• Clinics in Shoulder and Elbow
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• v.15 no.2
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• pp.86-90
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• 2012

Purpose: We studied the need for distal clavicle resection by comparing rotator cuff tear patients who underwent non-surgical treatment with and without acromioclavicular joint pathology. Materials and Methods: 45 cases that had been under follow up care for at least 9 months after receiving rotator cuff repair in our hospital between Jan. 2005 and Jun. 2011 had been studied. Acromioclavicular joint pathology group and control group were classified by physical examination and MRI findings. The temporal changes in shoulder joint abduction, internal and external rotation strength, ASES and KSS score of the two groups were measured and analyzed. Results: The acromioclavicular joint pathology complicated rotator cuff injury group's strength measurements for abduction, internal rotation, external rotation were each 8.05 (${\pm}4.54$), 11.33 (${\pm}6.05$), 10.24 (${\pm}5.27$) preoperatively and improved to 13.26 (${\pm}5.50$), 17.51 (${\pm}6.80$), 15.60 (${\pm}5.37$) post operatively while the KSS score and ASES score were each 49.07 (${\pm}15.28$) and 48.65 (${\pm}13.27$) preoperatively, improving to 84.48 (${\pm}10.96$) and 84.65. (${\pm}9.86$). The measurements for the group without complicating acromioclavicular pathology are as follows. The strength for abduction, internal rotation, external rotation was each 6.42 (${\pm}3.11$), 7.59 (${\pm}4.81$) and 7.93 (${\pm}4.49$) preoperatively, improving to 15.85 (${\pm}7.35$), 19.18 (${\pm}9.14$), 16.95 (${\pm}5.70$) post operatively, while the KSS score and ASES score each went from 42.12 (${\pm}6.43$) and 41.37 (${\pm}7.42$) to 83.44 (${\pm}6.30$) and 83.17 (${\pm}7.01$) respectively. The measurements for the two groups, however, did not show a statistically significant difference (p>0.05). Conclusion: Analysis of the rotator cuff injury groups with and without AC joint pathology showed that both groups had improved strength, ASES and KSS scores with no statistical difference difference among the groups. As such, it thought that conservative treatment is an acceptable alternative to distal clavicle resection.

• Progress in Medical Physics
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• v.25 no.3
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• pp.143-150
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• 2014

In general radiotherapy, mega-voltage (MV) x-ray images are widely used as the unique method to verify radio-therapeutic fields. But, the image quality of MV images is much lower than that of kilo-voltage x-ray images due to scatter interactions. Since 1990s, studies for the scatter correction have performed with digital-based MV imaging systems. In this study, a novel method for the scatter correction is suggested using scatter to primary ratio (SPR), instead of conventional methods such as digital image processing or scatter kernel calculations. We measured two MV images with and without a solid water phantom describing a patient body with given imaging conditions, and calculated un-attenuated ratios. Then, we obtained SPR distributions for the scatter correction. For experimental validation, a line-pair (LP) phantom using several Al bars and a clinical pelvis MV image was used. As the result, scatter signals of the LP phantom image were successfully reduced so that original density distribution of the phantom was restored. Moreover, image contrast values increased after SPR correction at all ROIs of the clinical image. The mean value of increases was 48%. The SPR correction method suggested in this study has high reliability because it is based on actually measured data. Also, this method can be easily adopted in clinics without additional cost. We expected that the SPR correction can be an effective method to improve the quality of MV image guided radiotherapy.

• Clinics in Shoulder and Elbow
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• v.16 no.1
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• pp.33-39
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• 2013

Purpose: The aim of this study is to evaluate the clinical result of intra-articular fractures of the distal humerus (AO type C) in elderly osteoporotic patients treated with double tension band osteosynthesis. Materials and Methods: From January 2006 to December 2010, 10 elderly osteoporotic patients(1 male, 9 females) with intra-articular fractures of the distal humerus (AO type C) were treated with double tension band osteosynthesis. The mean age of patients at the time of surgery was 74.6(66~84) years and the mean follow-up period was 39.2(20~74) months. The fracture union and complications were assessed and the functional result was evaluated by the rating system of Jupiter et al. and the Mayo elbow performance index. Results: Bone union was achieved in all patients with no secondary displacement. The mean time for union was 16.6(13~22) weeks. The average postoperative arc of elbow flexion was 119(100~140) degrees with a mean flexion contracture of 8.5(0~15) degrees. The recovery in two patients was rated as excellent, in 7 as good, and in 1 as fair in terms of the Mayo elbow performance index with average value of 82(70~90) points. Seven patients were rated as excellent, 1 as good, and 2 as fair in terms of the rating system of Jupiter et al. Changing tension band wiring was performed in one patient as skin irritation was noticed due to tension band knots. Heterotopic ossification developed in one patient but had no symptom. Conclusion: Double tension band osteosynthesis in intra-articular fractures of distal humerus (AO type C) in elderly osteoporotic patients can provide sufficient and secure stability to allow early rehabilitation.

