• Pediatric Infection and Vaccine
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• v.26 no.1
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• pp.1-10
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• 2019

Purpose: We investigated the distribution and antimicrobial resistance of pneumococcal isolates from hospitalized children at Asan Medical Center for recent 4 years, and aimed to recommend proper choice of empirical antibiotics for pneumococcal infection. Methods: From March 2014 to May 2018, children admitted to Asan Medical Center Childrens' Hospital with pneumococcal infection were subjected for evaluation of minimal inhibitory concentration (MIC) for ${\beta}-lactams$ and macrolide antibiotics. Patient's age, underlying disease, gender were retrospectively collected. Using Monte Carlo simulation model and MIC from our study, we predicted the rate of treatment success with amoxicillin treatment. Results: Sixty-three isolates were analyzed including 20.6% (n=13) of invasive isolates, and 79.4% (n=50) of non-invasive isolates; median age were 3.3 years old, and 87.3% of the pneumococcal infections occurred to children with underlying disease. Overall susceptibility rate was 49.2%, 68.2%, and 74.6% for amoxicillin, parenteral penicillin, and cefotaxime respectively. 23.8% and 9.5% of the isolates showed high resistance for amoxicillin, and cefotaxime. Only 4.8% (n=3) were susceptible to erythromycin. Monte Carlo simulation model revealed the likelihood of treatment success was 46.0% at the dosage of 90 mg/kg/day of amoxicillin. Conclusions: Recent pneumococcal isolates from pediatric patients with underlying disease revealed high resistance for amoxicillin and cefotaxime, and high resistance for erythromycin. Prudent choice of antibiotics based on the local data of resistance cannot be emphasized enough, especially in high risk patients with underlying disease, and timely vaccination should be implemented for prevention of the spread of resistant strains.

• Pediatric Infection and Vaccine
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• v.25 no.3
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• pp.148-155
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• 2018

Purpose: The purpose of this study was to investigate the clinical significance of Bacille Calmette-$Gu{\acute{e}}rin$ (BCG) site reaction in terms of diagnosis and outcome prediction in young children with Kawasaki disease (KD). Methods: The incidence of BCG site reaction in the respective age ranges was investigated in 1,058 patients who were admitted at Asan Medical Center between January 2006 and February 2017. The 416 patients under 18 months of age were enrolled as subjects for the analysis of the association between BCG site reaction and other laboratory and clinical findings. The analysis was performed separately in complete and incomplete KD groups. Results: The incidence rate of BCG site reaction was peaked at 6-12 months (83%) and decreased with increasing age after 12 months in 1,058 patients (P<0.001). The incidence rate was above 70% in KD aged less than 18 months and more frequent than those of cervical lymphadenopathy. The logistic regression analyses showed that the principal clinical findings including conjunctivitis (P=0.781), red lips/oral mucosa (P=0.963), rash (P=0.510), cervical lymphadenopathy (P=0.363), changes in extremities (P=0.283) and the coronary artery aneurysm (P=0.776) were not associated with the BCG site reaction. Conclusions: The BCG site reaction could be a useful diagnostic tool independent to principal clinical findings in KD developing in children aged <18 months, who underwent BCG vaccination. Outcome of KD patients was not different between groups with or without the BCG site reaction in both complete KD and incomplete KD.

• Journal of agricultural medicine and community health
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• v.20 no.1
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• pp.1-13
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• 1995

