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

BACKGROUND/AIMS: Early enteral nutrition (EEN) has benefits in reducing infectious complication, length of stay (LOS) and preserving liver function. There are few data about the effect of EEN in the patients who had total gastrectomy. The aim of this randomized and prospective study was to evaluate the effect of EEN after total gastrectomy on nutritional status, liver function, complications and LOS, compared to total parenteral nutrition (TPN) in patients with gastric cancer. METHODS: Among 56 patients with gastric cancer, 36 and 20 were randomly assigned to EEN and TPN groups, and finally 17 and 16 completed EEN and TPN schedules, respectively. The nutritional parameters, liver function, LOS and abdominal symptoms were compared between 2 groups on pre-operative day and post-operative 7th day. RESULTS: There was no significant difference in the nutritional parameters, liver function between EEN and TPN groups. Vomiting and abdominal distention were more frequent in EEN than TPN group (2 vs. 0 cases, p=0.485; 1 vs. 0 case, p=1.000, respectively), while increased AST, ALT and total bilirubin were more common in TPN than EEN group (4 vs. 2 cases, p=0.398; 1 vs. 0 case, p=0.485, respectively without statistical significance). LOS was shorter in EEN than TPN group without statistical significance (12 vs. 13 days, p=0.289). CONCLUSIONS: No significant differences were found in the nutritional status parameters, liver function, complications and LOS between EEN and TPN groups on 7th day after total gastrectomy. Further large scale studies on the advantages and disadvantages of EEN after total gastrectomy are warranted.
Adult ; Aged ; Aged, 80 and over ; Alanine Transaminase/blood ; Aspartate Aminotransferases/blood ; Bilirubin/blood ; *Enteral Nutrition ; Female ; Gastrectomy ; Humans ; Length of Stay ; Male ; Middle Aged ; *Parenteral Nutrition, Total ; Postoperative Care ; Prospective Studies ; Stomach Neoplasms/*surgery

STATEMENT OF PROBLEM: Several prosthetic options are available for the restoration of multiple adjacent implants. A passively fitting prosthesis has been considered a prerequisite for the success and maintenance of osseointegration. Passivity is a particular concern with multiple implants because of documented inaccuracies in the casting and soldering process. One way to avoid this problem is to restore the implants individually, however, the restorations of individual adjacent impants requires careful adjustment of interproximal contacts. PURPOSE: The purpose of this study was to compare the stress distribution pattern and amount surrounding Bicon implants with individual crowns and splinted restorations. MATERIAL AND METHOD: A photoelastic model of a human partially edentulous left mandible with 3 Bicon implants(4*1 mm) was fabricated. For non-splinted restorations, individual crowns were fabricated on 3 abutments (4.0*6.5 mm, 0 degree, 2.0 mm post, Bicon Inc., Boston, USA) After the units were cemented, 4 levels of interproximal contact tightness were evaluated: open, ideal (8 micrometershim stock drags without tearing), medium(40 micrometer), and heavy(80 micrometer). Splinted 3-unit fixed partial dentures were fabricated and cemented to the model. Changes in stress distribution under simulated non-loaded and loaded conditions(7.5, 15, 30 lb) were analyzed with a circular polaricope. RESULTS: 1. Stresses were distributed around the entire body of fin in Bicon implants. 2. Splinted restorations were useful for distribution of stress around implants especially with higher loads. 3. By increasing the contact tightness between the individually restored three implants, the stress increased in the coronal portion of implants. CONCLUSIONS: Ideal adjustment of the contact tightness was important to reduce the stresses around individually restored Bicon implants.
Crowns ; Denture, Partial, Fixed* ; Humans ; Mandible ; Osseointegration ; Prostheses and Implants ; Splints

