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Objective@#Incontrovertible disease markers are absent in delirium. This study investigated the usefulness of quantitative electroencephalography (qEEG) in diagnosing delirium. @*Methods@#This retrospective case-control study reviewed medical records and qEEG data of 69 age/sex-matched patients (delirium group, n=30; control group, n=39). The first minute of artifact-free EEG data with eyes closed was selected. Nineteen electrodes’ sensitivity, specificity, and correlation with delirium rating scale-revised-98 were analyzed. @*Results@#On comparing the means of absolute power by frontal, central, and posterior regions, the delta and theta powers showed significant differences (p<0.001) in all regions, and the magnitude of the absolute power was higher in the delirium group than in the control group; only the posterior region showed a significant (p<0.001) difference in beta power. The spectral power of theta at the frontal region (area under the curve [AUC]=0.84) and theta at the central and posterior regions (AUC=0.83) showed 90% sensitivity and 79% specificity, respectively, in differentiating delirious patients and controls. The beta power of the central region showed a significant negative correlation with delirium severity (R=-0.457, p=0.011). @*Conclusion@#Power spectrum analysis of qEEG showed high accuracy in screening delirium among patients. The study suggests qEEG as a potential aid in diagnosing delirium.
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Background@#Sleep duration is associated with hearing loss, especially presbycusis, which is the most common type of hearing loss; however, there is limited evidence regarding this association among the Korean population. We aimed to determine the relationship between sleep duration and high-frequency hearing loss in Korean adults aged ≥40 years. @*Methods@#We examined 5,547 Korean adults aged ≥40 years who completed audiometric tests and questionnaires regarding sleep duration during the 2010–2012 cycle of the Korea National Health and Nutrition Examination Survey. Mild presbycusis was defined as >25 decibels (dB) and 40 dB pure tone averages at high frequencies (3,000, 4,000, and 6,000 Hz) for both ears. Additionally, the sleep duration was divided into quartiles. Odds ratios and 95% confidence intervals were estimated using multivariable logistic regression after adjusting for covariates. @*Results@#The prevalence of presbycusis in South Korean adults was 62.1%, of which 61.4% showed moderate to severe presbycusis. The incidence of moderate-to-severe, but not mild, presbycusis showed a significant positive correlation with sleep duration. @*Conclusion@#Our findings suggest that sleep duration is associated with the prevalence of presbycusis.
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Objective@#Traumatic brain injury (TBI) is one of the major causes of death and disability in children. Understanding the epidemiologic characteristics of TBI in children is the first step for developing preventative strategies, optimizing care systems, and rehabilitating the injury. @*Methods@#This is a cross-sessional study based on the Emergency Department-based Injury In-depth Surveillance (EDIIS) in Korea. We identified children (aged 0 to 18 years) who presented with TBI in emergency departments between January 2011 and December 2018. Subjects were classified into four groups according to age and development: infant and toddler group (0-2 years), pre-school group (3-5 years), school-aged group (6-11 years), and adolescent group (12-18 years). Epidemiologic characteristics and outcomes were compared according to age groups, and temporal variability in incidence was evaluated. @*Results@#During the 8-year study period, 45,734 children with TBI were included in the analysis. A higher incidence of TBI was observed in males, road accidents, and school/educational facilities as compared to the lesser-aged group (all P<0.01). Motor vehicle collisions were more common in the older group, but falls were more common in the younger group. Compared to the infant/toddler group, the adolescent group had higher intracranial injuries (8.1% vs. 16.8%; adjusted odds ratio [AOR], 1.8; 95% confidence interval [CI], 1.6-2.0) and mortality rate (0.2% vs. 1.3%; AOR, 2.0; 95% CI, 1.3-3.0). @*Conclusion@#The epidemiological characteristics of TBI in children are different for each group. It is necessary to develop differentiated preventative strategies and treatment systems based on the age groups of children.
