Survey on Transfusion Laboratory Work inMedical Institutions Participating in the ExternalQuality Control Program for Blood Bank

Background@#Laboratory tests in blood banks vary with respect to methods,equipment, and quality control according to the hospital’s environment. @*Methods@#We surveyed institutions that regularly participated in the Koreanassociation of external quality assessment using a web-based questionnairecomprising 79 questions regarding transfusion laboratory work. @*Results@#A total of 84 institutions were surveyed including 17 senior generalhospitals, 43 general hospitals, 19 hospitals, four clinics, and one commerciallaboratory. ABO cell typing was performed by slide (63, 75.0%), tube (42,50.0%), automated column (19, 22.6%), and automated microplate (7, 8.3%)methods. ABO serum typing was performed by tube (75, 89.3%), automatedcolumn (19, 22.6%), automated microplate (7, 8.3%), and slide (7, 8.3%)methods. Irregular antibody screening test and identification test wasperformed by 58 (69.0%) and 36 (42.9%) institutions, respectively. Irregularantibody screening test and identification test was performed by the columnagglutination method in 34 (40.5%) and 26 (31.0%) institutions, respectively.Room temperature saline, albumin, and anti-globulin reagent crossmatchingtest (three-step method) was the most popular method (48, 57.1%). Theuse of anti-globulin reagent in the crossmatching test did not significantlyvary according to the size of the hospital. A daily quality control programfor ABO, Rh typing, and the crossmatching test was conducted in 58 (69.0%)institutions. @*Conclusions@#There were differences in transfusion-related laboratory testsamong the institutions. Although this survey included a limited number ofinstitutions, it can be helpful to evaluate the routine laboratory tests andtransfusion-related blood bank work in each institution.

Evaluation of Noninvasive Liver Fibrosis Blood Markers in Patients with Chronic Hepatitis B and Hepatitis C

BACKGROUND: Liver fibrosis evaluation is an important issue in chronic liver disease patients. We aimed to develop noninvasive liver fibrosis biomarkers based on transient elastography (TE, FibroScan®) through retrospective review of clinicopathological data. METHODS: We recruited 278 chronic hepatitis B patients who underwent Fibroscan and HBV DNA testing. A total of 115 HBeAg-positive and 159 HBeAg-negative chronic hepatitis B patients were analyzed. A total of 100 hepatitis C patients were analyzed. Successful fibroscan data, gamma-glutamyl transferase (GGT) to platelet ratio (GPR), platelet count, AST, ALT, international normalized ratio of prothrombin time, total cholesterol, triglycerides, bilirubin, mean platelet volume, AST to platelet ratio index, fibrosis index based on four factors (FIB-4), neutrophil to lymphocyte ratio (NLR), and NLR to platelet ratio were analyzed to determine the new noninvasive markers for assessing liver fibrosis. RESULTS: Elevated GPR (OR=9.1, P=0.011) and FIB-4 (OR=2.3, P=0.01) were associated with greater risk of liver fibrosis in chronic hepatitis B patients. FIB-4 (OR=6.04, P=0.005) was a risk factor for liver fibrosis in HBeAg-positive patients. FIB-4 (OR=2.371, P=0.015) and GPR (OR=33.78, P=0.003) were liver fibrosis risk factor in HBeAg-negative patients. In chronic hepatitis C patients, GGT (OR=1.033, P=0.002), triglyceride (OR=−0.990, P=0.038) and FIB-4 (OR=3.499, P=0.006) showed statistical significances. The AUCs were 0.816 in FIB-4 (P<0.001) and 0.849 in GPR (P<0.001). CONCLUSIONS: FIB-4 and GPR may be useful blood markers for assessing liver fibrosis in chronic hepatitis B and hepatitis C patients. Further well-designed prospective study is required to validate these noninvasive blood markers in clinical practice.

