Publications by authors named "Seockhoon Chung"

72 Publications

The Stress and Anxiety to Viral Epidemics-6 Items (SAVE-6) Scale: A New Instrument for Assessing the Anxiety Response of General Population to the Viral Epidemic During the COVID-19 Pandemic.

Front Psychol 2021 4;12:669606. Epub 2021 Jun 4.

Department of Psychiatry, ASAN Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

The general population has reported experiencing anxiety due to the COVID-19 pandemic. This study explored the validity and utility of the Stress and Anxiety to Viral Epidemics-6 items (SAVE-6) scale for measuring the anxiety response of the general population to the viral epidemic. About 1,009 respondents participated in an online survey. Of these, 501 (49.7%) participants were rated as having at least a mild degree of anxiety response to the viral epidemic (SAVE-6 score ≥ 15), while 90 (8.9%) and 69 (6.8%) participants were rated as having moderate degree of depression and anxiety, respectively. The SAVE-6 scale showed a good internal consistency (Cronbach's alpha = 0.815). Parallel analysis suggested a one-factor structure for the measure. The SAVE-6 scale was found to be a reliable, valid, and useful brief measure that can be applied to the general population.
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http://dx.doi.org/10.3389/fpsyg.2021.669606DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212887PMC
June 2021

Attitude of Medical Students About Their Role and Social Accountability in the COVID-19 Pandemic.

Front Psychiatry 2021 1;12:645340. Epub 2021 Jun 1.

Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

In this study, we aimed to explore the attitude of medical students toward their role and social accountability in this pandemic era. An online survey was developed to elicit information on (1) the role of medical students in the pandemic era; (2) Medical education in the "new normal," and (3) the impact of COVID-19 on medical students. The online survey, developed by a team consisting of three medical students, three psychiatry residents, and three professors of psychiatry, was conducted on 574 participants (213 medical students, 180 graduates, and 181 professors) in the University of Ulsan College of Medicine, Seoul, South Korea. Anxiety symptom rating scales, including the Stress and Anxiety to Viral Epidemics-6 (SAVE-6) scale and the Generalized Anxiety Disorder-7 (GAD-7) scale, were applied to measure participant anxiety level. Medical students indicated their willingness to join the healthcare response to the COVID-19 pandemic, if requested; however, graduates and professors recommended that medical students continue their training rather than join the pandemic healthcare response. In the new normal era, medical education has had to change appropriately. Moreover, adequate knowledge of COVID-19 infection and spread must be considered for the continuation of clinical clerkships during the pandemic. Overall, medical students who indicated anxiety about treating possible or confirmed cases of COVID-19 rated higher on the SAVE-6 scale. Finally, medical students who reported that COVID-19 had an impact on their studies and daily life rated higher on the general anxiety scale (GAD-7). Social accountability is an important issue for medical students in the pandemic era. At the same time, non-disruption of their academic calendar would ensure continuous availability of component medical professionals, which is important for adequate future healthcare responses.
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http://dx.doi.org/10.3389/fpsyt.2021.645340DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205150PMC
June 2021

Resilience and Work-Related Stress May Affect Depressive Symptoms in Nursing Professionals during the COVID-19 Pandemic Era.

Psychiatry Investig 2021 Apr 25;18(4):357-363. Epub 2021 Apr 25.

Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Objective: We aimed to investigate the effect of nursing professionals' resilience on their mental health, work-related stress, and anxiety in response to the COVID-19 pandemic.

Methods: We conducted an online survey in the Asan Medical Center and Ulsan University Hospital, South Korea. We extracted data of 824 nursing professionals who consented to participate, including demographic variables and the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), PHQ-9, GAD-7, and Brief Resilience Scale scores.

Results: Resilience was negatively correlated with Patient Health Questionnaire-9 (PHQ-9) (rho=-0.23), Generalized Anxiety Scale-7 items (GAD-7) (rho=-0.25), Stress and Anxiety to Viral Epidem-ics-6 items (SAVE-6) (rho=-0.15), and Stress And anxiety to Viral Epidemics-3 items (SAVE-3) (rho=-0.13, all, p<0.001). Logistic regression analysis adjusting age, marital status, and years of employment revealed that high level of general anxiety [adjusted odds ratio (aOR)=1.40, 95% confidence interval (CI)=1.31-1.50], work-related stress during viral epidemics (aOR=1.16, 95% CI=1.03-1.29), and a low level of resilience (aOR=0.91, 95% CI=0.85-0.97) were expecting variables for the depression of healthcare workers.

Conclusion: Nursing professionals' level of resilience may be associated with low level of work-related stress and anxiety induced by a viral epidemic. We need to explore further the possibility of resilience as coping strategy of healthcare workers in this pandemic era.
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http://dx.doi.org/10.30773/pi.2021.0019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8103016PMC
April 2021

Risk Perception, Unhealthy Behavior, and Anxiety Due to Viral Epidemic Among Healthcare Workers: The Relationships With Depressive and Insomnia Symptoms During COVID-19.

Front Psychiatry 2021 19;12:615387. Epub 2021 Mar 19.

Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.

We aimed to investigate the relationship between mental health problems and unhealthy behaviors among healthcare workers in response to the COVID-19 pandemic. Using an online survey, we collected data on healthcare workers' perception regarding COVID-19 exposure in a work unit. Workers' depression, insomnia, and anxiety symptoms were assessed using the Patient Health Questionnaire-9, Insomnia Severity Index, and Generalized Anxiety Disorder-7 scale, respectively. Work-related stress and anxiety in response to the viral epidemic were measured using the Stress and Anxiety to Viral Epidemic-9 (SAVE-9) scale. We found that work-related stress and anxiety in response to the viral epidemic was associated with female sex, perception of the workplace as being dangerous, and depressive symptoms. Unhealthy behaviors, such as smoking and drinking as coping behaviors during the pandemic, were associated with male sex, young age, depression, and insomnia. During the COVID-19 pandemic, it is necessary to closely observe the patterns of work-related stress and anxiety reactions among healthcare workers to reduce their burnout.
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http://dx.doi.org/10.3389/fpsyt.2021.615387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8017167PMC
March 2021

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition).

