Factors Associated with Depression Assessed by the Patient Health Questionnaire-2 in Long-Term Cancer Survivors

구애진,송윤미,신진영,고현영 대한가정의학회 2016 Korean Journal of Family Medicine Vol.37 No.4

Background: This cross-sectional study aimed to evaluate the prevalence of depressive disorders and factors associated in long-term cancer survivors. Methods: A total of 702 long-term cancer survivors over 5-years in remission were recruited in a university-affiliated tertiary hospital in Korea. Self-report using the Patient Health Questionnaire-2 and the Fatigue Severity Scale assessed depression and fatigue, respectively. Demographic characteristics, cancer-related clinical characteristics, comorbidity, health behaviors, and physical symptoms were assessed through the review of medical records or a structured self-administered questionnaire. Results: We identified 26.1% of patients who had a depressed mood or displayed a loss of interest. The most prevalent primary site of cancer was the stomach (65.2%), followed by lung, breast, colorectal, and thyroid cancer. We also found that 5.7% of subjects experienced double or triple primary cancers. Larger proportion among depressive group (89.1%) complained at least one physical problem than among non-depressive group (53.2%). Physical symptoms including sleep problems, dry mouth, indigestion, pain, decreased appetite, and febrile sense were more frequent in the depressive group than in the non-depressive group. The Fatigue Severity Scale scores were higher in the depressive group than in the non-depressive group (P<0.001). Multiple logistic regression analysisshowed that the highest tertile level of fatigue (odds ratio, 7.31; 95% confidence interval, 3.81–14.02) was associated with the increased risk of depression. Conclusion: These findings suggest that careful concern about depression is necessary in long-term cancer survivors. Fatigue may be a surrogate sign for depression, and warrants further evaluation.

소아청소년 자폐성 스펙트럼 장애에서 SSRI 장기 사용에 대한 후향적 분석

구애진,박진박,이종일,진혜경,김예니,Goo, Ae-Jin,Park, Jin-Park,Lee, Jong-Il,Jhin, Hye-Kyung,Kim, Yeni 대한생물정신의학회 2012 생물정신의학 Vol.19 No.4

Objectives The purpose of this study was to investigate clinical profile, efficacy, and safety of long-term treatment with selective serotonin reuptake inhibitors (SSRIs) in Korean autism spectrum disorders (ASDs) patients. Methods Effectiveness was assessed through a retrospective review of self-reported target symptom improvement at the last follow-up visit. Changes in illness severity and improvement were measured using the Clinical Global Impression-Severity (CGI-S) of illness and Clinical Global Impression-Improvement (CGI-I) Scales. Tolerability was assessed through a review of the reason for discontinuation of SSRI and documented adverse events. Results A total of 21 ASDs patients (aged 9 to 19 years) treated with SSRI during July 2010 to July 2011 in department of child and adolescent psychiatry of Seoul National Hospital were identified. The mean duration of SSRI treatment was 47.9 (standard deviation = 36.9) months (range 0.7-114.5), and the mean fluoxetine equivalent dosage of SSRIs was $27.1{\pm}10.8$ mg. Nineteen (90.5%) patients were using concomitant medication. We found that SSRIs were prescribed for symptoms of agitation, stereotyped behavior, aggression, depression, impulsivity and self-injury in ASDs. Ten patients (47.6%) reported improvement in their target symptom after SSRI treatment based on CGI-I scores (CGI-I ${\leq}$ 2). The side effects were reported in 5 patients (23.8%) ; vomiting (n = 2, 9.5%), excessive mood elevation (n = 1, 4.8%), insomnia (n = 1, 4.8%), somnolence (n = 1, 4.8%) and decreased appetite (n = 1, 4.8%). Self-injurious behavior was reported in one patient (4.8%). Conclusions The results of this study suggest that SSRIs may be used effectively in children and adolescents diagnosed with ASDs. However, safety issues need to be considered carefully when choosing SSRIs for treatment. Future controlled trials are needed to confirm these findings.

