Organizational Factors Facilitating the Internationalization of Korean Franchising Companies (해외진출 국내 프랜차이즈기업의 조직특성)
- Lim, Young-Kun;Lee, Dong-Whuy;Kim, Hee-Jung
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- Journal of Global Scholars of Marketing Science
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- v.19 no.2
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- pp.40-52
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- 2009
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Franchising is one of the fastest growing types of business. It is already popular and well-known in the U.S., and has been growing in many other countries including Korea. Furthermore, many Korean franchising companies have expanded their business overseas actively. According to the data by the Ministry of Industry and Resource, 82 companies out of a sample of 500 franchising companies are already operating in many foreign countries and 48% of them have started their foreign business since 2006. This clearly indicates the fast growing current trend of foreign operation by Korean franchising companies. In spite of the fast growing trend of foreign expansion in the industry, academic research on internationalization of franchising companies is extremely difficult to find. Accordingly, academic research on the issue is necessary and urgent in Korea. Among the various research questions on internationalization of franchising business, this study intends to investigate the difference in organizational factors between the franchising companies doing foreign operation and those doing business only domestically. More specifically, this research has the following purposes. First, considering the lack of theoretical basis of previous studies, resource-based theory and agency theory are employed as the theoretical bases. Second, this study explains the difference in internationalization based on organizational factors such as company size, history and growth rate. Third, the five hypotheses regarding the difference in organizational factors are presented and tested empirically, which is the first attempt in the area of this topic. Finally, the study attempts to clarify the conflicting implications among theories regarding some organizational factos such as growth rate. As the theoretical background, resource-based theory and agency theory are discussed. According to resource-based theory, a firm can grow continuously when it has competence and resource, and also the ability to develop them. The competence and resource can include capital, human resource, management skill, market information, ability to manage risk, etc. Meanwhile, agency theory views the relationship between franchisor and franchisee as an agency relationship. In agency theory, bonding capability and monitoring capability are the two key factors which promote internationalization of franchising companies. Based on the two theories, a conceptual model is designed. The model consists of two groups of variables. One is organizational factors including size, history, growth rate, price bonding and geographic dispersion. The other is whether a franchising company is operating overseas or not. We developed the following five research hypotheses basically describing the relationship between organizational factors and internationalization of franchising companies. H1: The size of franchising companies operating overseas is larger than that of franchising companies operating domestically. H2: The history of franchising companies operating overseas is longer than that of franchising companies operating domestically. H3: The growth rate of franchising companies operating overseas is higher than that of franchising companies operating domestically. H4: The price bonding of franchising companies operating overseas is higher than that of franchising companies operating domestically. H5: The geographic dispersion of franchising companies operating overseas is wider than that of franchising companies operating domestically. Data for the analyses are obtained from 2005 Korea Franchise Survey data co-generated by Ministry of Industry and Resource, GS1 Korea, and Korea Franchise Association. Out of 2,804 population companies, 2,489 companies are excluded for various reasons and 315 companies are selected as the final sample. Prior to hypotheses tests, validity and reliability of the measures of size, history, growth rate and price bonding are examined for further analyses. Geographic dispersion is not validated since it is measured using nominal data. A series of independent sample T-tests is used to find out whether there exists any significant difference between the companies internationalized and those operating only domestically for each organizational factor. Among the five factors, size and geographic dispersion show significant difference, growth rate and price bonding do not reveal any difference and, finally, history factor shows conflicting results in the difference depending on how to measure it.
shows the summary statistics for hypotheses testing. In conclusion, the results show that the size and history, which are the key variables in resource-based theory, have a significant relationship with internationalization and that geographic area, which belongs to agency theory, also has a strong relationship with internationalization. The results support the findings of extant research and, therefore, prove the usefulness of resource-based theory and agency theory in explaining internationalization of franchising companies. However, growth rate and price-bonding do not show a clear difference between the two types of companies. Accordingly, these two factors need further attention in the future research. Although this study shows meaningful findings theoretically and practically, it has several limitations. First, only organizational factors are considered even if there are various environmental factors influencing franchising firm's internationalization. Second, only being internationalized or not is considered. That is, modes of entry and the size of foreign operations are not included in the study. Third, internationalization strategy is often determined based on the desire for business expansion and higher profitability and egoistical reasons of the CEOs. However, this type of factors belonging to behavioral science is not discussed in the study. Finally, organizational ecology perspective is usefully applicable in explaining the survival and performance of internationally operating companies. Accordingly, research propositions based on this perspective need to be developed and tested.