Autophagy 2021 Jan 8;17(1):1-382. Epub 2021 Feb 8.

University of Crete, School of Medicine, Laboratory of Clinical Microbiology and Microbial Pathogenesis, Voutes, Heraklion, Crete, Greece; Foundation for Research and Technology, Institute of Molecular Biology and Biotechnology (IMBB), Heraklion, Crete, Greece.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field.
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http://dx.doi.org/10.1080/15548627.2020.1797280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7996087PMC
January 2021

Differences in sleep measures and waking electroencephalography of patients with insomnia according to age and sex.

J Clin Sleep Med 2021 Jun;17(6):1175-1182

Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea.

Study Objectives: Sleep characteristics are known to be different according to age and sex. The objective of this study was to investigate differences in sleep parameters and quantitative electroencephalography of patients with insomnia according to age and sex.

Methods: Patients with insomnia disorder ages 40-79 years were recruited. Each participant was assessed with the Pittsburgh Sleep Quality Index, 4-day wrist actigraphy, and quantitative electroencephalography derived from a 64-channel electroencephalogram system. These variables were compared between age groups (40-64 years vs 65-79 years) and sexes.

Results: Among 173 participants, 61 (35%) were ages 65-79 years and 64 (35%) were males. The older group reported shorter (P = .009) total sleep time than the middle-aged group based on the Pittsburgh Sleep Quality Index, while women slept longer than men based on actigraphy (P = .040). Regarding electroencephalography, women had higher relative beta power than men (P = .006). Older patients showed slower dominant occipital frequency than younger patients (P = .008). The age effect was more noticeable on both clinical variables and quantitative electroencephalography for women. Compared with younger women, older women reported shorter total sleep time in the Pittsburgh Sleep Quality Index (P = .025), underestimated their sleep time (Pittsburgh Sleep Quality Index total sleep time/actigraphic total sleep time, P = .034), and showed reduced alpha power in the frontal area (P = .009).

Conclusions: Clinicians should be aware of the age and sex difference on manifestation of insomnia, which may further impact an individual's behaviors, such as staying in bed for a longer time or seeking sleep aids.
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http://dx.doi.org/10.5664/jcsm.9156DOI Listing
June 2021

Depression, Rather Than Cancer-Related Fatigue or Insomnia, Decreased the Quality of Life of Cancer Patients.

Cancer Res Treat 2020 Dec 29. Epub 2020 Dec 29.

Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Purpose: Cancer-related fatigue is a common and distressing symptom that occurs during cancer treatment. This study aimed to find factors that are related to cancer-related fatigue, and its effect on patients' quality of life.

Materials And Methods: This study included 159 patients who completed questionnaires and interviews during their initial examination at the Cancer Stress and Sleep Clinic, Asan Medical Center, between December 2018 and January 2020. Their medical reports were reviewed retrospectively. Questionnaire data about depression, anxiety, and insomnia; fear of disease progression; and dysfunctional beliefs about sleep, pain, and quality of life, were reviewed. Additionally, patient sleep structure data were analyzed.

Result: Factors such as depression (p<0.0001), anxiety (p<0.0001), fear of cancer progression (p<0.0001), fatigue (p=0.027), and time in bed during 24 hours (p=0.037) were significant expecting variables for low quality of life from logistic regression analysis. In pathway analysis, depression (p<0.001), not cancer-related fatigue (p=0.537), act as a direct risk factor on quality of life. And also, depression was an overall risk factor for insomnia, fatigue, and daily activity of cancer patients.

Conclusion: Cancer-related fatigue did not show significant effect on patient's quality of life in this study. However, the result of pathway analysis highlights the importance of assessing depression in the process of cancer treatment and providing appropriate interventions.
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http://dx.doi.org/10.4143/crt.2020.1212DOI Listing
December 2020

Stress and Anxiety among Healthcare Workers Associated with COVID-19 Pandemic in Russia.

Psychiatr Danub 2020 Autumn - Winter;32(3-4):549-556

Faculty of Basic Medicine, Lomonosov Moscow State University, Moscow, Russia.

Background: Mental health of medical workers treating patients with COVID-19 is an issue of increasing concern worldwide. The available data on stress and anxiety symptoms among healthcare workers during the COVID-19 are relatively limited and have not been evaluated in Russia yet.

Subjects And Methods: The cross-sectional anonymous survey included 1,090 healthcare workers. Stress and anxiety symptoms were assessed using Stress and Anxiety to Viral Epidemics - 9 (SAVE-9) and Generalized Anxiety Disorder - 7 (GAD-7) scales. Logistic regression, Kaiser-Meyer-Olkin two component factor model, Cronbach's alpha and ROC-analysis were performed to determine the influence of different variables, internal structure and consistency, sensitivity and specificity of SAVE-9 compared with GAD-7.

Results: The median scores on the GAD-7 and SAVE-9 were 5 and 14, respectively. 535 (49.1%) respondents had moderate and 239 (21.9%) had severe anxiety according to SAVE-9. 134 participants (12.3%) had severe anxiety, 144 (13.2%) had moderate according to GAD-7. The component model revealed two-factor structure of SAVE-9: "anxiety and somatic concern" and "social stress". Female gender (OR - 0.98, p=0.04) and younger age (OR - 0.65, p=0.04) were associated with higher level of anxiety according to regression model. The total score of SAVE-9 with a high degree of confidence predicted the GAD-7 value in comparative ROC analysis.

Conclusions: Healthcare workers in Russia reported high rates of stress and anxiety. The Russian version of the SAVE-9 displayed a good ratio of sensitivity to specificity compared with GAD-7 and can be recommended as a screening instrument for detection of stress and anxiety in healthcare workers.
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http://dx.doi.org/10.24869/psyd.2020.549DOI Listing
January 2021

Application of the Stress and Anxiety to Viral Epidemics-6 (SAVE-6) and Coronavirus Anxiety Scale (CAS) to Measure Anxiety in Cancer Patient in Response to COVID-19.

