Kyphotic deformity of thoracic or lumbar spine is generally developed as a consequence of Scheuerman's kyphosis, ankylosing spondylitis, congenital kyphosis, tuberculous kyphosis, spinal tumor, senile kyphosis, trauma and extensive laminectomy etc. The method of treatment is usually conservative. However, in severe kyphosis, gross abnormaility and neurologic complications, and the compression of cardiopulmonary system are resulted and then surgery may be indicated. Since the report of spinal osteotomy by Smith-Peterson, several treatment options have been reported. Despite improved techniques for treating spinal kyphotic deformities, correction of severe and acutely angled deformities are less effective and resulting many complications. We propose the use of a new method of posterior closing spinal osteotomy for the treatment of severe and acutely angled kyphotic deformity to minimize the complications and for effective correction. We report the technique and results of this method in two cases of tuberculous kyphosis and a case of ankylosing spondylitis.
Congenital Abnormalities ; Kyphosis ; Laminectomy ; Methods ; Osteotomy ; Spine ; Spondylitis, Ankylosing

PURPOSE: This study was conducted to identify current health care management and barriers in health care management according to ecological systems, and to develop an ecological model for enhancing health care in child care centers. METHODS: Focus group interviews were conducted with directors and teachers of child care centers, and with parents of children enrolled in child care. Data were analyzed by the latent content analysis method. RESULTS: Twelve categories of health care management were identified. Barriers to child health care included knowledge deficit and lack of competence in health care by teachers, lack of useful health care manuals, non-existence of professional child health care personnel in child care centers, lack of mutual information sharing and disagreement on child health conditions between child care personnel and parents, lack of specific health related child care inspection criteria and time flexible child care centers with a lack of policy on collaboration with health care facilities. The ecological model developed included specific strategies to improve health care management in child care. CONCLUSION: The proposed ecological model to improve child health care management should be useful to plan future health care program considering both the immediate and indirect social environment surrounding children in child care.
Child ; Child Care ; Child Health ; Child, Preschool ; Cooperative Behavior ; Delivery of Health Care ; Ecology ; Ecosystem ; Focus Groups ; Humans ; Information Dissemination ; Mental Competency ; Parents ; Social Environment

PURPOSE: This study examined the mediating effect of school nurses' self efficacy, which is one of the significant cognitive factors influencing cultural sensitivity, on the mutual relationships between multicultural attitude and cultural sensitivity in Korean elementary schools. METHODS: A cross-sectional descriptive survey design was used. Participants were 157 school nurses in elementary schools located in Gyeonggi-do, South Korea. The survey instruments included Teacher Multicultural Attitude Survey, Teacher Efficacy Scale, and Multicultural Sensitivity Scale. Data were analyzed using three regression equations to test the mediation model. RESULTS: The mean score of the school nurses' cultural sensitivity was relatively low. A positive correlation among multicultural attitude, self efficacy, and cultural sensitivity was noted. Self efficacy of school nurses showed a significant mediating effect on the relationships between multicultural attitude and cultural sensitivity. CONCLUSIONS: Given the meaningful influence of positive multicultural attitude on cultural sensitivity and significant mediator effect of self efficacy as a school nurse between the two variables, the strategies to cultivate a positive multicultural attitude and enhance school nurses' self efficacy in their unique role should be considered in a training program. School nurses' health care services will benefit from the improvement of cultural sensitivity toward young children from multicultural families.
Adult ; *Attitude of Health Personnel ; Cross-Sectional Studies ; *Cultural Diversity ; Humans ; Middle Aged ; Nursing Staff, Hospital/*psychology ; Republic of Korea ; *Self Efficacy ; Surveys and Questionnaires

