OBJECTIVE: Diurnal preference is an attribute reflecting whether people are alert and preferring to be active either early or late in the day. It also referred to as chronotype or morningness-eveningness trait. The PER3 genes have been known to influence diurnal preference. In this study, we have investigated the associations between the PER3 gene polymorphisms and diurnal preference in a healthy young population, controlling for the social and environmental confounding factors. METHODS: The participants in this experiment included 299 unrelated medical college students (M=191, F=108), with a mean age of 22.9 years. Diurnal preference was measured by a single administration of the 13-item Composite Scale for Morningness (CSM). Genotyping of the PER3 VNTR (rs57875989) was performed using polymerase chain reaction. A two-tailed alpha of 0.05 was chosen. RESULTS: The mean+/-SD score on the CSM scale for all subjects was 31.90+/-6.39. There was no significant difference in total CSM score between gender groups, although females showed a trend towards higher morningness score. Although PER3 5R/5R showed the tendency towards high CSM scores, there were no significant differences on CSM scores among genotypes and allele status of PER3 VNTR (rs57875989). CONCLUSIONS: We could not confirm that the PER3 VNTR is associated with diurnal preference in a Korean healthy young population. The future studies need to investigate the association between diurnal preference and other polymorphisms of PER3 gene in larger sample of Korean young healthy population.
Alleles ; Female ; Genotype ; Humans ; Polymerase Chain Reaction

PURPOSE: The purpose of the study was to develop and validate a questionnaire to evaluate medical students' knowledge of, attitude towards and practice of evidence-based medicine (EBM). METHODS: The participants of the study were 418 medical students enrolled in the Kyung Hee University School of Medicine in Seoul, Korea. To examine construct validity of the questionnaire, an exploratory factor analysis (EFA) was performed with 118 participants; a confirmatory factor analysis (CFA) was conducted with the remaining 281 participants. We developed 41 items with a 4-point Likert scale. An EFA was performed to verify the emergence of four dimensions of EBM competencies. The principal axis factoring method and the direct oblimin rotation method were used. To confirm construct validity, a CFA was conducted with the remaining 281 participants. To evaluate model fitness, root mean square error of approximation (RMSEA) and comparative fit index (CFI) were used as fit indices. We conducted ANOVA with Scheffe as discriminant validation, and calculated Cronbach's alpha of 4 subscales as reliability checkup. RESULTS: After refinement procedure, factor analysis of the 32 items in therevised questionnaire yielded 4 factors. The Scree plot supported a 4 factor solution explaining 53.5% of the variance. The 4 components derived were: factor 1_knowledge on EBM (11 items; Cronbach's alpha=0.92); factor 2_ pursuit towards EBM (10; 0.88); factor 3_reluctance on EBM (7; 0.78); factor 4_practice of EBM (4; 0.75). The questionnaire could discriminate competence differences among 1-3 yr students. Satisfactory Cronbach's alpha scores were noted for each factor as well. CONCLUSION: The EBM competency questionnaire was validated.
Axis, Cervical Vertebra ; Education, Medical, Undergraduate ; Educational Measurement ; Evidence-Based Medicine ; Humans ; Korea ; Mental Competency ; Students, Medical ; Surveys and Questionnaires

