Background: Suicide is one of the leading causes of death in the military as in the general population. To mitigate such a serious public health problem, identifying the risk or protective factors of suicide behaviors is crucial. Methods: We analyzed the representative data of the 2014 Korean Armed Forces to explore the relationship between past year adverse events (PAE), accumulated lifetime trauma (ALT), mental illness vulnerability, perceived social support, and suicidal ideation in the previous year. Results: Among the 6,377 subjects, 3.7% of males and 6.2% of females reported suicidal ideation in the previous year. Multivariate analytic models identified significant associations of PAE and ALT with suicidal ideation with a dose-response pattern. The mental illness vulnerability showed the most significant association with suicidal ideation even after controlling PAE or ALT. We found that perceived social support may be potentially linked with a reduced risk of suicidal ideation. Conclusion This Korean military representative data demonstrates mental illness vulnerability; PAE; and lifetime trauma as significant risk factors of suicidal ideation, while perceived social support was found as a potential protective factor. Given the importance of the prevention of suicide in the military, those risk and protective factors may be used to screen soldiers at risk of suicide and provide further support on mental health services as needed.

Background: Suicide is one of the leading causes of death in the military as in the general population. To mitigate such a serious public health problem, identifying the risk or protective factors of suicide behaviors is crucial. Methods: We analyzed the representative data of the 2014 Korean Armed Forces to explore the relationship between past year adverse events (PAE), accumulated lifetime trauma (ALT), mental illness vulnerability, perceived social support, and suicidal ideation in the previous year. Results: Among the 6,377 subjects, 3.7% of males and 6.2% of females reported suicidal ideation in the previous year. Multivariate analytic models identified significant associations of PAE and ALT with suicidal ideation with a dose-response pattern. The mental illness vulnerability showed the most significant association with suicidal ideation even after controlling PAE or ALT. We found that perceived social support may be potentially linked with a reduced risk of suicidal ideation. Conclusion This Korean military representative data demonstrates mental illness vulnerability; PAE; and lifetime trauma as significant risk factors of suicidal ideation, while perceived social support was found as a potential protective factor. Given the importance of the prevention of suicide in the military, those risk and protective factors may be used to screen soldiers at risk of suicide and provide further support on mental health services as needed.

OBJECTIVES: The purposes of this study were to evaluate the prevalence of epilepsy and to estimate the cost of epilepsy in Korea, 2010. METHODS: This study used a prevalence based approach to calculate the cost of epilepsy. Claims data from the Korean national health insurance and data from the Korea health panel, the Korea National Statistical Office's records of causes of death, and labor statistics were used to estimate the cost of epilepsy. Patients were defined as those who were hospitalized or visited an outpatient clinic during 2010 with a diagnosis of epilepsy (International Classification of Diseases 10th revision codes G40-G41). Total costs of epilepsy included direct medical costs, direct non-medical cost and indirect costs. RESULTS: The annual prevalence of treated epilepsy was 228 per 100 000 population, and higher in men. The age-specific prevalence was highest for teenagers. The total economic burden of epilepsy was 536 billion Korean won (KW). Indirect cost (304 billion KW) was 1.3 times greater than direct cost (232 billion KW). By gender, the male (347 billion KW) were more burdened than the female (189 billion KW). The estimated cost in young age younger than 20 years old was 24.5% of the total burden of epilepsy. CONCLUSIONS: A significant portion of the economic burden of epilepsy is borne by people in young age. To reduce the economic burden of epilepsy, effective prevention and treatment strategies are needed.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; *Cost of Illness ; Epilepsy/*economics/epidemiology ; Female ; Health Care Costs/*statistics & numerical data ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; National Health Programs/economics ; Prevalence ; Republic of Korea/epidemiology ; Young Adult