제2형 당뇨병을 동반한 정신질환자의 당뇨병 관리 관련 요인: 당뇨 지식을 중심으로

주정민,구애진 대한가정의학회 2019 Korean Journal of Family Practice Vol.9 No.4

Background: Diabetes is a chronic disease that cause premature death worldwide. The rate of testing for diabetes among mentally ill patients is 1.5 times that of the general population, and intervention in diabetes care is needed for patient with severe mental illness and diabetes. Methods: This study was conducted using cross-sectional surveys distributed to patient with severe mental illness (n=54) among those who visited and were hospitalized at the National Mental Health Center. Results: According to the assessment of the knowledge level of diabetes in patient with severe mental illness accompanied by type 2 diabetes, the correct answer rate was lower than that in the general population. Education and income affected the level of diabetes knowledge, and as diabetes knowledge level increased, blood sugar level were observed to decrease. The linear regression model showed that self-efficacy and education level were found to be predictors of diabetes knowledge, and diabetes knowledge level were predictors of fasting blood sugar levels. Conclusion: The results of this study showed that the higher education level and self-efficacy of the patient with severe mental illness and diabetes increased the diabetes knowledge and affecting glycemic control. 연구배경: 당뇨병은 전세계적으로 조기사망을 초래하는 만성질환이며 정신질환자의 당뇨병 조사망률은 일반인구의 1.5배이다. 방법: 본 연구는 국립정신건강센터 외래 및 입원 환자 중 중증정신질환자(n=54)를 대상으로 단면조사를 실시한 것이다. 제2형 당뇨병을 동반한 중증정신질환자의 당뇨병 지식 수준 평가 결과 정답률은일반인구집단보다 낮았다. 결과: 교육수준, 소득이 당뇨 지식 수준에 영향을 미쳤으며, 당뇨 지식 수준이 높아질수록 공복혈당은 낮아지는 경향성을 관찰하였다. 선형 회귀 모형 작성 결과 자기효능감과 교육수준은 당뇨 지식 수준을, 당뇨 지식 수준은 공복혈당을 예측하는 변수로 확인되었다. 결론: 본 연구의 결과 제2 당뇨병을 가진 중증정신질환자의 높은 교육수준과 자기효능감은 당뇨 지식을 강화하며 공복혈당 조절에 영향을 미쳤다.

간호사의 신체화 증상과 정신건강의 관계

주정민,구애진,김성완,Joo, Jungmin,Goo, Ae Jin,Kim, Sung-Wan 한국정신신체의학회 2020 정신신체의학 Vol.28 No.2

