중국 중고령 층의 가족 돌봄과 돌봄자의 건강과의 관계

학위논문 (석사) -- 서울대학교 대학원 : 보건대학원 보건학과(보건정책관리학전공), 2021. 2. 김홍수.중국의 인구는 2010 년부터 2019 년까지는 빠르게 고령화되어 60 세 이상 인구 비율은 13.26 %에서 18.1 %로 증가했다 (NHCC, 2011-2020; NBSC, 2011-2020). 중국 고령화 문제 빠르게 심하하고 있으며 가족 돌봄은 노인 돌봄의 압력을 완화하는 데 중요한 역할이다. 그러나 가족 돌봄은 신체적, 정신적 건강에 부정적인 결과를 초래할 수 있다. 특히 돌봄의 효과에 대한 연구는 서양 국가에서 많이 이루어집니다. 서구 국가 돌봄의 연구 결과가 서구 국가와 가족 구조및 관계를 다른중국 사회에 적용되는지는 의문이다. 따라서 본 연구는 중국 대표적인 자료를 사용하여 중국의 중고령층 세대간 가족 돌봄과 돌봄자의 건강 상태와의 관계를 살펴보고 관련 요인을 하악하고자 하였다. 이 연구는 전체적으로 그리고 세 가지 돌봄 유형 그룹 간의 관계를 비교했다(부모님 돌보자만, 손자녀 돌봄자만, 둘다 돌봄자). 이 연구는 중국 건강 및 퇴직 패널조사 (CHARLS) 4 차 자료를 이차 분석을 수행하였다. CHARLS 자료는 중국에서 45 세 이상 성인을 대상으로 한 전국 패널조사이다. 연구의 개념적 틀은 문헌에 대한 포괄적인 검토를 통해 도출되었고 개인 특성, 가족 자원, 사회적 참여, 가족 돌봄현황, 건강상활을 포함한 분석 모델을 만드는 데 활용되었다. 가족 돌봄 현황은 돌봄 종류, 돌봄 강도, 돌봄 기간을 포함하였다. 돌봄 유형은 부모님만 돌봄,손자녀만 돌봄, 둘다 돌봄을 포함하였다. 건강상황은 주관적 건강인식 및 우울감을 포함을 하였다. 주관적 건강인식은 5 점 척도 질문으로 측정되었다. 우울감을 측 30 점 척도인 CESD-10 을 사용하였다. 이 연구는 카이 제곱 검정과 t- 검정을 사용하여 개인 특성, 가족 특성 및 사회 활동 상태에서 비돌봄자 및 돌봄자 간의 차이를 전반적으로 비교했다. 다음으로, 이 연구는 카이 제곱 검정과 ANOVA 분석 및 Tukey HSD 검정을 사용하여 개인 특성, 가족 특성 및 사회 활동 상태에서 비돌봄자 및 세종류 돌봄자 간의 차이를 전반적으로 비교했다. 마지막으로는 단변량 분석, 다변량 회귀분석을 실행하여 가족 돌봄 특성과 관련된 요인, 돌봄와 건강 상태 간의 관계를 파악하였다.상세한 결과는 다음과 같다. 6,871 명의 돌봄자을 대상으로 한 분석 자료중 74.36 %는 주관적 건강인식이 좋지 않았으며 36.24 %는 CES-D10 으로 측정 한 우울 증상을 나타냈다. 다변량 분석 결과에 따르면 소득, 거주 위치, 교육, 고용상태, ADL, IADL, 만성 질환, 가구 구성 및 사회 활동 상태가 돌봄자의 주관적 건강인식과 관련된 요인으로 나타났다. 또한, 연구 결과에 따르면 연령, 성별, 소득, 거주 위치, 교육, ADL, IADL, 만성 질환, 자녀수, 사회 활동 및 돌봄 강도가 돌봄자의 우울 증상과 관련된 요인으로 나타났다. 돌봄 유형별로 다변량 분석 결과에 따르면 손자녀 돌봄한 사람에서나쁜 주관적 건강인식이 가장 많이 나타났다. 부모님 돌봄자 중 성별, 소득, IADL 및 만성 질환이 주관적 건강 인식의 중요한 요소 인 것으로 밝혀졌다. 손자녀 돌봄자 중 소득, 교육, 고용, ADL, IADL, 만성 질환, 가구 구성 및 사회 활동이 주관적 건강인식의 중요한 요소이다. 부모님 및 손자녀 두개 다 돌봄한 사람 중 소득, IADL 및 만성 질환은 주관적 건강인식의 중요한 요소이다. 돌봄 유형별로 다변량 분석 결과에 따르면 손자녀 돌봄자에서 우울증 증상이 가장 많이 나타났다. 부모 돌봄자 중 성별, 소득, 고용, ADL, IADL, 만성 질환 및 간호 기간이 자기 평가 건강의 중요한 요소로 밝혀졌습니다. 손자 보호자 중 성별, 소득, 위치, 교육, ADL, IADL, 만성 질환, 아동 수 및 사회적 활동이 자기 평가 건강의 중요한 요인으로 밝혀졌습니다. 돌봄자 중 성별, 소득, ADL, IADL, 만성 질환 및 가구 구성은 자기 평가 된 건강의 중요한 요소이다. 이 연구는 중국의 손자녀 돌봄자가 다른 유형의 가족 돌봄자 보다는 주관적 건강상태 및 우울감이 가장 많이 나온 현상이 발견햇다. 이 결과는 중국의 수백만 명의 남은 자녀와 나이 많은 조부모 때문일 수 있습니다. 첫째, 중국에서 부모를 따라 외출하지 못하고 집에 남아있는 아이가 많이 있다.때문이다. 그런 아이들은 보통 조부모님의 보살핌을 받으며 시골에 남겨져 있다. 그래서 돌봄강도는 부모만을 돌보는 것보다 손자만을 돌보는 돌보는 사람의 2 배 이상이었다 (62.67대 30.68 시간/주). 손자를 돌보는 일은 거의 정규직과 같았다. 자녀가 결석하고 손자를 돌보는 강도가 높기 때문에 손자 돌보는 사람은 일반적으로 지친 느낌을 받았다. 또한 손자녀 돌봄자는 다른 유형의 돌봄자보다 나이가 많았다 (60.48 세 대 53.51 세 및 56.52 세). 노년층은 노년기에 건강 상태가 악화되어 사회적 참여 능력이 제한되어 노년기의 복지에 영향을 미칠 수 있다. 이 연구 결과는 돌봄 강도, 돌봄 기간 및 주관적 건강상태의 통계적으로 유의한 연관성을 규명하지는 못하였다. 이전 연구와 비교할 때, 선행 연구와이 연구 간의 자기 평가 건강 및 연구 유형 측정의 차이는 다른 결과를 초래했을 수 있다. 주관적 건강상태와 우울 감에 영향을 미치는 요인들을 단면적으로 조사 하였다. 가족 돌봄 제공 및 건강 (주관적 건강상태, 우울감)에 영향을 미치는 요인은 개인 특성, 가족 구조 및 사회 활동 상태에서 일관되게 나타났다. 이는 가족 돌봄자의 돌봄 제공 및 건강이 소득과 같은 개인적 요인뿐만 아니라 가족 구조 및 사회 활동 상태에 의해 영향을 받았음을 시사했다. 주관적 건강상태 및 우울감과 관련된 다차원적 요인은 가족 돌봄자를 위한 개입 정책을 취하는 포괄적인 접근 방식의 필요성을 나타냈다. 소득과 건강 사이의 강력한 연관성은 가족 돌봄자의 재정적 지원은 건강을 개선하는 효과적인 전략이 될 수 있음을 시사한다. 사회 활동과 건강 상태 간의 강한 연관성은 가족 돌봄자 내에서 사회적 참여를 촉진하는 것이 더 나은 건강 상태를위한 효과적인 전략이 될 수 있음을 시사한다. 마지막으로, 결과는 농촌 거주자가 도시 거주자보다 세대 간 보살핌을 제공 할 가능성이 더 높다는 것을 보여주었습니다. 중국의 공공 시설 분포가 여전히 도시와 농촌의 차이가 있다(예, 유치원, 요양원). 정부는 도시-농촌 격차를 줄이기 위해 사회 복지 형평성을 달성하고 유지하기위한 포괄적 인 접근 방식을 개발해야 한다.China's population aged rapidly from 2010 to 2019, with life expectancy at birth increasing from 71.4 years to 77.3 years and the proportion of the population over 60 rising from 13.26% to 18.1% (NHCC, 2011-2020; NBSC, 2011-2020). Family care plays a vital role in taking the pressure of aging-related care issues. However, the maintenance of such family responsibilities can lead to negative physical and mental health consequences. Most research on the effects of caregiving focuses on Western countries. It is questionable whether Western caregivers' findings