Living Alone, Social Isolation and Depressive Disorder Among Community-Dwelling Older Adults in an Urban Community in Korea

A Study on Factors Affecting Suicidal Tendency of the Elderly Living Alone on Care Services

OBJECTIVES: The high suicide rate has risen as a main concern in South Korea. Given the complexity of the mechanism resulting in complete suicide, studies targeting various populations are needed for broader understanding of its risk factors. This study aims to analyze the factors affecting the suicidal tendency in the population of the elderly living alone in Seoul depending on basic elderly-care services. METHODS: A total number of 415 people participated in the study. Home-visit interviews were administered by trained interviewers. Suicidal tendency was measured by the Korean version of mini international neuropsychiatric interview (K-MINI). Health-related quality of life was measured by a brief version of the World Health Organization Quality-of-life Scale (WHOQOL-BREF). Alcohol problem was assessed by the Korean version of the alcohol use disorders identification test (AUDIT-K). Among total subjects of 415 interviewees, the actual responses of 408 people were used for the final analysis. RESULTS: The result showed that the suicide risk was high in persons isolated from social support [odds ratio (OR) = 4.49], having depression (OR = 14.85), and having low quality of life (OR = 4.39). CONCLUSIONS: We found that social support, depression and health-related quality of life are associated with suicidal tendency in the elderly living alone on basic services. Our evidence will contribute to suicide prevention policy for the elderly living alone on care services.

Factors Affecting Cognitive Function in Patients with Stomach Cancer

PURPOSE: This study aimed to identify factors affecting cognitive function in stomach cancer patients. METHODS: This was a cross-sectional study designed to obtain data from stomach cancer patients. The Global Assessment of Recent Stress, Hospital Anxiety-Depression Scale, Distress Thermometer, Korean version of the Montreal Cognitive Assessment, and electronic medical records were used to assess stress, anxiety, depression, psychological distress, and cognitive function, respectively. RESULTS: Among 182 total participants, there were statistically significant differences in sex between the group of patients who received chemotherapy and those who did not (χ2=5.32, p=.029). There were statistically significant differences in stress and cognitive function between the two groups. The factors affecting cognitive function in stomach cancer patients included distress, stress, anxiety, and depression. CONCLUSION: Cognitive function should be examined with consideration of the psychological distress, stress, anxiety, and depression in patients with stomach cancer. Moreover, an improved program to manage cognitive function is needed, which includes mediation between psychological and physiological factors including stress, anxiety, and cognitive level.

Efficacy of Case Management for the Community Dwelling Schizophrenia Patients : A 36-Month Prospective Follow-Up Study / 신경정신의학

OBJECTIVES: This study was conducted to observe a longitudinal course of patients with schizophrenia enrolled in a community mental health center (CMHC) in Seoul, Korea, and to evaluate the clinical efficacy of case management provided for them. METHODS: Study subjects, including 50 patients in a case-managed group, and 34 patients in the control group, were enrolled from a CMHC and followed up for 36 months. Annual length of hospitalization was compared between two groups by t-tests and time until hospitalization by Kaplan-Meier survival analysis. RESULTS: For the first year of observation, there was no significant difference in annual length of hospitalization between two groups (3.4 weeks vs. 2.9 weeks), but annual length of hospitalization of the case-managed group became significantly shorter for the second (1.7 weeks vs. 7.2 weeks) and third year (1.4 weeks vs. 7.8 weeks). In Kaplan-Meier survival analysis, no difference in time until hospitalization was observed between two groups, but time until hospitalization more than 3 months was significantly shorter in the control group. CONCLUSION: At least two years of case management was required to reduce the length of hospitalization. Reduction in length of hospitalization was achieved by preventing long-term hospitalization.

Prevalence, Work-Loss Days and Quality of Life of Community Dwelling Subjects with Depressive Symptoms

The nationwide prevalence of major depressive disorder in Korea is lower than most countries, despite the high suicide rate. To explain this unexpectedly low prevalence, we examined the functional disability and quality of life in community-dwelling subjects with significant depressive symptoms not diagnosable as depressive disorder. A total of 1,029 subjects, randomly chosen from catchment areas, were interviewed with the Center for Epidemiologic Studies Depression scale, Mini International Neuropsychiatric Interview, WHO Quality of Life scale, and the WHO Disability Assessment Schedule. Those with scores over 21 on the depression scale were interviewed by a psychiatrist for diagnostic confirmation. Among community-dwelling subjects, the 1-month prevalence of major depressive disorder was 2.2%, but the 1-month prevalence of depressive symptoms not diagnosable as depressive disorder was 14.1%. Depressive disorders were the cause of 24.7% of work loss days, while depressive symptoms not diagnosable as depressive disorder were the cause of 17.2% of work loss days. These findings support the dimensional or spectrum approach to depressive disorder in the community and might be the missing link between the apparent low prevalence of depressive disorder and high suicide rate in Korea.

