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Background Two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) have been increasingly used in various intra-articular fractures including pilon fracture. However, no study has investigated intraobserver and interobserver reliabilities of pilon fracture classification using 3D CT images. Hypothesis (1) Intraobserver and interobserver agreements of fracture classifications and treatment recommendations will improve by using 2D CT images compared to using plain radiographs only; (2) agreements will improve by adding 3D CT images compared to adding 2D CT images; and (3) agreements of orthopedic residents rather than specialists will be influenced more by imaging modality. Materials and methods Ten orthopedic specialists and 10 residents completed a survey to classify the fractures according to the Ruedi-Allgower and AO/OTA classifications and to select treatment options using 25 pilon fracture images. The survey was conducted using plain radiographs, with 2D and 3D CT images introduced 3 and 6 weeks later, respectively. Kappa coefficients were calculated to determine reliabilities. Results Intraobserver reliabilities for fracture classifications in specialists significantly improved by using 2D images compared to using plain radiographs only. Addition of 3D CT did not significantly improve intraobserver reliabilities compared to those with 2D CT. Use of 2D CT images significantly improved overall interobserver agreement of both classifications, with the improvement being greater for residents. Use of 3D CT images did not improve the interobserver reliability of both classifications. Overall interobserver reliabilities for treatment recommendations did not significantly differ according to the imaging modality. However, interobserver agreement among residents significantly improved from slight agreement using radiographs only to fair agreement using 2D CT images. Discussion Intraobserver and interobserver reliabilities of pilon fracture classification and treatment recommendations did not improve between using 3D and 2D CT. Using 2D CT images improved the intraobserver and interobserver reliabilities of the fracture classifications in specialists and the interobserver reliabilities of the fracture classifications and the treatment recommendations in residents. Level of evidence IV, case control study.

Objectives: Regular uptake of mammogra­phy screening reduces the risk of advanced stage diagnosis of breast cancer (BC). How­ever, BC screening rates remain suboptimal among Korean American (KA) women. Using the Andersen’s Behavioral Model of Healthcare Services Utilization, this study examined factors associated with mammog­raphy screening among KA women aged 50 to 80 years in the state of Georgia, USA. Methods: We used purposive sampling to recruit study participants in the Atlanta met­ropolitan area from May 2015 to February 2016. A total of 303 KA women completed a cross-sectional, self-report survey about their sociodemographics, health care access information, knowledge, self-efficacy, deci­sional balance, and mammography history. Results: Descriptive analyses confirmed low rates of mammography screening in the participants. Multiple logistic regression analyses showed that having a mammogram within the past year was associated with greater BC knowledge, higher scores of decisional balance and fewer annual health check-ups among KA women without any cancer history. Conclusions: The findings offer implica­tions for health policy aimed at increas­ing BC screening by leveraging enabling factors among medically underserved KA women at both structural and cultural levels. Ethn Dis .2019;29(Suppl 2):427-434; doi:10.18865/ed.29.S2.427

Introduction: For Korean Americans (KAs), colorectal cancer (CRC) screening rates remain lower than the national target. This study aimed to examine factors predicting decisional stage of CRC screening adoption among older KAs using the precaution adoption process model. Method: Convenience sampling was employed to recruit KAs aged 50 to 75 years from the Atlanta metropolitan area in the United States. A total of 433 KAs completed a cross-sectional survey that collects information on sociodemographics, CRC screening history, a physician’s recommendation, knowledge, self-efficacy, and decisional balance pertaining CRC screening, and precaution adoption process model stage. Results: Higher scores of decisional balance (odds ratio [ OR] = 1.34), having a physician’s recommendation ( OR = 8.61), and having regular annual medical checkups ( OR = 4.44) were significantly associated with higher decisional stage compared with lower stage, controlling for other variables. Discussion: Intervention research should incorporate consideration of individuals’ decisional stage to move KAs forward from not engaging the screening to maintaining regular participation in CRC screening.