Comparison between Medion Vacuon Tube and BD Vacutainer Tube for Clinical Laboratory Practice

BACKGROUND: Most of the blood-test samples are collected and carried in vacuum tubes. We have compared a newly developed vacuum tube, ‘Vacuon’ (Medion, Korea) and ‘BD Vacutainer®’ (BD, USA) in three common clinical assays, i.e., hematological, chemical, and immunological tests. METHODS: A sum of 60 healthy volunteers were recruited in our study and their peripheral blood samples were collected in the tubes of the two brands. EDTA-tube samples were evaluated using 25 hematological tests. Serum separating tube samples were analyzed for 24 chemical parameters and the 3 thyroid hormones. The results were statistically analyzed using the paired t-test and Bland-Altman plot. In addition, the assay outcomes at t=0 hr were compared with those at t=24±2 hr for each of the tubes. RESULTS: The assay results of 22 hematological parameters, 24 chemical parameters, and 3 thyroid hormones had a statistically significant correlation between the 2 brands of vacuum tubes (t=0 hr). Two hematological parameters (mean corpuscular hemoglobin concentration [MCHC] and cell hemoglobin concentration mean [CHCM]) showed higher mean values, while a hematological parameter (lobularity index [LI]) showed lower mean values in Vacuon than BD Vacutainer (t=0 hr). The results after 24 hr showed similarity between the 2 brands, with some inconsistent results in BD Vacutainer (Mean platelet volume [MPV], plateletcrit [Pct], eosinophil, calcium, and triiodothyronine) and Vacuon (MPV, hemoglobin distribution width [HDW], CHCM, Pct, eosinophil, and calcium). CONCLUSIONS: BD Vacutainer and Vacuon tube showed good statistical concordance rate with some exceptions in the hematological parameters (MCHC, CHCM, and LI).

Algorithm for Differential Diagnosis of in Vitro and in Vivo Hemolysis in Anticoagulated Blood Specimens

BACKGROUND: Hemolytic specimens contain components that interfere with clinical laboratory results. We evaluated previously published hemolysis indices (HI) and developed an algorithm for differentiating between mechanical hemolysis and immune-mediated hemolysis based on complete blood count (CBC). METHODS: Sixty-three residual EDTA (ethylenediamine tetraacetic acid)-anticoagulated blood specimens were obtained during regular health check-ups, and each specimen was divided into 3 aliquots (A control, B, and C group). Aliquots B and C were mechanically hemolysed by 2 and 5 aspirations, respectively, using a 25-gauge needle before testing; aliquot A was analysed immediately without hemolysis. Additionally, we collected 36 specimens from patients suspected of having immune-mediated hemolysis after thorough reviewing their various laboratory results including direct antiglobulin test. We compared CBC parameters between the groups (A, B, C, D [B+C], and E [immune-mediated hemolysis group]). RESULTS: Our HI scoring system using the sum of red blood cell ghosts, measured hemoglobin-calculated hemoglobin, mean corpuscular hemoglobin concentration-corpuscular hemoglobin concentration mean, and mean platelet volume rather than mean corpuscular hemoglobin, effectively identified mechanical hemolysis; the results were similar to those of previous studies. Furthermore, the HI score using the sum of mean corpuscular volume, red cell distribution width, hemoglobin distribution width, polymorphonuclear %, and neutrophil % differentiated mechanical hemolysis from immune-mediated hemolysis (cut-off, 9; sensitivity, 91.7%; specificity, 92.9%; area under the receiver operating characteristic curve, 0.965 [95% confidence interval, 0.924–0.988]). CONCLUSIONS: The newly developed algorithm may provide effective screening for detecting hemolysis and differential diagnosis of mechanical hemolysis and immune-mediated hemolysis based on CBC results.

A Rare Case of Polycythemia Vera Following Acute Undifferentiated Leukemia Remission

No abstract available.

The Role of the Laboratory Physician for Blood Bank in Local Hospital / 대한수혈학회지

The goal of the laboratory physician is to achieve appropriate laboratory management for diagnosis of disease, proper therapy directions, anticipation of prognosis, health checkup, and consultation with each clinical department. In the laboratory department, the blood bank works with blood, which is a precious resource for appropriate care of patients. This article described the role of the laboratory physician in the blood bank of the local hospital, which is a common hospital type in Korea. The environment of laboratory medicine is constantly changing and tends to be restricted due to health insurance burdens. The blood bank has essential characteristics which remind laboratory physicians of the need for safe and proper usage of blood. The role of the transfusion medicine specialist in the local hospital is summarized as 1) central role as the manager for proper and safe transfusion 2) education of hospital workers, including clinical physicians 3) strict quality control and participation in laboratory accreditation programs 4) consultation with hospital staff 5) continued promotion of quality improvement 6) assessment of proper and safe blood usage 7) proper management of hospital transfusion committee 8) participation in hemovigilance programs 9) development of new laboratory territory. Laboratory physicians should obey the principles of transfusion medicine and make an effort to manage the blood bank efficiently.