COMPUTER GAME PLAYING PATTERNS AND PSYCHOPATHOLOGY IN SCHOOL-AGE CHILDREN (학령기 아동의 컴퓨터게임 이용 양상과 정신병리)
- Lim Seoung-Hu;Jeong Seoung-Shim;Park Jeone-Hwan;Kim Ji-Hae;Hong Sung-Do
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- Journal of the Korean Academy of Child and Adolescent Psychiatry
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- v.17 no.1
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- pp.19-26
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- 2006
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Objectives : The object of this study was to examine computer game playing patterns and psychopathologies related to computer game addiction in school-age children. Methods : The subjects were 533 elementary school students (4th to 6th grade) in Kangdonggu, Seoul. We evaluated computer playing patterns of all subjects using computer game playing pattern questionnaire, and determined the risk group of computer game addiction by internet game addiction scale score. We evaluated subscale score of K-CBCL from parents of all subjects, and conducted correlation analysis and logistic regression analysis between computer game addiction and subscale score of K-CBCL. Results : In 488 responders, 10.2% of started playing computer game in preschool age, and 67.2% started at low grade of elementary school. The mean frequency of computer game play per week was 3.66 days. Mean time spent playing computer games per day was 1.89 hours. 'Simply for fun' was the most common reason far playing computer games (40.8%). Male subjects showed statistically significant differences in age of starting computer game, frequency of computer game play per week, reasons for playing computer game and computer game addiction scale scores. There were significant correlations between computer game addiction scale scores and academic performance, somatic complaints, attention problems, and internalizing problems in K-CBCL. But In logistic regression analysis, only attention problems among K-CBCL subscales showed significant predictability to computer game addiction. Conclusion : Upper grade elementary school students experienced computer game playing at the very early age, and spend much time in playing computer games. There were significant correlation and predictability between computer game addiction and attention problems.
The Effects of Psychological Contract Violation on OS User's Betrayal Behaviors: Window XP Technical Support Ending Case (심리적 계약 위반이 OS이용자의 배신 행동에 미치는 영향: 윈도우 XP 기술적 지원서비스 중단 사례)
- Lee, Un-Kon
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- Asia pacific journal of information systems
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- v.24 no.3
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- pp.325-344
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- 2014
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Technical support of Window XP ended in March, 8, 2014, and it makes OS(Operating System) users fall in a state of confusion. Sudden decision making of OS upgrade and replacement is not a simple problem. Firms need to change the long term capacity plan in enterprise IS management, but they are pressed for time and cost to complete it. Individuals can not help selecting the second best plan, because the following OSs of Window XP are below expectations in performances, new PC sales as the opportunities of OS upgrade decrease, and the potential risk of OS technical support ending had not announced to OS users at the point of purchase. Microsoft as the OS vendors had not presented precaution or remedy for this confusion. Rather, Microsoft announced that the technical support of the other following OSs of Wndow XP such as Window 7 would ended in two years. This conflict between OS vendor and OS users could not happen in one time, but could recur in recent future. Although studies on the ways of OS user protection policy would be needed to escape from this conflict, few prior studies had conducted this issue. This study had challenge to cautiously investigate in such OS user's reactions as the confirmation with OS user's expectation in the point of purchase, three types of justice perception on the treatment of OS vendor, psychological contract violation, satisfaction and the other betrayal behavioral intention in the case of Window XP technical support ending. By adopting the justice perception on this research, and by empirically validating the impact on OS user's reactions, I could suggest the direction of establishing OS user protection policy of OS vendor. Based on the expectation-confirmation theory, the theory of justice, literatures about psychological contract violation, and studies about consumer betrayal behaviors in