• Journal of Preventive Medicine and Public Health
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• v.30 no.3 s.58
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• pp.567-576
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• 1997

To evaluate the effects of reflected glare on eyes, authors assessed the periodic health examination(1991-1996) & self-administered questionnaire data of a semiconductor producing company. The 13 lead frame(LF) department workers have been exposed to high reflected glare in the process for examining the silver plating products. We compared the data of connector(14) and clerical(12) workers as the non-exposed ones. Among LF department workers, 100% felt their visual acuity worsened(connector:81.8%, clerical:85.7%), and 70% had worn the glasses o. contact lenses(connector : 14.3%, clerical :40%) since working at the company. Major ophthalmic symptoms of the LF workers are asthenopia, tearing, decreased visual acuity, congestion and glare. Decrease of visual acuity by Hahn's line change of the LF workers is significantly high during a 5-year follow-up(p<0.05 by simple regression) compared with connector clerical workers.

• Journal of Preventive Medicine and Public Health
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• v.29 no.4 s.55
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• pp.721-732
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• 1996

This study was conducted to investigate the status of pregnancy and delivery and relationship among knowledge, attitude and practice about pregnancy and delivery in poor country, Nepal. A questionnaire survey by interviewer was conducted to examine the general characteristics, knowledge about pregnancy and delivery, attitude about pregnancy and delivery, the rate of prenatal care and delivery condition of women who had an experience of delivery during last year$(1994.4.13\sim1995.4.12)$ at a rural area, nepal(Dolakha Bazar Area). The major findings are as follows ; Among respondents, 87.5 percentage never had health education and the degree of knowledge about pregnancy and delivery was low. Among respondents, 56.6 percentage had the attitude that they didn't want antenatal care, 42.8 % of respondents answered that they wouldn't visit hospital or health center when vaginal bleeding occurred and 82.9% thought that the delivery itself was dirty. The proportion of women who experienced antenatal care was 28.3%, the proportion of health facilities delivery was 5.3%, which was very low and 82.6% of home delivery case didn't sanitate the tool to cut the umbilical cord. The women who had positive attitude about antenatal care and health facility utilization experienced more antenatal care and health facilities delivery. On consideration of above findings, health education for pregnancy and delivery is required to improve mother-child health status in poor country. To make efficient health education, the target population group, such as the uneducated, inhabitants far from health center or medical facility, must be chosen. To help the poor countries in medical field, the study on health status and its related factors on these countries like this article would be required.

• Journal of Preventive Medicine and Public Health
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• v.29 no.4 s.55
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• pp.765-783
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• 1996

This study surveyed and measured the level and structure of cancer deaths and their trends over time for offering the fundamental data of e cancer prevention and control in Pusan city in the future. Authors conducted the study of descriptive epidemiology using materials derived from the computerized data of total 3,722 certified cancer deaths in Pusan city from January 1 to December 31, 1993 registered on the National Statistical Once, the Republic of Korea. The obtained results were as follows: 1. According to the total registered cases of deaths(16,331 cases) in Pusan city during 1993, cancer(3,722 cases) and cerebrovascular disease(2,118 cases) were the first and second cause of deaths as 23.1% and 16.9%, respectively. These pattern showed the change between cancer (14.7%) and cerebrovascular disease(18.5%) in order of frequency in comparison to 1982. Also, the total number of cancer deaths was increased in comparison to 1982. The rate of death certification by physicians was 87.1% of all registered deaths, which was increased to 6.8% in comparison to 1982(80.3%). 2. Crude death rate and cancer specific death rate was 4.06 per 1,000 populations and 93.8 per 100,000 populations(male:117.8, female:70.0), respectively. The former was similar to that of 1982, but the latter was increased to 1.6 times as that of 1982. 3. Age-adjusted cancer specific death rate by standardization with whole country population was 111.9(male:141.5, female:106.7) per 100,000 populations, higher than not age-adjusted cancer specific death rate(93.8), and the sex difference was statistically significant with male predominance (p<0.05). 4. Cancer specific death rate by age was generally increased with age and most of cancer deaths(male:91.8%, female:88.5%) occurred since 40 years old. 5. The major cancer(cancer specific death rate per 100,000 populations) in male was liver(30.6) followed by stomach(25.6), lung(21.9), and GB and EHBD(5.7), in female stomach(15.7), liver(9.9), lung(7.3), and uterus(6.9). The relative frequency of the leading three cancer among total cancer deaths marked 66.3% in male and 47.l% in female, and decreased in comparison to 1982(male:72.2%, female:54.5%). 6. The total ratio of male to female cancer specific death rate showed 1.68 to 1 with male predominance. And the ratio was above 2.0 in larynx, oral cavity & pharynx, esophagus, liver, lung, bladder cancer and the ratio was $1.0\sim1.9$ in stomach, pancreas, gall bladder and EHBD, brain, rectum and anus cancer, leukemia, but the ratio was reversed in thyroid and colon cancer. In conclusion, cancer was the first cause of deaths. The proportion of lung cancer was increased, that of stomach & uterine cancer was decreased relatively, and liver cancer was constantly higher proportion. In the future, it is necessary to conduct the further investigations on the cancer risk factors considering areal specificity.

