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Evaluation and Management of Frailty, and Its Association With Pain (노쇠의 평가와 관리, 그리고 통증과의 연관성)

  • Kang Joon Lee
    • Korean Journal of Psychosomatic Medicine
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    • v.32 no.1
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    • pp.1-9
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    • 2024
  • Frailty is a clinical syndrome as an increased vulnerability to stressors, leading to a decrease in physiologic reserves and a decline in the ability to maintain a good homeostasis. This condition leads to an increased risk of hospitalization, disability and mortality. Frailty occurs due to various causes and requires a multidimensional approach. It is also important to detect and manage it early. Frailty is also deeply related to neuropsychiatric problems such as pain and depression. In evaluating frailty, it is desirable to comprehensively consider not only physical areas such as disease, nutrition, movement, and sensory functions, but also psychosocial areas, and representative scales include Fried's physical frailty phenotype and Rockwood's frailty index. Physical activity and appropriate protein intake are important for frailty management, and inappropriate drug use should be reduced and oral care, cognitive function, and falls should also be noted. Frailty and pain can affect each other, and pain can promote frailty. Evidence has been published that hormone and protein abnormalities, immune system activity and inflammatory response, and epigenetic mechanisms work in common in the field of frailty and pain. More extensive and high-quality research should be conducted in the future, and the quality of life will be improved if the results are applied to the suppression and treatment of old age and pain.

Effect of Acupuncture on Nasal Obstruction in Patients with Persistent Allergic Rhinitis: A Randomized Controlled Trial (지속성 알레르기비염의 비폐색에 대한 침치료의 효과: 무작위배정 대조군 연구)

  • Jo, Jeong-Hyo;Hong, Kweon-Eey;Kang, Wee-Chang;Choi, Sun-Mi;Park, Yang-Chun
    • Journal of Acupuncture Research
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    • v.22 no.6
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    • pp.229-239
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    • 2005
  • Objectives : Allergic rhinitis is a prevalent disease. Nasal obstruction is one of the main symptom in allergic rhinitis. It induces sleep disturbances, depression, attention deficit, memory impairments. Acupuncture treatment for rhinitis was mentioned in literature, but there is not enough report that provide evidence by well designed clinical study. The purpose of this research is to examine the effect of acupuncture treatment for nasal obstruction of allergic rhinitis. Methods : In this randomized, single blind, placebo-controlled study, we compared active acupuncture with minimal acupuncture for the treatment of nasal obstruction owing to persistent allergic rhinitis. Acupoints used in active acupuncture group were I120($Y{\hat{o}}nghyang$), GV23($Sangs{\hat{o}}ng$), IL4(Hapkok). Volunteers who satisfied the requirements were enrolled in study. Total nasal volume(NV) and total nasal minimum cross-sectional area(MCA) were measured by acoustic rhinometry before and after treatments(0min, 7.5min, 15min). Results : 101 subjects finished study. There were not difference between two groups on age, sex, weight, height, blood pressure, pulse, respiratory rate, severity of persistent allergic rhinitis, number of positive antigen. After treatment(0min) total NV were significantly increased compared with before treatment in active acupuncture group(p=0.0007) and minimal acupuncture group(p=0.0175). After treatment(15min) total NV of minimal acupuncture group was decreased compared with before treatment(p=0.2560), but total NV of active acupuncture group was maintained increasing in degree of borderline significance(p=0.0871). After treatment(0min) total NV were significantly increased compared with before treatment in active acupuncture group(0.0007) and minimal acupuncture group(p=0.0175). After treatment(Omin) total MCA were significantly increased compared with before treatment in active acupuncture group(p<0.000l) and minimal acupuncture group(p=0.0005). After treatment(15min) total MCA of minimal acupuncture group was decreased compared with before treatment(p=0.6082), but total NV of active acupuncture group was maintained increasing in degree of borderline significance(p=0.0929). Conclusion : Acupuncture treatment reduced nasal obstruction in persistent allergic rhinitis. Further study in the form of long term is needed.