the perspective of Herzberg(1968)'s dual factor theory, I developed the research model and hypothesis. Expectation-confirmation theory explain that consumers had expectation on the performance of product in the point of sale, and they could satisfied with their purchase behaviors, when the expectation could have confirmed in the point of consumption. The theory of justice in social exchange argues that treatee could be willing to accept the treatment by treater when the three types of justice as distributive, procedural, and interactional justice could be established in treatment. Literatures about psychological contract violation in human behaviors explains that contracter in a side could have the implied contract (also called 'psychological contract') which the contracter in the other side would sincerely execute the contract, and that they are willing to do vengeance behaviors when their contract had unfairly been broken. When the psychological contract of consumers had been broken, consumers feel distrust with the vendors and are willing to decrease such beneficial attitude and behavior as satisfaction, loyalty and repurchase intention. At the same time, consumers feel betrayal and are willing to increase such retributive attitude and behavior as negative word-of-mouth, complain to the vendors, complain to the third parties for consumer protection. We conducted a scenario survey in order to validate our research model at March, 2013, when is the point of news released firstly and when is the point of one year before the acture Window XP technical support ending. We collected the valid data from 238 voluntary participants who are the OS users but had not yet exposed the news of Window OSs technical support ending schedule. The subject had been allocated into two groups and one of two groups had been exposed this news. The data had been analyzed by the MANOVA and PLS. MANOVA results indicate that the OSs technical support ending could significantly decrease all three types of justice perception. PLS results indicated that it could significantly increase psychological contract violation and that this increased psychological contract violation could significantly reduce the trust and increase the perceived betrayal. Then, it could significantly reduce satisfaction, loyalty, and repurchase intention, and it also could significantly increase negative word-of-month intention, complain to the vendor intention, and complain to the third party intention. All hypothesis had been significantly approved. Consequently, OS users feel that the OSs technical support ending is not natural value added service ending, but the violation of the core OS purchase contract, that it could be the posteriori prohibition of OS user's OS usage right, and that it could induce the psychological contract violation of OS users. This study would contributions to introduce the psychological contract violation of the OS users from the OSs technical support ending in IS field, to introduce three types of justice as the antecedents of psychological contract violation, and to empirically validate the impact of psychological contract violation both on the beneficial and retributive behavioral intentions of OS users. For practice, the results of this study could contribute to make more comprehensive OS user protection policy and consumer relationship management practices of OS vendor.
Diagnostic Performance of HPV E6/E7 mRNA and HPV DNA Assays for the Detection and Screening of Oncogenic Human Papillomavirus Infection among Woman with Cervical Lesions in China
- Wang, Hye-young;Lee, Dongsup;Park, Sunyoung;Kim, Geehyuk;Kim, Sunghyun;Han, Lin;Yubo, Ren;Li, Yingxue;Park, Kwang Hwa;Lee, Hyeyoung
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- Asian Pacific Journal of Cancer Prevention
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- v.16 no.17
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- pp.7633-7640
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- 2015
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Background: Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide and it is responsible for most cases of cervical uterine cancer. Although HPV infections of the cervix do not always progress to cancer, 90% of cervical cancer cases have been found to be associated with high risk HPV (HR-HPV) infection. HPV DNA testing is widely used, along with Papanicolaou (Pap) testing, to screen for cervical abnormalities. However, there are no data on the prevalence of genotype-specific HPV infections assessed by measuring HPV E6/E7 mRNA in women representative of the Chinese population across a broad age range. Materials and Methods: In the present study, we compared the results with the