Study on Mental Health and Suicide Risk Factors among Elderly Residents in Gyeongsangbuk-do / 생물치료정신의학

Objectives@#：The purpose of this study was to identify suicide risk factors among elderly residents in Gyeongsangbuk-do and to reveal the relationships between them. In addition, the differences in suicide risk factors were analyzed between the cognitively impaired group and the cognitively normal group. @*Methods@#：We investigated 20,127 elderly over 65 years of age, from January 2019 to December 2019. Participants were asked to complete a questionnaire survey. Cognitive function, depression, anxiety, sleep disturbance, and suicidal ideation data were assessed using a Korean version of the Mini-Mental Status Examination for Dementia Screening (MMSE-DS), Short Geriatric Depression Scale for Korean version (S-GDS), Geriatric Anxiety Inventory (GAI), Athens Insomnia Scale (AIS), and Scale for Suicidal Ideation (SSI). Data were analyzed using the chi-squared test and logistic regression analysis to examine suicide risk factors and the relationships between them. Furthermore, differences in suicide risk factors according to cognitive function were examined. @*Results@#：Age, cognitive function, depression, anxiety, and sleep disturbance were identified as suicide risk factors among elderly residents in Gyeongsangbuk-do. Depression was the factor that increased risk of suicide the most, followed by anxiety, impaired cognitive function, sleep disturbance, and 65-74 years of age. In addition, depression increased risk of suicide by 1.86 times in the cognitively impaired group. @*Conclusions@#：Among elderly residents in Gyeongsangbuk-do, depression was the factor that contributed the highest risk for suicide. More active prevention and treatment measures for depressive symptoms should be implemented in the cognitively impaired group.

Directions and Current Issues on the Policy of Prevention and Management for Hypertension and Diabetes, and Development of Chronic Disease Prevention and Management Model in Korea / 農村醫學 地域保健

Objectives@#The purpose of this manuscript was to propose the policy and perspectives of prevention and management for hypertension and diabetes in Korea. @*Methods@#Authors reviewed the chronic disease prevention and management projects and models were executed in Korea until now, and analyzed and evaluated their performances. @*Results@#In the circumstances of Korea, the following several requisites should be improved ; Specific Korean strategy for development and pursuing of national level policy agenda for chronic disease management must be established. There are a need to establish several means of supplementing the weaknesses of the current chronic disease management policies and programs. Firstly, development and distribution of contents of guidelines on the systematic project execution regime (regarding systematization of local community, subjects and contents of the projects) with guarantee for the quality of chronic disease prevention and management are necessary. Secondly, there is a need for development of information system that can lead the chronic disease management programs currently being implemented. Thirdly, there is urgent need to develop resources such as cultivation of manpower and facilities for provision of education and consultation for the patients and holders of risk factors of chronic disease. Fourthly, there is a need for means of securing management system and financial resources for operation of policies and programs. @*Conclusions@#The results can be able to use as a road map, models, and direction and strategies of policies for chronic disease prevention and management of Korea.

Usefulness of the neutrophil-to-lmphocyte ratio as a prognostic predictor in elderly patients admitted to the intensive care unit through emergency department

OBJECTIVE@#The purpose of this study was to test the hypothesis that an increase in the neutrophil-to-lymphocyte ratio (NLR) increases the risk of in-hospital density in patients aged 65 and older, who are hospitalized in intensive care through the emergency rooms.@*METHODS@#A retrospective medical record study was conducted on elderly patients who were admitted to intensive care units via the emergency room. The exclusion criteria were data loss, intensive care unit reentry, cerebrovascular accidents, hematologic disease, and trauma cases.@*RESULTS@#The study included 526 patients; the mean age was 79, and 261 (49.6%) were male. The in-hospital mortality was 18.4% (97 patients). The initial NLR was higher in the non-survivor group than the survivor group, but the difference was not statistically significant (9.82±11.02 vs. 11.48±6.11, P=0.080). In multivariate logistic analysis, the initial NLR had no statistical significance, and the odd ratio was increased from one day later. Comparing the receiver operating characteristic curve of the NLR and Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) scores, the NLR showed an increase in the area of under curve (AUC) value over time as well as the highest AUC with the SAPS II scores.@*CONCLUSION@#In elderly adults, early NLR was found to have weak power to predict in-hospital mortality. Over time, the NLR values more than two days after intensive care unit admission may be useful in predicting the in-hospital mortality for older patients. This may be due to the delay in the immune response and the complex medical history.