Evaluation of Bio-Rad D-10 HbA1c Autoanalyzer / 임상검사와정도관리

BACKGROUND: Hemoglobin A1c (HbA1c) is a useful marker for the diagnosis and monitoring of diabetes, which has resulted in an increasing dependency on HbA1c levels for diagnosing diabetes in small- and medium-sized hospitals. We evaluated a high performance liquid chromatography (HPLC) based HbA1c autoanalyzer Bio-Rad D-10 (Bio-Rad Laboratories, USA) by comparing the analysis results with that by Tosoh HLC-723 G7 (Tosoh Corporation, Japan). METHODS: The Bio-Rad D-10 autoanalyzer was evaluated for its precision, linearity, and carryover. The analysis time and correlation were evaluated and compared with those by Tosoh HLC-723 G7 autoanalyzer. RESULTS: Bio-Rad D-10 showed within-run, between-day, and total precision of less than 1.3% coefficient of variation (CV) and excellent linearity between HbA1c in the range of 3.2%-21% (coefficient of determination, R 2 = 0.998). The sampleto-sample carryover was 0.57%. The results obtained by using Bio-Rad D-10 showed good correlation (r = 0.997; P < 0.001) with those by Tosoh HLC-723 G7; however, the analysis time using Bio-Rad D-10 was about 2.3 times per 10 samples and 2.5 times per 20 samples than those using Tosoh HLC-723 G7. CONCLUSIONS: Bio-Rad D-10 showed good performance in assaying HbA1c. Bio-Rad D-10 autoanalyzer would be suitable for use in laboratories with small to medium amount of samples to be analyzed, but its initial analyzing time was longer than that by Tosoh HLC-723 G7.

Analysis of the Patients with Indeterminate Results by Anti-HIV Western Blot Assay: Experience of a University Hospital During Recent 5 Years in Korea / 임상검사와정도관리

BACKGROUND: Interpretation of indeterminate results by anti-HIV Western blot assay, which is currently used as a confirmatory test for HIV infection, can be usually difficult. We analyzed outcomes of the patients with indeterminate results by anti-HIV Western blot. METHODS: Medical records of patients, who were indeterminate by the anti-HIV Western blot assay in a university hospital during recent 5 years, were retrospectively reviewed. HIV screening test was performed by chemiluminescent immunoassay autoanalyzer (Abbot Laboratories, USA) with HIV Ag/Ab Combo kits. Confirmatory Western blot assay for the positive samples by HIV screening test was committed to the Korean National Institute of Health. RESULTS: A total of 202,639 specimens were tested for HIV screening during the period, and 644 (0.32%) sera showed positive results. Among these, 46 (7.1%) cases were indeterminate by the Western blot, which were from 20 patients, and 13 of them converted to be anti-HIV positive, and 3 were lost to follow-up. Another four patients were turned out to be negative for HIV infection, including two neonates from HIV-positive mothers receiving antiviral treatment during pregnancy. CONCLUSIONS: Most of the patients who showed Western blot-indeterminate results converted to HIV positive after follow-up. Thus, careful monitoring of patients with indeterminate Western blot results should be essential.

