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Sung Woo Joo, Yeon Ho Joo, Chang Yoon Kim, Jung Sun Lee Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea Objective: This study examined the effect of stimulus parameters on the occurrence of adequate seizures and reconsidered the factors related to motor seizure duration.Methods: The medical records of 187 patients who received ECT in Asan Medical Center from January 2007 to May 2014 were retrospectively reviewed. The starting stimulus dose was determined using a preselected-dose method and the cutoff value to determine the adequate motor seizure duration was 20–25 seconds. The association between seizure parameters and the occurrence of adequate seizure was assessed with logistic regression using a generalized estimating equation.Results: Age (P

Catatonia is one of the main symptoms of anti-N-Methyl-D-aspartate receptor (NMDAR) encephalitis. However, it is unknown whether metabolic changes observed with 18F-Fluorodeoxyglucose positron-emission tomography (FDG-PET) are correlated with the severity of the catatonic symptoms and clinical course. Three patients with anti-NMDAR encephalitis showing variable degrees of catatonia were performed with FDG-PET scans during the acute and recovery phase. PET findings showed hypermetabolism in the frontotemporoparietal regions and bilateral basal ganglia in the patient with mild catatonia, but more widespread hypermetabolic regions including the thalamus and brainstem were observed in the patients with more severe catatonia. Follow-up PET scans in one patient showed mild hypermetabolism in the right basal ganglia that correlated with mild rigidity and tonic posturing in the left extremities. Extent of cerebral metabolic changes correlates with the severity of catatonia accompanied by behavioural, motor, autonomic, and breathing abnormalities in anti-NMDAR encephalitis.

Study of inpatient aggression in psychiatric inpatient units (PIUs), where vulnerable patients interact intensely in small groups, is hampered by a lack of systematic monitoring of aggressive events in the context of group dynamics. Our current study examines the relationship between aggression and group structure in the PIU of a general tertiary-care hospital over a 9-month period. The severity of aggression was monitored daily using the Overt Aggression Scale (OAS). Clinical data including the daily number and mean age of subpopulations with different diagnoses were acquired. Cross-correlation function and autoregressive integrated moving average modeling were used to assess the effects of various group structure parameters on the incidence of aggressive events in the PIU. The daily total OAS score correlated positively with the daily mean age of patients with schizophrenia and bipolar disorder. By contrast, the OAS total score demonstrated a negative correlation with the daily mean age of patients with major depression. The age of the patients at diagnosis is an important group structure that affects the incidence of aggression in a PIU.

This study tries to investigate inequity in supplementary private health insurance insured in terms of the analysis of insurance insured general characteristics and to analyze the influence of supplementary private health insurance on their admission and their outpatient medical utilization behavior. As a result of the analysis of the general characteristics of supplementary private health insurances insured, it has turned out that men, persons at low ages, people with a spouse and chronic diseases, and persons with a high income have applied such insurances more. We can also tell that low-income classes have difficulty in applying private health insurances as people in the fifth income quintile have applied such insurances about 9 times as much as those in the first income quintile. The analysis of supplementary private health insurance insured health care utilization behavior has revealed that both male and female insured aged less than 55 and without chronic diseases have increases the number of their use of health care, their patient charge, and their medical cost per visit.

Purpose: The purpose of this study was to evaluate the effect of periodic video education on knowledge about hemodialysis, patient role behavior and the physiologic index in patients with hemodialysis. Methods: One-group pretest-posttest design was applied. A total of 50 patients with hemodialysis at a university hospital hemodialysis unit in Daegu participated. Periodic video education about kidney function, diet, arteriovenous fistula management, medication, and exercise was administered to them for 12 weeks at inter vals of 2 weeks. Before and after the education, the participants completed the self-administered questionnaires of knowledge about hemodialysis and patient role behavior and the measures of serum potassium and phosphorus concentration, weight gain between hemodialysis sessions, and adequacy of dialysis (Kt/V). Statistical analysis was performed using paired t-test. Results: Knowledge about hemodialysis and patient role behavior were significantly different between before and after education ( p < .01). For the physiologic index, serum potassium concentration and weight gain between hemodialysis sessions were not significantly different but the serum phosphorus concentration and Kt/V were significantly different between before and after education ( p < .05). Conclusion: The results suggest that the periodic video education for patients with hemodialysis contributed to the change and improvement in knowledge about hemodialysis, patient role behavior, and the physiologic index.

Introduction Diffusion weighted MRI (dMRI) is a method sensitive to pathological changes affecting tissue microstructure. Most dMRI studies in schizophrenia, however, have focused solely on white matter. There is a possibility, however, that subtle changes in diffusivity exist in gray matter (GM). Accordingly, we investigated diffusivity in GM in patients with recent onset schizophrenia. Methods We enrolled 45 patients and 21 age and sex-matched healthy controls. All subjects were evaluated using the short form of the Wechsler Adult Intelligence Scale, the Positive and Negative Syndrome Scale (PANSS), and the video based social cognition scale. DMRI and T1W images were acquired on a 3 Tesla magnet, and mean Fractional Anisotropy (FA), Trace (TR) and volume were calculated for each of the 68 cortical GM Regions of Interest parcellated using FreeSurfer. Results There was no significant difference of FA and GM volume between groups after Bonferroni correction. For the dMRI measures, however, patients evinced increased TR in the left bank of the superior temporal sulcus, the right inferior parietal, the right inferior temporal, and the right middle temporal gyri. In addition, higher TR in the right middle temporal gyrus and the right inferior temporal gyrus, respectively, was associated with decreased social function and higher PANSS score in patients with schizophrenia. Conclusion This study demonstrates high sensitivity of dMRI to subtle pathology in GM in recent onset schizophrenia, as well as an association between increased diffusivity in temporal GM regions and abnormalities in social cognition and exacerbation of psychiatric symptoms.