Front Psychol 2020 23;11:604441. Epub 2020 Nov 23.

Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

This study investigated the usefulness of the six-item Stress and Anxiety to Viral Epidemics (SAVE-6) scale and the Coronavirus Anxiety Scale (CAS) as tools to assess anxiety related to coronavirus disease (COVID-19) in cancer patients. A total of 221 patients with cancer responded to an anonymous online questionnaire between 15 July and 15 August 2020. The functional impairment of the patients was assessed using the Work and Social Adjustment Scale (WSAS), and the SAVE-6 and CAS were also applied. Among these 221 cancer patients, 110 (49.8%) had SAVE-6 scores ≥ 15 and 21 (9.5%) had CAS scores ≥ 5. Within the study population, 104 (47.1%) and 29 (13.1%) patients had WSAS scores ≥ 11 (moderate to severe functional impairment) and ≥ 21 (severe functional impairment), respectively. The correlations between the SAVE-6 and WSAS ( < 0.001) and CAS ( < 0.001) scores were statistically significant. The cut-off for the SAVE-6 was 15 points, while that for the WSAS was 11. Our results suggested that the SAVE-6 and CAS could be used to evaluate moderate and severe degrees of functional impairment related to mental health, respectively, in cancer patients during viral epidemics.
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http://dx.doi.org/10.3389/fpsyg.2020.604441DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719621PMC
November 2020

The Development of a Sleep Intervention for Firefighters: The FIT-IN (Firefighter's Therapy for Insomnia and Nightmares) Study.

Int J Environ Res Public Health 2020 11 24;17(23). Epub 2020 Nov 24.

Department of Psychology, Sungshin University, Seoul 02844, Korea.

: Firefighters are vulnerable to irregular sleep patterns and sleep disturbance due to work characteristics such as shift work and frequent dispatch. However, there are few studies investigating intervention targeting sleep for firefighters. This preliminary study aimed to develop and test a sleep intervention, namely FIT-IN (Firefighter's Therapy for Insomnia and Nightmares), which was based on existing evidence-based treatment tailored to firefighters in consideration of their occupational characteristics. : This study implemented a single-group pre-post study design, utilizing an intervention developed based on brief behavior therapy for insomnia with imagery rehearsal therapy components. FIT-IN consisted of a total of three sessions (two face-to-face group sessions and one telephone session). Participants were recruited from Korean fire stations, and a total of 39 firefighters participated. Participants completed a sleep diary for two weeks, as well as the following questionnaires to assess their sleep and psychological factors: insomnia severity index (ISI), disturbing dream and nightmare severity index (DDNSI), Epworth sleepiness scale (ESS), depressive symptom inventory-suicidality subscale (DSI), and Patient Health Questionnaire-9 (PHQ-9). These questionnaires were administered before the first session and at the end of the second session. : The FIT-IN program produced improvements in sleep indices. There was a significant increase in sleep efficiency ( < 0.01), and a decrease in sleep onset latency, number of awakenings, and time in bed ( < 0.05), as derived from weekly sleep diaries. In addition, significant decreases were shown for insomnia ( < 0.001) and nightmare severity ( < 0.01). : There were significant improvements in sleep and other clinical indices (depression, PTSD scores) when comparing pre-and post-intervention scores. FIT-IN may be a feasible and practical option in alleviating sleep disturbance in this population. Further studies will be needed to ascertain FIT-IN's effectiveness.
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http://dx.doi.org/10.3390/ijerph17238738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7727785PMC
November 2020

Korean Clinical Practice Guideline for the Diagnosis and Treatment of Insomnia in Adults.

Psychiatry Investig 2020 Nov 18;17(11):1048-1059. Epub 2020 Nov 18.

Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Objective: We aim to present a clinical guideline for the diagnosis and treatment of insomnia in adults by reviewing and integrating existing clinical guidelines. The purpose of this guideline is to assist clinicians who perform evidence-based insomnia treatment.

Methods: We selected literature that may be appropriate for use in guideline development from evidence-based practice guidelines that have been issued by an academic or governmental institution within the last five years. The core question of this guideline was made in sentence form including Patient/Problem, Intervention, Comparison, Outcome (PICO) elements. After searching PubMed, EMBASE, and medical guideline issuing agencies, three guidelines were judged to be the most appropriately reviewed, up-to-date, and from trusted sources.

Results: The Appraisal of Guidelines for Research and Evaluation (AGREE) II tool was used to evaluate the quality of the three clinical guidelines. The final outcome of the guideline development process is a total of 15 recommendations that report the strength of the recommendation, the quality of evidence, a summary of content, and considerations in applying the recommendation.

Conclusion: It is vital for clinical guidelines for insomnia to be developed and continually updated in order to provide more accurate evidence-based treatments to patients.
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http://dx.doi.org/10.30773/pi.2020.0146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711116PMC
November 2020

A New Rating Scale (SAVE-9) to Demonstrate the Stress and Anxiety in the Healthcare Workers During the COVID-19 Viral Epidemic.

Psychiatr Danub 2020 Sep;32(Suppl 1):5-9

Psychiatric Studies Center (Cen.Stu.Psi.), Piazza Portici, 11 - 25050 Provaglio d'Iseo (BS), Italy,

The COVID-19 epidemic has been a major global public health problem during past months in Italy and in several other Countries and on the date of publication of this article, is still a serious public health problem. The health staff, engaged in the care of the sick and in the prevention of the spread of the infection have been subjected to a further increase in psychological difficulties and work-related stress, related to the workload for the continuous influx of sick and intense and close working shifts for the viral emergency. The SAVE-9 (Stress and Anxiety to Viral Epidemics - 9 items) scale has been developed as a tool for assessing work anxiety and stress in response to the viral epidemic of health professionals working to prevent the spread of the virus and to treat infected people.
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September 2020

A New Rating Scale (SAVE-9) to Demonstrate the Stress and Anxiety in the Healthcare Workers During the COVID-19 Viral Epidemic.

