No abstract available.
Perinatal Care*

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

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

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*

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

PURPOSE: The decrease in bone mineral density (BMD) is a major complication after kidney transplantation. This was reported to occur preferentially during the first 6 months. However, the treatment and prevention strategies against a decline of BMD are not yet clear. METHODS: The data on the pre-transplant baseline and post-transplant 1 year BMD were archived and retrieved in 125 renal transplant recipients. The post-transplant changes of the BMD were compared by the baseline status of the BMD and the types of anti-osteoporosis treatment either with a vitamin D agent (alfacalcidiol) (n=18) or alendronate (n=21). Anti-osteoporosis treatment began within 30 days after transplantation, with an oral administration of 0.5 mcg/day vitamin D or 70 mg/week alendronate, and maintained until 1 year after transplantation. RESULTS: Regardless the degree of baseline BMD status, each group (the control, vitamin D, or alendronate group) showed a significant and uniform decrease of BMD during the post-transplant 1 year. The mean change in the spine BMD in the control, vitamin D, and alendronate group was -7.1+/-7.5%, -3.3+/-7.4% and -2.6+/-6.5%, respectively. The femur BMD also changed -5.1+/-7.7%, 1.1+/-5.3% and -1.5+/-8.2%, respectively. The degree of BMD decrease in the treatment groups was significantly lower than that in the control (P=0.014 in spine, P=0.003 in femur). When the severely reduced baseline BMD (T-score of spine or femur < or =-1) subgroups were analysed separately, the treatment groups (-3.7+/-6.5% in vitamin D and -1.1+/-6.4% in alendronate group) showed a significantly less decrease in the spine BMD than the control (-8.2+/-6.2%)(P=0.036). The femur BMD also showed a less decrease in the BMD in the treatment group, but this was not statistically significant (P=0.234). There was no significant difference between the vitamin D and alendronate treatment groups. CONCLUSION: After renal transplantation, early administration of vitamin D or alendronate showed some benefit to reduce the post-transplant decrease of BMD in both spine and femur area.
Administration, Oral ; Alendronate* ; Bone Density* ; Femur ; Kidney Transplantation* ; Spine ; Transplantation ; Vitamin D* ; Vitamins*

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

Purpose: Many patients who have an acceptable living- kidney donor do not undergo transplantation because of the presence of antibodies against the donor cells resulting in a positive lymphocyte-crossmatch (LCX). Recently, the combination therapy of plasmapheresis, intravenous gamma- globulin and potent immunosuppression to induce negative conversion of LCX in patients who had positive LCX to their living donors was reported. Our institute gave these patients the combination therapy and reported the results of follow-up done 1~3 years after kidney transplantation. Methods: Eleven patients, who showed positive LCX to their living donors, underwent the conversion trials between January 1, 2002 and March 31, 2004. Combination therapy consisting of plasmapheresis, intravenous gamma globulin injection, tacrolimus, mycophenolate mofetil (MMF) and steroids was used. Plasmapheresis had been done every other day up to 6 times. Kidney transplantations were performed immediately after negative conversion was achieved. Five to ten day-courses of ATG (or OKT3) were used as an induction immunosuppression and tacrolimus, MMF, and steroids as a maintenance immunosuppression. Results: Negative conversions in ten out of eleven patients were achieved. Kidney transplantations in these 10 patients were successfully performed. No hyperacute rejection transpired, although four patients developed acute rejection, whose grafts were all rescued with steroid pulse therapy. Serum creatinine level was 1.57+/-0.12 mg/dL (mean+/-SD) during follow-up periods except for one whose graft was lost to Polyoma virus nephropathy. Conclusion: Nine of the 10 grafts are functioning well for 15~41 months after transplantations. Our results suggest that selected crossmatch positive patients can be transplanted successfully with living donor kidney allograft.
Allografts* ; Antibodies ; Creatinine ; Follow-Up Studies ; gamma-Globulins* ; Humans ; Immunosuppression ; Kidney ; Kidney Transplantation ; Living Donors ; Lymphocytes* ; Plasmapheresis* ; Polyomavirus ; Steroids ; Tacrolimus ; Tissue Donors ; Transplants