Adolescent ; Adult ; Aged ; Child ; Disease Outbreaks ; Humans ; Middle Aged ; Obesity ; epidemiology ; Singapore ; epidemiology ; Young Adult

No abstract available.
Urinary Tract Infections* ; Urinary Tract*

OBJECTIVES: The purpose of this study was to examine the difference in functional impairment between children with attention-deficit hyperactivity disorder (ADHD) and normal controls, and to compare the functional impairment across ADHD subtypes. METHODS: Children and adolescents with ADHD between the ages of 6 and 18 years were recruited for the study. Parents and teachers of the ADHD subjects completed the parents' and teachers' forms of the Children and Adolescents Functioning Impairment Scale (CAFIS), respectively. The results of these scales were compared to those of normal controls. RESULTS: Subjects included 110 children with ADHD, predominantly inattentive type (ADHD-IA); 23 with ADHD, predominantly hyperactive-impulsive type (ADHD-HI); and 60 ADHD, combined type (ADHD-C). When compared to 41 normal controls, there were significant differences in CAFIS-parent and CAFIS-teacher scales for the ADHD group. Functional impairment in the family relationship as rated by the parents was higher in children with ADHD-C when compared to that of children with ADHD-IA. CONCLUSION: In comparison to normal children, children with ADHD have a higher level of impairment in several functional areas, and differences exist in functional impairment across ADHD subtypes. Further, ratings of functional impairment between parents and teachers were inconsistent. Thus, gathering information from the teachers is important when diagnosing or establishing treatment regimens for ADHD.
Adolescent ; Child ; Family Relations ; Humans ; Parents ; Weights and Measures

OBJECTIVE: The objective of this study were to clarify the significance of PCNA and DNA ploidy as a possible parameter of the prognosis in squamous cell carcinoma of the uterine cervix. STUDY DESIGN: Women with the diagnosis of cervical cancer operated between January 1987, and July 1991, composed the study group(n=35) in this case-control group. Among these 35 patients.In theese patients we chose the patients with complete follow up treatment. Also we employed 7 control paraffin-embedded cervical specimens without any specific pathologic lesions for the comparison. Immunohistochemical staining to identify PCNA was applied to case of paraffin section and PCNA indices was obtained. DNA analysis was done by using flow cytometry and S-phase fraction and DNA ploidy were obtained. RESULT: The results were summarized as follows. 1. S-phase fraction were 20+/-7% in cervical cancer and 16+/-11% in control group. There were no statistical difference. Aneuploid ratio were 26%(9/35) in cervical cancer and 0%(0/7) in control group. There were statistical difference. PCNA indices were 45+/-6% in cervical cancer and 5+/-4% in control group. There were statistical difference. 2. There were no statistical difference in PCNA indices between large cell keratinizing type, and large cell nonkratinizing type of cervical cancer. 3. According to lymph node metastasis, there were no statistical difference in PCNA indices between positive group and negative group.4. According with various pathologic parameters, recurrence rate was hihger in cases of parametrial involvement. 5. The correlation of coefficient was 0.747 between PCNA indices and S-phasd fraction that is a significant relationship.6. According to recurrence, there were no statistical difference in S-phase fraction, aneuploidy and PCNA indices between group of recurrence and no recurrence.7. There were no statistical difference between <20% group nad>20%, group of S-phase, aneuploid and <60%, group and >60%, group of PCNA index in view of recurrence rate. conclusion: That is a significant relationship between S-phase fraction and PCNA indices, But, there are no statictical significance of PCNA indices, DNA ploid and a prognostic factor. So, that is a limitation in PCNA index DNA ploid when it was used as as prognostic parameter of nterine cervical cancer.
Aneuploidy ; Carcinoma, Squamous Cell ; Case-Control Studies ; Cervix Uteri ; Diagnosis ; DNA* ; Female ; Flow Cytometry ; Follow-Up Studies ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Paraffin ; Ploidies* ; Prognosis ; Proliferating Cell Nuclear Antigen ; Recurrence ; Uterine Cervical Neoplasms*

