Background: Human breast milk is essential and provides irreplaceable nutrients for early humans. However, breastfeeding is not easy for various reasons in medical institution environments. Therefore, in order to improve the breastfeeding environment, we investigated the difficult reality of breastfeeding through questionnaire responses from medical institution workers. Methods: A survey was conducted among 179 medical institution workers with experience in childbirth within the last five years. The survey results of 175 people were analyzed, with incoherent answers excluded. Results: Of the 175 people surveyed, a total of 108 people (61.7%) worked during the day, and 33 people (18.9%) worked in three shifts. Among 133 mothers who stayed with their babies in the same nursing room, 111 (93.3%) kept breastfeeding for more than a month, but among those who stayed apart, only 10 (71.4%) continued breastfeeding for more than a month (P = 0.024). Ninety-five (88.0%) of daytime workers, 32 (94.1%) two-shift workers, and 33 (100%) three-shift workers continued breastfeeding for more than a month (P = 0.026). Workers in general hospitals tended to breastfeed for significantly longer than those that worked in tertiary hospitals (P = 0.003). A difference was also noted between occupation categories (P = 0.019), but a more significant difference was found in the comparison between nurses and doctors (P = 0.012). Longer breastfeeding periods were noted when mothers worked three shifts (P = 0.037). Depending on the period planned for breastfeeding prior to childbirth, the actual breastfeeding maintenance period after birth showed a significant difference (P = 0.002). Of 112 mothers who responded to the question regarding difficulties in breastfeeding after returning to work, 87 (77.7%) mentioned a lack of time caused by being busy at work, 82 (73.2%) mentioned the need for places and appropriate circumstances. Conclusion In medical institutions, it is recommended that environmental improvements in medical institutions, the implementation of supporting policies, and the provision of specialized education on breastfeeding are necessary to promote breastfeeding.

Background: We purposed to evaluate the seasonality and associated factors of the incidence of gout attacks in Korea. Methods: We prospectively enrolled patients with gout attacks who were treated at nine rheumatology clinics between January 2015 and July 2018 and followed them for 1-year. Demographic data, clinical and laboratory features, and meteorological data including seasonality were collected. Results: Two hundred-five patients (men, 94.1%) were enrolled. The proportion of patients with initial gout attacks was 46.8% (n = 96). The median age, body mass index, attack duration, and serum uric acid level at enrollment were 50.0 years, 25.4, 5.0 days, and 7.4 mg/dL, respectively. Gout attacks were most common during spring (43.4%, P < 0.001) and in March (23.4%, P < 0.001). A similar pattern of seasonality was observed in the group with initial gout attacks. Alcohol was the most common provoking factor (39.0%), particularly during summer (50.0%). The median diurnal temperature change on the day of the attack was highest in the spring (9.8°C), followed by winter (9.3°C), fall (8.6°C), and summer (7.1°C) (P = 0.027). The median change in humidity between the 2 consecutive days (the day before and the day of the attack) was significantly different among the seasons (3.0%, spring; 0.3%, summer; −0.9%, fall; −1.2%, winter; P = 0.015). One hundred twenty-five (61%) patients completed 1-year follow-up (51% in the initial attack group). During the follow-up period, 64 gout flares developed (21 in the initial attack group). No significant seasonal variation in the follow-up flares was found. Conclusion In this prospective study, the most common season and month of gout attacks in Korea are spring and March, respectively. Alcohol is the most common provoking factor, particularly during summer. Diurnal temperature changes on the day of the attack and humidity changes from the day before the attack to the day of the attack are associated with gout attack in our cohort.

The objectives of this study were to assess the clinical outcomes of adults with Ebstein Anomaly (EA) according to their treatment modalities. All adult EA patients diagnosed between October 1994 and October 2014 were retrospectively evaluated by medical record review. Total 60 patients were categorized into 3 groups according to their treatment strategy, i.e. non-operative treatment (Group I, n = 23), immediate operative treatment (Group II, n = 27), and delayed operative treatment (Group III, n = 10). A composite of major adverse cardiac and cerebrovascular events (MACCE) and factors associated with MACCE were assessed in each treatment group. MACCE occurred in 13.0% patients in Group I, 55.6% patients in Group II and 50% in Group III (P = 0.006). Event free survivals at 5 years were 90% in Group I, 52.7% in Group II, 50.0% in Group III (P = 0.036). Post-operatively, most patients showed improvement on clinical symptoms. However, event free survival rate was lower in patients with operation compared to those with non-operative treatment (58.7% vs. 90.9%; P = 0.007). Major arrhythmic event occurred more frequently even after surgical ablation (50.0% vs. 20.0%; P = 0.034). Re-operation was more frequent in patients underwent delayed surgery compared to those with immediate surgery (50.0% vs. 18.5%; P = 0.001). Current guideline to decide patient's treatment strategy appeared to be appropriate in adult patients with EA. However, surgical ablation for arrhythmia was not enough so that concomitant medical treatment should be considered. Therefore, attentive risk stratification and cautious decision of treatment strategy by experienced cardiac surgeon are believed to improve clinical outcome.
Adult* ; Arrhythmias, Cardiac ; Disease-Free Survival ; Ebstein Anomaly* ; Humans ; Medical Records ; Retrospective Studies

BACKGROUND AND OBJECTIVES: The objective of this study was to analyze cardiovascular risk factors in adults with congenital heart disease (ACHD). SUBJECTS AND METHODS: The subjects for this study comprised 135 patients, aged 18 years and above, who visited the ACHD clinic at the Samsung Medical Center and 135 adults with a structurally normal heart who were randomly selected from the Center for Health Promotion during the same period. For the analysis, the ACHD group was further divided into an ACHD group that underwent correction by cardiac surgery and a cyanotic group. RESULTS: The mean (standard diviation) age (years) of patients in the surgically corrected group was 48.4 (10.9) years, while that of patients in the cyanotic group was 43.1 (9.0) years and that of patients in the control group was 47.1 (10.3) years (p=0.042). The adjusted odds ratios (ORs) for past smoking, hypertension, diabetes mellitus, hypercholesterolemia, obesity, and metabolic syndrome were significantly higher in the surgically corrected patients than in the controls. However, the ORs for all variables excluding past smoking were significantly lower in the cyanotic group compared with the control group. After adjustment for age, gender, smoking, alcohol use, and exercise, the ORs for metabolic syndrome were 0.46 (0.35-0.57, p<0.001) and 1.48 (1.14-1.92, p=0.003) in the cyanotic and surgically corrected groups, respectively. CONCLUSION: Cardiovascular risk factors need to be considered in surgically corrected ACHD patients as well as in adults with a structurally normal heart. A further study with a long-term follow-up is needed for developing guidelines for prevention.
Adult* ; Diabetes Mellitus ; Follow-Up Studies ; Health Promotion ; Heart ; Heart Defects, Congenital* ; Humans ; Hypercholesterolemia ; Hypertension ; Metabolic Syndrome X ; Obesity ; Odds Ratio ; Risk Factors* ; Smoke ; Smoking ; Thoracic Surgery

Ultrasound (US) elastography is a valuable imaging technique for tissue characterization. Two main types of elastography, strain and shear-wave, are commonly used to image breast tissue. The use of elastography is expected to increase, particularly with the increased use of US for breast screening. Recently, the US elastographic features of breast masses have been incorporated into the 2nd edition of the Breast Imaging Reporting and Data System (BI-RADS) US lexicon as associated findings. This review suggests practical guidelines for breast US elastography in consensus with the Korean Breast Elastography Study Group, which was formed in August 2013 to perform a multicenter prospective study on the use of elastography for US breast screening. This article is focused on the role of elastography in combination with B-mode US for the evaluation of breast masses. Practical tips for adequate data acquisition and the interpretation of elastography results are also presented.
Breast* ; Consensus ; Elasticity Imaging Techniques* ; Information Systems ; Mass Screening ; Ultrasonography*

OBJECTIVES: Lead exposure is known to be associated with high blood pressure, hypertension, coronary artery disease, peripheral arterial disease, left ventricular hypertropy, and electrocardiographic abnormalities. We investigated the association between blood lead and coronary artery calcification and stenosis. METHODS: Between April 2006 and July 2007, 502 adults (345 males and 157 females), who had no history of cardiovascular disease or occupational exposure to lead, were recruited as study subjects. All subjects underwent coronary CT angiography and blood lead measurement. RESULTS: Blood lead levels were distributed from 0.43 to 11.30 (microgram/dL with a geometric mean blood lead level of 2.98+/-1.5 (microgram/dL. The geometric mean blood lead levels were higher in men than women (3.31+/-1.5 (microgram/dL vs. 2.36+/-1.5 (microgram/dL, P < 0.01). Based on a multivariate analysis, a 1 unit ((microgram/dL) increase in blood lead level was associated with a 1.09 (95% confidence interval, 0.92~1.29) and a 1.01 fold (95% confidence interval, 0.63~1.63) greater risk for coronary artery calcification in men and women, respectively. Similarly, a 1 unit (microgram/dL) increase in blood lead level was associated with a 1.25 (95% confidence interval, 1.03~1.51) and a 1.42 fold (95% confidence interval, 0.73~2.75) greater risk for coronary artery stenosis in men and women, respectively. CONCLUSIONS: The results suggest that increased blood lead levels are associated with an increased risk of coronary artery stenosis.
Adult ; Angiography ; Cardiovascular Diseases ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Electrocardiography ; Female ; Humans ; Hypertension ; Male ; Multivariate Analysis ; Occupational Exposure ; Peripheral Arterial Disease

OBJECTIVES: Benign conditions have been known to cause an increase in the levels of serum carcinoembryonic antigen, a level change that is often associated with an increase in the occurrence of malignancy. The purpose of this study was to elucidate the relationship between serum CEA levels and type of work in shipyard workers. METHODS: From July-August 2007, 637 study subjects were enrolled into the study with the following characteristics: age 37~58 years, healthy shipyard workers, and who undergone an examination in a general hospital. Data on general characteristics was gathered from self-administered questionnaires. Information on job factors was collected from company personnel data. Serum CEA levels were measured after 10 hours'fasting. RESULTS: The level of mean serum CEA was 1.83+/-1.20 ng/mL. On univariate analysis, the mean CEA level was significantly higher in older age groups (P<0.05), current smokers, lower education, and in production workers (P<0.01). After adjusting for age, BMI, cigarette smoking, job pattern, and educational level, the serum CEA level was higher in production workers than in office workers(P<0.01). This is particularly true in the shipyard painters, who had the highest level of CEA across job groups. CONCLUSIONS: The goal of this was to determine if there were differences in serum CEA levels according to occupational role in shipyard workers. Production shipyard workers had relatively higher level of serum CEA than office workers, most likely due to occupational exposure. This serum CEA level is influenced by occupation role. Serum CEA level could be a parameter for evaluating pollutant effects.
Carcinoembryonic Antigen ; Hospitals, General ; Humans ; Occupational Exposure ; Occupations ; Questionnaires ; Smoking

