Depression, Type D Personality and Post-traumatic Stress Disorder in Adults and the elderly after Acute Coronary Syndrome

본 연구는 급성관상동맥증후군 성인과 노인 대상자의 우울, D유형 성격, 외상 후 스트레스 장애 정도를 파악하고 비교한 후 관계를 탐색하여 우울, D유형 성격, 외상 후 스트레스 장애를 고려하는 간호 중재 프로그램 개발을 위한 기초 자료를 제공하고자 시행한 서술적 비교 연구이다. 연구 대상자는 서울특별시 S상급종합병원에 급성관상동맥증후군으로 입원 치료를 한 후 퇴원한 성인 57명, 노인 59명을 편의 표본 추출하였고, 자료 수집은 2014년 4월 2일부터 5월 9일까지 실시되었다. 연구 도구는 우울, D유형 성격, 외상 후 스트레스 장애를 측정하는 구조화된 자가 보고식 설문지를 사용하였고, 총 73문항으로 구성되었다. 조사된 자료는 SPSS Win 19.0 통계프로그램을 이용하여 기술통계와 t-test, χ2–test, Pearson's Correlation Coefficient로 분석하였다. 연구의 결과를 요약하면 다음과 같다. 1. 급성관상동맥증후군 성인과 노인 대상자의 우울, D유형 성격, 외상 후 스트레스 장애를 비교한 결과 우울은 노인 대상자가 22.03±9.01점으로 성인 대상자의 17.04±7.63점보다 높게 나타났으며 통계적으로 유의한 차이가 있었다(t=-3.219, p=.002). D유형 성격, 외상 후 스트레스 장애는 두 집단간의 통계적으로 유의한 차이가 없었다. 2. 성인 대상자의 우울은 외상 후 스트레스 장애(r=.610, p<.001), D유형 성격의 하위 개념인 사회적 제한(r=.511, p<.001), 부정적 정서(r=.429, p<.001)와 양의 상관관계가 있었다. 외상 후 스트레스 장애는 D유형 성격의 하위 개념인 사회적 제한(r=.552, p<.001), 부정적 정서(r=.495, p<.001)와 양의 상관관계가 있었다. 노인 대상자의 우울은 외상 후 스트레스 장애(r=.644, p<.001), D유형 성격의 하위 개념인 사회적 제한(r=.568, p<.001), 부정적 정서(r=.490, p<.001)와 양의 상관관계가 있었다. 외상 후 스트레스 장애는 D유형 성격 중 사회적 제한(r=.684, p<.001)과 부정적 정서(r=.517, p<.001)와 양의 상관관계가 있었다. 본 연구의 결과를 통하여 급성관상동맥증후군 성인대상자보다 노인대상자의 우울이 높은 것을 인지하고 D유형 성격, 외상 후 스트레스 장애를 고려하는 간호 중재 프로그램 개발이 필요하다고 사료된다.;The purpose of this study was to describe and compare depression, D type personality and post-traumatic stress disorder in adults and elderly patients after acute coronary syndrome. The sample consisted of 57 adults and 59 elderly patients who discharged after hospitalization for acute coronary syndrome. The data were collected from April 12 to May 9, 2014, using structured questionnaires. The questionnaires included a total 73 questions were composed The Center for Epidemiologic Studies Depression Scale(CES-D scale), Type D scale-14(DS 14) and The Post-traumatic Stress Disorder Checklist for DSM-5(PCL-5). The collected data were analyzed with descriptive statistics, t-test, χ2–test with Pearson's Correlation Coefficient using the SPSS Win 19.0. The major findings of the study were as follows: 1. The mean score of depression was 17.04±7.63 for adults and 22.03±9.01 for the elderly. The elderly's depression scores was significantly higher than those of adults(t=-3.219, p=.002). No other statistically significant differences were found between the two groups on D type personality and post-traumatic stress disorder. 2. In adults, depression showed significant positive correlation with post-traumatic disorder(r=.610, p<.001), negative affect(r=.429, p<.001) and social inhibition(r=.511, p<.001) which are dimensions of D type personality. The post-traumatic disorder showed significant positive correlation with and negative affect(r=.495, p<.001) and social inhibition(r=.552, p<.001). In the elderly, depression showed significant positive correlation with post-traumatic disorder(r=.644, p<.001), and negative affect(r=.490, p<.001) and social inhibition(r=.568, p<.001). The post-traumatic disorder showed significant positive correlation with and negative affect(r=.517, p<.001) and social inhibition(r=.684, p<.001). The findings indicate that post-traumatic stress disorder after acute coronary syndrome is associated with depression and type D personality in adults and the elderly. It could be used to facilitate the assessment of patients at risk for post-traumatic stress disorder after acute coronary syndrome so they can be offered psychological nursing intervention as needed later.I. 서론 1 A. 연구의 필요성 1 B. 연구의 목적 4 C. 용어 정의 5 II. 문헌고찰 7 A. 급성관상동맥증후군 대상자 간호 7 B. 우울 10 C. D유형 성격 13 D. 외상 후 스트레스 장애 17 III. 연구방법 21 A. 연구 설계 21 B. 연구 대상 21 C. 연구 도구 22 D. 자료 수집 및 분석 25 E. 윤리적 고려 26 F. 연구의 제한점 26 IV. 연구결과 및 논의 27 A. 성인, 노인 대상자의 일반적 특성 27 B. 성인, 노인 대상자의 질병관련 특성 29 C. 성인, 노인 대상자의 우울, D유형 성격, 외상 후 스트레스 장애의 비교 32 D. 성인, 노인 대상자의 우울, D유형 성격, 외상 후 스트레스 장애의 관계 38 V. 결론 및 제언 41 A. 결론 41 B. 제언 43 참고문헌 44 부록 64 ABSTRACT 7

