Objective To study the incentives created by both government service purchase mode and direct funding mode on village clinics.Methods Sampling on village clinics in 24 counties in Guizhou province,to learn their public health services and villagers' satisfaction under both modes.Results Except for the infectious disease report,health lectures and health records,values of most public health service indexes of the government purchase services group are better than those of the direct investment one (P＜0.05).Villagers' satisfaction scores for facilities and service attitude showed no significant difference between the two modes,but the purchase services mode was better than direct funding one in other dimensions and comprehensive scores (P＜ 0.05).Conclusion Government purchase of health services has a great potential to improve the service efficiency of village clinics.It is,however,imperative to further break the monopoly,identify reasonable purchasing projects and approaches,and construct scientific supervision mechanisms to achieve incentive-compatible effects.

OBJECTIVE: The purpose of this study was to investigate the effects of video feedback training for the parents of autistic spectrum disorder children. METHOD: Ten Autistic spectrum disorder children and their mothers participated in this training. Twenty minutes play times were videotaped including free play time and chosen play time. After one session, watching videotape, the researcher analyzed the relation of the children and their mother and had a feedback training with the mother of child. RESULTS: The child's responses to the mother's start actions had significant differences (p<0.05). The language responses of children increased in the organized environment of chosen play. Language responses increased but negative actions and no responses reduced when mother encouraged child centered play rather than mother engaged in children's play directly. In log sector model, mother's responses according to the play type had meaningless difference (p0.05). But in division analysis mother's responses to child's start action had meaningful difference in pre/post treatment and play type. CONCLUSION: The effects of video feedback training of autistic spectrum disorder children's parents were positive. Through this investigation the interaction and the communication with autistic spectrum disorder children and their parents are influenced positively.
Child ; Humans ; Language Development* ; Mothers ; Parents* ; Videotape Recording

Postoperative pain may be associated with shallow breathing, inability to cough, and reduction in spirometric values which lead to restrictive pattern of ventilation with hypoxemia and/or hypercarbia. Therefore, postoperative pain should be managed with appropriate methods. The authors have usually performed intraoperative intercostal nerve block with 0.25% bupivacaine hydrochloride to alleviate postoperative thoracotomy pain. A 21 years old male patient developed sudden hypotension and severe bradycardia 1 minute following the intraoperative 4th, 5th, 6th intercostal nerve block with a total of 10 ml of 0.25% bupivacaine hydrochloride, who was treated by ephedrine with success. The authors discuss the possible causes of sudden hypotension and severe bradycardia in detail.
Anoxia ; Bradycardia ; Bupivacaine ; Cough ; Ephedrine ; Humans ; Hypotension* ; Intercostal Nerves* ; Male ; Pain, Postoperative ; Respiration ; Thoracotomy ; Ventilation ; Young Adult

Epidural anesthesia for cesarean section requires sensory blockade up to T4 level. 18 to 20 ml of 0.5% bupivacaine, 1.5 to 2.0% lidocaine, or 3.0% chloropmcaine usually produces an adequate sensory blockade to T4 level. However, when we used that amount of local anesthetics, most of the patients often complained of mild to moderate pain or discomfort during delivery of baby, manipulation of peritoneum or the uterus. So we feeled the need of increase in dosage of local anesthetics and we used 26 ml of local anesthetics or local anesthetic-fentanyl mixture. This study was undertaken to measure plasma concentration of lidocaine and observe the possible systemic toxicity of local anesthetics with the total dosage of beyond maximum recom-mended dose. Epidural anesthesia were performed with a 17 gauge Tuohy needle and local anesthetics were injected as follows. Group 1 (n;17): 0.5% bupivacaine 100 mg+2% lidocaine 80 mg+fentanyl 100 ug (50 ug/ml) Group 2 (n; 15): 2% lidocaine 520 mg without epinephrine Group 3 (n; ll): 2% lidocaine 480 mg + fentanyl 100 ug All groups were received 26 ml of local anesthetics or local anesthetic-fentanyl mixture. We checked the level of anesthesia, length of spinal column, cardiovascular changes, plasma concen- tration of lidocaine, toxic systemic reactions and patient's complaints. The plasma concentration of lidocaine were measured by immunofluorescence assay at 2, 5, 7, 10, 12 and 15 minutes after injection of local anesthetics. The results were as follows; 1) The peak plasma concentration of lidocaine were measured 12 minutes after administration of local anesthetics in the group 2 and 3. 2) Sensory blockade up to T4 level could be accomplished within 10 minutes after epidural anesthesia in the group l. 3) In the group 2 and 3, onset of action was more rapid. These groups had a tendency to fall in blood pressure than the group 1, but recovered soon with small dose of ephedrine. 4) In one patient, maximum peak plasma concentration of hdocaine was 6.8 ug/ml, but no adversereaction was observed. Above results suggested that 26 ml of local anesthetics in all groups could be used for appropriate anesthesia for cesarean section with minimal camplications and patient's satisfaction.
Anesthesia ; Anesthesia, Epidural* ; Anesthetics, Local* ; Blood Pressure ; Bupivacaine ; Cesarean Section* ; Ephedrine ; Epinephrine ; Female ; Fentanyl ; Fluorescent Antibody Technique ; Humans ; Lidocaine ; Needles ; Peritoneum ; Plasma* ; Pregnancy ; Spine ; Uterus

