Despite modern society's advancement in health care, family members remain the primary long term caregivers of individuals with chronic disease and disability. Recently, there has been growing interest in difficulties families experience providing care for a person with a brain injury. Because family members play a critical role in the long-term neurorehabilitation, reducing family members' careburden is very important for a patient as well as their family members. Therefore, understanding about family issues in neurorehabilitaiotn is necessary for health professionals who meet and treat them. This study investigated what is the most common issue which family members of neurorehabilitation patients, using the checklist about difficulties of family experience after a brain injury. The family members of 111 neurorehabilitation inpatients reported their experience about difficulties of caring patients. Five major family issues in neurorehabilitation are needs of clear explanation of the patient's condition and prognosis, financial problem, fear of recurrence, needs of information about social services and needs of information about community resource. Social isolation, frustration due to decreased personal time, increased stress and decreased quality of life, patient's poor motivation of treatment, patient's changed personality, adjustment problem after discharged from hospital are also family concerned about. Interventions designed to meet family caregivers' needs in these issues should be implemented. Recommendations for family support services are offered.
Brain Injuries ; Caregivers ; Checklist ; Chronic Disease ; Delivery of Health Care ; Frustration ; Health Occupations ; Humans ; Inpatients ; Motivation ; Prognosis ; Quality of Life ; Recurrence ; Social Isolation ; Social Work

BACKGROUND: Type 2 diabetes is usually preceded by a long and clinically silent period of increasing insulin resistance. The purpose of this study is to demonstrate that rosiglitazone and metformin fixed-dose combination therapy (RSG/MET) will safely and effectively control glycemia as a first line of oral therapy, better than rosiglitazone (RSG) or metformin (MET) monotherapy in Korean type 2 diabetes patients. METHODS: This study was a 32-week, multicenter, randomized, double-blind study. Twenty-seven type 2 diabetes patients (males 14; females 13) were included and randomly divided into the rosiglitazone, metformin group, or rosiglitazone /metformin combination groups. The primary objective of this study was to determine the change in HbA1c from baseline (week 0) to week 32. The secondary end-points were to determine changes in fasting plasma glucose (FPG) and homeostasis model assessment insulin resistance (HOMA-IR), from baseline to week 32. Other cardiovascular risk markers were also assessed. RESULTS: At week 32, there were significant reductions in HbA1c and FPG, in all three treatment groups. There was no statistical difference in HbA1c among the three groups, but the decrease in FPG in the RSG/MET group was statistically significant compared to the MET group (P < 0.05). RSG/MET significantly reduced HOMA-IR at week 32 compared to baseline, but there was no difference among the three groups. RSG/MET significantly decreased high-sensitive C-reactive protein (hs-CRP) value at week 32, compared to baseline. There were increases in adiponectin from baseline to week 32 in the RSG and RSG/MET groups, and the increase in the RSG/MET group was statistically significant compared to that of the MET group (P < 0.05). At week 32, there was a significant decrease in plasminogen activator inhibitor-1 (PAI-1) in all three treatment groups, but no statistically significant difference among them. The RSG/MET group significantly decreased in terms of urinary albumin-creatinine ratio at week 32, compared to baseline. CONCLUSIONS: In this study, rosiglitazone and metformin combination therapy was effective in glycemic control as an initial therapy, and it improved cardiovascular risk markers in Korean type 2 diabetes patients.
Adiponectin ; C-Reactive Protein ; Diabetes Mellitus, Type 2 ; Double-Blind Method ; Fasting ; Female ; Glucose ; Homeostasis ; Humans ; Insulin Resistance ; Metformin ; Plasma ; Plasminogen Activators ; Thiazolidinediones

