Child abuse and neglect refers to any act or failure to act that violates the rights of children and affects their overall optimal health, survival or development. Also sexual abuse in children is defined as engaging a child in sexual acts that the child does not understand, to which the child cannot give informed consent, or which violate the taboos of our society. Sexual abuse may involve direct acts perpetrated against children as well as other non-touching abuses, which include exhibitionism, voyeurism, or the use of children for pornographic purposes. Although precise incidence and prevalence rate data are lacking, sexual abuse of children is common in our country and throughout the world. Child sexual abuse is a universal problem that has frequently passed unrecognized and its victims (both children and perpetrators) untreated. Child sexual abuse results in significant social damage. The physical and psychological consequences of child sexual abuse may result in trauma and has implications throughout the lifespan. Experiencing sexual abuse as a child also has the consequence of contributing to an increased risk of violent victimization, perpetration, self-directed violence and suicide later in life. Despite the importance of the issues, information about sexual abuse in children and amongst adults has not been commonly shared by health professionals. The purpose of this review article is to assist the physician in their investigation of child sexual abuse by exploring the important topics.
Adult ; Child Abuse ; Child Abuse, Sexual ; Child* ; Crime Victims ; Exhibitionism ; Health Occupations ; Humans ; Incidence ; Informed Consent ; Prevalence ; Sex Offenses* ; Suicide ; Taboo ; Violence ; Voyeurism

No abstract available.
Perinatal Care*

To investigate predictable ultrasonographic findings of early abortion. To investigate objective rules for the screening of abortion Ultrasonographic examination of 111 early pregnancies between the sixth and ninth week in women who had regular 28 day menstrual cycles was performed. Ultrasonographic measurements of the gestational sac. Crown rump length and fetal heart rate were performed using a linear array real time transducer with doppler ultrasonogram. All measurements of 17 early abortions were compared to those of 94 normal pregnancies. Most of early aborted pregnanices were classified correctly by disciminant analysis with G-SAC and CRL (GSAC=0.5 CRL+15. Sensitivity 76.5%, specificity 96.8%). With the addition of FHR, 94.1 of early abortions could be predicted. In conclusion, ultrasonographic findings of early intrauterine growth retardation. Small gestational sac and bradycardia can be predictable signs suggestive of poor prognosis of early pregnancies.
Bradycardia ; Crown-Rump Length ; Female ; Fetal Growth Retardation ; Gestational Sac ; Heart Rate, Fetal ; Humans ; Mass Screening ; Menstrual Cycle ; Pregnancy ; Prognosis ; Sensitivity and Specificity ; Transducers ; Ultrasonography

Development of public health has had great impact on quality of human life since the Renaissance. Earlier, Rudolph Virchow indicated that medicine is social science, and politics are nothing else than medicine at large scale. In order to achieve healthy country, well designed health care policy is essential. Active participation of health care professionals in politics as well as policy planning is needed for the health and well-being of all people in Korea. Active involvement in health care planning can be social responsibility of health care professionals. In terms of methodology of active participation in health care policy, three folds approaches are suggested. First, to learn more in different field such as politics, public administration, and law. Secondly, to become politician and administrator actively as well as to become active voter. Thirdly, to work as a team of integration to maximize team spirit for the common good.
Administrative Personnel ; Ceramics ; Delivery of Health Care ; Humans ; Jurisprudence ; Korea ; Politics ; Public Health ; Social Justice ; Social Responsibility ; Social Sciences

Early fetal growth delay and early oligohydramnios have been suspected as signs of embryonal jeopardy. However, little information is available for the prediction of early abortion. Sonographic examination of 111 early pregnancies between the sixth and ninth gestational week with regular, 28 day menstrual cycles was performed to investigate predictable sonographic findings of early abortion. Sonographic measurements of the gestational sac (G-SAC), crown-rump length (CRL) and fetal heart rate (FHR) were performed using a linear array real time transducer with Doppler. All measurements of 17 early abortions were compared to those of 94 normal pregnancies to investigate the objective rules for the screening of early abortion. Most of the early aborted pregnancies were classified correctly by discriminant analysis with G-SAC and CRL (G-SAC = 0.5222 CRL + 14.6673 = 0.5 CRL + 15, sensitivity 76.5% specificity 96.8%). With the addition of FHR, 94.1% of early abortions could be predicted. In conclusion, sonographic findings of early intrauterine growth retardation, early oligohydromnios and bradycardia can be predictable signs for the poor prognosis of early pregnancies.
Abortion, Spontaneous/*ultrasonography ; Adult ; Discriminant Analysis ; Female ; Fetal Growth Retardation/ultrasonography ; Gestational Age ; Humans ; Predictive Value of Tests ; Pregnancy ; Prognosis ; Sensitivity and Specificity ; Time Factors ; *Ultrasonography, Prenatal

