Purpose: To identify changes in medical expenditures and health care utilization before and after visual impairment onset, then analyze differences according to visual impairment severity. Methods: Patients aged ≥ 18 years who were registered as visually disabled from 2005 to 2013 were selected using the database from the registry of the disabled and the National Health Insurance Service. The observation period of 3 years before and after the registration was divided into 6-month units (12 points of interest). At each point of interest, medical cost, number of outpatient visits, and length of hospital stay (LOS) were analyzed. The control group was obtained through 1:10 stratification randomization to match sex and age; individuals in the control group were then selected via 1:1 propensity score matching for the premium quantile and residential area. Results: In total, 131,434 patients with visual disability and the same number of non-visually impaired controls were included. Compared with non-disabled individuals, the mean medical cost and number of outpatient visits were higher for patients with visual disability (1.9- and 1.4-fold, respectively, p < 0.001); the LOS was also 3.5 days longer (p < 0.001). The mean medical cost and number of outpatient visits were greater in severely visually disabled patients than in mildly disabled patients (1.6- and 0.5-fold, respectively, p < 0.001); the LOS was also 12 days longer in severely disabled patients (p < 0.001). From 18 months before disability registration, medical costs and LOS increased according to the presence and severity of visual disability; the number of outpatient visits increased uniformly, regardless of disability and severity. Conclusions More severe cases of visual impairment are associated with greater health care utilization and expenditures. Policy intervention is necessary to ensure that patients receive appropriate treatment and steady health care by reducing the burden of medical expenditures.

OBJECTIVE: Endometriosis is a common and recurring gynecologic disease which have afflicting females of reproductive age. We investigated the efficacy of long-term, post-operative use of dienogest for ovarian endometrioma. METHODS: We studied 203 patients who had undergone laparoscopic or robotic surgery for ovarian endometrioma, and were administrated dienogest 2 mg/day beginning in July of 2013, and continuing. We evaluated side effects of dienogest and ultrasonography was performed every 6 months to detect potential recurrence of endometrioma (2 cm) in these post-surgical patients. RESULTS: The follow-up observation periods were 30.2±20.9 months from surgery. The mean age was 34.1±7.2 years old. The mean diameter of pre-operative endometrioma was 5.6±3.0 cm2. One hundred eighty-two (89.7%) women received dienogest continuously for 12.0±7.1 months. Of the subjects, 21 (10.3%) patients discontinued dienogest at 2.4±1.0 months. The most common side effect when dienogest was discontinued was abnormal uterine bleeding. The occurrence rate of vaginal bleeding was 15.8%, a number which did not differ significantly in patients with/without post-operative gonadotropin releasing hormone agonist administration. The other side effects were gastrointestinal trouble including constipation, acne, headache, depression, hot flush, weight gain, and edema. However, no serious adverse events or side effects were documented and recurrent endometriomas were diagnosed in 3 patients (1.5%). CONCLUSION: The data indicates that dienogest was both tolerable and safe for long-term use as prophylaxis in an effort to obviate the recurrence of ovarian endometrioma post-operatively, as well as potential need for surgical re-intervention.
Acne Vulgaris ; Constipation ; Depression ; Edema ; Endometriosis ; Female ; Follow-Up Studies ; Genital Diseases, Female ; Gonadotropin-Releasing Hormone ; Headache ; Humans ; Recurrence ; Ultrasonography ; Uterine Hemorrhage ; Weight Gain

