PURPOSE: This study was done to investigate factors affecting perceived financial burden of medical expenditures. METHOD: The participants were 2,024 inpatients who were enrolled in a survey on the benefit coverage rate of the National Health Insurance in 2006. The collected data were analyzed using t-test, ANOVA-test, Mann-Whitney-test, Kruskal-Wallis-test, Chi-square test and logistic regression. RESULTS: The crucial factors for perceived financial burden were age, job, equivalence scale, ratio of annual family income vs medical expenditure, and private health insurance. Perceived financial burden was higher for people who were older, who were unemployed, whose medical expenditures were high compared to annual family income, whose index of family equalization was low and for those who had no private health insurance. CONCLUSION: The results of the study indicate a demand for system reform that will enable management of no-pay hospital bills in the National Health Insurance to decrease the medical expense of people in the low-income bracket.
Health Expenditures ; Humans ; Inpatients ; Insurance, Health ; National Health Programs

PURPOSE: This study was to present the effects of home visiting health service on hypertension and DM clients. METHOD: The one-group pretest-posttest design was applied to 127 hypertension and 116 DM clients. To evaluate the effects of visiting nursing service, biological indexes and self-care abilities were measured from April to July, 2007. RESULT: Biological indexes and self-care abilities were improved in the hypertension and DM clients who received visiting nursing service. Especially, blood pressure and fasting blood sugar showed a dramatic decrease. CONCLUSION: Home visiting health service by public health centers is considered to be an effective nursing service in Gangwon-do. Therefore, case management is demanded not only for hypertension and DM but also for other chronic diseases.
Blood Glucose ; Blood Pressure ; Case Management ; Chronic Disease ; Diabetes Mellitus ; Fasting ; Gangwon-do ; Health Services* ; Home Care Services ; House Calls* ; Hypertension* ; Nursing Services ; Public Health ; Self Care

PURPOSE: The first Korean national population- based cancer registry using nationwide hospital-based recording system and the regional cancer registries provided the source to obtain national cancer incidences for the period 1999~2001. MATERIALS AND METHODS: The incidence of cancer in Korea was calculated based on the Korea Central Cancer Registry database, data from additional medical record review survey, the Regional Cancer Registry databases, site-specific cancer registry databases, and cancer mortality data from the Korea National Statistical Office. Crude and age-standardized rates were calculated by sex for 18 age groups. RESULTS: The overall crude incidence rates (CR) were 247.3 and 188.3 per 100, 000 for men and women and the overall age-standardized incidence rates (ASR) were 281.2 and 160.3 per 100, 000, respectively. Among men, five leading primary cancer sites were stomach (CR 58.6, ASR 65.6), lung (CR 42.1, ASR 50.9), liver (CR 41.9, ASR 44.9), colon and rectum (CR 24.2, ASR 27.3) and bladder (CR 7.7, ASR 9.2). Among women, the most common cancers were stomach (CR 30.8, ASR 25.8), breast (CR 25.7, ASR 21.7), colon and rectum (CR 19.6, ASR 16.7), uterine cervix (CR 18.4, ASR 15.5), and lung cancer (CR 15.1, ASR 12.4). In 0~14 age group, leukemia was most common for both sexes. For men, stomach cancer was most common in 15~64 age group, but lung cancer was more frequent for over 65 age group. For women, thyroid cancer in 15~34 age group, breast cancer in 35~64 age group, and stomach cancer in over 65 age group were most common for each age group. The proportions of death certificate only were 7.5% for men and 7.4% for women. CONCLUSION: This is the first attempt to determine the national cancer incidence and this data will be useful to plan for research and national cancer control in Korea.
Breast ; Breast Neoplasms ; Cervix Uteri ; Colon ; Death Certificates ; Female ; Humans ; Incidence* ; Korea* ; Leukemia ; Liver ; Lung ; Lung Neoplasms ; Male ; Medical Records ; Mortality ; Rectum ; Registries ; Stomach ; Stomach Neoplasms ; Thyroid Neoplasms ; Urinary Bladder

