Background: Mental illness is known to be caused by genetic, biological, and environmental risk factors. Although previous studies have established the link between mental illness and job stress, most of them are limited to major depression disorder. Therefore, this study examined the relationship between job stress and bipolar spectrum disorder (BSD). Methods: This is a cross-sectional study based on a survey conducted in April 2017 at an electronic parts manufacturing company in Busan. In a total of 441 workers, the degree of BSD was identified using the Korean version of the Mood Disorder Questionnaire, and the degree of job stress was identified using the Korean Occupational Stress Scale Short Form.This study also identified general characteristics of workers and job-related factors. The χ2 test and Fisher's exact test was conducted to determine the differences among the variables, based on BSD. Multiple logistic regression analysis was conducted to determine the influence of independent variables on BSD. Results: Cross-analysis showed significant differences between the BSD high-risk and lowrisk groups regarding age, sex, occupation, smoking, problem drinking, job stress total score, occupational climate, and major depression disorder symptom. In addition, the significant differences between the BSD high-risk and low-risk groups about job stress were observed in terms of job demand, job insecurity, and occupational climate. A multiple logistic regression analysis revealed that the high-risk group in the job stress group had a higher effect on BSD than the low-risk group (odds ratio [OR]: 2.32, 95% confidence interval [CI]: 1.10–4.88). Among the categories of job stress, high-risk groups in 3 areas—job demand (OR: 2.56, 95% CI: 1.27–5.17), job insecurity (OR: 4.42, 95% CI: 1.19–16.42), and occupational climate (OR:2.55, 95% CI: 1.29–5.05)—were more likely to have an impact on BSD than the low-risk groups. Conclusions This study demonstrated that the high-risk groups of job stress total score, job demand, job insecurity, and occupational climate had a more significant effect on BSD than the low-risk groups. As workers with BSD may have difficulties in their work and personal lives, there is a need to manage job stress to prevention of BSD.

Background: Mental illness is known to be caused by genetic, biological, and environmental risk factors. Although previous studies have established the link between mental illness and job stress, most of them are limited to major depression disorder. Therefore, this study examined the relationship between job stress and bipolar spectrum disorder (BSD). Methods: This is a cross-sectional study based on a survey conducted in April 2017 at an electronic parts manufacturing company in Busan. In a total of 441 workers, the degree of BSD was identified using the Korean version of the Mood Disorder Questionnaire, and the degree of job stress was identified using the Korean Occupational Stress Scale Short Form.This study also identified general characteristics of workers and job-related factors. The χ2 test and Fisher's exact test was conducted to determine the differences among the variables, based on BSD. Multiple logistic regression analysis was conducted to determine the influence of independent variables on BSD. Results: Cross-analysis showed significant differences between the BSD high-risk and lowrisk groups regarding age, sex, occupation, smoking, problem drinking, job stress total score, occupational climate, and major depression disorder symptom. In addition, the significant differences between the BSD high-risk and low-risk groups about job stress were observed in terms of job demand, job insecurity, and occupational climate. A multiple logistic regression analysis revealed that the high-risk group in the job stress group had a higher effect on BSD than the low-risk group (odds ratio [OR]: 2.32, 95% confidence interval [CI]: 1.10–4.88). Among the categories of job stress, high-risk groups in 3 areas—job demand (OR: 2.56, 95% CI: 1.27–5.17), job insecurity (OR: 4.42, 95% CI: 1.19–16.42), and occupational climate (OR:2.55, 95% CI: 1.29–5.05)—were more likely to have an impact on BSD than the low-risk groups. Conclusions This study demonstrated that the high-risk groups of job stress total score, job demand, job insecurity, and occupational climate had a more significant effect on BSD than the low-risk groups. As workers with BSD may have difficulties in their work and personal lives, there is a need to manage job stress to prevention of BSD.

PURPOSE: The purpose of this study was to explore the utility of autism spectrum disorder (ASD) screening tools using community network of home childcare center visiting nurses. METHODS: The design of this study is multilevel survey to find the ASD using modified checklist for autism in toddlers (M-CHAT) for first screening by childcare teachers, checklist for autism in toddlers (CHAT) for secondary screening by nurses, Autism diagnostic observation schedule (ADOS) and Autism diagnostic interview revised (ADI-R) for final diagnosis by pediatric psychiatrists. RESULTS: In first screening by using M-CHAT, 61 subjects(0.56%) were detected among 8,926 subjects. Among the first screened 61 subjects, 13 subjects were exempted for normal finding in CHAT. 24 subjects consented participation for final diagnosis and 23 of them were diagnosed ASD. CONCLUSION: In conclusion, M-CHAT and CHAT were verified their utility as screening tools for ASD in the community and the community health networks as a childcare visiting nurses can be useful network in early detection and referral of ASD.
Appointments and Schedules ; Autistic Disorder* ; Checklist ; Child ; Autism Spectrum Disorder* ; Community Networks ; Diagnosis ; Mass Screening* ; Nurses, Community Health* ; Psychiatry ; Referral and Consultation

