Association Between Chronotype, Sleep Quality and Resilience as Well as Anxiety Among Medical Students / 수면정신생리

Objectives@#Our study aimed to investigate the relationship between the anxiety at first year and chronotype and sleep quality at third year in medical students. We also investigated the association between sleep quality, chronotype, depression and resilience at third year. @*Methods@#Fifty two medical students (36 males, 69%, aged 21 ± 0.93) in first year, and forty four medical students (31 males, 70.5%, aged 23.05 ± 0.99) at third year answered Beck Depression Inventory 2, Beck anxiety inventory, Insomnia severity index-K, Composite scale of morningness and Conner-Davidson Resilience scale-10. Multiple linear regression analysises were performed to identify predictors of chronotype, sleep quality and resilience. @*Results@#Higher anxiety (β = -0.434, p = 0.006) at first year was significant predictor of eveningness at third year, while lower anxiety score (β = 0.606, p < 0.001) at first year was significant predictor of sleep quality at third year. Lower sleep quality (β = -0.314, p = 0.042) and eveningness (β = 0.315, p = 0.041) were associated with low resilience at third year. Also, Lesser depression (β = -0.717, p < 0.001) was associated with higher resilience at third year. @*Conclusion@#Our study showed that higher anxiety in first year had significantly related with eveningness and poor sleep quality at third year. In addition, higher sleep quality, morningness and less depression had significantly associated with better resilience at third year.

Perception Related to Coronavirus Disease-19 Induced Anxiety in Elderly

Objective@#To investigate perceptions of coronavirus disease-19 (COVID-19) associated with anxiety caused by the COVID-19 epidemic in the elderly who are vulnerable to mental health problems. @*Methods@#This study used data of a survey on perceptions of COVID-19 and changes in mental health of 1,000 out of residents in a province of Korea in April 2020. The survey included questions about psychological perceptions for COVID-19. Subjects were dived into two groups (<60 and ≥60). Binary logistic regression analyses were performed for evaluating the association between anxiety and perceptions about COVID-19 in each group. @*Results@#Results of binary logistic regression analyses revealed that only ‘fear of getting infected myself’among perceptions for COVID-19 was associated with anxiety in the elderly aged more than 60 years. However, in adults aged less than 60 years, all perceptions for COVID-19 except impairment of performance were associated with such anxiety. @*Conclusion@#We found that the anxiety for COVID-19 in elderly with age over 60 years was associated with ‘fear of getting infected myself’ rather than ‘fear of family or people around them’, unlike adults aged less than 60 years. These results can be applied in strategies for psychological quarantine against COVID-19 among the elderly.

Association between Early Spermarche and Suicide Attempts in Boys:the Korea Youth Risk Behavior Web-based Survey

Background@#Puberty is a biologically and psychologically unstable period, and pubertal changes differ by sex. However, most previous studies on pubertal timing and suicide have focused on girls. This study investigated the association between early spermarche and suicide attempts in boys. @*Methods@#We analyzed a nationally representative sample of Korean adolescents (The Korea Youth Risk Behavior Web-Based Survey, KYRBS) that included approximately 35,000 boys annually from 2011 to 2015. Pubertal timing in boys was defined by spermarche. Complex sampling logistic regression analyses were performed to evaluate the odds ratios (ORs) for suicide attempts between the early and average spermarche groups. @*Results@#The ORs for suicide attempts in boys with early spermarche were significantly higher than those in boys with average spermarche after adjustment for age, perceived stress, depressive symptoms, and suicidal ideation. The ORs from 2011 to 2015 were as follows: 1.782 (P < 0.001), 1.490 (P = 0.002), 1.693 (P < 0.001), 1.541 (P = 0.001), and 1.393 (1.024– 1.895; P = 0.035), respectively. @*Conclusion@#These findings suggest that early pubertal timing is a risk factor for suicide attempts in Korean boys after adjustment for depressive symptoms, perceived stress, and suicidal ideation, which have been previously reported as risk factors for suicide attempts. Therefore, careful attention should be paid to the prevention of suicide in boys who experience early spermarche in Korea.

