BACKGROUND: White coat effect (WCE) and white coat hypertension (WCH) are relatively prevalent in clinical situation (20 - 57% of WCH in the hypertensive population). The aim of this study was to analyze the determinant factors of WCE. METHODS: A prospective study was carried out in outpatient clinic in a consecutive hypertensives without receiving pharmacologic treatment. Twenty-four hour ambulatory blood pressure monitoring (ABPM) was performed following more than two resting blood pressure (BP) determinations carried out with the interval of 1 - 2 weeks by mercury sphygmomanometer. WCE was calculated for systolic and diastolic BP as the difference between a clinic BP (CBP) and an average daytime ambulatory BP (ABP). WCH was defined as;BP in the clinic > or = 140/90 mmHg with a mean daytime BP by ABPM < or =137/< or =89 mmHg. RESULTS: 1) Two hundred thirty-five patients (mean age 49.7 years, females 74%) were studied. Thirty-seven percent in male and forty-six percent in female patients fulfilled WCH criteria. 2) CBP was significantly correlated to daytime ABP (systolic BP;r=.47, p<.001 and diastolic BP;r=.65, p<.001). 3) The magnitude of WCE was greater in the group of WCH (28.9+14.6/19.3+6.9 mmHg) than ambulatory hypertensives (15.1+15.7/13.0+8.2 mmHg) (p<.001). 4) The magnitude of WCE is significantly correlated with female (r2=.12, p<.001) and the stage of CBP according to JNC-V (r2=.23, p<.001) in systolic BP, the stage (r2=.08, p<.001) in diastolic BP, and the stage (r2=.09, p<.001) and weight (r2=.15, p<.01) in mean BP. CONCLUSIONS: The magnitude of WCE in essential hypertension diagnosed at the clinic is significantly correlated with female, the magnitude of clinic BP, and weight.
Ambulatory Care Facilities ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Female ; Humans ; Hypertension* ; Male ; Prospective Studies ; Sphygmomanometers ; White Coat Hypertension

No abstract available.
Dentures*

No abstract available.
Animals ; Epidermal Growth Factor* ; Gene Expression* ; Gonadotropin-Releasing Hormone* ; Pituitary Adenylate Cyclase-Activating Polypeptide* ; Rats*

OBJECTIVE: Our purpose was to investigate the relationship between the levels of IL-6 and tumor necrosis factor-alpha in the peritoneal fluid(PF) of women with and without endometriosis and infertile women. Design: Prospective and case-control study. Setting: University hospital. Patients: Twenty-nine women with laparotomy or laparoscopic findings of minimal to severe endometriosis, and twenty-eight women with no visual evidence of pelvic endometriosis and with benign gynecologic disease. Main Outcome Measures: PF IL-6 and tumor necrosis factor-alpha levels were determined using commercial ELISA. IL-6 and tumor necrosis factor-alpha concentrations were compared among women with and without endometriosis, and with infertile and fertile women, and then also compared according the revised American Fertility Society classification. RESULTS: IL-6 and tumor necrosis factor-alpha concentrations were higher than in the PF of women with endometriosis than in matched normal controls. Cyclic variations in IL-6 concentrations were seen in PF from patients with endometriosis: the concentrations in the secretory phase were significantly higher than those in the proliferative phase. IL-6 concentrations were higher than in the PF among of infertile women than in fertile women. A significant correlation between PF IL-6 and tumor necrosis factor-alpha concentrations and endometriosis stage III and IV was noted. CONCLUSIONS: Increased PF levels of IL-6 and tumor necrosis factor-alpha in patients with endometriosis may be relate to endometriosis-associated infertility and to the pathogenesis of endometriosis suggesting that partially contribute to the disturbed immune regulation observed in patients with endometriosis.
Ascitic Fluid* ; Case-Control Studies ; Classification ; Endometriosis* ; Enzyme-Linked Immunosorbent Assay ; Female ; Fertility ; Genital Diseases, Female ; Humans ; Immunity, Cellular* ; Infertility ; Interleukin-6 ; Laparotomy ; Outcome Assessment (Health Care) ; Prospective Studies ; Tumor Necrosis Factor-alpha