• Childhood Kidney Diseases
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• v.9 no.1
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• pp.15-20
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• 2005

Purpose : Nutcracker syndrome must be considered when hematuria or proteinuria occurs in a healthy child. The purpose of this study is to investigate the prevalence of nutcracker syndrome among children with asymptomatic hematuria or proteinuria, and to obtain the ratios of the peak velocity of the left renal vein between the aortomesenteric portion and the hilar portion in children with asymptomatic hematuna or protelnuria in which nutcracker syndrome was excluded and to observe whether the ratios are affected by sex, age or urinalysis findings. Methods : Using Doppler ultrasonography, we measured the flow velocity and obtained the peak velocity ratios of the left renal vein at the aortornesenteric portion and at the hilar Portion of the left kidney in children with asymptomatic hematuria or proteinuria who visited the Division of Pediatric Nephrology, Severance Hospital from May 2001 to March 2004. Results : Of 304 children with asymptomatic hematuna or proteinuria, 107 children(35.2%) were diagnosed with nutcracker syndrome. For 197 children with asymptomatic hematuria or proteinuria excluding nutcracker syndrome, the mean ratio of the peak velocity was 2.54 $\pm$0.73, which was not affected by sex, age or urinalysis findings. Conclusion : Nutcracker syndrome was the major cause of asymptomatic hematuria or proteinurla In children, comprising 35% of all cases. Doppler ultrasonography was helpful in the screening of nutcracker syndrome and prevention of its complications. For children with asymptomatic hematuria or proteinuria excluding nutcracker syndrome, the peak velocity ratio of the left renal vein did not differ from that of normal children and was not affected by sex, age or urinalysis findings. (J Korean Soc Pediatr Nephrol 2005;9:15-20)

• Childhood Kidney Diseases
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• v.10 no.1
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• pp.27-32
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• 2006

Purpose : Conservative management of multicystic dysplastic kidney(MCDK) without nephrectomy has recently been advocated. The purpose of this study was to determine the clinical course of conservatively managed MCDK and to find out possible predictive factors for involution of MCDK by ultrasonography(US). Methods : A retrospective analysis was made on 45 patients(26 boys and 20 girls) in whom MCDK was detected and had been traced by US between Dec. 1993 and Aug. 2005 at Severance Hospital. Results : Median follow-up time was 30 months(range 2-102 months). All patients under-went radionuclide scans and voiding eystourethrograms. The serial follow-up US showed complete involution in 11(24%), partial involution in 19(41%), and no interval change or increased in cyst size in 13(28%) patients. Nephrectomy was done in 3 patients(7%) due to relapsing urinary tract infection(UTI) and severe abdominal distension. The mean age of complete involution of MCDK was 37 months(range 12-84 months). Episodes of UTI were present in 17 patients(37%) and additional genitourinary(GU) abnormalities were found in 22 patients(44%). Hypertension and renal insufficiency was complicated in one patient. No child developed malignant tumor. Univariate analysis showed that five variables were associated with complete involution of the MCDK; gender, site, UTI episode, additional GU abnormalities, and renal length on initial US. After adjusting using the Pearson model, the presence of additional GU abnormalities was exclusively associated with complete involution among the 5 variables(P=0.034). Conclusion : In our review of 46 cases of MCDK, non-surgical approach for patients with MCDK was advisable and we could predict poor prognosis when MCDK is associated with other GU anomalies.

• Childhood Kidney Diseases
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• v.7 no.2
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• pp.133-141
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• 2003

