Nature of Complex Network of Dengue Epidemic as a Scale-Free Network / 대한의료정보학회지

OBJECTIVES: Dengue epidemic is a dynamic and complex phenomenon that has gained considerable attention due to its injurious effects. The focus of this study is to statically analyze the nature of the dengue epidemic network in terms of whether it follows the features of a scale-free network or a random network. METHODS: A multifarious network of Aedes aegypti is addressed keeping the viewpoint of a complex system and modelled as a network. The dengue network has been transformed into a one-mode network from a two-mode network by utilizing projection methods. Furthermore, three network features have been analyzed, the power-law, clustering coefficient, and network visualization. In addition, five methods have been applied to calculate the global clustering coefficient. RESULTS: It has been observed that dengue epidemic follows a power-law, with the value of its exponent γ = −2.1. The value of the clustering coefficient is high for dengue cases, as weight of links. The minimum method showed the highest value among the methods used to calculate the coefficient. Network visualization showed the main areas. Moreover, the dengue situation did not remain the same throughout the observed period. CONCLUSIONS: The results showed that the network topology exhibits the features of a scale-free network instead of a random network. Focal hubs are highlighted and the critical period is found. Outcomes are important for the researchers, health officials, and policy makers who deal with arbovirus epidemic diseases. Zika virus and Chikungunya virus can also be modelled and analyzed in this manner.

A perspective on partially hydrolyzed protein infant formula in nonexclusively breastfed infants / 소아과

The World Health Organization recommends that infants should be exclusively breastfed for the first 6 months of life to provide optimal nutrition in this critical period of life. After this, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to 2 years of age or beyond. For nonbreastfed infants, infant formula is an available option to provide the nutrition needed. Infant formula is usually prepared from industrially modified cow's milk and processed to adjust for the nutritional needs of infants. However, cow's milk is one of the most common causes of food allergy, affecting 2%–5% of all formula-fed infants during their first year of life. One strategy to prevent cow's milk allergy in nonbreastfed infants is the use of partially hydrolyzed formula (pHF) in high-risk infants, which are infants born in families with atopic disease. However, based on an epidemiological study, approximately half of the infants who develop allergy are not part of the at-risk group. This is because the non-at-risk group is significantly larger than the at-risk group and the non-at-risk infants have approximately 15% risk of developing allergies. This study aimed to evaluate the effects of partially hydrolyzed whey formula (pHF-W) in nonbreastfed infants and determine whether pHF-W can prevent atopic disease in high-risk infants and can be used as routine starter formula regardless of the allergy risk status.

Modifiable prenatal environmental factors for the prevention of childhood asthma

The prevalence of asthma in children is increasing worldwide, yet risk factors for the development of asthma is unclear. Evidence to date indicates that environmental factors are the main reason of the recent increase in the prevalence of asthma. For example, exposure to air pollution and diet as well as microbial alterations are reported as environmental factors. In addition, we should focus on the critical period of the exposure, especially pregnancy period as an important period for human development. Therefore, environmental exposure during pregnancy to tobacco smoke or air pollutants, maternal stress, obesity, and vitamin D may contribute to the development of childhood asthma. Herein, modifiable prenatal exposure, its mechanisms associated with childhood asthma and multiple intervention controlling risk factors needed during pregnancy in order to achieve primary prevention of asthma has been described.

Cáncer de mama y su relación con el manejo de las emociones y el estrés / Breast cancer and its relationship with the management of emotions and stress

Resumen

Introducción: las emociones son breves alteraciones del ánimo que se presentan de manera abrupta y con manifestaciones físicas. Los sentimientos son las percepciones de cómo se siente el cuerpo en medio de una emoción. Los sentimientos y las emociones se modifican según la sociedad, la cultura, el contexto y se moldean de acuerdo con la personalidad.

Objetivo: identificar la relación entre las emociones-sentimientos y el estrés con el cáncer de mama (CaMa) y cuál es el nivel de evidencia de las investigaciones publicadas.

Metodología: se hizo una búsqueda sistemática con los siguientes algoritmos: a) cáncer de mama AND etiología AND emociones, b) cáncer de mama AND etiología emocional, c) cáncer de mama AND etiología AND estrés, en español e inglés; en bases de datos: BVS regional, Medline, SciELO, CINAHL, Cochrane.

