BACKGROUND: Supplier induced demand (SID) indicates the case when doctors increase the demand of the patients, following their (physicians') own best interests rather than patients'. This may occur when asymmetry of information exists between suppliers and consumers. This study aims to confirm whether SID exists in the Korean setting, particularly by dividing SID into both 'induced demand effect' and 'availability effect.' METHODS: Induced demand effect and availability effect are differentiated following Carlsen & Grytten's theoretical frame which divides doctor density regions into high and low ones. RESULTS: Positive correlation between doctors' density and utilization of their services was found, which could be interpreted as 'availability effect.' CONCLUSION: The result suggests that additional medical use for additional doctor, particularly in the area of low doctor density, can be interpreted to occur to meet the basic medical need of the people rather than as a result of unnecessary induced demand. It is important to make more medical doctors provided and to distribute them appropriately across the region in such a country like Korea where doctor's density is relatively low.
Humans ; Korea* ; Sudden Infant Death

No abstract available.
Female ; Humans ; Male ; Sudden Infant Death/*pathology

We examined the child-rearing environmental factors that affect the occurrence of sudden infant death syndrome (SIDS) using a nationwide survey. Infants who died due to SIDS between January 1996 and June 1997 in Japan were identified from death certificates. Controls of the same gender, birthplace, and birth months as the corresponding SIDS were chosen from birth certificates. Interviews of both cases and controls were undergone in January and February, 1998 by public health nurses. The following child-rearing factors exhibited a significant relationship with the occurrence of SIDS: Concerning the sleeping position, the prone position was associated with increased risk compared with the supine position, with an odds ratio of 3.02 (95% c.i. 2.07~4.65). Regarding the feeding method, artificial feeding alone demonstrated a higher risk than breast feeding alone, with an odds ratio of 4.92 (95% c.i. 2.78~9.63). With regard to smoking, infants with both parents who smoked exhibited a higher risk than infants where neither parent smoked, with an odds ratio of 3.50 (95% c.i. 1.74~8.32).
Sudden infant death syndrome ; occurrence ; Lower case sea ; Risk ; Affect

Hirschsprung's disease is a common functional obstructive disease in infants, and a lot of knowledge and experience have been accumulated about this disease. But the exact genesis of Hirschsprung's disease is still unknown, as well as there is a lack of knowledge about the pre- or postoperative complications. Enterocolitis is a common and serious complication that can cause death. The authors experienced sudden death with three cases that were treated with Duhamel's operation under the confirmed diagnosis of the Hirschsprung's disease. To prevent such sudden and unexpected death, we report here on some of the medical procedure that we performed for these 3 patients.
Death, Sudden ; Enterocolitis ; Hirschsprung Disease ; Humans ; Infant ; Postoperative Complications

In 1969, the International Conference proposed a definition of sudden infant death syndrome (SIDS): the sudden death of any infant or young child which is unexpected by history and in whom a thorough necropsy fails to demonstrate an adequate cause of death. The National Institute of Child Health and Human Development redefined SIDS in 1989, requiring death scene investigation with age restriction under 12 months. These definitions, however, are not adequate for the countries having under-organized medico-legal system. In South Korea, no mandatory or customary complete medico-legal investigation is not performed in the sudden child death cases, including autopsy. As a consequence, SIDS can be diagnosed as 'unknown 'by non-pathologists. Even in autopsy cases, the pathologists can not collect proper medical history by themselves. Furthermore, scene investigation is just performed by police or omitted. Age in SIDS is a controversial problem in both upper and lower limit. So the authors concluded that the above two definitions of SIDS are not agreeable with the country such as South Korea. We proposed a new concept of sudden child death syndrome (SCDS), which means 'the sudden death of any infant including neonate with good condition after birth, or young child which reveals no definite cause of death by inspection or autopsy ', for the purpose of not unreasonable diagnosis and adequate research in the countries having under-developed postmortem investigation system.
Autopsy ; Cause of Death ; Child* ; Death, Sudden ; Diagnosis ; Humans ; Infant ; Infant, Newborn ; Korea ; National Institute of Child Health and Human Development (U.S.) ; Parturition ; Police ; Sudden Infant Death*

