Factors associated with time to diagnosis from symptom onset in patients with early rheumatoid arthritis

( Soo-kyoung Cho ),( Dam Kim ),( Soyoung Won ),( Jiyoung Lee ),( Chan-bum Choi ),( Jung-yoon Choe ),( Seung-jae Hong ),( Jae-bum Jun ),( Tae-hwan Kim ),( Eunmi Koh ),( Hye-soon Lee ),( Jisoo Lee ),( D 대한내과학회 2019 The Korean Journal of Internal Medicine Vol.34 No.4

Background/Aims: To identify the factors associated with time to diagnosis after symptom onset in patients with early rheumatoid arthritis (RA). Methods: Early RA patients with ≤ 1 year of disease duration in the KORean Observational study Network for Arthritis (KORONA) database were included in this analysis. Patients were further divided into two groups according to the time to diagnosis from symptom onset: the early diagnosis group (time to diagnosis ≤ 1 year) and the late diagnosis group (time to diagnosis > 1 year). Using the multivariable regression model, we identified factors associated with early diagnosis. Results: Among 714 early RA patients, 401 patients (56.2%) and 313 patients (43.8%) were included in the early diagnosis and late diagnosis groups, respectively. The mean disease duration was 0.47 years in the early diagnosis group and 0.45 years in the late diagnosis group. In multivariable model analysis, greater age at onset (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02 to 1.05), high school education or higher (OR, 1.68; 95% CI, 1.14 to 2.47), higher income (OR, 1.48; 95% CI, 1.05 to 2.08), and initial small joint involvement (OR, 1.42; 95% CI, 1.02 to 1.98) were factors associated with early diagnosis. At diagnosis, disease activity scores using 28 joints on diagnosis (3.81 ± 1.44 vs. 3.82 ± 1.42, p = 0.92) and functional disability (0.65 ± 0.61 vs. 0.57 ± 0.62, p = 0.07) did not different between the two groups. However, hand joint erosion on X-ray (37.8% vs. 25.6%, p < 0.01) was more common in the late diagnosis group than the early diagnosis group. Conclusions: Older onset age, higher educational level and income, and initial small joint involvement were positive factors for early diagnosis of RA.

무균성 뇌막염에서 증상발현부터 진단까지 걸린 시간에 따른 시기별 유병기간의 검토

김탁수,허지연,박영희,정민구,김성원,Kim, Tag Soo,Hur, Ji Yeon,Park, Young Hee,Jung, Min Goo,Kim, Sung Won 대한소아감염학회 1996 Pediatric Infection and Vaccine Vol.3 No.2

Purpose : Aseptic meningitis is relatively frequent in children and caused mostly by enterovirus. The aim of the present study was to determine the effect of early diagnosis (spinal tapping) on symptom duration of childhood aseptic meningitis. Methods : One hundred fifty-three children who were hospitalized due to aseptic menigitis in the Department of Pediatrics St. Benedict Hospital from July 1996 through October 1996 were included in this study. Patients were divided to two groups according to the duration from first symptom onset to diagnosis. Early diagnosis group is diagnosed within 3 days from first symptom onset. Later diagnosis group is diagnosed after 4 days from first symptom onset. Results : 1) The average age of these patients was 4.3 years old in early diagnosis group and 4.1 years old in later diagnosis group. The sex ratio(male: female) was 2.04:1 in early diagnosis group and 2.5:1 in later diagnosis group. 2) The mean duration of diagnosis of this study was 2.04 day in early diagnosis group and 5.12 day in later diagnosis group. 3) The percentage of symptom and sign of the early diagnosis group were fever(100%), headache(88.4%), vomiting(86.9%), abdominal pain(39%), neck stiffness(36.2%), skin rash(18.8%), diarrhea(16.9%) and that of later diagosis group were fever(100%), headache(83.3), vomiting(80.9%), abdominal pain(47.6%), neck stiffness(41.6%), skin rash(29.7%), diarrhea(16.6%). 4) Initial CSF findings revealed leukocyte $146.8{\pm}386.3/mm^3$ with PMNL 38%, protein 32.47mg/dl, sugar 66.23mg/dl in early diagnosis group and leukocyte $458.1{\pm}663.2/mm^3$, protein 31.22mg/dl, sugar 64.21 mg/dl in later diagnosis group. 5) There was no statistically significant differance in the peripheral blood findings between early diagnosis group and later diagnosis group. 6) The duration of disappearance of symptom after spinal tap were 2.3 days in early diagnosis group and 2.24 days in later diagnosis group. Total symptom duration was 4.34 days in early diagnosis group and 7.36 days in later diagnosis group. Conclusions : Our results demonstrate that early diagnosis(early spinal tap) shortened duration of clinical symptoms.

