• Journal of Korean Academic Society of Home Health Care Nursing
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• v.3
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• pp.53-66
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• 1996

Home Health Care is one part of the total health care system. It includes health care services that link the hospital to the community. While it is important for early discharge patients, home care is also important for people with chronic illnesses or handicapping conditions. In 1989 the Korean government passed a law that opened the way for formal development of home health care services beginning with education programs to certify nurses for home care, and then demonstration home care services. Part of the mandate of the demonstration projects was evaluation of home care services. This study was done in order to provide basic data that would contribute to the development of records that could be used for evaluation through a retrospective audit and to examine the care that had been given in Home Care at Wonju Christian Hospital over a twenty year period from 1974 to 1994. The purposes of the study were : to identify to characteristics of the clients who had received home care, to identify the reasons for client referrals, to identify the nursing problems of these clients, to identify the nursing care provided to these clients, and to identify differences in these areas over the twenty year period. The study was a descriptive study involving a retrospective audit of the client records. Demographic data on all clients were included : 4,171 clients from 2,564 families. Data on referrals, nursing diagnosis and nursing interventions were from even numbered records which had a patient problem list included in the record, 2,801 clients, Frequencies and ANOVA were used in the analysis. The results of the study showed that the majority of the clients were from Wonju city /county. There were more women than men related to the high number of postpartum clients(1,300). The high number of postparttum clients and newborns was also evident in the age distribution. An the number of maternal-child clients decreased over the 20 years, the mean age of the clients increased significantly. Other factors also contributed to this change ; as increasing number of clients with brain injuries or with cancer, and fewer children with burns, osteomyelitis and tuberculosis. There was a decrease in the mean number of visits and mean length of coverage, reflecting a movement towards a short term acute care model. The number of new clents dropped sharply after 1985. The reasons for this are : the development of other treatment alternatives for clients, the establishment of an active wellbaby clinic, many more options plus a decreasing number of new cases of Hansen's Disase, and insurance that allows people with burns to be kept in hospital until skin grafts are healed. Socioeconomic changes have resulted in an increase in the number of cases of cancer, stroke, head injuries following car accidents, and of diabetes. Of the 2,801 client records, 2,541(60.9%) contained a written referral but for 1,802 it contained only the medical diagnosis. The number of records with a referral requesting specific nursing care was 739(29.1%). Many family members who were identified as in need of nursing care had no written referral. Analysis of the patient problem list showed that 41.9% of the enteries were nursing diagnoses. Others incuded medical diagnosis, symptoms, and plans. The most frequently used diagnoses were alteration in nutrition, less than body requirements(115 entries), alteration in skin integrity(114), knowledge deficit(111), pain(78), self-care deficit(66), and alteration in pattern of urinary elimination(50). These are reflected in the NANDA categories for which the highest number of diagnosis was in the Exchanging pattern(446), followed by Moving(178), Feeling(136) and Knowing (115). Analysis of the frequency of interventions showed that exercise and teaching about exercise was the most frequent intervention, followed by teaching concering the need for follow-up care, checking vital signs, managing nutritional problems, managing catheters, giving emotional support, changing dressings, teaching about medication, teaching (subject not specified), teaching about diet, IM and IV medications or fluid, and skin care, in that order. Recommendations included: development of a record that would allow for efficient recording of frequently used nursing diagnoses and nursing interventions: expansion of the catchment area for Home Care at Wonju Christian Hospital ; expansion of the service to provide complication prevention, rehabilitation services, and support to increase the health maintenance /health promotion of the people being served as well as providing client dentered care ; and development of a clinical record that will allow efficient data collection from records, even though the recording is done by a variety of health care providers.

