The purpose of this study is to estimate cesarean section rate in Korea and analyze the socioeconomic variables and health resources which affect regional variation in the rate. Samples were drawn from the record of vaginal and cesarean section deliveries based upon insurance claim bills which have been submitted to the National Federation of Medical Insurance for the first three months, January through March, 1991. The results are obtained as follows: It was found that, cesarean section rate was increasing rapidly up to 23.1% in 1991. Cesarean section per 10 thousand insured people was 4.8 and the number of cesarean section per 10 thousand insured eligible(15-49 years old) female was 7.6. The fee for normal delivery was 109,489 won and that for cesarean section was 390,024 won. The average days of hospitalization in normal delivery was 2.3 days, and those in cesarean section was 7.6 days. On the average cesarean section has a longer of stay as much as by 4.3 days and cost 3.6 times more than normal deliveries. Cesarean section rates vary among medical facilities: 19.8% at clinics 37.6% in small-scale hospitals, and 29.1% in general hospitals. The regional variation of cesarean section rates was also fairly prominent. The South Cheju Gun has the highest rate of cesarean section, 56.2%. Meanwhile no cesarean section cases has been reported in Sunchang Gun during the period of this study. The variation is noted among provinces. The rate for Cheju province has been 3.4 times higher than that for Chunnam. The number of cesarean section per 10 thousand insured people vary greatly among regions, too. This study has found that there exists significant regional variations among various geographic units in terms of average length of stay, average cost, number of obsretricians and number of beds. Multiple regression analysis was done to identify factors explaining the regional variance of various cesarean section rates: In the urban areas, no significant explaining variables were noted except the number of beds for the dependent variable of cesarean section cases per 10 thousand insured eligible females. The smaller the number of bed, the more cases of cesarean section was noted for an urban area. The is mostly because the rate of cesarean section is higher in medium-size hospitals than in large general hospitals. In the rural areas, the factor of education has been found significant for all three dependent variables. The higher the educational level, the rate of cesarean section is most likely to rise. An income variable measured by the amount of monthly insurance contribution has been identified a powerful predictor in explaining the variance of cesarean section rates. The same has been noted for the number of obstetricians. Similar findings are observed for the country as a whole. The income level has been found as the most powerful explaining factor in the regional variance of cesarean section rates. In general the rate is higher in the urban areas, and lower in the area with more small hospitals. As this is the initial attempt to identify the factors relevant to the regional difference in the rates of cesarean section, more elaborated study is urgently required.
Cesarean Section* ; Education ; Fees and Charges ; Female ; Health Resources ; Hospitalization ; Hospitals, General ; Humans ; Insurance ; Jeju-do ; Korea* ; Length of Stay ; Pregnancy

No abstract available.
Hydronephrosis* ; Turner Syndrome*

For a safe and efficient blood transfusion, the transportation period of blood components from the blood bank to the patient and the transfusion period of blood components should be under control. Based on the ‘30-minute rule’ and the guidelines of other countries, the author presents a managerial strategy for blood components not permitted to be returned to the blood bank because of exposure to uncontrolled temperatures for more than 30 minutes. Moreover, the transfusion period specified for each blood component is suggested as additional managerial indicators through the recommended transfusion period presented in the revised transfusion guidelines.

According to the transfusion guidelines, type O RBC is the best choice for emergency transfusions if the recipient’s ABO group is unknown. If the recipient’s ABO group is confirmed after pre-transfusion tests, ABO identical and ABO compatible (but non-identical) RBC is the second-best choice in that order. However, non-transfusion medicine physicians have a misconception that type O RBCs are always the second best for patients in all emergency/massive transfusions. The author suggests the use of optimal ABO non-identical but compatible RBC components in emergency/massive transfusions, especially for AB＋ recipients.

As in type 1 diabetes, the loss of pancreatic β-cells leads to insulin deficiency and the subsequent development of hyperglycemia. Exercise has been proposed as a viable remedy for hyperglycemia. Lithium, which has been used as a treatment for bipolar disorder, has also been shown to improve glucose homeostasis under the conditions of obesity and type 2 diabetes by enhancing the effects of exercise on the skeletal muscles. In this study, we demonstrated that unlike in obesity and type 2 diabetic conditions, under the condition of insulin-deficient type 1 diabetes, lithium administration attenuated pancreatic a-cell mass without altering insulin-secreting β-cell mass, implying a selective impact on glucagon production.Additionally, we also documented that lithium downregulated the hepatic gluconeogenic program by decreasing G6Pase protein levels and upregulating AMPK activity.These findings suggest that lithium’s effect on glucose metabolism in type 1 diabetes is mediated through a different mechanism than those associated with exerciseinduced metabolic changes in the muscle. Therefore, our research presents the novel therapeutic potential of lithium in the treatment of type 1 diabetes, which can be utilized along with insulin and independently of exercise.

