PURPOSE: The purpose of this study was to identify factors affecting health promotion behavior among workers with high risk of metabolic syndrome. This study was based on the planned behavior theory. METHODS: The participants were 167 workers at high risk of metabolic syndrome. Data were collected using a structured questionnaire. Surveyed variables were attitude, subjective norm, perceived behavioral control, intention, and health promotion behavior. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficients, and hierarchical regression analysis with SPSS/WIN 22.0. RESULTS: Perceived behavioral control affected the intention of health promotion behavior among the workers with high risk of metabolic syndrome. It explained 62% of variance in the intention of health promotion behavior (F=40.09, p<.001). Perceived behavioral control and occupation affected health promotion behavior among the risk workers with high risk of metabolic syndrome. The two factors explained 16% of variance in health promotion behavior (F=4.95, p<.001). CONCLUSION: The findings of this study suggest that perceived behavioral control is the only factor affecting health promotion behavior when the theory of planned behavior was applied. Therefore, intervention programs for improving health promotion behavior should be focused on strengthening perceived behavioral control.
Health Behavior ; Health Promotion* ; Intention ; Metabolic Syndrome X ; Occupations ; Surveys and Questionnaires

BACKGROUND: The goal of this study was to analyze the process and characteristics of withholding or withdrawal of life support (WLS) in Korean intensive care units (ICUs). METHODS: This was a single-centered retrospective analysis of patients who died in the ICUs of a tertiary hospital in Korea from January to December 2012. WLS informed consents and clinical data were analyzed. RESULTS: Of 285 deaths during the study period, informed consents for WLS were obtained from 228 patients (80.0%). All WLS decisions were made by family members after the patient's loss of decision-making capacity. Decisions were made most frequently by the patient's son (50.6%). Patients in the WLS group were older than those in the non-WLS group, and older age was associated with the WLS decision. Thirty-seven patients (16.2%) died within one hour of WLS approval, and 182 patients (79.8%) died on the day of WLS approval. The most frequently withheld life support modality was chest compression (100%), followed by defibrillation (95.9%) and pacemaker insertion (63.3%). CONCLUSIONS: Aggressive and invasive life support measures were those most frequently withheld or withdrawn by decision-makers in Korean ICUs. The most common proxy was the son, rather than the spouse.
Humans ; Informed Consent* ; Intensive Care Units* ; Korea ; Life Support Care ; Proxy ; Retrospective Studies ; Spouses ; Tertiary Care Centers ; Thorax ; Withholding Treatment

Depression is one of the most common mental disorders. Some characteristics of depression in Korea were elucidated. The tendency to express depressive feeling through somatic complaints is more prominent in Korea than in Western countries. Careful studies on depressive symptoms suggest that guilt and suicidal idea are apparent among Korean depressive patients as well as among Western subjects. But most depressive patients in Korea are reluctant to express suicidal idea, which is hidden under the somatic complaints. We should remember the possibility of research artifacts or cultural bias with regard to the evaluation of depressive symptoms of a country in comparison with other countries. Non-pharmacological treatment of depression includes dynamic psychotherapy, cognitive behavioral therapy, interpersonal psychotherapy, self-care treatment, etc. Some kinds of Korean culture relevant psychotherapies are introduced: Tea therapy, Imago therapy, Tao psychotherapy, and combined approach. Interest in the aged people is growing recently, and the research about the factors which affect the depressive disorders in older patients and treatment strategy for them is ongoing.
Artifacts ; Bias (Epidemiology) ; Cognitive Therapy ; Depression* ; Depressive Disorder ; Guilt ; Humans ; Korea* ; Mental Disorders ; Psychotherapy ; Self Care ; Tea ; Troleandomycin

PURPOSE: To analyze the causes, success rate, and the changes of Jones tube length in endoscopic conjunctivodacryocystorhinostomy (CDCR) reoperation cases. METHODS: The medical records of 40 patients (41 eyes, a total of 52 cases) who underwent reoperation of CDCR with Jones tube reinsertion using an endoscope from January 2013 to December 2018 were retrospectively reviewed. We analyzed the success rate, causes of reoperation, changes in lengths of used tubes, and the average interval times between operations. RESULTS: The most common cause of reoperation was medial tube migration (53.8%). As in other causes, tube loss (17.3%), obstructions related with conjunctival overgrowth or granulation (13.46%), lateral tube migration (11.53%), iatrogenic removal (1.92%), and acute dacryocystitis (1.92%) followed. In patients with medial tube migration, the average tube length used in reoperations decreased by approximately 1.11 mm compared to prior operations. In cases of lateral tube migration, the average tube length increased approximately 1.00 mm after the reoperation. The success rate of reoperations was 78.04%. The average interval time between the initial operation and the first reoperation was 52 months. In cases with several reoperations, the interval time decreased as the number of reoperations increased. CONCLUSIONS Because medial tube migration was found to be the most common cause of reoperations, it should be considered as a potential problem when performing surgery. The changes in the lengths of inserted Jones tubes were related to certain types of complication, which affected the prognoses. In endoscopic CDCR reoperations, the success rate was favorable. In recurrent cases, the average interval time between reoperations decreased as the number of operations increased.

