A survey was conducted to study perception and attitudes of health workers towards health centers activities and organization of health services, from August 15 to September 30, 1994. The study population was 310 health workers engaged in seven urban health centers in Taegu City area. A questionnaire method was used to collect data and response rate was 81.3 percent or 252 respondents. The following are summaries of findings: Profiles of study population: Health workers were predomina1itly female(62.3%); had college education(60. 3%); 'and held medical and nursing positions(39.6%), technicians(30.6%) and. public health/administrativc positions(29.8%). Perceptions on health center's resources: Slightly more than a half(51.1%) of respondents expressed that physical facilities of the centers are inadequate; equipments needed are short(39.0%); human resource is inadequate(44.8%); and health budget allocated is insufficient(38.5%) to support the performance of health center's activities. Decentralization and health services: The majority revealed that the decentralization of government system would affect the future activities of health centers(51.9%) which may have to change. However, only one quarter of respondents(25.4%) seemed to view the decentralization positively as they expect that it would help perform health activities more effectively. The majority of the respondents(78.6%) insisted that the function and organization of the urban health centers should be changed. Target workload and job satisfaction: A large proportion (43.3%) of respondents felt that present target setting systems for various health activities are unrealistic in terms of community needs and health center's situation while only 11.1 percent responded it positively; the majority(57.5%) revealed that they need further training in professional fields to perform their job more effectively; more than one third(35.7%) expressed that they enjoy their professional autonomy in their job performance; and a considerable proportion (39.3%) said they are satisfied with their present work. Regarding the personnel management, more worker (47.3%) perceived it negatively than positive(11.5%) as most of workers seemed to think the personnel management practiced at the health centers is not fair or justly done. Health services rendered: Among health services rendered, health workers perceived the following services are most successfully delivered; they are, in order of importance, Th controi, curative services, and maternal and child health care. Such areas as health education, oral health, environmental sanitation, and integrated health services are needed to be strengthening. Regarding the community attitudes towards health workers, 41.3 percent of respondents think they are trusted by the community they serve. New areas of concern identified which must be included in future activities of health centers are, in order of priority, health care of elderly population, home health care, rehabilitation services, and such chronic diseases control programs as diabetes, hypertension, school health and mental health care. In conclusion, the study revealed that health workers seemed to have more negative perceptions and attitudes than positive ones towards organization and management of health services and activities performed by the .urban health centers where they are engaged. More specifically, the majority of health workers studied revealed to have the following areas of health center's organization and management inadequate or insufficient to support effective performance of their health activities: Namely, physical facilities and equipments required are inadequate; human and financial resources are insufficient; pefsonnel management is unsatisfactory; setting of service target system is unrealistic in terms of the community needs. However, respondents displayed a number of positive 'perceptions, particularly' to those areas as further training needs 'and implementation of decentralization of government system which will bring more autonomy of local government as they perceived these change would bring the necessary changes to future activities of the health center. They also displayed positive perceptions in their job autonomy and have job satisfactions.
Aged ; Budgets ; Child ; Child Health ; Chronic Disease ; Daegu ; Surveys and Questionnaires ; Delivery of Health Care ; Health Education ; Health Priorities ; Health Services ; Humans ; Hypertension ; Job Satisfaction ; Local Government ; Mental Health ; Nursing ; Oral Health ; Personnel Management ; Politics ; Professional Autonomy ; Rehabilitation ; Sanitation ; School Health Services ; Urban Health*