PURPOSE: The purpose of the study was to develop and validate a questionnaire to evaluate medical students' knowledge of, attitude towards and practice of evidence-based medicine (EBM). METHODS: The participants of the study were 418 medical students enrolled in the Kyung Hee University School of Medicine in Seoul, Korea. To examine construct validity of the questionnaire, an exploratory factor analysis (EFA) was performed with 118 participants; a confirmatory factor analysis (CFA) was conducted with the remaining 281 participants. We developed 41 items with a 4-point Likert scale. An EFA was performed to verify the emergence of four dimensions of EBM competencies. The principal axis factoring method and the direct oblimin rotation method were used. To confirm construct validity, a CFA was conducted with the remaining 281 participants. To evaluate model fitness, root mean square error of approximation (RMSEA) and comparative fit index (CFI) were used as fit indices. We conducted ANOVA with Scheffe as discriminant validation, and calculated Cronbach's alpha of 4 subscales as reliability checkup. RESULTS: After refinement procedure, factor analysis of the 32 items in therevised questionnaire yielded 4 factors. The Scree plot supported a 4 factor solution explaining 53.5% of the variance. The 4 components derived were: factor 1_knowledge on EBM (11 items; Cronbach's alpha=0.92); factor 2_ pursuit towards EBM (10; 0.88); factor 3_reluctance on EBM (7; 0.78); factor 4_practice of EBM (4; 0.75). The questionnaire could discriminate competence differences among 1-3 yr students. Satisfactory Cronbach's alpha scores were noted for each factor as well. CONCLUSION: The EBM competency questionnaire was validated.
Axis, Cervical Vertebra ; Education, Medical, Undergraduate ; Educational Measurement ; Evidence-Based Medicine ; Humans ; Korea ; Mental Competency ; Students, Medical ; Surveys and Questionnaires

OBJECTIVES: This study was aimed to investigate the associations of childhood trauma with psychopathology and clinical characteristics in patients with schizophrenia. METHODS: This study enrolled 66 inpatients with schizophrenia. Korean Childhood Trauma Questionnaire (K-CTQ) and Life Event Questionnaire (LEQ) were administered to assess childhood trauma. Psychopatholgy and clinical characteristics were assessed with the Positive and Negative Syndrome Scale (PANSS), Beck Depression Inventory (BDI), Korean Version of Internalized Stigma of Mental Illness (K-ISMI), Perceived Stress Scale (PSS), and visual analogue scale of EuroQoL-5 Dimension Index (EQ-5D). RESULTS: Total scores on K-CTQ were positively associated with scores on the BDI, K-ISMI, PSS, and PANSS and negatively associated with the score on the EQ-5D. Among subscales of K-CTQ, emotional abuse was significantly associated with all measures for psychopathology and clinical characteristics. Patients with physical abuse (36.5%), emotional abuse (30.2%), or bullying (30.6%) according to the LEQ showed sighificanlty higher the ISMI score and lower EQ-5D score. Emotional abuse and bullying were also significantly associated with higher scores on BDI and/or PSS. CONCLUSION: Our results suggest that childhood trauma negatively influences on internalized stigma, depression, perceived stress and quality of life in patients with schizophrenia. Clinicians should carefully evalute and manage childhood traumatic experience of patients with schizophrenia.
Bullying ; Depression ; Humans ; Inpatients ; Physical Abuse ; Psychopathology* ; Quality of Life ; Schizophrenia*

OBJECTIVES: This study was aimed to investigate the associations of childhood trauma with psychopathology and clinical characteristics in patients with schizophrenia. METHODS: This study enrolled 66 inpatients with schizophrenia. Korean Childhood Trauma Questionnaire (K-CTQ) and Life Event Questionnaire (LEQ) were administered to assess childhood trauma. Psychopatholgy and clinical characteristics were assessed with the Positive and Negative Syndrome Scale (PANSS), Beck Depression Inventory (BDI), Korean Version of Internalized Stigma of Mental Illness (K-ISMI), Perceived Stress Scale (PSS), and visual analogue scale of EuroQoL-5 Dimension Index (EQ-5D). RESULTS: Total scores on K-CTQ were positively associated with scores on the BDI, K-ISMI, PSS, and PANSS and negatively associated with the score on the EQ-5D. Among subscales of K-CTQ, emotional abuse was significantly associated with all measures for psychopathology and clinical characteristics. Patients with physical abuse (36.5%), emotional abuse (30.2%), or bullying (30.6%) according to the LEQ showed sighificanlty higher the ISMI score and lower EQ-5D score. Emotional abuse and bullying were also significantly associated with higher scores on BDI and/or PSS. CONCLUSION: Our results suggest that childhood trauma negatively influences on internalized stigma, depression, perceived stress and quality of life in patients with schizophrenia. Clinicians should carefully evalute and manage childhood traumatic experience of patients with schizophrenia.
Bullying ; Depression ; Humans ; Inpatients ; Physical Abuse ; Psychopathology* ; Quality of Life ; Schizophrenia*