Cultural Competence of Health Care Providers in Daegu and Satisfaction on Health Care Services of Chinese Medical Tourists / 보건행정학회지

BACKGROUND: This study aims at making a survey on health care service providers' cultural competence and making an appraisal of Chinese medical tourists on service quality, health care service providers' cultural competence, perceived value, and satisfaction. METHODS: The data was collected from August until November, 2014 and 150 health care service providers and 65 Chinese medical tourists from 12 medical institutions in Daegu were enrolled in analysis. RESULTS: The results showed that health care service provider's knowledge on Chinese culture was very low with 33.5% of correct answer. Health care service providers were found to get 3.82 point on a 5 point-scale in cultural perception, 3.53 points in cultural sensitivity, and 2.85 points in cultural skills. Chinese medical tourists were analyzed to give 4.08 points on a 5-point scale to satisfaction on health care service, followed by 4.01 points to health care service quality, 4.00 points to perceived value of health care service, and last 3.85 points to a health care service providers' cultural skills. However, there was a difference in points in cultural skills between health care service providers and Chinese medical tourists. Chinese medical tourists' satisfaction with health care service in Daegu was found to be comparatively high, but in relation to satisfaction with communication, it was found to be relatively low. CONCLUSION: Through this research, health care service providers' knowledge level of Chinese culture and cultural skills were low while they seemed to take a half-hearted attitude towards educational experience for building up cultural competence and foreign patient service response.

Analysis of Death of Burn Patients in a Burn Specialized Hospital: A Retrospective Clinical Study

PURPOSE: Burns are one of the most important causes of mortality. We tried to analysis of death in severely burned patients in a single burn specialized hospital. METHODS: We reviewed the records of patients admitted to the intensive care unit for 5 years, from 2007 to 2011. Information was collected on age, sex, type of burn, burn surface area, length of intensive care unit stay, presence of inhalation injury and causes of mortality by chart review. RESULTS: During 5 years, 56 patients were died in our intensive care unit. The average was 51.6 years and the sex ratio was 1.95:1 for males and females. The mean burn surface area (BSA) was 67.2%. Eight (32.1%) of the patients died within 48 hrs. The hospital stay of the death was from 1 to 40 days (average 7.6 days). In outdoor accidents, sex ratio and BSA were 4.60:1 (P=0.023) and 75.4+/-22.7% (P=0.021), respectively, while 1.00:1 and 58.8+/-29.7%, respectively, in indoor accidents. CONCLUSION: The mortality in severe burn patient was 12.5%. In accidents occurred outdoors, male was predominant. In outdoor accidents, the BSA was larger than that of indoor disasters.

Epidemiology of Burn Patients Underwent Mechanical Ventilation Therapy: 4 Year Retrospective Study

PURPOSE: In severe burn injured patients, mechanical ventilation therapy (MVT) is often performed. However, little is known about the mortality and clinical outcomes in these patients. METHODS: A retrospective review of burn patients underwent MVT from January 2008 to December 2011 was conducted. The charts of patients were reviewed. RESULTS: Thirty hundred forty five patients were managed in the intensive care unit during 4 years and 67 patients were received MVT. Among them, 34 (50.7%) patients were intubated before arrival. Mean age was 47.8 years and mean burn surface area (BSA) was 53.4%. Thirty nine patients were died and mortality was 58.2%. The BSA in dead patients was larger (68.9+/-24.9%) than those patients who lived (31.8+/-18.4%) (P<0.001). There were no significant differences in the incidence of inhalation injury and age between survivors and non-survivors. CONCLUSION: The mortality rate was high in patients underwent MVT. BSA is the most important risk factor of mortality in these patients.

