Baseline Characteristics, Disease Severity, Laboratory Findings, and Treatment History of Patients with Severe Atopic Dermatitis:A Single-Center Cohort Study in Korea / 대한피부과학회지

Background@#Since the disease burden of atopic dermatitis (AD) understandably increases with its disease severity, studies, especially on the baseline characteristics of severe AD, have been conducted in some countries to deepen the understanding of the disease and, by extension, formulate a relevant national policy. However, research on the baseline characteristics of severe AD in Korea remains insufficient. @*Objective@#To report the baseline demographics and describe the clinical characteristics of adult Korean patients with severe AD, including medical and treatment history, clinical manifestations, disease severity, and laboratory findings, in order to understand the characteristics of severe AD. @*Methods@#A single-center, prospective, non-interventional, observational, longitudinal study of 108 patients with severe AD was conducted between January 2021 and December 2022. Clinical data and patient-reported measures of signs and symptoms of AD were recorded at baseline. @*Results@#The mean Eczema Area and Severity Index score of the patients was 28.5±6.8. The mean pruritus numerical rating scale, Patient-Oriented Eczema Measure, Dermatology Life Quality Index, and Atopic Dermatitis Control Tool scores were 8.1±1.7, 23.6±4.8, 21.9±6.6, and 19.5±3.9, respectively. Although a larger proportion of the headeck and trunk are affected than both limbs, the key signs of AD were less severe in the headeck region than in the other regions. Erythema and lichenification were more representative clinical signs of severe AD than induration and excoriation. The baseline data on previous treatments reflected the AD treatment guidelines in Korea. @*Conclusion@#This real-world data will provide dermatologists with a better understanding of severe AD, which will eventually lead to better clinical and health policy decisions for patients with severe AD.

Tuberculous Lymphadenitis in a Patient Treated with Dupilumab: A Case Report

Tuberculous lymphadenitis is among the most frequent presentations of extrapulmonary tuberculosis; the most common presentation is isolated chronic non-tender lymphadenopathy in young adults without systemic symptoms. Dupilumab is a fully human monoclonal antibody directed against interleukin-4 receptor-α that blocks the synergistic effects of interleukin-4 and interleukin-13 on allergic inflammation. Its well-known adverse events are allergic conjunctivitis, injection site reaction, and dupilumab facial redness. A 32-year-old female with severe atopic dermatitis was treated with dupilumab for 2 months at our clinic. She complained of multiple enlarged palpable lymph nodes on the right side of the neck and inguinal area for 2 months. Laboratory tests showed an increased total eosinophil count and immunoglobulin E level, as well as positive interferon-γ release assays. Radiological examination showed multiple low echoic and heterogeneous well-enhancing lymph nodes in level II, III, IV, and V of the neck. Histological examination revealed caseous necrosis and tuberculoid granuloma. The lymph node enlargements were completely relieved after antituberculosis treatment. The mechanism for the development of tuberculous lymphadenitis in a patient receiving dupilumab is not fully understood yet. In some previous studies, treatment with dupilumab suppressed the expression of genes related not only to T helper 2 and eosinophil response but also to proinflammatory responses. It could not inhibit the intracellular growth of Mycobacterium tuberculosis in macrophages, predisposing them to the development of tuberculous infection. To the best of our knowledge, this is the first report on the development of tuberculosis lymphadenitis in a patient treated with dupilumab.

The Relationship Between the Korean Adults Diet Evaluated Using Dietary Quality Indices and Metabolic Risk Factors: Based on the 2016 ~ 2019 Korea National Health and Nutrition Examination Survey / 대한지역사회영양학회지

