Application of Blockchain to Maintaining Patient Records in Electronic Health Record for Enhanced Privacy, Scalability, and Availability / 대한의료정보학회지

Significados atribuídos à vacinação contra o HPV por responsáveis legais de meninas / Meanings attributed to HPV vaccination by girls legal guardians

Trata-se de pesquisa descritiva e qualitativa, cujo objetivo foi descrever os significados atribuídos à vacinação contra HPV por responsáveis legais de meninas, a partir do processo de interação social no contexto do câncer do colo do útero. Realizada em locais próximos a escolas, ruas, praças, residências, no período entre maio e julho de 2018. Foram entrevistadas 10 responsáveis legais de meninas. Foram atendidas as exigências do Conselho Nacional de Saúde e o projeto foi aprovado pelo Comitê de Ética em Pesquisa da Universidade do Estado do Rio de Janeiro sob o n.º 2.449.934. A análise foi baseada nos pressupostos da Grounded Theory, por oferecer elementos para a discussão dos dados de modo comparativo constante dos resultados, e do interacionismo simbólico, que possibilita que a pesquisa qualitativa atinja o objetivo de pesquisar o sentido que os indivíduos propõem aos objetos, pessoas e símbolos com os quais interagem no meio social. Emergiram cinco categorias: Categoria 1 Aderindo à vacinação contra HPV, Categoria 2 Sentindo preocupação e medo em relação a comentários sobre reações adversas pela vacina contra HPV, Categoria 3 Considerando escassas as informações veiculadas sobre a vacinação contra HPV, Categoria 4 Preferindo vacinar por conhecer a gravidade da doença, e Categoria 5 - Escolhendo esperar a criança amadurecer para tratar de assuntos relacionados ao sexo, assim como, optar pela vacinação contra HPV. Evidenciou-se que a vacinação contra HPV causa preocupações e inseguranças nas pessoas por a considerarem uma vacina recente, o que gera muita especulação social, contribuindo para veiculação de boatos. Observou-se também a carência de informações que os responsáveis legais de meninas alegam ter acerca da vacinação no contexto do câncer uterino, trazendo à tona diversas solicitações de mais informação sobre o tema. Trata-se de um assunto delicado, pois se refere a prevenção de uma doença sexualmente transmissível em crianças e adolescentes, o que é tabu para alguns responsáveis legais. Evidenciou se maior dificuldade de articulação do diálogo e de adesão na idade de 9 anos, pois os responsáveis legais consideram suas crianças muito jovens para tratar assuntos inerentes ao sexo. Por outro lado, muitos responsáveis legais mantiveram a decisão de vacinar suas filhas, referindo satisfação da implementação da campanha pelo Ministério da Saúde.

This is a descriptive and qualitative research, whose objective was to describe the meanings attributed to HPV vaccination by legal guardians of girls, from the process of social interaction in the context of cervical cancer. Held in places close to schools, streets, squares, residences, in the period between May and July 2018. Ten legal guardians of girls were interviewed. The requirements of the National Health Council were met, and the project was approved by the Research Ethics Committee of the State University of Rio de Janeiro under Number 2,449,934. The analysis was based on the Grounded Theory assumptions, as it offers elements for the discussion of data in a constant comparative way of results, and symbolic interactionism, which enables qualitative research to reach the objective of researching the sense that individuals propose to objects, people and symbols with which they interact in the social environment. Five categories emerged: Category 1 adhering to HPV vaccination, Category 2 feeling concern and fear in relation to comments on adverse reactions by HPV vaccine, Category 3 Considering scarce the information conveed about the Vaccination against HPV, category 4 preferring to vaccinate for knowing the severity of the disease, and category 5-choosing to wait for the child to mature to deal with sex-related subjects, as well as , opt for HPV vaccination. It was evidenced that vaccination against HPV causes concerns and insecurities in people because they consider it a recent vaccine, which generates a lot of social speculation, contributing to the dissemination of rumors. It was also observed the lack of information that legal guardians of girls claim to have about vaccination in the context of uterine cancer, bringing to the fore several requests for more information on the subject. This is a delicate matter, as it refers to the prevention of a sexually transmitted disease in children and adolescents, which is taboo for some legal guardians. It was evidenced that greater difficulty in articulating dialogue and adherence at the age of 9 years, because legal guardians consider their children to be very young to treat issues inherent to sex. On the other hand, many legal guardians maintained the decision to vaccinate their daughters, referring to the satisfaction of the implementation of the campaign by the Ministry of Health

