• Title/Summary/Keyword: Behavior Management

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The Budget of Nutrients in the Estuaries Near Mokpo Harbor (목포항 주변 하구역의 영양염 수지)

  • Kim, Yeong-Tae;Choi, Yoon-Seok;Cho, Yoon-Sik;Oh, Hyun-Taik;Jeon, Seung-Ryul;Choi, Yong Hyeon;Han, Hyoung-Kyun
    • Journal of the Korean Society of Marine Environment & Safety
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    • v.22 no.6
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    • pp.708-722
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    • 2016
  • Land-Ocean Interactions in the Coastal Zone (LOICZ) models for nutrient budgets were used to estimate the seasonal capacity of the Youngsan Estuary and Youngam-Geumho Estuary to sink and/or supply nutrients such as dissolved inorganic phosphorus (DIP) and nitrogen (DIN) to provide an understanding of the behavior of the coupled biogeochemical cycles of phosphorus and nitrogen in the estuaries (Youngsan Estuary, Youngam-Geumho Estuary) near Mokpo Harbor. During non-stratified periods (May, September, and November, 2008), simple three-box models were applied in each sub-region of the system, while a two-layer box model was applied during on-site observation of stratification development (July, 2008). The resulting mass-balance calculation indicated that even after large discharges from artificial lakes (in May and July), DIP influxes due to a mixing exchange ($V_{X-3}$, or $V_{deep}$) were more than terrigenous loads, indicating the backward transportation of nutrients from a marine source. The model results also indicated that for nutrient loads (DIP and DIN fluxes) in September, an extreme congestion of nutrients occurred around the mouths (sub-region III of the model) of the estuaries, possibly due to an imbalance in physical circulations between the estuaries and offshore locations. In November, the Youngam-Geumho Estuary, into which freshwater was discharged from artificial lakes (Youngam and Geumho Lake), showed nutrient enrichment in the water column, but the Youngsan Estuary showed nutrient depletion. In conclusion, to efficiently control water quality in the estuaries near Mokpo Harbor, integrated environmental management programs should be implemented. I.e., the reduction of nutrient loads from land basins as well as the deposit of nutrient loads into adjacent coastal lines.

Characteristics of Middle Aged Depressed Women with Hot Flushes (안면 홍조 증상을 수반한 중년 우울증 여성의 특성)

  • Song, Minjae;Joe, Sook-Haeng;Jung, Hyun-Gang
    • Korean Journal of Psychosomatic Medicine
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    • v.25 no.2
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    • pp.176-184
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    • 2017
  • Objectives : Middle aged women with depression often experience hot flush symptoms. It is still unclear about the association between depression and hot flush symptoms. Therefore, we investigated hormonal profile, functional somatic symptoms, coping styles and attitude for menopause between depressed women with hot flush and those without hot flush. Methods : This study included 33 depressed patients with hot flush symptoms and 33 depressed patients without hot flush symptoms. Hot flush was confirmed through prospective daily symptom ratings for a week. Subjects' coping styles were assessed by the stress coping checklist. Somatic symptoms were assessed by the Patient Health Questionnaire-15(PHQ-15). Sex hormonal levels were assayed by a radioimmunoassay. The Brief World Health Organization Quality of Life Assessment Instrument(WHOQOL-BREF) was used to evaluate quality of life. Results : In coping style, depressed women with hot flush symptoms used less 'problem-centered coping'($13.15{\pm}3.17$) and 'search for social support'($11.83{\pm}2.84$) than those without hot flush symptoms($15.17{\pm}3.1$, p=0.028 ; $14.25{\pm}3.22$, p=0.009 ; respectively). Depressed women with hot flush symptoms showed more negative attitude toward post-menopause, but its statistical significance was marginally insufficient(p=0.059). We did not find any group differences in sex hormonal levels and somatic complaints assessed by the PHQ-15. The score of social relationship domain of WHOQOL-BREF was significantly lower in subjects with hot flush symptoms($8.62{\pm}2.04$) than subjects without hot flush symptoms($9.71{\pm}1.65$ ; p=0.044). Conclusions : Among middle aged women with depression, the manifestation of hot flush symptoms was associated with coping styles and attitude for menopausal transition. Hot flush symptoms in depressed women negatively influence quality of life, so clinicians actively perform therapeutic approach in case of depressed patients with hot flush symptoms. In case of depressed patients who present hot flushes, cognitive behavior therapy or stress management might be an effective treatment option in company with antidepressants or hormonal treatment. Later, longitudinal study will be needed to evaluate risk factor, cause and effect associated with hot flush and depression.

