Changhoon Kim

2009-2010 novel influenza A (H1N1) vaccination coverage in the Republic of Korea.

This study aimed to assess vaccination coverage for novel influenza A (H1N1) in Korea using a immunization registry system as the data source. Vaccination coverage was found to be 26.1% for the total population and 54.4% for priority groups targeted by a national vaccination campaign between October 27, 2009, to March 31, 2010. The factors associated with increased coverage were rapid vaccination and free vaccination; these factors may need to be considered in future pandemics.

Depression and Suicide Ideas of Cancer Patients and Influencing Factors in South Korea

BACKGROUND This study compared risk factors for depression and suicidal ideas among cancer patients for comparison with the general population, and identified influencing factors. MATERIALS AND METHODS We analyzed data from 2,472 cancer patients in the National Cancer Center and nine Regional Cancer Centers and frequency-matched data for age and sex from 2,349 members of the general population who completed the National Health and Nutrition Examination Survey in 2008. Logistic regression analysis was used to identify factors affecting depression and suicidal ideas. RESULTS Cancer patients were not likely to have more depression (OR=0.96, 95%CI=0.79-1.18) and were less likely to have suicidal ideas (OR=0.64, 95%CI=0.53-0.79) compared to the general population. Female sex, more stress, and lower quality of life were influencing factors. The additional risk factors for suicidal ideas among cancer patients included income (OR=0.62, 95%CI=0.43-0.91), smoking (OR=1.63, 95% CI=1.06-2.50), recurrence (OR=1.50, 95%CI=1.15-1.95), and chemotherapy (OR=1.66, 95%CI=1.26-2.19). CONCLUSIONS No differences appeared in depression rates between cancer patients and the general population, and cancer patients were less likely to have suicidal ideas. However, cancer patients were likely to have more risk factors than the general population, and those classified as being at high risk of suicide should receive distress management and social economic support, from early in the treatment process.

Different roles of zinc plus arachidonic acid on insulin sensitivity between high fructose- and high fat-fed rats

AIMS This study was to determine the effects of zinc plus arachidonic acid (ZA) treatment on the insulin action in the specific ZA target organs using hyperinsulinemic euglycemic clamp method. MAIN METHODS 18 Sprague-Dawley rats weighing ~130 g were divided into 3 groups of 6 rats and treated them with 1) normal rat chow, 2) high fructose (60.0%) diet only, or 3) the same fructose diet plus drinking water containing 10mg zinc plus 50mg arachidonic acid (AA)/L. In a separate study, male Wistar rats weighing ~250 g were fed normal rat chow (n=4) or high fat (66.5%) diet with drinking water containing zero (n=9) or 10mg AA plus 20mg zinc /L (n=9). After 4 week treatment, insulin action was assessed using the hyperinsulinemic eguglycemic clamp technique. KEY FINDINGS High fructose feeding impaired suppression of hepatic glucose output by insulin compared to controls during the clamp procedure (4.39 vs. 2.35 mg/kg/min; p<0.05). However, ZA treatment in high fructose-fed rats showed a significant improvement of hepatic insulin sensitivity compared to non-treatment controls (4.39 vs. 2.18 mg/kg/min; p<0.05). Glucose infusion rates in Wistar rats maintained on a high fat diet (HFD) were significantly lower compared to control rats (22.8 ± 1.3 vs. 31.9 ± 1.4 mg/kg/min; p<0.05). ZA treatment significantly improved (~43%) peripheral tissue insulin sensitivity in HFD fed animals (26.7 ± 1.3 [n=9] vs. 22.8 ± 1.3mg/kg/min; p<0.05). SIGNIFICANCE These data demonstrate that ZA treatment is effective in improving glucose utilization in hyperglycemic rats receiving either a high-fructose or a high-fat diet.

