PURPOSE: This was a cross sectional descriptive study to introduce the Infants Coma Scale (ICS), describe mental status of high risk infants using ICS and explore the relationships between ICS and clinical variables in infants hospitalized in a neonatal intensive care unit of a university hospital in Korea. METHODS: After ICS was developed and tested by the authors, a research nurse evaluated the mental status of the infants using the English version of ICS and obtained clinical information on the infants from their medical records. RESULTS: Data from 88 infants were analyzed. About 60% were male, 90% were preterm births, and 40% had pathologic abnormalities. Their mean gestational age was 32.4 (+/-3.50) weeks and the mean birth weight was 1,842 (+/-728.6) grams. The Cronbach's alpha for the ICS was .78. There was a statistically significant positive correlation between ICS total score and five clinical variables including gestational age, birth weight, 1 and 5 min Apgar scores and respiration status. CONCLUSION: Mental status is an important parameter in nursing assessment. ICS is a valid and reliable instrument, which clinicians can easily use to evaluate the mental status of high risk infants.
Birth Weight ; Brain Injuries/diagnosis/ultrasonography ; Female ; Gestational Age ; *Glasgow Coma Scale ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units, Neonatal ; Male ; *Mental Health ; Premature Birth ; Program Evaluation ; Respiration, Artificial

No abstract available.
Germ Cells* ; Neoplasms, Germ Cell and Embryonal*

PURPOSE: This study was to evaluate the quality of online health information related to infants and preschoolers accessible through mobile applications and websites. METHODS: Using combinations of the terms 'infant', 'preschooler', and 'health' as the main keyword or categories, the researchers searched relevant mobile applications and websites in Korean application markets and popular search engines. Twelve mobile application and 14 websites were finally selected according to our inclusion criteria and evaluated using DISCERN instrument. RESULTS: The overall quality score of online health information available through mobile applications was 2.00 of 5 points, the reliability score was 2.15, and the quality score was 1.76. The overall quality score of online health information available through websites was 2.29, the reliability score was 2.40, and the quality score was 1.82. CONCLUSION: The quality of online health information related to young children was found to be low and to have potentially significant drawbacks according to DISCERN criteria. Therefore, it is necessary to establish a system to evaluate and regulate the quality of online health information. Additionally, factors that readers can use to judge the quality of health information, such as references and the benefit versus risks of the information, should be provided.
Child ; Consumer Health Information ; Humans ; Infant ; Internet ; Mobile Applications ; Search Engine

Sexuality education in the period of adolescents need much care and attention. The programs of sexual education through the Internet are excellent resources for adolescents to gain the information related to their sexual health. And systematic program which is necessary for adolescents to manage their sexual health has been rarely found in Korea. The purpose of this study was to offer valuable database for program design and evaluation on sexual education of middle school students through the Internet. Needs assessment for the information of sexual education on the internet among middle school students were carried out. A questionnaire survey was conducted with respondents of 602 middle school students from January to March in 2002. In the sexual counseling center for middle school students, counseling cases through internet were analyzed and evaluated from October, 2001 to September, 2002, We have selected 16 Sexual educational websites in Seoul confirmed Korean Educational Human Resource. Contents which was illustrated in 16 sexual educational websites were analyzed and evaluated by 12 sexual counselors. Design and evaluation of the program on the internet for sexuality education of adolescences was conducted on the basis of this study results by middle school expert teachers, sexual counselors, sexuality education professionals. Data was statistically analyzed using dBSTAT 4.0 for Windows.The extent and phase of the teaching-learning program of the sexuality education on the internet was seen as follows :1. We evaluated to need for sexuality education on the internet by middle school student.2. We assessed the properness of sexuality education curriculum on the internet frequently used by middle school students.3. We designed teaching strategy and learning program for sexuality education of the middle school students. 4. We developed the assessment method for the teaching-learning program of the sexuality education in adolescences on the internet.Middle school students responded that sexual education through Internet is needed in the order of programs related to acquaintances with opposite sex, Sexual culture and ethics, Sexual health, Reproductive health structure and development, Marriage and family, Psychology of Sexuality, Pregnancy and birth. In the internet counseling, cases on the 'reproductive health structure and development' was ranked as the top. In short we have found the most needs as follows; Meaning of the marriage life and having family, Sexes and Love, Human relation, Sexual Culture.We recommend as follows on the basis of this study results: 1. It is necessary for sexuality education program on the internet to specify acccording to age and target the specific individual needs. 2. Sexual educators have to employ various educational materials such as flash, cartoon, multimedia in order to provide effective sexuality education. 3. Internet based sex education need to be evaluated regularly through reassessment of the effectiveness of sexuality education for content quality and richness.
Adolescent ; Counseling ; Curriculum ; Education* ; Ethics ; Friends ; Humans ; Internet* ; Korea ; Learning ; Love ; Marriage ; Multimedia ; Needs Assessment ; Parturition ; Pregnancy ; Psychology ; Surveys and Questionnaires ; Reproductive Health ; Seoul ; Sex Education ; Sexuality*

