Although occupational low back pain accounts for 20~40% of all occupational illness and injury, there are limited numbers of studies regarding the effectiveness of back school program. The objective of this study was to evaluate the economic benefit of back school program for early return to work of occupational low back pain patients in the current occupational injury compensation and management system. The cost-benefit analysis in this study was conducted to evaluate the relative magnitude of benefit to cost. The total cost was estimated by calculating the value of components in back school program according to governmental budget protocol. The back school program was consisted of three major approaches, pain center, work-hardening program and functional restoration program and each of components had various facilities and experts. The total amount of cost was estimated as 250,866,220 won per year. The most promising type of back school program were quite intensive (a 3 to 5-week stay in a specialized center), therefore, if we adopted the 5-week stay course, 10 courses could be held in a year. Following to the medical act, 20 patients per doctor could participate in a each course, ie, total 200 patients in a year. As a result, we could estimate the cost of 1,254,331 won a patient. we estimated the benefit by using data of a few local labor offices about average medical treatment beneficiary and off-duty beneficiary of 46 occupational low back pain patients in 1994. Ullman and Larsson(1977) mentioned that the group of chronic low back pain patients who participated in back school program needed less time to recover by 48.4% of beneficiary duration. And in the trying to estimate the benefit, we asked 10 rehabilitation board certificate doctors about reduction proportion of treatment cost by introducing back school program. The answered reduction proportions were in the range of 30~45%, average 39%. As a final result, we could see that the introduction of back school program in treatment of chronic occupational low back pain patients could produce the benefit to cost ratio as 3.90 and 6.28. And we could conclude that the introduction of back school program was beneficial to current occupational injury compensation and management system.
Budgets ; Compensation and Redress ; Cost-Benefit Analysis* ; Health Care Costs ; Humans ; Low Back Pain* ; Occupational Injuries ; Pain Clinics ; Rehabilitation ; Return to Work

Group occupational health service programme started in 1990 is one of the measures to cope with limited human and financial resources in occupational health. The programme has expanded rapidly to include 52 institutions, private as well as public, all over the country. In spite of its potential impact on health of employees and practice of occupational health in small and medium sized industries, comprehensive evaluation in terms of quality has not been tried. This study has aims to develop the criteria to assess the quality of newly developed group occupational health service programme, and to investigate the quality of institutions, and finally to develop policies for the quality improvement. 1) Criteria development : By defining occupational health services, in particular for small and medium sized industries, as one of the primary health care, followings are included as core elements of qualitative occupational health programme ; accessibility, continuity, comprehensiveness, technical quality, intersectoral collaboration, emphasis on preventive services, community participation, and adequacy. Again each element is divided into five major components of national health system infrastructure developed by the World Health Organization ; development of health resources, organized arrangement of resources, delivery of health care, economic support, and management. In turn, each component is categorized into three aspects of quality assessment, structure, process and outcome. Expert panel selected several criteria for each category to evaluate the programme. Criteria were modified according to each group of interviewees, to produce two sets of questionnaire, one for chief operating officer and another for nurses in the institutions, and the chief operating officer and workers in the workplace. 2) Subject : Of all 52 institutions, 25 voluntarily participated in the survey. At individual institution, chief operating officer and practicing nurses were interviewed in depth. After intensive education for interviewees, every interview was performed with standardized guideline and questionnaire. The quality of the 'Group occupational health service programme' was found to be lower than expected. Especially In continuity, comprehensiveness, technical quality, community participation and adequacy, lower quality in structural aspect was commonly identified throughout all the institutions. Quality in terms of accessibility and continuity highly varied among institutions. To improve quality of the programme, more comprehensive and systematic programme such as accreditation has to be introduced. In addition, human resources, governmental fund and information systems for individual workers are to be developed. As a long range plan, integration of occupational health services into the national health systems and pooling of financial resources and planned allocation should be considered.
Accreditation ; Consumer Participation ; Cooperative Behavior ; Delivery of Health Care ; Education ; Financial Management ; Health Resources ; Humans ; Information Systems ; Korea* ; Occupational Health Services* ; Occupational Health* ; Primary Health Care ; Quality Improvement ; Questionnaires ; Social Welfare ; World Health Organization

No abstract available.
Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Humans

OBJECTIVES: To determine the educational needs related to an integrated health and oral health project for community dental hygienists. METHODS: In this cross-sectional study, a survey was administered to 1,190 dental hygienists working in community health centers and 627 (about 53%) responded. The dependent variable was educational needs from oral health projects; the independent variables were region, job assignments, job position, and degree of self-development. Data were analyzed using descriptive statistics and chi-square tests, with PASW 20.0 (SPSS Inc., Chicago, IL, USA), and the significance threshold was .05. RESULTS: The educational needs of community dental hygienists were found to be high, at about 58.5 points out of 100. The highest educational needs were for oral health projects linked to public health projects. In this regard, participants reported a high need for "identification of issues and projects suited to the current state of the region," "establishment of strategies for integration of health and oral health projects," and "prioritization." CONCLUSIONS: Professional education for community dental hygienists should be expanded to include integration of health and oral health. It should be based on the assessment of these professionals' educational needs.
Community Health Centers ; Cross-Sectional Studies ; Dental Hygienists* ; Education, Professional ; Humans ; Oral Health* ; Public Health