Correlation of Early-Phase F-18 Florapronal PET with F-18 FDG PET in Alzheimer's Disease and Normal Brain / 대한핵의학회잡지

PURPOSE: F-18 florapronol (FPN) is the commercially recognized beta-amyloid positron emission tomography (PET) radiotracer in Korea. This study compared the early F-18 florapronol PET with F-18 fluorodeoxyglucose (FDG) PET between healthy controls (HC) and Alzheimer's dementia (AD) patients.METHODS: A total of 29 subjects (15 HC and 14 AD subjects) underwent F-18 FPN PET and F-18 FDG PET. F-18 FDG PET image was acquired from 30 to 60 min and F-18 FPN PET for 0 to 10 min. F-18 FPN and F-18 FDG images were spatially normalized with transformation matrices obtained from individual CTimages and standardized uptake value ration (SUVR) from cerebellum area, and the global mean was calculated using PMOD 3.6. Pearson's correlation coefficients between F-18 FDG and early F-18 FPN for predefined cortical brain regions were calculated.RESULTS: We compared the F-18 FDG and F-18 FPN for SUVR of a specific region in global mean normalization and cerebellum normalization, and most of the correlation coefficient was higher in global mean normalization. In global mean normalization, the correlation coefficient for SUVR of HC was higher than that of AD in all brain regions.CONCLUSIONS: Early F-18 FPN study can be used as a proxy marker for the F-18 FDG PET.

The Influence of Depression and School Life on the Quality of Life of Korean Child and Adolescent Patients with Attention-Deficit/Hyperactivity Disorder: A Comparison of the Perspectives of the Patients and Their Caregivers

OBJECTIVES: This study aimed to compare the quality of life reported by patients with attention-deficit/hyperactivity disorder (ADHD) to the patients' quality of life as reported by their caregivers. In addition, it aimed to examine how emotional problems, including depression and anxiety, and the severity of the symptoms affect the quality of life reported by the patients and their caregivers. METHODS: The patients' quality of life and their degree of depression and anxiety were measured using the Pediatric Quality of Life Inventory (PedsQL) 4.0 Child Self-Report, the Children's Depression Inventory (CDI), and the Revised Children's Manifest Anxiety Scale, respectively. The caregivers' perception of the patients' quality of life and severity of the ADHD symptoms were measured using the PedsQL 4.0 Parent Proxy Report and the Conners' Parent Rating Scale (CPRS), respectively. A total of 66 participants completed the survey. The independent-samples t-test, Pearson's correlation analysis, and multiple regression analysis were conducted. RESULTS: The mean score of the PedsQL 4.0 Child Self-Report was significantly higher than the mean score of the PedsQL 4.0 Parent Proxy Report. However, for school function, the PedsQL 4.0 Child Self-Report score was significantly lower than that of Parent Proxy Report. The correlation between the PedsQL 4.0 Child Self-Report and PedsQL 4.0 Parent Proxy Report scores was significant only for emotional function and social function. The multiple regression analysis showed that the PedsQL 4.0 Child Self-Report and PedsQL 4.0 Parent Proxy Report scores were significantly predicted by the CDI and CPRS scores, respectively. CONCLUSION: Our results demonstrate that there are clear differences between the quality of life reported by the patient themselves and that reported by their caregivers. In addition, the findings suggest that it is critical to treat the patients' accompanying depressive symptoms.

Comparison of Mortality Rate according to Hospital Level among Patients with Poisoning Based on Korean Health Insurance and Assessment Service

