• Tuberculosis and Respiratory Diseases
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• v.56 no.5
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• pp.485-494
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• 2004

Background : To assess the effects of mDOT implementation on sputum smear conversion for AFB (Acid fast bacilli) positive pulmonary tuberculosis patients, modified Directly Observed Treatment (mDOT) was started on October $8^{th}$ 2001 at a health center in Seoul. mDOT was defined through weekly interviewing and supervising of a patient by a supervisor (doctor, nurse, or lay health worker). The sputum smear conversion of a mDOT group was compared with that of a self-medication (self) group. Methods : This study included 52 AFB positive pulmonary tuberculosis patients registered at a health center in Seoul between October $8^{th}$ 2001 and April $23^{rd}$ 2002. 24 and 28 patients were enrolled in the mDOT and self medication groups, respectively. Paired (1:1) individual matching, by gender, extent of disease, relapse and age-matching variables, was performed between the two groups, resulting in 20 paired matches. This prospective study was planned as an unblinded, non-randomized quasiexperimental pilot project. Outcomes were identified from results of sputum smear examinations for AFB in both groups at 2 weeks, and 1 and 2 months. The paired matching data were analyzed using the SAS program version 8.1 by McNemar test. Results : At the end of 2 weeks of treatment, the sputum smear conversion of the mDOT group was somewhat higher than that of the self medication group (78.57 vs. 50%, p-value=0.289), and after 1 month of treatment no statistically significant difference was shown between the two groups (83.33 vs. 50, p-value=0.125). At the end of 2 months of treatment (initial intensive phase), the sputum smear conversions of the mDOT and self groups were 95 and 75%, respectively (p-value=0.219). Conclusions : The implementation of mDOT did not result in clinically significant increases in the sputum smear conversion at 2 weeks, and 1 and 2 months compared with that of the self medication group. However, the increases experienced might contribute to diminishing the infectious period of AFB positive patients, and this approach may act as a guide for a specific group of patients. In this study, mDOT was performed for one hundred percent of the intensive treatment phase. It can also be an effective treatment for pulmonary tuberculosis patients, and may be useful for some high risk tuberculosis patients.

• Journal of Hospice and Palliative Care
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• v.2 no.2
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• pp.114-124
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• 1999

Purpose : To clarify the relation between psychosocial variables and cancer in Korea. Methods : Case-control study. Participants: 239 subjects in 2 university hospitals in Seoul completed a series of psychometric instruments(the Olson's FACES III and the Lee's 98-items life event scale). Results : In bivariable analysis, there were statistically significant difference in age and economic status(income): marginal significance in education status and marital status between the cases and controls. The family function type and stress score were not significantly different. The result of multivariable logistic regression, analysis showed that the risk of cancer was associated with economic status and marital status, but neither the family function nor the life event stress. Conclusion : In this study, we cannot prove the statistical association between the family function, life event stress and cancer. It is necessary to persevere in our efforts to clarify the relation between stress and disease and to develop the useful tools to measure the Korean family function and life event stress.

• Pediatric Infection and Vaccine
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• v.12 no.2
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• pp.186-194
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• 2005

Purpose : Hepatitis A viral infections have been continued after re-emerging since mid 1990s in Korea. The incidence of this disease has been increased in young adults younger than 30 years of age since 2000. This study was performed to evaluate the prevalence of antibody to hepatitis A in Korea(two regions; Incheon and Changwon) in 2005, and was compared with the results of similar studies in mid 1990s. Methods : The study was conducted from January 2005 to June 2005, and consisted of 1,301 enrolled subjects, neonates to 50 years old, living in Incheon and Changwon in Korea. All sera were frozen and stored at $-70^{\circ}C$ until assayed. Anti-HAV IgG antibodies were measured by microparticle enzyme immunoassay(HAVAB, Abbott Lab., IL, USA). Results : The prevalence of anti-HAV IgG was 61.1% in infants younger than 1 year old, 30.5% in 1~5 years, 14.6% in 6~10 years, 1.7% in 11~15 years, 6.5% in 16~20 years, 36.6%in 21~30 years, 77.5% in 31~40 years, and 99.8% in 41~50 years. Statistical differences were not found between male and female, but there was statistical difference in 6~10 years old age group between the two areas. Conclusion : Our study indicate that the prevalence of antihepatitis A virus antibody has shifted from children to old adolescents and young adults. This result suggests that the risk of sudden outbreaks or increasing incidence of hepatitis A viral infections in young adults may be expected in our society. The preventive strategies of hepatitis A including vaccination should be prepared.