Introduction The aim of this study was to evaluate the efficacy and safety of quetiapine fumarate extended release (XR) in the treatment of Korean subjects with acute schizophrenia. Methods This was an 8-week, multi-center, open-label, non-comparative study to evaluate the efficacy and safety of quetiapine fumarate XR at a daily dose of 400–800mg. Changes in total scores on the Positive and Negative Syndrome Scale (PANSS) from baseline to week8 were analyzed to evaluate the efficacy of quetiapine XR. Additionally, the Clinical Global Impression scale and the Montgomery–Asberg Depression Rating Scale were administered. Results The mean change in PANSS total scores was 26.8, and the mean PANSS total score at the endpoint was significantly lower than that at baseline. The mean PANSS positive score, negative score, and general score showed statistically significant reductions at the end of the study. Statistically significant changes were also observed in Clinical Global Impression-Severity and Montgomery–Asberg Depression Rating Scale scores. The most common treatment-related adverse events in the group receiving quetiapine XR were sedation (10.6%) and constipation (9.6%). Conclusions In this study of Korean patients with acute schizophrenia, quetiapine XR showed clinical efficacy and relatively good tolerability. Copyright © 2012 John Wiley & Sons, Ltd.

OBJECTIVES The objectives of this 12-week multicenter, open-label, noncomparative study were to evaluate the overall effectiveness of paliperidone extended release (ER), the feasibility of maintaining patients on the initial dose of 6 mg, and the relationship between dose pattern and treatment response in schizophrenic patients with inadequate responses to initial treatment in a natural setting. METHODS All patients received 6 mg of paliperidone ER during the first 2 weeks, and subsequently, the dose was adjusted at each visit based on the patient response. We examined the response rate and the effectiveness of different dose patterns of paliperidone ER such as "early increase (dose increased to 9 mg at week 2)," "late increase (dose increased to 9 mg at week 4)," and "maintenance group." RESULTS The response rate based on the Clinical Global Impression of Improvement or Severity response criteria was 33.6% or 61.7%, respectively. The proportion of patients who stayed with the initial dose of 6 mg was 44.5% and the response rate of these patients was 79.8%. When the treatment response to the initial dose of 6 mg is inadequate (Clinical Global Impression of Improvement ≥ 4 at week 2), an early increase in the dose seems to be more effective than maintenance or late increase of the initial dose. CONCLUSIONS This study suggests that paliperidone ER may be an effective and well-tolerated antipsychotics in the treatment of patients with schizophrenia.

Purpose: This study was conducted to assess reported industrial accidents and non-reported industrial accidents that took place in 63 small and medium sized manufacturing industries located in Daegu and Gyeongsangbuk-do in the year of 2009. Methods: During the period from January to December 2009, the number of industrial accidents that happened each month was examined according to the characteristics of industry, industrial accidents, workers with industrial accidents, treatment, as well as causes and treatment of the non-reported. Results: The total incidence rate of industrial accidents was 3.48%, of which only 0.31% reported. The incidence rate in packing and distribution among manufacturing workplace, and in the industry with 50~99 employees, was higher than the other groups. Of the non-reported, over 80% in required under 10 days of medical treatment, and 56% in required cost of less than 100,000 won. Kappa values were 0.771 concurrence in opinions for causes of non-reported, and 0.571 concurrence in opinions for management termination of non-reported between the employees and employer. Conclusion: It is suggested that more supportive policy and precise, nationwide survey on the actual state of industrial accidents, including non-reported cases, be implemented to efficiently manage industrial accidents.

The 116C/G polymorphism in the promoter region of XBP1 is known to be associated with bipolar disorders. The G allele of the XBP1-116C/G polymorphism has reduced XBP1-dependent transcription activity compared with the C allele. Valproate treatment has been known to rescue the impaired response of cells with the G allele. We investigated the hypothesis that the G allele of XBP1-116C/G has better prophylactic treatment response to valproate compared to the C allele. This study involved 51 patients with bipolar disorder who were treated with valproate for prophylactic treatment. Prophylactic treatment response to valproate was retrospectively assessed using a scale described by Grof et al. [Grof, P., Duffy, A., Cavazzoni, P., Grof, E., Garnham, J., MacDougall, M., O'Donovan, C., Alda, M., 2002. Is response to prophylactic lithium a familial trait? Journal of Clinical Psychiatry 63, 942-947.]. We found that the patients with the G allele of XBP1-116C/G showed a better prophylactic treatment response to valproate compared to the C allele. This result is in agreement with in-vitro data showing that valproate ameliorates the endoplasmic reticulum (ER)-stress response compromised by the G allele.

Objective. To compare the effectiveness of olanzapine, risperidone, quetiapine, or haloperidol monotherapy in patients with schizophrenia who were treated in routine clinical practice settings for a period of 2 years. The incidence and persistence of adverse events encountered during long-term therapy are also reported. Method. Outpatients with schizophrenia who entered this 3-year, prospective, observational study were classified according to their initially prescribed antipsychotic monotherapy: olanzapine (n=3222), risperidone (n=1116), quetiapine (n=189), or haloperidol (n=256). Patients were included in the analysis for as long as this treatment was maintained. Results. Over 2 years, olanzapine recipients had significantly (P≤0.001) greater reduction in overall CGI-S score (and the negative, depressive, and cognitive symptoms domains), lower incidence of sexual and motor dysfunction, and greater odds of response compared to risperidone or haloperidol-treated patients. However, olanzapine patients gained more weight than patients in other treatment groups. The incidence of motor dysfunction was significantly (P≤0.001) greater in haloperidol-treated patients, relative to the atypical treatment groups. Conclusion. The results of this observational study indicate that, in these patients with schizophrenia, long-term monotherapy with olanzapine may offer benefits over risperidone and haloperidol, but the potential for weight gain should be considered in the clinical management of these patients.

