The 21-Item and 12-Item Versions of the Depression Anxiety Stress Scales: Psychometric Evaluation in a Korean Population

PURPOSE: This study aimed to evaluate the psychometric properties of the Depression Anxiety Stress Scales 21 and 12 in a Korean population. METHODS: The Depression Anxiety Stress Scales were translated into Korean using a translation and backtranslation technique, and the content validity was assessed by an expert panel. Participants were recruited from six community health centers (n = 431) and two community mental health centers (n = 50). A field test of the psychometric properties of the instruments was conducted using confirmatory factor analysis with bootstrap maximum likelihood estimation involving 1,000 samples, Pearson's analysis, t test, and Cronbach's α coefficient. RESULTS: Confirmatory factor analysis of the Depression Anxiety Stress Scales 21 and 12 supported both three-factor and second-order three-factor models. The Scales 21 and 12 satisfied convergent validity with the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Perceived Stress Scale-10 and discriminant validity with the Rosenberg Self-Esteem Scale. The scores for the Depression Anxiety Stress Scales 21 and 12 were higher for the psychiatric group than for the nonpsychiatric group, confirming the presence of known-groups validity. The Depression Anxiety Stress Scales 21 and 12 exhibited moderate-to-strong correlations with the Negative Affect. Cronbach's a coefficients for the Depression Anxiety Stress Scales 21 and 12 were .93 and .90, respectively. CONCLUSION: The Depression Anxiety Stress Scales 21 and 12 appear to be acceptable, reliable, and valid instruments. However, the shorter Depression Anxiety Stress Scales 12 may be more feasible to use in a busy practice and also be less burdensome to respondents.

Serrated neoplasia pathway as an alternative route of colorectal cancer carcinogenesis

In the past two decades, besides conventional adenoma pathway, a subset of colonic lesions, including hyperplastic polyps, sessile serrated adenoma/polyps, and traditional serrated adenomas have been suggested as precancerous lesions via the alternative serrated neoplasia pathway. Major molecular alterations of sessile serrated neoplasia include BRAF mutation, high CpG island methylator phenotype, and escape of cellular senescence and progression via methylation of tumor suppressor genes or mismatch repair genes. With increasing information of the morphologic and molecular features of serrated lesions, one major challenge is how to reflect this knowledge in clinical practice, such as pathologic and endoscopic diagnosis, and guidelines for treatment and surveillance.

Gastric Adenocarcinoma with Systemic Metastasis Involving the Intraocular Choroid and Duodenum

Gastric cancer with double metastasis to the orbit and duodenum is extremely rare. We report the case of a patient with gastric adenocarcinoma who presented with synchronous orbital and duodenal metastases at the time of initial diagnosis. A 60-year-old man presented with a 1-month history of visual disorder and pain in his right eye. He underwent ophthalmological examinations. The biopsy results suggested intraocular metastatic carcinoma. We conducted a systemic evaluation to identify primary malignancy. Finally, a diagnosis of advanced gastric adenocarcinoma with multi-organ metastasis was made. He planned to be treated with systemic chemotherapy.

Improvement of Knowledge, Self-Efficacy and Self-Care Behaviors among Diabetic Patients participated in the Education Program of Sejong Center for Hypertension and Diabetes Management / 農村醫學 地域保健

OBJECTIVE: This study was aimed to evaluate the effectiveness of the diabetes education program implemented in a community hypertension and diabetes education center. METHODS: Participants were thirty nine diabetic patients who received the education program in the center from May 2014 through May 2015. The education program consisted of two sessions for 2 days (45 minutes per session) regarding clinical information, nutrition and exercise for type 2 diabetes patients. Initially, they were assessed for general characteristics, knowledge on diabetes, self-efficacy and self-care behaviors. Reassessment was performed on their knowledge and self-efficacy directly after the program, and on self-care behaviors at 12 weeks after the program. RESULTS: The mean score of diabetes knowledge was significantly increased from 5.27±2.10 to 8.21±1.20 (p < 0.001) between before and after the program. The self-efficacy score was also significantly increased from 6.88±1.72 to 8.16±1.47 (p < 0.001). The self-care behavior score was significantly increased from 3.59±1.89 before the program to 4.35±1.29 (p < 0.001) at 12 weeks after the program. CONCLUSION: The diabetes education program may be effective on the improvement of knowledge, self-efficacy and self-care behaviors in type 2 diabetic patients.