BACKGROUND: Nonrheumatic atrial fibrillation is common in elderly and associated with an increased risk for thromboembolism. Left atrial spontaneous echo contrast(SEC) and thrombus. which are easily detected by transesophageal echocardiography(TEE) in patients with rheumatic mitral valve disease and atrial fibrillation, have been known as markers of thromboembolism. However, most of the previous studies on left atrial SEC and thrombus were performed in rheumatic mitral valve disease or various conditions including rheumatic mitral valve disease. Therefore this study was underaken in order to investigatd 1) the prevalence of left atrial SEC and thrombus, and 2) clinical and echocardiographic variables related to left atrial SEC and thrombus in nonrheumatic atrial fibrillation. METHODS: In patients with estabished atrial fibrillation over 7 days, we examined the clinical gistory and performed transthoracic echocardiography(TTE) and TEE simultaneously. Enlisted patients were those without rheumatic mitral valve disease, prosthetic valves, previous thromboembolism, and recent anticoagulant therapy. RESULTS: 1) Left atrial SEC was detected in 32(62.7%) of 51 patients and left atrial thrombus in 10(19.6%). All thrombi were located in the left atrial appendage. 2) In univariate analysis, SEC positive group showed higher prevalence of congestive heart failure(CHF)(56.3% vs 0%, p<0.001), lower ejection fraction(42.2+/-14.1% vs 50.8+/-9.7%, p<0.05), lower left atrial appendage blood flow velocity(peak positive flow velocity ; 18.7+/-11.1cm/sec vs 32+/-12.4cm/sec, p<0.01, and peak negative flow velocity ; 21.4+/-12.4cm/sec vs 31.9+/-12.8cm/sec, p<0.01) than SEC negative group. Multivariate analysis identifed CHF as an independent variable related to left atrial SEC(p=0.02, Odds ratio ; 2.38, 95% CI ; 1.18-4.82). 3) In univariate analysis. left atrial thrombus positive group showed higher prevalence of CHF(70% vs 26.8%, p<0.05), larger left atrial demension(34+/-3.4mm/m2 vs 30.6+/-4.6mm/m2, p<0.05) than thrombus negative group. Multivariate analysis identifed CHF as an independent variable related to left atrial thrombus(p=0.04, Odds ratio ; 4.30, 95% CI ; 1.11-16.68). 4) Left atrial thrombus is more frequent in SEC positive group than in SEC negative group(28.1% vs 5.3%), however, there was no statistical significance(p=0.07). CONCLUSION: 1) Left atrial SEC is common in nonrheumatic atrial fibrillation and significantly related to CHF. 2) Left atrial thrombus is frequently detected in SEC positive patients, however, it is more realted to CHF than left atrial SEC itself.
Aged ; Atrial Appendage ; Atrial Fibrillation* ; Echocardiography ; Estrogens, Conjugated (USP) ; Heart ; Humans ; Mitral Valve ; Multivariate Analysis ; Odds Ratio ; Prevalence ; Thromboembolism ; Thrombosis*

BACKGROUND: Twenty-four-hour ambulatory blood pressure(ABP) monitoring has become increasingly popular for diagnosing and treating hypertension. Therefore the reference value of normotensive subjects was necessary for interpretation of hypertensive subjects. Several studies were reported on reference values in normotensive subjects. The purpose of this study was to determine 24-hour ABP in normotensive Korean adults stratified for sex and five age groups. This study also assessed ABP in relation to a family history of hypertension, smoking and body mass index(BMI). METHODS: ABP monitoring was performed in 200 healthy normotensive volunteers(ranged in age from 20 to 69 years, five decades, 20 men and 20 women per each decade), over 24 hours, taking measurement at 30-min intervals. The 24-hour interval was divided into day-time(6am-10pm) and night-time(100pm-6am) periods. Mean ABP and pressure loads(percentage of systolic readings>140mmHg, diastolic readings>90mmHg) were obtained. RESULTS: The mean ABP in 200 subjects was 113+/-8.6/72+/-6.9mmHg over 24 hours, 117+/-9.7/75+/-7.0mmHg during day-time, and 106+/-9.8/67+/-8.3mmHg at night-time, and pressure loadd averaged 5.1+/-7.4/7.9+/-8.9% over 24 hours. The +2 standard deviation(SD) as the upper limit of normal was 130/86mmHg over 24 hours in 200 subjects. The mean ABP and pressure load were 116+/-7.6/74+/-7.6mmHg and 6.4+/-8.3/10.1+/-10.2% in 100 subjects of men, and 110+/-8.3+/-70+/-6.6mmHg, 3.7+/-6.0/5.7+/-6.8% in women. Mean ABP and pressure load showed significant difference in relation to age group and sex, however, no significant difference in relation to a family history of hypertension or smoking. In relation to BMI group, diastolic blood pressure and diastolic pressure load were significantly different.
Adult* ; Blood Pressure* ; Female ; Humans ; Hypertension ; Male ; Reference Values ; Smoke ; Smoking