A survey on sex life behavior and factors of low back pain (요통환자들의 성생활 행태와 영향 요인 조사)

  • Nam, Chul-Hyun;Woo, Kwang-Seog
    • Journal of Korean Physical Therapy Science
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    • v.9 no.3
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    • pp.31-49
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    • 2002
  • The purpose of this study was to investigate discomforts and sexual life and to identify the relation between the discomforts and sexual life with low back pain. The data were collected from March 2 through July 31, 2001. Four hundred forty-two questionnaires were returned (response rate=88.0%). Analysis of the data was done with SPSS PC+ and use descriptive statistics, $x^2$-test, t-test, ANOVA. regression. The statistics shows that over than 80% of the adults experienced lumbago at least one time in their life, and Back pain is known as one of the most common complaints made by the patients of all ages in the general hospital or local medical clinics throughout. However, in certain case it leads to a chronic condition which can cause a great deal of problems in management and in financial burden to individuals and society. The result of this study was summarized as follows: 1) It appeared that regarding the distribution of gender, male was the higher(63.6%) then that of female, the portion of forties was 28.5%. Sitting for long time was 23.1% in men and 21.7% in women. Unknown reason including sexual behaviour was 12.9% in men and 15.5% in women. Patients treated medicine and physical therapy were 36.4%. In level of educational background, the rate of high school was 31.0%, technical college was 28.5%. The highest proportion by occupation was 18.3% of office workers, occupation posture was 41.9% of sitting. 2) Men(26.0%) and most of women(34.8%) were not satisfied in the explanation satisfaction rate of sex life concerned disease. 23.8% in men and 23.6% in women considered flexibility of waist good. Man(33.3%) and most of woman(35.0%) considered that Health education is necessary. 32.7% in men and 27.3% in women did't mind educator is whoever. Preventing of lower back pain(LBP) and proper Health education of sex life are demanded in daily life. 3) 58.0% of man and 64.0% of woman mostly had a posture which is man over woman. 28.5% in men and 27.8% in women considered that proper information finding of LBP and sex life was very few and few. 37.7% in men and 42.7% in women have acquired information about sex life flung their friends. 4) The number of sex life was decreased from 2.96 0.98 to 2.61 1.63 and also the time of sex life was decreased from 3.65 1.89 to 226 1.64. The satisfaction rate of sex life changed from 3.60 0.86 to 2.77 1.10. In the number of sex life, The non correct group was 2.62 1.91 and the correct group was higher in 2.68 1.65. In the time of sex life, The non correct group was 2.02 1.47 and the correct group was higher in 229 1.65. The satisfaction rate of sex life was 2.76 0.86 in non correct group and 2.88 1.10 in correct group. So there was a difference. 5) In the satisfaction rate of sex life, Men who have a lower back pain were higher than women and no attack group was higher than attack group. As they had many sex life, the satisfaction rate was higher significantly in statistics. As the time of sex life was short, the satisfaction rate was lower significantly in statistics. As the age was low, the demand rate of Health education was high and as means of patient who had a lower back pain was high, the demand rate of Health education was high. As the patient who had a lower back pain had a long married life, the demand rate of Health education was high and as education level was high, the demand rate of Health education was high. It is necessary to provide patients with conservative treatment, educational teaching, and training to prevent further injuries in the future. In general, it is important to educate the public how to prevent back injuries and how to treat themselves in an onset period to prevent further injuries sliding into a chronic state. Sexuality is an integral part of normal and healthy relationships, but patients are unable to enjoy sex because they are riot able to get into a comfortable position due to back pain. Many conditions of the spine can make certain positions uncomfortable. Health educator should make the education program of the discomforts and the sexual pattern for low back pain in workplace and/or hospital. Further study Is needed on how to integrate the educational program on sexuality into the total rehabilitation program.