Psychiatr Danub 2020 Sep;32(Suppl 1):5-9

Psychiatric Studies Center (Cen.Stu.Psi.), Piazza Portici, 11 - 25050 Provaglio d'Iseo (BS), Italy,

The COVID-19 epidemic has been a major global public health problem during past months in Italy and in several other Countries and on the date of publication of this article, is still a serious public health problem. The health staff, engaged in the care of the sick and in the prevention of the spread of the infection have been subjected to a further increase in psychological difficulties and work-related stress, related to the workload for the continuous influx of sick and intense and close working shifts for the viral emergency. The SAVE-9 (Stress and Anxiety to Viral Epidemics - 9 items) scale has been developed as a tool for assessing work anxiety and stress in response to the viral epidemic of health professionals working to prevent the spread of the virus and to treat infected people.
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September 2020

The Prevalence and Incidence of Insomnia in Korea during 2005 to 2013.

Psychiatry Investig 2020 Jun 27;17(6):533-540. Epub 2020 May 27.

Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.

Objective: The aim of this study was to estimate the progress of insomnia prevalence and incidence over the past several years. Also, this study compared survival rates between individuals with and without insomnia.

Methods: The National Health Insurance Service-National Sample Cohort (NHIS-NSC) from 2002-2013 was used for this study. Prevalent cases of insomnia were defined using ICD-10 codes F51.0 or G47.0, or a prescription of sedatives. Cox's proportional hazard analysis was conducted to compare survival rates between insomnia patients and people without insomnia.

Results: In 2013, there were 46,167 (5.78%) insomnia patients over 20 years old in this cohort. Insomnia was more common among women and the elderly. Annual incidence over the past several years remained steady but the prevalence increased. The survival of insomnia patients was lower than that of people without insomnia, and the hazard ratio for overall mortality was 1.702 (p<0.001).

Conclusion: This large-scale population-based cohort study provided current epidemiologic indicators of insomnia in the Korean general population.
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http://dx.doi.org/10.30773/pi.2019.0218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7324735PMC
June 2020

A Mobile Technology for Collecting Patient-Reported Physical Activity and Distress Outcomes: Cross-Sectional Cohort Study.

JMIR Mhealth Uhealth 2020 05 4;8(5):e17320. Epub 2020 May 4.

Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.

Background: Electronic patient-reported outcome (PROs) provides a fast and reliable assessment of a patient's health-related quality of life. Nevertheless, using PRO in the traditional paper format is not practical for clinical practice due to the limitations associated with data analysis and management. A questionnaire app was developed to address the need for a practical way to group and use distress and physical activity assessment tools.

Objective: The purpose of this study was to assess the level of agreement between electronic (mobile) and paper-and-pencil questionnaire responses.

Methods: We validated the app version of the distress thermometer (DT), International Physical Activity Questionnaire (IPAQ), and Patient Health Questionnaire-9 (PHQ-9). A total of 102 participants answered the paper and app versions of the DT and IPAQ, and 96 people completed the PHQ-9. The study outcomes were the correlation of the data between the paper-and-pencil and app versions.

Results: A total of 106 consecutive breast cancer patients were enrolled and analyzed for validation of paper and electronic (app) versions. The Spearman correlation values of paper and app surveys for patients who responded to the DT questionnaire within 7 days, within 3 days, and on the same day were .415 (P<.001), .437 (P<.001), and .603 (P<.001), respectively. Similarly, the paper and app survey correlation values of the IPAQ total physical activity metabolic equivalent of task (MET; Q2-6) were .291 (P=.003), .324 (P=.005), and .427 (P=.01), respectively. The correlation of the sum of the Patient Health Questionnaire-9 (Q1-9) according to the time interval between the paper-based questionnaire and the app-based questionnaire was .469 for 14 days (P<.001), .574 for 7 days (P<.001), .593 for 3 days (P<.001), and .512 for the same day (P=.03). These were all statistically significant. Similarly, the correlation of the PHQ (Q10) value according to the time interval between the paper-based questionnaire and the app-based questionnaire was .283 for 14 days (P=.005), .409 for 7 days (P=.001), .415 for 3 days (P=.009), and .736 for the same day (P=.001). These were all statistically significant. In the overall trend, the shorter the interval between the paper-and-pencil questionnaire and the app-based questionnaire, the higher the correlation value.

Conclusions: The app version of the distress and physical activity questionnaires has shown validity and a high level of association with the paper-based DT, IPAQ (Q2-6), and PHQ-9. The app-based questionnaires were not inferior to their respective paper versions and confirm the feasibility for their use in clinical practice. The high correlation between paper and mobile app data allows the use of new mobile apps to benefit the overall health care system.

Trial Registration: ClinicalTrials.gov NCT03072966; https://clinicaltrials.gov/ct2/show/NCT03072966.
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http://dx.doi.org/10.2196/17320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235805PMC
May 2020

Time to Take Sleeping Pills and Subjective Satisfaction among Cancer Patients.

Psychiatry Investig 2020 Mar 5;17(3):249-255. Epub 2020 Mar 5.

Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Objective: We investigated the influence of the time to take hypnotics and daytime activity on patient satisfaction with sleeping pills.

Methods: Ninety-six cancer patients who were currently taking benzodiazepine or z-drug as hypnotics were grouped into satisfied and dissatisfied groups. The subjects' symptoms, time to take sleeping pills, bedtime, sleep onset time, wake up time, and time in bed within 24 hours (TIB/d) were obtained.

Results: The satisfied group had significantly late sleeping pill ingestion time (p=0.04); significantly early wake up time (p=0.01); and significantly shorter sleep latency, TIB/d, duration from the administration of pills to sleep onset, and duration from the administration of pills to wake up time (PTW). Logistic regression analysis revealed that the significant predictors of patient satisfaction to hypnotics were less severity of insomnia [odds ratio (OR)=0.91] and the time variables, including late sleeping pill administration time (OR=1.53) and early wake up time (OR=0.57). Among the duration variables, short PTW (OR=0.30) and short TIB/d (OR=0.64) were significantly related with the satisfaction to hypnotics.