PURPOSE: To identify clinical and laboratory features of atypical Kawasaki disease(KD), and to develop criteria for early diagnosis of atypical KD patients. METHODS: All patients with KD treated at our hospital from January 1998 to June 2000 were reviewed retrospectively. RESULTS: Among a total of 167 patients, 28(16.8%) were atypical KD of which seven(25%) were infants. Among the five cardinal symptoms, oral mucosal change(96.4%) occurred most frequently, followed by conjuntivitis(57.1%) and rash(46.4%). Most notable laboratory findings were anemia, and increased erythrocyte sedementation rate(ESR) or C-reactive protein(CRP). Coronary artery abnormalities developed in seven(25.8%) atypical KD patients, compared with 14.4% in typical KD patients. We considered oral mucosal change as major criterion, and conjunctivitis, rash, hematocrit <35% and ESR >30 mm/hr or CRP >3.1 mg/dL as minor criteria. Proposed modification in diagnostic criteria for atypical KD include fever of >or=5 days;major criterion+>or=2 minor criteria, or fever of >or=5 days+4 minor criteria. CONCLUSION: The modified diagnostic criteria has yielded a sensitivity 89.3%. Our diagnostic criteria may be used for early diagnosis of atypical KD.
Anemia ; Conjunctivitis ; Coronary Vessels ; Early Diagnosis ; Erythrocytes ; Exanthema ; Fever ; Hematocrit ; Humans ; Infant ; Mucocutaneous Lymph Node Syndrome* ; Retrospective Studies

BACKGROUND AND OBJECTIVES: We sought to determine whether high-dose aspirin is necessary for the acute therapy of Kawasaki disease (KD) in the intravenous immunoglobulin (IVIG) era. SUBJECTS AND METHODS: Two groups of KD patients treated during the different periods were included. Study group (n=51, treated with IVIG without concomitant use of aspirin in the acute phase) was compared with control group (n=129, treated with IVIG plus high-dose aspirin) with regard to the response to IVIG, duration of fever after IVIG completion, time to C-reactive protein (CRP) <3 mg/dL, and the incidence of coronary artery lesions (CALs). RESULTS: There was no difference between the groups in age, sex, and duration of fever before treatment. Pre-IVIG laboratory measures also did not differ from each other. IVIG-resistant cases were 8 (15.7%) in study group and 22 (17.1%) in control group (p=1.000). Mean duration of fever after IVIG completion in IVIG-responsive patients was 13.3+/-13.5 hours in study group compared to 6.2+/-8.3 hours in control group (p=0.000). The mean time to decrease in CRP was 4.0+/-1.7 days in study group and 4.1+/-2.2 days in control group (p=0.828). There were 2 (3.9%) patients with CALs in study group and 10 (7.8%) in control group (p=0.514). CONCLUSION: Although high-dose aspirin shortens the duration of fever, treatment without aspirin in the acute phase has no influence on the response to IVIG, resolution of inflammation, or the development of CALs. In the IVIG era, high-dose aspirin may provide little benefit to the treatment in the acute phase of KD.
Aspirin ; C-Reactive Protein ; Coronary Vessels ; Fever ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Incidence ; Inflammation ; Mucocutaneous Lymph Node Syndrome