• Clinical and Experimental Pediatrics
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• v.51 no.7
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• pp.671-689
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• 2008

The economic recession of North Korea has been prolonged, the need for humanitarian assistance for the women and children of DPRK has been raised. In March 2006, South Korean government signed MOU with World Health Organization (WHO) to financially support "Improving Women's and Children's Health in DPRK (IWCH)" project. The assistance projects through UNICEF and the non-government organizations of South Korea were also followed. IWCH project consists of three parts; nutrition, disease management, children and maternity care. The first term (2006-2007) of the project leading by WHO was finished, and the second term (2008-2010) is just begun. The projects driven by NGOs have relatively been delayed due to difficulties in negotiating on project contents and places with North Korea. Recently, however, re-modeling processes of an obstetric/gynecology hospital and a children hospital in Nampo were started. Up to recently, South Korean government has played only a limited role in the humanitarian assistance for North Korea. IWCH project is, however, a full-scale initiative driven by government based on a systematic review of need and priorities. A significant amount of budget and relatively long term (five year) project compare to the previous short term and small size programs were expected to make more meaningful achievement. Despite these positive aspects, the project remains a list of unsolved problems a lack of mutual trust, a different decision making process between South and North Korea, a lack of conflict management process, and unpredictability and complexity of international politics. In spite of such kind of political uncertainty, the health care sector will be a leading area in the process of improving relationship between South and North Korea, particularly, humanitarian assistance for women and children will play a crucial role in the process. The successful implementation of IWCH project, therefore, will contribute to provide the reference model in developing the mutually constructive relationship between South and North

• Journal of Chest Surgery
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• v.42 no.1
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• pp.63-71
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• 2009

Background: The treatment of tracheal stenosis includes less invasive bronchoscopic intervention and more invasive segmental resection & anastomosis. Depending on the patient's clinical features, sometimes all these methods are inappropriate. Silicone T-tube stenting has recently been used as an alternative, safe management of tracheal stenosis. We studied the short term and Intermediate term results of using T-tubes in patients with tracheal stenosis, and this tracheal stenosis was caused by various underlying diseases. Material and Method: We retrospectively reviewed 57 patients with tracheal stenosis and who were treated with T-tubes between Jan 1997 and Apr 2007. Based on the patient's medical records and the imaging studies, we evaluated the clinical findings and status of T-tube removal. Result: There was no T-tube related morbidity or mortality in this series. On follow-up, one patient underwent sleeve resection and end-to-end anastomosis. The T-tube could be successfully removed from 13 patients (13/57, 22.8%) without additional interventions. For another four patients, a T-tube was again inserted after removal of the first T-tube due to tracheomalacia or recurrent stenosis. Four patients died of underlying disease and cancer. The patients' gender and previous tracheostomy significantly affected T-tube removal. By contrast, multiple logistic regression analysis identified gender as a predictor of successfully removing a T-tube. Gender (p=0.033) and previous tracheostomy (p=0.036) were the two factors for success or failure of T-tube removal. Conclusion: A T-tube provided reliable patency of a stenotic airway that was caused by any etiology. We have proven that using a T-tube is safe and effective therapy for patients with tracheal stenosis for the short term or the intermediate term.

• Journal of Hospice and Palliative Care
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• v.4 no.2
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• pp.122-129
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• 2001

