Developing and Validating a Korean Version of the Assessment of Children's Emotional Skills.

In this study, a Korean Assessment of Children's Emotional Skills (ACES) was developed by modifying the original ACES which was initially introduced in the United States. Specifically, the original ACES was translated into Korean and revised to better fit the Korean cultural context. The content validity of the revised Korean ACES was established via expert reviews. To test its reliability, the revised Korean ACES was conducted on 286 six-year-old children. A confirmatory factor analysis indicated that our newly developed Korean ACES can be used as an appropriate tool to measure Korean children's emotional skills. The Korean ACES can stimulate further studies on these emotional skills and contribute to various international collaborative studies that seek to compare the emotional skills of children from diverse cultural backgrounds.

Assessment of masticatory function in patients with non-sagittal occlusal discrepancies.

Non-sagittal occlusal discrepancies such as posterior cross-bite and anterior openbite are common types of malocclusion, but studies on masticatory function related to those malocclusions have been scarce. The aim of this study was to quantify the masticatory performance in patients with non-sagittal discrepancies compared to those with normal occlusion, using both objective and subjective measures. Maximum bite force and contact area using Dental Prescale(®) system as a static objective assessment, Mixing Ability Index (MAI) as a dynamic objective evaluation and food intake ability (FIA) as a subjective assessment were analysed from 21 people in normal occlusion (Group N) and 64 patients with posterior cross-bite (Group C), anterior openbite (Group O) or both (Group B). The differences of the maximum bite force, the contact area, the MAI and the FIA were compared, and their correlations were figured out. The non-sagittal malocclusion groups showed lower values in the maximum bite force, the contact area, the MAI and the FIA compared to those in the normal group (P < 0·0001). Compared to Group N, Groups C, O and B showed 61·5%, 42·1% and 40·1% of the maximum bite force, and 84%, 84% and 76% of hard food FIA, respectively. However, there were no significant differences among Groups C, O and B. The MAI showed higher correlation with the FIA (r = 0·38, P < 0·01), than with the maximum bite force and the contact area (both r = 0·24, P < 0·5). These results revealed that masticatory function in patients with non-sagittal discrepancies is significantly reduced both objectively and subjectively.

Advanced criticality assessment method for sewer pipeline assets.

For effective management of water and wastewater infrastructure, the United States Environmental Protection Agency (US-EPA) has long emphasized the significant role of risk in prioritizing and optimizing asset management decisions. High risk assets are defined as assets with a high probability of failure (e.g. soon to fail, old, poor condition) and high consequences of failure (e.g. environmental impact, high expense, safety concerns, social disruption). In practice, the consequences of failure are often estimated by experts through a Delphi method. However, the estimation of the probability of failure has been challenging as it requires the thorough analysis of the historical condition assessment data, repair and replacement records, and other factors influencing the deterioration of the asset. The most common predictor in estimating the probability of failure is calendar age. However, a simple reliance on calendar age as a basis for estimating the asset's deterioration pattern completely ignores the different aging characteristics influenced by various operational and environmental conditions. This paper introduces a new approach of using 'real age' in estimating the probability of failure. Unlike the traditional calendar age method, the real age represents the adjusted age based on the unique operational and environmental conditions of the asset. Depending on the individual deterioration pattern, the real age could be higher or lower than its calendar age. Using the concept of real age, the probability of failure of an asset can be more accurately estimated.

Changing patterns of medication use in patients with rheumatoid arthritis in a Medicaid population.