Based on the questionnaires sent to 270 nurses of public health centers in kyungnam during the period of March 19 to April 11 in 1992, this study was written for the of finding out the grade of satisfaction, obstacles in carrying out duties concerned with nursing services and the change of nurses role needed according to the change of the local public health administration. The first-ranking tasks carried by nurses of public health center are believed to have been family planning activities before the 1970's, nursing services during the 1970's, mother-child health activities during the 1980's, and nursing services during the period of 1990 to 1992. As far as the priority order of all the family planning activities is concerned, the counseling of the insertion of intrauterine contraceptive device, the use of oral pill or the distribution of condom was placed emphasis on before 1970, and publicity activities of family planning after that time. The first priority order of mother-child health activities has been put on the registration of pregnant women since 1970, with prenatal examination and vaccination ranking next to it. The priority order for activities against tuberculosis was laid on finding out and registration of new T.B. patients every year, with patients' control, and medication or injection ranking next to it. As for the priority order of nursing services, traveling medical examination and treatment ranked the first-stressed activity before 1970, with medication and injection ranking next to it. The first priority order management activity of communicable diseases was put on vaccination before 1970, with medication and injection. ranking next. And consultation and education ranked second to it during 1990 to 1992. As for the health services of the aged, traveling examination and treatment ranked the order, with the assistance of medical examination ranking next to it. As far as troubles and obstacles shown in case of family planning, the rate of residents' lack understanding was 28.8%, that of lacking budget 13.6%, and the imperfection of public health administration system 11.9%. In the case of tuberculosis control, residents' lacking understanding was 32.5%, the deficiency of public health administration system 18.2%, over-duty(shortage of hands) 15.6%, and the insufficiency skill and know-how 13.0%. In the case of nursing services, the deficiency of public health administration system was 18.2%, each over-duty(the shortage of hands) and the shortage of facilities and equipment 15.6% respective, and residents' lacking understanding 13.0%. The rate of dissatisfaction with the chance or possibility of promotion for his or her career or capability was shown to be 49.2%, and 65.9% of the health nurses expressed their complaints of the deficiency of the chance of the promotion to a professional or expert. when the public health nurses were asked in the questionably whether they were satisfied or not with current state of equipment and facilities needed for public health service, 49.6% of them answered in the negative. The grade of the satisfaction with the current individual position was shown to be low as much as the status of his or her position was now. 37.6% of those asked in the research answered to have the readiness to switch jobs for the reasons of dissatisfaction and so on with lacking promotion chance as well as bad working condition. Significant correlation between the grade of job satisfaction and the current status of the po as found to be in this research, which showed that the lower the status of position was, the lower the grade of job satisfaction was. But little correlation between the grade of job satisfaction and his or her schooling and career was found. In order to carry out primary health care successfully, it can be said that more education and publicity activities to make public health nurses and residents see it in a new light are requested. In addition to it, it is suggested that the improvement of promotion system for public health nurses and the enlargement of job province should also be taken in consideration of the high dissatisfaction with and complaints of the chance of promotion and the system of position. In order words, it is important that considerations for system improvement enough to make nursing services pleasant and satisfactory should be taken into.

• Tuberculosis and Respiratory Diseases
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• v.53 no.4
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• pp.401-408
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• 2002

Background : Tuberculin skin test is a method to examine M. tuberculosis infection and has been used all over the world. But various factors make it difficult to understand testing results. In 2000, the American Thoracic Society recommended that skin test results should be decided by considering risk factors of the tested. In Korea, high tuberculosis infection rate and BCG vaccination rate make it difficult to differentiate current infection, past infection, and no infection by the skin test. This study was attempted to examine a negative predictive value of the skin test to understand how the skin test acts on deciding administration of anti-tuberculosis drug. Methods : From Mar. 1 to Jul. 31 in 2001, the test was performed for patients hospitalized in Department of Internal Medicine, Hallym University College of Medicine, Chunchon, Korea by administering Tuberculin PPD RT23 2 TU (0.1 ml)to them that has been currently used in Korea based on Mantoux method. They were decided to be infected with tuberculosis bacilli by following diagnostic standard: 1) tuberculosis bacilli was cultured in sputum by microbiological diagnostic standard or Acid-fast bacilli was proven on a microscopic examination or 2) tuberculosis bacilli was not proven in the aforesaid microbiological test by clinical diagnostic standard, while there was opinion or symptom suitable for tuberculosis by radiographic or histological standard so the doctor decided to apply the tuberculosis treatment. Results : In this study, total 210 patients except 20 patients (8.7%) among 230 hospitalized patients were evaluated. Their average age was 60±16.8 years, and male-female rate was 1.28 : 1 (male: 118, female: 92). Number of patient, who was diagnosed and decided as tuberculosis, was 53(25.2%). Pulmonary tuberculosis was found in 45 patients (84.9%); 22 patients were decided to be positive in the Acid-fast bacilli smear test by microbiological examination (culture positive: 13, culture negative: 9), and 23 patients were decided to be tuberculosis patients by clinical diagnosis standard. Tuberculosis pleuritis was found in 8 patients (15.1%); 4 patients were diagnosed and decided by histological standard, and 4 patients were decided and treated by clinical standard. In differentiating patients into 'Negative' and 'Positive' by the skin test standard of the American Thoracic Society, negative predictive value 92.3%, positive predictive value 47.3%, sensitivity and specificity were 83%, 68.8%, respectively. Conclusion : In hospitalized respiratory patients, there was high negative predictive vlaue 92.3% by tuberculin skin test, therefore skin test would be a important factor for deciding administration of anti-tuberculosis drug on negative skin test patient.