Resultados: se encontraron artículos que sugieren que la etiología del cáncer de mama puede relacionarse con situaciones estresantes vividas en la infancia, represión de sentimientos, tensión crónica, depresión, ansiedad y estrés.

Conclusiones: hay coincidencias en cuanto a que los problemas vividos durante la niñez pueden influir en la vulnerabilidad a desarrollar diversas enfermedades, incluido el cáncer de mama en la edad adulta.

Abstract

Introduction: Emotions are rapid mood swings which occur abruptly and with physical manifestations. Feelings are the perceptions of how the body feels in the midst of an emotion. Feelings and emotions are modified according to society, culture, context, and are shaped according to personality.

Objective: To identify the relationship between emotions-feelings and stress, with breast cancer and what is the level of evidence of published research.

Methods: It was carried out a systematic search with the following algorithms: a) breast cancer AND etiology AND emotions, b) breast cancer AND emotional etiology, c) breast cancer AND etiology AND stress, in Spanish and English, in regional BVS, Medline, SciELO, CINAHL and Cochrane databases.

Results: We found articles that suggest that the etiology of breast cancer can be related to stressful situations experienced in childhood, repression of feelings, chronic tension, depression, anxiety and stress.

Conclusions: There are coincidences in which it is stated that the problems experienced during childhood may trigger the vulnerability to develop various diseases, including breast cancer in adulthood.

Integrated Management Plan for Graduate Medical Education and Accreditation Bodies in Korea / 의학교육논단

Graduate medical education is the most important phase among the three stages of medical education. It links basic medical education and continuing professional development. It is also a critical period in acquiring meaningful knowledge, skills and professionalism. The residents should be able to develop the core common competencies on top of their specialozeds field's expertise, in order to function as independent and qualified physicians. Despite the obvious importance of graduate medical education, the system in Korea has been designed and executed to meet the needs of the hospitals in the perspective of manpower management, rather than to educate and empower the residents. As a result, graduate medical education in Korea lacks clear educational objectives and systemic, resident-centered curriculums. Yet, we have no accreditation body to evaluate graduate medical education programs. In order to normalize graduate medical education, an integrated and unified institution that manages the whole process of the graduate medical education is desperately needed. Special attention should be given to the role of medical schools in educating the core common competencies. The Korean Association of Medical Colleges, the Korean Institute for Medical Education and Evaluation, and the Korean Academy of Medical Sciences should cooperate intimately to establish a new organization for the systemic management and development of graduate medical education.

Fat and bone in children – where are we now?

The risk of fracture secondary to low-impact trauma is greater in obese children, suggesting obese children are at risk of skeletal fragility. However, despite this finding, there is a lack of agreement about the impact of excessive adiposity on skeletal development. The combination of poor diet, sedentary lifestyle, greater force generated on impact through falls, and greater propensity to falls may in part explain the increased risk of fracture in obese children. To date, evidence suggests that in early childhood years, obesity confers a structural advantage to the developing skeleton. However, in time, this relationship attenuates and then reverses, such that there is a critical period during skeletal development when obesity has a detrimental effect on skeletal structure and strength. Fat mass may be important to the developing cortical and trabecular bone compartments, provided that gains in fat mass are not excessive. However, when fat accumulation reaches excessive levels, unfavorable metabolic changes may impede skeletal development. Evidence from studies examining bone microstructure suggests skeletal adaption to excessive load fails, and bone strength is relatively diminished in relation to body size in obese children. Mechanisms that may explain these changes include changes in the hormonal environment, particularly in relation to alterations in adipokines and fat distribution. Given the concomitant rise in the prevalence of childhood obesity and fractures, as well as adult osteoporosis, further work is required to understand the relationship between obesity and skeletal development.

