PURPOSE: The purpose of this study was to investigate the influencing factors of influenza vaccination in the elderly participating in lifetime transitional health examination. METHODS: This study was a secondary analysis of data collected from lifetime transitional health examination (for 66-year-old people) conducted by the National Health Insurance Corporation (NHIC) from January 1 to December 31, 2008. Questionnaires were received from NHIC to obtain information regarding gender, chronic diseases, health-related behaviors, and ADL. A total of 255,333 participants who responded all the questions in the questionnaire were included in the analysis. Collected data were analyzed by descriptive statistics, chi2 test, and multiple logistic regression. RESULTS: The influenza vaccine coverage rate in 66-year-old people was 66.1%. The influenza vaccine coverage rate was higher in female elders and those with hypertension, diabetes, heart disease or past smoking, and lower in those with stroke, current smoking, drinking, no-exercise or ADL-dependency. CONCLUSION: Strategies for improving the influenza vaccination coverage rate in the elderly are needed. The strategies should give priority to the elderly with current smoking, drinking, and no-exercise, and home visiting programs are needed for the elderly with stroke and ADL-dependency.
Activities of Daily Living ; Aged* ; Chronic Disease ; Drinking ; Female ; Heart Diseases ; House Calls ; Humans ; Hypertension ; Influenza Vaccines ; Influenza, Human* ; Logistic Models ; National Health Programs ; Smoke ; Smoking ; Stroke ; Vaccination* ; Surveys and Questionnaires

This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. THE SPECIFIC OBJECTIVES WERE: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i) FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the medically supervised deliveries, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. STUDY DESIGN: The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum "package" program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and "before and after" surveys were conducted to measure the change. SERVICE INPUT: This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. METHOD OF EVALUATION: a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed. b. Neverthless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the "intergration process" itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltructure, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable. Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. SUMMARY OF FINDINGS: A) PROGRAM EFFECTS AND IMPACT. 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 78% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller. 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) & delivery care (45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregnancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) EFFECTS ON INTERACTIVE LINKAGE. 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in carrying for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, 85-90% of the services provided by the health workers were other than FP/MCH, mainly for immunization such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs. 31%) and for more combined care (45% vs. 23%). C) ORGANIZATION FACTORS (ADMINISTRATIVE INTEGRATIVE ISSUES). 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub-center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwives's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea). 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through planning practice. 2) Goal consensus in FP/MCH should be made among the health workers & administrators, especially to emphasize the need of care of "wanted" child. But there is a long way to go to realize the "real" integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (ii) there should be a health sub-center director who can provide leadership training for managing the integrated program. There is a need for "organizational support", if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the management of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Workers, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.
Abortion, Induced ; Administrative Personnel ; Child ; Child Health ; Chungcheongnam-do ; Cohort Studies ; Community Health Workers ; Consensus ; Contraception ; Cooperative Behavior ; Delivery of Health Care ; Encephalitis ; Family Characteristics ; Family Health ; Family Planning Services* ; Female ; Hand ; Health Personnel ; Health Services ; House Calls ; Humans ; Immunization ; Infant ; Infant Mortality ; Insurance Benefits ; Clinical Trial* ; Jurisprudence ; Korea* ; Leadership ; Live Birth ; Local Government ; Midwifery ; Organization and Administration ; Parturition ; Population Growth ; Postnatal Care ; Pregnancy ; Prenatal Care ; Primary Health Care ; Referral and Consultation ; Social Control, Formal ; Specialization

OBJECTIVE: We attempted to confirm the effects of the combined treatment of medication and parent training on the behavioral problems of referred ADHD children, the maternal behavior, and the parenting stress of their mothers. METHODS: Twenty-four children between the ages of 5 to 11 and their mothers were selected as subjects from Child Psychiatric Clinics of Hanyang University Hospital. Three groups were organized : combined treatment group of medication and parent training(N=6) ; wating list group(N=6) ; and medication only group(N=6). Methylphenidate(0.5-0.7 mg/kg/day) was prescribed for children. Mothers of the combined treatment group of medication and parent training and the wating list group attended the parent training once a week for nine weeks and a booster session 4 weeks later. Treatment outcomes were evaluated by comparing both treatment groups at pre- and post-treatment using the various rating scales. Especially the combined treatment group was followed up after 6 months to evaluate the stability of treatment effects. RESULTS: This study showed greater effectiveness of the combined treatment of medication and parent training relative to the medication only in decreasing the overall behavioral problems of ADHD children and the parenting stress of mothers as well as in increasing the desirable maternal behavior. In addition, these improvements were maintained at 6 month follow-up. CONCLUSION: The combined treatment of medication and parent training facilitated the behavioral improvement of referred ADHD children in several aspects.
Child* ; Drug Therapy ; Follow-Up Studies ; Humans ; Maternal Behavior ; Mothers ; Parenting ; Parents* ; Weights and Measures

