Validity of the Morse Fall Scale and the Johns Hopkins Fall Risk Assessment Tool for fall risk assessment in an acute care setting.

AIMS AND OBJECTIVES: To evaluate the measured fall risk score that more accurately reflects the changeable conditions in acute care settings, and to efficiently evaluate the association between falls and fall risk score. BACKGROUND: The Morse Fall Scale (MFS) is a well-known easy-to-use tool, while the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) consists of items with high specificity. Evaluating suitable fall-risk assessment tools to measure these changeable conditions may contribute to preventing falls in acute care settings. DESIGN: Retrospective case-control study using the STROBE checklist. METHODS: In an acute care setting (708-bedded university hospital with a regional emergency medical centre), the non-fall group was adjusted to fall group using propensity score matching. According to the fall rate of 3-5%, non-fall groups for each tool were selected (1386 and 1947) from the before adjusted data, and the fall groups included 42 and 59. The applied covariates were individual characteristics that ordinarily changed such as age, gender, diagnostic department and hospitalisation period. The adjusted data were analysed using generalised estimating equations and mixed effect model. RESULTS: After adjustment, the fall group measured using the JHFRAT had a significantly higher difference between the initial and re-measured total score than the non-fall group. The JHFRAT, especially with the re-measured score, had a higher AUC value for predicting falls than the MFS. MFS's sensitivity was 85.7%, and specificity was 58.8% at 50 points; for JHFRAT, these were 67.8% and 80.2% at 14 points, respectively. These cut-off points were used to evaluate validity during tool development and are commonly used as reference scores. CONCLUSIONS: JHFRAT more accurately reflects acute changeable conditions related to fall risk measurements after admission. RELEVANCE TO CLINICAL PRACTICE: JHFRAT may be useful for effective fall prevention activities in acute care settings.

Role of Parental Social Class in Preterm Births and Low Birth Weight in Association with Child Mortality: A National Retrospective Cohort Study in Korea.

PURPOSE: We explored the role of parental social class in preterm birth (PTB) and low birth weight (LBW) in association with child mortality in Korea. MATERIALS AND METHODS: A total of 7,302,732 births in Korea between 1995 and 2007 were used for designing the national retrospective cohort study. Kaplan-Meier survival curves and Cox proportional hazard models were used to determine the risk of child death after adjusting for covariates. RESULTS: Parental social class was associated with adverse birth outcomes and child mortality in Korea. Parental social class increased the strength of the relationship of adverse birth outcomes with child mortality. Child mortality was higher among PTB and LBW infants from parents with a lower social class than normal births from parents with a higher social class. In particular, the disparity in child mortality according to parental social class was greater for LBW and PTB than intrauterine growth retardation births. When one of the parents had a middle-school education or lower, the disparity in child mortality due to adverse birth outcomes was large regardless of the other spouse's educational status. Inactive economic status for the father, as well as an occupation in manual labor by the mother, increased the risk of child mortality. CONCLUSION: Strong relationships for social inequalities and adverse birth outcomes with inequalities in child mortality in South Korea were found in this study. Tackling social inequalities, as well as reducing adverse birth outcomes, are needed to reduce the disparities in child mortality in South Korea.

Trends of Social Inequalities in the Specific Causes of Infant Mortality in a Nationwide Birth Cohort in Korea, 1995-2009.

The relationship between social disparity and specific causes of infant mortality has rarely been studied. The present study analyzed infant mortality trends according to the causes of death and the inequalities in specific causes of infant mortality between different parental social classes. We analyzed 8,209,836 births from the Statistics Korea between 1995 and 2009. The trends of disparity for cause-specific infant mortality according to parental education and employment were examined using the Cox proportional hazard model for the birth-year intervals of 1995-1999, 2000-2004, and 2005-2009. Adjusted hazard ratios were calculated after adjusting for infants' gender, parents' age, maternal obstetrical history, gestational age, and birth weight. An increasing trend in social inequalities in all-cause infant mortality according to paternal education was evident. Social inequalities in infant mortality were greater for "Not classified symptoms, signs and findings" (International Classification of Diseases 10th revision [ICD-10]: R00-R99) and "Injury, poisoning and of external causes" (S00-T98), particularly for "Ill-defined and unspecified causes" (R990) and "Sudden infant death syndrome (SIDS)" (R950); and increased overtime for "Not classified symptoms, signs and findings" (R00-R99), "Injury, poisoning and of external causes" (S00-T98) and "Conditions in perinatal period" (P00-P96), particularly for "SIDS" (R950) and "Respiratory distress syndrome of newborns (RDS)" (P220). The specific causes of infant mortality, in particular the "Not classified causes" (R00-R99 coded deaths) should be investigated more thoroughly to reduce inequality in health.