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Objective@#The present study analyzes the prognostic performance of prehospital oxygen saturation (SpO2) for 30-day mortality in patients with isolated traumatic brain injury (TBI). @*Methods@#This retrospective observational study included patients with severe isolated TBI admitted through the prehospital emergency medical services system between January 2019 and December 2020. Multivariate analysis was performed using logistic regression of relevant covariates, including prehospital SpO2, for predicting 30-day mortality. Receiver operating characteristics analysis examined the prognostic performance of prehospital SpO2. The primary outcome was 30-day mortality. @*Results@#A total of 189 patients were included in the study. The 30-day mortality rate was determined to be 16.9% (n=32). Prehospital SpO2 of survivors was higher than that of non-survivors—98% (95%-98%) vs. 89% (81%-97%). Results of multivariate analysis revealed that prehospital SpO2 (odds ratio, 0.868; 95% confidence interval [CI], 0.789-0.954) is independently associated with 30-day mortality. The area under the curve of prehospital SpO2 was 0.768 (95% CI, 0.701-0.826; P<0.001). @*Conclusion@#Results of the present study indicate that prehospital SpO2 is associated with 30-day mortality in patients with severe isolated TBI. Therefore, determining the prehospital SpO2 will help to rapidly classify and transport patients with TBI to the appropriate hospital.
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Background@#The risk of device thrombosis and device-oriented clinical outcomes with bioresorbable vascular scaffold (BVS) was reported to be significantly higher than with contemporary drug-eluting stents (DESs). However, optimal device implantation may improve clinical outcomes in patients receiving BVS. The current study evaluated mid-term safety and efficacy of Absorb BVS with meticulous device optimization under intravascular imaging guidance. @*Methods@#The SMART-REWARD and PERSPECTIVE-PCI registries in Korea prospectively enrolled 390 patients with BVS and 675 patients with DES, respectively. The primary endpoint was target vessel failure (TVF) at 2 years and the secondary major endpoint was patientoriented composite outcome (POCO) at 2 years. @*Results@#Patient-level pooled analysis evaluated 1,003 patients (377 patients with BVS and 626 patients with DES). Mean scaffold diameter per lesion was 3.24 ± 0.30 mm in BVS group.Most BVSs were implanted with pre-dilatation (90.9%), intravascular imaging guidance (74.9%), and post-dilatation (73.1%) at proximal to mid segment (81.9%) in target vessel.Patients treated with BVS showed comparable risks of 2-year TVF (2.9% vs. 3.7%, adjusted hazard ratio [HR], 1.283, 95% confidence interval [CI], 0.487–3.378, P = 0.615) and 2-year POCO (4.5% vs. 5.9%, adjusted HR, 1.413, 95% CI, 0.663–3.012,P = 0.370) than those with DES. The rate of 2-year definite or probable device thrombosis (0.3% vs. 0.5%, P = 0.424) was also similar. The sensitivity analyses consistently showed comparable risk of TVF and POCO between the 2 groups. @*Conclusion@#With meticulous device optimization under imaging guidance and avoidance of implantation in small vessels, BVS showed comparable risks of 2-year TVF and device thrombosis with DES.
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Background@#The number of revision total knee arthroplasty (TKA) has been increasing. Although many studies have analyzed the causes of revision TKA in Western countries, a limited number of studies have analyzed changes in causes of or trends in revision TKA in Asia. This study analyzed and determined the frequency and causes of failures after TKA in our hospital. We also analyzed the differences and trends over the past 17 years. @*Methods@#A total of 296 revision TKAs performed in a single institution from 2003 to 2019 were analyzed. During the 17-year study period, patients who had undergone primary TKA between 2003 and 2011 were classified into a past group, while those who had undergone primary TKA from 2012 to 2019 were classified into a recent group. A revision performed within 2 years after primary TKA was defined as early revision. Further, differences in causes of revision TKA according to the interval from primary TKA to revision TKA were determined. The causes of revision TKA were analyzed through a comprehensive analysis of patients’ medical records. @*Results@#Overall, infection was the most common cause of failure (151/296 cases, 51.0%). Compared to the past group, the recent group had a relatively higher proportion of patients undergoing revision TKA for mechanical loosening (past group, 19.1% vs.recent group, 31.9%) and instability (11.2% vs. 13.5%) and a relatively lower proportion of patients undergoing revision TKA for infection (56.2% vs. 48.8%), polyethylene (PE) wear (9.0% vs. 2.9%), osteolysis (2.2% vs. 1.9%), and malalignment (2.2% vs. 1.0%).On comparison according to the interval from primary TKA to revision TKA, the rate of infection relatively decreased, whereas the rate of mechanical loosening and instability relatively increased in the late revision TKA compared to the early revision TKA. @*Conclusions@#Infection and aseptic loosening were the most common reasons of revision TKA in both past and recent groups.Compared to the past, revision TKA due to PE wear has decreased significantly and revision TKA due to mechanical loosening has relatively increased recently. Orthopedic surgeons need to be aware of recent trends in mechanisms of failure and should try to recognize and address the probable causes in TKA
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Antibiotic resistance has emerged as a global threat to modern healthcare systems and has nullified many commonly used antibiotics. β-Lactam antibiotics are among the most successful and occupy approximately two-thirds of the prescription antibiotic market. They inhibit the synthesis of the peptidoglycan layer in the bacterial cell wall by mimicking the D-Ala-D-Ala in the pentapeptide crosslinking neighboring glycan chains. To date, various β-lactam antibiotics have been developed to increase the spectrum of activity and evade drug resistance. This review emphasizes the three-dimensional structural characteristics of β-lactam antibiotics regarding the overall scaffold, working mechanism, chemical diversity, and hydrolysis mechanism by β-lactamases. The structural insight into various β-lactams will provide an in-depth understanding of the antibacterial efficacy and susceptibility to drug resistance in multidrug-resistant bacteria and help to develop better β-lactam antibiotics and inhibitors.
