Background/Aims: To examine the prevalence and clinical characteristics of apparent treatment-resistant hypertension among ambulatory hypertensive patients. Methods: We enrolled adult ambulatory hypertensive patients at 13 well-qualified general hospitals in Korea from January to June 2012. Apparent resistant hypertension was defined as an elevated blood pressure > 140/90 mmHg with the use of three antihypertensive agents, including diuretics, or ≥ 4 antihypertensives, regardless of the blood pressure. Controlled hypertension was defined as a blood pressure within the target using three antihypertensives, including diuretics. Results: Among 16,915 hypertensive patients, 1,172 (6.9%) had controlled hypertension, and 1,514 (8.9%) had apparent treatment-resistant hypertension. Patients with apparent treatment-resistant hypertension had an earlier onset of hypertension (56.8 years vs. 58.8 years, p = 0.007) and higher body mass index (26.3 kg/m2 vs. 24.9 kg/m2, p < 0.001) than those with controlled hypertension. Drug compliance did not differ between groups. In the multivariable analysis, earlier onset of hypertension (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.97 to 0.99; p < 0.001) and the presence of comorbidities (OR, 2.06; 95% CI, 1.27 to 3.35; p < 0.001), such as diabetes mellitus, ischemic heart disease, heart failure, and chronic kidney disease, were independent predictors. Among the patients with apparent treatment-resistant hypertension, only 5.2% were receiving ≥ 2 antihypertensives at maximally tolerated doses. Conclusions Apparent treatment-resistant hypertension prevalence is 8.9% among ambulatory hypertensive patients in Korea. An earlier onset of hypertension and the presence of comorbidities are independent predictors. Optimization of medical treatment may reduce the rate of apparent treatment-resistant hypertension.

Background/Aims: To examine the prevalence and clinical characteristics of apparent treatment-resistant hypertension among ambulatory hypertensive patients. Methods: We enrolled adult ambulatory hypertensive patients at 13 well-qualified general hospitals in Korea from January to June 2012. Apparent resistant hypertension was defined as an elevated blood pressure > 140/90 mmHg with the use of three antihypertensive agents, including diuretics, or ≥ 4 antihypertensives, regardless of the blood pressure. Controlled hypertension was defined as a blood pressure within the target using three antihypertensives, including diuretics. Results: Among 16,915 hypertensive patients, 1,172 (6.9%) had controlled hypertension, and 1,514 (8.9%) had apparent treatment-resistant hypertension. Patients with apparent treatment-resistant hypertension had an earlier onset of hypertension (56.8 years vs. 58.8 years, p = 0.007) and higher body mass index (26.3 kg/m2 vs. 24.9 kg/m2, p < 0.001) than those with controlled hypertension. Drug compliance did not differ between groups. In the multivariable analysis, earlier onset of hypertension (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.97 to 0.99; p < 0.001) and the presence of comorbidities (OR, 2.06; 95% CI, 1.27 to 3.35; p < 0.001), such as diabetes mellitus, ischemic heart disease, heart failure, and chronic kidney disease, were independent predictors. Among the patients with apparent treatment-resistant hypertension, only 5.2% were receiving ≥ 2 antihypertensives at maximally tolerated doses. Conclusions Apparent treatment-resistant hypertension prevalence is 8.9% among ambulatory hypertensive patients in Korea. An earlier onset of hypertension and the presence of comorbidities are independent predictors. Optimization of medical treatment may reduce the rate of apparent treatment-resistant hypertension.

