Public Perception on Coinsurance Rate of the National Health Insurance in Korea / 보건행정학회지

Background@#Although Korean government have been adopting several policies to expand coverage of National Health Insurance (NHI) program, the coverage rate is still below average across Organization for Economic Cooperation and Development countries.This study was to identify public perception on appropriateness of coinsurance rate and factors associated with coinsurance rate in National Health Insurance. @*Methods@#For this cross-sectional study, 507 participants over aged 20 years were recruited from telephone surveys. Respondents experienced at least one and more visiting medical facilities due to medical problems in last 12 months. Demographic factors, socioeconomic positions, and experiences on medical utilization were measured in order to identify factors associated with perception appropriateness of coinsurance rate. @*Results@#The 49.9% (n=209) of the public responded that the coinsurance rate of NHI program was appropriate. There were no differences in positive perception according to socio-demographic factors and experiences on medical utilization except for gender, residential area, and felt expensive when using medical services. People who felt burden of medical expenditure were more likely to perceive coinsurance rate inappropriate (odds ratio, 2.33; 95% confidence interval, 1.52–3.58) @*Conclusion@#In spite of the relatively low coverage rate of NHI, this study identified that 49.9% of the public perceived the current coinsurance rate was adequate. However, people who felt the burden of medical expenditure were still had a negative perception of the coinsurance rate needed to decrease the coinsurance rate.

Public Perception on Coinsurance Rate of the National Health Insurance in Korea / 보건행정학회지

Background@#Although Korean government have been adopting several policies to expand coverage of National Health Insurance (NHI) program, the coverage rate is still below average across Organization for Economic Cooperation and Development countries.This study was to identify public perception on appropriateness of coinsurance rate and factors associated with coinsurance rate in National Health Insurance. @*Methods@#For this cross-sectional study, 507 participants over aged 20 years were recruited from telephone surveys. Respondents experienced at least one and more visiting medical facilities due to medical problems in last 12 months. Demographic factors, socioeconomic positions, and experiences on medical utilization were measured in order to identify factors associated with perception appropriateness of coinsurance rate. @*Results@#The 49.9% (n=209) of the public responded that the coinsurance rate of NHI program was appropriate. There were no differences in positive perception according to socio-demographic factors and experiences on medical utilization except for gender, residential area, and felt expensive when using medical services. People who felt burden of medical expenditure were more likely to perceive coinsurance rate inappropriate (odds ratio, 2.33; 95% confidence interval, 1.52–3.58) @*Conclusion@#In spite of the relatively low coverage rate of NHI, this study identified that 49.9% of the public perceived the current coinsurance rate was adequate. However, people who felt the burden of medical expenditure were still had a negative perception of the coinsurance rate needed to decrease the coinsurance rate.

Measuring Differences in Food Iintakes and Dietary Habits of Preschool Children by the Weight-Length Index

This study was conducted to obtain data and offer advice regarding dietary intake at kindergarten and to recommend dietary habits to prevent childhood obesity. The study was conducted in 85 children aged 4 to 5 years. Body weight and height, dietary intakes of lunch served at Kindergarten and questionnaires for dietary behaviors in Kyeongnam area were studied. All subjects were classified by their weight-length index (WLI). According to the standard WLI values, 41.2% of the children were within the normal value (90 or =120). The mean energy intake at lunch for kindergarteners was 287.1+/-13.4 kcal in the normal group, 307.6+/-10.2 kcal in the overweight group and 323.7+/-8.6 kcal in the obese group. The percent energy of estimated energy requirement (EER) was 21.8%. The intake of protein, iron, zinc, vitamin A, and pyridoxine were significantly different by WLI (P<0.05). A comparison of nutrients in the lunch menu provided with those of 1/3 recommended intake (RI) showed that preschoolers took in fewer calories, calcium, and vitamin B2, and that their deficiency rates were high (81.2%, 76.5% and 70.6% of recommended levels, respectively). There was a significant difference in the preference of fruits and milk and dairy products by WLI. Therefore, a nutritional education program and new guidance in the proper nutrition management for kindergarteners should be developed to enhance nutritional status during childhood.