Characteristic high signal intensities confined to the globus pallidus on T1-weighted magnetic resonance image (MRI) can be observed in manganese (Mn)-exposed workers, however, these high signals should be differentiated from those due to other causes such as fat, hemoglobin breakdown products, melanoma, neurofibromatosis, and calcification. A 39-year-old woman was admitted with mutism and involuntary movements which had developed the day before. She had ingested two packs of liquid herbal medicine containing 0.53 mg of Mn daily for 4 months prior to visiting our hospital. Her MRI showed high signals, confined mainly to the globus pallidus on T1-weighted images. Follow-up brain MRI at an interval of 11 months showed no interval change. Brain computed tomography (CT) at the time of the second MRI showed symmetric calcification on both globus pallidus. Blood levels of liver function tests, calcium, phosphorus, and parathyroid hormone were within normal ranges. The increased signals, which were first presumed to be induced by Mn, were concluded to be due to calcification based on the following reasons. First, follow-up brain MRI at an interval of 11 months did not show any interval change. Second, the ingested amount of 1.06 mg Mn daily for 4 months is even less than that added to mineral supplements for adults. Third, Mn-induced high signals in T1-weighted MRI do not show any abnormal findings in brain CT. The present case report suggests that brain CT should be performed to rule out symmetric calcification on basal ganglia in patients showing increased signals in T1-weighted MRI, but who do not have a significant exposure history to Mn. The present report also showed that the amount of 1.06 mg Mn daily ingested for 4 months did not cause the high signal in brain MRI.

Purpose Compared with the general population, adolescent psychiatric patients are subject to premature death from all causes, but suicide-specific mortality rates in this population have not been carefully investigated. Therefore, we examined the high mortality due to unnatural causes, particularly suicide, using standardized mortality ratios (SMRs) relative to sex, diagnosis, and type of psychiatric service. Methods A total of 3,029 patients aged 10–19 years presented to the outpatient clinic of a general hospital in Seoul, Korea, or were admitted to that hospital for psychiatric disorders from January 1995 to December 2006. Unnatural causes mortality risk and suicide mortality risk in these patients were compared with those in sex- and age-matched subjects from the general Korean population. Results The SMR for unnatural causes was 4.6, and for suicide it was 7.8. Female subjects, the young, and inpatients had the highest risks for unnatural causes of death or suicide. Among the different diagnostic groups, patients with psychotic disorders, affective disorders, and personality disorders had significantly increased SMRs for unnatural causes, and those with psychotic disorders, affective disorders, and disruptive behavioral disorders had significantly increased SMRs for suicide. Conclusions The risks of unnatural death and suicide are high in adolescent psychiatric inpatients in Korea, but not as high in adolescent outpatients. Effective preventative measures are required to reduce suicide mortality in adolescent psychiatric patients, particularly female patients admitted for general psychiatric care.

Objective Genetic variation in the serotonin-2C receptor encoded by the HTR2C gene is one of the genetic determinants of antipsychotic-induced weight gain. Peroxisome proliferator-activated receptors are nuclear receptors regulating the expression of genes involved in lipid and glucose metabolism. In this cross-sectional study, we investigated whether HTR2C-759C/T, HTR2C-697G/C, PPARα V227A, and PPARγ 161C/T genotypes were associated with metabolic syndrome (MetS) in patients with schizophrenia taking clozapine. Methods One hundred forty-six Korean patients using clozapine for more than one year were genotyped for the HTR2C-759C/T, HTR2C-697G/C, PPARα V227A, and PPARγ 161C/T polymorphisms, and their weight, waist circumference, blood pressure, triglycerides, high-density lipoprotein-cholesterol, total cholesterol, and glucose were measured. We used the criteria for MetS proposed by the National Cholesterol Education Program-adapted Adult Treatment Panel III. Results The prevalence of MetS was 47.3% and was similar among men (49%) and women (42.9%). We found no significant differences between patients with and without MetS in terms of genotypes or allele frequencies. Logistic regression analyses also revealed no association between MetS and each genotype. Conclusion We did not find significant associations between four polymorphisms (HTR2C-759C/T, HTR2C-697G/C, PPARα V227A, and PPARγ 161C/T) and MetS in patients with schizophrenia taking clozapine.