OBJECTIVES: To evaluate preoperative anti-Mullerian hormone (AMH) levels in women with endometrioma or other benign ovarian cysts and differences of AMH changes according to various characteristics. METHODS: Ninety-seven patients aged 20 to 39 years who underwent surgery for benign ovarian cyst were enrolled retrospectively. Of these, 65 patients were diagnosed as endometriomas, and 32 had other benign cysts. Serum AMH, mean, maximum, and total diameter of ovarian cysts were measured. The AMH levels were compared according to pathology (endometrioma vs. other benign cyst), size of ovarian cyst, age-matched AMH quartile percentile and characteristics of endometrioma. RESULTS: Preoperative serum AMH level was significantly lower in endometrioma group than other benign cyst group (4.12 +/- 2.42 ng/mL vs. 6.02 +/- 2.29 ng/mL, P < 0.001). Serum AMH level was significantly lower in endometrioma group, especially in patients aged 30 to 39 years. Dividing to age-matched AMH quartile percentile, there were significantly fewer patients with AMH level > or = 75 percentile in endometrioma group (24.6% vs. 50.0%, P = 0.035). Among 4 subgroups of endometrioma, patients with AMH level > or = 75 percentile were significantly decreased in multiple bilateral endometrioma group. Mean and total diameter of cysts were negatively correlated with preoperative serum AMH level in other benign cyst group. CONCLUSION: We suggest that preoperative AMH level measurement might be considered in women with endometrioma, especially in 30 to 39 years old, multiple bilateral type, or big-sized other benign ovarian cyst to assess the diminished ovarian reserve.
Anti-Mullerian Hormone* ; Endometriosis* ; Female ; Humans ; Ovarian Cysts* ; Pathology ; Retrospective Studies

OBJECTIVE: To compare and analyze the clinical characteristics of children with delayed language acquisition due to two different diagnoses, which were specific language impairment (SLI, a primarily delayed language development) and global developmental delay (GDD, a language delay related to cognitive impairment). METHODS: Among 1,598 children who had visited the developmental delay clinic from March 2005 to February 2011, 467 children who were diagnosed with GDD and 183 children who were diagnosed with SLI were included in this study. All children were questioned about past, family, and developmental history, and their language competences and cognitive function were assessed. Some children got electroencephalography (EEG), in case of need. RESULTS: The presence of the perinatal risk factors showed no difference in two groups. In the children with GDD, they had more delayed acquisition of independent walking and more frequent EEG abnormalities compared with the children with SLI (p<0.01). The positive family history of delayed language development was more prevalent in children with SLI (p<0.01). In areas of language ability, the quotient of receptive language and expressive language did not show any meaningful statistical differences between the two groups. Analyzing in each group, the receptive language quotient was higher than expressive language quotient in both group (p<0.01). In the GDD group, the Bayley Scales of Infant Development II (BSID-II) showed a marked low mental and motor quotient while the Wechsler Intelligence Scale showed low verbal and nonverbal IQ. In the SLI group, the BSID-II and Wechsler Intelligence Scale showed low scores in mental area and verbal IQ but sparing motor area and nonverbal IQ. CONCLUSION: The linguistic profiles of children with language delay could not differentiate between SLI and GDD. The clinicians needed to be aware of these developmental issues, and history taking and clinical evaluation, including cognitive assessment, could be helpful to diagnose adequately and set the treatment plan for each child.
Child ; Child Development ; Diagnosis ; Electroencephalography ; Humans ; Intelligence ; Language ; Language Development ; Language Development Disorders ; Linguistics ; Risk Factors ; Walking ; Weights and Measures

OBJECTIVE: To identify the clinical characteristics and investigate function related aspects of Korean children with Rett syndrome. METHOD: A total of 26 patients diagnosed as Rett syndrome were clinically observed until the age of five or over. We surveyed past history, developmental history, and presence of typical clinical features of Rett syndrome. Furthermore, we investigated differences in clinical characteristics according to functional status and changes in clinical features related to growth. RESULTS: There were no problems related to gestational, perinatal or neonatal history. Only 12 patients had an ultimate head circumference of less than 3 percentile. Developmental regression was definite in all patients. At final assessment, only 14 patients were able to walk. Twenty patients had an epileptic history requiring medication. Sixteen patients with scoliosis showed progression during serial follow-up. The percentage of patients who were able to walk before 16 months was higher in the high function group than the low function group. The age of regression was 5.4 and 4.0 years in the high and low function group respectively, but the difference was not statistically significant. Scoliosis was more severe and seizure onset age was younger in the low function group. CONCLUSION: We investigated 26 clinical characteristics in Korean children with Rett syndrome. Their clinical features change according to age, and we believe such knowledge could be utilized in rehabilitation to minimize their disabilities.
Age of Onset ; Child ; Follow-Up Studies ; Gait ; Head ; Humans ; Rett Syndrome ; Scoliosis ; Seizures

