducing salpingo-oophorectomy (RRSO) by the recommended age. This study aimed to find the incidence of precursor lesions and cancer after RRSO. METHODS: We retrospectively reviewed breast cancer patients identified as BRCA mutation carriers who underwent RRSO at Asan Medical Center, Seoul, Korea, from 2010 to 2014. From 2013, all cases were examined according to the Sectioning and Extensively Examining the Fimbria (SEE/FIM) protocol and underwent immunohistochemically staining. RRSO was performed in 63 patients, 27 in 2010 to 2012 and 36 in 2013 to 2014. RESULTS: The median age at RRSO was 46.5 years (range, 32 to 73 years). Occult invasive cancer was detected in eight patients, of ovarian origin in five and of tubal origin in three. All occult invasive cancer cases with metastasis were detected in patients older than 40 years. Of the 36 patients from the 2013 to 2014 cohort, seven showed p53 overexpression, one showed Ki-67 overexpression, two showed serous tubal intraepithelial carcinoma, and three showed occult cancer. The detection rate of precursor lesions or cancer was 36.1% (13/36). In the analysis according to age, precursor lesions were more common in BRCA1 mutation carriers younger than 40 years old (66.7% vs. 20.0%). In BRCA2 mutation carriers, precursor lesions were only detected in those older than 40 years of age, indicating the possible faster occurrence of precursor lesions in BRCA1 mutation carriers. CONCLUSION: Many patients still tend to delay RRSO until after they are 40 years old. Our findings support the significance of RRSO before the age of 40 in germline BRCA mutation carriers.
Breast Neoplasms* ; Breast* ; Carcinoma in Situ ; Chungcheongnam-do ; Cohort Studies ; Humans ; Incidence ; Korea ; Neoplasm Metastasis ; Retrospective Studies ; Seoul

PURPOSE: We conducted comparative analysis of dietary behavior and food and nutrient intakes of Korean elderly in urban and rural areas using the 2014 Korea National Health and Nutrition Examination Survey (KNHANES). METHODS: This study was conducted on 1,239 participants (urban elderly: 867, rural elderly: 372) aged 65 years and over who participated in the health examination and nutrition survey in the 6th 2014 KNHANES. Dietary behaviors, including skipping meals, eating out frequencies, and food and nutrient intakes were analyzed using 24-hour recall data. Analysis of complex sample design data through SPSS 19.0 was used for the analysis. RESULTS: The rate of skipping dinner was higher in urban (6.5%) than in rural elderly (3.6%) (p < 0.05), and the frequency of eating out per week of urban elderly (1.73) was higher than that of rural elderly (1.35) (p < 0.001). The rural elderly consumed a greater amount of grain compared to urban elderly, whereas consumption of water, seaweed food, and dairy products was lower in rural than in urban areas (p < 0.05). The rural elderly consumed significantly less highly unsaturated fatty acids, n-6 fatty acids, phosphorus, iron, vitamin A, carotene, niacin, and vitamin C in comparison with elderly in urban areas. Comparison of the percentages of Dietary Reference Intakes for Koreans (KDRIs) between the two groups showed that intakes of vitamin A and vitamin C were significantly lower in the rural elderly than in urban elderly. CONCLUSION: The elderly in rural areas showed unbalanced food and nutrient intakes compared to the elderly in urban areas. Therefore, customized nutrition education according to residential areas should be developed and provided to rural elderly to improve their health and nutritional status.
Aged* ; Ascorbic Acid ; Carotenoids ; Dairy Products ; Eating ; Education ; Fatty Acids, Omega-6 ; Fatty Acids, Unsaturated ; Humans ; Iron ; Korea* ; Lunch* ; Meals ; Niacin ; Nutrition Surveys* ; Nutritional Status ; Phosphorus ; Recommended Dietary Allowances ; Seaweed ; Vitamin A ; Water