In connective tissue diseases, autoantibodies cause pulmonary interstitial inflammation and fibrosis, and patients require treatment with an immunosuppressive agent such as a steroid. Dermatomyositis is an incurable, uncommon form of connective tissue disease that occasionally causes diffuse pulmonary inflammation leading to acute severe respiratory failure. In such cases, the prognosis is very poor despite treatment with high-dose steroid. In the present case, a 46-year-old man was admitted to our hospital with dyspnea. He was diagnosed with dermatomyositis combined with cryptogenic organizing pneumonia (COP) with respiratory failure and underwent treatment with steroid and an immunosuppressive agent, but the COP was not improved. However, the respiratory failure did improve after treatment with intravenous immunoglobulin, which therefore can be considered a treatment option in cases where steroids and immunosuppressive agents are ineffective.
Autoantibodies ; Connective Tissue Diseases ; Cryptogenic Organizing Pneumonia* ; Dermatomyositis* ; Dyspnea ; Fibrosis ; Humans ; Immunoglobulins* ; Immunosuppressive Agents ; Inflammation ; Lung Diseases, Interstitial ; Middle Aged ; Pneumonia ; Prognosis ; Respiratory Insufficiency ; Steroids

BACKGROUND: Obese type 2 diabetic subjects are recently increasing in Korea, indicating the importance of insulin resistance rather than insulin secretory defects in the pathophysioloy of type 2 diabetes. The purpose of this study is to evaluate the safety and efficacy of fixed dose rosiglitazone/metformin combination therapy in poorly controlled subjects with type 2 diabetes mellitus. METHODS: 12 type 2 diabetic subjects who had a HbA1c > 11% or fasting plasma glucose > 15 mmol/L were included. After a 2 week screening period, the subjected took the fixed does rosiglitazone/metformin for 24 weeks. The treatment with rosiglitazone/metformin began at week 0 with an initial dose of 4 mg/1000 mg and, unless tolerability issues arose, subjects would be increased to 6 mg/1500 mg at week 4 and at week 8 to the maximum dose of 8 mg/2000 mg. The primary object of this study was to characterize the magnitude of HbA1c reduction from baseline after 24 weeks of rosiglitazone and metformin treatment in poorly controlled type 2 diabetics. RESULTS: The mean age of the subjects was 48.9 +/- 10.6 years old, body mass index was 25.0 +/- 3.5 kg/m2, HbA1c was 12.0 +/- 1.0%, and fasting plasma glucose was 16.3 +/- 3.1 mmol/L. HbA1c was reduced to 7.54 +/- 1.45% and fasting plasma glucose reduced to 7.96 +/- 2.38 mmol/L at week 24. The proportion of HbA1c responder who showed the reduction from baseline of > or = 0.7% or HbA1c < 7% was 11 among 12 subjects (91.7%). 41% of the subjects (5 among 12 subjects) achieved HbA1c level < 7.0% and 75% (9 among 12 subjects) achieved HbA1c level < 8.0%. CONCLUSIONS: In this study, rosiglitazone and metformin combination therapy was effective in glycemic control in poorly controlled subjects with type 2 diabetes mellitus.
Body Mass Index ; Diabetes Mellitus, Type 2 ; Fasting ; Glucose ; Insulin ; Insulin Resistance ; Korea ; Mass Screening ; Metformin ; Plasma ; Thiazolidinediones

BACKGROUND: Specific IgE responses to allergens provide useful models for evaluating the genetic factors that control human immune responses. HLA class II gene products are involved in the antigen presentation of exogenous antigens. OBJECTIVE: The aim of this study was to evaluate whether susceptibility or resistance to asthma induced by the citrus red mite (Panonychus citri, CRM) was associated with HLA class II gene-encoded antigens. METHODS: Peripheral venous blood samples were collected from two groups of unrelated Korean adults. Ninety-one patients with citrus red mite-induced asthma and 98 exposed, healthy control subjects. The second exon of the HLA-DRB1 genes was selectively amplified by the polymerase chain reaction method. HLA typing was carried out using PCR-sequence specific oligonucleotide probes(PCR-SSOP). RESULTS: The frequency of HLA-DR7 was significantly higher among the CRM-sensitive asthmatics than among the controls (17.6% vs 4.1%, RR=3.92, p=0.01). Conversely, the frequency of HLA-DR4 was significantly lower among the CRM-sensitive asthmatics than among the controls(19.8% vs 40.8%, RR=0.36, p=0.01). No significant difference was found in the distributions of the other HLA-DRB1 gene-encoded antigens between the two groups. CONCLUSION: HLA-DRB1 genes may be involved in the development of citrus red mite-induced asthma. In addition, HLA-DR7 may increase, and DR4 decrease, the risk of developing asthma in exposed individuals.
Adult ; Allergens ; Antigen Presentation ; Asthma* ; Citrus* ; Exons ; Genes, MHC Class II ; Histocompatibility Testing ; HLA-DR Antigens ; HLA-DR4 Antigen ; HLA-DR7 Antigen ; HLA-DRB1 Chains ; Humans ; Immunoglobulin E ; Mites* ; Polymerase Chain Reaction

