The effects of parental loss in childhood on mental health in adults

보건대학원/박사Background Previous research has focused on the mental health of children and adolescents who experienced parental loss. Studies so far have been investigating the short-term effects of loss rather than the long-term effects. Parental death in childhood has little identified yet as a risk factor for mental health problems in adulthood. Objectives: The purpose of this study was to investigate the effects of parental loss in childhood as a risk factor for mental health problems, such as depression symptoms and suicidal ideation, in adults in the Republic of Korea. Methods This study used the Korean Welfare Panel Study (KOWEPS) data from 2006 to 2013 with follow-up examinations each year. Information on childhood (0-17 years of age) parental loss was collected retrospectively in 2006. Prevalence of depression symptoms was measured by the Korean version of the Center for Epidemiologic Studies Depression Scale (CES-D) each year. A cut-off of 16 points or more was used to define depression symptoms. After excluding missing values, the study subjects for depression symptom analyses included 13,671 (84,012 observations). In the suicidal ideation analyses, (9,285 subjects (26,986 observations) from 2011 to 2013 were included. A Generalized Estimating Equations (GEE) analysis was conducted to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) of depression symptoms and suicidal ideation respectively in relation to parental loss in childhood. Results Among the study population (n=13,671), 26.2% (n=3,577) were suffering from depression symptoms, and 18.7% (n=2,566) had experienced parental loss in childhood. Parental loss was associated with depression symptoms (OR = 1.185; 95% CI: 1.114-1.260). After stratification by gender, the risk of depression symptoms was significant for both men and women who had experienced parental loss (OR = 1.189; 95% CI: 1.076-1.314 in men; OR = 1.174; 95% CI: 1.086-1.268 in women). ORs by age group indicated that middle-aged (OR = 1.229; 95% CI: 1.115-1.354) and elderly (OR = 1.184; 95% CI: 1.089-1.287) participants were significantly more likely to exhibit depression symptoms. Among the total population of 9,285, the number of people who experienced suicidal ideation was 12.8% (n=1,192). The number of people who experienced parental loss was 19.5% (n=1,814). Parental loss was associated with suicidal ideation (OR = 1.189; 95% CI: 1.041-1.358). After stratifying by gender, the risk of suicidal ideation was not significant for men or women who had experienced parental loss (OR = 1.194; 95% CI: 0.955-1.494 in men; OR = 1.163; 95% CI: 0.985-1.373 in women). ORs by age group indicated that middle-aged participants were at a significantly higher risk of suicidal ideation (OR = 1.260; 95% CI: 1.031-1.540). However, young adults and the elderly were not. Conclusions Parental death in childhood was positively associated with the risk of adulthood depression symptoms and suicidal ideation respectively. The risk of depression symptoms was statistically significant for both men and women. The risk was significantly higher in middle-aged and elderly people. The risk of suicidal ideation was significant for middle-aged people. Therefore, this study identified that parental death in childhood negatively affected mental health in adults. In this regard, the results of this study will help policy development of family support programs for bereaved families.ope

A single measure of cancer burden combining incidence with mortality rates for worldwide application.

We attempted to develop an indicator combining incidence with mortality rates (single measure of cancer burden, SMCB) and to compare the magnitudes of cancer burden by world region. The SMCB was used to measure the size of cancer burden summarizing the incidence and mortality. The incidence and mortality were divided in equivalent forms and were split. The criteria dividing the size of cancer burden were used as the maximum incidence and mortality by men and women according to the world database, and the value corresponding to 10% of each maximum was set as the cut-off value. In SMCB, the size of cancer burden was highest for men with lung cancer (SMCB=18) and for women with breast cancer (SMCB=14) in MDR (more developed regions) compared to the size of burden in LDR (lower developed regions) (lung, SMCB=11, breast, SMCB=8). For men, the size of cancer burden by region was highest in EURO (SMCB=18, lung), followed by WPRO (SMCB=16, lung), PAHO (SMCB=14, prostate), AFRO (SMCB=8, prostate) and SEARO (SMCB=7, lung). Moreover, for women, the size of cancer burden was greatest in EURO (SMCB=14, breast), followed by PAHO (SMCB=13, breast), AFRO (SMCB=11, cervix uteri), EMRO (SMCB=9, breast) or SEARO (SMCB=8, cervix uteri) and WPRO (SMCB=7, lung). The summary indicator will help to provide a priority setting for reducing cancer burden in health policy.ope

