This study aims to find factors that affect variations in cesarean section frequency rates among OBGY clinics in Metropolitan areas. The factors include patient, medical supplier characteristics and economic factors. This study is a cross-sectional analysis using health insurance delivery claims from July to December 2000 and files of the NHIC(national health insurance corporation). Multiple regression was used to analyze the dependent variable of cesarean section frequency rate at each clinic. The results are as follows : Cesarean section frequency rate is increasing in proportion to the number of the following patients : repeated caesarean section, disproportion, obstructed labour, fetal distress, emergency caesarean section and self-employed patients. There are geographic variations as well. Cesarean section frequency rates are higher in Inchon and Gyonggi province than in Seoul. The higher number of total delivery the clinic has, the lower rate of cesarean section it has. Clinics with high frequency rates in 1999 showed higher rates the next year. Further research is required to develop evidence based delivery modes and change strategies for increasing normal delivery and activating midwife clinics.
Cesarean Section* ; Cross-Sectional Studies ; Emergencies ; Female ; Fetal Distress ; Humans ; Incheon ; Insurance, Health ; Midwifery ; Pregnancy ; Seoul ; Small-Area Analysis

INTRODUCTIONHyperlipidaemia is a major risk factor for coronary artery disease (CAD). Its effective treatment has been shown to reduce the incidence of cardiovascular events, both in secondary and primary prevention. An essential component of risk factor management at the community level is public awareness and knowledge of treatment benefits. However, this data is limited in Singapore.

METHODSA cross-sectional survey questionnaire of public perception and knowledge on cholesterol treatment among adult Singaporeans aged 30-69 years was commissioned by the Singapore Heart Foundation and conducted by a professional market survey company. Regional quota sampling was performed to ensure that the sample was representative of the Singapore population. This was followed by random sampling of households and respondents.

RESULTSOf the 365 respondents, 40.9% were male, 70.3% were Chinese, 18.8% Malay and 10.9% Indian. The mean age was 47.5 years. Although 81.9% of respondents had medical check-ups involving blood tests, only 11.0% knew their actual cholesterol levels. A third of the respondents saw herbal medicine as healthier and safer than Western medication. More than 80% of respondents believed that diet and exercise were equally effective at lowering cholesterol as medication. About half of the respondents associated long-term use of statins with damage to the liver and kidney, while a third associated chronic statin use with the development of cancer.

CONCLUSIONThere are gaps in the level of public awareness and understanding of cholesterol treatment in Singapore. Common misconceptions should be addressed, as they could potentially impair effective management or treatment compliance.

Adult ; Aged ; Asian Continental Ancestry Group ; Cholesterol ; metabolism ; Cross-Sectional Studies ; Female ; Health ; Health Knowledge, Attitudes, Practice ; Health Literacy ; Humans ; Hyperlipidemias ; diagnosis ; Male ; Middle Aged ; Perception ; Pilot Projects ; Prospective Studies ; Public Opinion ; Risk Factors ; Singapore ; Surveys and Questionnaires

Behcet's disease was originally described as a triple symptom complex of oral aphthous ulceration, genital ulceration, and hypopyon iritis. It is now known to have a wide systemic manifestations. Among them, the central nervous system involvement should be diagnosed earlier because of it's lethal potential. Recently the authors experienced a case of Behcet's disease with CNS involvement. A 51-year-old female patient was admitted due to deterioration of mentality and generalized ache since 2 years prior to admission. The findings on physical examination were compatible with Behcet's disease, but without cerebrospinal pleocytosis. The manifestations were improved with medications of prednisolone, chlorambucil, colchicines, but relapsed relapsed 2 months later during subsequent tapering of prednisolone and chlorambucil. The patient is now on medication again. A case of Behcet's disease with CNS manifestations is reported with review of literature.
Behcet Syndrome ; Central Nervous System ; Chlorambucil ; Female ; Humans ; Iritis ; Leukocytosis ; Middle Aged ; Physical Examination ; Prednisolone ; Stomatitis, Aphthous ; Ulcer