PURPOSE: The purpose of this study was to present our thoughts on the medical student evaluation of the courses via online at Konkuk University School of Medicine (KUSM) and to prompt us to improve the course evaluation system. METHODS: Electronic questionnaire for computer-aided course evaluation via online was completed by 93 medical students who attended 32 block lectures at KUSM in 2007. The questionnaire consisted of 21 evaluation items. Frequency analysis of response on the evaluation items was conducted to find out the key features. RESULTS: Evaluation forms for 32 lectures were received from the attendees via online. An average response rate was 63.8%. Among 17 Likert-scaled items, more negative response was observed in class quantity, studying method guidance, lecture note, teaching methods, and relevance of final examination. CONCLUSION: The current course evaluation at KUSM includes more questions that request students to state the overall quality of course modules than the detailed quality or skill of each lecturer. As the objective of the course evaluation is to promote students' learning and to give a feedback to the lecturer, the current consideration on the course evaluation prompted us to reorganize the design of the questionnaire according to the objective.
Educational Measurement ; Electronic Mail ; Electronics ; Electrons ; Humans ; Learning ; Lectures ; Program Evaluation ; Students, Medical ; Teaching ; Surveys and Questionnaires

The angiotensin-converting enzyme (ACE) gene DD homozygote has been suggested to be a significant risk factor for the progression of diabetic nephropathy. We analyzed clinical parameters and ACE genotype distribution between type 2 diabetic patients at the extremes of renal risk, i.e. an end-stage renal failure (ESRF) group (n = 103, group 1) who were on dialysis therapy due to progression of diabetic nephropathy, and a no progression group (n = 88, group 2) who had maintained normal renal function and normoalbuminuria for more than 15 years. There were no significant differences in age, sex, body mass index, HbA1c level, or lipid profiles between the two groups (p > 0.05). Group 1 had a significantly higher prevalence of hypertension [group 1: 82.5% (85/103) vs. group 2: 50.0% (44/88), p < 0.05] and diabetic retinopathy [group 1: 103/103 (100%) vs. group 2: 28/88 (31.8%), p < 0.05] than group 2. Daily urinary albumin excretion was also higher in group 1 than in group 2 [group 1: 2873 +/- 2176 mg/day vs. 12 +/- 7 g/day, p < 0.05]. The frequencies of the DD, ID, and II genotypes of the ACE gene in group 1 and group 2 were 26.2%, 47.6%, and 26.2%, and 7.9%, 57.9%, and 34.2%, respectively. The ACE genotype frequencies between the two groups were significantly different according to a chi-square test with Bonferroni's correction (p = 0.004). The presence of the DD genotype increased the risk of ESRF 4.286-fold compared to the II genotype [odds ratio 4.286, 95% CI 1.60- 11.42, p = 0.005]. The frequency of the D-allele was higher in both male and female patients in group 1 compared to group 2, but reached statistical significance only in males [male, group 1: 50.8% vs. group 2: 35.0%, p = 0.018, female, group 1: 48.8% vs. group 2: 39.5%, p = 0.231]. This study, although limited by sample size, showed that type 2 diabetic ESRF patients more frequently expressed the DD genotype. These findings may substantiate the previously noted relationship between the ACE DD genotype and the progression of diabetic nephropathy in Korean type 2 diabetic patients.
Renal Dialysis ; *Polymorphism, Genetic ; Peptidyl-Dipeptidase A/*genetics/metabolism ; Middle Aged ; Male ; Kidney Failure, Chronic/diagnosis/*genetics ; Humans ; Homozygote ; Gene Frequency ; Female ; Diabetic Nephropathies/diagnosis/*genetics ; Diabetes Mellitus, Type 2/diagnosis/*genetics ; Aged