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A Study on the Competition Strategy for Private Super Market against Super Super Market (슈퍼슈퍼마켓(SSM)에 대한 개인 슈퍼마켓의 경쟁전략에 관한 연구)

  • Yoo, Seung-Woo;Lee, Sang-Youn
    • The Journal of Industrial Distribution & Business
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    • v.2 no.2
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    • pp.39-45
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    • 2011
  • The Korean distribution industry is gearing up for an endless competition. Greeting low growth era, less competitive parties will be challanged seriously for their survival. But for large discount stores, they have shown steady annual growth for years. However, because of the saturation for numbers of stores, the difficulty of gaining new sites, and the changes in the consumer's consumption behavior caused by the recession, now they are seeking for a new customers-based business formats. Accordingly, a large corporate comopanies made supermarkets which are belonged to affiliated companies of large corporate comopanies. They based on the strong buying power, focused on SSM(Super Super Market) ave been aggressively develop nationwide multi-stores. The point is that these stores are threatening at small and medium-sized, community-based private supermarkets. Private supermarkets and retailers, who are using existing old operation systems and their dilapidated facilities, are losing a competitive edge in business. Recent the social effects of large series of corporate supermarkets for traditional markets has been very controversial, and commercial media, academia, and industry associated with it have been held many seminars and public hearings. This may slow down the speed in accordance with the regulations, but will not be the crucial alternative. The reason for this recent surge of enterprise-class SSM up, one of the reasons is a stagnation in their offline discount mart, so they are finding new growth areas. Already in the form of large supermarkets across the country got most of the geographical centre point and is saturated with stages. Targeting small businesses that do not cover discount Mart, in order to expand business in the form of SSM is urgent. By contrast, private supermarkets are going to lose their competitiveness. The vulnerability of individual supermarkets, one of the vulnerabilities is price which economies of scale can not be realized so they are purchasing a small amount of products and difficult to get a quantity discount. The lack of organization and collaboration, and education which is not practical, caused the absencer of service-oriented situations. As a first solution, making specialty shops which are handling agricultures, fruits and vegetables and manufactured goods is recommended. Second, private supermarkets franchisees join the organization for the organization and collaboration is recomaned. It can be meet the scale of economy and can be formed a alternative business formats to a government. Third, the education is needed as a good service will get consumer's awareness. In addition, a psychological stores operating is also one way to stimulate consumer sentiment as SSM can't operate. Japan already has a better conditions of their lives through small chain expression. This study includes the vulnerabilities of private supermarkets, and suggests a competitiveness reinforcement strategies.

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Therapeutic Compliance for Calcium Supplements and Its Related Factors in Rural Osteoporotic Women (일부 농촌지역 여성 골다공증 환자의 칼슘보조제 치료순응도와 결정요인)

  • Chun, Byung-Yeol;Kam, Sin;Lee, Young-Ja;Lee, Sang-Won;Lee, Kyung-Eun;Lee, Young-Seok;Kim, Bong-Kee
    • Journal of agricultural medicine and community health
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    • v.26 no.2
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    • pp.111-132
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    • 2001
  • This study was conducted to examine the therapeutic compliance and its related factors in rural women with osteoporosis. A questionnaire survey was performed from April to May in 2000 for 140 osteoporotic patients who were diagnosed from April to June in 1999 through community health program. The study employed the health belief model for predicting and explaining sick role behavior. The analysis techniques employed included contingency table analysis and path analysis using LISREL. The major results of this study were as follows: Of the subjects, 12.1% were continuously complaint, 53.6% were intermittently compliant, and 34.3% were non- compliant to calcium supplement therapy. As the result of path analysis, the therapeutic compliance was significantly higher(${\mid}T{\mid}$ >2.0) as patients had higher perceived severity of disease, lower perceived barriers of treatment, and when patients thought their disease status as severe. As the patients had higher educational level, more experience of mass media contact or health education about osteoporosis, and when family had more concern for patient treatment, they had higher perceived susceptibility of complication(bone fracture)${\mid}T{\mid}$ >2.0). The patients had higher perceived severity(${\mid}T{\mid}$ >2.0) as they had more educational level, more advice for treatment from their doctors, and when family had more concern for their treatment. As the patients had more advice for treatment from their doctors and when family had more concern for their treatment, they had higher perceived benefit of treatment and lower perceived barriers to treatment(${\mid}T{\mid}$ >2.0). In order to improve the therapeutic compliance in rural osteoporotic women, it would be necessary that the patient should recognize their disease severity properly. And the perceived barriers should be removed through supportive environments for osteoporosis treatment such as doctor 's more advice and family 's more concern for treatment. In addition, effective and continuous management system for osteoporotic patients should be established.

