BACKGROUND: Direct observation of healthcare workers is commonly used in hospitals to investigate hand hygiene compliance. However, the hand hygiene compliance rate may increase due to the Hawthorne effect, which is the modification of behavior simply because subjects become aware that they are being observed. The objective of this study was to investigate the occurrence of the Hawthorne effect when directly observing hand hygiene compliance in intensive care unit (ICU) healthcare personnel. METHODS: A total of 87 staff members from the coronary care unit and cardiac surgery ICU of a general hospital in Seoul were included in this study: 24 residents and interns, 55 nurses, and 8 nursing assistants. Both covert and overt observations, where subjects were either unaware or aware of any direct observation, were performed on separate occasions. RESULTS: A total of 1,052 covert and 1,336 overt observations were documented over 30 and 34 occasions, respectively. Overall hand hygiene compliance was significantly higher with overt observation than with covert observation (1,041/1,336, 77.9% vs. 659/1,052, 62.6%, P<0.001). The Hawthorne effect was present in all professions and behaviors, with the exception of nursing assistants, and prior to touching a patient. CONCLUSION: Direct observation of hand hygiene compliance was associated with the Hawthorne effect when observations were made overtly and this was likely to contribute to an overestimation of compliance rate.
Compliance ; Coronary Care Units* ; Delivery of Health Care* ; Effect Modifier, Epidemiologic* ; Hand Hygiene* ; Health Personnel ; Hospitals, General ; Humans ; Intensive Care Units* ; Nursing ; Seoul ; Thoracic Surgery*

PURPOSE: This study was conducted to adapt the standardized evidence-based nursing protocol using the IPC (intermittent pneumatic compression) intervention to prevent venous thromboembolism in surgical patients. Further, an investigation was done to measure knowledge on prevention of venous thromboembolism, surrogate incidence of venous thromboembolism and to assess IPC compliance in the study patients compared with those in surgical patients who underwent IPC intervention due to previous clinical experience. METHODS: An analysis was done of the nine modules suggested by National Evidence-based Healthcare Collaborating Agency (NECA) in the adaptation manual of the clinical practice guideline for protocol adaptation. A nonequivalent control group post test design as a quasi-experiment was used to verify the effect of the IPC protocol. RESULTS: There was a significant difference in knowledge of prevention of venous thromboembolism, IPC application time after intervention and the number of IPC applications between the experimental group (n=50) using the IPC nursing protocol and the control group (n=49). However, the symptoms of deep vein thrombosis and pulmonary thromboembolism were not observed in either the experimental group or the control group after the intervention. CONCLUSION: Results confirm that the standardized IPC nursing protocol provides effective intervention to prevent venous thromboembolism in surgical patients.
Compliance ; Evidence-Based Nursing ; Evidence-Based Practice ; Humans ; Incidence ; Intermittent Pneumatic Compression Devices ; Nursing Assessment* ; Nursing* ; Pulmonary Embolism ; Venous Thromboembolism* ; Venous Thrombosis

OBJECTIVES: The aims of this study were to investigate the pattern of stress coping strategies and the effects of stress coping strategies on quality of life in patients with schizophrenia. METHODS: Stress coping strategies and quality of life were examined using Ways of Coping Checklist and Schizophrenia Quality of Life Scale for 98 patients with schizophrenia. Stress coping strategies were composed of problem-focused coping, social support seeking, emotion-focused coping, and wishful thinking. Among these, problem-focused coping and social support seeking were active coping strategies while emotion-focused coping and wishful thinking were passive coping strategies. Positive and Negative Syndrome Scale (PANSS) and Beck's Depression Inventory (BDI) were also administered. RESULTS: Active coping scores were higher than passive coping scores in patients with schizophrenia. Quality of life was higher in the active coping group compared to the passive coping group. Active coping usage was a significant predictor of higher quality of life even after controlling for gender, age, PANSS, and BDI scores. CONCLUSION: Patients with schizophrenia used more active coping strategies than passive coping strategies, which showed significant association with higher quality of life. A treatment program to provide education on use of active coping strategies in a proper and flexible way might contribute to enhanced quality of life in patients with schizophrenia.
Adaptation, Psychological ; Checklist ; Depression ; Education ; Humans ; Quality of Life* ; Schizophrenia* ; Stress, Psychological ; Thinking

