The Effect of Residential Migration on the Utilization and Accessibility of Medical Care / 보건행정학회지

Background@#In Korea, the health gap widens due to the number of medical resources and access to medical services between metropolitan and rural. The purpose of this study is to identify the impact of residential migration on medical utilization and accessibility. @*Methods@#This study extracted 528,516 claimed cases in the National Health Insurance Service-Cohort Sample Database from 2006 to 2015. Subjects were classified into two groups by the magnitude of the region, the metropolitan and the rural. The inversed probability weights were calculated for each group. And coefficients of the two-part model were estimated by generalized estimation equation. @*Results@#Those who moved region from metropolitan to rural tend to increase the length of stay and inpatients with ambulatory care sensitive conditions (ACSC) disease. Contrariwise, those who moved areas from rural to metropolitan tend to decrease the total medical cost, the adjusted patient days, the number of outpatients and the number of outpatients and inpatients with ACSC disease. @*Conclusion@#This study identified that between the residents who continued to reside in the region and the migrants, there were significant differences in the medical accessibility, quality of primary care, and unmet medical need.

The Effect of Residential Migration on the Utilization and Accessibility of Medical Care / 보건행정학회지

Background@#In Korea, the health gap widens due to the number of medical resources and access to medical services between metropolitan and rural. The purpose of this study is to identify the impact of residential migration on medical utilization and accessibility. @*Methods@#This study extracted 528,516 claimed cases in the National Health Insurance Service-Cohort Sample Database from 2006 to 2015. Subjects were classified into two groups by the magnitude of the region, the metropolitan and the rural. The inversed probability weights were calculated for each group. And coefficients of the two-part model were estimated by generalized estimation equation. @*Results@#Those who moved region from metropolitan to rural tend to increase the length of stay and inpatients with ambulatory care sensitive conditions (ACSC) disease. Contrariwise, those who moved areas from rural to metropolitan tend to decrease the total medical cost, the adjusted patient days, the number of outpatients and the number of outpatients and inpatients with ACSC disease. @*Conclusion@#This study identified that between the residents who continued to reside in the region and the migrants, there were significant differences in the medical accessibility, quality of primary care, and unmet medical need.

The Survey of Recognition about Rehabilitative Robots for Treatmentin Physical Therapists

Purpose@#This study examined the recognition of rehabilitative robots for treatment in physical therapists. @*Methods@#This study surveyed 100 physical therapists in Seoul and Gyeonggi-do using Google Form, an online survey tool. The questionnaire consisted of 21 questions, including eight questions on the general characteristics, 13 questions on the recognition of rehabilitative robots. @*Results@#The general characteristics of the physical therapists showed differences and influences on recognition of rehabilitative robots, and there were statistically significant differences. There were significant differences in the recognition of rehabilitation robots according to general characteristics in gender, age, education degree, type of hospital, average weekly working time, and treatment field. Multiple regression analysis found that gender and the type of hospital influenced the recognition of rehabilitation robots. @*Conclusion@#Physical therapists showed differences in recognition of rehabilitative robots according to their general characteristics, and gender and the type of hospital influence the recognition of rehabilitation robots. Sufficient systematic education programs should be provided, and physical therapists require policy adjustments to increase their accessibility to rehabilitation robots through continuing education.

The Adaptation Processes of Family with Sudden Bereavement / 재활간호학회지

Purpose@#This study was attempted to develop an entity theory about the sudden bereavement experience with the family by understanding and describing the semantic system of the adaptation experience of the family who experienced sudden bereavement. @*Methods@#Data were collected through in-depth interview with a purposive sampling of nine people who experienced sudden bereavement. Data analysis was in the stages of open coding, axis coding, and selection coding by applying the grounded theory method. @*Results@#As a result of this study, the core categories was 'Accepting loss and enduring life', the central phenomenon was 'Heartbreaking grief', the context was 'Guilty and regret', the action/interaction strategy were 'Immerse in the sorrow', 'Accepting reality', and the intervention condition was 'Supporting system'. As a result, the sudden bereavement experience presented 'A life to start again' and 'A difficult daily life to endure'. @*Conclusion@#Based on the results of this study, it can be seen that systematic and professional counseling strategies, multidisciplinary intervention programs and programs are urgently needed to care for the bereaved family members.