No abstract available.
Cytomegalovirus Infections*

No abstract available.
Urticaria Pigmentosa* ; Urticaria*

Intramedullary myelitis due to bacterial meningitis associated with cervical epidural abscess is very rare. Its cause and clinical features are non-specific, therefore exact diagnosis is often missed or mistaken for other disease and immediate treatment may be delayed. We report a case of intramedullary myelitis due to epidural abscess presented with prominent symptoms of meningitis and manifestations of acute cerebrovacular accident. A 69 -year-old man was admitted due to right hemicranial headache with pain on right posterior neck and febrile sensation. At first, the patient's headache was improved by conservative therapy. Three weeks later, the patient showed abrupt right hemiparesis (MRC grade 2/5) with drowsy mentality. The CSF findings of the patient were compatible with acute bacterial meningitis. Cervical spine MRI showed cervical epidural abscess and extensive intramedullary myelitis from cervical to lumbar spinal cord. After antibiotic therapy, mentality of the patient became to be alert and right hemiparesis was improved to MRC grade 4/5. Follow up cervical spine MRI after several weeks represented that the lesions of cervical epidural abscess and intramedullary myelitis were significantly diminished.
Diagnosis ; Epidural Abscess* ; Follow-Up Studies ; Headache ; Humans ; Magnetic Resonance Imaging ; Meningitis ; Meningitis, Bacterial* ; Myelitis* ; Neck ; Paresis ; Sensation ; Spinal Cord ; Spine

OBJECTIVE: This study aimed to investigate the prevalence of metabolic syndrome, associated factors in schizophrenia patients and whether metabolic syndrome have an effect on health related quality of life (QoL) and body image. METHODS: 81 subjects were included in this study, who were diagnosed as schizophrenia defined by DSM-IV criteria and admitted in neuropsychiatric department, Wonkwang University Hospital. For each subject, anthropometric index and laboratory parameters were measured. Metabolic syndrome defined by National Cholesterol Education Program-Adult Treatment Panel III. The subjects were evaluated health related QoL with Short-Form 36 Health Survey-Korean (SF-36-K), and were evaluated body image with Body Image Scale. RESULTS: Of patients, 24.7% had metabolic syndrome. Metabolic syndrome was associated with long duration of illness. The patients with metabolic syndrome showed poorer QoL, especially role physical and bodily pain in SF-36-K. Also, the patients with metabolic syndrome had negative body image, especially body feature, compared to the patients without metabolic syndrome. CONCLUSION: This study suggests that metabolic syndrome is common among patients with chronic schizophrenia. Also It may lead to lowering of QoL and deterioration of body image. So clinicians should be cautious to aware the increased risk for the metabolic syndrome and intervene actively to prevent and treat metabolic morbidity among chronic patients with schizophrenia.
Body Image ; Cholesterol ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Prevalence ; Quality of Life ; Schizophrenia

BACKGROUND: Interest in pharmacist participation in the multidisciplinary intensive care team is increasing. However, studies examining pharmacist interventions in the medical intensive care unit (MICU) are limited in Korea. The aim of this study was to describe the current status of pharmacist interventions and to identify common pharmacologic problems requiring pharmacist intervention in the MICU. METHODS: Between September 2013 and August 2014, a retrospective, observational study was conducted in the 22-bed MICU at a university hospital. Data were obtained from two trained pharmacists who participated in MICU rounds three times a week. In addition to patient characteristics, data on the cause, type, related drug, and acceptance rate of interventions were collected. RESULTS: In 340 patients, a total of 1211 pharmacologic interventions were performed. The majority of pharmacologic interventions were suggested by pharmacists at multidisciplinary rounds in the MICU. The most common pharmacologic interventions were adjustment of dosage and administration (n = 328, 26.0%), followed by parenteral/enteral nutritional support (n = 228, 18.1%), the provision of drug information (n = 228, 18.1%), and advice regarding pharmacokinetics (n = 118, 9.3%). Antimicrobial agents (n = 516, 42.6%) were the most frequent type of drug associated with pharmacist interventions. The acceptance rate of interventions was 84.1% with most accepted by physicians within 24 hours (n = 602, 92.8%). CONCLUSIONS: Medication and nutritional problems are frequently encountered pharmacotherapeutic problems in the MICU. Pharmacist interventions play an important role in the management of these problems.
Anti-Infective Agents ; Humans ; Critical Care ; Intensive Care Units* ; Korea ; Nutritional Support ; Observational Study ; Pharmacists* ; Pharmacokinetics ; Retrospective Studies