PURPOSE: Mortality rate in the health services research field is frequently considered as a proxy for measuring healthcare quality. We compared the mortality rate and hospitalization levels among patients with poisoning. METHODS: A population-based study of hospital size and level based on the Korean health insurance and assessment service was conducted to identify the impact of hospital level on patient mortality. RESULTS: We analyzed a total of 16,416 patients, of which 7,607 were from tertiary hospitals, 8,490 were from general hospitals, and 319 were from hospitals. The highest mortality rate of diagnosis regarding poisoning was T60.31 (other herbicides and fungicides, 16%), followed by T60.0 (organophosphate and carbamate insecticides, 12.7%). There was no statistical difference in mortality among hospital levels for gender. Among age groups, tertiary hospitals had lower mortality than general hospitals and hospitals for patients aged more than 70 years (11.9% mortality at tertiary vs 14.2% at general and 23% at hospital; p=0.003, adjusted z score=−6.9), general hospitals had lower mortality than tertiary hospitals and hospitals for patients aged 18 to 29 (0.6% at general vs 2.4% at tertiary and 3.7% at hospital; p=0.01, adjusted z score=−4.3), and hospitals had lower mortality than tertiary hospitals and general hospitals for patients between 50 and 59 years of age (0% at hospital vs 6.4% at general and 8.3% at tertiary; p=0.004). CONCLUSION: Overall, there was no significant difference between mortality and hospital level among poisoned patients. However, to establish an efficient treatment system for patients with poisoning, further studies will be needed to identify the role of each facility according to hospital level.

Quality of life and adherence to treatment in early-treated Brazilian phenylketonuria pediatric patients

Early dietary treatment of phenylketonuria (PKU), an inborn error of phenylalanine (Phe) metabolism, results in normal cognitive development. Although health-related quality of life (HRQoL) of PKU patients has been reported as unaffected in high-income countries, there are scarce data concerning HRQoL and adherence to treatment of PKU children and adolescents from Brazil. The present study compared HRQoL scores in core dimensions of Brazilian early-treated PKU pediatric patients with those of a reference population, and explored possible relationships between adherence to treatment and HRQoL. Early-treated PKU pediatric patient HRQoL was evaluated by self- and parent-proxy reports of the Pediatric Quality of Life Inventory (PedsQL) core scales. Adherence to treatment was evaluated by median Phe levels and percentage of results within the therapeutic target range in two periods. Means for total and core scales scores of PedsQL self- and parent proxy-reports of PKU patients were significantly lower than their respective means for controls. Adequacy of median Phe concentrations and the mean percentage of values in the target range fell substantially from the first year of life to the last year of this study. There was no significant difference in mean total and core scale scores for self- and parent proxy-reports between patients with adequate and those with inadequate median Phe concentrations. The harmful consequences for intellectual capacity caused by poor adherence to dietary treatment could explain the observed decrease in all HRQoL scales, especially in school functioning. Healthcare system and financial difficulties may also have influenced negatively all HRQoL dimensions.

Residential NO₂ exposure is associated with urgent healthcare use in a thunderstorm asthma cohort

BACKGROUND: There is increasing interest in the role of traffic-related air pollution (TRAP) in allergic airway diseases. Few studies investigate the relationship between TRAP exposure and acute exacerbations of asthma. OBJECTIVE: The 2016 Melbourne thunderstorm asthma epidemic provided an opportunity to investigate the relationship between proxies of TRAP exposure and asthma exacerbation requiring urgent healthcare in the previous 12 months. METHODS: Current asthmatics who presented to the 3 Emergency Departments of Melbourne's second-largest health service with epidemic thunderstorm asthma in November 2016 were identified and completed a standard questionnaire. Their residential addresses were geocoded and the annual average nitrogen dioxide (NO2) exposure for each patient was assigned using a validated satellite-based land use regression model. Residential distance to the nearest major road was calculated using ArcGIS. Multivariate logistic regression was used to investigate the relationship between each TRAP proxy and healthcare use, adjusting for potential confounders. RESULTS: From 263 thunderstorm asthma patients, 88 patients identified with current asthma were analysed. Those with higher mean annual residential NO2 exposure had greater odds of urgent healthcare use in the previous year (odds ratio [OR], 3.45 per one interquartile-range increase; 95% confidence interval [CI], 1.31–9.10; p = 0.01), however distance from major road (OR, 0.95 per 100-m increase; 95% CI, 0.80–1.13; p = 0.57) and living < 200 m from a major road (OR, 1.47; 95% CI, 0.29–7.45; p = 0.64) were not significantly associated. CONCLUSION: In current asthmatics who presented during an epidemic thunderstorm asthma event, greater exposure to residential NO2 was significantly associated with greater odds of asthma exacerbations requiring urgent healthcare in the previous 12 months.