32주 미만 미숙아에서 초기 dexamethasone치료의 만성 폐질환 예방 효과

극소 저출생 체중아에서 초기 dexamethasone의 치료가 만성 폐질환을 감소시키는지를 규명하고, 초기 dexamethasone의 치료에 따른 부작용을 알아보고자 하였다. 전향적 무작위 연구로 32주 미만의 유리질막병이 있는 미숙아에게 생후 12시간내에 0.25 ㎎/㎏의 dexamethasone을 12시간 간격으로 3일간 투여하고 10일 후 같은 방법으로 투여하는 것을 교정 재태연령 36주까지 투여하였다. 20명의 신생아(dexamethasone군 10명, 대조군 10명)를 대상으로 하였으며 각 군에서의 만성 폐질환 발생율과 합병증에 대해 비교 분석하였다. 1. 만성 폐질환 발생율은 dexamethsone 치료군에서 2명(20%)으로 대조군 7명(70%)에 비해 낮았으나 두 군간 의미 있는 차이가 없었다(P=0.07). 1000 g 미만 미숙아만에서도 치료군에서 6명 중 2명(33.3%)으로 대조군의 3명 중 2명(66.7%)에 비해 만성 폐질환 발생율이 낮았으나 두 군간에 통계적 차이는 없었다(P=0.53). 2. 산소치료기간, 인공호흡기 사용기간과 입원기간은 두 군간에 차이가 없었다. 3. 뇌실주위 백질연화증의 발생은 치료군에서 의미 있게 높았고(P=0.03). 미숙아 망막증 역시 치료군에서 높았다(P=0.03). 그 외의 합병증은 두 군간에 유의한 차이가 없었다. 결론적으로 초기 dexamethasone의 치료는 만성 폐질환 발생율에 영향을 주지 못하였고 뇌실주위 백질연화증과 미숙아 망막증 등의 발생 빈도를 증가시켜 32주 미만의 극소 저출생 체중아에서의 사용이 재고되어야 할 것이다. ;The Optimal timing and the consequences of dexamethasone therapy in chronic lung disease remain unknown. The purpose of this study was to determine whether early dexamethasone therapy would reduce the incidence of chronic lung disease and to determine the adverse effects and complications of prematurity associated with such therapy. 20 neonates with hyaline membrane disease(dexamethasone n=10, placebo n=10) less than 32 weeks of gestation at Ewha Womens University Mokdong Hospital were enrolled. Infants were randomized to receive either early dexamethasone or placebo within 12 hours after birth for 3 days every 10 days intervals until postconceptional age was 36 weeks. 1. There were no significant differences in the incidence of chronic lung disease. 2. The duration of the ventilator therapy, O_(2) therapy and the duration of admission in the NICU were not different between the two groups. 3. Retinopathy of prematurity and periventricular leukomalacia were more common in the dexamethasone-treated group(P<0.05). There were no different in other complications between two groups. In conclusion, dexamethasone therapy not only was ineffective on the incidence of chronic lung disease, but also significantly increased the incidence of retinopathy of prematurity and periventricular leukomalacia. This study suggested that dexamethasone treatment in extreme low birth weight premature infants may be discouraged. And the duration of treatment and total dosage of dexamethasone should be reevaluated.목차 = iii 논문개요 = v I. 서론 = 1 II. 연구대상 및 방법 = 2 II. 결과 = 4 IV. 고찰 = 13 V. 결론 = 17 참고문헌 = 18 Abstract = 2

