PURPOSE: An online system concerning bed and equipment availability in the referral centers was developed to prevent any delay in the transport of newborn infants to a referral center with adequate equipments. METHODS: A program using web user interface was developed by Developer 2000 and Oracle database under UNIX system. The availability of equipments in the NICU, patient's medical information, user's information were included. The program was tested on the server of the Yeungnam University Medical Center with personal computers as clients. RESULTS: The program consisted of six menus : bed and equipment availability, updating the data, contact numbers, patients' informations, users informations, others. After login, availability of beds and equipments were shown according to the selected area which was chosen by the user. Phone numbers of physicians at the referral center appear on a window newly opened by clicking on the hospital name where newborn patient will be transferred. Medical information about patients can be transmitted to the referral center. The data can be updated by the webmaster of the individual hospital, and new hospital, delivery mode, treatment modality can be added by the system operator. It took 5.1+/-0.7 seconds from connection to execution of the program when it was connected through local area network in the medical center, and 10.2+/-0.2 seconds after 15+/-0.9 seconds' connection time if it was connected by 56K dial-up modem. Conclusion : This program will be very useful if connection time were shortened, and shortage of the neonatal intensive care beds nationwide were resolved.
Academic Medical Centers ; Emergency Medical Service Communication Systems ; Humans ; Infant, Newborn* ; Intensive Care, Neonatal ; Local Area Networks ; Microcomputers ; Modems ; Online Systems* ; Referral and Consultation* ; Transportation of Patients

BACKGROUND: In general, increased body weight may be a risk factor for hypertension, diabetes, hyperlipidemia, and coronary heart disease. It is very difficult to lose weight especially in aged people. Osteoporosis is commonly developed in aged. Many reports revealed that obesity may prevent bone loss. The protective effect of obesity on bone has been ascribed to a high body fat content. Obese aged people can be very confused whether to decide to lose weight or not. METHODS: We evaluated 137 women aged over 60 who visited a health care center of a university hospital in Seoul from Jan. 1999 to Oct. 1999 to determine the effects of obesity on bone mineral density in aged Korean women. We measured anthropometrical characteristics, BMD of lumbar spine, markers of bone turnover, and FSH of the subjects. RESULTS: The results revealed that obese group had a greater BMD at lumbar spine, but the levels of FSH were noted to be lower than the non obese group. But, none of the markers of bone turnover showed significant differences between the two groups. BMI was positively correlated with BMD (r=0.455, P<0.001) by Pearson's correlation matrix. Also, the level of total alkaline phosphatase significantly had negative association with BMD. The level of FSH revealed that it had a negative correlation (r= 0.290, P<0.01) with BMI. CONCLUSION: We concluded that obesity might have a protective effect related with FSH. Prospective studies on endocrinologic association with BMD, bone markers, FSH and estradiol will be needed.
Adipose Tissue ; Alkaline Phosphatase ; Body Weight ; Bone Density* ; Coronary Disease ; Delivery of Health Care ; Estradiol ; Female ; Humans ; Hyperlipidemias ; Hypertension ; Obesity* ; Osteoporosis ; Risk Factors ; Seoul ; Spine

BACKGROUND: The placenta from a pregnancy that is complicated by intrauterine growth retardation (IUGR) tends to be smaller than that from a normal pregnancy. To investigate this difference, we analyzed the telomerase activity, the proliferative activity and the mRNA levels of apoptosis mediators in placentas. METHODS: In 20 placentas from normal third-trimester pregnancies and 22 placentas form pregnancies that were complicated by IUGR, the telomerase activity was detected by a telomeric repeat amplification protocol assay. The proliferative activity was assessed by immunohistochemical staining using the MIB-1 monoclonal antibody. The expression of the apoptosis mediator was evaluated by semi-quantitative reverse transcription-polymerase chain reactions for fas and fas ligand. RESULTS: Telomerase activity was detected in 2 (10%) of 20 normal placentas, whereas it was not observed in all tested 13 placentas that were associated with IUGR. The proliferative activity was significantly low in the placentas that were associated with IUGR (7.44+/-2.96%), compared with the normal placentas (11.0+/-3.48%, p=0.002). There was no statistically significant difference in the mRNA levels of fas or fas ligand between two groups. CONCLUSIONS: Low telomerase and proliferative activities in the placenta may play a role in the pathogenesis of IUGR.
Apoptosis ; Fas Ligand Protein* ; Female ; Fetal Growth Retardation* ; Humans ; Placenta* ; Pregnancy ; RNA, Messenger ; Telomerase*

Prenatal diagnosis of Down syndrome requires an invasive test in women considered to be at high risk after screening. At present, there are variable screening tests. For a 5% false-positive rate, the sensitivities are approximately 20-30% for maternal age alone, 60-70% for maternal age and second-trimester maternal serum markers, 85% for maternal age with fetal nuchal translucency and maternal serum free beta-human chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A) at 11-14 weeks, and 94% for maternal age with fetal nuchal translucency and maternal serum free beta-human chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A) at 11-14 weeks following second-trimester maternal serum markers. This article examines the studies of screening for Down syndrome and summarizes the results from major studies reporting on the implementation of this method.
Biomarkers ; Chorionic Gonadotropin ; Down Syndrome* ; Female ; Humans ; Mass Screening ; Maternal Age ; Nuchal Translucency Measurement ; Pregnancy-Associated Plasma Protein-A ; Prenatal Diagnosis*