apply to Chinese society with family structures and family relationships differ from Western countries. Therefore, this study aims to investigate the relationship between family caregiving and caregivers' health among middle-aged and older adults in China by analyzing a representative sample. We compare the relationships overall and between three care-type groups: parent caregiving only, grandchild caregiving only, and both. This study conducted a secondary analysis of the China Health and Retirement Longitudinal Study (CHARLS) wave 4 data. The CHARLS data is a national longitudinal survey of adults aged over 45 in China. A conceptual framework was drawn through a comprehensive review of the literature applied to create an analytic model, including individual characteristics, family structures, social participation status, family caregiving provision, and health outcomes. Family caregiving provision includes care type, care intensity, and care duration. Based on the review, care type includes parent caregiving only, grandchild caregiving only, and both. Health outcome is divided into self-rated health and depression. A five-point scale question measured self-rated health. Depression was measured using the CES-D-10, a 30-point scale. This study compared the differences between non-caregivers and caregivers overall in individual characteristics, family characteristics, and social activity status using chi-square test and t-test. Next, this study also compared the differences between non-caregivers and caregivers classified by three-care types in individual characteristics, family characteristics, and social activity status using chi-square test, ANOVA analysis, and Tukey HSD test. Moreover, bivariate analysis and multivariate analysis were performed to identify the factors associated with family caregiving provision and the relationship between family caregiving provision and health. The results of this study are as follows. Among the analytical sample of 6,871 caregivers, 74.36% were not in good self-rated health, and 36.24% presented with depressive symptoms as measured by CES-D-10. Multivariate analysis of all caregivers results showed income, location, education, employment, ADL, IADL, chronic disease, household composition, and social activity status to be factors associated with caregivers' self-rated health. Study results also showed that age, sex, income, location, education, ADL, IADL, chronic diseases, the number of children, social activity, and care intensity are factors associated with caregivers depressive symptoms. Multivariate analysis of the caregivers self-rated health by care type revealed that poor self-rated health was most prevalent among caregivers who only provided grandchild caregiving. For caregivers who only provided parent caregiving, gender, income, IADL, and chronic disease significantly affected self-rated health. For caregivers who only provided grandchildren caregiving, income, education, employment, ADL, IADL, chronic disease, multi-generation family, and social activity largely influence self-rated health. For caregivers who provided both parent and grandchild caregiving, income, IADL, and chronic disease were significant factors of self-rated health. Multivariate analysis of the sample's depressive symptoms by care type revealed that depressive symptoms were also most prevalent among caregivers who only provided grandchild caregiving. For caregivers who only provided parent caregiving, gender, income, employment, ADL, IADL, chronic disease, and care duration were significant factors of depressive symptoms. For caregivers who only provided grandchild caregiving, gender, income, location, education, ADL, IADL, chronic disease, child number, and social activity were significant factors of depressive