Association Between Cohabitation Status and Sleep Quality in Families of Persons With Dementia in Korea: A Cross-sectional Study / 예방의학회지

Objectives@#The aim of this study was to identify the association between cohabitation status and sleep quality in family members of people with dementia (PwDs). @*Methods@#Data of 190 365 participants aged ≥19 years from the 2018 Korea Community Health Survey were analyzed. Participants were categorized according to their cohabitation status with PwDs. Multiple logistic regression and ordinal logistic regression analyses were performed to evaluate the relationship between the cohabitation status of PwDs’ relatives and sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI) and PSQI subscales. @*Results@#Compared to participants without PwDs in their families, both cohabitation and non-cohabitation with PwDs were associated with poor sleep quality (cohabitation, male: odds ratio [OR],1.28; 95% confidence interval [CI], 1.08 to 1.52; female: OR, 1.40; 95% CI, 1.20 to 1.64; non-cohabitation, male: OR, 1.14; 95% CI, 1.05 to 1.24; female: OR, 1.23; 95% CI, 1.14 to 1.33). In a subgroup analysis, non-cohabiting family members showed the highest odds of experiencing poor sleep quality when the PwD lived alone (male: OR, 1.48; 95% CI, 1.14 to 1.91; female: OR, 1.58; 95% CI, 1.24 to 2.01). Cohabiting male and female participants had higher odds of poor subjective sleep quality and use of sleeping medications than non-cohabiting male and female participants, respectively. @*Conclusions@#The residence of PwDs and cohabitation status may contribute to poor sleep quality among PwDs’ family members. The circumstances faced by cohabiting and non-cohabiting family members should be considered when evaluating sleep quality in family members of PwDs, and appropriate interventions may be needed to improve sleep quality in both cohabiting and non-cohabiting family members.

Association Between Cohabitation Status and Sleep Quality in Families of Persons With Dementia in Korea: A Cross-sectional Study / 예방의학회지

Objectives@#The aim of this study was to identify the association between cohabitation status and sleep quality in family members of people with dementia (PwDs). @*Methods@#Data of 190 365 participants aged ≥19 years from the 2018 Korea Community Health Survey were analyzed. Participants were categorized according to their cohabitation status with PwDs. Multiple logistic regression and ordinal logistic regression analyses were performed to evaluate the relationship between the cohabitation status of PwDs’ relatives and sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI) and PSQI subscales. @*Results@#Compared to participants without PwDs in their families, both cohabitation and non-cohabitation with PwDs were associated with poor sleep quality (cohabitation, male: odds ratio [OR],1.28; 95% confidence interval [CI], 1.08 to 1.52; female: OR, 1.40; 95% CI, 1.20 to 1.64; non-cohabitation, male: OR, 1.14; 95% CI, 1.05 to 1.24; female: OR, 1.23; 95% CI, 1.14 to 1.33). In a subgroup analysis, non-cohabiting family members showed the highest odds of experiencing poor sleep quality when the PwD lived alone (male: OR, 1.48; 95% CI, 1.14 to 1.91; female: OR, 1.58; 95% CI, 1.24 to 2.01). Cohabiting male and female participants had higher odds of poor subjective sleep quality and use of sleeping medications than non-cohabiting male and female participants, respectively. @*Conclusions@#The residence of PwDs and cohabitation status may contribute to poor sleep quality among PwDs’ family members. The circumstances faced by cohabiting and non-cohabiting family members should be considered when evaluating sleep quality in family members of PwDs, and appropriate interventions may be needed to improve sleep quality in both cohabiting and non-cohabiting family members.