Validity of Single Question for Screening Intimate Partner Violence among Urban Latina Women.

OBJECTIVE: The purpose of this study was to test the validity of a single violence question compared with revised Conflict Tactics Scales (CTS2) as an initial tool which can be easily used in community-based health care settings to detect IPV in Latina women. DESIGN AND SAMPLE: The study was conducted using secondary analyses of the baseline data from a culturally tailored HIV risk prevention project SEPA. A total of 657 Mexican and Puerto-Rican women aged 18-40, who reported sexual activities were interviewed. MEASURES: We used data regarding sociodemographic factors, Latino acculturation, a single violence question of "Did your partner hit or hurt you in any way?" and the CTS2 measuring intimate partner violence. RESULTS: Using the CTS2 as a gold standard, the sensitivity and specificity of a single question for screening partner physical violence was 45.9% and 94.7%, respectively. The positive likelihood ratio of a single question for physical violence was 8.59. The sensitivity, specificity, and likelihood ratio of a single question for screening psychological aggression were 17.9%, 98.5%, and 11.89, respectively. CONCLUSION: While a single question used in our study needs further improvement for desirable sensitivity, it may be usable as an initial question for detecting IPV.

A Spray-On Carbon Nanotube Artificial Neuron Strain Sensor for Composite Structural Health Monitoring.

We present a nanocomposite strain sensor (NCSS) to develop a novel structural health monitoring (SHM) sensor that can be easily installed in a composite structure. An NCSS made of a multi-walled carbon nanotubes (MWCNT)/epoxy composite was installed on a target structure with facile processing. We attempted to evaluate the NCSS sensing characteristics and benchmark compared to those of a conventional foil strain gauge. The response of the NCSS was fairly good and the result was nearly identical to the strain gauge. A neuron, which is a biomimetic long continuous NCSS, was also developed, and its vibration response was investigated for structural damage detection of a composite cantilever. The vibration response for damage detection was measured by tracking the first natural frequency, which demonstrated good result that matched the finite element (FE) analysis.

Regional Deprivation Index and Socioeconomic Inequalities Related to Infant Deaths in Korea.

Deprivation indices have been widely used to evaluate neighborhood socioeconomic status and therefore examine individuals within their regional context. Although some studies on the development of deprivation indices were conducted in Korea, additional research is needed to construct a more valid and reliable deprivation index. Therefore, a new deprivation index, named the K index, was constructed using principal component analysis. This index was compared with the Carstairs, Townsend and Choi indices. A possible association between infant death and deprivation was explored using the K index. The K index had a higher correlation with the infant mortality rate than did the other three indices. The regional deprivation quintiles were unequally distributed throughout the country. Despite the overall trend of gradually decreasing infant mortality rates, inequalities in infant deaths according to the deprivation quintiles persisted and widened. Despite its significance, the regional deprivation variable had a smaller effect on infant deaths than did individual variables. The K index functions as a deprivation index, and we may use this index to estimate the regional socioeconomic status in Korea. We found that inequalities in infant deaths according to the time trend persisted. To reduce the health inequalities among infants in Korea, regional deprivation should be considered.

Trend analysis in the prevalence of type 2 diabetes according to risk factors among Korean adults: based on the 2001~2009 Korean National Health and Nutrition Examination Survey data.