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The subscapularis tendon is the largest and most powerful muscle in the rotator cuff, playing a more important role in raising the arm than the supraspinatus or infraspinatus tendon. Subscapularis tendon tears are uncommon, but when it does occur, symptoms are often minimal and diagnosis can be delayed until severe atrophy occurs, leading to weakness of the shoulder muscles. Therefore, early diagnosis and surgical repair of suspected subscapularis tendon injury in athletes is very important for achieving the best functional outcome. Shoulder injuries in professional boxers have been reported to account for only about 3% of all boxing injuries, but there is no specific research on the specific location of these injuries. In this study, the authors report on a case of isolated subscapularis tendon injury that occurred during sparring in a professional boxer and discuss the mechanism of injury and treatment outcomes along with a review of the literature.
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Achalasia, a rare motility disorder of the esophagus, is generally accepted as a premalignant disorder. This paper presents the case of a 72-year-old male with achalasia and synchronous superficial esophageal cancer who experienced dysphagia symptoms for five years. As achalasia is associated with an increased risk of esophageal cancer, both can be treated simultaneously if detected at the time of diagnosis. Achalasia and synchronous esophageal cancer are rarely detected and treated endoscopically. This paper reports a case of concurrent successful treatment.
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Purpose@#We aimed to analyze the clinical characteristics, recurrence, neurological outcomes, and the impact of coronavirus disease 2019 pandemic in children who visited 2 emergency departments (EDs) with febrile seizure (FS). @*Methods@#We retrospectively reviewed medical records of 3,172 episodes, involving 2,510 children aged 6-60 months whose diagnoses were FSs at the EDs in 2 hospitals from 2013 through 2022. Through the review, we analyzed clinical characteristics and associated factors for the recurrence of FS. As a sub-analysis, the variables were compared between before (2017-2019) and during (2020-2022) the pandemic. @*Results@#A total of 3,172 FS-related visits to the EDs were found in 2,510 children. Of these, 890 children (35.5%) underwent recurrences of FS. The recurrence of FS was associated with boys (63.3% vs. 57.8%; P = 0.007), seizures lasting longer than 5 minutes (16.6% vs. 12.7%; P = 0.007), family history of FS (23.7% vs. 16.2%; P < 0.001), complex FS (13.3% vs. 8.0%; P < 0.001), and epilepsy diagnosed thereafter (9.1% vs. 3.0%; P < 0.001). During the pandemic, we noted a decrease in the number of FS-related visits to the EDs (from 1,274 to 383), an increase in the percentage of complex FS (9.3% vs. 13.8%; P = 0.012), and a decrease in the percentage of recurrent FS (49.4% vs. 33.4%; P < 0.001), compared to before the pandemic. @*Conclusion@#Our study identified factors associated with recurrence of FS, and confirmed the increase in complex FS with the decrease in the recurrence during the coronavirus disease 2019 pandemic. These findings could be helpful when caring for children with FS in EDs.
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Serious acupuncture-related complications are rare in infants. We experienced a case of a 58-day-old infant with an umbilical hernia who received acupuncture from a non-professional guardian. Upon initial examination in the emergency department, the omentum protruded through the skin defect caused by acupuncture performed on top of the hernia. The infant underwent emergency surgery, and subsequently recovered uneventfully.