Background: Age-adjusted bone mineral density (BMD) in postmenopausal women decreases in developed countries whereas incidence of osteoporotic fracture decreases or remains stable. We investigated secular trends of bone density from 2008 to 2017 among different age groups of postmenopausal women. Methods: We analyzed BMD data obtained from health check-ups of 4,905 postmenopausal women during three survey cycles from 2008 to 2017. We divided them into 3 groups by age (50–59 years, 60–69 years, and 70 years or more) and observed the transition of lumbar and femoral BMD in each group, before and after adjusting for variables that may affect BMD. Results: Age-adjusted BMD, bone mineral content (BMC), and T-score demonstrated a declining trend over the survey period at lumbar spine (−2.8%), femur neck (−3.5%) and total femur (−4.3%), respectively. In the analysis for the age groups, the BMD, BMC, and T-score presented linear declining trend (−6.1%) in younger postmenopausal women while women aged over 70 or more showed linear increasing trends (+6.3%) at lumbar spine during the survey period. Femoral neck and total femur BMD demonstrated a declining linear trend only in the 50–59 and 60–69 years groups (−5.5%, −5.2%, respectively), but not in the 70 years or more group. Conclusion BMD in younger postmenopausal women has decreased considerably but has increased or plateaued in elderly women. This discordance of BMD trends among different age groups may contribute to decreased incidence of osteoporotic fracture despite a recent declining BMD trend in postmenopausal women.

BACKGROUND: Weaning from mechanical ventilation is difficult in the intensive care unit (ICU). Many controversial questions remain unanswered concerning the predictors of weaning failure. This study investigates patient characteristics and delayed weaning after lung transplantation. METHODS: This study retrospectively reviewed the medical records of 17 lung transplantation patients from October 2012 to December 2013. Patients able to be weaned from mechanical ventilation within 8 days after surgery were assigned to an early group (n = 9), and the rest of the patients were assigned to the delayed group (n=8). Patients' intraoperative and postoperative characteristics were collected and analyzed, and conventional weaning predictors, including rapid shallow breathing index (RSBI), were also assessed. RESULTS: The results of the early group showed a significantly shorter ICU stay in addition to a shorter hospitalization overall. Notably, the early group had a higher body mass index (BMI) than the delayed group (20.7 vs. 16.9, p = 0.004). In addition, reopening occurred more frequently in the delayed group (1/9 vs. 5/8, p = 0.05). During spontaneous breathing trials, tidal volume (TV) and arterial oxygen tension were significantly higher in the early group compared to the delayed weaning group, but differences in RSBI and respiratory rate (RR) between groups were not statistically significant. CONCLUSIONS: Low BMI might be associated with delayed ventilator weaning in lung transplantation patients. In addition, instead of the traditional weaning predictors of RSBI and RR, TV might be a better predictor for ventilator weaning after lung transplantation.
Body Mass Index* ; Hospitalization ; Humans ; Intensive Care Units ; Lung Transplantation* ; Medical Records ; Oxygen ; Respiration ; Respiration, Artificial ; Respiratory Rate ; Retrospective Studies ; Tidal Volume ; Ventilator Weaning* ; Weaning

Artificial intelligence (AI) is expected to affect various fields of medicine substantially and has the potential to improve many aspects of healthcare. However, AI has been creating much hype, too. In applying AI technology to patients, medical professionals should be able to resolve any anxiety, confusion, and questions that patients and the public may have. Also, they are responsible for ensuring that AI becomes a technology beneficial for patient care. These make the acquisition of sound knowledge and experience about AI a task of high importance for medical students. Preparing for AI does not merely mean learning information technology such as computer programming. One should acquire sufficient knowledge of basic and clinical medicines, data science, biostatistics, and evidence-based medicine. As a medical student, one should not passively accept stories related to AI in medicine in the media and on the Internet. Medical students should try to develop abilities to distinguish correct information from hype and spin and even capabilities to create thoroughly validated, trustworthy information for patients and the public.