Effects of Tianeptine on Adult Rats Following Prenatal Stress

OBJECTIVE: Exposing a pregnant female to stress during the critical period of embryonic fetal brain development increases the risk of psychiatric disorders in the offspring. The objective of this study was to investigate the effect of antidepressant tianeptine on prenatally stressed (PNS) rats. METHODS: In this study, a repeated variable stress paradigm was applied to pregnant rats during the last week of gestation. To investigate the effects of antidepressant tianeptine on PNS rats, behavioral and protein expression analyses were performed. Forced swim test, open field test, and social interaction test were performed to determine changes in PNS rats compared to non-stressed offspring. Haloperidol was used as a positive control as an antipsychotic drug based on previous studies. RESULTS: Behavioral changes were restored after treatment with tianeptine or haloperidol. Western blot and immunohistochemical analyses of the prefrontal cortex revealed downregulation of several neurodevelopmental proteins in PNS rats. After treatment with tianeptine or haloperidol, their expression levels were increased. CONCLUSION: Downregulation of several proteins in PNS rats might have caused subsequent behavioral changes in PNS rats. After tianeptine or haloperidol treatment, behavioral changes in PNS rats were restored. Therefore, tianeptine might decrease incidence of prenatal stress related-psychiatric disorders such as depression and schizophrenia.

The current status of health data on Korean children and adolescents / 한국역학회지

Childhood and adolescence are critical periods that affect adults' health status. Therefore, the factors influencing the health of children and adolescents should be analyzed. In Korea, a wide range of youth-related health data has been obtained, both on the regional level and on the national level. This report summarizes the current status of studies related to the health of Korean children and adolescents. Data for which open access is offered include the Korea Youth Risk Behavior Web-based Study, the Panel Study on Korean Children, the Korean Youth Panel Survey, the Korean Children and Youth Panel Survey, and the Student Health Examination. In addition, the Health Examination of Korean Youth Outside of School, the Korean Children and Adolescents Obesity Cohort Study, the Korean Children's Environmental Health Study, the Korea Youth Media Use and Harmful Environment Survey, the Comprehensive Survey of Korean Youth, and the Multicultural Adolescents Panel Study are summarized.

Effect of Motivations and Attitudes toward Nutrition Information on College Students' Use Intentions of Menu Labeling at University Dining Services

A menu labeling initiative is a lawful regulation with an aim to promote public health by providing customers the right to make informed menu choices. As college years are a critical period in which students form dietary habits, which are sustained throughout their lives, provision of nutritional information at the university dining services is important to students' health and life. Due to the lack of research on menu labeling at university dining services, the purpose of this study was to examine college students' attitudes and motivations toward menu labeling at university dining services, as well as their use intentions toward nutrition information at university dining services. Data were collected from a self-administered survey distributed to 484 college students who had experienced university dining services. Motivations of university students toward menu labeling were categorized into ‘knowledge pursuit’ and ‘health pursuit’. Students' attitudes toward menu labeling had a positive effect on their intention to use menu labeling at university dining services. The findings of the study indicated that female students, or those who frequently used nutrition information, tended to have higher attitudes, motivations, and use intentions toward nutrition information. The study results suggest that facilitation of healthy eating environments at university dining services by offering nutrition information, and nutrition and health education is necessary.

What is fetal programming?: a lifetime health is under the control of in utero health

The “Barker hypothesis” postulates that a number of organ structures and associated functions undergo programming during embryonic and fetal life, which determines the set point of physiological and metabolic responses that carry into adulthood. Hence, any stimulus or insult at a critical period of embryonic and fetal development can result in developmental adaptations that produce permanent structural, physiological and metabolic changes, thereby predisposing an individual to cardiovascular, metabolic and endocrine disease in adult life. This article will provide evidence linking these diseases to fetal undernutrition and an overview of previous studies in this area as well as current advances in understanding the mechanism and the role of the placenta in fetal programming.

