PURPOSE: Mortality rate in the health services research field is frequently considered as a proxy for measuring healthcare quality. We compared the mortality rate and hospitalization levels among patients with poisoning. METHODS: A population-based study of hospital size and level based on the Korean health insurance and assessment service was conducted to identify the impact of hospital level on patient mortality. RESULTS: We analyzed a total of 16,416 patients, of which 7,607 were from tertiary hospitals, 8,490 were from general hospitals, and 319 were from hospitals. The highest mortality rate of diagnosis regarding poisoning was T60.31 (other herbicides and fungicides, 16%), followed by T60.0 (organophosphate and carbamate insecticides, 12.7%). There was no statistical difference in mortality among hospital levels for gender. Among age groups, tertiary hospitals had lower mortality than general hospitals and hospitals for patients aged more than 70 years (11.9% mortality at tertiary vs 14.2% at general and 23% at hospital; p=0.003, adjusted z score=−6.9), general hospitals had lower mortality than tertiary hospitals and hospitals for patients aged 18 to 29 (0.6% at general vs 2.4% at tertiary and 3.7% at hospital; p=0.01, adjusted z score=−4.3), and hospitals had lower mortality than tertiary hospitals and general hospitals for patients between 50 and 59 years of age (0% at hospital vs 6.4% at general and 8.3% at tertiary; p=0.004). CONCLUSION: Overall, there was no significant difference between mortality and hospital level among poisoned patients. However, to establish an efficient treatment system for patients with poisoning, further studies will be needed to identify the role of each facility according to hospital level.
Diagnosis ; Health Facility Size ; Health Services Research ; Herbicides ; Hospitalization ; Hospitals, General ; Humans ; Insecticides ; Insurance ; Insurance, Health ; Mortality ; Poisoning ; Proxy ; Quality of Health Care ; Tertiary Care Centers

Primary autoimmune myelofibrosis, the development of which is not preceded by a well-defined autoimmune disease, has recently been defined as a distinct clinicopathologic syndrome. We report herein a case of a 68-year-old woman who was diagnosed with primary autoimmune myelofibrosis and present a review of the literature. The patient manifested peripheral pancytopenia, was positive for autoantibodies, and developed myelofibrosis with no preceding autoimmune or hematologic disorders. Her condition was dramatically improved after administration of prednisolone.
Aged ; Autoantibodies ; Autoimmune Diseases ; Female ; Humans ; Pancytopenia ; Prednisolone ; Primary Myelofibrosis*

The ketogenic diet is an effective treatment for the patients with intractable epilepsy, however, the diet therapy can sometimes be discontinued by complications. Protein–losing enteropathy is a rarely reported serious complication of the ketogenic diet. We present a 16-month-old Down syndrome baby with protein-losing enteropathy during the ketogenic diet as a treatment for West syndrome. He suffered from diarrhea, general edema and hypoalbuminemia which were not controlled by conservative care for over 1 month. Esophagogastroduodenoscopy and stool alpha-1 antitrypsin indicated protein-losing enteropathy. Related symptoms were relieved after cessation of the ketogenic diet. Unexplained hypoalbuminemia combined with edema and diarrhea during ketogenic suggests the possibility of protein-losing enteropathy, and proper evaluation is recommended in order to expeditiously detect it and to act accordingly.
Diarrhea ; Diet Therapy ; Down Syndrome ; Drug Resistant Epilepsy ; Edema ; Endoscopy, Digestive System ; Humans ; Hypoalbuminemia ; Infant ; Infant, Newborn ; Ketogenic Diet* ; Protein-Losing Enteropathies* ; Spasms, Infantile

