Background: Aromatase inhibitors (AIs) play an important role in the endocrine therapy of postmenopausal breast cancer patients, with a recent tendency to extend the duration of their use. However, AIs may increase the risk of osteoporotic bone fractures. This meta-analysis evaluated the risk of osteoporotic fractures of the hip, spine, and other locations in breast cancer patients using AIs. Methods: We performed a systematic search to identify randomized controlled clinical trials that investigated osteoporotic fractures in breast cancer patients on AI therapy. The main outcomes were the incidence and risk of osteoporotic fractures in general and of hip, vertebral, and non-vertebral fractures in AI users and controls. Results: The systematic review found a total of 30 randomized controlled trials including 117,974 participants. The meta-analysis showed a higher incidence of osteoporotic fracture in AI users: The crude risk ratio for all osteoporotic fractures was 1.35 (95% confidence interval [CI], 1.29–1.42;P < 0.001), for hip fractures 1.18 (95% CI, 1.02–1.35; P < 0.001), for vertebral fractures 1.84 (95% CI, 1.36–2.49; P < 0.001), and for non-vertebral fractures 1.18 (95% CI, 1.02–1.35; P < 0.001), respectively, compared to the controls. Conclusion Our meta-analysis suggested an increased risk of osteoporotic fractures for AI therapy in patients with breast cancer that was most expressed for vertebral fractures. Breast cancer patients on AIs need to be monitored for osteoporosis and osteoporotic fractures, and active prevention measures should be implemented.

This article provides an overview of the developmental history and rationale of medical ethics to establish the code of ethics and professional conduct of the Korean Academy of Child and Adolescent Psychiatry (KACAP). Most medical professional organizations have their own codes of ethics and conduct because they have continuous responsibility to regulate professional activities and conducts for their members. The Ethics and Award Committee of the KACAP appointed a Task-Force to establish the code of ethics and conduct in 2012. Because bioethics has become global, the Ethics Task Force examined global standards. Global standards in medical ethics and professional conduct adopted by the World Medical Association and the World Psychiatric Association have provided the basic framework for our KACAP's code of ethics and professional conduct. The Code of Ethics of the Americal Academy of Child and Adolescent Psychiatry has provided us additional specific clarifications required for child and adolescent patients. The code of ethics and professional conduct of the KACAP will be helpful to us in ethical clinical practice and will ensure our competence in recognizing ethical violations.
Adolescent ; Adolescent Psychiatry* ; Adolescent* ; Advisory Committees ; Awards and Prizes ; Bioethics ; Child* ; Codes of Ethics ; Ethics ; Ethics, Medical* ; Humans ; Mental Competency ; Societies

OBJECTIVES: The objective of this study was to examine the effects of osmotic-controlled release oral delivery system methylphenidate on changes in regional cerebral blood flow (rCBF) in children with attention-deficit hyperactivity disorder (ADHD) using single photon emission computed tomography (SPECT). METHODS: A total of 26 children with ADHD (21 boys, mean age: 9.2±2.05 years old) were recruited. Each ADHD participant was examined for changes in rCBF using technetium-99m-hexamethylpropylene amine oxime brain SPECT before and after 8 weeks methylphenidate medication. Brain SPECT images of pediatric normal controls were selected retrospectively. SPECT images of ADHD children taken before medication were compared with those of pediatric normal controls and those taken after medication using statistical parametric mapping analysis on a voxel-wise basis. RESULTS: Before methylphenidate medication, significantly decreased rCBF in the cerebellum and increased rCBF in the right precuneus, left anterior cingulate, right postcentral gyrus, right inferior parietal lobule and right precentral gyrus were observed in ADHD children compared to pediatric normal controls (p-value<.0005, uncorrected). After medication, we observed significant hypoperfusion in the left thalamus and left cerebellum compared to pediatric normal controls (p-value<.0005, uncorrected). In the comparison between before medication and after medication, there was significant hyperperfusion in the superior frontal gyrus and middle frontal gyrus and significant hypoperfusion in the right insula, right caudate, right middle frontal gyrus, left subcallosal gyrus, left claustrum, and left superior temporal gyrus after methylphenidate medication (p-value<.0005, uncorrected). CONCLUSION: This study supports dysfunctions of fronto-striatal structures and cerebellum in ADHD. We suggest that methylphenidate may have some effects on the frontal lobe, parietal lobe, and cerebellum in children with ADHD.
Basal Ganglia ; Brain ; Cerebellum ; Child* ; Frontal Lobe ; Humans ; Methylphenidate* ; Parietal Lobe ; Rabeprazole ; Retrospective Studies ; Thalamus ; Tomography, Emission-Computed, Single-Photon