Association Between Suicide and Drinking Habits in Adolescents

Objectives@#Adolescent suicide is a serious social problem. Adolescent alcohol use is one of the most important risk factors for adolescent suicide. This study aimed to identify the relationship between drinking habits and suicide among Korean adolescents. @*Methods@#Data from the 14th and 15th Korean Youth Risk Behavior Web-based Survey, conducted in 2018 and 2019, were used for analysis. Multiple logistic regression analysis was used to identify the relationship between drinking habits—including the age of drinking initiation, frequency of drinking, average drinking amount, frequency of drunkenness—and suicidal ideation, plans, and attempts. @*Results@#Even after adjusting for age, sex, school grade, academic achievement, socioeconomic status, depression, stress, and drinking habits, the frequencies of drinking and drunkenness increased the risk of suicide attempts. Suicide attempts were associated with the frequency of drinking in girls and middle school students, and with the frequency of drunkenness in boys and high school students. @*Conclusion@#This study identified associations between drinking habits (the age of drinking initiation, frequency of drinking, average amount of drinking, frequency of drunkenness) and suicidal behavior in adolescents. Our findings suggest that to prevent adolescent suicide, it might be necessary to investigate drinking habits, including the frequencies of drinking and drunkenness. Moreover, considering the differences in sex and school grade, it is important to include the individual group characteristics when evaluating drinking habits.

The Type of Daily Life Stressors Associated with Social Media Use in Adolescents with Problematic Internet/Smartphone Use

Objective@#This study investigated the types of daily life stressors associated with social media use in adolescents with problematic Internet/smartphone use in a city in Korea. @*Methods@#Data from 2,997 Internet and smartphone users who participated in a survey about the actual use of smart digital media in Korea were included. The measurement tools included questionnaires on Internet and smartphone usage patterns and types of daily life stressors as well as the Internet Gaming Use-Elicited Symptom Screen and a smartphone addiction scale. The subjects were divided into a problematic Internet/smartphone use group and a control group. We compared the types of daily life stressors associated with social media use for each group. @*Results@#All types of daily life stressors were more prevalent in the problematic Internet use group than in the control group. In the problematic Internet/smartphone use group, the types of daily life stressors that were positively associated with social media use were sibling rivalry and physical health. In the control group, social media use was negatively associated with daily life stressors related to appearance and heterosexual relationships. @*Conclusion@#There is a need to provide personalized stress management related to social media use for adolescents with problematic Internet/smartphone use.

Perception Related to Coronavirus Disease-19 Induced Anxiety in Elderly

Objective@#To investigate perceptions of coronavirus disease-19 (COVID-19) associated with anxiety caused by the COVID-19 epidemic in the elderly who are vulnerable to mental health problems. @*Methods@#This study used data of a survey on perceptions of COVID-19 and changes in mental health of 1,000 out of residents in a province of Korea in April 2020. The survey included questions about psychological perceptions for COVID-19. Subjects were dived into two groups (<60 and ≥60). Binary logistic regression analyses were performed for evaluating the association between anxiety and perceptions about COVID-19 in each group. @*Results@#Results of binary logistic regression analyses revealed that only ‘fear of getting infected myself’among perceptions for COVID-19 was associated with anxiety in the elderly aged more than 60 years. However, in adults aged less than 60 years, all perceptions for COVID-19 except impairment of performance were associated with such anxiety. @*Conclusion@#We found that the anxiety for COVID-19 in elderly with age over 60 years was associated with ‘fear of getting infected myself’ rather than ‘fear of family or people around them’, unlike adults aged less than 60 years. These results can be applied in strategies for psychological quarantine against COVID-19 among the elderly.

Association between Early Spermarche and Suicide Attempts in Boys:the Korea Youth Risk Behavior Web-based Survey

Background@#Puberty is a biologically and psychologically unstable period, and pubertal changes differ by sex. However, most previous studies on pubertal timing and suicide have focused on girls. This study investigated the association between early spermarche and suicide attempts in boys. @*Methods@#We analyzed a nationally representative sample of Korean adolescents (The Korea Youth Risk Behavior Web-Based Survey, KYRBS) that included approximately 35,000 boys annually from 2011 to 2015. Pubertal timing in boys was defined by spermarche. Complex sampling logistic regression analyses were performed to evaluate the odds ratios (ORs) for suicide attempts between the early and average spermarche groups. @*Results@#The ORs for suicide attempts in boys with early spermarche were significantly higher than those in boys with average spermarche after adjustment for age, perceived stress, depressive symptoms, and suicidal ideation. The ORs from 2011 to 2015 were as follows: 1.782 (P < 0.001), 1.490 (P = 0.002), 1.693 (P < 0.001), 1.541 (P = 0.001), and 1.393 (1.024– 1.895; P = 0.035), respectively. @*Conclusion@#These findings suggest that early pubertal timing is a risk factor for suicide attempts in Korean boys after adjustment for depressive symptoms, perceived stress, and suicidal ideation, which have been previously reported as risk factors for suicide attempts. Therefore, careful attention should be paid to the prevention of suicide in boys who experience early spermarche in Korea.