BACKGROUND: Although sexuality in old women is important for the quality of life, that has been overlooked due to social indifference. Because the studies for sexuality in old women were lack in Korea, we surveyed sexuality and its influential factors in old women. METHODS: From March to July 2000, we surveyed 115 old women over 60 years with 22 items of questionnaire. Data was gathered through written responses to the questionnaire and one to one interview between doctor and subject. Statistical analysis was done with SPSS ver10.0/PC and its significance was tested by chi square(p<0.05). RESULTS: Mean age of 115 women is 64.84+/-4.54year. There are 80 cases(69.6%) that thought sexuality is important in old women. Sexuality and sexual interest get gradually decreased by aging. Marital state, age of husband, family structure, economic state, sexual interest are statistically significant as the influential factors of sexuality(p<0.05). Sexual satisfaction comes out 35.7%. Age, marital state, family structure, job, economic state, subjective health state, current medication, sexual interest are statistically signifiant as the influential factors of sexual satisfaction(p<0.05). The reasons of decreased sexuality is due to aging process(47.8%), no partner(17.4%), partner problem(14.8%), physical illness(10.4%) and decreased libido. CONCLUSION: We conclude that sexuality in old women is important. Its influential factors are marital state, age of husband, family structure, economic state, sexual interest. Age, marital state, family structure, job, economic state, subjective health state, current medication, sexual interest are statistically signifiant as the influential factors of sexual satisfaction.
Aging ; Female ; Humans ; Korea ; Libido ; Quality of Life ; Sexuality* ; Spouses ; Surveys and Questionnaires

An aneurysm of the innominate artery could compress the tracheal lumen, and this requires special care. Intubation without intensive monitoring and antihypertensive agents could aggravate the hypercapnia and completely rupture the aneurysm. There are few reports on the airway management of tracheal compression that's caused by an innominate artery aneurysm. We report here on a patient who had a severe hypercapnia after endotracheal intubation above the stenotic area of the tracheal compression, which was caused by an artery aneurysm. Permissive hypercapnia was inadvertently enforced without our knowledge, but the patient recovered without any neurologic problems.
Airway Management ; Aneurysm ; Antihypertensive Agents ; Arteries ; Brachiocephalic Trunk ; Humans ; Hypercapnia ; Intubation ; Intubation, Intratracheal ; Rupture

A 74-year-old male patient receiving ventilatory support due to aspiration pneumonia developed bilateral pneumothorax, pneumopericardium, pneumomediastinum, pneumo-retroperitoneum, and subcutaneous emphysema, after manual ventilation while being transferred from the intensive care unit (ICU) to the operating room (OR). These complications were assumed to be secondary to inappropriate manual ventilation of the intubated patient. In addition, it is likely that the possible migration of an already marginally acceptable endotracheal tube (ETT) position during transport was the cause of these complications. Finally, aggravation of a latent pneumothorax might have contributed to these complications.
Aged ; Barotrauma ; Humans ; Intensive Care Units ; Male ; Mediastinal Emphysema ; Operating Rooms ; Pneumonia, Aspiration ; Pneumopericardium ; Pneumothorax ; Subcutaneous Emphysema ; Ventilation

In order to examine the relationship between the number of different foods consumed and nutrient intake, one-day food consumption were surveyed by 24-hour recall from a sample of 287 individuals(20-49 years) living in Daejon City. The number of consumed food items did not include seasonings except red pepper power, sugar, oil, and soybean paste when used in large amounts(DVS). The number, including all seasonings except salt and vinegar(DVSS), was also counted. Of the total subjects, 43.6%(DVS) or 39.0%(DVSS) consumed 18-23 daily different foods with an average of 20.2 or 22.9, respectively. As the DVS increased, daily intakes of total foods and most food groups were elevated. Cereals however were not changed and eggs were decreased with increasing DVS. Energy and nutrient intakes and their mean adequacy ratio(MAR) and index of nutritional quality(INQ) also show positive correlations with DVS. MAR equal to or greater than(> or =) 0.75 was taken as a cut-off point for nutritional adequacy. In that case, the mean INQ was shown to be > or =1. MRI(10) for energy and 9 nutrients and MAR(3) for Ca, vitamin A, and riboflavin were estimated. Form a regression analysis, when MAR(10) was 0.75, the DVS and DVSS were assumed to be 19.6 and 22.2, respectively. And when MAR(3) was 0.75, the DVS and DVSS were assumed to be 31.6 and 34.6, respectively. However the subjects whose MAR(3) was 0.75(0.7-0.8) 23.8(DVS) or 26.6(DVSS) different foods in average, and their mean intakes of energy and all nutrients, except vitamin A, were ranged at 85-100% of the RDA. Of the 74 subjects who consumed DVS> or =24, 24 to 42 numbers took <75% RDA of Fe, Ca, riboflavin, and vitamin A. And five of 7 who consumed DVS> or =32 took > or =125%RDA of protein, which showed concerns of overnutrition in case of DVS> or =32. Form the above results it could be suggested that a daily intake of 24-32(or 28) of DVS or 27-35(or 31) of DVSS was recommendable for an optimal nutritional of all nutrients if the variety of food groups and sufficient intake of vitamin A and calcium were emphasized together.
Calcium ; Capsicum ; Edible Grain ; Daejeon ; Eggs ; Overnutrition ; Ovum ; Riboflavin ; Seasons ; Soybeans ; Vitamin A