PURPOSE: The characteristics of oxidized titanium (Ti) surfaces varied according to treatment conditions such as duration time and temperature. Thermal oxidation can change Ti surface characteristics, which affect many cellular responses such as cell adhesion, proliferation, and differentiation. Thus, this study was conducted to evaluate the surface characteristics and cell response of thermally treated Ti surfaces. METHODS: The samples were divided into 4 groups. Control: machined smooth titanium (Ti-S) was untreated. Group I: Ti-S was treated in a furnace at 300degrees C for 30 minutes. Group II: Ti-S was treated at 500degrees C for 30 minutes. Group III: Ti-S was treated at 750degrees C for 30 minutes. A scanning electron microscope, atomic force microscope, and X-ray diffraction were used to assess surface characteristics and chemical composition. The water contact angle and surface energy were measured to assess physical properties. RESULTS: The titanium dioxide (TiO2) thickness increased as the treatment temperature increased. Additional peaks belonging to rutile TiO2 were only found in group III. The contact angle in group III was significantly lower than any of the other groups. The surface energy significantly increased as the treatment temperature increased, especially in group III. In the 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, after 24 hours of incubation, the assessment of cell viability showed that the optical density of the control had a higher tendency than any other group, but there was no significant difference. However, the alkaline phosphatase activity increased as the temperature increased, especially in group III. CONCLUSIONS: Consequently, the surface characteristics and biocompatibility increased as the temperature increased. This indicates that surface modification by thermal treatment could be another useful method for medical and dental implants.
Alkaline Phosphatase ; Cell Adhesion ; Cell Survival ; Dental Implants ; Electrons ; Phase Transition ; Tetrazolium Salts ; Thiazoles ; Titanium ; Transition Temperature ; Water ; Wettability ; X-Ray Diffraction

OBJECTIVE: To perform an in depth evaluation of children, and thus provide a systematic method of managing children, who after infantile health screening, were categorized as suspected developmental delay. METHOD: 78 children referred to the Developmental Delay Clinic of Ilsan Hospital after suspected development delay on infantile health examinations were enrolled. A team comprised of a physiatrist, pediatrician and pediatric psychiatrist examined the patients. Neurological examination, speech and cognitive evaluation were done. Hearing tests and chromosome studies were performed when needed clinically. All referred children completed K-ASQ questionnaires. Final diagnoses were categorized into specific language impairment (SLI), global developmental delay (GDD), intellectual disability (ID), cerebral palsy (CP), motor developmental delay (MD) or autism spectrum disorder (ASD). RESULTS: 72 of the 78 patients were abnormal in the final diagnosis, with a positive predictive value of 92.3%. Thirty (38.4%) of the 78 subjects were diagnosed as GDD, 28 (35.8%) as SLI, 5 (6.4%) as ASD, 9 (12.5%) as MD, and 6 (7.6%) as normal. Forty five of the 78 patients had risk factors related to development, and 18 had a positive family history for developmental delay and/or autistic disorders. The mean number of abnormal domains on the K-ASQ questionnaires were 3.6 for ASD, 2.7 for GDD, 1.8 for SLI and 0.6 for MD. Differences between these numbers were statistically significant (p<0.05). CONCLUSION: Because of the high predictive value of the K-ASQ, a detailed evaluation is necessary for children suspected of developmental delay in an infantile health promotion system.
Cerebral Palsy ; Child ; Autism Spectrum Disorder ; Health Promotion ; Hearing Tests ; Humans ; Intellectual Disability ; Mass Screening ; Neurologic Examination ; Psychiatry ; Risk Factors ; Surveys and Questionnaires