Characteristics of Occupational Exposure to Benzene during Turnaround in the Petrochemical Industries

OBJECTIVES: The level of benzene exposure in the petrochemical industry during regular operation has been well established, but not in turnaround (TA), where high exposure may occur. In this study, the characteristics of occupational exposure to benzene during TA in the petrochemical companies were investigated in order to determine the best management strategies and improve the working environment. This was accomplished by evaluating the exposure level for the workers working in environments where benzene was being produced or used as an ingredient during the unit process. METHODS: From 2003 to 2008, a total of 705 workers in three petrochemical companies in Korea were studied. Long- and short-term (< 1 hr) samples were taken during TAs. TA was classified into three stages: shut-down, maintenance and start-up. All works were classified into 12 occupation categories. RESULTS: The long-term geometric mean (GM) benzene exposure level was 0.025 (5.82) ppm (0.005-42.120 ppm) and the short-term exposure concentration during TA was 0.020 (17.42) ppm (0.005-61.855 ppm). The proportions of TA samples exceeding the time-weighted average, occupational exposure level (TWA-OEL in Korea, 1 ppm) and the short-term exposure limit (STEL-OEL, 5 ppm) were 4.1% (20 samples of 488) and 6.0% (13 samples of 217), respectively. The results for the benzene exposure levels and the rates of exceeding the OEL were both statistically significant (p < 0.05). Among the 12 job categories of petrochemical workers, mechanical engineers, plumbers, welders, fieldman and scaffolding workers exhibited long-term samples that exceeded the OEL of benzene, and the rate of exceeding the OEL was statistically significant for the first two occupations (p < 0.05). CONCLUSION: These findings suggest that the periodic work environment must be assessed during non-routine works such as TA.

Characteristics of Occupational Exposure to Benzene during Turnaround in the Petrochemical Industries

OBJECTIVES: The level of benzene exposure in the petrochemical industry during regular operation has been well established, but not in turnaround (TA), where high exposure may occur. In this study, the characteristics of occupational exposure to benzene during TA in the petrochemical companies were investigated in order to determine the best management strategies and improve the working environment. This was accomplished by evaluating the exposure level for the workers working in environments where benzene was being produced or used as an ingredient during the unit process. METHODS: From 2003 to 2008, a total of 705 workers in three petrochemical companies in Korea were studied. Long- and short-term (< 1 hr) samples were taken during TAs. TA was classified into three stages: shut-down, maintenance and start-up. All works were classified into 12 occupation categories. RESULTS: The long-term geometric mean (GM) benzene exposure level was 0.025 (5.82) ppm (0.005-42.120 ppm) and the short-term exposure concentration during TA was 0.020 (17.42) ppm (0.005-61.855 ppm). The proportions of TA samples exceeding the time-weighted average, occupational exposure level (TWA-OEL in Korea, 1 ppm) and the short-term exposure limit (STEL-OEL, 5 ppm) were 4.1% (20 samples of 488) and 6.0% (13 samples of 217), respectively. The results for the benzene exposure levels and the rates of exceeding the OEL were both statistically significant (p < 0.05). Among the 12 job categories of petrochemical workers, mechanical engineers, plumbers, welders, fieldman and scaffolding workers exhibited long-term samples that exceeded the OEL of benzene, and the rate of exceeding the OEL was statistically significant for the first two occupations (p < 0.05). CONCLUSION: These findings suggest that the periodic work environment must be assessed during non-routine works such as TA.

Comparisons of Three Automated Systems for Genomic DNA Extraction in a Clinical Diagnostic Laboratory

PURPOSE: The extraction of nucleic acid is initially a limiting step for successful molecular-based diagnostic workup. This study aims to compare the effectiveness of three automated DNA extraction systems for clinical laboratory use. MATERIALS AND METHODS: Venous blood samples from 22 healthy volunteers were analyzed using QIAamp(R) Blood Mini Kit (Qiagen), MagNA Pure LC Nucleic Acid Isolation Kit I (Roche), and Magtration-Magnazorb DNA common kit-200N (PSS). The concentration of extracted DNAs was measured by NanoDrop ND-1000 (PeqLab). Also, extracted DNAs were confirmed by applying in direct agarose gel electrophoresis and were amplified by polymerase chain reaction (PCR) for human beta-globin gene. RESULTS: The corrected concentrations of extracted DNAs were 25.42 +/- 8.82 ng/microLiter (13.49-52.85 ng/microLiter) by QIAamp(R) Blood Mini Kit (Qiagen), and 22.65 +/- 14.49 ng/microLiter (19.18-93.39 ng/microLiter) by MagNA Pure LC Nucleic Acid Isolation Kit I, and 22.35 +/- 6.47 ng/microLiter (12.57-35.08 ng/microLiter) by Magtration-Magnazorb DNA common kit-200N (PSS). No statistically significant difference was noticed among the three commercial kits (p > 0.05). Only the mean value of DNA purity through PSS was slightly lower than others. All the extracted DNAs were successfully identified in direct agarose gel electrophoresis. And all the product of beta-globin gene PCR showed a reproducible pattern of bands. CONCLUSION: The effectiveness of the three automated extraction systems is of an equivalent level and good enough to produce reasonable results. Each laboratory could select the automated system according to its clinical and laboratory conditions.

