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Psychotherapy for Somatoform Disorder (신체형 장애의 정신치료)

  • Lee, Moo-Suk
    • Korean Journal of Psychosomatic Medicine
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    • v.4 no.2
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    • pp.269-276
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    • 1996
  • A theroretical study was made on the psychodynamism of somatoform disorder. Somatoform disorder is caused by a defense mechanism of somatization. Somatization is the tendency to react to stimuli(drives, defenses, and conflict between them) physically rather than psychically(Moore, 1990). Ford(1983) said it is a way of life, and Dunbar(1954) said it is the shift of psychic energy toward expression in somatic symptoms. As used by Max Shur(1955), somatization links symptom formation to the regression that may occur in response to acute and chronic conflict. In the neurotic individual psychic conflict often provokes regressive phenomena that may include somatic manifestations characteristic of an earlier developmental phase. Schur calls this resomatization. Pain is the most common example of a somatization reaction to conflict. The pain has an unconscious significance derived from childhood experiences. It is used to win love, to punish misdeeds, as well as a means to amend. Among all pains, chest pain has a special meaning. Generally speaking, 'I have pain in my chest' is about the same as 'I have pain in my mind'. The chest represent the mind, and the mind reminds us about the heart. So we have a high tendency to recognize mental pain as cardiac pain. Kellner(1990) said rage and hostility, especially repressed hostility, are important factors in somatization. In 'Psychoanalytic Observation on Cardiac Pain', psychoanalyst Bacon(1953) presented clinical cases of patients who complained of cardiac pain in a psychoanalytic session that spread from the left side of their chests down their left arms. The pain was from rage and fear which came after their desire to be loved was frustrated by the analyet. She said desires related to cardiac pain were dependency needs and aggressions. Empatic relationship and therapeutic alliances are indispensable to psychotherapy in somatoform disorder. The beginning of therapy is to discover a precipitating event from the time their symptoms have started and to help the patient understand a relation between the symptom and precipitating event. Its remedial process is to find and interpret a intrapsychic conflict shown through the symptoms of the patient. Three cases of somatoform disorder patients treated based on this therapeutic method were introduced. The firt patient, Mr. H, had been suffering from hysterical aphasia with repressed rage as ie psychodynamic cause. An interpretation related to the precipitating event was given by written communication, and he recovered from his aphasia after 3 days of the session. The second patient was a dentist in a cardiac neurosis with agitation and hypochondriasis, whose psychodynamism was caused by a fear that he might lose his father's love. His symptom was also interpreted in relation to the precipitating event. It showed the patient a child-within afraid of losing his father's love. His condition improved after getting a didactic interpretation which told him, to be master of himself, The third patient was a lady transferred from the deparment of internal medicine. She had a frequent and violent fit of chest pains, whose psychodynamic cause was separation anxiety and a rage due to the frustration of dependency needs. Her symptom vanished dramatically when she wore a holler EKG monitor and did not occur during monitoring. By this experience she found her symptom was a psychogenic one, and a therapeutic alliance was formed. later in reguar psychotherapy sessions, she was told the relaton between symptoms and precipitating events. Through this she understood that her separation anxiety was connected to the symptom and she became less terrifide when it occurred. Now she can travel abroad and take well part in social activities.

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A Study on the Born Global Venture Corporation's Characteristics and Performance ('본글로벌(born global)전략'을 추구하는 벤처기업의 특성과 성과에 관한 연구)