This is a statistical analysis based on the data of legal autopsies under 1 year of age performed at the Headquarters of the National Institute Scientific Investigation, requested from law enforcement agencies from 1996 to 2000. This report aims to analyse various aspects of 530 unusual deaths under 1 year of age in Korea, chiefly Seoul and its surrounding area. Male was 55.8% and female was 44.2%. Unnatural deaths were 39.6%, natural 53.4%, and the unknown 7.0%. Homicide occupied 66.7% in unnatural death and asphyxia was 41.4%, starvation and neglect 35.0%, and trauma 20.7% in homicide. Smothering was the leading cause of asphyxial homicide and accidental death. Natural death including perinatal disorders, sudden infant death syndrome and congenital malformations was the main cause of death in this age group.
Asphyxia ; Autopsy* ; Cause of Death ; Female ; Homicide ; Humans ; Korea ; Law Enforcement ; Male ; Seoul ; Starvation ; Sudden Infant Death

PURPOSE: The purposes of this study were to develop an infant sleep health education program using a video for SIDS prevention education and to measure the effects of the program. METHODS: The infant sleep health education program consisted of presentations and motor images. The formation of educational material was directed by the systematic design of instruction. Participants in this study were 59 primiparous women from postpartum care centers. The instruments used in this study were criterion referenced test items for knowledge about infant sleep health and confidence inventory. Experimental group I was given the treatment of infant sleep health education program. Experimental group II was given the program using a video reinforcement after 2 weeks. On the other hand, control group was given no treatment. RESULTS: There was a significant increase in knowledge and confidence in the performance of mother's roles of both experimental group I and experimental group II over the control group. No significant difference was founds for knowledge and confidence in the performance of mother's roles between experimental group I and II. CONCLUSION: The results indicate that this program is a very effective intervention for better sleep health in infants by helping the mothers increase confidence in their role performance.
Education* ; Female ; Hand ; Health Education ; Humans ; Infant ; Mothers ; Postnatal Care ; Sudden Infant Death*

Venipuncture is a routine and relatively safe and painless medical procedure, necessary for accurate diagnosis and treatment. However, given that pain related to medical procedures may have adverse effects for children, could venipuncture cause deaths in infants and children? We analyzed our cases of unexpected death after venipuncture and conducted a literature review on them. A vasovagal response to noxious stimuli may explain such a sudden death immediately after venipuncture, commonly presented as needle phobia, breath-holding spell, and reflex anoxic seizure in the literature, despite the fact that the current medical evidence is not enough to prove their casual relationship. In addition, pain prevention and management during medical procedure is incorporated in clinical guidelines for pediatric patients, because painful medical procedures negatively affect child development. Thus, prevention and management of pain related to medical procedure may be helpful to avoid an adverse vasovagal response to noxious stimuli from occurring.
Autopsy ; Child ; Child Development ; Death, Sudden ; Diagnosis ; Forensic Pathology ; Humans ; Infant ; Infant Death ; Needles ; Phlebotomy ; Phobic Disorders ; Reflex ; Seizures

The purpose of this study was to compare the sleep characteristics between the prone and the supine position in healthy newborns. The 48 newborns were observed in the prone position and the supine position respectively on the 2nd day after birth. The data were collected from January to May, 1999. The state of a newborn was classified and categorized to 6 states (deep sleep, light sleep, drowsy, quiet alert, active alert, crying) by Barnard. The movements of eyes, face and extremities, pulse and arterial oxygen were observed and recorded continuously from the start of sleep after feeding until the time of being woken for the next feeding by a trained nurse. The data was analyzed by using paired t-test. The results of this study were as follows; 1. There was no significant difference in the length of sleeping time between the prone and the supine position. 2. There was no significant difference in the length and frequencies of each states(deep sleep, light sleep, drowsy, quiet alert, active alert, crying) between the prone and the supine position. But the frequency of light sleep in the supine position was significantly higher than that of the prone position. 3. There was no significant difference in the numbers of eyes movements between the prone and the supine sleep position. But the amount of facial and extremity movement in the supine position was significantly higher than those in the prone position 4. There was no significant difference in the arterial oxygen content between the prone and the supine sleep position. 5. There was no significant difference in the heart rates between the prone and the supine sleep position. The above results indicated that the newborns in the prone position moved less and slept deeper than those in the supine position, though there was no difference in the length of sleep or arterial oxygen content between the prone and the supine sleep position. But, Nurses and mothers should consider the relationship between the sleep position and SIDS suggested by previous researches. The infant's 'awakening' during sleep is a normal process and rather valuable because it can provide an opportunity to promote a stronger relationship between mother and baby. So, It is suggested that the supine sleep position is better than the prone sleep position for infants.
Extremities ; Heart Rate ; Humans ; Infant ; Infant, Newborn* ; Mothers ; Oxygen ; Parturition ; Prone Position ; Sudden Infant Death ; Supine Position ; Child Health