OBJECTIVES: We aimed to determine whether the adult attachment styles of pregnant women could predict development of postpartum depression. METHODS: Korean version of Revised Adult Attachment Scale, State Trait Anxiety Inventory-State/Trait (STAI-S/T), and Center for Epidemiologic Studies-Depression Scale (CES-D) were administered at baseline. Edinburgh Postnatal Depression Scale (EPDS), Parenthood Stress Questionnaire (PSQ), STAI-S, and CES-D were assessed at week 2 and 6 postpartum. Participants were categorized into the secure-mom (SM ; n=48) or insecure-mom (IM ; n=9) group. RESULTS: While STAI-S scores in SM showed a continuous decrease during the entire observation period, STAI-S scores in IM decreased during the first two weeks but increased during the next four weeks. While SM showed decreased CES-D scores from week 2 to 6, IM showed increased CES-D scores from week 2 to 6. Although SM showed decreased EPDS scores from week 2 to 6, IM showed increased EPDS scores from week 2 to 6. In SM, the change in EDPS score from week 2 to week 6 showed positive correlation with PSQ-ability and PSQ-social subscale scores. CONCLUSION: Assessing the maternal adult attachment style before giving birth appears to be helpful for screening the high-risk group who are vulnerable to development of postpartum depression.
Adult* ; Anxiety ; Depression, Postpartum* ; Female ; Humans ; Mass Screening ; Parenting* ; Parents* ; Parturition ; Postpartum Period* ; Pregnant Women

OBJECTIVES: The current study was conducted in order to investigate teachers'recognition of school bullying using a nationwide database of adolescents in middle and high school in Korea. METHODS: Students in the 7th to 12th grades at 23 secondary schools participated in the current study during the fall of 2009. Subjects completed the self-report form of the Adolescent Mental Health and Problem Behavior Screening Questionnaire-II (AMPQ-II) and Symptom Checklist-90 Revised (SCL-90-R). In addition, relevant teachers used the teachers' rating scale of the AMPQ-II to report their students' status. Differences in the number of bullied students between teachers' recognition and students' report were explored. RESULTS: A total of 2270 subjects provided relevant responses to the questionnaire. While the one-month prevalence of victimization according to students' self-reports was 28.9%, the recognized prevalence by teachers was only 10.6%. For prediction of the presence of school bullying according to students' self reports on the AMPQ-II, item 7 of the teachers' report on the AMPQ-II showed a sensitivity of 16%, a specificity of 92%, a positive predictability of 44%, a negative predictability of 72%, a false positive rate of 8%, a false negative rate of 84%, and an accuracy of 69%, respectively. No significant differences in subscores of students' self reports of the AMPQ-II and SCL-90-R were observed between bullied students who were recognized by teachers and those who were not recognized. In stepwise discriminant analysis, classification of teachers' item 2 and item 7 on the AMPQ-II with respect to school bullying according to students' reports showed an accuracy of 63.4%. Using this model, 75.2% of non-victimized subjects were classified correctly, while only 35.2% of victimized subjects were classified correctly. CONCLUSION: Despite the high prevalence in Korea, teachers' recognition of school violence among their students remains low. Pre-professional and continuing education to improve teachers' understanding of school bullying and knowledge of effective classroom-based prevention activities should be encouraged.
Adolescent ; Bullying ; Crime Victims ; Education, Continuing ; Humans ; Korea ; Mass Screening ; Mental Health ; Prevalence ; Self Report ; Sensitivity and Specificity ; Violence ; Surveys and Questionnaires

