• Advances in pediatric surgery
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• 제17권2호
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• pp.133-138
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• 2011

Extracorporeal membrane oxygenation (ECMO) has been utilized in congenital diaphragmatic hernia (CDH) patients with severe respiratory failure unresponsive to conventional medical treatment. We retrospectively reviewed 12 CDH patients who were treated using ECMO in our center between April 2008 and February 2011. The pre ECMO and on ECMO variables analyzed included gestational age, sex, birth weight, age at the time of ECMO cannulation, arterial blood gas analysis results, CDH location, timing of CDH repair operation, complications and survival. There were 9 boys and 3 girls. All patients were prenatally diagnosed. Mean gestational age was $38.8{\pm}1.7$ weeks and mean birth weight was $3031{\pm}499$ gram. Mean age at the time of ECMO cannulation was $29.9{\pm}28.9$ hours. There were 4 patients who survived. Survivors showed higher 5 min Apgar scores ($8.25{\pm}0.96$ vs. $7.00{\pm}1.20$, p=0.109), higher pre ECMO mean pH ($7.258 {\pm}0.830$ vs. $7.159{\pm}0.986$, p=0.073) and lower pre ECMO $PaCO_2$ ($48.2{\pm}7.9$ vs. $64.8{\pm}16.1$, p=0.109) without statistical significance. The hernia was located on the left side in 10 patients and the right side in 2 patients. The time interval from ECMO placement to operative repair was about 3~4 days in 5 early cases and around 24 in the remaining cases. There were 3 cases of post operative bleeding requiring re operation and 2 cases of abdominal compartment syndrome requiring abdominal fascia reopening. ECMO catheter reposition was required in 4 cases. Three cases of arterial or venous thrombosis were detected and improved with follow up. Our data suggests that ECMO therapy could save the lives of some neonates with CDH who can not be maintained on other treatment modalities. Protocolized management and accumulation of case experience might be valuable in improving outcomes for neonates with CDH treated with ECMO.

• Advances in pediatric surgery
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• 제18권2호
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• pp.68-74
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• 2012

Colonic atresia (CA) is the rare cause of intestinal obstruction, and diagnosis of CA is difficult. But only few research has been performed, so little information has been available. The purposes of this study was to analyze the clinical findings of CA so that help physicians make decision properly. Children with CA who were treated at the division of pediatric surgery at Asan Medical Center in the period from January 1989 to December 2011 were evaluated retrospectively. A total of 6 children were treated with CA. These accounted for 2.7% of all gastrointestinal atresias managed in Asan Medical Center. Only one child was premature and low birth weight, the others were fullterm neonates and showed normal birth weight. Vomiting and abdominal distension were common symptoms and simple X-ray and barium study were used for diagnose of CA. But only 66.7% of the babies were diagnosed as CA pre-operatively. And 2 children out of 6 underwent re-operation due to missed CA at the time of the first operation. In aspect of types of atresia, the type IIIa were two, type IV were two, type I was one case, and one child showed rectal stenosis due to rectal web. Various operations were done according to individual findings and associated diseases. The 50% (n=3) of children underwent the primary anastomosis and the others (n=3) underwent colostomy first and staged operation later for missed CA or associated disease. All of them were recovered any significant complications. Therefore, the prognosis of CA is satisfactory if diagnosis and surgical management could be made properly. But because of the low incidence of CA, delay of diagnosis and treatment may occur. To prevent delay of diagnosis, we suggest prompt evaluation of doubtful infant and careful inspection of distal patency of bowel including whole colon and rectum when operating patients with intestinal atresia at any level.

• 지역사회간호학회지
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• 제13권2호
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• pp.280-291
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• 2002

