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Background@#The objective of this study is to identify the working conditions and health status of Vietnamese male migrant workers in Republic of Korea, in comparison to the Korean general population. @*Methods@#We conducted our survey through the Migrant People Center, and we received completed questionnaires from 87 male Vietnamese migrant workers. The questionnaire employed was identical to those used in the Korean Working Conditions Survey and the 2020 Korea National Health and Nutrition Examination Survey. The collected data from the Vietnamese migrant workers was then compared with the Korean reference population using indirect age-standardization. @*Results@#Vietnamese male workers demonstrated a higher prevalence of health problems including hearing problems (age-standardized prevalence ratio (aSPR) 13.22, 95% confidence interval [CI]: 8.07–20.4), skin problems (aSPR 13.49, 95% CI: 8.07–20.4), and low back pain (aSPR 8.40, 95% CI: 6.50–10.69). Elevated exposure to workplace hazards such as chemicals (aSPR 2.36, 95% CI: 1.51–3.51), organic solvents (aSPR 2.22, 95% CI: 1.44–3.28), handling of heavy objects (aSPR 1.67, 95% CI: 1.24–2.21), and high temperatures (aSPR 1.96, 95% CI: 1.46–2.57) was observed among them. Additionally, they faced a higher risk of no personal protective equipment (aSPR 2.53, 95% CI: 1.26–4.52) and a greater prevalence of unmet medical needs (aSPR 7.14, 95% CI: 4.74–10.32). @*Conclusion@#Our findings highlight the elevated workplace hazards, health problems, and unmet medical needs among Vietnamese male workers compared to the Korean reference population. These findings underscores the urgency for enhanced scrutiny over working conditions and protective equipment provision, coupled with efforts to improve healthcare accessibility and worker education.
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Background@#Nirmatrelvir-ritonavir is highly effective in preventing severe coronavirus disease 2019 (COVID-19) in high-risk patients with mild-to-moderate severity. However, real-world performance data are limited, and the drug is not so acceptable to the COVID-19 patients at high risk who need it in Korea. @*Methods@#To evaluate the effectiveness of nirmatrelvir-ritonavir, we conducted a propensity score-matched retrospective cohort study on patients with mild-to-moderate COVID-19 at high risk for a severe disease who were hospitalized at four hospitals in South Korea from February 2022 to April 2022. A total of 236 patients in the treatment group (administered nirmatrelvir-ritonavir) and 236 in the matched control group (supportive care only) were analyzed for the primary outcome, i.e., the time to oxygen support-free survival. The secondary outcome was a composite result of disease progression. The reason for not prescribing nirmatrelvir-ritonavir to the indicated patients was also investigated. @*Results@#The treatment group showed significantly longer oxygen support-free survival than the matched control group (adjusted hazard ratio [aHR], 0.07; 95% confidence interval [CI], 0.01–0.31; P < 0.001). Multivariate Cox regression analysis showed that age (aHR, 1.03; 95% CI, 1.00–1.07), National Early Warning Score-2 at admission (aHR, 1.36; 95% CI, 1.08–1.71), nirmatrelvir-ritonavir treatment, female sex (aHR, 0.37; 95% CI, 0.15–0.88), and time from symptom onset to admission (aHR, 0.67; 95% CI, 0.48–0.95) were significantly associated with oxygen therapy. However, none of the factors were related to the composite outcome. In the unmatched control group, 19.9% of 376 patients had documented explanations for nirmatrelvir-ritonavir non-prescription, and 44.0% of these were due to contraindication criteria. In the treatment group, 10.9% of patients discontinued the medication primarily because of adverse events (71.4%), with gastrointestinal symptoms being the most common (50.0%). @*Conclusion@#Nirmatrelvir-ritonavir treatment significantly reduced oxygen therapy requirements in high-risk patients with COVID-19 during the omicron variant surge in South Korea. Physicians are encouraged to consider the active use of nirmatrelvir-ritonavir and to be watchful for gastrointestinal symptoms during medication.
