노년기 치매와 우울증의 유병률 및 위험인자

서국희,김장규,연병길,박수경,유근영,양병국,김용식,조맹제 大韓神經精神醫學會 2000 신경정신의학 Vol.39 No.5

경기도 연천군에 거주하는 만 65세이상 노인 1,037명을 대상으로 1996년 12월부터 1997년 8월까지 9개월간에 걸쳐 치매와 노년기 우울장애의 유병률과 위험인자에 관한 이 단계 역학조사(일차선별검사후 이차 진단적 면접)를 수행하였다. 다단계 층화집락표본추출에 의한 확률표본법으로 대상자 선정을 하였고, 반응률은 85.2%이 었다. 일차선별검사에는 노인정신장애 평가척도 한국어판(K-PAS)을 사용하였고, 일상생활 능력척도(ADL) 및 수단적 일상생활 능력척도(IADL)를 사용하여 기능을 평가했고, 지지도 척도(APGAR)를 사용하여 사회적 지지정도를 평가하였다. 이차 진단적 면접에서는 진 신장애의 진단 및 통계편람 제3판 개정판(DSM-III-R)의 진단기준을 따라 임상 진단을 확정하였다. 감별진단 및 장애 정도의 평가를 위하여 보조적인 진단도구들을 사용하였다. 1) 연령 보정된 치매의 유병률(%)[95% 신뢰구간]은 6.83[6.12∼7.54](남자 6.34[5.29∼7.40], 여자7.09[6.14∼8.04]이었다. 이중 알쯔하이머형 치매의 유병률(%)[95% 신뢰구간]은 4.17[3.61∼4.74] (남자 2.42[1.76∼3.08], 여자 5.31[4.48∼6.14]이었고, 혈관성치매의 유별률(%)[95% 신뢰구간]은2.38[1.95∼2.81](남자 3.46[2.67∼4.25], 여자 1.63[1.16∼2.10])이었다. 2) 연령 보정된 우울장애의 유병률(%)[95% 신뢰구간]은 10.99[10.11∼11.87](남자 7.59[6.44∼8.73], 여자 13.46[12.20∼14.73])이었다. 진단별로는 주요 우울장애의 유병률(%)[95% 신뢰구간] 이 7.50[6.76∼8.26](남자 4.42[3.54∼5.31], 여자 9.78[8.68∼10.88]), 기분부전장애의 유병률(%)[95% 신뢰구간]이 2.02[1.62∼2.42](남자 1.37[0.86∼1.87], 여자 2.46[1.88∼3.03], 달리 특정되지 않은 우울장애 유병률 (%)[95% 신뢰구간]이 1.49[1.15∼1.83](남자 1.85[1.47∼2.23], 여자 1.28[0.96∼1.60])이었다. 3) 알쯔하이머형 치매의 통계적으로 유의한 5가지 위험인자는 85셍상의 고령(O.R.= 10.27), 무학(O.R.= 4.01), 흡연[흡연년수 0.1∼30년(O.R.= 3.11), 흡연년수 30년 이상 (O.R.= 4.60)], 알코올남용(O.R.= 2.98)과 치매의 가족력 (O.R.= 4.85)이었다. 4) 혈관성 치매의 통계적으로 유의한 3가지 위험인자는 '무학' (O.R.= 3.78), 흡연[40년 이상 흡연년수 (O.R.= 11.15)]과 '뇌졸중의 과거력 (O.R.= 26.76)'이었다. 5) 우울장애의 통계적으로 유의한 3가지 위험인자는 '75∼79세 연령군' (O.R.= 2.87), '뇌졸중의 과거력' (O.R.= 3.33)과 '우울장애의 가족력' (O.R.= 7.16)이었다. 중심단어:알쯔하이머형 치매·혈관성 치매·우울장애·유병률·위험인자·흡연. An epidemiological survey was conducted to estimate the prevalence of and identify the risk factors of dementia and depression in the elderly between December 1997 and August 1998 in Yonchon County, Korea. A total of 1,037 elderly aged 65 years and over underwent a two phase diagnocstc procedure. Multiple stage, random cluster sampling method was used to select the subjects. Response rate was 85.4%. For the Ist stage screening survey, the