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IMMOBILIZATION OF LOWER MANDIBULAR ALVEOLAR BONE FRACTURE USING RESIN-WIRE OPEN CAP SPLINT (하악 유전치부 치조골 골절시 resin-wire open cap splint를 이용한 고정)

  • Kwon, Joung-Hyun;Choi, Byung-Jai;Choi, Hyung-Jun;Kim, Seong-Oh;Son, Heung-Kyu;Lee, Jae-Ho
    • Journal of the korean academy of Pediatric Dentistry
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    • v.35 no.1
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    • pp.175-180
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    • 2008
  • Traumatic injuries to the primary dentition are commonly encountered problems in dental practice. It is found that 30% of the children had injuries to the primary dentition and 22% to the permanent dentition. The greatest incidence of trauma to the primary dentition occurs at the ages of 2 and 3 as children start to learn motor coordination. Because teeth and alveolar bone are traumatized simultaneously, alveolar bone fractures are likely to occur when multiple teeth are involved in injuries. Dental splints are indicated for the management of maxillofacial fractures. They enable anatomic reduction of fractured segments and help immobilization and maintenance of the fragments after reduction. They also act as a stabilizer during rehabilitation. Various types of dental splints are available. In this case, routine resin-wire splint technique could not be applied because of the child's uncooperative behavior. Oral sedation was not indicated because N.P.O. had not been preceded. Therefore, we decided to use open-cap acrylic splint instead. Stabilization using open cap acrylic splint requires minimum chair time with reduced discomfort to both patient and dentist. It is an effective means of splint for uncooperative children and especially useful when other means of fixation have been failed. Because trauma on the primary dentition can affect the underlying permanent tooth germ, it is important to monitor eruption process of the permanent dentition.

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Analysis of the Quantitative Effect of Seoul Social Welfare Budget Spending (서울시 사회복지 예산지출의 계량적 효과 분석)

  • Kim, Keum Hwan;Joe, Soon Joem
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.9 no.2
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    • pp.163-173
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    • 2014
  • Budget for social welfare social welfare with a sharp increase in business is to be expanded in various fields. At this point, do the social welfare policies of local governments and assistance projects supported by the Seoul Metropolitan Government's justification and rationale for concluding that we need clarity, and welfare economics point of this study is related to social welfare spending budget and other areas in Seoul quantitative effects of the economic effects were investigated. Social welfare policy for the achievement of corporate and personal consumption spending behavior is continuously and directly or indirectly derived thereby, and Seoul Industry Input-Output Tables in this study to re-create the social welfare spending as the economic effects of production, value added, employment, work and how do you contribute to the quantitative estimation of suggested. Municipal social welfare spending in Seoul by the annual production of 10.02 trillion won sikimyeo caused, directly or indirectly Article 6 billion in 4936 to spread the value was analyzed. In addition, employment and 203,430.3 132,992.3 people letting people was estimated to generate employment. These results suggest that social welfare spending and social spending in the atmosphere is recognized as a social and financial pressures caused controversy at the present time factor in the welfare sector and the government's social welfare policy in Seoul, intervention and support and assistance of the the validity of the justification debate eventually be supported through empirical analysis depends on whether we believe in, and for this study it as a basis for presenting the fundamental study has its significance. In addition, Korea is not a welfare budget is spent volatile social and economic impact on a variety of industries that derive a significant number were found in this study, continued political support and social consensus through research is needed.

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The Gender difference of Nutritional Status by Health Practice on the University Freshmen in Metropolitan Area (남녀 대학 신입생의 건강실천에 따른 영양상태)