  • Kim, Hyung-Jun;Jung, Duk-Hwa
    • Journal of Global Scholars of Marketing Science
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    • v.17 no.3
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    • pp.39-59
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    • 2007
  • The international involvement of a firm has been described as a gradual development process "a process in which the enterprise gradually increases its international involvement in many studies. This process evolves in the interplay between the development of knowledge about foreign markets and operations on one hand and increasing commitment of resources to foreign markets on the other." On the basis of Uppsala internationalization model, many studies strengthen strong theoretical and empirical support. According to the predictions of the classic stages theory, the internationalization process of firms have been recognized and characterized gradual evolution to foreign markets, so called stage theory: indirect & direct export, strategic alliance and foreign direct investment. However, termed "international new ventures" (McDougall, Shane, and Oviatt 1994), "born globals" (Knight 1997; Knight and Cavusgil 1996; Madsen and Servais 1997), "instant internationals" (Preece, Miles, and Baetz 1999), or "global startups" (Oviatt and McDougall 1994) have been used and come into spotlight in internationalization study of technology intensity venture companies. Recent researches focused on venture company have suggested the phenomenons of 'born global' firms as a contradiction to the stages theory. Especially the article by Oviatt and McDougall threw the spotlight on international entrepreneurs, on international new ventures, and on their importance in the globalising world economy. Since venture companies have, by definition. lack of economies of scale, lack of resources (financial and knowledge), and aversion to risk taking, they have a difficulty in expanding their market to abroad and pursue internalization gradually and step by step. However many venture companies have pursued 'Born Global Strategy', which is different from process strategy, because corporate's environment has been rapidly changing to globalization. The existing studies investigate that (1) why the ventures enter into overseas market in those early stage, even in infancy, (2) what make the different international strategy among ventures and the born global strategy is better to the infant ventures. However, as for venture's performance(growth and profitability), the existing results do not correspond each other. They also, don't include marketing strategy (differentiation, low price, market breadth and market pioneer) that is important factors in studying of BGV's performance. In this paper I aim to delineate the appearance of international new ventures and the phenomenons of venture companies' internationalization strategy. In order to verify research problems, I develop a resource-based model and marketing strategies for analyzing the effects of the born global venture firms. In this paper, I suggested 3 research problems. First, do the korean venture companies take some advantages in the aspects of corporate's performances (growth, profitability and overall market performances) when they pursue internationalization from inception? Second, do the korean BGV have firm specific assets (foreign experiences, foreign orientation, organizational absorptive capacity)? Third, What are the marketing strategies of korean BGV and is it different from others? Under these problems, I test then (1) whether the BGV that a firm started its internationalization activity almost from inception, has more intangible resources(foreign experience of corporate members, foreign orientation, technological competences and absorptive capacity) than any other venture firms(Non_BGV) and (2) also whether the BGV's marketing strategies-differentiation, low price, market diversification and preemption strategy are different from Non_BGV. Above all, the main purpose of this research is that results achieved by BGV are indeed better than those obtained by Non_BGV firms with respect to firm's growth rate and efficiency. To do this research, I surveyed venture companies located in Seoul and Deajeon in Korea during November to December, 2005. I gather the data from 200 venture companies and then selected 84 samples, which have been founded during 1999${\sim}$2000. To compare BGV's characteristics with those of Non_BGV, I also had to classify BGV by export intensity over 50% among five or six aged venture firms. Many other researches tried to classify BGV and Non_BGV, but there were various criterion as many as researchers studied on this topic. Some of them use time gap, which is time difference of establishment and it's first internationalization experience and others use export intensity, ration of export sales amount divided by total sales amount. Although using a mixed criterion of prior research in my case, I do think this kinds of criterion is subjective and arbitrary rather than objective, so I do mention my research has some critical limitation in the classification of BGV and Non_BGV. The first purpose of research is the test of difference of performance between BGV and Non_BGV. As a result of t-test, the research show that there are statistically efficient difference not only in the growth rate (sales growth rate compared to competitors and 3 years averaged sales growth rate) but also in general market performance of BGV. But in case of profitability performance, the hypothesis that is BGV is more profit (return on investment(ROI) compared to competitors and 3 years averaged ROI) than Non-BGV was not supported. From these results, this paper concludes that BGV grows rapidly and gets a high market performance (in aspect of market share and customer loyalty) but there is no profitability difference between BGV and Non_BGV. The second result is that BGV have more absorptive capacity especially, knowledge competence, and entrepreneur's international experience than Non_BGV. And this paper also found BGV search for product differentiation, exemption strategy and market diversification strategy while Non_BGV search for low price strategy. These results have never been dealt with other existing studies. This research has some limitations. First limitation is concerned about the definition of BGV, as I mentioned above. Conceptually speaking, BGV is defined as company pursue internationalization from inception, but in empirical study, it's very difficult to classify between BGV and Non_BGV. I tried to classify on the basis of time difference and export intensity, this criterions are so subjective and arbitrary that the results are not robust if the criterion were changed. Second limitation is concerned about sample used in this research. I surveyed venture companies just located in Seoul and Daejeon and also use only 84 samples which more or less provoke sample bias problem and generalization of results. I think the more following studies that focus on ventures located in other region, the better to verify the results of this paper.