BACKGROUND: Recently, several studies have assessed the association between diabetes and hearing impairment. However, the effect of diabetes on hearing impairment is not well known in diabetic patients exposed to noise, a typical cause of hearing impairment. The aim of this study is to longitudinally analyze the effect of diabetes on hearing impairment in workers exposed to similar noise levels from 2013 to 2017 who had experienced little change in their working conditions. METHODS: The study subjects included 2,087 male workers exposed to noise in a single company and who underwent health examinations at the same hospital in Ulsan city in 2013 and 2017. Hearing impairment was defined that a pure-tone average of pure-tone audiometry (PTA) thresholds at 1,000, 2,000, 3,000, and 4,000 Hz was 25 dB and over in both ears. Statistical analyses were conducted using χ2 tests, ANOVA, and Cox proportional hazard models. We analyzed covariates that might affect hearing impairment, including age; working period; levels of total cholesterol, triglyceride, and serum creatinine; smoking and alcohol history; and noise level. RESULTS: The average PTA thresholds and their average changes between 2013 and 2017 were significant in the diabetes mellitus (DM) group than those in the normal and impaired fasting glucose group. Among the subjects with the same status of fasting glucose group in 2013 and 2017, the adjusted hazard ratios for incident hearing impairment among those in the DM group compared to normal group were 3.35 (95% confidence interval [CI], 1.54–7.29) in the left ear and 5.66 (95% CI, 2.01–15.98) in the right ear. CONCLUSIONS: This study suggested that the risk of hearing impairment in the DM group was significantly higher than that in the normal group in both ears, even when exposed to similar noise levels.
Audiometry, Pure-Tone ; Blood Glucose ; Cholesterol ; Creatinine ; Diabetes Mellitus ; Ear ; Fasting ; Glucose ; Hearing Loss ; Hearing ; Humans ; Longitudinal Studies ; Male ; Noise ; Proportional Hazards Models ; Smoke ; Smoking ; Triglycerides ; Ulsan

OBJECTIVES: To investigate the effects of smoking on hearing loss among workers exposed to occupational noise. METHODS: From the results of a special workers health examination performed in 2011, we enrolled 8,543 subjects exposed to occupational noise and reviewed the findings. Using self-reported questionnaires and health examination results, we collected data on age, smoking status, disease status, height, weight, and biochemistry and pure tone audiometry findings. We divided the workers into 3 groups according to smoking status (non-smoker, ex-smoker, current smoker). Current smokers (n = 3,593) were divided into 4 groups according to smoking amount (0.05-9.9, 10-19.9, 20-29.9, > or =30 pack-years). We analyzed the data to compare hearing thresholds between smoking statuses using analysis of covariance (ANCOVA) after controlling for confounder effects. RESULTS: According to ANCOVA, the hearing thresholds of current smokers at 2 k, 3 k, and 4 kHz were significantly higher than that of the other groups. Multiple logistic regression for smoking status (reference: non-smokers) showed that the adjusted odds ratios of current smokers were 1.291 (95% confidence interval [CI]: 1.055-1.580), 1.180 (95% CI: 1.007-1.383), 1.295 (95% CI: 1.125-1.491), and 1.321 (95% CI: 1.157-1.507) at 1 k, 2 k, 3 k, and 4 kHz, respectively. Based on smoking amount, the adjusted odds ratios were 1.562 (95% CI: 1.013-2.408) and 1.643 (95% CI: 1.023-2.640) for the 10-19.9 and > or =30 pack-years group, respectively, at 1 kHz (reference: 0.05-9.9 pack-years). At 2 kHz, the adjusted odds ratios were increased statistically significantly with smoking amount for all groups. At all frequencies tested, the hearing thresholds of noise-exposed workers were significantly influenced by current smoking, in particular, the increase of hearing loss at low frequencies according to smoking amount was more prevalent. CONCLUSIONS: Current smoking significantly influenced hearing loss at all frequencies in workers exposed to occupational noise, and heavier smoking influenced low-frequency hearing loss more greatly. There was a dose-response relationship between smoking amount and low-frequency hearing thresholds; however, this was not observed for high-frequency hearing thresholds. Therefore, well-designed prospective studies are needed to clarify the effects of smoking on the degree of hearing loss.
Audiometry ; Biochemistry ; Hearing Loss* ; Hearing* ; Logistic Models ; Noise, Occupational* ; Odds Ratio ; Smoke ; Smoking* ; Tobacco Products* ; Surveys and Questionnaires