The purpose of this study was to investigate the effects of a nutrition education and personalized lunch service program in a senior welfare center. A total of 30 elderly (14 males, 16 females) aged 62~89 years participated in this study. Nutrition education lessons (2 hour/lesson/week) were provided for 4 weeks. Also, ten weeks from week 3rd to week 12th, personalized lunch providing 1/3 personal needed energy was served 5 times for a week. After the nutrition intervention program, we compared anthropometric characteristics, blood biochemical characteristics, nutrition knowledge, dietary attitude and dietary intake using 24 hr recall with those before the intervention. The body weight (p < 0.001) and body mass index (BMI) (p < 0.001) were decreased. There were significant increases in score of nutrition knowledge (p < 0.01) and consumption of milk & milk products for snacks. There was a positive effect on fasting blood sugar (FBS) showing significant decreases in portion of impaired fasting glucose and diabetes mellitus (p < 0.05). Also, serum triglyceride (TG) was significantly decreased (p < 0.05). In evaluation of nutrient intake by Dietary Reference Intakes for Koreans (KDRIs), riboflavin (p < 0.01), vitamin C (p < 0.001), calcium (p < 0.05) were positively improved. The index of nutritional quality (INQ) and intakes of vitamin C (p < 0.001), riboflavin (p < 0.05), Ca (p < 0.01) and Fe (p < 0.05) were increased. In conclusion, this nutrition education and lunch service program providing 1/3 personal needed energy can be used to develop and implement a tailored nutritional intervention programs in the setting of a community senior welfare center to improve health and nutritional status of Korean elderly.
Aged ; Ascorbic Acid ; Blood Glucose ; Body Mass Index ; Body Weight ; Calcium ; Diabetes Mellitus ; Fasting ; Glucose ; Humans ; Lunch ; Male ; Milk ; Nutritional Status ; Nutritive Value ; Riboflavin ; Snacks

Ethical problems in an emergency department (ED) are much more common than is usually recognized. But these difficult ethical dilemmas have not been dealt with by general medical ethicists. Most medical ethics guidelines tend to concentrate on chronic or at least relatively stable situations rather than on the acute, episodic cases that are typical in the ED. most ethical problems such as abortion, euthanasia, and professionalism can be solved after reflection and deliberation, and after a process of communication that reveals the values and interests of the patient or the patient's family. In contrast, when health care professionals in the ED recognize ethical problems, they often don't have enough time for an ethical consultation such as a Hospital Ethics Committee. Ethical principles such as autonomy, beneficence, nonmaleficence, and justice need to be applied to the unique setting of emergency medicine. Hence, it is necessary to develop ethics guidelines in emergency medicine and ethics education for health care professionals in emergency departments. At first, we collected cases involving ethical problems and reviewed the ethical and legal aspects of those cases. In this article, we summarize the ethical issues in emergency medicine, deal with actions in emergency medical services, and also consider the relationships between ethical issues and act on emergency medical services. We want to present the important factors that should be considered in ethical decision making within an emergency medicine department including patient decision making capacity, legal custody, and ethical principles.
Beneficence ; Decision Making ; Delivery of Health Care ; Emergencies ; Emergency Medical Services ; Emergency Medicine ; Ethicists ; Ethics Committees, Clinical ; Ethics, Medical ; Euthanasia ; Humans ; Jurisprudence ; Social Justice

