Effect of antibiotic use on the incidence of asthma and atopic dermatitis in infants

학위논문 (석사)-- 서울대학교 대학원 : 보건학과(보건학전공), 2017. 2. 원성호.Background: Previous studies have shown that both asthma and atopic dermatitis are caused by allergic marching in the childhood, with their cooccurrence or with some pre-existing relationship. Because of these relationship, the behavior of both diseases and their risk factors have been jointly investigated. Asthma and atopic dermatitis are from the complex interplay various factors such as demographic factors, infectious disease related factors, medicinal use factors, dietary related factors, and atmospheric environmental factors are mixed and acting together. Among the various risk factors, the use of antibiotics has been studied to cause long-term changes in intestinal microorganisms such as decreased actinomycetes, increased bacteria, and decreased enzymes. It has also been studied to increase the incidence of allergic sensitization to allergies such as asthma and atopic dermatitis by inhibiting the proper growth of infantile immune system and inhibiting the development of immune tolerance because it causes an increase in the immature microbial growth. Nevertheless, due to the difficulty in diagnosing asthma and atopic dermatitis of less than 5 years old, there have been few studies about disease status and on the risk factors including antibiotic use. Objective: The purpose of this study is to investigate the effect of antibiotics use in infants on the risk of asthma and atopic dermatitis with the current status of asthma and atopic dermatitis of newborns between 2011 and 2013 in Korea. Method: This study used claims data of the Health Insurance Review and Assessment Service of newborns born in 2011, 2012, and 2013 in Korea. The registered analysis number of the data requested by the Health Insurance Review and Assessment Service is M2016082442, which is applied to the remote access system and granted access to data. The data to be used in this study were composed by combining the general information, healthcare information, diagnostic information and prescriptions information based on the patient identification code and the key code. The directed acyclic graph (DAG) was made through literature review, and was used to choose confounding variables. Frequency analyses were performed to examine the characteristics of the data, and the prevalences and incidence rates of asthma and atopic dermatitis were estimated. Incidence was estimated by person-month. Kaplan-Meier survival curves were estimated for subjects with the antibiotic use before the diseases, with the antibiotic use before the disease and the respiratory disease, and with the respiratory disease in the antibiotic use and pyelonephritis. Finally, the cox proportional hazard model was used to estimate the hazard ratio for the use of antibiotics in the development of asthma and atopic dermatitis. This study also estimated the hazard ratio for the development of asthma and atopic dermatitis according to the type of antibiotics proposed by WHO. Results: The prevalence of asthma was about 60% and its incidence rate was 0.0238 per person-month who were less than one year old in 2011-2013, and the prevalence of atopic dermatitis was about 80% and incidence rate was 0.0845 per person-month. Both diseases were found to have higher prevalence and incidence rates for subjects using antibiotics before the diseases. DAG reveals that respiratory disease is a main confounder between asthma, atopic dermatitis and antibiotics, and the subjects were categorized into four different groups based on the antibiotics use and respiratory diseases. Kaplan-Meier survival curves show that both asthma and atopic dermatitis were associated with the highest risk in the group of antibiotic use and respiratory disease. The log-rank test also showed that there was a substantial difference in the survival functions between groups because the significance probability was less than 0.0001. Finally, the hazard ratio of antibiotic use before asthma in the Cox proportional hazards model was estimated to be 1.556 (95% CI: 1.543 - 1.569) for the development of asthma, and hazard ratio of antibiotic use before atopic was estimated to be 1.369 (95% CI: 1.360 - 1.378) for the occurrence of atopic dermatitis. The hazard ratio of antibiotic use for asthma among subjects with respiratory diseases was estimated to be 1.518 (95% CI: 1.510 - 1.527) and the hazard ratio for atopic dermatitis was estimated to be 1.210 (95% CI: 1.205 - 1.215). Effects of different antibiotics were estimated with the Cox proportional hazards model, and hazard ratios of the beta-lactam antibacterials and penicillins for asthma was 1.682 (95% CI: 1.668-1.695), and those for atopic dermatitis was 1.408 (95% CI: 1.399 – 1.417). Conclusion: In this study, the use of antibiotics before the onset of asthma and atopic dermatitis was found to be an important risk factor affecting the incidence of asthma and atopic dermatitis. Especially, the effect of beta-lactam antibacterials, penicillins on the incidence of asthma and atopic dermatitis was found to be the largest among antibiotics, and thus we can conclude that careful prescription for those antibiotics may be necessary to minimize the risk of asthma and atopic dermatitis in infants.Ⅰ. Introduction 1 1. Background & Necessity 1 2. Objectives 3 Ⅱ. Theoretical background 5 1. Asthma, atopic dermatitis and antibiotics 5 2. Risk factors of asthma and atopic dermatitis 6 3. The association of asthma and atopic dermatitis with antibiotics 7 4. Directed acyclic graphs 8 Ⅲ. Method 10 1. Study design 10 2. Hypotheses 17 3. Statistical methods 17 Ⅳ. Results 20 1. Characteristics of study population 20 2. Prevalence and Incidence rate of asthma and atopic dermatitis 24 3. Kaplan-Meier curve of asthma and atopic dermatitis by antibiotics, respiratory disease and pyelonephritis 26 4. Cox proportional hazard model of asthma and atopic dermatitis 28 Ⅴ. Conclusion 33 Ⅵ. Reference 37 국문초록 40Maste

