OBJECTIVE: This study examined the incidence of workplace violence (WPV) in an emergency department (ED), and its influence on ED workers' mental health. METHODS: A cross-sectional, anonymous survey was conducted on ED workers employed in a local emergency medical center during August 2018. The survey respondents' data on the demographic characteristics, WPV episode, Korean-translated Brief Encounter Psychosocial Instrument (BEPSI-K), stress questionnaire for Korean National Health and Nutrition Examination Survey (KNHANES), and Patient Health Questionnaire-9 (PHQ-9) were obtained. The results of the stress (BEPSI-K, KNHANES) and depression (PHQ-9) score were compared with the WPV experience of ED workers. RESULTS: A total of 104 of 120 ED workers (86.7%) were exposed to WPV. ED workers that experienced physical violence within the past year had higher KNHANES, BEPSI-K, and PHQ-9 than the workers, who did not experience such violence (P≤0.001). In addition, this survey demonstrated that a physical violence episode within the past year was associated with above moderate depression (P≤0.001; odds ratio, 19.597). CONCLUSION: Recent physical violence can cause psychiatric disorders in ED workers, such as depression or stress disorder. Therefore, policies are needed to prevent WPV in ED and support ED workers who have experienced WPV.
Anonyms and Pseudonyms ; Depression ; Emergencies ; Emergency Service, Hospital ; Humans ; Incidence ; Mental Health ; Nutrition Surveys ; Odds Ratio ; Physical Abuse ; Violence ; Workplace Violence

Cervical spine fracture can occur in patients with ankylosing spondylitis (AS) by even a minor trauma, which can lead to serious results. We report on the case of a 52-year-old male patient suffering from AS, who was admitted to our hospital with cardiac arrest due to fracture of the upper cervical spine without other organ injuries. A computed tomographic scan showed a cervical 2-3 level fracture and posterior dislocation of the upper cervical column. The patient was admitted to ICU, but died in hospital on day 3.
Cervical Vertebrae ; Dislocations ; Female ; Heart Arrest ; Humans ; Male ; Middle Aged ; Motor Vehicles* ; Spinal Fractures ; Spine* ; Spondylitis, Ankylosing* ; Whiplash Injuries

PURPOSE: Current management for patients with differentiated thyroid cancer includes near total thyroidectomy and radioactive iodine therapy followed by administration of supraphysiological doses of levothyroxine (L-T4). Although hyperthyroidism is a well known risk factor for osteoporosis, the effects of L-T4 treatment on bone mineral density (BMD) in patients with thyroid cancer do not appear to be as significant as with endogenous hyperthyroidism. In this study, we evaluated the impact of long-term suppressive therapy with L-T4 on BMD and bone turn over markers in Korean female patients receiving L-T4 suppressive therapy. METHODS: We enrolled 94 female subjects (mean age, 50.84 +/- 11.43 years) receiving L-T4 after total or near total thyroidectomy and radioactive iodine therapy for thyroid cancer (mean follow-up period, 12.17 +/- 4.27 years). The subjects were divided into three groups by thyroid stimulating hormone (TSH) level (group 1 with TSH level < or =0.001 microIU/mL, group 2 with TSH level between 0.001 and 0.17 microIU/mL, group 3 with TSH level >0.17 microIU/mL) and four groups by quartile of free T4 level. L-T4 dosage, BMD (examined by dual-energy x-ray absorptiometry), and bone turnover markers were evaluated according to TSH and free T4 levels. RESULTS: No significant decrease was detected in BMD or bone turnover markers according to TSH level or free T4 level. Also, the prevalence of osteoporosis and osteopenia was not different among groups. CONCLUSION: Long-term L-T4 suppressive therapy after thyroid cancer management did not affect bone density or increase the prevalence of osteoporosis even though TSH levels were supraphysiologically suppressed.
Bone Density* ; Bone Diseases, Metabolic ; Female ; Follow-Up Studies ; Humans ; Hyperthyroidism ; Iodine ; Osteoporosis ; Prevalence ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyrotropin ; Thyroxine*