OBJECTIVES: This study examined psychiatric characteristics including addictive behavior and personality traits among workers with hazardous drinking. METHODS: The cross-sectional study included 486 workers. Socio-demographic and clinical variables were collected, and employed the Alcohol Use Disorders Identification Test-Korean version (AUDIT-K), Korean translation of the Internet Addiction Test, Smartphone Addiction Scale, Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), Korean version of Connor-Davidson Resilience Scale (K-CD-RISC), Big Five Inventory-Korean version-10 (BFI-K-10). Hazardous drinking was identified with the AUDIT-K score of 10 in men and 6 in women. Univariate and logistic regression analysis were used to identify factors associated with hazardous drinking. RESULTS: One hundred sixty-eight (34.6%) workers reported hazardous drinking. It was more common in men and workers with lower levels of education, workers that smoked and experienced smartphone addiction, and had experienced attempted suicide. Among the assessment scales, scores on the HADS and PSS were higher, and scores on the K-CD-RISC were lower for these workers. Regarding scores for the BFI-K-10, higher extraversion, lower agreeableness, and lower openness were related to hazardous drinking. Logistic regression analysis revealed that smoking, smartphone addiction, history of attemptd suicide, and higher scores on extraversion of the BFI-K-10 were significantly associated with hazardous drinking. CONCLUSION: Our findings demonstrate that hazardous drinking tends to coexist with other addictive behaviors such as smoking and smartphone addiction. Clinicians should also be aware of suicidal risk in people with hazardous drinking.
Alcohol Drinking* ; Anxiety ; Behavior, Addictive* ; Cross-Sectional Studies ; Depression ; Drinking ; Education ; Extraversion (Psychology) ; Female ; Humans ; Internet ; Logistic Models ; Male ; Smartphone ; Smoke ; Smoking ; Suicide ; Suicide, Attempted ; Weights and Measures

PURPOSE: Among the survivors of a ST elevation myocardial infarction (STEMI), higher platelet volume indices (mean platelet volume, MPV; platelet distribution width, PDW) are associated with impaired reperfusion and ventricular dysfunction. This study examined the relationship between the platelet volume indices and 30-day mortality with STEMI patients who underwent primary percutaneous coronary intervention (PCI). METHODS: This retrospective cohort study included patients presenting to the emergency department with STEMI between January 2011 and May 2016. The platelet volume indices were measured serially, using an automatic hematology analyzer, from admission to 24 hours after admission. The prognostic value of MPV, PDW for the 30-day mortality was determined by Cox proportional hazards model analysis. RESULTS: A total of 608 STEMI patients, who underwent reperfusion, were enrolled in this study. According to the multivariable Cox proportional hazard model, higher MPV (hazard ratio [HR], 1.414; 95% confidence interval [CI], 1.024-1.953; p=0.035) and PDW (HR, 1.043; 95% CI, 1.006-1.083; p=0.024) values at time-24 (24 hours after admission) were significant risk factors for the 30-day mortality. A MPV value >8.6 fL (HR, 5.953; 95% CI, 2.973-11.918; p<0.001) and PDW value >56.1% (HR, 5.117; 95% CI, 2.640-9.918; p<0.001) at time-24 were associated with an increased risk of 30-day mortality. CONCLUSION: The platelet volume indices without an additional burden of cost or time, can be measured rapidly and simply. Higher MPV and PDW levels predict independently the 30-day mortality in patients with STEMI after PCI.
Blood Platelets* ; Cohort Studies ; Emergency Service, Hospital ; Hematology ; Humans ; Mean Platelet Volume ; Mortality* ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Platelet Activation ; Prognosis ; Proportional Hazards Models ; Reperfusion ; Retrospective Studies ; Risk Factors ; Survivors ; Ventricular Dysfunction