  • Rhie, Seung-Gyo;Lee, Young-Hee;Won, Hyang-Rye
    • The Korean Journal of Community Living Science
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    • v.17 no.4
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    • pp.151-161
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    • 2006
  • This study was made to find out how health practice affect on nutrition status of the college freshmen in male and female. 400 freshmen students in 4year colleges were surveyed. Questionnaire and blood analysis were made. The contents of questionnaire contained general characteristics, health practice behavior, and food intake. The physical measurement included height, weight and blood pressure. The questions for health practice were about drinking, smoking, BMI, skipping breakfast and sleeping. Nutrient intake was expressed by DDS(Dietary Diversity Score by 5 food groups) and DVS (Dietary Variety Score) and 24-hrs recall method was used to find out the quantity of daily food intake. EAR% was calculated and NAR and MAR were produced. The results are as follows: 1) BMI was $22.77kg/m^2$ for males and $20.42kg/m^2$ for females. The ratio maintaining normal weight indicated by BMI of 18.5-23 was higher(p<0.001) for female students(63.2%) than males(56.5%). The ratio of overweight with over $23kg/m^2$ of BMI was 28.5% for males and 8.8% for females(p<0.001). 2)The ratio of drinking students was 59.4% for males and 40.6% for female(p<0.001). And the ratio of smoking students was 95.2% for males and 4.8% for females(p<0.001). 3) The ratio of poor health practice group was 35.7% for males and 25.5% for females, and that of excellent one was 25.4% for males and 33.1% for females(p<0.05). 4) In NAR, the lowest ratio was observed for the intake of Ca, Fe, Vitamin C and Vitamin $B_2$. The intake of Fe, Vitamin $B_2$ and phosphorus were different significantly according to sexuality. For Fe, female students showed lower level than male students(p<0.001). For Vitamin $B_2$, and phosphorus female students showed higher level(p<0.001). 5) In MAR, there was no difference according to sexuality in almost all of the ingredients. 6) For energy intake, male and female students showed 59% and 66% of EAR and it was insufficient for them. 7) For protein, more than 100% was obtained. The lowest ratio was observed for the intake of vitamin C 50.8%, Ca 53.6% and Fe 65.1% of EAR were obtained. The lowest intake ratio and for the intake of Fe female students obtained just 37.5% of EAR showing high risk of anemia. The intake of energy(p<0.001), phosphorus(p<0.01), niacin(p<0.05), Fe(p<0.001), and Vitamin $B_2$ (p<0.001) were different significantly according to sexuality. For Fe, female students showed lower level than male students(p<0.001). For energy, phosphorus, niacin, and Vitamin $B_2$ female students showed higher level(p<0.001) than male students. 8) For blood pressure, male students showed normal level of 120.7/79.1 mmHg, however, female students showed 114.5/75.4 mmHg lower than male (p<0.001). 9). In blood, for hemoglobin female students showed significantly lower level than that of male(p<0.001). T-Cholesterol and HDL-Cholesterol female students showed higher level than males (p<0.001), And for triglyceride male students showed higher level than females(p<0.001). Ca and Fe female students showed lower level (p<0.001).

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An Empirical Study on How the Moderating Effects of Individual Cultural Characteristics towards a Specific Target Affects User Experience: Based on the Survey Results of Four Types of Digital Device Users in the US, Germany, and Russia (특정 대상에 대한 개인 수준의 문화적 성향이 사용자 경험에 미치는 조절효과에 대한 실증적 연구: 미국, 독일, 러시아의 4개 디지털 기기 사용자를 대상으로)