OBJECTIVES: This study was conducted to determine the reference interval of serum thyroid hormones (TSH, FT3, FT4) in healthy Korean adults. METHODS: Health examination data from 1,591 healthy Korean adults who visited an university hospital were analyzed. Patients with specific health conditions capable of altering laboratory results were excluded from the study. Serum thyroid hormones were measured using IMMULITE 2000 (DPC, USA, 2002). Subjects were 18-65 years old; 911 were male, and 690 were female. RESULTS: The arithmetic means of TSH, FT3, and FT4 values for male subjects were 1.28+/-1.84 microIU/ml, 3.23+/-0.57 pg/ml, and 1.42+/-0.22 ng/dl, respectively. In female subjects, the arithmetic means of TSH, FT3, and FT4 values were 1.49+/-2.08 microIU/ml, 3.08+/-0.54 pg/ml, and 1.29 +/-0.24 ng/dl, respectively. The arithmetic mean FT4 value for males decreased with age (p

Electroconvulsive therapy(이하 ECT)는 1938년 Ugo Cerletti 와 Luigi Bini에 의해 처음으로 고안된 치료 방법이다. 1950년대 중반 barbiturate와 succinylcholine을 이용하여 마 취하에 ECT를 시행하면서 이전보다 안전하게 환자들을 치 료할 수 있게 되었다. 하지만 정신증상과 기분증상을 치료할 수 있는 덜 침습적인 약물치료가 개발되고 나서 ECT의 사용 빈도는 감소하였다. 그러나 일부 환자의 경우 약물치료에도 증상 호전이 없거 나 부작용으로 약을 복용할 수 없는 등의 약물치료의 한계가 나타났다. 예를 들어 조울병 우울삽화에서 장기간 항우울제 를 투약함에도 증상 호전이 없는 경우가 있으며, 항우울제 투 약 후 조증삽화가 발생하는 경우가 있어 조울병 우울삽화 치 료에 어려움이 있다. 조현병 환자 중 약 10~30%는 약물치 료에 반응하지 않으며 추가적으로 30%의 환자에서 부분적 반응은 있으나 양성증상이 지속되어 일상생활에 장애를 일 으킨다는 결과가 있다. 이러한 한계를 해결하기 위한 방법 으로 ECT가 다시 주목받기 시작하였고 여러 연구에서 ECT 가 약물치료 저항성 환자 또는 부작용으로 약물을 사용할 수 없는 환자에게 효과적인 치료 방법이라고 보고되었다. 현재는 대부분 마취하에 ECT를 시행하고 있어 골절 등 시 행 초기에 발생했던 많은 부작용들이 감소하였다. 그러나 여전히 기억상실을 비롯한 ECT 후 발생되는 인지기능 저하 ORIGINAL ARTICLE

Background: In treating patients with psychosis, practicing clinicians use various dosing strategies of antipsychotic medications, including risperidone. To evaluate the outcome of different risperidone dosing strategies in clinical practice, we undertook a large, prospective, naturalistic study in which daily dosage was determined freely by local standards of care. Method: In a 6-week trial between December 2000 and January 2002, 1713 patients with DSM-IV schizophrenia and related psychoses were treated with risperidone, with the dose, daily changes in dose, and weekly changes in Brief Psychiatric Rating Scale score documented. Cluster analysis was performed to identify homogeneous dosing patterns among the heterogeneous total population. Results: Of the 6 dosing patterns identified by cluster analysis, a 2-week titration cluster, with a starting dose of 1.8 mg/day titrated to a maximum dose of 4.7 mg/day at day 14, and a 1-week titration cluster, with a starting dose of 2.6 mg/day titrated to a maximum dose of 5.4 mg/day at day 7, showed superior clinical outcomes compared with the other clusters, in which titrations were slower and higher. Conclusion: Our results indicate that the current consensus regarding risperidone dosing is appropriate for clinical practice, whereas a slower titration schedule does not guarantee a better clinical outcome, thus emphasizing the need for appropriate early titration.

Background: Durable results of total hip arthroplasty have been difficult to achieve in young patients. We reviewed the intermediate-term clinical and radiographic results in a series of active, higher-demand patients who were less than fifty years old when they underwent cementless total hip arthroplasty with the use of the Metasul metal-on-metal articulation. Methods: Seventy total hip arthroplasties were performed in sixty-two patients who were younger than fifty years of age (average age, thirty-seven years). Two patients (two hips) had had a resection arthroplasty because of deep infection less than five years postoperatively and were excluded. Sixty patients (sixty-eight hips) were available for complete clinical and radiographic analysis after a mean duration of follow-up of seven years. Results: The mean preoperative Harris hip score of 49 points improved to 95 points at the time of final follow-up; fifty-six patients (93%) had an excellent result. No component was seen to be loose radiographically at the time of final follow-up. Only one focal area of pelvic osteolysis in one patient and two small focal areas of femoral osteolysis in another patient were identified. The hip with focal pelvic osteolysis underwent revision surgery with a liner change and bone-grafting of the osteolytic lesion around a stable component. Conclusions: At a mean of seven years after arthroplasties with a Metasul metal-on-metal articulation, there was a low rate of osteolysis and aseptic loosening in this group of young patients. However, additional follow-up is necessary to determine any possible long-term deleterious effects associated with this metal-on-metal articulation. Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

Fan Zhang,1 Tianmei Si,2,3 Chiun-Fang Chiou,4 Anthony WF Harris,5 Chang Yoon Kim,6 Padmashree Jahagirdar,7 Steve Ascher8 1Xian Janssen Pharmaceuticals, Beijing, People’s Republic of China; 2Department of Clinical Psychopharmacology, Peking University Institute of Mental Health, Beijing, People’s Republic of China; 3Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, People’s Republic of China; 4Janssen Asia-Pacific, Singapore; 5Discipline of Psychiatry, Sydney Medical School, University of Sydney, Australia and Brian Dynamics Center, Westmead Millennium Institute for Medical Research, Westmead, NSW, Australia; 6Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; 7Theorem Clinical Research, Bangalore, India; 8Janssen Research and Development, LLC, Titusville, NJ, USA Objective: To evaluate the efficacy, safety, and impact on hospitalizations of long-acting injectable paliperidone palmitate (PP) treatment, in patients with recent-onset schizophrenia who had not responded satisfactorily to oral antipsychotics.Methods: In this 18-month, open-label, Phase-IIIb study from Asia-Pacific region, patients (18–50 years) with recent-onset (≤5 years) schizophrenia unsatisfactorily treated with previous oral antipsychotics were initiated on PP 150 mg eq on day 1, 100 mg eq on day 8, followed by flexible once monthly maintenance doses of 50–150 mg eq. The number and duration of hospitalizations were compared using a mirror analysis method between two periods: retrospective (12 months before PP initiation) and prospective (12 and 18 months after PP treatment) periods.Results: A total of 303 out of 521 (58%) patients (mean age, 28.7 years; 65.5% men, 92.5% Asian) completed the study. Positive and Negative Syndrome Scale (PANSS) total score improved significantly from baseline to month 18 (mean [standard deviation, SD] change: -11.3 [21.38], P

