BACKGROUND: To assess the efficacy of functional electrical stimulation(FES) with multi-joints coordinate movement compared to electric muscular stimulation for mono-joint movement in enhancing the upper extremity motor and functional recovery of hemiplegic survivors. METHODS: Forty patients with hemiplegia were divided into two groups. The FES group received FES to produce hand grip, elbow flexion, elbow extension and hand release in sequence with voluntary movement. Control group received electrical stimulation to produce wrist extension without voluntary movement. All groups received for 20 minutes per session, twice a day, 5 days a week during 4 weeks and under the same occupational and physical therapies during 4 weeks. Outcomes were assessed in a blinded manner with the upper extremity component of the Fugl-Meyer Motor Assessment, the self-care component of the Modified Barthel Index(MBI), Upper extremity muscle strength, Wolf Motor Function Test(WMFT), spasticity, and Range of motion(ROM) of shoulder before and after treatment. RESULTS: There were significant improvements of the power at shoulder & elbow flexion, WMFT, Fugl-Meyer, hand grip, and MBI in both group(p<0.05). ROM of shoulder, the power of wrist extension, and pinch improved only at the FES group(p<0.05). The FES group had better effects at WMFT, Fugl-Meyer, hand grip, pinch, MBI, shoulder ROM, and spasticity after treatment(p<0.05). CONCLUSION: This study showed that FES and multi-joints coordinate movements are better than electric muscular stimulation for mono-joint movement to enhance the upper extremity functional recovery in hemiplegia.
Arm ; Elbow ; Electric Stimulation ; Hand ; Hand Strength ; Hemiplegia ; Humans ; Muscle Spasticity ; Muscle Strength ; Muscles ; Self Care ; Shoulder ; Upper Extremity ; Wolves ; Wrist

Since patients who have suffered from strokes have chronic health problems, the development of a protocol for home care nursing is required. Therefore, this study was done to test the effects of such a protocol on stroke patients. This study was conducted by using a single group pre-post design. The subjects for the study were 13 home care nurses and 30 home care patients who had a stroke. Data collection was done from October 1997 to February 1998. The collected data was analyzed using the Wilcoxon signed rank test and paired t-test and the results were as follows : 1. The first hypothesis that "working satisfaction of home nurses would be higher after using the home care protocol" was supported. 2. The second hypothesis that "patients" satisfaction would be higher after using the home care protocol" was rejected. 3. The third hypothesis that "the level of ADL of patients would be higher after using the home care protocol" was supported. In conclusion, by using a home care protocol, the satisfaction of nurses' work and the ADL of patients increased, and the patients' satisfaction also increased without statistical significance. The above results confirm that the application of a home care protocol is very effective. Thus, this protocol can be helpful in the quality care of stroke patients. Therefore, developing and organizing protocols, according to health problem, can be useful for beginner nurses who interact with high risk patients.
Activities of Daily Living ; Data Collection ; Home Care Services* ; Humans ; Nurses, Community Health ; Nursing Care* ; Nursing* ; Stroke*

PURPOSE: The purpose of this study was to investigate the welfare status of nurses and the status of fixed night shifts and flexible work arrangements in both general hospitals and advanced general hospitals in Korea. METHODS: A total of 167 hospitals participated in this study, done from April to October 2018. RESULTS: There were 103 hospitals utilizing the fixed night shift system, 22 in the two-shift system, 3 in the fixed holiday shift, 79 in the fixed shift system, and 39 in the short-time working system. The average welfare benefits for nurses increased to 33.02 million won on average. However, welfare services for the nurses were poor: 41.8% of the respondents had a nurses' lounge, 81.7% were given dormitory space at their place of employment, 41.8% had access to welfare facilities, and 56.4% were provided with welfare support countermeasures. CONCLUSION: The results show an increasing trend of hospitals to utilize fixed night shift and flexible work arrangements. An institutional strategy at the national policy level should be established to implement flexible work arrangements including the fixed night shift system, which has a poor level of welfare.
Employment ; Holidays ; Hospitals, General ; Korea ; Surveys and Questionnaires