Efficacy and safety of eltrombopag in adult refractory immune thrombocytopenia

BACKGROUND: Eltrombopag is a thrombopoietin receptor agonist with excellent treatment outcomes in immune thrombocytopenia (ITP). Here, we analyzed the dose of eltrombopag required to achieve and maintain safe platelet counts in Korean ITP patients. METHODS: Adult refractory ITP patients ( or =50,000 cells/microL). After achieving the target platelet count, the dose of concomitant ITP medications and eltrombopag was reduced to identify the lowest effective dose required to maintain the platelet count. RESULTS: Among 18 patients, 66.7% achieved complete response, 5.6% achieved platelet counts between 50,000 and 100,000 cells/microL, and 27.8% failed to achieve the target platelet count. The median ITP duration was significantly shorter in patients who achieved the target platelet count. The initial dose required to achieve the target platelet count was 25 mg/d. The adjusted maintenance doses were 25 mg twice per week or 25 mg/d. After discontinuation, 83.3% relapsed, and the median relapse-free survival was 15 days. Two relapsed and 1 failed patient switched to romiplostim. The response to romiplostim was similar to eltrombopag. During eltrombopag treatment, 38.9% showed hepatobiliary laboratory anomalies. Among 9 follow-up bone marrow examinations, 1 revealed fibrosis after 1 year of treatment. CONCLUSION: Eltrombopag was well tolerated with excellent treatment outcomes in refractory adult ITP patients. Low-dose eltrombopag effectively maintained the target platelet count. However, some patients required longer or higher-dose treatment to maintain the target platelet count, especially in heavily pretreated or longer ITP cases.

OCT-1, ABCB1, and ABCG2 Expression in Imatinib-Resistant Chronic Myeloid Leukemia Treated with Dasatinib or Nilotinib / 전남의대학술지

This study explored drug transporter expression levels and their impact on clinical response to imatinib and second-generation tyrosine kinase inhibitors (TKIs) in imatinib- resistant chronic myeloid leukemia (CML). Imatinib-resistant chronic phase CML patients treated with dasatinib (n=10) and nilotinib (n=12) were enrolled. The mRNA expression of the OCT-1, ABCG2, and ABCB1 genes was quantified by using paired bone marrow samples obtained before administering imatinib and at the point of detecting imatinib resistance (just before starting second-generation TKIs). The expression levels of OCT-1 and ABCG2 were lower in follow-up than in imatinib-naive samples. ABCB1 revealed highly variable expression levels before and after imatinib treatment. In addition, median ABCB1 expression in follow-up samples was lower in patients achieving complete cytogenetic response or major molecular response during imatinib treatment than in failed patients. Higher ABCG2 expression in imatinib-exposed samples showed a negative impact on optimal response to dasatinib. Patients with higher ABCG2 expression in imatinib-exposed samples also had shorter progression- free survival with dasatinib treatment. However, no significant correlation was found between these drug transporter expression levels in imatinib-naive or imatinib- exposed samples and responses to nilotinib. In imatinib-resistant CML, OCT-1 and ABCG2 mRNA expression decreased after imatinib treatment. Patients with higher ABCG2 expression in imatinib-exposed samples showed poor treatment outcome with dasatinib. On the other hand, a higher expression level of ABCB1 in imatinib-exposed samples did not affect second-generation TKI responses but was correlated with poor imatinib responses.

OCT-1, ABCB1, and ABCG2 Expression in Imatinib-Resistant Chronic Myeloid Leukemia Treated with Dasatinib or Nilotinib / 전남의대학술지

This study explored drug transporter expression levels and their impact on clinical response to imatinib and second-generation tyrosine kinase inhibitors (TKIs) in imatinib- resistant chronic myeloid leukemia (CML). Imatinib-resistant chronic phase CML patients treated with dasatinib (n=10) and nilotinib (n=12) were enrolled. The mRNA expression of the OCT-1, ABCG2, and ABCB1 genes was quantified by using paired bone marrow samples obtained before administering imatinib and at the point of detecting imatinib resistance (just before starting second-generation TKIs). The expression levels of OCT-1 and ABCG2 were lower in follow-up than in imatinib-naive samples. ABCB1 revealed highly variable expression levels before and after imatinib treatment. In addition, median ABCB1 expression in follow-up samples was lower in patients achieving complete cytogenetic response or major molecular response during imatinib treatment than in failed patients. Higher ABCG2 expression in imatinib-exposed samples showed a negative impact on optimal response to dasatinib. Patients with higher ABCG2 expression in imatinib-exposed samples also had shorter progression- free survival with dasatinib treatment. However, no significant correlation was found between these drug transporter expression levels in imatinib-naive or imatinib- exposed samples and responses to nilotinib. In imatinib-resistant CML, OCT-1 and ABCG2 mRNA expression decreased after imatinib treatment. Patients with higher ABCG2 expression in imatinib-exposed samples showed poor treatment outcome with dasatinib. On the other hand, a higher expression level of ABCB1 in imatinib-exposed samples did not affect second-generation TKI responses but was correlated with poor imatinib responses.