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The Effects of Functional Tea (Mori Folium, Lycii Fructus, Chrysanthemi Flos, Zizyphi Fructus, Sesamum Semen, Raphani Semen) Supplement with Medical Nutrition Therapy on the Blood Lipid Levels and Antioxidant Status in Subjects with Hyperlipidemia (고지혈증 환자에서 의학영양치료와 병행하여 섭취한 기능성차(상엽, 구기자, 국화, 대추, 참깨, 나복자)의 혈중 지질 농도 저하 및 항산화 효과)

  • Lim, Hyun-Jung;Cho, Kum-Ho;Choue, Ryowon
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.34 no.1
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    • pp.42-56
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    • 2005
  • Hyperlipidemia is one of the risk factors for coronary artery disease. Despite of epidemiological evidence that tea consumption is associated with the reduced risk of coronary heart disease, experimental studies designed to show that drinking tea affects blood lipid concentration or oxidative stress have been unsuccessful. The purpose of this study was to investigate whether functional tea (three servings/day) supplement with medical nutrition therapy (MNT) lead to a beneficial outcomes in mildly hyperlipidemic adults. From February to October, 2003, the 43 hyperlipidemic (23 men, 20 women) subjects (total cholesterol$\geq$200 mg/dL or triglyceride$\geq$150 mg/dL) admitted to K Medical Center were studied. Subjects were randomly divided into 3 groups; placebo tea (PT), half dose of functional tea (HFT), full dose of functional tea (FFT). During 12 weeks of study period, the subjects were given placebo or functional tea daily with MNT. Anthropometric measurements, blood chemical analysis including lipid levels, total superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) levels, and dietary assessment were carried out at the beginning and end of experiment. The effects of functional tea were compared with the placebo in randomized clinical trial study. The placebo was prepared to match with the functional tea in color and taste. After the 12 weeks of MNT, the subjects had regular and balanced meal pattern. Consumption of foods high in cholesterol and saturated fat, salty foods, fried foods, and instant foods decreased significantly in all three groups (p<0.05). Intake of energy and cholesterol also decreased (p<0.05). Drinking three servings per day (390 mL/day) of functional tea significantly reduced the levels of blood triglyceride (HFT, 42.5%; FFT, 29.4%), total cholesterol (HFT, 8.5%; FFT, 13.7%), and atherogenic index (HFT, 14.6%; FFT, 21.7%). Whereas no changes were found in the LDL-, HDL-cholesterollevels, and LDL/HDL ratio. Plasma homocysteine (Hcy) concentration decreased significantly (p<0.05) in functional tea groups (HFT, 14.9%; FFT, 14.1%). SOD increased significantly (p<0.05) in HFT (8.3%). GSH-Px increased significantly (p<0.05) in FFT (12.8%). In conclusion, the MNT improved the dietary habits, in addition, functional tea supplement decreased blood lipid levels and Hcy, and increased SOD and GSH-Px levels. These results indicate that functional tea consumption may decrease the risk of cardiovascular disease via improving blood lipid levels and antioxidant status.

Considerable Aspects for Technical and Vocational Training in Forestry (임업기술(林業技術) 및 직업훈련(職業訓練)에 고려(考慮)되어야 할 사항(事項))

  • Ma, Sang Kyu
    • Journal of Korean Society of Forest Science
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    • v.51 no.1
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    • pp.56-65
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    • 1981
  • The training of forest ranger level and forest worker level to push the sound forest management and to increase the employment effects in forestry will be done without delay as soon as possible. So several opinions to be considered are here discussed. 1. The ranger level will be at first completely trained with the technics developed and modernized, to process really the sound forest management based on the concept of ecological and economical technic. 2. The organization of vocational training and it's systematical training method will be newly adopted to increase the labour efficiency in forestry. The case of fulltime worker level should be more intensively trained and part-time worker or forest famer level should be trained by the forest ranger and skilled worker with visiting circularly their working place. And the daily employed workers and village people for working should be done by the skilled workers. 3. The training subjects for them at the beginning step will be exploited by the instructors and concerned experts with studying their current conditions. Their practical training is more reasonable to do in the practically managing forest and to carry out under the responsible of leader of this forest. 4. The instructors included rangers of training forest will get specially certain intensive training through the aids of outside experts or through the group instruction with them. 5. The training fields and their reasons to be learned by them are discussed in this paper from the basic knowledge to the skill technics. 6. In oder to systematize and mordernize more rapidly our forest technics that need for training them and also applying directly in the forest management, a total effort of certain type by scientists and technicians scattered individually all over the country is now earnestly demanded to synthesize their knowledge, technic and experience. So to do like this, the establishment of certain organization through which can do their total efforts together will be considered and assisted by the concerned authority. 7. For better lieving of full-time workers, the whole-round year working amount have to be supplied though the work technic-and working plan development. And under the conditions that the timber harvesting work is still not so enough and it has a bad climatic season, the in-side working system and side - job aids will be developed for their sound lieving. 8. The organization of labour management will be soon introduced in the concerning administrativ authority to solve the forest labour problems and to increase the employing effects in forestry in future. 9. The supply programm of improved and trained tools and maschines for forest work is also considered to use by the trained persons. If not to do so, the training results will return to the original condition and will get nothing any more.