• Pediatric Infection and Vaccine
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• v.6 no.2
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• pp.245-252
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• 1999

Purpose : The aim of this study is to determine the age-specific seropositivity and the level of measles specific IgG in adults and to evaluate herd immunity to measles in Korea, the measles specific IgG were measured from the sera of adults over ages of 20 in Korea. Methods : 156 sera were collected from 156 out-patients over ages 20, who had visited clinical laboratory from June to July in 1997 at Korea University Ansan Hospital. The histories of natural measles or vaccination were not undertaken. Measles specific IgG titers were measured using ELISA method($SIA^{TM}$ Measles IgG Kit Co. St. Louis. Mo). Results : The results obtained from this study were as follows. 1) The seropositivity of measles specific IgG in adults was 94.9%. And there were no significant differences in their age and gender. 2) The mean measles-specific IgG titer was $238{\pm}84AU/mL$. And there were no significant differences in age and gender, except significant lower in 4th decades than other age groups. And there were no significant correlations between age and measles specific IgG level. Conclusion : In conclusion, a seropositivity of in adults was 94.9% which was higher than that of adolescents(91.2% in previous study), and antibody level was similar with adolescents. The herd immunity of the adults were considered to enough for protecting the transmission of measles in the community. For the eradication of measles in Korea, more efforts will be required to increase the vaccine coverage rate in children and adolescents.

• Pediatric Infection and Vaccine
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• v.4 no.1
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• pp.90-96
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• 1997

Purpose : Recently a shift in hepatitis A incidence from children to adults has been well noted. We experienced under 15-years old 31 patients who presented hepatitis A infection. In order to prepare for the prevention on hepatitis A outbreak in the future, we studied the clinical and epidemiologic manifestations of these patients. Methods : We enrolled patients from July to December in 1996 (6 months) and evaluated the monthly incidence, geographical distribution, age and sex, and clinical manfestations, including laboratory fadings. Results : Many cases of hepatitis A occured in the summer months, especially August (16/31 cases). Most of patients (87%) were living in the Seo-Ku area (northwest district of the city). In age distribution, there were no cases under 3 years of age, 3 cases from 4~5 years, 13 cases from 6~10 years, 15 cases from 11~15 years. Clinical profiles showed that dark urine, nausea and vomiting, anorexia, abdominal pain, fever, and fatigue were the common presenting symptoms. The initial presenting laboratory tests included total bilirubin 3.3mg/dl, alkaline phosphatase of 856units/L, and serum asparate aminotransferase and alanine aminolransferase levels of 910IU/L and 1239IU/L, respectively. No patient presented atypical clinical courses or complications. Conclusions : Hepatitis A in children shows benign clinical features. This study showed that the possibility of another outbreak of Hepatitis A in the TaeJon area or elsewhere in the near future Korea will be possible. To prevent an outbreak we will be concerned about the anti-HAV IgG prevalance rate in children and preventive modalities including vaccination against hepatitis A.