BACKGROUND: Mycobacterium tuberculosis is one of the most clinically significant infectious agents. Especially during mass outbreaks, accurate identification and monitoring are required. The proportion of Beijing family members is very high among infecting strains, and spoligotyping is not suitable for strain typing. Therefore, we studied the homogeneity of isolates using the mycobacterial interspersed repetitive units-variable number of tandem repeats (MIRU-VNTR) method and identified its utility for carrying out molecular epidemiologic analysis. METHODS: Eighty-one clinical M. tuberculosis isolates that had previously been analyzed by spoligotyping were used in this study. We used the 12 standard MIRU loci and further four exact tandem repeat (ETR) loci (ETR-A, -B, -C, and -F). Four strains each of randomly selected Beijing and Beijing-like families were subjected to IS6110- restriction fragment length polymorphism analysis. RESULTS: All 81 samples showed amplification products of all VNTR loci, and all of them showed differences in at least one locus. The calculation of the Hunter-Gaston diversity index (HGDI) for MIRU-VNTR gave the value of 0.965. Discriminatory index in the six loci (MIRU-10, -16, -26, -31, -39, and ETR-F) were found to be highly discriminated (HGDI >0.6). Beijing and Beijing-like family isolates were discriminated into different MIRU-VNTR types. CONCLUSIONS: MIRU-VNTR analysis by using well-selected loci can be useful in discriminating the clinical M. tuberculosis isolates in areas where the Beijing family is predominant.
Bacterial Typing Techniques/*methods ; DNA, Bacterial/analysis ; Genotype ; Humans ; *Minisatellite Repeats ; Mycobacterium tuberculosis/*classification/genetics/isolation & purification ; Polymerase Chain Reaction ; Republic of Korea ; Tuberculosis/diagnosis/*microbiology

Acute necrotizing esophagitis (AEN), also called "black esophagus," is a rare disorder with an unknown pathogenesis. Endoscopic findings generally show black pigmentation throughout the esophagus. This case also offered rare views of the gross anatomy of this disorder. Histological examination revealed that the mucosal and submucosal layers of the esophagus were involved in the severe necrotizing inflammation. The chief manifestation of this disease is hematemesis from hemorrhage of the upper gastrointestinal tract with a typically multifactorial etiology. AEN is also characterized by a clear boundary at the gastroesophageal junction where the necrosis stops. In this study, we report an autopsy case of a 61-year-old man with necrotizing inflammation throughout the esophagus and esophageal necrosis from the laryngopharynx to the gastroesophageal junction. The patient was a disabled person with a history of alcohol abuse who was also diagnosed with mild coronary arteriosclerosis and fatty liver on the basis of the underlying diseases. In this case, the main etiology for poor perfusion from the distal esophageal area was likely underlying illness, history of alcoholism, and malnutrition.
Alcoholism ; Autopsy* ; Coronary Artery Disease ; Disabled Persons ; Esophagitis* ; Esophagogastric Junction ; Esophagus ; Fatty Liver ; Hematemesis ; Hemorrhage ; Humans ; Hypopharynx ; Inflammation ; Malnutrition ; Middle Aged ; Necrosis ; Perfusion ; Pigmentation ; Upper Gastrointestinal Tract