• Child Health Nursing Research
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• v.4 no.2
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• pp.159-176
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• 1998

In effort to conduct comparative study on the caregiving environment of Neonatal Intensive Care Unit(NICU) in both U. S and Korea, this study was been conducted first in the U.S. Purpose : The purpose of this study is to identify the physical environment and direct caregiving practices to lowbirth weight infants in NICU in the US. It also aims to examine the NICU outcome status and behavioral reponses of lowbirth weight infants. Methods : A study design using descriptive and inferential statistics was been conducted through an observational, field method. A sample of 15 preform infants admitted to NICU were recruited for the study. The subjects were those with birth weight between 1,000 gm to 1,500 gm, born at the gestation period of 27 to 33 weeks, and without any chromosomal or other genetic anomalies, major congenital infections, or maternal illness. Thirty minutes observation(three times of ten minutes of continuous observation)of the infant's behavior and physiological status, and an four-hour observation of the physical environment and direct care giving procedures were been conducted on the 3rd and 10th day after birth, and on the day of discharge from the NICU or at 34weeks postconception. The data to be collected were in four areas : the demograghic characteristics of the infants, the physical environment and care giving procedures, the frequency of the infant's designated behavior and physiological response, and NICU outcome variables. A descriptive analysis and Kruskal-Wallis, Pearson r were been applied according to variable characteristics. Results : 1. Mother's mean age was 29.47. The sample consisted of 6 males and 9 females. Mean gestational ages were 29.17 weeks. Mean birth weight was 1236.33g. Mean Apgar scores at one minute were 6.6, and 7.8 at five minutes. 2. The location for the incubator was in the distance from the light, X-ray screens and nursing station, in proximity to side-lamp, telephone and faucet on the third day after birth. The location for the incubator was in the distance from the light and radio on the tenth day and in proximity to nursing station on the day of dischage from the NICU or at 34weeks postconception. 3. Nesting was the most applying aids to the infants. And foot roll, shielding and plastic frame were frequently using by nurses for facilitating well modulated restful posture. 4. There were statistically significant changes in the patterns of physical environment included locating the infant's incubator and bedding, specific aids to self regulation on the 3rd and 10th day after birth, and on the day of discharge from the NICU or at 34weeks postconception. 5. Statistically significant changes were not appeared in the patterns of direct caregiving procedure to the infants included stress inducing or reducing manipulations on the 3rd and 10th day after birth, and on the day of discharge from the NICU or at 34weeks postconception. 6. The stress response of the infants in NICU were significantly reduced as the infants grow older. 7. There were not statistically significant correlation between the physical envronment and the stress responses of the infants in NICU. 8. There were statistically significant correlation between the direct caregiving procedure to the infants and the stress response of the infants in NICU in the second and third observation on the day three. 9. Average weight gain per day from birth to discharge was 38.73g, number of days in the hospital was 42.60, number of days before bottle feeding was 3.6. Postconception age starting bottle feed ing was 31/sup +5/ weeks. Number of days on mechanical ventilator was average 7.64, 11.42 was an average number of days of oxygen need. Conclusion : It, thus, appears that to minimize the sensorymotor stimulation for the low birthweight preterm infant in NICU, manipulation of care giving practices to the babies whatever the stress inducing or reducing procedures, have to be limited in the immediate early stage after birth. And it needed to be reexamine to identify the appropriate and specific physical environment and the patterns of direct caregiving to the low birthweight preform infant as the infants grow older in NICU.

• Clinical and Experimental Pediatrics
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• v.51 no.11
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• pp.1165-1171
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• 2008

