PURPOSE: This study was conducted to discover the related factors of neonatal suckling in the initiation of breastfeeding in primiparous mothers and to provide basic data for promoting nursing intervention strategies to improve the practice of breastfeeding. METHOD: The subjects of this study were 71 primiparous mothers who had normal vaginal deliveries at one obstetric hospital in P metropolitan city and one delivery center in J city. The collected data was analyzed using the SPSS program. RESULT: The average IBFAT (Infant Breastfeeding Assessment Tool) score was 9.6+/-2.3. The general characteristics studied that had a significant influence on neonatal suckling in the initiation of breastfeeding were the place of delivery (ex: Hospital, Postnatal Unit), whether oxytocin was used, no usage of analgesic medication, amount of satisfaction after the first breastfeeding weight of the newborns and the Apgar score at one minute. CONCLUSIONS: A higher IBFAT score was related to primiparous mothers who had a hospital delivery, received oxytocin, received maternal labour analgesics, neonatal weight, Apgar score at one minute, and satisfaction after the first breastfeeding.
Analgesics ; Apgar Score ; Breast Feeding* ; Humans ; Infant, Newborn ; Mothers* ; Nursing ; Oxytocin

A 24-year-old woman was seen for evaluation of an skin lesion on thiright nipple. Examination revealed a solitary 1.5 x 1cm-sized, erythematous, oozing, eroded andruted, verrucous nodule on the right nipple. A small amount of serous discharge was found but there was no pain or tenderness. Histopathologic findings showed cystic invaginations extending down vard from the epidermis and papillary projections extending into the lumina of the invagination. Pupiae were lined by two rows of cells. In stroma, there were marked inflammatory infiltrates containing any plasma cells. The overlying dermis showed an adenomatous growth pattern with a prolifertion of round, oval or irregular shaped ducts and fibrotic stroma.
Adenoma* ; Cytochrome P-450 CYP1A1 ; Dermis ; Epidermis ; Female ; Humans ; Nipples* ; Plasma Cells ; Skin ; Young Adult

To find the medical insurance utilization of workers when suffering from low back pain, an analysis was made toward the data of medical insurance benefits matched with the general characteristics of 10,183 workers, who were registered continuously from 1993 to 1995 at a medical insurance cooperation for industrial workers. The results were as follows; 1. The period prevalence of the medical insurance utilization for low back pain for 3 years from 1993 to 1995 was calculated as 17.1% for male workers and 19.4% for female workers. Most common cause of utilization was other dorsopathies including the herniation of lumbar discs. 2. The utilization rate increased significantly as the present age and the age joining the company got older(p<0.001). As the duration of employment got longer, the utilization rate of the male showed the tendency to increase and that of the female increased significantly(p<0.05). Among male workers employed at cement and concrete manufacturing companies showed higher utilization rate and among female laborers showed significantly higher utilization rate than clerical workers(p<0.01). 3. Annual utilization rate for low back pain didn't show any difference, but the portion of other dorsopathies among cause of utilization showed the tendency to increase from 1993 to 1995. 4. The mean number of claims for outpatient medical care for low back pain differed significantly by age, working duration, type of industries, income level(p<0.05), and the mean of total visiting days for care of low back pain differed siginificantly by working duration. In conclusion, considering the fact that the medical insurance utilization for low back pain increased annually and other dorsopathies including the herniation of dorsopathies were increasing, an effective preventive or management program for low back pain toward worker employed at industries were required.
Employment ; Female ; Humans ; Insurance Benefits ; Insurance* ; Low Back Pain* ; Male ; Outpatients ; Prevalence

PURPOSE: The purpose of this study was to validate the Needs Assessment Tool for Case Management (NATCM) for use with Korean medical aid beneficiaries. METHODS: Psychometric testing was performed with a sample of 645 Korean medical aid beneficiaries, which included 41 beneficiaries who were selected using proportional sampling method, to examine intraclass correlation coefficients (ICC). Data were evaluated using item analyses, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), Cronbach's alpha, and ICC. RESULTS: Through psychometric testing the final version of NATCM was found to consist of two subscales: 1) Appropriateness of Health Care Utilization (5 items) and 2) Self Care Ability (6 items). The two subscale model was validated by CFA (RMSEA=.08, GFI=.97, and CFI=.93). Internal consistency measured by Cronbach's alpha was .82, and subscale reliability ranged from .79 to .84. The ICC of the NATCM between case managers was .73 and between case managers and health care professionals. .82. CONCLUSION: This study suggests that the final version of NATCM is a brief, reliable, and valid instrument to measure needs of Korean medical aid beneficiaries. Therefore, the NATCM can be effectively utilized as an important needs assessment as well as outcome evaluation tool for case management programs in Korea.
Activities of Daily Living ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Case Management ; Female ; Health Status ; Humans ; Male ; Middle Aged ; *Needs Assessment ; Pain Management ; Psychometrics ; Questionnaires ; Republic of Korea ; Social Support

