Tackling the Challenge of the Aging Society: Detecting and Preventing Cognitive and Physical Decline through Games and Consumer Technologies / 대한의료정보학회지

OBJECTIVES: This study seeks to review some of the approaches employed to address health and well-being issues in the elderly population. METHODS: This article reviews and analyses a range of projects and approaches designed for the elderly population and aimed at preserving and/or enhancing physical and cognitive capabilities in later life. RESULTS: Various intervention measures have been developed across the globe to preserve and/or enhance physical and cognitive capabilities of the elderly population. A selection of these measures is described in this article. CONCLUSIONS: Approaches which combine games psychology and mechanics with enabling technologies designed to engage, influence and motivate elderly people can encourage healthy active aging lifestyles. Healthy active aging helps to realise a double dividend of reduced healthcare costs and an improved quality of life for the elder citizen.

New Evaluation Vector through the Stanford Mobile Inquiry-Based Learning Environment (SMILE) for Participatory Action Research / 대한의료정보학회지

OBJECTIVES: This article reviews an evaluation vector model driven from a participatory action research leveraging a collective inquiry system named SMILE (Stanford Mobile Inquiry-based Learning Environment). METHODS: SMILE has been implemented in a diverse set of collective inquiry generation and analysis scenarios including community health care-specific professional development sessions and community-based participatory action research projects. In each scenario, participants are given opportunities to construct inquiries around physical and emotional health-related phenomena in their own community. RESULTS: Participants formulated inquiries as well as potential clinical treatments and hypothetical scenarios to address health concerns or clarify misunderstandings or misdiagnoses often found in their community practices. From medical universities to rural village health promotion organizations, all participatory inquiries and potential solutions can be collected and analyzed. The inquiry and solution sets represent an evaluation vector which helps educators better understand community health issues at a much deeper level. CONCLUSIONS: SMILE helps collect problems that are most important and central to their community health concerns. The evaluation vector, consisting participatory and collective inquiries and potential solutions, helps the researchers assess the participants' level of understanding on issues around health concerns and practices while helping the community adequately formulate follow-up action plans. The method used in SMILE requires much further enhancement with machine learning and advanced data visualization.

Subconscious Learning via Games and Social Media / 대한의료정보학회지

No abstract available.

Social Network Analysis of Elders' Health Literacy and their Use of Online Health Information / 대한의료정보학회지

OBJECTIVES: Utilizing social network analysis, this study aimed to analyze the main keywords in the literature regarding the health literacy of and the use of online health information by aged persons over 65. METHODS: Medical Subject Heading keywords were extracted from articles on the PubMed database of the National Library of Medicine. For health literacy, 110 articles out of 361 were initially extracted. Seventy-one keywords out of 1,021 were finally selected after removing repeated keywords and applying pruning. Regarding the use of online health information, 19 articles out of 26 were selected. One hundred forty-four keywords were initially extracted. After removing the repeated keywords, 74 keywords were finally selected. RESULTS: Health literacy was found to be strongly connected with 'Health knowledge, attitudes, practices' and 'Patient education as topic.' 'Computer literacy' had strong connections with 'Internet' and 'Attitude towards computers.' 'Computer literacy' was connected to 'Health literacy,' and was studied according to the parameters 'Attitude towards health' and 'Patient education as topic.' The use of online health information was strongly connected with 'Health knowledge, attitudes, practices,' 'Consumer health information,' 'Patient education as topic,' etc. In the network, 'Computer literacy' was connected with 'Health education,' 'Patient satisfaction,' 'Self-efficacy,' 'Attitude to computer,' etc. CONCLUSIONS: Research on older citizens' health literacy and their use of online health information was conducted together with study of computer literacy, patient education, attitude towards health, health education, patient satisfaction, etc. In particular, self-efficacy was noted as an important keyword. Further research should be conducted to identify the effective outcomes of self-efficacy in the area of interest.

Psychological and Social Factors Affecting Internet Searches on Suicide in Korea: A Big Data Analysis of Google Search Trends

PURPOSE: The average mortality rate for death by suicide among OECD countries is 12.8 per 100000, and 33.5 for Korea. The present study analyzed big data extracted from Google to identify factors related to searches on suicide in Korea. MATERIALS AND METHODS: Google search trends for the search words of suicide, stress, exercise, and drinking were obtained for 2004-2010. Analyzing data by month, the relationship between the actual number of suicides and search words per year was examined using multi-level models. RESULTS: Both suicide rates and Google searches on suicide in Korea increased since 2007. An unconditional slope model indicated stress and suicide-related searches were positively related. A conditional model showed that factors associated with suicide by year directly affected suicide-related searches. The interaction between stress-related searches and the actual number of suicides was significant. CONCLUSION: A positive relationship between stress- and suicide-related searches further confirmed that stress affects suicide. Taken together and viewed in context of the big data analysis, our results point to the need for a tailored prevention program. Real-time big data can be of use in indicating increases in suicidality when search words such as stress and suicide generate greater numbers of hits on portals and social network sites.