Postpartum modern contraceptive use in northern Ethiopia: prevalence and associated factors / 한국역학회지

OBJECTIVES: The postpartum period is a critical period for addressing widespread unmet needs in family planning and for reducing the risks of closely spaced pregnancies. However, contraception during the extended postpartum period has been underemphasized in Ethiopia. Therefore, this study aimed to assess postpartum modern contraceptive use among women in northern Ethiopia and to identify factors associated with modern contraceptive use in the postpartum period.METHODS: A community based cross-sectional study was conducted from March to April, 2015. Data were entered using Epi Info version 7 and then exported into Stata version 12 for analysis. Bivariate and multivariate logistic regression models were fitted to identify the determinants of postpartum modern contraceptive use. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated, and p-values < 0.05 were considered to indicate statistical significance.RESULTS: Nearly half (48.0%) of women used modern contraceptives during the extended postpartum period. Postpartum modern contraceptive use was significantly associated with secondary and tertiary education levels (aOR, 4.25; 95% CI, 1.29 to 14.00; aOR, 5.36 ; 95% CI, 1.14 to 25.45, respectively), family planning counseling during prenatal and postnatal care (aOR, 5.72 ; 95% CI, 2.67, 12.28), having postnatal care (aOR, 2.36; 95% CI, 1.15 to 4.87), resuming sexual activity (aOR, 9.53; 95% CI, 3.74 to 24.27), and menses returning after birth (aOR, 6.35; 95% CI, 3.14 to 13.39). In addition, experiencing problems with previous contraceptive use was negatively associated with modern contraceptive use (aOR, 0.34; 95% CI, 0.16 to 0.72).CONCLUSIONS: Low rate of postpartum modern contraceptive use were found in the study area. Therefore, strengthening family planning counseling during antenatal and postnatal care visits, improving utilization of postnatal care services and improving women's educational status are crucial steps for to enhance modern contraceptive use among postpartum women.

The current status of health data on Korean children and adolescents / 한국역학회지

Childhood and adolescence are critical periods that affect adults' health status. Therefore, the factors influencing the health of children and adolescents should be analyzed. In Korea, a wide range of youth-related health data has been obtained, both on the regional level and on the national level. This report summarizes the current status of studies related to the health of Korean children and adolescents. Data for which open access is offered include the Korea Youth Risk Behavior Web-based Study, the Panel Study on Korean Children, the Korean Youth Panel Survey, the Korean Children and Youth Panel Survey, and the Student Health Examination. In addition, the Health Examination of Korean Youth Outside of School, the Korean Children and Adolescents Obesity Cohort Study, the Korean Children's Environmental Health Study, the Korea Youth Media Use and Harmful Environment Survey, the Comprehensive Survey of Korean Youth, and the Multicultural Adolescents Panel Study are summarized.

Postpartum modern contraceptive use in northern Ethiopia: prevalence and associated factors / 한국역학회지

OBJECTIVES: The postpartum period is a critical period for addressing widespread unmet needs in family planning and for reducing the risks of closely spaced pregnancies. However, contraception during the extended postpartum period has been underemphasized in Ethiopia. Therefore, this study aimed to assess postpartum modern contraceptive use among women in northern Ethiopia and to identify factors associated with modern contraceptive use in the postpartum period. METHODS: A community based cross-sectional study was conducted from March to April, 2015. Data were entered using Epi Info version 7 and then exported into Stata version 12 for analysis. Bivariate and multivariate logistic regression models were fitted to identify the determinants of postpartum modern contraceptive use. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated, and p-values < 0.05 were considered to indicate statistical significance. RESULTS: Nearly half (48.0%) of women used modern contraceptives during the extended postpartum period. Postpartum modern contraceptive use was significantly associated with secondary and tertiary education levels (aOR, 4.25; 95% CI, 1.29 to 14.00; aOR, 5.36 ; 95% CI, 1.14 to 25.45, respectively), family planning counseling during prenatal and postnatal care (aOR, 5.72 ; 95% CI, 2.67, 12.28), having postnatal care (aOR, 2.36; 95% CI, 1.15 to 4.87), resuming sexual activity (aOR, 9.53; 95% CI, 3.74 to 24.27), and menses returning after birth (aOR, 6.35; 95% CI, 3.14 to 13.39). In addition, experiencing problems with previous contraceptive use was negatively associated with modern contraceptive use (aOR, 0.34; 95% CI, 0.16 to 0.72). CONCLUSIONS: Low rate of postpartum modern contraceptive use were found in the study area. Therefore, strengthening family planning counseling during antenatal and postnatal care visits, improving utilization of postnatal care services and improving women's educational status are crucial steps for to enhance modern contraceptive use among postpartum women.