Education as a Protective Factor Moderating the Effect of Depression on Memory Impairment in Elderly Women

OBJECTIVE: The cognitive reserve theory explicates individual differences observed in the clinical manifestation of dementia despite similar brain pathology. Education, a popular proxy of the cognitive reserve, has been shown to have protective effects delaying the onset of clinical symptoms including memory. This study was conducted to test whether education can moderate the negative effect of depressive mood on memory performance in elderly women residing in the community. METHODS: 29 elderly “unschooled” female (less than 6 years of formal education) and 49 “schooled” female (6 or more years) people were compared with regard to association between depressive mood and verbal memory functioning, which were measured by the Geriatric Depression Scale and the Elderly Verbal Learning Test, respectively. RESULTS: The results showed that completing or receiving more than primary school education significantly reduced the negative association between depressive mood and memory performance. Participants who did not complete primary schooling showed a decline in memory test scores depending on the level of depressive mood; whereas participants who have completed or received more than primary education displayed relatively stable memory function despite varying level of depressive mood. CONCLUSION: Our findings imply that education in early life may have protective effects against memory impairment related to elderly depression.

Text Network Analysis of Newspaper Articles on Life-sustaining Treatments

PURPOSE: This study tried to understand discourses of life-sustaining treatments in general daily and healthcare newspapers. METHODS: A text-network analysis was conducted using the NetMiner program. Firstly, 572 articles from 11 daily newspapers and 258 articles from 8 healthcare newspapers were collected, which were published from August 2013 to October 2016. Secondly, keywords (semantic morphemes) were extracted from the articles and rearranged by removing stop-words, refining similar words, excluding non-relevant words, and defining meaningful phrases. Finally, co-occurrence matrices of the keywords with a frequency of 30 times or higher were developed and statistical measures—indices of degree and betweenness centrality, ego-networks, and clustering—were obtained. RESULTS: In the general daily and healthcare newspapers, the top eight core keywords were common: “patients,” “death,” “LST (life-sustaining treatments),” “hospice palliative care,” “hospitals,” “family,” “opinion,” and “withdrawal.” There were also common subtopics shared by the general daily and healthcare newspapers: withdrawal of LST, hospice palliative care, National Bioethics Review Committee, and self-determination and proxy decision of patients and family. Additionally, the general daily newspapers included diverse social interest or events like well-dying, euthanasia, and the death of farmer Baek Nam-ki, whereas the healthcare newspapers discussed problems of the relevant laws, and insufficient infrastructure and low reimbursement for hospice-palliative care. CONCLUSION: The discourse that withdrawal of futile LST should be allowed according to the patient's will was consistent in the newspapers. Given that newspaper articles influence knowledge and attitudes of the public, RNs are recommended to participate actively in public communication on LST.

The Role of Preoperative Puborectal Muscle Function Assessed by Transperineal Ultrasound in Urinary Continence Outcomes at 3, 6, and 12 Months After Robotic-Assisted Radical Prostatectomy / 대한배뇨장애요실금학회지

PURPOSE: The efficacy of pelvic floor muscle training (PFMT) for men with postprostatectomy incontinence (PPI) after robotic-assisted radical prostatectomy (RARP) is controversial and the mechanism for its possible effect remains unclear. The aim of this study was to investigate the relationship between bladder neck (BN) displacement, as a proxy for puborectal muscle activation, and continence outcomes after RARP. METHODS: Data were extracted from the South Australian Prostate Cancer Clinical Outcomes Collaborative database for men undergoing RARP by high volume surgeons who attended preoperative pelvic floor physiotherapy for pelvic floor muscle (PFM) training between 2012 and 2015. Instructions were to contract the PFM as if stopping the flow of urine. BN displacement was measured with 2-dimensional transperineal ultrasound, without digital rectal examination. Urinary continence status was assessed preoperatively and at 3, 6, and 12 months using the Expanded Prostate Cancer Index Composite 26. Data were analysed using logistic regression and mixed effects linear modelling. Confounding variables considered were baseline continence, age at diagnosis, margin status, nerve sparing procedures and pathological stage. RESULTS: Of 671 eligible men, 358 met the inclusion criteria and were available for analysis, with 136 complete datasets at 12-month follow-up. While BN movement was associated with preoperative continence, there was no significant effect of BN displacement on the change in urinary continence at 12 months postprostatectomy (P=0.81) or on the influence of time on continence over 3–12 months. CONCLUSIONS: Continence outcomes were not associated with BN displacement, produced by activity of the puborectal portion of the levator ani muscle, at 3, 6, or 12 months after RARP. These results suggest that the puborectal muscle does not play a role in the recovery of continence after RARP and may help to explain the negative findings of many studies of PFMT for PPI.