Scalding Burns Affected by Instant Ramen in Children

PURPOSE: Ramen is one of the most favorite instant noodles in Korea. Ramen is usually cooked by hot water and it may cause scald burns. The aim of this study was to determine the characteristics of reman-related scald burns (RRSBs) in children. METHODS: From Jan 2007 to Dec 2011, RRSBs in children under 14 years-old were retrospectively evaluated. Age, burn surface area, burn location, ramen source, and seasonal variation were evaluated. RESULTS: During 4 years, 191 children were treated with RRSBs (9.6% of total scalding burns). The average age was 5.6 years and the sex ratio was 1:0.93 for males and females. The mean burn surface area (BSA) was 2.2%. The peak age was 1 year (17.3%) followed by 2 years (12.0%). The packet ramen and cup ramen ratio was 1:0.24. August was the peak month (13.1%) and the most affected skin lesion was lower extremity (45.1%). CONCLUSION: Approximately 5% of scald burn injured children were affected by ramen. Toddlers are the most affected age group. The lower extremity was the most common lesion. Burns from ramen is preventable. Parents and carers should be careful when handle hot water to prevent burns in their children.

Fragmentectomy versus Conventional Microdiscectomy in Single-Level Lumbar Disc Herniations : Comparison of Clinical Results and Recurrence Rates

OBJECTIVE: This retrospective study aimed to compare clinical outcomes in terms of pain relief and recurrence rate between fragmentectomies and conventional microdiscectomies in patients with lumbar disc herniation (LDH). METHODS: Between January 2008 and May 2011, a total of 175 patients met the inclusion criteria of this study. The visual analogue scale (VAS) scores of back and radicular pains were recorded before surgery, 2 and 6 weeks after surgery. Recurrence was defined when a patient had the same pattern of preoperative symptoms and was confirmed with magnetic resonance imaging. RESULTS: Seventy-four patients (42.3%) were suitable for fragmentectomy, and 101 patients underwent conventional microdiscectomy. There were no significant differences in VAS scores between the fragmentectomy and conventional microdiscectomy groups 2 and 6 weeks after surgery. During the follow-up period, 3 patients (4.05%) in the fragmentectomy group and 7 patients (6.93%) in the conventional microdiscectomy group relapsed. CONCLUSION: If patients are selected according to well-defined criteria, fragmentectomy can be a good surgical option for LDH, in the physiological aspect of preserving healthy intervertebral disc materials.

Central Venous Catheter-related Infection in Major Burn Patients: Comparison of Subclavian Vein and Femoral Vein / 대한구급학회지

BACKGROUND: A central venous catheter (CVC) is usually inserted in patients with severe burns and the selection of the CVC is often difficult due to widespread burned skin. We investigated the incidences of colonization and catheter-related blood stream infection (CRBSI) according to the insertion site of the CVC in major burn patients METHODS: In 63 adult massive burn patients in the intensive care unit, 93 CVCs (47 polyurethane standard CVCs and 46 Oligon anti-mocrobial CVCs) were randomly inserted via the subclavian vein (SCV group, n = 66) or femoral vein (FEV group, n = 27). All catheter tips removed were routinely cultured. Bacterial findings from the burn wound and peripheral blood were also monitored in all patients RESULTS: There was no significant difference in the average insertion length of the CVC (14.3 +/- 6.8 days in SCV and 13.6 +/- 3.8 days in FEV) between the two groups. There were no significant differences in CVC colonization (48.5% in SCV and 63.0% in FEV) and CRBSI (7.6% in SCV and 11.1% in FEV) between the two groups. Logistic analysis found that the use of polyurethane standard CVC is significantly associated with increased risk of CVC colonization (odds ratio = 2.68) CONCLUSIONS: The placement of the CVC via the femoral vein does not increase the incidence of CVC colonization in massive burn patients. The use of Oligon anti-microbial CVC may be helpful to reduce CVC colonization in major burn patients.

Estimating Quality Adjusted Life Year Loss of Persons Disabled by Stroke Using EQ-5D in Korea / 農村醫學 地域保健

No abstract available.