Association Between Suicide and Drinking Habits in Adolescents

Objectives@#Adolescent suicide is a serious social problem. Adolescent alcohol use is one of the most important risk factors for adolescent suicide. This study aimed to identify the relationship between drinking habits and suicide among Korean adolescents. @*Methods@#Data from the 14th and 15th Korean Youth Risk Behavior Web-based Survey, conducted in 2018 and 2019, were used for analysis. Multiple logistic regression analysis was used to identify the relationship between drinking habits—including the age of drinking initiation, frequency of drinking, average drinking amount, frequency of drunkenness—and suicidal ideation, plans, and attempts. @*Results@#Even after adjusting for age, sex, school grade, academic achievement, socioeconomic status, depression, stress, and drinking habits, the frequencies of drinking and drunkenness increased the risk of suicide attempts. Suicide attempts were associated with the frequency of drinking in girls and middle school students, and with the frequency of drunkenness in boys and high school students. @*Conclusion@#This study identified associations between drinking habits (the age of drinking initiation, frequency of drinking, average amount of drinking, frequency of drunkenness) and suicidal behavior in adolescents. Our findings suggest that to prevent adolescent suicide, it might be necessary to investigate drinking habits, including the frequencies of drinking and drunkenness. Moreover, considering the differences in sex and school grade, it is important to include the individual group characteristics when evaluating drinking habits.

The Type of Daily Life Stressors Associated with Social Media Use in Adolescents with Problematic Internet/Smartphone Use

Objective@#This study investigated the types of daily life stressors associated with social media use in adolescents with problematic Internet/smartphone use in a city in Korea. @*Methods@#Data from 2,997 Internet and smartphone users who participated in a survey about the actual use of smart digital media in Korea were included. The measurement tools included questionnaires on Internet and smartphone usage patterns and types of daily life stressors as well as the Internet Gaming Use-Elicited Symptom Screen and a smartphone addiction scale. The subjects were divided into a problematic Internet/smartphone use group and a control group. We compared the types of daily life stressors associated with social media use for each group. @*Results@#All types of daily life stressors were more prevalent in the problematic Internet use group than in the control group. In the problematic Internet/smartphone use group, the types of daily life stressors that were positively associated with social media use were sibling rivalry and physical health. In the control group, social media use was negatively associated with daily life stressors related to appearance and heterosexual relationships. @*Conclusion@#There is a need to provide personalized stress management related to social media use for adolescents with problematic Internet/smartphone use.

The Mediating Effect of Depressive Symptoms on the Relationship between Adverse Childhood Experiences and Problematic Internet Use in Children and Adolescents

The purpose of this study was to evaluate the mediating effect of depressive symptoms on the relationship between adverse childhood experiences (ACEs) and problematic internet use. The study participants were 180 students between the ages of 9 and 18 years. Path analysis was performed to measure the relationships among ACEs, depressive symptoms and problematic internet use. ACEs significantly affected depressive symptoms (standardized regression weight, 0.36; P < 0.01), and depressive symptoms also affected problematic internet use (standardized regression weight, 0.40; P < 0.01). We found that depressive symptoms had a significant mediating effect on the relationship between problematic internet use and ACEs. The management of depressive symptoms would be important to prevent problematic internet use in children and adolescents with ACEs.

Normal-But-Low Serum Folate Levels and the Risks for Cognitive Impairment

OBJECTIVE: This study aimed to examine the association between normal-but-low folate levels and cognitive function in the elderly population using a prospective cohort study. METHODS: We analyzed 3,910 participants whose serum folate levels were within the normal reference range (1.5–16.9 ng/mL) at baseline evaluation in the population-based prospective cohort study named the “Korean Longitudinal Study on Cognitive Aging and Dementia.” The association between baseline folate quartile categories and baseline cognitive disorders [mild cognitive impairment (MCI) or dementia] was examined using binary logistic regression analysis adjusting for confounding variables. The risks of incident MCI and dementia associated with the decline of serum folate level during a 4-year follow-up period were examined using multinomial logistic regression analysis. RESULTS: The lowest quartile group of serum folate (≥1.5, ≤5.9 ng/mL) showed a higher risk of cognitive disorders than did the highest quartile group at baseline evaluation (odds ratio 1.314, p=0.012). Over the 4 years of follow-up, the risk of incident dementia was 2.364 times higher among subjects whose serum folate levels declined from the 2nd–4th quartile group to the 1st quartile than among those for whom it did not (p=0.031). CONCLUSION: Normal-but-low serum folate levels were associated with the risk of cognitive disorders in the elderly population, and a decline to normal-but-low serum folate levels was associated with incident dementia. Maintaining serum folate concentration above 5.9 ng/mL may be beneficial for cognitive status.