Calf Circumference as a Simple Screening Marker for Diagnosing Sarcopenia in Older Korean Adults: the Korean Frailty and Aging Cohort Study (KFACS)

BACKGROUND: The purpose of this study was to explore the optimal cut-off point of calf circumference (CC) as a simple proxy marker of appendicular skeletal muscle mass (ASM) and sarcopenia in the Korean elderly and to test the criterion-related validity of CC by analyzing its relationships with the physical function. METHODS: The participants were 657 adults aged 70 to 84 years who had completed both dual energy X-ray absorptiometry (DXA) and physical function test in the first baseline year of the Korean Frailty and Aging Cohort Study. RESULTS: ASM and skeletal muscle mass index (SMI) were correlated positively with CC (male, ASM, r = 0.55 and SMI, r = 0.54; female, ASM, r = 0.55 and SMI, r = 0.42; all P < 0.001). Testing the validity of CC as a proxy marker for low muscle mass, an area under the curve (AUC) of 0.81 for males and 0.72 for females were found and their optimal cut-off values of CC were 35 cm for males and 33 cm for females. In addition, CC-based low muscle groups were correlated with physical functions even after adjusting for age and body mass index. Also, the cut-off value of CC for sarcopenia was 32 cm (AUC; male, 0.82 and female, 0.72). CONCLUSION: The optimal cut-off values of CC for low MM are 35 cm for males and 33 cm for females. Lower CC based on these cut-off values is related with poor physical function. CC may be also a good indicator of sarcopenia in Korean elderly.

Discrepancia en la evaluación de la calidad de vida relacionada con la salud entre niños y padres a través del cuestionario EQ-5D-Y / Parent-child discrepancy in the assessment of health-related quality of life using the EQ-5D-Y questionnaire

Introducción. La evaluación de la calidad de vida relacionada con la salud (CVRS) permite detectar cambios en el tiempo en la salud de pacientes y posibilita realizar un análisis de coste-efectividad de tratamientos. En niños con características especiales de salud que no pueden autoevaluarse, existe la posibilidad de evaluar su CVRS a través de padres o cuidadores. Hasta la fecha, no se ha analizado la discrepancia en la evaluación de la CVRS a través del cuestionario EQ-5D-Y entre niños con parálisis cerebral (PC) y sus padres. El objetivo del presente estudio fue analizar el grado de concordancia en la evaluación de la CVRS a través del cuestionario EQ-5D-Y y su versión Proxy entre niños con PC y sus padres o cuidadores. Población y métodos. Participaron, en el estudio, niños y adolescentes con PC, así como sus padres y madres, procedentes de un centro de educación especial de la región de Extremadura (España). Se utilizó el cuestionario EQ-5D-Y para los niños y el EQ-5D-Y Proxy para los padres. Las entrevistas fueron llevabas a cabo durante el primer trimestre de 2015. Se analizó la concordancia en las respuestas mediante el nivel de acuerdo con kappa de Cohen para las 5 dimensiones que componen el EQ-5D-Y y el coeficiente de correlación intraclase para la escala visual analógica. Resultados. Participaron 62 niños con PC con afectación leve y/o moderada de su capacidad funcional, sus padres y madres. Hubo una pobre concordancia en la evaluación de la CVRS entre niños y padres en todas las dimensiones del cuestionario (< 0, 20) y justo o pobre (< 0, 60) en la escala visual analógica. Conclusiones. Existe un alto desacuerdo en la evaluación de la CVRS entre padres e hijos en población con PC a través del cuestionario EQ-5D-Y.

