Residual Risk and Its Risk Factors for Ischemic Stroke with Adherence to Guideline-Based Secondary Stroke Prevention

Yuesong Pan,Zixiao Li,Jiejie Li,Aoming Jin,Jinxi Lin,Jing Jing,Hao Li,Xia Meng,Yilong Wang,Yongjun Wang 대한뇌졸중학회 2021 Journal of stroke Vol.23 No.1

Background and Purpose: Despite administration of evidence-based therapies, residual risk of stroke recurrence persists. This study aimed to evaluate the residual risk of recurrent stroke in acute ischemic stroke or transient ischemic attack (TIA) with adherence to guideline-based secondary stroke prevention and identify the risk factors of the residual risk. Methods: Patients with acute ischemic stroke or TIA within 7 hours were enrolled from 169 hospitals in Third China National Stroke Registry (CNSR-III) in China. Adherence to guideline-based secondary stroke prevention was defined as persistently receiving all of the five secondary prevention medications (antithrombotic, antidiabetic and antihypertensive agents, statin and anticoagulants) during hospitalization, at discharge, at 3, 6, and 12 months if eligible. The primary outcome was a new stroke at 12 months. Results: Among 9,022 included patients (median age 63.0 years and 31.7% female), 3,146 (34.9%) were identified as adherence to guideline-based secondary prevention. Of all, 864 (9.6%) patients had recurrent stroke at 12 months, and the residual risk in patients with adherence to guidelinebased secondary prevention was 8.3%. Compared with those without adherence, patients with adherence to guideline-based secondary prevention had lower rate of recurrent stroke (hazard ratio, 0.85; 95% confidence interval, 0.74 to 0.99; P=0.04) at 12 months. Female, history of stroke, interleukin- 6 ≥5.63 ng/L, and relevant intracranial artery stenosis were independent risk factors of the residual risk. Conclusions: There was still a substantial residual risk of 12-month recurrent stroke even in patients with persistent adherence to guideline-based secondary stroke prevention. Future research should focus on efforts to reduce the residual risk.

청소년 자살 예방개입 프로그램의 효과에 관한 메타분석: 1, 2, 3차 예방개입에 따른 분석

최신희(Choi, Shin-hee),김현수(Kim, Hyun-soo) 한국아동심리치료학회 2021 한국아동심리치료학회지 Vol.16 No.2

The purpose of this study is to shed light on the efficacy of various suicide preventive interventions for adolescents using meta-analysis. Specifically, this study aims to examine the effects of primary (1st prevention), secondary (2nd prevention), and tertiary (3rd prevention) suicide preventive interventions on direct suicidal and suicide-related outcomes (risk factors and protectors for suicide) and further identify which types of intervention show a high effect under the context of the 1st, 2nd, and 3rd preventions. Suicidal ideation and impulse were included in the suicidal index, depression and negative automatic thoughts in the risk factor index, and self-esteem, problem-solving skills, and life-respecting attitude in the protector index. Thirty-seven suicide studies (one outlier study was excluded) published between 1991 and 2020 were meta-analyzed. Comprehensive Meta-Analysis (CMA) 3.0 software was used for the meta-analysis. The results are as follows. The average effect size of suicide preventive interventions for adolescents is 0.74. Average effect sizes of the 1st, 2nd, and 3rd preventions were 0.44, 1.07, and 1.24, respectively, revealing better effects in the 2nd and the 3rd preventions than in the 1st prevention. The similarly better effects of the 2nd and the 3rd preventions than the 1st prevention were found for the indices of suicide, risk factor, and protector. Under the context of the 1st prevention, the program promoting respect for life and smile treatment showed relatively better effects as compared to Cognitive Behavior Therapy (CBT) and the preventive education group. Under the context of the 2nd prevention, CBT, mindfulness+ACT, reality therapy, narrative therapy, and art therapy showed large effects on suicide and the suicide-related indices. Under the context of the 3rd prevention, only CBT was applied and showed large effects on suicide and the suicide-related indices. Clinical implications of these findings were discussed.