연구목적 간호사의 신체화 증상과 스트레스, 우울 및 불안, 정신 증상 위험의 관계를 확인하여 정신신체의학 연구의 임상 근거를 창출하고, 신체화 증상의 의미에 대해 제고하는 것을 목적으로 한다. 방 법 서울시 내 1개 상급종합병원 외과계 중환자실 간호사 70명에게 자가기입형 도구(Perceived Stress scale, Fatigue Severity Scale, Patient Health questionnaire-15, Korean Beck Depression Inventory, Korean Beck Anxiety Inventory, Symptom Checklist-90-Revision)를 사용하여 수집한 데이터를 분석하였다. 결 과 대상자 중 12.9%가 신체화 증상을 경험하였고 피로, 낮은 에너지, 생리통, 허리 통증이 나타났다. 신체화 증상과 정신적 스트레스 인지의 통계적 관련성은 없었으나 불안한 느낌이나, 자신감의 감소는 신체화 증상의 수준과 관련이 있었다. 신체화 증상이 심한 집단은 우울, 불안을 더 많이 경험하였다. 신체적 피로가 높은 집단은 정신적 스트레스 인지의 통계적 관련성은 없었으나 긴장이나 스트레스를 느끼거나 통제력이 감소되는 경험에 영향을 미쳤다. 신체적 피로 수준의 증가는 불안과는 관련이 없었고 우울을 더 많이 경험하는 것으로 확인되었다. 신체화 수준이 높을수록 정신 증상 중 강박과 적대감이 증가하였다. 선형회귀모형에서 스트레스, 우울, 불안은 신체화 증상을 39.3%, 신체적 피로 증상을 16.1% 설명하였다. 결 론 이 연구의 결과를 바탕으로 우리는 한국 문화에서 신체화 증상의 특징으로 스트레스 인지 증상의 감소, 우울과 불안 경험, 강박 및 적대감의 동반 가능성을 추정할 수 있다. 이 연구에서 신체화와 정신 증상은 인과관계를 확인할 수 없었으나 상호관련성이 관찰되어 향후 중재 전략 마련에 참조할 수 있을 것이다. Objectives : To identify the relationship between somatization, stress, depression, anxiety, and psychological symptoms risk for nurses working in the intensive care unit. Create clinical evidence of psychosomatic medicine research and complement the meaning of somatization. Methods : Seventy of the mental health checkups conducted by the National Mental Health Center among the nurses using tools including Perceived Stress scale, Fatigue Severity Scale, Patient Health questionnaire-15, Korean Beck Depression Inventory, Korean Beck Anxiety Inventory, and Symptom Checklist-90-Revision. Results : 12.9% of the patients experienced more than moderate somatization. There was no statistical relationship between somatization and psychological stress perception, but feeling of anxiety and decreased self-confidence were related to the level of somatization. The group with severe somatization experienced more depression and anxiety. The group with high physical fatigue also had no statistical relationship with psychological stress perception, but had an effect on the feeling of tension, stress, or decreased control. Physical fatigue level was increased by experience of depression, not by anxiety. For psychological symptoms the higher the level of somatization, the higher the obsession and hostility was explored. In the linear regression model, stress, depression, and anxiety accounted for 39.3% of somatization and 16.1% of physical fatigue symptoms. Conclusions : We can estimate the decrease in stress cognitive symptoms, accompanying depression and anxiety, compulsion and hostility as characteristics of somatization. The causal relationship between somatization and psychological symptoms cannot be confirmed in this study, but the interrelationships are observed, can be referred to mediation strategies.

Validation Study for the Korean Version of Fear of Cancer Recurrence Inventory

신진영,구애진,고현영,김지혜,임승우,이한경,Sébastien Simard,송윤미 대한의학회 2017 Journal of Korean medical science Vol.32 No.11

Fear of cancer recurrence (FCR) is one of the most prevalent unmet psychosocial needs. This study aimed to confirm the cultural equivalence, reliability, and validity of the Korean version of Fear of Cancer Recurrence Inventory (K-FCRI). We conducted a forward–backward translation of the English version FCRI to Korean version through meticulous process including transcultural equivalence test. The psychometric property of the K-FCRI was then validated in 444 survivors from cancers at various sites. The Korean translation was accepted well by participants. There was a good cultural equivalence between the Korean version and the English version of FCRI. Confirmatory factor analysis supported the original seven-factor structure with slightly insufficient level of goodness-of-fit indices (comparative fit index = 0.900, non-normed fit index = 0.893, root mean square error of approximation = 0.060). The K-FCRI had high internal consistency (α = 0.85 for total scale and α = 0.77–0.87 for subscales) and test-retest reliability (r = 0.90 for total scale and r = 0.54–0.84 for subscales). The K-FCRI had significant correlations with the Korean version of Fear of Progression Questionnaire, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Version 3.0, Hospital Anxiety and Depression Scale, and Fatigue Severity Score, supporting the good construct validity and psychometric properties of K-FCRI. The K-FCRI was confirmed as a valid and reliable psychometric test for measuring FCR of Korean survivors from cancers at various sites.

국내 말기 의료 현황과 웰다잉법

이지은,구애진,조비룡 대한노인병학회 2016 Annals of geriatric medicine and research Vol.20 No.2

Recently, the Well-dying Act was legislated in Korea, and it will come into force in 2018. The rapid aging of this society has made many older patients and their families suffer from pain and disability for a long time towards the end of life. Hospice care, when compared to life-sustaining treatment, can relieve such burdens. Regarding the decision of choosing hospice care at the end of life, advance care planning and advance directives can help people express their preference beforehand. In Korea, hospice care is still not actively used and most patients endure life-sustaining treatment until death. Many patients want hospice care, but there has not been a legal basis for such a decision, leading to social conflict and many legal problems. The Well-dying Act will provide a legal basis for such a decision. This will help establish and promote hospice care in Korea. However, sufficient discussion and preparation are required before enforcing the Act.