PURPOSE: The purpose of this study was to develop a nutrition quotient for adolescents (NQ-A) to assess overall dietary quality and food behavior of Korean adolescents. METHODS: Development of the NQ-A was undertaken in three steps: item generation, item reduction, and validation. Candidate items of the NQ-A checklist were selected based on literature reviews, results of the fifth Korea National Health and Nutrition Examination Survey data, dietary guidelines for Korean adolescents, expert in-depth interviews, and national nutrition policies and recommendations. A total of 213 middle and high school students participated in a one-day dietary record survey and responded to 41 items in the food behavior checklist. Pearson's correlation coefficients between the responses to the checklist items along with nutritional status of the adolescents were calculated. Item reduction was performed, and 24 items were selected for the nation-wide survey. A total of 1,547 adolescents from 17 cities completed the checklist questionnaire. Exploratory factor and confirmatory factor analyses were performed to develop a final NQ-A model. RESULTS: Nineteen items were finalized as the checklist items for the NQ-A. Checklist items were composed of five factors (balance, diversity, moderation, environment, and practice). The five-factor structure accounted for 47.2% of the total variance. Standardized path coefficients were used as weights of the items. The NQ-A and five-factor scores were calculated based on the obtained weights of the questionnaire items. CONCLUSION: Nutrition Quotient for adolescents (NQ-A) would be a useful instrument for evaluating dietary quality and food behavior of Korean adolescents. Further research on NQ-A is needed to reflect changes in adolescent's food behavior and environment.
Adolescent* ; Checklist ; Diet Records ; Humans ; Korea ; Nutrition Policy ; Nutrition Surveys ; Nutritional Status ; Weights and Measures

PURPOSE: We explored whether a gender difference was evident in terms of the associations of snoring with hemoglobin A1c (HbA1c) and homeostatic model assessment-insulin resistance (HOMA-IR) levels in a healthy population without type 2 diabetes mellitus (DM). MATERIALS AND METHODS: We analyzed 2706 males and 4080 females who participated in the baseline survey of the Namwon Study. In terms of self-reported snoring frequency, participants were classified as non-snorers or occasional (1–3 days/week), frequent (4–6 days/week), or constant (7 days/week) snorers. Participants with DM, defined as a fasting blood glucose level ≥126 mg/dL and/or use of insulin or hypoglycemic medication, were excluded from the analysis. RESULTS: In females, the fully adjusted mean (95% confidence interval) HbA1c levels in non-snorers and in occasional, frequent, and constant snorers were 5.53% (5.47–5.59%), 5.53% (5.47–5.59%), 5.57% (5.49–5.64%), and 5.57% (5.51–5.64%), respectively, reflecting a dose-response relationship (p trend=0.004). Compared with female non-snorers, the risk of an elevated HbA1c level (top quintile, ≥5.9%) in constant snorers remained significant (odds ratio 1.30, 95% confidence interval 1.02–1.66) after full adjustment. In addition, in females, a significant linear trend in HbA1c level odds ratio by increased snoring frequency was apparent (p trend=0.019 in model 3). In contrast, no significant association between snoring frequency and HbA1c level was identified in males. No significant association between snoring frequency and HOMA-IR was detected in either gender. CONCLUSION: We discovered a gender-specific association between snoring and HbA1c level in a healthy, community-dwelling population free of DM.
Blood Glucose ; Diabetes Mellitus, Type 2* ; Fasting ; Female ; Hemoglobin A ; Humans ; Insulin ; Insulin Resistance ; Jeollabuk-do ; Male ; Odds Ratio ; Snoring* ; Surveys and Questionnaires

As the associations between pediatric overweight/obesity and bone health remain controversial, we investigated the effects of overweight/obesity as well as lean mass (LM) and fat mass (FM) on bone parameters in adolescents. Bone parameters were evaluated using dual-energy X-ray absorptiometry (DXA) data of 982 adolescents (aged 12–19 years) from the Korea National Health and Nutrition Examination Survey (2009–2010). Z-scores for LM, FM, bone mass, bone mineral density (BMD), and bone mineral apparent density (BMAD) using Korean pediatric reference values were used for analysis. Adolescents with overweight/obesity had significantly higher bone mass and density of the total-body-less-head (TBLH), lumbar spine, and femur neck than underweight or normal-weight adolescents (P < 0.001) after adjusting for vitamin D deficiency, calcium intake, and insulin resistance in both sexes. LM was positively associated with bone parameters at all skeletal sites in both sexes (P < 0.001). FM was negatively related to TBLH BMD in boys (P = 0.018) but was positively associated to BMD and BMAD of the lumbar spine and femur neck in girls. In conclusion, overweight/obesity and LM play a positive role in bone health in adolescents. The effect of FM on bone parameters is sex- and site-specific.
Absorptiometry, Photon ; Adolescent* ; Body Composition ; Bone Density ; Calcium ; Female ; Femur Neck ; Humans ; Insulin Resistance ; Korea ; Miners ; Nutrition Surveys ; Obesity* ; Overweight* ; Pediatric Obesity ; Reference Values ; Spine ; Thinness ; Vitamin D Deficiency