Purpose : This study aimed to identify the true extent of non-responsiveness in full-term infants born from HBsAg-negative or HBsAg-positive mothers and vaccinated against hepatitis B virus (HBV) at 0, 1, and 6 months of age and to evaluate the effect of revaccination among non-responders. Methods : The study included 716 full-term infants born in 2004-2007. Of 716, 662 infants (A group) were born to HBsAg-negative mothers and 54 infants (B group: 50, except HBsAg-positive infants) were born to HBsAg-positive mothers. All infants were administered DNA recombinant vaccines at 0, 1, and 6 months of age. B group infants received hepatitis B immunoglobulin at birth. Anti-HBs titers were tested at 7-12 and 9-15 months in A and B groups, respectively. Three revaccination doses were administered to non-responders whose anti-HBs titers were under 10 mIU/ml; revaccinated infants were retested at 1-3 months after last vaccination. The association between HBeAg seropositivity of mother and the failure of HBV immunoprophylaxis was evaluated. Results : The seroconversion rates after primary hepatitis B vaccination were higher in A group (94.1%) than in B group (78%, P<0.001). The seroconversion rates were high in revaccinated infants (A group non-responders: 96.9%, B group non-responders: 87.5%). The failure of HBV immunoprophylaxis was significantly associated with maternal HBeAg seropositivity (P<0.001). Conclusion : The seroconversion rates after primary hepatitis B vaccination were low in B group infants. Revaccination of non-responders in B group was very effective. Therefore, anti-HBs testing and revaccination of B group is very important. Revaccination of non-responders in A group was also very effective. Thus, testing the immune status of infants born to HBsAg-negative mothers even after primary hepatitis B vaccination should be considered. However, to realize this, further studies on the cost-effectiveness of anti-HBs testing in healthy full-term infants are necessary.

• Journal of Preventive Medicine and Public Health
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• v.1 no.1
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• pp.25-36
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• 1968

Introduction In order to improve medical education through the introduction of a concept of comprehensive health care of a community, an area surrounding the University Campus was chosen for the Community Health Service Project. It has been on operation for last 4 years with its major emphasis on family planning services, and maternal and child health care. The major objectives of this survey at the area are to obtain: 1) The demographic data, 2) The health need and trend of medical care, 3) The attitude and practice in maternity care to be used for further improvement of the planning and the services of the project. Population and Survey Method Out of three Dongs of the Community Health Service Area, only two Dongs namely Changchun and Yonhee were selected for the survey. Total number of households and population in the area studied was 3,683 and 21,857 respectively. An interview was performed with questionnaire schedule which was recorded by interviewers. This includes the degree of utilization of health services provided by the Community Health Service Program such as family planning, prenatal care during their last pregnancy, delivery history and complications of the delivery as well as the incidence of illnesses in general. Prior to the interview, all interviewers were trained for interviewing technique for two days. The survey was carried out during the period from October December 1967. Results 1) Demographic Data : 41.3% of the population studied were children under age 15 and only 3.5% were over 60 years of age. Crude birth rate and crude death rate of this area studied during the period of November 1966-October 1967 were 20.5 and 7.7 respectively. Infant mortality rate during the same period was 35.9. 50.4% of the 2,832 households fell into the category of middle class, 39.8% to the lower class and 9.5% to the upper class in economic condition. 19.8% of 2,832 householders had no formal education, 22.7% primary school, and 57.5% middle or higher school education. 2) Health Status and Utilization of the Community Health Service: Those who suffered from many illnesses during the month of October, 1967 were 690(4.6% of 14,891 persons). Classification of these patients into the type of disease shown respiratory diseases 27.4%, gastrointestinal diseases 18.1%, tuberculosis 10.9%, skin and genitourethral diseases 4.5% and gynecologic patients 4.5%. Only 55.9% of the patients received medical care at hospital or doctor's clinic. But among TB and gynecologic patients, 70.7% and 72.4% were treated at medical facilities. 10.6% of 2,832 householders interviewed has ever utilized the Community Health Service Program provided by the Yonsei Medical School, Classifying these clients into the type of service, 35.9% utilized the wellbaby clinic, 31.0% the family planning clinic, 14.7% the home delivery care, and the rest utilized other services such as the premarital guidance cinlic and the sanitary inspection service. 3) Maternity Care: 23.6% of 2,151 deliveries were done at medical facilities such as hospital, private clinic, while 76.4% were done at home. Acceptance rate of prenatal care was 32.6% as whole, but 49.6 of 774 women who had the prenatal care service had their deliveries at medical facility. 45.1% of total deliveries were attended by medical and or paramedical personnel. 75.8% of the deliveries of those received prenatal care were attended by medical and or paramedical personnel while only 27.8% of the deliveries of those who did not have prenatal care attended by medical and or paramedical personnel. 49.8% of deliveries of the upper class, 29.8% of the middle class and 9.9% of the lower class were attended by medical and or paramedical personnel. 6.2, 3.3% and 24.8% of mothers reported about their xeperience of edema, coma and fever during the period of trimester of pregnancy and puerperium. 4) Family Planning: The rate of practice of family planning was 27.9%. 31.7% of them were by IUD, 2.9% by oral pill, 15.2% by sterilization and the rest by traditional methods. Those women who had 3 to 4 children had highest(30.2%). Practice rate among the various methods of family planning, oral pill was the most popular method to whom had 2 or less children. In relation between the practicing rate of family planning and living standard, the upper, middle and lower class practiced 37.5, 29.4 and 19.9% respectively.