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Objectives@#The Korea Disease Control and Prevention Agency promotes vaccination by regularly providing information on its benefits for reducing the severity of coronavirus disease 2019 (COVID-19). This study aimed to analyze the number of averted severe COVID-19 cases and COVID-19-related deaths by age group and quantify the impact of Republic of Korea’s nationwide vaccination campaign. @*Methods@#We analyzed an integrated database from the beginning of the vaccination campaign on February 26, 2021 to October 15, 2022. We estimated the cumulative number of severe cases and COVID-19-related deaths over time by comparing observed and estimated cases among unvaccinated and vaccinated groups using statistical modeling. We compared daily age-adjusted rates of severe cases and deaths in the unvaccinated group to those in the vaccinated group and calculated the susceptible population and proportion of vaccinated people by age. @*Results@#There were 23,793 severe cases and 25,441 deaths related to COVID-19. We estimated that 119,579 (95% confidence interval [CI], 118,901–120,257) severe COVID-19 cases and 137,636 (95% CI, 136,909–138,363) COVID-19-related deaths would have occurred if vaccination had not been performed. Therefore, 95,786 (95% CI, 94,659–96,913) severe cases and 112,195 (95% CI, 110,870–113,520) deaths were prevented as a result of the vaccination campaign. @*Conclusion@#We found that, if the nationwide COVID-19 vaccination campaign had not been implemented, the number of severe cases and deaths would have been at least 4 times higher. These findings suggest that Republic of Korea’s nationwide vaccination campaign reduced the number of severe cases and COVID-19 deaths.
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Laryngopharyngeal foreign bodies are among the cases most frequently encountered by otolaryngologists. Most foreign bodies can be easily removed without any complications. However, surgical removal is required in some cases. Therefore, a delayed diagnosis or misdiagnosis could cause fatal complications for patients who need a surgical approach. We report a rare case of extraluminal migration of a foreign body to the deep cervical space. The foreign body (a fishbone) was removed by a surgical approach. With a literature review, we also propose an algorithm for the management of suspicious foreign bodies in the neck.
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Background@#Dermatophyte infection is one of the most common skin diseases affecting the skin, hair, and nails. Despite widespread recognition of the disease, missing details and misperceptions are commonplace in the general population. @*Objective@#This study aimed to investigate the public perception and behavior regarding dermatophytosis of the hands and feet. @*Methods@#This results from an online survey conducted between July 2022 and August 2022. The survey included 1,000 Korean participants aged 20 to 69 years, of whom 60% experienced symptoms of tinea pedis or onychomycosis. The questionnaire focused on the awareness and personal experience of tinea pedis and perception of the treatment of dermatophytosis. @*Results@#Of the 1,000 participants, nearly 80% regarded tinea pedis as a common skin condition by which anyone can be affected. Furthermore, 88.4% had heard that the treatment of tinea pedis could be harmful, causing skin rash (60.4%) and worsening liver function (48.5%). Among 896 participants who noticed suspicious symptoms, 81.2% did not visit the clinic because it was not severe (50.1%) and seemed easily manageable (25.7%). Of the respondents, 84.4% preferred to meet dermatologists rather than non-dermatologist doctors regarding skin diseases, mainly because of trust in experts and belief in a faster cure. @*Conclusion@#Providing accurate and detailed information via online media, educational campaigns, and medical papers can rectify misconceptions and improve patient appliance, contributing to public skin health.