• Journal of dental hygiene science
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• v.11 no.3
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• pp.285-292
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• 2011

The purpose of this study was to analyze and investigate temporomandibular disorders(TMD) and dental clinic outpatients by food intake ability to improve the quality of life. A survey of questionnaires with 208 subjects visiting a dental clinics located in Daejeon city from January to September in 2010 was performed. Analysis were performed with survey results, in which a symptoms of TMD, parafunctional habits and abnormal functions, food intake ability : 1. The main symptoms of TMD showed pain on TMJ(45.7%), pain on joint sound(45.2%), pain during chewing(41.3%), pain during mouth opening(38.0%), pain during non chewing(19.7%) and pain on joint dislocation(13.0%) in turn. 2. The symptoms of TMD by gender showed joint dislocation of 18.0% for male and 8.3% for female(p=0.038); pain on chewing of 49.0% for male and 34.3% for female(p=0.031), which were statistically significant. 3. The parafunctional habits and abnormal functions by gender showed clenching habit of 35.0% for male and 22.0% for female; bruxism of 21.0% for male and 9.3% for female, which were statistically significant. 4. The symptoms of TMD by age showed 52.8% of 27.8% for often and 25.0% for sometimes of 21-30 age in pain on TMJ, which were statistically significant(p=0.001). 5. The parafunctional habits and abnormal functions by age showed over 31 age of 48.3%, which were statistically significant(p=0.003). 6. The food intake ability by symptoms of TMD showed no joint sound(p=0.000), no pain on chewing(p=0.000) and without pain on TMJ(p=0.000), which were statistically significant. 7. The food intake ability by parafunctional habits and abnormal functions showed no clenching habit(p=0.000), no bruxism(p=0.000) and no headache, which were statistically significant. 8. The distribution type of operation by symptoms of TMD showed 30.8% of rest, 24.0% of physical medicine and 16.4% of pharmacotherapy. The pain on chewing showed 36.0% of pharmacotherapy; 52.4% of pain on TMJ for often and 40.5% for sometimes, in which pharmacotherapy and physical medicine were statistically significant(p=0.000). These results showed that management run parallel with survey for multiple factors in TMD we consider aspect of physical, social, physiology to enhance quality of life to increase food intake, construction of program for treatment and prevention because the individual differences need to be multifaceted, further research is suggested to continue.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.1
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• pp.30-38
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• 2009

Purpose: To investigate the physical and biochemical parameters related with elevated serum alanine aminotransferase (ALT) levels in obese children. Methods: One hundred forty-two obese or overweight children who visited the out-patient clinics of Chungnam National University Hospital between January 2006 and August 2008 were enrolled. Physical measures and biochemical tests were performed in all patients. Liver sonography was performed in 43 patients. They were divided into the following 2 groups based on ALT levels: group I, normal ALT levels (n=65); and group II, elevated ALT levels (n=77). We compared the physical measures, biochemical results, and ultrasonographic findings of the livers in both groups. Other causes of elevated serum ALT levels were ruled out. Results: The male-to-female ratios were 1.6:1 in group I and 7.6:1 in group II. Among physical parameters, the waist circumference-to-height ratio and hip circumference-to-height ratio were significantly higher in group II (p=0.001 and 0.046, respectively). Among biochemical parameters, aspartate aminotransferase (AST), ${\gamma}$-glutamyltransferase (${\gamma}$-GT), and total cholesterol levels were significantly higher in group II (p<0.001, 0.001, and 0.001, respectively). The AST/ALT ratio was <1 (mean, 0.55) and statistically lower in group II. There was a positive correlation between the serum ALT level and ${\gamma}$-GT (p<0.001, r=0.750), and a positive correlation between the serum ALT level and the waist circumference-to-height ratio in group II (p<0.001, r=0.401). Conclusion: The results suggest that the waist circumference-to-height ratio and ${\gamma}$-GT may be associated with elevated alanine aminotransferase activity in obese children.