Objectives: In the current study, we aimed to compare the levels of and factors associated with mental health attitude between males and females. Of particular interest was ascertaining the degree to which mental health literacy was related to mental health attitude and whether this relationship would vary by gender. Methods: A total of 732 participants aged 18 years or more were recruited from attendees at the 2016 Minnesota State Fair. We used the Mental Health Literacy Scale (MHLS) to measure attitude toward and literacy of mental health. Results: Our multivariate analysis reported that males' mental health attitude was significantly lower than females. Some factors associated with mental health attitude differed by gender as well. Among men, receiving more social support, experiencing higher levels of depression, and being married predicted greater mental health attitude. Among women, older age was associated with lower mental health attitude levels. However, mental health literacy was the strongest factor regardless of gender. Men and women with greater mental health literacy had a more positive mental health attitude. Conclusions: Provision of tailored mental health literacy education both for males and females could potentially improve the public's mental health attitude toward mental illness.

BACKGROUND: Korean American (KA) women have experienced higher prevalence and lower survival rates of breast cancer (BC) than other ethnic groups in the United States. However, BC screening rates for KA women remain significantly lower than the national target (81.1%) specified by Healthy People 2020. Few studies have explained how the decision to adopt BC screening occurs and progresses and what factors contribute to this decision among KA women. This study used Weinstein’s Precaution Adoption Process Model (PAPM) as a theoretical framework to examine characteristics and factors associated with the decisional stage of mammography adoption. METHODS: A cross-sectional self-report survey was administered among KA women (N = 308) ages 50 to 80 from the Atlanta metropolitan area. A total of 281 KA women completed the survey, answering questions about socio-demographics, health-related information, mammography history, doctor recommendation, BC screening knowledge, self-efficacy for BC screening, decisional balance scores on attitudes and beliefs pertaining to mammography, and the seven-stage PAPM. RESULTS: KA women reported a low rate of mammography uptake with about 24% and 35% of the participants undergoing mammography within the last year and two years, respectively. KA women in stages 5 (decided yes), 6 (action), and 7 (maintenance) were likely to have increased screening-related knowledge, positive decisional balance, and regular medical check-up compared to those in stages 1 (unaware), 2 (unengaged), and 3 (deciding). CONCLUSION: This study highlights important factors that could potentially facilitate BC screening among KA women in Georgia. The findings also provide implications for interventions and practice for increasing mammography screening among medically underserved populations.

PURPOSE/OBJECTIVES: Korean Americans (KAs) report suboptimal colorectal cancer (CRC) screening adherence. This study investigated factors that enable KAs to adhere to CRC screening guidelines using Andersen’s Behavioral Model of Health Services Utilization. DESIGN: Cross-sectional survey using self-report measures of CRC screening behaviors. SAMPLE AND METHODS: Purposive sampling was used to recruit 433 KAs aged 50–75 from the Atlanta metropolitan area who completed questionnaires measuring predisposing (i.e., gender, age, marital status, educational attainment), enabling (income, health insurance, regular annual check-ups, doctor recommendation, English proficiency, CRC knowledge, self-efficacy for CRC screening, decisional balance in CRC screening), and need (family cancer history, self-reported health status) factors associated with CRC screening. FINDINGS: A multiple logistic regression model including all 14 predictor variables revealed that several enabling factors (i.e., income, regular annual health check-ups, doctor’s recommendation, self-efficacy, and decisional balance) independently predicted increased CRC screening adherence in KAs. No predisposing or need factors independently predicted CRC screening. CONCLUSIONS AND IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS OR POLICY: To increase CRC screening adherence among KAs, psychosocial interventions should target on improving their self-efficacy and decisional balance regarding CRC screening, while policy interventions should focus on promoting health providers’ CRC screening recommendations during routine health check-ups.