BACKGROUND: Doxylamine is an over-the-counter drug that is popular in the treatment of insomnia. Doxylamine is relatively safe but can cause rhabdomyolysis. The aim of this study was to evaluate whether the incidence of rhabomyolysis increased in elderly patients (age> or =65 years) with doxylamine overdose. METHODS: This study included 108 patients admitted to an Emergency Department after doxylamine overdose between January 1, 2000, and March 31, 2013. Age, sex, time ingested before admission, amount of drug ingested, gastric lavage, tachycardia, vomiting, hematuria, blood urea nitrogen, blood creatinine, urine pH, and alcohol ingestion were investigated for the risk factors of rhabdomyolysis. RESULTS: Forty-three patients (47.6%) developed rhabdomyolysis. Of 16 elderly patients, 11 developed rhabdomyolysis. Of the 92 patients <65 years-of-age, 34 developed rhabdomyolysis. Advanced age, alcohol ingestion, and increased blood creatinine level were significantly associated with the development of rhabdomyolysis. CONCLUSION: In elderly patients with doxylamine overdose, the incidence rate of rhabdomyolysis may be increased. A high index of suspicion and evaluation of rhabdomyolysis is warranted in elderly patients with doxylamine overdose.
Aged* ; Blood Urea Nitrogen ; Creatinine ; Doxylamine* ; Eating ; Emergencies ; Gastric Lavage ; Hematuria ; Humans ; Hydrogen-Ion Concentration ; Incidence* ; Rhabdomyolysis* ; Risk Factors ; Sleep Initiation and Maintenance Disorders ; Tachycardia ; Vomiting

PURPOSE: Doxylamine is commonly used for relief of insomnia; in addition, it is also a drug that is freguently used for intoxication in Korea. This drug is relatively safe; however, it is known to occasionally induce rhabdomyolysis. We have seen many cases of alcohol ingestion in doxylamine intoxications; however, few previous studies have documented the effects of alcohol on rhabdomyolysis. Therefore, the purpose of this study is to determine the effect of alcohol on rhabdomyolysis in doxylamine intoxicated patients. METHODS: This study was conducted on 91 patients admitted to an emergency department after doxylamine intoxication during the period from January 2001 to March 2012. Using the protocol developed beforehand, the amount of drug ingestion, past history, laboratory results, and whether or not alcohol was ingested were recorded. Rhabdomyolysis was defined as serum creatine kinase (CK) over 1,000 U/L. The SPSS package with logistic regression, t-test, and Fisher's test was used for analysis of data. RESULTS: Alcohol ingestion was detected in 52% of the study patients. The presence of hematuria and alcohol ingestion showed a significant association with development of rhabdomyolysis. CONCLUSION: Doxylamine intoxicated patients with alcohol ingestion may have a high rate of incidence of rhabdomyolysis. Therefore, doxylamine intoxicated patients who drink alcohol at the same time should be aware of rhabdomyolysis.
Creatine Kinase ; Doxylamine ; Eating ; Emergencies ; Hematuria ; Humans ; Incidence ; Korea ; Logistic Models ; Rhabdomyolysis