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Clinical Study of Tuberculous Meningitis in Children (소아 결핵성 뇌막염의 임상적 고찰)

  • Kim, Woo Sik;Kim, Jong Hyun;Kim, Dong Un;Lee, Won Bae;Kang, Jin Han
    • Pediatric Infection and Vaccine
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    • v.4 no.1
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    • pp.64-72
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    • 1997
  • Purpose : The incidence of tuberculous meningitis in Korean children has been markedly decreased after 1980s, but this disease has still occurred with low rate. Therefore, it may be suspected that delayed diagnosis and treatment will be happened because of lacking of clinical experiences and indistinguishable other meningitis, so it is important to make early diagnosis and treatment of tuberculous meningitis concerning with the prognosis. In this aspect, we conducted study to concern and investigate sustainly about the diagnostic criteria, clinical characteristics, radiological findings, complications, and prognosis of typical or atypical tuberculous meningitis in children. Methods : Forty four children who were hospitalized and treated due to tuberculous meningitis in pediatric wards of Our Lady of Mercy Hospital, St. Holy Hospital, St. Vincent Hospital and Uijungbu St. Mary Hospital from January 1985 to June 1996 were included in this study. We reviewed medical records of these patients retrospectively. Results : 1) The tuberculous meningitis has occured continuosly since mid-1980s. The highest 2) The diagnosis was made by contact history of active tuberculous patients, positive tuberculin test, responses of antituberculous antibiotics and discovery of Mycobacterium tuberculosis from CSF or other specimens. Among patients, 7 children(16%) were not vaccinated with BCG, and only 18 children(40%) were positive in tuberculin test. 3) The symptoms and signs of our patients on initial examinations were fever, vomiting, headache, lethargy, poor feeding, weight loss, neck stiffness, convulsion, abdominal pain and motor deficits. 4) The findings of initial CSF samples revealed leukocyte $239.5/mm^3$(mean) with lymphocyte predominant, elevated protein levels(mean;259.5mg%) and low sugar level(mean;40.7mg%). And the ratio of CSF/blood sugar was 0.407. But, atypical CSF findings were seen in 31.8% patients. 5) On brain imaging study, 34 out of 39 children had findings of hydrocephalus, basilar meningeal enhancement, infarction and subarachnoidal inflammations etc. On chest X-ray, the findings of miliary tuberculosis(34.1%), normal finding(29.5%), parenchymal infiltrations (11.4%) and calcifications(9.1%) were showed. 6) In neurological clinical stage, there were twenty-six children(59%) in stage 1, fourteen children(32%) in stage 2 and four children(9%) in stage 3. The late sequeles were encountered by 29.5% with mild and 4.6% with severe neurological injury. The most common neurological injury was quadriplegia and the mortality rate was 6.8%. 7) The SIADH was developed in 20 children(45.5%) after the 4th hospital day. Half of all SIADH patients were symptomatic. Conclusion : Tuberculosis meningitis is still an important extrapulmonary disease with high morbidity and mortality. Early diagnosis with clinical contact history of active tuberculosis and radiological imaging examinations and early treatments are essential in order to prevent and decrase the rate of late sequeles and death.