Book Review: Healthcare Analytics for Quality and Performance Improvement / 대한의료정보학회지

No abstract available.

Ultrasonographic Findings of the Gallbladder in Patients with Acute Hepatitis A: Do They Have Clinical Relevance?

PURPOSE: To determine the association of gallbladder (GB) abnormalities on ultrasonography (US) of patients with acute hepatitis A with demographic, clinical, and biochemical factors, and with other US findings. MATERIALS AND METHODS: This retrospective study was approved by our institutional review board, which waived the requirement for informed consent. We retrospectively evaluated 152 consecutive patients with acute hepatitis A who underwent US. The diagnosis of acute hepatitis A was made during acute illness by demonstrating anti-HAV of the IgM class. US images were reviewed simultaneously by two abdominal radiologists and a consensus was reached for GB wall thickening, GB collapse, lymphadenopathy, and hepatic echogenicity. The associations between demographic, clinical, biochemical, and US findings and GB wall thickening or collapse were then assessed. RESULTS: GB wall thickening was present in 123 (81%) and GB collapse in 96 (63%) of the 152 patients. Total bilirubin level and GB collapse differed significantly (p < 0.05) between patients with and without GB wall thickening. Gender ratio, total and peak total bilirubin level, and GB wall thickness differed significantly (p < 0.05) between patients with and without GB collapse. Multivariate analysis showed that GB wall thickening was associated with GB collapse and vice versa. CONCLUSION: GB wall thickening and GB collapse are common US abnormalities associated with each other in patients with acute hepatitis A. However, GB wall thickening or collapse is not associated with any demographic, clinical, or biochemical factors, or with other US findings, in patients with acute hepatitis A.

Book Review: Social Networks and Health: Models, Methods, and Applications / 대한의료정보학회지

No abstract available.

Application of Social Network Analysis to Health Care Sectors / 대한의료정보학회지

OBJECTIVES: This study aimed to examine the feasibility of social network analysis as a valuable research tool for indicating a change in research topics in health care and medicine. METHODS: Papers used in the analysis were collected from the PubMed database at the National Library of Medicine. After limiting the search to papers affiliated with the National Institutes of Health, 27,125 papers were selected for the analysis. From these papers, the top 100 non-duplicate and most studied Medical Subject Heading terms were extracted. NetMiner V.3 was used for analysis. Weighted degree centrality was applied to the analysis to compare the trends in the change of research topics. Changes in the core keywords were observed for the entire group and in three-year intervals. RESULTS: The core keyword with the highest centrality value was "Risk Factor," followed by "Molecular Sequence Data," "Neoplasms," "Signal Transduction," "Brain," and "Amino Acid Sequence." Core keywords varied between time intervals, changing from "Molecular Sequence Data" to "Risk Factors" over time. "Risk Factors" was added as a new keyword and its social network was expanded. The slope of the keywords also varied over time: "Molecular Sequence Data," with a high centrality value, had a decreasing slope at certain intervals, whereas "SNP," with a low centrality value, had an increasing slope at certain intervals. CONCLUSIONS: The social network analysis method is useful for tracking changes in research topics over time. Further research should be conducted to confirm the usefulness of this method in health care and medicine.

A Three-Year Autoregressive Cross-Lagged Panel Analysis on Nicotine Dependence and Average Smoking / 대한의료정보학회지

OBJECTIVES: Previous studies have been limited to the use of cross sectional data to identify the relationships between nicotine dependence and smoking. Therefore, it is difficult to determine a causal direction between the two variables. The purposes of this study were to 1) test whether nicotine dependence or average smoking was a more influential factor in smoking cessation; and 2) propose effective ways to quit smoking as determined by the causal relations identified. METHODS: This study used a panel dataset from the central computerized management systems of community-based smoking cessation programs in Korea. Data were stored from July 16, 2005 to July 15, 2008. 711,862 smokers were registered and re-registered for the programs during the period. 860 of those who were retained in the programs for three years were finally included in the dataset. To measure nicotine dependence, this study used a revised Fagerstrom Test for Nicotine Dependence. To examine the relationship between nicotine dependence and average smoking, an autoregressive cross-lagged model was explored in the study. RESULTS: The results indicate that 1) nicotine dependence and average smoking were stable over time; 2) the impact of nicotine dependence on average smoking was significant and vice versa; and 3) the impact of average smoking on nicotine dependence is greater than the impact of nicotine dependence on average smoking. CONCLUSIONS: These results support the existing data obtained from previous research. Collectively, reducing the amount of smoking in order to decrease nicotine dependence is important for evidence-based policy making for smoking cessation.

