PURPOSE: This is a comparative study using secondary data from the Korean national long term care (LTC) insurance. METHODS: Visiting nursing (VN) service users (n=666) and non-users (n=4,375) were extracted and compared in terms of medical expenditures, length of hospitalization, and annual number of ambulatory care visits to investigate effects of VN services in LTC. RESULTS: Total health care expenditures were compared between the two groups and it was found that VN service users spent about $ 1700 than non-users for their medical costs between 2009 and 2011. The average length of in-hospital stay for VN service users was 19.4 days shorter than that of non-users. However, using VN services did not significantly influence the annual number of ambulatory care visits. CONCLUSION: The study has found that VN services are effective ways of providing community-based LTC services. We recommend LTC policy makers to further utilize VN services to deliver cost effective health care services.
Administrative Personnel ; Ambulatory Care ; Delivery of Health Care* ; Health Care Costs ; Health Expenditures ; Hospitalization ; Humans ; Inpatients ; Insurance ; Insurance, Long-Term Care* ; Long-Term Care* ; Nursing Services* ; Nursing* ; Outpatients

PURPOSE: Lumbar degenerative kyphosis (LDK) is a subgroup of the flatback syndrome, which is a condition caused by spinal degeneration. LDK is reported to be the most frequent cause of lumbar spine deformity in the farming districts of the 'Oriental' countries. We investigated the relationship between the cross-sectional area (CSA) and the moment arm length (MAL) of the erector spinae muscle and the thickness of the psoas major muscle (PT) and the body mass index (BMI) by performing statistical analysis, and we tried to show the crucial role of these variables for diagnosing LDK. MATERIALS AND METHODS: From July 2004 to April 2005, we retrospectively reviewed 17 LDK patients who had undergone anterior lumbar interbody fusion (ALIF) with posterior stabilization. We measured both the CSA & MAL on the transverse cross-sectional MR image of the trunk at the fourth to fifth vertebrae (L4/5). The MAL was defined as the anterior-posterior distance between the center of the erector spinae muscle and that of the vertebral body. A comparative study was undertaken between the LDK group and the matched (according to age & gender) control group with regard to the CSA, MAL, PT and BMI. RESULTS: The 17 LDK patients were all females [age: 62.5+/-4.93 years, height: 157+/-6.19 cm, weight: 55.59+/-4.7 kg, and BMI: 22.58+/-2.08 kg/m2]. The control group patients were all females [age: 63.6+/-2.27 years, height: 156+/-5.05 cm, weight: 59.65+/-7.39 kg and BMI: 24.38+/-2.94 kg/m2]. Spearman's rho indicated a positive association between the CSA & BMI (rho=0.49, p=0.046), between the MAL & BMI (rho=0.808, p=0.000) and between the CSA & PT (rho=0.566, p=0.018) in the LDK patients. In terms of the CSA versus MAL, there was a positive association in both groups (rho=0.67, p=0.000, MAL=0.023CSA+5.454 in the LDK group; rho=0.564, p=0.018, MAL=0.02CSA+5.832 in the control group with using linear regression analysis). Independent t-tests revealed that both groups had statistically different mean values (p=0.000) in terms of the CSA & MAL. CONCLUSION: This study showed that the patients with LDK not only had atrophied erector spinae muscles, but also atrophied psoas major muscles and short MALs, which is harmful because of the increased lower back load in the aged patients. Along with BMI, measurement of the CSA, MAL & PT on the MR images provides an objective assessment of the dimension & severity of the muscle atrophy in the LDK patients.
Arm* ; Body Mass Index* ; Congenital Abnormalities ; Female ; Humans ; Kyphosis* ; Linear Models ; Magnetic Resonance Imaging* ; Muscles ; Muscular Atrophy ; Retrospective Studies ; Spine

Spinocerebellar ataxia type-2 (SCA2) is an autosomal dominant cerebellar ataxia that occurs due to expanded CAG trinucleotide repeats in the ATXN2 gene. Clinical features of parkinsonism in SCA2 vary from phenotypes of levodopa-responsive parkinsonism to multiple system atrophy. We described a patient with SCA2 presenting typical clinical manifestations of multiple system atrophy-c type with levodopa responsive parkinsonism whose dopamine transporter (DAT) image showed atypically reduced DAT uptake in in the striatum.