Objectives: This study was conducted to evaluate the maternal child health services provided by public health centers in Pyungtaek city. Methods: Data were collected based on multiple sources of official records. A questionnaire survey was obtained from 50 mothers with premature babies, and 89 mothers with full- term babies, in order to compare their demographic factors, and physical, obstetrical, and emotional status. In addition, the investigators collected data on pre and post follow-up care for the remature group to evaluate the effects of home visiting services on them. Moreover, additional data were collected from 135 pregnant women and 315 mothers with infants, to assess their degree of satisfaction for prenatal education course and breast feeding practices. Results: 1) The pregnant women's satisfaction for the prenatal education course, knowledge, and practices on self care were considered to be high. 2) Of the mothers with infants, 62.9% experienced breast feeding, but only 35.9% of them did it for six months. 3) Premature birth rate in the region was 5.6%, and 75.6% of all premature babies received follow-up care. 4) The mothers with premature babies experienced premature rupture of membrane. placenta previa, preeclampsia, and cesarean section more frequently than the mothers with full-term babies. 5) At the pre-intervention data collection point. mothers with premature babies experienced significantly less social support than mothers with full-term babies. In addition, mothers with premature babies reported higher levels of stress and care-giving burdens, and lower level of self esteem, than mothers with full-term babies, although the differences were not statistically significant. 6) In the premature group, stress, care giving burdens, and postpartum depression decreased after the intervention, whereas maternal self esteem, and the husband's support were increased after the intervention. Social support from significant others were somewhat decreased. 7) Satisfaction for the home visiting service in the mothers with premature babies was very high. Conclusion: These results showed a possibility that the recently started maternal child health services provided by the public health centers may be efficient. Although statistically significant differences were not found, the investigators found a potential for changes in a positive direction. Long-term effects of the health services on maternal child health needs should be addressed in future studies.

• Advances in pediatric surgery
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• 제17권1호
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• pp.65-71
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• 2011

Currarino syndrome is a hereditary syndrome characterized by the triad of a sacral bony defect, presacral mass and anorectal malformation. We retrospectively reviewed 13 Currarino syndrome patients who were treated in our center between 1997 and 2010. Demographic data, initial symptoms, initial diagnosis. pathologic diagnosis of presacral mass, associated anomalies and managements were analyzed. There were 8 boys and 5 girls. Four patients were diagnosed as Currarino syndrome immediately after birth with failure of passage of meconium and abdominal distension. Four patients underwent surgery for imperforate anus immediately after birth and W8re diagnosed as Currarino syndrome later and underwent reoperation. Three patients were diagnosed during work-up and management with of the tentative diagnosis of Hirschsprung's disease. Diagnosis of the remaining two patients was at the age of 26 months and 9 years and anorectal malformation was not associated. Twelve patients showed hemi-sacrum and one patient showed bilateral sacral subtotal agenesis. Two patients without anorectal malformation underwent presacral mass excision, untethering of spinal cord and repair of myelomeningocele. Six out of 8 patients, excluding 3 that expired or were lost to follow up, with anorectal malformation underwent colostomy, presacral mass excision, untethering of spinal cord, repair of myelomeningocele, posterior sagittal anorectoplasty and colostomy repair. One patient underwent only posterior sagittal anorectoplasty after colostomy. One waits the scheduled operation only with Hegar dilatation. Pathologic examation of presacral masses showed myelomeningoceles in 4 patients, lipomyelomeningoceles in 3 patients and dermoid Cyst in one patient. Teratoma was combined in 2 patients. Eight patients needed neurosurgical operation for spinal cord problems. Seven patients had urologic anomalies and two of them underwent operation. Currarino syndrome should be considered as a differential diagnosis in pediatric patients with abdominal distension, constipation and anorectal malforlnation. For proper evaluation and treatment, a multi-disciplinary approach is recommended.

• 토지주택연구
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• 제9권3호
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• pp.29-36
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• 2018

This study aims at suggesting directions to make children's parks considering the actual groups using them by comparative analysis of age distribution in residents within area of use and locations of children's parks with regards to changes in population structure of low birth rate and aging. Cheongju was selected for the study, and the current status of children's parks and population structure were categorized into six stages and the investigation and analysis were conducted by statistics by population group and by using Arc GIS Program. As a result of the analysis, children under 13 were 13.1% of the entire population in Cheongju and share of middle-aged and aged group including middle-aged was 31.3%. Park area per one children under 13 was 5.9㎡ and based on walking use area(250m), average number of parks available by autonomous district was eight. As a result of the analysis of characteristics of distribution of children's parks, they are densely located in old downtowns or the distribution density was relatively high in newly developed areas such as Osong-eup or Ochang-eup. However, outer rural areas have no children's parks or relatively low rate. As a result of the analysis on population structure and co-efficient of park location, in nine autonomous districts, aged group is increasing, leading to decrease use of children's parks. If resident rate aged group is higher in the region where a children's park is located, it is necessary to re-compose the existing one to different one or to change purposes of parks to be planned. Also, in the area with similar rates in both children's group and aged group, composing complex parks for both of them could be considered. This study has limitations by not conducting field studies about the current status of use of children's parks in areas where the population structure has been changing and not suggesting specifically new types of parks according to changes in population structure. It is necessary to conduct the following studies about relationship between children's parks and policies for composing parks responding to changes in population structure in neighboring regions in future.