BACKGROUND: Prosthetic valve thrombosis is an uncommon but serious complication. Thrombolytic therapy has recently been proposed as an alternative to surgical methods in treating this condition and is used increasingly. However, the indications for thrombolytic treatment in prosthetic valve thrombosis have not been well defined and differential diagnosis of thrombosis is still difficult. METHODS: Four symptomatic patients with prosthetic valve thrombosis underwent 9 thrombolytic sessions for 7 distinct episodes. Transthoracic or transesophageal echocardiography and cinefluoroscopy were performed and repeated after each thrombolytic session. Urokinase or rt-PA (recombinant tissue-type plasminogen activator) was used and repeated dose was given if necessary. Recurrent thrombosis was treated also either with urokinase or rt-PA. RESULTS: All patients were female and mean age was 38.5 years old. Two valves were in mitral position and the other two were in tricuspid position. The anticoagulation status was inadequate in three patients. The initial success after first dose was 43% (3/7), which increased to 54% (4/7) after repeated thrombolytic therapy. Thrombolytic therapy was failed in three episodes; two thromboses and one ingrowths of pannus. Operations were needed in these cases. No complication was seen. CONCLUSION: Thrombolytic treatment can be used as an alternative to surgical therapy with a low risk of complications. But guideline of thrombolytic therapy for the recurrent thrombosis and education for the patients about the adequate anticoagulation were needed.
Diagnosis, Differential ; Echocardiography, Transesophageal ; Education ; Female ; Humans ; Plasminogen ; Thrombolytic Therapy ; Thrombosis* ; Urokinase-Type Plasminogen Activator

PURPOSE: The porosity of the bone cement is the most important cause of fatigue failure, the most common mode of failure of bone cement using widely in arthroplasty. It is important to evaluate the porosity of bone cement for improvement or development of bone cement, but the conventional 'stain, 'cut, and 'polish, manual method takes long time and efforts. So it is necessary to develop a new technique for evaluation of porosity of bone cement. We tried a technique using computer image analysis system to evaluate the porosity of bone cement specimen and assess efficacy of the method. Simultaneously we evaluated the relationship between the porosity of bone cement and fatigue failure. MATERIAL AND METHODS: We made 59, 2.5inch-length bone cement specimens(30 Simplex P, 29 Palacos R) using Simplex P and Palaces R which are widely using in clinical situation and checked radiogram using mammography film. After scanning the mammography film, we measured the porosity of the bone cement specimens using NIH(National Institute for Health) Image 1.6 version image analysis program. We also, measured the porosity of the bone cement specimens with conventional 'stain','cut' and 'polish' method, after then compared the results of two methods. Simultaneously, we evaluated the relationship between porosity & fatigue failure by loading 9.0, 10.0, 12.5 and 15.0 MPa load with frequency of 10Hz to the bone cement specimens under the physiologic condition. RESULTS: The coefficient of relation of simplex P and palaces R was 0.729 and 0.713 respectively, so there was high relationship between the image analysis system method and conventional one. It was easy and took shorter time to measure the porosity of bone cement specimens with image analysis system. There was high correlation between cement porosity and fatigue failure, regardless of level of load. CONCLUSION: It was very easy and fast to measure the porosity of the bone cement specimens with image analysis system and there was high correlation between cement porosity and fatigue failure.
Arthroplasty ; Fatigue ; Mammography ; Methylmethacrylate ; Porosity*

Educational evironment and condition strongly influence the quality of graduate medical education. However, in Korea educational environment of in-hospital graduate medical education and training has not been explored in details. To evaluate current situation, we investigated 1,859 graduate trainees(residents) by self-administered questionnaire from May to July in 1996. Major findings of the survey were as follows; 1. Major providers of education were senior trainees(46.7%), compared with other sources of training such as self-study(22.9%) and staff trainers(14.5%). 2. At hospitals with less than or equal to 500 beds, formal educational programs for training were more poorly developed than hospitals with more than 500 beds. Among them, weakness in programs of case conference, staff lecture and training in affiliated hospitals was more remarkable. 3. At small hospitals with less than or equal to 500 beds, satisfaction level of trainees on their training were lower than that of trained at hospitals with more than 500beds. Research, conference, discussion with senior residents, and outpatient care were more dissatisfactory in particular. 4. Significant barriers to ideal training were work overload(57.2%) and shortage of educational programs(19.0%). Most of trainees are not satisfied with environment and condition of their training programs. To improve the quality of graduate medical education which is closely related with health care quality in the near future, general environment of education such as work load and educational programs has to be reoriented.
Ambulatory Care ; Education ; Education, Medical, Graduate* ; Korea ; Quality of Health Care ; Surveys and Questionnaires