Purpose : After Acquired Immunodeficiency Syndrome (AIDS) is known to be a fatal disease, efforts and studies are made to determine the cause, treatment method and method of preventing infection. However, no treatment method is present and vaccine development has not been made. Therefore, the most effective treatment method is prevention, and almost 100% prevention is possible when correct preventive measures are taken. We suggest effective prevention education by comparing knowledge and attitude of those unmarried men who had sexual encounters with prostitutes (high risk group) and those with no sexual encounters with prostitutes (low risk group). Methods : From January 1, 2000 to June 30, 2000, a survey was done in 516 unmarried soldiers and college students. With the collected data, chi-square test was used to compare and analyze the demographic characteristic, knowledge on AIDS, and attitude on AIDS between the high risk group and low risk group. One-way ANOVA test was used to compare and analyze the scores on knowledge between these two groups. Results : Among 516 unmarried men, 256 men (49.6%) fell into the high risk group and 260 men (50.4%) into the low risk group. Both groups showed that they heard of AIDS during their middle school years. The main route of obtaining knowledge on AIDS was through TV programs with 124 men(48.4%) in the high risk group and 167 men (64.2%) in the low risk group (P=0.002). Among 20 items, the average score on knowledge was $13.9{\pm}1.9$ in the high risk group and $14.1{\pm}1.8$ in the low risk group with no statistical difference between these two groups (P=0.191). Two items showed statistical significance in the low risk group compared with the high risk group; these were the item of AIDS being transmitted through transfusion (P=0.014) and through mosquitoes (P=0.009). As for attitude, statistical significance was present in the item stating that AIDS patients should be isolated in the high risk group compared with the low risk group (P=0.029). Conclusions : The present study showed that both the high risk group and low risk group obtained knowledge on AIDS through TV. No statistical difference was present between the two groups other than the high risk group showed statistically high results in two items on knowledge and one item on attitude. Thus, these results showed that exposure to AIDS can be lowered with better knowledge and the attitude of those with a low risk of infection was more positive.

• Clinical and Experimental Pediatrics
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• v.48 no.9
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• pp.991-997
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• 2005

Purpose : Cow's milk protein-induced enterocolitis(CMPIE) is a symptom complex of vomiting and/or diarrhea caused by delayed hypersensitivity and may result in serious complications. This study was undertaken to identify high risk factors to facilitate the early recognition of CMPIE. Methods : We reviewed the data of 101 patients, aged 15 to 45 days, admitted due to vomiting and/or diarrhea between 2003 and 2004. After excluding 13 patients absolutely breast-fed and 2 patients transferred from other hospitals with the impression of CMPIE, the 86 study subjects were divided into three groups based on the underlying etiologies; CMPIE, infectious and non-infectious group. Results : CMPIE was diagnosed in 11 patients(12.8%). On admission, failure to gain weight(P=0.003), hypoalbuminemia(P=0.003), peripheral leukocytosis(P=0.015), and metabolic acidosis(P=0.014) were more significant in the CMPIE group than in the others. Multiple logistic regression analysis showed that the independent predictors of high risks for CMPIE were failure to gain weight <10 g/day(OR, 10.25[95% CI, 1.62-65.06]) and serum hypoalbuminemia <3.5 g/dL(OR, 9.18[95% CI, 1.69-49.74]). Cow's milk challenges were performed in the 11 CMPIE patients; vomiting(81.8%), abnormal stool test(80.0%), peripheral leukocyte count and absolute neutrophil count(ANC) increase(100.0%) (P<0.05), and enteropathy(100.0%). Conclusion : CMPIE is not a rare clinical disease in early infancy. The high risk factors of CMPIE were identified as follow : failure to gain weight below 10 g/day, hypoalbuminemia on admission and a rapid decrease during admission. Cow's milk challenge test with endoscopic duodenal biopsy was helpful to confirm CMPIE.

• Clinical and Experimental Pediatrics
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• v.49 no.11
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• pp.1186-1193
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• 2006

Purpose : Enterovirus infection is a type of viral infection that occurs relatively frequently in children during summer. It has clinical symptoms of non-specific fever, aseptic encephalomeningitis, gastrointestinal diseases, skin rash and, hand-foot-mouth disease. However, it can also occcaisionally, result in fatal symptoms like myocarditis, epicardial inflammation, transverse myelitis, quadriplegia and etc. There have been epidemic enterovirus studies, but not in the Chungnam area. Therefore, we undertook this study in order to comprehend the cause viruses in this area. Methods: We enlisted 157 children hospitalized with enteroviral infections at Soonchunhyang University hospital in Cheonan between May and August 2005. Cerebrospinal fluids or feces were collected during the acute phase after hospitalization, and observed the cytopathic effects caused by enterovirus and using reverse transcription polymerase chain reaction (RT-PCR). Results : The number of children hospitalized due to possible enteroviral infection during the period of study was 157. The number of children who tested positive with the reverse transcription polymerase chain reaction totalled 32 cases (20.4 percent). Among the children with entroviral diseases, 20 were male and 12 were female, thus the sex ratio of male to female was 1.67:1. Their clinical symptoms included fever most frequently (93.7 percent), was followed by headaches (90.0 percent), meningeal irritation signs (65.0 percent), and abdominal pain (30.0 percent). As for the type of isolated enterovirus, there were 17 cases of echovirus 18 and 6 cases of coxsackievirus B5. Furthermore, there were 2 cases of echovirus 9, 1 case of coxsackievirus A6 and coxsackievirus B3, respectively. But 5 cases were not determined by genotype. Conclusion : Echovirus 18 is circulating in Korea. We reported on identified enteroviruses, including echovirus 18, using RT-PCR in the Chungnam area during the summer of 2005.