Esophageal Squamous Cell Carcinoma Presenting as a Subepithelial Tumor

Esophageal squamous cell carcinoma (ESCC) presenting as subepithelial tumor-like growth is a very rare form of the disease. We report a case of primary ESCC with intramural growth, covered with normal esophageal epithelium. The patient was initially referred due to a subepithelial tumor at the mid-esophagus, butendoscopic ultrasonography revealed a heterogeneously hypoechoic mass, which disrupted the structure of the muscularis propria. An endoscopic submucosal dissection was performed for accurate diagnosis, and the lesion was diagnosed histopathologically as moderately differentiated squamous cell carcinoma. Computed tomography revealed an enlarged left upper paratracheal lymph node, which showed increased uptake on positron emission tomography. The patient underwent subtotal esophagectomy with total mediastinal lymphadenectomy and adjuvant chemotherapy. Primary ESCC with intramural growth is extremely rare. For accurate diagnosis, when there is a high index of suspicion, additional investigations such as endoscopic ultrasonography or diagnostic endoscopic submucosal dissection might be needed.

Gastric Mucosal Calcinosis / 대한소화기학회지

No abstract available.

A Study on the Effectiveness of Adolescent's Suicide Prevention Program / 신경정신의학

OBJECTIVES: Though the youth suicide rate in Korea is similar to those in other OECD countries, it was the first cause of death among youths in Korea during the five years from 2009 to 2013. This study aims to evaluate the effects of a school based suicide prevention program for adolescents. METHODS: A survey was conducted with 134 first grade students in middle school in Gyeonggi-do. The independent samples t-test was performed to detect differences in the suicide attitude between the experimental and control groups, and the levels of suicide prevention knowledge and activities were analyzed by χ² (chi-squared) analysis. RESULTS: The difference in the effectiveness of the suicide prevention program for adolescents on the suicide attitude between the control group (−1.12±2.08) and experimental group (1.24±4.51) turned out to be statistically significant (t=3.893, p<0.001). The experimental group was more likely to show a positive change than the control group. Moreover, since it raised the suicide prevention knowledge (χ²=6.041, p=0.049) and activities (χ²=16.284, p<0.001) compared to the control, it was confirmed that the suicide prevention program for adolescents would be very effective. CONCLUSION: The adolescent's suicide prevention program of Gyeonggi-do is considered to reinforce teenagers' values against suicide and bring about behavioral changes leading to effective suicide prevention. Further studies are needed for the evaluation and expansion of the long-term effects of the program.

Trends in Colorectal Cancer Incidence in Daejeon and Chungcheongnam-do, South Korea (2000-2012) / 農村醫學 地域保健

OBJECTIVES: Colorectal cancer is one of the major cancers in South Korea. We described the time trends in colorectal cancer incidence in Daejeon, a metropolitan city, and Chungcheongnam-do (Chungnam), a rural province, South Korea. METHODS: Using the databases from the Daejeon Cancer Registry (DCR) and the Chungnam Cancer Registry (CCR), age-standardized (to world standard population) rates for incidence (ASRW) were calculated. Average annual percent change (AAPC) was assessed as a trend indicator. The completeness (such as the mortality/incidence ratio) and validity (such as the death certificate only %, microscopic verification %, primary site uncertain %, and age unknown %) were analyzed to examine the data quality of DCR and CCR. RESULTS: Incidence of colorectal cancer showed increasing trend in both sexes. Over the years 2000-2012 in Daejeon, ASRW was increased significantly from 37.2 to 51.7 per 100,000 person-years (AAPC, 3.9%) among men and from 17.1 to 28.4 (AAPC, 3.9%) among women, respectively. In Chungnam, ASRW was also increased from 29.8 to 50.1 per 100,000 person-years (AAPC, 5.1%) among men and from 15.9 to 26.6 (AAPC, 3.2%) among women, respectively. The AAPC for colon cancer was greater than rectal cancer in both Daejeon and Chungnam. The trend of rectal cancer incidence was differ by sex (AAPC in men vs women, 2.7% vs 1.7% in Daejeon; 3.5% vs 0.8% in Chungnam). Indices of completeness and validity showed that the quality control of DCR and CCR was adequate to describe the trends of ASRW. CONCLUSIONS: Both Daejeon and Chungnam have had a rapid increase in colorectal cancer incidence. Monitoring and intervention are required on the risk factors which may contribute to this trend.