• Pediatric Infection and Vaccine
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• v.19 no.1
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• pp.19-27
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• 2012

Purpose : As the number of children who attend child care centers has increased, concerns has increased about the effect of child day care on childhood illness. This study was conducted to examine the relationship between experience in child care and common infectious diseases in children under 5 years of age. Methods : Data were collected by surveying 1,000 respondents with children under age 5 through online interviews using a structured questionnaire. The contents of the survey were composed of demographic characteristics, child care facilities usage, experience in infectious diseases, and immunization status Results : Among the 1,000 children <5 years of age, 78.5% attended a child care facility. Rates of common communicable illnesses were higher in children in child care than for children reared exclusively at home. The predominant communicable diseases which the respondents' children experienced, in order of decreasing frequency, were gastroenteritis (47.1%), otitis media (41.8%) and pneumonia (19.1%). The immunization rate of vaccines that are not included the national immunization program (NIP) (Haemophilus influenzae type b vaccine - 76.6%, hepatitis A vaccine - 63.3%, pneumococcal vaccine - 59.4%, rotavirus vaccine - 43.1%) was lower than that of the NIP vaccines (90.4%) Conclusion : Children in child care experience more bouts of common infectious disease, so nationwide policies to prevent or to control the spread of infectious agents in a child-care should be available and appropriate immunization should be emphasized as the most effective method for the control of infectious disease for children.

• Pediatric Infection and Vaccine
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• v.10 no.1
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• pp.81-86
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• 2003

Purpose : Streptococcus pneumoniae remains a leading cause of meningitis, sepsis, pneumonia, and otitis media in children worldwide. Emergence of drug-resistant organism has substantially complicated the therapy of these infections. This study was conducted to determine the clinical features and changing patterns of antibiotic-resistant rates of Streptococcus pneumoniae. Methods : We have retrospectively examined 306 cases of culture proven patients who were admitted to the Department of Pediatrics, Severance hospital, from the year 1991 to year 2000. The type of culture specimen used, presence of penicillin resistance, characteristics according to various presenting diseases and their prevailing year were also examined. Results : The mean age of cases was 7.9 year and the ratio of male to female was 1.6 : 1. The main age group of pneumococcal infection was under 2 years(42%). Systemic infections associated with pneumococci were sepsis(19.3%) and meningitis(9.5%), while local infections presented as pneumonia(29.2%), otitis media(19.3%), exudative tonsillitis(13.3%), and sinusitis(9.2%) in the order of frequency. Seasonal variation was seen in the incidence of pneumococcal infection: high incidence of infection was seen in Spring(Mar.~Apr; 32%), while the incidence was low during summer(Aug.~Sep.; 6%). Penicillin-resistant rate of pneumococci was steadily on the increase since the year 1991(65%) to year 2000(84%). Conclusion : Antibiotic-resistant pneumococci increased during the past decade. For effective prevention of pneumococcal infections, national survey of pneumococcal infections and expanded use of pneumococcal vaccination would be needed.

• Asian-Australasian Journal of Animal Sciences
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• v.13 no.11
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• pp.1619-1637
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• 2000