BACKGROUND/AIMS: The bedside index of severity in acute pancreatitis (BISAP) is a new, convenient, prognostic multifactorial scoring system. As more data are needed before clinical application, we compared BISAP, the serum procalcitonin (PCT), and other multifactorial scoring systems simultaneously. METHODS: Fifty consecutive acute pancreatitis patients were enrolled prospectively. Blood samples were obtained at admission and after 48 hours and imaging studies were performed within 48 hours of admission. The BISAP score was compared with the serum PCT, Ranson's score, and the acute physiology and chronic health examination (APACHE)-II, Glasgow, and Balthazar computed tomography severity index (BCTSI) scores. Acute pancreatitis was graded using the Atlanta criteria. The predictive accuracy of the scoring systems was measured using the area under the receiver-operating curve (AUC). RESULTS: The accuracy of BISAP (> or = 2) at predicting severe acute pancreatitis was 84% and was superior to the serum PCT (> or = 3.29 ng/mL, 76%) which was similar to the APACHE-II score. The best cutoff value of BISAP was 2 (AUC, 0.873; 95% confidence interval, 0.770 to 0.976; p < 0.001). In logistic regression analysis, BISAP had greater statistical significance than serum PCT. CONCLUSIONS: BISAP is more accurate for predicting the severity of acute pancreatitis than the serum PCT, APACHE-II, Glasgow, and BCTSI scores.
Biological Markers/blood ; Calcitonin/*blood ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Pancreatitis/blood/*diagnosis ; Prognosis ; Prospective Studies ; Protein Precursors/*blood ; ROC Curve ; *Severity of Illness Index

OBJECTIVES: This study was carried out to define the relationship between the characteristics of tinnitus and hearing threshold (puretone and speech) in workers with noise induced hearing loss (NIHL). METHODS: A total of 189 cases(378 ears) from workers with compensation claims for NIHL during 2004-2009 were investigated. Various factors, including age, work carriers, body mass index (BMI), blood pressure, noise exposure level of worksite hearing threshold, speech discrimination score, pitch match, and loudness of tinnitus were analyzed. RESULTS: The average hearing threshold of all subject was 44.2 dBHL, puretone audiometry thresholds in subjects with tinnitus were lower than the non-tinnitus group (except at 8000 Hz). Using speech audiometry, the tinnitus group showed a lower speech recognition threshold and speech discrimination score. The tinnitus group also had an average tinnitus frequency of 4195.2 Hz, loudness of 73.6 dB, and tinnitus sensation average of 6.0 dBSL. These frequencies of tinnitus were in the lowest puretone audiometry frequencies. Tinnitus loudness had a strong relationship with puretone and speech audiometry thresholds. CONCLUSIONS: In cases beyond moderate hearing loss, the tinnitus group had a better puretone (except 8000 Hz) and speech hearing status, and most comfortable loudness (MCL) level. In addition, puretone and speech audiometry thresholds increase with tinnitus loudness.
Audiometry ; Audiometry, Speech ; Blood Pressure ; Body Mass Index ; Compensation and Redress ; Hearing ; Hearing Loss ; Noise ; Sensation ; Speech Perception ; Tinnitus ; Workers' Compensation ; Workplace