Conclusion: Reducing the duration from the administration of hypnotics to wake up time and TIB/d can influence the satisfaction to sleeping pills.
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http://dx.doi.org/10.30773/pi.2019.0216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7113171PMC
March 2020

Exercise Promotion and Distress Reduction Using a Mobile App-Based Community in Breast Cancer Survivors.

Front Oncol 2019 10;9:1505. Epub 2020 Jan 10.

Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

Physical activity (PA) enhancement and mental distress reduction are important issues in cancer survivorship care. Mobile technology, as an emerging method for changing health behaviors, is gaining attention from many researchers. This study aimed to investigate the effect of a mobile app-based community on enhancing PA and decreasing distress in breast cancer survivors. We conducted a non-randomized, prospective, interventional study that had a mobile community-later arm and mobile community-first arm. With an Android smartphone app (WalkON®), daily walk steps and weekly distress scores using app-based Distress Thermometer (DT) questionnaires were collected from participants for about 12 weeks. To examine the difference in weekly step counts before and during the community activity, we used a paired -test method. For a comparative analysis, we referred to a previous prospective observational study without a mobile community intervention that had the same setting as the present study. After propensity score matching (PSM), multivariable regression modeling with difference-in-difference (DID) was performed to estimate the effect of the mobile app-based community on PA and mental distress. From January to August 2018, a total of 64 participants were enrolled in this study. In the univariate analysis, after participation in the mobile community, the participants showed a significant increase in total weekly steps ( = -3.5341; = 0.00208). The mean of the differences was 10,408.72 steps. In the multivariate analysis after PSM, the mobile community significantly increased steps by 8,683.4 per week ( value <0.0001) and decreased DT scores by 0.77 per week ( value = 0.009) in the mixed effect model. In the two-way fixed effect model, the mobile community showed a significant increase in weekly steps by 8,723.4 ( value <0.0001) and decrease in weekly DT by 0.73 ( value = 0.013). The mobile app-based community is an effective and less resource-intensive tool to increase PA and decrease distress in breast cancer survivors. NCT03190720, NCT03072966.
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http://dx.doi.org/10.3389/fonc.2019.01505DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6966488PMC
January 2020

The Effect of a Sleep Education and Hypnotics Reduction Program on Hypnotics Prescription Rate for the Hospitalized Patients with Cancer at a General Hospital.

Clin Psychopharmacol Neurosci 2019 Nov;17(4):542-546

Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Objective: We aimed to investigate whether the sleep education and hypnotics reduction program (the i-sleep program), developed for all hospitalized patients and medical personnel, help reducing the hypnotics prescriptions rate among hospitalized cancer patients in a general hospital.

Methods: Patient data such as hypnotics prescribed at the time of admission and discharge during prior to (year of 2014) and after (year of 2015) initiation of the i-sleep program were collected and compared. Also, hypnotics prescription rate at the first day of each month of 2014 and 2015 were estimated and compared.

Results: All of 12,382 patients in 2014 and 12,313 patients in 2015 were admitted to the Department of Oncology of the hospital. In 2014, 782 (6.3%) of 12,382 inpatients were already taking hypnotics at the time of admission, and 594 (76.0%) of the 782 patients were still taking sleeping pills at the time of discharge. Following initiation of the i-sleep program (2015), 792 (6.4%) of 12,313 inpatients were already taking hypnotics at the time of admission, and 553 (69.8%) of the 792 inpatients were still taking them at the time of discharge (relative risk, 0.92; 95% confidence interval, 0.87-0.98). On the first day of each month of 2014, 7.3% to 12.6% (mean, 10.0%) of inpatients had prescriptions for hypnotics. Following initiation of the program, the rate of hypnotic prescription was significantly reduced (3.2-10.8%; mean, 8.0%; = 0.03).

Conclusion: Our date showed that the i-sleep program may help to reduce the hypnotic prescription rate in hospitalized cancer patients.
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http://dx.doi.org/10.9758/cpn.2019.17.4.542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852672PMC
November 2019

An Assessment of Physical Activity Data Collected via a Smartphone App and a Smart Band in Breast Cancer Survivors: Observational Study.

J Med Internet Res 2019 09 6;21(9):13463. Epub 2019 Sep 6.

Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Background: Although distress screening is crucial for cancer survivors, it is not easy for clinicians to recognize distress. Physical activity (PA) data collected by mobile devices such as smart bands and smartphone apps have the potential to be used to screen distress in breast cancer survivors.

Objective: The aim of this study was to assess data collection rates of smartphone apps and smart bands in terms of PA data, investigate the correlation between PA data from mobile devices and distress-related questionnaires from smartphone apps, and demonstrate factors associated with data collection with smart bands and smartphone apps in breast cancer survivors.

Methods: In this prospective observational study, patients who underwent surgery for breast cancer at Asan Medical Center, Seoul, Republic of Korea, between June 2017 and March 2018 were enrolled and asked to use both a smartphone app and smart band for 6 months. The overall compliance rates of the daily PA data collection via the smartphone walking apps and wearable smart bands were analyzed in a within-subject manner. The longitudinal daily collection rates were calculated to examine the dropout pattern. We also performed multivariate linear regression analysis to examine factors associated with compliance with daily collection. Finally, we tested the correlation between the count of daily average steps and distress level using Pearson correlation analysis.

Results: A total of 160 female patients who underwent breast cancer surgeries were enrolled. The overall compliance rates for using a smartphone app and smart bands were 88.0% (24,224/27,513) and 52.5% (14,431/27,513), respectively. The longitudinal compliance rate for smartphone apps was 77.8% at day 180, while the longitudinal compliance rate for smart bands rapidly decreased over time, reaching 17.5% at day 180. Subjects who were young, with other comorbidities, or receiving antihormonal therapy or targeted therapy showed significantly higher compliance rates to the smartphone app. However, no factor was associated with the compliance rate to the smart band. In terms of the correlation between the count of daily steps and distress level, step counts collected via smart band showed a significant correlation with distress level.