BACKGROUND: Emergence agitation (EA) in children after sevoflurane anesthesia is common. The purpose of this study was to compare the incidences of EA between ketamine and thiopental sodium induction in children underwent sevoflurane anesthesia. We also evaluated if a small dose of fentanyl could reduce the incidence of EA. METHODS: The patients who were scheduled for strabismus or entropion surgery were divided into 4 groups. The patients in Groups 1 and 2 were induced anesthesia with ketamine 1.5 mg/kg; those in Groups 3 and 4 were induced with thiopental sodium 5 mg/kg. The patients in Groups 1 and 3 received an injection of fentanyl 1.5 microgram/kg, whereas the patients in Groups 2 and 4 received IV saline of the same volume. Anesthesia was maintained with sevoflurane. The recovery characteristics and EA in recovery room were assessed. RESULTS: The incidence of EA was significantly higher in Groups 2 and 4 and there was no difference between Groups 2 and 4. Group 2 had almost an eleven-fold higher risk of developing EA than did Group 1, and the incidence of EA in Group 4 was sixty-nine-fold higher than that of Group 1. The risk factor for EA was only the kind of medication. Preoperative anxiety had no significant correlation with EA. CONCLUSIONS: The incidence of EA after sevoflurane anesthesia is similar between ketamine and thiopental sodium anesthetic induction in children undergoing pediatric ophthalmic surgery. Also, the addition of a small dose of fentanyl after anesthetic induction decreases the incidence of EA.
Anesthesia ; Anxiety ; Child ; Dihydroergotamine ; Entropion ; Fentanyl ; Humans ; Incidence ; Ketamine ; Methyl Ethers ; Recovery Room ; Risk Factors ; Strabismus ; Thiopental

BACKGROUND: Emergence agitation (EA) in children after sevoflurane anesthesia is common. The purpose of this study was to compare the incidences of EA between ketamine and thiopental sodium induction in children underwent sevoflurane anesthesia. We also evaluated if a small dose of fentanyl could reduce the incidence of EA. METHODS: The patients who were scheduled for strabismus or entropion surgery were divided into 4 groups. The patients in Groups 1 and 2 were induced anesthesia with ketamine 1.5 mg/kg; those in Groups 3 and 4 were induced with thiopental sodium 5 mg/kg. The patients in Groups 1 and 3 received an injection of fentanyl 1.5 microgram/kg, whereas the patients in Groups 2 and 4 received IV saline of the same volume. Anesthesia was maintained with sevoflurane. The recovery characteristics and EA in recovery room were assessed. RESULTS: The incidence of EA was significantly higher in Groups 2 and 4 and there was no difference between Groups 2 and 4. Group 2 had almost an eleven-fold higher risk of developing EA than did Group 1, and the incidence of EA in Group 4 was sixty-nine-fold higher than that of Group 1. The risk factor for EA was only the kind of medication. Preoperative anxiety had no significant correlation with EA. CONCLUSIONS: The incidence of EA after sevoflurane anesthesia is similar between ketamine and thiopental sodium anesthetic induction in children undergoing pediatric ophthalmic surgery. Also, the addition of a small dose of fentanyl after anesthetic induction decreases the incidence of EA.
Anesthesia ; Anxiety ; Child ; Dihydroergotamine ; Entropion ; Fentanyl ; Humans ; Incidence ; Ketamine ; Methyl Ethers ; Recovery Room ; Risk Factors ; Strabismus ; Thiopental

Adult ; Bone Development ; Connective Tissue ; Humans ; Male ; Membranes ; Osteogenesis ; Rabbits