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A study on the interaction between visual perception and the body in contemporary painting space (20세기 회화공간에서 시지각과 신체의 상관성에 관한 연구)

  • Lee, Kum-Hee
    • Journal of Science of Art and Design
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    • v.11
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    • pp.109-152
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    • 2007
  • This thesis started from accepting the criticism and concretely seeking the possibility of visual visuality, in particular, visual physicality or physical visuality through the expression revealed in painting space. This study aims at stressing the role of the body in visual perception and pictorial expression by it by examining the interaction between it and the body. First of all, this study explored perception and the position of the body in the great frame of the historical stream from modernism, through minimalism, through post-minimalism to later art in order to confirm the interaction between visual perception and the body or the change in the intervention of physicality in the stream of contemporary art, and connected them with a discourse on perception and the body. It raised as the grounds for it the discussions which provided the theoretical background about perception. It dealt with the scientific discussions on perceptual physicality by Gestalt psychology in perceptive psychology, and next the discussion of Rudolf Arnheim who exemplified Gestalt psychology mainly on the dimension of visual art. It is significant in explaining the perceptual activeness which is the same as that of M. Merleau-Ponty as a primary debater to solve the questions of perceptual physicality and physical visuality. M. Merleau-Ponty set forth ambiguous perception and the body as its background as the fundamental bases for perceiving the world rather than consciousness proved explicitly. As Hal Foster said, as minimalist phenomenological background they provided appropriate theoretical background to the late art rising against modernist logic. Next, after the 1970s Frank Stella showed a working method and a tendency entirely different from those in the previous period. For example, deconstruction of frame, decentralized spatial expression, dynamic and mixed expression, and allowing real space by overlapping were judged to swing to approval of perceptual physicality. Francis Bacon's painting structure, that is, figure, triptych, aplat and a method of production by accident were understood to well reflect M. Merleau-Ponty's chair logic of chiasme. This study tries to seek the possibility of pictorial expression from works aiming at defining the question of seeing in connection with physicality, the role of the body as the body accumulated and the linking with a real, daily life as the background of the body, and confirm the phase shift.

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Analysis of the Radiation Therapy Outcomes and Prognostic Factors of Thymoma (흉선종에 대한 방사선치료 성적 및 예후인자분석)

  • Lee, Seok-Ho;Lee, Kyu-Chan;Choi, Jin-Ho;Lee, Jae-Ik;Sym, Sun-Jin;Cho, Eun-Kyung
    • Radiation Oncology Journal
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    • v.28 no.1
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    • pp.1-8
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    • 2010
  • Purpose: This retrospective study was performed to evaluate the efficacy of radiation therapy (RT) and to investigate the prognostic factors for thymoma when treated with RT. Materials and Methods: We analyzed 21 patients with thymoma and also received RT from March 2002 to January 2008. The median follow-up time was 37 months (range, 3 to 89 months). The median patient age was 57 years (range, 24 to 77 years) and the gender ratio of males to females was 4:3. Of the 21 patients, complete resections (trans-sternal thymectomy) and R2 resections were performed in 14 and 1 patient, respectively. A biopsy was performed in 6 patients (28.7%). The WHO cell types in the 21 patients were as follows: 1 patient (4.8%) had type A, 10 patients (47.6%) had type B1-3, and 10 patients (47.6%) had type C. Based on Masaoka staging, 10 patients (47.6%) were stage II, 7 patients (33.3%) were stage III, and 4 patients (19.1%) were stage IVa. Three-dimensional RT was adminstered to the tumor volume (planned target volume), including the anterior mediastinum and the residual disease. The total RT dose ranged from 52.0 to 70.2 Gy (median dose, 54 Gy). Consistent with the WHO criteria, the response rate was only analyzed for the 6 patients who received a biopsy only. The prognostic factors analyzed for an estimate of survival included age, gender, tumor size, tumor pathology, Masaoka stage, the possibility of treatment by performing surgery, the presence of myasthenia gravis, and RT dose. Results: The 3-year overall survival rate (OS) and the progression free survival rate (PFS) were 80.7% and 78.2%, respectively. Among the 10 patients with WHO cell type C, 3 of 4 patients (75%) who underwent a complete resection and 3 of 6 patients (50%) who underwent a biopsy survived. Distant metastasis developed in 4 patients (19.1%). The overall response rate in the 6 patients who received biopsy only were as follows: partial remission in 4 patients (66.7%), stable disease in 1 patient (16.6%), and progressive disease in 1 patient (16.6%). Acute RTOG radiation pneumonitis occurred in 1 patient (4.8%), grade 2 occurred in 2 patients (9.5%), grade 3 occurred in 1 patient (4.8%), and grade 4 occurred in 1 patient (4.8%). A univariate analysis revealed that the significant prognostic factors for OS were age (${\geq}60$, 58.3%; <60, 100%; p=0.0194), pathology (WHO cell type A-B3, 100%; C, 58.3%; p=0.0194) and, whether the patient underwent surgery (yes, 93.3%; no, 50%; p=0.0096). Conclusion: For the 15 patients who received surgery, there was no local failure within the radiation field. In patients with WHO cell type C, surgical procedures could have resulted in a more favorable outcome than biopsy alone. We report here our clinical experience in 21 patients with thymoma who were treated by radiation therapy.