「학교폭력예방 및 대책에 관한 법률」의 법적 문제

조성규 행정법이론실무학회(行政法理論實務學會) 2019 행정법연구 Vol.- No.56

School and violence are words that don't fit together at all, but today school violence has become too familiar and one of the biggest social problems in our society. To solve such social problems, the Act on the Prevention and Countermeasures against Violence in Schools (hereinafter referred to as the School Violence Prevention Act) was enacted in 2004, which mainly focuses the establishment of school violence-related institutions, the preparation of a legal framework for guiding and educating perpetrators, and protection of victims of school violence. However, the School Violence Prevention Act has a fundamental problem in that it attempts to establish a uniform law code for the education sector that should be guaranteed independence and professionalism of education guaranteed by the Constitution, unlike the legislative intent to prepare a legal system for the prevention of school violence. In addition, the School Violence Prevention Act excessively expands the scope of ‘school violence’ resulting in new legal problems, including excessive legal intervention in education and serious violation of school rights. From the point of view of ensuring independence and professionalism of education, it is reasonable to leave the problem of schools to the education field first, and the law should be secondary. In that respect, the School Violence Prevention Act needs to be improved, and its direction is as follows. First, it is necessary to limit the scope of school violence under the School Violence Prevention Act to clarify the legal systemic relationship between criminal law system as the basis for criminal punishment of violence and the Elementary and Secondary Education Act as the basis for student punishment in school. Second, legal systems need to be improved to enhance the effectiveness of measures against perpetrators of school violence, and in particular, the current law requires consideration of the normative justification of written apology as the disposal of schoolmasters. Third, there is a need to rectify legal problems arising from the dualization of the appeals process under the current law in relation to the disobeying procedure. Finally, in the case of complaints about the schoolmasters' disposal of perpetrators in relation to school violence, there is currently a legal difference between public and private schools, which does not seem appropriate. Therefore, given that the nation's education system is basically a public education system despite the distinction between public and private schools, it is reasonable to allow the measures taken by private schoolmasters to be subject to administrative litigation by acknowledging the disposition stipulated in the Administrative Procedure Act. 교육의 현장인 학교와 폭력은 전혀 어울리지 않는 용어임에도 오늘날 우리 사회에서 학교폭력은 너무나 익숙한 용어가 되었으며, 우리 사회의 가장 큰 문제 중의 하나가 되고 있다. 이러한 상황에서 학교폭력을 예방하기 위하여 2004년 제정된 법률이 ‘학교폭력예방 및 대책에 관한 법률(’학교폭력예방법‘)은 심각한 사회문제로 대두하고 있는 학교폭력문제에 효과적으로 대처하기 위한 전담기구의 설치, 학교폭력 피해자의 보호와 가해자에 대한 선도・교육 등 학교폭력의 예방 및 대책을 위한 법제도적 틀을 마련하려는 것을 그 제정목적으로 입법화되었다. 그러나 동 법률은 학교폭력의 예방을 위한 법제도적 대응이라는 법취지와는 달리, 헌법에 의해 교육의 자주성 및 전문성이 보장되어야 하는 교육영역에 대한 획일적 법규범화가 타당한가라는 근본적 문제에서부터, 법제도적으로도 ‘학교폭력’의 범위를 과도하게 확대함으로써 교육현장에 대한 과도한 법적 개입을 가져옴으로써 새로운 법적 문제를 초래하는 부작용이 노정되고 있다. 그러한 점에서 학교폭력예방법의 개선이 필요한바, 그러한 방향성으로는 우선적으로 학교폭력의 범위를 제한하여 폭력에 대한 처벌로서 형사법제 및 징계법제로서 초・중등교육법과의 법체계적 관계를 명확히 하는 것이 필요하다. 둘째, 학교폭력의 가해자에 대한 조치와 관련하여 조치의 실효성을 제고하기 위한 법제 개선이 필요하며, 특히 현행법제상 서면사과 처분에 대해서는 헌법상 양심의 자유 및 교육법적 관점에서 조치의 정당성에 대한 검토가 필요하다. 셋째, 불복절차와 관련하여 재심절차의 이원화에 따른 법적 문제의 개선이 필요하며, 마지막으로서 학교장의 처분에 대해 국・공립학교와 사립학교 사이에 발생하는 쟁송방식의 차이는 적절하지 않다고 보이는바, 우리나라의 공교육체계를 고려할 때, 사립학교의 경우에도 학교장의 처분에 대해 처분성을 인정하여 행정쟁송의 대상이 되도록 하는 것이 타당하다고 보인다.