The goal of the present study was to evaluate the diagnostic value of a joint distractor in arthroscopy in small-breed dogs. Sixty stifle joints, which were collected from thirty cadavers, were used in this study. To simulate different injuries, no medial meniscal tear, a full-thickness vertical longitudinal tear, a partial-thickness vertical longitudinal tear, full- and partial-thickness vertical longitudinal tears, or a peripheral detachment were created on the caudal horn of the medial meniscus of each stifle joint along with rupture of the cranial cruciate ligament. Each stifle joint then underwent arthroscopy with and without a joint distractor. The sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and correct classification rate (CCR) for the diagnosis of each type of medial meniscus pathology were calculated. For arthroscopy with and without a joint distractor, the Sn was 85% and 60%, the Sp was 96% and 92%, the PPV was 85% and 65%, the NPV was 96% and 90%, and the CCR was 94% and 86%, respectively. Arthroscopy is an effective diagnostic method for the assessment of medial meniscal pathologies in small-breed dogs, especially when performed with the aid of a joint distractor.
Animals ; Anterior Cruciate Ligament ; Arthroscopy ; Cadaver ; Classification ; Diagnosis ; Dogs* ; Horns ; Joints* ; Menisci, Tibial ; Methods ; Pathology ; Rupture ; Sensitivity and Specificity ; Stifle ; Tears

PURPOSE: The purpose of this study was to examine the effects of parental stress, social support, and coping behavior on burnout among mothers caring for children with cerebral palsy. METHODS: Participants in this cross-sectional, descriptive study were 185 mothers who completed a self-report structured questionnaire. The data were analyzed using descriptive statistics, t-test, one-way ANOVA, correlation and multiple linear regression analyses with IBM SPSS Win 22 program. RESULTS: Parental stress and coping behavior were strong predictors of burnout among mothers of children with cerebral palsy. These variables explained 50.0% of the variance in burnout. Social support was not a predictor of burnout. A higher level of burnout was associated with higher levels of parental stress and lower levels of social support and coping behavior. CONCLUSION: Mothers of children with cerebral palsy are vulnerable to burnout. These results show that effective strategies for reducing parental stress and improving positive coping behavior are needed to reduce burnout in these mothers.
Adaptation, Psychological ; Cerebral Palsy* ; Child* ; Humans ; Linear Models ; Mothers* ; Parenting ; Parents ; Stress, Psychological

The authors note that the units on page 188 were reported incorrectly.

BACKGROUND: Micro-needle patches have been recently used to increase skin permeability, which improves drug delivery, and for cosmetic purposes. However, these patches may often have limited efficacy due to insufficient skin penetration and reduced compliance caused by discomfort. OBJECTIVE: We evaluated the efficacy and the safety of soluble micro-spicule containing epidermal growth factor (MS-EGF) for the treatment of periocular wrinkles. METHODS: Twenty healthy volunteers aged 33 to 54 years were enrolled in a randomized, controlled, split-face study. For 4 weeks, a periocular wrinkle was treated daily with either a soluble MS-EGF cream or a cream containing EGF alone. All subjects underwent 8 weeks of follow-up. Efficacy was assessed using an ultrasonic measurement of dermal depth and density, digital skin image analysis, 5-point photonumeric scale for periocular wrinkles and subjective satisfaction. RESULTS: MS-EGF group showed statistically significant increase of dermal depth and density compared to EGF alone group after 4 and 8 weeks. In addition, there was a marked improvement shown in clinical and 3-dimensional skin image in MS-EGF group. The treatments were well-tolerated; no significant side-effect was noted. CONCLUSION: The MS-EGF formulation may represent an effective and biocompatible advance in the treatment of periocular wrinkles.
Compliance ; Epidermal Growth Factor* ; Follow-Up Studies ; Healthy Volunteers ; Permeability ; Skin ; Ultrasonics