The Korea School Lunch Program mandates that school meals should safeguard the health and well-being of our children. School meals provide a nutritious diet that contains at least 1/3 of the daily Recommended Dietary Allowances of necessary nutrients at reasonable prices. This study was performed to assess the nutritional management of primary school meals, and to provide basic data for improvement of school meal nutritional guidelines. Three hundred and thirty six dietitians who worked at primary schools were recruited using a stratified sampling method. A survey was done by e-mail with a set of questionnaires about nutritional meal management. During school lunch planning, dietitians referred nutrition standards with priority, followed by students' food preferences and food hygiene. They considered energy as a most important nutrient during primary school lunch planning, followed by protein and calcium. Protein is usually over-served, whereas iron, vitamin A and calcium are usually under-served during primary school meal planning. For first and second grade primary students, grains, meat and vegetable side dishes seemed to be large compared to their eating capacity. Over 92% of school dietitians agreed the needs of food group standards for primary school lunch program. For making a checklist of the school lunch program, energy, protein and calcium were highly recommended, and meat.fish.egg group, vegetable.fruit group and dairy group were also highly recommended by school dietitians. Cooking method was also highly recommended. School dietitians proposed that remodeling of school kitchens and new cooking machine were the most important factors for improving school lunch system. These results suggest that food standards should be established for health-oriented nutritional management of primary school lunch programs. Nutritional checklists could include nutrient-rich foods and food groups, and items about cooking methods.
Calcium ; Edible Grain ; Checklist ; Child ; Cooking ; Diet ; Eating ; Electronic Mail ; Food Preferences ; Humans ; Hygiene ; Iron ; Korea ; Lunch* ; Meals ; Meat ; Nutritionists ; Surveys and Questionnaires ; Recommended Dietary Allowances ; Vegetables ; Vitamin A

The Korea School Lunch Program mandates that school meals should safeguard the health and well-being of our children. School meals provide a nutritious diet that contains at least 1/3 of the daily Recommended Dietary Allowances of necessary nutrients at reasonable prices. This study was performed to assess the nutritional management of primary school meals, and to provide basic data for improvement of school meal nutritional guidelines. Three hundred and thirty six dietitians who worked at primary schools were recruited using a stratified sampling method. A survey was done by e-mail with a set of questionnaires about nutritional meal management. During school lunch planning, dietitians referred nutrition standards with priority, followed by students' food preferences and food hygiene. They considered energy as a most important nutrient during primary school lunch planning, followed by protein and calcium. Protein is usually over-served, whereas iron, vitamin A and calcium are usually under-served during primary school meal planning. For first and second grade primary students, grains, meat and vegetable side dishes seemed to be large compared to their eating capacity. Over 92% of school dietitians agreed the needs of food group standards for primary school lunch program. For making a checklist of the school lunch program, energy, protein and calcium were highly recommended, and meat.fish.egg group, vegetable.fruit group and dairy group were also highly recommended by school dietitians. Cooking method was also highly recommended. School dietitians proposed that remodeling of school kitchens and new cooking machine were the most important factors for improving school lunch system. These results suggest that food standards should be established for health-oriented nutritional management of primary school lunch programs. Nutritional checklists could include nutrient-rich foods and food groups, and items about cooking methods.
Calcium ; Edible Grain ; Checklist ; Child ; Cooking ; Diet ; Eating ; Electronic Mail ; Food Preferences ; Humans ; Hygiene ; Iron ; Korea ; Lunch* ; Meals ; Meat ; Nutritionists ; Surveys and Questionnaires ; Recommended Dietary Allowances ; Vegetables ; Vitamin A

BACKGROUND: Several biologically plausible mechanisms have been proposed for estrogen-associated changes in lipid and bone metabolism. These effects are thought to be mediated via estrogen receptor (ER). Several polymorphisms in the gene encoding estrogen receptor alpha may modify the effects of hormone replacement therapy on lipid and bone density in postmenopausal women. METHODS: We examined 284 postmenopausal women for thymine-adenine (TA) repeat polymorphism at the ER gene locus and its relationship to lipid and bone density. Their mean age was 52.2+/-5.0 years. We also investigated the association between ER TA repeat polymorphism and changes in lipid and bone density after 3 months and 1 year of hormone replacement therapy. RESULTS: According to the mean number of TA repeats, the women were divided into two groups: group H, with higher number of repeats (TA>16)(n=110); group L, with lower number of repeats (TA Bone Density* ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Estrogen Receptor alpha ; Estrogens* ; Female ; Hormone Replacement Therapy* ; Humans ; Metabolism ; Receptors, Estrogen ; Triglycerides

Small cell carcinoma of the colon and rectum is a rare primary epithelial malignancy at this location. Histologically, this tumor represents a spectrum of neuroendocrine differentiation. The neuroendocrine cancers of the colon manifest a highly aggressive behavior, even more than their adenocarcinoma counterpart of the same stage. Small cell carcinoma in the colon has early metastasis and the prognosis is extremely poor. We report a case of small cell carcinoma of the rectum manifesting as femur neck fracture during sleep.
Adenocarcinoma ; Carcinoma, Small Cell* ; Colon ; Femoral Neck Fractures* ; Femur Neck* ; Femur* ; Neoplasm Metastasis ; Prognosis ; Rectum*