PURPOSE: We report on a modified four-corner bladder neck suspension using a manufactured Tension-free Vaginal Tape (TVT) carrier for moderate-degree cystocele, with a simultaneous TVT procedure, for stress urinary incontinence (SUI). MATERIALS AND METHODS: The operation was performed in 21 SUI patients with moderate cystocele. Seven patients were operated on under local anesthesia, and the others under general anesthesia. Two incisions were made over the suprapubic area, and a midline incision over the anterior vaginal wall for the TVT procedure. For cystocele repair, bilateral parallel incisions were made over both the lateral vaginal walls. Through the lateral incisions, a dissection was carried out to expose the vesicopelvic fascia. Then a Gore-Tex suture was placed on each side. Each suture incorporated the entire vaginal wall, excluding the epithelium, cardinal ligament and pubocervical fascia. We made two pinholes at the end of the TVT carrier for the suture materials to be threaded through. Using the TVT carrier, each thread was transferred to the ipsilateral suprapubic incisions through the retropubic space. Each side of the ligature was tied together under the subcutaneous space, and the TVT procedure completed. RESULTS: Mean operation time and hospitalization days were 75+/-24 minutes and 3.3+/-2.19 days, respectively. The cystocele was fully corrected in 19 patients (90.5%), and diminished to grade I in 2. There were no significant operative or postoperative complications, including bladder perforations or retropubic hematomas, etc. CONCLUSIONS: It is suggested that the repair of cystocele and incontinence, using a TVT device, is an effective treatment for moderated cystocele, with a simple technique, low morbidity and high cure rate.
Anesthesia, General ; Anesthesia, Local ; Cystocele* ; Epithelium ; Fascia ; Hematoma ; Hospitalization ; Humans ; Ligaments ; Ligation ; Neck ; Polytetrafluoroethylene ; Postoperative Complications ; Suburethral Slings* ; Sutures ; Urinary Bladder ; Urinary Incontinence

No abstract available.
Oocytes* ; Pregnancy* ; Spermatozoa*

The purpose of this study was to investigate utilization and storage management practice of the frozen and refrigerated foods in school foodservice. 222 dietitians employed in school foodservice were surveyed. In school foodservice, the refrigerated stock farm products and seafoods (78.3%) were more used rather than frozen products (47.5%). According to school foodservice characteristics, the refrigerated meats including dairy products were more frequently used in elementary and middle schools than high school foodservice. On the other hand, the foodservice in high school used more frozen seafoods and processed foods than elementary school did. The data also showed a tendency for the contracted foodservice using more frozen meats and seafoods rather than refrigerated products when comparing with the self-operated foodservice. In terms of receiving conditions, storage methods and storage time, the result indicated that frozen or refrigerated products were often delivered at inappropriate temperature. Especially some products which were needed to be shipped and stored at refrigerated temperature such as mollusks, were delivered and kept at room temperature. The most frequently used thawing method were running water (56.9%), however, the frozen products were often sitted at room temperature for the purpose of thawing. According to the results, several inappropriate handling processes for frozen and refrigerated products were found in school foodservice. In order to improve handling process for frozen and refrigerated products, recognition of food handlers' weakness about storage and distribution, development of radical standards for receiving conditions, storage and thawing methods should be debated.
Dairy Products ; Hand ; Humans ; Meat* ; Mollusca ; Nutritionists ; Running ; Seafood* ; Ships ; Water

PURPOSE: The purpose of this study was to develop extracurricular coaching programs to improve communication skills and leadership for nursing students and evaluate the effects of the programs. METHODS: The 8-week extracurricular coaching program was developed based on the Joo, Whitmore and Hong models. A quasi-experimental design was used. The subjects were selected by two full-time nursing professors training students at one university in city G. The subjects were chosen from among the advisees of these two professors. Of the students who participated in this study, 29 were in the experimental group and 27 were in the control group. Data was analyzed through t-test and Mann Whitney U-test. RESULTS: The experimental group showed significantly higher post-test scores in communication skills, communication as a nursing outcome, observation of communication, leadership, and leadership as a nursing outcome than those of the control group. However, the experimental group did not reveal significantly higher post-test scores in the number of leadership activities using a portfolio than those of the control group. CONCLUSION: This extracurricular coaching program can help cultivate important, basic grounding as well as achieve nursing student learning outcomes upon graduation.
Humans ; Leadership* ; Learning ; Nursing ; Students, Nursing*