The Common Patterns of Multimorbidity and Its Impact on Healthcare Cost in Korea

Background: Current trends in Korea population aging with advances in public health and clinical medicine foretell rises in the prevalence of not only chronic diseases but also patients with multimorbidity. One important aspect in analyzing multimorbidity is to define the list of chronic diseases included when calculating multimorbidity index. The objective of this study is to describing the effect of multimorbidity on healthcare cost in Korea using US Office of the Assistant Secretary of Health (OASH) list. Methods: We analyzed the Korea Health Panel Data representing non-institutionalized Korean adult populations aged 20 and more. We calculated multimorbidity index based on OASH list and estimated the prevalence and healthcare cost for each OASH chronic disease. Results: In 2011, 15.2 million (39.6%) Koreans aged 20 and more were living with chronic condition. The health care cost due to chronic diseases, accounted for 80.2% of the overall healthcare costs and the prevalence of chronic conditions, the prevalence of multimorbidity and healthcare cost increased with ages. In the analysis using OASH list, 40% of the adult population over the age of 20 and 66.7% of the population over the age of 65 was affected with multimorbidity. In most of diseases in OASH list, prevalence of mulitmorbidity was high and healthcare cost increased with multimorbidity. Conclusion: OASH chronic disease list that accounts for 72.4% of prevalence and 86.7% of healthcare cost of persons with chronic conditions in Korea. OASH chronic disease list would be a useful and representative indicator for studying multimorbidity.

Disparities by Age, Sex, Tumor Stage, Diagnosis Path, and Area-level Socioeconomic Status in Survival Time for Major Cancers: Results from the Busan Cancer Registry

Our goal was to examine the effect of area-level deprivation on patient survival time for seven major cancers — stomach, colon, liver, lung, breast, cervix, and thyroid cancer. Data on 10,902 subjects who were diagnosed with major cancers from 2010 and 2011 in Busan were collected regarding the survival time along with several important prognostic factors and an area-level deprivation index was constructed from education, income, unemployment, and welfare assistance, to assess the comprehensive area-level socioeconomic status. A multilevel Cox proportional hazard model was used to investigate the effects of multiple risk factors such as gender, age, tumor stage, diagnosis path, and the area-level deprivation. After adjusting for risk factors the area-level deprivation index was found to be significant in associating with higher hazard rate for several cancers. Estimated hazard ratios (95% CI) were 1.08 (0.99–1.18), 1.23 (1.12–1.36), 1.36 (1.21–1.53) for the second, the third, and the fourth quartile of deprivation index groups, respectively, when compared to the least deprived group. When compared with the least deprived group, the more deprived group showed significant decrease in survival time for major cancers. This novel finding may contribute to the literature regarding the association of area-level socioeconomic status and highlight the importance of careful monitoring of socioeconomic characteristics for cancer prevention and care services.

Cross-cultural application of the Korean version of the EORTC QLQ-ELD14 questionnaire for elderly patients with cancer

OBJECTIVES The European Organization for Research and Treatment of Cancer (EORTC) QLQ-ELD14 is a validated tool that measures Health-related Quality-of-life (HRQOL) for elderly patients with cancer. This study was conducted to evaluate the psychometric properties of the Korean version of the EORTC QLQ-ELD14 to determine if this tool can be used to evaluate HRQOL for older Korean patients with cancer. MATERIALS AND METHODS We recruited 439 elderly patients with cancer aged ≥60years from 11 cancer centers and completed the EORTC QLQ-ELD14 questionnaires. The reliability and validity of the EORTC QLQ-ELD14 questionnaire were assessed via Cronbach alpha, multitrait scaling analyses, correlation analyses with the EORTC QLQ-C30, and known-group comparisons. Known-group comparisons were conducted by dividing the patients into groups based on the cancer stage, depression level, and loss of mobility. RESULTS The scale structure of the Korean version of the EORTC QLQ-ELD14 was consistent with the originally hypothesized scale structure. Cronbach alpha coefficients ranged 0.65-0.88. Multitrait scaling analysis showed good item convergent and discriminant validity. Low scaling errors (3.1%) were observed. Divergent validity was demonstrated by no strong correlation with the EORTC QLQ C30. The clinical validity of the Korean version of the EORTC QLQ-ELD14 was demonstrated by its ability to discriminate among patient subgroups categorized by AJCC stage, depression level, and loss of mobility. CONCLUSION Our findings indicate that the Korean version of the EORTC QLQ-ELD14 questionnaire is reliable and valid for measuring QOL of older Korean patients with cancer.

The Relationship between Microcirculatory Resistance and Fractional Flow Reserve in Patients with Acute Myocardial Infarction.