The human transforming growth factor-3 (TGF-3) is an important cytokine to maintain bone mass by inhibiting osteoclast differentiation. Recently raloxifene response element (RRE), a new enhancer with a polypurine sequence for estrogen receptor (ER)-mediated gene activation, was identified on the TGF-3 gene. Functional analysis of the RRE-mediated pathway has shown that this would be an important pathway for bone preserving effect. We found a novel mutation in the RRE sequence by single-strand conformational polymorphism analysis in one of 200 Korean women. Cloning and sequencing revealed a heterozygote in which one allele had an insertion of 20 nucleotides (AGAGAGGGAGAGGGAGA GGG) between nucleotide +71 and +72 and a point mutation at nucleotide +75 (G-A transition), and the other allele had normal sequence. The insertion was a nearly perfect tandem duplication of the wild type DNA sequence. The bone mineral density of the affected woman was not much lower than that of age-matched controls. Transient transfection of the mutant allele showed no significantly different activity compared with that of the wild type allele. These observations suggest that the heterozygote variation of the RRE sequence seems not to be operative in determination of bone mass.
Estrogen Antagonists/*pharmacology ; Female ; Human ; Middle Age ; *Mutation ; Raloxifene/*pharmacology ; *Response Elements ; Transfection ; Transforming Growth Factor beta/*genetics

Information on precise effects of deflazacort on bone cell function, especially osteoclasts, is quite limited. Therefore, the present study was undertaken to test effects of deflazacort on osteoclast-like cell formation in mouse bone marrow cultures and on the regulation of osteoprotegerin (OPG) and its ligand (RANKL) mRNA expressions by RT-PCR in the ST2 marrow stromal cells. TRAP-positive mononuclear cells increased after the treatment of deflazacort at 10(-9) to 10(-7) M alone for 6 days in a dose-dependent manner. Number of TRAP-positive multi-nucleated cells (MNCs) increased significantly with combined treatment of deflazacort at 10(-7) M and 1,25-(OH)2D3 at 10(-9) M compared to that of cultures treated with 1,25-(OH)2D3 alone (p<0.05). Exposure to deflazacort at 10(-7) M in the presence of 1,25-(OH)2D3 at 10(-9) M in the last 3-day culture had greater stimulatory effect on osteoclast-like cell formation than that of the first 3-day culture did. Deflazacort at 10(-10) -10(-6) M downregulated OPG and upregulated RANKL in mRNA levels in a dose-dependent manner. These observations suggest that deflazacort stimulate osteoclast precursor in the absence of 1,25-(OH)2D3 and enhance differentiation of osteoclasts in the presence of 1,25-(OH)2D3. These effects are, in part, thought to be mediated by the regulation of the expression of OPG and RANKL mRNA in marrow stromal cells.
Animal ; Bone Marrow Cells/*cytology ; Calcitriol/pharmacology ; Calcium Channel Agonists/pharmacology ; Carrier Proteins/*genetics ; Cell Differentiation/drug effects ; Cells, Cultured ; Dexamethasone/pharmacology ; Gene Expression/drug effects ; Glucocorticoids, Synthetic/pharmacology ; Glycoproteins/*genetics ; Immunosuppressive Agents/*pharmacology ; Male ; Membrane Glycoproteins/*genetics ; Mice ; Mice, Inbred ICR ; Osteoclasts/*cytology ; Pregnenediones/*pharmacology ; RNA, Messenger/analysis ; Receptors, Cytoplasmic and Nuclear/*genetics ; Stromal Cells/cytology

McCune-Albright syndrome (MAS) is a sporadic disease classically including polyostotic fibrous dysplasia, cafe -au-lait spots, sexual precocity, and other hyperfunctional endocrinopathies. Recent investigations suggest an etiological role for activating embryonic somatic missense mutations in the gene for the a subunit of Gs (Gsa), the G protein that stimulates adenylyl cyclase. DNA from bone, ovary, and blood was analyzed by using polymerase chain reaction and sequenced. A embryological somatic mutation of Gsa gene encoding substitution of a Cys for Arg at amino acid 201 from cells of dysplastic bone and ovary was observed, and the distribution of mutant gene reveals mosaic pattern. We report a case of McCune-Albright syndrome with an activating mutation at codon 201 of Gsa subunit on ovary and bone tissue that was experienced recently.
Adenylyl Cyclases ; Bone and Bones ; Codon ; DNA ; Female ; Fibrous Dysplasia, Polyostotic* ; GTP-Binding Proteins* ; Mutation, Missense ; Ovary ; Polymerase Chain Reaction