BACKGROUND: Chronic idiopathic thrombocytopenic purpura is an autoimmune disorder caused by sequestration of antibody-sensitized platelets in the reticuloendothelial system. However, uncertainty as to the specificity, frequency and clinical significance of such antibodies still remains. So, we tried to further clarify the above uncertainty in childhood chronic idiopathic thrombocytopenic purpura. METHODS: We analyzed sera from 29 patients. Twenty six patients were chronic ITP who were admitted or followed up to the Department of Pediatrics, Severance Hospital, Yonsei University Medical College from August 1996 to March 1997 by employing a modified antigen-capture ELISA(MACE), flow cytometry and electrophoresis(SDS-PAGE) and immuno-blotting(IB) assays. Three patients with ITP less than 6 months after onset of ITP were included to know the possibility to differrentiate between acute ITP and chronic ITP in this study. RESULTS: 1) Glycoprotein(GP)-specific antibodies were found in 28% (8/29) of patients, with 2 patients having antibodies directed solely to Gp II b/III a, no patients holding antibodies specific only for GPI b/I X and 6 possessing antibodies against both anti-GP I b/I X and Gp II b/III a antigen. 2) The detection rate of GP-specific antibodies of flow cytometry was about 10%. The positivity of anti-GPI b/I X antibodies by MACE and immunoblotting was 14% (4/29), respectively, the positivity of anti-Gp II b/III a antibodies by MACE and immunoblotting was, 21 % (6/29) respectively. The concordance rate between two assays(MACE and IB) was 79% (23/29). None of the three methods was good enough to stand alone. 3) Serum antibodies were not more frequently detected in active(p=1.0) or non-splenectomized(p=.54) chronic ITP patients. 4) No association was found between antibody specificity(anti-GPI b/I X, anti-Gp II b/ III a) and platelet counts(p : .87). CONCLUSION: We conclude that in korean childhood chronic ITP, antibodies against both anti-GPI b/I X and Gp II b/III a antigen were predominant antibody. But, the longterm follow-up in more cases is needed to further clarify the clinical significance of antral-platelet antibody in chronic ITP should be assessed.
Antibodies* ; Blood Platelets* ; Flow Cytometry ; Follow-Up Studies ; Humans ; Immunoblotting ; Mononuclear Phagocyte System ; Pediatrics ; Purpura, Thrombocytopenic, Idiopathic* ; Sensitivity and Specificity ; Uncertainty

Penicillin resistance in Streptococcus pneumoniae has increased sharply within the past few years and extended-spectrum cephalosporins haute been recommended for the empiric therapy of bacterial meningitis. However, therapeutic failure are being reported with increasing frequency due to extended-spectrum cephalosporin-resistant strains. We report two cases of meningitis caused by S. pneumoniae resistant to penicillin and cefotaxime. Both patients were recovered after ceftriaxone and vancomycin treatment, but one of them was left with neurological sequelae because of a delay in the institution of an antibiotic therapy appropriate for resistant pneumococci. This report indicates that extended-spectrum cephalosporin-resistance must be considered In all clinical isolates of S. pneumoniae and in vitro susceptibility testings should be performed promptly and accurately to detect antibiotic resistance.
Cefotaxime ; Ceftriaxone ; Cephalosporins ; Drug Resistance, Microbial ; Humans ; Meningitis* ; Meningitis, Bacterial ; Penicillin Resistance ; Penicillins ; Pneumonia ; Streptococcus pneumoniae* ; Streptococcus* ; Vancomycin

BACKGROUND: The nationwide tuberculosis registry system in Korea has been operated with the dual reporting system - public health center (PHC) and private medical services (PMS) - since 2000. While three-fifths of the registered cases in 2002 was reported by PMS, it was reported that the success rate of patients at PMS was lower than that at PHC. To identify the problems of the patients' management at the PMS as well as the PHC in a community is the aim of this paper. METHODS: The subject was selected from the registered cases of the pulmonary tuberculosis in Jejudo, 2002. The needed items for this study were gathered by the reviewing the medical charts directly. METHODS: Of the 262 patients included in the subject, 92 cases (35%) were treated initially at PMS. The sputum smear as an essentially diagnostic test was carried out with 69.2% at private clinics compared with 98.2% at PHC. The success rate of the treatment at PMS was 59.8% so that it had a statistically significant difference from that at PHC (80.0%; p<0.01). CONCLUSION: These results showed that there were several problems in diagnosis and treatment for the patient of pulmonary tuberculosis at PMS. To improve the success rate of the treatment at PMS, the nationwide clinical guideline for control of pulmonary tuberculosis should be systematically disseminated and strongly recommended at PMS by the government.
Diagnosis ; Diagnostic Tests, Routine ; Humans ; Jeju-do* ; Korea ; Private Practice ; Public Health ; Sputum ; Treatment Outcome ; Tuberculosis ; Tuberculosis, Pulmonary*