사람 중이점막세포 내에서 Interleukin 1-beta에 의한 Na+-K+-2Cl- cotransporter의 증가 연구

Dept. of Medical School/석사[한글]삼출성중이염은 감기나 비염, 급성중이염 등이 생긴 후에 적절한 치료가 되지 않아 만성발열이나 통증 등 염증의 증상이 없이 고막 안에 삼출액이 차 있는 경우로 소아의 가장 흔한 청력장애의 원인이 되고 있다. 삼출액의 발생을 그 성분 중에 가장 많은 염증성 cytokine 으로 알려져 interleukin-1ss(IL-1ss)가 삼출성 중이염 환자의 중이강 내에서 주변 세포에 체적과 분비, 물 수송에 관여하는 기능성 막 단백질에 미치는 어떤 영향으로 예상했다.종래의 연구에서 IL-1ss의 세포생리학적인 기능은 아직 연구가 미비한 실정이다. 그래서 기도점액에서 세포 체적과 분비기능이 있는 Na+-K+-Cl- cotransporter 1(NKCC1)이 조직 특이성이 비슷한 중이점막상피세포에서 발현하는지의 여부와 IL-1ss에게서 받는 영향을 분석하였다.정상인의 중이점막상피세포를 채취하여 P2 단계까지 배양한 후 H+를 세포막의 안팎으로 강제 이동시키며 pH 변화를 통해 세포의 기저외측막에서 NKCC1의 실직적인 기능을 확인하면서 동시에 IL-1ss를 처리하였을 때 그 기능이 유의성 있게 증가하는 것을 확인하였다.또한 단백질 수준에서 IL-1ss를 시간 별로 처리한 시료와 삼출성 중이염 환자군에서 채취한 시료가 동일한 결과를 보였으며 NKCC1을 특이적으로 저해하는, bumetanide 를 처리하여 실질적으로 물 수송 양이 줄어드는 결과로 보아 NKCC1이 기도상피세포와 마찬가지로 정상사람 중이 점막상피세포에서도 그 기존의 역할을 하는 것으로 보여진다. 세포 첨부측에 일정량의 Kreb’s solution 을 넣어주고 IL-1ss를 처리했을 때 물의 분비량이 대조군에 비해 유의성 있게 증가하였으며 이를 중이 내 삼출액의 발생원인으로 추정한다.이와 같은 연구들이 염증성 cytokine 에 의한 기능성 막 단백질의 이상으로 야기되는 삼출성 중이염의 병리 생리를 연구하는데 기초가 될 것이다. [영문]Disruption of periciliary fluid homeostasis is the main pathogenesis of otitis media with effusion (OME), which is one of the most common childhood diseases. Although the underlying molecular mechanisms are unclear, it has been suggested that the altered functions of ion channels and transporters are involved in the fluid collection of middle ear cavity of OME patients. In the present study, we analyzed effects of the inflammatory cytokine Interleukin-1ss(IL-1ss) on Na+-K+-2Cl-- cotransporter 1 (NKCC1) in human middle ear cells. Intracellular pH (pHi) were measured in primary cultures of normal human middle ear epithelial (NHMEE) cells using a double perfusion chamber, which enabled us to analyze membrane-specific transporter activities. NKCC activities were estimated by the pHi reduction due to bumetanide-sensitive intracellular uptake of NH4+. In addition, transepithelial fluid transport was measured with or without bumetanide-treatments. NKCC activities were observed in the basolateral membrane, but not in the luminal membrane of NHMEE cells. Correspondingly, immunoblotting of membrane-cultured NHMEE cells revealed the expression of NKCC1 on the basolateral membrane. Interestingly, IL-1ss treatments augmented the basolateral NKCC activities and increased NKCC1 expression. In addition, IL-1ss stimulated bumetanide-sensitive fluid transport in NHMEE cells. Furthermore, NKCC1 expression was increased in middle ear cells from the patients with OME when compared to samples from control individuals. The above results provide comprehensive evidence that the inflammatory cytokine IL-1β upregulates NKCC1 in the middle ear epithelial cells, which would be one of the important underlying mechanisms of fluid overcollection in patients with OME.ope