Conclusions: Smartphone apps or smart bands are feasible tools to collect data on the physical activity of breast cancer survivors. PA data from mobile devices are correlated with participants' distress data, which suggests the potential role of mobile devices in the management of distress in breast cancer survivors.

Trial Registration: ClinicalTrials.gov NCT03072966; https://clinicaltrials.gov/ct2/show/NCT03072966.
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http://dx.doi.org/10.2196/13463DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6788332PMC
September 2019

The Development of Evidence-Based Guideline for Diagnosis and Management of Headache in Korea.

Psychiatry Investig 2019 Mar 21;16(3):199-205. Epub 2019 Mar 21.

Department of Psychiatry, Wonkwang University School of Medicine and Hospital, Iksan, Republic of Korea.

Objective: We aimed to develop the clinical guideline for headache by the systematic review and synthesis of existing evidence-based guidelines. The purpose of developing the guideline was to improve the appropriateness of diagnosis and treatment of headache disorder, and consequently, to improve patients' pain control and quality of life. The guideline broadly covers the differential diagnosis and treatment of tension-type headache, migraine, cluster headache, and medication-overuse headache.

Methods: This is a methodological study based on the ADAPTE methodology, including a systematic review of the literature, quality assessment of the guidelines using the Appraisal of Clinical Guidelines for REsearch & Evaluation II (AGREE II) Instrument, as well as an external review using a Delphi technique. The inclusion criteria for systematic search were as follows: topic-relevant, up-to-date guidelines including evidence from within 5 years, evidence-based guidelines, guidelines written in English or Korean, and guidelines issued by academic institutions or government agencies.

Results: We selected five guidelines and conducted their quality assessment using the AGREE II Instrument. As a result, one guideline was found to be eligible for adaptation. For 13 key questions, a total of 39 recommendations were proposed with the grading system and revised using the nominal group technique.

Conclusion: Recommendations should be applied to actual clinical sites to achieve the ultimate goal of this guideline; therefore, follow-up activities, such as monitoring of guideline usage and assessment of applicability of the recommendations, should be performed in the future. Further assessment of the effectiveness of the guideline in Korea is needed.
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http://dx.doi.org/10.30773/pi.2018.11.23DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6444101PMC
March 2019

Development of Dysfunctional Beliefs and Attitude about Sleep Scale for Cancer Patients.

Behav Sleep Med 2020 May-Jun;18(3):287-297. Epub 2019 Feb 21.

Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

: This study aimed to develop a scale utilizing the original Dysfunctional Beliefs and Attitudes about Sleep (DBAS) scale that measured maladaptive cognitions associated with sleep that is especially sensitive to cancer patients. In addition to the original scale, we added two additional items that reflected cancer-specific dysfunctional beliefs about sleep. : Participants consisted of 337 cancer patients (mean age 54.0 ± 11.8 years, 32.0% men). All participants completed the DBAS-16, two cancer specific items, and the Insomnia Severity Index. Item-to-total-score correlations, internal consistency, item selection, and factor structure were examined. : The DBAS-16 was found to be reliable, and internal consistency was also adequate when adding two cancer-specific questions (Cronbach's alpha = 0.89). A total of 14 items were selected, and a four-factor model was selected using exploratory factor analysis (Tucker-Lewis index = 0.86, root mean square error of approximation = 0.08). The four factors were (a) sleep expectations, (b) worry about insomnia, (c) perceived consequences of insomnia and medication, and (d) two cancer-related items. The modified 14 items of the Cancer-related DBAS (C-DBAS-14) well differentiated cancer patients with and without insomnia. : The C-DBAS-14 is a promising measure that has adequate internal consistency. It is also sensitive to sleep-related cognitions in cancer patients and can discriminate patients with cancer who are experiencing insomnia from those who are good sleepers. The enhanced utility of the shortened 14-item scale tailored specifically to cancer patients may be useful in both clinical practice and research settings. CBT: cognitive behavioral therapy; C-DBAS-14: Cancer-Related Dysfunctional Beliefs and Attitude about Sleep; C-DBS: Cancer-Related Dysfunctional Beliefs about Sleep; DBAS-16: Dysfunctional Beliefs and Attitudes about Sleep; ISI: Insomnia Severity Index.
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http://dx.doi.org/10.1080/15402002.2019.1578773DOI Listing
June 2020

Psychological Responses among Humidifier Disinfectant Disaster Victims and Their Families.

J Korean Med Sci 2019 Jan 16;34(4):e29. Epub 2019 Jan 16.

Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

To substantiate psychological symptoms following humidifier disinfectant (HD) disasters, counseling records of 26 victims and 92 family members of victims (45 were bereaved) were analyzed retrospectively. Among the victims, 34.6% had Clinical Global Impression-Severity scores of over 4, which meant they were moderately ill. While anxiety/fear and depression with respiratory symptoms were frequently observed in victims and family members, chronic psychological distress such as alcohol/smoking abuse and insomnia was relatively high in bereaved family members. In conclusion, it is important to provide mental health support for victims and their families, focusing on the characteristic symptoms of each group as well as monetary compensation.
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http://dx.doi.org/10.3346/jkms.2019.34.e29DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345639PMC
January 2019

Psychological Distress and Drawing Tests among Women with Breast Cancer.

J Korean Med Sci 2018 Apr 19;33(17):e140. Epub 2018 Apr 19.

Department of Medical Humanities and Social Sciences, University of Ulsan College of Medicine, Seoul, Korea.

Background: The aim of this study was to evaluate the use of the Diagnostic Drawing Series (DDS) as a screening tool for the breast cancer patients with psychological distress.

Methods: All of 64 patients with breast cancer participated in this study. Patients' depressive and anxiety symptoms were assessed using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) when the DDS was applied to the partipicants.