• Clinical and Experimental Pediatrics
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• v.45 no.4
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• pp.489-497
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• 2002

Purpose : The objectives of this study were to investigate the causes of chronic cough and to establish the appropriate diagnostic approach to chronic cough in children. Methods : One hundred and thirty two cases of chronic cough were prospectively evaluated. They visitors to pediatric chronic cough clinics at Kang-nam saint Mary's Hospital of Catholic University from August 2000 to July 2001 for 12 months. Careful history taking by questionnaire, physical examination, radiologic studies of chest and sinus, hematologic and immunologic studies, allergic skin tests, and methacholine challenge tests were performed. Color doppler(CD) ultrasonography were performed and compared with simultaneous 24 Hr. esophageal pH monitoring to diagnose gastroesophageal reflux disease(GERD). Results : Age distributions were demonstrated that nine in infants, 82 in early childhood, 38 in late childhood, and three in adolescence. Common causes of chronic cough were bronchial asthma in 40 cases, chronic sinusitis in 22 cases, GERD in seven cases, bronchial asthma combined with sinusitis in 28 cases, bronchial asthma combined with GERD in 14 cases, psychogenic cough in two. cases, foreign body in one case, chronic bronchitis in one case, and bronchiolitis in one case. Comparing with 24 Hr. pH monitoring, sensitivity, specificity, positive predictive value and negative predictive values of CD ultrasonography were 88%, 69%, 85 %, and 73% respectively. Conclusion : The most common causes of chronic cough in children were bronchial asthma, sinusitis and GERD in order. We suggest that CD ultrasonography can be used as a good, convenient screening method for patients with suspected GERD in outpatient settings.

• Journal of Oral Medicine and Pain
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• v.31 no.2
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• pp.185-197
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• 2006

The aim of this study was to investigate the beneficial effect of a daily dose of 300 mg of ASU taken for more than 3 months on the subjects diagnosed as osteoarthritis of temporomandibular joint by RDC/TMD. Total 68 outpatients(15-54y) of female except menopause in Orofacial Pain Clinics of the Pusan National University Hospital were randomly assigned to either an ASU group(n=36) or a placebo group(n=32). The pain, noise and limited mouth opening(LOM) were evaluated by numerical analogue scale(NAS, range 0-10) and maximum comfortable opening(MCO) were measured by milimeter scale. The difference of simple uptake rate(SUR) on bone scan, hot spot(HS) on coronal SPECT, condylar bony changes on CT between the ASU and placebo groups were compared to investigate the objective effect. The obtained results were as follows. 1. Comparison of the NAS of pain, noise, LOM and MCO before treatment and 3, 6 and 9 months after treatment showed no significant difference between the ASU and placebo groups. 2. Comparison of the NAS of pain, noise, LOM and MCO before treatment and 3, 6 and 9 months after treatment showed no significant difference between the ASU and placebo groups without splint treatment, but showed more increased MCO in the ASU group than the placebo group with splint treatment at 6, 9 months after treatment. 3. Comparison of the NAS of pain before treatment and 3, 6 and 9 months after treatment that the NAS of pain at first visit divided into two groups(above or below 6) showed more decreased the NAS of pain in the ASU group than the placebo group that the NAS of pain at first visit was above 6. 4. Comparison of the NAS of pain, noise, LOM and MCO during 6 months period showed improvement of clinical symptoms within group, but no significant difference between subjects. 5. The simple uptake ratio(SUR) on bone scan and hot spot(HS) on coronal SPECT showed more increased SUR and HS in affected side than non-affected side of the ASU and placebo groups. 6. Comparing of condylar bony changes, osseous remodeling were observed highest, osteophyte lowest in the affected and non-affected side of the two groups. After treatment, comparison of condylar bony changes were observed more decreased erosive features in the ASU group than the placebo group.

• Journal of agricultural medicine and community health
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• v.26 no.2
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• pp.79-96
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• 2001