The Reliability and Validity of the Korean Version of the Child Sexual Behavior Inventory

OBJECTIVE: This study examined the reliability and validity of the Korean version of the Child Sexual Behavior Inventory (CSBI) in Korean children aged from 6 to 12 years old and the suitability of and potential for clinical application of the CSBI in Korean population. METHODS: The participants consisted of 158 typically growing children and 122 sexually abused children. The subjects were evaluated using the Korean version of the Child Sexual Behavior Inventory (CSBI), the Child Behavior Checklist (CBCL), and the Trauma Symptom Checklist for Young Children (TSCYC). Internal consistency was examined as a measure of reliability. To investigate the concurrent validity, Pearson's correlations were calculated. One-way ANCOVA was used to demonstrate discriminant validity. RESULTS: The Cronbach's alpha value was 0.84. The CSBI total score was moderately correlated with the CBCL subscales and mildly correlated with the sexual concern subscale of the TSCYC. The total score of the CSBI for the sexually abused children group was significantly higher than that of typically growing children group. CONCLUSION: This study demonstrated that the Korean version of the Child Sexual Abuse Inventory (CSBI) is a reliable and valid tool. It can be applied in the clinical field for assessing the sexual behavior of Korean children aged from 6 to 12 who are suspected to have been sexually abused.

Reliability and Validity of the Korean Version of the Child Report of Post-Traumatic Symptoms (CROPS) and the Parent Report of Post-Traumatic Symptoms (PROPS)

OBJECTIVES: The Child Report of Post-traumatic Symptoms (CROPS) and the Parent Report of Post-traumatic Symptoms (PROPS) are screening measures for post-traumatic symptoms in children. The present study aimed to investigate the reliability and validity of the Korean versions of the CROPS and the PROPS. METHODS: The Korean versions of the CROPS and the PROPS were administered to a sample of 304 children aged 6 to 15 years old. The internal reliability, test-retest reliability, factorial validity, predictive validity and concurrent validity were evaluated. RESULTS: The reliability of the CROPS and the PROPS was shown to have excellent internal consistency and test-retest correlation. The single factor structure of the PROPS was good and that of the CROPS was borderline acceptable according to confirmatory factor analysis. Other validity measures such as the predictive validity and concurrent validity were also shown to be satisfactory. CONCLUSION: This study demonstrated that the Korean versions of the CROPS and the PROPS were reliable measures with satisfactory psychometric qualities. Because it takes less than 5 minutes to fill out the CROPS and the PROPS, respectively they can be quick and easy screening scales for assessing post-traumatic symptoms in Korean children.

Psychiatric Characteristics of Adolescents with Minor Offenses and Follow-Up after a 6-Month Protective Disposition