OBJECTIVES: The cold provocation test for diagnosing the vascular component in hand-arm vibration syndrome (HAVS) is likely to be accepted as an objective test, and a few studies have been performed. However, controversy has continued regarding the diagnostic performance of this method. Although objective methods such as plethysmography and laser doppler flowmetry have been studied, they have not received as much attention as other diagnostic methods. Therefore, our study aim was to spread the awareness of HAVS by reporting the results of the cold provocation test in a hand-transmitted vibration exposure group. METHODS: The study subjects were 549 workers who had been exposed to hand-transmitted vibrations and reported symptoms in their hands. While the subject immersed both their hands in 10degrees C water for 10 minutes, the skin temperature of 10 fingers was recorded from pre-immersion time to 20 minute postimmersion including 10 minutes immersion time. The recovery rates were calculated from the recorded skin temperatures. The 'decreased recovery rate' criteria were less than 30% at 5 minutes post-immersion and 60% at 10 minute post-immersion. RESULTS: Of the subjects, 69.1% and 30.9% had more severe symptoms in the right and left hands, respectively. The mean finger skin temperature of the right hand after cold-water immersion for 10 minutes was approximately 10degrees C, which increased gradually with time, but they did not reach the baseline temperature at 20 minutes post-immersion. The deviations of the skin temperature in the subjects were higher in the recovery phase than in the baseline and cold immersion phase. The 3rd finger of both hands showed the lowest 5-minute recovery rate among the fingers examined, and the left 4th finger and right 3rd finger showed the lowest 10-minute recovery rate. Of the subjects, 37.6% and 10.4% of subjects showed a lower recovery rate at 5 and 10 minutes in at least one finger, respectively, while 10.2% showed a lower recovery rate at both 5 and 10 minutes simultaneously in at least one finger. CONCLUSIONS: The larger deviations in the recovery phase than in the other phases indicated that interindividual differences are more prominent in the recovery phase. There might be no benefit in observing the finger skin temperature for an additional 10 minutes after 10 minutes post-immersion. Overall, approximately 10% of the subjects in the HAVS risk group had HAVS.
Cold Temperature ; Fingers ; Hand ; Hand-Arm Vibration Syndrome ; Immersion ; Laser-Doppler Flowmetry ; Plethysmography ; Skin Temperature ; Vibration ; Water

OBJECTIVES: Workers from a factory was selected to compare 8 standard threshold shift criteria with the Korean diagnostic criteria of noise-induced hearing loss for this cohort study. METHODS: From 1990 to 1999, 491 workers at a manufacturing company with complete record of the hearing test covering the range of 0.5~6 kHz for 10 consecutive years were finally selected. Eight standard threshold shift criteria (15 dB once, NIOSH (1972), 10 dB average 3~4 kHz, OSHA STS, AAOHNS, 15 dB twice, 15 dB 1~4 kHz, OSHA STS twice) along with the Korean standard for diagnosing the noise-induced hearing loss (the average hearing threshold at 0.5, 1 and 2 kHz) were compared to calculate the degree of the threshold shift and the minimum time required to detect the change. RESULTS: Those workers showing at least one positive shift in the 'once'criteria of NIOSH (1972) were 92.5%; the 'average'criteria of 10 dB average 3~4 kHz were 35.8%; 'twice'criteria of 15 dB twice were 44.4%. The duration from the baseline to the year showing the first positive shift was from 3.2 +/- 3.1 years (NIOSH, 1972) to 6.0 +/- 2.1 years (OSHA STS twice). The percentage of true positive shift ranging from 20.4% (AAO-HNS) to 69.8% (NIOSH, 1972). There were 10 (2%) which met the Korean diagnostic criteria of noise-induced hearing loss. CONCLUSIONS: Currently the concept of hearing threshold shift in diagnosing the hearing loss was adopted in Korea thus in this study we determined the validity and the effect of the various hearing threshold shift criteria and showed that NIOSH (1972) criteria was the best of all. In the future, hearing data from various manufacturing workers should be compared to thoroughly evaluate the threshold shift criteria and to establish adequate standard for Korean workers.
Cohort Studies ; Hearing Loss ; Hearing Loss, Noise-Induced ; Hearing Tests ; Hearing* ; Korea ; National Institute for Occupational Safety and Health (U.S.) ; United States Occupational Safety and Health Administration