Role of Innate Immunity in Otitis Media / 대한이비인후과학회지

Otitis media (OM) is the most prevalent disease of childhood and a public health problem in developed and developing countries. Despite appropriate treatment, acute OM can progress to chronic suppurative OM, characterized by effusion and discharge. Moreover, OM lead to conductive hearing loss during critical periods of language acquisition and risking permanent damage to the middle ear and inner ear in severe cases. The reasons for the chronicity of middle ear disease in 10 to 20% children are not clear. However, although many factors can contribute to OM, bacterial infection is considered to be a predominant etiology, producting inflammation characterized by mucosal hyperplasia, effusion, and leukocytic infiltration of middle ear. In this review, we review the role of innate immunity as it applies to OM and deal with recent progresses in understanding the role of innate immune cell in the middle ear epithelium.

Effect of Environmental Enrichment on Cognitive Impairment-induced by Ethanol Exposure in Adolescent Rat

PURPOSE: Adolescents who experienced the alcohol consumption have gradually increased. Adolescence is a critical period of the neural plasticity in the brain. Neural plasticity is mediated by neurotrophins and has an impact on cognitive function. Environmental enrichment ameliorates the cognitive function and increases neurotrophins. Thus, we investigated the neuroprotective effect of environmental enrichment on ethanol induced cognitive impairment in adolescent rats. METHODS: The ethanol groups and the controls groups were injected with ethanol (0.5g/kg) and phosphate buffered saline, respectively, through intraperitoneal from 28th day of birth for 11 days. The environmental enrichment groups were provided larger cages containing toys than the standard cage . Passive avoidance test and Y-maze test were performed to evaluate the spatial memory. RESULTS: Environmental enrichment+ethanol group showed higher alterations than the standard environment+ethanol group in Y-maze test (p<.05). In hippocampus, The environmental enrichment+ethanol group showed significantly higher level of the number of c-fos positive celsl and density of tropomyosin receptors kinase B receptor than the standard environment+ethanol group (p<.05). CONCLUSION: So, we suggested that the environmental enrichment played a role as a prophylaxis for prevention of memory impairment induced by ethanol exposure in adolescence.

Age-Related Changes in Immunological Factors and Their Relevance in Allergic Disease Development During Childhood

PURPOSE: Allergic diseases are triggered by Th2-mediated immune reactions to allergens and orchestrated by various immunological factors, including immune cells and cytokines. Although many reports have suggested that childhood is the critical period in the onset of allergic diseases and aging leads to alter the susceptibility of an individual to allergic diseases, age-related changes in various immunological factors in healthy individuals as well as their difference between healthy and allergic children have not yet been established. METHODS: We investigated the ratio of Th1/Th2 cells and the levels of 22 allergy-related cytokines across all age groups in individuals who were classified as clinically non-atopic and healthy. We also examined their differences between healthy and allergic children to evaluate immunological changes induced by the development of allergic diseases during childhood. RESULTS: The Th1/Th2 ratio rose gradually during the growth period including childhood, reaching peak values in the twenties-thirties age group. Th1/Th2 ratios were significantly lower in allergic children than in healthy controls, whereas 14 of 22 cytokines were significantly higher in allergic children than in healthy controls. On the other hand, there were no differences in Th1/Th2 ratios and cytokines between healthy and allergic adolescents. CONCLUSIONS: In this study, age-related changes in Th1/Th2 ratios were found in normal controls across all age groups, and decreases in Th1/Th2 ratio were observed with increasing of 14 cytokines in allergic children. The results of this study may be helpful as reference values for both monitoring immunological changes according to aging in healthy individuals and distinguishing between normal and allergic subjects in terms of immune cells and soluble factors.