BACKGROUND/AIMS: The meaning of specialized intestinal metaplasia (SIM) in the diagnosis of Barrett's esophagus (BE) is not clear. This study was designed to determine the clinical significance of SIM in the diagnosis of Barrett's esophagus. MATERIALS AND METHODS: Biopsies were taken from 601 subjects with endoscopically suspected columnar-lined esophagus. Under light microscopy with Alcian-blue stain, SIM was identified. Demographic characteristics, gastroesophageal (GE) reflux symptoms and endoscopic findings were compared between the SIM-present group and the SIM-absent group. RESULTS: Among 601 subjects, 184 (30.6%) were confirmed by pathology to have SIM. Age over 40 years (P<0.001) and a medication history of proton pump inhibitor or H2 blocker were found more frequently in the SIM-present group (P=0.01) than in the SIM-absent group. Any of 7 GE reflux symptoms (heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, cough and epigastric soreness) were more frequent in the SIM-present group than SIM-absent group (P<0.001). Specifically, heartburn, chest pain and cough were significantly more common in the SIM-present group. There was no clinically significant difference associated with endoscopic findings or other clinical characteristics. CONCLUSIONS: When subjects with endoscopically suspected BE are analyzed based on the presence or absence of SIM, the SIM-present group was significantly associated with GE reflux symptoms suggestive of frequent GE reflux. However, the presence of SIM did not correlate with endoscopic findings.
Barrett Esophagus ; Biopsy ; Chest Pain ; Cough ; Esophagus ; Gastroesophageal Reflux ; Heartburn ; Hoarseness ; Light ; Metaplasia ; Microscopy ; Prospective Studies ; Proton Pumps ; Sensation

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P<0.001) and in the older age group (> or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.
Dyspepsia ; Endoscopy ; Female ; Gastritis ; Gastritis, Atrophic ; Helicobacter pylori ; Humans ; Incidence ; Korea ; Male ; Metaplasia ; Peptic Ulcer ; Prevalence ; Stomach Neoplasms

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P<0.001) and in the older age group (> or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.
Dyspepsia ; Endoscopy ; Female ; Gastritis ; Gastritis, Atrophic ; Helicobacter pylori ; Humans ; Incidence ; Korea ; Male ; Metaplasia ; Peptic Ulcer ; Prevalence ; Stomach Neoplasms

Animals ; Dental Implants ; Dogs ; Durapatite ; Femur ; Humans ; Intention ; Mentors ; Osseointegration ; Osteogenesis ; Reference Values

PURPOSE: Case-control and cohort studies have reported inconsistent findings for the association between gender and mortality from a traumatic brain injury. We investigated the effect and association of gender on moderate to severe traumatic brain injury using meta-analysis. METHODS: We searched electronic health care databases including MEDLINE (Pubmed), the Cochrane Library, CINAHL, and Koreamed (January 2001 to December 2009) in August 2010. The keywords searched included traumatic brain injury or traumatic head injury, gender, and mortality. Two independent investigators selected and reviewed articles according to predefined inclusion and exclusion criteria. The quality of selected articles was evaluated by applying the Newcastle Ottawa scale. Data were abstracted by predetermined criteria. Odds ratios were calculated and combined using fixed and random effect models. RESULTS: Of 130 articles, four case-control studies and three cohort studies were included in the final analysis. In total, 89,335 patients were included(26,287 females and 63,048 males). Compared with the mortality of male patients, the combined odds ratio for the mortality of female patients was 1.074(95% confidence interval [CI], 1.027~1.124) in a fixed effect model, and 1.319(95% CI, 1.104~1.576) in a random effects model, respectively. The heterogeneity of all participants was severe, so the results were discarded and a subgroup analysis was conducted. The total number of participants was divided into premenopausal and postmenopausal groups by the menopausal age defined in each article. The pooled odds ratio of the premenopausal group was 1.014(95% CI, 0.949~1.083) in the fixed effect model and that of the postmenopausal group was 1.237(95% CI, 0.895~1.712) in the random effects model. The pooled estimate of the random effect model was adopted because of the severe heterogeneity of the postmenopausal group. CONCLUSION: We found no distinct effect of gender on moderate to severe traumatic brain injury. Large-scaled prospective studies based on female hormone levels are needed.
Brain ; Brain Injuries ; Case-Control Studies ; Cohort Studies ; Craniocerebral Trauma ; Delivery of Health Care ; Electronics ; Electrons ; Female ; Humans ; Male ; Odds Ratio ; Population Characteristics ; Research Personnel