Socio-economic factors and medical conditions affecting regular stomach cancer screening in Korea: a retrospective longitudinal study using national public health data for 11 years.

OBJECTIVE: This study aimed to explore socio-economic factors and medical conditions that affect regular stomach cancer (SC) screening among Korean adults. STUDY DESIGN: This was a retrospective observational study. METHODS: Study subjects were 5545 adults aged ≥40 years who participated in the 2007-2012 Korean National Health and Nutrition Examination Survey and were followed up to year 2017 based on data linking to the Korean National Health Insurance Service and Korean Health Insurance Review and Assessment. Socio-economic factors included sex, age, residential area, education, occupation, marital status, disability, public and private health insurance, service through local public health organizations, history of cancer except for SC, and family history of SC. Medical factors included six gastric lesions with the possibility of facilitating SC screening, including benign gastric neoplasm, chronic atrophic gastritis, gastric polyp, Helicobacter pylori infection, intestinal metaplasia, and peptic ulcers. The outcome was adherence to SC screening, which was divided into non-adherence, irregular adherence, and regular adherence. RESULTS: After adjusting for the effects of socio-economic factors, multivariate ordinal logistic regression revealed that participants with a history of four types of gastric lesions were more likely to regularly participate in SC screening: chronic atrophic gastritis (odds ratio [OR] 1.567; 95% confidence interval [CI] = 1.276-1.923), gastric polyps (OR 1.565; 95% CI = 1.223-2.003), H. pylori infection (OR 1.637; 95% CI = 1.338-2.003), and peptic ulcer (OR 2.226; 95% CI 1.750-2.831). CONCLUSIONS: To improve participation in SC screening, it is necessary to implement personalized strategies for individuals at risk for gastric cancer in addition to population-based strategies for vulnerable groups.

Quantitative assessment of cerebrospinal fluid hydrodynamics using a phase-contrast cine MR image in hydrocephalus.

This investigation was undertaken to characterize CSF flow at the level of the aqueduct of Sylvius with a phase-contrast cine MR pulse sequence in 28 healthy volunteers. Sixteen patients with obstructive hydrocephalus and 11 patients with normal pressure hydrocephalus (NPH) were investigated with the same sequence before and after CSF diversion. The peak CSF flow velocity and stroke volume in the aqueduct increased significantly in the NPH group and decreased significantly in the obstructive hydrocephalus group. After lumboperitoneal shunting in the NPH group, the retrograde flow of CSF was anterogradely converted and the peak flow velocities decreased somewhat. The clinical diagnosis of NPH was well correlated with the results of cine MRI. After endoscopic III ventriculostomy in the obstructive hydrocephalus group we noted increased CSF flow velocity with markedly increased stroke volume at the prepontine cistern. Phase-contrast cine MR is useful in evaluating CSF dynamics in patients with hyperdynamic aqueductal CSF or aqueductal obstruction.

Evaluation of the completeness of cancer case ascertainment in the Seoul male cohort study: application of the capture-recapture method.

Since the completeness of case ascertainment is directly related to the validity of a study, the evaluation of completeness is an essential feature of a cohort study. To estimate the completeness of cancer case ascertainment during a three year period (Jan. 1, 1993, to Dec. 31, 1995) in which the Seoul Male Cohort was followed up, we applied capture-recapture method. Data were obtained from the cancer registries, medical records and death certificates, with cases identified from each source numbering 103, 105, and 38, respectively. After eliminating duplicate cases, the total number was 141, and by using a log-linear model, the number of cases not detected by any of the three data sources was estimated to be 16. For all cancers, the estimated completeness of follow-up was 89.9%.

[Development in the National Hospice Care Service in Korea].