CervicGen HPV RT-qDx assay, which detects 16 HR-HPV genotypes (Alpha-9: HPV 16, 31, 33, 35, 52, and 58; Alpha-7: HPV 18, 39, 45, 51, 59, and 68; and Alpha-5, 6: HPV 53, 56, 66, and 69), and the REBA HPV-ID assay, which detects 32 HPV genotypes based on the reverse blot hybridization assay (REBA) for the detection of oncogenic HPV infection according to cytological diagnosis. We also investigated the prevalence and genotype distribution of HPV infection with a total of 324 liquid-based cytology samples collected in western Shandong province, East China. Results: The overall HPV prevalences determined by HPV DNA and HPV E6/E7 mRNA assays in this study were 79.9% (259/324) and 55.6% (180/324), respectively. Although the positivity of HPV E6/E7 mRNA expression was significantly lower than HPV DNA positivity, the HPV E6/E7 mRNA assay showed greater specificity than the HPV DNA assay (88.6% vs. 48.1%) in normal cytology samples. The prevalence of Alpha-9 (HPV 16, 31, 33, 35, 52, and 58) HPV infection among these women accounted for up to 80.3% and 76.1% of the high-grade lesions detected in the HPV mRNA and DNA tests, respectively. The HR-HPV genotype distribution, based on HPV DNA and E6/E7 mRNA expression by age group in patients with cytologically confirmed lesions, was highest in women aged 40 to 49 years (35.9% for cytologically confirmed cases, Pearson correlation r value=0.993, p<0.001) for high-grade lesions. Among the oncogenic HR-HPV genotypes for all age groups, there was little difference in the distribution of HPV genotypes between the HPV DNA (HPV -16, 53, 18, 58, and 33) and HPV E6/E7 mRNA (HPV -16, 53, 33, 58, and 18) assays. HPV 16 was the most common HPV genotype among women with high-grade lesions. Conclusions: Our results suggest that the HPV E6/E7 mRNA assay can be a sensitive and specific tool for the screening and investigation of cervical cancer. Furthermore, it may provide useful information regarding the necessity for early cervical cancer screenings and the development of additional effective HPV vaccines, such as one for HPV 53 and 58. Additionally, gaining knowledge of HPV distribution may also inform us about ecological changes in HPV after the vaccination.
A Study on the infringement of privacy of unmanned aircraft : Focusing on the analysis of legislation and US policy (무인항공기의 사생활 침해에 대한 법적 대응 : 미국 정책.입법안 분석을 중심으로)
- Kim, Sun-Ihee
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- The Korean Journal of Air & Space Law and Policy
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- v.29 no.2
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- pp.135-161
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- 2014
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An unmanned aerial vehicle (UAV), commonly known as a drone and also referred to as an unpiloted aerial vehicle and a remotely piloted aircraft (RPA) by the International Civil Aviation Organization (ICAO), is an aircraft without a human pilot aboard. ICAO classify unmanned aircraft into two types under Circular 328 AN/190. Unmanned aircraft, which is the core of the development of the aviation industry. However, there are also elements of the legal dispute. Unmanned aircraft are manufactured in small size, it is possible to shoot a record peripheral routes stored in high-performance cameras and sensors without the consent of the citizens, there is a risk of invasion of privacy. In addition, the occurrence of the people of invasion of privacy is expected to use of civilian unmanned aircraft. If the exposure of private life that people did not want for unmanned aircraft has occurred, may occur liability to the operator of unmanned aircraft, this is a factor to be taken into account for the development of unmanned aircraft industry. In the United States, which is currently led by the unmanned aircraft industry, policy related to unmanned aircraft, invasion of privacy is under development, is preparing an efficient measures making. Unmanned aircraft special law has not been enforced. So there is a need for legal measures based on infringement of privacy by the unmanned aircraft. US was presented Privacy Protection Act of unmanned aircraft (draft). However Korea has many laws have been enacted, to enact a new law, but will be able to harm the legal stability, there is a need for the enactment of laws for public safety of life. Although in force Personal Information Protection Law, unmanned aerospace, when the invasion of privacy occurs, it is difficult to apply the Personal Information Protection Law. So, it was presented a privacy protection bill with infringement of privacy of unmanned aircraft in the reference US legislation and the Personal Information Protection Act.