A Study on the Design of Safety Management Cost System for Coastal Passenger Ship

이 논문은 운항관리자 제도의 운영재원인 여객선 안전운항관리 부담금을 연구하였다. 현행 여객선 안전운항관리 부담금 부과체계를 분석하고 문제점을 도출하여, 이를 토대로 여객선 안전운항관리 부담금 시스템을 설계하였다.목 차 목차 ⅰ 그림목차 ⅲ 표목차 ⅲ Abstract ⅴ Ⅰ. 서 론 1 1.1 연구의 배경 및 목적 1 1.2 연구의 방법 및 내용 6 Ⅱ. 연안여객선 및 운항관리자 현황 분석 8 2.1 연안여객선 2.1.1. 항해구역별, 선종별 및 총톤수별 척수 8 2.1.2. 차량적재(카페리 및 차도선) 여객선 현황 11 2.2 운항관리자 2.2.1. 연혁 및 운영근거 13 2.2.2. 운항관리 조직도 18 2.2.3. 운항관리자의 업무의 성격 19 2.2.4. 운항관리자의 주요업무 절차서 22 Ⅲ. 안전운항관리 부담금 현황 분석 27 3.1 안전운항관리 부담금 3.1.1. 안전운항관리 부담금 법적근거 및 성격 27 3.1.2. 안전운항관리 부담금 재원의 구성 38 3.2 안전운항관리 부담금 부과 실태 분석 3.2.1. 안전운항관리 부담금의 이해관계 41 3.2.2. 운항관리제도 운영주체 44 3.2.3. 안전운항관리 부담금 구성 45 Ⅳ. 안전운항관리 부담금 부과 체계 분석 48 4.1 안전운항관리 부담금 국․내외 사례 분석 4.1.1. 국내사례 48 4.1.2. 외국사례 53 4.2 안전운항관리 부담금 부과 체계 분석 4.2.1. 안전운항관리 부담금 부과체계 문제점 56 4.2.2. 차량(화물) 안전운항관리 부담금 부과 체계 분석 56 4.2.3. 낙도보조항로 안전운항관리 부담금 부과 체계 분석 61 Ⅴ. 안전운항관리 부담금 시스템 65 5.1 개선방향 5.2 안전운항관리 부담금 부과 체계 설계 5.2.1. 안전운항관리 부담금 재정확보 설계 65 5.2.2. 안전운항관리 부담금 제도개선 설계 66 5.3 차량 안전운항관리 부담금 부과 방안 5.3.1. 차량 안전운항관리 부담금 시스템 설계 73 5.3.2. 수요자 중심의 차량 Risk 부과 개선 방안 78 5.4 낙도보조항로 부담금 개선 방안 5.4.1. 낙도보조항로 안전운항관리 부담금 개선(안) 80 5.4.2. 낙도보조항로 공공기관 위탁운영 85 5.5 안전운항관리 부담금 공공성 확보 방안 5.5.1. 안전운항관리 부담금 전액 국고지원 88 5.5.2. 공공기관 공공성 및 독립성 확보 90 Ⅵ. 결론 9

Insulinoma Presenting as Hypersomnia and Unconscious Wandering.