Peroxiredoxin expression in rat brain during perinatal development and by dexamethasone

학위논문(박사) --서울대학교 대학원 :의학과(소아과학전공),2008. 8.Docto

Stepwise silver-staining-based immunosorbent assay for amyloid-β autoantibody detection

Thesis(masters) --서울대학교 대학원 :화학부 (생화학전공),2009.2.Maste

Oxidative stress and the antioxidant enzyme system in the developing brain

Preterm infants are vulnerable to the oxidative stress due to the production of large amounts of free radicals, antioxidant system insufficiency, and immature oligodendroglial cells. Reactive oxygen species (ROS) play a pivotal role in the development of periventricular leukomalacia. The three most common ROS are superoxide (O2•-), hydroxyl radical (OH•), and hydrogen peroxide (H2O2). Under normal physiological conditions, a balance is maintained between the production of ROS and the capacity of the antioxidant enzyme system. However, if this balance breaks down, ROS can exert toxic effects. Superoxide dismutase, glutathione peroxidase, and catalase are considered the classical antioxidant enzymes. A recently discovered antioxidant enzyme family, peroxiredoxin (Prdx), is also an important scavenger of free radicals. Prdx1 expression is induced at birth, whereas Prdx2 is constitutively ex- pressed, and Prdx6 expression is consistent with the classical antioxidant enzymes. Several antioxidant substances have been studied as potential therapeutic agents; however, further preclinical and clinical studies are required before allowing clinical application. © 2013 by The Korean Pediatric Society

Paternal involvement and early infant neurodevelopment: The mediation role of maternal parenting stress