• Journal of Preventive Medicine and Public Health
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• v.22 no.1 s.25
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• pp.125-135
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• 1989

This paper was carried out to study on correlation between mentally retardation and lead and zinc. The subjects were 297 mentally retarded children: 132 of Bomyung special school and Sunmyung, which were located in Taegu city of Korea. The former had their parents but the latter had not. The control group 63 children were randomly seleted from the Dong-in primary school near to Medical School of Kyungpook National University. Atomic absorption spectrophotometer, model IL-551 connected with CTF atomizer(IL. 655) was used for the analysis of lead and zinc. The mean value of lead in hair of mentally retarded children was $14.97{\pm}3.71ppm$ which is significantly higher than that of control group, $11.36{\pm}2.83ppm$. But the content of zinc was not significant in both groups. In the lead there was no significant correlation to age but significant negative correlation to IQ. Zinc showed significant correlation to age but not to IQ. Among the handicapped children, no signigicant correlation between orphan group and non orphan group. Handicaps of mentally-retarded children were speech impairment, emotional disturbance, double and triple handicaps, sensory impairment and abnormal dietary patterns. There were significantly higher contents of lead compared with normal group, except the latter two groups. The disease conditions of mentally retarded children were mongolism, autism, cerebral palsy, epilepsy and microcephaly. In comparing with mongolism, significant difference were existent only on the cerebral palsy and group of unknown etiology. We attempted to divide their past history into external etiology and internal etiology, but could not find significant difference. In view of the whole results, the relationship between mentally-retarded children and lead was presumed to be the early time exposure rather than long interval exposure during growth and the contact opportunity was considered important subject in maternal and child health care.

• Clinical and Experimental Pediatrics
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• v.50 no.8
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• pp.740-745
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• 2007

Purpose : There is a dominant opinion that in vitro fertilization (IVF) leads to an increased incidence of twins, low birth weight (LBW) infants, prematurity and mortality. On the other hand, technical development of IVF and improvement of neonatal intensive care have increased the survival rate of neonates. The purpose of this study was to verify the tendency by comparing the clinical aspects of IVF and spontaneously conceived twins, and to establish methods to increase the survival rate of neonates after IVF. Methods : Retrospective reviews were performed on all twin infants who were admitted to the nursery and NICU at Kangnam Sacred Heart Hospital, Hallym University from January 1, 2000 to December 31, 2006. Medical records of IVF twins (study group, n=92) and spontaneously conceived twins (control group, n=265) were analyzed and compared. Neonatal outcomes and complications, as well as obstetric outcomes, were analyzed and compared. Results : Mean gestational age and birth weight of the study group ($34.6{\pm}3.5$ weeks, $2,203.9{\pm}617.2g$) were considerably lower than those of the control group ($36.3{\pm}2.4$ weeks, $2,367.0{\pm}517.9g$). The frequency of prematurity less than 37 weeks (68.5% vs 51.3%) and extremely LBW (15.2% vs 6.4%) were also significantly higher in the study group. Other neonatal outcomes were all insignificant. The obstetric characteristics, maternal age ($32.6{\pm}3.3$ years vs $30.3{\pm}3.9$ years) and the frequency of cesarean delivery(95.7% vs 79.9%) were significantly higher in the study group. Other obstetric outcomes were insignificant except for the frequency of incompetent internal os of cervix (36.2% vs 3.6%) and cerclage operation (38.3% vs 4.3%). Conclusion : Based on the above results, clinical outcomes of twin infants will be further improved by careful attention and thorough antenatal care of the IVF twins.