PURPOSE: There is an unmet need for the treatment of moderate-to-severe atopic dermatitis (AD), leading to variation in management strategies. To investigate distinct features and treatment modalities according to physicians' specialties, we collected data on the current treatment approach to moderate-to-severe AD among allergists, pediatric allergists and dermatologists in Korea. METHODS: This questionnaire-based study was administered to physicians from the Korean Academy of Asthma, Allergy and Clinical Immunology (KAAACI), Korean Academy of Pediatric Allergy and Respiratory Disease (KAPARD), and Korean Atopic Dermatitis Association (KADA). RESULTS: A total of 93 physicians participated in the study; 64.5% were pediatric allergists and 31.2% were dermatologists. The major patient age groups were “less than 5 years” for 100% of pediatric allergists and “6–12 years old” for 38% of dermatologists. The proportion of patients with moderate-to-severe AD was higher for dermatologists and allergists compared to pediatric allergists. Physicians agreed on the necessity of education including demonstration of basic skin care and application of topical therapies (88.2%), nutritional consultation (83.9%) and psychological counseling (75.3%). However, less than half were able to educate and counsel their patients in real practice. There were noticeable differences in first-line treatment among physician groups. For pediatric allergists, the order of preferred systemic treatment was wet wrap therapy, systemic corticosteroids and oral cyclosporin. Dermatologists ranked cyclosporin, phototherapy, and systemic corticosteroids as first-line treatment regimens. Major reported barriers to proper management were steroid phobia, unproven complementary and alternative medicine, lack of education, and the unreasonable insurance system. CONCLUSIONS: Our findings suggest there are distinct differences in moderate-to-severe AD treatment according to physicians' specialties. Medical policy changes along with governmental supports are required in order to implement the ideal approach in real practice. For moderate-to-severe AD, a consensus on the approach to optimal management should be reached for the best outcomes, based on further randomized controlled trials.
Adrenal Cortex Hormones ; Allergy and Immunology ; Asthma ; Complementary Therapies ; Consensus ; Counseling ; Cyclosporine ; Dermatitis, Atopic* ; Education ; Humans ; Hypersensitivity ; Insurance ; Korea* ; Phobic Disorders ; Phototherapy ; Skin Care

BACKGROUND AND OBJECTIVES: Electrical dyssynchronicity (Dsyn) appears to be prognostic of survival in congestive heart failure (CHF). Recent study has shown some discrepancy between the electrical Dsyn and the Doppler tissue image (DTI) assessed mechanical Dsyn. The aim of our study was to evaluate the relationship between the QRS duration and DTI assessed Dsyn. SUBJCETS AND METHODS: One hundred and forty patients, with CHF and left ventricular ejection fractions < or =40%, were enrolled. DTI was performed on 5-basal and 5-mid segments to assess the time from the R-wave to the peak systolic velocity (RS time). A QRS duration >130 msec, standard deviation (SD) of the RS time >40 msec, or a difference in the maximal and minimal RS times (RS time-diff) >100 msec were indicators of'Dsyn'. RESULTS: The prevalence of myocardial Dsyn, by QRS duration, SD of the RS time and the RS time-diff were 19, 43 and 47%, respectively. The SD of the RS time (49.8+/-23.6 vs. 36.6+/-20.7, p<0.01) and the RS time-diff (139.2+/-63.2 vs. 98.0+/-54.3, p<0.01) were prolonged in the wide (>130 msec) compared with the narrow QRS group. There was also a weak positive correlation between the QRS duration and the SD of the RS time (R=0.34, p<0.001) and the RS time-diff (R=0.38, p<0.001). However, from a cross-tabulation analysis, more than one third of patients had a discrepancy between QRS duration and DTI assessed mechanical Dsyn. From a multivariate analysis, a major determinant of the SD of the RS time was the QRS duration. CONCLUSION: Although a major determinant of the DTI assessed Dsyn was the QRS duration, more than one-third of patients had a discrepancy between electrical and mechanical Dsyn. Therefore, not only the QRS duration, but the DTI assessed Dsyn, should be measured when considering cardiac resynchronization therapy.
Cardiac Resynchronization Therapy ; Diagnosis* ; Electrocardiography* ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Humans ; Multivariate Analysis ; Prevalence ; Stroke Volume