BACKGROUND: An increase in bone mineral density during adolescence increases resistance to fractures in older age. The Korean Society for Bone and Mineral Research and the Korean Society of Exercise Physiology developed exercise guidelines to increase the peak bone mass (PBM) in adolescents based on evidence through a systematic review of previous research.METHODS: Articles were selected using the systematic method, and the exercise guidelines were established by selecting key questions (KQs) and defining the effects of exercises based on evidence through a literature review for selecting the final exercise method. There were 9 KQs. An online search was conducted on articles published since 2000, and 93 articles were identified.RESULTS: An increase in PBM in adolescence was effective for preventing osteoporosis and fractures in older age. Exercise programs as part of vigorous physical activity (VPA) including resistance and impact exercise at least 5 to 6 months were effective for improving PBM in adolescents. It is recommended that resistance exercise is performed 10 to 12 rep·set⁻¹ 1-2 set·region⁻¹ and 3 days·week⁻¹ using the large muscles. For impact exercises such as jumping, it is recommended that the exercise is performed at least 50 jumps·min⁻¹, 10 min·day⁻¹ and 2 days·week⁻¹.CONCLUSIONS: Exercise guidelines were successfully developed, and they recommend at least 5 to 6 months of VPA, which includes both resistance and impact exercises. With the development of exercise guidelines, the incidence of osteoporosis and fractures in the aging society can be reduced in the future, thus contributing to improved public health.
Adolescent ; Aging ; Bone Density ; Exercise ; Humans ; Incidence ; Methods ; Miners ; Motor Activity ; Muscles ; Osteoporosis ; Physiology ; Public Health

Objectives: Rapid eye movement (REM) sleep without atonia (RSWA) fulfils one of the criteria for diagnosing REM sleep behavior disorder (RBD) according to the International Classification of Sleep Disorders, Third Edition. However, RSWA quantification is an unresolved issue, which is associated with the future direction of revising the diagnostic criteria. The purpose of this study was to evaluate the quantification of RSWA in patients with RBD and identify an optimal cut-off value of quantitative RSWA for RBD diagnosis. Methods: Medical records and polysomnographic results were analyzed retrospectively to diagnose sleep disorders from June 2017 to May 2018 at Pusan National University Hospital. Nineteen subjects with idiopathic RBD were included in the present study. Propensity score matching was used to control age, gender, and anti-depressant factors, which influenced RSWA. RSWA was scored according to the American Academy of Sleep Medicine scoring manual. Cohen’s kappa coefficient was measured to test inter-rater reliability between two polysomnography raters. Results: Cohen’s kappa coefficients were 0.755 (p<0.001) and 0.689 (p<0.001) for tonic and phasic activities, respectively. RSWA was significantly increased in subjects with RBD compared with controls [median and interquartile range: 16.5 (8.8–24.6) vs. 6.3 (4.1–7.2) p=0.001]. The optimal cut-off value was 8.0% for the proportion of RSWA (sensitivity 78.5%, specificity 85.7%, area under the receiver-operating characteristic curve 0.837). Conclusions Subjects with RBD had significantly increased RSWA compared to controls. The proportion of RSWA during REM sleep can be applied to discriminate subjects with RBD from controls.

Both diabetic retinopathy (DR) and coronary heart disease (CHD) are clinically significant in diabetic patients. We investigated the correlation between the severity of DR and the presence and severity of CHD among type 2 diabetic patients. A total of 175 patients who were examined at the DR clinic and underwent dual-source computed tomography (DSCT) angiography within 6 months were included. The degree of DR was graded as no DR, nonproliferative DR (NPDR), and proliferative DR (PDR). The severity of CHD and the numbers of significant stenotic coronary artery on DSCT angiography according to DR grade were assessed. The mean Agatston Calcium Score (ACS) in patients with PDR was significantly higher than other groups (P < 0.001). The overall odds of an ACS increase were about 4.7-fold higher in PDR group than in no DR group (P < 0.001). In PDR group, in comparison with in no DR, the odds of having 1 or 2 arterial involvement were 3-fold higher (P = 0.044), and those of having 3 were 17-fold higher (P = 0.011). The c-index, one of the predictability values in regression analysis model, was not significantly increased when PDR was added to classical CHD risk factors (0.671 to 0.706, P = 0.111). Conclusively, patients with PDR develop a greater likelihood of not only having CHD, but being more severe nature. PDR has no additional effect to classical CHD risk factors for predicting CHD.
Aged ; Angiography ; Coronary Artery Disease/complications/*pathology ; Coronary Vessels/diagnostic imaging ; Diabetes Mellitus, Type 2/*complications ; Diabetic Retinopathy/complications/*diagnosis/diagnostic imaging ; Female ; Glomerular Filtration Rate ; Humans ; Linear Models ; Male ; Middle Aged ; Odds Ratio ; Risk Factors ; Severity of Illness Index ; Tomography, X-Ray Computed