No abstract available.
Female ; Ovulation*

PURPOSE: Cancer patients require emotional, financial and practical support as well as information/advice regarding their illness. This study aims to explore opportunities and barriers for the provision of the social support services in Australia and Korea. METHODS: The survey was carried out by an email questionnaire for social workers in Australia and Korea, and collected data were analyzed using a thematic analysis by Braun and Clarke. RESULTS: In Australia and Korea, various types of social support were available for cancer patients. However, social support for cancer patients should be better understood first in Korea, and more personalized support is needed in Australia. CONCLUSION: These findings will ultimately help to improve social support services for cancer patients in Korea an Australia, through grasping the current state and making up for the weak points.
Australia ; Electronic Mail ; Hand Strength ; Hospice Care ; Humans ; Korea ; Social Workers

The purpose of this study was to investigate the correlation between food behavior and Attention Deficit Hyperactivity Disorder (ADHD) score in elementary students in Suwon-si, Gyeonggi-do. Two hundreds and thirty two students (113 male and 119 female) in grades 4~6 participated. We assessed food behavior by using Nutrition Quotient (NQ). NQ was examined by an NQ questionnaire, which consisted of 19 food behavior checklist items. Their items were grouped into five categories: balance, diversity, moderation, regularity, and practice. All data were statistically analyzed by SPSS 18.0. Among the five factors, NQ for food behavior and balance factor showed the lowest score, whereas that of diversity factor showed the highest score. The final Nutrition Quotient (NQ) score weighted on such five factors was 62.59 points. The average level of ADHD by Conners-Wells Adolescent Self-Report Scale (Short Form) [CASS(S)] was 17.02 points out of a total of 81 points. Six students (2.2%) who scored more than 41 points were classified as ADHD risk. By gender, male students (19.76 points) showed a higher CASS(S) score than female students (14.41 points) did. There was a significant negative correlation between NQ and CASS(S) score (r=-0.445, P<0.001). Multiple regression determined the effects of moderation (Exp(beta)=-0.193, P<0.01) and practice (Exp(beta)=-0.345, P<0.001) on CASS(S) score. In conclusion, distinctive nutritional education is needed for students with a high level of ADHD to help their understanding considering their different levels of attention.
Adolescent ; Attention Deficit Disorder with Hyperactivity* ; Checklist ; Education ; Female ; Gyeonggi-do ; Humans ; Korea ; Male ; Surveys and Questionnaires

Background: Fresh frozen plasma (FFP) has been inappropriately using in spite of limited transfusion indications. Our institution applied the transfusion indication data-entry to a computerized order system in February 2018. Physicians should select the indication during transfusion order. In January 2019, the warning pop-up additionally applied for informing whether or not the coagulation test results correspond to FFP transfusion indications. We investigated the effects of a new applied program on the appropriateness of FFP transfusion. Methods: By comparing the appropriateness of transfusion before applying the transfusion indication data-entry, we investigated whether there were improvements of appropriateness after applying the transfusion indication data-entry and after applying the warning pop-up. We compared the percentages of performing pre-transfusion coagulation tests and transfusion among FFP requests before and after applying the warning pop-up. Results: After applying the transfusion indication data-entry, the appropriateness improved from 54.5% to 66.7%. The appropriateness of the surgery department was the lowest compared with that of the medical departments and emergency departments. The warning pop-up would be effective to induce pre-transfusion coagulation tests from surgery departments and emergency department. However, there was no further improvement in the appropriateness. Many requests from the surgery departments did not lead to transfusion. As the results of the analysis conducted by dividing each department that belonged to surgery departments, we could determine the wrong transfusion practice specific to each department. Conclusion The transfusion indication data-entry contributed to improving the appropriateness of FFP transfusion. Department-specific education and real-time auditing are needed for further improvement.

Previously, immediate reactions to ionic high-osmolar iodinated contrast media (ICM) were regarded as nonimmunological. However, despite the use of lower-osmolar ICM, ICM hypersensitivity still occurs in some patients and recent studies suggest that there would be a true allergic response, especially in more severe form. Currently, it is important to identify the sensitized ICM and avoid the agent; however, the usefulness of skin tests and challenge tests has not yet been established, since there are few large-scale studies on them. Although, skin test-negative ICM can be safely used in clinical practice, conflicting results have been reported through various studies, depending on the challenge protocols used. Therefore, standard protocols need to provided. Even if a culprit agent is not proven by skin tests, its use should be avoided. Reuse of contrast media increases the risk of occurrence of hypersensitivity reactions. For patients with previous hypersensitivity reactions to contrast media, premedication can help prevent recurrence, but breakthrough in hypersensitivity is not fully achieved by premedication, especially when the previous reaction was a severe form such as anaphylaxis. Therefore, it is necessary to establish an optimal strategy to choose alternative ICM and premedication protocols to prevent recurrence of hypersensitivity reactions to nonionic contrast media.