• 대한간학회지
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• 제24권4호
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• pp.374-383
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• 2018

Background/Aims: There have been numerous efforts to reduce mother-to-child transmission (MTCT) of hepatitis B virus (HBV) with antiviral agents during pregnancy. However, there are limited data regarding the outcomes of pregnant women after delivery. This study was performed to evaluate the efficacy of antiviral agents in preventing MTCT of HBV and maternal long-term outcomes. Methods: The HBV-infected pregnant women treated with antiviral agents to prevent MTCT were retrospectively reviewed. Forty-one pregnant women who received telbivudine or tenofovir during late pregnancy (28-34 week) were analyzed. Hepatitis B virus surface antibody (HBsAb) positivity was tested in 43 infants after 7 months of birth. Eleven mothers were followed >1 year after delivery. Results: The mean HBV DNA titer before antiviral therapy was 8.67 (6.60-9.49) log copies/mL, and the median age at delivery was 32 years (range, 22-40). Eleven patients were treated with tenofovir and 30 with telbivudine. The median duration was 57 days (range, 23-100), and the median HBV DNA titer at birth was 5.06 log copies/mL (range, 2.06-6.50). Antiviral treatments were associated with significant HBV DNA reduction (P<0.001). Among 43 infants (two cases of twins), HBsAb was not detected in two, subsequently confirmed to have HBV infection. Biochemical flare was observed in two of 11 mothers followed >12 months, and an antiviral agent was administered. Conclusions: Antiviral treatment during late pregnancy effectively reduced MTCT. Long-term follow-up should be required in such cases. In addition, given that maternal biochemical flare occurred in 18% of mothers, re-administration of antiviral agents might be required.

• 산업진흥연구
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• 제8권2호
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• pp.119-132
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• 2023

본 논문의 목적은 명리학과 기문둔갑에서 사용하는 사주(四柱)라는 동양의 시간 개념을 재정립하고 특히 시주(時柱)에 대한 정확성과 객관화를 위해 출생 지역에 따른 진태양시의 사용, 야자시(夜子時)와 정자시(正子時) 중 정자시의 선택, 태시(胎時)에 대한 정확한 의미 확인 등을 논의하고자 함이다. 한국 사회에서 통념적 시간의 사용은 동경시를 표준시로 삼고, 자정 0시를 기준으로 새로운 날이 시작되는 시진을 사용한다. 하지만 역학적으로 중요한 것은 사회적 통용성이 아니라 우주의 중심인 내가 태어난 그 우주의 시간과 공간이 내 명(命)의 기준이 되어야 하므로 내가 태어난 장소의 경도를 사용하여 정확한 나의 시진(時辰)을 결정해야만 하고, 우주 에너지의 흐름은 반 시진, 즉 1시간은 앞서 '기미와 징조'가 발생하므로 역술과 명리학에서 오랜 기간 논쟁의 화두가 되어왔던 간지기시법 중 야자시와 정자시의 선택 문제는 정자시법을 적용해야 한다고 주장한다. 이러한 시진과 시주의 설정에 대한 타당성을 확보하기 위해 기문둔갑의 포국을 통한 시진 조정법을 활용하여 사례 분석을 시행하였다. 분석 대상자와의 심층 면담을 통해 과거 살아온 인생을 날짜와 시간별로 수집한 후 각 인생 사건의 발생 시기가 정확한지를 기문둔갑 해단법으로 확인해 보았다.

• 문화기술의 융합
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• 제8권3호
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• pp.297-304
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• 2022