Korean Psych-ogeriatric Assessment Scale was used as a primary screening tool, which had already been standardized in Korea, and functioning and social support were assessed by ADL, IADL and APGAR. At the 2nd stage, diagnoses were confirmed according to the DSM-Ⅲ-R. And several other scales were used as supporting information for differential diagnoses and for evaluating severity. 1) Age-sex adjusted prevalence(%)[95% C.I] of dementia was 6.83[6.12-7.54](male 6.34 [5.29-7.40], female 7.09[6.14-8.04]). Prevalence of the dementia of the Alzheimer's type was 4.17[3.61-4.74](male 2.42[1.76-3.08], female 5.31[4.48-6.14]) and that of the va-scular dementia was 2.38[1.95-2.81](male 3.46[2.67-4.25],female 1.63[1.16-2.10]). 2) Age-sex adjusted prevalence(%)[95% C.I.] of depressive disorder was 10.99[10.11-11.87](male 7.59[6.44-8.73], female 1346[12.20-14.73]. Among depressive disorders, prev-alence(%)[95% C.I.] of major depressive disorder was 7.50[6.76-8.26](male 4.42[3.54-5.31], female 9.78[8.68-10.88]), that of dysthymic disorder was 2.02[1.62-2.42](male 1.37[0.86-1.87], female 2.46[1.88-3.03]) and that of depressive disorder NOS was 1.49[1.15-1.83](male 1.85[1.47-2.23], female 1.28[0.96-1.60]). 3) Five statistically significant risk factors of the dementia of the Alzheimer's type were identified : age over 85(O.R. = 10.27), illiteracy (O.R. = 4.01), alcohol abuse (O.R. = 2.98), smoking [0 < pack year ≤30(O.R. = 3.11), pack year>30(O.R. = 4.60)] and family history of dementia (O.R. = 4.85). 4) Three statistically significant risk factors of the vascular dementia were identified : illiteracy (O.R. = 3.78), history of CVA(O.R. = 26.76) and smoking over 40 pack year(O.R. = 11.15). 5) Three statistically significant risk factors of the depressive disorder were identifed : age between 75 and 79(O.R. = 2.87), past history of CVA(O.R. = 3.33) and family history of depressive disorder(O.R. = 7.16). KEY WORDS:Dementia of the Alzheimer's Type·Vascular dementia·Depressive disorder·Prevalence·Risk factor·Smoking.