BACKGROUND: This study was performed to accurately discover the correlation between the epidural depth and physical measurements. METHODS: We measured the L2-3, L3-4 epidural depth pre-marked on the needle shaft only when the block was successful. Correction of the depth was made by the angulation of the needle from the perpendicular line (with regard to both the x- and y-axis) to the skin. Height and weight from the medical record was noted and neck, waist, and hip circumferences of each subject was measured. Physical parameters such as waist/neck (waist circumference-to-neck circumference ratio), waist/height (waist circumference-to-height ratio), waist/hip (waist circumference-to-hip circumference ratio), weight/neck (weight- to-neck circumference ratio), weight/height (weight-to-height ratio) and body mass index (BMI) were calculated. Peason's correlation and a regression test between the epidural depth and the physical mea surements were performed. RESULTS: Significant correlation with epidural depth was found in weight, waist, hip, neck, BMI, waist/height, waist/hip, weight/neck, and weight/height. With the regression test, we found weight to be the most important for predicting epidural depth (R square = 0.330, P < 0.05). CONCLUSIONS: Weight has the highest predictive value for lumbar epidural depth.
Body Mass Index ; Hip ; Medical Records ; Neck ; Needles ; Skin

Neonatal intensive care in Korea has improved remarkably since the 1990s, but there is still a shortage of facilities and equipment in NICUs. Only 71.1% of the beds needed for neonatal intensive care are available. Mechanical ventilators are not appropriately distributed to the NICUs that are equipped to handle neonatal intensive care. The number of doctors is far too small, making the number of patients per doctor very high. Nurses, too, need to take care of 7.7 patients per nurse, making it very difficult to provide adequate intensive care. All this is caused by insufficient investment by the hospitals, which, in turn, is caused by inadequate reimbursement from health insurance. Therefore, a government-sponsored effort is necessary to bring the level of neonatal intensive care up to par.
Humans ; Infant, Newborn ; Insurance, Health ; Critical Care ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal ; Investments ; Korea ; Ventilators, Mechanical

Although the advantages of breastfeeding, such as nutritional and immunologic support to the baby and improvement of emotional bonding between mother and baby, are well recognized, economic benefits of the breastfeeding are not emphasized. Breastfeeding help mothers save money to purchase breast milk substitutes and related equipments, such as bottles, nipples and sterilizers. It also reduces the incidences of common respiratory and gastrointestinal infection of babies, premenopausal breast cancer and ovarian cancer of mothers, and related hospital expenses. For employed mothers, a hospital visit due to illness of their babies can cause absence from their work places. For estimation of the economic advantages of breastfeeding in Korea, we surveyed the cost of the breast milk substitutes and related equipments. The yearly costs for the formulas were 763 thousand to 2.5 million wons, and for the equipment was 360 to 480 thousand wons. If the breastfeeding rate of the total population increased to 50%, 162-294 billion wons can be saved per year in this country by reducing the costs for the formula at the equipment. Total hospital expenses for the illness of babies can be reduced by 7.9-13.8 billion wons per year and hospital costs for maternal breast and ovarian cancers can be reduced by 24.8-57.7 billion wons per year. Durations of maternal absence from their work can be reduced to the value of 21.6-42.5 billion wons per year. In summary, by increasing breastfeeding rates in this country to 50%, 216.4-407.5 billion wons can be saved every year.
Breast ; Breast Feeding ; Breast Neoplasms ; Hospital Costs ; Humans ; Incidence ; Korea ; Milk, Human ; Mothers ; Nipples ; Object Attachment ; Ovarian Neoplasms ; Workplace

BACKGROUND: Reperfusion in ischemia is believed to generate cytotoxic oxidative stress, which mediates reperfusion injury. These stress conditions can initiate lipid peroxidation and damage to proteins, as well as promote DNA strand breaks. As biliverdin and bilirubin produced by heme oxygenase isoform 1 (HO-1) have antioxidant properties, the production of both antioxidants by HO-1 may help increase the resistance of the ischemic brain to oxidative stress. In the present study, the survival effect of HO-1 was confirmed using hemin. METHODS: To confirm the roles of HO-1, carbon monoxide, and cyclic guanosine monophosphate further in the antioxidant effect of HO-1 and bilirubin, cells were treated with cycloheximide, desferoxamine, and zinc deuteroporphyrin IX 2,4 bis glycol, respectively. RESULTS: HO-1 itself acted as an antioxidant. Furthermore, iron, rather than carbon monoxide, was involved in the HO-1-mediated survival effect. HO-1 activity was also important in providing bilirubin as an antioxidant. CONCLUSION: Our results suggested that HO-1 helped to increase the resistance of the ischemic brain to oxidative stress.
Animals ; Antioxidants ; Bilirubin ; Biliverdine ; Brain* ; Carbon Monoxide ; Cycloheximide ; DNA ; Guanosine Monophosphate ; Heme ; Heme Oxygenase (Decyclizing) ; Hemin ; Iron ; Ischemia ; Lipid Peroxidation ; Microvessels* ; Oxidative Stress ; Oxygen* ; Oxygenases ; Rats* ; Reperfusion ; Reperfusion Injury ; Zinc