Objectives@#This study was designed to investigate the relationship between metabolic risk factors, Index of Nutrition Quality, and the dietary quality index score of Korean adults. @*Methods@#The subjects were 18,652 Korean adults aged 19 years or older (7,899 males, 10,753 females) who participated in the 2016-2019 Korea National Health and Nutrition Examination Survey. Subjects were divided into normal, pre-metabolic syndrome, and metabolic syndrome (MetS) groups according to the number of their metabolic risk factors. Data were analyzed using the SPSS program. @*Results@#About 44.7% of men in the MetS group were at least college graduates (P < 0.001), whereas 52.0% of women in the MetS group were middle school graduates or lower (P < 0.001). The frequency of fruit and dairy products intake tended to decrease as the number of metabolic risk factors increased in both men and women (P for trend < 0.001). As the number of metabolic risk factors decreased, the frequency of grain intake tended to decrease in men (P for trend < 0.001) while the frequency of intake of red meat (P for trend = 0.001), poultry (P for trend < 0.001), and eggs (P for trend < 0.001) decreased in women. The total scores of Diet Quality Index-International (DQI-I) (men P < 0.001, women P < 0.01) and Korean Healthy Eating Index (KHEI) (men and women P < 0.001) were significantly lower in the MetS group compared to the other groups, and the total score of DQI-I and KHEI tended to decrease as the number of metabolic risk factors increased. @*Conclusions@#Dietary quality evaluation using various indices can provide more information on the dietary problems related to metabolic risk factors. Nutrients and foods that have been confirmed to be related to metabolic risk factors can be used to develop dietary guidelines for the nutritional management of metabolic diseases.

Dietary Factors Associated with Metabolic Syndrome Status in Korean Menopausal Women:Based on the 2016 ~ 2017 Korea National Health and Nutrition Examination Survey / 대한지역사회영양학회지

Objectives@#This study evaluated dietary behavior and nutritional status according to the metabolic syndrome status in Korean menopausal women. @*Methods@#The subjects were 1,392 menopausal women aged 50 to 64 who took part in the Korea National Health and Nutrition Examination Survey of 2016 and 2017.Subjects were classified into normal (NOR) group, pre-metabolic syndrome (Pre-MetS) group, and metabolic syndrome (MetS) groups according to the number of metabolic syndrome risk factors present. @*Results@#The overall prevalence of metabolic syndrome was 33.7%. Using the NOR group as a reference, the odds of belonging to the MetS group in Model 1 adjusted for age were higher at 53% (OR = 1.53, 95% CI:1.011-2.307) for ‘not used’ subjects compared to ‘used’ subjects of the nutrition labeling system. Using the NOR group as a reference, every 1g increase in the intake of monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA) decreased the odds of belonging to the MetS group in Model 1 adjusted for age by 3% (MUFA, OR = 0.97, 95% CI:0.946-0.991; PUFA, OR = 0.97, 95% CI:0.942-0.993). @*Conclusions@#These results suggest that to reduce the number of risk factors of metabolic syndrome in menopausal women, nutritional education should emphasize the adequate intake of riboflavin, unsaturated fatty acids, protein, and calcium, and also encourage the recognition and use of nutritional labeling. Results of this study are expected to be utilized as basic data for the health management of menopausal women.

Extent of Subprosthetic Pannus after Aortic Valve Replacement: Changes Over Time and Relationship with Echocardiographic Findings

Purpose@#This study aimed to evaluate changes of subprosthetic pannus on cardiac CT and determine its relationship to echocardiographic findings in patients with mechanical aortic valve replacement (AVR). @*Materials and Methods@#Between April 2011 and November 2017, 17 AVR patients (56.8 ± 8.9 years, 12% male) who showed pannus formation on CT and had undergone both follow-up CT and echocardiography were included. The mean interval from AVR to the date of pannus detection was 10.5 ± 7.1 years. In the initial and follow-up CT and echocardiography, the pannus extent and echocardiographic parameters were compared using paired t-tests. The relationship between the opening angle of the prosthetic valve and the pannus extent was evaluated using Pearson correlation analysis. @*Results@#The pannus extent was significantly increased on CT (p < 0.05). The peak velocity (3.9 ± 0.8 m/s vs. 4.2 ± 0.8 m/s, p = 0.03) and mean pressure gradient (36.4 ± 15.5 mm Hg vs. 42.1 ± 15.8 mm Hg, p = 0.03) were significantly increased. The mean opening angles of the mechanical aortic leaflets were slightly decreased, but there was no statistical significance (73.1 ± 8.3° vs. 69.4 ± 12.1°, p = 0.12). The opening angle of the prosthetic leaflets was inversely correlated with the pannus extent (r = −0.57, p < 0.001). @*Conclusion@#The pannus extent increases over time, increasing transvalvular peak velocity and the pressure gradient. CT can be used to evaluate the pannus extent associated with hemodynamic changes that need to be managed by surgical intervention.