Purpose : Idiopathic Membranous Nephropathy(IMN) is a rare renal disease in children. To help better understanding of its clinical course and treatment strategies, we reviewed the clinical manifestations and pathological findings of children with IMN. Methods : Among 58 cases with MN, from 1977 to 2003, 42(72.4%) were hepatitis B virus (HBV) associated and 16(27.6%), 6 males and 10 females, were idiopathic. All cases diagnosed aster 2000 were IMN. Several clinicopathological findings(sex, onset age, proteinuria, serum albumin, cholesterol, creatinine clearance, tubulointerstitial changes, glomerular sclerosis, hypertension, renal vein thrombosis, the use of ACE inhibitor, and immunosuppressive therapy) were compared between the remission and the non-remission group of the patients with IMN. Results : The median onset age was 13.4 years. Clinical manifestations were nephrotic syn-drome(7 cases, 43.8%), gross hematuria(5 cases, 31.3%) and microscopic hematuria with proteinuria(3 cases, 18.8%). Hypertension, hypocalcemic tetany and renal vein thrombosis were accompanied in 2, 1 and 2 cases, respectively. In addition to the typical findings of MN, the kidney biopsies showed segmental sclerosis(5 cases, 31.3%) or global sclerosis(6 cases, 37.5 %), diffuse crescents(1 case), and mild(11 cases, 68.7%) or moderate tubulointerstitial changes(3 cases, 18.8%). Thirteen cases(86.7%) received oral steroid. Among them 2 cases received cyclophophamide and 1 received cyclosporin as well. Ten cases(62.5%) received ACE inhibitors. In the patients followed up, 7 cases(46.7%) became free from proteinuria (remission group) while 8(53.3%) presented continous proteinuria (non-remission group), two (13.3%) of which progressed to renal failure. Clinicopathological findings showed no significant differences between the two groups. Conclusion : With HBV vaccination, HBV associated MN decreased markedly and IMN has taken up most of MN in children. For better understanding of this rare disease, a prospective multicenter study of the clinical course and treatment strategies should be done.

• Childhood Kidney Diseases
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• v.7 no.2
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• pp.174-180
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• 2003

Purpose : Unstable bladder has been known to be one of the reasons for the genesis and persistance of primary vesicoureteral reflux(VUR) in children. And treatment of unstable bladder by anticholinergic agent may contribute to the resolution of primary VUR. We evaluated the effect of an anticholinergic agent(oxybutynin) on the resolution of primary VUR in children with different toilet training and voiding functions. Methods : 152 children with persistant primary VUR after one year of follow up were randomly assigned to the oxybutynin group(n=59, oxybutynin 0.2 mg/kg twice daily) and the control group(n=93, no oxybutynin) at Ewha Womans University Mok-Dong Hospital from October 1996 to April 2002. The resolution rate of the VUR and the difference according to the status of toilet training and voiding dysfunction were analyzed. Statistical analysis was done by the Chi-square test and a P-value of less than 0.05 was considered as significant. Results : VUR was resolved in 49.2%, improved in 20.3% and not changed in 30.5% in the oxybutynin group(n=59) which was not significantly different to 45.2%, 16.1%, 38.7% in the control group(n=93), respectively. In the non-toilet trained young children, VUR was resolved in 50.0%, improved in 23.5% and not changed in 26.5% in the oxybutynin group(n=34) which was not significantly different to 44.2%, 19.2%, 36.6% in the control group(n=52), respectively. In the toilet trained older children, VUR was resolved in 48.0%, improved in 16.0% and not changed in 36.0% in the oxybutynin group(n=25) which was not significantly different to 46.3%, 12.2%, 41.5% in the control group(n=41), respectively. In the toilet trained older children with no voiding dysfunction, VUR was resolved in 33.3%, improved in 11.1% and not changed in 55.5% in the of oxybutynin group(n=9) which was not significantly different to 53.6 %, 10.7%, 35.7% in the control group(n=28), respectively. In the toilet trained older children with voiding dysfunction, VUR was resolved in 56.3%, improved in 18.7% and not changed in 25.0% in the oxybutynin group(n=16), which looked higher than 30.7%, 15.4%, 53.9% in the control group(n=13), respectively, but these were not significantly different either. Conclusion : Oxybutynin was not effective in the resolution of primary VUR in non-toilet trained young children and toilet trained older children. Oxybutynin showed slightly higher tendency of reflux resolution in toilet-trained older children with voiding dysfunction but the difference was not statistically significant. Judicious use of oxybutynin is required in selected older children with VUR and voiding dysfunction.

• Childhood Kidney Diseases
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• v.17 no.2
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• pp.65-72
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• 2013

Purpose: Urinary tract infection (UTI) caused by gram-positive uropathogens is usually hospital-acquired and associated with predisposing conditions. However, the incidence of gram-positive bacteria in community-acquired UTIs has recently increased worldwide. We aimed to investigate the clinical significance of UTI and associated genitourinary malformations in young children with febrile UTIs caused by gram-positive bacteria. Methods: We retrospectively reviewed the medical records of 566 patients (age, <1 year) who visited the Korea University Medical Center for febrile UTIs between January 2008 and May 2013. We classified the patients into the following two groups: gram-positive (P group) and gram-negative (N group), according to the results of urine culture. The fever duration; white blood cell (WBC) counts and C-reactive protein (CRP) levels in peripheral blood; and the presence of hydronephrosis, cortical defects, vesicoureteral reflux (VUR), and renal scarring were compared between the two groups. Results: The number of patients with gram-positive bacteria was 23 (4.1%) and with gram-negative bacteria was 543 (95.9%). The most common pathogen was Escherichia coli, and Enterococcus faecalis showed the highest incidence among gram-positive uropathogens. Patients with gram-positive bacteria showed longer fever duration compared to that in patients with gram-negative bacteria (P vs. N, $3.4{\pm}1.2$ vs. $2.9{\pm}1.6$ days, P <0.05). The incidence of VUR was increased in the gram-positive group compared to that in the gram-negative group (P vs. N, 55.6 vs. 17.8%, P<0.05). However, there were no significant differences in other laboratory and radiologic findings. Conclusion: The findings of our study show that community-acquired UTIs in patients younger than 1 year of age, caused by gram-positive uropathogens, can be associated with prolonged fever duration and the presence of VUR.