The Survey of Recognition about Rehabilitative Robots for Treatmentin Physical Therapists

Purpose@#This study examined the recognition of rehabilitative robots for treatment in physical therapists. @*Methods@#This study surveyed 100 physical therapists in Seoul and Gyeonggi-do using Google Form, an online survey tool. The questionnaire consisted of 21 questions, including eight questions on the general characteristics, 13 questions on the recognition of rehabilitative robots. @*Results@#The general characteristics of the physical therapists showed differences and influences on recognition of rehabilitative robots, and there were statistically significant differences. There were significant differences in the recognition of rehabilitation robots according to general characteristics in gender, age, education degree, type of hospital, average weekly working time, and treatment field. Multiple regression analysis found that gender and the type of hospital influenced the recognition of rehabilitation robots. @*Conclusion@#Physical therapists showed differences in recognition of rehabilitative robots according to their general characteristics, and gender and the type of hospital influence the recognition of rehabilitation robots. Sufficient systematic education programs should be provided, and physical therapists require policy adjustments to increase their accessibility to rehabilitation robots through continuing education.

Treatment effects of mandibular total arch distalization using a ramal plate / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to evaluate treatment effects after distalization of the mandibular dentition using ramal plates through lateral cephalograms. METHODS: Pre- and post-treatment lateral cephalograms and dental casts of 22 adult patients (11 males and 11 females; mean age, 23.9 ± 5.52 years) who received ramal plates for mandibular molar distalization were analyzed. The treatment effects and amount of distalization of the mandibular molars were calculated and tested for statistical significance. The significance level was set at p < 0.001. RESULTS: The mandibular first molar distalization at the crown and root were 2.10 mm (p < 0.001) and 0.81 mm (p = 0.011), respectively. In the evaluation of skeletal variables, there was a significant increase in the Wits appraisal (p < 0.001). In the evaluation of the soft tissue, there was no significant effect on upper lip position, but the lower lips showed a significant retraction of 2.2 mm (p < 0.001). CONCLUSIONS: The mandibular molars showed a significant amount of distalization accompanied by limited extrusion and mesiobuccal rotation of the crowns. A ramal plate may be a viable device for mandibular total arch distalization in Class III patients who are reluctant to undergo orthognathic surgery.

The Vertical Changes of Lip and Perioral Soft Tissue Following Orthognathic Surgery in Skeletal Class III Patients by a Cephalometric Analysis of Cone Beam Computed Tomography

A case of bilateral submandibular gland mucoceles in a 16-month-old child / 소아과

Mucoceles are common benign cystic lesions of the oral cavity that develop following extravasation or retention of mucous material from the major or minor salivary glands. Mucoceles are usually located in the lower lip (60 to 70% of cases), and the floor of the mouth is only involved in 6 to 15% of cases. Submandibular gland mucocele is extremely rare but should be considered in the differential diagnosis of swelling at the submandibular triangle in young children. We present the rare case of a 16-month-old child who was diagnosed with bilateral submandibular gland mucocele, presenting as serial swellings in both submandibular regions. We removed the cystic mass with the submandibular and sublingual glands to prevent recurrence.

A case of bilateral submandibular gland mucoceles in a 16-month-old child / 소아과

Mucoceles are common benign cystic lesions of the oral cavity that develop following extravasation or retention of mucous material from the major or minor salivary glands. Mucoceles are usually located in the lower lip (60 to 70% of cases), and the floor of the mouth is only involved in 6 to 15% of cases. Submandibular gland mucocele is extremely rare but should be considered in the differential diagnosis of swelling at the submandibular triangle in young children. We present the rare case of a 16-month-old child who was diagnosed with bilateral submandibular gland mucocele, presenting as serial swellings in both submandibular regions. We removed the cystic mass with the submandibular and sublingual glands to prevent recurrence.