OBJECTIVES: This study investigated the differences between the psychiatric characteristics of minor juvenile offenders and normal adolescents as well as differences in psychiatric symptoms after a six month protective disposition. Further, the current study aimed at determining psychiatric screening methods for evaluating delinquent adolescents. METHODS: The Latent Delinquency Questionnaire (LDQ), the Revised Children's Manifest Anxiety Scale (RCMAS), the Children's Depression Inventory (CDI), the Reynolds Suicidal Ideation Questionnaire (SIQ), the Piers-Harris Children's Self Concept Inventory (SCI), and the Korean Youth Self Report (K-YSR) were administered to 134 normal adolescents (114 males) and 109 minor offenders (97 males) aged 12 to 16 years. After six months, 46 offenders (all males) completed the RCMAS, CDI, SIQ, and SCI again. RESULTS: Adolescents with minor offenses had more delinquent, aggressive behavior and externalizing behavior problems, but were significantly less depressive, anxious, or suicidal than normal controls. Further, recidivists had more anxiety, depression, and delinquent behavior than non-recidivists. Minor offenders reported that their anxiety and depressive mood decreased after six months of protective disposition. CONCLUSION: Adolescents with minor offenses had more delinquent, aggressive behavior and externalizing behavior problems suggesting that psychiatric screening tools for minor offenders should measure disruptive behavior disorder.

An Analysis of In-Training Examination for the Psychiatric Residents in Korea: Five-year Cumulative Results / 신경정신의학

OBJECTIVES: The in-training examination (Performance Examination, PE) for psychiatric residents in Korea was launched 5 years ago by the Korean Neuropsychiatric Association (KNPA). This article analyzes 5-year accumulated data on the PE, and tries to make some suggestions for further development of the PE. METHODS: The 5-year data, previously utilized for the generation of formal annual reports were reanalyzed, with an emphasis on longitudinal trends. RESULTS: The analyses indicated the following; 1) Higher-year residents earned definitely higher scores than their lower-year colleagues on the PE. This trend was especially prominent in the area of psychopharmacology-biological psychiatry, geriatric psychiatry, child and adolescent psychiatry, and the emergency-organic psychiatry. There was no year-related performance difference in the area of psychoses. 2) In the area of anxiety-somatization disorder, psychophysiological disorder, and geriatric psychiatry, the residents in the university-affiliated hospitals outperformed those in the specialized psychiatric hospitals. 3) Through analyzing multiple-times examinees, it was found that their first-and second-time performances were moderately correlated, and that their ranks tended to improve, demonstrating a continuously improving performance according to the training year. CONCLUSION: These result suggested that the KNPA PE is a feasible measure for the estimation of an individual resident's performance as well as the adequacy of the environment provided by the training institutes.

Effect of Modafinil and Methylphenidate on Sleep-Wake Architecture and EEG Power Spectra in Rats / 대한정신약물학회지

OBJECTIVE : Modafinil, methylphenidate, and caffeine are wakefulness-promoting substances. Previously, it was reported that caffeine-induced wakefulness differs from natural wakefulness in terms of the EEG spectral profiles. In order to evaluate whether wakefulness induced by other psychostimulants differs from both caffeine-induced and natural wakefulness, we examined the effects of the psychostimulants on sleep-wake architecture and EEG spectral profiles. METHODS : Eighteen Sprague-Dawley male rats underwent an EEG/EMG recording session from 10 : 30 to 17 : 30. They received caffeine (7.5, 15, 30 mg/kg i.p.), methylphenidate (1, 2, 5, 10 mg/kg i.p.) or modafinil (5, 10, 25, 50, 100 mg/kg i.p.) at 13 : 30. The number, total duration, and average duration of sleepwake states were obtained. EEG band powers were calculated by spectral analysis. Frequency bands were divided into the following ranges : D1, 1-2.5 Hz ; D2, 2.5-4.5 Hz ; T1, 4.5-7 Hz ; T2, 7-10 Hz ; SI, 10-14 Hz ; B1, 14-22 Hz ; B2, 22-34 Hz ; GA, 34-50 Hz. RESULTS : All three psychostimulants significantly and dose-dependently increased active wake duration and decreased slow-wave sleep. Equipotent doses of caffeine, methylphenidate, and modafinil for increasing active wake and decreasing slow-wave sleep were 7.5 mg/kg, 10 mg/kg, and 100 mg/kg, respectively. In equipotent doses, an increase of active wake duration by caffeine and methylphenidate was attributed to increases of both frequency and average duration of active wake state, whereas increase of active wake duration by modafinil was attributed to increase of average duration of active wake state only. In equipotent doses, caffeine and methylphenidate decreased the power of lower frequency bands (1-22 Hz), whereas modafinil did not. During slow-wave sleep, modafinil and methylphenidate increased the power of lower frequency bands, but caffeine did not. All the psychostimulants increased the power of the GA band, which was more prominent in the frontal cortex than the parietal cortex. CONCLUSION : These results suggest that moda-nil-induced wakefulness differs from caffeine- or methylphenidate-induced wakefulness in terms of EEG spectral profiles and sleep-wake architecture.