PURPOSE: The objective of this study was to provide a trend analysis of the prevalence of diabetes relative to the socioeconomic, lifestyle, and physiologic risk factors among Korean adults aged over 30 years for a 10-year period using data from the Korean National Health and Nutrition Examination Survey. METHODS: Prevalence difference and the slope index of inequality were calculated for each risk factors using binomial regression by considering the repeated cross-sectional features of the data. The prevalence ratio and the relative index of inequality were calculated using log-binomial regression. Linear trend tests were performed using SAS 9.2. RESULTS: Crude prevalence of diabetes increased over the 10-year period, and was higher for men than for women. It was very high for adults 60 years or over, consistently increasing over time. The prevalence among unemployed men, women with higher level of stress, women with hypertension, and adults with serum triglyceride levels over 135 mg/dL increased over the 10-year period in comparison with the respective control group. CONCLUSION: Considering the rapid economic development and associated lifestyle changes in Korea, action should be taken to control the prevalence of diabetes by both preventing and consistently monitoring these identified risk factors using a public-health approach.

Social inequality in birth outcomes in Korea, 1995-2008.

Social inequality in adverse birth outcomes has been demonstrated in several countries. The present study examined the separate and joint effects of parental education and work in order to investigate the causal pathways of social class effects on adverse birth outcomes in Korea. The occurrence of low birth weight, preterm births, and intrauterine growth retardation was examined among 7,766,065 births in Korea from 1995 to 2008. The effect of social inequality, as represented by parental education and work, was examined against adverse birth outcomes using multivariate logistic regression after controlling for other covariates. Parental education had the most significant and greatest effect on all three adverse outcomes, followed by parental work and employment, which had lesser effects. For adverse birth outcomes, the gap between educational levels increased steadily in Korea from 1995 to 2008. Throughout the analysis, the effect of maternal manual work on adverse birth outcomes was apparent in the study results. Given this evidence of social inequality in education and employment, social interventions should aim at more in-depth and distal determinants of health.

Hepatic vein arrival time as assessed by contrast-enhanced ultrasonography is useful for the assessment of portal hypertension in compensated cirrhosis.

The measurement of the hepatic venous pressure gradient (HVPG) for the estimation of portal hypertension (PH) in cirrhosis has some limitations, including its invasiveness. Hepatic vein arrival time (HVAT), as assessed by microbubble contrast-enhanced ultrasonography (CEUS), is negatively correlated with the histological grade of liver fibrosis because of the associated hemodynamic abnormalities. Anatomical and pathophysiological changes in liver microcirculation are the initial events leading to PH. However, the direct relationship between HVAT and PH has not been evaluated. The present study measured both HVPG and HVAT in 71 consecutive patients with compensated cirrhosis and analyzed the relationship between the two parameters (i.e., the derivation set). Results were validated in 35 compensated patients with cirrhosis at another medical center (i.e., the validation set). The derivation set had HVPG and HVAT values of 11.4 ± 5.0 mmHg (mean ± standard deviation; range, 2-23) and 14.1 ± 3.4 seconds (range, 8.4-24.2), respectively; there was a statistically significant negative correlation between HVPG and HVAT (r(2) = 0.545; P < 0.001). The area under the receiver operating characteristic curve (AUROC) was 0.973 for clinically significant PH (CSPH; HVPG, ≥ 10 mmHg), and the sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratios for CSPH for an HVAT cut-off value of 14 seconds were 92.7%, 86.7%, 90.5%, 89.7%, 6.95, and 0.08, respectively. In addition, a shorter HVAT was associated with worse Child-Pugh score (P < 0.001) and esophageal varices (P = 0.018). In the validation set, there was also a significant negative correlation between HVAT and HVPG (r(2) = 0.538; P < 0.001), and AUROC = 0.953 for CSPH. HVAT was significantly correlated with PH. These results indicate that measuring HVAT is useful for the noninvasive prediction of CSPH in patients with compensated cirrhosis.

The Mothers and Children's Environmental Health (MOCEH) study.