  • Lee, In-Seong;Choi, Gi-Woong;Kim, So-Lyung;Lee, Ki-Ho;Kim, Jin-Woo
    • Asia pacific journal of information systems
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    • v.19 no.1
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    • pp.113-145
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    • 2009
  • Recently, due to the globalization of the IT(Information Technology) market, devices and systems designed in one country are used in other countries as well. This phenomenon is becoming the key factor for increased interest on cross-cultural, or cross-national, research within the IT area. However, as the IT market is becoming bigger and more globalized, a great number of IT practitioners are having difficulty in designing and developing devices or systems which can provide optimal experience. This is because not only tangible factors such as language and a country's economic or industrial power affect the user experience of a certain device or system but also invisible and intangible factors as well. Among such invisible and intangible factors, the cultural characteristics of users from different countries may affect the user experience of certain devices or systems because cultural characteristics affect how they understand and interpret the devices or systems. In other words, when users evaluate the quality of overall user experience, the cultural characteristics of each user act as a perceptual lens that leads the user to focus on a certain elements of experience. Therefore, there is a need within the IT field to consider cultural characteristics when designing or developing certain devices or systems and plan a strategy for localization. In such an environment, existing IS studies identify the culture with the country, emphasize the importance of culture in a national level perspective, and hypothesize that users within the same country have same cultural characteristics. Under such assumptions, these studies focus on the moderating effects of cultural characteristics on a national level within a certain theoretical framework. This has already been suggested by cross-cultural studies conducted by scholars such as Hofstede(1980) in providing numerical research results and measurement items for cultural characteristics and using such results or items as they increase the efficiency of studies. However, such national level culture has its limitations in forecasting and explaining individual-level behaviors such as voluntary device or system usage. This is because individual cultural characteristics are the outcome of not only the national culture but also the culture of a race, company, local area, family, and other groups that are formulated through interaction within the group. Therefore, national or nationally dominant cultural characteristics may have its limitations in forecasting and explaining the cultural characteristics of an individual. Moreover, past studies in psychology suggest a possibility that there exist different cultural characteristics within a single individual depending on the subject being measured or its context. For example, in relation to individual vs. collective characteristics, which is one of the major cultural characteristics, an individual may show collectivistic characteristics when he or she is with family or friends but show individualistic characteristics in his or her workplace. Therefore, this study acknowledged such limitations of past studies and conducted a research within the framework of 'theoretically integrated model of user satisfaction and emotional attachment', which was developed through a former study, on how the effects of different experience elements on emotional attachment or user satisfaction are differentiated depending on the individual cultural characteristics related to a system or device usage. In order to do this, this study hypothesized the moderating effects of four cultural dimensions (uncertainty avoidance, individualism vs, collectivism, masculinity vs. femininity, and power distance) as suggested by Hofstede(1980) within the theoretically integrated model of emotional attachment and user satisfaction. Statistical tests were then implemented on these moderating effects through conducting surveys with users of four digital devices (mobile phone, MP3 player, LCD TV, and refrigerator) in three countries (US, Germany, and Russia). In order to explain and forecast the behavior of personal device or system users, individual cultural characteristics must be measured, and depending on the target device or system, measurements must be measured independently. Through this suggestion, this study hopes to provide new and useful perspectives for future IS research.

A Case of Adult-onset Type II Citrullinemia Confirmed by Mutation of SLC25A13 (SLC25A13 유전자 돌연변이로 확진된 성인형 제 2형 시트룰린혈증 1례)

  • Jeung, Min Sub;Yang, Aram;Kim, Jinsup;Park, Hyung-Doo;Lee, Heon Ju;Jin, Dong-Kyu;Cho, Sung Yoon
    • Journal of The Korean Society of Inherited Metabolic disease
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    • v.16 no.1
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    • pp.34-41
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    • 2016
  • Adult-onset type II citrullinemia (CTLN2) is characterized by episodes of neurologic symptoms associated with hyperammonemia leading to disorientation, irritability, seizures, and coma. CTLN2 is distinct from classical citrullinemia, which is caused by a mutation of the argininosuccinic acid synthetase (ASS) gene. The serum citrulline level is elevated, while the activity of ASS in liver tissue is decreased. CTLN2 is known to have a poor prognosis if the proper treatment is not taken. We reported a female aged 37 years who developed recurrent attacks of altered consciousness, aberrant behavior, and vomiting. We initially suspected the patient had CTLN2 because of the signs of hyperammonemic encephalopathy, such as altered mentality, memory disturbance, and aberrant behaviors provoked by exercise-induced stress and excessive intravenous amino acid administration. Through her peculiar diet preferences and laboratory findings that included hyperammonemia and citrullinemia, we diagnosed the patient as CTLN2, and SLC25A13 sequencing revealed known compound heterozygous mutations (IVS11+1G>A, c.674C> A). Her parents were heterozygous carriers, and we identified that her older sister had the same mutations. The older sister had not experienced any episodes of hyperammonemia, but she had peculiar diet preferences. The patient and her sister have been well with conservative management. When considering the clinical course of CTLN2, it was meaningful that the older sister could be diagnosed early in an asymptomatic period and that preemptive treatment was employed. Through this case, CTLN2 should be considered in adults who present symptoms of hyperammonemic encephalopathy without a definite etiology. Because of its rare incidence and similar clinical features, CTLN2 is frequently misdiagnosed as hepatic encephalopathy, and it shows a poor prognosis due to the lack of early diagnosis and proper treatment. A high-carbohydrate diet, which is usually used to treat other urea cycle defects, can also exaggerate the clinical course of CTLN2, so proper metabolic screening tests and genetic studies should be performed.

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