For the regeneration of osseous defect on the furcation area, autogeneous bone graft has been primarily used. But it has the limitation of donor site, additive surgical operation etc. Recently anorganic xenogenic bone graft materials of removing all organic components are commonly used for the regeneration of periodontal defects. This study was the comparison of the effect on the regeneration with two types xenografts(Bio-oss(R) and Ca-P thin coated Bovine bone powder) on the furcation involvement in Beagle dogs. After surgically induced chronic periodontitis in bifurcation area of premolar, Bio-oss(R) and Ca-P BBP were grafted on the osseous defects. Tissue blocks including defects with soft tissues were harvested following a four-& eight-week healing interval and prepared for histologic analysis. The results of this study were as follows: 1. Bio-oss(R) group: there were significant differences among the Bio-oss? group at 4weeks and 8weeks, but the control group had various appearances : new bone formation, resorption of graft materials by multinuclear giant cells, connective tissue cells intervention in the bone graft sites etc. 2. Ca-P BBP group: lots of new bone formation were observed but the arrangement of periodontal ligament was not completed at 4weeks. New bone were replaced mature bone and the periodontal ligaments showed the functional arrangement at 8weeks. 3. By reason of undergrowing the epithelium within the osseous defects, new bone formation was not happened in the upper area of bifurcation in Bio-oss(R) group. 4. In Ca-P BBP group, epithelial undergrowth was not seen and generally showed much more new bone formation. 5. Ca-P BBP group showed the osteocyte-like cells at the inner portion of the graft materials 6. Both groups were similar to resorptive appearances of graft materials, but Ca-P BBP group had the better effects of osteoconduction.
Animals ; Bicuspid ; Bone Regeneration ; Chronic Periodontitis ; Connective Tissue Cells ; Dogs* ; Epithelium ; Giant Cells ; Heterografts* ; Humans ; Osteogenesis ; Periodontal Ligament ; Regeneration* ; Tissue Donors ; Transplants

Background: Anxiety disorder is one of the most common mental illnesses in primary care. It is associated with increased reliance on medical care, comorbidities, and poor quality of life. This study is intended to evaluate the relationship between scores on the Generalized Anxiety Disorder 7-item (GAD-7) scale and adult health behavior based on the 2021 Korea National Health and Nutrition Examination Survey (KNHANES 2021). Methods: The study selected 5,191 Korean adults, who completed the survey and evaluation according to KNHANES 2021. To determine the effect of the GAD-7 scale on outpatient visits, underweight, obesity, smoking, drinking, and physical activity, a multiple logistic regression analysis was performed. Additionally, subgroup analysis was performed by dividing the sexes. Results: Among the study subjects, people in the mild, moderate, and severe anxiety groups numbered 560, 141, and 95, respectively. The odds ratio (OR) of the probability of outpatient visits within two weeks increased (mild: OR, 1.79; 95% confidence intervals [CI], 1.46–2.19; moderate: OR, 1.78; 95% CI, 1.16–2.74; severe: OR, 1.76; 95% CI, 1.09–2.85) compared to the normal group. The risk of smoking and drinking increased in the moderate group (OR, 2.10; 95% CI, 1.24–3.58; OR, 1.70; 95% CI, 1.15–2.52). In the subgroup analysis, the probability of outpatient visits increased among both sexes, and the risk of smoking increased among females. Conclusion Among Korean adults, the probability of outpatient visits and the risk of smoking and drinking increased in the anxiety group compared to the normal group.