장기 갑상선암 경험자의 관리

이지은,구애진,이규언,박도준,조비룡 대한의사협회 2016 대한의사협회지 Vol.59 No.4

Recently, thyroid cancer survivors are rapidly increasing in Korea, up to 21% of 1,234,879 total cancer survivors in 2012. The survival rate after thyroid cancer treatment is high, but many of the survivors suffer from fatigue, depressive mood and anxiety. Rarely, thyroid cancer treatment can result in long-term complications such as voice change and hypocalcemia. Thyroid-stimulating hormone suppression for preventing recurrence of thyroid cancer might lower bone density and increase risk of cardiovascular diseases including atrial fibrillation. For thyroid cancer survivorship care-management of such long-term complications, comorbid conditions and psychosocial problems, second primary cancer screening, promotion of healthy behaviors, support for family caregivers, role of primary care physicians is important. Systematic shared care between oncologists and primary care physicians is expected. And further research to generate evidence regarding effective management of thyroid cancer survivors is needed.

조현병 환자의 동반 만성신체질환 현황 및 총 의료비용에 관한 연구

이상욱,이예린,오인환,유빈,구애진,김유석,Lee, Sang-Uk,Lee, Ye-rin,Oh, In-Hwan,Ryu, Vin,Goo, Ae-Jin,Kim, You-Seok 한국정신신체의학회 2018 정신신체의학 Vol.26 No.1

연구목적 본 연구에서는 조현병 환자의 만성신체질환 유병현황을 확인하고, 총 의료비용에 미치는 영향을 제시하고자 하였다. 방 법 2014~2015년 건강보험심사평가원 자료를 활용하였으며, 자료의 정확성을 높이기 위하여 조현병 및 만성신체질환은 주/부상병으로 동일 상병을 3회이상 진단받은 경우만 해당 질환으로 분류하였다. 총 의료비용은 보건의료체계적 관점으로 보험자의 비용과 함께 본인부담비용을 포함하였다. 결 과 조현병 환자의 24.5%는 1개, 17.3%는 2개, 23.4%는 3개이상의 만성신체질환을 가지고 있는 것으로 나타났으며, 만성신체질환의 1~5순위는 만성위염/위식도역류질환이 27.3%, 알레르기가 19.5%, 고혈압이 13.2%, 만성요통이 11.0%, 당뇨병이 10.6%로 위장간질환 및 알레르기 질환, 대사성 질환뿐만 아니라 근골격계 질환의 유병률도 높게 나타났다. 2014년에 진단받은 조현병 환자의 2015년 총 의료비용은 약 1조 8백억원이었으며, 총 의료비용에 영향을 미치는 요인으로는 성별, 연령, 만성신체질환의 수, 건강보험여부로 나타났다. 결 론 조현병 환자의 만성신체질환의 문제를 해결하기 위한 접근방법은 단순히 개별 질환을 중심으로 치료하기 보다는 조현병 환자의 다양한 신체 질환을 동시에 치료 및 관리할 수 있는 새로운 형태의 진료체계에 대한 모델 개발이 필요할 것이다. Objectives : This study tried to explore the prevalence of chronic physical diseases in patients with schizophrenia and its effects on total medical costs. Methods : The Health Insurance Review and Assessment Service data in 2014-2015 was employed. Only the injuries and diseases, identically diagnosed 3 times or more as a major or minor injury and disease, were classified into chronic physical diseases to improve data accuracy. Total medical costs included out-of-pocket and insurer's costs from health care system perspective. Results : It was shown that 24.5%, 17.3% and 23.4% of schizophrenia patients had one, two and three or more chronic physical diseases, respectively. There was a high prevalence of not only metabolic, but also musculoskeletal, diseases in those patients. The amount of 2015 total medical costs of patients with schizophrenia in 2014 was about 1.08 trillion won. The factors affecting the costs included sex, age, number of chronic physical diseases, and health insurance status. Conclusions : It is considered that clinical practice guidelines based on personal diseases may not sufficiently solve the problems for comorbidities in schizophrenia patients. Accordingly, it should be required to develop models for new types of medical systems capable of treating and caring varied illnesses at the same time.

