왜 COVID-19는 노인에게 치명적인가?: 취약노인 지역사회케어 전략

서국희 한국보건의료기술평가학회 2020 보건의료기술평가 Vol.8 No.1

This review aims to answer the question of why the elderly mortality rate after SARS-CoV-2 infec- tion is greatly higher than younger population, and to propose practical ways for caring older dis- abled people in time of COVID-19 pandemic. Three databases (MEDLINE, EMBASE, and Co- chrane library) up to May, 2020 with the search terms (SARS-CoV-2, COVID-19, mortality, dementia, disability) were searched. Among searched papers, 55 were selected to review. Blood- brain barrier (BBB) dysfunction has been proposed as a mechanism of neuro-invasion or neuro-in- flammation caused by SARS-CoV-2 from peripheral to brain. ApoE4 is linked to BBB dysfunction, which may possibly increase the risk of central nervous system infection in Alzheimer’s disease (AD) patients even more. Korean Centers for Disease Control and Prevention indicates age-related steep increase in the mortality rate caused by COVID-19, which were 2.8% for those 60 to 69 years, 10.8% for those 70 to 79 years, and 25.5% for those 80 years or older. In light of the fact that older people with dementia show much higher mortality, elderly care strategies should aim to protect them from SARS-CoV-2 infection and to minimize the negative impacts associated with imple- mentation of public health interventions (i.e., lock-down, physical distancing). There are some evi- dences of neuro-invasion of SARS-CoV-2, which means older people with BBB dysfunction might be greatly vulnerable to brain infection leading to death. At-home and institutional care strategies for older disabled people are suggested.

한국어판 노인정신상태검사(GMS-AGECAT)의 신뢰도 및 타당도

서국희,연병길,류성곤,방현숙,이동우 대한신경정신의학회 2002 신경정신의학 Vol.41 No.6

연구목적: 본연구는 한국 노인인구에 대한 GMS-AGECAT(Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy)의 신뢰도 및 타당도를 확인하는 데 있다. 방 법: 여러 차례의 예비연구를 거쳐 번역위원회가 GMS-A3 판을 번역하여 한국어판 GMS를 제작하였다. 원래 영어판에서 거의 수정이 필요하지 않을 정도였다. 만 65세 이상 아산 지역사회 노인의 대표 무작 위 표본(N=1256)을 대상으로 진단적 타당도를 평가하였다. 이 단계 연구로 계획하였다. 1단계에는 비 전문가 평가자가 GMS-AGECAT 한국어판, MMSE, GDS를 사용하여 평가하였고, 2단계에는 정신과 전문의가 304명을 대상으로 DSM-Ⅳ로 임상적 진단을 내렸다. 신뢰도, 공시적 타당도 및 절차 타당도 를 구하기 위해, 한강성심병원에 입원한 만 65세 노인 환자 28명을 평가하였다. 결 과: GMS-AGECAT 진단의 신뢰도 지수는 평가자간 kappa=0.78, 검사-재검사 kappa=0.56이었다. 공시적 타당도를 위한 일치도 지수는 MMSE와 0.76, GDS와 0.73이었다. GMS 진단에 있어 비전문가 평가자 진단과 정신과 전문의 평가자 진단을 비교한 절차 타당도에 있어서는 사례/비사례 구분, 민감도 95.5%, 특이도 75%;기질성 구분, 민감도 100%, 특이도 83.3%;우울증 구분, 민감도 92.3%, 특이 도 100%이었다. DSM-IV 진단과 GMS-AGECAT 진단을 비교한 진단적 타당도에 있어서는 사례/비 사례 구분, 민감도 92.7%, 특이도 81%;치매 구분, 민감도 77.3%, 특이도 92.1%;우울증 구분, 민 감도 83.6%, 특이도 84.1%이었다. 결 론: 한국 노인인구에 대한 GMS-AGECAT의 신뢰도 및 타당도를 확인하였고, 국제적인 비교연구에 GMS 한국어판이 널리 사용될 것으로 기대한다 Objectives:This study aims to confirm the reliability and validity of the GMS-AGECAT(Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy) in a Korean elderly population. Methods:Translation committee developed Korean version GMS translating GMS-A3 after preliminary studies. Few changes from the original English version were necessary. A random sample(N= 1256) of the elderly(65+ years) in Asan, community was assessed for diagnostic validity. A two-phase study was designed:Korean version of GMS-AGECAT, MMSE and GDS rated by lay interviewer and clinical assessment by psychiatrists according to DSM-IV. A consecutive hospital sample(N=28) of the elderly(65 + years) admitted in Hangang Sacred Heart Hospital was assessed for reliability, concurrent & procedural validity. Results:Reliability coefficients of GMS-AGECAT diagnosis were Inter-rater kappa 0.78 and testretest kappa 0.56. Correlation coefficients for concurrent validity were 0.76 with MMSE and 0.73 with GDS. Procedural validity of psychiatrist’s GMS-AGECAT diagnosis and lay-interviewers’ were as follow:case/ no case distinction sensitivity 95.5%, specificity 75%;organicity distinction sensitivity 100%, specificity 83.3% and depression distinction, sensitivity 92.3%, specificity 100%. Diagnostic validity of DSM-IV diagnoses and GMS-AGECAT diagnoses were:case/ no case distinction sensitivity 92.7%, specificity 81%, dementia distinction sensitivity 77.3%, specificity 92.1% and depression distinction sensitivity 83.6%, specificity 84.1%. Conclusions:This study confirms the reliability and validity of the GMS-AGECAT in Korean elderly. Korean version GMS can be used in the international comparison studies