A Case of Pancreatic Cancer with Markedly Elevated Serum Immunoglobulin G4 / 대한췌담도학회지

Differential diagnosis between autoimmune pancreatitis (AIP) and pancreatic cancer is often difficult due to similar clinical manifestations and radiological findings. Serum immunoglobulin G4 (IgG4) is a marker to differentiate AIP from pancreatic cancer. Although serum IgG4 can be elevated in 10% of patients with pancreatic cancer, most of serum IgG4 elevation in pancreatic cancer is limited within two times of upper normal limit. Herein, we report a case of pancreatic cancer with markedly elevated serum IgG4 over six times of upper normal limit that needed steroid trial to differentiate from AIP.

Exercise-Induced Intrapulmonary Arteriovenous Shunt in a Patient Complaining of Dyspnea during Strenuous Exercise

A 51-year-old highly fit man presented for dyspnea with strenuous aerobic exercise. The patient was asymptomatic and all tests were normal at rest. With increasing exercise intensity, he suddenly complained of dyspnea and showed a severe exercise-induced hypoxemia with an excessive alveolar-arterial oxygen tension difference. In agitated saline contrast echocardiography at peak exercise, a large amount of left to right shunt was identified after > 5 cardiac cycles, which suggests the presence of exercise-induced intrapulmonary arteriovenous shunt in this patient.

A Case of Vertebral Osteomyelitis and Spinal Epidural Abscess Caused by Haemophilus aphrophilus / 대한내과학회지

Haemophilus aphrophilus is an aerobic, gram-negative oropharyngeal bacterium, commonly isolated from cases of HACEK endocarditis. In addition, H. aphrophilus has also been shown to cause invasive bone and joint infections. Although multiple cases of H. aphrophilus endocarditis have been described, no cases of invasive bone and joint infections caused by H. aphrophilus have been reported in Korea. Here we report the case of a 69-year old woman with a diagnosis of vertebral osteomyelitis and spinal epidural abscess with compressive myelopathy caused by H. aphrophilus, in which there was no objective evidence of infective endocarditis. She was successfully treated with intravenous administration of cefotaxime and drainage of the epidural abscess by laminectomy of the T3-7 vertebrae.

Non-surgical treatment of hemorrhagic shock caused by rupture of iatrogenic pseudoaneurysm / 영남의대학술지

Iatrogenic femoral artery pseudoaneurysm is a complication in patients undergoing catheterization. The risk increased when large-bore sheaths, concomitant anticoagulation therapy, and antiplatelet therapy are used during the intervention. Ultrasound-guided thrombin injection has become the treatment of choice. Rapid expansion, rupture, infection, and mass effect resulting in distal or cutaneous ischaemia or peripheral neuropathy, as well as failure of other treatment options are all indications for surgery. We report a 48-year-old man who developed hemorrhagic shock due to femoral pseudoaneurysm rupture after coronary angiography, and successfully treated by ultrasound-guided thrombin injection.

Comparing the Efficacy of Aquatic Physiotherapy and Land-based Physiotherapy for Patients after Total Knee Replacement Surgery / 대한정형외과연구학회지

PURPOSE: The purpose of this study is to compare the rehabilitation effects between aquatic physiotherapy and land-based physiotherapy after total knee arthroplasty. PARTICIPANTS AND METHODS: The study was performed by patients with TKA caused by knee OA. The participants were divided into two groups based on random sampling method. One group received aquatic physiotherapy while the other received land-base physiotherapy. Each physiotherapy program lasted 40 minutes a day, 5 days a week, for 1 week starting a week after the operation. Pertinent indicators, knee extensor strength, knee flexor strength, walking speed, knee circumference, WOMAC index and Visual analogue scale were recorded before and after the physiotherapy programs, 1 week, 2weeks and 6 weeks after the operation. RESULTS: The aquatic physiotherapy group showed statistically significant improvements in knees circumference and VAS scores, compared to the land-based physiotherapy group between 1week and 2 weeks after the operation, whereas no statistical differences were found in Knee extensor strength, knee flexor strength, walking speed and WOMAC index. CONCLUSION: The aquatic physiotherapy group showed statistically significant improvements in knee circumference and VAS scores compared to the land-based physiotherapy group between 1 and 2 weeks after the operation. Further studies are required to confirm these findings. We were able to conclude that aquatic physiotherapy is an alternative rehabilitation program for patients with TKA.