정신분열병 환자를 위한 인지재활훈련 프로그램의 개발 : Korean-Cognitive Differentiation Program 한국형 인지분화훈련 프로그램

현명호,안석균,이만홍,조현상,최충식,이연희,송선미,유계준,김장우,김태용,이희상 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.2

연구배경 : 정신분열병 환자들은 인지장애를 보이는바, 저자들은 이들을 대상으로 한국형 인지분화훈련 프로그램을 개발하여 정신분열병 환자들을 대상으로 인지재활훈련을 실시한 후 환자들의 인지기능, 정신병리 및 문제해결기술에 미치는 효과를 조사하였다. 방 법 : 28명의 정신분열병 환자를 훈련군(n=14)과 대조군(n=14)으로 나누어 훈련군에게 한국형 인지분화훈련 프로그램을 1회 60분씩, 주당 2회씩, 11주간 총 22회를 실시하였다. 환자들의 인지기능은 K-WAIS의 산수, 빠진곳찾기, 어휘, 공통점찾기 소검사로 측정하였고 정신병리는 양성 및 음성증상 척도로 측정하였으며 문제해결기술은 사회문제해결척도로 평가하였다. 인지재활훈련의 효과를 평가하기 위해 훈련 전후의 인지기능, 정신병리 및 문제해결기술의 변화를 종속변수로 하고 훈련 유무를 독립변수로 하여 반복측정에 의한 변량분석으로 자료를 분석하였다. 결 과 : 한국형 인지분화훈련이 시간에 따른 인지기능검사 중 산수 소검사, 문제해결기술 중 시회문제해결척도의 전체 점수와 문제해결기술 소척도의 점수의 변화에 유의한 영향을 미쳤으나, 시각적 주의력, 개념화 능력 및 정신병리의 점수의 변화에 유의한 영향을 미치지 않았다. 결 론 : 한국형 인지분화훈련 프로그램은 정신분열병 환자에서 청각적 주의력 및 문제해결기술의 호전을 꾀할 가능성이 있음을 시사한다. Objectives : The purpose of this study was to investigate the effects of cognitive differentiation training program- Korean version(a training program of attention and conceptual abilities) on cognitive function, psychopathology and problem solving skills in patients with schizophrenia. Methods : A total of patients diagnosed as schizophrenia using DSM-Ⅳ were randomly assigned to 2 groups. The training group went through a total of 22 sessions of cognitive differentiation training(60 min/ session×2 sessions/wk×11 wks). The attention-placebo control group received psychoeducation program during the same period. Arithmetic, vocabulary, similarities, picture completion of Wechsler Adult Intelligence Scale-Korean version, Positive and Negative Syndrome Scale, and Social Problem Solving Scales were administered to all patients, both before and after the training program. Results : In the arithmetic scores(F=6.35, af=1, p=0.018) of Wechsler Adult Intelligence Scale-Korean version, and total scores(F=6.35, af=1, p=0.018) and problem solving skill scale scores(F=4.88, af=1, p=0.036) of social problem solving scale, interaction effects of training was significant. Conclusion : Our findings suggest that cognitive differentiation training program-Korean version is effective on improving auditory attention and problem solving skills in patients with schizophrenia.

2003년 국내 중증급성호흡기증후군 진료 현황 및 문제점 분석

이진수,김은실,정문현,백제중,정선화,안주희,최영화,이선희,고철우,김성범,김민자,박승철,기현균,송재훈,최상호,김양수,이상오,조용균,박영훈,정숙인,김연숙,이흥범,손창희,장성희,정희진,김우주 대한감염학회 2004 감염과 화학요법 Vol.36 No.3

목적 : 2002년 말 중국에서 SARS가 발생한 이후 국내에서도 2003년 10월까지 총 3명의 추정환자, 17명의 의심환자가 보고되었다. 향후 추가적인 SARS의 유행이 우려되는 상황에서, 그간의 SARS 환자 진료에 있어서의 실질적인 준비사항, 진료 현황 등에 대한 조사를 통해 문제점을 파악하여, 향후 더 나은 대비가 될 수 있도록 개선점을 제시하고자 하였다. 재료 및 방법 : SARS로 의심되는 환자를 진료 경험이 있는 병원의료진을 대상으로 2003년 10월에 설문조사를 실시하였다. 설문에는 SARS 환자 진료 시의 실질적인 조치, 진료 현황, 병실, 응급실 및 외래에서의 격리 시설과 준비사항, 보건당국의 관리와 지원에 관한 사항을 포함하였다. 결과 : 대상이 되는 22개 병원 중 17개(17/22, 77.2%) 병원이 설문에 응하였다. SARS 환자를 위한 격리실은 응급실, 외래, 일반병실 및 중환자실에서 각각 9개(9/17, 52.9%), 5개(5/17, 29.4%), 15개(15/16, 93.7%), 4개(4/16, 25%) 병원에서 음압처리가 되어있지 않은 일인실 혹은 다인실이 사용되었고, 1개(1/16, 6.3%) 병원에서만 일반병실에서 음압격리실이 운영되었다. 입원환자의 진찰 시 개인보호구의 착용은 거의 모든 의료기관에서 이루어졌다. 보건당국에서 SARS지정병원의 시설 등을 사전에 확인한 곳은 1곳(1/12, 8.3%)이였고, 14개 병원(14/15, 93.3%)에서는 보건당국에 의뢰한 검사결과를 통하 받지 못하였다. 결론 : 의료기관에서 SARS 환자용 격리실뿐만 아니라 기존의 격리실 설비 등이 미흡하였으며, 특히 중환자실 및 외래의 준비가 더욱 부족하였다. 보건당국의 의료기관에 대한 종합적인 지원이 부족하였고, 병원과의 원활한 연계가 잘 이루어지지 않았다. SARS 만이 아닌 격리를 필요로 하는 질환의 적절한 진료를 위해 향후 병원 시설의 정비와 정부차원에서의 보다 구체적이고 실질적인 대책마련이 필요하다. Background : There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. Materials & Methods : Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. Results : The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. Conclusions : The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.