Pernicious anemia is caused by the absence of intrinsic factor from autoimmune destruction of parietal cells. Patients with pernicious anemia are predisposed to the development of gastric cancer. We report here a case of pernicious anemia with early gastric cancer. A 65 year old woman was presented with severe anemia and glossitis. Her serum cobalamin level was low, and serologic test to anti-intrinsic factor antibody and anti-parietal cell antibody were positive. Gastroscopic examination revealed an early gastric cancer and type A atrophic gastritis. This patient underwent radical subtotal gastrectomy and received daily oral vitamin B12 replacement.
Aged ; Anemia ; Anemia, Pernicious* ; Female ; Gastrectomy ; Gastritis, Atrophic ; Glossitis ; Humans ; Intrinsic Factor ; Rabeprazole ; Serologic Tests ; Stomach Neoplasms* ; Vitamin B 12

BACKGROUND AND OBJECTIVES: This study was designed to investigate the relationship between myocardial perfusion defect in single photon emission tomography(SPECT) and the difference in left ventricular functional parameters obtained after stress and at rest. MATERIALS AND METHODS: Eighty five patients known to have coronary artery disease (CAD) or suspected to have CAD underwent gated Tc-99m sestamibi SPECT using one or separate day rest/stress protocol. We compared post-stress left ventricular ejection fraction (LVEF-s) with that at rest (LVEF-r) in gated myocardial SPECT. We considered myocardial stunning was developed when LVEF was >5% lower than that at rest. METHODS: Forty one (48%) patients demonstrated reversible or irreversible perfusion defects in gated perfusion SPECT (group 1). Forty four (52%) patients demonstrated normal perfusion status (group 2). In group 1, LVEF-s was significantly lower than that at rest([mean+/-SD] 46+/-15.5 vs 48+/-16.0 respectively, p<0.05). In group 2, There was no significant difference among LVEF-s and LVEF-r(60+/-7.6 vs 61+/-7.9, p=NS). In group 1, no difference was observed between LVEF-s and LVEF-r by stress modes. In 13 (32%) of 41 patients with perfusion defects, LVEF-s was >5% lower than LVEF-r. CONCLUSION: The LVEF obtained after stress with gated SPECT may not reflect true resting values. We recommend gated myocardial perfusion SPECT should be performed also at rest especially in patients with myocardial perfusion defects.
Adenosine* ; Coronary Artery Disease ; Humans ; Myocardial Stunning ; Perfusion* ; Stroke Volume ; Tomography, Emission-Computed, Single-Photon* ; Ventricular Function, Left*

BACKGROUND/AIMS: Functional dyspepsia (FD) is a gastrointestinal disorder in which the patient suffers from chronic abdominal symptoms despite the absence of organic disease. Benachio Q solution (soln.)(R) is a new prokinetic herbal medicine. The aim of the present study is to determine the efficacy and safety of Benachio Q soln.(R) in patients with postprandial distress syndrome (PDS) subtype in FD. METHODS: A single-center, randomized, double-blind, placebo-controlled pilot study was performed in 20 patients with PDS. Patients were assigned to receive either Benachio Q soln.(R) or placebo three times a day. After 4 weeks of treatment, the data on response rates, symptoms severity of PDS and gastric emptying time were analyzed to evaluate its efficacy. Adverse events, laboratory tests and vital sign were analyzed to assess its safety. RESULTS: Nine patients were assigned to Benachio group and 10 patients to placebo group. The response rate after 4 weeks was 44.4% and 20.0% in Benachio and placebo group, respectively (p=0.350). The response rate during the first week in Benachio group was better compared to that of placebo group with marginal difference (33.3% vs. 0.0%, p=0.087). Changes of severity score in early satiety on second and third week were -1.8+/-0.6, -1.9+/-0.4 and -1.3+/-0.5, -1.4+/-0.6 in Benachio and placebo group, respectively (p=0.059 vs. p=0.033). No adverse event was observed. CONCLUSIONS: The new herbal drug, Benachio Q soln.(R) seems to improve the symptoms of PDS subtype in FD and could be used safely. Further larger trial is needed in the future.
Adult ; Double-Blind Method ; Drug Administration Schedule ; Dyspepsia/*drug therapy/pathology ; Female ; Gastrointestinal Agents/*therapeutic use ; *Herbal Medicine ; Humans ; Male ; Middle Aged ; Pilot Projects ; Placebo Effect ; Postprandial Period ; Severity of Illness Index ; Treatment Outcome