OBJECTIVE: Low self-esteem is associated with suicide risk in the general psychiatric population. The aim of this study was to examine associations between suicidality and self-esteem in patients with schizophrenia. METHODS: Subjects meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnostic criteria for schizophrenia were enrolled. Sociodemographic and clinical variables, including previous suicide attempt history, were assessed. Psychopathology, self-esteem, and self-perceived stigma were also measured using the Positive and Negative Syndrome Scale, the Rosenberg Self-Esteem Scale (SES), the Beck Depression Inventory (BDI), the Beck Hopelessness Scale, and the Korean version of the Internalized Stigma of Mental Illness scale (K-ISMI). RESULTS: Of the total of 87 participants, 20 (23.0%) had attempted suicide. Patients with a history of suicide attempts had significantly higher scores on the BDI (p=0.036) and K-ISMI (p=0.009), and significantly lower scores on the SES (p=0.001). Analysis of covariance revealed that the SES scores were significantly lower in patients with a history of previous suicide attempts than in those with no history, after controlling for K-ISMI and BDI scores (p=0.039). CONCLUSION: Low self-esteem appears to represent a psychological dimension that is closely related to suicide risk. Therefore, clinical attention should be paid to the evaluation and enhancement of low self-esteem in schizophrenia patients with suicidality. A longitudinal prospective study is required to ascertain whether low self-esteem leads suicide attempts.
Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Prospective Studies ; Psychopathology ; Schizophrenia* ; Suicide ; Suicide, Attempted

Objective: The early prediction of multiple organ dysfunction syndrome (MODS) in trauma patients and provision ofprompt treatment may improve their outcomes. We investigated the efficacy of the mean platelet volume (MPV) for predictingMODS in cases of severe trauma. Methods: This retrospective, observational cohort study was performed with patients prospectively integrated in a criticalpathway of TRAUMA. We analyzed the severe trauma patients admitted to the emergency department (ED), based onthe Advanced Trauma Life Support guideline, between January 1, 2011 and May 31, 2017. The outcomes were developedfrom MODS at least 48 hours after ED admission. Results: A total of 348 patients were enrolled. An increase in the MPV at 12 hours (odds ratio [OR], 2.611; P<0.001) wasa strong independent predictor of MODS development. The increasing predictability of MODS was closely associatedwith an MPV at 12 hours>8.6 fL (OR, 4.831; P<0.001). The area under the receiver operating characteristic curve(AUROC) value of the MPV at 12 hours (0.751; 95% confidence interval [CI], 0.687-0.818; P<0.01) was not inferior thanthat of Acute Physiology and Chronic Health Evaluation II score, injury severity score, lactate, and total CO2 for predictingMODS. Conclusion MPV was an independent predictor of MODS development in severe trauma patients. Emergency physicianscan use the MPV as an ancillary biomarker for predicting MODS.

OBJECTIVE: Only a few studies have examined the role of lactate reflecting on tissue hypoperfusion determining the severity of postpartum hemorrhage (PPH) patients in the emergency department (ED). This study evaluated the utility of the arterial lactate level as a prognostic marker of severity in PPH patients admitted to an ED. METHODS: This retrospective, observational cohort study was conducted on patients integrated prospectively in a critical pathway of SPEED (Severance Protocol to save postpartum bleeding through Expeditious care Delivery). Adult primary PPH patients admitted to the ED between July 1, 2010 and March 31, 2017 were analyzed. The outcomes were the development of severe PPH including death, hysterectomy, surgical treatment, and massive transfusion. RESULTS: A total of 112 patients were enrolled in this study. An increase in the arterial lactate value was a strong independent predictor of severe PPH. The increasing predictability of severe PPH was closely associated with an arterial lactate ≥3.15 mL/L at admission (odds ratio, 13.870; P < 0.001). CONCLUSION: Lactate is an independent predictor of severe PPH and is suitable for a rapid and simple estimation of the severity of PPH. Emergency physicians can use lactate to determine the initial treatment strategies more precisely.
Adult ; Cohort Studies ; Critical Pathways ; Emergencies ; Emergency Service, Hospital ; Hemorrhage ; Humans ; Hysterectomy ; Lactic Acid ; Postpartum Hemorrhage ; Postpartum Period ; Prognosis ; Prospective Studies ; Retrospective Studies