Introduction. The assessment of health-related quality of life (HRQoL) serves to detect changes over time in patients' health status and allows to do a cost-effectiveness analysis of treatments. When children with special health features cannot perform a self-assessment, it is possible to assess their HRQoL through their parents or caregivers. To date, the discrepancy in the assessment of HRQoL using the EQ-5D-Y questionnaire among children with cerebral palsy (CP) and their parents has not been analyzed. The objective of this study was to analyze the level of agreement in the HRQoL assessment using the EQ-5D-Y questionnaire and its proxy version among children with CP and their parents or caregivers. Population and methods. Children and adolescents with CP, and their parents, from a special education school in the region of Extremadura (Spain) participated in the study. The EQ-5D-Y questionnaire was used for children and the EQ-5D-Y proxy version, for parents. Interviews were conducted in the first quarter of 2015. The level of agreement in the responses was analyzed using the Cohen's kappa coefficient for the five domains of the EQ-5D-Y and the intraclass correlation coefficient for the visual analogue scale. Results. Sixty-two children with CP and mild and/or moderate functional capacity impairment, and their parents, participated in the study. The level of agreement was poor in the HRQoL assessment between children and parents in all the questionnaire domains (<0.20) and fair or poor (<0.60) in the visual analogue scale. Conclusions. A high level of parent-child disagreement was observed in the HRQoL assessment in the population with CP using the EQ-5D-Y questionnaire.

Análise da prevalência de perda auditiva autodeclarada e fatores associados: informante primário versus proxy / Analysis of prevalence of self-reported hearing loss and associated factors: primary versus proxy informant / Análisis de la prevalencia de pérdida auditiva auto-declarada y factores asociados: informante primario versus proxy

O objetivo foi avaliar diferenças entre as prevalências de perda auditiva autodeclarada e fatores associados, obtidas nas respostas de informantes primário e proxy no Estudo de Distúrbios da Comunicação Humana de Base Populacional (DCH-POP). Trata-se de um estudo de métodos em epidemiologia, utilizando dados de um inquérito domiciliar do tipo transversal, com uma amostra de 1.253 indivíduos do Sul do Brasil. Para verificar diferenças de prevalências entre informantes primários e informante proxy foram utilizados os testes qui-quadrado ou exato de Fisher para variáveis categóricas, e Mann-Whitney para as contínuas. Ainda, o modelo log-binomial foi ajustado para a variável dependente perda auditiva considerando-se três conjuntos de dados: toda a amostra, apenas informantes primários e apenas informantes proxy, estimando-se as associações por meio da razão de prevalências. Nos modelos finais, apenas as variáveis independentes idade e tontura estiveram associadas com o desfecho de perda auditiva independentemente do conjunto de dados utilizado. Em geral, informantes proxy subestimaram as prevalências dos desfechos estudados em relação aos informantes primários.

The objective was to evaluate differences between prevalence rates for self-reported hearing loss and associated factors, obtained from responses by primary and proxy informants in a Population-Based Study on Human Communication Disorders (DCH-POP in Portuguese). This was a study on epidemiological methods using data from a cross-sectional household survey with a sample of 1,253 individuals from Southern Brazil. To verify differences between prevalence rates comparing primary informants and proxy informants, we used the chi-square or Fisher's exact test for categorical variables and Mann-Whitney for continuous variables. The log-binomial model was adjusted for hearing loss as the dependent variable, considering three datasets: the entire sample, only primary informants, and only proxy informants, estimating association by prevalence ratios. In the final models, only the independent variables age and dizziness were associated with hearing loss, independently of the dataset that was used. Proxy informants generally underestimated the prevalence rates for the target outcomes, when compared to primary informants.

El objetivo fue evaluar las diferencias entre las prevalencias de pérdida auditiva autodeclarada y factores asociados, obtenidas en las respuestas de informantes primarios y proxy en el Estudio de Disturbios de la Comunicación Humana de Base Populacional (DCH-POP). Se trata de un estudio de método en epidemiología, utilizando datos de una encuesta domiciliaria de tipo transversal, con una muestra de 1.253 individuos del sur de Brasil. Para verificar diferencias de prevalencias entre informantes primarios e informantes proxy fueron utilizados los test chi-cuadrado o Exacto de Fisher para variables categóricas, y Mann-Whitney para las continuas. Incluso, el modelo log-binomial se ajustó a la variable dependiente pérdida auditiva, considerándose tres conjuntos de datos: toda la muestra, sólo informantes primarios, y sólo informantes proxy, estimándose las asociaciones mediante la razón de prevalencias. En los modelos finales, sólo las variables independientes edad y mareo estuvieron asociadas con el resultado de pérdida auditiva independientemente del conjunto de datos utilizado. En general, los informantes proxy subestimaron las prevalencias de los resultados estudiados, en relación con los informantes primarios.

