Comparison of Early Trauma History between Young/Middle Adulthood Patients and Earlier/Later Older Adulthood Patients with Panic Disorder

OBJECTIVE: To investigate the early trauma history between young/middle adulthood patients and earlier/later older adulthood patients with panic disorder (PD). METHODS: 216 patients with PD and 76 healthy controls (HCs) were included for analysis. Patients with PD were operationally dichotomized into two groups of young/middle adulthood (age below 50 years) and earlier/later older adulthood (age 50 years or over) to compare the early trauma history between two groups. Data of sociodemographic factors, self-reported shortened form of the Early Trauma Inventory (ETI), and the Albany Panic and Phobia Questionnaire (APPQ) were analyzed. RESULTS: Patients with PD showed higher scores of ETI than HCs. Young/middle adulthood PD showed statistically significantly higher levels of general trauma (t=-2.088, p=0.041), physical abuse (t=-2.456, p=0.014), emotional abuse (t=-3.690, p=0.000), and total scores of trauma (t=-3.534, p=0.001) except sexual abuse. In the young/middle adulthood PD group, ETI scores were significantly correlated with APPQ scores while no significant correlation with ETI was found in earlier/later older adulthood PD. CONCLUSION: These results show that PD is statistically associated with early trauma history and that early trauma history is more significantly related with PD in young/middle adulthood than earlier/later older adulthood. These findings suggest that the age factor should be considered in clinical practice for patients with PD.

Evaluation of the Effectiveness of a Suicide Prevention Advertising Media Campaign : Analysis of Changes in Knowledge-Attitude-Behavior by Using Propensity Score Matching / 신경정신의학

OBJECTIVES: This study was conducted to evaluate the effectiveness of a suicide prevention advertising media campaign by the Korea Suicide Prevention Center in 2014 and to analyze the changes in the levels of suicide prevention related-knowledge, attitude, and behavior of the advertisement viewers. METHODS: Data of 703 participants who responded to both the pre and post telephone surveys out of 1100 adults aged 19 or over randomly selected nationwide were analyzed using a stratified proportional quota sampling method considering sex, age, and region by a survey agency. A propensity score matching (PSM) analysis was used to adjust for potential biases in estimated effects. RESULTS: Of 703 participants who completed pre and post survey interviews, 25.9% watched the media campaign. Comparing the knowledge, attitude, and behavior scores between the advertisement viewers (n=182) and non-viewers (n=521), of those who watched the media campaign, participants' knowledge score showed a statistically significantly increase in all methods of the PSM analysis while there were no statistically significant changes in attitude and behavior. CONCLUSION: The results supported the effectiveness of a suicide prevention media campaign in terms of knowledge, but not of attitude and behavior related to suicide prevention. Further long-term large evaluation studies are suggested.

The Prevalence of Chronic Diseases, Status of Health Behaviors and Medical Service Utilization: Focused on Female Blue-Collar Workers / 農村醫學 地域保健

OBJECTIVE: Despite the increasing number of female participation in employment, blue-collar women have been exposed to higher health risk. This study is to describe the prevalence of chronic diseases, health behaviors, and medical service utilization of female blue-collar workers. METHODS: Data were derived from the 2001 Korea National Health and Nutrition Survey (KNHANES). The sample was made up of 37,108 male and female participants aged 20 or over selected nation-wide by probability sampling from Korea. This study applied the logistic regression for nominal variables such as disease prevalence and health behaviors and with the regression for continuos variables such as the length and costs of medical services. RESULTS: In general, women's prevalence of chronic illness and uncured rate were significantly higher than male, and especially female blue-collar workers had the highest prevalence, uncured rate, unhealthy status, and perceived stress. However, the medical care cost was the lowest in female blue-collar workers. CONCLUSIONS: The findings suggest that female blue-collar workers were more likely to experience health problems, and that despite the highest health risk, health service is not effectively utilized, and health policy maker should take consider of special status of female blue collar workers who are in health inequality.

Does Extended Emergency Department Length of Stay (EDLOS) Affect Mortality in Patients with Traumatic Intraperitoneal Hemorrhage needing Emergency Laparotomy?