Perception of Importance of Patient Safety Management, Patient Safety Culture and Safety Performance in Hospital Managerial Performance of Hospital Nurses / 간호행정학회지

PURPOSE: The purpose of this study was to examine the effects of perception of importance of patient safety management, patient safety culture and safety performance on managerial performance of hospital nurses. METHODS: A cross-sectional design was used, with a convenience sample of 393 nurses from seven general hospitals. Data were collected through self-evaluation questionnaires. The data collection period was April and May, 2016 and data were analyzed using descriptive statistics, t-test, One-way ANOVA, Pearson correlation coefficients and stepwise multiple regression with the SPSS/WIN 24.0 program. RESULTS: There were significantly positive relationships (p < .001) between hospital managerial performances and perception of importance of patient safety management (r=.36), patient safety culture (r=.51), safety performance (r=.44). Factors influencing hospital managerial performances in the hospital nurses were identified as patient safety culture (β=.34), type of hospital (advanced general hospital) (β=.31), and safety performance (β=.20). The explanation power of this regression model was 39.0% and it was statistically significant (F=183.82, p < .001). CONCLUSION: The results from this study can be used to develop further management strategies for enhancement of hospital managerial performances.

Nutritional status of 3~5 year old children attending kindergarten and childcare facilities: Using data from the 2010 and 2014 Korea National Health and Nutrition Examination Surveys / 한국영양학회지

PURPOSE: The purpose of this study was to investigate the nutritional status of 3~5 year old children attending kindergarten and childcare facilities in 2010 and 2014. METHODS: Data were obtained from the 2010 and 2014 Korea National Health and Nutrition Examination Surveys (KNHANES) and included 509 subjects aged 3~5 years old attending kindergarten and childcare facilities. RESULTS: In 2014, rate of skipping meals by children was 16.2%, an increase of 5.5% compared with the rate of skipping meals by children in 2010. Calcium intake in 2014 was 397.41 mg at 3 years old, 419.27 mg at 4 years old, and 414.01 mg at 5 years old. For the mean nutrient adequacy ratio (MAR) of subjects in 2010 and 2014, MAR at 3 years old (0.86) was significantly lower than those at 4 and 5 years old (0.90, 0.91) (p < 0.01). In 2010 and 2014, EAR intake at 3 years old (2.72) was significantly higher than those at 4 years old (2.14) and 5 years olds (1.92) (p < 0.01). CONCLUSION: As a result, compared with 2010 before establishment of the Children's foodservice management center, there was no improvement in the polarization of nutrient intake of children in 2014. Therefore, researchers believe that a continuous monitoring system developed by nutrition experts and children's foodservice management center are needed to improve the nutritional status of children. Of children between the ages of 3~5 years old, those with intakes under EAR were mostly 3 years old. Therefore, researchers suggest that the infant age group of KDRIs, which is classified as 1~2 years old and 3~5 years old, needs to be reestablished considering the growth and development of infants.