Comparing the Efficacy of Aquatic Physiotherapy and Land-based Physiotherapy for Patients after Total Knee Replacement Surgery / 대한정형외과연구학회지

PURPOSE: The purpose of this study is to compare the rehabilitation effects between aquatic physiotherapy and land-based physiotherapy after total knee arthroplasty. PARTICIPANTS AND METHODS: The study was performed by patients with TKA caused by knee OA. The participants were divided into two groups based on random sampling method. One group received aquatic physiotherapy while the other received land-base physiotherapy. Each physiotherapy program lasted 40 minutes a day, 5 days a week, for 1 week starting a week after the operation. Pertinent indicators, knee extensor strength, knee flexor strength, walking speed, knee circumference, WOMAC index and Visual analogue scale were recorded before and after the physiotherapy programs, 1 week, 2weeks and 6 weeks after the operation. RESULTS: The aquatic physiotherapy group showed statistically significant improvements in knees circumference and VAS scores, compared to the land-based physiotherapy group between 1week and 2 weeks after the operation, whereas no statistical differences were found in Knee extensor strength, knee flexor strength, walking speed and WOMAC index. CONCLUSION: The aquatic physiotherapy group showed statistically significant improvements in knee circumference and VAS scores compared to the land-based physiotherapy group between 1 and 2 weeks after the operation. Further studies are required to confirm these findings. We were able to conclude that aquatic physiotherapy is an alternative rehabilitation program for patients with TKA.

Effect of Combining Multiple CNV Defining Algorithms on the Reliability of CNV Calls from SNP Genotyping Data

In addition to single-nucleotide polymorphisms (SNP), copy number variation (CNV) is a major component of human genetic diversity. Among many whole-genome analysis platforms, SNP arrays have been commonly used for genomewide CNV discovery. Recently, a number of CNV defining algorithms from SNP genotyping data have been developed; however, due to the fundamental limitation of SNP genotyping data for the measurement of signal intensity, there are still concerns regarding the possibility of false discovery or low sensitivity for detecting CNVs. In this study, we aimed to verify the effect of combining multiple CNV calling algorithms and set up the most reliable pipeline for CNV calling with Affymetrix Genomewide SNP 5.0 data. For this purpose, we selected the 3 most commonly used algorithms for CNV segmentation from SNP genotyping data, PennCNV, QuantiSNP; and BirdSuite. After defining the CNV loci using the 3 different algorithms, we assessed how many of them overlapped with each other, and we also validated the CNVs by genomic quantitative PCR. Through this analysis, we proposed that for reliable CNV-based genomewide association study using SNP array data, CNV calls must be performed with at least 3 different algorithms and that the CNVs consistently called from more than 2 algorithms must be used for association analysis, because they are more reliable than the CNVs called from a single algorithm. Our result will be helpful to set up the CNV analysis protocols for Affymetrix Genomewide SNP 5.0 genotyping data.

Accuracy of Death Certificates Completed by Medical Students / 農村醫學 地域保健

OBJECTIVES: The purpose of this research was to evaluate the ability of completing death certificates among medical students. METHODS: The self-administered questionnaires were completed, during May to August 2007, by 380 medical students in senior. The questionnaire was composed of 10 cases to write the death certificate. The cause-of-deaths written by students were compared with the gold standards and their errors in the certificates also evaluated. RESULTS: Mean agreement score for 10 underlying cause-of-deaths completed on the lowest line of part I in the death certificate (UC1) was 4.8+/-1.7, and for underlying cause-of-death selected by a coder of the death certificates (UC2) was 5.6+/-1.5. The UC1 and UC2 were significantly higher among the students having the case-oriented education for death certificate than others. For the major errors in the certificates completed by students, the students having the error with no antecedent cause were highest, the error with two or more conditions secondly highest. Mean number of errors was significantly lower in the case-oriented education group than others. CONCLUSIONS: Errors are common in the death certificates completed by medical students in senior. The accuracy of death certification may be more improved with the case-oriented education than the traditional method.

Effect of Case Management Program on Self-Efficacy, Self-Care Behaviors and Glycometabolic Control in Patient with Diabetes / 農村醫學 地域保健

OBJECTIVES: We examined the effects of diabetes mellitus (DM) case management program developed by National Health Insurance Corporation in Korea. METHODS: One trained nurse performed the case management for 30 DM patients recruited through the reimbursement information of National Health Insurance in a rural community. The case manager had four home visits and two telephone calls for 12 weeks. We evaluated the effectiveness of the program in terms of self-efficacy, self-care behaviors and glyco-metabolic control. RESULTS: The self-efficacy score was significantly increased from 70.0 of pre-intervention to 80.5 of post-intervention (p<0.001). The self-care score was also significantly increased from 2.86 to 3.60 (p<0.001). The scores of its components such as nutritional care, self-test of sugar level, foot care, oral care, and aerobic exercise were significantly improved (p<0.001). However, the improvement of score in medication management was statistically marginal (p=0.071). The fasting blood sugar level and HbA1c level was significantly decreased from 128.6 mg/dl to 114.5 mg/dl (p<0.001) and from 6.78 % to 6.54 % (p<0.001) respectively. CONCLUSIONS: The case management program was effective to improve the self-efficacy and self-care behaviors, and to control blood sugar level in DM patients.

