[Show abstract][Hide abstract] ABSTRACT: To evaluate perceived risk, diagnostic testing, and acceptance of a diagnosis of irritable bowel syndrome (IBS) among the Korean laypersons.
We designed a conceptual framework to evaluate the health-seeking behavior of subjects based on a knowledge, attitude, and practice model. We developed a vignette-based questionnaire about IBS based on a literature review and focused group interviews. The vignette described a 40-year-old woman who meets the Rome III criteria for IBS without red-flag signs. It was followed by questions about demographic characteristics, health behaviors, IBS symptoms, risk perception, perceived need for diagnostic tests, and acceptance of a positive diagnosis of IBS. We planned a nationwide survey targeting laypersons without IBS and between the ages of 20 and 69 years. Survey participants were selected by quota sampling stratified by gender, age, and nationwide location. A multivariate logistic model was constructed based on literature reviews, univariate analysis, and a stepwise selection method to investigate correlations between the perceived risk, need for diagnostic tests, and acceptance of a positive diagnosis.
Of 2354 eligible households, 1000 subjects completed the survey and 983 subjects were analyzed, excluding those who met symptom criteria for IBS. After reading the IBS vignette, the majority of subjects (86.8%) responded that the patient was at increased risk of severe disease. The most frequent concern was colon cancer (59.8%), followed by surgical condition (51.5%). Most subjects responded the patient needs diagnostic tests (97.2%). Colonoscopy was the most commonly required test (79.5%). Less than half of the respondents requested a stool examination (45.0%), blood test (40.7%), abdominal ultrasound (36.0%), or computed tomography (20.2%). The subjects who felt increased risk were more likely to see a need for colonoscopy [adjusted odds ratio (aOR) = 2.10, 95%CI: 1.38-3.18]. When asked about the positive diagnosis, the most frequent response was that "the patient would not be reassured" (65.7%). The increased risk perception group was less likely to be reassured by a positive diagnosis of IBS, compared to the other respondents (aOR = 0.52, 95%CI: 0.34-0.78).
For IBS diagnosis, increased risk perception is a possible barrier to the appropriate use of diagnostic tests and to the patient's acceptance of a positive diagnosis.
World journal of gastroenterology : WJG. 12/2014; 20(48):18360-6.
[Show abstract][Hide abstract] ABSTRACT: Screening for hepatocellular carcinoma (HCC) is clinically important as its early detection has remarkable survival benefits. We investigated the possible role of FIB-4, a recently developed noninvasive marker for liver fibrosis based on routine laboratory tests, as a clinical indicator for predicting future HCC among hepatitis B surface antigen (HBsAg) carriers. Our retrospective cohort study involved 986 Korean HBsAg carriers aged 40 or older who visited Seoul National University Hospital for health check-up. National medical service claims data was used to determine HCC incidence. Median follow-up time was 5.4 years (interquartile range 4.4 years). Adjusted for age, sex, body mass index, smoking, alcohol, and anti-viral medication for hepatitis B, compared to subjects with FIB-4 <1.25, subjects with 1.7≤ FIB-4 <2.4 showed aHR 4.57 (95% CI 1.50-13.92) and subjects with FIB-4 ≥2.4 showed aHR 21.34 (95% CI 7.73-58.92) for HCC incidence. FIB-4 was shown to have incremental predictive value to ultrasonographic liver cirrhosis for HCC incidence (C-index 0.701 vs. 0.831; P=0.001). FIB-4 was also better predictive of HCC incidence compared to that of ultrasonographic liver cirrhosis (C-index 0.775 vs. 0.701; P=0.040). Conclusion: High FIB-4 is a highly predictive risk factor for HCC incidence among Korean HBsAg carriers. FIB-4 is a promising, easily applicable, and cost-effective clinical tool in identifying a subpopulation of HBsAg carriers who are at heightened risk. Our study needs to be replicated in larger future studies on various ethnic groups; nonetheless, our study suggests FIB-4 may play a valuable role in HCC screening among HBsAg carriers. This article is protected by copyright. All rights reserved.