The MOCEH study is a prospective hospital- and community-based cohort study designed to collect information related to environmental exposures (chemical, biological, nutritional, physical, and psychosocial) during pregnancy and childhood and to examine how exposure to environmental pollutants affects growth, development, and disease. The MOCEH network includes one coordinating center, four local centers responsible for recruiting pregnant women, and four evaluation centers (a nutrition center, bio-repository center, neurocognitive development center, and environment assessment center). At the local centers, trained nurses interview the participants to gather information regarding their demographic and socioeconomic characteristics, complications related to the current gestation period, health behaviors and environmental factors. These centers also collect samples of blood, placenta, urine, and breast milk. Environmental hygienists measure each participant's level of exposure to indoor and outdoor pollutants during the pre- and postnatal periods. The participants are followed up through delivery and until the child is 5 years of age. The MOCEH study plans to recruit 1,500 pregnant women between 2006 and 2010 and to perform follow-up studies on their children. We expect this study to provide evidence to support the hypothesis that the gestational environment has an effect on the development of diseases during adulthood. We also expect the study results to enable evaluation of latency and age-specific susceptibility to exposure to hazardous environmental pollutants, evaluation of growth retardation focused on environmental and genetic risk factors, selection of target environmental diseases in children, development of an environmental health index, and establishment of a national policy for improving the health of pregnant women and their children.

Availability of trauma specialists in level I and II trauma centers: a national survey.

BACKGROUND: Despite American College of Surgeons Committee on Trauma's criteria, little data exists about the variability of practices in both the composition of trauma teams and timing of specialist availability across trauma centers. The purpose of the study was to determine the availability of trauma team personnel in Level I and II trauma centers across the United States. METHODS: Two surveys were developed and mailed to trauma directors and coordinators in 450 centers. Responses were received from 254 directors (56%) and 218 coordinators (48%). The director survey was designed to collect data on trauma team composition and timeliness in response to a hypothetical scenario. The coordinator survey was designed to collect data on trauma center characteristics and general availability of trauma specialists. RESULTS: Eighty-two percent of Level I and II centers had trauma surgeons available within 15 minutes of and 37% at patient admission. The in-house (IH) centers (60%) had a trauma surgeon at patient admission significantly more than on-call centers did (22%). The specialty surgeons, such as neurosurgeons (73%) and orthopedic surgeons (75%), were mostly available through the on-call system. An IH system, high volumes of trauma patients, and designation by American College of Surgeons were significantly associated with higher likelihood of trauma surgeons physically present at the bedside within 15 minutes. CONCLUSIONS: There was a large variation in the availability of expertise at or shortly after a trauma admission. For centers with low patient volume, early triage, better notification systems based on advanced telecommunication technology, and compensation for IH call may be a solution to better use the trauma surgical specialties.

[Environmental health surveillance of low birth weight in Seoul using air monitoring and birth data].

OBJECTIVES: The principal objective of this study was to determine the relationship between maternal exposure to air pollution and low birth weight and to propose a possible environmental health surveillance system for low birth weight. METHODS: We acquired air monitoring data for Seoul from the Ministry of Environment, the meteorological data from the Korean Meteorological Administration, the exposure assessments from the National Institute of Environmental Research, and the birth data from the Korean National Statistical Office between January 1, 2002 and December 31, 2003. The final birth data were limited to singletons within 37-44 weeks of gestational age. We defined the Low Birth Weight (LBW) group as infants with birth weights of less than 2500g and calculated the annual LBW rate by district. The air monitoring data were measured for CO, SO(2), NO(2), and PM(10) concentrations at 27 monitoring stations in Seoul. We utilized two models to evaluate the effects of air pollution on low birth weight: the first was the relationship between the annual concentration of air pollution and low birth weight (LBW) by individual and district, and the second involved a GIS exposure model constructed by Arc View 3.1. RESULTS: LBW risk (by Gu, or district) was significantly increased to 1.113(95% CI=1.111-1.116) for CO, 1.004 (95% CI=1.003-1.005) for NO(2), 1.202(95% CI=1.199-1.206) for SO(2), and 1.077(95% CI=1.075-1.078) for PM(10) with each interquartile range change. Personal LBW risk was significantly increased to 1.081(95% CI=1.002-1.166) for CO, 1.145(95% CI=1.036-1.267) for SO(2), and 1.053(95% CI=1.002-1.108) for PM(10) with each interquartile range change. Personal LBW risk was increased to 1.003(95% CI=0.954-1.055) for NO(2), but this was not statistically significant. The air pollution concentrations predicted by GIS positively correlated with the numbers of low birth weights, particularly in highly polluted regions. CONCLUSIONS: Environmental health surveillance is a systemic, ongoing collection effort including the analysis of data correlated with environmentally-associated diseases and exposures. In addition, environmental health surveillance allows for a timely dissemination of information to those who require that information in order to take effective action. GIS modeling is crucially important for this purpose, and thus we attempted to develop a GIS-based environmental surveillance system for low birth weight.