OBJECTIVE: To examine changes in patterns of medication utilization in patients with RA. METHODS: Data from Tennessee Medicaid (TennCare) databases (1995-2004) were used to identify adults with both a diagnosis of RA and at least one DMARD prescription each year. Annual age-specific utilization of DMARDs, glucocorticoids, NSAIDs and narcotics was measured on the last day of each year to determine the point prevalence of use of these agents. RESULTS: Records from 23 342 patients with treated RA were analysed. Most patients were females (78%) and white (74%). The median age was 57 yrs (interquartile range: 48-65). The proportion of patients who had a current DMARD prescription on the index date increased from 62% in 1995 to 71% in 2004 (P < 0.001). MTX was the most commonly used DMARD. By the end of 2004, 22% of patients had a current prescription for a biologic, and etanercept represented 51% of all biologic therapies. During the study period, the overall utilization of glucocorticoids decreased from 46% to 38% (P < 0.001), whereas NSAID utilization increased from 33% to 38% (P < 0.001), and use of narcotics increased from 38% to 55% (P < 0.001). A secondary analysis that identified RA patients based on diagnosis codes alone, showed similar patterns, but lower DMARD utilization which increased from 33% to 52% overall and from 0% to 16% for biologics. CONCLUSIONS: The utilization of DMARDs increased in TennCare patients with RA, and by 2004, use of biologics was substantial. Although glucocorticoid utilization decreased, use of both NSAIDs and narcotics increased.

Financial burden of national health insurance for treating patients with transfusion-dependent thalassemia in Taiwan.

The thalassemias are a heterogeneous group of inherited hypochromic anemias of varying severity. The mainstay of supportive treatment is regular blood transfusion accompanied by iron-chelating therapy. Hematopoietic stem cell transplantation (HSCT) provides an alternative option when curative therapy is considered. More than 400 patients in Taiwan have beta-thalassemia major or other transfusion-dependent thalassemias, and their treatment costs account for a considerable percentage of the National Health Insurance expenditure. In this report, we estimated the treatment costs of conventional therapy (regular blood transfusion accompanied by iron-chelating agents) and HSCT. The undiscounted medical cost of 20 years of follow-up (20 years from diagnosis) and the undiscounted total lifetime cost were NT$ 4 739 888 (NT$ means New Taiwan Dollars)/US$ 149 288 and NT$ 11 529 990/US$ 363 149, respectively, for patients undergoing conventional therapy, and NT$ 2 639 982/US$ 83 149 and NT$ 3 511 172/US$ 110 588, respectively, for those undergoing successful HSCT. Comparisons of treatment costs and other parameters between these two modalities can add to the information base on which policy is made by health authorities or clinicians.

Patient absconding behaviour in a public general hospital: retrospective study.

OBJECTIVE: To identify characteristics of patients who abscond from general hospital wards, and to determine patient outcomes. DESIGN: Retrospective study. SETTING: In-patient wards of a public general hospital, Hong Kong. SUBJECTS AND METHODS: Incident reports of 116 absconding episodes over a 20-month period from 1 November 1998 to 30 June 2000 were reviewed. Clinical characteristics, time and reason for absconding, destination of patient, outcomes, and adverse events were recorded. RESULTS: The majority of patients who absconded were middle-aged males admitted through the Accident and Emergency Department to the specialty of general medicine. Most incidences occurred within 24 hours of admission while in the emergency admission wards. Twelve percent of incidents were repeated episodes of absconding. The most common clinical diagnoses given to this patient group were drug overdose, intoxication, and soft tissue injury. Known drug addicts (29.3%) formed a substantial proportion of the patient group. Forty- seven patients returned to the ward within a few hours, while a further nine (7.8%) re-attended the Accident and Emergency Department of the hospital within 4 days. Several adverse outcomes were recorded: one patient died following a fall from height and two patients committed criminal offences. CONCLUSION: Patient absconding incidents are an important issue in hospital risk management. They can delay the delivery of appropriate medical treatment and may lead to other adverse patient outcomes, in addition to potential medicolegal consequences.

What happens to the triangular fibrocartilage complex during pronation and supination of the forearm? Analysis of its morphology and diagnostic assessment with MR arthrography.

