No abstract available.
B-Lymphocytes* ; Lymph Nodes* ; Pertussis Toxin* ; Whooping Cough*

No abstract available.

Demand for high quality medical care has recently been increasing in step with high level of income and education. Patients prefer the use of large general hospitals to small community hospitals. Large hospitals, usually located at urban area, expand their capacities to cope with the increasing demand, therefore, they easily secure revenue necessary for growth and development of hospitals. However, small community hospitals are facing with serious financial difficulties caused from the reduction of patients in one hand and the inflation of cost in another. If small rural hospitals were closed, the closure would have negative impacts on local economies in addition to the decrease in access to medical care. Community leaders should have an insight on the contribution of community hospitals to local economies. They could make a rational decision on the hospital closure only with the understanding of hospital's contribution to the community. This study is designed to develop an economic model to estimate the contribution of rural hospital to local economies, and also to apply this model with a specific hospital. The contribution of a hospital to local economies consists of two elements, direct effect and multiplier effects. The direct impacts include hospital's local purchasing power, employee's local purchasing power, and the consumption of patients coming from outside the community. The direct impact induces multiplication effect in the local economy. The seed money invested to other industries grows through economic activities in the economy. The seed money invested to other industries grows through economic activities in the region. This study estimated the direct effect with the data of expenditure of the case hospital. The total effect was calculated by multiplied the direct effect with a multiplier. The multiplier was drown from the ratio of marginal propensity of income and expenditure. Beside the estimation of the total impacts, the economic effect from the external resources was also analyzed by the use of the ratio of patients coming outside the region. The results are as follows. 1. The direct economic contribution of the hospital to the local economy is 1,104 million won. 2. The value of multiplier in the region is 2.976. 3. The total economic effect is 3,286 million won, and the multiplication effect is 2,182 million won. 4. The economic contribution from the external resources is 245 million won which is 7.5% of the total economic effect.
Education ; Growth and Development ; Hand ; Health Expenditures ; Health Facility Closure ; Hospitals, Community ; Hospitals, General ; Hospitals, Rural* ; Humans ; Inflation, Economic ; Models, Economic

The beneficial effects of sunlight and ultraviolet light for the treatment, of psoriasis vulgaris has long been recognized. Parrish et al were the first to introduce a controlled light source, which allowed the delivery of a known quantity of light energy to the patients skin after the patient had ingested a photosensitizer, 8-methoxypsoralen (methoxsalen) two hours previous to UVA exposure. This successful treatment has become known as PUVA (psoralen and UVA). PUVA photochernotherapy denotes a systemic approach that is based on the interaction of light and a photoactive drug. Parrish et al have described successful treatment of psoriasis with PUVA and other investigators alI over the world have confirmed their beneficial results. The rationale of photochemotherapy in psoriasis is the inhibition of the increased DNA synthesis within the psoriatic lesions by the interaction of psoralen molecule and light energy in the UVA range(320-400nm). The present study was undertaken to evaluate the therapeutic effectiveness of PUVA photochernotherapy combining orally administered methoxsalen and UAA exposure using Dermatron UVA phototherapy system in patients with wi5espread psoriasis. A total of 15 patients with psoriasis over more than 30% of their bodies were selected at the department of dermatology, National Medical Center through March 1978 to September 1978. Oral administration of methoxsalen, 20 to 50 mg doses according to body weight, was followed by exposure to a high-intensity longwave ultraviolet light emitting a continuous spectrum between 320 and 400nm (peak emission, 350 - 365nm). Initial UVA exposure times were based on each patients minimal phototoxicity dose (MPD) and exposure times were increased at each treatment by 1 - 2 minutes to maintain minimal erythema. Frequency of treatment was two to three times weekly. Once the psoriatic lesions had, cleared completely the patient was placed on a maintenance schedule. If psoriasis recurred the frequency of treatment was increased. The results were as follows: l. 5 patients were dropped out due to unknown reasons. 2. 7 cases showed clearing of over 95, of the lesions (Response 5'). Mean number of PU VA therapy was 16. 7. During 1 4 months follow-up period, 4 cases remained free of psoriasis but 3 cases couldn't be followed. 3. Immediate side effects of PUVA were temporary and generally mild. No significant changes in laboratory screenings were noted. Side effects of therapy included transient nausea(33.3%), dizziness(26.7%), erythema.(66.7%), pruritus (60%), increased pigrnentation(100 %). 4. Comparison of pre-and post-PUVA therapy in biopsy specimens by light microscopy revealed histologic improvement evidenced by diminished acanthosis and parakeratosis, and regeneration of granular layers in all of 8 cases. Glycogen accumulation in the affected epiderrnis was significantly decreased or absent after PUVA therapy in all cases.
Administration, Oral ; Appointments and Schedules ; Biopsy ; Body Weight ; Dermatitis, Phototoxic ; Dermatology ; DNA ; Erythema ; Ficusin ; Follow-Up Studies ; Glycogen ; Humans ; Mass Screening ; Methoxsalen ; Microscopy ; Parakeratosis ; Photochemotherapy* ; Phototherapy ; Pruritus ; Psoriasis* ; PUVA Therapy ; Regeneration ; Research Personnel ; Skin ; Sunlight ; Ultraviolet Rays