사회성 증진 프로그램이 정신과 병동에 입원한 소아·청소년의 또래관계, 소외감에 미치는 효과

학위논문(석사)--서울대학교 대학원 :간호학과 간호학전공,2000.Maste

P2Y2 agonist induces mucin secretion via Ca2+- and inositol 1,4,5-triphosphate-dependent pathway in human middle ear epithelial cells

Purinergic agonists regulate mucin secretion in the airway epithelial cells. This study examined the effects of the apical application of purinergic agonists on Ca(2+) influx ([Ca(2+)](i)), and mucin secretion along with their underlying signaling pathway in normal human middle ear epithelial (NHMEE) cells. The apical membrane of NHMEE cells were stimulated with various purinergic agonists, including UTP, and the [Ca(2+)](i) was measured using a miniature Ussing double perfusion chamber. P2Y(2) receptor in NHMEE cells was also localized by immunohistochemistry. UTP-induced mucin secretion was quantified by an immunoblotting assay. The order of the purinergic agonist potency with respect to [Ca(2+)](i) determined in this study was ATP = UTP > 2-MeSATP > UDP >> adenosine which is consistent with that obtained from P2Y(2) receptor activation. The P2Y(2) receptor is expressed in the apical membrane of monolayered cultured NHMEE cells. Apical UTP-induced [Ca(2+)](i) was inhibited by 2-aminoethoxydiphenyl borate (2-APB) but not by ryanodine. UTP-induced mucin secretion was inhibited by a Ca(2+) chelating agent, BAPTA-AM, and was stimulated by ionomycin. UTP-induced mucin secretion was also suppressed by U73122 and 2-APB, while Calphostin C suppressed it to a small extent and PD98059 was ineffective. Caffeine also inhibited the UTP-induced [Ca(2+)](i) and mucin secretion. These results suggest that the P2Y(2) receptor is expressed in NHMEE cells, and plays a major role in modulating the [Ca(2+)](i) from the IP(3)-sensitive intracellular Ca(2+) store. UTP-induced mucin secretion in NHMEE cells is strongly dependent on Ca(2+)- and IP(3).restrictio