PURPOSE: The flipped classroom has been suggested as a method for efficient teaching in medical education. However, its feasibility and effectiveness in the educational environment are often overlooked. The authors redesigned an epidemiology course applying the flipped classroom method under a traditional curriculum consisting of heavily scheduled classroom hours and explored its feasibility and effectiveness. METHODS: In the fall semester of 2017, we flipped the ‘practice of epidemiology’ course for third-year medical students at Korea University College of Medicine. We provided online lectures and assigned readings as pre-class materials, and substituted group discussions and communicative activities for traditional lectures. We conducted pre- and post-course surveys to review students' perceptions. We also analyzed the pre-test results and final exam scores for quantitative comparison. RESULTS: Ninety-seven students out of 120 completed the course. Most students made use of the online lectures, but not the reading materials. Lack of time was the most frequently cited reason for under-preparedness. We observed improvements in preparedness, participation, and effectiveness at the end of the course, while changes in satisfaction were unclear. Students' perceptions of course relevance and difficulty were predictive of pre-test outcomes, but the effects of preparedness and length of materials were insignificant. The authors found no evidence of differing test scores before and after the course. CONCLUSION: This study supports the feasibility of the flipped classroom model even under a traditional, heavily scheduled medical curriculum. To encourage self-directed learning and achieve better learning outcomes, restructuring pre-existing curricular components should also be considered in parallel with new instructional methods.
Curriculum ; Education, Medical ; Epidemiology ; Humans ; Korea ; Learning ; Lectures ; Methods ; Preventive Medicine ; Reading ; Students, Medical

PURPOSE: The flipped classroom has been suggested as a method for efficient teaching in medical education. However, its feasibility and effectiveness in the educational environment are often overlooked. The authors redesigned an epidemiology course applying the flipped classroom method under a traditional curriculum consisting of heavily scheduled classroom hours and explored its feasibility and effectiveness. METHODS: In the fall semester of 2017, we flipped the ‘practice of epidemiology’ course for third-year medical students at Korea University College of Medicine. We provided online lectures and assigned readings as pre-class materials, and substituted group discussions and communicative activities for traditional lectures. We conducted pre- and post-course surveys to review students' perceptions. We also analyzed the pre-test results and final exam scores for quantitative comparison. RESULTS: Ninety-seven students out of 120 completed the course. Most students made use of the online lectures, but not the reading materials. Lack of time was the most frequently cited reason for under-preparedness. We observed improvements in preparedness, participation, and effectiveness at the end of the course, while changes in satisfaction were unclear. Students' perceptions of course relevance and difficulty were predictive of pre-test outcomes, but the effects of preparedness and length of materials were insignificant. The authors found no evidence of differing test scores before and after the course. CONCLUSION This study supports the feasibility of the flipped classroom model even under a traditional, heavily scheduled medical curriculum. To encourage self-directed learning and achieve better learning outcomes, restructuring pre-existing curricular components should also be considered in parallel with new instructional methods.

Background: s/Aims: We evaluated long-term pancreatic functional outcomes, including pancreatic volumetry after pancreaticoduodenectomy (PD) for peri-ampullary neoplasm. Methods: We retrospectively reviewed 353 patients with a 12-month follow-up who underwent elective pancreaticoduodenectomies for peri-ampullary neoplasms at a single university hospital between January 2011 and December 2020. Perioperative and postoperative outcomes, long-term pancreatic endocrine functions, and pancreatic volume changes 12 month postoperatively were evaluated. Results: The mean age was 65.4 years, and the sex ratio was 1.38. The patients with prediagnosed diabetes mellitus (DM) comprised 31.4%. The peri-ampullary neoplasm origins were: the pancreas (49.0%), common bile duct (27.2%), ampulla of Vater (18.4%), and duodenum (5.4%). The 1-week, and 3-, 6-, and 12-month postoperative proportions of patients with DM diagnosed before surgery combined with new-onset postoperative DM were 39.7%, 42.8%, 43.9%, and 49.6%, respectively. The preoperative and postoperative 1-week, and 3-, 6-, and 12-month mean pancreatic volumes were 82.3, 38.7, 28.1, 24.9, and 25.5 mL, respectively. Univariate risk factor analyses for new-onset DM after PD observed no significant difference between the ‘No DM after PD’ and ‘New-onset DM after PD’ groups. Conclusions Following PD for peri-ampullary neoplasms, pancreatic endocrine functions and volumes continued to decrease for a minimum of 12 months. The current study did not identify any causal relationship between pancreatic endocrine dysfunction and pancreatic atrophy following PD.