The Relationship between Anxiety, Depression and 24-hour Ambulatory Blood Pressure in Hotel Employees / 農村醫學 地域保健

OBJECTIVES: Anxiety and depression are known to be associated with hypertension, and blood pressure can vary spontaneously throughout the day. The aim of this study was to evaluate anxiety, depression and 24-hour ambulatory blood pressure (24-h ambulatory BP) in employees at their worksite. METHODS: A total of 107 volunteers among 136 employees at a hotel in Gyeongju, Korea were enrolled in this study between December 2009 and March 2010. The Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI) were used to assess anxiety and depression, respectively. Blood pressure was measured using a 24-h ambulatory BP monitoring system. RESULTS: No significant differences in either BAI or BDI scores were found when hypertensive individuals were compared to normotensive individuals. The frequency of diastolic non-dipper was significantly higher in individuals with depressive symptoms compared to those without (p<0.05). Depression was significantly associated with diastolic non-dipper (OR: 6.85, 95% CI: 1.50-30.01). CONCLUSIONS: The results of this study indicate that depression should be considered when deciding upon blood pressure control regimens, and appropriate additive psychotherapy may be beneficial in the treatment of hypertensive patients.

Antimicrobial Central Venous Catheter Dose Not Reduce Catheter-related Bacteremia in Major Burn Injured Patients

PURPOSE: We previously reported that antimicrobial central venous catheter (CVC) reduced catheter colonization in major burn patients. In this study, we investigated whether antimicrobial CVC could reduce catheter-related blood stream infection (CRBSI) in major burn patients. METHODS: Burn patients with over 20% of total body surface area were randomly assigned to undergo catheterization with standard CVC (STD group, n=50) or antimicrobial Vantex(R) CVC (VTX group, n=50). Upon removal of CVC, bacterial cultures for wound, catheter tip, and blood were performed. RESULTS: Colonization rate was significantly decreased in VTX group (42%) compared to STD group (64%) (P0.05). CONCLUSION: Even though the antimicrobial CVC could reduce the catheter colonization, the CRBSI rate was not reduced by antimicrobial CVC in major burn patients.

Emergence Agitation after Sevoflurane Anesthesia in Burn Injured Children

PURPOSE: Sevoflurane is a well accepted anesthetic in children but results high incidence of undesirable emergence agitation (EA). We investigated the EA in burn injured children. METHODS: In 219 un-premedicated burn injured children aged 2~8 years, mask induction with sevoflurane was performed. On arriving operating room, modified Yale preoperative anxiety scale (m-YPAS) was checked. In the postanesthesia care unit, EA scale was recorded as follows; EA1 (no EA), EA2 (mild EA) and EA3 (marked EA). RESULTS: The incidence of EA was 50.2%. The m-YPAS was significantly higher in EA2 and EA3 compared to EA1 (P<0.001). Burn surface area was significantly wider in EA3 compared to EA1 (P<0.05). In deep second-degree burned children, the incidence of EA1 was greatest, whereas EA3 was the greatest in third-degree burned children. CONCLUSION: The incidence of EA after sevoflurane anesthesia in burn injured children was higher as the burn surface areas was greater. In addition, the symptoms of EA in third-degree burned children were more severe than in second-degree burned children.

Frequency and Related Factors of Masked Hypertension at a Worksite in Korea / 예방의학회지

OBJECTIVES: Masked hypertension is associated with metabolic risks and increased risk of cardiovascular disease. The purpose of this study was to identify the frequency of and risk factors of masked hypertension in Korean workers. METHODS: The study was conducted among 121 employees at a hotel in Gyeongju, Korea, from December 2008 to February 2009. We measured blood pressure (BP) both in the clinic and using 24-hour ambulatory BP monitors for all subjects. Hypertension was defined independently by both methods, and subjects were classified into four groups: true normotension, masked hypertension, white coat hypertension, and sustained hypertension. RESULTS: The frequency of masked hypertension in our study group was 25.6%. Compared with true normotension, the factors related to masked hypertension were male gender (odds ratio [OR], 10.7; 95% confidence interval [CI], 1.41 to 81.09), aging one year (OR, 0.88; 95% CI, 0.78 to 0.99), clinic BP 120-129/80-84 mmHg (OR, 8.42; 95% CI, 1.51 to 46.82), clinic BP 130-139 / 85-89 mmHg (OR, 12.14; 95% CI, 1.80 to 81.85), smoking (OR, 5.51; 95% CI, 1.15 to 26.54), and increase of total cholesterol 1 mg / dL (OR, 1.05; 95% CI, 1.02 to 1.08). In males only, these factors were clinic BP 120-129 / 80-84 mmHg (OR, 15.07; 95% CI, 1.55 to 146.19), clinic BP 130-139 / 85-89 mmHg (OR, 17.16; 95% CI, 1.56 to 189.45), smoking (OR, 11.61; 95% CI, 1.52 to 88.62), and increase of total cholesterol 1 mg/dL (OR, 1.05; 95% CI, 1.01 to 1.09). CONCLUSIONS: The frequency of masked hypertension was high in our study sample. Detection and management of masked hypertension, a known strong predictor of cardiovascular risk, could improve prognosis for at-risk populations.