The determination of motor nerve conduction velocity is an important part to electrodiagnosis. Its value as neurophysiologic investigative procedure has been known for many years, and recently it has been utilized as a chinical diagnostic technic. Its most valuable role is differentiating between those conditions which affect the axon primarily and those which affect the anterior horn cell. Many factors such as temperature in the vicinity of the nerve, diameter of the axon, degree of myelinization, age of the patient, local environment of the nerve and intensity of electrical stimulation have been demonstrated to affect the rate of propagation of impulses along motor fibers. Pathologic conditions affecting the axon usually alter the excitability along involved segments and, therefore, result in reduced conduction velocity. The purpose of this study was to determine the normal data of the motor nerve conduction velocities of median, ulnar, tibial and peroneal nerves in Korean. 1. The motor nerve conduction velocities of median, ulnar, peroneal and tibial nerves were 61.54±6.95 (46.7–94.2) m/sec, 61.74±7.28 (45.6–95.0)m/sec, 48.80±5.54 (38.8–69.9) m/sec, 47.39±4.85 (36.2–64.2 m/sec respectively. 2. The condition velocity in the upper extremities has been found 13.5 m/sec faster than in the lower extremities. 3. A significant decline in motor nerve conduction velocities was noted in the over 60 year old age group. 4. There were significant differences between the sexes.
Anterior Horn Cells ; Axons ; Electric Stimulation ; Electrodiagnosis ; Humans ; Lower Extremity ; Myelin Sheath ; Neural Conduction ; Peroneal Nerve ; Tibial Nerve ; Upper Extremity

BACKGROUND: Catheterization of central vein may cause fetal complications such as cardiac arrhythmia, cardiac temponade, atrial perforation etc. For prevention of these complications, tip of central venous catheter should located in superior vena cava. The purpose of this study was to investigate the optimal positioning of central venous catheters. METHOD: From March 1996 to Jun 1996, a total of 50 patients who requiring central venous catheters were involved. First, we evaluate the accuracy of predetermined formula of 'Peres'. Second, we hypothesized that height of patients was correlated with optimal length of central venous catheters and we analysed relationship between height and optimal length of central venous catheters using simple regression analysis by SAS. RESULTS: 1) Predetermined formula of 'Peres' inaccurately predicted required length of central venous catheter. The accuracy was 78%. 2) There were a linear relationships between height and optimal length of central venous catheter. Their relationships was followed, Y=0.09X(Y: optimal length of central venous catheters, X: height, p=0.0001, R2=0.39). CONCLUSION: Using height of patients, we can accurately predict the optimal length of central venous catheters.
Arrhythmias, Cardiac ; Catheterization ; Catheters ; Central Venous Catheters* ; Humans ; Veins ; Vena Cava, Superior

Tissue temperatures were measured by a thermistor-thermometer, at suprachoroid, inner retinal surface and intravitreous portion (1mm deep), during diathermy applications on the scleral surfaces of rabbit eyes. Castroviejo's Electro-surgical Ophthalmic unit Model S-5 was used and power intensity(current) was fixed to 2, and diathermy was applied on the sclera 3mm, 2mm, and 1mm from and above the measuring points. Measurements were performed in the following groups: Group 1: Spark gap power 2. duration of application 2 sec. Group 2: Spark gap power 2. duration of application 3 sec. Group 3: Spark gap power 3. duration of application 2 sec. Group 4: Spark gap power 3. duration of application 3 sec. Maximum rise of temperature was 20.0 degrees C at suprachoroid, 16.8 degrees C at inner retinal surface and 6.6 degrees C at vitreous in Group 4. Temperature rise in vitreous was much lower than that in suprachoroid and inner retinal surface (table II, which revealed percentage of average rise per tissue temperature before diathermy). Highest measuring temperature at inner retinal surface in this experiment was under 60 degrees C, at which vitreous collagen fibrils may coagulate.
Collagen ; Diathermy* ; Retinaldehyde ; Sclera