Background and Objectives It was demonstrated that the fractional flow reserve (FFR) with partial balloon obstruction may have implications for assessing viable myocardium. In a different way, the index of microcirculatory resistance (IMR) was introduced as a useful indicator for assessing microvascular function. We evaluated the relationship between the FFR0.8 and the IMR. Subjects and Methods We studied 48 consecutive patients who had undergone coronary intervention for acute myocardial infarction (AMI). After revascularization using stent(s), an undersized short balloon was positioned inside the stent and inflated to create a specific normalized pressure drop of FFR (distal coronary/aortic pressure=0.80) at rest. The FFR0.8 was obtained during hyperemia with the fixed state balloon-induced partial obstruction. IMR was measured by three injections of saline. The association between the FFR0.8 and the IMR was investigated. Results The mean age of the patients was 60±12 years and 36 (75%) overall presented with ST-segment elevation myocardial infarction. The mean FFR0.8 was 0.68±0.06. A statistically significant correlation between the FFR0.8 and the log-transformed IMRtrue (LnIMRtrue) was found through a multivariable linear regression analysis (β=0.056, p<0.001). Both the FFR0.8 and the LnIMRtrue had a positive correlation with the log-transformed peak troponin I (TnI) with statistical significance (r2=0.119, p=0.017; r2=0.225, p=0.006, respectively). Conclusion There was a positive correlation between the LnIMRtrue and the FFR0.8. Both of the values were associated with peak TnI. Those values may be used as appropriate surrogate measures of microvascular function after AMI.

Effect of Area-Level Deprivation on Cancer Survival Time: A Register-Based Follow-up Study of 145 585 Korean Subjects:

Our goal is to evaluate the strengths of the associations between area-level deprivation and survival time for a variety of cancers. A total of 145 585 subjects were diagnosed with various cancers in Busan, Korea, and an area-level deprivation index constructed from several important socioeconomic variables. A multilevel Cox model was used in the analysis to investigate the effects of multiple risk factors. After adjusting for gender and age, an increased area-level deprivation index was found to be significantly associated with a higher hazard rate for major cancers. Estimated hazard ratios (95% confidence interval) were 1.08 (1.06, 1.11), 1.15 (1.13, 1.18), and 1.22 (1.18, 1.25) for the second, third, and fourth quartiles of deprivation index groups, respectively, when compared with the least deprived group. When compared with the least deprived group, the more deprived group showed significant decrease in survival time for major cancers. This finding highlights the importance of preventive and care services incorporating socioeconomic characteristics of areas.

The influence of side branch stenosis on fractional flow reserve assessment of the main branch in a swine model

The aim of this study was to explore the effect of one stenosis in a daughter artery on the fractional flow reserve (FFR) of another stenosis parallels in side branch. Background: The impact of one stenosis on the FFR of another parallel stenosis has not been evaluated. Methods: The proximal segments of the left anterior descending (LAD) and left circumflex (LCX) arteries were exposed and encircled with a Teflon pledget complex in seven swine (55–70 kg). Five degrees of stenosis (to approximate angiographic diameter stenoses of 0%, 25%, 50%, 75%, and 100%) were made by tightening the pledgets. FFR was evaluated simultaneously in the LAD and the LCX with two pressure wires in each coronary artery. A mixed‐effects linear model was used to evaluate the association between the FFR values. Results: A total of 115 paired FFR values were obtained. The FFR of the LAD and LCX were not significantly associated with each other (F = 0.237 and P = 0.627 for the LCX FFR to predict the LAD FFR; F = 0.541 and P = 0.463 for the LAD FFR to predict the LCX FFR). Conclusions: The individual FFR values of each parallel stenosis in the LAD and the LCX were not significantly influenced by each other. This relationship was independent of the mean aortic pressure and heart rate.

Effects of contemporary management on clinical outcomes in elderly patients with acute myocardial infarction

acute myocardial infarction Jun-Hyok Oh , ChanghoonKim ,Mi Jin Yang , Sung Gyu An , HyeWon Lee , Jung-Hyun Choi , Han Cheol Lee , Kwang Soo Cha ⁎, Taek Jong Hong a and others from the Korea Acute Myocardial Infarction Registry a Department of Cardiology, Medical Research Institute, Pusan National University Hospital, Busan, South Korea b Department of Preventive Medicine, Medical Research Institute, Pusan National University Hospital, Busan, South Korea