PURPOSE: B cell-activating factor (BAFF) is a tumor-necrosis factor (TNF) superfamily member best known for its role in the survival and maturation of B cells. BAFF activity is observed in naive cells as well as in effector/memory T cells. We aimed to explore whether BAFF in sputum is expressed at elevated levels in asthmatic airways and associated with eosinophilic inflammation, pulmonary function, and bronchial hyperresponsiveness in children. METHODS: One hundred and fifty-four asthmatic children and 98 healthy children were enrolled in the study. Sputum supernatants were collected and sputum BAFF and eosinophil cationic protein (ECP) levels were measured. We performed pulmonary function tests and methacholine challenge tests, while measuring total eosinophil count, total serum IgE, and serum ECP in all subjects. RESULTS: Asthmatic children had significantly higher levels of BAFF in induced sputum [26.50 (10.50-100.27) pg/mL] compared to healthy children [18.32 (7.68-44.63) pg/mL; P=0.011]. Sputum BAFF positively correlated with sputum eosinophils (gamma=0.406, P<0.001) and sputum ECP (gamma=0.789, P<0.001). Significant negative correlations were found between sputum BAFF and FEV1 (gamma=-0.291, P<0.001) or post-bronchodilator FEV1 (gamma=-0.334, P<0.001), whereas nonsignificant correlations were found between sputum BAFF and bronchial hyperresponsiveness, serum eosinophil count, and serum ECP. CONCLUSION: These findings suggest that BAFF may play a role in childhood asthma, and BAFF levels in sputum could be a supportive marker that represents airway inflammation, especially eosinophilic inflammation.
Asthma ; B-Lymphocytes ; Child ; Eosinophil Cationic Protein ; Eosinophils ; Humans ; Immunoglobulin E ; Inflammation ; Methacholine Chloride ; Pneumonia ; Respiratory Function Tests ; Sputum ; T-Lymphocytes

PURPOSE: The prevalence and morbidity of asthma, allergic rhinitis and atopic dermatitis are increasing worldwide. The International Study of Asthma and Allergies in Childhood (ISAAC) was a standardized method to evaluate the prevalence of these diseases, and to compare it between countries. Using the standardized protocol, proposed by ISAAC Steering Committee, the prevalence of allergic diseases in Korean children was reported in 1995 and 2000. In this study, we aimed to evaluate the prevalence and changing patterns of morbidity of allergic diseases in Korean children for recent 10 years. METHODS: From October 2006 to November 2006, Korean ISAAC written questionnaires were completed by the parents of 37,365 children attending 438 elementary schools in Seoul and 14 provinces. The questionnaires consisted of the questions about wheezing, rhinitis and eczema. RESULTS: The prevalences of "wheeze, ever", "wheezing, last 12 months", "diagnosis of asthma, ever" and "treatment of asthma, last 12 months" were 10.53%, 4.7%, 7.81% and 2.51%, respectively. The prevalences of "rhinitis, ever", "rhinitis, last 12 months", "diagnosis of allergic rhinitis, ever" and "treatment of allergic rhinitis, last 12 months" were 37.7%, 32.8%, 27.94% and 21.44%, respectively. And prevalences of "itchy eczema, ever", "itchy flexural eczema, last 12 months", "diagnosis of atopic dermatitis, ever" and "treatment of atopic dermatitis, last 12 months" were 20.99%, 15.91%, 28.22% and 13.91%, respectively. CONCLUSION: From the results of this study, the prevalence of asthma decreased slightly compared to previous studies. In contrast, the prevalences of allergic rhinitis and atopic dermatitis are still increasing in Korean children in 2006.
Asthma ; Child ; Dermatitis, Atopic ; Eczema ; Humans ; Hypersensitivity ; Korea ; Parents ; Prevalence ; Surveys and Questionnaires ; Respiratory Sounds ; Rhinitis ; Rhinitis, Allergic, Perennial