[Show abstract][Hide abstract] ABSTRACT: The fabrication of interlayer dielectrics (ILDs) in flexible organic light-emitting diodes (OLEDs) not only requires flexible materials with a low dielectric constant, but also ones that possess the electrical, thermal, chemical, and mechanical properties required for optimal device performance. Porous polymer-silica hybrid materials were prepared to satisfy these requirements. Hollow SiO2 spheres were synthesized using Atomic Layer Deposition (ALD) and a thermal calcination process. The hybrid film which consists of hollow SiO2 spheres and polyimide shows a low dielectric constant of 2.35 and excellent thermal stability up to 530oC. After the bending test for 50,000 cycles, the porous hybrid film exhibits no degradation in its dielectric constant or leakage current. These results indicate that the hybrid film made of hollow SiO2 spheres and polyimide (PI) is useful as a flexible insulator with a low dielectric constant and high thermal stability for flexible OLEDs.
Physical Chemistry Chemical Physics 11/2014; · 4.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Continuity of care is considered a core element of high-quality primary care, but its impact on mortality and health care costs is unclear. We aimed to determine the impact of continuity of care on mortality, costs, and health outcomes in patients with newly diagnosed cardiovascular risk factors.
The Annals of Family Medicine 11/2014; 12(6):534-41. · 4.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Previous studies on the association of alcohol consumption with lower urinary tract symptoms (LUTS) have been inconsistent, and none took into account the dynamic nature of LUTS, fluctuating over time. The purpose of the study was to determine the longitudinal association of alcohol consumption with LUTS.Methods
We used generalized estimating equations to analyze the longitudinal association of alcohol consumption with LUTS in a longitudinal study of 9,712 healthy men 30 years or older who visited our institution multiple times for routine comprehensive health evaluations, with an average follow-up period of 27.9 months.ResultsLight–moderate alcohol consumption (0.1 to 29 g/d) was associated with decreased likelihood of moderate–severe LUTS, whereas heavy alcohol consumption (≥30 g/d) was associated with increased likelihood of moderate–severe LUTS in a dose-dependent manner. Compared to those with 0 g/d alcohol intake, subjects who drank 0.1 to 9.9, 10 to 19.9, 20 to 29.9, 30 to 39.9, or ≥40 g/d of alcohol were in general significantly associated with moderate–severe LUTS with adjusted odds ratio (95% confidence interval) as follows respectively: 0.94 (0.87 to 1.02), 1.00 (0.91 to 1.09), 0.85 (0.77 to 0.93), 1.08 (0.98 to 1.19), and 1.31 (1.19 to 1.44). However, the protective association of light–moderate alcohol consumption with LUTS was greatly attenuated when serum high-density lipoprotein (HDL) was added to the analysis, specifically for voiding symptoms.Conclusions
We show strong evidence there is longitudinal association of alcohol consumption with LUTS. The protective effect of light–moderate alcohol consumption on LUTS is in part modulated by HDL as a confounder, similar to its effect on coronary heart disease.
Alcoholism Clinical and Experimental Research 11/2014; · 3.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Many tissues of the human body encounter hyperosmotic stress. The effect of extracellular osmotic changes on melanin production has not yet been elucidated. In this study, we determined that hyperosmotic stress induced by organic osmolytes results in reduced melanin production in human melanoma MNT-1 cells. Under hyperosmotic stress, few pigmented mature melanosomes were detected, but there was an increase in swollen vacuoles. These vacuoles were stained with an anti-M6PR antibody that recognizes late endosomal components and with anti-TA99 and anti-HMB45 antibodies, implying that melanosome formation was affected by hyperosmotic stress. Electron microscopic analysis revealed that the M6PR-positive swollen vacuoles were multi-layered and contained melanized granules, and they produced melanin when L-DOPA was applied, indicating that these vacuoles were still capable of producing melanin, but the inner conditions were not compatible with melanin production. The vacuolation phenomenon induced by hyperosmotic conditions disappeared with treatment with the PI3K activator 740 Y-P, indicating that the PI3K pathway is affected by hyperosmotic conditions and is responsible for the proper formation and maturation of melanosomes. The microarray analysis showed alterations of the vesicle organization and transport under hyperosmotic stress. Our findings suggest that melanogenesis could be regulated by physiological conditions, such as osmotic pressure.