A Real-world Cost-effectiveness Analysis of Sevelamer Versus Calcium Acetate in Korean Dialysis Patients

Cho, Jang-Hee,Jang, Hye Min,Jung, Hee-Yeon,Choi, Ji-Young,Park, Sun-Hee,Kim, Chan-Duck,Yang, Chul Woo,Jin, Dong-Chan,Kim, Yong-Lim Elsevier 2018 Clinical therapeutics Vol.40 No.1

<P><B>Abstract</B></P> <P><B>Purpose</B></P> <P>Sevelamer, a noncalcium phosphate binder, has been shown to attenuate the progression of vascular calcification and improve survival in patients with chronic kidney disease undergoing dialysis compared with calcium-based binders. Using real-world data from a cohort study and the Health Insurance Review and Assessment Service database, we conducted a cost-effectiveness analysis comparing sevelamer with calcium acetate in dialysis patients from the perspective of the National Health Insurance Service in South Korea.</P> <P><B>Methods</B></P> <P>Data (demographic, diagnostic, laboratory, and survival) from 4674 patients undergoing dialysis enrolled in a multicenter prospective cohort study conducted in South Korea between September 2008 and December 2012 were linked to phosphate binder use, hospitalization, and cost data available from the Health Insurance Review and Assessment Service database. After propensity score matching, a dataset comprising comparable patients treated with either sevelamer (n = 501) or calcium acetate (n = 501) was used in the cost-effectiveness analysis. A Markov model was used to estimate costs, life years, quality-adjusted life years (QALYs), and cost-effectiveness over each patient’s lifetime. Forty-month treatment-specific overall survival (OS) data available from the dataset were extrapolated to lifetime survival with the use of regression analysis.</P> <P><B>Findings</B></P> <P>Patients had a mean age of 56.3 years and were treated with dialysis for a mean duration of 67.6 months. Compared with calcium acetate, sevelamer was associated with an incremental cost of South Korean Won (₩) 12,246,911 ($10,819) and a gain of 1.758 life years and 1.108 QALYs per patient. This outcome yielded incremental cost-effectiveness ratios of ₩6,966,350 ($6154) and ₩11,057,699 ($9768) per life year and QALY gained, respectively. Conclusions regarding sevelamer’s cost-effectiveness were insensitive to alternative assumptions in time horizon, discount rate, hospitalization rate, costs, and health utility estimates, and they remained consistent in 100% of the model iterations, considering a willingness-to-pay threshold of ₩31,894,720 ($28,176) per QALY gained.</P> <P><B>Implications</B></P> <P>This analysis of real-world data found that sevelamer’s higher cost relative to calcium acetate was adequately offset by improved survival among patients undergoing dialysis in South Korea. As such, sevelamer offers good value for money, representing a cost-effective alternative to calcium-based binders.</P>

Symposia : Neurobiology: From Synapse to Memory ; TRPM8 mediated calcium influx in mast cells can induce menthol and cold allergy