• Tuberculosis and Respiratory Diseases
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• v.57 no.2
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• pp.168-179
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• 2004

Background : The statistical analysis is an essential procedure ensuring that the results of researches are based on evidences rather than opinion. The purpose of this study is to evaluate which statistical techniques are used and whether these statistical methods are used appropriately or not in the journal of Tuberculosis and Respiratory Diseases. Materials and Methods : We reviewed 185 articles reported in the journal of Tuberculosis and Respiratory Diseases in 1999. We evaluated the validity of used statistical methods based upon the checklist that was developed on the basis of the guideline for statistical reporting in articles for medical journals by International Committee of Medical Journal Editors. Results : Among 185 articles, original articles and case reports were 110 (59.5%) and 61 (33.0%) respectively. In 112 articles excluding case reports and reviews, statistical techniques were used in 107 articles (95.5%). In 94 articles (83.9%) descriptive and inferential methods were used, while in 13 (11.6%) articles only descriptive methods were used. With the types of inferential statistical techniques, comparison of means was most commonly used (64/94, 68.1%), followed by contingency table (43/94, 45.7%) and correlation or regression (18/94, 19.1%). Among the articles in which descriptive methods were used, 83.2% (89/107) showed inappropriate central tendency and dispersion. In the articles in which inferential methods were used, improper methods were applied in 88.8% (79/89) and the most frequent misuse of statistical methods was inappropriate use of parametric methods (35/89, 39.3%). Only 14 articles (13.1%) were satisfactory in utilization of statistical methodology. Conclusion : Most of the statistical errors found in the journal were misuses of statistical methods related to basic statistics. This study suggests that researchers should be more careful when they describe and apply statistical methods and more extensive statistical refereeing system would be needed.

• Tuberculosis and Respiratory Diseases
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• v.60 no.2
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• pp.228-234
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• 2006

Background : Acinetobacter baumannii is an important pathogen associated with nosocomial infections in intensive care units, and is responsible for nosocomial pneumonia, UTI, bacteremia, etc. The main concern is that this pathogen is often resistant to many antimicrobial agents, particularly to carbapenem. This study compared the clinical those of ICU admitted patients with the carbapenem resistant A. baumannii isolated from the sputum with characteristics of patients with carbapenem sensitive A. baumannii. Methods : A total of 49 patients with A. baumannii from a sputum culture who were admitted to the ICU from January to December 2003 were enrolled in this study. This study evaluated the demographic variables, mortality, APACHE II score, comorbidity, antibiotics used, hospital and ICU stay, Clinical Pulmonary Infection Score, and mechanical ventilation. A retrospective analysis was made by a review of the patients' medical records. Results : Carbapenem sensitive and resistant A. baumannii was isolated from 23 patients and 26 patients respectively. Univariate analysis revealed renal disease, the use of carbapenem and aminoglycoside to be statistically significant factors for carbapenem resistance. Multivariate analysis revealed carbapenem use(p=0.024; OR, 8.17; CI 1.32 to 50.68) to be positively associated with carbapenem resistance, and aminoglycoside use(p=0.026; OR, 0.18; CI, 0.04 to 0.82) to be negatively associated with carbapenem resistance. There was no significant difference in mortality between the carbapenem sensitive and resistant group(30 vs 42%. P=0.39). Conclusion : The occurrence of carbapenem resistant A. baumannii is positively associated with carbapenem use and negatively associated with aminoglycoside use. Carbapenem resistance in the sputum culture did not affect the mortality rate.