OBJECTIVES: This study examined the association between socioeconomic factors and asthma symptoms. METHODS: A total of 6,919 elementary school children in Seoul were enrolled in the study. Data were obtained from a web-based questionnaire survey. The questionnaire was based on the International Study of Asthma and Allergies in Childhood core module. The prevalence of wheeze in the past 12 months and severe asthma symptoms were obtained. The potential risk factors for asthma symptoms included household income and the number of siblings. A multiple logistic regression analysis was used to calculate the odds ratios (OR) and 95% confidence interval (CI) for the risk factors of asthma symptoms. RESULTS: The prevalence of current wheeze (wheeze in the past 12 months) was 5.2%. Household income and asthma symptoms were inversely associated after adjusting for other potential risk factors (p for trend=0.03). This association was modified by the number of siblings. With two or more siblings, the effect of household income on asthma symptoms was not significant. However, low household income was still a significant variable for patients with fewer than two siblings (OR 1.41; 95% CI, 1.09-1.81). CONCLUSIONS: It appears that childhood asthma disparity is dependent on household income. Therefore, policies to improve childhood health inequities should be emphasized.
Asthma ; Child ; Family Characteristics ; Humans ; Hypersensitivity ; Logistic Models ; Odds Ratio ; Prevalence ; Risk Factors ; Siblings ; Socioeconomic Factors ; Surveys and Questionnaires

OBJECTIVES: Antimicrobial chemicals are used in a variety of household and personal care products. Exposure to antimicrobial household products has been hypothesized to lead to allergic diseases in children. METHODS: We investigated antimicrobial household product exposure and allergic symptoms in Korean children. An antimicrobial exposure (AE) score was derived. To examine the symptoms of allergic diseases (current wheeze, current rhinitis, and current eczema) in the past 12 months, we used a questionnaire based on the core module of the International Study of Asthma and Allergies in Children. Complete data for the analysis were available for 25,805 of the 35,590 (72.5%) children. RESULTS: The prevalence of current allergic diseases was as follows: wheeze, 5.6%; allergic rhinitis, 32.6%; and eczema, 17.7%. The mean (standard deviation) AE score was 14.3 (9.3) (range: 0-40). Compared with subjects with a low AE score (reference), subjects with a high AE score (fourth quartile) were more likely to have symptoms of wheezing and allergic rhinitis (adjusted odds ratio [aOR] for wheezing 1.24, 95% confidence interval [CI], 1.05-1.45, p for trend=0.24; aOR for allergic rhinitis 1.30, 95% CI, 1.20-1.40, p<0.01). CONCLUSIONS: These findings suggest that frequent use of antimicrobial household products was associated with current wheeze and current allergic rhinitis.
Asthma ; Child ; Eczema ; Family Characteristics ; Household Products* ; Humans ; Hypersensitivity ; Odds Ratio ; Prevalence ; Respiratory Sounds ; Rhinitis ; Triclosan ; Surveys and Questionnaires

PURPOSE: Since 1988, the annual or biannual survey was conducted by Korean Association of Smoking and Health (KASH) to examine the smoking rate, knowledge and attitude on smoking of students attending middle and high school in Korea. The objective of this study was to investigate the test-retest reliability of self-administered smoking questionnaire for Korean middle and high school students. METHODS: For the test-retest study, we sampled 30 school among 106 schools which participated in annual survey on June of 2002. Among 30 schools, 26 schools (86.7%) were responded for this study. RESULTS: 1) For the subjects of 1st and 2nd surveys, there were no difference on smoking related variable including attitude, knowledge, perceived health status, father's smoking status, friend's smoking status, willingness to smoke, and readiness to quit smoking 2) For middle school students among male, current smoking rates were 3.5% for 1st survey and 3.0% for 2nd survey, which was statistically no significant. For high school students, however, current smoking rate of 1st survey was higher (21.1%) than that of 2nd (18.2%), although the rate was not significantly differed. 3) For middle school students among female, current smoking rates were 1.1% for 1st survey and 3.3% for 2nd survey, which was statistically no significant. Corresponding rate for high school students were 9.8% and 11.4%, respectively. CONCLUSION: The results indicated that smoking questionnaire has been conducted by KASH is reliable for use in estimation for prevalence of smoking for middle and high school students.
Female ; Humans ; Korea ; Male ; Prevalence ; Smoke* ; Smoking* ; Surveys and Questionnaires