BACKGROUND: Increased bone turnover results in bone loss after menopause. After menopause, the major cause of bone loss is estrogen deficiency. Rate of bone loss seems to increase after menopause and then formation coupled with resorption is also increased. Antiresorptive drugs are known to be helpful in preventing bone loss. Alendronate is one of antiresorptive drugs for the treatment of osteoporosis which results in a decrease in bone turnover. Some papers report about nonresponders to antiresorptive drugs, and screening people early is very important to optimal management. There are no available data of Korean people. Therefore, this study evaluated the effects of alendronate in Korean postmenopausal osteoporosis patients after 3 months of treatment. METHODS: We studied 96 women with postmenopausal osteoporosis (bone mineral density{BMD} T score<2.5) who visited Climacteric Clinic in Samsung Cheil Hospital from Jan. 1999 to Jul. 1999. Subjects were stratified in to 3 groups: Group 1 treated with alendronate (Fosamax ; MSD, Rahway, NJ, USA) 10mg/day and estrogen, Group 2 treated with calcitonin nasal spray 100 IU every other day and estrogen, and Group 3 treated with estrogen alone for 3 months. We measured serum marker of bone formation (osteocalcin [BGP]), and marker of bone resorption (deoxypyridinoline [DPYD]) from urine at baseline and 3 months after treatment. RESULTS: The mean difference in change of markers among the three groups at the end of study that were significant were BGP 25.7 4.8% and DPYD 23.3 2.3%. DPYD known as bone resorption marker showed a significant response in alendronate and estrogen therapy group than estrogen alone group (P<0.05). Also, BGP showed response to estrogen alone, and calcitonin and estrogen group, but its responsiveness was lesser than alendronate therapy. CONCLUSION: Our data showed that using alendronate with estrogen in patients of osteoporosis further prevents bone resorption. Therefore, we conclude that alendronate therapy with estrogen is helpful in managing osteoporosis patients.
Alendronate* ; Biomarkers ; Bone Density Conservation Agents ; Bone Resorption ; Calcitonin ; Climacteric ; Estrogens ; Female ; Follow-Up Studies* ; Humans ; Mass Screening ; Menopause ; Osteogenesis ; Osteoporosis ; Osteoporosis, Postmenopausal* ; Postmenopause

PURPOSE: We tried to find the relationships between the fetal beta-cell function and neonatal birth weight, anthropometric measures, and maternal characteristics, and to observe role of insulin as fetal growth factor in offsprings of mothers who have normal glucose metabolism. METHODS: We measured umbilical cord blood insulin and C-peptide concentrations in 236 neonates delivered at Cheil General Hospital from Jan. 1 to Jan. 31 1994. Their mothers had normal glucose metabolism during pregnancy. The birth weight and other anthropometric measures were performed within 24 hours after birth by same pediatrician. RESULTS: 1) The mean gestational age was 39.5+/--0.1 wk and mean birth weight was 3.3+/--0.2 Kg. According to birth weight percentile, the numbers of small for gestational age(SGA), adequete for gesational(AGA), and large for gestational age(LGA) infans were 3(1.3%), 178(75.4%), and 55(23.3%), respectively. There were no differences in gestational age, birth weight, length, head circumference, chest circumference, Ponderal index, and symmerty index between male and female infants. 2) The maternal weight gain during pregnancy was related to neonatal birth weight, length, and head circumference, but not to Ponderal index and symmetry index. 3) The mean cord blood insulin and C-peptide concentrations were 5.1+/--0.1uU/ml and 1.3+/--0.1 ng/ml. There was a significant positive correlation between insulin and C-peptide concentrations. 4) There were no significant differences in cord blood insulin and C-peptide concentrations among the SGA, AGA, and LGA group. 5) The cord blood insulin and C-peptide concentrations had weak positive correlations with neonatal birth weight, obesity, and gestational age, but nor with maternal weight gain during pregnancy. CONCLUSIONS: Although insulin has a significant role in fetal growth in diabetic pregnancy or intrauterine growth retardation(IUGR), our results suggest that it does not have a significant effect on fetal growth in offsprings of mothers who have normal glucose metabolism.
Birth Weight ; C-Peptide ; Female ; Fetal Blood* ; Fetal Development ; Gestational Age ; Glucose* ; Head ; Hospitals, General ; Humans ; Infant ; Infant, Newborn ; Insulin ; Male ; Metabolism* ; Mothers* ; Obesity ; Parturition ; Pregnancy ; Thorax ; Umbilical Cord* ; Weight Gain