PURPOSE: Malnutrition and failure to thrive have long been recognized as common systemic consequences of congenital heart disease(CHD). But there is little data about the prevalence and severity of malnutrition with CHD in Korea. We designed this study to determine the prevalence of malnutrition among hospitalized children with CHD. METHODS: We reviewed 100 hospitalized children with CHD who were randomly selected from consecutive admissions at department of pediatrics and thoracic surgery of Asan Medical Center from Jul. 1998 to Jun. 1999. A cross-sectional, retrospective study was done. Acute malnutrition was determined by calculating a ratio of the children's weight to the mean weight for the children's height. Chronic malnutrition was assessed by obtaining a ratio of the children's height to the mean height for the children's age. According to these criteria, malnutrition is divided into mild, moderate, and severe categories. RESULTS: Acute and chronic malnutrition occurred in 39% and 31% of the children, respectively. Age, diagnosis, and symptoms were analysed with the presence of the malnutrition. Forty nine percent of infants diagnosed as suffering from acute malnutrition, and cyanosis appear to be the ones the most severely important factor(P<0.001). Cyanotic children with pulmonary hypertension are the ones most severely affected(P<0.001). Acute or chronic malnutrition occurred in more than 44% of children with cyanosis and/or congestive heart failure but in only 11% of children with neither(P<0.001). CONCLUSION: Malnutrition in CHD is relatively high. We suggest nutritional screening and intervention for the children with CHD should be considered.
Child ; Child Nutrition Disorders* ; Child, Hospitalized ; Chungcheongnam-do ; Cyanosis ; Diagnosis ; Failure to Thrive ; Heart ; Heart Defects, Congenital* ; Heart Failure ; Humans ; Hypertension, Pulmonary ; Infant ; Korea ; Malnutrition* ; Mass Screening ; Pediatrics ; Prevalence ; Retrospective Studies ; Thoracic Surgery

PURPOSE: To reduce the side effects and improve the effectiveness of standard chemoradiation therapy, many complementary or alternative medicines have been tried. However, little is known about its immunologic effects in breast cancer patients. The aim of this study was to assess the immunologic effects of mistletoe extract (Viscum album L., VAE) in patients with early breast cancer after surgery followed by standard adjuvant chemoradiation therapy. METHODS: A total 20 patients with early breast cancer treated with breast conserving surgery followed conventional chemoradiation therapy. Ten of these patients received subcutaneous injections of VAE for 7 weeks. IL-2, IL-4, IL-6, IL-10, TGF-beta, and IFN-gamma levels in serum samples were measured in all patients. RESULTS: The concentrations of IL-2, IL-4, IL-10, and TGF-beta were not significantly changed between before and after VAE treatment in both test and control group. The concentration of IL-6 in the test group was increased from 8.19+/-1.75 pg/mL to 9.86+/-1.46 pg/mL after treatment (p=0.013). The concentration of IFN-gamma in the test group was remarkably increased from 91.76+/-17.16 pg/mL to 167.42+/-66.61 pg/mL after treatment (p=0.009). CONCLUSION: Significant increases in the concentration of IL-6 and IFN-gamma were observed after VAE treatment. These results suggest that VAE treatment can stimulate immune responses, especially cell-mediated immunity in immune-compromised patients received the chemoradiation for breast cancer.
Breast ; Breast Neoplasms ; Humans ; Immunity, Cellular ; Injections, Subcutaneous ; Interleukin-10 ; Interleukin-2 ; Interleukin-4 ; Interleukin-6 ; Mastectomy, Segmental ; Mistletoe ; Transforming Growth Factor beta

