• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.2 no.2
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• pp.153-163
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• 1999

Purpose: The purpose of our study is to provide useful information for diagnostic methods of fatty liver by childhood simple obesity and to provide correlation between serum alanine aminotransferase (ALT) for screening test and abdominal computerized tomography (CT) and liver biopsy for confirmative diagnostic methods of fatty liver. Methods: Among 78 obese childrens who visited our hospital, CT was carried out in 26 childrens. Of these, liver biopsy was carried out in 15 childrens who had high obesity index or severe elevated ALT. Based on the level of serum ALT, 26 cases were classified into 3 groups, and compared with physical measurements and degree of fatty infiltration on CT and liver biopsy. Results: 1) Correlation between ALT and physical measurements: Of 26 obese children, ALT was abnormally elevated (>30 IU/L) in 17 cases (67.4%) but there was no significant correlation between ALT and physical measurements (p>0.05). 2) Correlation between degree of fatty infiltration on CT and ALT: Of 26 cases, 13 cases (50%) revealed fatty liver on CT. The degree of fatty liver on CT had significant correlation with elevation of ALT (p<0.05). 3) Correlation between the degree of fatty infiltration on liver biopsy and ALT: Liver biopsy was performed in 15 cases of which 14 cases revealed fatty liver. But one case had normal hepatic histology with severe obesity and normal ALT. Fourteen fatty liver cases on liver biopsy were classified into 3 groups by the degree of fatty infiltration and analysed with obesity index and ALT. The histologic hepatic steatosis had no significant correlation with obesity index (p>0.05), but significant correlation with ALT (p<0.05). 4) Correlation between CT and liver biopsy finding: Both CT and liver biopsy were performed in 15 cases of which 6 cases revealed normal finding on CT and 9 cases manifested fatty liver. There was significant correlation between CT and liver biopsy findings (r=0.6094). Conclusion: The results of our study suggest that abdominal CT and liver biopsy are useful and accurate methods of estimating fatty liver in the childhood obesity. But biochemical abnormalities of routine liver function tests dot not correlate well with severity of the fatty liver and liver injury.

• Tuberculosis and Respiratory Diseases
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• v.45 no.6
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• pp.1236-1251
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• 1998

Background : TNF-$\alpha$ appears to be a central mediator of the host response to sepsis. While TNF-$\alpha$ is mainly considered a proinflammatory cytokine, it can also act as a direct cytotoxic cytokine. However, there are not so many studies about the relationship bet ween TNF-$\alpha$ level and lung injury severity in ALI, particularly regarding the case of ALI caused by direct lung injury such as diffuse pulmonary infection. Recently, a natural defense mechanism, known as the stress response or the heat shock response, has been reported in cellular or tissue injury reaction. There are a number of reports examining the protective role of pre-induced heat stress proteins on subsequent LPS-induced TNF-$\alpha$ release from monocyte or macrophage and also on subsequent LPS-induced ALI in animals. However it is not well established whether the stress protein synthesis such as HSP can be induced from rat alveolar macrophages by in vitro or in vivo LPS stimulation. Methods : We measured the level of TNF-$\alpha$, the percentage of inflammatory cells in bronchoalveolar lavage fluid, protein synthesis in alveolar macrophages isolated from rats at 1, 2, 3, 4, 6, 12, and 24 hours after intratracheal LPS instillation. We performed histologic examination and also obtained histologic lung injury index score in lungs from other rats at 1, 2, 3, 4, 6, 12, 24 h after intratracheal LPS instillation. Isolated non-stimulated macrophages were incubated for 2 h with different concentration of LPS (0, 1, 10, 100 ng/ml, 1, or 10 ${\mu}g/ml$). Other non-stimulated macrophages were exposed at $43^{\circ}C$ for 15 min, then returned to at $37^{\circ}C$ in 5% CO2-95% for 1 hour, and then incubated for 2 h with LPS (0, 1, 10, 100ng/ml, 1, or 10 ${\mu}g/ml$). Results : TNF-$\alpha$ levels began to increase significantly at 1 h, reached a peak at 3 h (P<0.0001), began to decrease at 6 h, and returned to control level at 12 h after LPS instillation. The percentage of inflammatory cells (neutrophils and alveolar macrophages) began to change significantly at 2 h, reached a peak at 6 h, began to recover but still showed significant change at 12 h, and showed insignificant change at 24 h after LPS instillation compared with the normal control. After LPS instillation, the score of histologic lung injury index reached a maximum value at 6 h and remained steady for 24 hours. 35 kDa protein band was newly synthesized in alveolar macrophage from 1 hour on for 24 hours after LPS instillation. Inducible heat stress protein 72 was not found in any alveolar macrophages obtained from rats after LPS instillation. TNF-$\alpha$ levels in supernatants of LPS-stimulated macro phages were significantly higher than those of non-stimulated macrophages(p<0.05). Following LPS stimulation, TNF-$\alpha$ levels in supernatants were significantly lower after heat treatment than in those without heat treatment (p<0.05). The inducible heat stress protein 72 was not found at any concentrations of LPS stimulation. Whereas the 35 kDa protein band was exclusively found at dose of LPS of 10 ${\mu}g/ml$. Conclusion : TNF-$\alpha$ has a direct or indirect close relationship with lung injury severity in acute lung injury or acute respiratory distress syndrome. In vivo and in vitro LPS stimulation dose not induce heat stress protein 72 in alveolar macrophages. It is likely that 35 kDa protein, synthesized by alveolar macrophage after LPS instillation, does not have a defense role in acute lung injury.