A Three-Year Autoregressive Cross-Lagged Panel Analysis on Nicotine Dependence and Average Smoking / 대한의료정보학회지

OBJECTIVES: Previous studies have been limited to the use of cross sectional data to identify the relationships between nicotine dependence and smoking. Therefore, it is difficult to determine a causal direction between the two variables. The purposes of this study were to 1) test whether nicotine dependence or average smoking was a more influential factor in smoking cessation; and 2) propose effective ways to quit smoking as determined by the causal relations identified. METHODS: This study used a panel dataset from the central computerized management systems of community-based smoking cessation programs in Korea. Data were stored from July 16, 2005 to July 15, 2008. 711,862 smokers were registered and re-registered for the programs during the period. 860 of those who were retained in the programs for three years were finally included in the dataset. To measure nicotine dependence, this study used a revised Fagerstrom Test for Nicotine Dependence. To examine the relationship between nicotine dependence and average smoking, an autoregressive cross-lagged model was explored in the study. RESULTS: The results indicate that 1) nicotine dependence and average smoking were stable over time; 2) the impact of nicotine dependence on average smoking was significant and vice versa; and 3) the impact of average smoking on nicotine dependence is greater than the impact of nicotine dependence on average smoking. CONCLUSIONS: These results support the existing data obtained from previous research. Collectively, reducing the amount of smoking in order to decrease nicotine dependence is important for evidence-based policy making for smoking cessation.

Soft Tissue Masses in the Extremities: The Accuracy of an Ultrasonographic Diagnosis

PURPOSE: We wanted to retrospectively determine the accuracy of an ultrasonographic diagnosis of superficial soft tissue masses in the extremities by using the histologic results as the reference standard. MATERIALS AND METHODS: From January 2005 to June 2010, 154 patients with soft tissue masses in the extremities and who underwent ultrasonographic evaluation followed by biopsy or resection were retrospectively evaluated. The ultrasonographic and histologic diagnoses of the soft tissue masses were lipoma, ganglion cyst, hemangioma, neurogenic tumor, giant cell tumor of the tendon sheath, epidermoid cyst, fibroma, glomus tumor, Baker's cyst and neurofibromatosis. RESULTS: Out of 154 patients, 114 (74%) patients showed concordance between the histologic diagnosis and the ultrasonographic diagnosis, and the remaining 40 (26%) patients did not. The diagnostic accuracy of each soft tissue mass was 95% for lipoma, 83% for ganglion cyst, 75% for hemangioma, 72% for neurogenic tumor, 50% for giant cell tumor of the tendon sheath, 43% for epidermoid cyst, 33% for fibroma and 100% each for glomus tumor, fibromatosis and Baker's cyst. Aside from these tumors, there were also sarcoma, malignant melanoma, elastofibroma, Kimura disease and pilomatricoma. Among the cases that showed discordance between the histologic diagnosis and the ultrasonographic diagnosis, three of them were notable; pilomatricoma being misdiagnosed as dermatofibroma protuberans, angiolipoma being misdiagnosed as vascular leiomyoma and malignant fibrous histiocytoma being misdiagnosed as a malignant soft tissue mass. CONCLUSION: The accuracy of an ultrasonographic diagnosis for soft tissue masses in the extremities varies greatly according to each type of mass. Lipoma, ganglion cyst, hemangioma, glomus tumor, neurogenic tumor and Baker's cyst showed a relatively high rate of concordance between the ultrasonographic diagnosis and the histologic diagnosis, but epidermoid cyst and fibroma showed a relatively lower rate of concordance.

Experience of Combination Treatment of Toenail Onychomycosis with Oral Itraconazole and Topical 5% Amorolfine Nail Lacquer / 대한의진균학회지