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THE CLASSIFICATION OF ADOLESCENTS IN RUNAWAY SHELTERS BY THE EVALUATION OF THEIR PSYCHOPATHOLOGY (보호시설 가출청소년의 정신병리에 대한 평가와 분류)

  • Lee, Jong-Sung;Kwack, Young-Sook
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.12 no.2
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    • pp.192-217
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    • 2001
  • Object:This study was carried out to classify adolescents in runaway shelters by evaluating their psychopathology. And the ultimate purpose is to offer basic data for preventing adolescents‘ runaway and for diversifying runaway shelters suitable for the problem of individual adolescent. Method:128 adolescents who stay in the runaway shelters were asked to complete self-report qeustionnaires including basic sociodemographic data, Child Behavior Check List(CBCL), Minnesota Multiphasic Personality Inventory(MMPI), and Symptom Check List-90-Revised(SCL-90-R). Korean Wechsler Adult Intelligence Scale(K-WAIS)[or Korean Educational Developmental Institute-Wechsler Intelligence Scale for Children(KEDI-WISC)] and Bender-Gestalt test(BGT) were also done by clinical psychologists. Results:The most common age of the subjects were 15-year-old, and they dropped out their schools in the middle school most commonly. Mostly they were from middle class family and their parents' educational level were high school graduates. The first runaway episode was most common in the middleschool period, and their runaways were repeated. The most common frequency of runaways were more than 10 times. About 10% of them abused drugs and about 80% of them abused alcohol. One third of them had experiences of illegal problems and 10% of them engaged in sexual activity for money. 95 adolescents(83%) in CBCL, 42 adolescents(36%) in SCL-90-R, and 70 adolescents(69.3%) in MMPI showed clinical significance. In intelligence test, 22 adolescents(22%) were mentally retarded. In BGT, 35 adolescents(39.4%) manifested brain dysfunction signs. Conclusion:Runaway adolescents in the shelters have variable and severe psychopathology. Their psychopathology is classified as follows;The behavior disorder group, the mood disorder group with anxiety/depression, the somatic disorder group with somatic symptoms, and the psychosis group with possibility of severe psychopathology. Therefore it is very important to evaluate psychiatric problems of runaway adolescents, and specific therapeutic interventions according to their problems are required.

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Effect of Frequency of Using Forest Environment on Workers' Stress: a Comparative Study on Workers in Medical and Counseling Service Institution (산림환경 이용 빈도가 근로자의 스트레스에 미치는 영향: 의료 및 상담서비스기관 종사자에 대한 비교 연구)

  • Jung, Won Hee;Woo, Jong-Min;Ryu, Jee Soo
    • Journal of Korean Society of Forest Science
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    • v.103 no.1
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    • pp.129-136
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    • 2014
  • This study aims to investigate the effect of frequency of using forest environment on workers' stress. Workers in medical and counseling industry, which is recently known to require heavy emotional burden and thus cause a lot of stress and burnout syndrome, participated in the study. We classified 370 subjects, who were working at medical and counseling service institutions in Seoul metropolitan area, into two groups according to frequency of using forest environment by conducting a screening survey. 69 subjects submitted written consent and were recruited for either forest therapy program or control-group test; the "high" group (n=27) at the high frequency of using forest environment and the "low" group (n=42) at the low level. We measured the level of stress by using psychosocial indicators such as Worker's Stress Response Inventory (WSRI), Recovery Experience Questionnaire (REQ), and Maslach Burnout Inventory-General Survey (MBI-GS) and biological ones such as heart rate variability (HRV), cortisol, and Natural Killer cell (NK cell). The results suggested that the level of stress differed by frequency. The "high" group showed significantly low scores in the depression and work sub-scale and the total score of WSRI, emotional exhaustion, professional efficacy and total score of MBI-GS, and high scores in the total score of REQ. Similar tendencies were observed in the most of other indicators of psychosocial measures. Regarding the biological indicators, the "high" group showed the highest SDNN, RMSSD and TP measures of HRV and NK Cell activity and the low cortisol, although the statistical power did not reach the significant level. Our results suggest that the subjects who use forest environment frequently show favorable stress level both psychologically and biologically.