The urgent needs to establish hospice care systems in Korea arise from the following reasons: (1) a drastic increase in chronically ill patients with the increase of aged population: (2) rapid changes in living environment from the traditional habitation (e.g., Many Koreans living in apartment complexes, which is the most popular form of modern residence in recent years, prefer to die in the hospital.): the overall increase in patients with advanced cancer: (4) recent trends in early discharge of terminally ill patients from the limited hospital facilities to accommodate other medical insurance beneficiaries: (5) easy acceptance of euthanasia owing to the recent social atmosphere that belittles the dignity of human life: (6) medical and nursing care of AIDS patient in terminal stage: (7) and the problem associated with inhumane medical care system, overtreatment, and groundless fears against narcotics. Terminally ill patients were used to be treated in the hospital in the past. In these days, however, they are forced to have home cares with little assistance from the qualified medical personnel because of insufficient hospital facilities, which are even short for the need of emergency patients and provide priority cares to medical insurance beneficiaries with other acute problems. And yet, neither are there any administrative organizations nor systematic medical studies that deal with the level of terminally ill patient's need, their family's problems and resources of hospice care systems in Korea. Thus, most patients are not able to get appropriate medical care at the terminal stage of their lives. The objective of this study is to make comprehensive database for various hospice care organization currently in operation, link them through medical information system, and develop an easily accessible hospice care model that meets the need of most Korean people. Our survey results may be summarized as follows: Nationally there are 40 organizations that provide partial or full hospice care. However, these organizations are not linked to any formal medical service network. Furthermore, the objective of hospice care, care principles, personnel with appropriate training, educational programs, standard for care, costs, consulting service to patients' family members, the extent of medical care from professional staff members, status of hospice facility, and management of those institutions are neither clearly defined nor organized compared to the international hospice care standards. The surveys on patients of terminal stage, grouped in hospice and non-hospice care patients, reveal what they want visiting nursing care to help their pain control, psychological, social and spiritual demands. While the more than 90% of hospice care patients want to reduce their pains, the non-hospice care patients, in addition to their desire for pain control, demanded more psychological, social and spiritual helps as well. The results of this research could be utilized to (1) define the standard of hospice care, (2) provide the guidance for hospice medical care costs, (3) establish the database of hospice care systems, (4) develop softwares, (5) build communication network through Medinet, and (6) provide an organized visiting home nursing care system. These information should be a valuable resource to many medical staffs who are involved in cancer therapy, nursing care, and social welfare programs.

The demographic transition in the Korean peninsula, 1910-1990: South and North Korea compared.

PIP: North and South Korea have both experienced demographic transition and fertility and mortality declines. The fertility declines came later in North Korea. In 1990, the population was 43.4 million in South Korea and 21.4 million in North Korea and the age and sex compositions were similar. This evolution of population structure occurred despite differences in political systems and fertility determinants. Differences were in the fertility rate and the rate of natural increase. The total fertility rate was 2.5 children in North Korea and 1.6 in South Korea. The rate of natural increase was 18.5 per 1000 in North Korea and 9.8 in South Korea. Until 1910, the Korean peninsula was in the traditional stage characterized by high fertility and mortality. The early transitional stage came during 1910-45 under the Japanese annexation. Health and medical facilities improved and the crude birth rate rose and then declined. With the exception of the war years, population expanded as a function of births, deaths, and international migration. Poor economic conditions in rural areas acted as a push factor for south-directed migration, migration to Japan, and urban migration. Next came the chaotic stage, during 1945-60. South Korean population expanded during this period of political unrest. Repatriation and refugee migration constituted a large proportion of the population increase. Although the war brought high mortality, new medicine and disease treatment reduced the mortality rate after the war. By 1955-60, the crude death rate was 16.1 per 1000 in South Korea. The crude birth rate remained high at 42 per 1000 between 1950-55. The postwar period was characterized by the baby boom and higher fertility than the pre-war period of 1925-45. Total fertility was 6.3 by 1955-60. The late transitional stage occurred during 1960-85 with reduced fertility and continued mortality decline. By 1980-85, total fertility was 2.3 in the closed population. The restabilization stage occurred during 1985-90, and fertility declined to 1.6. In North Korea, strong population control policies precipitated fertility decline. In South Korea, the determinants were contraception, rising marriage age, and increased use of abortion concomitant with improved socioeconomic conditions.^ieng

Ultrasonography and oral cholecystography: a comparison of their use in the diagnosis of gallbladder disease.

The charts of all cholecystectomy patients at the White Memorial Medical Center, Los Angeles, from January 1977 to December 1979 were reviewed; of 374 patients, 76 had had both abdominal ultrasound scan and oral cholecystography performed preoperatively. Cholecystography accurately diagnosed gallbladder disease in 71 of these 76 patients, an accuracy rate of 93.4% with one false-positive and four false-negative results. Ultrasonography correctly predicted gallbladder disease in 66 of 76 patients, an accuracy rate of 86.8%, with one false-positive and nine false-negative results. On the basis of this study and others in the literature, ultrasound scanning is recommended as the initial screening diagnostic study for gallbladder disease. Oral cholecystography should follow in patients in whom ultrasonography fails to identify gallbladder calculi.