OBJECTIVE: This study was performed to analyze the length of work-related musculoskeletal disability and to identify the various related factors of disability duration. METHOD: Approved cases work-related musculoskeletal disease between Jan 1, 2000 and Jan 6, 2004 were collected by using the workers' compensation company's database and questionnaire. The cases were comprised of 16 more frequent musculoskeletal diseases. 551 approved musculoskeletal disease cases were composed of 295 recuperated cases and 256 recuperating cases. RESULTS: The average length of work-related musculoskele- tal disability were 420.3+/-246.2 day in the recuperated group and 428.0+/-328.9 day in the recuperating group. The mean disability length of musculoskeletal diseases were over one year with similar distribution except for ganglion. The length of disability were not affected by age, employment duration, type and number of co-mobidity, time from claim receipt to allowance, type of treatment. But, operation history and accident type were affected to the length of disability. CONCLUSION: The results suggest that the length of work- related musculoskeletal disability was not determined by biomedical disease related factors, however, it determined by social and social insurance systemic factors.
Employment ; Ganglion Cysts ; Insurance ; Musculoskeletal Diseases* ; Surveys and Questionnaires ; Social Security ; Workers' Compensation

PURPOSE :The goals of this study were to investigate the medical care utilization and statistics of lengths of admissions such as the means, modes, medians, maximums, and minimums for patients with some musculoskeletal diseases among the National Health Insurance Corporation data. We provided basic recommendations for the proper lengths of admissions of occupationally injured workers with these diseases in Korea. METERIALS AND METHODS: The study subjects were 20 to 59 year-old patients who were admitted from January 1, 2000 to June 30, 2001, over 4-day lengths of admission for the management of 20 different musculoskeletal disorders. We calculated means, standard deviations, modes, medians, maximums, minimums, and points of inflection for the lengths of admission of patients with these disorders. RESULTS: The mean length of admission for carpal tunnel syndrome was 8.0+/-6.2 days, that of Raynaud's syndrome was 10.5+/-7.7 days, that of internal derangements of the knee was 12.9+/-11.8 days, that of unspecified internal derangements of the knee was 13.3+/-13.0 days, that of cervical disc disorder with radiculopathy was 16.8+/-19.0 days, that of other cervical disc displacements was 15.9+/-15.9 days, that of lumbar and other intervertebral disc disorders with radiculopathy was 14.9 +/-13.8 days, that of unspecified intervertebral disc displacements was 14.9+/-13.9 days, that of unspecified synovitis and tenosynovitis was 12.5+/-9.9 days, that of ganglions was 7.5+/-7.3 days, that of fasciitis, NEC, was 19.8+/-24.7 days, that of adhesive capsulitis of the shoulder was 15.2+/-15.5 days, that of impingement syndrome of the shoulder was 11.4+/-12.0 days, that of medial epicondylitis was 11.2+/-7.3 days, that of lateral epicondylitis was 12.1+/-11.5 days, that of myalgias was 12.4+/-19.5 days, that of sprain and strain of the cervical spine was 12.4+/-10.2 days, that of sprain and strain of the lumbar spine was 12.3+/-10.9 days, that of a current tear of the meniscus was 13.3+/-13.2 days, and that of sprain and strain involving the cruciate ligaments of the knee was 18.2+/-17.0 days. Every point of inflection was the 80th percentile or the 90th percentile of the lengths of admission of the subjects. CONCLUSION: This study has significant weaknesses, such as limitations of applicable ranges and errors in the National Health Insurance Corporation data, among others. However, the authors present various statistics and points of inflection of lengths of admissions for patients suffering from 20 work-related musculoskeletal disorders in the general population. Those cases in which the lengths of admissions of patients with the above-mentioned musculoskeletal disorders that are greater than the points of inflection, need to be evaluated carefully.
Bursitis ; Carpal Tunnel Syndrome ; Fasciitis ; Ganglion Cysts ; Humans ; Intervertebral Disc ; Intervertebral Disc Displacement ; Knee ; Korea ; Ligaments ; Middle Aged ; Musculoskeletal Diseases ; Myalgia ; National Health Programs* ; Occupations ; Radiculopathy ; Shoulder ; Spine ; Sprains and Strains ; Synovitis ; Tenosynovitis