BACKGROUND: The aim of this study is to evaluate the influence of immunosuppressants on in-hospital mortality from sepsis. METHODS: Using data of the Health Insurance Review & Assessment Service, we collected data from patients who were admitted to the hospital due to sepsis from 2009 to 2013. Based on drugs commonly used for immunosuppression caused by various diseases, patients were divided into three groups; immunosuppressant group, steroid-only group, and control group. Patients with no history of immunosuppressants or steroids were assigned to the control group. To identify risk factors of in-hospital mortality in sepsis, we compared differences in patient characteristics, comorbidities, intensive care unit (ICU) care requirements, and immunodeficiency profiles. Subgroup analysis according to age was also performed. RESULTS: Of the 185,671 included patients, 13,935 (7.5%) were in the steroid-only group and 2,771 patients (1.5%) were in the immunosuppressant group. The overall in-hospital mortality was 38.9% and showed an increasing trend with age. The steroid-only group showed the lowest in-hospital mortality among the three groups except the patients younger than 30 years. The steroid-only group and immunosuppressant group received ICU treatment more frequently (p < 0.001), stayed longer in the hospital (p < 0.001), and showed higher medical expenditure (p < 0.001) compared to the normal group. Univariate and multivariate analyses revealed that age, male gender, comorbidities (especially malignancy), and ICU treatment had a significant effect on in-hospital mortality. CONCLUSIONS: Despite longer hospital length of stay and more frequent need for ICU care, the in-hospital mortality was lower in patients taking immunosuppressive drugs than in patients not taking immunosuppressive drugs.
Comorbidity ; Health Expenditures ; Hospital Mortality ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Insurance* ; Insurance, Health ; Intensive Care Units ; Korea* ; Length of Stay ; Male ; Mortality ; Multivariate Analysis ; Risk Factors ; Sepsis* ; Steroids

Purpose: The purpose of this study is to examine the effects of the rural elderly suicide literacy level upon suicide stigma and coping advice with suicidal crises (recommending professional help for a suicidal person). In particular, this study investigates the role of cultural norms (perceived social expectations for the experience of negative emotions) on suicide stigma and coping ability. Methods: A survey was conducted addressing elderly people (N=119) living in rural areas. Regression analysis using SPSS PROCESS macro was used to examine the relationships among the key variables. Results: Participants with higher suicide literacy showed lower suicide stigma, and this perception had a significant effect on enhancing their coping advice with suicidal crises. Also, perceived social expectations significantly influenced the relationship between suicide stigma and coping advice. With lower levels of social expectations, the mediating effect of suicide stigma on the relationship between suicide literacy and recommending professional help did not exist whereas the indirect effect was significant when it pertained to high levels of social expectations. Conclusion This result signifies that suicide stigma serves as a barrier deterring Koreans from reaching out for professional help regarding their mental health. Moreover, these findings underscore the importance of cultural psychological factors such as perceived social expectations in terms of developing suicide prevention strategies.

PURPOSE: X-linked agammaglobulinemia (XLA) is a primary immunodeficiency caused by mutations in the Bruton's tyrosine kinase (Btk) gene. The aim of this study was to investigate the clinical manifestations, molecular features, and treatment status of XLA in Korean patients at Seoul National University Children's Hospital. METHODS: Fourteen Korean boys with XLA showing serum agammaglobulinemia, non-detectable to less than 2% of peripheral B-cells, and mutation of the Btk gene were enrolled. We observed the clinical features, laboratory findings, status of treatment, and complications in these XLA patients. RESULTS: All XLA patients had a history of recurrent bacterial infections before diagnosis, and 20% of them had a neutropenia. Of the XLA patients 35.7% had a family history of XLA and 75% of their mothers were carriers. Btk gene analysis showed variable gene mutations in Xq22 including 9 amino acid substitutions, 3 frameshifts, 1 premature stop codon, and 1 splice defect. After intravenous immunoglobulin replacement therapy, infection episodes decreased, but complications such as bronchiectasis and chronic sinusitis remained. CONCLUSIONS: In patients less than 4 years of age with recurrent infection, analysis of serum gamma globulin levels and the Btk gene are recommended for the early diagnosis of XLA and for the appropriate prevention of recurrent infection.
Agammaglobulinemia* ; Amino Acid Substitution ; B-Lymphocytes ; Bacterial Infections ; Bronchiectasis ; Codon, Nonsense ; Diagnosis ; Early Diagnosis ; gamma-Globulins ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Mothers ; Neutropenia ; Protein-Tyrosine Kinases ; Seoul ; Sinusitis