Clinical study on metabolic liver diseases in infancy and childhood

의학과/석사[한글] 간장은 체내 탄수화물, 지질, 단백, 무기질 및 비타민 등의 합성, 분해, 조절 등의 대사과정에 중추적인 역할을 하는 장기로, 효소결핍 혹은 대사이상으로 인하여 간장에 영향을 줄 때 선천성 대사질환들이 발생될 수 있다. 이러한 질환들의 임상양상은 감염성, 중독성 혹은 다른 전신질환 등의 다양한 임상소견과 매우 유사하게 나타날 수 있어 진단시 주의를 요하며, 그 병리기전의 정확한 이해와 조기진단이 앞으로 치료 및 예후에 결정적인 역할을 할 수 있다. 한편 우리나라에서는 상대적으로 적은 환아의 수와 더불어 이 병에 대한 관심이 적고 확진방법의 문제점 등으로 다른 분야보다 낙후된 상태에 있으며 이러한 선천성 대사성 간질환에 대한 문헌을 찾아보기 힘든 실정에 있다. 이에 저자는 1980년 1월부터 1990년 12월까지 만 11년동안 연세의대 세브란스병원 소아과에 내원하였던 선천성 대사질환 환아들중 간장에 이상 소견을 보였던 환아들을 대상으로 원인질환별 분포상태, 임상소견, 검사소견 및 병리학적 소견 등을 알아보고자 본 연구를 시행하여 다음과 같은 결과를 얻었다. 1. 선천성 대사질환 환아 62례 중 30례(48%)에서 간장에 이상소견이 있었으며, 그 원인질환으로는 당원병 11례, 윌슨병 9례, 고세병 4례, phenylketonuria 2례, mucopolysaccharidosis 2례, hereditary tyrosinemia 1례, histidinemia 1례 등이 있었다. 2. 전체적으로 볼 때 연령 및 성별 분포는, 1-5세 사이의 연령군이 전체의 43%로 가장 많았고, 남녀의 비는 1:1.1로 거의 비슷하였다. 대사성간질환의 성별 분포는 당원병과 윌슨병은 남녀 비가 각각 5:6 및 5:4로 비슷하였으나 고세병은 1:3으로 여아에 호발하였다. 3. 진단시 연령은 윌슨병이 11.3세로 가장 높았고 당원병으로 4.9세, phenylketonuria 4.0세 순이었으며, 진단시까지 증상이 지속되었던 기간은 phenylketonuria가 48.5개월로 가장 길었고 당원병이 29.1개월 등의 순이었다. 4. 재태기간, 출생시 체중 및 입원당시 성장상태는 90%의 환아가 재태연령이 37주 이상이었고 6.7%의 환아만이 출생시 체중이 2.5kg미만의 저체중아였으나, 연령이 증가하면서 해당연령에 대한 체중 및 신장으로 평가한 성장상태가 50 백분위수 (percentile) 미만인 환아가 각각 30례중 21례(70%) 및 16례중 9례(56%)인 것으로 보아 점차 성장장애가 온다는 점을 관찰할 수 있었다. 5. 임상소견으로는 간장종대(53%), 비장종대(43%), 간비장종대(40%), 복부팽만(40%), 성장장애(30%) 등의 순으로 많았으며, 질환별 간비장종대의 소견으로, 당원병에서는 간장종대가, 고세병에서는 비장종대의 소견이 심함을 알 수 있었다. 6. 총 30례중 14례(47%)에서 가족력이 있었으며, 그중 형제가 9례(30%)로 가장 많았다. 7. 검사소견으로는 총30례중, 전례에서 AST의 상승, 18례(60%)에서 ALT의 상승, 15례(50%)에서 빈혈 및 11례(37%)에서 혈청 bilirubin 농도의 상승소견등을 볼 수 있었다. 8. 병리소견으로는 주로 당원병에서 간장세포의 팽윤, 당원핵, 간내담즙정체, 지방화 등의 소견을 볼 수 있었고, 윌슨병에서는 간경변이, 고세병에서는 고세세포 등이 주 소견이었다. 결론적으로 소아기 선천성 대사질환 환아의 약 50%에서 간장의 이상이 초래되며 그 주요 질환으로 우리나라에서는 당원병, 윌슨병, 고세병 등이 가장 많음을 알 수 있었다. 따라서 소아에서 원인 불명의 간장 및 비장 종대를 동반하면서 간기능 이상 소견이 있을 때 가능한 간생검을 시행함으로써 조기에 선천성 대사성 간질환을 발견할 수 있을 것으로 생각된다. [영문] The liver plays a central role in synthetic, degradative, and regulatory pathways involving the metabolism of carbohydrates, protein, lipid, mineral, and vitamins. There are many metabolic abnormalities or specific enzyme deficiencies that affect the liver. The clinical manifestations of metabolic diseases of the liver mimic infections, intoxications, and other systemic diseases. The comprehension of the pathogenesis on the inborn metabolic errors and early diagnosis are essential to a good prognosis. But there are few reports on this category of the diseases