Kawasaki disease (KD) is an immune-mediated disease which is a leading cause of acquired cardiovascular disease in developed country. Recently, tumor necrosis factor-alpha (TNF-alpha) blocker, infliximab has been considered a promising option for patients with refractory KD. Although chronic use of a TNF-alpha blocker could increase risk of opportunistic infections, a few studies have documented that use of infliximab was safe without serious adverse effects in patients with KD. We observed serious bacterial infection after infliximab treatment in an infant with refractory KD. Our patient was a 5-month-old male infant diagnosed with KD who did not respond to repeated doses of intravenous immunoglobulin. We effectively treated him with a single infusion of infliximab (5 mg/kg), but gram-negative (Acinetobacter lwoffii) septicemia developed after infliximab infusion. Therefore, we report a case of serious septicemia after treatment with infliximab, and suggest considering the risk of severe infection when deciding whether to prescribe infliximab to an infant with refractory KD.
Bacterial Infections ; Cardiovascular Diseases ; Developed Countries ; Humans ; Immunoglobulins ; Infant* ; Male ; Mucocutaneous Lymph Node Syndrome* ; Opportunistic Infections ; Sepsis* ; Tumor Necrosis Factor-alpha ; Infliximab

PURPOSE: To evaluate the usefulness and safety of unified technique of vascular control before renal exposure in reconstructive surgery of renal trauma. MATERIALS AND METHODS: From July 1995 to June 1997, 10 patients with major renal trauma who operated by unified approach technique were included in this study. Blunt trauma was the mechanism of injury in 8 patients and 2 were resulted from penetrating(stab) injury. Of the injuries 2 were grade 3, 7 grade 4, 1 grade 5. RESULTS: Of the 10 patients, 8(80%) were performed kidney preserving surgery and 2(20%) resulted in nephrectomy. Partial nephrectomy was underwent in 6 patients(with vascular repair in 2 cases) and renorrhaphy in 2 patients. Pedicle flap of omentum was used mainly and polyglycolic acid mesh also used in 2 cases as coverage material of parenchymal defect. Complications occurred in 2 cases(20%) but none resulted in renal loss with the mean followup of 10 months(1 to 15 months). CONCLUSIONS: Unified approach technique of vascular control before renal exposure seems to be a safe and effective method for reconstructive surgery in renal trauma. To confirm this result, studies with more cases and longer followup are needed.
Follow-Up Studies ; Humans ; Kidney* ; Nephrectomy ; Omentum ; Polyglycolic Acid

BACKGROUND: The number of patients of doxylamine overdose has increased, but there were little clinical reports. The purpose of this study is review the patients of doxylamine overdose for aid clinical decision making of patients disposition. METHODS: We reviewed medical records of patients who ingested doxylamine succinate retrospectively from Jan. 1, 1996 to Dec. 31. 1996. Data that was recorded were followed: age, sex, psychiatric history, amounts of ingestion, time interval from ingestion to arrival to hospital, initial vital signs and symptoms, EKG, chest PA, Lab. findings, treatment, patients disposition, length of hospital stay, complication. RESULTS : 1) Total number of patients was ninety and average dosage of ingestion was 1062mg. 2) Tachycardia was the most frequent anticholinergic symptom(46%). 3) Routine lab. findings was not abnormal except one patient who was diagnosed as Rhabdomyolysis. 4) Gut decontamination was performed in patients who had arrived at hospital in 2-3 hours, and who had ingested large dose of drug. 5) Five patients were admitted to Psychiatric dept. and one patient was admitted to emergency dept. for treatment of rhabdomyolysis. 6) The mean duration of hospital stay was 6.5 hours. CONCLUSION: The patients who ingested overdose of doxylamine was managed safely in emergency department, but we should warn against the possibility of rhabdomyolysis.
Decision Making ; Decontamination ; Doxylamine* ; Eating ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Humans ; Length of Stay ; Medical Records ; Retrospective Studies ; Rhabdomyolysis ; Succinic Acid* ; Tachycardia ; Thorax ; Vital Signs