symptoms. For caregivers who provided both parent and grandchild caregiving, gender, income, ADL, IADL, chronic disease, and household composition were significant factors of depressive symptoms. This study found that poor self-rated health and depressive symptoms were most prevalent among caregivers who cared for grandchildren. This result may be due to the millions of left-behind children and older grandparents in China. Firstly, left-behind children mean that childrens parents worked in a distant place. The children are left behind in their rural communities, cared for by their grandparents in China. The intensity was more than two times caregivers caring for grandchildren only than caring for parents only (62.67 vs 30.68 hours per week). Providing care to grandchildren was almost equivalent to a full-time job. With children absent and high intensity of care for grandchildren, grandchild caregivers commonly feel burn out. Also, caregivers who only cared for grandchildren were older than other types caregivers (60.48 vs. 53.51 and 56.52 years old). Older individuals may experience a deterioration of their health condition in older ages, limiting their capacity for social engagement and, in turn, influencing their well-being in later life. The results of this study could not clarify a statistically significant association between care intensity, care duration and self-rated health. Compared with previous research, the difference in the measurement of self-rated health and study type between the earlier studies and this study may have resulted in different outcomes. Factors influencing self-rated health and depressive symptoms were examined cross-sectionally. The factors influencing family caregiving provision and health (self-rated health, depression) were consistently shown in individual characteristics, family structures, and social activity status. This suggests caregiving provision and health of family caregivers were influenced not only by personal factors such as income but also by family structures and social activity status. The multidimensional factors associated with self-rated health and depressive symptoms indicated the need for a comprehensive approach to releasing intervention policy for family caregivers. The strong association between income and health suggests that promoting family caregivers' financial support could be an effective strategy to improve their health. The strong association between social activity and health advances that promoting social engagement within the family caregivers may improve their health. Finally, the results showed that rural caregivers had worse self-rated health and more depressive symptoms than urban caregivers. There is still an urban-rural disparity in social public infrastructure distribution (i.e., kindergartens, nursing homes) in China. The truth that the location influences health suggests reducing the rural-urban gap in public infrastructure distribution could be an effective health-equity strategy.Chapter 1. Introduction . 1 1.1 Background . 1 1.2 Objective . 4 Chapter 2. Literature review . 5 2.1 Theoretical background . 5 2.2 Family caregiving provision 6 2.2.1 Care type 6 2.2.2 Care intensity . 7 2.2.3 Care duration . 8 2.3 Factors associated with the family caregiving provision 10 2.3.1 Studies Abroad . 10 2.3.2 Studies in China . 12 2.4 The health of caregivers . 14 2.5 The relationship between family caregiving provision and self-rated health 16 2.5.1 Studies Abroad . 16 2.5.2 Studies in China . 17 2.6 The relationship between family caregiving provision and depressive symptom . 19 2.6.1 Studies Abroad . 19 2.6.2 Studies in China . 22 2.7 Literature review conclusion . 24 Chapter 3. Method 26 3.1 Conceptual framework 26 3.2 Study data . 27 3.3 Measurements . 