Advanced fibrosis is not a negative pretreatment predictive factor for genotype 2 or 3 chronic hepatitis C patients

BACKGROUND/AIMS: Chronic hepatitis C patients with advanced fibrosis have unsatisfactory sustained virological response (SVR) rates. Few data demonstrating the efficacy of combination therapy in chronic hepatitis C patients with advanced fibrosis in South Korea are available. The purpose of this study was to assess whether the stage of fibrosis impacts the efficacy of combination therapy for chronic hepatitis C. METHODS: We retrospectively reviewed data for a total of 109 patients with chronic hepatitis C, treated with peginterferon alfa and ribavirin. SVR according to the stage of liver fibrosis assessed by pretreatment liver biopsy and genotype results were analyzed. RESULTS: Data from 66 genotype 1 patients (60.6%) and 43 genotype 2 or 3 patients (39.4%) among the 109 patients were analyzed. SVR rates for the genotype 1 patients were significantly lower for the stage 3-4 group (32.1%) than the stage 0-2 group (78.9%; P<0.001). SVR rates (92.0% for stage 0-2, 77.8% for stage 3-4, P=0.184) of genotype 2 or 3 patients were not significantly different according to fibrosis stage. Likewise, the frequency of adverse events was not significantly different according to fibrosis stage. CONCLUSIONS: Compared to patients without advanced fibrosis, we can anticipate good SVR rates for genotype 2 or 3 patients with advanced fibrosis and they did not show an inferior tolerability for peginterferon and ribavirin combination therpy. Our results suggest that active treatment is needed for genotype 2 or 3 patients with advanced fibrosis.

A Case of Pyogenic Liver Abscess with Multiple Septic Metastatic Infections and Colon Cancer

Klebsiella pneumoniae (K. pneumoniae) is one of the most common pathogens to cause liver abscess. Because K. pneumoniae is highly virulent, it may cause embolic complications. The rate of metastatic infection has a range of 3.5% to 20%. Thus, a diagnostic work-up for metastatic complications should be employed in K. pneumoniae liver abscess cases, including chest radiography and computed tomography if chest radiographies are abnormal and ophthalmic examination in diabetic patients. Cryptogenic pyogenic liver abscess has been recently reported to potentially signal colorectal cancer, especially in female patients with diabetes. We present a case of liver abscess with endophthalmitis and septic pulmonary embolism, which is associated with silent colon cancer.

Treatment of a Spontaneous Coronary Artery Dissection Involving the Left Main Coronary Artery Using the Culotte Stent Technique / 대한내과학회지

Spontaneous coronary artery dissection (SCAD) is an extremely rare clinical manifestation of ischemic heart disease. A 43-year-old female was admitted to our hospital for non-ST elevation myocardial infarction. She had no cardiac risk factors except smoking. Coronary angiography showed moderate stenosis of the proximal left circumflex artery (LCX) with intraluminal haziness and a spastic appearance from the culprit lesion in the left main coronary artery (LM). Subsequent analysis by intravascular ultrasound (IVUS) revealed a clear dissection flap from the LCX to the LM. Generally, SCAD of the LM or multivessel involvement requires primary surgical management. The present case was treated percutaneously using the culotte stent technique.

Frozen Section Biopsy to Evaluation of Obscure Lateral Resection Margins during Gastric Endoscopic Submucosal Dissection for Early Gastric Cancer

PURPOSE: To determine the diagnostic utility of a frozen section biopsy in patients undergoing endoscopic submucosal dissection (ESD) for early gastric neoplasms with obscure margins even with chromoendoscopy using acetic acid and indigo carmine (AI chromoendoscopy). MATERIALS AND METHODS: The lateral spread of early gastric neoplasms was unclear even following AI chromoendoscopy in 38 patients who underwent ESD between June 2007 and May 2011. Frozen section biopsies were obtained by agreement of the degree of lateral spread between two endoscopists. Thus, frozen section biopsies were obtained from 23 patients (FBx group) and not in the other 15 patients (AI group). RESULTS: No significant differences were observed for size, histology, invasive depth, and location of lesions between the AI and FBx groups. No false positive or false negative results were observed in the frozen section diagnoses. Adenocarcinoma was revealed in three patients and tubular adenoma in one, thereby changing the delineation of lesion extent and achieving free lateral margins. The rates of free lateral resection margins and curative resection were significantly higher in the FBx group than those in the AI group. CONCLUSIONS: Frozen section biopsy can help endoscopists perform more safe and accurate ESD in patients with early gastric neoplasm.