Background: Helicobacter pylori infection in children causes gastrointestinal symptoms and iron deficiency anemia. This study aimed to investigate trends in H. pylori stool antigen (HpSA) positivity in children and the relationship between HpSA test results and anemia.Methods: We analyzed the results of 2,762 HpSA tests and the correlation of hemoglobin and ferritin with HpSA in patients aged 0-18 years from 2008 to 2014 at a tertiary care center. Additionally, we prospectively evaluated HpSA test results and correlation with hemoglobin in 352 specimens obtained from five centers.Results: From 2008-2014, the mean positive rate of the HpSA test was 5.8%, with a high of 9.1% in 2012 and a low of 2.3% in 2013. The positive rate correlated with age: 2.9% in 0-6-year-olds, 5.8% in 7-12-year-olds, and 10.6% in 13-18-year-olds (P

Invasive techniques for diagnosis of Helicobacter pylori (H. pylori) infection require an endoscopic examination which is expensive and inconvenient and may cause complications. Stool cultures for H. pylori or a direct detection of H. pylori antigen in stools by PCR are expensive, tedious, and have a low sensitivity. We recently used an enzyme immunoassay (EIA) to detect H. pylori antigen in stool specimens. A total of 41 patients were seen at Inha University Hospital, Inchon, Korea between September and October 1998. There were 26 men and 15 women who had an average age of 37.6 years which ranged from 5 to 71 years in the present study. All of these patients came to the hospital complaining of an upper abdominal discomfort and were subjected to endoscopy and biopsies. Fifteen had a gastric ulcer, 13 had a duodenal ulcer, 1 had an early gastric cancer, and there were 12 chronic gastritis patients as shown by endoscopy. The biopsy specimens were examined by histology, CLO test, and cultures and these results were used as gold standards. Stool specimens were tested for the H. pylori antigen by EIA. A dual wavelength cut-off of 0.100 that was recommended by the manufacturer gave a good performance (87.1% sensitivity, 100% specificity, 100% positive predictive value, 71.4% negative predictive value, and a 90.2% efficiency). But the adjusted cut-off value using the receiver operating characteristic curve improved the performance of the test (using the cut-off value of 0.024, the sensitivity, specificity, PPV, NPV, and efficiency were 100%, 90.0%, 96.9%, 100%, and 97.6% respectively). Re-evaluation of the cut-off value may be needed for Korean patients. This technique is non-invasive, rapid, easy-to-use, and shows good performance characteristics for diagnosis of H. pylori infections. Therefore, this technique may be a substitute for gastric endoscopy especially in children and some patients who are unable to tolerate an endoscopic examination and it may be substituted for a serologic test in epidemiological research.

Purpose: Antimicrobial resistance monitoring could be a useful source of information for treating and controlling nosocomial infections. We analyzed antimicrobial resistance data generated by Korean Hospitals and by a commercial laboratory in 2005 and 2007. Materials and Methods: Susceptibility data for 2005 and 2007 were collected from 37 and 41 hospitals, respectively, and from one commercial laboratory. Intermediate susceptibility was not included in the calculation of resistance rates. Results: Methicillin-resistant Staphylococcus aureus (MRSA) (64%), third-generation cephalosporin-resistant Klebsiella pneumoniae (29%), fluoroquinolone-resistant Escherichia coli (27%), Pseudomonas aeruginosa (33%), and Acinetobacter spp. (48%), and amikacin-resistant P. aeruginosa (19%) and Acinetobacter spp. (37%) were prevalent in hospitals in 2007. A gradual increase of vancomycin-resistant Enterococcus faecium and imipenem-resistant Acinetobacter spp. was observed. Higher incidences of thirdgeneration cephalosporin-resistant E. coli and K. pneumoniae and imipenemresistant P. aeruginosa were found in the commercial laboratory than in the hospitals. Conclusion: Methicillin-resistant S. aureus, third-generation cephalosporin-resistant K. pneumoniae, and fluoroquinolone-resistant E. coli, P. aeruginosa and Acinetobacter spp. remain prevalent in Korea, while the incidence of vancomycin-resistant E. faecium and imipenem-resistant Acinetobacter spp. has increased gradually. The higher prevalences of third-generation cephalosporinresistant E. coli and K. pneumoniae, and imipenem-resistant P. aeruginosa in the commercial laboratory are a new concern.