Results: Depressed patients used more enclosure in the Feeling drawings ( = 0.002) and tilt in Free drawings ( = 0.048). Patients with anxiety drew a picture over 67% of the paper ( = 0.015) in Tree drawing and more medium pressure ( = 0.049) in Feeling drawings. Thirty four subjects (77.3%) of unstable emotion group used over 67% of the space ( = 0.002). More Landscapes were observed in the Feeling drawings of unstable patients ( = 0.042).

Conclusion: These results suggested that DDS could be used as a supplemental screening tool for psychological distress in breast cancer patients.
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http://dx.doi.org/10.3346/jkms.2018.33.e140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5909107PMC
April 2018

A Sleep Education and Hypnotics Reduction Program for Hospitalized Patients at a General Hospital.

Psychiatry Investig 2018 Jan 16;15(1):78-83. Epub 2018 Jan 16.

Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Objective: We applied a program of sleep education and hypnotics reduction for inpatients (the i-sleep program). This study explored whether the i-sleep program is effective for reducing the prescription rate of sleeping pills to inpatients in a general hospital.

Methods: We estimated the proportion of inpatients prescribed hypnotics at admission to and discharge from the hospital, excluding pediatric care units, before (2014) and after (2015) the program. In addition, we estimated the proportion of inpatients prescribed sleeping pills among all inpatients on the first day of each month of 2014 and 2015.

Results: The proportion of inpatients prescribed hypnotics as discharge medication among inpatients who had been prescribed them at the time of admission decreased significantly, from 57.0% to 46.8%, after the i-sleep program (RR=0.82, 95% CI: 0.79-0.86). The proportion of inpatients newly prescribed sleeping pills after admission to the hospital did not significantly decrease (1.97% to 2.00%; RR=1.01, 95% CI: 0.96-1.07). The mean prescription rate of sleeping pills per day was 8.18% in 2014 and 7.78% in 2015.

Conclusion: The i-sleep program reduced the proportion of inpatients who continued to take sleeping pills from admission until discharge, although it did't reduce the prescription rate per day.
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http://dx.doi.org/10.4306/pi.2018.15.1.78DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5795035PMC
January 2018

The Prevalence of Depression among Patients with the Top Ten Most Common Cancers in South Korea.

Psychiatry Investig 2017 Sep 11;14(5):618-625. Epub 2017 Sep 11.

Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.

Objective: Among the various psychiatric disorders, depression is a common comorbid condition in cancer patients. Due to the distinct and diverse nature of cancer, the prevalence of depression may be assumed to be affected by differences in primary cancer sites. In this study, we explored the prevalence rates of depression among the ten most prevalent cancers in South Korea using a national patient sample.

Methods: This was a 1-year cross-sectional study using a national patient sample provided by the South Korean National Health Insurance in 2011. We selected all patients who had received ICD-10 codes of the 10 most prevalent cancers and major depressive disorder. Afterwards, the cancer and depression groups were merged and analyzed.

Results: The MDD prevalence rate was highest in lung cancer (11.0%), followed by non-Hodgkin's lymphoma (9.2%), prostate (9.1%), bladder (8.8%), breast (7.8%), cervix (7.8%), colorectal (7.7%), stomach (6.9%), liver (6.5%), and thyroid cancer (5.6%). Within all cancer groups, patients with a MDD diagnosis were significantly older (p<0.05) than non-MDD patients. Colorectal, stomach, and thyroid cancer displayed a higher female proportion in the MDD group than the non-MDD group. In the subgroup analysis, the prevalence rate differed by age and sex.

Conclusion: The prevalence of depression varied according to cancer types. Patients with lung cancer were the most prone to experience depression. Because clinical and psychological factors may influence MDD prevalence, these factors will need to be studied more closely in the future.
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http://dx.doi.org/10.4306/pi.2017.14.5.618DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5639130PMC
September 2017

Prescription Pattern of Antidepressants for Children and Adolescents in Korea Based on Nationwide Data.

J Korean Med Sci 2017 Oct;32(10):1694-1701

Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Antidepressant prescription for youths has recently been on the increase. There is a growing concern over the increasing off-label usage of antidepressants. Current data on off-label antidepressant usage vary across countries and healthcare systems. Therefore, we examined the extent and pattern of antidepressant prescription for Korean children and adolescents using population-based data. Our data was retrieved from the Korean National Health Insurance Service National Sample Cohort of the year 2013. Among 0.2 million children and adolescents aged 6-18 years from the cohort, subjects who had received any antidepressant medication in the year 2013 were investigated for the prescribed medication, concomitant psychotropic medication, and the associated diagnosis. A total of 2,190 children and adolescents (boys, 55.4%) received antidepressant medication. The most common diagnosis was depressive disorders (n = 469, 21.4%), followed by attention-deficit/hyperactivity disorder (n = 442, 20.2%). Among the prescriptions (n = 3,370), escitalopram (n = 650, 24.1%) and fluoxetine (n = 553, 20.5%) were the two most frequently prescribed drugs. A majority of prescriptions (n = 2,039, 60.5%) included concomitant psychotropic agents, consisting of antipsychotics (n = 901, 26.7%), sedatives (n = 263, 26.3%), medication for attention-deficit/hyperactivity disorder (n = 822, 24.4%), and some others. Our study shows the prescription pattern of antidepressants for children and adolescents in Korea, of which a large proportion is off-label. The results call for close monitoring by clinicians treating this population.
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http://dx.doi.org/10.3346/jkms.2017.32.10.1694DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5592186PMC
October 2017

Noise sensitivity, rather than noise level, predicts the non-auditory effects of noise in community samples: a population-based survey.

BMC Public Health 2017 04 12;17(1):315. Epub 2017 Apr 12.

Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, Republic of Korea.

Background: Excessive noise affects human health and interferes with daily activities. Although environmental noise may not directly cause mental illness, it may accelerate and intensify the development of latent mental disorders. Noise sensitivity (NS) is considered a moderator of non-auditory noise effects. In the present study, we aimed to assess whether NS is associated with non-auditory effects.