Identification of Adenovirus, Influenza Virus, Parainfluenza Virus, and Respiratory Syncytial Virus by Two Kinds of Multiplex Polymerase Chain Reaction (PCR) and a Shell Vial Culture in Pediatric Patients with Viral Pneumonia

PURPOSE: Early identification of causative agents in lower respiratory infection of pediatric patients can reduce morbidity and prevent an overuse of antimicrobials. Two kinds of multiplex polymerase chain reaction (PCR) and a commercial shell vial viral culture were performed to identify causative agents in pediatric patients. MATERIALS AND METHODS: Nasopharyngeal aspirates of 220 children diagnosed with viral pneumonia were obtained. Two kinds of multiplex PCR (Seeplextrade mark RV detection kit, and Labopasstrade mark RV detection kit), and a shell vial culture by R-Mix were performed. RESULTS: Positive samples from 220 total samples by two multiplex PCRs were 52.7% and 46.4%, respectively. We also cultured 103 samples that showed positive results of the adenovirus, influenza virus, parainfluenza virus, and respiratory syncytial virus (RSV) by two multiplex PCR. The RSV was most frequently detected in 53.0% (Seeplex) and 51.7% (Labopass) of patients. The detection rate of adenovirus (AdV) was 10.3% and 12.1%, influenza virus (IFV) A and B was 12.5% and 3.4%, and parainfluenza virus (PIFV) 1, 2, and 3 were 2.9% and 2.6%. Shell vial cultures showed concordant results with each multiplex PCR by 96.1% and 77.7%, respectively. Sequencing results were 90% consistent with multiplex PCR. CONCLUSION: Multiplex PCR showed more positivity than the shell vial culture and it can be an effective primary test. Other complementary efforts such as viral cultures and sequencing analysis could be considered, according to clinical and laboratory conditions.

Arg72Pro Polymorphism and Exon 7 Codon 249 Mutation of Plasma DNA p53 Gene in Early Hepatocellular Carcinoma Patients with Hepatitis B Virus Infection in a Korean population / 임상검사와정도관리

BACKGROUND: This study was performed to investigate on the genotypic frequencies of p53 Arg72Pro polymorphism and the prevalence of p53 codon 249 mutation in hepatocellular carcinoma patients. METHODS: Plasma DNAs were extracted from the samples of 44 early HCC cases, 24 chronic B-viral hepatitis patients and 27 healthy individuals. Serum levels of AFP, PIVKA-II, and HBV DNA-positive rates among the study groups were also compared. PCR-based restriction fragment length polymorphism method was used to determine p53 Arg72Pro genotype and to detect codon 249 mutation. RESULTS: Serum AFP and PIVKA-II level, Edmondson grade, tumor size and frequency of HBV DNA-positivity among HCC group according to Arg72Pro genotypes showed no statistically significant difference. The frequencies of Arg72Pro genotypes (Arg/Arg, Arg/Pro, Pro/Pro) were respectively as follows: 34.1%, 47.7%, 18.2% in HCC group; 29.2%, 54.2%, 16.7% in hepatitis group; 29.6%, 55.6%, 14.8% in control group. Pro homozygote genotype had a higher risk for developing HCC by adjusted OR (1.529, 95% CI 0.325-7.193), but not statistically significant (P=0.591). No codon 249 mutation was found among 44 HCC cases. CONCLUSIONS: Pro homozygote was around 16% in all study groups, and did not statistically increase risks to developing HCC. We suggest that Arg72Pro polymorphism of p53 gene is not a significant risk factor in early hepatocarcinogenesis.