Isolation and characterization of fowl adenovirus serotype 4 from chickens with hydropericardium syndrome in Korea / 대한수의학회지

Four strains of fowl adenovirus (FAdV) were isolated from 4 flocks of broiler or layer chickens affected by hydropericardium syndrome in Korea. These FAdVs were classified as serotype 4 by restriction fragment length polymorphism patterns of hexon genes and whole genomes. The virus exhibited cytopathic effects consisting of rounding, ballooning and clustering in primary chicken embryo liver cell cultures. In transmission electron microscopy, virus particles in hexagonal shape aggregated exclusively in the nuclei of hepatocytes of the chickens as the typical appearances in adenovirus infections. Buoyant density of the virus in cesium chloride (CsCl) was 1.34 g/mL. The virus was stable to chloroform, ether, 50~70% ethanol, acidic condition at pH 3, 0.25% trypsin (1 : 250), heat at 50degrees C for 30 min, but labile to 100% ethanol, heat at 52~60degrees C for 30 min, 1 M MgCl2 at 50degrees C for 1 h, 1 : 2,000 formalin (37%). All of the physicochemical properties pertained to the characteristics of adenoviruses. Eight viral polypeptides were determined in CsCl-purified virus by sodium dodecyl sulfate-polyacrylamide gel electrophoresis.

Effect of Ascorbic Acid at Early Fluid Resuscitation in Severe Burn Injured Patients

PURPOSE: Ascorbic acid is a potent antioxidant capable of scavenging oxygen free radicals. We investigated the effect of ascorbic acid on initial management of a major burn. METHODS: A total of twenty two patients with extent of burn injury greater than 30% of the body surface area (BSA) were enrolled. Early fluid resuscitation was performed with Parkland formula ( or =40% BSA). In ascorbic acid group, ascorbic acid was continuously infused at a dose of 30 mg/kg/h during first 24 hours of fluid resuscitation. Target urine output was 0.5~1 ml/kg/h. RESULTS: There were no significant differences in age, sex, and BSA among the groups. In the cases of Parkland formula, there was no significant difference in the fluid requirement between control group (4.26+/-1.29 ml/kg/%burn) and ascorbic acid group (3.53+/-0.87 ml/kg/%burn). However, in the cases of modified hypertonic formula, there was significant difference in the fluid requirement between control group (3.31+/-0.95 ml/kg/%burn) and ascorbic acid group (2.34+/-0.35 ml/kg/%burn). CONCLUSION: High-dose ascorbic acid reduces fluid requirement at early fluid resuscitation in severely burned patients managed with modified hypertonic formula.

Epidemiology in Preschooler Burn Injuries in a Single Burn Unit Hospital for 3 Years

PURPOSE: Burns are an important cause of injury to young children. The aim of this study was to investigate epidemiology in preschooler's burns. METHODS: A retrospective study was reviewed age, sex, burn surface area, and burn type in preschool children underwent burn surgery. Children were classified into three age groups: infant group ( or =10% of the body surface area) in groups of infant, toddler, and early childhood were 7.9%, 5.6%, and 4.7%, and the mean burn size were 18.7+/-1.7% (P=0.003 vs. toddler group), 13.7+/-0.4%, and 17.7+/-2.7%, respectively. CONCLUSION: The major etiology in preschool children' burns was scalding. Toddler was most affected age group. In severe burns, infant group showed larger burn size than toddler group.