Immediate Reoperation for Failed Mitral Valve Repair (승모판막성형술 실패 직후에 시행한 재수술)

  • Baek, Man-Jong;Na, Chan-Young;Oh, Sam-Se;Kim, Woong-Han;Whang, Sung-Wook;Lee, Cheol;Chang, Yun-Hee;Jo, Won-Min;Kim, Jae-Hyun;Seo, Hong-Ju;Kim, Wook-Sung;Lee, Young-Tak;Park, Young-Kwan;Kim, Chong-Whan
    • Journal of Chest Surgery
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    • v.36 no.12
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    • pp.929-936
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    • 2003
  • We analysed the surgical outcomes of immediate reoperations after mitral valve repair. Material and Method: Eighteen patients who underwent immediate reoperation for failed mitral valve repair from April 1995 through July 2001 were reviewed retrospectively. There were 13 female patients. The mitral valve disease was regurgitation (MR) in 12 patients, stenosis (MS) in 3, and mixed lesion in 3. The etiologies of the valve disease were rheumatic in 9 patients, degenerative in 8, and endocarditis in 1. The causes of reoperation was residual MR in 13 patients, residual MS in 4, and rupture of left ventricle in 1. Fourteen patients had rerepair for residual mitral lesions (77.8%) and four underwent replacement. Result: There was no early death. After mean follow-vp of 33 months, there was one late death. Echocardiography revealed no or grade 1 of MR (64.3%) in 9 patients and no or mild MS in 11 patients (78,6%). Reoperation was done in one patient. The cumulative survival and freedom from valve-related reoperation at 6 years were 94% and 90%, respectively. The cumulative freedom from recurrent MR and MS at 4 years were 56% and 44%, respectively. Conclusion: This study suggests that immediate reoperation for failed mitral valve repair offers good early and intermediate survival, and mitral valve rerepair can be successfully performed in most of patients. However, because mitral rerepair have high failure rate, especially in rheumatic valve disease, adequate selections of valvuloplasty technique and indication are important to reduce the failure rate of mitral rerepair.

Early Clinical Experience in Aortic Valve Replacement Using On-X$^{circledR}$Prosthetic Heart Valve (On-X$^{circledR}$ 기계판막을 이용한 대동맥판 치환술의 조기 임상 경험)