( Yeon Gyo Cho ),( Chang Hun Lee ),( Young Duk Yang ),( Jae Yeon Koo ),( Seung Pyo Park ),( Min Ho Tak ),( Yong Woo Jang ),( Kyung Ha Shin ),( Jun Hee Pyo ),( Min Jung Kim ),( Min Kyung Kim ),( Ha Won 한국생화학분자생물학회 (구 한국생화학회) 2007 생화학분자생물학회 춘계학술발표논문집 Vol.2007 No.-

Poster Session : Neurobiology: From Synapse to Memory ; TRPM8 mediated calcium influx in mast cells can induce menthol and cold allergy

( Yeon Gyo Cho ),( Chang Hun Lee ),( Young Duk Yang ),( Jae Yeon Koo ),( Seung Pyo Park ),( Min Ho Tak ),( Yong Woo Jang ),( Kyung Ha Shin ),( Jun Hee Pyo ),( Min Jung Kim ),( Min Kyung Kim ),( Ha Won 한국생화학분자생물학회 (구 한국생화학회) 2007 생화학분자생물학회 춘계학술발표논문집 Vol.2007 No.-

Clinical Characteristics and Long-Term Prognosis of Alport Syndrome: A Retrospective Single-Center Study

Jang, Hea Min,Baek, Hee Sun,Park, Sun-Hee,Kim, Yong-Lim,Kim, Chan-Duck,Jung, Hee-Yeon,Cho, Jang-Hee,Han, Man Hoon,Kim, Yong Jin,Cho, Min Hyun Korean Society of Pediatric Nephrology 2020 Childhood kidney diseases Vol.24 No.2

Purpose: Alport syndrome (AS) is one of the most common inherited renal diseases caused due to mutations of genes encoding specific proteins of the type IV collagen family, and its major clinical manifestations include progressive renal failure, sensorineural deafness, and ocular abnormalities. We investigated the clinical characteristics and long-term prognosis of AS in Korean pediatric and adult populations. Methods: We conducted a retrospective review of medical records of 33 children and adults who had been diagnosed or treated with AS from 1985 to 2019. Results: The mean age of the 33 patients diagnosed with AS was 16.2±13.6 years, and the male-to-female ratio was 2:1. At the first visit, recurrent gross hematuria was the most common initial symptom. In 10 of 33 patients (30.3%), sensorineural hearing loss (SNHL) was diagnosed, but none had ophthalmic problems. Moreover, 11 of 33 patients (33.3%) had advanced to end-stage renal disease (ESRD), and a significant difference was observed in the age of the patients who progressed to ESRD based on the presence or absence of SNHL (P=0.035). Conclusion: SNHL in AS can be an important prognostic factor for long-term deterioration of renal function. Further investigation is required to confirm the clinical course and the genetic characteristics of AS in Korea through prospective national cohort studies.

Renal involvement in children and adolescents with inflammatory bowel disease

Jang, Hea Min,Baek, Hee Sun,Kim, Jung-Eun,Kim, Ju Young,Lee, Yeon Hee,Cho, Hee Yeon,Choe, Yon Ho,Kang, Ben,Choe, Byung-Ho,Choi, Bong Seok,Cho, Min Hyun The Korean Pediatric Society 2018 Clinical and Experimental Pediatrics (CEP) Vol.61 No.10

Purpose: The incidence of inflammatory bowel disease (IBD) is rapidly increasing, and several reports have described the renal complications of IBD. We sought to evaluate the clinical manifestations of renal complications in children with IBD in order to enable early detection and prompt treatment of the complications. Methods: We retrospectively reviewed the medical records of 456 children and adolescents aged <20 years who had been diagnosed with IBD since 2000. We analyzed patient age, sex, medication use, IBD disease activity, and clinical manifestations of renal symptoms. Results: Our study comprising 456 children with IBD included 299 boys (65.6%) and 157 girls (34.4%). The study included 346 children with Crohn disease and 110 children with ulcerative colitis. The incidence of kidney-related symptoms was 14.7%, which was significantly higher than that in normal children. We observed 26 children (38.8%) with isolated hematuria, 30 children (44.8%) with isolated proteinuria, and 11 children (16.4%) with hematuria and concomitant proteinuria. A renal biopsy was performed in 7 children. Histopathological examination revealed immunoglobulin A nephropathy in 5 children (71.4%). All children presented with mild disease and well-controlled disease activity of IBD. Conclusion: Children with IBD are more likely to show kidney-related symptoms than healthy children and adolescents are. Therefore, regular screening of urine and evaluation of renal function in such children are necessary for early detection of renal complications.

