Status of Rehabilitation After Ischemic Stroke: A Korean Nationwide Study

Objective To investigate the post-stroke rehabilitation status according to stroke severity using the database of the Korean Health Insurance Review and Assessment Service. Methods The data of patients admitted to the neurology departments of 12 hospitals within 7 days of onset of ischemic stroke were collected. A total of 2,895 patients hospitalized between November 2010 and December 2011 were included. The patients were classified into three groups according to their initial National Institutes of Health Stroke Scale (NIHSS) scores (mild, ≤5; moderate, >5 and ≤13; and severe, >13). Length of hospital stay (LoS) with rehabilitation, NIHSS score after acute care, and scores on modified Rankin Scale (mRS) were examined at 1 year post-stroke according to stroke severity and ongoing rehabilitation. Results The total LoS for ongoing rehabilitation significantly increased with stroke severity (mild, 91.66±149.70; moderate, 197.26±241.93; severe, 263.50±275.75 days; p<0.01). However, the proportion of LoS with ongoing rehabilitation to the total LoS tended to decline with increasing stroke severity (mild, 77.93±29.50, p<0.01; moderate, 71.83±32.13; severe, 62.29±37.19). The home discharge rate of the group that underwent continuous inpatient rehabilitation was significantly higher in patients with moderate and severe stroke, respectively (14.2% vs. 0.0%, p<0.001; 7.4% vs. 0.0%, p=0.032). Conclusion This study showed that intermittent rehabilitation was often provided after acute care, whereas ongoing rehabilitation positively affected rate of home discharge in patients with moderate and severe stroke in Korea. These results represent evidence for improving the healthcare system to promote adequate rehabilitation in the future

Cigarette Smoking and Risk of Lung Cancer in Korean Men: The Seoul Male Cancer Cohort Study

Lung cancer is the leading cause of cancer deaths in Korea. The aim of this study was to estimate lung cancer risk of cigarette smoking in Korean men by a 10-yr follow-up prospective cohort study using the primary databases. The number of subjects was 14,272 men, who had full information of smoking habits among participants in the Seoul Male Cancer Cohort Study (SMCC). Total 125,053 person-years were calculated by determining the number of days from the start of follow-up, January 1, 1993, until the date of lung cancer diagnosis, death from another cause, or the end of follow-up, December 31, 2002, followed by converting the number of days to years. The information of outcome was obtained by the database of Korea Central Cancer Registry, Seoul Regional Cancer Registry, and Korea Statistical Office. The relative risk (RR) and its 95% confidence interval (CI) values of smoking were calculated using Cox proportional hazards regression stratified on potential confounders. During the follow-up periods, 78 cases of lung cancer occurred. The cigarette smoking is the major risk factor and increases the 4.18-fold risk of lung cancer in Korean men. In order to control lung cancer, intervention of quitting smoking is needed

NuSTAR Discovery of Dead Quasar Engine in Arp 187

Recent active galactic nucleus (AGN) and quasar surveys have revealed a population showing rapid AGN luminosity variability by a factor of $\sim10$. Here we present the most drastic AGN luminosity decline by a factor of $\gtrsim 10^{3}$ constrained by a NuSTAR X-ray observation of the nearby galaxy Arp 187, which is a promising "dead" quasar whose current activity seems quiet but whose past activity of $L_\mathrm{bol} \sim 10^{46}$ erg s$^{-1}$ is still observable at a large scale by its light echo. The obtained upper bound of the X-ray luminosity is $\log (L_{\rm 2-10 keV}/{\rm erg} {\rm s}^{-1}) < 41.2$, corresponding to $\log (L_\mathrm{bol}/{\rm erg} {\rm s}^{-1}) < 42.5$, indicating an inactive central engine. Even if a putative torus model with $N_\mathrm{H} \sim 1.5 \times 10^{24}$ cm$^{-2}$ is assumed, the strong upper-bound still holds with $\log (L_{\rm 2-10 keV}/{\rm erg} {\rm s}^{-1}) < 41.8$ or $\log (L_\mathrm{bol}/{\rm erg} {\rm s}^{-1}) < 43.1$. Given the expected size of the narrow line region, this luminosity decrease by a factor of $\gtrsim 10^3$ must have occurred within $\lesssim 10^4$ yr. This extremely rapid luminosity/accretion shutdown is puzzling and it requires one burst-like accretion mechanism producing a clear outer boundary for an accretion disk. We raise two possible scenarios realizing such an accretion mechanism: a mass accretion 1) by the tidal disruption of a molecular cloud and/or 2) by the gas depletion as a result of vigorous nuclear starformation after rapid mass inflow to the central engine.Comment: 7 pages, 2 figures, accepted for publication in ApJ

The socio-economic transition and health professions education in Mongolia: a qualitative study

Background Former socialist countries have undergone a socio-economic transition in recent decades. New challenges for the healthcare system have arisen in the transition economy, leading to demands for better management and development of the health professions. However, few studies have explored the effects of this transition on health professions education. Thus, we investigated the effects of the socio-economic transition on the health professions education system in Mongolia, a transition economy country, and to identify changes in requirements. Methods We used a multi-level perspective to explore the effects of the transition, including the input, process, and output levels of the health professions education system. The input level refers to planning and management, the process level refers to the actual delivery of educational services, and the output level refers to issues related to the health professionals, produced by the system. This study utilized a qualitative research design, including document review and interviews with local representatives. Content analysis and the constant comparative method were used for data analysis. Results We explored tensions in the three levels of the health professions education system. First, medical schools attained academic authority for planning and management without proper regulation and financial support. The government sets tuition fees, which are the only financial resource of medical schools; thus, medical schools attempt to enroll more students in order to adapt to the market environment. Second, the quality of educational services varies across institutions due to the absence of a core curriculum and differences in the learning environment. After the transition, the number of private medical schools rapidly increased without quality control, while hospitals started their own specialized training programs. Third, health professionals are struggling to maintain their professional values and development in the market environment. Fixed salaries lead to a lack of motivation, and quality evaluation measures more likely reflect government control than quality improvement. Conclusions Mongolia continues to face the consequences of the socio-economic transition. Medical schools lack of financial authority, the varying quality of educational services, and poor professional development are the major adverse effects. Finding external financial support, developing a core curriculum, and reforming a payment system are recommended