In order to ascertain the utilization patterns and Perception and attitudes of Primary Health Post(PHP) by rural residents in farm areas, a survey was conducted of 753 households(1,803 persons) in 24 PHPs in Sangju-si, Gyeongsangbuk- do, from December 10, 2000 to January 15, 2001. The morbidly rate of acute illnesses for last two weeks for all households was 29.6%, and the rate of use of medical facilities to treat acute illness was 98.3%. The morbidly rate was highest between the ages of 60 and 69, with a rate of 35.4%. The higher their ages and the lower their educational levels were, the higher the morbidly rate was. The morbidly rate of chronic illnesses for one year for all households was 19.2%, and the rate of use of medical facilities to treat chronic illness was 92.8%. The elderly over 70 years old had the highest morbidly rate of 37.2%. The higher their ages and the lower their educational levels were, the higher the chronic illnesses rate was. For the rate of use of medical facilities to treat acute diseases, the use of PHPs was 89.5%, accounting for the majority of the time. However, for chronic diseases, hospitals and clinics were used more often, with a rate of 48.9%, compared to the use of PHPs, 40.2%. Their previous experiences on the use of PHPs one year before the survey showed that 94.8% used PHPs, 72.2% just visited them, not for the purpose of getting any medical assistance, and 73.3% received health education from PHPs. 98.5% remembered the locations of PHPs, 98.6% thought that PHPs were helpful for their health management, and 84.3% said that PHPs were playing great roles in development of their communities. 97.4% said that they found PHPs necessary. They understood the main job of PHPs as in the order of disease treatment, vaccination and health counseling. The work that they mostly wanted PHPs to do was health counseling and health management, which 31.6% answered. 88.9% said the examination fee was not expensive, 98.4% said CHPs were kind, and 97.0% said they were satisfied with the services at PHPs. Complaints about PHPs included a lack of a variety of medications, said by 42.9%, and poor facilities, by 15.8%. According to the above results, it is concluded that local residents on survey were frequently using PHPs due to their geographical and economical conditions. Also, the residents appeared to be satisfied with the services at PHPs, and they had a high demand for public health service as well as disease treatment. Considering the complaints about medications and medical facilities and equipment, active supports are required to manage PHPs in a way it can provide desirable services to the residents in remote villages through the readjustment of PHPs' functions, reinforcement of facilities and equipment and enhancement of CHPs ' training.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.2
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• pp.179-186
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• 2008

Purpose: Feeding problems are common for typically developing children and have negative effects on physical, behavioral, and cognitive development. The purpose of the current study was to examine factors related to childhood feeding problems for typically developing children via parental reports. Methods: The feeding questionnaire developed by the authors and the Childhood Eating Behavior Inventory (CEBI) were administered to 796 parents of children who recruited from 2 pediatric outpatient clinics (n=379) and community (n=417). Problem eaters (PE) were identified by parental report and frequency analysis was conducted for types of feeding problems and its severity, problem behaviors during mealtime, the feeding methods of the parents, and the need for treatment. Results: The CEBI scores were significantly different between the PE and non-problem eaters (NPE), which suggests that the parental reports were reliable. The younger children had more feeding problems than the older children. The most frequent and severe feeding problems were selective eating and longer mealtimes across all age groups. One-half of the children had more than one problem behaviors during mealtime. Most parents of PE used ineffective methods to deal with children's behaviors during meal time, such as cajoling, which was related to their increased level of stress. Many parents reported their children need professional help for the feeding problems. Conclusion: Feeding problems are prevalent among children, especially younger children. Children with feeding problems showed a number of problem behaviors during mealtime and parental coping methods appeared to be ineffective. The need for treatment was considerable, thus the characteristics of this population must be acknowledged for providing proper treatment and advice.

• Journal of agricultural medicine and community health
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• v.37 no.2
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• pp.84-95
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• 2012

Background: In Korea, private health insurance has neglected to induce externality on national health insurance by moral hazard. Therefore, we conducted this study in order to explore the influence of private health insurance on unnecessary medical utilization among patients with cervical or lumbar sprain. Method: The study examined a population of 449 patients (admission, 384; out-patient; 85) diagnosed with simple cervical or lumbar sprain without neurological symptoms at 20 small hospitals or clinics in Gwangju and Jeollanam provinces from Jul. 1 to Aug. 31 2008. The data were collected using structured, self-administrated questionnaire which collected information such as whether or not the patient was admitted (as a dependent variable), whether or not they had private health insurance (as a independent variable), and covariates such as socio-demographic characteristics, the factors related to the sprain, and characteristics of the insurance provider. Results: From hierarchical multiple logistic regression analysis, it was found that the admission rate of patient with private health insurance was higher than that those without it (Odds ratio=3.31, 95% Confidence interval; 1.14-9.58), meaning that private health insurance was an independent factor influencing the admission of patients with these conditions. Other determinants of admission were patient age and physician referral. Conclusions: This study is the first empirical study to explore the influence of private health insurance on inducing moral hazard in admission services, specifically among patients with cervical or lumbar sprain. Regulation of benefits provided by private health insurance may be necessary, as the effect of this moral hazard may mean existence of externality.