A Case of Successful Spontaneous Pregnancy after Laparoscopic Radical Trachelectomy with Trans-Abdominal Cervicoisthmic Cerclage Treatment

Women in the reproductive age group diagnosed with cervical cancer can receive radical trachelectomy for fertility preservation. Extremely short cervix following radical trachelectomy could result in cervical incompetence. Although prophylactic cervicoisthmic cerclage is placed at the time of radical trachelectomy, it might not be sufficient to prolong pregnancy. We present a successful term pregnancy after laparoscopic radical trachelectomy and concurrent cervicoisthmic cerclage for early stage cervical cancer.

Korean Mothersafe Center 10th Anniversary: Outcome and Future Prospects

PURPOSE@#The purpose of this report is to organize the history of Korean Mothersafe, a professional teratology information center. Throughout its domestic and international activities, Mothersafe has firm role to write journals and books, to provide counseling, to run educational courses on maternal and fetal toxicology, and so on. This paper delineates the achievements in last ten years and discusses the vision of Mothersafe.@*METHODS@#In order to formulate the accomplishments of Korean Mothersafe, the volume of counseling calls are carefully reviewed by their contents, counselees, and the consultation results, etc. Textbooks and journals based on the data from Mothersafe are evaluated. Other roles of the Mothersafe, such as hosting symposium and running public programs are also noted.@*RESULTS@#Korean Mothersafe provided 76,555 counseling to 45,933 expectant women and 30,622 breast-feeding women. The database has total 52,130 enrollments from 2010 to 2019. A total of 33 papers are published regarding medication, alcohol, smoking, radiation, etc. A specialized book on maternal-fetal toxicology was published and teratology part of obstetrics textbook was updated. Education programs and symposiums were held and primary care programs for expectant parents are run by Mothersafe.@*CONCLUSION@#Korean Mothersafe has contributed to safe environments for numerous pregnant and breast-feeding women regarding medication, drinking, smoking, and other hazardous substances. The huge database provided evidence for researches, textbooks and seminars, etc. Korean Mothersafe is now facing a new challenge to go forward through social dynamics with many issues regarding prevention and continuance of pregnancy, abortion, and so on.

Four Consecutive Recurrent Abortions in Patient with Essential Thrombocythemia

Essential thrombocythemia (ET) is characterized by most cases in which platelet counts exceed 1 million/µL. ET is usually no symptoms during non-pregnancy, but arterial and venous thrombosis and hemorrhage may develop in pregnancy. Pregnancy in these patients is associated with many complications in both pregnant women and fetuses such as recurrent abortion, intrauterine fetal growth restriction, preterm delivery, preeclampsia, and stillbirth. In these patients, aspirin, low-molecular-weight heparin (LMWH), and interferon alpha (INF-α) are recommended during pregnancy. We report a case of four consecutive abortions despite being treated with INF-α, low dose aspirin, and LMWH in patient with ET.

A Case of Idiopathic Acute Hepatitis with Complications in Mid-Trimester Pregnancy

Although liver diseases in pregnancy are rare, they can seriously affect mother and fetus. Although any type of liver disease can develop during pregnancy, it is difficult to identify features of liver disease in pregnant women because of physiological changes. Physiologic changes of pregnancy can be confounding with the symptoms of liver diseases. It can not only complicate mother's life but also burden life of fetus to growth restriction. We describe an uncommon case of acute hepatitis with disseminated intravascular coagulation and clinical chorioamnionitis coincidentally in mid-trimester pregnancy. She experienced the development of acute hepatitis of unknown causes. She presented with fever, maternal tachycardia, and fetal tachycardia. We decided termination of pregnancy because of 16 weeks' gestation. After termination, she was managed about acute hepatitis. So we report our case with a brief reviews of the literature.

Medication Adherence and its Predictors in Community Elderly Patients with Hypertension

BACKGROUND: Medication adherence is important for hypertension management but still stay low level. It is reasonable method to classify medication nonadherence into intentional nonadherence and unintentional nonadherence and manage it according to this categories. This study aimed to explore medication adherence and its predictors in community patients with hypertension, especially dividing into intentional nonadherence and unintentional nonadherence. METHODS: Study subjects included 1,988 patients who were prescribed hypertension drugs among 2012 community health survey subjects of 10 cities in Gyeongsangnamdo and we analyzed medication adherence with hypertension and its predictors. We conducted chi-square test for nominal variable and ANOVA test for continuous variable and use multinominal regression to analyze independent predictors of intentional nonadherence and unintentional nonadherence in contrast to medication adherence. RESULTS: Of the 1,988 patients, 49.7% were adherent, 26.1% were unintentionally nonadherent and 24.2% intentionally nonadherent. Independent predictors of unintentional nonadherence were depressive symptoms (odds ratio [OR]=1.696, P=0.047) and arthritis (OR=1.319, P=0.030) and independent predictors of intentional nonadherence were cardiocerebrovascular disease (OR=1.464, P=0.044), self-efficacy (OR=0.984, P=0.007), beliefs about medications questionnaire (necessity [OR=0.834, P<0.001] and concern [OR=1.236, P<0.001]). CONCLUSIONS: In order to manage hypertension in community, improvement in medication adherence is needed. Depressive symptom and self-efficacy need to be managed, but especially patients'beliefs about their medication need to be considered to improve intentional nonadherence.

Physical disability, perceived dependence and depression in women with osteoarthritis / 農村醫學 地域保健

OBJECTIVE: This study assessed whether both physical disability and perceived dependence relate to depression or whether perceived dependence in personal care activities, household activities, community mobility and recreational activities is an intermediate step in the relationship between physical disability and depressive symptoms. METHODS: Data come from a cross-sectional survey of 209 women, aged 55 or older, with osteoarthritis (OA). Mediation analyses occurred in four step and included logistic regression analyses as outlined by Baron & Kenny. RESULTS: The results from step 1 showed that greater difficulty with each domain of physical disabilities was significantly related to greater perceived dependence. In step 2, greater perceived dependence was significantly associated with greater depressive symptoms in all domains. Step 3 analyses showed that greater physical disabilities in each domain were significantly associated with depression. The final step testing mediation indicated that personal care activities, household activities and community mobility were fully mediated by perceived dependence. That was, once dependence was taken into account, the relationship between physical disabilities and depression was no longer significant. Partial mediation was found for dependence and recreational activity limitations. CONCLUSION: It is important to take into account the experience of perceived dependence as a mediator in understanding the relationship between disability and depression in the domains of personal care, household, and community mobility. To conclude, these findings point to the importance of taking into account an individual's reaction to their disability rather than just focusing on the severity of disability.

The Association of Trust, Social Participation with Self-Rated Health Status: Mediating Effect of Depression / 農村醫學 地域保健

OBJECTIVES: This study was performed to investigate the relationship between individual-level social capital and depression. And, we assessed if depressive symptom mediates the relationship between social capital and self-rated health status. METHODS: Data from the 2011 Community Health Survey were analyzed for this study. We used chi-square tests and analyzed a four step approach in which several regression analyses were conducted and significance of the coefficients was examined at each step. RESULTS: In men, the results of controlling mediating factor (depression): social participation was not significantly associated with self-rated health status(p=0.082), the finding supports that social participation was fully mediated by depression. In women, the relationship between social capital(trust, social participation) and self-rated health status was partially mediated by depression. CONCLUSIONS: In order to increase self rated health status, not only improvement in trust and social participation are needed but effort to reduce depression must be combined.