Differences in Grip Strength by Living Conditions and Living Area among Men and Women in Middle and Later Life (독거여부와 거주지역에 따른 중년기와 노년기 남성과 여성의 악력 차이)

  • Joo, Susanna;Jun, Hey Jung;Park, Hayoung
    • 한국노년학
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    • v.38 no.3
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    • pp.551-567
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    • 2018
  • Demographic and socio-structural information is useful to identify potential welfare recipients who are in need of disease-prevention and intervention services. Thus, the present study aims to explore the differences in grip strength among middle and old-aged adults by living conditions and by living area. The 5th wave data of Korean Longitudinal Study of Aging was utilized. The dependent variable was grip strength, and the independent variables were living alone (living alone or not) and living area (city or non-city). Covariates were age, education, log-transformed household income, spouse existence, body mass index, self-rated health conditions, depressive symptoms, cognitive function, smoking, regular exercise, frequency of meeting with friends, and the number of social participation. Regression analysis was performed for middle-aged men, middle-aged women, old-aged men, and old-aged women, respectively. ANOVA and Chi-test were additionally used to specifically discuss significant results. Cross-sectional weight was applied to all analyses. According to the results, living alone and living area did not have significant effects on grip strength among middle-aged men, old-aged men, and old-aged women. In middle-aged women, however, living alone and living area were significantly associated with grip strength. To be specific, middle-aged women who lived alone in rural areas had the lowest grip strength compared to other middle-aged women. Additional analysis showed that middle-aged women who lived alone in rural areas had risk factors, such as low education level, low income, or high depressive symptoms. It implies that middle-aged women living alone in rural areas may have physical health risks, so they might be in need of disease prevention. This study is meaningful in that it can provide reliable information on the latent welfare recipients by using representative panel data and applying weight values.

Characteristics of the Factor Structure of the Child Behavior Checklist Dysregulation Profile for School-aged Children (학령기 아동의 CBCL 조절곤란프로파일(Child Behavior Checklist Dysregulation Profile)의 요인구조와 특성)

  • Kim, Eun-young;Ha, Eun-hye
    • Korean Journal of School Psychology
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    • v.17 no.1
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    • pp.17-38
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    • 2020
  • This study examined the factor structure of the Child Behavior Checklist Dysregulation Profile(CBCL-DP) for school-aged children in Korea identified differences in the level of maladjustment and problematic behaviors between the clinical group which had characteristics of CBCL-DP and the control group which did not. Confirmative factor analysis was performed on three alternative models from the literature to determine which was the most appropriate factor structure for the CBCL-DP. The result showed that the bi-factor model fit the sample data better than both the one and second-factor models. To confirm that the bi-factor model was the most appropriate factor structure, regression paths with relevant variables examined. The showed that CBCL-DP with the bi-factor model was associated with executive function difficulty as reported by parents and with school adjustment and all sub-factors of strength and difficulty as reported by teachers. The results also showed that this model had a different relationship with anxiety/depression, aggressive behavior, and attention problems than the other models. The clinical group was shown to have more executive function difficulty, worse adjustment of school life and to be less likely to engage in desired behaviors than the control group. These results indicate the CBCL-DP is more related to negative outcomes than any other factor, and that the bi-factor model was found to best fit the sample data, consistent with other studies. The early discovery of CBCL-DP can be used to provide interventions for high-risk children who exhibit emotional and behavioral problems, making its detection a significant diagnostic tool. The implications of these result, the limitations of this study, and areas for future research are discussed in this paper.

Eating Traits and General Psychopathology of Korean Males Who Show High Score on the Korean Version of Eating Attitudes Test-26 (한국판(韓國版) 식사태도(食事態度) 검사(檢査)-26에서 고득점(高得點)을 보인 한국(韓國) 일반(一般) 남성군(男性群)의 식사특성(食事特性)과 일반정신병리(一般精神病理))