in Korea, probably because of relatively low incidence, low index of suspicion, and lack of confirmative diagnostic tools. This investigative study of the clinical, laboratory, and pathologic findings of the underlying conditions of the patients, who were admitted during the period from January 1980 to December 1990 with the metabolic diseases related to the hepatic dysfunction to the department of Pediatrics, Yonsei University College of Medicine. The results were as follows: 1. There were obvious liver disorders in 30 cases of 62 patients (48%) with the inborn errors of metabolism, including glycogen storage disease, wilson disease, Gaucher disease, hereditary tyrosinemia, histidinemia, phenylketonuria and mucopolysaccharidosis. 2. These metabolic problems were most common in the age group of 1 to 5 years old age group, and there was no statistical significance in sex ratio, except in Gaucher disdisease, where there was a female predominance(1:3). 3. The eldest group at diagnosis was those with Wilson disease and the longest duration between the onset of symptoms and the diagnosis was in cases of phenylketonuria. 4. More than 90% of the patients were of the full-term and of average gestational age. Only 6.7% of the patients were of low birth weights, but 70% and 56% were below the 50th percentile in weight and height, repectively, on admission. Therefore, there was growth retardation after birth. 5. Frequent clinical manifestations included hepatomegaly (53%), splenomegaly(43%), hepatosplenomegaly(40%), abdominal distension (40%) and growth retardation (30%). The major enlarged organs in GSD and Gaucher disease were the liver and the spleen. 6. Family histories were found in 47% of the patients, most frequent(30%) in siblings. 7. The laboratory findings were anemia(50%), elevated AST(100%), elevated ALT(60%) and elevated serum total bilirubin level(37%). 8. the pathologic findings on liver biopsy were hepatocyte swelling, glycogen nuclei, intrahepatic cholestasis and fatty changes. The above results indicate there were obvious liver disorders in about half of the patients with the inborn errors of metabolism, such as glycogen storage disease, Wilson disease, and Gaucher disease in Korea. Further evaluations of the liver, such as the liver biopsy, are essential to early diagnosis and good prognosis for the inborn errors of metabolism and should be required in the patients with the unknown hepatomegaly, splenomegaly, and deteriorated liver function.restrictio