Automated Collection of Leukoreduced Double Red Blood Cell Units using an Alyx Apheresis Device / 대한수혈학회지

BACKGROUND: Automated collection of leukoreduced double red blood cell (RBC) units has been used to improve blood collection efficiency in many countries. The aim of this study was to evaluate leukoreduced double RBC unit collection using apheresis and to determine its clinical uses. METHODS: Automated leukoreduced double RBC units were collected from 17 healthy male volunteers using an Alyx apheresis device (Baxter, DeerWeld, IL). Our institutional criteria for male donors were as follows: height > or =170 cm, weight > or =70 kg, and hemoglobin > or =14.5 g/dL. Each donor's complete blood count (CBC) was determined before and after the apheresis procedure. In order to validate the final leukoreduced double RBC units, white blood cell (WBC) counts were measured manually using a Nageotte chamber. RESULTS: Leukoreduced double RBC units were collected in an average of 27+/-7 min, without specific donor reactions. The average volume of one unit of leukoreduced RBCs was 281+/-6 mL. Each donor's hemoglobin (P<0.001) and hematocrit (P<0.001) were significantly lower after donation, though WBC and platelet counts were no different. No residual WBCs were found in the leukoreduced, filtered product upon Nageotte chamber counting. Twenty-eight units of leukoreduced RBCs from 14 donors were transfused to patients who required leukoreduced RBCs, without specific transfusion reactions. CONCLUSION: The Alyx apheresis device allowed for safe and effective collection of leukoreduced double RBC units from a single donor. Automatically collected leukoreduced double RBC units were transfused to patients for the first time in Korea.

Automated Collection of Leukoreduced Double Red Blood Cell Units using an Alyx Apheresis Device / 대한수혈학회지

BACKGROUND: Automated collection of leukoreduced double red blood cell (RBC) units has been used to improve blood collection efficiency in many countries. The aim of this study was to evaluate leukoreduced double RBC unit collection using apheresis and to determine its clinical uses. METHODS: Automated leukoreduced double RBC units were collected from 17 healthy male volunteers using an Alyx apheresis device (Baxter, DeerWeld, IL). Our institutional criteria for male donors were as follows: height > or =170 cm, weight > or =70 kg, and hemoglobin > or =14.5 g/dL. Each donor's complete blood count (CBC) was determined before and after the apheresis procedure. In order to validate the final leukoreduced double RBC units, white blood cell (WBC) counts were measured manually using a Nageotte chamber. RESULTS: Leukoreduced double RBC units were collected in an average of 27+/-7 min, without specific donor reactions. The average volume of one unit of leukoreduced RBCs was 281+/-6 mL. Each donor's hemoglobin (P<0.001) and hematocrit (P<0.001) were significantly lower after donation, though WBC and platelet counts were no different. No residual WBCs were found in the leukoreduced, filtered product upon Nageotte chamber counting. Twenty-eight units of leukoreduced RBCs from 14 donors were transfused to patients who required leukoreduced RBCs, without specific transfusion reactions. CONCLUSION: The Alyx apheresis device allowed for safe and effective collection of leukoreduced double RBC units from a single donor. Automatically collected leukoreduced double RBC units were transfused to patients for the first time in Korea.

A Case of Hemolytic Transfusion Reaction in a Patient with Anti-E, Anti-M, Anti-Jkb, and Anti-Lea / 대한수혈학회지

We reported a case of hemolytic transfusion reaction that was related to multiple RBC antibodies such as anti-E, anti-M, anti-Jkb and anti-Lea after serial RBC transfusions. A forty-nine year old female visited the emergency room (ER) with hematochezia. She had previously received 16 units of packed RBCs from 2003 to Jan 2007 for her intermittent esophageal varix bleeding. No specific antibodies were identified before this visiting. At the ER, under the request for packed RBCs, we identified anti-E antibody within her serum. Her blood type was AB, RhD+ with the phenotype of CcDe. She received 5 units of E antigen negative RBCs. However, she showed hemolytic transfusion reactions such as mild fever with a decrease of hemoglobin from 11.4 g/dL to 6.8 g/dL after the transfusion. From the 8th to the 10th hospital day, another 3 units of E-antigen negative with the least incompatible RBCs were transfused to the patient, but the level of hemoglobin was not definitely increased. At the 14th hospital day, she received a final 2 units of leuko-reduced RBCs without E, M and Jkb antigens. Her hemoglobin was increased right after the final transfusion. We found that the patient's serum reacted with multiple RBC antibodies such as anti-E, anti-M, anti-Jkb and anti-Lea antibodies. She finally recovered from acute varix bleeding and was discharged on the 26th hospital day with the level of hemoglobin being 8.3 g/dL.