Intensive Cognitive Behavioral Case Management for Functional Recovery of Young Patients with Schizophrenia / 대한정신분열병학회지

Intensive case management provided at the critical period following the onset of schizophrenia is crucial for early social and vocational recovery. We report the young schizophrenia patient who had been treated for 2 years but frequently relapsed and attempted suicide. After receiving cognitive behavioral case management from community mental health center, she has functionally recovered without recurrence for 4 years. Collaboration between psychiatrists of hospital and case manager of community mental health center was very important factor that contributed to her functional recovery. Cognitive behavioral case management promoting coping skills and reducing perceived stress was effective on successful social adaptation even during the stressful situations. In conclusion, psychosocial management including cognitive behavioral case management at the early stage of schizophrenia is crucial to prevent the relapse and to recover patients' function.

Impact of perinatal environmental tobacco smoke on the development of childhood allergic diseases / 소아과

Allergic diseases such as asthma, allergic rhinitis, atopic dermatitis, and food allergy, are most common chronic, noncommunicable diseases in childhood. In the past few decades, the prevalence has increased abruptly worldwide. There are 2 possible explanations for the rising prevalence of allergic diseases worldwide, that an increased disease-awareness of physician, patient, or caregivers, and an abrupt exposure to unknown hazards. Unfortunately, the underlying mechanisms remain largely unknown. Despite the continuing efforts worldwide, the etiologies and rising prevalence remain unclear. Thus, it is important to identify and control risk factors in the susceptible individual for the best prevention and management. Genetic susceptibility or environments may be a potential background for the development of allergic disease, however they alone cannot explain the rising prevalence worldwide. There is growing evidence that epigenetic change depends on the gene, environment, and their interactions, may induce a long-lasting altered gene expression and the consequent development of allergic diseases. In epigenetic mechanisms, environmental tobacco smoke (ETS) exposure during critical period (i.e., during pregnancy and early life) are considered as a potential cause of the development of childhood allergic diseases. However, the causal relationship is still unclear. This review aimed to highlight the impact of ETS exposure during the perinatal period on the development of childhood allergic diseases and to propose a future research direction.

Assessment of Circulatory Status of the Newborn in the Neonatal Intensive Care Unit

Birth is a moment of transition from intra- to extra-uterine life, which is characterized as switching of gas-exchanging organs from the placenta to the lungs. It is achieved by aeration as well as perfusion of the lungs (increase in pulmonary blood flow). This is, without doubt, the most challenging event in human life. Assessment of circulatory status of the newborn in this critical period is challenging as well. For monitoring those tiny, vulnerable, and unstable creatures, technology requires non-invasiveness and a reasonably high signal/noise ratio. Conventionally, we have monitored circulatory status of newborns by inspection and physical examination, including vital signs such as body temperature, skin color, heart rate and blood pressure. Echocardiography was introduced in the 1980's and its function has been developing and advancing ever since. It is certainly the most powerful tool for both the assessment and management of circulation in the newborn infants. Although echocardiography is actually not a 'continuous monitor' but an 'intermittent check-up'. Its disadvantage can be overcome to some extent by performing it quickly and frequently. However, some novel methods for monitoring circulation are being developed and becoming available in clinical neonatology. For example, near-infrared spectroscopy, electrical cardiometry and laser Doppler flowmetry may be useful for monitoring other aspects of circulation.

Association between Medication Adherence and Duration of Outpatient Treatment in Patients with Schizophrenia

OBJECTIVE: Medication adherence is important in the treatment of schizophrenia, and critical periods during treatment may be associated with relapse. However, the relationship between adherence and duration of outpatient treatment (DOT) remains unclear. The authors aimed to clarify the relationship between adherence and DOT at a psychiatric hospital in Japan. METHODS: For outpatients with schizophrenia who regularly visit Shin-Abuyama hospital, the authors conducted a single questionnaire survey (five questions covering gender, age, DOT, medication shortages, and residual medication) over one month period. Participants were divided into two groups whether DOT were from more than one year to within five years or not. Mantel-Haenszel analysis and logistic regression analysis were performed on the data regarding the medication adherence. RESULTS: Effective answers were received for 328 patients. The residual medication rate was significantly higher among those receiving outpatient treatment from more than one year to within five years than five years than those receiving outpatient treatment for more than five years or less than one year (p=0.016). CONCLUSION: This survey suggests that there are critical periods during which patients are most prone to poor adherence. Because poor adherence increases the risk of relapse, specific measures must be taken to improve adherence during these periods.