  • 안병희;전준경;류상완;최용선;김병표;홍성범;박종춘;김상형
    • Journal of Chest Surgery
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    • v.36 no.9
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    • pp.651-658
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    • 2003
  • Since the first implanted in September 1997, the use of On-X prosthetic heart valve has been increasing around in the world. This study was designed to assess the feasibility, safety, and the postoperative hemodynamics with this new valve in clinical setting. Material and Method: The current study was carried out on 52 patients undergoing aortic valve replacement with this prosthesis between April 1999 to August 2002 at Chonnam National University Hospital to evaluate the surgical results. 52% of the patients were male and the average age at implant was 50$\pm$13 years. The study followed the guidelines of the AATS/STS. Preoperatively, 32(61.5%) patients were in NYHA functional class III or IV and 2 patients had previous aortic valve surgery. Concomitant cardiac surgery was performed in 71.1%. The implanted valve sizes were 19 mm in 13 patients, 21 mm in 26, 23 mm in 10 and 25 mm in 3, respectively. Mean follow-up was 16.6$\pm$10.5 months (1∼39 months). Echocardiographic assessment was performed pre- and immediate postoperatively, as well as 3, 6, 12 months after surgery, evaluating pressure loss and regression of left ventricular hypertrophy. Result: Mean cardiopulmonary bypass time was 191$\pm$94.7 minutes with an aortic cross-clamp time of 142$\pm$51.7 minutes. There was no early and late mortality, Freedom from adverse events at 1 year in the study were as follows: thromboembolism, 95.6$\pm$6%; bleeding events, 90.2$\pm$4%; paravalvular leakage 92.3$\pm$4%; and overall valve-related morbidity at 1 year was 76.6$\pm$3%. There were no cases of valve thrombosis, prosthetic valve endocarditis and structural or non-structural failure. Left ventricular function at 12 months after surgery (EF=62.7$\pm$9.8%) revealed a statistically significant improvement compared to preoperative investigation (EF=55.8$\pm$15.9%, p=0.006). Left ventricular mass index was 247.3$\pm$122.3 g/$m^2$ on preoperative echocardiographic study, but regressed to 155.5$\pm$58.2 g/$m^2$ at postoperative 1 year (p=0.002). Over the follow-up period a further decrease of peak transvalvular gradients was observed in all patients: 62.5$\pm$38.0 mmHg on preoperative assessment, 18.2$\pm$6.8 mmHg at immediate postoperative period (p < 0.0001), 7.6$\pm$5.09 mmHg (p<0.0001) at 6 month, 18.0$\pm$10.8 mmHg (p<0.0001) at 1 year. Conclusion: The On-X prosthetic heart valve performs satisfactorily in the first 1 year period. Clinical outcome by examining NYHA functional classification revealed especially good results. Effective regression of left ventricular hypertrophy and statistically significant decrease of transvalvular gradient were observed over the first year, but longer-term follow-up of this patient group is needed to establish the expected rates for late valve-related events as well as the long-term clinical efficacy of this valve.

Perceptions of Married Women on Childbirth and Sex Preference and Related Factors in Gyeongju, Korea (도농복합지역 기혼여성들의 출산과 성 선호에 대한 인식 및 관련요인)

  • Youm, Seog-Heon;Kang, Pock-Soo;Kim, Chang-Yoon;Lee, Kyeong-Soo;Hwang, Tae-Yoon;Hwang, In-Sob
    • Journal of agricultural medicine and community health
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    • v.35 no.3
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    • pp.260-273
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    • 2010
  • Objectives: The purpose of this study was to investigate the perceptions of married Korean women regarding marriage and childbirth, and their awareness of childbirth-related issues such as low birth rates, sex preferences and sex imbalances in Korea. Methods: A total of 453 married women aged 20 or older were randomly selected from four urban districts and five rural districts out of 25 districts in Gyeongju, a consolidated city located in Gyeongsangbuk-do Province, South Korea. The survey was conducted from December 2005 to February 2006. A total of 392 out of 453 questionnaires(86.5% response rate) were collected, and 44 incomplete questionnaires were excluded, leaving 348 completed questionnaires to be used for data analysis. Age was divided into three groups as below 49, 50-69, 70 or older. Results: Women's perceptions of marriage were associated with age(p<0.01). Perceptions about childbirth were also significantly related to age(p<0.01), type of residential area (p<0.01) and education level(p<0.05). Sex preferences were significantly related to age(p<0.05) and occupation(p<0.01). Of the respondents aged 49 or younger, 34.8% indicated that the ideal number of children is two, while 25.5% of respondents aged 50 to 69 and 15.3% of respondents aged 70 and 33.7% of respondents aged 70 or older considered four children to be the ideal number. Perceptions of sex imbalance were significantly related to socioeconomic status(p<0.01) and occupation(p<0.01). The largest number of respondents cited "economic burden" as the main reason for low birth rates. Multiple logistic regressions were performed for all three age groups using male sex preference as the dependent variable under the assumption that respondents can have only a single child. Socioeconomic status (p<0.01) and residential area (p<0.05) were significant variables for those aged 49 or below. Education level(p<0.05) and residential area (p<0.01) were statistically significant variables on preferring son in case of having only one child for respondents aged 50 to 69. We did not detect any significant independent variables in respondents who were 70 or older. Conclusions: Our results highlight the necessity of developing policies and public education programs to explain the consequences of low birth rates and sex imbalances in Korea. As increasing numbers of women work outside the home, it is important for the government and employers to provide social and working environments where women do not consider marriage and childbirth to be obstacles to social and business activities.