BACKGROUND AND OBJECTIVES: We sought to determine parameters to guide the decision of retreatment in patients with Kawasaki disease (KD) who remained febrile after initial intravenous immunoglobulin (IVIG). SUBJECTS AND METHODS: A total of 129 children with KD were studied prospectively. Patients were treated with IVIG 2 to 9 days after the onset of disease. Laboratory measures, such as white blood cell (WBC), percentage of neutrophils, C-reactive protein (CRP), and N-terminal pro-brain natriuretic peptide (NT-proBNP), were determined before and 48 to 72 hours after IVIG treatment. Patients were classified into IVIG-responsive and IVIG-resistant groups, based on the response to IVIG. RESULTS: Of a total of 129 patients, 107 patients (83%) completely responded to a single IVIG therapy and only 22 patients (17%) required retreatment: 14 had persistent fever and 8 had recrudescent fever. There was no significant difference between the groups in age, gender distribution, and duration of fever to IVIG initiation, but coronary artery lesions developed significantly more often in the resistant group than in the responsive group (31.8% vs. 2.8%, p=0.000). Compared with pre-IVIG data, post-IVIG levels of WBC, percentage of neutrophils, CRP, and NT-proBNP decreased to within the normal range in the responsive group, whereas they remained high in the resistant group. Multivariate logistic regression indicated that neutrophil counts, CRP, and NT-proBNP were independent parameters of retreatment. CONCLUSION: Additional therapy at an early stage of the disease should be administered for febrile patients who have high values of CRP, NT-proBNP, and/or neutrophil counts after IVIG therapy.
C-Reactive Protein ; Child ; Coronary Vessels ; Fever ; Humans ; Immunization, Passive ; Immunoglobulins ; Immunoglobulins, Intravenous ; Leukocytes ; Logistic Models ; Mucocutaneous Lymph Node Syndrome ; Natriuretic Peptide, Brain ; Neutrophils ; Peptide Fragments ; Prospective Studies ; Reference Values ; Retreatment

PURPOSE: We undertook this study to investigate discrepancies in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values, and variations following intravenous immunoglobulin (IVIG) therapy in Kawasaki disease (KD). METHODS: A total of 123 KD patients were retrospectively enrolled. Patients were treated with IVIG 2 g/kg at 2 to 9 days after disease onset. We obtained white blood cell (WBC) count, percentage of neutrophils (% neutrophils), CRP, ESR, and N-terminal pro-brain natriuretic peptide (NT-proBNP) values before and 48 to 72 hours after IVIG treatment. Discrepancy was defined as CRP ≥10 mg/dL and ESR <50 mm/hr (Group 1), or CRP <10 mg/dL and ESR ≥50 mm/hr (Group 2). RESULTS: Thirty-six of 123 subjects (29.2%) had a discrepancy: 25 (20.3%) in Group 1 and 11 (8.9%) in Group 2. In Group 1, 15 patients (60%) had fever for <5 days (early presenter) and 10 (40%) had fever for ≥5 days (late presenter). There were six early presenters (55%) and five late presenters (45%) in Group 2. Late presenters had higher ESR than early presenters (34.3±21.0 mm/hr vs. 26.3±19.3 mm/hr, P=0.029). After IVIG treatment, elevated WBC count, % neutrophils, CRP, and NT-proBNP levels normalized. In contrast, ESR increased from 37.4±21.9 mm/hr to 48.0±22.7 mm/hr (n=36, P=0.051). CONCLUSIONS: A discrepancy may be related to the duration of fever. Due to discrepancies in CRP and ESR values in acute KD, both should be measured to assess the degree of inflammatory activity before IVIG treatment. After IVIG treatment, the ESR should not be used as a marker of response to therapy in KD.
Blood Sedimentation* ; C-Reactive Protein* ; Erythrocytes* ; Fever ; Humans ; Immunization, Passive* ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Leukocytes ; Mucocutaneous Lymph Node Syndrome* ; Neutrophils ; Retrospective Studies