Factors associated with time to diagnosis from symptom onset in patients with early rheumatoid arthritis

조수경,김담,원소영,이지영,최찬범,최정윤,홍승재,전재범,김태환,고은미,이혜순,이지수,유대현,윤보영,배상철,성윤경 대한내과학회 2019 The Korean Journal of Internal Medicine Vol.34 No.4

Background/Aims: To identify the factors associated with time to diagnosis after symptom onset in patients with early rheumatoid arthritis (RA). Methods: Early RA patients with ≤ 1 year of disease duration in the KORean Observational study Network for Arthritis (KORONA) database were included in this analysis. Patients were further divided into two groups according to the time to diagnosis from symptom onset: the early diagnosis group (time to diagnosis ≤ 1 year) and the late diagnosis group (time to diagnosis > 1 year). Using the multivariable regression model, we identified factors associated with early diagnosis. Results: Among 714 early RA patients, 401 patients (56.2%) and 313 patients (43.8%) were included in the early diagnosis and late diagnosis groups, respectively. The mean disease duration was 0.47 years in the early diagnosis group and 0.45 years in the late diagnosis group. In multivariable model analysis, greater age at onset (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02 to 1.05), high school education or higher (OR, 1.68; 95% CI, 1.14 to 2.47), higher income (OR, 1.48; 95% CI, 1.05 to 2.08), and initial small joint involvement (OR, 1.42; 95% CI, 1.02 to 1.98) were factors associated with early diagnosis. At diagnosis, disease activity scores using 28 joints on diagnosis (3.81 ± 1.44 vs. 3.82 ± 1.42, p = 0.92) and functional disability (0.65 ± 0.61 vs. 0.57 ± 0.62, p = 0.07) did not different between the two groups. However, hand joint erosion on X-ray (37.8% vs. 25.6%, p < 0.01) was more common in the late diagnosis group than the early diagnosis group. Conclusions: Older onset age, higher educational level and income, and initial small joint involvement were positive factors for early diagnosis of RA.

젖소에서 초음파 조기 임신진단이 태아사 발생에 미치는 영향

김일화,이제인,김의형,강현구 한국임상수의학회 2008 한국임상수의학회지 Vol.25 No.2

This study assessed the incidence of embryo and fetal los folowing early pregnancy diagnosis usingultrasonography in dairy cows. A positive pregnancy was a recognition of the vesicle, embryo or fetus by ultra-sonography. Seven hundreds and two pregnancies determined by ultrasonography folowing artificial insemination weredivided into three groups according to the number of days diagnosed pregnant: early A group (27 to 40 days, n = 143),early B group (41 to 50 days, n = 172), or standard group (51 to 70 days, n = 387). Following a positive pregnancydiagnosis, embryo or fetal loss included all cows with observed abortions and cows found open after the positivepregnancy diagnosis. The incidence rate of embryo or fetal los within 7 days after pregnancy diagnosis was 1.4,0.6 and 0.3% for the early A, early B, and standard groups, respectively (P. 0.05). The incidence of the embryoor fetal loss during 8 to 30 days after pregnancy diagnosis did not differ (P. 0.05) among the early A (0%), earlyB (1.2%), and standard groups (1.0%). Furthermore, the cumulative incidence of the embryo or fetal los before calvingdid not difer (P. 0.05) among the early A (9.8%), early B (9.3%), and standard groups (5.9%). These results indicatethat early pregnancy diagnosis using ultrasonography does not increase the risk of embryo and fetal los comparedwith that of routine pregnancy diagnosis in dairy cows.