Treatment of Cytomegalov irus-associated IgA Nephropathy by Deflazacort and Intrav enous Immunoglobulin

It has been suspected that various infections, including cytomegalovirus(CMV) infection, are associated with IgA nephropathy. In case of CMV infection, ganciclovir is known to be a treatment of choice for severe CMV infection in general. But ganciclovir has a lot of severe toxicity, so children with normal immunity are seldom treated by ganciclovir when CMV infection is suspected. On the other hand, intravenous immunoglobulin can also be used to treat CMV infection.

Febrile Seizures and Benign Convulsion with Mild Gastroenteritis in Children / 대한소아신경학회지

PURPOSE: Febrile Seizures and Benign convulsion with mild gastroenteritis(BCwMG) are common neurological disorders in children. We would like to know the clinical characteristics and prognosis of febrile seizure associated with acute gastroenteritis(A), BCwMG(B) and febrile seizure associated with a febrile illness not caused by acute gastroenteritis(C) in children. METHODS: We reviewed the medical records of 569 pediatric patients aged from 3 months to 5 years that admitted to the Wonju Christian Hospital from 2004 to 2007 for febrile seizures or BCwMG. RESULTS: The mean ages were A; 1.51+/-1.10 years, B; 1.14+/-0.44 years, C; 1.84+/-1.33 years. The most common seizure type was generalized seizure(95.4%). The average frequency of seizure was higher in B than A and C(A; 1.53+/-0.88, B; 2.12+/-1.35, C; 1.23+/-1.11 times/day, P<0.001). The incidence of positive parents history for febrile seizures was higher in A and C compared to B(A; 14.5%, B; 4.3%, C; 17.8%, P<0.05). The mean WBC count in peripheral blood was higher in C than A and B(A; 10,532+/-5,151, B; 8,686+/-3,053, C; 12,932+/-5,866 mmol/L, P<0.001). The positive rate of stool rotavirus antigen test was higher in A and B compared to C(A: 45.7%, B: 42.6%, C: 14.5%, P<0.05). But there were no statistically significant differences of sex ratio, duration of seizures, serum sodium level, abnormal neurodevelopmental status, rate of EEG and neuroimaging abnormalities among three groups. The recurrence rate of febrile seizure after the 1st seizure was A; 9.1%, B; 5.8%, C; 11.9% and unprovoked seizure was A; 5.4%, B; 1.4%, C; 1.6%. CONCLUSION: We consider prophylactic short term management of recurrent episodes of seizures within 24 hours, especially in febrile seizure associated with acute gastroenteritis and BCwMG. Also, It will be necessary to educate parents about the possibility of recurrence of febrile seizures or unprovoked seizures, although the risk is low.

Effect of Smoking on the Levels of Antioxidant Vitamins and Enzymes in Healthy and Young Men

It has been reported that cigarette smoking increases free radical generation, which can also increase lipid peroxides and deplete antioxidants. The purpose of this study was to determine whether cigarette smoking and other lifestyle choices may affect serum lipid peroxide concentrations, serum antioxidant concentrations such as tocopherol and vitamin C, and serum antioxidant enzyme activity such as glutathione peroxidase and superoxide dismutase. Dietary intakes were assessed by 24-hour recall and survey questionnaires from 48 male non-smokers and 52 male smokers. Overnight fasting blood was collected and measured for individual antioxidant status. The daily vitamin C intakes of smokers tended to be lower than those of non-smokers, and the intakes of both groups were under the Recommended Daily Allowance (RDA). Vitamin E intake was suffcient for smokers and non-smokers. Serum lipid peroxide concentrations were no difference among all subjects. The serum alpha-tocopherol concentrations of all subjects were in a normal range, and they were highest in mild smokers (p<0.05). Mean serum vitamin C levels were lowest in heavy smokers (p<0.05). The activities of serum glutathione peroxidase and superoxide dismutase were not significantly different in smokes and non-smokers. In conclusion, smoking did not increase oxidative stress in heathy young men. However, it is desirable for heavy smokers to consume more vitamin C than the RDA sine their serum vitamin C concentrations are relatively low.