  • Han, Ki-Seok;Lee, Young-Ho;Rhee, Min-Kyu;Park, Se-Hyun;Sohn, Chang-Ho;Chung, Young-Cho;Hong, Sung-Kook;Lee, Byung-Kwan;Chang, Phi-Lip;Yoon, A-Rhee
    • Korean Journal of Psychosomatic Medicine
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    • v.7 no.1
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    • pp.87-102
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    • 1999
  • Objectives : The purposes of this study were to estimate the prevalence rate of eating disorders in Korean males and to clarify their characteristics in sociodemograhic data, the eating traits, and general psychopathology through the comparison with those of female high scored group on the Korean version of Eating Attitudes Test-26(KEAT-26). Methods : Using a multi-stage questionnaire sampling method including area sampling, proportionated stratified sampling, and quota sampling, we surveyed a total of 4,400 Korean adults over 18 in a nationwide area(9 kus, 10 middle or small cities, and 17 kuns), obtaining usable responses on 3,896. Of the 3,062 subjects(1249 males and 1813 females) who were available for analysis, we ascertained 52 males and 208 females who had high score($\geq$ cutoff point 21) on the KEAT-26. Results : 1) The proportion of this high score group was 1.7% in male and 6.8% in female with a sex ratio(male versus female) of 1 : 4. 2) The mean age was higher in the male group than in the female group, although it was not statistically significant(p=0.0514). Mean Body Mass Index(BMI) of the male group was significantly higher than that of female group, and the number of male subjects with below 20 of BMI was also significantly lower than in the female group. 3) There were no significant difference in past history of physical illness between two groups. However, frequency of smoking and alcohol use, and mean amount of alcohol consumption per month were significantly higher in the male group than in the female group. There were no significant differences between the two groups on various socio-demographic correlates such as economic status, total duration of education, number of family, marital status, religious status, and area of residence, but the exception of being occupational status. 4) The 'Eating Habits Scale' score and score of 'preference for vegetables and fish, and dislike for sweet-tasting food' of the male group were significantly lower than those of the female group. Although there was no significant difference between the two groups in total scores of the KEAT-26, the mean score on 'pursuit of thinness' subscale was higher in the female group than in the male group, while scores of 'food preoccupation' and 'self-control' subscales were higher in the male group than in the female group. 5) Scores on 'psychoticism' was significantly higher in the male group than in the female group, although there were no significant differences between the two groups on 'locus of control for weight', 'depression' and 'hypochondriasis'. Conclusion : These results support a possibility of a high prevalence of eating disorders in Korean males. These results suggest that eating related characteristics of high scorer on the EAT are different by sex in spite of the same high score on the EAT, and also suggest that male patients with eating disorders have more serious personality pathology than female patients with eating disorders.

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Nutritional Status and Health Risks of Low Income Elderly Women in Gwangju Area (광주지역 저소득층 여자노인의 영양상태와 건강위험요인에 관한 연구)

  • Yang, Eun-Ju;Bang, Hee-Myung
    • Journal of Nutrition and Health
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    • v.41 no.1
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    • pp.65-76
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    • 2008
  • This study was performed to identify association between nutritional status and health risks of the elderly. This was a cross-sectional study involving low income elderly women in Gwangju, Korea (${\geq}$65y, n = 92). Socio-demographics, life style characteristics, health conditions, dietary intakes based on 24h-recall method, anthropometric measures, and clinical biochemistry parameters were examined. Anthropometric and clinical parameters included wt, ht, waist, hip, body protein, body fat, abdominal fat, total cholesterol, HDL-cholesterol, triglyceride, total protein, albumin, hemoglobin, hematocrit, fasting blood glucose, ferritin, IL-2, IL-6, TNF-${\alpha}$, CRP, TAS, TBARS, systolic blood pressure, and diastolic blood pressure. The subjects were divided into three groups based on age (65-74y, 75-84y, 85y${\leq}$) and were divided into two groups according to the sum of the Nutrition Screening Initiative (NSI) checklist score (adequate nutritional status, NSI score ${\leq}$3; at risk of malnutrition, NSI score >3). Mean and frequency of variables were estimated. Analysis of Variance, Tukey test, Chi-square test, and Multiple linear regression analyses were performed. Mean BMI and body fat were 25.1 $kg/m^2$ and 40.0%, respectively. However, for over 80% of subjects, the intakes of energy, fiber, thiamin, riboflavin, niacin, folate, Ca, K, and Zn were less than the Korean DRI (EAR or AI). The subjects who had lower NSI score tended to have better health status, eat meals frequently, have less depression, and exercise regularly. The subjects who had higher NSI score tended to have tooth problems, to eat alone most of time, and to be physically unable to cook or feed. Serum IL-6 and TNF-${\alpha}$ were significantly related with nutritional status which suggested higher tendency of inflammatory response. Serum IL-2, TAS, and glucose were significantly correlated with body fat (%) or abdominal fat (%). These results suggest that improving the nutritional status, increasing regular exercise, maintaining normal weight are beneficial to health care of low income elderly women.