OBJECTIVES: To estimate whether coronary artery calcification in postmenopausal women is associated with serum estradiol level. METHODS: The present study retrospectively examined the clinical records of 162 postmenopausal women who visited the Health Promotion Center for a routine checkup and underwent a multidetector CT scan of the heart. Serum estradiol level, coronary heart disease (CHD) risk factors, current hormone therapy status, and BMD of the lumbar vertebrae and femoral neck were analyzed in women with coronary artery calcium score (CACS) > or = 100 and < 100. RESULTS: Compared to women with higher CACS (> or = 100), women with lower CACS (< 100) had a significantly higher level of serum estradiol (27.34 +/- 2.96 vs. 13.31 +/- 1.10 pg/ml, P = 0.030) and lower mean age (57.63 +/- 0.44 vs. 61.88 +/- 1.90, P = 0.037). Women with CACS < 100 were significantly more likely to have a serum estradiol level greater than 20 pg/ml (42.25 vs. 0 %, P = 0.022) and lower prevalence of hypertension (28.17 vs. 62.50%, P = 0.053, borderline significant). However, multiple logistic regression analysis showed that any factors did not have a significant association with CACS except hypertension (OR 5.831 [95% CI 1.035 to 32.85], P = 0.046). CONCLUSION: Serum estradiol level might be associated with the degree of calcification of coronary artery in postmenopausal women.
Calcium ; Coronary Disease ; Coronary Vessels ; Estradiol ; Female ; Femur Neck ; Health Promotion ; Heart ; Humans ; Hypertension ; Logistic Models ; Lumbar Vertebrae ; Postmenopause ; Prevalence ; Retrospective Studies ; Risk Factors

Endometriosis is a long term, disabling condition and a relatively common disease, affecting 5~15% of the adult female population. Endometriosis of the urinary tract, which occurs mostly bladder or ureter, is rare and accounts for 1 or 2% of cases. However, they may cause hydronephrosis and other serious complications on the involved site. We experienced one case of vesical endometriosis and two cases of ureteral endometriosis, and report these cases with a brief review of the concerned literatures.
Adult ; Endometriosis ; Female ; Humans ; Hydronephrosis ; Ureter ; Urinary Bladder ; Urinary Tract

OBJECTIVE: This study was performed to evaluate the effect of body mass index (BMI) on the outcome of in vitro fertilization and embryo transfer (IVF-ET) in patients with polycystic ovary syndrome (PCOS). METHODS: Ninety-six patients with PCOS who completed their first cycle of IVF-ET were included in this retrospective study. All patients were stimulated by GnRH antagonist multi-dose protocol. The patients were divided into one of two groups on the basis of BMI > or =23 kg/m2 vs. BMI <23 kg/m2, and their outcome of IVF-ET was compared. Additionally the patients with BMI > or =23kg/m2 were divided into patient group with 23 < or =BMI <25 kg/m2 and patient group with BMI > or =25 kg/m2, and these three groups were also compared in regard to the outcome of IVF-ET. RESULTS: The total amount and duration of rhFSH administration were significantly higher in PCOS women with BMI > or =23 kg/m2 than in those with BMI <23 kg/m2 (P<0.001 in both). The implantation rate was significantly lower in women with BMI > or =23 kg/m2 (17.4% vs 7.8%, P=0.024). When compared three group divided on the basis of BMI <23 kg/m2 vs BMI 23~25 kg/m2 vs BMI > or =25 kg/m2, similar results were showed in women with BMI > or =25 kg/m2, although implantation rate in women with BMI > or =25 kg/m2 was lower with borderline significance (P=0.069). CONCLUSION: Obesity (BMI > or =23 kg/m2) has a detrimental effect on implantation rate and is associated with the increased total amount and duration of rhFSH administration for ovarian stimulation in IVF-ET cycle. Consequently BMI may be a predictor for IVF outcomes in patients with PCOS.
Body Mass Index ; Embryo Transfer ; Embryonic Structures ; Female ; Fertilization in Vitro ; Gonadotropin-Releasing Hormone ; Humans ; Obesity ; Ovulation Induction ; Polycystic Ovary Syndrome ; Retrospective Studies