PURPOSE: Although eosinophilia is a common laboratory finding in many neonatal intensive care units (ICUs), its causative mechanisms remain obscure. We aimed to determine the causes of eosinophilia in the neonatal ICU environment. METHODS: Serial eosinophil counts were determined weekly for 288 hospitalized, appropriately grown neonates. Infants were divided into four groups according to gestational age, and the incidence and etiologic factors of eosinophilia were retrospectively studied. RESULTS: Absolute eosinophilia (>700/mm3) was documented in 18% (52/288) of neonates. Twenty-two infants (42.3%) exhibited mild eosinophilia (700-999 cells/mm3), 27 (51.9%) exhibited moderate eosinophilia (1,000-2,999 cells/mm3), and 3 (5.8%) exhibited severe eosinophilia (>3,000 cells/mm3). Of the 288 infants studied, 54 suffered sepsis. Thirty of these 54 infants (55.6%) showed eosinophilia, and 22 out of the remaining 234 infants (9%) without sepsis showed eosinophilia, indicating that eosinophilia was more prevalent in the sepsis group (P <0.05). All 5 infants suffering from bronchopulmonary dysplasia showed eosinophilia, and 47 out of the remaining 283 infants (16.7%) without bronchopulmonary dysplasia showed eosinophilia. Thus, eosinophilia was more prevalent in the bronchopulmonary dysplasia group (P <0.05). Furthermore, increased prevalence of eosinophilia was associated with respiratory distress syndrome, ventilator use, blood transfusion, and total parenteral nutrition (P <0.05). CONCLUSION: Our results suggest that eosinophilia is influenced by sepsis and bronchopulmonary dysplasia, although it can also occur idiopathically at birth. Moreover, the potential role of eosinophils in conditions such as wound healing and fibrosis in sepsis or chronic lung disease may be a cause of eosinophilia.
Blood Transfusion ; Bronchopulmonary Dysplasia ; Eosinophilia ; Eosinophils ; Fibrosis ; Gestational Age ; Humans ; Incidence ; Infant ; Infant, Newborn ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal ; Lung Diseases ; Parenteral Nutrition, Total ; Parturition ; Prevalence ; Retrospective Studies ; Sepsis ; Stress, Psychological ; Ventilators, Mechanical ; Wound Healing

BACKGROUND: The hypotensive effects of muscle relaxants has traditionally been associated with a ganglion block and histamine release. However, it was exhibited that the ability of certain analogues of the steroidal muscle relaxant directly caused relaxation of isolated vascular smooth muscles. The ability of mivacurium to elicit a direct relaxant effect on vascular smooth muscle has been studied using isolated rat thoracic aortic rings contracted with phenylephrine (PE). METHODS: Each ring of the thoracic aorta was suspended on wire supports in a 20 ml tissue bath under 2 gm of resting tension. All tissues were bathed in a Tris Tyrode solution at 37oC and 100% oxygen was supplied. RESULTS: Mivacurium 3 X 10 5 M and 10 3 M inhibited PE induced contractions of the aortic rings significantly (P < 0.05) and shifted the cumulative concentration-effect curves of PE to the right. The maximum contractile response from 81.9% to 55.0% (with PE 10 6 M) was the same as that seen with mivacurium 10 3 M pretreatment. Relaxation of aortic ring with mivacurium 10 3 M was not reversed with L-NAME pretreatment. Methylene blue reversed the relaxation of the aortic rings with mivacurium 10 3 M and shifted the cumulative concentration-effect curve of PE to the left. Indomethacine enhanced the relaxation of the aortic rings with mivacurium 10 3 M and shifted this curve to the right. Mivacurium 10 3 M inhibited the influx of extracellular Ca2+. CONCLUSIONS: The results suggest that the relaxation effects of mivacurium is related with the endothelium and at least, in part, cyclooxygenase inhibition and guanylate cyclase activation are related with this relaxation effect. Also, mivacurium inhibited extracelluar calcium influx.
Animals ; Aorta, Thoracic ; Baths ; Calcium ; Endothelium ; Ganglion Cysts ; Guanylate Cyclase ; Histamine Release ; Indomethacin ; Methylene Blue ; Muscle, Smooth, Vascular ; NG-Nitroarginine Methyl Ester ; Oxygen ; Phenylephrine ; Prostaglandin-Endoperoxide Synthases ; Rats* ; Relaxation