• Tuberculosis and Respiratory Diseases
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• v.47 no.6
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• pp.824-835
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• 1999

Background: Sleep-related breathing disorders are commonly found in patients with chronic renal failure and particularly, sleep apnea may have an influence on the long-term mortality rates in these patients. Maintenance hemodialysis is the mainstay of medical measures for correcting the metabolic derangements of chronic renal failure but it is uncertain whether it may alleviate sleep disorders including sleep apnea. Methods: Forty seven patients on maintenance hemodialysis were surveyed with the sleep questionnaire about their clinical symptoms related to sleep disorders. Among them, 15 patients underwent the polysomnography and their blood levels of urea nitrogen, creatinine, electrolytes and the arterial blood gases in the nights before and following hemodialysis were measured. Results: Forty(85.1%) of the 47 patients complained of the symptoms associated with sleep-wake cycle disturbances, 55.3% experienced snoring and 27.7% reported witnessed apneas. The duration of REM sleep increased significantly in the nights after hemodialysis compared to the nights without hemodialysis(p<0.05) and the percentage of total sleep time comprising NREM sleep decreased significantly in the nights following hemodialysis compared to the nights before hemodialysis(p<0.05). The percentage of total sleep time consisting of the stage 1 and 2 NREM sleep showed the trend for a decrease in the nights after hemodialysis(p=0.051), while the percentage of total sleep time comprising the stage 3 and 4 NREM sleep did not change between nights. The obstructive sleep apnea was more predominant type than the central one in both nights and there were no differences in the apnea index and the apnea-hypopnea index between the nights. The decrease in the blood level of urea nitrogen, creatinine, potassium and phosphorus was observed after hemodialysis(p<0.05), but the differences of parameters measured during polysomnography between the nights did not correlate with the changes of biochemical factors obtained on the two nights. Arterial blood gas analysis showed that pH was significantly greater in the nights after hemodialysis than in the nights before hemodialysis(p<0.05), but there were no correlations between the parameters examined during polysomnography and the parameters of arterial blood gas analysis(p<0.05). Conclusion: These results suggest that chronic renal failure is an important systemic disorder which is strongly associated with sleep disorders. Maintenance hemodialysis, although it is a widely accepted measure to treat chronic renal failure, did not significantly modulate the sleep architecture and the severity of sleep apnea. Thus, taking the patients with chronic renal failure into account, it is advisable to try not only to find a substantial way for correcting metabolic derangements but also to consider the institution of more effective treatments for sleep disorders.

• Sleep Medicine and Psychophysiology
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• v.24 no.1
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• pp.24-31
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• 2017