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This study compared the effectiveness of self-propelling diatom microbubblers to clean dental appliances with commercial denture cleaning agents according to the Ministry of Food and Drug Safety’s guidelines. The microbubbler is made by doping diatoms with MnO2 nanosheets that can decompose hydrogen peroxide to generate oxygen bubbles. Artificial saliva is prepared in accordance with the criteria presented by the American Dental Association, dispensed, and dried in 96 well plates. Experimental groups include 10-15% NaOCl (positive control), distilled water (negative control), diatom microbubbler A (Aulacoseira, MnO2-polydopamine (PDA)-A), diatom microbubbler M (Melosira nummuloids, MnO2-sugar (S)-M), Polident (GlaxoSmithKline, Dungarvan, Ireland), Dentfix-forte (Helago-Phama GmbH&Co, Parchim, Germany). After washing, absorbance (OD 600) was measured. If the absorbance was 70% or higher, the condition was determined to have “cleaning power potency,”Statistical significance was evaluated by one-way ANOVA and Bonferroni correction to compare cleaning effects among groups (p<0.05).The average cleaning rates were 93.8±1.0% in NaOCl (positive control) and 79.1±1.5% in distilled water (negative control).With the diatom microbubbler A, the average cleaning rate was 79.8±4.5% in the 3% H 2O 2 2 mg/mL, 64.7±5.5% in 6% H 2O 2 2 mg/mL, and 81.9±7.9% in 6% H 2O 2 4 mg/mL. The diatom microbubbler M group showed average cleaning rates of 88.5±3.6% in 3% H2O2 2 mg/mL, 75.8±4.0% in 6% H2O2 2 mg/mL, and 84.5±4.5% in 6% H2O2 4 mg/mL. Finally, conventional denture cleaning agents showed average cleaning rates of 88.2±1.2% in Polident and 83.3±3.0% in Dentfix-forte. The positive control group had significant differences from all experimental groups, but the negative control group showed significant differences only in A2 and A3, M1 and M2, M3, Polident, and Dentfix-forte (F=190.141, p<0.001). Among all groups except the positive control group, MnO2 -S-M mixed with 3% H2O2 2 mg/mL showed the highest cleaning rate. As the results of this study show, diatom complexes exhibit cleaning effects compatible with conventional denture cleaning agents. Further studies need to be conducted to narrow down the specific optimal conditions of diatom microbubblers and maximize the cleaning effect.
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Objective@#The objective of this study was to investigate job stress, depression, insomnia, and fatigue of coronavirus disease 2019 (COVID-19) medical staff and analyze the differences according to their general characteristics. @*Methods@#The study enrolled 98 workers at emergency medical institutions with COVID-19 treatment facilities located in Gangwon Province. An online survey was used to protect personal information. Data were analyzed using the statistical program SPSS version 28. The differences in job stress, depression, insomnia, and fatigue of COVID-19 medical staff were verified by t-test and analysis of variance. @*Results@#Analyzing job stress revealed that the average of the lowest relationship conflict stress for each sub-factor was 2.22, the average stress for job demand was the highest at 3.78, and the average whole job stress was 3.04. Contrarily, the average for depression was 1.69, insomnia 2.96, and fatigue 3.07. No statistically significant differences were observed for job stress, depression, insomnia, and fatigue when considering the type of workplace, gender, and occupation of COVID-19 medical staff. However, statistically significant differences were obtained in some variables including age, family members, working period, COVID-19 confirmed, and COVID-19-related education experience. @*Conclusion@#In this study, differences in job-related stress, depression, insomnia, and fatigue were confirmed considering the general characteristics of COVID-19 medical staff. In particular, the results of this study are significant since the difference in perceived stress in performing COVID-19 tasks was identified through empirical analysis by considering sub-factors of job stress.
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Objectives@#This study identifies the socioeconomic characteristics and attitudes toward suicide (ATTS) of gatekeepers participating in a suicide prevention project in Gyeongsangbuk-do. Through this study we hope to increase the understanding required to prevent suicide in the community. @*Methods@#We conducted a survey from October 11 to November 4, 2022, with 1,284 individuals from private organizations who participated in the suicide prevention project between September 23 and November 30, 2022. The survey established demographic characteristics, experience in participating in suicide prevention projects, awareness and need for suicide prevention and mental health services, and ATTS. The study conducted cross-analysis and chi-square tests to identify differences in responses according to demographics. An independent sample t-test, one-way analysis of variance, and Scheffe’s post hoc test were performed to analyze the comparisons between each measurement factor. SPSS 21.0 was used to process data and the level of statistical significance was set to p<0.05. @*Results@#The gatekeepers’ ATTS were moderate, with an average of 3.11 out of 5. Specifically, preventability obtained the highest score (4.07), followed by preparedness to prevent (3.96), incomprehensibility (3.74), and noncommunication (3.34). Conversely, resignation obtained the lowest score (2.05), followed by tabooing (2.32) and relation-caused (2.51). The scores for preventability and preparedness to prevent increased with sustained participation in the suicide prevention program, while those for suicidal process decreased. @*Conclusions@#Gatekeepers’ ATTS may improve as a result of participation in the suicide prevention project, with better results with continued participation. Thus, actively recruiting more gatekeepers and keeping them engaged in the program may help prevent suicide.