PURPOSE: X-linked agammaglobulinemia (XLA) is a primary immunodeficiency caused by mutations in the Bruton's tyrosine kinase (Btk) gene. The aim of this study was to investigate the clinical manifestations, molecular features, and treatment status of XLA in Korean patients at Seoul National University Children's Hospital. METHODS: Fourteen Korean boys with XLA showing serum agammaglobulinemia, non-detectable to less than 2% of peripheral B-cells, and mutation of the Btk gene were enrolled. We observed the clinical features, laboratory findings, status of treatment, and complications in these XLA patients. RESULTS: All XLA patients had a history of recurrent bacterial infections before diagnosis, and 20% of them had a neutropenia. Of the XLA patients 35.7% had a family history of XLA and 75% of their mothers were carriers. Btk gene analysis showed variable gene mutations in Xq22 including 9 amino acid substitutions, 3 frameshifts, 1 premature stop codon, and 1 splice defect. After intravenous immunoglobulin replacement therapy, infection episodes decreased, but complications such as bronchiectasis and chronic sinusitis remained. CONCLUSIONS: In patients less than 4 years of age with recurrent infection, analysis of serum gamma globulin levels and the Btk gene are recommended for the early diagnosis of XLA and for the appropriate prevention of recurrent infection.
Agammaglobulinemia* ; Amino Acid Substitution ; B-Lymphocytes ; Bacterial Infections ; Bronchiectasis ; Codon, Nonsense ; Diagnosis ; Early Diagnosis ; gamma-Globulins ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Mothers ; Neutropenia ; Protein-Tyrosine Kinases ; Seoul ; Sinusitis

In this study, we analyzed the healthcare system of North Korea using Kleczkowski's model which categorizes national healthcare infrastructure into five components: health resources, organization, healthcare delivery system, economic support, and management. It was found that the healthcare system in North Korea, which provides clinical medicine, Koryo medicine and preventive medicine, is constituted of a physician system of independent geographic sectors and centralized delivery system while maintaining free universal health coverage. These systems are all managed by the government and the People's Committee Party. However, North Korea has been confronted with severe economic difficulties since the 1990s, such that we question whether the healthcare system has been able to function properly despite of the lack of resources in general throughout the country.
Clinical Medicine ; Collodion ; Delivery of Health Care ; Democratic People's Republic of Korea ; Health Resources ; Preventive Medicine

This study analyzes the role of the Sorting Hat in structuring the identity of the characters in the Harry Potter series written by J. K. Rowling. In the different stages of adolescence, one explores and re-establishes one's identity. One's sense of identity is determined by the commitments made regarding personal and social traits. However, it is difficult to establish a concrete identity formation process theory that is communicable to adolescents. In Harry Potter, the characters' identities are reflected upon the Sorting Hat and are continuously molded throughout the book. The Sorting Hat provides nurturing experiences based on temperament. Based primarily on their temperament, it sorts the students into four houses, each with their own distinct characteristics. Once sorted, the houses become the living and learning communities in which the students share the same dormitory and classes until their graduation. Within the community, the students seek connections, supportive relationships, and understanding within the group. The taking on of the group identity is an explanatory variable in the formation of individual identity. The Sorting Hat provides the students with stability and a safe boundary. After being sorted based on their temperament, the inexperienced and immature adolescents can explore different options under the guidance of the Hat before making a definite commitment. By presenting them with an appropriate environment (such as a mentor, friend, or family member), the Hat further shapes their identity and integrates the identity elements ascribed in the beginning. By providing experiences and interactions based on their unique temperament and environment, the Sorting Hat plays a crucial role in establishing the students' identities. The Sorting Hat can be an ideal model for finding one's identity during adolescence.
Adolescent* ; Friends ; Fungi ; Humans ; Learning ; Mentors ; Sociological Factors ; Temperament

BACKGROUND: The aim of this study is to evaluate the influence of immunosuppressants on in-hospital mortality from sepsis. METHODS: Using data of the Health Insurance Review & Assessment Service, we collected data from patients who were admitted to the hospital due to sepsis from 2009 to 2013. Based on drugs commonly used for immunosuppression caused by various diseases, patients were divided into three groups; immunosuppressant group, steroid-only group, and control group. Patients with no history of immunosuppressants or steroids were assigned to the control group. To identify risk factors of in-hospital mortality in sepsis, we compared differences in patient characteristics, comorbidities, intensive care unit (ICU) care requirements, and immunodeficiency profiles. Subgroup analysis according to age was also performed. RESULTS: Of the 185,671 included patients, 13,935 (7.5%) were in the steroid-only group and 2,771 patients (1.5%) were in the immunosuppressant group. The overall in-hospital mortality was 38.9% and showed an increasing trend with age. The steroid-only group showed the lowest in-hospital mortality among the three groups except the patients younger than 30 years. The steroid-only group and immunosuppressant group received ICU treatment more frequently (p < 0.001), stayed longer in the hospital (p < 0.001), and showed higher medical expenditure (p < 0.001) compared to the normal group. Univariate and multivariate analyses revealed that age, male gender, comorbidities (especially malignancy), and ICU treatment had a significant effect on in-hospital mortality. CONCLUSIONS: Despite longer hospital length of stay and more frequent need for ICU care, the in-hospital mortality was lower in patients taking immunosuppressive drugs than in patients not taking immunosuppressive drugs.
Comorbidity ; Health Expenditures ; Hospital Mortality ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Insurance ; Insurance, Health ; Intensive Care Units ; Korea ; Length of Stay ; Male ; Mortality ; Multivariate Analysis ; Risk Factors ; Sepsis ; Steroids