PLoS ONE 08/2014; 9(8):e105965. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Testosterone is an endocrine hormone with functions in the reproductive organs, anabolic events and skin homeostasis. We report here that GPRC6A serves as a sensor and mediator of the rapid action of testosterone in epidermal keratinocytes. The silencing of GPRC6A inhibited testosterone-induced intracellular calcium ([Ca2+]i) mobilization and H2O2 generation. These results indicated that a testosterone-GPRC6A complex is required for the activation of Gq protein, IP3 generation, and [Ca2+]i mobilization, leading to Duox1 activation. H2O2 generation by testosterone stimulated the apoptosis of keratinocytes through the activation of caspase-3. The application of testosterone into 3-D skin equivalents increased the apoptosis of keratinocytes between the granular and stratified corneum layers. These results support an understanding of the molecular mechanism of testosterone-dependent apoptosis in which testosterone stimulates H2O2 generation through the activation of Duox1.
Journal of Biological Chemistry 08/2014; · 4.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The complexity of end-of-life (EOL) communication in cancer care is often increased by family caregivers, who frequently affect the information and decision-making process. We assessed cancer patient preferences (PP), family caregiver preferences (FCP), and family caregiver predictions of patient preferences (FCPPP) regarding the disclosure of terminal status, family involvement in the disclosure process, and EOL choices, and we evaluated the concordances among them.
[Show abstract][Hide abstract] ABSTRACT: Abstract Purpose: To investigate the health behaviors of people with retinitis pigmentosa (RP) in the Republic of Korea. Methods: An online questionnaire was used to survey members of the Korean Retinitis Pigmentosa Society (KRPS), over 3 months from December 2010 to February 2011. Controls were selected from participants of the 4th Korean National Health and Nutrition Examination Survey and were matched with people with RP using the propensity score method to optimize comparative analysis. A semi-structured interview was also conducted with five members of the KRPS to identify potential reasons for physical inactivity and unhealthy diet and to develop effective interventions. Results: A total of 194 eligible people with RP responded to the online survey, and 187 individuals were matched with the control population by propensity score matching. RP subjects reported a lower rate of current smoking and greater use of preventive healthcare services. However, people with RP were more physically inactive (50.8% vs 27.3%, p < 0.001) and consumed more fast food (69.5% vs 58.3%, p = 0.024) than the control population. Conclusion: Physical inactivity and fast food consumption were more frequently reported in people with RP than the general population. Efforts to understand the possible reasons and develop interventions to improve these health behaviors are warranted.
[Show abstract][Hide abstract] ABSTRACT: Human epidermal γδ T cells are known to play crucial roles in the defense and homeostasis of the skin. However, their precise mechanism of action in skin inflammation remains less clear.
Annals of Dermatology 06/2014; 26(3):308-13. · 0.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We assessed the accuracy of communication between doctors and patients by evaluating the consistency between patient perception of cancer stage and the medical records, and analyzed the most influential factors of incongruence among cancer patients at 10 cancer centers across Korea.
Information was gathered from cancer patients at the National Cancer Center and nine regional cancer centers located in every province of Korea between 1 July 2008 and 31 August 2008. Data were analyzed using Pearson's χ2 test and multivariate logistic regression analysis.
The stages of cancer reported by the 1,854 patients showed a low degree of congruence with the stages given in medical records (k = 0.35, P<0.001). Only 57.1% of the patients had accurate knowledge of their cancer stage. In total, 18.5% underestimated their stage of disease, and the more advanced the cancer stage, the more likely they were to underestimate it, in order of local (14.2%), regional (23.7%), and distant (51.6%). Logistic regression analysis showed that congruence was lower in patients with cervical cancer (odds ratio [OR] = 0.51, 95% confidence interval [CI] = 0.30-0.87), recurrence (OR = 0.64, 95% CI = 0.50-0.83), and treatment at the National Cancer Center (OR = 0.53, 95% CI = 0.39-0.72).
There are knowledge gaps between patients' perceived and actual stage of cancer. Patients with cervical cancer, recurrence, and who received treatment at a regional cancer center showed less understanding of their cancer stage.