OBJECTIVES: We aimed to assess the test-retest reliability, internal consistency, and validity of the Korean version of the Quantitative Checklist for Autism in Toddlers (Q-CHAT). METHODS: The Korean version of the Q-CHAT and the Korean version of the Child Behavior Checklist (CBCL) 1.5-5 were completed by parents of 24 toddlers and preschoolers with autism spectrum disorder (ASD) and 80 unselected toddlers and preschoolers. Parents of the ASD group also completed the Social Communication Questionnaire (SCQ), and Childhood Autism Rating Scale (CARS) scores were obtained from medical records. RESULTS: The ASD group scored higher on the Q-CHAT than the unselected group. The Cronbach's alpha coefficient of the Q-CHAT was 0.658, and test-retest reliability was calculated to be 0.836. The estimated area under the curve was 0.793. The total scores of the Q-CHAT in the ASD group demonstrated significant positive correlations with findings regarding pervasive development problems in the CBCL, SCQ, and CARS. A total score of 33.5 may be a useful cutoff point to use when identifying toddlers at risk of ASD. CONCLUSION: The Korean version of the Q-CHAT has good reliability and validity and can be used as a screening tool in order to identify toddlers and preschool children at risk of ASD.
Autism Spectrum Disorder ; Autistic Disorder* ; Checklist* ; Child ; Child Behavior ; Child, Preschool ; Humans ; Mass Screening ; Medical Records ; Parents ; Reproducibility of Results*

BACKGROUND: Dendritic cells (DCs) are increasingly being utilized for anti-cancer immunotherapy. Acute myeloid leukemia (AML) blasts are able to generate leukemia-derived DC. Advances in culture techniques and AML-DC characterization justify possible clinical applications. We investigated the ability of AML, acute lymphoblastic leukemia (ALL) and biphenotypic acute leukemia (BAL) blasts to differentiate into DCs in vitro and the qualified function of the leukemia-derived DCs. METHODS: Leukemia cells from 11 patients with AML, 3 patients with ALL and 2 patients with BAL were cultured with GM-CSF, IL-4 and with or without SCF. Cultured leukemia cells were evaluated by phenotype, mixed lymphocyte reaction (MLR), cytokine production and cytotoxic T cell (CTL) inducing activity. RESULTS: DCs were generated with GM-CSF and IL-4 from the leukemic blasts in 72% of the AML patient cells. MHC class I/II, CD11c and ICAM-1 were highly expressed in the AML-derived DCs. MLR and enzyme linked immunospot (ELISPOT) assays demonstrated that AML-DCs were able to induce T cell proliferation and activation into IFN-gamma secreting effector cells. The ALL blasts from two out of three patients differentiated into DCs with MHC class I/II+, CD11c+ only in the presence of GM-CSF, SCF and IL-4 for 14 days. CONCLUSION: These results suggest that functionallyactive DCs can be differentiated from AML blasts using GM-GSF and IL-4 and ALL, BAL blasts were differentiated into DCs only under stem cell-DC culture conditions.
Cell Proliferation ; Culture Techniques ; Dendritic Cells ; Granulocyte-Macrophage Colony-Stimulating Factor ; Humans ; Immunotherapy ; Intercellular Adhesion Molecule-1 ; Interleukin-4 ; Leukemia* ; Leukemia, Biphenotypic, Acute ; Leukemia, Myeloid, Acute ; Lymphocyte Culture Test, Mixed ; Phenotype ; Precursor Cell Lymphoblastic Leukemia-Lymphoma

The guidewire is an essential accessory in ERCP. Although rare, guidewires can cause complications, such as subcapsular hepatic hematoma, perforation, knotting, fracture, and impaction, during ERCP. This report describes a guidewire impaction during the endoscopic treatment of a patient with symptomatic chronic pancreatitis. The methods used to treat guidewire impaction are not well known. In the present case, the impacted guidewire was retrieved by inserting another guidewire and dilating the space adjacent to it. Endoscopists should check for the free movement of the guidewire before stent deployment. Additionally, it is important to ask for help from experienced senior staff to overcome any challenges during the procedure. In conclusion, endoscopists should be aware of the possibility of a guidewire impaction during ERCP.