PURPOSE: Outcome for critically ill patients often depends on time-sensitive critical care interventions. Thus we examined the effects of time on the mortality and the factors affecting emergency department length-of-stay (EDLOS) in hypotensive patients needing laparotomy in an emergency department. METHODS: ED records were reviewed for documentation of factors that might be associated with prolonged EDLOS, such as computed tomography, the number of standard radiographs, overcrowding, special procedures, and consultations. EDLOS was considered to consist of the time from arrival in the ED to departure from the ED. To assess the effect of multiple simultaneous factors a Cox proportional hazard model was created and a risk ratio (RR) was used to assess the effect of time on mortality. Risk ratio for death was equal to the percentage of patients with tested attributes among patients who died divided by the percent with those attributes among survivors. RESULTS: One-hundred sixteen patients met the inclusion criteria. Average time to the ED was 199.7+/-100.0 minutes. Using a Cox proportional hazards model, the independent predictors of prolonged EDLOS were determined to be additional CT for other areas outside of the abdomen, the number of standard radiographs, whether the patients had a weekend visit, and overcrowding. The risk ratio for time spent in the ED before laparotomy increased up to a time of 120 minutes, then significantly decreased below all earlier values on patients with hypotension and unreponsive to fluid therapy. The risk ratio increased after 240 minutes in patients with hypotension and responsive to fluid therapy. CONCLUSION: The probability of death showed a relationship to the EDLOS for patients who were in the EDLOS for 120 minutes or less in hypotensive abdominal injury patients needing laparotomy in the emergency department.

Development and Prognosis of Non-Q Myocardial Infarction

PURPOSE: In the prethrombolytic era, patients with non-Q myocardial infarction (non-MI) exhibited a lower short-term mortality, but were at higher risk for inhospital and long-term reinfarction, leading to a higher long-term mortality rate than for patients with Q MI. The objective of this study was to determine whether the incidence of non-Q MI among and the prognosis for patients with ST-segment elevation and thrombolytic therapy were different from those among patients who did not have thrombolytic therapy. METHODS: A retrospective chart review was done for 222 patients of acute myocardial infarction with ST-segment elevation The analysis compared the rate of transformation of ST-elevation to Q MI and non-Q MI and the clinical outcome (30-day mortality, reinfarction, recurrent angina, left ventricular (LV) dysfunction, and new congestive heart failure (CHF)) of patients who subsequently developed a Q or non-Q MI postthrombolysis to those for the controls. RESULTS: The rate of non-Q MI was not significantly higher among patients receiving thrombolysis than among the control (31% vs 25%, p>0.1). Among patients receiving thrombolysis, the 30-day mortality (2.6% vs 0%), the inhospital reinfarction (10.3% vs 11.5%), and recurrent angina (20.6% vs 14.5%) were not significantly lower for those who developed a non-Q MI compared with either those who developed a Q MI or the control patients who developed non-Q MI, but left ventricular dysfunction (35.9% vs 55.2%) and new congestive heart failure (0 vs 10.3%) were significantly lower compared with those who developed Q MI. CONCLUSION: Patients receiving thrombolysis do not necessarily develop a non-Q MI and do not have a better prognosis than those who either develop a postthrombolysis Q MI or a non-Q MI after no thrombolysis.

Differentiation of Central and Peripheral Causes according to Clinical Features of Dizzy Patients in an Emergency Setting

PURPOSE: Central dizziness infrequently develops to a cerebellar or brainstem infarction. However, in the acute phase, central lesions masquerade as peripheral causes. This study was performed to provide the diagnostic guidelines for differentiation between peripheral and central causes. METHODS: From January 2002 to December 2002, we investigated 307 dizzy patients with normal brain computerized tomography. The patients were analyzed according to age, history, associated symptoms, duration of attacks, neurologic examination, and tests of balance such as gait, tandem gait, and nystagmus. RESULTS: The history of cerebral vascular accidents and neurologic symptoms, such as numbness, diplopia, dysarthria, dysphagia, or weakness, suggested central causes. Episodes of dizziness lasting seconds suggested benign positional vertigo. Dizziness associated with vertebrobasilar insufficiency typically last minutes whereas peripheral inner ear causes of recurrent dizziness typically last hours. Patients with peripheral or central causes have impaired balance, but this is more severe with central causes than with peripheral causes. Spontaneous nystagmus of a central origin changed direction with gaze to the side of the fast phase. CONCLUSION: The history, the associated symptoms, and the tests of balance provided the key information for distinguishing between peripheral and central causes, and the guideline applied in this study will be helpful to diagnose the cause of the dizziness.