BACKGROUND AND OBJECTIVES: The pathogenesis of hyponatremia (serum sodium <135 mEq/L) in Kawasaki disease (KD) remains unclear. We investigated the clinical significance of hyponatremia, and the role of interleukin (IL)-6 and IL-1beta in the development of hyponatremia and syndrome of inappropriate antidiuretic hormone secretion (SIADH) in KD. SUBJECTS AND METHODS: Fifty KD patients were prospectively enrolled and analyzed for clinical and laboratory variables according to the presence of hyponatremia or SIADH. RESULTS: Thirteen KD patients (26%) had hyponatremia and 6 of these had SIADH. In patients with hyponatremia, the percentage of neutrophils (% neutrophils), C-reactive protein (CRP), and N-terminal pro-brain natriuretic peptide (NT-proBNP) were higher than in those without hyponatremia, while serum triiodothyronine (T3) and albumin were lower. Patients with hyponatremia had a higher incidence of intravenous immunoglobulin-resistance but this was not statistically significant. No differences existed between patients with and without SIADH with regard to clinical or laboratory variables and the incidence of IVIG-resistance. Serum sodium inversely correlated with % neutrophils, CRP, and NT-proBNP, and positively correlated with T3 and albumin. Serum IL-6 and IL-1beta levels increased in KD patients and were higher in patients with hyponatremia. Plasma antidiuretic hormone increased in patients with SIADH, which tended to positively correlate with IL-6 and IL-1beta levels. CONCLUSION: Hyponatremia occurs in KD patients with severe inflammation, while increased IL-6 and IL-1beta may activate ADH secretion, leading to SIADH and hyponatremia in KD.
C-Reactive Protein ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome ; Incidence ; Inflammation ; Interleukin-6 ; Interleukins ; Mucocutaneous Lymph Node Syndrome ; Natriuretic Peptide, Brain ; Neutrophils ; Peptide Fragments ; Plasma ; Prospective Studies ; Sodium ; Triiodothyronine

BACKGROUND/AIMS: Liver biopsy has been used to evaluate the degree of hepatic fibrosis in patients with chronic liver diseases. It is important to assess liver fibrosis when following the course of chronic liver diseases. Histopathological examination of percutaneous biopsy specimens is invasive and is also of questionable value because of the heterogenous distribution of pathological changes in the liver. Therefore, non-nvasive methods to determine the progress of liver fibrosis are needed. Serum hyaluronic acid and type IV collagen are known to be related to hepatic fibrosis. This study was performed to evaluate the clinical usefulness of serum hyaluronic acid and type IV collagen measurement as a differential point in patients with chronic liver diseases and early cirrhosis. METHODS: This study included 109 patients with chronic liver diseases caused by various etiologies. Liver biopsy and histopathological classification were done in all patients. Serum hyaluronic acid and type IV collagen were measured by one-tep sandwich binding protein assay and one-tep sandwich enzyme immunoassay. RESULTS: The concentrations of hyaluronic acid and type IV collagen in the early cirrhosis group (208.5+/-186.4 ng/mL, 242.1+/-162.8 ng/mL) were significantly higher (p<0.01) than those in the normal and fatty liver group (26.3+/-21.7 ng/mL, 79.2+/-28.8 ng/mL), mild chronic hepatitis group (22.8+/-15.4 ng/mL, 125.5+/-79.7 ng/mL), moderate to severe hepatitis group (66.3+/-60.5 ng/mL, 148.5+/-78.7 ng/mL). At the cutoff value of 100 ng/mL for hyaluronic acid and 200 ng/mL for type IV collagen, the sensitivities were 66.7% and 55.6%, and specifities were 82.9% and 89%, and diagnostic efficiencies were 78.9% and 80.7% respectively for discriminating patients with cirrhosis (4 points) from the mild to severe fibrosis (0~3 points). CONCLUSIONS: The serum levels of hyaluronic acid and type IV collagen may be sensitive markers of fibrotic process in chronic liver diseases and useful biochemical markers in differentiation of the patients with early cirrhosis from those with chronic liver diseases.
Biomarkers ; Biopsy ; Carrier Proteins ; Classification ; Collagen Type IV* ; Fatty Liver ; Fibrosis ; Hepatitis ; Hepatitis, Chronic* ; Humans ; Hyaluronic Acid* ; Immunoenzyme Techniques ; Liver Cirrhosis* ; Liver Diseases ; Liver*