Three-dimensional analysis of pharyngeal airway change of skeletal class III patients in cone beam computed tomography after bimaxillary surgery

INTRODUCTION: To evaluate the 3-dimensional changes in the pharyngeal airway of skeletal class III patients after bimaxillary surgery. MATERIALS AND METHODS: The study sample consisted of 18 Korean patients that had undergone maxillary setback or posterosuperior movement and mandibular bilateral sagittal split osteotomy setback surgery due to skeletal class III malocclusion (8 males, 10 females; mean age of 28.7). Cone beam computed tomography was taken 1 month before and 6 months after orthognathic surgery. Preoperative and postoperative volumes of the nasopharyngeal, oropharyngeal, and laryngopharyngeal airways and minimum axial areas of the oropharyngeal and laryngopharyngeal spaces were measured. Moreover, the pharyngeal airway volume of the patient group that had received genioplasty advancement was compared with the other group that had not. RESULTS: The nasopharyngeal and laryngopharyngeal spaces did not show significant differences before or after surgery. However, the oropharyngeal space volume and total volume of pharyngeal airway decreased significantly (P<0.05). The minimum axial area of the oropharynx also decreased significantly. CONCLUSION: The results indicate that bimaxillary surgery decreased the volume and the minimum axial area of the oropharyngeal space. Advanced genioplasty did not seem to have a significant effect on the volumes of the oropharyngeal and laryngopharyngeal spaces.

Eagle's Syndrome Presenting Unilateral Facial Nerve Palsy: Case Report

A clinical evaluation of safety of an office bleaching gel containing 30% hydrogen peroxide / 대한치과보존학회지

This study evaluated the safety of an office bleaching gel (RemeWhite, Remedent Inc., Deurle, Belgium) containing 30% hydrogen peroxide. 37 volunteers were recieved office bleaching with the RemeWhite for 3 times at one visit, total 2 visits. As control group, the same gel in which hydrogen peroxide was not included was applied to 34 volunteers with the same protocol. There was no difference between experimental group and control group using electric pulp test. In the result of gingival inflammation index and tooth sensitivity test, there was mild pain response in experimental group but it disappeared as time went by. Therefore, safety of the office bleaching gel containing 30% hydrogen peroxide was confirmed.

Coexisting Sustained Tachyarrthymia in Patients With Atrial Fibrillation Undergoing Catheter Ablation

BACKGROUND AND OBJECTIVES: During the index procedure of catheter ablation (CA) for atrial fibrillation (AF), it is important to assess whether other atrial or ventricular tachyarrhythmia coexist. Their symptoms are often attributed to residual tachycardia after successful elimination of AF by CA. This tachycardia could also be non-pulmonary vein (PV) foci initiated AF. This study examined the coexistence of other sustained tachyarrhythmia of patients who underwent radiofrequency CA (RFCA) for AF. SUBJECTS AND METHODS: Four hundred fifty-nine consecutive patients (375 males, aged 53.4+/-11.4 years) who underwent RFCA for AF were investigated. Atrial and ventricular programmed stimulation (PS) with or without isoproterenol infusion were performed, and spontaneously developed tachycardias were analyzed. RESULTS: Fifteen patients (3.3% of total) were diagnosed to have other sustained arrhythmias that included slow-fast type atrioventricular nodal reentrant tachycardia (AVNRT, n=6), atrioventricular reentrant tachycardia (AVRT, n=5) that utilized left posteroseptal (n=4) and parahisian bypass tract (n=1), atrial tachycardia (AT, n=2) originating from the foramen ovale (n=1) and the ostium of coronary sinus (n=1), sustained ventricular tachycardia (VT, n=2) involving one from the apical posterolateral wall of left ventricule in a normal heart and one from an anterolateral wall in an underlying myocardial infarction (MI). These sustained tachycardias were neither clinically documented nor had structural heart diseases, with the exception of one patient with MI associated VT. Two patients had the triple tachycardia; one involved AVNRT, AVRT, and AF, and the other involved VT, AT, and AF. All associated tachycardias were successfully eliminated by RFCA. CONCLUSION: Fifteen (3.3%) patients with AF had coexisting sustained tachycardia. RFCA was successful in these patients. Identification of tachycardia by PS before RFCA for AF should be done to maximize the efficacy of the first ablation session.

