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Lee MJ, Chung Y, Hong S, Lee HJ, Park G, Lee SM. Effects of Psychotherapy on the Problem Behaviors of Humidifier Disinfectant Survivors: The Role of Individual Characteristics and Adaptive Functioning. Healthcare (Basel) 2023; 11:2179. [PMID: 37570419 PMCID: PMC10418790 DOI: 10.3390/healthcare11152179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
This study aimed to examine group differences in the survivors of humidifier damage and the effect of individual psychotherapy on the psychological symptoms of the survivor groups, using the single group pre-post study design. A series of Wilcoxon-Mann-Whitney tests were conducted to investigate the level of psychological problems before and after psychotherapy, as well as the main and interaction effects of demographic characteristics and adaptive functioning on the treatment effects in 69 humidifier disinfectant survivors. The results demonstrated significant differences in problems with socioeconomic status (SES), life functioning, friendships, family relationships, and job adjustment in the survivor groups. Groups with high SES, low life functioning, and poor friend relationships had more problem behaviors than other groups. Problem behaviors related to friendship levels were different before and after psychotherapy. After psychotherapy, individuals with limited social connections exhibited a greater decrease in problem behaviors compared to those with strong friendships. This paper extends the international literature on the long-term consequences of environmental health hazards and the importance of tailored mental health interventions.
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Affiliation(s)
- Min Joo Lee
- Department of Education, Korea University, Seoul 02841, Republic of Korea; (M.J.L.); (Y.C.); (S.H.); (G.P.)
| | - Yubin Chung
- Department of Education, Korea University, Seoul 02841, Republic of Korea; (M.J.L.); (Y.C.); (S.H.); (G.P.)
| | - Soeun Hong
- Department of Education, Korea University, Seoul 02841, Republic of Korea; (M.J.L.); (Y.C.); (S.H.); (G.P.)
| | - Hun-Ju Lee
- University Industry Foundation, Yonsei University, Seoul 03722, Republic of Korea;
| | - Gippeum Park
- Department of Education, Korea University, Seoul 02841, Republic of Korea; (M.J.L.); (Y.C.); (S.H.); (G.P.)
| | - Sang Min Lee
- Department of Education, Korea University, Seoul 02841, Republic of Korea; (M.J.L.); (Y.C.); (S.H.); (G.P.)
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Pak C, Cowl CT, Kim JH, Kang BJ, