Objectives: This study analyzed the current state of community mental health programs in Korea to develop evidence-based criteria for these programs. Methods: Seventy community mental health facilities nationwide were surveyed about the scope of their operated mental health programs. Details, including program structure, staff expertise, standardization, and quality management, of the 511 programs submitted by the facilities as their representative programs were also analyzed to evaluate their efforts for evidence-based practice. Results: The average number of programs operated by community mental health welfare centers was 15.9. The most common programs were those related to serious mental illness (SMI), followed by child/adolescent mental health programs, early psychosis programs, and non-SMI adult mental health programs. In the case of community addiction management centers, there were 7.2 different addiction-related programs per center. Among the psychiatric rehabilitation facilities for SMI, the average number of programs for SMI was 13.1, with some programs for early psychosis. Of the 511 programs submitted as representative programs in their facilities, only 12.3% were judged to be good evidence-based programs. Conclusion More efforts by mental health professionals and governments are needed to implement evidence-based programs in Korea.

PURPOSE: To evaluate the effects of intravitreal aflibercept injection in the treatment of submacular hemorrhage secondary to neovascular age-related macular degeneration (nAMD). METHODS: This retrospective, observational study included patients diagnosed with nAMD with submacular hemorrhage treated with intravitreal aflibercept monotherapy. A total of 54 eyes of 54 patients were treated with an initial series of three monthly intravitreal aflibercept injections followed by as-needed injections. At the 6 month follow-up, changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and submacular hemorrhage area (SMH) were evaluated. RESULTS: The mean preoperative BCVA was 0.79 ± 0.59 logMAR, which improved significantly to 0.53 ± 0.46 logMAR at 3 months and 0.48 ± 0.50 logMAR at 6 months (p < 0.001, in both). The CMT significantly decreased in all eyes: preoperative, 454.4 ± 131.5 µm, to 242.6 ± 39.7 µm at 6 months. The SMH was also reduced in all eyes: preoperative, 6.4 ± 4.8 disc areas (DAs) to 0.8 ± 1.4 DAs at 6 months. Ten eyes were diagnosed with typical nAMD (18.5%) and 44 eyes were diagnosed polypoidal choroidal vasculopathy (81.5%). There was no significant difference at 6 months in the visual outcomes of the subgroups. CONCLUSIONS: Intravitreal aflibercept monotherapy is well-tolerated as a treatment in maintaining or improving vision in patients with SMH secondary to nAMD.
Choroid ; Follow-Up Studies ; Hemorrhage ; Humans ; Macular Degeneration ; Observational Study ; Retrospective Studies ; Visual Acuity

BACKGROUND: To investigate the influence of nocturnal ambient light on visual function and ocular fatigue. METHODS: Sixty healthy subjects (30 men and 30 women) aged 19 through 29 years with no history of ocular disease were recruited. All subjects spent 3 consecutive nights in the sleep laboratory. During the first and second nights, the subjects were not exposed to light during sleep, but during the third night, they were exposed to ambient light, measuring 5 or 10 lux at the eye level, which was randomly allocated with 30 subjects each. The visual function and ocular fatigue were assessed at 7 a.m. on the 3rd and 4th mornings, using best-corrected visual acuity, refractive error, conjunctival hyperemia, tear break-up time, maximal blinking interval, ocular surface temperature, and subjective symptoms reported on a questionnaire. RESULTS: Three men and three women subjects failed to complete the study (4 in the 5 lux; 2 from the 10 lux). For the entire 54 subjects, tear break-up time and maximal blinking interval decreased (P = 0.015; 0.010, respectively), and nasal and temporal conjunctival hyperemia increased significantly after sleep under any ambient light (P < 0.001; 0.021, respectively). Eye tiredness and soreness also increased (P = 0.004; 0.024, respectively). After sleep under 5 lux light, only nasal conjunctival hyperemia increased significantly (P = 0.008). After sleep under 10 lux light, nasal and temporal conjunctival hyperemia, eye tiredness, soreness, difficulty in focusing, and ocular discomfort increased significantly (P < 0.05). CONCLUSION: Nocturnal ambient light exposure increases ocular fatigue. Avoiding ambient light during sleep could be recommended to prevent ocular fatigue.
Asthenopia ; Blinking ; Dry Eye Syndromes ; Fatigue* ; Female ; Healthy Volunteers ; Humans ; Hyperemia ; Lighting ; Male ; Refractive Errors ; Tears ; Visual Acuity

PURPOSE: To evaluate changes in subfoveal choroidal thickness (SFCT) after patterned panretinal photocoagulation (PRP) using pattern scan laser (PASCAL) in patients with diabetic retinopathy. METHODS: This study included 39 patients (50 eyes) treated with patterned PRP using PASCAL and who were followed for at least 3 months. Patients were classified into 2 groups according to severity: severe non-proliferative diabetic retinopathy and proliferative diabetic retinopathy. SFCT was measured by enhanced depth imaging of spectral-domain optical coherence tomography. The change in SFCT was analyzed at 1 and 3 months after PRP. RESULTS: SFCT was 270.42 ± 61.44 µm before PRP, 264.52 ± 60.78 µm at 1 month, and 255.74 ± 56.89 µm at 3 months after PRP. Significant change of SFCT was found at 3 months after PRP. Central macular thickness was 275.56 ± 50.61 µm before PRP and increased to 295.18 ± 52.80 µm and 293.10 ± 57.24 µm at 1 and 3 months post-treatment, respectively. There were no significant differences between groups in SFCT at baseline or in the amount of change in SFCT after PRP. CONCLUSIONS: SFCT significantly decreased after patterned PRP using PASCAL.
Choroid* ; Diabetic Retinopathy* ; Humans ; Light Coagulation* ; Tomography, Optical Coherence

PURPOSE: To compare the characteristics of optical coherence tomography in eyes with treatment-naïve typical neovascular age-related macular degeneration (typical nAMD), polypoidal choroidal vasculopathy (PCV), and retinal angiomatous proliferation (RAP). METHODS: One hundred fifty-three eyes newly diagnosed with exudative AMD were retrospectively collected. All study eyes were classified into three subtypes: typical nAMD, PCV, and RAP. Subfoveal choroidal thickness (SFCT) was measured using enhanced depth imaging optical coherence tomography (EDI-OCT). Central macular thickness (CMT) and other OCT features including intraretinal cystoid fluid and subretinal fluid were also evaluated in all eyes. SFCT, CMT and other OCT features were compared among the three subtypes of exudative AMD. RESULTS: Seventy-four eyes with typical nAMD, 55 eyes with PCV, and 24 eyes with RAP were included. SFCT was significantly thickest in PCV and thinnest in RAP (p < 0.001). RAP showed the thickest CMT and the highest frequency of intraretinal cystoid fluid (p = 0.004, p < 0.001, respectively). CONCLUSIONS: In patients with exudative AMD, different characteristics of OCT were observed according to the three subtypes. Identification of OCT characteristics could help differentiate the subtypes of exudative AMD.
Choroid ; Humans ; Macular Degeneration* ; Retinaldehyde ; Retrospective Studies ; Subretinal Fluid ; Tomography, Optical Coherence*

PURPOSE: To investigate the clinical and demographic features of idiopathic macular telangiectasia (MacTel) in Korean patients since the introduction of spectral domain optical coherence tomography (SD-OCT). METHODS: We reviewed medical records of patients who were diagnosed with MacTel from 2009 to 2013. All patients underwent fluorescein angiography and SD-OCT and were classified as type 1 or type 2 according to the classification system proposed by Yannuzzi. RESULTS: Over a period of 5 years, 4 (18.2%) patients were diagnosed with type 1 MacTel and 18 (81.8%) patients were diagnosed with type 2 MacTel. All patients with type1 MacTel were male, and their mean age was 51 +/- 8.6 years. Among patients with type 2 MacTel, 3 (16.7%) were male, 15 (83.3%) were female, and the mean age was 60 +/- 13.6 years. Whereas all type 1 MacTel patients had either metamorphopsia or mild scotoma, of the 18 patients with type 2 MacTel, only 4 (22.2%) had those symptoms, 10 (55.6%) complained of only mild visual impairment, and the other 4 (22.2%) had no symptoms. Intraretinal cystoid spaces were observed in 26 (72.2%) of 36 eyes with type 2 MacTel by SD-OCT. These cystoid spaces had irregular boundaries and did not correspond to angiographic leakages. CONCLUSIONS: Type 2 MacTel was most common in the present study. The wider availability of SD-OCT may have contributed to the diagnosis of type 2 MacTel. Type 2 MacTel may be more prevalent than type 1 in Koreans, which corresponds to the results of Western countries.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Retina/pathology ; *Retinal Telangiectasis/diagnosis/epidemiology/pathology/physiopathology ; Retrospective Studies

PURPOSE: To investigate the clinical and demographic features of idiopathic macular telangiectasia (MacTel) in Korean patients since the introduction of spectral domain optical coherence tomography (SD-OCT). METHODS: We reviewed medical records of patients who were diagnosed with MacTel from 2009 to 2013. All patients underwent fluorescein angiography and SD-OCT and were classified as type 1 or type 2 according to the classification system proposed by Yannuzzi. RESULTS: Over a period of 5 years, 4 (18.2%) patients were diagnosed with type 1 MacTel and 18 (81.8%) patients were diagnosed with type 2 MacTel. All patients with type1 MacTel were male, and their mean age was 51 +/- 8.6 years. Among patients with type 2 MacTel, 3 (16.7%) were male, 15 (83.3%) were female, and the mean age was 60 +/- 13.6 years. Whereas all type 1 MacTel patients had either metamorphopsia or mild scotoma, of the 18 patients with type 2 MacTel, only 4 (22.2%) had those symptoms, 10 (55.6%) complained of only mild visual impairment, and the other 4 (22.2%) had no symptoms. Intraretinal cystoid spaces were observed in 26 (72.2%) of 36 eyes with type 2 MacTel by SD-OCT. These cystoid spaces had irregular boundaries and did not correspond to angiographic leakages. CONCLUSIONS: Type 2 MacTel was most common in the present study. The wider availability of SD-OCT may have contributed to the diagnosis of type 2 MacTel. Type 2 MacTel may be more prevalent than type 1 in Koreans, which corresponds to the results of Western countries.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Retina/pathology ; *Retinal Telangiectasis/diagnosis/epidemiology/pathology/physiopathology ; Retrospective Studies

PURPOSE: To investigate the clinical efficacy of blepharotomy to treat upper eyelid retraction associated with thyroid eye disease. METHODS: A retrospective survey was performed with 9 eyes of 7 thyroid ophthalmopathy patients, who visited Korea University Medical Center from August 2009 to February 2011, and had undergone blepharotomy. The sex, age, change of upper eyelid retraction, postoperative complication, follow-up periods, and the surgical results were reviewed. To assess the efficacy of blepharotomy more objectively, the preoperative and postoperative pictures of patients were taken and the following lid parameters measured: marginal reflex distance 1, interpalpebral fissure height, total palpebral fissure area, upper nasal palpebral fissure area, and upper temporal palpebral fissure area. RESULTS: The mean age of patients was 37.4 years and mean follow-up period was 12.8 months. Five patients had undergone surgery unilaterally and 2 patients, bilaterally. Seven eyes of 6 patients had undergone full thickness blepharotomy and 2 eyes of 1 patient had undergone graded blepharotomy. According to the 3-month preoperative and postoperative picture analysis, all lid parameters improved significantly after blepharotomy (2.03 mm, 1.95 mm, 24.28 mm2, 12.98 mm2, and 16.21 mm2, respectively). Complications associated with blepharotomy included multiple and high folds in 2 eyes of 2 patients who had undergone full thickness blepharotomy. Re-operation was performed on only 1 eye and the result was satisfactory. CONCLUSIONS: Blepharotomy for upper eyelid retraction is a safe and highly effective surgery for upper eyelid retraction associated with symptomatic thyroid eye disease. This technique achieves excellent functional and cosmetic outcomes.
Academic Medical Centers ; Cosmetics ; Eye ; Eye Diseases ; Eyelids ; Follow-Up Studies ; Humans ; Korea ; Postoperative Complications ; Reflex ; Retrospective Studies ; Thyroid Gland

Human listeriosis is a relatively rare but serious disease with mortality rate 20~40%. Listeria monocytogenes affects patients with decreased cell mediated immunity such as the elderly, transplant recipients, cancer patients, renal failure, diabetes, HIV, pregnant women and unborn child, neonate. We experienced a case of listeriosis in twin pregnant woman at 35th weeks without preterm labor. The pregnant woman present sepsis with fever at first time. Sepsis progress to MODS (multiple organ dysfunction syndrome) and combined endocarditis. We reported it with brief of literatures.
Aged ; Child ; Endocarditis ; Female ; Fever ; HIV ; Humans ; Immunity, Cellular ; Infant, Newborn ; Listeria ; Listeria monocytogenes ; Listeriosis ; Multiple Organ Failure ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy Trimester, Third ; Pregnancy, Twin ; Pregnant Women ; Renal Insufficiency ; Sepsis

OBJECTIVE: There are some evidences that some epithelial ovarian cancer cells respond to hormonal therapy. And in vitro studies have revealed that treatment of various human cancer cell lines with selective cyclooxygenase 2 (COX-2) inhibitors induces apoptotic cell death. The goal of this article is to evaluate the effects of tamoxifen and celecoxib, a selective COX-2 inhibitor, on the ovarian cancer cells and the benefits of combining these agents in the management of ovarian cancer. METHODS: SK-OV-3 epithelial ovarian cancer cells were exposed to increasing concentration of tamoxifen (10(-8) M, 10(-7) M, 10(-6) M, 10(-5) M and 10(-4) M) and celecoxib (10(-8) M, 10(-7) M, 10(-6) M, 10(-5) M and 10(-4) M) as well as a combination of both drugs. The activity of apoptosis was evaluated by the morphologic examination and the MTT assay. The pattern of apoptosis was also assessed by the caspase-3 activity and the fraction of cleaved PARP (poly ADP-ribose polymerase) protein. RESULTS: Single application of both drugs could significantly increase the rate of apoptosis after 24 h of continuous exposure. Concomitant treatment of SK-OV-3 cells with tamoxifen and celecoxib induced significant increase in apoptosis, comparing with single drug exposure. The pattern of apoptosis induced by these agents on SK-OV-3 cells seemed to be caspase-3 dependent. CONCLUSION: Our data suggest that combining tamoxifen with selective COX-2 inhibitor seems to have at least an additive tumoricidal effect. A more definitive role for this combination therapy in clinical settings in ovarian cancer will need to be defined through the conduct of clinical trials.
Adenosine Diphosphate Ribose ; Apoptosis ; Caspase 3 ; Cell Death ; Cell Line* ; Cyclooxygenase 2 ; Humans ; Ovarian Neoplasms* ; Tamoxifen* ; Celecoxib