• Korean Journal of Community Nutrition
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• v.13 no.4
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• pp.555-564
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• 2008

Essential fatty acids are important essential nutrients during pregnancy. The objective of this study was to compare fatty acid composition of serum phospholipids and essential fatty acid intakes between Korean pregnant women with a single baby and Korean pregnant women with twins. A total of 116 pregnant women who had maintained their health without any symptoms of pregnancy complications participated in the study. The subjects consisted of 57 women of singleton pregnancy and 58 women of twin pregnancy at the 1st, 2nd, or 3rd trimester of pregnancy. A 24-hour dietary recall was administered to each subject to obtain dietary information. The mean ages of the singleton pregnancy group and the twin pregnancy group were 31.44 years and 32.27 years, respectively, and the mean height values were 161.86 cm and 160.64 cm, respectively. The mean daily energy intakes in the singleton pregnancy group were 1639.95 kcal, 1904.71 kcal, and 1882.82 kcal for the 1st, 2nd, and 3rd trimester group, respectively. The mean daily energy intakes in the twin pregnancy group were 1745.99 kcal, 2203.46 kcal, and 2092.26 kcal for the 1st, 2nd, and 3rd trimester group, respectively. There were no significant differences in the mean fatty acid intakes by the type of pregnancy (i.e., singleton vs. twins) and the stage of pregnancy (i.e., 1st vs. 2nd vs. 3rd trimester). However, the mean total fatty acid intake of those at the 1st trimester among the singleton pregnancy group tended to be higher than that of those at the 1st trimester among the twin pregnancy group. Such a trend seemed to be retro-versed. That is, the mean total fatty acid intakes of the twin pregnancy group were higher compared to the singleton pregnancy group for the 2nd and 3rd trimester group. The LA and total n6 concentrations of serum phospholipids of the singleton pregnancy group were significantly higher as the gestational age increased(p<0.05). The $\alpha-LNA$(p<0.05), EPA(p<0.05), and total n3(p<0.001) concentrations of serum phospholipids of the twin pregnancy group were significantly lower as the gestational age increased. The $\alpha-LNA$ concentrations of serum phospholipids in the singleton pregnancy group at the 3rd trimester were significantly higher than that in the twin pregnancy group at the same trimester(p<0.05). The serum phospholipids levels of AA and DHA of the twin pregnancy group were generally higher compared to those of the singleton pregnancy group. Particularly the differences reached at the level of statistical significance for those at the 1st trimester(p<0.01). It is concluded that the study findings imply that fatty acid metabolism may meaningfully differ by the type and stage of pregnancy. Future research needs to be conducted to more elucidate grounding etiology and possible roles of dietary fatty acid intake levels in relation to the study findings.

• Journal of Preventive Medicine and Public Health
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• v.28 no.4 s.51
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• pp.845-862
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• 1995