Background: Decreased handgrip strength (HGS) reflects overall muscle mass reduction, which can reduce respiratory muscle strength and impair lung function. Obstructive sleep apnea (OSA) has also been reported to cause muscle catabolism and lung damage. This study aimed to investigate the relationship between HGS and lung function by exploring the effect modifiers, including OSA. Methods: Data from the 8th Korea National Health and Nutrition Examination Survey was used in this study. A total of 3,207 adults aged >40 years were included. The association between HGS and lung function was determined using correlation analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using complex sample logistic regression analysis to determine the association between lung function (restrictive or obstructive pattern) according to HGS groups stratified by sex and OSA risk. Results: In total, 1,264 males and 1,479 females had normal HGS. In males, the low HGS group had lower forced vital capacity (FVC, L), FVC (%, predicted), forced exploratory volume in one second (FEV 1), FEV 1 (%, predicted), and FEV 1/FVC, than the normal HGS group. The risk of having restrictive pattern of lung function was higher in males with low HGS (adjusted OR, 2.77; 95% CI, 1.22–6.30). The association between low HGS and decreased lung function was stronger in males (P interaction of sex: 0.022 for obstructive pattern and 0.008 for restrictive pattern). However, there was no significant effect modification by OSA risk. Conclusion Males with a low HGS showed a higher risk of restrictive pattern of decreased pulmonary function.

Background: Anxiety disorder is one of the most common mental illnesses in primary care. It is associated with increased reliance on medical care, comorbidities, and poor quality of life. This study is intended to evaluate the relationship between scores on the Generalized Anxiety Disorder 7-item (GAD-7) scale and adult health behavior based on the 2021 Korea National Health and Nutrition Examination Survey (KNHANES 2021). Methods: The study selected 5,191 Korean adults, who completed the survey and evaluation according to KNHANES 2021. To determine the effect of the GAD-7 scale on outpatient visits, underweight, obesity, smoking, drinking, and physical activity, a multiple logistic regression analysis was performed. Additionally, subgroup analysis was performed by dividing the sexes. Results: Among the study subjects, people in the mild, moderate, and severe anxiety groups numbered 560, 141, and 95, respectively. The odds ratio (OR) of the probability of outpatient visits within two weeks increased (mild: OR, 1.79; 95% confidence intervals [CI], 1.46–2.19; moderate: OR, 1.78; 95% CI, 1.16–2.74; severe: OR, 1.76; 95% CI, 1.09–2.85) compared to the normal group. The risk of smoking and drinking increased in the moderate group (OR, 2.10; 95% CI, 1.24–3.58; OR, 1.70; 95% CI, 1.15–2.52). In the subgroup analysis, the probability of outpatient visits increased among both sexes, and the risk of smoking increased among females. Conclusion Among Korean adults, the probability of outpatient visits and the risk of smoking and drinking increased in the anxiety group compared to the normal group.

Background: Decreased handgrip strength (HGS) reflects overall muscle mass reduction, which can reduce respiratory muscle strength and impair lung function. Obstructive sleep apnea (OSA) has also been reported to cause muscle catabolism and lung damage. This study aimed to investigate the relationship between HGS and lung function by exploring the effect modifiers, including OSA. Methods: Data from the 8th Korea National Health and Nutrition Examination Survey was used in this study. A total of 3,207 adults aged >40 years were included. The association between HGS and lung function was determined using correlation analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using complex sample logistic regression analysis to determine the association between lung function (restrictive or obstructive pattern) according to HGS groups stratified by sex and OSA risk. Results: In total, 1,264 males and 1,479 females had normal HGS. In males, the low HGS group had lower forced vital capacity (FVC, L), FVC (%, predicted), forced exploratory volume in one second (FEV 1), FEV 1 (%, predicted), and FEV 1/FVC, than the normal HGS group. The risk of having restrictive pattern of lung function was higher in males with low HGS (adjusted OR, 2.77; 95% CI, 1.22–6.30). The association between low HGS and decreased lung function was stronger in males (P interaction of sex: 0.022 for obstructive pattern and 0.008 for restrictive pattern). However, there was no significant effect modification by OSA risk. Conclusion Males with a low HGS showed a higher risk of restrictive pattern of decreased pulmonary function.