A Prediction Model of Factors related to Career Maturity in Korean High School Students

PURPOSE: The purpose of this study was to identify factors associated with career maturity among Korean high school students. METHODS: A descriptive cross-sectional design was adopted using secondary data from the 2012 Korean Welfare Panel Study (KoWePS). The participants were 496 high school students who completed the supplemental survey for children, which included items on career maturity, self-esteem, study stress, teacher attachment, relationship with parents, peer attachment, depression and anxiety. Descriptive statistics, the chi-square-test, the t-test, and a decision tree were used for data analysis. RESULTS: The decision tree identified five final nodes predicting career maturity after forcing self-esteem as the first variable. The highest predicted rate of high career maturity was associated with high self-esteem, experience of career counseling, and high teacher attachment. The lowest predicted rate of high career maturity was associated with low self-esteem and low attachment to friends. CONCLUSION: Factors influencing career maturity were varied by levels of self-esteem in Korean high school students. Thus, it is necessary to develop different approaches to enhance career maturity according to levels of self-esteem.

Cognitive Stimulation as a Therapeutic Modality for Dementia: A Meta-Analysis

OBJECTIVE: Although cognitive stimulation (CS) is one of the most popular non-pharmacological interventions for people with dementia, its efficacy is still debatable. We performed a meta-analysis of randomized controlled trials (RCTs) on the efficacy of CS in people with dementia. METHODS: Data sources were identified by searching PubMed, MEDLINE, Embase, psychINFO, and Cochrane Reviews Library. A total of 7,354 articles were identified, and of these, 30 RCTs were selected based on the selection criteria. Of these 30 RCTs, 14 were finally included in our meta-analysis [731 participants with dementia; 412 received CS (CS group) and 319 received usual care (control group)]. RESULTS: We found that the people with dementia had a moderate benefit from CS. The mean difference between the CS and control groups was 2.21 [95% CI (0.93, 3.49), Z=3.38, p=0.00007] in the Alzheimer's Disease Assessment Scale-Cognition and 1.41 [95% CI (0.98, 1.84), Z=6.39, p<0.00001] in the Mini-Mental State Examination. CS also improved quality of life in people with dementia [95% CI (0.72, 3.38), Z=3.02, p=0.003]. CONCLUSION: CS is effective for improving cognition and quality of life in people with dementia; however, its effects were small to moderate.

Emotional Characteristics of Adolescents in Monocultural and Multicultural Families in Korea

OBJECTIVES: We aimed to compare the smoking behaviors in adolescents from monocultural and multicultural families and to evaluate the associations between their smoking behavior and number of suicide attempts. METHODS: The data used in this study was collected from The Tenth Korea Youth Risk Behavior Web-based Survey. The differences in the sociodemographic characteristics between the adolescents in the multicultural and monocultural families were analyzed through the χ2-test, and a logistic regression was conducted to evaluate the relationships between the smoking behavior and number of suicide attempts of the adolescents in multicultural families. The process involved an analysis using a complex sample design. RESULTS: There was significant difference in the weighted rates of the current smoking behavior (13.3% vs. 8.4%, p<0.001), experience of violence (6.8% vs. 2.3%, p<0.001), and number of suicide attempts (5.4% vs. 2.7%, p<0.001) between the adolescents from the multicultural and monocultural families. In both groups, the current smoking behavior was associated with the number of suicide attempts (multicultural families OR=6.5, p=0.005; monocultural families OR=1.5, p<0.001). CONCLUSION: Our results showed that the percentage of current smokers in the adolescents from multicultural families was higher than that in the monocultural families and that current smoking behavior is related to the number of suicide attempts in both groups, after adjustment for age, sex, socioeconomic status, academic achievement, current smoking behavior, depressive mood and experience of violence.

Contents Analysis of Health Textbooks for Elementary Schools / 한국간호교육학회지

PURPOSE: The objective of this study was to analyse the content of health-textbooks in elementary school in order to offer the basic data required for development or revision of health-textbook for elementary school. METHODS: This study was methodological study of the content of health-textbooks. The study sample consisted of 10 health-textbooks of elementary school which were edited in 2009~2010. The components of contents divides into holistic analysis and specific areas. RESULTS: One textbook was no introductory remarks and 2 textbooks were no preface. The health-textbooks consisted of 7 areas and were comprehensive for school education. The proportion of each was different in 10 textbooks. Sexuality and health was accounted for the largest portion of the seven areas in both the fifth and sixth grade. However, given that the mortality rate for the child's safety accidents is higher than in developed countries, the proportion of accident prevention and first aid can be relatively weak area. CONCLUSION: It is essential that health-textbooks empower schoolers to make healthy decisions through the promotion of useful life skills that provide a more integrated concept of health. Therefore, there is a need for approaches to health textbook to integrate more values of health.