Legal medicine: assessing mental capacity and writing medical reports for deputy applications

Medical reports are required to support court applications to appoint a deputy to make decisions on behalf of a person who has lost mental capacity. The doctor writing such a medical report needs to be able to systematically assess the mental capacity of the person in question, in order to gather the necessary evidence for the court to make a decision. If the medical report is not adequate, the application will be rejected and the appointment of the deputy delayed. This article sets out best practices for performing the assessment and writing the medical report, common errors, and issues of concern.

Socioeconomic Inequality in Malnutrition in Under-5 Children in Iran: Evidence From the Multiple Indicator Demographic and Health Survey, 2010 / 예방의학회지

OBJECTIVES: The aim of this study was to assess the socioeconomic inequality in malnutrition in under-5 children in Iran in order to help policymakers reduce such inequality. METHODS: Data on 8443 under-5 children were extracted from the Iran Multiple Indicator Demographic and Health Survey. The wealth index was used as proxy for socioeconomic status. Socioeconomic inequality in stunting, underweight, and wasting was calculated using the concentration index. The concentration index was calculated for the whole sample, as well as for subcategories defined in terms of categories such as area of residence (urban and rural) and the sex of children. RESULTS: Stunting was observed to be more prevalent than underweight or wasting. The results of the concentration index at the national level, as well as in rural and urban areas and in terms of children's sex, showed that inequality in stunting and underweight was statistically significant and that children in the lower quintiles were more malnourished. The wasting index was not sensitive to socioeconomic status, and its concentration index value was not statistically significant. CONCLUSIONS: This study showed that it can be misleading to assess the mean levels of malnutrition at the national level without knowledge of the distribution of malnutrition among socioeconomic groups. Significant socioeconomic inequalities in stunting and underweight were observed at the national level and in both urban and rural areas. Regarding the influence of nutrition on the health and economic well-being of preschool-aged children, it is necessary for the government to focus on taking targeted measures to reduce malnutrition and to focus on poorer groups within society who bear a greater burden of malnutrition.

A study on the ecosystem of welfare technology using social economy: a case study of dental clinics in health welfare social cooperative / 대한구강보건학회지

OBJECTIVES: In this study, we strived to determine the possibility of socioeconomic welfare in oral healthcare by analyzing the National Health Insurance (NHI) coverage rate. To date, efforts to realize the “social economy” of healthcare are active. While oral disease is common and chronic among Koreans, the rate of NHI coverage of dental clinics is substantially lower than that of the medical clinics. METHODS: We defined the NHI coverage of dental clinics as a proxy for “social skills” to improve oral health problems. The data were collected through a comparative analysis of the NHI coverage of dental clinics and that of non-dental clinics, in health welfare social cooperatives. RESULTS: The NHI coverage rate of the dental clinics in health welfare social cooperatives ranged from 0.97 to 2.62 times that of the non-dental clinics in health welfare social cooperatives. CONCLUSIONS: In conclusion, responsible management is recommended for making health welfare social cooperatives meaningful as a social economy.

Evaluation of Geographic Indices Describing Health Care Utilization / 예방의학회지

OBJECTIVES: The accurate measurement of geographic patterns of health care utilization is a prerequisite for the study of geographic variations in health care utilization. While several measures have been developed to measure how accurately geographic units reflect the health care utilization patterns of residents, they have been only applied to hospitalization and need further evaluation. This study aimed to evaluate geographic indices describing health care utilization. METHODS: We measured the utilization rate and four health care utilization indices (localization index, outflow index, inflow index, and net patient flow) for eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee replacement surgery, caesarean sections, hysterectomy, computed tomography scans, and magnetic resonance imaging scans) according to three levels of geographic units in Korea. Data were obtained from the National Health Insurance database in Korea. We evaluated the associations among the health care utilization indices and the utilization rates. RESULTS: In higher-level geographic units, the localization index tended to be high, while the inflow index and outflow index were lower. The indices showed different patterns depending on the procedure. A strong negative correlation between the localization index and the outflow index was observed for all procedures. Net patient flow showed a moderate positive correlation with the localization index and the inflow index. CONCLUSIONS: Health care utilization indices can be used as a proxy to describe the utilization pattern of a procedure in a geographic unit.