ObjectivesZZThe aim of this study was to examine the drug adherence and treatment effect of the paliperidone long acting injection (LAI) in patients with schizophrenia or other psychotic disorders. MethodsZZWe reviewed the medical charts of patients who were prescribed paliperidone LAI from January 2010 to April 2014. Date of each injection, last observation, and first admission af ter use of the drug were obtained. Kaplan-Meier survival analysis was used for calculation of drug adherence. The dose of paliperidone LAI, concurrent oral antipsychotics, and anticholinergic agent was also obtained. Antipsychotics dose was calculated as olanzapine equivalent dose. ResultsZZThe drug adherence of the paliperidone LAI on day 365 was 65%. The reasons for all cause discontinuation were follow-up loss, no effect, poor insight, rejection, extrapyramidal symptom, pain, etc. A total dose of 9.1 mg of oral antipsychotics was decreased, while the dose of anticholinergic agent was increased.

Objectives: This study evaluated the acute health effect of formaldehyde during an anatomy dissection course. Methods: The formaldehyde concentrations in a gross anatomy laboratory were measured and analyzed during an anatomy dissection course attended by eighty medical students. The Pulmonary Function Test and three tests of the Korean Computerized Neurobehavioral Test (digit classification, digit addition and symbol digit) were given to thirty of the eighty medical students at the pre- and post-exposure. A questionnaire survey was administered to the eighty medical students at the pre- and post-exposure. Results: The differences in the mean FVC and FEV1 were statistically significant (p

Purpose : The purpose of this study was to evaluate the long-term results of cemented Muller prostheses using a 32 mm metal femoral head. Materials and Methods : We reviewed 43 (31 patients) of 76 (55 patients) consecutive THAs, which were performed between April 1978 and September 1985. The average duration of follow-up was 148 months (range, 65-279 months). The average age at the time of index operation was 44.4 years. Preoperative diagnosis was osteonecrosis in 31 hips, posttraumatic osteonecrosis in 8 hips, osteoarthritis in 2 hips, and rheumatoid arthritis in 2 hips. We assessed cases clinically by Harris hip scores and radiographically by loosening and osteolysis, and measured polyethylene wear by the Livermore method. Kaplan-Meier analysis was used to evaluate survivability. We analyzed the relationship and the statistical difference between wear and age, weight, height, body mass index, diagnosis, polyethylene thickness, and cup inclination (Pearson correlation's analysis, Student t-test, ANOVA test). The p-value was set p/yr respectively, and a 10-year cumulative survival rate was 72% (67-80%, 95% confidence interval). Revision surgery was performed in 27 hips (63%) and the mean time from index operation to revision was 129 months. The linear and volumetric wear rates increase significantly as body mass index increased (p or > ) (p

Purpose : To evaluate the early intermediate outcomes of total hip arthroplasty using hydroxyapatite (HA)-coated smooth surface hemispherical acetabular component. Materials and Methods : Seventy total hip arthroplasties were performed, in 63 patients, using a HA-coated smooth surface hemispherical acetabular component consecutively between June 1993 and August 1996. Fifty-four cases were followed at an average of 71 months. The mean age at the time of arthroplasty was 49 years old. Clinical results were evaluated using the modified Harris hip score, and the radiologic results were evaluated in terms of stability, polyethylene wear rate, and osteolysis around the acetabular component. Results : The mean preoperative Harris hip score of 50.9 was improved to 82.2 points at the most recent follow-up. Pelvic osteolysis was found at 18 cases (33%) and the mean polyethylene wear rate was 0.15 mm/year. Eight acetabular components (15%) were unstable radiologically and 7 acetabular components (13%) were revised. Conclusion : Total hip arthroplasty using HA-coated smooth surface hemispherical acetabular component showed accelerated polyethylene wear rate, which was accompanied by a high incidence of osteolysis, and a high loosening rate due to failure of bony ongrowth at early midterm.

A study was conducted to investigate the blood lead and zinc protoporphyrin(ZPP) concentrations of the underground parking lot workers who exposed to vehicular exhaust aerosols which contained lead. The blood samples were collected from 25 study subjects of underground parking lot and from 33 controls in Taegu, from July to October, 1997. And also the related factors to the blood lead and ZPP concentrations were investigated. Blood lead concentration and ZPP concentration were measured by flameless furnace atomic absorption spectrophotometer (1L.551) and hemetofluorometer, respectively. The mean blood lead concentrations of study subjects and controls were and , respectively(p and , respectively. No significant correlations were observed between the blood lead concentration of the study subjects and their job duration and between blood ZPP concentration of the study subjects and their job duration. There were no statistically significant differences in the blood lead concentration and the blood ZPP concentration of smokers and nonsmokers. In multiple regression analysis on blood lead concentration of the study subjects and controls, occupation was a only significant dependent variable. In case of bood ZPP concentration, age was a only significant dependent variable in the study subjects and controls.