A clinical evaluation of efficacy of an office bleaching gel containing 30% hydrogen peroxide / 대한치과보존학회지

This study evaluated the efficacy of an office bleaching gel (RemeWhite, Remedent Inc., Deurle, Belgium) containing 30% hydrogen peroxide. 31 volunteers were recieved office bleaching with the RemeWhite for 3 times at one visit, total 2 visits. As control group, the same gel in which hydrogen peroxide was not included was applied to 31 volunteers with the same protocol. The shade change (DeltaE*, color difference) of 12 anterior teeth was measured using Colorimerter and Vitapan classical shade guide. The shade change of overall teeth in the experimental group was significantly greater than that in the control group which was measured using Colorimeter. There was also a significant difference between baseline and 14 weeks or 26 weeks though color rebounding phenomenon occurred as time went by. Small shade change difference can be measured accurately using Colorimeter than using Vitapan classical shade guide.

Stress distribution pattern of the different diameter and length of short implants according to the bone quality: 3-D Finite Elements Analysis

Screening and Identification of Unexpected Red Cell Antibodies by Simultaneous LISS/Coombs and NaCl/Enzyme Gel Methods

We evaluated the clinical usefulness of simultaneous LISS/Coombs and NaCl/Enzyme testing using the gel method for screening and identification of unexpected antibodies in 15,014 samples. When unexpected antibodies were detected by either screening test, those antibodies were identified using both the LISS/Coombs and the NaCl/Enzyme gel test. The positive screening rates of the LISS/Coombs, NaCl/Enzyme, and combined tests (excluding 25 autoantibody cases) were 0.48%, 1.29%, and 1.39%, respectively. Among the 57 samples positive by both screening methods, the antibodies in 19.3% could be identified only by the NaCl/Enzyme method. Among the 137 samples positive only by NaCl/Enzyme screening, 74.5% showed positive results in antibody identification only by the NaCl/Enzyme test, although 7.3% were also positive in the LISS/Coombs test. The NaCl/Enzyme method thus showed about threefold higher detection rates than the LISS/Coombs method, especially in screening for Rh antibodies, and higher exact identification rates and discriminatory power for identifying mixed antibodies. Addition of the NaCl/Enzyme method to routine laboratory procedures may detect and identify considerable numbers of significant antibodies that might be missed if only the LISS/Coombs method is used.

Acute Lymphadenitis with Cellulitis Caused by Staphylococcus lugdunensis / 대한진단검사의학회지

Although coagulase-negative staphylococci (CNS) have been considered part of the resident flora on the human skin, Staphylococcus lugdunensis is an unusually virulent CNS and can cause many types of infection. We report a rare case of acute lymphadenitis with cellulitis in the right infraauricular region caused by S. lugdunensis. A 62-yr-old woman visited the Department of Otolaryngology of Busan Paik university hospital. She had a palpable mass and swelling in the right infraauricular region and complained of aggressive pain and a febrile sensation in the region for 5 days. On the suspicion of abscess with infection, percutaneous aspiration was performed and smooth, flat, white, opaque colonies grew on a blood agar plate as a pure culture. The biochemical test results showed the organism to be catalase positive, tube coagulase negative, ornithine decarboxylase positive, slide coagulase positive, and latex agglutination tests for coagulase positive. The API Staph Kit was used to identify the isolate to the species level as S. lugdunensis with a 64.6% probability (profile 6716152). We confirmed the species identification of this strain by 16S rDNA sequence analysis. The patient's clinical condition improved with appropriate antimicrobial therapy and pus drainage.