BACKGROUND: Epidermal cysts seldom arise on the palm or sole because of the absence of pilosebaceous apparatus in palmoplantar skin. Palmoplantar epidermal cysts (PPECs) are not included in this location's tumor category, because they appear as slightly elevated, hardly movable dermal or subcutaneous nodules without a central punctum, unlike other epidermal cysts. As a result, PPECs often mimic corns, calluses, or verruca. OBJECTIVE: The purpose of this study was to review the clinical features of PPECs and to explore the usefulness of ultrasonography as a diagnostic tool. METHODS: We retrospectively reviewed the medical records and ultrasonographic findings of 31 patients with PPECs among 341 patients with a confirmed epidermal cyst. Among them, 12 patients were evaluated preoperatively by ultrasonography. The data were compared between the ultrasonographic diagnosis and the final diagnosis. RESULTS: Unlike previous reports, PPECs were relatively common, and comprised 9.1% (31/341) of all epidermal cysts. They also appeared more on the sole than on the palm. In addition, PPECs were confused with corns, calluses, and other benign tumors at the first visit, because of their different clinical features from ordinary epidermal cysts. However, preoperative ultrasonography of 12 cases enabled us to make a correct diagnosis. After the operation, no recurrence was found at the last follow-up in any of the patients. CONCLUSION: PPECs have some different clinical features compared to typical epidermal cysts with a non- palmoplantar location. Therefore, it is often difficult to distinguish PPECs from other benign tumorous conditions. However, ultrasonography was useful for the preoperative diagnosis of PPECs because of its safety, low cost, non-invasiveness and, most importantly, its accuracy.
Bony Callus ; Callosities ; Epidermal Cyst ; Follow-Up Studies ; Humans ; Hydrazines ; Medical Records ; Recurrence ; Retrospective Studies ; Skin ; Warts ; Zea mays

Although obesity is a risk factor for infection, whether it has the same effect on coronavirus disease 2019 (COVID-19) need confirming. We conducted a retrospective propensity score matched case-control study to examine the association between obesity and COVID-19. This study included data from the Nationwide COVID-19 Registry and the Biennial Health Checkup database, until May 30, 2020. We identified 2,231 patients with confirmed COVID-19 and 10-fold-matched negative test controls. Overweight (body mass index [BMI] 23 to 24.9 kg/m2; adjusted odds ratio [aOR], 1.16; 95% confidence interval [CI], 1.1.03 to 1.30) and class 1 obesity (BMI 25 to 29.9 kg/m2; aOR, 1.27; 95% CI, 1.14 to 1.42) had significantly increased COVID-19 risk, while classes 2 and 3 obesity (BMI ≥30 kg/m2) showed similar but non-significant trend. Females and those <50 years had more robust association pattern. Overweight and obesity are possible risk factors of COVID-19.

The milk fat globule-EGF-factor 8 protein (MFG-E8) has been identified in various tissues, where it has an important role in intercellular interactions, cellular migration, and neovascularization. Previous studies showed that MFG-E8 is expressed in different cell types under normal and pathophysiological conditions, but its expression in hematopoietic stem cells (HSCs) during hematopoiesis has not been reported. In the present study, we investigated MFG-E8 expression in multiple hematopoietic tissues at different stages of mouse embryogenesis. Using immunohistochemistry, we showed that MFG-E8 was specifically expressed in CD34+ HSCs at all hematopoietic sites, including the yolk sac, aorta-gonad-mesonephros region, placenta and fetal liver, during embryogenesis. Fluorescence-activated cell sorting and polymerase chain reaction analyses demonstrated that CD34+ cells, purified from the fetal liver, expressed additional HSC markers, c-Kit and Sca-1, and that these CD34+ cells, but not CD34- cells, highly expressed MFG-E8. We also found that MFG-E8 was not expressed in HSCs in adult mouse bone marrow, and that its expression was confined to F4/80+ macrophages. Together, this study demonstrates, for the first time, that MFG-8 is expressed in fetal HSC populations, and that MFG-E8 may have a role in embryonic hematopoiesis.
Animals ; Antigens, CD34/analysis ; Antigens, Surface/*analysis ; Bone Marrow/ultrastructure ; Female ; Hematopoietic Stem Cells/*cytology ; Liver/embryology ; Mice/*embryology ; Milk Proteins/*analysis ; Placentation ; Pregnancy

No abstract available.
Animals ; Mice* ; Skin*