신종코로나 시대의 자유

서국희 한국보건의료기술평가학회 2021 보건의료기술평가 Vol.9 No.2

We are in the time of COVID-19, when structural weakness in each country’s health care system and social security system are clearly exposed. The pandemic will come to an end, but its long-term effects will change lives across economic, social and cultural spheres. This COVID-19 era is seriously asking whether individual freedom can be restricted in the name of public interest. If it can be restricted, it is important to clearly define what is public interest, and practically specify under what principles, whose liberty can be restricted in what ways and how much. Using the novel information and communication technologies, it is possible to monitor everyone anytime and anywhere. Even some governments have excellent surveillance systems. Some of them may try to keep the excellent surveillance system after COVID-19 era to collect and look into personal information under the pretext of establishing a long-lasting infectious disease monitoring system to protect public health. If people are forced to accept the offer and can’t stand it, wisdom of Stanley Milgram famous for his Eichmann experiment should be borrowed. First, responsibility and obligations of each person in charge at each stage of the related system must be clearly defined. Second, shift of responsibility to other person must not be allowed. Third, the 3rd party should constantly monitor compliance with all of them.

치매 기능평가를 위한 치매장애평가척도 한국어판의 개발

서국희 대한노인병학회 2003 대한노인병학회지 Vol.7 No.4

리스페리돈과 올란자핀의 후향적 비교 약물경제학적 연구

서국희,이태진 대한정신약물학회 2003 대한정신약물학회지 Vol.14 No.2

Objective: The study aims to compare daily treatment costs of risperidone and olanzapine in the Korean RODOS data. Methods: Retrospective inpatient chart review yielded pharmacoeconomic data of 1096 patients with schizophrenia and schizoaffective disorder. Results: The mean ± SD daily effective dose of olanzapine treatment was 14.9 ±5.3 mg compared to 5.1 ±1.8 mg for risperidone. Use of concomittant neuroleptics was higher in olanzapine group(risperidone 29%; olanzapine 35%; p=0.034), while use of other concomitant drugs was higher in risperidone group(risperidone 97%; olanzapine 90%; p<0.001). The mean ± SD total costs of all inpatient drugs was significantly higher (p< 0.001) for olanzapine (338,431 Korean Won± 289,884 ) than risperidone(114,775 Korean Won± 97,835). Although this difference in the average total costs in part reflects the longer treatment duration for olanzapine compared to risperidone (52 day versus 43 day), the cost difference remained when looking at costs on a daily basis and when correcting the baseline differences. The mean ± SD daily costs of all inpatient drugs was significantly higher (p< 0.001) for olanzapine (9,409 Korean Won± 10,767) than risperidone(4,475 Korean Won± 4,312). Conclusion: When both olanzapine and risperidone are considered appropriate, it is desirable to choose risperidone first in terms of the pharmacoeconomic consideration of the cost of these drugs.