Objectives: Periodic limb movement disorder (PLMD) has been debated with regard to its clinical significance and diagnostic criteria. The current diagnostic criterion for PLMD in adults has been changed from periodic limb movement index (PLMI) > 5/hour to PLMI > 15/hour by the International Classification of Sleep Disorders (ICSD). In this study, we aimed to investigate the changes in polysomnographic sleep variables according to PLMI and to determine the relevance of the diagnostic criterion for PLMD. Methods: Out of 4195 subjects who underwent standard polysomnography, we selected 666 subjects (370 males and 296 females, aged $47.1{\pm}14.8$) who were older than 17 years and were not diagnosed with primary insomnia, sleep apnea, narcolepsy, or REM sleep behavior disorder. Subjects were divided into three groups according to PLMI severity: group 1 ($PLMI{\leq}5$), group 2 (5 < $PLMI{\leq}15$), and group 3 (PLMI > 15). Demographic and polysomnographic sleep variables and Epworth sleepiness scale (ESS) were compared among the three groups. Results: There were significant differences among the three groups in age and gender. Sleep efficiency (SE) and stage 3 sleep percentage in group 1 were significantly higher than those in groups 2 and 3. The wake after sleep onset (WASO) score in group 1 was significantly lower than those in groups 2 and 3. However, there were no significant differences in SE, stage 3 sleep percentage, or WASO between groups 2 and 3. Sleep latency (SL) in group 1 was significantly lower than that in group 3, but there was no difference in SL between group 2 and group 3. ESS score in group 1 was significantly higher than that in group 3, but there was no difference between group 2 and group 3. Partial correlation analysis adjusted by age showed that PLMI was significantly related to SE and WASO. Conclusion: This study suggests that PLMI influences polysomnographic sleep variables. In addition, we found the individuals who did not have PLMD but had PLMI > 5 were not different in polysomnographic sleep variables from the individuals who had PLMD according to the current criterion. These results raise questions about the relevance of the current diagnostic criterion of PLMD.

• Korean Journal of Clinical Laboratory Science
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• v.48 no.3
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• pp.255-261
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• 2016

The purpose of this study was to investigate the relationship between excessive daytime sleepiness (EDS) and blood pressure (BP) in patients with obstructive sleep apnea-hypopnea (OSAH). Patients were classified into four groups based on their severity of polysomnographic data: the snoring group (n=108)-characterized by Apnea-Hypopnea Index (AHI<5); the mild OSA group (n=186)-AHI $5{\leq}AHI$<15; the moderate OSA group (n=179)- AHI $15{\leq}AHI$<30; and the severe OSA group (n=233)-$AHI{\geq}30$. On the same night of polysomnography (PSG), BP levels were measured before sleeping (bedtime BP) and immediately after waking up on the following morning (morning BP). EDS was recognized as ESS (epworth sleepiness scale)${\geq}9$. The differences and correlations between BP and PSG parameters in the EDS and non-EDS groups of OSAH patients were analyzed. MAP was positively correlated with BMI, AHI, and total arousal (r=0.099, r=0.142, r=0.135, p<0.01, p<0.01, p<0.01), while negatively correlated with mean $SaO_2$ (r=-0.258, p<0.01). The EDS group had overall younger population ($47.2{\pm}11.3$ vs $50.3{\pm}11.4$, p=0.023), higher DBP (both bedtime and morning, $83.1{\pm}9.7$ vs $81.4{\pm}8.8$ and $86.4{\pm}9.2$ vs $83.6{\pm}9.7$)(p=0.031, p=0.047), and higher SBP (both bedtime and morning, $126.7{\pm}11.2$ vs $123.4{\pm}12.4$, $128.9{\pm}12.4$ vs $125.3{\pm}12.9$)(p=0.021, p=0.021) than compared with the non-EDS group. In hypertensive OSAH patients, patients with EDS were also younger and had higher total arousal number, as well as higher morning and bedtime DBP and SBP than compared with the non-EDS group (p<0.005, p=0.008, p<0.001 and p<0.001). EDS in OSAHS patients is a special phenotype characterized by younger age, higher DBP, more severe desaturation, and hypertension.

• The Journal of Internal Korean Medicine
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• v.25 no.1
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• pp.138-148
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• 2004

Objective : Insomnia is the disorder of initiation or maintenance in sleeping that results in daytime sleepiness and dysfunction, and it arises from multiple psychological, physiological and environmental factors. A number of stroke patients suffer from insomnia are classified as sleep disorder patients with physical illness. In addition, insomnia may have profound deleterious effects on the natural course of stroke. We are to assess the effectiveness of intradermal acupucture on stroke combined with insomnia. Methods : We recruited hospitalized patients with insomnia after stroke. Then, the subjects were allocated into a treatment group and a control group by randomization. The treatment group received intradermal acupuncture therapy at He-7(神門), EH-6(內關) correctly. However in control group, intradermal acupuncture were just attached to He-7(神門), EH-6(內關) without insertion. Treatment over time at first day and second day a various indexes were repeatedly checked such as sleep latency, total sleep time, sleep quality, condition on awakening, ability of concentration, morning sleepiness, Insomnia Severity Index, and Athens Insomnia Scale. In the second analysis, we divided the treatment group into a response and a non-response group by their response to intradermal acupuncture. With the acupuncture treatment, accompanied symptoms were checked Results : Among thirty two subjects, two of them were dropped out: One complained the pain from needle insertion, and the other underwent the change of his herbal medication. At baseline investigation with the residual 30 subjects, the control and the treatment group were assessed to have an equal comparability. In the treatment group, sleep latency, total sleeping time, a number of awakenings, sleep quality and ability of concentration showed improvement significantly compared with the control group. The non-response Group showed symptoms such as nausea and halitosis, belching and acid regurgitation, abundant expectoration, while Responder Group showed palpitation, oppressed feelings in chest and sleep disorder. Conclusions: The result of this clinical study suggests that the intradermal acupuncture at He-7(神門), EH-6(內關) is one of the effective treatments for the insomnia after stroke.