Epidural anesthesia for cesarean section requires sensory blockade up to T4 level. 18 to 20 ml of 0.5% bupivacaine, 1.5 to 2.0% lidocaine, or 3.0% chloropmcaine usually produces an adequate sensory blockade to T4 level. However, when we used that amount of local anesthetics, most of the patients often complained of mild to moderate pain or discomfort during delivery of baby, manipulation of peritoneum or the uterus. So we feeled the need of increase in dosage of local anesthetics and we used 26 ml of local anesthetics or local anesthetic-fentanyl mixture. This study was undertaken to measure plasma concentration of lidocaine and observe the possible systemic toxicity of local anesthetics with the total dosage of beyond maximum recom-mended dose. Epidural anesthesia were performed with a 17 gauge Tuohy needle and local anesthetics were injected as follows. Group 1 (n;17): 0.5% bupivacaine 100 mg+2% lidocaine 80 mg+fentanyl 100 ug (50 ug/ml) Group 2 (n; 15): 2% lidocaine 520 mg without epinephrine Group 3 (n; ll): 2% lidocaine 480 mg + fentanyl 100 ug All groups were received 26 ml of local anesthetics or local anesthetic-fentanyl mixture. We checked the level of anesthesia, length of spinal column, cardiovascular changes, plasma concen- tration of lidocaine, toxic systemic reactions and patient's complaints. The plasma concentration of lidocaine were measured by immunofluorescence assay at 2, 5, 7, 10, 12 and 15 minutes after injection of local anesthetics. The results were as follows; 1) The peak plasma concentration of lidocaine were measured 12 minutes after administration of local anesthetics in the group 2 and 3. 2) Sensory blockade up to T4 level could be accomplished within 10 minutes after epidural anesthesia in the group l. 3) In the group 2 and 3, onset of action was more rapid. These groups had a tendency to fall in blood pressure than the group 1, but recovered soon with small dose of ephedrine. 4) In one patient, maximum peak plasma concentration of hdocaine was 6.8 ug/ml, but no adversereaction was observed. Above results suggested that 26 ml of local anesthetics in all groups could be used for appropriate anesthesia for cesarean section with minimal camplications and patient's satisfaction.
Anesthesia ; Anesthesia, Epidural* ; Anesthetics, Local* ; Blood Pressure ; Bupivacaine ; Cesarean Section* ; Ephedrine ; Epinephrine ; Female ; Fentanyl ; Fluorescent Antibody Technique ; Humans ; Lidocaine ; Needles ; Peritoneum ; Plasma* ; Pregnancy ; Spine ; Uterus

The authors analysed statistically 314 cases of the ocular injuries among 37.826 Out and In-patients who visited to Severance Hospital for 6 years duration (from sept. 1965 to Aug. 1971). Male (72%) was three times as much as female (28%) among the patients and they were mostly 2nd and 3rd decades. Most frequent causes of injuries were finger. fist and iron pieces which mainly resulted in subconjunctival hemorrhage and corneal foreign body.
Female ; Fingers ; Foreign Bodies ; Hemorrhage ; Humans ; Iron ; Male

Many surgical procedures are delayed or cancelled due to inadequate preoperative assess- ment and preparation. To improve patient care and minimize operative delays and cancella- tions, preoperative evaluation and preparation of medically compromised patients is neces- sary. We analyzed 174 cases of written interdepartmental consultations submitted to our department from January 1991 to December 1992. Thus we expected more systemized and improved preoperative consultstion from reviewing the past consultations. The analysis were as follows: 1. The overall consultation rate was 1.38%. 2. Age distribution : 21.8% of total consulted cases were in the fifties and 39.7% were over 60 years old. 3. Sex distribution: Male : Female = 58%: 42%. 4. Departmental distribution of consultation : orthopedic surgery 41.4%, general surgery 16.7 %, neurosurgery 12.6%, urology 12.6%. 5. Interdepartmental consultation rate: orthopedic surgery 4.4%, urology 3.1%, neurosurgery 1.9%, cardiothoracic surgery 1.1%. 6. The primary reasons for consultation were related to the cardiovascular system (28.8% of cases), gastrointestinal system including hepatic disease(24%), respiratory system(23% ) and the endocrine system(15% ). Among the cardiovascular problems, 58% were associated with hypertension and 33% were associated with EKG abnormalities. The most frequently consulted problem was hepatic disease ineluding elevated transaminases(50 cases, 21.5% ) followed by hypertension(39 cases, 16.7%), diabetes mellitus(26 cases, 11.2% ) and EKG abnormalities(22 cases, 9.4%). 7. Results of consultation: 1) Frequency of consultation : 166 eases (95.4%) were once and the rest were twice. 2) Contents of problems : 129 cases(74.1%) had single problem, 35 cases(20.1%) had two problems, 8 cases(4.6%) had three problems. 3) Operation was done in 115 cases (66.1% of the consulted cases), delayed in 42 cases(24.1%) and cancelled in 17 cases(9.8%). Major causes of delay of elective surgery were elevated transaminases(26.4%) followed by hypertenaion(20.4%), diabetea. mellitua(15.1 %), others were tuberculosis and abnormal PFT. Major causes of cancellation were similar to that of delayed surgery, i.e., elevated transaminases(35.3%), decreased pulmonary function (14.8% ), liver cirrhosis (14.8%). Above results suggested thst the more systemized protocol may be needed to minimize the delay and cancellation of elective surgery.
Age Distribution ; Anesthesiology* ; Cardiovascular System ; Electrocardiography ; Female ; Humans ; Hypertension ; Liver Cirrhosis ; Male ; Middle Aged ; Neurosurgery ; Orthopedics ; Patient Care ; Referral and Consultation ; Sex Distribution ; Tuberculosis ; Urology