만성 폐쇄성 폐질환의 조기 진단과 관리

이세원 ( Sei Won Lee ),유지홍 ( Jee-Hong Yoo ),박명재 ( Myung Jae Park ),김은경 ( Eun Kyung Kim ),윤호일 ( Ho Il Yoon ),김덕겸 ( Deog Kyeom Kim ),이창훈 ( Chang Hoon Lee ),박용범 ( Yong Bum Park ),박주헌 ( Joo Hun Park ),황용일 ( 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.70 No.4

Chronic obstructive pulmonary disease (COPD) is a substantially under-diagnosed disorder, and the diagnosis is usually delayed until the disease is advanced. However, the benefit of early diagnosis is not yet clear, and there are no guidelines in Korea for doing early diagnosis. This review highlights several issues regarding early diagnosis of COPD. On the basis of several lines of evidence, early diagnosis seems quite necessary and beneficial to patients. Early diagnosis can be approached by several methods, but it should be confirmed by quality-controlled spirometry. Compared with its potential benefit, the adverse effects of spirometry or pharmacotherapy appear relatively small. Although it is difficult to evaluate the benefit of early diagnosis by well-designed trials, several lines of evidence suggest that we should try to diagnose and manage patients with COPD at early stages of the disease.

ASD 조기진단도구 개발을 위한 기초연구

최진혁 ( Choi¸ Jinhyeok ),박재국 ( Park¸ Jaekook ),김지훈 ( Kim¸ Jihoon ),최민혁 ( Choi¸ Minhyeok ),김민영 ( Kim¸ Minyoung ) 한국특수아동학회 2021 특수아동교육연구 Vol.23 No.3

Purpose: The purpose of this study is to develop an early diagnosis tool that can diagnose ASD at an early stage. Method: In order to achieve this research purpose, the diagnostic questions were extracted based on the existing diagnostic tools and previous studies related to ASD diagnosis. Afterwards, a Delphi survey was conducted twice on 20 ASD diagnosis-related experts. Through the Delphi survey, the relevance and age fit of the diagnostic items were verified. Results: As the results of the study, 33 items were calculated for the ASD early diagnosis tool in 3 areas: 'social interaction', 'sensory response', and 'restricted interest and repetitive behavior'. Conclusion: In this study, ASD early diagnosis items were extracted, and based on this, the future direction and discussion points of the ASD early diagnosis tool were presented.