Methods: We recruited a community sample of 1836 residents residing in Ulsan and Seoul, South Korea. From July to November 2015, participants were interviewed regarding their demographic characteristics, socioeconomic status, medical history, and NS. The non-auditory effects of noise were assessed using the Center of Epidemiologic Studies Depression, Insomnia Severity index, State Trait Anxiety Inventory state subscale, and Stress Response Inventory-Modified Form. Individual noise levels were recorded from noise maps. A three-model multivariate logistic regression analysis was performed to identify factors that might affect psychiatric illnesses.

Results: Participants ranged in age from 19 to 91 years (mean: 47.0 ± 16.1 years), and 37.9% (n = 696) were male. Participants with high NS were more likely to have been diagnosed with diabetes and hyperlipidemia and to use psychiatric medication. The multivariable analysis indicated that even after adjusting for noise-related variables, sociodemographic factors, medical illness, and duration of residence, subjects in the high NS group were more than 2 times more likely to experience depression and insomnia and 1.9 times more likely to have anxiety, compared with those in the low NS group. Noise exposure level was not identified as an explanatory value.

Conclusions: NS increases the susceptibility and hence moderates there actions of individuals to noise. NS, rather than noise itself, is associated with an elevated susceptibility to non-auditory effects.
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http://dx.doi.org/10.1186/s12889-017-4244-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5389011PMC
April 2017

Orexin Impairs the Phagocytosis and Degradation of Amyloid-β Fibrils by Microglial Cells.

J Alzheimers Dis 2017 ;58(1):253-261

Department of Brain Science, University of Ulsan College of Medicine, Seoul, Korea.

Background: Intracranial accumulation of amyloid-β (Aβ) is a characteristic finding of Alzheimer's disease (AD). It is thought to be the result of Aβ overproduction by neurons and impaired clearance by several systems, including degradation by microglia. Sleep disturbance is now considered a risk factor for AD, but studies focusing on how sleep modulates microglial handling of Aβ have been scarce.

Objective: To determine whether phagocytosis and degradation of extracellular Aβ fibrils by BV2 microglial cells were impaired by treatment with orexin-A/B, a major modulator of the sleep-wake cycle, which may mimic sleep deprivation conditions.

Methods: BV2 cells were treated with orexin and Aβ for various durations and phagocytic and autophagic processes for degradation of extracellular Aβ were examined.

Results: After treatment with orexin, the formation of actin filaments around Aβ fibrils, which is needed for phagocytosis, was impaired, and phagocytosis regulating molecules such as PI3K, Akt, and p38-MAPK were downregulated in BV2 cells. Orexin also suppressed autophagic flux, through disruption of the autophagosome-lysosome fusion process, resulting in impaired Aβ degradation in BV2 cells.

Conclusions: Our results demonstrate that orexin can hinder clearance of Aβ through the suppression of phagocytosis and autophagic flux in microglia. This is a novel mechanism linking AD and sleep, and suggests that attenuated microglial function, due to sleep deprivation, may increase Aβ accumulation in the brain.
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http://dx.doi.org/10.3233/JAD-170108DOI Listing
February 2018

Humidifier disinfectant lung injury, how do we approach the issues?

Environ Health Toxicol 2016 29;31:e2016019. Epub 2016 Aug 29.

Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

A large portion of the Korean population has been exposed to toxic humidifier disinfectants (HDs), and considering that the majority of the victims are infants, the magnitude of the damage is expected to be considerably larger than what has currently been revealed. The current victims are voicing problems caused by various diseases, including but not limited to lung, upper respiratory tract, cardiovascular, kidney, musculoskeletal, eye, and skin diseases, etc. However, there has been difficulty in gaining validation for these health problems and identifying causal relationships due to lack of evidence proving that toxic HD is the specific causes of extrapulmonary diseases such as allergic rhinitis. Furthermore, the victims and bereaved families of the HD case have not received any support for psychological distress such as post-traumatic stress disorder, depression, feelings of injustice, and anger caused by the trauma. In addition, because the underlying mechanisms of the toxic materials within the HDs such as polyhexamethylene guanidine phosphate, poly(oxyalkylene guanidine) hydrochloride, chloromethylisothiazolinone/methylisothiazolinone have yet to be determined, the demand for information regarding the HD issue is growing. The victims of the HD cases require support that goes beyond financial aid for medical costs and living expenses. There is a desperate need for government-led integrated support centers that provide individualized support through health screenings; in other words, we need an integrated facility that provides the appropriate social support to allow the victims to recover their physical and mental health, so as to well prepare them to return to a normal life. The implementation of such a plan requires not only the close cooperation between those departments already directly involved such as the Ministry of Environment and the Ministry of Health and Welfare, but also active support on a national scale from pan-governmental consultative bodies.
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http://dx.doi.org/10.5620/eht.e2016019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5080795PMC
August 2016

The major risk factors for delirium in a clinical setting.

Neuropsychiatr Dis Treat 2016 21;12:1787-93. Epub 2016 Jul 21.

Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Objective: We aimed to determine the major risk factors for the development of delirium in patients at a single general hospital by comparison with a control group.

Subjects And Methods: We reviewed the medical records of 260 delirium patients and 77 control patients. We investigated age, sex, and risk factors for delirium in the total delirium group (n=260), the delirium medical subgroup (n=142), and the delirium surgical subgroup (n=118). Logistic regression analysis adjusting for age and sex was performed to identify the odds ratio.

Results: The mean age and the percentage of males were significantly higher in the delirium group compared with the control group (68.9 vs 54.3 years and 70% vs 41.6%, respectively). Risk factors for the delirium group were lower plasma albumin, hypertension, mechanical ventilation, and antipsychotic drug use. Plasma sodium level and hypertension were important risk factors for the delirium medical subgroup. Stroke history, hypertension, ICU care, and medication were important risk factors for the delirium surgical subgroup.

Conclusion: Lower plasma albumin, hypertension, mechanical ventilation, and antipsychotic drug use are important risk factors for delirium.
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http://dx.doi.org/10.2147/NDT.S112017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4959764PMC
August 2016