Factors Related to the Disability of Stroke Patients in Gyeongju, Korea / 農村醫學 地域保健

OBJECTIVES: This study was conducted to evaluate factors related to the degree of disability of stroke patients in a rural community. METHODS: The study subjects included 641 patients selected from 975 stroke patients over the age of 50 with brain lesion-related disabilities living in Gyeongju, Korea, an urban-rural consolidated community. The data were obtained by interviews from July to October 2008. The subjects were divided into a seriously disabled group (1st and 2nd disability grade) and mildly disabled group (3th, 4th, 5th and 6th disability grade) by degree of disability according to registered disability grade. The collected data were analyzed using the SPSS 14.0 statistical package. RESULTS: The study subjects included 379 males (59.1%) and 262 females (40.9%), and most patients were in their 70s (256 cases, 39.9%). The seriously disabled group included 287 patients (44.8%) and the mildly disabled group included 354 persons (55.2%). Age, prehospital delayed time and number of related chronic diseases were risk factors for serious disability (p<0.05). CONCLUSIONS: Our results indicate that the degree of disability can be reduced by decreasing prehospital delayed time. We suggest that education of high risk groups and establishment of emergency services as well as a transport system for stroke patients are required to reduce the degree of disability due to stroke.

The Retrial of Percutaneous Vertebroplasty for the Treatment of Vertebral Compression Fracture

OBJECTIVE: For the treatment of osteoporotic vertebral compression fracture, percutaneous vertebroplasty (PVP) is currently widely used as an effective and relatively safe procedure. However, some patients do not experience pain relief after PVP. We performed several additional PVP procedures in those patients who did not have any improvement of pain after their initial PVP and we obtained good results. Our purpose is to demonstrate the effective results of an additional PVP procedure at the same previously treated level. METHODS: We reviewed the medical records and the radiologic data of the PVP procedures that were performed at our hospital from November 2005 to May 2008 to determine the patients who had undergone additional PVP. We identified ten patients and we measured the clinical outcomes according to the visual analogue scale (VAS) score and the radiologic parameters, including the anterior body height and the kyphotic angulation. RESULTS: The mean volume of polymethylmethacrylate injected into each vertebrae was 4.3 mL (range: 2-8 mL). The mean VAS score was reduced from 8 to 2.32. The anterior body height was increased from 1.7 cm to 2.32 cm. The kyphotic angulation was restored from 10.14 degrees to 2.32 degrees. There were no complications noted. CONCLUSION: The clinical and radiologic outcomes suggest that additional PVP is effective for relieving pain and restoring the vertebral body in patients who have unrelieved pain after their initial PVP. Our study demonstrates that additional PVP performed at the previously-treated vertebral levels could provide therapeutic benefit.

Volatile Induction and Maintenance of Anesthesia without Intravenous Access in Mild to Moderate Burn Injured Pediatric Patients

PURPOSE: Peripheral intravenous (I.V.) access is a common but stressful procedure in children, their parents and medical staffs. We evaluated the efficacy of volatile induction and maintenance of anesthesia (VIMA) without intravenous access for brief procedures in mild to moderate burn-injured pediatric patients. METHODS: VIMA without I.V. was conducted to healthy pediatric patients. Adverse events such as cough, breath holding, airway obstruction, arrhythmia, bradycardia and tachycardia, etc. were evaluated. RESULTS: From July 2008 to December 2009, 1,495 cases of VIMA with sevoflurane were performed in 859 children. Burn-injured patients were 94.9% and patients with hypertrophic scar were 5.1%. Scalding burn and contact burn were 90.1% of the burn-injured patients. Mean anesthesia duration was 29.3+/-6.2 min. In 1,495 VIMA cases, 47 cases had cardiovascular adverse events, including tachycardia (36), bradycardia (7), arrhythmia (3), and hypertension (1). All of these cardiovascular events returned normal after anesthesia. The respiratory adverse events occurred in 72 cases, including cough (49), breath holding (10), partial airway obstruction (8), hypoxia (4), and laryngospasm (1). None of the patients had bronchospasm. Most of the respiratory adverse events could be controlled by manual ventilation with mask, and oropharyngeal airway or laryngeal mask insertion. In four cases with hypoxia, the duration was less than 1 minute and these cases were no eventful after anesthesia. CONCLUSION: VIMA without I.V. access can be effective in brief procedures with mild to moderate burn-injured pediatric patients, even though a longer period of study may be required to assess the efficacy and safety.