뇌졸중재활 통합측면에서 뇌졸중의 이차예방

유승돈 대한뇌신경재활학회 2014 뇌신경재활 Vol.7 No.2

Stroke is the second leading cause of death, and the leading cause of acquired disability in adults. Survivors of stroke are at risk of a recurrent event, which is often more disabling than first-ever stroke. Recurrent strokes continue to account for 25∼30% of all strokes. That represents the needs of successful secondary prevention. Appropriate secondary prevention of recurrent stroke needs rapid diagnosis and treatment and prompt identification of the underlying cardiovascular cause. Some epidemiological data suggest that a substantial proportion of strokes can be attributed to unhealthy lifestyle behaviors. This review summarizes the evidence for optimum secondary prevention of recurrent ischemic stroke as integral part of physical medicine and rehabilitation.

뇌졸중 최신지견 2009: 뇌졸중의 급성기 치료 및 이차예방

권순억 대한뇌졸중학회 2010 Journal of stroke Vol.12 No.1

There were several positive clinical trials with new anticoagulants and antiplatelet agents which will affect on the guideline of the secondary stroke prevention. Dabigatran, an oral direct thrombin inihibitor, had better clinical outcomes than warfarin in the prevention of cardiovascular events in the patients with atrial fibrillation. Ticagrelor and prasugrel are new antiplatelet agents. They successfully reduced cardiovascular events after acute myocardial infarction without increase bleeding complications compared to clopidogrel. The effects of platelet inhibition of those thienopyridine antiplatelet agents were influenced by the usage of proton pump inhibitor owever, there are no direct supporting evidences to avoid concomitant use of prohibition of proton pump inhibitors and thienopyridines. Genetic polymorphisms of cytochrome P450 2C19, which affects on the metabolism of thienopyridines, affect on the antiplatelet effects of thienopyridines and clinical outcomes. One small clinical trial showed that niacin was better in the prevention of progression of intima-medial thickness of common carotid artery than ezetimibe.

이차 뇌졸중 예방을 위한 라이프스타일 수정 : 문헌고찰

신재용(Shin, Jae-Yong) 한국노인작업치료학회 2020 한국노인작업치료학회지 Vol.2 No.2

Introduction : Secondary stroke accounts for 23% of all stroke incidents and can be prevented by up to 90% by controlling risk factors such as high blood pressure, cholesterol levels, obesity, physical inactivity, diabetes, smoking, and alcohol intake. Among the methods of controlling risk factors, lifestyle modification is a non-pharmaceutical method in which a healthy lifestyle can be maintained through diet, physical activity, smoking cessation, abstinence, and obesity management. Body : Lifestyle modification is essential to prevent secondary stroke. This includes maintaining a healthy diet, moderate-intensity exercise of 20-60 minutes per day, smoking cessation, moderate alcohol consumption (2 glasses for men, 1 glass for women), and a BMI of 25 or less. These can lower blood pressure and LDL cholesterol, which are major risk factors for stroke, reduce body weight and blood sugar levels, and relieve vascular sclerosis. It is more beneficial to apply multiple factors at the same time than to adjust only one or two factors, and in particular, to maintain a healthy lifestyle through self-directed lifestyle correction for successful long-term prevention of secondary stroke. Conclusion : An effective secondary stroke prevention program requires planning one that comprehensively covers risk factors, with a multidisciplinary approach and a long-term, intensive, and sustainable system and strategy for successful operation in place. 서론 : 이차 뇌졸중은 전체 뇌졸중 발생의 약 23%를 차지하는데, 고혈압, 콜레스테롤 수치, 비만, 신체 비활동성, 당뇨, 흡연, 그리고 알콜 섭취 등의 뇌졸중 위험인자 조절을 통해 최대 90%까지 예방할 수 있다. 위험인자를 조절하는 방법 중 비약물적인 방법인 라이프스타일 수정은 식단 조절, 신체활동, 금연, 금주, 그리고 비만관리 등의 방법을 통해 건강한 생활습관을 유지하도록 하는 것이다. 본론 : 라이프스타일 수정은 이차 뇌줄중 예방에 필수적인 요소로, 건강한 식단유지, 하루 20-60분의 중등도 강도의 운동, 금연, 적당량의 알콜 섭취(남자: 2잔, 여자: 1잔), 그리고 체질량지수 25미만으로 유지하기 등이 있다. 이와 같은 생활습관을 유지하면 뇌졸중의 주요 위험인자인 혈압과 LDL콜레스테롤을 낮출 수 있으며, 체중과 혈당수치 감소, 혈관경화 완화 등의 효과를 볼 수 있다. 라이프스타일 수정은 한·두 가지 요인만 조절하는 것 보다는 여러 요인을 동시에 적용하는 것이 더 유익하며, 특히 자기주도적인 라이프스타일 수정을 통해 건강한 라이프스타일을 유지하여 장기간의 성공적인 이차 뇌졸중 예방을 할 수 있다. 결론 : 효과적인 이차 뇌졸중 예방 프로그램을 위해서는 위험요인을 포괄적으로 다루는 프로그램을 계획해야 하며, 성공적인 운영을 위해서 다학제적인 접근과 함께 집중적이고 장기간 지속될 수 있는 제도와 전략이 마련되어야 한다.