BACKGROUND: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease with genetic and environmental backgrounds. While the prevalence of AD is increasing, many patients lack accurate information and understanding about AD. OBJECTIVE: This study was performed to investigate the understanding of AD among Korean AD patients. METHODS: We developed a survey instrument to assess patient understanding of AD. Surveys were conducted over a 6-month period (from May 2010 to October 2010) among 415 patients with AD who visited 10 dermatology clinics at a university teaching hospital affiliated with the Korean Atopic Dermatitis Association. RESULTS: We identified points of understanding in Korean AD patients, such as knowledge and attitudes about AD, awareness of AD treatment, reliability of health care providers and information sources, and acting with AD treatment. As the results of this survey, it was confirmed that the patients' understanding of the cause and prognosis of AD was relatively inadequate, and it could be seen that the perception of the negative attitude toward the medical treatment of AD and inconveniences caused by AD was high. However, the results of the survey on the perception about the medical treatment methods of AD showed that they perceived medical doctors' treatment and prescriptions to have the best curative value, and as the criteria for choosing the treatment methods for AD, they chose the curative value rather than safety and cost. With regard to the information source for AD, they evaluated the treatment postscript on the internet sites and reliability of news media more highly than other information sources, and they responded that the main channel through which they obtain information related to AD was the medical doctors' explanations. CONCLUSION: We conducted the first systematic questionnaire survey to assess the understanding of AD among Korean AD patients. The results of this survey indicate that in the education and promotion on AD patients, additional education with regard to the cause and prognosis of AD is needed, and it is considered that efforts should be made to reduce the negative perception of AD through smooth communication with the medical team. In education and promotion related to AD, treatment postscripts on news media and the internet sites should also be addressed. Ultimately, the patients' self-discipline capabilities should be reinforced through proper education and development of programs related to AD.
Dermatitis, Atopic ; Dermatology ; Health Personnel ; Hospitals, Teaching ; Humans ; Internet ; Prescriptions ; Prevalence ; Prognosis ; Skin Diseases ; Surveys and Questionnaires

OBJECTIVE: The purpose of this study was to investigate the association between the T102C polymorphism in the serotonin 2A receptor gene and attention-deficit/hyperactivity disorder (ADHD) in Korean patients. METHODS: A total of 189 Korean children with ADHD as well as both parents of the ADHD children and 150 normal children participated in this study. DNA was extracted from blood samples from all of the subjects, and genotyping was conducted. Based on the allele and genotype information obtained, case-control analyses were performed to compare the ADHD and normal children, and Transmission disequilibrium tests (TDTs) were used for family-based association testing (number of trios=113). Finally, according to the significant finding which was showed in the case-control analyses, the results of behavioral characterastics and neuropsychological test were compared between ADHD children with and without the C allele. RESULTS: In the case-control analyses, statistically significant differences were detected in the frequencies of genotypes containing the C allele (chi2=4.73, p=0.030). In the family-based association study, TDTs failed to detect linkage disequilibrium of the T102C polymorphism associated with ADHD children. In the ADHD children, both the mean reaction time and the standard deviation of the reaction time in the auditory continuous performance test were longer in the group with the C allele compared to the group without the C allele. CONCLUSION: The results of this study suggest that there is a significant genetic association between the T102C polymorphism in the serotonin 2A receptor gene and ADHD in Korean children.
Alleles ; Case-Control Studies ; Child ; DNA ; Genotype ; Humans ; Linkage Disequilibrium ; Neuropsychological Tests ; Parents ; Reaction Time ; Receptor, Serotonin, 5-HT2A ; Serotonin