Background: Father-child interactions are associated with improved developmental outcomes among infants. However, to the best of our knowledge, no study has addressed the effects of paternal involvement on the neurodevelopment of infants who are less than 6 months of age, and no study has reported how maternal parenting stress mediates the relationship between paternal involvement and infant neurodevelopment during early infancy. This study investigates the direct and indirect relationship between paternal involvement and infant neurodevelopment at 3-4 months of age. The indirect relationship was assessed through the mediating factor of maternal parenting stress. Methods: The participants were recruited through the Sesalmaul Research Center's website from April to June 2014. The final data included 255 mothers and their healthy infants, who were aged 3-4 months. The mothers reported paternal involvement and maternal parenting stress by using Korean Parenting Alliance Inventory (K-PAI) and Parenting Stress Index (PSI), respectively. Experts visited the participants' homes to observe infant neurodevelopment, and completed a developmental examination using Korean version of the Ages and Stages Questionnaire II (K-ASQ II). A hierarchical multiple regression analysis was used for data analysis. Results: Infants' mean ages were 106 days and girls accounted for 46.3%. The mean total scores (reference range) of the K-PAI, PSI, and the K-ASQ II were 55.5 (17-68), 45.8 (25-100), and 243.2 (0-300), respectively. Paternal involvement had a positive relationship with K-ASQ II scores (β = 0.29, p < 0.001) at 3-4 months of age, whereas maternal parenting stress was negatively related with K-ASQ II scores (β = -0.32, p < 0.001). Maternal parenting stress mediated the relationship between paternal involvement and early infant neurodevelopment (Z = 3.24, p < 0.001). A hierarchical multiple regression analysis showed that paternal involvement reduced maternal parenting stress (β = -0.25, p < 0.001), which led to positive infant outcomes (β = 0.23, p < 0.001). Conclusions: Paternal involvement is significantly associated with infant neurodevelopment during early infancy, and maternal parenting stress partially mediates that association. This result emphasizes the importance of fathers' involvement and mothers' parenting stress on early infant neurodevelopment. © 2016 The Author(s)

Intraventricular hemorrhage and post hemorrhagic hydrocephalus among very-low-birth-weight infants in Korea

Here, we aimed to evaluate the incidence and mortality of intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus (PHH) among very-low-birth-weight (VLBW) infants in Korea and assess the associated factors of PHH. This cohort study used prospectively collected data from the Korean Neonatal Network (KNN). Among 2,386 VLBW infants in the KNN database born between January 2013 and June 2014, 63 infants who died without brain ultrasonography results were excluded. Maternal demographics and neonatal clinical characteristics were assessed. The overall incidence of IVH in all the VLBW infants was 42.2% (987 of 2,323), while those of IVH grade 1, 2, 3, and 4 were 25.1%, 7.0%, 4.8%, and 5.5%, respectively. The incidence and severity of IVH showed a negatively correlating trend with gestational age and birth weight. PHH developed in 0%, 3.5%, 36.1%, and 63.8% of the surviving infants with IVH grades 1, 2, 3, and 4, respectively. Overall, in the VLBW infants, the IVH-associated mortality rate was 1.0% (24/2,323). Only IVH grade severity was proven to be an associated with PHH development in infants with IVH grades 3-4. This is the first Korean national report of IVH and PHH incidences in VLBW infants. Further risk factor analyses or quality improvement studies to reduce IVH are warranted

The Prediction of Bronchopulmonary Dysplasia in Very Low Birth Weight Infants through Clinical Indicators within 1 Hour of Delivery

Background: Despite the advances in neonatology, the incidence of bronchopulmonary dysplasia (BPD) is increasing. It is important to prevent the development of BPD in the first place. The online BPD outcome estimator from National Institute of Children Health and Human Development and Neonatal Research Network is available. However, it is not applicable for Asians. Moreover, limits are set for birth weight and gestational weeks excluding those who may still have BPD. The aim of this study was to develop a prediction model for BPD using first hour perinatal and neonatal factors in Korean very low birth weight infants (VLBWIs). Methods: Data were collected for 8,022 VLBWIs with gestational age (GA) ≥ 22 weeks who were born between January 1, 2013 and December 31, 2016, and admitted to the neonatal intensive care units of the KNN. Multiple logistic regression models reanalyzed by stepwise selection with significant clinical indicators for BPD. PROC package was used to calculate the area under curve (AUC) and corresponding 95% confidence intervals. Moreover, it was used to search the best cut-off value. External validation was performed with the 2017 Korean neonatal network (KNN) data. Results: After all missing data were excluded, 4,600 VLBWIs were included in the training dataset of the prediction model. Predictability of presence of BPD was 90.8% and prediction P value cut off was 0.550. Five-minute Apgar score, birth weight, GA, sex, surfactant use were significant indicators. Predictability of severe BPD was 81.5% and prediction P value cut off was 0.160. Five-minute Apgar score, birth weight, maternal PIH, chronic maternal hypertension, GA, sex, respiratory distress syndrome, need of resuscitation at birth were significant indicators. After external validation, sensitivity and specificity did not change significantly. Conclusion: From this study, high predictability was obtained using clinical parameters obtained within one hour of life. P value for prediction of each grade of BPD and equation for calculation was presented. It can be helpful for the early prediction of BPD in Korean VLBWI. This study will contribute to the prediction of BPD in Asians especially Korean VLBWIs, not currently included in the NICHD BPD online BPD predictor. In addition, the predictive power may be continuously increased with the cumulative data of KNN. © 2021 The Korean Academy of Medical Sciences. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited

Comparison of gastric and other bowel perforations in preterm infants: A review of 20 years’ experience in a single institution

Purpose: In this study, we aimed to review the clinical presentation of preterm infants with gastrointestinal perforations and compare the clinical features of gastric perforation with other intestinal perforations. Methods: The medical records of preterm neonates with pneumoperitoneum, admitted to the neonatal intensive care unit (NICU) between January 1994 and December 2013, were retrospectively reviewed. Results: Twenty-one preterm infants underwent exploratory laparotomy to investigate the cause of the pneumoperitoneum. The sample consisted of five patients (23.8%) with gastric perforation and 16 patients (76.2%) with intestinal perforation. No statistical differences were found in the birth history and other perinatal factors between the two groups. Underlying necrotizing enterocolitis, bilious vomiting, and paralytic ileus preceding the perforation were statistically more common in the intestinal perforation group. All preterm infants with gastric perforation survived to discharge; however, six preterm infants with intestinal perforation expired during treatment in the NICU. In the gastric perforation group, sudden pneumoperitoneum was the most common finding, and the mean age at diagnosis was 4.4±1.7 days of life. The location and size of the perforations varied, and simple closure or partial gastrectomy was performed. Conclusion: Patients with gastric perforation did not have a common clinical finding preceding the perforation diagnosis. Although mortality in previous studies was high, all patients survived to discharge in the present study. When a preterm infant aged less than one week presents with sudden abdominal distension and pneumoperitoneum, gastric perforation should first be excluded. Prompt exploratory laparotomy will increase the survival rates of these infants. © 2015 by The Korean Pediatric Society

Influence of anti-tumor necrosis factor-alpha therapy on pregnant women with inflammatory bowel disease and their children's immunity

The onset of inflammatory bowel disease (IBD) usually occurs at young age, and therefore, women IBD patients experience pregnancy during their disease progression. Recently, the use of anti-tumor necrosis factor-α (anti-TNF-α) has been rapidly increasing. The aim of this study was to evaluate pregnancy related outcomes in women with IBD who were treated with anti-TNF-α during pregnancy and immunity of their children. Methods: Korean women with IBD who had been treated with anti-TNF-α during pregnancy had been enrolled. Medical records were reviewed and a survey was performed for each patient. For the patients who agreed on additional examination for their children, children's growth, medical history and antibody to hepatitis B surface antigen (anti-HBs) titer were checked. Results: All 18 patients had been diagnosed with Crohn's disease. There was not any case of preterm delivery, low birth-weight infant, congenital anomaly, nor stillbirth. All 12 children had followed the regular vaccination schedule for hepatitis B and 4 of them showed negative results for anti-HBs. After the 1 booster vaccination, all children demonstrated seroconversion. Regarding live vaccines, 4 children had bacillus Calmette-Guerin and 4 had rotavirus vaccine before 6 months, without any specific side effects. Conclusions: This was the first study of immunity of the children born from IBD women who had been treated with anti-TNF-α medication during their pregnancy. IBD women had comparable pregnancy outcomes with the general women population, suggesting that the disease activity rather than the administered medication would be more important in healthy pregnancy. Considering the history of vaccination and anti-HBs titers, immunity seems to be intact in the children. © 2019. Korean Association for the Study of Intestinal Diseases. All rights reserved