Nuclear Terrorism and Global Initiative to Combat Nuclear Terrorism(GICNT): Threats, Responses and Implications for Korea (핵테러리즘과 세계핵테러방지구상(GICNT): 위협, 대응 및 한국에 대한 함의)
- Yoon, Tae-Young
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- Korean Security Journal
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- no.26
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- pp.29-58
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- 2011
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Since 11 September 2001, warnings of risk in the nexus of terrorism and nuclear weapons and materials which poses one of the gravest threats to the international community have continued. The purpose of this study is to analyze the aim, principles, characteristics, activities, impediments to progress and developmental recommendation of the Global Initiative to Combat Nuclear Terrorism(GICNT). In addition, it suggests implications of the GICNT for the ROK policy. International community will need a comprehensive strategy with four key elements to accomplish the GICNT: (1) securing and reducing nuclear stockpiles around the world, (2) countering terrorist nuclear plots, (3) preventing and deterring state transfers of nuclear weapons or materials to terrorists, (4) interdicting nuclear smuggling. Moreover, other steps should be taken to build the needed sense of urgency, including: (1) analysis and assessment through joint threat briefing for real nuclear threat possibility, (2) nuclear terrorism exercises, (3) fast-paced nuclear security reviews, (4) realistic testing of nuclear security performance to defeat insider or outsider threats, (5) preparing shared database of threats and incidents. As for the ROK, main concerns are transfer of North Korea's nuclear weapons, materials and technology to international terror groups and attacks on nuclear facilities and uses of nuclear devices. As the 5th nuclear country, the ROK has strengthened systems of physical protection and nuclear counterterrorism based on the international conventions. In order to comprehensive and effective prevention of nuclear terrorism, the ROK has to strengthen nuclear detection instruments and mobile radiation monitoring system in airports, ports, road networks, and national critical infrastructures. Furthermore, it has to draw up effective crisis management manual and prepare nuclear counterterrorism exercises and operational postures. The fundamental key to the prevention, detection and response to nuclear terrorism which leads to catastrophic impacts is to establish not only domestic law, institution and systems, but also strengthen international cooperation.
Professionalism raising of the escort which leads an instance analysis (사례분석을 통한 경호 전문성 제고)
- Yu, Hyung-Chang
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- Korean Security Journal
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- no.18
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- pp.73-99
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- 2009
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There are three assassination and treatening cases in this thesis introduced as analysis data. They are shooting accidents of the U.S.A's President Reagun (1981,3.30), and the President Park Jeong Hee of South Korea(1974.8.15), assassination of the Prime Minister Lavin of Israel (1995.11.4) In March 30, 1981, there was an accident where criminal, Hinckley, fired ball cartridges right before the President Reagan got into the car to move to White House after completing the announcement of Hilton Hotel of Washington. As a result, the chest of president was shot and public information secretary and safeguard were wounded. In August, 15, pm 10:23, where the 29th 8.15 independent anniversay event was being celebrated by the people at the National theater in Jangchungdong, Seoul, the criminal Moon Sekwang fired ball cartridges, he failed to assassinate the President Park Jeong Hee of Korea, but shot the First lady Yuk Young Soo. She was wounded right part of head and died. In November 4, Saturday, pm 22:00 the Prime Minster Lavin had finished the supporting event of Middle Asia's Peace project and was taking on the car when he was killed by the criminal Amir's shooting, The accidents left very important lesson from the aspect of security analysis and it has been frequently used as a material for the education and training of safeguard organization. In Korea, as well as Presidential Security Service, national security departments have selected it as an important model for the subjects such as 'Security Analysis, 'Security Practice' and 'Security Methodology'. In the performance of security duty, security skill is the most important matter. Moreover, it has a close relationship with politics, society and culture. The purpose of this study is to analyze and reevaluate the case, which has been treated as a usual model from the aspect of security analysis, beyond its introduction. Attempted assassination of President Reagan was evaluated as a positive success example because of its rapid response of adjacent guards to evacuate Reagan, who is a guard target, within 10 seconds after the shot. When comparing it to President Kennedy Assassination of 1963, it was evaluated that guards were significantly specialized. In the study, however, it was possible to found many problems such as carelessness of guard, who is in charge of external area of event place, idle attitude for frequently used event place, confusion of wireless communication, risk of wireless security disclose, insufficient provision of compulsory record file, insufficient profiling of dangerous person and unsecured hospital and first-aid room.