OBJECTIVE: To evaluate the dynamic morphologic changes of the triangular fibrocartilage complex (TFCC) during pronation and supination of the forearm using high-resolution MR arthrography in cadavers and to evaluate the impact of these changes on the diagnostic assessment of the normal and abnormal TFCC. DESIGN AND SPECIMENS: High-resolution MR arthrography of 10 wrists of cadaveric specimens was obtained in maximum pronation, in the neutral position, and in maximum supination of the forearm. The structures of the TFCC were evaluated by two musculoskeletal radiologists and correlated with anatomic sections. The position of the forearm that allowed the best visualization of normal structures and lesions of the TFCC was determined. RESULTS: The shape and extent of the articular disc as well as the radial portions of the radioulnar ligaments did not change with pronation and supination. The articular disc was horizontal in the neutral position and tilted more distally to align with the proximal carpal row in pronation and supination. The fibers of the ulnar part of the radioulnar ligaments (ulnar attachment of the articular disc) revealed the most significant changes: their orientation was coronal in the neutral position and sagittal in positions of pronation and supination. The ulnomeniscal homologue was largest in the neutral position and was reduced in size during pronation and supination. The extensor carpi ulnaris tendon was centered in its groove in the neutral position and pronation. In supination this tendon revealed subluxation from this groove. The dorsal capsule of the distal radioulnar joint was taut in pronation, and the palmar capsule was taut in supination. The preferred forearm position for analysis of most of the structures of the TFCC was the neutral position, followed by the pronated position. The neutral position was rated best for the detection of ulnar and radial detachments of the TFCC, followed by the pronated position, except for two central perforations of the TFCC which were best seen with supination. CONCLUSION: The articular disc and the surrounding radial portions of the radioulnar ligaments form a rigid, unified complex with the radius without change in their shape in positions of pronation and supination of the forearm, while the ulnar attachment of the TFCC shows important dynamic changes. The neutral forearm position is the best position to analyze both the normal and the abnormal TFCC.

Leg ulceration in the sickle cell patient.

BACKGROUND: The purpose of this study was to determine cost of care for leg ulcers in sickle cell patients and suggest an improved modality in ulcer care. STUDY DESIGN: We performed a retrospective study of a group of sickle cell disease patients with leg ulcers. RESULTS: Eighteen patients with a leg ulcer (duration: mean, 53.7 months), sickle cell disease, and a mean of 20.7 years of age had various modalities of treatment with the only consistency in healing being a commercial moist-wound dressing. CONCLUSIONS: There is no consistency in the treatment of the sickle cell patient with a leg ulcer. Treatment with a moist dressing had the best results.

Racial differences in home ownership and home equity among preretirement-aged households.

This article measures the racial disparities in home ownership and home equity among preretirement-aged households. It computes the proportion of the racial gap explained by discrimination in housing and credit markets. Maximum likelihood and nonlinear least squares estimates are obtained for models of home ownership probabilities and home equity, conditional on home ownership, yielding computations for expected home equity for black and white households. The results reveal an average discriminatory gap in expected home equity as a percent of the actual gap of 55%. In the top third of the family income distribution, the measured discriminatory gap is 82%; in the middle third it is 83%; in the lowest third it is 62%.

Health insurance and utilization of medical care for children with special health care needs.

Based on analyses of the 1988 National Center for Health Statistics, National Health Interview Survey, Child Health Supplement, this study examines the insurance coverage and utilization of physicians, hospitals, and prescribed medicine among the 9.6 million U.S. children with special health care needs, defined as children who had one or more selected chronic conditions that caused them to experience pain, discomfort, or being upset often or all of the time in the last year, or who were limited in their major childhood activities (playing or going to school) as a result of these or other impairments or health problems. The findings confirmed that substantial variation in access to routine medical care exists among these children. Though health status is an important predictor of which children use services in general, poor, minority children who lived with their mother or someone other than their parents, or those without insurance or an identifiable regular medical provider were most likely to experience financial barriers to access or were less apt to seek care than other children with comparable needs. Access to routine medical care remains particularly problematic for these subsets of children with special health care needs.

Determination of whole-body nitrogen and radiation assessment using in vivo prompt gamma activation technique.