PURPOSE: The purpose of this study is to evaluate the costs and benefits of individual home visiting health care using secondary data and literature review. METHODS: The total number of subjects was 1,008,837. A specific program was classified into disease management, care of infant, child and women, or elderly care. The costs and effects of a program were identified from a societal perspective, and the effects were converted into monetary terms or benefits. The total cost was calculated in the way that medical expenses, travel costs and productivity losses were offset by the decrease in benefits and thus only the program budget was included in the total cost. RESULTS: The total program cost was 47.6 billion won per year and the total annual benefit was estimated at 435.6 billion won. The benefits of arthritis management were the biggest among disease management programs. The net benefit was 388.0 billion won per year and the benefit/cost ratio was 9.16. CONCLUSION: Home visiting health care was validated to be economically effective. It made a positive contribution to improving the health status of vulnerable populations and reducing medical expenses. These results suggest that home visiting care should be extended more broadly to vulnerable populations.
Aged ; Arthritis ; Budgets ; Child ; Cost-Benefit Analysis* ; Delivery of Health Care* ; Disease Management ; Efficiency ; Female ; House Calls* ; Humans ; Infant ; Vulnerable Populations

No abstract available.
Lung* ; Thorax*

Acquired idiopathic generalized anhidrosis (AIGA) is a very rare disease, and its pathogenesis is poorly understood. We here report on a 20-year-old man presenting with a history of inability to sweat, small wheals, and occasional heat intolerance since 3 months. On provocation test, there was no sweating over the entire surface of the body, excluding the palms and axillae. His medical history was unremarkable and laboratory examination findings were all normal. There was no familial history suggestive of neuroendocrine disease. Based on these findings, we diagnosed acquired idiopathic generalized anhidrosis. To our knowledge, this is the first case of AIGA in Korean dermatologic literature. Herein, we report a rare case of AIGA.
Axilla ; Hot Temperature ; Humans ; Hypohidrosis* ; Rare Diseases ; Sweat ; Sweating ; Young Adult

Trichophyton tonsurans is an anthropophilic dermatophyte that is not yet truly prevalent in Korea. Especially, cases of toe nail infection during childhood are very rare, and no cases have been reported prior to this report. We report a single case of tinea unguium due to T. tonsurans in a healthy child. A 7 year-old patient visited an outpatient clinic presenting with subungual hyperkeratosis of the 1st and 3rd Rt. toe nails, which had first presented at an age of 28 months, and no other symptoms. Numerous hyphae were evident on the KOH smear examination. A confirmative diagnosis of tinea unguium cased by T. tonsurans was made after culturing scales from the toe nail lesion. The patient is currently undergoing follow-up, after being treated with oral terbinafine hydrochloride, without a relapse in symptoms.
Ambulatory Care Facilities ; Arthrodermataceae ; Child ; Follow-Up Studies ; Humans ; Hyphae ; Korea ; Nails ; Naphthalenes ; Onychomycosis ; Polyenes ; Recurrence ; Toes ; Trichophyton ; Weights and Measures

Depression in the elderly population has shown increased likelihood of neurological disorders due to structural changes in the subcortical area. However, further investigation into depression related subcortical changes is needed due to mismatches in structural analysis results between studies as well as scarcities in research regarding subcortical connectivity patterns of subclinical depression populations. This study aims to investigate structural differences in subcortical regions of aged participants with subclinical depression using 3Tesla MRI. In structural analysis, volumes of each subcortical region were measured to observe the volumetric difference and asymmetry between groups, but no significant difference was found. In addition, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) did not show any significant differences between groups.Structural analysis using probabilistic tractography indicated that the connection strength between left nucleus accumbens-right hippocampus, and right thalamus-right caudate was higher in the control group than the subclinical depression group. The differences in subcortical connection strength of subclinical depression groups, have shown to correlate with emotional and cognitive disorders, such as anxiety and memory impairment. We believe that the analysis of structural differences and cross-regional network measures in subcortical structures can help identify neurophysiological changes occurring in subclinical depression.

Depression in the elderly population has shown increased likelihood of neurological disorders due to structural changes in the subcortical area. However, further investigation into depression related subcortical changes is needed due to mismatches in structural analysis results between studies as well as scarcities in research regarding subcortical connectivity patterns of subclinical depression populations. This study aims to investigate structural differences in subcortical regions of aged participants with subclinical depression using 3Tesla MRI. In structural analysis, volumes of each subcortical region were measured to observe the volumetric difference and asymmetry between groups, but no significant difference was found. In addition, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) did not show any significant differences between groups.Structural analysis using probabilistic tractography indicated that the connection strength between left nucleus accumbens-right hippocampus, and right thalamus-right caudate was higher in the control group than the subclinical depression group. The differences in subcortical connection strength of subclinical depression groups, have shown to correlate with emotional and cognitive disorders, such as anxiety and memory impairment. We believe that the analysis of structural differences and cross-regional network measures in subcortical structures can help identify neurophysiological changes occurring in subclinical depression.

Airway management is challenging during general anesthesia particularly in small infants. Airway obstruction is prone to occur in premature infants during general anesthesia due to several reasons. We report a case of airway obstruction occurred during the induction of general anesthesia in a 2-month-old infant. Several attempts at endotracheal intubation with positive pressure ventilation resulted in repeated patterns of no end-tidal carbon dioxide output after each trial of endotracheal intubation, but it was reappeared after extubation. However, anesthetic induction with self-respiration and gentle assistance with manual bagging led to a successful intubation. This case was explained by hydromechanics in a collapsible premature airway.
Airway Management ; Airway Obstruction* ; Anesthesia, General* ; Bronchial Spasm* ; Carbon Dioxide ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Intubation ; Intubation, Intratracheal ; Positive-Pressure Respiration