Factors associated with unmet needs of daily living assistance in the disabled elderly.

보건정책 및 관리학과/석사[한글] 전 세계적으로 노인인구가 급속하게 증가하고 있으며, 우리나라의 경우도 고령사회에 이르는 속도가 빠르게 진행되고 있다. 노년기는 신체적, 정신적으로 기능이 저하되고 질병 이환율이 증가한다. 신체기능장애로 활동이 어려워지면 가족 부양 등 수발을 요구하게 되는데 현재 그 실태파악이 부족한 실정이다. 그러므로 이 연구는 수원시에 거주하는 65세 이상의 재가노인 979명을 대상으로 일상생활 수행능력(ADL)과 수단적 일상생활 수행능력(IADL)의 장애 실태를 조사하여, 수발 미충족 수요를 파악하고 일반적특성과 건강상태, 사회적 지원, 서비스 이용 등 여러 요인들과 관련이 있는지 규명하고자 하였다. 신체기능의 장애 실태는, ADL에서 앉았다 일어서기(16.8%)와, IADL의 대중교통수단 이용(26.8%)에서 가장 높았으며, 각각에 2개 이상의 장애를 지닌 노인도 모두 55%이상으로 높게 나타났다. 미충족 수요는 ADL에 목욕하기(35.6%)가 가장 많았고, IADL은 물건구입(26.5%)과 대중교통수단 이용(26.4%)이 비슷한분포로 높게 나타났다. 또한 1개 이상의 미충족 항목을 지닌 경우는 ADL(33.7%)이 IADL(29.4%)보다 높음을 알 수 있었다. ADL의 미충족과 관련 있는 요인으로는 교육수준(p<.048)과 관절염(p<.017), ADL 장애 수(p<.012)로 분석되었고, IADL은 관절염(p<.000), IADL장애 수(p<.046), 입원여부(p<.039)이었다. 미충족과 전체 요인과의 다변량 분석에서는 ADL, IADL 모두 장애 수와 관절염이 유의하여, 대부분의 노인들이 일상생활을 수행하는데 있어 장애가 많을수록 어려움이 많고, 수발에 대한 욕구도 커지는 것을 알 수 있었다. 또한 복지보다는 보건 측면에 미충족 수요가 많아 상대적으로 제공이 미흡한 보건의료서비스에 욕구가 큰 것으로 보였다. 관절염은 우리나라 노인에게 가장 많이 나타나는 만성질환뿐 아니라 수발 욕구도 높았다. 항목별 분석에서는 관절염과 요통, 입원, 장애 수 등 여러 요인들과 관련이 있었고, 특히 입원은 목욕하기(p<.048), 앉았다 일어서기(p<.037), 화장실 이용(p<.009), 물건구입(p<.012)에서 모두 미충족 수요와 관련 있는 요인으로 분석되었다. 따라서 노인은 재가보호 뿐 아니라 시설보호에 있어서도 많은 욕구를 가지는 것으로 나타났다. 이에 노인 수발 미충족에 대한 연구는 장기요양서비스의 잠재 수요를 예상할 수 있다는 점에서 좋은 근거 자료가 될 것이다. 향후 노인의 기능상태 변화나 수발 수요의 장기 추적 조사는 전체 지역사회로 확대 실시되어져야 하며, 노인 삶의 질 향상을 위해 국가가 뒷받침하는 시책으로 거듭나야 할 것이다. [영문] The population of the elderly is increasing rapidly throughout the world and also in Korea. Physical and mental functions decrease and the disease rate increases in older people. Once daily living gets difficult in the elderly due to decreased physical functions, the elderly require assistance from people such as from their families. However, data are currently lacking on the factors associated with daily living assistance. Thus, we investigated the status related with ADL(activities of daily living) and IADL (instrumental activities of daily living) in 979 community dwelling older people older than 65 years of ge residing in Suwon city in order to determine the unmet needs of assistance and relationship with several factors such as general characteristics, health status, social support and service utilization. The most prevalent handicap associated with physical functions was transferring(16.8%) in ADL and was using public transportation(26.8%) in IADL. The rate of having more than 2 handicaps was high at 55%. The most prevalent unmet needs were bathing(35.6%) in ADL, and buying products(26.5%) and using public transportation(26.4%) in IADL. A higher rate of more than one unmet need was present in ADL(33.7%) compared with IADL(29.4%). The factors associated with unmet need in ADL were education level(p<.048), arthritis(p<.017), and the number of ADL handicaps(p<.012). The factors associated with unmet need in IADL were arthritis(p<.000), the number of IADL handicaps(p<.046), and hospitalization(p<.039). Multiple analysis of variance of unmet needs showed a significant relationship with the number of handicaps and arthritis in both ADL and IADL, suggesting that the elderly experience more difficulty and require more assistance with more number of handicaps. Furthermore, more need was present from the health sector rather than the welfare sector, showing more need for health and welfare services, which are lagging in Korea. Arthritis is a chronic disease most prevalent in the Korean elderly and required a high rate of assistance. According to each item, arthritis, back pain, hospitalization and number of handicaps were associated with unmet needs. Hospitalization especially was the factor related with all unmet needs such as bathing(p<.048),transferring(p<.037), using toilet(p<.009), buying products(p<.012). Therefore, the elderly had many needs requiring both community and institutional care. Studies on unmet needs for assisting the elderly would provide good data for predicting the potential need for long care services. Long-terms studies on functional changes or the need for assistance should be conducted in different regions and the results of these studies should be reflected in national policies for improving the quality of life in the elderly.ope

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Thesis(master`s)--서울대학교 국제대학원 :국제학과(국제협력전공),2007.Maste