대나무 분말의 항산화력과 돼지의 면역 활성에 미치는 영향

송윤오 ( Yun O Song ),추교문 ( Gyo Moon Chu ),장선희 ( Sun Hee Jang ),구애진 ( Ae Jin Goo ),고응규 ( Yeoung Gyu Ko ),하지희 ( Ji Hee Ha ),이재형 ( Jae Young Lee ),강석남 ( Suk Nam Kang ),송영민 ( Young Min Song ),조재현 ( Jae Hyeo 한국동물위생학회 2014 韓國家畜衛生學會誌 Vol.37 No.2

본 연구는 대나무 분말의 항산화 활성이 비육돈에서 면역조절 효과에 미치는 영향을 구명하기 위해 실시하였으며, 이를 위해 대나무 분말 추출물의 항산화능을 검정하기 위하여, 총페놀 함량, 플라보노이드함량 및 DHHP, ABST, hydroxyl radical 등의 소거활성능을 알아보았다. 대나무 추출물의 항산화능은 높게 나타났으며, DPPH와 ABTS, HRSA 라디칼 소거능은 12∼21%였으며, 추출물의 유효성분으로 총페놀 함량은 171 mg/g이었으며, 플라보노이드 함량은 127.mg/g으로 나타났다. 다음으로 대나무 분말이 함유된 배합사료 급여시 돼지의 면역력에 미치는 영향을 알아보았다. 처리구에는 일반사료를 급여하였고, 시험구는 일반사료에 대나무분말을 1.0%, 2.0% 및 3.0%을 첨가하여 급여하였다. 대나무분말 첨가수준에 따라 혈액의 혈구계수 중 백혈구, 적혈구, 헤마토크리트 함량에서 유의적인 수준의 차이를 나타내지 않았다. 하지만 헤모글로빈 함량이 무처리 대조구에 비교하여 증가하였으며 특히 2∼3%의 처리구에서 헤모글로빈 함량은 높게 나타났다. 혈액 내 총단백질, 혈중알부민의 농도를 분석한 결과 처리구와 무처리구간에 유의적인 차이를 나타내지 않았다. AST, ALT 함량은 대나무 분말 처리군에서 무처리군보다 약간 높게 나타나지만 정상적인 범위내에서의 변화를 보였다. immunoglobulin에서 IgA와 IgG 농도는 무처리구에 비교하여 대나무 분말 처리구에서 높게 나타나고, IgA는 처리구 간의 차이가 나타나지 않았지만 IgG 농도에서는 대나무 추출물 2%, 3% 처리구가 1% 처리구에 비해 높은 수준을 나타냈다. TNF-α의 경우 무첨가구와 첨가구 사이의 유의적인 차이가 없었지만, 대나무 분말 첨가구에서 interferon-γ의 함량은 모든 첨가구에서 무처리 군보다 유의적으로 높게 나타났다. 특히 2%, 3% 처리구가 1%의 처리구 보다도 높은 interferon-γ의 함량을 나타내었다. 이는 대나무의 페놀, 또는 플라보노이드 성분에 기초한 높은 항산화력에 의하거나, 또는 대나무에 포함된 돼지 초기 면역반응을 활성화시킬 수 있는 물질에 의한 면역활성 증강에 따른 것으로 사료된다. 결론적으로 대나무 분말의 높은 항산화력은 돼지 면역력 향상에 기여하였으며, 특히 2∼3% 대나무 분말 첨가 사료는 돼지 생리활성을 크게 증강시키는 것으로 사료된다. The present study was designed to explore the antioxidant effect of Bamboo powder and its immunoreactivity in pigs. We investigated the functional properties of Bamboo extracts by means of measuring the contents of total polyphenols and flavonoid as well as determining ABST, DPPH radical scavenging activity, and hydroxyl radical scavenging activity and anticancer activity. The total phenolic compound and flavonoids contents of Bamboo extracts were 171.25 mg/g and 127.5 mg/g, respectively. The DPPH radical, hydroxyl radical, ABST radical scavenging activity of Bamboo extracts were 17.3%, 12.5% and 21.5%, respectively. Evidenced by MTT and cell cycle assay, Bamboo dose-dependently inhibited the cell proliferation and induced G0/G1-phase arrest in CHO cells at concentrations of 100, 250, and 500 μg/ml Bamboo extracts. More than 80% of apoptotic cells were observed by staining with annexin V in 500 μg/ml Bamboo-treated CHO cells, indicating that Bamboo had potent anticancer activities. Next, to investigate the effect of Bamboo on cytokine, immunoglobulin concentration, and blood compositions, flatting pigs were fed with Bamboo powder for 38 days. Flatting pigs were divided into 4 groups; basal diet (control), basal diet supplemented with 1% Bamboo powder (T1), 2% Bamboo powder (T2), and 3% Bamboo powder (T3). The level of hemoglobin increased in the all Bamboo-fed groups compared with the normal control group. In particular, platelet levels in the all Bamboo-treated groups increased by approximately 90% compared with the levels from pig on a normal control. Serum levels of immunoglobulins (IgG, IgA) in the pigs fed Bamboo powder were modestly increased, and the interferon-γ level also was strongly increased in 2% or 3% Bamboo-fed groups compared with the levels in control groups. Together, these results demonstrated that Bamboo extracts had an effective capacity of scavenging for ABTS, DPPH, and hydroxyl radicals and showed correlation with potent phenol and flavonoid contents, thus suggesting its antioxidant potential. Moreover, administration of Bamboo in 2∼3% improved blood parameters and platelets, and especially immunity-related ones such as IgG, IgA, and interferon- γ, leading to be potential feed additives in flatting pigs.