Pseudo-outbreak of Klebsiella oxytoca fromBronchial Washing Specimens / 대한임상미생물학회지

BACKGROUND: We noticed a sudden increase in the isolation of Klebsiella oxytoca from bronchial washing specimens during May to June 2006. An epidemiological investigation was conducted to identify the cause of the outbreak and to implement appropriate infection control measures. METHODS: A total of 18 isolates of K. oxytoca were found. The 14 bronchial washing specimens that yielded K. oxytoca were taken in the outpatient bronchoscopy suite, and the other 4 specimens were obtained by a portable bronchoscopy. The medical records and microbiologic findings of these patients were reviewed. Environmental samples from two bronchoscopes and the bronchoscopy suite were cultured. The relations between the available 10 isolates from bronchial washing fluid were investigated by pulsed-field gel electrophoresis (PFGE). RESULTS: No patients were judged to have had true infections attributable to K. oxytoca either before or after bronchoscopy. Cultures of samples from two bronchoscopes and related environment did not grow K. oxytoca. The PFGE analysis showed that 8 of 10 isolates had a similar pattern of DNA fragments. An infection control strategy was implemented, including adequately cleaning and disinfecting the bronchoscopes, and a sharp reduction in the incidence of K. oxytoca from bronchial washing samples followed. CONCLUSION: The sudden increase of K. oxytoca from bronchial washing specimens was a pseudo-outbreak. We presumed that the bronchoscopes became contaminated during a procedure in a patient colonized with K. oxytoca in the upper-respiratory tract.

Osteogenesis by BMP-2 in adult stem cell derived from buccal fat pad

Bone morphogenetic proteins (BMPs) in combination with stem cells gain more significance for their use in bone tissue engineering. The mesenchymal stem cell can be differentiated into osteoblast by the treatment of BMP. The aim of this study is to characterize the osteogenic differentiation process of adult stem cells derived from buccal fat pad according to BMP-2 within culture media and decide the appropriate concentration of BMP-2 to facilitate osteogenesis. The authors procured the stem cell from buccal fat pad and analyzed for presence of stem cell by flow cytomety against CD-34, CD-105 and STRO-1. The buccal fat derived stem cells (BFDC) were treated by application of the different concentration with BMP-2 of 0, 10, 50, 100 and 200ng/ml, respectively. And their ability to differentiate into osteogenic pathway were checked by alkaline phosphatase(ALP) staining, Alizarin red staining and RT-PCR for osteocalcin(OC) gene expression at 7, 14 and 21day of culture. Flow cytometric analysis and biochemical assays demonstrated that BFDC might be a distinguished stem cells, and mineralization was accompanied in proportion to BMP-2 concentration. However, with 100ng/ml concentration of BMP-2, the BFDC demonstrated most efficent staining pattern of ALP and Alizarin red. The feasibilty of the osteogenic differentiation in the group of both 50ng/ml and 200ng/ml of BMP-2 showed similar activity and relatively weaker than that of 100ng/ml. These results suggest that the BMP-2 stimulate osteogenesis by BFDC effectively and that bone induction might be controlled through negative regulatory feedback in higher concentration.

The hypermethylation of E-cadherin gene in oral squamous cell carcinoma

Loss of E-cadherin (E-cad) expression has been found in multiple cancers and is postulated to facilitate tumor cell dissociation and metastais. Promotor methylation may provides an alternative pathway for loss of gene function. This study evaluated the role of hypermethylation in the down-regulation of E-cad in oral squamous cell carcinoma (OSCC). We examined the E-cad expression by immunohistochemical staining and detected methylation status by methylation-specific polymerase chain reaction (MSP) in 20 OSCC tissues. Overally, 12 (60 %) cases of hypermethylation of E-cad were detected and we found there were no correlation between methylation and age, histologic grade, lympn node metastasis, tumor size and clinical stage. However, Eleven (73.3 %) of 15 samples which was negative for E-cad staining showed hypermethylation of E-cad promotor region. On the other hand, only one (20 %) of 5 E-cad positive sample was observed with methylated status. The underexpression of E-cad was found to be related to promotor hypermethylation (p=0.035). In conclusion, we suggest that hypermethylation play a role in inactivation of E-cad gene and may be a appreciable biomarker for diagnosis and treatment of OSCC.