A Case of Pneumatosis Cystoides Intestinalis in Which Endoscopic Ultrasonography Was Useful for the Diagnosis / 대한소화기내시경학회지

Pneumatosis cystoides intestinalis (PCI) is an uncommon condition in which submucosal or subserosal gas cysts are present within the bowel wall. We report a case of a 37-year-old man with no medical history. He underwent a colonoscopy for screening purposes, which revealed multiple and variably sized submucosal tumors in the ascending colon. Endoscopic ultrasonographic (EUS) finding showed multiple hyperechogenic regions with distal acoustic shadowing within the submucosa of the ascending colon. A computed tomography scan showed multiple air-filled cystic masses in the ascending colon. EUS appears to be effective for the diagnosis of PCI.

Interstitial Pneumonitis in a Patient with Chronic Hepatitis C and Chronic Renal Failure on Interferon Therapy / 대한소화기학회지

After 4-months of alpha interferon (IFN-alpha), a 64-year old woman with chronic hepatitis C developed a cough and dyspnea and showed diffuse infiltrative opacities on her chest X-ray. Her symptoms persisted after stopping the IFN-alpha therapy. Pulmonary function testing revealed a reduced forced vital capacity. High-resolution computed tomography of the lung showed peripheral and peribronchovascular ground glass attenuation and consolidation associated with reticulation. Bronchoalveolar lavage was performed for further evaluation and showed a lymphocyte level of 8.2%, an uncommon finding in IFN-alpha-induced interstitial pneumonitis. We performed a lung biopsy to diagnose her disease and it suggested interstitial pneumonitis. This was considered to be due to the immunomodulatory effects of INF-alpha. Although rare, any sign of significant pulmonary involvement should be evaluated.

Anti-TNFalpha Treatment for Two Cases of Acute Generalized Exanthematous Pustulosis Caused by Rhus Hypersensitivity / 대한내과학회지

Acute generalized exanthematous pustulosis (AGEP) is characterized by the rapid occurrence of many sterile, nonfollicular pustules on an edematous erythema accompanied by leucocytosis and fever. It is usually attributed to drugs, including herbal medications such as rhus in Korea. We report two cases of AGEP due to rhus hypersensitivity treated with anti-tumor necrosis factor (TNF)-alpha. The patients developed a generalized erythematous rash and edema, particularly on the face, with high fever and leukocytosis several days after ingesting rhus chicken or contacting rhus extract. Following treatment with a systemic steroid, the skin rash spread to the entire body and pustules arose on an edematous erythema. After stopping the systemic steroid and administering a subcutaneous injection of Etanercept, the pustular rashes, fever, and edema improved within 4 days. These results suggest that anti-TNF-alpha treatment may be effective for rapidly improving AGEP.

The Difference of Perception about Nutritional Problems and Food intakes, Nutrition Knowledge Score and Realities of Nutrition Education between Parents and Preschool Teachers / 대한지역사회영양학회지

This study was conducted to investigate the difference of perception about nutritional problems and food intakes and nutrition knowledge score and realities of nutrition education between parents and preschool teachers. This research can be summarized as follows: there was the statistical difference of perception (chi2 = 52.451, p = 0.000) about nutritional problem of preschoolers between parents and preschool teachers. Parents (56.4%) and teachers (58.5%) identified eating only what they want as the most common nutritional problem of children, but they had different perception about the other problems. To parents, "No nutritional problem" (16.3%) is the second and "Overindulgence of processed food" (11.1%) is the third problem of preschoolers. To teachers, "Overindulgence of processed food" (23.8%) is the second and "Obesity" (14.3%) is the third problem. The perception on food intakes of preschoolers was statistically different in meats (chi2 = 8.892, p = 0.030), fish (chi2 = 32.241, p = 0.000), beans (chi2 = 14.770, p = 0.005), vegetables (chi2 = 12.706, p = 0.013), fruits (chi2 = 14.438, p = 0.006) and milk & dairy products (chi2 = 28.591, p = 0.000) between parents and preschool teachers. However, nutritional knowledge was not different between parents and preschool teachers. While 96.6% of preschool teachers felt that it was necessary to educate preschoolers, only 41.5% of them said that they fulfilled nutrition education, showing that nutrition education was not adequately carried out on the spot. Therefore providing basic materials through which nutritional management guidance and proper nutrition education for preschoolers can be carried out by investigating and analyzing knowledge on their nutrition and meal guidance activities for preschooler teachers and parents.