PURPOSE: Obesity has become a pandemic and especially the prevalence of childhood obesity has increased remarkably over the past years. Childhood obesity is often accompanied by the expected morbidities such as hyperlipidemia, fatty liver and glucose intolerance. We evaluated the pattern of alteration in the body mass index (BMI), serum adiponectin concentration, insulin resistance (HOMA-IR), and complication rates after one year follow-up. METHODS: Forty two obese children (age: 8-15 years, 95th percentile of BMI for age and sex) were examined twice annually on June, 2004 and July, 2005. The body mass index (BMI) and sexual maturity rating (SMR) were determined annually by the same examiner and serum fasting glucose, liver enzyme, lipid profiles, adiponectin, insulin and HOMA-IR were measured and annual results were compared. Upper abdominal sonography was performed to detect fatty liver. RESULTS: BMI (25.3+/-2.9 kg/m2 vs. 26.0+/-2.9 kg/m2) and HOMA-IR (3.6+/-1.8 vs. 4.7+/-1.9) have increased significantly after one-year follow-up. The serum adiponectin concentration (17.2+/-5.2 g/mL vs. 12.6+/-5.2 g/mL) has decreased after one year. The prevalence of hyperlipidemia and fatty liver were not changed significantly but that of hyperinsulinemia increased after one-year. HOMA-IR showed a positive correlation with BMI and SMR, but was negatively correlated with serum adiponectin concentration. CONCLUSION: Obese children in our study showed significant increment of insulin resistance during one year. These results suggest that well-organized and continuous obesity control is required especially for obese adolescent to prevent complication of obesity.
Adiponectin* ; Adolescent* ; Body Mass Index ; Child* ; Fasting ; Fatty Liver ; Follow-Up Studies* ; Glucose ; Glucose Intolerance ; Humans ; Hyperinsulinism ; Hyperlipidemias ; Insulin Resistance* ; Insulin* ; Liver ; Obesity ; Pandemics ; Pediatric Obesity ; Prevalence

OBJECTIVE: To compare the diagnostic accuracy of ultrasonographic endometrial thickness with that of hysteroscopy, it is to establish the most appropriate method for the diagnosis of endometrial cancer and other endometrial diseases in postmenopausal women with abnormal uterine bleeding (AUB). METHODS: This retrospective study was conducted in 105 consecutive postmenopausal patients with AUB, who underwent ultrasonographic evaluation of endometrial thickness, hysteroscopy and endometrial biopsy. Evaluation of sensitivity and specificity was performed. RESULTS: Histologic findings for <4 mm level revealed that atrophy was present in 30 (71.4%) and in 1 case (2.4%) endometrial cancer was found; for > or =4 mm values polyps and myomas were present in 31 (49.2%) and there were 3 (4.8%) in endometrial cancer. Sensitivity and specificity for trans-vaginal ultrasound, with a cut-off value > or =4 mm, was 75% and 40.6%. CONCLUSIONS: Generally speaking, obstetrics & gynecologists know that endometrial aspiration biopsy is the routine method in postmenopausal women with AUB. However transvaginal ultrasound remains the first line diagnostic procedure in postmenopausal women without AUB. In case of endometrial thickness less than 4 mm, it is likely to miss the early stage endometrial cancer but trans-vaginal ultrasound remains the first line diagnostic procedure in postmenopausal women, because it is not invasive and has high sensitivity for detecting endometrial cancer and other endometrial disease; According to our experience, hysteroscopy with biopsy is mandatory in all postmenopausal women with AUB.
Atrophy ; Biopsy ; Biopsy, Needle ; Diagnosis ; Endometrial Neoplasms ; Female ; Hemorrhage* ; Humans ; Hysteroscopy* ; Myoma ; Obstetrics ; Polyps ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography ; Uterine Diseases ; Uterine Hemorrhage

OBJECTIVE: This study was performed to examine the relationship between community-based social support and psychosocial distress in workers. METHODS: The study subjects were 596 workers recruited from 11 companies in Chungju city. A structured questionnaire was used to assess sociodemographics, health-related behaviors, job characteristics, job stress, work-based social support, community-based social support and level of psychosocial distress. RESULTS: Hierarchical multiple regression analysis showed that workers with no chronic disease, exercise and sufficient sleep had a higher score of psychosocial distress than those with chronic disease, no exercise, and not enough sleep. Coworker's work-based social support and community-based social support were negatively associated with psychosocial distress. The R square value of total independent variables on psychosocial distress was 0.409, and that of community-based social support on psychosocial distress was 0.052. CONCLUSION: This study showed that community-based social support served as a protective factor against psychosocial distress in some workers. We recommend the establishment of a worksite stress reduction program in occupational level as well as community-based social support.
Chronic Disease ; Chungcheongbuk-do ; Questionnaires ; Workplace