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Objectives@#The purpose of this study is to analyze the prevalence and factors of depression among the elderly population, a significant issue in Korea’s aging society. We aim to provide basic indicators for improving mental health and quality of life. @*Methods@#From February to December 2021, a study was conducted on a population of 19,158 elderly individuals aged 65 and above residing in Gyeongsangbuk-do province. The severity of depression was evaluated using the Korean version of the Patient Health Questionnaire (PHQ)-9. In addition, demographic information was collected to analyze factors that may influence depression. @*Results@#In the PHQ-9 screening, the average score was 3.65. The results showed that 13,705 individuals (71.5%) were in the normal group with scores ranging from 0 to 4, 3,683 individuals (19.2%) were in the mild group with scores ranging from 5 to 9, 1,575 individuals (8.2%) were in the moderate group with scores ranging from 10 to 19, and 195 individuals (1.0%) were in the severe group with scores of 20 or higher. It was found that place of residence, education level, type of housing, top two difficulties in daily life, subjective economic status, desired services, subjective mental health, past and current history of mental health treatment, and medication for physical illness had statistically significant effects on depression. @*Conclusions@#Various factors were found to have a significant impact on depression among the elderly population in Gyeongsangbuk-do. Proactive prevention and treatment tailored to the population characteristics of the region may be necessary.
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Objectives@#During the coronavirus disease 2019 (COVID-19) pandemic, the prevalence of anxiety and depression in the general population was higher than before the pandemic. Identifying subjects at high risk for mental disorders may be necessary for effective mental health intervention. This study examines the prevalence of anxiety, depression, and anger and the related factors in the general population living in Daegu City one year after the COVID-19 pandemic. @*Methods@#This study collected data on sociodemographic variables, the need for mental health intervention, Generalized Anxiety Disorder Assessment, Patient Health Questionnaire-9, and State-Trait Anger Expression Inventory state anger from 1,000 subjects. This study performed independent samples t-test, one-way ANOVA, post hoc analysis, chi-square tests, and binary logistic regression analyses to examine the relationship between sociodemographic variables including the need for mental health intervention and depression, anxiety, and anger. @*Results@#The prevalence rates of depression, anxiety, and anger were 22.4%, 31.3%, and 42.3%. The need for mental health intervention was associated with the prevalence of depression, anxiety, and anger (p<0.001). Additionally, the risk of depression, anxiety, and anger was higher in the group with the need for mental health intervention compared to those without the need (odds ratio [95% confidence interval]; anxiety, 3.270 [2.337–4.575], p<0.001; depression, 4.475 [3.284– 6.097], p<0.001; anger, 4.225 [3.121-5.718], p<0.001). @*Conclusions@#One year after the COVID-19 pandemic, the prevalence of anxiety, depression, and anger in the general population of Daegu City was high. The subject’s perceived need for mental health intervention is associated with the prevalence of anxiety, depression, and anger and helps identify subjects requiring additional mental health intervention.
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Neurocritical patients who can self-report pain use the 0-10 numerical rating scale (NRS, verbal or visual form). However, critically ill patients whose nervous systems cannot express pain use the behavioral pain scale (BPS) and the critical care pain observation tool (CPOT) behavioral pain assessment tools. These tools reveal pain-related changes in movement, facial expression, posture, and physiological indicators such as heart rate, blood pressure, and respiratory rate. In pain control, it is first essential to reduce unnecessary painkillers through non-drug therapy and maximize the effect of the administered analgesics. For nonneuropathic pain, narcotic analgesics such as fentanyl, hydromorphone, morphine, and remifentanil are administered intravenously. Gabapentin, pregabalin, and carbamazepine are recommended along with narcotic analgesics for neuropathic pain control. In addition, nonnarcotic analgesics for multi-modal analgesia are used to reduce the use of narcotic analgesics or the side effects of narcotic analgesics. In the intensive care unit (ICU), the sedation-agitation scale (SAS) and the Richmond agitation-sedation scale (RASS) are used to determine the depth of sedation to be maintained during shallow or deep sedation, considering the condition of the critically ill patient. When selecting sedatives for critically ill patients, preferentially consider nonbenzodiazepines such as propofol or dexmedetomidine rather than benzodiazepines such as midazolam or lorazepam. In addition, patients use painkillers or sedatives for over a week, and neurological changes or physiological dependence may occur. Therefore, clinicians should evaluate the critically ill patient’s condition, and sedatives and painkillers should be reduced or discontinued.