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Background@#The implementation of an effective suicide prevention program requires the identification and monitoring of subpopulations with elevated risks for suicide in consideration of demographic characteristics, to facilitate the development of tailored countermeasures for tackling the risk factors of suicide. We examined the annual trends in emergency department (ED) visits for suicide attempts (SAs) or self-harm and investigated the sex- and age-specific characteristics of individuals who visited the ED for SA and self-harm. @*Methods@#Data on ED visits for SAs or self-harm in Korea from 2016 to 2020 were extracted from the National Emergency Department Information System and assessed. We evaluated the age-standardized incidence rate of ED visits for SAs or self-harm, and hospital mortality among individuals who visited the ED for SAs or self-harm. In addition, the characteristics of the individuals were compared according to sex and age. @*Results@#We identified 145,963 ED visits for SAs or self-harm (0.42% of the total ED visits) during the study period. The rate of ED visits increased in the youngest age group (19–29 years old), and was more prominent among women (increased by an annual average of 22.5%), despite the coronavirus disease pandemic. The middle-aged group (45–64 years old) had a higher rate of mortality than other age groups, and the highest proportion of individuals on Medical Aid. @*Conclusion@#It is necessary to plan age- and gender-specific suicide prevention programs that focus on improving the limited public mental health resources for the vulnerable populations.
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The aim of this study was to develop evidence-based recommendations for determining the surgical extent in patients with locally invasive differentiated thyroid cancer (DTC). Locally invasive DTC with gross extrathyroidal extension invading surrounding anatomical structures may lead to several functional deficits and poor oncological outcomes. At present, the optimal extent of surgery in locally invasive DTC remains a matter of debate, and there are no adequate guidelines. On October 8, 2021, four experts searched the PubMed, Embase, and Cochrane Library databases; the identified papers were reviewed by 39 experts in thyroid and head and neck surgery. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence, and to develop and report recommendations. The strength of a recommendation reflects the confidence of a guideline panel that the desirable effects of an intervention outweigh any undesirable effects, across all patients for whom the recommendation is applicable. After completing the draft guidelines, Delphi questionnaires were completed by members of the Korean Society of Head and Neck Surgery. Twenty-seven evidence-based recommendations were made for several factors, including the preoperative workup; surgical extent of thyroidectomy; surgery for cancer invading the strap muscles, recurrent laryngeal nerve, laryngeal framework, trachea, or esophagus; and surgery for patients with central and lateral cervical lymph node involvement. Evidence-based guidelines were devised to help clinicians make safer and more efficient clinical decisions for the optimal surgical treatment of patients with locally invasive DTC.
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Since severe acute respiratory syndrome-coronavirus-2 variant B.1.1.529 (omicron) was first reported to the World Health Organization on November 24, 2021, the cases of the omicron variant have been detected in more than 90 countries over the last month. We investigated the clinical and epidemiological characteristics of the first 40 patients with the omicron variant who had been isolated at the National Medical Center in South Korea during December 4–17, 2021. The median age of the patients was 39.5 years. Twenty-two patients (55%) were women. Seventeen patients (42.5%) were fully vaccinated, and none were reinfected with the omicron. Eighteen (45%) had recent international travel history. Half of the patients (19, 47.5%) were asymptomatic, while the others had mild symptoms. Six patients (15%) showed lung infiltrations on chest image; however, none required supplemental oxygen. These mild clinical features are consistent with recent case reports on the omicron variant from other countries.
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Clinical research including human participants should be based on truth, demonstrate scientific integrity, and follow ethical standards and guidelines to protect study participants. The publication of clinical research should be transparent and adhere to strict criteria for authorship. A thorough understanding and knowledge of ethical issues will limit investigator misconduct in clinical research and publication. In this article, basic ethical issues in clinical research and publication are reviewed and summarized based on recent guidelines.