The purpose of this paper is to collect the comparative data regarding the actions of Diamox and Neptazane in short-term and long-term administrations. This investigations were divided into three parts. (1) a single dose response in normal and glaucomatous eyes, (2) actions on aqueous flow and (3) long-term treatments in glaucomatous eyes. (I) A single dose response. Ten eyes from 10 normal subjects, ages ranging from 24 to 57 years, were chosen. They were given 500mg of Diamox or 100mg of Neptazane alternately and intra-ocular pressure was determined at regular intervals. In another series, 18 eyes from 18 glaucomatous patients were investigated in the same manner. The patients comprise 13 cases of chronic simple glaucoma and 5 cases of chronic narrow-angle glaucoma. No considerations were given as to their sex and age differences. Prior to administration of the drugs, the diurnal variations of intraocular pressure in each eye had been recorded during the daytime. The intra-ocular pressure was measured by Goldmann's applanation tonometer. (II) Actions on aqueous flow. Actions of Diamox (500mg) and Neptazane (100)mg on the aqueous flow were studied by the perilimbal suction cup method of Rosengren and Ericson in 8 normal eyes. The suction cup was applied 3 hours after Diamox and 6 hours after Neptazane administration. (III) Long-term treatments. Fifteen glaucomatous patients, 10 chronic simple glaucoma and 5 chronic narrow-angle glaucoma, were investigated. Their ages were from 43 to 61 years. The schedules of dosage were 250mg of Diamox, t.i.d. or 50mg of Neptazane, t.i.d. and followed up to 35 days. In some cases, treatment was discontinued or the doses were reduced to 250mg of Diamox, b.i.d. and 50mg of Neptazane, b.i.d., due to the side reactions. Results: (I) Results of measurements of intra-ocular pressure in normal eyes were shown in Table 1 and 2. (a) Diamox: The ocular tension begins to fall as early as 30 minutes, and maximal lowering occurred between 1~4 hours (average, 2.3 hours). Thereafter, tensions rose again and returned to the original level within 24 hours in all cases except in 2 cases. The maximal reduction was on the average 3.7mmHg. Side reactions were observed in 3 cases. (b) Neptazane: The tention begins to fall 0.5~1 hour and the maximal fan was obsered between 4~8 hours (average, 6.4 hours). The maximal degree of fall was 3.3 mmHg. The ocular pressure was still low after 24 hours in all cases except in 3 cases. No side reaction was encountered. (B) In glaucomatous eyes: Results were summarized in Table 3 and 4. (a) Diamox: Ocular tension begins to fall: 30 minutes and maximal fall was attained at 2.2 hours. The degree of maximal reduction was 13.7 mmHg. The lowered tension returned to the initial level within 24 hours in most cases. Side reactions were observed in 5 cases. (b) Neptazane: Ocular tension begins to fall 0.5~1 hour and maximum lowering was observed after 6 hours. The extent of maximal fall was 12.3 mmHg. The ocular tension was still low after 24 hours in most cases Side reactions were encountered in 3 cases. (II) Perilimbal suction cup studies revealed that both Diamox and Neptazane reduced the aqueous flow considerably as shown in table 5. (III) Results of long-term treatments were tabulated in table 6 and 7. (a) Diamox: The maximal degreess of fall in ocular tension were observed relatively early in the treatment and thereafter the tension fluctuates irregularly and showed tendencies to gradual rises. Sid effects were observed in 10 cases. Complete normalization of ocular tension, e.g., under 21 mmHg, was achieved in 8 cases. (b) Neptazane: The same tendency was observed in this group. Side reactions were encountered in 6 cases and milder than in Diamox treated group. As these results show, both Diamox and Neptazane showed a significant tension lowering effect. Neptazane is five times more powerful than Diamox in equal dosage basis. The ocular pressure falls more slowly and its duration was longer in Neptazane treated eyes. Sid reactions were observed more frequently in Diamox group and somewhat severe.
Acetazolamide ; Appointments and Schedules ; Glaucoma, Angle-Closure ; Glaucoma, Open-Angle ; Humans ; Intraocular Pressure ; Suction ; Sudden Infant Death