The effects of newly formed synthetic peptide on bone regeneration in rat calvarial defects

PURPOSE: Significant interest has emerged in the design of cell scaffolds that incorporate peptide sequences that correspond to known signaling domains in extracellular matrix and bone morphogenetic protein. The purpose of this study was to evaluate the bone regenerative effects of the synthetic peptide in a critical-size rat calvarial defect model. METHODS: Eight millimeter diameter standardized, circular, transosseus defects created on the cranium of forty rats were implanted with synthetic peptide, collagen, or both synthetic peptide and collagen. No material was was implanted the control group. The healing of each group was evaluated histologically and histomorphometrically after 2- and 8-week healing intervals. RESULTS: Surgical implantation of the synthetic peptide and collagen resulted in enhanced local bone formation at both 2 and 8 weeks compared to the control group. When the experimental groups were compared to each other, they showed a similar pattern of bone formation. The defect closure and new bone area were significantly different in synthetic peptide and collagen group at 8 weeks. CONCLUSIONS: Concerning the advantages of biomaterials, synthetic peptide can be an effective biomaterial for damaged periodontal regeneration.

Two Cases of Bacteremia Caused by Community-Associated Methicillin-Resistant Staphylococcus aureus

Recent reports have described an increasing incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in patients who do not exhibit established risk factors for healthcare exposure. We report two cases of CA-MRSA bacteremia complicated by vertebral osteomyelitis. Both of CA-MRSA isolates were resistant to beta-lactam agents, but susceptible to clindamycin, trimethoprim-sulfamethoxazole, gentamicin, ciprofloxacin, and tetracycline. Both isolates carried staphylococcal cassette chromosome mec (SCCmec) type IVA, and were identified as sequence type (ST) 72 by mlultilocus sequence typing (MLST). However, the Panton-Valentine leukocidin (PVL) gene was not identified.

Two Cases of Bacteremia Caused by Community-Associated Methicillin-Resistant Staphylococcus aureus

Recent reports have described an increasing incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in patients who do not exhibit established risk factors for healthcare exposure. We report two cases of CA-MRSA bacteremia complicated by vertebral osteomyelitis. Both of CA-MRSA isolates were resistant to beta-lactam agents, but susceptible to clindamycin, trimethoprim-sulfamethoxazole, gentamicin, ciprofloxacin, and tetracycline. Both isolates carried staphylococcal cassette chromosome mec (SCCmec) type IVA, and were identified as sequence type (ST) 72 by mlultilocus sequence typing (MLST). However, the Panton-Valentine leukocidin (PVL) gene was not identified.

Factors for Determining Survival in Acute Organophosphate Poisoning

BACKGROUND/AIMS: Organophosphate poisoning has a high mortality rate. Recently, differences among organophosphorus insecticides in human self-poisoning were reported. This study investigated the prognostic risk factors and the mortality of different organophosphates following acute organophosphate poisoning. METHODS: This retrospective study included 68 patients with acute organophosphate poisoning. We investigated patient survival according to initial parameters, including the initial Acute Physiology and Chronic Health Evaluation (APACHE) II score, serum cholinesterase level, and hemoperfusion and evaluated the mortality according to organophosphate types. RESULTS: Thirteen of the 68 patients died. The agents responsible for mortality were different. The APACHE II score was a significant predictor of mortality (odds ratio [OR], 1.194; p<0.01; 95% confidence interval [CI], 1.089 to 1.309) and respiratory failure (OR, 1.273; p<0.01; 95% CI, 1.122 to 1.444). The mortality was 0% for dichlorvos, malathion, chlorpyrifos and profenofos. However, other organophosphates showed different mortality (16.7% for O-ethyl-O-4-nitrophenyl phenylphosphonothioate, 25% for phenthoate, 37.5% for phosphamidon, 50% for methidathion). The usefulness of hemoperfusion appears to be limited. CONCLUSIONS: The initial APACHE II score is a useful prognostic indicator, and different organophosphates have different mortality.