PURPOSE: To determine the magnetic resonance imaging (MRI) findings in patients with traumatic thoracic aortic injury and to assess the usefulness of MRI for the diagnosis of aortic injury. MATERIALS AND METHODS: Between May 1990 and June 2000, sixteen patients with blunt thoracic aortic injury underwent MRI. The findings were evaluated with regard to the type of aortic injury, aortic circumference, the size, direction and shape of the pseudoaneurysm, the intimal flap, and pseudocoarctation. Six patients underwent follow-up MRI, and any changes in the findings were assessed. RESULTS: MRI indicated that traumatic thoracic aortic injury comprised localized pseudoaneurysm in 15 patients and extensive aortic dissection in one. The aortic circumference was partially involved in all cases. Pseudoaneurysms were located at the aortic isthmus in 16 cases and the descending thoracic aorta in one. Two patients each had two lesions: two pseudoaneurysms in one, and aortic dissection and pseudoaneurysm in the other. The mean diameter and length of the pseudoaneurysms was 2.8+/-0.8 cm (mean+/-SD) and 3.3+/-1.0 cm (mean+/-SD), respectively. Their direction was anteromedial or anterolateral in 15 cases and posterolateral in two. All were saccular shaped. An intimal flap was present in seven cases and pseudocoarctation was demonstrated in ten. Follow-up MRI revealed changes in the size of a pseudoaneurysm or the length of an aortic dissection. CONCLUSION: The most common finding demonstrated by MRI in patients with traumatic thoracic aortic injury was an anteromedially-directed saccular pseudoaneurysm in the aortic isthmus. This modality was considered useful for evaluation of the entire aorta in cases of multiple pseudoaneurysms or aortic dissection.
Aneurysm, False ; Aorta ; Aorta, Thoracic ; Diagnosis ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging*

In connective tissue diseases, autoantibodies cause pulmonary interstitial inflammation and fibrosis, and patients require treatment with an immunosuppressive agent such as a steroid. Dermatomyositis is an incurable, uncommon form of connective tissue disease that occasionally causes diffuse pulmonary inflammation leading to acute severe respiratory failure. In such cases, the prognosis is very poor despite treatment with high-dose steroid. In the present case, a 46-year-old man was admitted to our hospital with dyspnea. He was diagnosed with dermatomyositis combined with cryptogenic organizing pneumonia (COP) with respiratory failure and underwent treatment with steroid and an immunosuppressive agent, but the COP was not improved. However, the respiratory failure did improve after treatment with intravenous immunoglobulin, which therefore can be considered a treatment option in cases where steroids and immunosuppressive agents are ineffective.
Autoantibodies ; Connective Tissue Diseases ; Cryptogenic Organizing Pneumonia ; Dermatomyositis ; Dyspnea ; Fibrosis ; Humans ; Immunoglobulins ; Immunosuppressive Agents ; Inflammation ; Lung Diseases, Interstitial ; Middle Aged ; Pneumonia ; Prognosis ; Respiratory Insufficiency ; Steroids

Dental Occlusion ; Humans ; Incidence ; Mandibular Fractures ; Medical Records ; Molar ; Molar, Third ; Retrospective Studies ; Risk Factors