장수와 치매의 예방

전진숙 대한신경정신의학회 2009 신경정신의학 Vol.48 No.4

Objectives The aim of this study was to understand pharmacological and non-pharmacological methods of dementia prevention. Methods An internet searchof literature published from 2006 thru 2008 was done using combinations of the words‘dementia’ and‘prevention’. These publications were subsequently reviewed. Results 1) Reduction of risk factors:control of vascular risk factors (hypertension, diabetes mellitus, obesity, hypercholesterolemia, smoking, hyperhomocysteinemia, and platelet aggregation) and medical risk factors (head trauma, depression, herpes simplex, hyperthyroidism, and alcohol problems). 2) Pharmacological trial:NSAIDs, selective COX-2 inhibitors, estrogen replacement therapy, and antioxidants. 3) Healthy diet and nutrition:macronutrients (polyunsaturated fatty acid such as omega-3, alpha-linolenic acid, docosahexaenoic acid) and micronutrients (vitamins such as vitamin A, vitamin B1, 3, 6, 9, 12, vitamin C, vitamin D, vitamin E, vitamin K;minerals such as iron, iodine, magnesium, zinc, manganese, copper, cobalt, selenium;trace elements;and non-essential micronutrients such as polyphenols). 4) Regular excercise and activities:physical activities including aerobics, flexibility, and strength exerrcises;Recreational activities including participation in religious or social activities, healthy sex life with partner, and stimulating cognitive activities. Conclusion The final goal of dementia treatment is primary prevention. However, there is no proven method to achieve this. Therefore, secondary prevention or preventative maintenance through risk reduction and introduction of a healthy lifestyle in an attempt to postpone the onset of disease is a realistic goal.

뇌졸중 이차예방을 위한 항혈소판제의 사용: 2012년 한국 뇌졸중 이차예방 진료지침 부분 개정

박태환,김민기,오형근,오미선,유경호,홍근식,배희준,권순억,나정호,허지회,오창완,이병철,윤병우 대한뇌졸중학회 2012 Journal of stroke Vol.14 No.1

Writing Committee of Korean clinical practice guidelines for secondary prevention of stroke has reviewed recent randomized controlled trials of cilostazol published after the fi rst edition of Korean clinical practice guidelines that considered evidences published before June 2007. Two clinical trials and 1 meta-analysis which compared cilostazol directly with aspirin in the prevention of stroke in patients with cerebral infarction or transient ischemic attack (TIA) were identifi ed and included for the current guideline update. Review of fi ndings indicates that cilostazol as compared to aspirin achieved a greater reduction of stroke as well as composite vascular events of stroke, myocardial infarction, and vascular death. For safety, cilostazol was associated with fewer major bleeding events than aspirin. Accordingly, new recommendations for cilostazol are made for prevention of stroke in the setting of noncardioembolic stroke or TIA. Changes in the guidelines necessitated by new evidences will be continuously refl ected in future guidelines.