OBJECTIVES: This study was conducted to investigate the prevalence of victims of bullying and the demographic characteristics of victims, and their related psychopathology, in a Korean nationwide sample of youths in middle and high school over a one month period. METHODS: During the autumn of 2009, students in the 7th to 12th grades at 23 secondary schools participated in a nationwide, cross-sectional study. The study subjects completed the Adolescent Mental Health and Problem Behavior Screening Questionnaire- II (AMPQ-II) and Symptom Checklist-90-Revision (SCL-90-R). Based on the data acquired, descriptive statistics, correlation coefficients and multiple logistic regression analysis were performed. RESULTS: Among the 3364 participants, 2272 (67.54%) completed the questionnaire. The prevalence of victimization was 28.9%. Male gender was positively associated with victimization, and grade level was negatively related to victimization. The AMPQ-II bullying score (Factor 4) was significantly (p<.001) and positively correlated to the AMPQ-II student total score (r= 0.50), Worry and thought (Factor 1 ; r=0.38), Mood and suicide (Factor 2 ; r=0.31), Academic and Internet-related problems (Factor 3 ; r=0.24), Rule violations (Factor 5 ; r=0.23), and AMPQ-II teacher total score (r=0.11). Somatization (r=0.23), Obsessive-compulsive behavior (r=0.24), Interpersonal sensitivity (r=0.30), Depression (r=0.33), Anxiety (r=0.26), Hostility (r=0.30), Phobic anxiety (r=0.22), Paranoid ideation (r=0.36), and Psychoticism (r=0.31) results from the SCL-90-R were also found to be positively related to the AMPQ-II bullying score, and remained significant after adjusting for age and gender. A total of 26% of the victims reported suicidal ideations as compared to 9% of non-victims over the month prior to the evaluation (chi2=119.595, df=1, p<.001). The multiple logistic regression analysis indicated that the AMPQ-II bullying score significantly increased the risk of suicidal ideation [Exp(b)=1.55, df=1, p<.001] after adjusting for age and gender. CONCLUSION: School bullying was highly prevalent among Korean middle and high school students. This study provided strong evidence that suicidal ideation and psychopathology were serious problems among the victims of bullying.
Adolescent ; Anxiety ; Bullying ; Crime Victims ; Cross-Sectional Studies ; Depression ; Hostility ; Humans ; Logistic Models ; Male ; Mass Screening ; Mental Health ; Prevalence ; Psychopathology ; Suicidal Ideation ; Suicide ; Surveys and Questionnaires

Quantification of quality of life (QOL) related to disease severity is important in patients with atopic dermatitis (AD), because the assessment provides additional information to the traditional objective clinical scoring systems. To document the impact of AD on QOL for both children and adults as well as to quantify the relationship with disease severity, QOL assessments were performed over a 6-month period on 415 patients with AD. A questionnaire derived from the Infants' Dermatitis Quality of Life Index (IDQOL), the Children's Dermatology Life Quality Index (CDLQI) and the Dermatology Life Quality Index (DLQI) was used to determine the QOL for 71 infants, 197 children and 147 adults, respectively. To measure AD severity, both the Rajka & Langeland scoring system and the Scoring of Atopic Dermatitis (SCORAD) index were used. The mean scores were as follows: 7.7 +/- 5.5 for IDQOL, 6.6 +/- 6.3 for CDLQI, and 10.7 +/- 7.9 for DLQI. In conclusion, these QOL scores are correlated with AD severity scores as estimated by the Rajka & Langeland severity score and the SCORAD. The outcome of the QOL instruments in this study demonstrates that atopic dermatitis of both children and adults affects their QOL.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Dermatitis, Atopic/pathology/*psychology ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; *Quality of Life ; Questionnaires ; *Severity of Illness Index ; Young Adult

Quantification of quality of life (QOL) related to disease severity is important in patients with atopic dermatitis (AD), because the assessment provides additional information to the traditional objective clinical scoring systems. To document the impact of AD on QOL for both children and adults as well as to quantify the relationship with disease severity, QOL assessments were performed over a 6-month period on 415 patients with AD. A questionnaire derived from the Infants' Dermatitis Quality of Life Index (IDQOL), the Children's Dermatology Life Quality Index (CDLQI) and the Dermatology Life Quality Index (DLQI) was used to determine the QOL for 71 infants, 197 children and 147 adults, respectively. To measure AD severity, both the Rajka & Langeland scoring system and the Scoring of Atopic Dermatitis (SCORAD) index were used. The mean scores were as follows: 7.7 +/- 5.5 for IDQOL, 6.6 +/- 6.3 for CDLQI, and 10.7 +/- 7.9 for DLQI. In conclusion, these QOL scores are correlated with AD severity scores as estimated by the Rajka & Langeland severity score and the SCORAD. The outcome of the QOL instruments in this study demonstrates that atopic dermatitis of both children and adults affects their QOL.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Dermatitis, Atopic/pathology/*psychology ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; *Quality of Life ; Questionnaires ; *Severity of Illness Index ; Young Adult