Surveys of Stroke Patients and Their Next of Kin on Their Opinions towards Decision-Making and Consent for Stroke Thrombolysis

<p><b>INTRODUCTION</b>Early initiation of stroke thrombolysis is associated with improved outcomes. Procurement of consent is a key factor in prolonging the door-to-needle duration. This study aimed to determine the attitudes and preferences of stroke patients and their next of kin (NOK) towards decision-making for stroke thrombolysis in Singapore.</p><p><b>MATERIALS AND METHODS</b>We surveyed acute ischaemic stroke patients (n = 171) who presented beyond the 4.5-hour therapeutic window and their NOK (n = 140) using a questionnaire with scenarios on obtaining consent for intravenous thrombolysis.</p><p><b>RESULTS</b>In the patient survey, 83% were agreeable for their NOK to decide on their behalf if mentally incapacitated and 74% were agreeable for the doctor to decide if the NOK was absent. In the NOK survey, the majority (81%) wanted to be consulted before mentally capacitated patients made their decision; 72% and 74%, meanwhile, were willing to decide on behalf of a mentally capacitated and mentally incapacitated patient, respectively. In the scenario where a doctor recommended a mentally incapacitated stroke patient to undergo thrombolysis but the family declined, there was a near equal split in preference to follow the family's or doctor's decision in both the patient and NOK surveys.</p><p><b>CONCLUSION</b>The survey found that in the decision-making process for stroke thrombolysis, there was no clear consensus on the preference for the decision maker of the mentally incapacitated patient. In Singapore, there is a strong influence of the NOK in decision-making for thrombolysis.</p>

Greater Lymph Node Retrieval Improves Survival in Node-Negative Resected Gastric Cancer in the United States

PURPOSE: Guidelines in western countries recommend retrieving ≥15 lymph nodes (LNs) during gastric cancer resection. This study sought to determine whether the number of examined lymph nodes (eLNs), a proxy for lymphadenectomy, effects survival in node-negative disease. MATERIALS AND METHODS: The US National Cancer Database (2003–2011) was reviewed for node-negative gastric adenocarcinoma. Treatment was categorized by neoadjuvant therapy (NAT) vs. initial resection, and further stratified by eLN. Kaplan-Meier and Weibull models were used to analyze overall survival. RESULTS: Of the 1,036 patients who received NAT, 40.5% had ≤10 eLN, and most underwent proximal gastrectomy (67.8%). In multivariate analysis, greater eLN was associated with improved survival (eLN 16–20: HR, 0.71; P=0.039, eLN 21–30: HR, 0.55; P=0.001). Of the 2,795 patients who underwent initial surgery, 42.5% had ≤10 eLN, and the majority underwent proximal gastrectomy (57.2%). In multivariate analysis, greater eLN was associated with improved survival (eLN 11–15: HR, 0.81; P=0.021, eLN 16–20: HR, 0.73; P=0.004, eLN 21–30: HR, 0.62; P30: HR, 0.58; P<0.001). CONCLUSIONS: In the United States, the majority of node-negative gastrectomies include suboptimal eLN. In node-negative gastric cancer, greater LN retrieval appears to have therapeutic and prognostic value, irrespective of initial treatment, suggesting a survival benefit to meticulous lymphadenectomy.

The Journal Impact Factor: Moving Toward an Alternative and Combined Scientometric Approach

The Journal Impact Factor (JIF) is a single citation metric, which is widely employed for ranking journals and choosing target journals, but is also misused as the proxy of the quality of individual articles and academic achievements of authors. This article analyzes Scopus-based publication activity on the JIF and overviews some of the numerous misuses of the JIF, global initiatives to overcome the ‘obsession’ with impact factors, and emerging strategies to revise the concept of the scholarly impact. The growing number of articles on the JIF, most of which are in English, reflects interest of experts in journal editing and scientometrics toward its uses, misuses, and options to overcome related problems. Solely displaying values of the JIFs on the journal websites is criticized by experts as these average metrics do not reflect skewness of citation distribution of individual articles. Emerging strategies suggest to complement the JIFs with citation plots and alternative metrics, reflecting uses of individual articles in terms of downloads and distribution of related information through social media and networking platforms. It is also proposed to revise the original formula of the JIF calculation and embrace the concept of the impact and importance of individual articles. The latter is largely dependent on ethical soundness of the journal instructions, proper editing and structuring of articles, efforts to promote related information through social media, and endorsements of professional societies.