Body nitrogen content in the phantom is measured by semiconducting and scintillation spectrometers using in vivo prompt gamma-ray activation analysis technique. The effective dose rate equivalents for sensitive organs and tissues inside the phantom are assessed by dosimetric measurement and neutron transport calculation. The bismuth germanate scintillator is found superior to the germanium semiconducting detector to quantitatively measure the photopeak of the 10.829 MeV prompt gamma-ray emitted from the 14N(n, gamma) reaction. Recommended scanning period for current setup using the BGO detector is 1 h on the modified mobile nuclear reactor. The effective dose equivalents from both neutrons and gamma-rays are estimated around 63 microSv per scan in the phantom test, making it a safe and reliable nuclear analytical method for in vivo body nitrogen measurement.

Trend analysis of social and economic indicators of mammography use in Hawaii.

We examine the relationship between ethnicity and income as determinants of mammography use over a span of four years as a means of assessing community intervention impacts. The sample consisted of 1,447 women older than 34 years, living in Hawaii, who participated in the Behavioral Risk Factor Surveillance System (BRFSS). The percentage of women in the sample reporting a screening mammogram within the past two years was 31.4% in 1987, 54.1% in 1989, and 51.6% in 1990. Women of Hawaiian ancestry had the lowest percentage of mammogram use in the past two years (38.7%), while Japanese women had the highest percentage (49.8%). Results of logistic regression analysis indicate a significant increase in mammography use from 1987 to 1989 and no difference from 1989 to 1990. Findings also showed an association between age, income, and ethnicity with use in the past two years. Greater age, higher income, and Japanese origin, compared to Hawaiian, were all independently associated with increased odds of having had a mammogram in the past two years. We discuss results in terms of program evaluation and future research implications for community health surveys.

Health-related behaviors in Korea: smoking, drinking, and perinatal care.

The prevalence of major health-related behaviors and the relationship of these factors with selected sociodemographic factors were studied in South Korea. Subjects studied were household heads and their wives from 989 households. Age-standardized prevalences of smoking were 74.8% and 2.9% for men and women respectively, with no urban-rural difference. There was a tendency of younger or less-educated men smoking more heavily. The prevalence of use of alcoholic drinks were 79.8% and 26.0% for men and women respectively. More drinking was associated with a younger age and higher level of education. The mean prevalences of prenatal care, clinic or hospital delivery, and breastfeeding were 75.0%, 62.6%, and 75.2% respectively in the urban area, whereas the corresponding rates were 63.0%, 50.9%, and 81.1% in the rural area. Higher rates in prenatal care and hospital delivery were associated with a younger age and higher educational level, while breastfeeding showed the opposite trend.

Health risk behaviours and ethnicity in Hawaii.

This study has examined the relationships of health-related behaviours to sociodemographic factors with special emphasis on ethnicity in Hawaii. Behavioural variables investigated were non-use of car seat belts, overweight, physical inactivity, smoking, heavier alcohol use, and driving while intoxicated. Sociodemographic factors considered were ethnicity, island, sex, age, education, employment status, marital status, and household income. Major ethnic groups studied were Caucasians, Hawaiians including part-Hawaiians, Chinese, Filipinos, and Japanese. The relationships of ethnic factors with the behavioural characteristics were studied by logistic regression after fitting significant non-ethnic sociodemographic variables. Multiple risk behaviour was investigated by canonical correlation analysis. Different behavioural factors were found to be associated with different sets of non-ethnic socioeconomic variables. There were significant ethnic differences in individual at-risk behaviours except for driving while intoxicated. Overweight was most prevalent among Hawaiians followed by Caucasians. Caucasians and Hawaiians were at higher risk for non-use of seat belts, cigarette smoking, and heavier alcohol use compared to Chinese, Filipinos, and Japanese. Orientals were physically less active than Caucasians and Hawaiians. Implications of the observed ethnic differences are discussed.

Women who obtain repeat abortions: a study based on record linkage.

The proportion of induced abortions in a year that are repeat procedures rises over time, but this rate is as low as can be expected given the shortcomings of currently available contraceptives. There is no evidence that women substitute abortion for contraception. Teenagers and poor women have greater difficulty avoiding unwanted pregnancies.