29 3.3.1 Independent variable: General characteristics . 29 3.3.2 Independent variable: Care-related characteristics 31 3.3.3 Dependent variable 3 3 3.4 Statistical methods . 37 Chapter 4. Results . 38 4.1 Sample characteristics . 38 4.1.1 Descriptive statistics of the sample . 38 4.1.2 Family caregiving provision and health of the sample 42 4.2 Sample characteristics by care type . 44 4.2.1 Descriptive statistics of the sample by care type . 44 4.2.2 Caregiving provision and health of the sample by care type 49 4.3 Factors associated with care intensity 53 4.3.1 Bivariate analysis of the factors associated with care intensity. 53 4.3.2 Multivariate analysis of the factors associated with care intensity. 58 4.4 Factors associated with care duration 63 4.4.1 Bivariate analysis of the factors associated with care duration . 63 4.4.2 Multivariate analysis of the factors associated with care duration . 68 4.5 The relationship between family caregiving provision and self-rated health 73 4.5.1 Bivariate analysis of the relationship between family caregiving provision and self-rated health . 73 4.5.2 Multivariate analysis of the relationship between family caregiving provision and self-rated health . 78 4.6 The relationship between family caregiving provision and depressive symptom . 83 4.6.1 Bivariate analysis of the relationship between family caregiving provision and depressive symptom . 83 4.6.2 Multivariate analysis of the relationship between family caregiving provision and depressive symptom . 88 Chapter 5. Discussion . 93 5.1 Caregivers' characteristics, caregiving provision, and health in China . 93 5.2 Factors associated with family caregiving provision 97 5.2.1 Factors associated with family caregiving intensity 97 5.2.2 Factors associated with family caregiving duration 98 5.3 The relationship between family caregiving provision and health . 99 5.3.1 The relationship between family caregiving provision and self-rated health 99 5.3.2 The relationship between family caregiving provision and depression . 100 5.4 Policy implications 103 5.5 Significance and limitation of the study 105 Biography . 107 국문초록 123Maste

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Objectives: Diabetes has been strongly associated with periodontal diseases. The periodontal ligament (PDL) has an abundant extracellular matrix (ECM). Lysyl oxidases (LOXs) are closely associated with various diseases caused by abnormal ECM functions, however, the role of LOXs in periodontal diseases induced by diabetes remains unclear. Methodology: In this study, 8-week-old Zucker diabetic fatty rats were used to establish a type 2 diabetes mellitus (T2DM) model. After 9 and 16 weeks, hematoxylin and eosin (H&E), Masson’s trichrome, and immunohistochemical staining were performed. Results:After 9 weeks, loose collagen fibers were found in the interradicular area of the diabetic group, in opposition to the control group. There were no significant differences in LOX expression between the diabetic and control groups (p>0.05). However, after 16 weeks, the diabetic group presented a disordered arrangement of the PDL, showing decreased collagen content and significantly increased lysyl oxidase-like protein 3 (LOXL3) expression when compared with the control group (p<0.05). This suggests that LOXL3 plays a significant role in periodontal histopathological changes in diabetic rats. Conclusion:Our study showed elevated LOXL3 expression in the PDL of diabetic rats after 16 weeks, suggesting that LOXL3 may be involved in the occurrence and development of periodontal histopathological changes in diabetic rats. LOXL3 could be further used as an indicator for the early diagnosis of diabetic periodontitis in T2DM patients in clinical settings

Can Small Language Models be Good Reasoners for Sequential Recommendation?