The Changes in stress, symptoms, coping responses, and health behaviors during the IMF crisis

BACKGROUND: In Korea, there were many socioeconomic changes under the IMF management system. Therefore we assumed that the stress levels increased. This study was done to investigate the changes in people's stress, health behaviors, symptoms, and coping responses which might be affected by socioeconamic changes during the IMF crisis with in 1 year. METHODS: In September, 1998, we sent questionnaires to a total of 560 persons who were over 18 years old and lived in Changwon city. We chose 359 subject who completed the survey. Assuming that the stress of ones own marriage was 50 points, we asked them what degree of stress was the previaus year and after August of 1997. Also, we asked them to estimate how much degree of stress had changed based on the 17 factors of life events according to Likert 5 points scale. Specifically, we investigated on how health behaviors were chared, how people responded to stress by using 19 coping options of Billing and Moos, and how the 20 symptoms were changed. RESULTS: 71.7% of subjects replied that income was within 1 year. The amount of stress was increased by 13.2 points compared to the stress previous year. The levels stress in men increased significantly more than in women(P=0.003), but there were no significant differences in terms of marital status, education, and age. With respect to the change of health behaviors, there was a tendency that the amount of exercise decreased significantly in subjects who had more stress(P=0.020). But there was no significant difference in the amount of smoking and drinking, in the frequency of drinking,sleeping time, and the regularity of eating. The health behavior score, the number of positive health behaviors, was significantly changed to negative in those whose stress increased(P=0.015). There was a tendency that the frequency of 15 symptoms among 20 symptoms significantly increased in those whose stress increased. Also, those whose stress increased significantly used more avoidant coping respanses(P=0.007). CONCLUSIONS: In this study, we found that those whose stress levels increased within 1 year compared to the year before up to September of 1987, had their health behaviors significantly deteriorated, and had more symptoms with avoidant coping responses. In conclusion, we suggest that those whose stress levels increased should be guided to promote good health behaviors, to use active coping responses rather than avoidant coping responses, and should be given more social support.

A CLINICAL STUDY OF MAXILLARY SINUS GRAFT FOR IMPLANT PLACEMENT

Statistical study of size of the cranium in parents of children with cleft lip and/ or palate

No abstract available.

Statistical Studies on Pediatric Emergency Room Patients

The authors reviewed 1134 pediatric patients in the ebergency room in this hospital during 5 years period from Jan. 1979. to Dec. 1979. The results were obtained as follows: 1) Among the patients visiting the emergency room, the patients under 15 years of age were 6.1%(1134) of total emergency patients(18447). 2) The male to female ratio was 1.5:1. 3) The highest age group was in the 3-5 years, and the patients in this age group were occupied 23.8%. The age distribution showed that 57.7% was under the 5 years of age. 4) Seasonal distribution of patients showed high incidence in summer(June, July, and Aug.). 5) The most popular time of visiting the emergency room was between 8:00 P.M. to 12:00 P.M. at which time about 32.8% of patients were seen. 6) Distribution of cases as follows: Respiratory disease 35.7%, accident 177% and gastrointestinal disease 14.8%, in turn, kusted reseoectuvely in decresing order of frequency. URI was the most frequency, 25.1% of the total cases, The next diseases were diarrhea(9.5%), Bronchitis(6.6%) and febrile convulsion(6.3%) in turn decreasing order. 7) The most frequent case in various age groups was Respiratory disease. 8) Admission rate of total pediatric patients visiting ER was 7.4% by recommendation. Rate against recommendation of admission was 3.2% of total pediatric patients visiting ER. 9) We think the number of pediatric emergent patient is increasing due to understanding of community inhabitant.