Practical Diagnostic Approaches to Chronic Abdominal Pain in Children and Adolescents

Chronic abdominal pain (CAP) in children and adolescents remains one of the pathogenetically ambiguous disorders and a great trouble to their caretakers as well as patients. Although the symptom does not usually lead to a crucial problem, the parents may be terribly worried, the child may be in distress, and the practitioner may be concerned about ordering tests to confirm a serious occult disease. Systemized diagnostic approaches are needed to overcome this unique difficulty. The presence of red flag symptoms or signs is a general indication to pursue diagnostic testing for organic etiologies of CAP on the basis of specific symptoms in an individual case. Functional abdominal pain can be normally diagnosed when there are no red flag symptoms or signs. According to the Rome III criteria for pediatric functional gastrointestinal disorders, functional disorders of CAP can be classified into functional dyspepsia, irritable bowel syndrome, abdominal migraine, and chronic functional abdominal pain syndrome. Cyclic vomiting syndrome and pathologic aerophagia are also major functional causes of CAP. Modern concepts of the pathogenesis of functional abdominal pain include brain-gut interaction, visceral hypersensitivity, autonomic dysfunction, and psychosocial factors. In addition, psychiatric disorders, presented with red flag symptoms or signs, may induce the CAP in children and adolescents. We introduce practical and systemized diagnostic approaches by illustrating clinical cases of CAP in children and adolescents.

The Korean Version of the Adolescent Dissociative Experience Scale: Psychometric Properties and the Connection to Trauma among Korean Adolescents

OBJECTIVE: The Adolescent Dissociative Experience Scale (A-DES) is a screening measure for dissociative experience in adolescents. The present study aimed to investigate the reliability, validity and psychometric properties of the Korean version of the Adolescent Dissociative Experience Scale. METHODS: The Korean version of the A-DES was administered to a normative group of 371 adolescents aged 12 to 18 years and a traumatized group of 33 adolescents aged 12 to 18 years with known trauma. RESULTS: The internal consistency was excellent (Cronbach's alpha=0.91) and the test-retest correlation of the A-DES was high (r=0.99). Correlation between the A-DES and other measures of dissociation was moderate (r=0.48). There were no significant age differences in mean total A-DES scores for the normative sample, or for boys or girls separately. Nor were there any significant gender differences for any age group. The mean total score of the A-DES was significantly higher in the traumatized group than in the normative group. There was a statistically significant difference between adolescents with self-reported trauma and those without a trauma history in the normative group. CONCLUSION: This study demonstrated that the Korean version of the A-DES is a reliable measure with excellent internal consistency and good stability over a 4-week test-retest interval with single factor structure. It can be used to screen for dissociative symptoms in Korean adolescents between the ages 12 and 18.

Reliability and Validity of the 20-Item Toronto Alexithymia Scale in Korean Adolescents

OBJECTIVE: Adolescence is a period of developing emotional regulation. However, alexithymia has rarely been examined during this period. The objective of this study is to examine the factor structure and internal consistency of the Korean version of the 20-item Toronto Alexithymia Scale (TAS-20K) in normal adolescents in South Korea. METHODS: The TAS-20K was administered to a sample of 290 adolescents aged from 12 to 16 years old. Internal reliability, test-retest reliability, and factorial validity were evaluated. RESULTS: The three factors of the TAS-20K were confirmed by confirmatory factor analysis. The internal consistency, measured using Cronbach's alpha coefficient was acceptable for difficulty in identifying feelings, good for difficulty in describing feelings, and acceptable for externally oriented thinking. CONCLUSION: Our study indicates that the TAS-20K is an appropriate instrument to assess alexithymia in Korean adolescents.