OBJECTIVES: The aim of this study was to investigate medium- and long-term developmental directions of mental hospitals. METHODS: The preliminary investigation is composed of unstructured interviews with 10 psychiatrists, literature and case investigations, and development of models for medium- and long-term developmental model. The qualitative investigation consisted of constructed interviews with seven professionals. The quantitative investigation was conducted using questionnaires, which were sent to members of the Korean Neuropsychiatric Association, etc. Data were analyzed using frequency analysis. RESULTS: Through the preliminary investigation we were able to make three models : community model emphasizing linkage between mental hospitals and community, specialization model stressing specializations of mental hospitals, and extension model highlighting extensions of the roles of the mental hospital. In the qualitative investigation, two of the seven professionals gave a special preference for the community model, one for the specialization model, and two for the extension model. In the quantitative investigation, the community model and the specialization model were the most favorite models, and the extension model was the least favorite model. CONCLUSION: Three developmental models could be used in planning of the medium- and long-term developmental directions of mental hospitals, although each model needs to be embodied in order to work in practice.
Hospitals, Psychiatric* ; Psychiatry ; Surveys and Questionnaires

OBJECTIVES: The traditional roles of psychiatrists are being threatened according to the changes of requests from society. Psychiatrists need to rapidly adapt to new upcoming circumstances, improve leadership skills, and prepare for emerging ethical problems. The aim of this study is to predict and suggest what will happen in the future in the area of mental health, what role models might be required, what we should do and how we can prepare. METHODS: The authors interviewed seven mental health professionals on topics of leadership, participating roles of psychiatrists. Three models for psychiatrists were suggested : clinical model, community leader model, and mental health promoting model. Afterwards, a questionnaire on each role model was distributed to members of the Korean Neuropsychiatric Association via email and results were analyzed. RESULTS: Experts and stakeholders suggested that the following components from the interview will be fostered in the future : leadership in collaboration with other communities, introduction of leadership programs for young psychiatrists, strategies for sensitization of ethical issues, active communication with community partners, training professionals in legislation and administration. Regarding the questionnaire, 32 members responded. The most preferred role model was the Community leader model (46.9%, n=15), followed by the mental health promoting model (34.4%, n=11) and clinical model (15.6%, n=5). Most responders recognized that these issues are emerging and answered affirmatively on the developmental potential of each role model. A question about primary agents who are supposed to take charge of development of a suitable model was answered as follows : university professors for the clinical model (37.5%, n=12), psychiatrists working for public hospitals both for community leader (28.1%, n=9), and mental health promoting model (43.8%, n=14). Various opinions on leadership and strategies for fulfilling the role model were proposed. CONCLUSION: This study investigated leadership, ethics, social roles, and future directions of psychiatrists in order to provide suggestions on how to properly respond to changes of environment. It is expected that this study will be helpful in establishment of guidelines for leadership development and improving ethical orientation of psychiatrists, and will provide an opportunity for Korean NeuroPsychiatric Association members to have deep consideration and radical debate on our transforming roles.
Cooperative Behavior ; Electronic Mail ; Ethics ; Ethics, Medical ; Ethics, Professional* ; Hospitals, Public ; Leadership* ; Mental Health ; Professional Role ; Psychiatry* ; Surveys and Questionnaires

Catecholamine-induced cardiomyopathy associated with pheochromocytoma is a relatively well-recognized but rare entity. We report a case of 15-year old man with a pheochromocytoma and severe heart failure caused by a catecholamine-induced cardiomyopathy. He had symptoms such as fatigue, cold sweating, and dyspnea for 7 months. The chest x-ray showed an enlarged cardiac shadow and pulmonary edema. Echocardiography showed severe decreased left ventricular contractility with multiple thrombi and right ventricular hypokinesia with mild pulmonary hypertension. This report describes our experience of the anesthetic management for the removal of pheochromocytoma with catecholamine-induced cardiomyopathy, which barely responded to high vasopressin and epinephrine.
Cardiomyopathies ; Cold Temperature ; Dyspnea ; Echocardiography ; Epinephrine ; Estrogens, Conjugated (USP) ; Fatigue ; Heart Failure ; Hypertension, Pulmonary ; Hypokinesia ; Pheochromocytoma ; Pulmonary Edema ; Sweat ; Sweating ; Thorax ; Vasopressins