Recent variceal bleeding: Doppler US hepatic vein waveform in assessment of severity of portal hypertension and vasoactive drug response.

PURPOSE: To prospectively evaluate both the correlation between abnormal Doppler ultrasonography (US) hepatic vein waveforms and the hepatic venous pressure gradient (HVPG) and the response to drug treatment in patients with cirrhosis. MATERIALS AND METHODS: Ethics committee approval and informed consent of patients and control subjects were obtained. In 78 patients with cirrhosis (70 men, eight women; mean age, 49.4 years +/- 9.7 [standard deviation]) and a history of variceal bleeding, both the hepatic vein waveform--as measured with Doppler US--and the HVPG were measured, and the relationship between them was analyzed. Hepatic vein Doppler waveforms were classified as triphasic, biphasic, or monophasic. Severe portal hypertension was defined as an HVPG of more than 15 mm Hg. In a subgroup of 21 patients, changes in hepatic vein waveform and HVPG were evaluated after intravenous administration of 2 mg of terlipressin. Statistical analyses were performed with Spearman rank correlation, logistic regression analysis, and cross tabulation. RESULTS: Abnormal hepatic vein waveforms were seen in 72 patients (92%). Forty-four patients (56%) had biphasic waveforms, 28 (36%) had monophasic waveforms, and six (8%) had triphasic waveforms. A positive correlation was found between the extent of abnormalities in hepatic vein waveforms and the increase in HVPG (P < .05). Monophasic waveforms were associated with severe portal hypertension, with a sensitivity of 74% and a specificity of 95%. Twenty patients in the terlipressin subgroup had abnormal baseline waveforms; the baseline waveform improved in 18 patients in association with the HVPG reduction after injection of terlipressin. CONCLUSION: Doppler US hepatic vein waveform assessment is useful in the noninvasive evaluation of the severity of portal hypertension and the response to vasoactive drugs in patients with portal hypertension and variceal bleeding.

The effectiveness of embolotherapy for treatment of hemoptysis in patients with varying severity of tuberculosis by assessment of chest radiography.

The effectiveness of percutaneous embolotherapy in cases of hemoptysis due to pulmonary tuberculosis from increasing severity of lung parenchymal injury was compared. The pattern of pleural involvement, as seen on chest radiography and angiography, were comparatively analyzed in 230 patients who were available for follow-ups from March 1992 to December 2003. Chest radiography findings were classified into 4 types based on levels of complicated lesions and pleural involvement. Angiography findings were divided into 4 groups based on the level of blood supply to lesions. Early hemostasis with respect to radiographic group were as follows: Type I- 92% (73/79), Type II- 80% (52/65), Type III- 70% (42/60), and Type IV- 56% (52/92); there was an average success rate of 73% (219/296), and continued hemostasis was found in 80% of Type I patients (62/77), 77% of Type II patients (41/53), 62% of Type III patients (25/40), and 45% of Type IV patients (27/60), with an average long- term hemostatic rate of 67% (155/230). Increasing severity of pleural involvement and associated complications correlated with increasing development of systemic collateral arteries other than the bronchial artery. The severely increased circulation in systemic collateral arteries makes it difficult to predict good hemostatic results following embolization. Therefore, we recommend aggressive treatment, such as surgical intervention, after embolization in such instances.