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Objectives@#：The study aimed to identify factors associated with suicidal attempt in Korean adults experiencing thoughts of suicide. @*Methods@#：This study analyzed outcomes of suicidal behavior in the Korea National Health and Nutrition Examination Survey (KNHANES) 2015, 2017, and 2019. This survey was administered by the Korea Centers for Disease Control and Prevention (KCDC). The suicidal idea group was divided into individuals who had attempted suicide (n=92) and those who had not (n=831). Complex samples crosstabs analysis was conducted to compare the two groups’ sociodemographic, psychiatric, and clinical characteristics. In addition, factors related to attempted suicide were investigated using complex samples logistic regression analysis. @*Results@#：The attempted suicide group had significantly higher rates of depression, recent psychiatric counsel-ing, and suicidal plan (p<0.001) than the non-attempting group. In addition, the groups differed significantly in the frequency of binge drinking and smoking (p<0.05). Adjusted multivariate analysis revealed that the presence of a suicidal plan (Odds ratio [OR]=8.46, 95% Confidential Intervals [CI]=4.72-15.00), daily binge drinking (OR=3.14, 95% CI=1.26-7.84), psychiatric counseling within the past year (OR=3.03, 95% CI=1.75-5.23), low income level (OR=2.89, 95% CI=1.17-7.10), and history of depression (OR=2.39, 95% CI=1.29-4.42) were signifi-cantly associated with suicidal attempt. @*Conclusions@#：Factors associated with suicidal attempt among suicidal ideators in the general Korean population were identified across all sociodemographic, psychiatric, and clinical variables. Assessment of and interven-tion in suicidal plan, binge drinking, income level, and depression might prevent progression to suicidal attempt among those contemplating suicide.
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Ectopic thymic neoplasm, particularly ectopic thymic carcinoma, is a rare disease that presents as a neck mass. Here, we present a case of ectopic thymic squamous carcinoma in a 65-year-old man who presented with persistent hoarseness. After fine needle aspiration cytology, the patient underwent total thyroidectomy with lymph node dissection. The final histopathological examination revealed the ectopic thymic squamous carcinoma. The patient was discharged without any postoperative complications. The patient received adjuvant radiation therapy and did not progress during the 1-year follow-up period.
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The apocrine morphology of the breast is observed in a broad pathological spectrum, ranging from benign cysts to invasive carcinomas. However, the number of clinical research investigating malignant apocrine lesions is limited. This study retrospectively reviewed the data of patients with malignant apocrine lesions admitted in a tertiary center between January 2004 and December 2021, based on the radiology-pathology correlation and the recent advances in their status to enhance the therapeutic implications of androgen receptor (AR). Among the 37 patients with lesions, 27 (73.0%) had triple-negative subtypes with predominant AR expression. The radiological features of malignant apocrine lesions did not differ from those of typical invasive ductal carcinoma or ductal carcinoma in situ. This study demonstrated that knowledge on the imaging features of malignant apocrine lesions and their histological basis could enhance the adoption of new targeted therapies in patients with this particular type of breast cancer.
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The recommended meal composition allows the general people to organize meals using the number of intakes of foods from each of six food groups (grains, meat·fish·eggs·beans, vegetables, fruits, milk·dairy products and oils·sugars) to meet Dietary Reference Intakes for Koreans (KDRIs) without calculating complex nutritional values. Through an integrated analysis of data from the 6th to 7th Korean National Health and Nutrition Examination Surveys (2013–2018), representative foods for each food group were selected, and the amounts of representative foods per person were derived based on energy. Based on the EER by age and gender from the KDRIs, a total of 12 kinds of diets were suggested by differentiating meal compositions by age (aged 1–2, 3–5, 6–11, 12–18, 19–64, 65–74 and ≥ 75 years) and gender.The 2020 Food Balance Wheel included the 6th food group of oils and sugars to raise public awareness and avoid confusion in the practical utilization of the model by industries or individuals in reducing the consistent increasing intakes of oils and sugars. To promote the everyday use of the Food Balance Wheel and recommended meal compositions among the general public, the poster of the Food Balance Wheel was created in five languages (Korean, English, Japanese, Vietnamese and Chinese) along with card news. A survey was conducted to provide a basis for categorizing nutritional problems by life cycles and developing customized web-based messages to the public. Based on survey results two types of card news were produced for the general public and youth. Additionally, the educational program was developed through a series of processes, such as prioritization of educational topics, setting educational goals for each stage, creation of a detailed educational system chart and teachinglearning plans for the development of educational materials and media.