지역사회거주 청소년의 우울증상 유병율

徐國熙,趙猛濟 서울醫大 1997 精神醫學 Vol.22 No.2

인간의 디지털화와 개인 맞춤형 의학

서국희 한국보건의료기술평가학회 2014 보건의료기술평가 Vol.2 No.1

좋은 죽음

서국희 한국보건의료기술평가학회 2014 보건의료기술평가 Vol.2 No.2

People do not recognize death during daily life. Their minds are full of wishes to be immortal, which are expressed as every measure for health promotion. In truth, deaths are nearly as unique as the lives that came before them. A death seems good if a person dies on his own terms, relatively free from pain, in a supported and dignified setting. In terms of social health care system, the categorical imperative “Do the right thing for the right reason” must be strongly considered. Some did the right thing for the wrong reason. The wrong reasons are mostly related to the utilitarianism, normative ethics holding that the proper course of action is the one that maximizes utility, especially considering cost-effectiveness. In any way, meaning itself is not in the death but in the life so that we can live more meaningful life as soon as we recognizes good death.

정신질환자 범죄 증가의 원인과 대책

서국희 한국보건의료기술평가학회 2019 보건의료기술평가 Vol.7 No.1

Hyper-dopaminergic state in the brain may show schizophrenia-like psychosis. Professionals state that psychosis is not a disease of mind but a disease of brain. Antipsychotics can easily lead to full remission of psychosis. However, psychosis easily relapses because people with psychosis stop taking medication after full remission. Since 2016, crimes by people with mental disorders have greatly increased. It is supposed that the revised mental health act has been working as one-way check valve system draining people with mental disorders in mental institutions into the community while near paralyzing mental institution admission system from community, causing explosive tension of criminal acts by rapidly increased fully psychotic patient in the community without treatment and rehabilitation. They need urgent medical intervention by psychiatrist in spite of self-refusal of treatment. There appears three ways to reduce explosive tension by fully psychotic patients in community. Firstly, patient in the neglect-abandonment land must be relocated into the treatment-rehabilitation land in the community to use long-acting antipsychotics injection every month, which would be expected to greatly reduce or remit psychotic symptoms and move next step for rehabilitation. Secondly, current mental health act should be revised again not to paralyze mental institution admission system and to allow admission of fully psychotic patients who need urgent medical intervention by psychiatrist. Judicial admission order might not be ideal because judge is not a professional for psychotic patient so that psychiatrist, the professional for psychotic patient would be a better individual to make decision for admission of fully psychotic patients who need urgent medical intervention. Thirdly, holding and caring capacity of judicial institution for medical treatment and custody should be expanded, and then this institution should increase close connection to the treatment-rehabilitation land in community to help people under judicial institution for medical treatment and custody successfully relocate after termination.

정보 공개 프레임의 명과 암

서국희 한국보건의료기술평가학회 2018 보건의료기술평가 Vol.6 No.1

Once searching for a disease, anyone can easily get detailed information about etiology, symptoms and signs, diagnosis, treatment and prognosis and so on. The number of patients, who finished diagnosis by themselves through internet search and visit a clinic or hospital to get the same medication for treatment suggested by internet, are increasing. This tendency may be caused by mixture of several factors like easy access of internet, distrust toward medical experts, and human right to know. These individuals are showing consumption pattern of purchasing goods from the consumers’ perspective. Even every hospital now calls the patient a customer. The biggest problem with the expertization of non-experts is that non-experts may not be able to properly understand every detailed information as these information truly means. It is a kind of homonym, or it is like a foreign language written in Hangul, especially in the field of medicine and law. Each medical or legal term has a definition but is written in common term for public use, but the public does not know that it is a medical or legal term with a definition. Disbelief of non-experts is much more likely to make them caught up in the market while internet searching to be new consumers for substances or foods that have never had proven efficacy or safety, which will eventually waste valuable personal assets. It is much worse that distrust toward experts cause doctor shopping, which may waste limited health resources unnecessarily. A frame is a mental construct that forms the way of individual world viewpoint. One formed, the frame determines whether good or bad. A frame consists of a series of unconscious cognitive processes so that the presence of a frame can only be seen through the outcome that is revealed. The frame of information disclosure, that individual has a right to know, supports the expertization of non-experts. In the 21st century, public demand for information disclosure has greatly increased. However, market is increasingly inclined to profit from and exploit increasing information disclosure, and to expand those benefits. It is the time to be aware of the seriousness of the unnecessary waste of personal assets and limited health resources due to expanding market.