Factors Affecting the Frequency of Skipping Meals of Prime-Aged Mothers with Children : Data from the Fifth Korea National Health and Nutrition Examination Survey, 2010-2011 / 대한지역사회영양학회지

OBJECTIVES: This study was designed with the goal of understanding the factors affecting the frequency of skipping meals of prime-aged mothers with children as well as their nutritional status. METHODS: Utilizing data from the 2010-2011 Korea National Health and Nutrition Survey, the frequency of skipping meals of mothers aged between 30 to 49 years with children aged between 3 to 11 years during a two day period was statistically analyzed. The number of meals skipped calculated and categorized into skipping no meals, skipping one meal, skipping two meals or more. RESULTS: Compared to subjects who corresponded to mean nutrient adequacy ratio(MAR) of 4 quartile, subjects who corresponded to MAR of 2 quartile had 2.766 (95% CI: 1.552-4.931) probability of being in the 1 meal skippers group, while the probability of being in the more than 2 meals skippers group was 2.743(95% CI: 1.353-5.564). Also, compared to subjects who corresponded to MAR of 4 quartile, subjects who corresponded to MAR of 1 quartile had 3.471 (95% CI: 1.871-6.442) probability of being in the 1 meal skippers group, while the odds ratio for being in the more than 2 meals skippers group was 5.258(95% CI: 2.642-10.466). CONCLUSIONS: The results have the advantage of being generalized because the study selected subjects from probability sampling of the female population of Korea. The research results showed that the elements influencing skipping meals of prime-aged mothers with children were mean nutrient adequacy ratio and the number of nutrients, under estimated average requirement intake, and others. Therefore, to encourage dietary behaviors in the right direction, an integrated approach that considers the associated factors must be realized. Future studies are needed to understand how the frequency of skipping meals of mothers affects their children.

A Structural Equation Model of Pressure Ulcer Prevention Action in Clinical Nurses

PURPOSE: The purpose of this study was to construct and test a structural equation model for pressure ulcer prevention action by clinical nurses. The Health Belief Model and the Theory of Planned Behavior were used as the basis for the study. METHODS: A structured questionnaire was completed by 251 clinical nurses to analyze the relationships between concepts of perceived benefits, perceived barriers, attitude, subjective norm, perceived control, intention to perform action and behavior. SPSS 22.0 and AMOS 22.0 programs were used to analyze the efficiency of the hypothesized model and calculate the direct and indirect effects of factors affecting pressure ulcer prevention action among clinical nurses. RESULTS: The model fitness statistics of the hypothetical model fitted to the recommended levels. Attitude, subjective norm and perceived control on pressure ulcer prevention action explained 64.2% for intention to perform prevention action. CONCLUSION: The major findings of this study indicate that it is essential to recognize improvement in positive attitude for pressure ulcer prevention action and a need for systematic education programs to increase perceived control for prevention action.

Diversity of Main Dishes of Menus at University Faculty Cafeterias

This study investigated the main dishes of menus at university faculty cafeterias to understand current lunch menu trends. A sample of 1040 menus was collected from Internet homepages of 52 universities between March and May, 2014. The main dishes of menus were categorized into six groups based on main ingredients and cooking methods. The most frequently served main dish ingredient was pork followed by fish/seafood, and poultry. Pork dishes and chicken dishes were mainly roasted, pan fried, or deep fried with various carbohydrate ingredients to bulk them up. Large amounts of chili pepper, corn syrup, and oil were added to improve the bland flavor of these dishes, which contain starchy ingredients. In contrast to pork dishes or chicken dishes, 40.2% of beef dishes was served in a more traditional way as soup. Fewer kinds of fish or seafood were used, and the cooking methods also lacked diversity. In conclusion, main dish menus at university faculty cafeterias have undergone changes in terms of ingredients and cooking methods. Meat dishes cooked using traditional methods are becoming less common, especially for pork and chicken dishes, which are quite sweet, salty, and spicy. Extensive use of carbohydrate ingredients was found in some meat dishes and side dishes in one-dish meals.