장수와 치매의 예방

전진숙 대한신경정신의학회 2009 신경정신의학 Vol.48 No.5

Objectives: The aim of this study was to understand pharmacological and non-pharmacological methods of dementia prevention. Methods: An internet searchof literature published from 2006 thru 2008 was done using combinations of the words‘dementia’ and‘prevention’. These publications were subsequently reviewed. Results: 1) Reduction of risk factors:control of vascular risk factors (hypertension, diabetes mellitus, obesity, hypercholesterolemia, smoking, hyperhomocysteinemia, and platelet aggregation) and medical risk factors (head trauma, depression, herpes simplex, hyperthyroidism, and alcohol problems). 2) Pharmacological trial:NSAIDs, selective COX-2 inhibitors, estrogen replacement therapy, and antioxidants. 3) Healthy diet and nutrition:macronutrients (polyunsaturated fatty acid such as omega-3, alpha-linolenic acid, docosahexaenoic acid) and micronutrients (vitamins such as vitamin A, vitamin B1, 3, 6, 9, 12, vitamin C, vitamin D, vitamin E, vitamin K;minerals such as iron, iodine, magnesium, zinc, manganese, copper, cobalt, selenium;trace elements;and non-essential micronutrients such as polyphenols). 4) Regular excercise and activities:physical activities including aerobics, flexibility, and strength exerrcises;Recreational activities including participation in religious or social activities, healthy sex life with partner, and stimulating cognitive activities. Conclusion: The final goal of dementia treatment is primary prevention. However, there is no proven method to achieve this. Therefore, secondary prevention or preventative maintenance through risk reduction and introduction of a healthy lifestyle in an attempt to postpone the onset of disease is a realistic goal. 치매치료의 궁극적 목표는 일차적 예방(primary prevention)이다. 그러나, 아직 이를 위한 치료법은 개발되지 않았다. 치매의 진행을 예방할 수 있는 약물치료나 생활양식은 입증된 것이 없다. 따라서, 현재로서는 이차예방이나 예방적 유지책(환자의 전반적 건강, 정신상태, 기능을 극대화 시킴으로써 과다한 질병을 감소시키는)에 중점을 두는 수밖에 없다. 다시말하면, 위험인자를 감소시키거나, 건강한 생활양식을 도입하여 치매의 발병을 지연시키는 것이다.

Analysis of Factors Influencing Social Distancing Practices for Prevention of COVID-1

Eun-Gyeong Kim,Sook-Kyoung Park,Hye Young Kim 한국간호과학회 2021 한국간호과학회 학술대회 Vol.2021 No.10

Aims: This study is a secondary analysis study to identify and analyze relationship between demographic characteristics, psychological effects, and practice of quarantine rules related to the practice of social distancing for the prevention of COVID-19. Methods: This study used raw data from the Community Health Survey (CHS) conducted in 2020. A total of 229,269 subjects participated in the survey were used for the final analysis. Data analysis was performed using IBM SPSS Statistics 21.0 program. The t-test and the Pearson Correlation Coefficient were used for the difference and correlation of social distancing practices for COVID-19 prevention according to the characteristics of subjects, and multiple regression analysis was performed to identify the factors affecting social distancing for the prevention of COVID-19. Results: Multiple regression was conducted and analyzed to identify the factors affecting the practice of social distancing for COVID-19 prevention. As a result, the explanatory power was 35.6% and the model was found to be suitable (Wald F=111.07, p<.001). Also, in general characteristics, age (β=.01, p=.001), spouse presence (β=.08, p<.001), monthly income (β=-.01, p<.001), subjective health status (β =-.04, p<.001) was found to have statistically significant explanatory power. Conclusions: This study identified factors related to the practice of social distancing for the prevention of COVID-19, and as a result, it was confirmed that they were related to age, spouse presence, income, subjective health status.