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Concerns about the effectiveness of current vaccines against the rapidly spreading severe acute respiratory syndrome-coronavirus-2 omicron (B.1.1.529) variant are increasing. This study aimed to assess neutralizing antibody activity against the wild-type (BetaCoV/Korea/ KCDC03/2020), delta, and omicron variants after full primary and booster vaccinations with BNT162b2. A plaque reduction neutralization test was employed to determine 50% neutralizing dilution (ND 50 ) titers in serum samples. ND 50 titers against the omicron variant (median [interquartile range], 5.3 [50 titers than the detection threshold (50 titers against BetaCoV/Korea/KCDC03/2020, delta, and omicron, although titers against omicron remained lower than those against the other variants (P < 0.001). Our study suggests that booster vaccination with BNT162b2 significantly increases humoral immunity against the omicron variant.
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Background@#The coronavirus disease 2019 (COVID-19) outbreak and subsequent disease-containment measures (such as school closures) significantly affected the lives of adolescents. We evaluated the mental-health status and factors associated with anxiety and depression among South Korean adolescents. @*Methods@#A nationwide online survey was conducted to evaluate the mental-health status of South Korean adolescents during the COVID-19 pandemic. In total, 570 adolescents aged 13–18 years were surveyed between May 27 and June 11, 2021. The participants completed the Generalized Anxiety Disorder Scale (GAD-7) and Patient Health Questionnaire (PHQ-9) to determine anxiety and depression symptoms, respectively. Stepwise logistic regression models were constructed to determine factors related to anxiety and depression. @*Results@#Among the study participants, 11.2% and 14.2% had anxiety and depression, respectively. The results suggested that several factors, such as the experience of COVID-19 infection and quarantine of oneself, a family member or an acquaintance, physical and mental health problems, and fear of one’s local community being discriminated against as a COVID-19 area were related to anxiety and depression. @*Conclusion@#The present study identified COVID-19-related factors associated with anxiety and depression among adolescents, and provides insights regarding potential interventions to improve the mental health of adolescents. To promote the mental health of adolescents during the COVID-19 pandemic, special attention should be paid to individuals with physical or mental-health problems, and efforts should be made to reduce the negative social and emotional impacts of infection-control measures.
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Background and Objectives@#Variable types of electrodes for intraoperative neuromonitoring (IONM) during thyroid surgery have been introduced to make up for the shortcomings of conventional endotracheal electromyogram tube. In this study, we sought to evaluate the efficacy of transcutaneous adhesive skin electrodes for IONM of recurrent laryngeal nerve (RLN) during thyroidectomy.Subjects and Method A total 97 nerves at risk of 80 patients were enrolled in this study. Two disposable adhesive skin electrodes were attached at both upper margins of thyroid cartilage. Using NIM 3.0 system (Medtronic), we recorded the amplitude and latency of signals of vagus nerve and RLN following the standard procedure of IONM. Clinicopathologic factors as well as the preoperative and postoperative vocal cord functions of the patients were analyzed. @*Results@#IONM was successful in all nerves at risk without any false loss of signals. There were no complications nor any significant time delay due to adhesive skin electrodes. The mean amplitudes from the vagus nerve (V1) and RLN (R1) were 230.64 µV and 293.48 µV, respectively. Two nerves at risk showed loss of signal and the two patients showed postoperative temporary vocal cord paralysis. The amplitude of signals from the vagus nerve (V1, V2) was significantly higher in the lower body mass index (BMI) group compared to that of the higher BMI group. @*Conclusion@#IONM using transcutaneous skin electrodes may be considered as an alternative technique for IONM during thyroid surgery.