A Comparison between Asia-Pacific Region Criteria and Entropy Model Criteria about Body Mass Index of Elderly Females Using Morbidity of Chronic Disease / 대한지역사회영양학회지

OBJECTIVES: This study was conducted to propose the need of re-establishing the criteria of the body weight classification in the elderly. We compared the Asia-Pacific Region Criteria (APR-C) with Entropy Model Criteria (ENT-C) using Morbidity rate of chronic diseases which correlates significantly with Body Mass Index (BMI). METHODS: Subjects were 886 elderly female participating in the 2007-2009 Korea National Health and Nutrition Examination Survey (KNHANES). We compared APR-C with those of ENT-C using Receiver Operating Characteristics (ROC) curve and logistic regression analysis. RESULTS: In the case of the morbidity of hypertension, the results were as follows: Where it was in the T-off point of APR-C, sensitivity was 67.5%, specificity was 43.1%, and Youden's index was 10.6. While in the cut-off point of ENT-C, it was 56.7%, 56.6%, and 13.3 respectively. In the case of the morbidity of diabetes, the results were as follows: In the cut-off point of APR-C, Youden's index was 14.2. While in the cut-off point of ENT-C, it was 17.2 respectively. The Area Under the ROC Curve (AUC) of the subjects who had more than 2 diseases among hypertension, diabetes, and dyslipidemia was 0.615 (95% CI: 0.578-0.652). Compared to the normal group, the odds ratio of the hypertension group which will belong to the overweight or obesity was 1.79 (95% CI: 1.30-2.47) in the APR-C, and 2.04 (95% CI: 1.49-2.80) in the ENT-C (p > 0.001). CONCLUSIONS: We conclude that the optimal cut-off point of BMI to distinguish between normal weight and overweight was 24 kg/m2 (ENT-C) rather than 23 kg/m2 (APR-C).

Pentraxin 3 as a Novel Marker Predicting Congestive Heart Failure in Subjects With Acute Coronary Syndrome

BACKGROUND AND OBJECTIVES: Pentraxin 3 (PTX3) was shown to be elevated in the acute phase of acute myocardial infarction (AMI) and to have prognostic significance in AMI patients. The aim of this study was to estimate whether the value of PTX3 could be used as a prognostic biomarker, with the global registry of acute coronary events (GRACE) risk assessment tool, in patients with acute coronary syndrome (ACS). SUBJECTS AND METHODS: Between July 2007 and June 2008, 137 patient subjects (mean age : 61+/-12 years, M : F=108 : 29) with ACS who underwent coronary intervention, but did not have a prior percutaneous coronary intervention (PCI) and/or follow-up coronary angiogram, were enrolled. We estimated the all-cause mortality or death/MI, in-hospital and to 6 months, using the GRACE risk scores and compared these estimates with serum PTX3 concentrations. RESULTS: The serum PTX3 concentration showed a significant increase in ST segment elevation myocardial infarction (STEMI) greater than the unstable angina pectoris (UAP) group (2.4+/-2.1 ng/mL vs. 1.3+/-0.9 ng/mL, p= 0.017, respectively), but did not show a significant difference between non-ST segment elevation myocardial infarction (NSTEMI) and the UAP group (1.9+/-1.4 ng/mL vs. 1.3+/-0.9 ng/mL, p=0.083, respectively). The serum PTX3 concentration was closely related to death/MI in-hospital (r=0.242, p=0.015) and death/MI to 6 months (r=0.224, p=0.023), respectively. The serum PTX3 concentration was not related to all-cause mortality in-hospital (r=0.112, p=0.269) and to 6 months (r=0.132, p=0.191), respectively. Among the parameters determining the GRACE risk scores, the degree of Killip class in congestive heart failure (CHF) was independently associated with the supramedian PTX3 concentration [odds ratio: 2.229 (95% confidence interval: 1.038-4.787), p=0.040]. CONCLUSION: The serum PTX3 level provides important information for the risk stratification of CHF among the parameters determining the GRACE risk scores in subjects with ACS.