Analysis and Safety Assessment of Antioxidants Migrated from Polyethylene and Polypropylene Food Packaging Materials into Food Simulants (폴리에틸렌 및 폴리프로필렌 기구·용기·포장 유래 산화방지제 분석 및 안전성평가)
- Choi, Heeju;Choi, Jae Chun;Bae, In-Ae;Park, Se-Jong;Kim, MeeKyung
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- Journal of Food Hygiene and Safety
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- v.32 no.5
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- pp.424-433
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- 2017
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Antioxidants are used in the manufacturing of commercial food packages made of polyolefin plastic such as polyethylene and polypropylene for the purpose to delay the oxidation reaction of the polymer due to oxygen or traces of ozone in the atmosphere. Additives in plastics may be migrated from the packaging materials into foods, thereby presenting a potential health risk to the consumer. Therefore, it is necessary to determine migration level of antioxidants from food packaging materials to foodstuffs in order to take proactive management. In this study, we have developed a method for the analysis of 10 antioxidants, which are butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), Cyanox 2246, 425 and 1790, Irgafos 168, and Irganox 1010, 1330, 3114 and 1076, migrated from the food packaging materials into four food simulants for aqueous, acidic, alcoholic and fatty foods. The antioxidants were determined by reversed-phase high-performance liquid chromatograph-ultraviolet detector with 276 nm after solid-phase extraction with a hydrophilic-lipophilic balance (HLB) cartridge or dilution with isopropanol. The analytical method showed a good linearity of coefficient (
$R^2{\geq}0.99$ ), limits of detection (0.11~0.41 mg/L), and limits of quantification (0.34~1.24 mg/L). The recoveries of antioxidants spiked to four food simulants ranged from 71.3% to 109.4%. The migrated antioxidants in this study were within the safety levels that resulted from the safety assessment by the estimated daily intake to the tolerable daily intake.
Investigation of Microbial Contamination Levels of Leafy Greens and Its Distributing Conditions at Different Time - Focused on Perilla leaf and Lettuce - (시기별 엽채류의 미생물 오염도와 유통 조건 조사 - 들깻잎과 상추를 중심으로 -)
- Kim, Won-Il;Jung, Hyang-Mi;Kim, Se-Ri;Park, Kyeong-Hun;Kim, Byung-Seok;Yun, Jong-Chul;Ryu, Kyoung-Yul
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- Journal of Food Hygiene and Safety
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- v.27 no.3
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- pp.277-284
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- 2012
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The objective of this study was to investigate and evaluate microbial contamination levels of leafy greens (perilla leaf and lettuce) and its distributing conditions at different seasons (Feb, May, Aug, and Nov of the year 2011) in order to provide insight into any potential health hazards associated with consumption of these commodities. Leafy greens were collected from a farm located in Geumsan, Chungnam and wholesale markets (WM) and traditional markets (TM) located in Suwon. At the same time, temperature and relative humidity fluctuations experienced by the leafy greens during distribution from the farm to the distribution center were measured by a data logger. The contamination levels of perilla leaf and lettuce were determined by analyzing total plate count. Coliform groups, Bacillus cereus, Escherichia coli, Escherichia coli O157:H7, Salmonella spp., Listeria monocytogenes and Staphylococcus aureus were determined. The contamination levels of total aerobic bacteria, coliform groups and B. cereus in both vegetables sampled during May and August found to be higher than those sampled during February and November. E. coli O157:H7, Salmonella spp., L. monocytogenes were not detected in the vegetables analyzed in this study. There were no significant trends between samples at WM and TM in the contamination levels. Relative humidity of vegetables distributed from the farm to the distribution center showed over 90% during distribution regardless of measured seasons. In the case of background microflora on leafy greens, the density was significantly increased at 20, 30 and
$37^{\circ}C$ during storage of 24h. E. coli O157:H7 and B. cereus inoculated on the leaves also showed similar increases in the storage tests. The microbial contamination levels determined in this study may be used as the fundamental data for microbial risk assessment.