Both diabetic retinopathy (DR) and coronary heart disease (CHD) are clinically significant in diabetic patients. We investigated the correlation between the severity of DR and the presence and severity of CHD among type 2 diabetic patients. A total of 175 patients who were examined at the DR clinic and underwent dual-source computed tomography (DSCT) angiography within 6 months were included. The degree of DR was graded as no DR, nonproliferative DR (NPDR), and proliferative DR (PDR). The severity of CHD and the numbers of significant stenotic coronary artery on DSCT angiography according to DR grade were assessed. The mean Agatston Calcium Score (ACS) in patients with PDR was significantly higher than other groups (P < 0.001). The overall odds of an ACS increase were about 4.7-fold higher in PDR group than in no DR group (P < 0.001). In PDR group, in comparison with in no DR, the odds of having 1 or 2 arterial involvement were 3-fold higher (P = 0.044), and those of having 3 were 17-fold higher (P = 0.011). The c-index, one of the predictability values in regression analysis model, was not significantly increased when PDR was added to classical CHD risk factors (0.671 to 0.706, P = 0.111). Conclusively, patients with PDR develop a greater likelihood of not only having CHD, but being more severe nature. PDR has no additional effect to classical CHD risk factors for predicting CHD.
Aged ; Angiography ; Coronary Artery Disease/complications/*pathology ; Coronary Vessels/diagnostic imaging ; Diabetes Mellitus, Type 2/*complications ; Diabetic Retinopathy/complications/*diagnosis/diagnostic imaging ; Female ; Glomerular Filtration Rate ; Humans ; Linear Models ; Male ; Middle Aged ; Odds Ratio ; Risk Factors ; Severity of Illness Index ; Tomography, X-Ray Computed

PURPOSE: Comorbidities have been considered a mortality risk factor in pediatric critical care patients. We studied the characteristics and prognostic factors of children without comorbidities who were admitted to the intensive care unit (ICU) due to respiratory failure. METHODS: We reviewed the medical charts of patients (< 18 years) admitted to the ICU for respiratory support in a single tertiary center between January 2006 and December 2016. Patients with comorbidities and perioperative statuses were excluded. RESULTS: Of the 4,712 ICU patients, 73 (1.5%) were included in this study. The median age was 31 months (8–57) and 51 (69.9%) were boys. Twenty-nine patients (39.7%) presented with pneumonia, 14 (19.2%) with acute respiratory distress syndrome (ARDS), and 11 (15.1%) with obstructive airway disease. The median duration of ICU hospitalization was 5 days (2–14.5), and 45 of the 73 patients (61.6%) needed mechanical ventilation. Mortality was 13.7% (10/73). None of the patients with pneumonia or obstructive airway disease died. The most frequent cause of death was ARDS (5 of 10, 50%). In adjusted analysis, the extent of extrapulmonary organ dysfunction was significantly associated with mortality (odds ratio, 2.89; 95% confidence interval, 1.17–7.11; P=0.023). CONCLUSION: The mortality rate of previously healthy pediatric patients needing respiratory support in the ICU should not be negligible. Multiple organ dysfunctions might be a significant risk factor for mortality in such patients.
Cause of Death ; Child* ; Comorbidity ; Critical Care* ; Hospitalization ; Humans ; Intensive Care Units* ; Mortality ; Pneumonia ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Risk Factors

Basal cell carcinoma (BCC) is the most common malignant tumor of the skin, with a nearly 2-fold increase in incidence rates over the last two decades. A punch biopsy is considered the primary diagnostic tool for BCC; however, recent studies have reported favorable sensitivity and specificity of dermoscopy as a diagnostic tool for this malignancy. Diagnosis of BCC using the “Menzies criteria” was associated with high sensitivity, and surgery performed immediately after clinico-dermoscopic diagnosis was associated with a high positive predictive value.Therefore, in view of the high diagnostic accuracy, positive predictive value, and cost-effectiveness, direct surgical treatment without preoperative biopsy may serve as a primary therapeutic strategy for BCCs that present with typical clinico-dermoscopic features. We report two cases of BCC in patients who underwent successful Mohs microsurgery without preoperative biopsy, using dermoscopy as a primary diagnostic tool.

Basal cell carcinoma (BCC) is the most common malignant tumor of the skin, with a nearly 2-fold increase in incidence rates over the last two decades. A punch biopsy is considered the primary diagnostic tool for BCC; however, recent studies have reported favorable sensitivity and specificity of dermoscopy as a diagnostic tool for this malignancy. Diagnosis of BCC using the “Menzies criteria” was associated with high sensitivity, and surgery performed immediately after clinico-dermoscopic diagnosis was associated with a high positive predictive value.Therefore, in view of the high diagnostic accuracy, positive predictive value, and cost-effectiveness, direct surgical treatment without preoperative biopsy may serve as a primary therapeutic strategy for BCCs that present with typical clinico-dermoscopic features. We report two cases of BCC in patients who underwent successful Mohs microsurgery without preoperative biopsy, using dermoscopy as a primary diagnostic tool.