Infantile onset diabetes mellitus(especially, neonatal diabetes) is rare disorder and may be transient or permanent. Most patients are full-term but small-for-date infants and typical symptoms occur within the first 4-6 weeks of life, requiring insulin therapy. Neonatal diabetes differs from type 1 diabetes in many aspects and seems to form a distinct entity of inborn pancreatic malfunction. The transient cases often develop type 2 diabetes mellitus later in life. In recent reports, transient neonatal diabetes is associated with paternal uniparental isodisomy and unbalanced duplication of chromosome 6q22-23. In our study, clinical course of case 1 was compatible with transient neonatal diabetes, but chromosomal abnormalities such as above was not shown in DNA analysis. In case 2 and 3, we could not decide exactly on genetic basis.
Chromosome Aberrations ; Diabetes Mellitus, Type 1* ; Diabetes Mellitus, Type 2 ; DNA ; Genomic Imprinting* ; Humans ; Infant ; Insulin ; Uniparental Disomy

OBJECTIVE: The study was designed to document the effects of regular drainage after penile vibrator stimulation on the quality of semen in spinal cord injured (SCI) men. METHOD: Three tetraplegics and eight paraplegics, aging from 20 to 39 years with neurological levels of C7 to L4 were examined between 1 and 11 years after injury (mean; 4 years 11 months). None had ejaculated after the injury. Eleven responders to penile vibrator stimulation (PVS) were prospectively examined. We used a vibrator (POWER MASSAGER ) with a frequency of 100 Hz and an amplitude of about 2.0 mm. Stimulations were performed mostly 2~3 times per week. Semen quality was characterized by semen analysis every visits. We compared baseline values with the values of post-treatment 1~3 months. RESULTS: The percentage of motile sperm and the total count of motile sperm per ejaculate were low but increased substantially with treatment. CONCLUSION: We concluded that repeated ejaculation treatment, for at least 1 month, using the vibrator technique improves semen quality in SCI men who have not ejaculated earlier after injury.
Aging ; Drainage ; Ejaculation* ; Humans ; Male ; Prospective Studies ; Semen Analysis ; Semen* ; Spermatozoa ; Spinal Cord Injuries ; Spinal Cord*

Objectives: This study was conducted to determine the incidence and risk factors of myocardial infarction (MI) and stroke in farmers compared to the general population and to establish 5-year prediction models. Methods: The farmer cohort and the control cohort were generated using the customized database of the National Health Insurance Service of Korea database and the National Sample Cohort, respectively. The participants were followed from the day of the index general health examination until the events of MI, stroke, or death (up to 5 years). Results: In total, 734 744 participants from the farmer cohort and 238 311 from the control cohort aged between 40 and 70 were included. The age-adjusted incidence of MI was 0.766 and 0.585 per 1000 person-years in the farmer and control cohorts, respectively. That of stroke was 0.559 and 0.321 per 1000 person-years in both cohorts, respectively. In farmers, the risk factors for MI included male sex, age, personal history of hypertension, diabetes, current smoking, creatinine, metabolic syndrome components (blood pressure, triglycerides, and high-density lipoprotein cholesterol). Those for stroke included male sex, age, personal history of hypertension, diabetes, current smoking, high γ-glutamyl transferase, and metabolic syndrome components (blood pressure, triglycerides, and high-density lipoprotein cholesterol). The prediction model showed an area under the receiver operating characteristic curve of 0.735 and 0.760 for MI and stroke, respectively, in the farmer cohort. Conclusions Farmers had a higher age-adjusted incidence of MI and stroke. They also showed distinct patterns in cardiovascular risk factors compared to the general population.