A Case of Childhood Obstructive Sleep Apnea Syndrome with Co-morbid Attention Deficit Hyperactivity Disorder Treated with Continuous Positive Airway Pressure Treatment (지속적(持續的) 상기도(上氣道) 양압술(陽壓術)을 시행(施行)하여 치료효과(治療效果)를 본 주의력(注意力) 결핍(缺乏).과잉(過剩) 운동장애(運動障碍)를 동반(同伴)한 소아기(小兒基) 폐쇄성(閉鎖性) 수면무호흡증(睡眠無呼吸症) 1례(例))
- Sohn, Chang-Ho;Shin, Min-Sup;Hong, Kang-E;Jeong, Do-Un
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- Sleep Medicine and Psychophysiology
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- v.3 no.1
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- pp.85-95
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- 1996
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Obstructive sleep apnea syndrome(OSAS) in childhood is unique and different n-om that in adulthood in several aspects, including pathophysiology, clinical features, diagnostic criteria, complications, management, and prognosis. Characteristic features of childhood OSAS in comparison with the adult form are the variety of severe complications such as developmental delay, more prominent behavioral and cognitive impairments, vivid cardiovascular symptoms, and increased death risk, warranting a special attention to the possible diagnosis of OSAS in children who snore. However, the childhood OSAS is often neglected and unrecognized. We, therefore, report a case of very severe OSAS in a 5-year-old boy who was sucessfully treated with continuous positive airway pressure(CPAP) treatment. Interestingly, the patient was comor-bid with the attention deficit hyperactivity disorder. Prior to the initial visit to us, adenotonsillectomy had been done at the age of 4 with no significant improvement of apneic symptoms and heavy snoring. On the initial diagnostic procedures, marked degree of snoring was audible even in the daytime wake state and the patient was observed to be very hyperactive. Increased pulmonary vascularity with borderline cardiomegaly was noted on chest X-ray. The baseline polysomnography revealed that the patient was very sleep-apneic and snored very heavily, with the respiratory disturbance index(RDI) of 46.9 per hour of sleep, the mean SaO2 of 78.8%, and the lowest SaO2 of 40.0%(the lowest detectable oxygen level by the applied oxymeter). The second night polysomnography was done for CPAP titration and the optimal pressure turned out to be
$8.0\;cmH_2O$ . The applied CPAP treatment was well tolerated by the patient and was found to be very effective in alleviating heavy snoring and severe repetitive sleep apneas. After 18 months of the CPAP treatment, the patient was followed up with nocturnal polysomnography(baseline and CPAP nights) and clinical examination. Sleep apneas were still present without CPAP on the baseline night. However, the severity of OSAS was significantly decreased(RDI of 15.7, mean SaO2 of 96.2%, and the lowest SaO2 of 83.0%), compared to the initial polysomnographic findings before initiation of long-term CPAP treatment. Wechsler intelligence tests done before and after the CPAP treatment were compared with each other and surprising improvement of intelligence(total 9 points, performance 16 points) was noted. Clinically he was found to be markedly improved in his attention deficit hyperactive behavior after CPAP treatment, but with minimal change of TOVA(test of variables of attention) scores except conversion of reaction time score into normal range. On the chest X-ray taken after 18 months of CPAP application, the initial cardiopulmonary abnormalities were not found at all. We found that the CPAP treatment in a young child is very effective, safe, and well-tolerated and also improves the co-morbid attention deficit hyperactive symptoms. Overall, the growth and development of the child has been facilitated with the long-term use of CPAP. Cardiovascular complications induced by OSAS have been also normalized with CPAP treatment. We suggest that early diagnosis and active treatment intervention of OSAS in children are crucial in preventing and ameliorating possible serious complications caused by repetitive sleep apneas and consequent hypoxic damage during sleep.
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