ABSTRACT
Efficiency of intraoperative neuromonitoring (IONM) for recurrent laryngeal nerve (RLN) during thyroid or parathyroid surgery has been well established. Electromyogram (EMG) tube has been utilized as a standard method of IONM for RLN. However, limitations of EMG tube including false positive signals due to malposition of the tube and relatively high cost have been issued. Recently, there have been several alternative methods using variable types of skin electrodes to overcome the limitations of conventional EMG tube. These recent methods using skin electrodes will be reviewed in this article.
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Full-mouth rehabilitation with increasing vertical dimension can be used for patients with severely worn teeth. In severely worn teeth also, the alveolar process can be elongated to compensate for the reduced vertical dimension, and the patient’s vertical dimension of occlusion can be kept constant. However, full-mouth rehabilitation with increasing vertical dimension must be carefully chosen, because the vertical dimension can be reduced by tooth wear. It is important to establish a treatment plan with the systematic diagnosis of the change in the vertical dimension and gain space for the prosthesis. It is necessary to change the vertical dimension to secure the restoration space and select the minimum vertical dimension elevation for the esthetic and functional goal. In this case report, the patient complained of difficulty during chewing due to a worn dentition and wanted esthetic improvement of the short mandibular anterior teeth. After systematic evaluation and diagnosis, we performed full-mouth rehabilitation with minimum vertical dimension elevation to obtain the space for restoration. This resulted in a stable and harmonious occlusion, and the functional and esthetic problems of the patient were solved after treatment. The patient was satisfied with the results of the treatment and maintained stable occlusion during the follow-up period.
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Fibromyalgia syndrome (FMS) has chronic widespread pain (CWP) as a core symptom and a variety of associated somatic and psychological symptoms such as fatigue, sleep problems, cognitive disturbances, multiple somatic pain, and depression. FMS is the subject of considerable controversy in the realm of nosology, diagnosis, pathophysiology, and treatment.Moreover, the fact that FMS and mental illness are closely associated with each other might intensify the confusion for the distinction between FMS and mental disorders. This narrative literature review aims to provide the concept, diagnosis, and treatment of FMS from the integrative biopsychosocial and psychosomatic perspective. This article first explains the concepts of FMS as a disease entity of biopsychosocial model, and then summarizes the changes of diagnostic criteria over past three decades, differential diagnosis and comorbidity issue focused on mental illnesses. In addition, an overview of treatment of FMS is presented mainly by arranging the recommendations from the international guidelines which have been developed by four official academic associations.
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Objectives@#：This study evaluated the medical communication skills of trainee doctors and analyzed the relationship between medical communication skills, self-efficacy on clinical performance (SECP) and empathy. @*Methods@#：A total of 106 trainee doctors from a university hospital participated. The questionnaire comprised self-evaluated medical communication skills, modified SECP and the Korean version of the Jefferson Scale of Empathy-Health Professionals version. The mean difference in medical communication skills scores according to gender, age, division (intern, internal medicine group or surgery group) and position (intern, first-/second- and third-/fourth-year residents) were analyzed. Pearson correlation coefficients were determined between medical communication skills, modified SECP and empathy. The effects of each variable on medical communication skills were verified using the structural equation model. @*Results@#：There were no statistically significant mean differences in self-evaluated medical communication skills according to gender, age, division or position. Medical communication skills had a significant positive correlation with modified SECP (r=0.782, p<0.001) and empathy (r=0.210, p=0.038). Empathy had a direct effect on modified SECP (β=0.30, p<0.01) and modified SECP had a direct effect on medical communication skills (β=0.80, p<0.001). Empathy indirectly influenced medical communication skills, mediating modified SECP (β=0.26, p<0.05). @*Conclusions@#：Medical communication skills are an important core curriculum of residency programs, as they have a direct correlation with SECP, which is needed for successful treatment. Moreover, the medical communication needs a new understanding that is out of empathy.