A review was undertaken to obtain information on the range of beak-trimming methods available or under development. Beak-trimming of commercial layer replacement pullets is a common yet critical management tool that can affect the performance for the life of the flock. The most obvious advantage of beak-trimming is a reduction in cannibalism although the extent of the reduction in cannibalism depends on the strain, season, and type of housing, flock health and other factors. Beak-trimming also improves feed conversion by reducing food wastage. A further advantage of beak-trimming is a reduction in the chronic stress associated with dominance interactions in the flock. Beak-trimming of birds at 7-10 days is favoured by Industry but research over last 10 years has shown that beak-trimming at day-old causes the least stress on birds and efforts are needed to encourage Industry to adopt the practice of beak-trimming birds at day-old. Proper beak-trimming can result in greatly improved layer performance but improper beak-trimming can ruin an other wise good flock of hens. Re-trimming is practiced in most flocks, although there are some flocks that only need one trimming. Given the continuing welfare scrutiny of using a hot blade to cut the beak, attempts have been made to develop more welfare friendly methods of beak-trimming. Despite the developments in design of hot blade beak-trimmers the process has remained largely unchanged. That is, a red-hot blade cuts and cauterises the beak. The variables in the process are blade temperature, cauterisation time, operator ability, severity of trimming, age of trimming, strain of bird and beak length. This method of beak-trimming is still overwhelmingly favoured in Industry and there appears to be no other alternative procedures that are more effective. Sharp secateurs have been used trim the upper beak of both layers and turkeys. Bleeding from the upper mandible ceases shortly after the operation, and despite the regrowth of the beak a reduction of cannibalism has been reported. Very few differences have been noted between behaviour and production of the hot blade and cold blade cut chickens. This method has not been used on a large scale in Industry. There are anecdotal reports of cannibalism outbreaks in birds with regrown beaks. A robotic beak-trimming machine was developed in France, which permitted simultaneous, automated beak-trimming and vaccination of day-old chicks of up to 4,500 chickens per hour. Use of the machine was not successful because if the chicks were not loaded correctly they could drop off the line, receive excessive beak-trimming or very light trimming. Robotic beak-trimming was not effective if there was a variation in the weight or size of chickens. Capsaicin can cause degeneration of sensory nerves in mammals and decreases the rate of beak regrowth by its action on the sensory nerves. Capsaicin is a cheap, non-toxic substance that can be readily applied at the time of less severe beak-trimming. It suffers the disadvantage of causing an extreme burning sensation in operators who come in contact with the substance during its application to the bird. Methods of applying the substance to minimise the risk to operators of coming in contact with capsaicin need to be explored. A method was reported which cuts the beaks with a laser beam in day-old chickens. No details were provided on the type of laser used, or the severity of beak-trimming, but by 16 weeks the beaks of laser trimmed birds resembled the untrimmed beaks, but without the bill tip. Feather pecking and cannibalism during the laying period were highest among the laser trimmed hens. Currently laser machines are available that are transportable and research to investigate the effectiveness of beak-trimming using ablasive and coagulative lasers used in human medicine should be explored. Liquid nitrogen was used to declaw emu toes but was not effective. There was regrowth of the claws and the time and cost involved in the procedure limit the potential of using this process to beak-trim birds.

• Journal of agricultural medicine and community health
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• v.27 no.2
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• pp.107-126
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• 2002

Health sub-centers(HSCs) have played an important role in primary health care in rural area in Korea. The unification of neighboring HSCs was a strategy to improve the role of HSCs. This study was conducted to reveal the efficacy of the unified HSC established in Yangbuk-myeon, Gyeongju-si in1997. The utilization patterns of HSC and its related factors, and satisfaction of consumer on HSC were compared before and after unification of two HSCs in Gampo-eup, Yangnam-myeon using questionnaire survey, and also the statistics of medical care services and public health services were compared. Four hundred forty nine subjects were questioned in survey, 156 from Gampo-eup, 147 from Yangbuk-myeon, and 146 from Yangnam-myeon. Following unification, the utilization rates and the frequency of visits in Gampo-eup declined. In all three areas, chronic illness was the common factor influencing the utilization and change in frequency of visits to the unified HSC. Following unification, aspects of consumer satisfaction, for example; accessibility and affordability decreased in Gampo-eup, but increased in both Yangbuk-myeon and Yangnam-myeon. The statistics relating to medical care, X-ray examination, home visiting service, vaccination, and health education showed an increase for the unified HSC when compared to the sum of the statistics for the previous two. The execution rates for other public health services were the same, or a little decreased. Clinical laboratory examinations and the issuing of civil affair documents were new services offered by the unified HSC. It is concluded, the overall consumer satisfaction with the unified HSC was improved. In Gampo-eup, where after unification there was no HSC, it seemed to be a barrier to accessing the unified HSC. The effect of the unified HSC, in the respect of medical care and public health services, was not as significant as expected at the time of being established. Therefore, the strategies to reenforce the unified HSC should be developed to provide all residents with comprehensive primary health care services.