We followed prospectively some hospital-delivered mothers to identify characteristics of those not initiated breast-feeding and predictors of breast-feeding discontinuation in monthly telephone interviews. Recruits were composed of 482 mothers who delivered their babies at one university hospital and one OB/GYN clinic in September to November 1991. Breast-feeding discontinuation was defined as switch to 100% formula lasting more than one week regardless of solid foods. Average age of the study subjects was 27.3 years of age(standard deviation 3.2). Multiple logistic regression analysis indicated native place, occupation, method of delivery and method of feeding considered to be better for maternal health were statistically significant(p<0.1) between initiators and non-initiators of breast feeding. In starting cohort(N=242) of those initiated breast-feeding, that median of breast-feeding discontinuation were 5 months and 25th and 75th percentiles were 3 and 9 months respectively. In Cox's proportional hazard model, mothers with $10\sim13$ years of education were 2.63 times (95% confidence interval, CI $1.50\sim4.60$) more likely to discontinue than those with less than 9 years of education and those with more than 13 years of education were 3.55 time (95% CI $1.99\sim6.33$). Compared with house wife, mothers with part-time jobs were 1.99 times (95% CI $0.86\sim4.57$) more likely to discontinue and those with employed full-time were 1.55 times (95% CI $0.96\sim2.51$). These results suggest that the predictors of initiation and discontinuation of breast-feeding may be different and different target populations should be selected to promote initiation and to prevent discontinuation of breast-feeding according to the period after birth.

• Childhood Kidney Diseases
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• v.9 no.1
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• pp.8-14
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• 2005

Purpose : This study was peformed to study normative blood pressure data in full-term neonates that may be used to facilitate Identification of neonatal hypertension.Methods : 383 newborns born in our hospital from May 2003 to January 2004 were enrolled in this study Using an oscillometric device(BP-88 NEXT, COLIN Corp.), their blood pressures were measured more than one time within a week after birth. According to each clinical variable such as sex, delivery mode, birth weight, gestational age and presence of maternal disease or perinatal problems, we divided the population into groups and calculated the mean blood pressures of each group. We compared mean blood pressures between the divided groups according to each clinical variable statistically.Results : Mean systolic and diastolic blood pressure of the Population was 70.8$\pm$ 10.9 mmHg and 43.4 $\pm$ 8.0 mmHg, respectively. There was no satistically significant difference in blood pressure according to clinical variables. Mean systolic pressure showed positive correlation with birth weight and gestational age(r=0.1420, 0.03130).Conclusion : Our results are almost in agreement with Zubrow's data from 695 newborns in U.S.A, 1995. Our data may be helpful for early detection and management of neonatal hypertension, thereby maintaining renal function ,and preventing possible complications of renal disease.

• Childhood Kidney Diseases
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• v.9 no.1
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• pp.31-37
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• 2005

Puruose : Thin glomerular basement membrane disease(TGBMD) is found in patients with family history of hematuria. TGBMD is autosomal dominant and is known to be one of the commonest causes of asymptomatic hematuria. This study was conducted to evaluate the histological and clinical features of patients with TGBMD. Methods : 150 cases diagnosed with TGBMD by renal biopsy while admitted in the department of pediatrics, Kyungpook National University Hospital between January 1999 and December 2003 comprised the study group. The following parameters were retrospectively anaIyzed age of onset, hematuria pattern, existence of proteinuria, process of diagnosis, laboratory findings, thickness and character of basement membrane and family history. Results : The mean age at the time of diagnosis was 7.9 years. The male to female ratio was 65:77. 94 patients or 66% visited the hospital with a chief complaint of persistent microscopic hematuria. Gross hematuria accounted for 13 cases or 9%. 78 cases(55%) were found to have hematuria for the first time from a routine school urinalysis screening. The renal biopsy showed the thickness of basement membrane to be 186$\pm$36 nm. Focal lamellation of the basement membrane was found in eight cases. In the family history, hematuria was shown in 10 cases on the Paternal side, 13 on The maternal side and none on both sides. In seven cases, hematuria was shown among siblings. No significant differences were found among the laboratory test results which were conducted at an average interval of fifteen months. Conclusion : TGBMD is one of the major causes of asymptomatic hematuria in children, which was diagnosed in increasing numbers since school urinary mass screening test started in 1998. In cases with familial progressive renal disease or focal duplication in the basement membrane Alport syndrome should be considered.