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Anti-N-methyl-D-aspartate receptor (Anti-NMDAR) encephalitis is a neuroinflammatory disease mediated by autoantibodies to NMDAR. In the initial clinical stages of anti-NMDAR encephalitis, psychiatric symptoms like delusions, perceptual disturbances, and disorganized speech or behaviors are pronounced even without obvious neurological symptoms. Early treatments like immunotherapy and/or tumor removal are central to good clinical outcomes. Hence, it is important to diagnose early anti-NMDAR encephalitis, distinguishing it from mental disorder. In the present case study, the authors described psychiatric symptoms assessed with Positive and Negative Syndrome Scale (PANSS) of Ms. A, a 26-year-old woman, in the early phase of anti-NMDAR encephalitis. We will discuss the characteristic psychopathology of anti-NMDAR encephalitis toward prompt diagnosis and treatment. Ms. A showed a higher negative subscale score than positive one on the PANSS. Compared with mental disorder, negative symptoms and cognitive impairment would be more prominent in the early stage of anti-NMDAR encephalitis. Rituximab and teratoma removal were effective, and quetiapine showed good tolerability. It is recommended to evaluate anti-NMDAR encephalitis when negative symptoms, cognitive impairment, catatonia, changes in consciousness level, and neurological symptoms are observed, especially in young women.
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Background/Objectives@#Extracapsular dissection has the advantage of reducing complications by minimizing tissue loss of the parotid without intentionally exposing the facial nerve in patients with benign parotid tumor. However, there has been controversy over the surgical results. Thus, the surgical outcomes of extracapsular dissection for benign parotid tumor was compared to those of superficial parotidectomy.Materials & Methods: A retrospective chart review was conducted with 132 patients who received surgery for benign parotid tumor in our center from January 2014 to December 2018 retrospectively. @*Results@#A total of 132 people were enrolled, with 62 people receiving extracapsular dissection, 38 people receiving partial superficial parotidectomy and 32 people receiving superficial parotidectomy. No significant difference was found between the three groups regarding complications such as facial nerve palsy, Frey's syndrome, or first bite syndrome. Operation time and hospital stay was significantly short in extracapsular dissection group. @*Conclusion@#For well-selected cases, extracapsular dissection can be considered as an option for surgery of benign parotid tumor.
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Background@#Papillary breast lesions (PBLs) comprise diverse entities from benign and atypical lesions to malignant tumors. Although PBLs are characterized by a papillary growth pattern, it is challenging to achieve high diagnostic accuracy and reproducibility. Thus, we investigated the diagnostic reproducibility of PBLs in core needle biopsy (CNB) specimens with World Health Organization (WHO) classification. @*Methods@#Diagnostic reproducibility was assessed using interobserver variability (kappa value, κ) and agreement rate in the pathologic diagnosis of 60 PBL cases on CNB among 20 breast pathologists affiliated with 20 medical institutions in Korea. This analysis was performed using hematoxylin and eosin (H&E) staining and immunohistochemical (IHC) staining for cytokeratin 5 (CK5) and p63. The pathologic diagnosis of PBLs was based on WHO classification, which was used to establish simple classifications (4-tier, 3-tier, and 2-tier). @*Results@#On WHO classification, H&E staining exhibited ‘fair agreement’ (κ = 0.21) with a 47.0% agreement rate. Simple classifications presented improvement in interobserver variability and agreement rate. IHC staining increased the kappa value and agreement rate in all the classifications. Despite IHC staining, the encapsulated/solid papillary carcinoma (EPC/SPC) subgroup (κ = 0.16) exhibited lower agreement compared to the non-EPC/SPC subgroup (κ = 0.35) with WHO classification, which was similar to the results of any other classification systems. @*Conclusions@#Although the use of IHC staining for CK5 and p63 increased the diagnostic agreement of PBLs in CNB specimens, WHO classification exhibited a higher discordance rate compared to any other classifications. Therefore, this result warrants further intensive consensus studies to improve the diagnostic reproducibility of PBLs with WHO classification.