The AIDS is a serious health problem worldwide today and also in Korea. Increasing knowledge and modification of behavior by health education is an important goal of human immunodeficiency virus(HIV) prevention strategies. And school health education is an important part of health education. This study was conducted to evaluate the knowledge and attitude about AIDS in teachers and professors in Taegu City and to provide the basic data for school health education. A self-administered questionnaire was given to 1,124 teachers and professors from April to June 1992. Indeed, the majority of the teachers and professors have a lot of knowledges about AIDS, but many of them also have misconceptions. The level of knowledge about AIDS was positively associated with attitude toward infected students. The sources of knowledge about AIDS were mainly TV, newspapers and magazines, but a few of the subjects obtained their knowledge from health education programs. This study suggests that the reinforcement of health education for the teachers, professors and students he needed to provide the accurate knowledge on AIDS and adequate knowledge sources and materials for school health education on AIDS should be developed.

This study was conducted to explore the feasibility of using the lead level in the hair of children as a screening test for lead intoxication of children and as an indicator for environmental pollution. Lead concentration of hair was measured for 268 seven to nine-year-old elementary school children in Taegu city (147 children) and Gampo town(121 children). The lead level in hair was measured by atomic absorption spectrophotometer equipped with a graphite furnace atomizer. The following information was obtained for all children: sex, age, father's occupation and smoking habits, kinds of hair cleaner, fingernail biting habits, and status of the child's hands and clothing. The mean lead level in hair was in the urban area and in the rural area. There were significant differences between two groups(p, dirty: ) and child's clothing(clean: , dirty: ) were statistically significant, but other factors were not significant. In multiple regression analysis, difference of residency and age were significant variables for lead level in the hair of children. These findings suggest that measurement of lead level in the hair is a useful method for the screening of the lead intoxication of children and monitoring environmental conditions.

This study was carried out to assess medical care expenditure of residents in urban poor area. The study population included 377 family members of 85 households in the poor area of Daemyung 8-Dong, Nam-Gu, Taegu and 442 family members of 96 households in a control area. The data was collected through self-administered questionnaires completed by housewives. The survey was conducted from March 1 to May 31, 1992. The mean age was 31.1 years in the poor area and 37.1 years in the control area. The average number of households per house was 4.5 in the poor area and 4.5 in the control area. The frequency of medical care utilization per household in a one month period was 4.6 in the poor area and 4.3 in the control area. The average number of days of utilization was 12.9 in the poor area and 12.5 in the control area. The average monthly income of a househlod in the poor area was 848,600 Won compared to the control area's 1,752,300 Won. The average monthly consumption expenditure of a household in the poor area was 568,800 Won and that in the control area 1,238,400 Won. The average medical care monthly expenditure per household was 34,500 Won in the poor area and 58,400 Won in the control area. The proportion of the medical care expenditure to monthly income and to monthly consumption expenditure was 4.1% and 6.1% respectively in the poor area, and 3.3% and 4.7%, respectively in the control area. The premium of medical insurance was 1.5% in both areas. The proportion of cost for drug was 57.4%, for medical appliance was 1.2%, and for medical treatment was 41.1% in the poor area and in the control area 52.4%, 1.9%, 45.7%, respectively. The highest proportion of medical care expenditures in the poor area was herb clinic utilization (36.9%), while hospital and clinic(37.8%) was the highest proportion in the control area. Mean medical care expenditure per visit was 7,400 Won in the poor area and 12,600 Won in the control area. Mean medical care expinditure per day was 2.800 Won in the poor area and 6,300 Won in the control area.

A case-control study was conducted to investigate the association between the risk of cancer and selenium concentration in blood and toenails. Seventy three patients and two hundreds eighty three controls were, selected at the Yeungnam University Hospital between May and September in 1991. The selected cases were patients who had been hospitalized for stomach or colon cancer at the Depertment of General Surgery. The controls were people who visited to check physical examination at the Automated Mediscreening Center. The selenium concentration in whole blood and toenails were measured by atomic absorption spectrophotometer equipped with graphite furnace atomizer. The following information was ascertained for all cancer patients and controls : sex, age, body mass index, blood pressure, total serum cholesterol, and history of smoking and drinking. The mean selenium concentration in blood and toenail for all cancer patients were and and for the controls, and , respectively. The difference in blood and toenail selenium concentrations of the two cancer sites was not statistically significant. Metastasis did not influence the concentration of selenium in blood and toenails. In the multiple logistic regression analysis, the blood selenium concentration(: 0.888, 95% CI : 0.860-0.918), age, BMI and total serum cholesterol were significant variables for risk of cancer, but the selelenium concentration in toenail was not shown to be a significant variable in this regression analysis. The coefficient for blood selenium concentration adjusted for age, sex, diastolic blood pressure, total serum cholesterol, body mass index and smoking was -0.1184(p