Service diversification is recognized as an important strategy against turbulent environmental change. This study is designed to find out the trend of service diversification in Korean health care organizations and also to identify factors associated with the degree of service diversification. Data were collected from 69 hospitals out of 71 hospitals with over 300 beds. Important findings are summarized below. 1. Types of diversification are closely related to hospital size. Large hospitals have a tendency to provide sophisticated service requiring specialized skills and equipment, while small hospital have concentrated their efforts on health screening programs. 2. The more competitive and bigger hospitals are, the greater number of services that provide. Also, hospitals operating rational management information systems provide more services. Contrary to the expectation, hospitals with a low performance during last 3 years showed more service diversification. 3. A trend of more diversification was observed in hospitals whose chief executive officer used a prospector strategy. 4. A multiple regression analysis revealed that bed size, competitive environment, degree of rational management, and the growth pattern were significantly associated with teh service diversification.
Delivery of Health Care ; Health Facility Size ; Hospital Bed Capacity ; Management Information Systems ; Mass Screening

There are increasing interest and need for information on health care consumer with the significance of hospital marketing and strategic planning being increasingly emphasized. This study was conducted to investigate the criteria for selection of medical facilities according to the characteristics of health care consumer by the types of medical services on a sample of 1,500 population aged 20 years and above. Major findings are as follows; 1. When considering the criteria for selection of medical facilities into two factors, namely, quality or convenience factors, convenience factor was the major contributor for outpatient and dental services whereas it was quality factor for inpatient services. 2. Females and those residing in large cities selected medical facilities based on convenience factor in the outpatient services. In the case of inpatient service, persons who considered their present health status to be good and whose ages were 50 years old and above choose medical facilities based on quality factor. 3. Persons who considered medical facilities to be profit-making tended to choose medical facilities based on convenience factor for outpatient services. There were no differences in the cases of inpatient and dental services. 4. There was no significant difference on the criteria for selection of medical facilities according to the decision maker for selection or trust on medical facilities. On the use of health service information, selection of medical facilities was based on qPality factor for those who made more use of the information in the cases of outpatient and dental services. 5. Analysis using the logistic regression model on the criteria for the selection of medical facilities with the characteristics of health care consumer as independent variables was performed. The selection of medical facilities was significantly related with residential area, sex, and use of information on medical facilities for outpatient services and with age, average monthly income, and perception of health status for inpatient services. For dental services significant association with residential area and use of information on medical facilities was seen. The results of this study, despite some limitations, can be used as baseline data for marketing and strategic planning of hospital management.
Delivery of Health Care ; Female ; Health Services ; Humans ; Inpatients ; Logistic Models ; Marketing ; Middle Aged ; Outpatients ; Patient Selection

According to literatures, the different types of fractures can occur as a result of arm wrestling ; Spiral fracture of the humeral shaft associating often with a bntterfly fragment, fracture of medial epicondyle of the humerus, and the marginal radial head fracture with anterior dislocation. The last type is very rarely reported. In addition to the fracture occurrence, other injuries such as muscular strain of the arm, and sprain or luxation of the shoulder, elbow and wrist joints can be taken place. However, it is thought that the most of those injuries by arm wrestling have been treated simply by general practioners unreported. The arouse the attention of the jury of the game, wrestlers and the surgenons, the cases of bony injuries sustained during the arm-wrestling are reported. Thirteen patients were treated by us since 1977. Among them, five cases had fractures of the humeral shaft, and eight cases had fractures of medial epicondyle of the humerus. Among the five shaft fractures, three were treated by conservatively, and two by operatively. Among 8 avulsion fractures of the medial epicondyle only two were treated conservatively, and 6 operatively. One patient sustained the medial epicondylar avulsion fracture twice for which K-wire fixation treatment was done. The results of treatment were all satisfactory. However, because of the possibility of wrestlers sustaining such injuries. Arm wrestling should not be considered a totally benign sport.
Arm ; Dislocations ; Elbow ; Head ; Humans ; Humerus ; Shoulder ; Sports ; Sprains and Strains ; Wrestling ; Wrist Joint

No abstract available.

Chronic granulomatous disease (CGD) is an inherited immunodeficient disease characterized by recurrent infections and granuloma formation. Granulomatous obstruction of esophagus is one of the rare complications of CGD. The use of steroids and antimicrobials for esophageal obstruction by granuloma in CGD patients has been controversial due to the possibility of concomitant inapparent infection. We report a case of esophageal obstruction in an 8-year-old CGD patient showing the poor response to antibiotics therapy. However, dramatic improvement of symptoms and radiologic findings of esophageal obstruction were achieved after steroid therapy. One month after discontinuation of steroid, esophageal obstruction recurred and the patient was re-treated with steroid. After that time, he experienced one more recurrence of esophageal obstruction. This symptom subsided after antibiotics therapy without steroid and he has been followed up to the present without further relapse.
Anti-Bacterial Agents ; Child ; Esophageal Stenosis ; Esophagus ; Granuloma ; Granulomatous Disease, Chronic* ; Humans ; Recurrence ; Steroids