This paper addresses the issue of adolescent sexuality education as one component of school health education. Health education is a key element in comprehensive health care. The purpose of school health education is to develop the motivation and skills required by students to cope with challenges to health and to build the foundation of knowledge required to comprehend the further health learning scheduled for their future. Same principle applies to sexuality education. Today's sexuality education is about the facts of living, and that education continues throughout the life cycle. Sexuality education is a life-long process. Also knowledge and information about sexuality and family planning are essential for everyone. By sexuality education, young students would realize that each sexual decision has an effect or consequence and sexual decisions should support the dignity, equality and worth of each individual and they should take into account the medical, psychological and social effects of sexual activity and concept of sexuality. Values of sexuality education are thoroughly investigated. Furthermore, several models including online and offline services of sexuality education which would be performed by physicians are suggested and discussed in this paper.
Adolescent ; Comprehensive Health Care ; Education* ; Family Planning Services ; Health Education ; Humans ; Learning ; Life Cycle Stages ; Motivation ; School Health Services* ; Sexual Behavior ; Sexuality*

PURPOSE: To find the incidence and risk factors for polyomavirus (PV) infection, we monitored urine decoy cell (UDC) after renal transplantation. METHODS: From March 2003 to September 2004, 142 de novo renal recipients were prospectively monitored for UDC at post-transplant 1, 3, 6, 9, 12 months. According to the number of UDC in Cytospin, patients were divided into 3 groups: A (0), B (1~9) and C (> or =10). We decreased immunosuppression (IS) when group C status persisted for more than 1 month or more than 4 UDC was continuously detected for more than 3 months. Differences in demographics and clinical characteristics among the groups were compared. RESULTS: Forty four (31%) patients were found to have positive UDC at least at one examination (30 in group B and 14 in C). The number of patients with positive UDC at postoperative 1, 3, 6, 9, 12 months were 10 (22.7%), 14 (31.8%), 17 (38.6%), 27 (61.3%), 20 (45.4%) respectively with a highest at 9 months. One PV nephropathy was documented by renal biopsy. During the period from January 2001 to December 2002 when we did not prospectively monitor UDC, 7 PV nephropathy cases were documented among 116 recipients. Tacrolimus (Tac) and episode of acute rejection (AR) were significant risk factor for positive UDC (P=0.036, 0.010, respectively). Cumulative incidence of PV infection was significantly different by the use of Tac and episode of AR (P=0.03, 0.013, respectively). CONCLUSION: Use of Tac and episode of AR were risk factor for positive UDC and PV infection. Modulation of IS by the result of UDC monitoring could decrease the development of PV nephropathy after renal transplantation.
Biopsy ; Demography ; Humans ; Immunosuppression ; Incidence ; Kidney Transplantation* ; Kidney* ; Polyomavirus ; Polyomavirus Infections ; Prospective Studies* ; Risk Factors ; Tacrolimus

PURPOSE: Osteoporosis is one of the common complications following kidney transplantation which causes profound morbidity. Using the pre-transplant bone mineral density (BMD) data, post-transplant change in the BMD of recipients was retrospectively evaluated. The risk factors affecting the post-transplant BMD changes were also evaluated in this study. METHODS: Between Jan. 1996 and Sep. 2003, 294 kidney transplant recipients were enrolled in this study. The BMD was expressed as the T-score of the spine and femur. The gender, age, the presence of pre-transplant diabetes mellitus, the matching degree of ABO blood types, the mode and duration of dialysis, and the history of previous transplantation were considered as variables possibly affecting the pre-transplant BMD and post-transplant BMD loss. Comparison analysis in each group was performed by a Students t-test or ANOVA. RESULTS: According to the pre-transplant BMD study, the mean of the spine T-score was significantly lower in the retransplant group. The mean femur T-score was also significantly lower in the retransplant group as well as the elderly (more than 45 years) and female recipients. In the 3 years following transplantation, rapid bone loss occurred particularly in the first post-transplant year. After a kidney transplantation, the normal pre-transplant BMD group (T- score>-1.0) showed a significantly higher bone loss than the abnormal pre-transplant BMD group (T-score< or =-1.0). Prolonged pre-transplant hemodialysis (more than 12 months) and a retransplant were risk factors affecting the BMD loss in the first post-transplant year. The early application of anti-osteoporosis management (such as alfacalcidol, alendronate sodium, or risendronate sodium) was effective in ameliorating the post-transplant BMD loss. However, anti- osteoporosis management after the first post- transplant year was not effective. CONCLUSION: A pre-transplant evaluation of the BMD and the significant BMD loss during the first post-transplant year should not be overlooked. Prophylactic management against the bone loss and the treatment of osteoporosis should be started as soon as possible after transplantation in recipients with both normal and abnormal pre-transplant BMD.
Aged ; Alendronate ; Bone Density* ; Diabetes Mellitus ; Dialysis ; Female ; Femur ; Humans ; Kidney Transplantation* ; Kidney* ; Osteoporosis ; Renal Dialysis ; Retrospective Studies ; Risk Factors ; Spine ; Transplantation