장애위험 유아의 선별 및 진단 의뢰과정 실태와 유아교사의 인식

박체희,황순영,차세진 부산대학교 교육발전연구소 2021 교육혁신연구 Vol.31 No.1

Purpose: This study is intended to be served as foundational data to support early screening and early intervention by investigating the facts and perceptions of early childhood teachers requesting children at risk of disability for disability diagnosis. Method: A survey was conducted on 163 early childhood teachers at daycare centers and kindergartens in Busan and Gyeongnam. Results: First, According to the actual situation of the early childhood teachers about the process of requesting the diagnosis of the disorder of at-risk children, the majority of early childhood teachers had experience teaching infants with an average of 1 or 2 at-risk children, but they didn’t know or use screening tools. Most respondents answered that they don‘t know or don’t have a support system to consult. In addition, a majority of respondents said that teachers who informed parents about their children's problems or asked for help expressed negative responses, such as parents not acknowledging their children's problems. Second, According to the awareness of the early childhood teachers about the process of requesting the diagnosis of the disorder of at-risk children, the most common answer was that the teachers lacked accurate knowledge about the disorder. The most common opinion was that it was difficult to ask the director and manager for cooperation because of conflicts with parents. Parents need to improve their perception of disorders screening and acceptance attitude, and that it is most desirable to place special education teachers in preschool educational institution. Conclusion: The results of this study showed that early childhood teaches' difficulties in the process of requesting disorder diagnosis were identified and in order to solve this problem, it will be necessary to develop a system to improve the awareness of at-risk children, to acquire accurate knowledge of disorder from preliminary teachers. 연구목적: 본 연구는 유아교사가 장애위험 유아를 선별하여 장애 진단에 의뢰하는 실태와 인식을 조사하여, 조기선별 및 조기중재를 지원하는 기초자료로 활용하고자 한다. 연구방법: 부산, 경남지역의 어린이집과 유치원의 유아교사 163명을 대상으로 설문조사를 실시하였다. 연구결과: 첫째, 장애위험 유아의 장애 진단 의뢰과정 실태를 살펴보면, 과반수 이상의 유아교사들은 평균 1~2명의 장애위험 유아로 생각한 유아를 지도한 경험이 있었으나 선별도구를 모르거나 사용하지 않았고, 자문할 지원체계가 없거나 모른다는 응답이 가장 많았다. 유아의 문제를 학부모에게 알 거나 협조 요청을 한 유아교사는 문제는 인정하지만 도움을 원치 않거나 문제 자체를 인정하지 않는 등 부정적인 반응을 보였다고 응답하였다. 둘째, 장애위험 유아의 장애 진단 의뢰과정에 관한 유아교사의 인식을 살펴보면, 장애 진단 의뢰과정에서 학부모에게 협조 요청하기 어려운 이유로는 교사 스스로 장애에 대한 정확한 지식이 부족하기 때문이라는 응답이 가장 많았으며, 장애위험 유아를 선별하는 과정에서도 교사의 전문적 지식이 부족하여 장애위험 유아로 과소진단 또는 과잉진단의 우려가 방해 요인으로 확인되었다. 또한 학부모와의 갈등을 우려하여 원장 및 관리자에게 협조 요청하기 어렵다는 의견이 가장 많았다. 이러한 어려움을 해소하기 위해 필요한 자원으로 유아교사는 장애위험 유아의 문제행동 원인, 장애 영역별 특성에 대한 정보 제공 및 교육 지원이 필요하고, 학부모는 장애 선별에 대한 인식 개선 및 수용적인 태도가 요구되며, 유아교육기관 측면에서는 특수교사 배치를 가장 원하는 것으로 나타났다. 논의 및 결론: 장애 진단 의뢰과정에서 유아교사가 겪는 어려움을 파악하여 장애위험 유아에 대한 인식 개선 및 장애 진단 의뢰과정의 지원체계를 확대하고, 예비교사부터 장애에 대한 정확한 지식을 습득할 수 있는 체계를 마련해야 한다는 시사점을 도출하였다.

류마티스관절염에서 치료 시기가 질병 활성도 및 관절 손상에 미치는 영향

길지훈 ( Jee Hoon Ghil ),정세진 ( Se Jin Jung ),최상태 ( Sang Tae Choi ),강은진 ( Eun Jin Kang ),이상원 ( Sang Won Lee ),박민찬 ( Min Chan Park ),박용범 ( Yong Beom Park ),이수곤 ( Soo Kon Lee ) 대한류마티스학회 2006 대한류마티스학회지 Vol.13 No.4

Objective: We investigated the effect of the early diagnosis and treatment on the disease activity and joint damage in patients with rheumatoid arthritis (RA). Methods: We enrolled 242 RA patients (male 50 patients, female 192 patients, mean age 49.7±13.5 years old) in this study. They were divided into two groups according to lag-time to diagnose RA from the onset of symptoms. 136 RA patients whose lag-time did not exceed 12 months were classified into early diagnosed RA group and 106 RA patients whose lag-time over 12 months were classified into delayed diagnosed RA group. Baseline date were assessed at the time of diagnosis. Disease activity was assessed by sums of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) during first year after diagnosis. Radiological joint damages were evaluated using modified Sharp score. Results: At the time of diagnosis, the age of patients, ESR and platelet counts were significantly decreased, and hemoglobin level was significantly increased in early diagnosed RA group. Early diagnosed RA group showed lower sums of ESR and CRP than delayed diagnosed RA group significantly. Modified sharp score at the time of diagnosis and after treatment were significantly lower in early diagnosed RA group than delayed diagnosed RA group. The difference of modified sharp score between at the time of diagnosis and after treatment were lower in early diagnosed RA group than delayed diagnosed RA group too. Conclusion: The early diagnosis and treatment of RA reduced extent of joint damage and provoked better response to treatment significantly.