이 연구의 목적은 쏜톤 와일더의 『우리 읍내』에 나타난 일상극의 특징과 연극주의를 살펴보고, 우리로 하여금 코로나19 시대에 일상생활의 소중함을 인식하게 해 주는 이 작품을 재조명하고자 한다. 이 작품은 탄생, 사랑과 결혼, 죽음이라는 일상생활을 소재로 아주 사소한 사건에서 어떤 가치를 찾아내는 것이다. 이 작품의 배경이 되는 그로버스 코너즈는 현재 모든 사람들이 생활하는 마을과 우주를 상징하고, 액션은 1901년에서 1913년에 걸쳐 있으며, 이 액션은 현재에서도 일어나는 일상생활로 보편성을 나타낸다. 와일더는 이 작품으로 두 번째 퓰리처상을 수상하였고 비사실주의 연극을 대표하는 작가이다. 이 작가는 빈 무대를 기본 틀로 하고, 이 작품에서 무대 위의 행동이 사실이 아니라는 점을 인정하고 그 사실을 관객에게 그대로 보여 주는 이론인 연극주의를 보여 준다. 또한 그는 소품 대신에 배우가 마임으로 액션을 하도록 이끌고, 관객들로 하여금 상상력을 자극하여 무대에 없는 소품을 실제로 존재하는 것처럼 생각하게 만든다. 이 작품은 일상적 삶의 중요성을 인식하게 해 주는 일상극으로 관객이 거리를 두고 연극과 인생을 성찰할 수 있는 기회를 만들어 주는 효과를 낸다.

• 대한간호학회지
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• 제25권4호
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• pp.825-836
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• 1995

This ethnogrphic exploratory study sought to de-fine the meaning of Sanhubyung, as consequence from the perspective of the women who experienced it. A convenience sample of 9 elderly women in San Francisco. and 20 postpartal women and their 20 non-professional helpers during postpartum in Seoul, Korea were observed and interviewed for 23 months from January 1991 to December 1992 at the Human Development Center in San Francisco and at the hospital and their homes in Seoul, Korea. Sanhubyung was regarded as the consequence of "Doing a Sanhujori Wrongly," as a group of symptoms or sequelae which have two types of characteristics of symptoms . chronic and acute. It can be called a culture bound syndrome in the cultural context re-lated to childbearing phenomenon in Korea. If women violate the principles of Sanhujori, such symptoms can appear at various times : during the period of postpartum itself, at any time, periodically, especially at the anniversary of the child's birth, late forties, and in old age. Acute symptoms that can be classified into immediate and late types include painful and edematous gingiva, sensitive teeth, strange sensation and pain in the knees or backache. Besides, there is a localized sense of soreness and pain ; sense of being in a draft and cold, stomach upset, GI irritation, chilling, shivering, and tiredness, pain and dazzling in the eyes. Chronic symptoms occur in the head, neck, teeth, back, hands, knees, hands and feet, arms and legs, eyes, sinews and joints, bones, and in the body or as a whole. Generally these symptoms are pain, often accompanying a feeling of being cold and in a draft, regardless of actual weather conditions. In conclusion, this findings reflect the Oriental way of thought of causal relationship of women's health and illness based on the wholistic paradigm of harmony and balance of two forces, Yin(cold) -Yang(hot). It provides a challenge to the professional sector to rethink the effect of culture on health and illness. Finally, it suggests care providers use cultural assessment for the appropriateness of the intervention and quality of care for desirable health outcomes.

• Journal of Preventive Medicine and Public Health
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• 제7권1호
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• pp.203-209
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• 1974

This study is intended to comparison of the recent ideal number of children and atrial approach for analyzing value system for children that form attitude affecting birth control with earlier study conducted 10 years ago. In general the traditional fertility pattern of Korea may be considered as 'early marriage and high fertility' backed by the confucian value system of a farming-oriented country. A selective attitude favoring sons contributes substantially to fertility. But Korea is now moving toward a late marriage and fertility pattern. This has been due to the repid introduction of western culture and a partial acceptance of western value systems, a relative weakening of traditional value systems, a gradual increase in infant and child servival rates thresh medicines, and a desire to avoid having too many children because of economic poverty. This study showed following results: Ideal number of sons and daughters in urban area was decreased by 0.2 respectively compared to earlier study. In rural area, the number of decrease of sons and daughters was 0.5 and 0.2 respectively. The conception concerning Happiness has changed to wealth from health in previous opinion. Regarding attitude toward having sons, 98 percent of them wanted to have sons positively, moreover 10 percent of them wanted two or more sons. Regarding reasons for the wanting sons, we see that economic and traditional considerations, such as dependance in old age, and inheritance of the family line, are a principle concern of about 56 percent in both areas. The rate of dependence in old age was decreased conspicuously compare to previous study while the rate of helding rituals was increased remarkably in rural area. Among reasons for limiting family size. 'for better living and for better education for their children were main rasons reted 46 percent in urban, 51 percent in rural areas. The rates were not changed compare to previous study. Regarding attitude of those who have no son or children, the rate of re-marriage with second wife was decreased remarkably in rural area and the rate of living without special behaivor for having son was increased compare to previous study.