A Comparison of Food and Nutrient Intake Status of Aged Females in A Rural Long Life Community by the Stage Model of Dietary Behavior Change / 대한지역사회영양학회지

For the correct dietary habit and balanced dietary intake of aged people, the nutrition management that fits to the dietary behavior change stage has to be accomplished. In order to do so, in this paper, we chose 175 women that are aged more than 65 years old who are rural long life community residents and surveyed the dietary intake for 2 days including a twice depth interview and the 24 hour recall method. Also, for the sake of our aim, using the transtheoretical model, the dietary behavior change stage group was divided into the contemplation stage group, the preparation stage group, the action stage group and the maintenance stage group. The results are as follows: In the intake amount of protein (p < 0.01), vitamin B1 (p < 0.05) and vitamin B6 (p < 0.05), the intake amount of these nutrients in the action stage group and the maintenance stage group were significantly larger than the intake amount in the contemplation stage group and the preparation stage group. The nutrition evaluation according to the dietary behavior change stage, the ratio of subjects who took insufficient amount of energy, protein, vitamin A, and vitamin C were low as the dietary behavior change stage was upgraded. The subjects of maintenance stage group were most likely to consume vegetables more than once a day, and consume fruits and milk and milk products more than 5 times/week. MAR [13], MAR [10] and MAR [4] of subjects in the action stage group and the maintenance stage roup were significantly higher than MAR [13], MAR [10] and MAR [4] of subjects in the contemplation stage group and the preparation stage group (p < 0.001). From the above results, there were differences of nutrient intakes according to the dietary behavior change stage. Therefore, it is considered that the intervention for the dietary behavior motivation induction has to be advanced before accomplishing the individually fitting intervention at the time of nutrient management intervention.

A Survey of Food and Nutrient Intakes of the Eged People in Rural Area, Gyeongbuk Yecheon

This research has done for 262 people of the aged men and women that are more than 65 years old who are live in 9 areas of Yecheon as target; through twice of face to face interview for 24 hours recall method, the result of food intake for 2 days is as following. In case of energy, the aged men (women) of sixties ingested 67.7 (72.0)% of Korean RDA by 1,369 (1264) kcal, for the ages of seventies and eighties, 68.9 (66.9)% of Korean RDA and 76.3 (65.8)% by each 1,309 (1104) kcal and 1,368 (1052) kcal. The aged men ingested protein 46.0~49.6 g (70.6~82.9% of RDA), and aged women ingested protein 32.7~40.2 g (59.4~73.0% of RDA). Calcium intake of aged men was 388.8 mg, 319.8 mg, 284.4 mg by age range, and aged women was 291.9 mg (41.6% of RDA), 246.5 mg (35.3% of RDA), 240.1 mg (34.3% of RDA). Iron intake of aged men was 8.6~8.9 mg (72~74% of RDA), and aged women ingested 8.6 mg (71.3% of RDA), 7.5 mg (62.6 of RDA%), 6.6 mg (55.4% of RDA) for iron by age range. Vitamin B1 intake of aged men was 0.62~0.71 mg (62~71% of RDA), and aged women's intake was 0.50~0.60 mg (50~60% of RDA). Vitamin B2 intake of aged men was 0.59~0.60 mg (49% of RDA), and aged women's intake was 0.45~0.50 mg (37~42% of RDA). Vitamin C intake by age range, in case of aged men (women) in sixties was 53.1 (48.9) mg, in seventies was 49.9 (33.2) mg and more than eighties was 34.1 (33.4) mg. The average food intake by age range, in aged men (women) of sixties was 828.9 (670.8) g and seventies was 726.8 (568.8) g and more than eighties was 656.0 (525.3) g. Plant food intake of aged men was 490.8~569.5 g and aged women was 417.9~537.7 g. Aged men (women) of MAR by age range, sixties was 0.60 (0.58), seventies was 0.59 (0.50) and more than eighties was 0.56 (0.49), respectively. INQ for protein, phosphorus, iron, vitamin A, vitamin B, niacin, vitamin C was more than 1 in 60's and 70's aged men, but there was no nutrients in eighties of aged women. Aged men and women's KDDS points represent average 3.14 and 3.04 (out of 5 points), and while intake of the milk was the most lacking, but intake of the fruit was the most lacking in DDS.