Background: CLSI provides a guideline only for a agar dilution method of testing clarithromycin susceptibility for Helicobacter pylori. This study was to evaluate a disk diffusion method for clarithromycin and amoxicillin. Methods: One hundred and forty clinical isolates of H. pylori isolated from May 2005 to May 2007 were tested by the CLSI agar dilution method and a disk diffusion method using 2μg (2CLR) and 15μg (15CLR) clarithromycin disks and 2μg (2AMX) and 10μg (10AMX) amoxicillin disks. The interpretation criteria used for the disk diffusion method were established by linear regression and error rate-bounded method for disk diffusion zone of inhibition (DDZ) compared to MIC. Results: Resistance and intermediate rates to clarithromycin were 21.4% and 1.4%, respectively. A number of isolates with MIC 0.5, 1, and 2 (μg/mL) to amoxicillin were 7, 2, and 1, respectively. For 2CLR and 15CLR, the coefficients of determination (R) between MIC and DDZ were 0.931 and 0.923 (P< 0.001), respectively, and the criteria for resistance/ susceptibility were 12/28 mm for 2CLR and 23/39 mm for 15CLR. For 2AMX and 10AMX, the R between MIC and DDZ were 0.478 and 0.421 (P< 0.001), respectively, and the criteria for resistance with breakpoint of 2μg/mL were 21 mm for 2AMX and 32 mm for 10AMX. All isolates had DDZ

Background: The entrance of microbes into blood stream results in rapid spreading of infection through circulation system progressing to sepsis with accompanying fever, leukocytosis and circulatory collapse necessitating prompt recognition and treatment. We calculated the difference between white blood cell counts measured in myeloperoxidase and basophil channel, designated as “delta neutrophil”, and found that the value correlates the progression of sepsis. Methods: We categorized patients who were referred for automatic blood cell analysis according to the calculated value of delta neutrophil and analyzed positive rate of blood culture, mortality and laboratory data including hemoglobin, platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen, fibrinogen degradation product, D-dimer, ESR, CRP. Delta neutrophil values were calculated as above mentioned from measured values from automatic blood cell analyzer, ADVIA® 120 automated Hematology System (Bayer Diagnostics, New York, USA). Among 1781 patients selected, those with delta neutrophil value less then 5 were categorized as group I, 5 to 10 as group II, 10 to 20 group III, 20 to 30 group IV, 30 to 40 group V, 40 to 50 group VI and greater than 50 as group VII, arbitrarily. Patients with hematologic malignancy or with Gynecologic malignancy were excluded in this study. Results: The mortality and blood culture rate in group VII were 75.0% and 57.1% and in group VI 76% and 46.7%, group V 46.2% and 37.9%, respectively. On the contrary for group I the mortality and isolation rate were 3.3% and 17.1%. (The means of hemoglobin concentration for group I and II were 13.2 g/dL and 12.1 g/dL compared with 10.5 g/dL and 10.2 g/dL in group VI and VII.) With regard to consumptive coagulopathy, the means of platelet count were 263,700/mL and 259,200/mL in group I and II while those for group VI and VII were 107,200/mL and 112,600/mL. Antithrombin activities were 5.20 % and 7.98% in group VII and VI in contrast to 66.6% and 75.8% for group I and II. Conclusion: The categorization by delta neutrophil value correlated with the isolation rate of bacteria from blood culture and mortality. The delta neutrophil value is expected to provide useful information for following up progression of sepsis.

To clarify the diabetic complications mediated by increased platelet activity, we undertook a study of the mean platelet component (MPC), as determined by an automated hematologic analyzer (ADVIA 120, Bayer). Prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen were also measured to investigate blood viscosity abnormalities. MPC was determined in 100 healthy controls and in 100 diabetic patients, the latter of which were subdivided into no diabetic retinopathy (DR) (n = 25), nonproliferative DR (n = 30), and proliferative DR (n = 45) groups. The mean MPC level was 26.9 g/dl in the control group and 22.5 g/dl in the diabetic patients (p < 0.05). PT and aPTT were similar for the diabetic patients and the controls; however, their corresponding fibrinogen levels were significantly different between the two groups(3.26 +/- 1.14 g/L vs. 4.21 +/- 2.35 g/L, p < 0.05). Our results suggest that platelet hyperfunction in diabetic patients may be implicated in the pathogenesis of diabetic retinopathy.