• Clinical and Experimental Pediatrics
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• v.49 no.5
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• pp.523-528
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• 2006

Purpose : The purpose of this study was to investigate the relationship between depression and resilience in adolescents with congenital heart disease(CHD) and to identify the variables associated with depression. Methods : The Resilience Scale(cronbach's ${\alpha}=0.92$), Children's Depression Inventory(cronbach's ${\alpha}=0.72$) and Maternal Behavior Research Instrument(cronbach's ${\alpha}=0.88$) were applied and analyzed to assess depression and resilience among 231 adolescents after surgery for CHD from three major cardiac centers in Korea. This group consist of 114 males and 117 females. The mean age was 15.8 years(range : 13-18 years). The clinical severity of illness was rated by CHD functional index and NYHA functional class. Results : The mean score for depression and resilience was 16.74(range : 0-49) and 115.84(range : 70-132) respectively. Depression was significantly related to age(r=0.25, P<0.001) and NYHA functional class(r=0.35, P<0.001), as well as being negatively correlated with oxygen saturation(r=-0.39, P<0.001), academic achievement(r=-0.41, P<0.001), parental attitude(r=-0.49, P<0.001) and resilience (r=-0.59, P<0.001). The results of multiple regression analysis showed that parental attitude(${\beta}=-0.48$, P<0.01) and resilience(${\beta}=-0.62$, P<0.01) were related to depression. Conclusion : This study demonstrated that adolescents with CHD had a higher resilience and were less depressed with an affectionate parent. With respect to medical and nursing intervention programs, it is essential to identify strengths of adolescents with CHD in order to increase their resilience. Additionally, it is also important that parenting and counseling programs be implemented for the parents of adolescents with CHD.

• Korean Journal of Adult Nursing
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• v.12 no.1
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• pp.99-111
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• 2000

The purpose of this study was to identify risk factors related to sexual function of women with coronary artery disease, and to determine the predictors of sexual function. The study design, a descriptive correlational study, was done through structural questionnaire and interview. A total of 50 subjects from C University Hospital at Kwang-ju city who have undergone coronary angiography at department of cardiology were observed and interviewed from Feb. 22, 1999 to March. 23, 1999. The number of affected vessels, the level of total serum cholesterol, and the ejection fraction of 2-D echo cardiography were analyzed to evaluate the severity of coronary artery disease. And also type A behavior pattern, health behavior, Brief Index of Sexual Functioning for Women (BISF-W) were measured. The data obtained were analyzed using percentage, mean and standard deviation, t-test, ANOVA, Pearson's correlation coefficient, and stepwise multiple regression analysis via SPSS PC+. The results of this study were as follows: 1. The mean age of the subjects were 58.1 and 72.0% of those have been married over 30 years. Seventy two percentage were unemployed and monthly family income of 56.6% was less than 1,000,000 won (approximately $ 840). Eighty percent were in their postmenopausal state, and the frequency of sexual intercourse of 84.0% were two to three times per month. 2. The scores of type A behavior pattern were from 16 to 38(mean 24.94) and health behavior ranged from 21 to 43(mean 31.2). Abstinence from smoking, alcohol, and caffeine were best compliant factors and weight control and exercise were least abided ones. The result of 2D-ECHO EF showed that the half of the subjects were abnormal, and 24% had more than 240mg/dl of total serum cholesterol. The coronary angiography showed that 64% of the subjects had more than one affected vessels. 3. The predictors to explain the factor score of 'orgasm' were number of health examination, the pre- or post-menopausal state, protestant, number of coronary vessel affected, level of serum total cholesterol, and comorbid group of hypertension and diabetes, and it's total variance accounted for 52.4%. The predictors to explain the factor score of 'sexual activity' were comorbid group of hypertension and diabetes and type A behavior pattern, which accounted for 22.4% of total variance. The predictors to explain the factor score of 'sexual satisfaction' were type A behavior pattern, no religion, exercise, level of serum total cholesterol, and pre or post menopausal state, which accounted for 52.1%. The predictors to explain the factor score of 'sexual desire' were the period of marriage, type A behavior, employment or unemployment, and weight control, which accounted for 43.2%. The predictors to explain the factor score of 'external force of sexual functioning' were physical overload and exercise, which accounted for 41.1%. The predictors to explain the factor score of 'sexual activity' were family monthly income, catholics, and exercise, and which accounted for 35.4%. Above results lead us to some consensus that sexual function of women with coronary artery disease is related to various factors including vasogenic factors such as total serum cholesterol level, number of coronary vessel affected, an endocrinal factor such as menopausal state, and type A behavior pattern as a sociopshychological factor. And also health behaviors such as fitness care, overwork, weight control, and emotional tension are contributed to sexual function.