BACKGROUND: Target of oral itraconazole is nail matrix via nail bed diffusion. On the contrary, topical amorolfine directly acts on nail plate through a transungual drug delivery system. When this combination treatment of oral itraconazole and topical amorolfine nail lacquer is applied for onychomycosis, we may expect their synergistic effects. OBJECTIVE: We will discuss our clinical experiences of 78 patients in Chung Ang University hospital about combination treatment of onychomycosis with oral itraconazole and topical 5% amorolfine nail lacquer. METHODS: We treated 135 toenail onychomycosis patients (M/F=79/56) from January 2001 to April 2004. But, among 135 patients, we analyzed only 78 (57.8%) patients (M/F=46/32) treated by combination treatments composed of twice weekly application of topical 5% amorolfine nail lacquer and 3 pulse therapy of oral itraconazole. Efficacies of treatment are composed of clinical cure based on decrement of affected nail area by digital camera recording and mycological cure based on KOH exam, and fungus cultures on after 6 months. RESULTS: Distribution of patients by clinical types is as follows; distal subungual onychomycosis (DSO) : 68 patients (87.2%), whitish superficial onychomycosis (WSO) : 4 patients (5.1%), and total dystrophic onychomycosis (TDO) : 6 patients (7.7%). Reduction rates of affected area by clinical types are DSO: 85.1%, WSO: 83.1%, and TDO: 70.3%. Isolated strains from the fungal culture are T. rubrum: 67 (85.9%), T. mentagrophytes: 5 (6.4%), and Candida spp.: 6 (7.7%). Reduction rate of affected nail area (75.0%) in patients with diabetes mellitus is significantly reduced comparing with that (80.8%) of patients without associated disease. The total reduced rate of affected nail area and cure rate are 81.5%, and 57.4% respectively. CONCLUSION: Oral itraconazole and topical amorolfine nail lacquer combination therapy will be a promising treatment modality for onychomycosis.

Prognostic Factors for the Hyperosmolar Nonketotic State

BACKGROUND: A hyperosmolar nonketotic state has been known to have a high mortality, and even now, despite this high mortality, only a few studies of this disease have been performed. We studied the prognostic factors for the hyperosmolar nonketotic state. METHODS: We retrospectively studied the cases of 40 patients who were in a hypersomolar nonketotic state when admitted to Sanggye Paik Hospital during the 6-year period from 1995 through 2000. We divided the hyperosmolar nonketotic patients into two groups, the complete recovery group and the incomplete recovery group, and compared the clinical features, the laboratory findings, and the precipitating factors between two groups. RESULTS: 1) A total of 40 patients were studied: 24 in the complete recovery group and 16 patients in the incomplete recovery group. The mortality rate was 32.5%. 2) No significant statistical difference existed among the clinical features of the two groups, except for the sex(p<0.01). 3) Among the laboratory findings of both groups, analysis revealed that the effective osmolarity was significantly higher among those in the incomplete recovery group(p<0.01). Serum sodium concentration was also significantly higher among those in the incomplete recovery group(p<0.01). Serum creatinine was also significantly higher among those in the incomplete recovery group(p<0.05). Serum bicarbonate concentration, on the other hand, was significantly lower among those in that group(p<0.05). 4) Infection was identified as the most common precipitating factor(62.5%). Among the precipitating factors of the two groups, there were significant statistical difference in pneumonia, UTI, and inappropriate glucose control. 5) A significant statistical difference existed among the initial level of onsciousness of both groups(p<0.05). 6) The only significant independent factor responsible for prognosis of nonketotic hyperosmolar state patients was the sex. CONCLUSION: The sex was only significant independent prognostic factor of nonketotic hyperosmolar state patients.

Factors Influencing the Survival of the Patients with Prehospital Cardiac Arrest

BACKGROUND AND OBJECT: The survival rate of the patients with prehospital cardiac arrest in Korea is lower than that in other developed countries. The main cause of this low survival rate is that prehospital emergency medical service systems are not yet well established in Korea. This study was undertaken to obtain a fundamental data for the development of prehospital emergency medical service systems. MATERIALS AND METHOD: We retrospectively analized 104 patients with prehospital cardiac arrest on whom cardiopulmonary resuscitation (CPR) had been attempted in Sanggye Paik Hospital from January 1998 through December 1999. RESULTS: As to the CPR results, 43 patients (41.3%) showed no return of spontaneous circulation (ROSC), 22 patients (21.2%) died within 24 hours, 28 Patients (26.9%) survived over 24 hours but eventually died during admission, and 11 patient (10.6%) survived and were discharged. The mean time of the arrest-to-CPR interval was 19.69.0 min. Patients with ROSC and patients who had survived over 24 hours had shorter the arrest-to-CPR interval than patients without ROSC and patients who died within 24 hours, respectively (p<0.01, p<0.01). The cutting point of the arrest-to-CPR interval for ROSC was 21.3 minutes. CONCLUSION: The arrest-to-CPR interval is important to improve the survival rate of the patients with prehospital cardiac arrest. And CPR should be attempted aggresively in prehospital cardiac arrests when the arrest-to-CPR interval is within 21.3 minutes, considering the possibility of ROSC.