PLoS ONE 05/2014; 9(5):e90483. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: (-)-Epigallocatechin-3-O-gallate (EGCG) has long been known as a potent inducer of keratinocyte differentiation. Although its molecular mechanisms have been extensively studied, its actions on human skin remain to be elucidated. In this study, we demonstrated that methylated EGCG and EGCG increase the expression of klotho, and that klotho functions as a downstream target of EGCG and methylated EGCG in keratinocyte differentiation. We demonstrated that methylated EGCG3 and EGCG induce morphological changes in normal human epidermal keratinocytes (NHEKs) that are related to up-regulation of klotho expression. We also demonstrated that a klotho-induced keratinocyte differentiation marker in NHEKs is inhibited by H-89, a protein kinase (PKA) inhibitor. These results suggest that methylated EGCG and EGCG may function as inducers of keratinocyte differentiation via transcriptional regulation of the klotho protein.
International Journal of Molecular Sciences 04/2014; 15(4):5749-61. · 2.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
To investigate the potentially different relationship between family history (FH) of coronary heart disease (CHD) and carotid or coronary atherosclerosis.
Asymptomatic healthy Korean adults older than 30 years who received both coronary CTA and carotid USG as part of a self-referred health check-up were retrospectively investigated (N = 662). Multivariable logistic regression analysis was employed to investigate the relationship between FH of CHD and either coronary CTA or carotid USG results.
Adjusted for major CVD risk factors, FH of CHD was significantly associated with presence of any plaque in coronary arteries (aOR 2.10, 95% CI 1.07–4.16) and significant coronary stenosis (aOR 4.92, 95% CI 1.58–15.4), but was not associated with presence of any plaque in carotid arteries (aOR 1.27, 95% CI 0.61–2.63) and increased carotid IMT (aOR 1.44, 95% CI 0.40–5.22). Addition of FH of CHD had significant incremental predictive value to models for any coronary plaque (AUC 0.781 vs. 0.786, p = 0.0351), and significant coronary stenosis (AUC 0.772 vs. 0.808, p = 0.0129), but not for any carotid plaque (AUC 0.748 vs. 0.748, p = 0.528), and increased carotid IMT (AUC 0.778 vs. 0.783, p = 0.591).
To our knowledge, our study is the first to show specific comparative evidence that FH of CHD is more strongly associated with coronary than with carotid atherosclerosis. Our results suggest FH of CHD adds predictive value specifically to coronary atherosclerosis, but not carotid atherosclerosis, and suggest the possibility that screening for coronary atherosclerosis (via CAC) among low to intermediate risk asymptomatic adults with FH of CHD may be beneficial, who otherwise would not be screened according to traditional risk algorithms.
[Show abstract][Hide abstract] ABSTRACT: We demonstrate a simple electrospinning for preparing Si-carbon composite Nanofiber (NF) in which aciniform aggregates of Si particles are well encased by amorphous carbon. The Si-carbon composite NF exhibit a significantly improved electrochemical performance with a high specific capacity of 1250 mAh·g−1 and a superior cycling performance during 50 cycles at a rate of 0.2 C. More importantly, Si-carbon composite NF maintain about 70% of initial capacity at 0.2 C and an excellent cycling stability even at 25 times higher current density compared to the initial condition, proving that it has superb kinetics compared to ever reported Si or SiOx materials. The electrochemical superiority of Si-carbon composite NF can be attributed to amorphous carbon framework accommodating the inherent volume expansion of Si during lithiation as well as the enlarged contact area between active materials and conducting agent attributed to the morphological characteristics of its one dimensional (1D) nanostructure.
[Show abstract][Hide abstract] ABSTRACT: Decisions for cancer susceptibility genetic testing (CSGT) uptake and dissemination of results occur within the family context. A national survey was performed with 990 patient-family member dyads (participation rate:76.2%), with paired questionnaires examining attitudes toward CSGT uptake and disclosure of results in response to a hypothetical scenario in which a reliable cancer susceptibility genetic test was available for the specific cancer a patient was being treated. While most patients and family members responded they would uptake or recommend CSGT if available, concordance between the dyads was poor for both patient's testing (agreement rate 77.5%, weighted κ =0.09) and first-degree relatives' testing(agreement rate 78.0%, weighted κ =0.09). Most patients (93.2%) and family members (92.9 %) indicated that patients should disclose positive CSGT results to family members, with dyadic agreement of 89.1% (κ = 0.15). However, there were substantial disagreement regarding when disclosure should take place, who should make the disclosure (the patient or the health care professionals), and to whom the results should be disclosed. Patients and family members may hold different attitudes toward CSGT uptake of and disclosure of results within the family. Our findings reinforce the need for a family system approach to incorporate perspectives of patients as well as their family members.