OBJECTIVES: This study investigated the prevalence of reading and mathematical learning disabilities of students at primary schools in Jeju Island, South Korea. We examined major causes of learning disabilities including reading disorder, mathematical disorder, attention deficit, and other causes including socioemotional factors. METHODS: We conducted screening processes to 659 participants (340 male, 51%) in 4 elementary schools in Jeju Island. To identify the causes of learning problems, 84 children were administered tests such as the Korean-Wechsler Intelligence Scale for Children-fourth edition, the Comprehensive Learning Test-Reading/Math, and the Comprehensive Attention Test. RESULTS: This study found that 13% of elementary school students in the Jeju region had learning disabilities. Among learning disabilities, specific reading and mathematical disorders accounted for 9% of study subjects. In addition, 2% of participants had intellectual impairment and 1% had other causes such as socioemotional factors. 65% of children with learning disabilities and 74% of children with reading or mathematic disorders had concurrent attention deficit disorder. 68% of children with reading disorders also had comorbid mathematical disorder. CONCLUSION: The prevalence, causes, and comorbidity of reading and mathematical learning disabilities of students in Jeju Island, South Korea did not differ from those in foreign countries. Because most learning disabilities are complex, comprehensive evaluations and tailored interventions are necessary to help children with learning disabilities.
Attention Deficit Disorder with Hyperactivity ; Child* ; Comorbidity ; Dyscalculia ; Dyslexia ; Epidemiology ; Humans ; Intelligence ; Korea ; Learning Disorders* ; Learning* ; Male ; Mass Screening ; Mathematics ; Prevalence*

PURPOSE: We aimed to evaluate the association between immunoglobulin G (IgG) at birth and late-onset sepsis (LoS) in preterm infants. METHODS: Medical records of very-low-birth-weight infants, born at gestational age <28 weeks, between 2013 and 2016, were retrospectively reviewed. Subjects were divided into two groups based on the occurrence of LoS (LoS vs. non-LoS), and IgG levels at 1 day, and at 2 weeks and 4 weeks after birth were investigated. IgG levels, other perinatal factors, and clinical factors were compared in the two groups. The relationship between IgG levels and mortality among infants in the LoS group was also analyzed. RESULTS: A total of 105 infants were analyzed after exclusion of cases with early onset sepsis or death at < 72 hours of life. Gestational age in the LoS group was lower than in the non-LoS group (25.0±1.8 vs. 26.3±1.4 weeks, P=0.004). IgG levels at birth were similar between the two groups (236.4±96.4 vs. 282.0±104.7 mg/dL, P=0.078). Multivariate analysis showed that IgG at birth was not an independent risk factor for LoS. In the LoS group, IgG levels at birth were comparable between survivors and cases involving mortality. CONCLUSION: IgG levels at birth were not associated with the occurrence of LoS in extremely preterm infants.
Gestational Age ; Humans ; Immunoglobulin G* ; Immunoglobulins* ; Infant* ; Infant, Extremely Premature ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight* ; Medical Records ; Mortality* ; Multivariate Analysis ; Parturition* ; Retrospective Studies ; Risk Factors ; Sepsis* ; Survivors

PURPOSE: To evaluate the effects of exclusive breast milk feeding (BMF) on the incidence of necrotizing enterocolitis (NEC) in preterm infants. METHODS: All newborn infants, born at <32 weeks of gestation and weighing <1,500 g, admitted to the neonatal intensive care center at Seoul National University Bundang Hospital during the study period, were included. The study was divided into period I: pre-exclusive BMF (January 2010–March 2014) and period II: exclusive BMF (April 2014–December 2016). RESULTS: A total of 374 infants were enrolled in this study, with 174 in period I and 174 in period II. The incidence of NEC was 11.5% in period I and 3.4% in period II. As the mean gestational age and birth weight were significantly greater in infants in period II, the difference in the incidence of NEC between the two periods was adjusted by gestational age. After adjustment, the incidence of NEC in period II was significantly lower than in period I (P=0.024). CONCLUSION: Exclusive BMF significantly reduced the incidence of NEC in a single neonatal intensive care center.
Birth Weight ; Breast* ; Enterocolitis, Necrotizing* ; Gestational Age ; Humans ; Incidence* ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal* ; Milk, Human* ; Pregnancy ; Seoul