Inactivation of TPEF Gene by Aberrant Methylation in Hepatocellular Carcinoma

BACKGROUND: Abnormalities of genomic methylation patterns have been shown to play a role in the development of carcinoma, and the silencing of tumor suppressor genes is related to local de novo methylation. METHODS: Using methylation specific arbitrarily primed-Polymerase Chain Reaction (Ms AP-PCR), we identified a 322 bp sequence that contained a 5' un-translated and exon1 regions of the TPEF gene. To evaluate the inactivation of the TPEF gene through hypermethylation in hepatocellular carcinoma (HCC), we investigated the correlation between methylation patterns and TPEF expression in tumor tissues of human HCC and cell lines via a Combined Bisulfite Restriction Assay (CoBRA) and RT-PCR. RESULTS: A dense methylation pattern of the TPEF was detected in most cell lines, as well as in 10 of the 14 (71.4%) HCC tissues. In addition, loss of heterozygosity (LOH) from the TPEF gene was observed in 5 of the 14 (36%) HCC tissues. Furthermore, RT-PCR analysis revealed TPEF expression in 5 of 8 (62.5%) cell lines. Finally, treatment with a demethylating agent, 5-Aza- 2'-deoxycitidine (5-AzaC), increased the expression of TPEF mRNA. CONCLUSION: These results indicate that inactivation of the TPEF gene through hypermethylation may be a mechanism by which tumorigenesis occurs in HCC.

Daytime Sleepiness and Fatigue in Male Adults in relation to Shift Work / 대한산업의학회지

OBJECTIVES: The purpose of this study was to examine daytime sleepiness-related factors, including sleeping patterns and daytime activities, in shift and non-shift workers. METHODS: One hundred and twenty two shift workers, and two hundred and fifty four non-shift workers, were selected and identified in terms of their general characteristics, such as age, tenure, educational level, marital status and religion. Screening questionnaires were composed of the Epworth Sleepiness Scale (ESS) for evaluation of daytime sleepiness, the Multidimensional Fatigue Scale (MFS) for fatigue, and the Korean version of the National Institute for Occupational Safety and Health (NIOSH) for sleeping patterns. RESULTS: The shift worker group reported significantly higher rates of sleep disturbance and higher fatigue scores compared with the non-shift workers (all p<0.01). The prevalence of daytime sleepiness was higher in the shift workers (19.7%) than the non-shift workers (10.6%) (p<0.05). The significant daytime sleepiness-related factors were found to be shift work, tenure and difficulties in falling back to sleep once woken (p<0.05). Shift work was proved to be an important factor in workers aged less than 40 years (p<0.05). However, this association was not evident in workers aged 40 years and over. CONCLUSIONS: The shift workers showed a significantly higher prevalence of daytime sleepiness compared with the non-shift workers. The present study suggests a need for the implementation of sleeping and fatigue management programs for shift workers in order to improve working efficiency and control safety accidents during shift work.

Effectiveness of Web Based Learning on Competence, Knowledge, and Confidence in Foley-Catheter Management in Basic Nursing Education / 기본간호학회지

PURPOSE: This study was done to compare the effectiveness of web based learning versus traditional education for learning foley-catheterization in Basic Nursing. METHOD: This study was a quasi-experimental research. The participants were 60 students who were taking Basic Nursing at A nursing college (3 years) in G city. Thirty students each were assigned to the experimental or control group. Data were collected between October 20 and November 4, 2003. The data were analyzed by descriptive statistics, t-test and ANCOVA. RESULTS: The mean score for competence in foley-catheterization practice in the experimental group was 48.63 and in the control group, 44.67. This result was statistically significant (t=7.655, p=.001). The mean score for knowledge in the experimental group was 63.0, while for the control group, 64.0. This result was not statistically significant (t=-.330, p=.743). The mean score for confidence in learning in the experimental group was 26.70 for the pre-test and 30.73 for the post-test, and in the control group 27.93 and 28.37 respectively, but this result was not statistically significant (F=.858, p=.358). CONCLUSION: The Web based learning was found to be effective in nursing practice but not nursing knowledge. It is necessary to continue to develop approaches to teaching nursing and to evaluate these approaches with further research.