Impact of Dialysis Modality on the Incidence of 2009 Pandemic H1N1 Influenza in End-Stage Renal Disease Patients

Cho, Jang-Hee,Do, Jun-Young,Kim, Sung-Ho,Kim, Jong-Yeon,Seo, Jung-Ju,Choi, Ji-Young,Park, Sun-Hee,Kim, Chan-Duck,Jung, Sun-Young,Cho, Kyu-Hyang,Park, Jong-Won,Lee, Duk-Hyun,Song, Kyung Eun,Kim, Yong-L SAGE Publications 2011 Peritoneal dialysis international Vol.31 No.3

Immunologic Monitoring of T-Lymphocyte Subsets and Hla-Dr-Positive Monocytes in Kidney Transplant Recipients : A Prospective, Observational Cohort Study

Cho, Jang-Hee,Yoon, Young-Deuk,Jang, Hye Min,Kwon, Eugene,Jung, Hee-Yeon,Choi, Ji-Young,Park, Sun-Hee,Kim, Yong-Lim,Kim, Hyung-Kee,Huh, Seung,Won, Dong-Il,Kim, Chan-Duck Wolters Kluwer Health 2015 Medicine Vol.94 No.44

<P><B>Abstract</B></P><P>The clinical significance of circulating T-lymphocyte subsets and human leukocyte antigen (HLA)-DR-positive monocytes in the peripheral blood of kidney transplant recipients (KTRs) remains unclear. We examined the efficacy of enumerating these cells for the immunologic monitoring of KTRs.</P><P>Blood samples were obtained before transplantation, 2 weeks after transplantation and at diagnosis, and 2 weeks after treating biopsy-proven acute cellular rejection and cytomegalovirus (CMV) infection. Serial flow cytometric analysis was performed using peripheral blood obtained from 123 patients to identify the frequencies of HLA-DR<SUP>+</SUP>, CD3<SUP>+</SUP>, CD4<SUP>+</SUP>, CD8<SUP>+</SUP>, and CD25<SUP>+</SUP> T-lymphocytes and HLA-DR-positive monocytes.</P><P>Frequencies of CD4<SUP>+</SUP>CD25<SUP>+</SUP>/CD4<SUP>+</SUP> T cells, CD8<SUP>+</SUP>CD25<SUP>+</SUP>/CD8<SUP>+</SUP> T cells, and HLA-DR-positive monocytes were significantly lower at 2 weeks after transplantation than before transplantation (all <I>P</I> < 0.001). This decrease was not correlated with clinical parameters. The frequency of CD4<SUP>+</SUP>CD25<SUP>+</SUP>/CD4<SUP>+</SUP> T cells was significantly higher in KTRs with acute rejection than in KTRs at 2 weeks after transplantation (9.10% [range 4.30–25.6%] vs 5.10% [range 0.10–33.3%]; <I>P</I> = 0.024). However, no significant differences were observed between stable KTRs and KTRs with CMV infection. Analysis of the receiver operating characteristic curve adjusted by covariates showed that acute rejection could be predicted with 75.0% sensitivity and 68.4% specificity by setting the cutoff value of CD4<SUP>+</SUP>CD25<SUP>+</SUP>/CD4<SUP>+</SUP> T cell frequency as 5.8%.</P><P>Circulating T-lymphocyte and monocyte subsets showed significant and consistent changes in their frequencies after immunosuppression. Of the various immune cells examined, circulating levels of CD4<SUP>+</SUP>CD25<SUP>+</SUP> T cells might be a useful noninvasive immunologic indicator for detecting acute rejection.</P>