OBJECTIVES: The purpose of this study was to evaluate the predictors of metabolic syndrome in shipyard workers in the Southwestern part of South Korea and determine its prevalence. METHODS: The study subjects were composed of 1,198 medical check-up examinees, age 37 to 58 years who were examined in a general hospital from July, 2007 to August, 2008. Information about age, smoking, drinking and exercise was based on data from self-administered questionnaires. We collected job factors, education level and marital status from company personnel data and the indices of metabolic syndrome from the medical check-up. RESULTS: The prevalence of metabolic syndrome among the 1,198 shipyard workers was 15.0%. The prevalence of the components of metabolic syndrome was as follows: 26.9% for central obesity, 31.7% for hypertension, 32.2% for hypertriglyceridemia, 19.2% for low HDL-cholesterolemia and 5.2% for hyperglycemia. Adjusted odds ratio for metabolic syndrome was significantly decreased in productive workers (OR: 0.500, 95% CI: 0.327-0.764). Furthermore, factors such as age, smoking, drinking, exercise, work duration and job type were significantly associated with metabolic syndrome. CONCLUSIONS: Our findings suggest that even though shipyard workers work for the same employer, the prevalence of metabolic syndrome varies to job type, shift work and work duration. Therefore, general metabolic syndrome management programs for shipyard workers should be designed and tailor-made for specified job characteristics to prevent cardiovascular disease more effectively. Also, thorough control and management of the tailor made metabolic syndrome management programs is needed in the early stages of metabolic syndrome for good health outcomes.
Cardiovascular Diseases ; Drinking ; Health Promotion ; Hospitals, General ; Hyperglycemia ; Hypertension ; Hypertriglyceridemia ; Marital Status ; Obesity, Abdominal ; Occupations ; Odds Ratio ; Prevalence ; Questionnaires ; Republic of Korea ; Smoke ; Smoking

PURPOSE: Despite recent advances in the surgical and postoperative management of infants with congenital heart disease, nutritional support for this population is often suboptimal. The purpose of this study was to develop a nutritional program for the postoperative period for infants who have had cardiac surgery and to evaluate effects of the program. METHODS: A quasi-experimental design with pretest and posttest measures was used. A newly developed nutritional program including a feeding protocol and feeding flow was provided to the study group (n=19) and usual feeding care to the control group (n=19). The effects of the feeding program were analyzed in terms of total feed intake, total calorie intake, gastric residual volume, and frequency of diarrhea. RESULTS: Calorie intake and feeding amount in the study group were significantly increased compared to the control group. However, the two groups showed no significant differences in gastric residual volume and frequency of diarrhea. CONCLUSION: The results indicate that the nutritional program used in the study is an effective nursing intervention program in increasing feeding amount and calorie intake in infants postoperative to cardiac surgery and does not cause feeding-related complications.
Diarrhea/complications/etiology ; Enteral Nutrition/*methods/standards ; Female ; Heart Diseases/*surgery ; Humans ; Infant ; Infant, Newborn ; Male ; Nutritional Requirements ; *Postoperative Care/methods ; Postoperative Complications ; Program Development ; Program Evaluation

Pregnancy outcomes in patients with congenital heart disease have not been fully assessed in Korea. Forty-nine pregnancies that occurred in 34 women with congenital heart disease who registered at our hospital between September 1995 and April 2006 were reviewed. Spontaneous abortions occurred in two pregnancies at 6+1 and 7 weeks, and another two underwent elective pregnancy termination. One maternal death in puerperium occurred in a woman with Eisenmenger syndrome. Maternal cardiac complications were noted in 18.4%, pulmonary edema in 16.3%, symptomatic arrhythmia in 6.1%, deterioration of New York Heart Association (NYHA) functional class by > or =2 in 2.0%, and cardiac death in 2.0%. Independent predictors of adverse maternal cardiac events were an NYHA functional class of > or =3 (odds ratio [OR], 20.3), right ventricular dilation (OR, 21.2), and pulmonary hypertension (OR, 21.8). Neonatal complications occurred in 22.4% of pregnancies and included preterm delivery (16.3%), small for gestational age (12.2%), and neonatal death (2.0%). Independent predictors of adverse neonatal events were pulmonary hypertension (OR, 6.8) and NYHA functional class > or =3 (OR, 23.0). Pregnancy in women with congenital heart disease was found to be significantly associated with maternal cardiac and neonatal complications. Pre-pregnancy counseling and multidisciplinary care involving cardiologists and obstetricians are recommended for women with congenital heart disease contemplating pregnancy.
Abortion, Spontaneous ; Adult ; Female ; Heart Defects, Congenital/complications/*physiopathology ; Humans ; Korea ; Multivariate Analysis ; Obstetrics/methods ; Odds Ratio ; Pregnancy ; Pregnancy Complications, Cardiovascular/physiopathology ; Pregnancy Outcome