BACKGROUND AND OBJECTIVES: Electrical dyssynchronicity (Dsyn) appears to be prognostic of survival in congestive heart failure (CHF). Recent study has shown some discrepancy between the electrical Dsyn and the Doppler tissue image (DTI) assessed mechanical Dsyn. The aim of our study was to evaluate the relationship between the QRS duration and DTI assessed Dsyn. SUBJCETS AND METHODS: One hundred and forty patients, with CHF and left ventricular ejection fractions < or =40%, were enrolled. DTI was performed on 5-basal and 5-mid segments to assess the time from the R-wave to the peak systolic velocity (RS time). A QRS duration >130 msec, standard deviation (SD) of the RS time >40 msec, or a difference in the maximal and minimal RS times (RS time-diff) >100 msec were indicators of'Dsyn'. RESULTS: The prevalence of myocardial Dsyn, by QRS duration, SD of the RS time and the RS time-diff were 19, 43 and 47%, respectively. The SD of the RS time (49.8+/-23.6 vs. 36.6+/-20.7, p<0.01) and the RS time-diff (139.2+/-63.2 vs. 98.0+/-54.3, p<0.01) were prolonged in the wide (>130 msec) compared with the narrow QRS group. There was also a weak positive correlation between the QRS duration and the SD of the RS time (R=0.34, p<0.001) and the RS time-diff (R=0.38, p<0.001). However, from a cross-tabulation analysis, more than one third of patients had a discrepancy between QRS duration and DTI assessed mechanical Dsyn. From a multivariate analysis, a major determinant of the SD of the RS time was the QRS duration. CONCLUSION: Although a major determinant of the DTI assessed Dsyn was the QRS duration, more than one-third of patients had a discrepancy between electrical and mechanical Dsyn. Therefore, not only the QRS duration, but the DTI assessed Dsyn, should be measured when considering cardiac resynchronization therapy.
Cardiac Resynchronization Therapy ; Diagnosis* ; Electrocardiography* ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Humans ; Multivariate Analysis ; Prevalence ; Stroke Volume

BACKGROUND: Although arthroscopic shoulder surgery is less invasive and painful than open shoulder surgery, it can often cause intra-operative hemodynamic instability and severe post-operative pain. This study was conducted to investigate the efficacy of the interscalene brachial plexus block (IBPB) on intra-operative hemodynamic changes and post-operative pain during arthroscopic shoulder surgery. METHODS: After institutional review board approval, 50 consecutive patients that had undergone arthroscopic shoulder surgery under general anesthesia were randomly assigned to one of two groups to evaluate intra-operative hemodynamic changes and post-operative pain control. Group 1 patients received an IBPB with 10 ml of normal saline guided by a nerve stimulator before induction, and Group 2 patients received 10 ml of 0.5% ropivacaine hydrochloride with the same technique. The heart rate and systolic and diastolic blood pressures were recorded before the incision and 1, 3, 5, 10, and 20 minutes after the incision. Pre-operative and post-operative pain was evaluated with a visual analog scale 1, 3, 6, 12, and 24 hours after surgery. The patients were given tramadol as a rescue medication option. The total volume of tramadol that was injected was also evaluated over the same intervals. RESULTS: Group 2 showed significantly lower systolic and diastolic blood pressures and heart rates intra-operatively compared to Group 1 (P < 0.05). The visual analog scale pain scores, except at 24 hours after surgery, were significantly lower in Group 2 (P < 0.05). The total tramadol consumption significantly reduced in Group 2 (P < 0.05). CONCLUSIONS: IBPB effectively controlled the hemodynamic changes that occurred during arthroscopic shoulder surgery as well as post-operative pain.
Amides ; Anesthesia, General ; Arthroscopy ; Brachial Plexus ; Ethics Committees, Research ; Heart Rate ; Hemodynamics ; Humans ; Nerve Block ; Pain, Postoperative ; Shoulder ; Tramadol