The purpose of the this study was to assess the morbidity pattern of urban residents in the poor area by health screening for the community diagnosis. The items of health screening were history taking and physical examination by medical doctor and hearing test, check blood pressure, test for hematocrit, liver function(sGOT, sGPT), urine sugar and protein, and chest X-ray. The examinee in health screening were 437 persons and they occupied 16.9% of total residents in the poor area. Male examinee were 129 persons(9.9% of total residents) and female examinee were 308 persons(23.9% of total residents). Age group of above sixty years old, 42.0% of total residents in the poor area were participated, but only 5.9% were participated in age group of 10 to 19 years old. Among the 437 examinee, 191 persons(43.7%) had one or more abnormal findings in health screening. In male 38.7% had abnormal findings, and some what lower than that of female(45.8%). Age group of above sixty years had most high rate of abnormal findings(69.8%), in contrast to age group of 10 to 19 years old (10.9%). Diseases of the digestive system was the most common and which occupies 23.7% of total abnormal findings. And diseases of the circulatory system occupied 19.7%. Low hematocrit(14.6% of total participants of 437 persons) occupies the most common abnormal findings for screening test(hematocrit, blood pressure, hearing test, sGOT/sGPT, urine protein and urine sugar, chest X-ray) and high blood pressure(10.1%) occupied second, third; hearing impairment (5.5%), fourth ; abnormal liver function (4.1%), fifth ; sugar in urine (2.3%), sixth ; protein in urine(1.4%) and lastly abnormal chest X-ray (0.9%). The positive rate of abnormal findings in health screening was very high compared with morbidity rate by health interview. It is supposed that some portion of this high rate is by selection bias in examinee in health screening specially high participating rate in older age, and the other portion is due to the low socioecomic status and bad environment of the residents of the poor area. These findings will be good information for the research and development of health care system in the urban poor area.

The purpose of the study was to assess the morbidity pattern and the medical care utilization behavior of the urban residents in the poor area. The study population included 2,591 family members of 677 households in the poor area of Daemyong 8 Dong, Nam-Gu, Taegu and 2,686 family members of 688 households, near the poor area in the same Dong, were interviewed as a control group. On this study the household interview method was applied. Well-trained interviewers visited every household in the designated area and individually interviewed heads of households or housewives for general information, morbidity condition, and medical care utilization with a structured questionnaire. Individuals were interviewed from 1 to 30 December 1988. The major results were summarized as follows : The proportion of the people below 5 years of age was 4.2% of the total study population and 5.5% were above 65 years of age in the poor area. This was slightly higher than in the control area. The average monthly income of a household in the poor area was 403,000 won versus 529,000 won in the control area. Fifty-eight percent of the residents in the poor area and sixty-one percent in the control area were medical security beneficiaries, but the proportion of medical aid beneficiaries was 7.8% in the poor area and 4.6% in the control area. The 15-day period morbidity rate of acute illnesses was 57.1 per 1,000 in the poor area and 24.2 per 1,000 in the control area. Respiratory disease is the most common acute illness in both areas. The most frequently utilized medical facility was the pharmacy among the patients with acute illnesses in the poor area. Among them 58.1% visited pharmacy initially while 38.4% of the patients in the control area visited a clinic. Among persons with illnesses during the 15 days 8.8% in the poor area and 4.6% in the control area did not seek any medical facility. Mean duration of utilization of medical facilities was 3.5 days in the poor area and 3.3 days in the control area. Initially of the medical facilities in Daemyong 8 Dong, The pharmacy in the poor area and the clinic in the control area were most commonly utilized. The most common reason for visiting the hospital was 'regular customers' in the poor area and 'geographical accessibility' in the control area. The one year period morbidity rate of chronic illness in the poor area was 83.0 per 1,000 population and 28.0 per 1,000 in the control area. Disease of nervous system was the most common chronic illness in the poor area while cardiovascular disease in male and gastrointestinal disease in female were most prevalent in the control area. The most frequently utilized medical facility was the pharmacy among the patients with chronic illnesses in the poor area. Among them 24.2% visited the pharmacy initially while 34.7% of the patients in the control area visited the out-patient department of the hospital within a 15-day period. Among the patients with chronic illnesses 34.9% in the poor area and 16.0% in the control area did not seek any medical facility. Mean duration of utilization of medical facilities was 9.2 days in the poor area and 9.9 days in the control area within a 15-day period. Initially of the medical facilities in Daemyong 8 Dong, the pharmacy in the poor area and the hospital in the control area were most commonly utilized. The most common reason for visiting the hospital, clinic, health center or pharmacy in the poor area was 'geographical accessibility' while the reason for visiting herb clinic was 'good result' and 'reputation' in both areas.

A household survey was conducted to compare the patterns of morbidity and medical care utilization between medical aid beneficiaries and medical insurance beneficiaries. The study population included 285 medical aid beneficiaries that were completely surveyed and 386 medical insurance benficiaries selected by simple random sampling from a Dong(Township) in Taegu. Well-trained surveyers mainly interviewed housewives with a structured questionnaire. The morbidity rates of acute illness during the 15-day period, were 63 per 1,000 medical aid beneficiaries and 62 per 1,000 medical insurance beneficiaries. The rates for chronic illness were 123 per 1,000 medical aid beneficiaries and 73 per 1,000 medical insurance beneficiaries. The most common type of acute illness in medical aid and medical insurance beneficiaries was respiratory disease. In medical aid beneficiaries, musculoskeletal disease was most common, but in medical insurance beneficiaries, gastrointestinal disease was most common. The mean duration of acute illness of medical aid beneficiaries was 3.8 days and that of medical insurance beneficiaries was 6.8 days. During the one year period, mean duration of medical aid beneficiaries chronic illnesses was 11.5 months which was almost twice as long compared to medical insurance beneficiaries. Pharmacy was most preferrable facility among the acute illness patient in medical aid beneficiaries, but acute cases of medical insurance beneficiaries visited the clinic most commonly. Chronic cases of both groups visited the clinic most frequently. There were some findings suggesting that much unmet need existed among the medical aid beneficiaries. In acute cases, the average number of days of medical aid users utilized medical facilities was less than medical insurance users. On the other hand, the length of medical care utilization of chronic cases was reversed. Geographical accessibility was the most important factors in utilization of medical facilities. Almost half of the study population answered the questions about source of funds on medical security correctly. Most respondents considered that the objective of medical security was afford ability. The chief complaint on hospital utilization was the complicated administrative procedures. These findings suggest that there were some problems in the medical aid system, especially in the referral system.