• Korean Journal of Psychosomatic Medicine
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• v.7 no.2
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• pp.184-195
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• 1999

Objectives : As traumatic brain injury(TBI) leaves chronic sequelae in mind and body, the injured patients should rectify the meaning and object that they have pursued in their lives and set up a new purpose in life that they may make the rest of their lives meaningful. This study was designed to investigate the purpose and quality of life levels and the influence of demographic and clinical variables on the levels in the patients with TBI, and to be of some help to their rehabilitation. Methods : In order to assess the purpose in life(PIL) and the quality of life(QOL) levels, Purpose-in-Life Test, Sickness Impact Profile, Quality of Life Index, Head Injury Symptom Ckecklist, and Neurobehavioral Rating Scale were administered to the subjects. The subjects were thirty-two patients with TBI and the same numbered normal controls. The TBI group was composed of 16 to 65 year-aged patients who had received mild or severe TBI at least 12 months before, and the controls were siblings or friends of the patients whose age, sex, and educational level were similar to them. Results : 1) The PIL and QOL levels of the patients with TBI remained significantly lower than that of control group after their symptoms of injury were stabilized(p<.01, p<.01). 2) The mean PIL score of TBI group was $58.8{\pm}23.2$, which was to be regarded as the level of existential vacuum. 3) The PIL level of TBI group was significantly correlated with the QOL level(p <.01). 4) The subgroup with lower PIL level in patients with TBI has significantly higher rate of female than that with higher PIL(p<.05), the PIL level of female patients was significantly lower than that of male patients(p <.05). 5) The significant differences in PIL levels were not found, in which comparison was performed between each pair of subgroups of patients with TBI divided by severity of injury(mild vs severe), marital status(married vs unmarried), and occupational status prior to injury(employed vs unemployed). Conclusion : The PIL of patients with TBI still remained the level of existential vacuum after symptoms of sequelae had been stabilized, The QOL level was also extremely low, and as the PIL level was low the QOL was also low. The demographic and clinical variables except sex did not have influence on the PIL level in brain-injured patients. It is suggested that every patient should admit their mental and physical limitations caused by brain injury and revise their purpose in life for successful rehabilitation.

• Korean Journal of Psychosomatic Medicine
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• v.20 no.2
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• pp.98-104
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• 2012

Objectives : This study aimed to investigate the correlations between neurological and psychiatric symptoms at two weeks after stroke. Methods : For 412 stroke patients, stroke severity was evaluated by the National Institutes of Health Stroke Scale(NIHSS), disability by the Barthel Index(BI) and modified Rankin Scale(mRS), cognitive function by the Korean Mini-Mental State Examination(K-MMSE), and muscle power by grip strength. Psychiatric symptoms were assessed by Symptom check list-90-Revision(SCL-90-R), consisted of nine symptom domains : Somatization, Obsessive-compulsive, Interpersonal sensitivity, Depression, Anxiety, Hostility, Phobic anxiety, Paranoid ideation, Psychoticism, and Additional items. The correlations between the neurological and psychiatric symptoms were investigated at the time of admission and before discharge(i.e. before and after treatment). Results : At the time of admission, NIHSS score was associated with scores on Phobic anxiety and Additional items ; and scores on BI and mRS were associated with Depression, Phobic anxiety and Additional items. At the time of discharge, NIHSS score was associated with scores on Somatization, Depression, Phobic anxiety, and Additional items ; scores on BI and mRS were associated with scores on Depression, Phobic anxiety and Additional items ; MMSE score was associated with Obsessive-compulsive, Depression, Phobic anxiety, and Additional items ; and grip strength was associated with Somatization, Depression, Anxiety and Additional items. Conclusions : More severe neurological symptoms were associated with higher psychiatric morbidity particularly in depression, phobic anxiety, sleep and appetite disturbance at acute stage of stroke. More intensive psychiatric care and intervention are needed for the high risk group.