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      공황 발작으로 인한 응급실 내원과 대기 오염의 연관성 : 시간-층화 환자-교차 연구 = Emergency Department Visits for Panic Attacks and Ambient Air Pollution: A Time-Stratified Case-Crossover Analysis

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      다국어 초록 (Multilingual Abstract)

      Objectives This study investigates the association between short-term exposure to air pollutants and panic attacks requiring emergency department (ED) visits. Methods We identified 1926 patients who visited EDs in Seoul with panic attacks as the primary cause during the period from 2008 to 2014. We estimated short-term exposure to particles <2.5 μm (PM2.5), particles <10 μm (PM10), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), ozone (O₃), and carbon monoxide (CO). We applied a time-stratified case-crossover study design and conducted a conditional logistic regression analysis to assess the association between air pollutants levels and ED visits due to panic attacks. Results Increasing O₃ concentration was significantly associated with an increased risk of panic attacks requiring ED visits (odds ratio: 1.15; 95% confidence interval: 1.04-1.27) on the same day of exposure. This association was robust to the sensitivity analysis using two pollutant models. Conclusion Our results show that short-term exposure to elevated O₃ concentration is associated with the exacerbation of panic attacks. This finding strongly suggests the detrimental effects of O₃ on major public health problems and provides insights for further research to investigate the causal associations between air pollution and poor mental health.
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      Objectives This study investigates the association between short-term exposure to air pollutants and panic attacks requiring emergency department (ED) visits. Methods We identified 1926 patients who visited EDs in Seoul with panic attacks as the prima...

      Objectives This study investigates the association between short-term exposure to air pollutants and panic attacks requiring emergency department (ED) visits. Methods We identified 1926 patients who visited EDs in Seoul with panic attacks as the primary cause during the period from 2008 to 2014. We estimated short-term exposure to particles <2.5 μm (PM2.5), particles <10 μm (PM10), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), ozone (O₃), and carbon monoxide (CO). We applied a time-stratified case-crossover study design and conducted a conditional logistic regression analysis to assess the association between air pollutants levels and ED visits due to panic attacks. Results Increasing O₃ concentration was significantly associated with an increased risk of panic attacks requiring ED visits (odds ratio: 1.15; 95% confidence interval: 1.04-1.27) on the same day of exposure. This association was robust to the sensitivity analysis using two pollutant models. Conclusion Our results show that short-term exposure to elevated O₃ concentration is associated with the exacerbation of panic attacks. This finding strongly suggests the detrimental effects of O₃ on major public health problems and provides insights for further research to investigate the causal associations between air pollution and poor mental health.

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      목차 (Table of Contents)

      • 서 론 방 법 결 과 고 찰 결 론
      • 서 론 방 법 결 과 고 찰 결 론
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      참고문헌 (Reference)

      1 Kim YP, "Trend of air quality in Seoul: policy and science" 18 : 2141-2156, 2018

      2 Hettema JM, "The structure of genetic and environmental risk factors for anxiety disorders in men and women" 62 : 182-189, 2005

      3 Power MC, "The relation between past exposure to fine particulate air pollution and prevalent anxiety: observational cohort study" 350 : h1111-, 2015

      4 Kessler RC, "The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication" 63 : 415-424, 2006

      5 Weissman MM, "The cross-national epidemiology of panic disorder" 54 : 305-309, 1997

      6 Maclure M, "The case-crossover design : a method for studying transient effects on the risk of acute events" 133 : 144-153, 1991

      7 Curriero FC, "Temperature and mortality in 11 cities of the eastern United States" 155 : 80-87, 2002

      8 Sheehan DV, "Serotonin in panic disorder and social phobia" 8 (8): 63-77, 1993

      9 Maron E, "Serotonin function in panic disorder: important, but why?" 31 : 1-11, 2006

      10 Atkinson RW, "Role of outdoor aeroallergens in asthma exacerbations : epidemiological evidence" 59 : 277-278, 2004

      1 Kim YP, "Trend of air quality in Seoul: policy and science" 18 : 2141-2156, 2018

      2 Hettema JM, "The structure of genetic and environmental risk factors for anxiety disorders in men and women" 62 : 182-189, 2005

      3 Power MC, "The relation between past exposure to fine particulate air pollution and prevalent anxiety: observational cohort study" 350 : h1111-, 2015

      4 Kessler RC, "The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication" 63 : 415-424, 2006

      5 Weissman MM, "The cross-national epidemiology of panic disorder" 54 : 305-309, 1997

      6 Maclure M, "The case-crossover design : a method for studying transient effects on the risk of acute events" 133 : 144-153, 1991

      7 Curriero FC, "Temperature and mortality in 11 cities of the eastern United States" 155 : 80-87, 2002

      8 Sheehan DV, "Serotonin in panic disorder and social phobia" 8 (8): 63-77, 1993

      9 Maron E, "Serotonin function in panic disorder: important, but why?" 31 : 1-11, 2006

      10 Atkinson RW, "Role of outdoor aeroallergens in asthma exacerbations : epidemiological evidence" 59 : 277-278, 2004

      11 Kim CS, "Regional deposition of inhaled particles in human lungs: comparison between men and women" 84 : 1834-1844, 1998