To determine the incidence rate of accidents and its associated factors, a prospective survey was carried out in a rural area of a total of 1,360 residents for 1 year from January 1 to December 31, 1988 in Shin-am Ri, Jungdong Myun, Sangju Kun, Kyungpook Province. Data for accidents were collected by the community health practitioner who is working at Primary Health Post in Shin-am Ri. A total number of accident cases was 85 among 1,360 persons during one year study period, and annual incidence rate was 62.5 per 1,000 persons. The highest incidence rate of accident was observed in the age group of 30-39 was 179.8. The incidence rate of accident in male was 86.5 which was about 2 times that in female. In male, the highest incidence rate was seen in 30-39 age group and in female, 60-69 age group. The highest incidence rate of accident was observed in spring(29.4%) and summer(29.4%), and the lowest in fall(17.7%). The highest incidence rate of accident was observed in Friday(24.5%) by day of week, and between 9 a.m. to 12 a.m. by time zone. The most frequent use of medical facilities was Primary Health Post(51.8%) and the next was clinic(38.8%). Mean duration of treatment was 9.8 days. The accident occured in the room and kitchen(23.5%), in the yard and barn(23.5%), on the road(22.4%). and in the rice field and dry field(20.0%). The causes of accident were motor vehicle accident(20.0%), piercing or cutting(20.0%), collision or fighting(12.9%), and poisoning(11.8%) in order of frequency. The most common type of injury was open wound which was 43.5%. The most common tool of accident was farm machine which was 23.5%. The most common injuried part of body was extremity(55.3%).

To investigate the blood lead concentration, their interrelation, correlation factor and influence on pregnant women and newborn, lead concentration in the maternal blood and umbilical cord blood were determined. Samples were collected from 130 mothers who were living in the Taegu City, during March, 1989. Blood lead concentration was estimated using the Atomic Absorption Spectrophotometer(IL. 551) equipped with Flameless Furnace Atomizer (IL. 665). The mean lead concentration of maternal and cord blood were , , respectively. A significant correlation was observed between the lead concentration of maternal and cord blood, r=0.663, Y=0.667X+3.646. No significant correlation was observed between previous spontaneous abortion and obstetric complication of mother and maternal blood lead concentration. Similarly, no significant correlation was observed between the sex, gestational age of neonate and cord blood lead concentration. But the birth weight of neonate had some negative correlation with cord blood lead concentration. The blood lead concentration of mother who had engaged in manufactures were higher than others and the longer working years were, the higher blood lead concentration were. Significant correlation was observed between husband's occupational exposure to lead and maternal blood lead concentration.

The effect of interpregnancy interval on birthweight of the subsequent child was investigated for the 1,347 womens of 25 to 40 years old age who visited OBGY and Pediatric department of the general hospital in Taegu city. Questions in designed questionnaire were asked by student interviewers who were trained in nursing school. Mean birth weight by interpregnancy intervals were compared by the intervals of 6 months. Mean birth weight increased from 3,250 grams for intervals of 6 months to 3,357 grams for intervals of 25-30 months, hut the difference was not statistically significant(=0.47). Correlations between the continuous variables which were suspected as con founders and interpregnancy interval and birth weight were investigated. The coefficient of correlation between maternal age and interpregnancy interval was 0.39, between gestational period and birth weight 0.30 and between prepregnant weight and birth weight 0.16 and between birth weight of first baby and birth weight(of second baby) 0.44. But maternal age, gestational period and prepregnant weight were not considered as confounder, because they were not correlated simultaneously with birth interval and birth weight. Associations between the discrete variables which were suspected as confounders, and interpregnancy interval were investigated by Chi-square test. Associations between interpregnancy interval and educational level of mothers, types of husband's occupation, types of medical security, sex were not significant(P-values were 0.59, 0.75, 0.75, 0.82 respectively), so we did not considered these variables as confounding variables. In multiple regression analysis of birth weight, significant variables were birth weight of first baby, gestational period, sex of neonate and prepregnancy body weight of mother. Of the 1,347 births, the rate of low birth weight was 2% (27 birth). The rate for interpregnancy interval 7-12 months was highest as 3.6% and that for 13-18 months was lowest as 0.6%, but there was no regular tendency related with interpregnancy interval.

This study was conducted to compare the date on knowledge, attitude and motivation toward blood donation between donors and nondonors. The study population included 622 donors and 322 nondonors who visited the mobile blood donation car of Taegu Red Cross Blood Center and participated the group appointed blood donation campaign managed by the center from March 1 to March 31, 1989. The donors and nondonors were questioned above mentioned items with a formulated questionnaire. Among the general characteristics of the subjects in the study, male predominace(84.1% in donors and 73.6% in nondonors) in young age group (16-24 years) was the outstanding feature. As a medium of information about blood donation, "television" was playing a dominant role(donors ; 75.2%, nondonors ; 78.9%), while "magazine"played more important roles among donors. Of the donors, 70.6% and of the nondonors, 58.1% replied that they had ever been induced to donate blood (p