원발성 척수종양의 임상적 고찰 : MRI소견과 병리조직학적 결과를 중심으로 Basis of MR Diagnosis and Histopathologic Diagnosis

양국희,박형천 최신의학사 2000 最新醫學 Vol.43 No.9-10

만 3세 미만 장애 영아 부모를 통해 본 장애 발견과 진단 및 조기개입 연계과정과 지원요구

조윤경 ( Cho Youn Kyung ) 한국보건사회연구원 2013 保健社會硏究 Vol.33 No.1

본 연구는 만 3세 미만 장애 영아에 대한 효과적인 서비스 전달 체계 구축을 위해서, 영아의 문제를 발견하여 의뢰하는 부모의 관점에서 조기 선별과 장애진단과정, 조기 개입 서비스 연계의 현재 상황과 일련의 연계과정 지원 구축방안 및 지원요구를 알아보고자 하였다. 기관을 통한 설문 형식으로 38개 기관 재원 130명의 만 3세 이하 영아 부모가 설문에 응답하였다. 분석 결과, 첫째, 장애 영아 부모들은 1세 이하의 비교적 빠른 시기에 자녀의 문제를 발견하고 있었으며, 장애 의심이 드는 경우 곧바로 본인의 결정과 병원의 권유로 진단 평가를 받았다. 둘째, 장애 영아 부모들은 진단 평가 후 서비스를 받았고, 가장 최초로 받은 서비스는 재활치료가 주를 이루었으며, 이에 대한 만족도는 대체로 높았다. 진단 평가 후에 정확한 서비스 안내가 없거나 부모의 장애 진단 수용 거부 등으로 일부 부모들은 진단 후에 서비스를 받지 않은 경우도 있었다. 셋째, 3세 미만 장애 영아 부모들은 장애 선별-장애 진단 평가-서비스 시행의 연계 구축에 대한 강한 요구를 보였고, 교육과학기술부와 보건복지부가 상호 협력하여 별도의 지원체계를 구성하는 방법을 선호하였다. 넷째, 일련의 연계 진행 과정 시행에서 장애영아 부모들은 부모양육지원 강화와 현행과 같은 재활치료 바우처 제공, 법적 제도 내의 다양한 서비스 실시를 요구하였다. 이상의 결과에 의거하여 추후 시행되어야 하는 방안들이 논의되었다. This study investigated the connective procedure of early child findings, diagnosis, early intervention services, and the supports needed from the parents` view of children with special needs under 3 year old. Because of individual information protection, the surveys were distributed to institutions. The sample consisted of 38 institutions which operated early intervention programs across the country, 130 parents of children with special needs under 3 years were responded. The results were as followed. First, parents found out the problems of their child as early as possible before 1 year old, and referred to diagnosis with self-determination and advices of medical personnels. Second, after parents were identified the problems of their child by diagnosis, they immediately got the early intervention services. Mainly they received rehabilitation therapies, and showed the relatively high satisfactions. Without the correct guidance for the proceedings and with refusal of parents on disability of their child, some cases didn`t get the services after the diagnosis. Third, parents demanded the connective procedures of child finding-disability diagnosis-early intervention service implementation. They wanted the cooperative relationship and role differentiation of connective systems run by Dept of Education, Science, and Technology and Dept of Health and Welfare. Fourth, parents wanted the child raising support-parents empowerment, expansion of rehabilitative voucher provision, and implementation of diverse services manifested in the law. Based on these results, further directions for improving the system were discussed.