PURPOSE: The natural history of renal transplant recipients with positive HBs Ag is still unclear and unpredictable. Liver-related morbidity and mortality after long-term immunosuppression need clinical challenges. We retrospectively investigated the clinical outcome of pre-transplant HBs Ag positive renal recipients in a single transplant center located in endemic area. METHODS: After excluding post-transplant de novo HBV infected, and peri-transplant anti-hepatitis C virus positive recipients, the clinical outcome of 1,816 recipients was examined by the nature of pre-transplant HBs Ag positivity. RESULTS: Pre-transplant HBs Ag positivity was documented in 61 recipients (M/F=47/14). During mean follow up of 71.61+/-54.14 months, 24 recipients died (6 by infection, 12 by hepatic failure, 2 by hepatocellular carcinoma, 2 by other malignancies, 1 by suicide, 1 by gastrointestinal bleeding). In 14 recipients (58.3%), death was related to liver-associated reasons. The 10-year patient survival rates in HBs Ag negative and positive groups were 90.0% and 62.6%, respectively (P<0.0001). The 10-year graft survival rates in HBs Ag negative and positive groups were 82.0% and 55.6%, respectively (P<0.0001). When pre-transplant HBV DNA viral load by PCR was positive or when the level of post-transplant HBV-DNA viral load flared up, we started lamivudine therapy since 1997. Seventeen recipients received daily 100 mg lamivudine. The mean duration of patients survival with (n=17) and without (n=44) lamivudine therapy was 104.3+/-45.6 and 59.0+/-51.2 months, respectively (P= 0.003). The 10-year patient survival rates in patients with and without lamivudine therapy were 80.7% and 55.4%, respectively (P=0.0698). CONCLUSION: Overall patient and graft survival in patients with positive pre-transplant HBs Ag was lower than negative recipients. Although, statistically not significant, lamivudine therapy showed a marginally positive impact on the survival of patients with pre-transplant positive HBs Ag.
Carcinoma, Hepatocellular ; DNA ; Follow-Up Studies ; Graft Survival ; Hepatitis B Surface Antigens* ; Hepatitis B* ; Hepatitis* ; Humans ; Immunosuppression ; Kidney Transplantation* ; Lamivudine ; Liver Failure ; Mortality ; Natural History ; Polymerase Chain Reaction ; Retrospective Studies ; Suicide ; Survival Rate ; Transplantation ; Viral Load

PURPOSE: The aims of this study were to review the result of kidney re-transplantation in comparison with first kidney transplantation, and to identify the prognostic factors affecting long-term outcome at a single center. METHODS: Between April 1979 and January 2006, the total number of renal allografts was 2,495. Among these, 159 cases received second (155 cases) or third (4 cases) transplantation. Demographic characteristics and clinical outcomes of both groups were compared. And we examined the risk factors affecting long-term outcome in re-transplantation recipients. RESULTS: The mean duration of previous graft survival in re-transplantation group was 86.1+/-51.4 (0~215) months. Major cause of the previous graft failure was chronic rejection (n=88, 55.3%). One-, 5-, and 10-year graft survivals of the re-transplantation group and the first transplantation group were 94.1%, 88.9%, 76.0% and 96.0%, 84.8%, 69.1%, respectively without significant difference (P=0.2203). In uni-variate survival analysis, acute rejection experienced group, elderly recipient more than 50 years old, and female gender group showed significant inferior graft survival rate compared to control group. Previous graft survival duration didn't cause significant graft survival difference. Multivariate survival analysis also confirmed that the episodes of acute rejection within 12 months after transplantation (P=0.035, Odd ratio= 2.514), elderly recipient more than 50 years old (P=0.002, odd ratio=3.734), and female gender (P=0.005, Odd ratio= 3.692) were statistically significant independent risk factors affecting graft survival in kidney re-transplantation. CONCLUSION: Long-term outcomes after kidney re-transplantation were not different from that of first kidney transplantation. Therefore, renal re-transplantation could be the treatment of choice even in recipients with previous failed renal allograft.
Aged ; Allografts ; Female ; Graft Survival ; Humans ; Kidney Transplantation ; Kidney* ; Middle Aged ; Risk Factors* ; Survival Rate ; Transplants