CLINICAL CHARACTERISTICS OF CHILDREN AND ADOLESCENTS WITH CONDUCT PROBLEMS ADMITTED INTO A PSYCHIATRIC UNIT (소아정신과 병동에 입원한 품행장애 소아 청소년의 임상 특성)

  • Pyo, Kyung-Sik;Kang, Yun-Hyong;Bahn, Geon-Ho;Cho, Soo-Churl;Lee, Eun-Jung
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.9 no.2
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    • pp.227-236
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    • 1998
  • Objectives:Conduct disorder is one of the most frequent diagnosis in outpatient and inpatient mental health facilities for children and adolescents. This study investigated the clinical characteristics of children and adolescents with conduct disorder. Methods:The study employed a retrospective review of 45 inpatients diagnosed with conduct disorder by DSM-IV criteria at SNUH Child Psychiatric Unit from 1993, March to 1998, September. Results:The results were as follows:1) The sex ratio was 2:1, male dominant. Mean age on admission was $12.8{\pm}2.4$ years old(male:$12.2{\pm}2.3$, female:$14.1{\pm}2.1$). The mean age of male subjects was significantly lower than that of female subjects(p<.05). 2) We classified all subjects according to child- or adolescent-onset type by DSM-Ⅳ. Childhoodonset type was 42.2%, and adolescent-onset, 57.8%. The onset of male subjects were significantly earlier than that of female subjects(p<.05). 3) The most common complaint was 'serious violation of rules'(77.8%) by DSM-Ⅳ dimensions, while the most common single symtom was 'run away from home overnight at least twice while living in parental or parental surrogate home'(48.9%). 4) The comorbid psychopathology of the subjects were frequently described as follows, in order of frequency:substance use(42.2%), ADHD(35.6%), depression(20.0%), tic disorder(11.1%), bipolar disorder(4.4%). 5) On MMPI, both Pd and Ma subscales got the highest scores. The mean of total IQ by KEDIWISC was $100.0{\pm}15.1$. Female subjects' IQ was higher than that of male subjects. 6) Regarding the number of visits to the OPD after discharge, many subjects(33.3%) had visited OPD fewer than four times. Conclusions:In this study, the male to female ratio of adolescent type showed a decreasing trend. An interesting finding was the fact that socio-economic circumstances, as well as the level of education among patients, were higher than those of previous studies. The subjects' problem were also principally self contered and posed no threat to others.

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The Relationship between Posttraumatic Stress Disorder and the Quality of Life among the Vietnam War Veterans (베트남전 참전 퇴역 군인에서 외상후스트레스장애와 삶의 질과의 관계)

  • Oum, Se-Joon;Choi, Jin-Hee;Kim, Tae-Yong;Chung, Hae-Gyung;Chung, Moon-Yong;So, Hyung-Seok
    • Korean Journal of Psychosomatic Medicine
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    • v.19 no.2
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    • pp.83-91
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    • 2011
  • Objectives: Posttraumatic stress disorder(PTSD) has devastating effects on multiple aspects of the quality of life(QoL). Therefore, the purpose of this study is to compare the QoL between PTSD group and non-PTSD group, and identify the variables affecting the QoL of the Vietnam War veterans. Methods: We recruited 39 veterans with PTSD and 43 veterans without PTSD, all of whom had deployed to the Vietnam War. We used the Korean version of Mini International Neuropsychiatric Interview-Plus, the Korean version of Clinician-Administered PTSD Scale, Combat Exposure Scale and the Korean version of World Health Organization Quality of Life Assessment Instrument abbreviated version. We used independent samples t-test to identify the differences between PTSD and non-PTSD group in each domains of the quality of life. We also used stepwise multiple linear regression analysis to figure out the variables affecting the QoL of the Vietnam War veterans. Results: In the PTSD group, all domains of the QoL and the QoL total score(p<0.01) were significantly lower than those in the non-PTSD group. In the Vietnam War veterans, PTSD, major depressive disorder and education levels were the variables affecting the QoL. Among these, PTSD uniquely explained the QoL of the overall and general health(${\beta}$=-1.411, $R^2$=0.180), the physical health domain(${\beta}$=-2.806, $R^2$=0.089) and the total score (${\beta}$=-11.479, $R^2$=0.104). Conclusions: These results suggest that among the Vietnam War veterans, the QoL of the PTSD group is significantly lower than that of the non-PTSD group. Among the combat exposed veterans, PTSD may be one of the main reasons that affect the multiple domains of the QoL.

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