BACKGROUND: Tetanic spasm is often noted in hyperventilating patients coming in to emergency departments. Classical explanation far this phenomenon was decreased ionized calcium levels due to respiratory alkalosis precipitated by the hyperventilation. Clinically these symptoms were observed in hypocalcemia and were thought as such without doubt. But clinical investigation on the levels of ionized calcium levels have not been clarified. Recent investigations on hyperventilating volunteers have suggested other pathophysiology for tetanic spasm in hyperventilating patients which is the decrement of ionized magnesium level rather than ionized calcium. We wanted to see if these results applied to our hypeventilating patients and see if ionized magnesium level was a factor producing tetanic symptoms. METHOD AND MATERIAL : 35 patients with diagnosis of hyperventilation syndrome by emergency physician were studied retrospectively. Hyperventilating patients arriving at Severance hospital Emergency Center from Jan.1996 to Feb. 1998 were included. Patients with cardiovascular, pulmonary diseases, history of renal or liver disease were excluded. Ion-selective method was used to detect ionized calcium, magnesium levels and arterial blood gas features. Average levels were compared to reference ranges and Wilkoxon-rank. sum test was used to compare hyperventilating patients with tetanic spasm and those with other symptoms such as dyspnea, chest pain and palpitations. RESULTS: 1) Sodium, potassium and chloride levels were 138mmol/L, 3.6mmo1/L, 106mmol/L each which were within a normal range. 2) Degrees of hyperventilation were similar with average of PH 7.54(7.4-7.71), pCO2 23.6mmHg, showing respiratory alkalosis. 3) Ionized calcium and ionized magnesium each showed 0.61mg/dL, 0.16mg/dL lower values than the lowest reference ranges which were 4.5-5.6mg/dL for ionized calcium and 1.19-1.63 for ionized magnesium. 4) No statistical difference points were observed between the tetanic spasm group and group without spasm. Female preponderance were noted in tetanic spasm group. CONCLUSION: We conclude that ogler than decrement of ionized calcium, decrement of ionized magnesium could be a factor far inducing tetanic spasm in respiratory alkalosis caused by hyperventilation.
Alkalosis, Respiratory ; Calcium* ; Chest Pain ; Diagnosis ; Dyspnea ; Emergencies ; Emergency Service, Hospital ; Female ; Humans ; Hydrogen-Ion Concentration ; Hyperventilation* ; Hypocalcemia ; Liver Diseases ; Lung Diseases ; Magnesium* ; Potassium ; Reference Values ; Retrospective Studies ; Sodium ; Spasm ; Volunteers

No abstract available.
Adenoma* ; Colorectal Neoplasms*

PURPOSE: To estimate the incidence and risk of significant renal injury quantitatively in the admitted patients with abdominal trauma. MATERIALS AND METHODS: From January 1992 to July 1997, 511 patients who admitted to departments of urology and general surgery due to major abdominal trauma with and without renal injury were included in this study. The risk of renal injury was defined as the percentage of square of Abbreviated Injury Scale of kidney in the Injury Severity Score(ISS) per each patient. The patients were classified to 5 groups according to the causes of trauma as traffic accident, falls, assault, other blunt and stab Injury, then compared the incidence and risk of renal injury each other. RESULTS: The overall incidence of significant renal injury was 14.9%, and the incidence according to the causes was 27.0%,20.8%, 16.1%, 14.3% and 10.7% in falls, assault, stab injury, other blunt and traffic accident, respectively. The overall risk of significant renal injury estimated by ISS was 15.7% and the risk according to the causes was 26.7%,24.9%, 11.9%,9.9% and 4.9% in assault, falls, traffic accident, other blunt and stab injury, respectively Mean ISS in the patients with renal injury was markedly higher than that of the patients without renal injury(27.5 vs 13.6)(p < 0.01). CONCLUSIONS: Our study shows that both the incidence and risk of significant renal injury in the admitted patients with abdominal trauma can be expected in the probability of 15% or so, and according to the causes, those in the traumatized patients by the assault and falls mark high.
Abbreviated Injury Scale ; Accidents, Traffic ; Humans ; Incidence* ; Injury Severity Score ; Kidney ; Urology