OBJECTIVES: The most common chromosomal abnormality contributing to recurrent abortion is the balanced chromosomal translocation. However the exact incidence of fetal losses are still unknown. The objectives of this study were to evaluate the incidence of fetal chromosomal abnormalities and outcome of pregnancy in recurrent miscarriage couples with balanced translocation. DESIGN: A retrospective analysis of recurrent spontaneous abortion patients with balanced chromosomal translocation. MATERIALS AND METHODS: Cytogenetic analysis was performed in 56 couples with history of recurrent abortions from 1995 to 1999. The use of high resolution banding technique and fluorescent in situ hybridization (FISH) in the chromosomal analysis has made the precise evaluation of chromosome aberrations. RESULTS: Among 56 couples, 42 patients had reciprocal translocation and 14 had Robertsonian translocation. Chromosomal aberrations were more frequent in women (36 cases) than in men (20 cases). Prenatal cytogenetic analyses were carried out in 14 subsequent pregnancies for carrier couples with balanced translocation. The fetal karyotypes showed that 5 cases (35.7%) was normal, 8 (57.1%) were balanced translocation, and 1 (7.1%) was unbalanced translocations. And cytogenetic analyses were done on 15 subsequent chorionic villi samples of abortuses for carrier couples with balanced translocations. Fourteen of fifteen abortuses (93.3%) were abnormal karyotype. CONCLUSIONS: Although the incidence of chromosomal imbalance in the fetuses was relatively low in prenatal cytogenetic analysis, individuals with balanced translocations are predisposed to giving birth to malformed offsprings with chromosomal imbalance (partial trisomy or monosomy). Therefore we recommend preimplantation genetic diagnosis (PGD) for recurrent abortions with balanced translocation and preventing the birth of offspring with chromosomal abnormalities.
Abnormal Karyotype ; Abortion, Habitual* ; Abortion, Spontaneous ; Chorionic Villi ; Chromosome Aberrations* ; Cytogenetic Analysis ; Family Characteristics* ; Female ; Fetus ; Humans ; In Situ Hybridization, Fluorescence ; Incidence* ; Karyotype ; Male ; Parturition ; Pregnancy ; Preimplantation Diagnosis ; Retrospective Studies ; Translocation, Genetic ; Trisomy

From January 1984 to June 1991, we studied testicular relapsed patients among 105 cases of acute lymphocytic leukemia in children who were admitted to the Department of Pediatrics and Yonsei Cancer Center, Yonsei University Severance Hospital. The results were as follows: 1) 15 out of 105 (14.4%) cases of acute lymphocytic leukemia were diagnosed as testicular relapse. According to the prevalence by the age groups, there were no patient under 2 years old, 14 out of 73 (19.4%) in 2~9 years old and 1 out of 26 (3.8%) over 10 years old groups. 2) At initial diagnosis of acute lymphocytic leukemia there were significant correlation between testicular relapse and initial lymphadenopathy (p=0.09), but not with WBC count, hemoglobin level, platelet count, hepatomegaly and splenomegaly. 3) Mean duration to testicular relapse from initial diagnosis of acute lymphocytic leukemia was 3.1+/-1.7 years. 4) Among 15 patients, 7 cases combined with bone marrow or central nervous system relapse. Their survival rate was lower than isolated testicular relapse groups. 5) The 5 years survival rate of testicular relapsed patients was 67% after the combinations of chemotherapy, radiotherapy and orchiectomy.
Bone Marrow ; Central Nervous System ; Child ; Child, Preschool ; Diagnosis ; Drug Therapy ; Hepatomegaly ; Humans ; Lymphatic Diseases ; Orchiectomy ; Pediatrics ; Platelet Count ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Prevalence ; Radiotherapy ; Recurrence* ; Splenomegaly ; Survival Rate

Paraffin embedded sections of 64 breast carcinomas were stained immunohistochemically using a commercially available monoclonal antibody to estrogen receptor. To improve the sensitivity of the staining, the authors used a Pronase enzyme pretreatment, biotinylated antibody to rat IgG as secondary antibody, streptavidin-alkaline phosphatase as tertiary reagent and fast red as chromogen. When compared to the results of estrogen receptor enzyme immunoassay, this method yielded an 85.9% concordance rate, 86.2% specificity and 85.7% sensitivity. When compared to estrogen receptor immunocytochemistry(ER-ICA) in frozen section and considering the inherent advantages of immunohistochemical staining over biochemical assay, the major advantages of this method are good morphology, suitability for retrospective study and reduced cost of staining due to dilution of expensive primary antibody. Thus, this method offers an alternative to ER assay using fresh tissue and should provide additional valuable information about estrogen receptor
Adult ; Aged ; Breast Neoplasms/*metabolism ; Carcinoma/*metabolism ; Comparative Study ; Female ; Human ; Immunoenzyme Techniques ; Middle Aged ; Paraffin Embedding ; Prognosis ; Receptors, Estrogen/*analysis ; Sensitivity and Specificity ; Support, Non-U.S. Gov't