Insulinoma is a rare endocrine tumor that frequently causes neurologic symptoms. We report a case of a 17-year-old man with hypersomnia and abnormal behavior lasting for 10 months. He had recurrent attacks of hypersomnia that lasted for up to 36 hours and of unconscious wandering mimicking an ictal or postictal state. Hypoglycemia was documented (30 mg/dL) and insulinoma was found at the most-recent episode. Clinicians should be aware that hypersomnia and unconscious wandering can present in association with hypoglycemia.ope

The localizing and lateralizing value of auras in lesional partial epilepsy patients

PURPOSE: We investigated the localizing and lateralizing values of auras in patients with lesional partial epilepsy on an outpatient basis. MATERIALS AND METHODS: A total of 276 subjects were retrospectively selected for this study if they had a unilateral single lobar lesion based on magnetic resonance image (MRI) results, and their scalp electroencephalography (EEG) findings were not discordant with the MRI-defined lobar localization and lateralization. According to the lesion locations, subjects were considered as having mesial temporal (MTLE), lateral temporal (LTLE), frontal (FLE), parietal (PLE), or occipital (OLE) lobe epilepsies. Auras were classified into 13 categories. RESULTS: A hundred and seventy-six subjects (63.8%) had experienced at least one aura. FLE subjects had the fewest number of auras. Epigastric and psychic auras were frequent among MTLE subjects, while visual auras were common in those with PLE and OLE. Somatosensory auras and whole body sensations were more frequent in the subjects with PLE than those without. Autonomic auras were more common in MTLE subjects than in LTLE subjects. Dysphasic auras were more frequently found in left-sided epilepsies. Five pairs of aura categories showed concurrent tendencies, which were the epigastric and autonomic auras, autonomic and emotional auras, visual and vestibular auras, auditory and vestibular auras, and whole-body sensation and auditory auras. Autonomic and emotional auras had a concurrent tendency in left-sided epilepsies, but not in right-sided epilepsies. CONCLUSION: Our results support the previously known localizing value of auras, and suggest that dysphasic auras and the association of emotional and autonomic auras may have a lateralizing value.ope

Hemodynamic factors affecting the lesion distribution of the posterior reversible encephalopathy syndrome

의학과/석사배경 후부 가역성 뇌병증 증후군의 특징적 영상 소견은 뇌 후두부에 발생하는 혈관성 부종이다. 그러나, 영상 소견이 비특이적인 경우도 많고, 각각의 임상 조건과 영상 소견과의 연관성이 아직 명확하게 규명되지 않은 상태이다. 본 연구는 39명의 환자를 대상으로 영상소견과 임상소견을 분석하였으며, 여러 임상소견 중에서 혈역동학적 인자가 뇌 병변 분포에 어떠한 영향을 주는지 알아보고자 했다.방법 2005년 ~ 2010년 사이에 발생한 환자를 후향적으로 분석하였다. 뇌 영상 자료가 부족하거나, 의무기록이 부실하여 증상 발생 시점이 불분명하거나, 증상에 대한 기록이 부실한 경우, 혈압 측정 자료가 부족한 경우에는 제외하였다.결과 뇌 후두부 침범율이 가장 높았으며, 30%정도의 환자에게서는 큰 동맥에서 직접 분지되는 관통동맥 영역 침범이 있었다. 이 환자들의 경우, 그렇지 않았던 환자들에 비해서 기준 수축기 혈압과 발병 후 이완기 혈압이 높은 경향을 보였다. 이중 한 명의 환자는 뇌 피질부위 병변이 없이 뇌간, 소뇌, 기저핵의 침범만 있었다.결론 현재까지 뇌병변 분포와 선행되는 임상 조건간의 뚜렷한 연관성은 밝혀진 바가 없다. 기준 수축기 혈압이 높을수록 큰 동맥 근위부의 관통동맥 영역 병변이 발생할 가능성이 높다는 연구 결과는 본 질환의 병태생리를 이해하는 한가지 근거가 될 수 있을 것이다.ope

암호 프로토콜의 성능 향상을 위한 효율적인 연산 알고리즘 설계

Thesis (doctoral)--서울대학교 대학원 :전기·컴퓨터공학부,2003.Docto

The Astronomical knowledge about the heaven in ancient China : the formation and development of the astronomical knowledge in the Han period

학위논문(박사)--서울대학교 대학원 :협동과정 과학사 및 과학철학전공 ,1997.Docto

A Study on nonlinear design of microwave oscillator based on load line

학위논문(박사)--서울대학교 대학원 :전자공학과,1999.Docto