Large language models (LLMs) open up new horizons for sequential recommendations, owing to their remarkable language comprehension and generation capabilities. However, there are still numerous challenges that should be addressed to successfully implement sequential recommendations empowered by LLMs. Firstly, user behavior patterns are often complex, and relying solely on one-step reasoning from LLMs may lead to incorrect or task-irrelevant responses. Secondly, the prohibitively resource requirements of LLM (e.g., ChatGPT-175B) are overwhelmingly high and impractical for real sequential recommender systems. In this paper, we propose a novel Step-by-step knowLedge dIstillation fraMework for recommendation (SLIM), paving a promising path for sequential recommenders to enjoy the exceptional reasoning capabilities of LLMs in a "slim" (i.e., resource-efficient) manner. We introduce CoT prompting based on user behavior sequences for the larger teacher model. The rationales generated by the teacher model are then utilized as labels to distill the downstream smaller student model (e.g., LLaMA2-7B). In this way, the student model acquires the step-by-step reasoning capabilities in recommendation tasks. We encode the generated rationales from the student model into a dense vector, which empowers recommendation in both ID-based and ID-agnostic scenarios. Extensive experiments demonstrate the effectiveness of SLIM over state-of-the-art baselines, and further analysis showcasing its ability to generate meaningful recommendation reasoning at affordable costs.Comment: Accepted by TheWebConf (WWW) 202

BMP4 inhibits myogenic differentiation of bone marrow–derived mesenchymal stromal cells in mdx mice

AbstractBackground aimsBone marrow–derived mesenchymal stromal cells (BMSCs) are a promising therapeutic option for treating Duchenne muscular dystrophy (DMD). Myogenic differentiation occurs in the skeletal muscle of the mdx mouse (a mouse model of DMD) after BMSC transplantation. The transcription factor bone morphogenic protein 4 (BMP4) plays a crucial role in growth regulation, differentiation and survival of many cell types, including BMSCs. We treated BMSCs with BMP4 or the BMP antagonist noggin to examine the effects of BMP signaling on the myogenic potential of BMSCs in mdx mice.MethodsWe added BMP4 or noggin to cultured BMSCs under myogenic differentiation conditions. We then injected BMP4- or noggin-treated BMSCs into the muscles of mdx mice to determine their myogenic potential.ResultsWe found that the expression levels of desmin and myosin heavy chain decreased after treating BMSCs with BMP4, whereas the expression levels of phosphorylated Smad, a downstream target of BMP4, were higher in these BMSCs than in the controls. Mdx mouse muscles injected with BMSCs pretreated with BMP4 showed decreased dystrophin expression and increased phosphorylated Smad levels compared with muscles injected with non-treated BMSCs. The opposite effects were seen after pretreatment with noggin, as expected.ConclusionsOur results identified BMP/Smad signaling as an essential negative regulator of promyogenic BMSC activity; inhibition of this pathway improved the efficiency of BMSC myogenic differentiation, which suggests that this pathway might serve as a target to regulate BMSC function for better myogenic differentiation during treatment of DMD and degenerative skeletal muscle diseases

Variation in Foraging Activity Areas of Worker Ants in Newly Established Red Imported Fire Ant Colonies Across Different Habitats

Red imported fire ant (Solenopsis invicta Buren) is a severe and highly destructive invasive species. It has invaded mainland China since 2004. Understanding the foraging behavior patterns of workers in different habitats and conditions can help to develop scientific prevention and control measures. In this study, we used bait traps to measure the foraging activity of workers in newly established fire ant nests in various habitats and time periods. The results showed that the presence or absence of vegetation cover was an important factor affecting the foraging activity of fire ant workers. In bare land habitats, the foraging range and number of fire ant workers were significantly different from those in habitats with vegetation cover. The analysis of the daily average activity patterns of fire ants showed that the number of workers in sweet potato fields showed a bimodal pattern. In contrast, those in bare land and sugarcane fields showed an unimodal pattern, and those in pineapple fields showed a fluctuating pattern. It is worth noting that the bimodal and unimodal peaks in sweet potato, bare land, and sugarcane fields all occurred at 10:00 and 16:00. Therefore, in natural environments, vegetation cover, and temperature are important factors affecting the foraging activity of fire ants