BACKGROUND: A number of recent reports have described the usefullness of the epidural injection of narcotics for the relief of postoperative pain. Morphine, an micro-receptor agonist, produces strong analgesic effects with side effects. Nalbupine, a micro-antagonist and kappa-agonis, has an analgesic effect comparable to morphine with little side effects. The comparison of side effects and analgesic effects of epidural morphine alone and a combination of nalbuphine and droperidol respectively to morphine were sutudied in cesarean section patients. METHODS: We divided 45 patients into 3 groups utilizing a two-day Boxter infusor in normal saline 100 ml at 2.0 ml/hr: Group M (n = 15) initially a 1 mg bolus 2 mg/day of maintenance morphine. Group M D (n = 15): initially received a 1 mg bolus 2 mg/day of maintenance morphine 1.25 mg/day of maintenance droperidol. Group M N (n = 15): initially received a 1 mg morphine bolus 2 mg/day of maintenance morphine 5 mg/day of maintenance nalbupine. The Analgesic effect was evaluated by a visual analogue scale (0 10) at 30 min, 4 hr, 12 hr and 24 hr postoperatively and the incidence of side effects was observed too. RESULTS: The average VAS scores are below 3 in all groups. In addition, there are no significant changes between groups. There are no significant differences in side effects between groups except sedation of patients is significantly (P< 0.05) high in group M D. CONCLUSIONS: We concluded that the analgesic effect of epidural morphine, morphine with nalbuphine and morphine with droperidol are good in all patients and there is no significant difference even though there is a belief that a combination of nalbuphine or droperidol increases analgesic effects of morphine. Comparing the incidence of side effects in the three groups, the sedative effect of morphine with droperidol is increased significantly over the other two groups.intubation.
Cesarean Section* ; Droperidol* ; Female ; Humans ; Hypnotics and Sedatives ; Incidence ; Infusion Pumps ; Injections, Epidural ; Morphine* ; Nalbuphine* ; Narcotics ; Nausea ; Pain, Postoperative ; Pregnancy ; Pruritus ; Vomiting

Purpose: This study was conducted to review the web-based trauma-education programs for mental-health professionals reported in English and Korean. Methods: A systematic literature search was conducted using the PubMed, CINALH, EMBASE, Cochrane Library, PsycINFO, Web of Science, RISS, KISS, NDSL, US National Library of Medicine, Clinical Research Information Service, and Virginia Henderson International Nursing Library. The database search identified 11,852 articles. The selection of articles involved a three-phase process, in which duplications were identified and, titles and abstracts of retrieved articles were determined according to inclusion criteria, followed by full-text reading of articles identified. Finally, a total of three studies were included in this review, which published in the United States in 2011, 2014, and 2019. One was a pilot randomized controlled trial and two were pre- and post- studies. Only one included nurses as participants. Selected studies were rated for quality assessment using the Risk of Bias tool of Cochrane’s collaboration. Results: Although the specific content of the programs was unknown, they improved mental health professionals' knowledge level, performance confidence, satisfaction, and education-completion rate. Conclusion More well-designed studies are needed of the optimal content for web-based education programs in mediating trauma for a broad spectrum of mental-health professionals.

BACKGROUND: Recently, many cardiac centers have been using aprotinin to reduce operative bleeding in cardiac operations using cardiopulmonary bypass. A variety of reports have confirmed the effectiveness of the drug in cardiac operations. In addition to the operations which could be considered to cause severe operative bleeding such as redo operation, long cardiopulmonary bypass operation and etc, the use of aprotinin is increasing in the field of primary cardiac operations. Varying doses of regimen have been introduced since the first report by Royston et al, and also various opinions on the effectiveness and safeness of the each regimen have been reported. We reviewed our own experience of the full dose aprotinin regimen(Hammersmith regimen) retrospectively. MATERIAL AND METHOD: From October 1994 to February 1998, 40 cases of cardiac operative patients were randomized into two groups: aprotinin group(20 patients) which received a full dose aprotinin regimen and control group(20 patients) which did not receive aprotinin. To evaluate the degree of bleeding decrease, we analysed and compared the amount of postoperative 6 hours and 24 hours bleeding in the each group. To confirm the renal dysfunction, we measured the postoperative creatinine level. RESULT: In the amount of postoperative 6 hours bleeding, a statistically significant bleeding decrease was demonstrated in the aprotinin group compared to the control group(aprotinin group: 186+/-40cc, control group:409+/-69cc, P=0.010). Similar result was observed in the postoperative 24 hours(aprotinin group:317+/-53cc, control group: 671+/-133cc, P=0.024). CONCLUSION: We concluded that full dose regimen of aprotinin can remarkably reduce postoperative bleeding in cardiac operations without significant renal dysfunctions.
Adult* ; Aprotinin* ; Cardiopulmonary Bypass ; Creatinine ; Hemorrhage ; Humans ; Retrospective Studies ; Thoracic Surgery