BACKGROUND: Firefighters are exposed to many dangerous working conditions. Many studies have identified the risk of disease for firefighters, but only a few studies have addressed the medical expenses of firefighters, which represents a concrete scale of disease. Our purpose in this study was to determine the medical expenditures of firefighters to assess the overall scale of disease in Korea. We focused on cancer, mental disorders, cardio-cerebrovascular disease, and musculoskeletal disease, the prevalence of which was expected to be high in firefighters. METHODS: This study utilized National Health Insurance Service data. We targeted firefighters, police officers, and government officials. We classified disease based on the 10th revision of the International Statistical Classification of Diseases and Related Health Problems codes. We compared prevalence by the age-standardized prevalence rate, considering standard distribution of the population. Medical expenditure of disease was defined as outpatient fees, hospitalization fees, and drug costs. Total medical expenditures were calculated by the sum of those 3 categories. RESULTS: The age-standardized prevalence of cancer, mental disorders, and cardiovascular disease in firefighters was slightly higher than or similar to that of government officials and police officers (no significant difference). However, medical expenditures for stomach cancer, mental disorders, and most cardio-cerebrovascular diseases were higher in firefighters than in others. In particular, firefighters spent 12 times more money for ischemic heart disease than did government officials. Of musculoskeletal diseases, lumbar disc disorder had the highest expenditures among firefighters. CONCLUSIONS The age-standardized prevalence of most of diseases of firefighters was not as high as in the other groups, but the medical expenses of firefighters were much higher than those of government officials and police officers.

BACKGROUND: Firefighters are exposed to many dangerous working conditions. Many studies have identified the risk of disease for firefighters, but only a few studies have addressed the medical expenses of firefighters, which represents a concrete scale of disease. Our purpose in this study was to determine the medical expenditures of firefighters to assess the overall scale of disease in Korea. We focused on cancer, mental disorders, cardio-cerebrovascular disease, and musculoskeletal disease, the prevalence of which was expected to be high in firefighters. METHODS: This study utilized National Health Insurance Service data. We targeted firefighters, police officers, and government officials. We classified disease based on the 10th revision of the International Statistical Classification of Diseases and Related Health Problems codes. We compared prevalence by the age-standardized prevalence rate, considering standard distribution of the population. Medical expenditure of disease was defined as outpatient fees, hospitalization fees, and drug costs. Total medical expenditures were calculated by the sum of those 3 categories. RESULTS: The age-standardized prevalence of cancer, mental disorders, and cardiovascular disease in firefighters was slightly higher than or similar to that of government officials and police officers (no significant difference). However, medical expenditures for stomach cancer, mental disorders, and most cardio-cerebrovascular diseases were higher in firefighters than in others. In particular, firefighters spent 12 times more money for ischemic heart disease than did government officials. Of musculoskeletal diseases, lumbar disc disorder had the highest expenditures among firefighters. CONCLUSIONS The age-standardized prevalence of most of diseases of firefighters was not as high as in the other groups, but the medical expenses of firefighters were much higher than those of government officials and police officers.

Cardiovascular Diseases ; Drug Costs ; Fees and Charges ; Firefighters ; Health Expenditures ; Hospitalization ; Humans ; International Classification of Diseases ; Korea ; Mental Disorders ; Musculoskeletal Diseases ; Myocardial Ischemia ; National Health Programs ; Occupational Groups ; Outpatients ; Police ; Prevalence ; Stomach Neoplasms

We experienced a case of Xq deletion -- 46,X,del(X)(q22.3) -- detected by abnormal noninvasive prenatal screening, subsequently diagnosed by amniocentesis. Genetic counseling was a challenge because there are few reports of prenatal diagnosis of Xq deletion. In each female cell, one X chromosome is inactivated at random early in development, and there may be a preferential inactivation of the abnormal X chromosome. But some proportions of genes escape inactivation. The most common manifestation in women with Xq deletion is primary or secondary ovarian failure. Critical regions for ovarian function may be located at the long arm of the X chromosome. But, the onset and the severity of ovarian failure may vary with diverse, intricate factors. We anticipate that noninvasive prenatal screening can identify the broader range of chromosomal or genetic abnormalities with the advances in technology and analytic methods. We report our case with a brief review of the literature.