• Childhood Kidney Diseases
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• v.17 no.2
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• pp.57-64
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• 2013

Purpose: In children, 24-hour urine collections are unreliable for evaluating glomerular filtration rate (GFR) because of the difficulty of regulating voiding and the daily variation of urinary creatinine up to 25%. Additionally, creatinine clearance (Ccr) based on urinary creatinine is considered inaccurate. The purpose of this study was to compare estimated GFR determined using Ccr, formulas with serum cystatin C and creatinine, and $^{99m}Tc$-mercaptoacetyltriglycine (MAG3) dynamic renal scintigraphy. Methods: This retrospective study included 101 patients (age, <18 years) who visited Chung-Ang University Hospital between July 2011 and August 2012. GFR was estimated using 24-hour urinary creatinine, five formulas with serum creatinine and cystatin C, and $^{99m}Tc$-MAG3 renal scan. Results: Of the 101 patients, glomerular renal diseases were present in 60 patients (59.4%) and non-glomerular diseases were present in 41 patients (40.6%). There was a significant correlation between estimated GFR determined using $^{99m}Tc$-MAG3 renal scan and Ccr (r=0.389, P <0.001). The correlation values between estimated GFR determined using $^{99m}Tc$-MAG3 renal scan and each formula of Schwartz, Counahan-Barratt, Cockcroft-Gault, Filler and Lepage, and Bokencamp were 0.265 (P=0.007), 0.128 (P=0.044), 0.230 (P=0.021), 0.356 (P<0.001), and 0.355 (P <0.001), respectively. $^{99m}Tc$-MAG3 renal scan was correlated with estimated-GFR by all formulas in decreased renal function. Conclusion: Estimated GFRs determined using serum creatinine and cystatin C, and $^{99m}Tc$-MAG3 renal scan correlated well with estimated GFR determined using Ccr. $^{99m}Tc$-MAG3 renal scan may be replaced for evaluation of renal function with convenience in patients with renal disease and decreased renal function in childhood.

• Childhood Kidney Diseases
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• v.17 no.2
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• pp.49-56
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• 2013

Purpose: IgA nephropathy (IgAN) is one of the major causes of end-stage renal disease. Mass school urine screening (SUS) has been performed to enable early detection of chronic renal diseases, including IgAN. We wanted to evaluate the patients with IgAN, including those diagnosed through SUS. Methods: Between 1998 and 2010, 64 children were diagnosed with IgAN based on renal biopsy results obtained at the Pediatric Nephrology Department, ${\bigcirc\bigcirc}$ University Hospital. We divided these patients into the SUS group (37 cases), diagnosed through SUS, and the symptomatic (Sx) group (27 cases), diagnosed clinically. The medical records of both groups were analyzed retrospectively. Results: The mean age of the SUS and Sx groups was $10.8{\pm}2.7$ and $9.5{\pm}3.4$ years (P >0.05), respectively. Both groups had a higher proportion of male patients. The time from the notification of an abnormal urinary finding to a hospital visit or renal biopsy was shorter in the Sx group than in the SUS group. Regarding clinical manifestations, there were fewer cases with gross hematuria (P <0.001) and edema (P =0.008) in the SUS group, but there were no differences in terms of the therapeutic regimen and treatment duration. Regarding laboratory parameters, the Sx group had a higher white blood cell count (P =0.007) and lower hemoglobin (P =0.007) and albumin (P =0.000) levels. There were no differences in the renal biopsy findings in both groups, based on the history of gross hematuria or the severity of proteinuria. However, in all 64 patients with IgAN, the light microscopy findings (Hass classification) were related to a history of gross hematuria or the severity of proteinuria. Conclusion: There were no significant clinical and histological differences between the groups, as both had early stage IgAN. Although SUS facilitates the early detection of IgAN, long-term, large-scale prospective controlled studies are needed to assess the benefits of early diagnosis and treatment in chronic renal disease progression.