      12 Markowitz JS, "Quality of life in panic disorder" 46 : 984-992, 1989

      13 Scheel LD, "Physiologic, biochemical, immunologic and pathologic changes following ozone exposure" 14 : 67-80, 1959

      14 Freire RC, "Panic disorder respiratory subtype : a comparison between responses to hyperventilation and CO2 challenge tests" 157 : 307-310, 2008

      15 Dager SR, "Panic disorder precipitated by exposure to organic solvents in the work place" 144 : 1056-1058, 1987

      16 Fleet RP, "Panic disorder in emergency department chest pain patients:prevalence, comorbidity, suicidal ideation, and physician recognition" 101 : 371-380, 1996

      17 Asmundson GJ, "Panic disorder and agoraphobia : an overview and commentary on DSM-5 changes" 31 : 480-486, 2014

      18 Gackière F, "Ozone inhalation activates stress-responsive regions of the CNS" 117 : 961-972, 2011

      19 Mokoena ML, "Ozone exposure of Flinders Sensitive Line rats is a rodent translational model of neurobiological oxidative stress with relevance for depression and antidepressant response" 232 : 2921-2938, 2015

      20 Hovatta I, "Oxidative stress in anxiety and comorbid disorders" 68 : 261-275, 2010

      21 Sorahan T, "Non-differential misclassification of exposure always leads to an underestimate of risk : an incorrect conclusion" 51 : 839-840, 1994

      22 Thomson EM, "Mapping acute systemic effects of inhaled particulate matter and ozone : multiorgan gene expression and glucocorticoid activity" 135 : 169-181, 2013

      23 Morrow LA, "Increased incidence of anxiety and depressive disorders in persons with organic solvent exposure" 62 : 746-750, 2000

      24 Abelson JL, "Hypothalamic-pituitary-adrenal axis activity in panic disorder. 24-Hour secretion of corticotropin and cortisol" 53 : 323-331, 1996

      25 Forstner AJ, "Genome-wide association study of panic disorder reveals genetic overlap with neuroticism and depression" 2019

      26 Sheikh JI, "Gender differences in panic disorder : findings from the National Comorbidity Survey" 159 : 55-58, 2002

      27 Goldstein RB, "Familial aggregation and phenomenology of ‘early’-onset(at or before age 20 years)panic disorder" 54 : 271-278, 1997

      28 Olaya B, "Epidemiology of panic attacks, panic disorder and the moderating role of age: results from a population-based study" 241 : 627-633, 2018

      29 Bandelow B, "Epidemiology of anxiety disorders in the 21st century" 17 : 327-335, 2015

      30 Dorado-Martínez C, "Effects of different ozone doses on memory, motor activity and lipid peroxidation levels, in rats" 108 : 149-161, 2001

      31 Armstrong BG, "Effect of measurement error on epidemiological studies of environmental and occupational exposures" 55 : 651-656, 1998

      32 de Jonge P, "Cross-national epidemiology of panic disorder and panic attacks in the world mental health surveys" 33 : 1155-1177, 2016

      33 Smit F, "Costs of nine common mental disorders : implications for curative and preventive psychiatry" 9 : 193-200, 2006

      34 Tager IB, "Chronic exposure to ambient ozone and lung function in young adults" 16 : 751-759, 2005

      35 Kessler RC, "Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey" 27 : 1101-1119, 1997

      36 Janes H, "Case-crossover analyses of air pollution exposure data : referent selection strategies and their implications for bias" 16 : 717-726, 2005

      37 González-Piña R, "Brain monoamine changes in rats after short periods of ozone exposure" 22 : 63-66, 1997

      38 Copeland KT, "Bias due to misclassification in the estimation of relative risk" 105 : 488-495, 1977

      39 Kahn RS, "Behavioral indications for serotonin receptor hypersensitivity in panic dis order" 25 : 101-104, 1988

      40 Lu P, "Attributable risks associated with hospital outpatient visits for mental disorders due to air pollution : a multi-city study in China" 143 : 105906-, 2020

      41 Kim Y, "Association between air pollution and suicide in South Korea : a nationwide study" 10 : e0117929-, 2015

      42 Cho J, "Ambient ozone concentration and emergency department visits for panic attacks" 62 : 130-135, 2015

      43 Cho J, "Air pollution as a risk factor for depressive episode in patients with cardiovascular disease, diabetes mellitus, or asthma" 157 : 45-51, 2014

      44 Szyszkowicz M, "Air pollution and emergency department visits for suicide attempts in Vancouver, Canada" 4 : 79-86, 2010

      45 Szyszkowicz M, "Air pollution and daily emergency department visits for depression" 22 : 355-362, 2009

      46 Bell ML, "Adverse health effects of particulate air pollution : modification by air conditioning" 20 : 682-686, 2009

      47 Sirivelu MP, "Activation of the stress axis and neurochemical alterations in specific brain areas by concentrated ambient particle exposure with concomitant allergic airway disease" 114 : 870-874, 2006

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