먹물버섯(Coprinus comatus )의 항산화 활성 및 Zucker rat에 대한 항비만 효과

이수정 ( Soo Jung Lee ),박형준 ( Hyoung Joon Park ),송윤오 ( Yuno Song ),장선희 ( Sun Hee Jang ),구애진 ( Ae Jin Goo ),고응규 ( Yeoung Gyu Ko ),조재현 ( Jae Hyeon Cho ) 한국동물위생학회 2014 韓國家畜衛生學會誌 Vol.37 No.1

The aim of the study was to investigate the anti-obesity effect of Coprinus comatus (CC) in high-fat diet-fed Zucker rat (fa/fa). Obesity was induced by feeding on high-fat diet (HFD) containing 60% kcal fat for 10 weeks, in which CC extracts were administrated through the gastrointestinal tract at a concentration of 200 mg/kg BW/day for 10 weeks. The total polyphenol and flavonoid contents of CC extracts were found to be 18.5±1.1 mg of catechin equivalent/g, and 5.24±0.54 mg of quercetin equivalent/g extract, respectively. The DPPH, ABTS, and hydroxyl radical scavenging activities of CC extracts were 15.34 %, 17.25%, and 16.18%, respectively. In animal study, CC administration significantly reduced the body weight, while there were no significant differences in the daily food intake between the HFD-fed Zucker rats and HFD plus CC-fed rats. CC treatment decreased epididymal and perirenal fat weights in HFD-fed Zucker rats. Significant decreases in the levels of triglyceride and total cholesterol in the serum and liver were observed in the CC-treated group compared with HFD-fed Zucker rats.Serum HDL-cholesterol levels in the CC-treated group were increased compared with the HFD-fed groups. Serum AST and ALT activities in the CC group were significantly lower than those of the HFD-fed group. Taken together, these data demonstrated that CC has potential in preventing high-fat diet induced obesity and is a good candidate for an anti-obesity agent.