Natural Killer Cell Activity in North Korean Defectors with PTSD / 신경정신의학

OBJECTIVES: The objective of this study was to evaluate an association between posttraumatic stress disorder (PTSD) and altered immunity in North Korean defectors who were more likely to develop medical conditions and other stress-related psychiatric disorders. METHODS: Twenty-four North Korean defectors with PTSD and twenty-two controls without PTSD were recruited from the resettlement and training center for North Korean defectors in South Korea. Peripheral T lymphocyte subsets, natural killer (NK) cells, NK cell activity and plasma hormones (ACTH and cortisol) were obtained from all subjects. We also applied the Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A) for all subjects. RESULTS: We found NK cell activity was relatively lower than number of NK cells in North Korean defectors with PTSD. Subjects with PTSD had higher HAM-D and HAM-A scores than controls. However, there were no statistical differences in ACTH, cortisol, CD3, CD4, CD8, CD4/CD8 ratio, CD19 and CD56 between the two groups. CONCLUSION: These findings suggest North Korean defectors with PTSD show higher levels of depression, anxiety and impaired or weak immune function in NK cells.

Cognitive Behavioral Therapy for Sexually Abused Children

OBJECTIVES: Child sexual abuse is a highly prevalent societal problem that cuts across all ethnic, racial, educational, and socioeconomic groups. There has been mounting empirical evidence for the efficacy of manual-based, cognitive behavioral treatment(CBT) for sexually abused children. Therefore, the aim of this review was to address the rationale and efficacy of CBT for sexually abused children, and to introduce a broad outline of a typical CBT program for young people suffering the emotional and behavioral consequences of sexual abuse. METHODS: A selective literature review was undertaken. RESULTS: To date, trauma-focused CBT is the most effective treatment for the sexually abused child. The rationale and efficacy of CBT was reviewed and a typical CBT program was outlined session by session. CONCLUSION: Based on trauma-focused CBT for sexually abused children, the results demonstrate the need for future development of a standard CBT program for the Korean population.

The Implementation of Problem-based Learning in Kyungpook National University School of Medicine and its Evaluation / 한국의학교육

The effectiveness of Problem-based Learning(PBL) in medical education has already been acclaimed widely. Representatives of the curriculum committee at Kyungpook National University School of Medicine paid a visit to McMaster University School of Medicine in Canada in May, 1994 in order to learn mechanics and effectiveness of PBL in its medical education and they were impressed by the efficacy of PBL. Soon after that the school launched a pilot PBL tutorial for two years from 1994 through 1996(4-semester) as a non-credit course for senior, junior and sophomore in medical school during one semester each, to introduce PBL to faculty members and students as well. After the pilot, opinion survey on PBL from both faculty and students revealed affirmative for PBL from 55.1% of seniors, 61.4% of juniors and 83.9% of faculty members. The faculty body at medical school was then encouraged by the pilot experience and decided to include the PBL as the part of medical education reform. During the fall semester in 1998, the senior at pre-medical course was given PBL experience to prepare for implementation of PBL at school of medicine. The PBL was implemented as an essential 2-credit-hour course in each semester commencing in 1999 to the freshmen class throughout the year; it was extended to the sophomore in 2000 and to the junior in 2001. Although there had been initial excitements of over expectations, confusion, and disappointments from faculty members and students, majority opinion of both parties on continuation of PBL was positive. The issues to be settled are preparation of study cases, students learning resources, and method of evaluating students' performance. The PBL was started as an essential course in medical school in 1999 after 4 years of preparation and on the basis of our interim evaluations the following conclusions were made: we have reached the following consensus that students seem to follow the objectives of PBL and new PBL tutorial has well been accepted by students; and enhancing the program by correcting currently known weaknesses, the PBL tutorials could further be expanded to be a major modality of teaching in our medical school.

A study of clinical application of cultured epithelial autograft

No abstract available.