Effects of rhBMP-2 with various carriers on bone regeneration in rat calvarial defect / 대한치주과학회지

PURPOSE: Bone morphogenetic protein (BMP) is a potent differentiating agent for cells of the osteoblastic lineage. It has been used in the oral cavity under a variety of indications and with different carriers. However, the optimal carrier for each indication is not known. This study evaluated the bone regenerative effect of rhBMP-2 delivered with different carrier systems. MATERIALS AND METHODS: 8 mm critical-sized rat calvarial defects were used in 60 male Sprague-Dawley rats. The animals were divided into 6 groups containing 10 animals each. Two groups were controls that had no treatment and absorbable collagen membrane only. 4 groups were experimentals that contained rhBMP-2 only and applied with absorbable collagen sponge(Collatape(R)), MBCP(R), Bio-Oss(R) each. The histological and histometric parameters were used to evaluate the defects after 2- or 8-week healing period. The shape and total augmented area were stable in all groups over the healing time. RESULTS: New bone formation was significantly greater in the rhBMP-2 with carrier group than control group. rhBMP-2/ACS was the highest in bone density but gained less new bone area than rhBMP-2/MBCP(R) and rhBMP-2/Bio-Oss(R). The bone density after 8 weeks was greater than that after 2 weeks in all groups. However, rhBMP-2 alone failed to show the statistically significant difference in new bone area and bone density compared to control group. Also MBCP(R) and Bio-Oss(R) particles remained after 8 weeks healing period. CONCLUSION: These results suggest that rhBMP-2 with carrier system is an excellent inductive agent for bone formation and we can use it as the predictable bone tissue engieering technique. Future study will likely focus on the kinetics of BMP release and development of carriers that is ideal for it.

Effects of capsaicin on the c-fos Protein-like immunoreactivities in the spinal cord and substance P- and CGRP-like immunoreactivities in the dorsal root ganglia of the experimental arthritic rat model / 대한해부학회지

To analyze the effects of capsaicin administered to the arthritic rat model, immunohistochemical stains for c-fos protein in the spinal dorsal horn and for substance P and CGRP in the dorsal root ganglia (DRG) were done. Kaolin and careegenan were administered to the knee joint cavity of adult rats to induce arthritis, and capsaicin was administered immediately after kaolin-careegenan injection. A count was conducted of the c-fos immunoreactive dorsal horn neurons and substance P and CGRP immunoreactive cells in L5 and L6 DRG to elucidate the effect of capsaicin. The results were summarized as follows. 1. The number of c-fos immunoreactive neurons in the superficial dorsal horn was increased markedly 2 hours after the kaolin and careegenan injection to the knee joint, and decreased gradually to the control level 1 week after injection. 2. The number of c-fos immunoreactive neurons in the superficial dorsal horn of capsaicin- treated rats was less than in those rats not injected with capsaicin. 3. The number of c-fos immunoreactive neurons in the deep dorsal horn was increased later than those in the superficial dorsal horn and reached peak level 16 hours after the kaolin and careegenan injection, and decreased gradually therafter. 4. The number of c-fos immunoreactive neurons in the deep dorsal horn of the capsaicin treated rats was less than in those rats not treated with capsaicin. 5. The number of substance P and CGRP immunoreactive DRG neurons increased 24 hours after the kaolin and careegenan injection to the knee joint, and also apparently increased 1 week after injection. 6. The number of substance P and CGRP immunoreactive DRG neurons of capsaicin- treated rats was less than in those rats not treated with capsaicin administered rats. Capsaicin reduces the number of c-fos immunoreactive neurons in the spinal dorsal horn, and also reduces the number of substance P and CGRP immunoreactive neurons in the DRG of the arthritic rat model, which may be closely related to the analgesic effects of capsaicin.