The aims of this study are to evaluate the quality of hospital food services and the evaluate the quality in selected hospitals trough the use of the questionnaires. A survey of 30 hospital food and nutrition service department was undertaken and detailed information was collected from each, including, surveys of 1,016 patient. Statistical data analysis was completed using the SAS/win 6.11 package for descriptive analysis, t-test chi2-test ANOVA principal component analysis, and cluster analysis and cluster analysis. In the case of patient satisfaction with hospital food and food services, overall satisfaction scores of male and female were 3.54 and 3.45 showing higher levels than the average score(3.00) The aspect of the food and food service which received the lowest ratings by patients was 'meal rounding while dining'. After conduction of factor analysis of variables affecting the patients meal satisfaction 3 groups including the 'menu satisfaction factor', 'service satisfaction factor' and 'nutrition management satisfaction factor' were selected. 3 clusters were categorized by the 'service cluster' 'nutrition management cluster', 'men cluster', and 'menu nutrition service cluster' after conducting a cluster analysis with influencing variables affecting patients meal satisfaction. The overview results of patient satisfaction by cluster were : in the case of the service group, such factors as taste, portion size, dealing with complaints while dining meal rounding while dining should be managed with caution In case of the nutrition management group, such factors as taste, portion size, temperature of the food intake, and dependence on hospital food should be managed with care, In the case of the menu groups, such factors as punctuality of meal times, contaminated substances in meals and serving mistakes, cleanliness of dishes, kindness of the server meal rounding while dining should by particularly managed with importance.
Data Interpretation, Statistical ; Eating ; Female ; Food Service, Hospital ; Food Services* ; Humans ; Male ; Meals ; Patient Satisfaction* ; Portion Size ; Principal Component Analysis ; Surveys and Questionnaires

BACKGROUND: Lymphedma occurs when tissue swelling develops through a failure of lymph drainage in the face of a normal capillary filtration. Little is known about water behavior in lymphedma. OBJECTIVE: Our purpose was to investigate, by means of ultrasound, the distribution of intradermal fluid in patients with lymphedema in response to 2 weeks physical therapy. METHODS: Ten patients with lymphedema were treated by 2 weeks' physical therapy. Before and after 2 weeks' treatment, circumference and ultrasonographic evaluation was done. Ultrasound images were obtained with a 20 MHz scanner. The echogenicity of the dermis and the skin thickness were quantified by in-built image analyzer. RESULTS: Low echogenic pixels showed the most noticeable and consistent change after 2 weeks' physical therapy. CONCLUSION: Ultrasonographic evaluation could be a useful tool in evaluating lymphedema.
Capillaries ; Dermis ; Drainage ; Filtration ; Humans ; Lymphedema* ; Skin ; Ultrasonography ; Water

We report a case of Aspergillus terreus discitis which developed in a patient with acute lymphoblastic leukemia following induction chemotherapy. A. terreus was isolated from sputum, one month earlier, but the physician did not consider it significant at the time. Magnetic resonance imaging study showed the involvement of L3-4, L4-5 and L5-S1 intervertebral discs. Etiology was established by means of histology and culturing a surgical specimen of disc materials. Our patient survived after a surgical debridement and amphotericin B administration with a total dose of 2.0 g. Discitis caused by Aspergillus terreus is a very rare event. A. terreus is one of the invasive Aspergillus species. The pathogenetic mechanism is discussed and the literature is reviewed.
Aspergillosis/surgery ; Aspergillosis/pathology ; Aspergillosis/microbiology* ; Aspergillosis/drug therapy ; Aspergillosis/complications ; Aspergillus/isolation & purification ; Aspergillus/classification ; Journal Article ; Discitis/surgery ; Discitis/pathology ; Discitis/microbiology* ; Discitis/drug therapy ; Human ; Intervertebral Disk/surgery ; Intervertebral Disk/pathology ; Intervertebral Disk/microbiology* ; Leukemia, Lymphocytic, Acute/microbiology ; Leukemia, Lymphocytic, Acute/drug therapy ; Leukemia, Lymphocytic, Acute/complications* ; Lumbar Vertebrae/surgery ; Lumbar Vertebrae/pathology ; Lumbar Vertebrae/microbiology*

No abstract available.
Pneumoconiosis* ; Welding*