Pulmonary embolism is a common and lethal, which accounts for substantial morbidity and mortality. Clinical manifestations of pulmonary embolism are nonspecific during general anesthesia. A 60 years old female received elective operation for left femur fracture under general anesthesia. At the end of operation, she suddenly became hypotensive and developed cyanosis. Immediate cardiopulmonary resuscitation(CPR) was performed without definitive diagnosis. Pulmonary embolism was suspected by clinical signs and echocardiography. So, patient was transferred to intensive care unit and with intensive care and aggressive treatment, patient's vital signs and ventilatory status were progressively improved. However, the endotracheal tube was accidentally extubated by the patient at the second postoperative day, and then cardiac arrest was developed and the patient expired. The primary goal of therapy for pulmonary embolization is to prevent reembolization. In the pulmonary thromboembolization, early diagnosis and intensive care improve outcome.
Anesthesia, General* ; Cyanosis ; Diagnosis ; Early Diagnosis ; Echocardiography ; Embolism ; Female ; Femur* ; Heart Arrest ; Humans ; Critical Care ; Intensive Care Units ; Middle Aged ; Mortality ; Pulmonary Embolism* ; Vital Signs

Very little is known about the relation between isoflavone intake and menopausal symptoms in Korean woman To find the effects and correlations between these factors, questionnaires(maternal factors, menopausal symptoms) anthropometric measurement, 24hr dietary recalls, and urinary isoflavones analysis were conducted in 100 postmenopausal women residing in the Kyunggi-do rural area. The average age hight and weight of the subject were 61.5 years, 153.6 cm and 56.2kg. The average age at menarche, menopause, and menstrual cycle were 16.7 years, 47.2 years, 29.8 years, respectively. Most of the postmenopausal women experienced mildly menopausal symptoms. The mean calorie, protein and calcium intake were 1417.6 kcal(74.7% of the Korean RDA) 53.2 g(88.6% of the Korean RDA) and 454.0mg(65.6% of the Korean RDA) respectively. The ration of energy from carbohydrate, protein, and fat was 68: 15: 17 The average isoflavone intake from soy foods was 27.27 mg. The major food source of the isoflavone were soybeans and soybean curd. The average urinary isoflavone excretion was 2. 78nmol/mg Cr and showed significant positive correlation with isoflavone intake. Isoflavone intake from soy foods had a negative correlation with the severity of menopausal symptoms. Therefore, soy foods which contain isoflavone may have a protective effect on menopausal symptoms of women in Korea.
Calcium ; Female ; Gyeonggi-do ; Humans ; Isoflavones ; Korea ; Menarche ; Menopause ; Menstrual Cycle ; Soy Foods* ; Soybeans

PURPOSE: Brain metastasis is estimated to occur in 20~40% of solid tumor patients and the most common primary tumor is lung cancer. Even though the prognosis of brain metastasis is grave and the 1-year survival rate is only 15%, symptom palliations are made with whole brain radiation therapy. We retrospectively evaluated the clinical features and prognostic factors of lung cancer with brain metastasis. MATERIALS AND METHODS: From January 1987 to October 1999, 50 lung cancer patients with brain metastasis underwent whole brain radiation therapy. We reviewed the improvement in neurologic symptoms and survival according to the following parameters; performance status, histological type, presence of brain metastasis at the initial diagnosis of lung cancer, presence of extracranial metastasis, multiplicity of brain lesion, presence of primary lung symptom and treatment modalities. RESULTS: The most frequent symptom with brain metastasis was a headache (50%). Palliation of the headache and other symptoms was achieved in 81% of the patients. Median overall survival after brain metastasis was 21 weeks and the 1 year survival rate was 15%. Patients without extracranial metastasis had a longer median survival than those with, 38 weeks versus 15 weeks, respectively (p=0.01). CONCLUSION: In lung cancer with brain metastasis, neurologic symptoms can be palliated with whole brain radiation therapy, and in this study among such patients, absence of extracranial metastasis can be a good prognostic factor.
Brain* ; Diagnosis ; Headache ; Humans ; Lung Neoplasms* ; Lung* ; Neoplasm Metastasis* ; Neurologic Manifestations ; Prognosis* ; Retrospective Studies ; Survival Rate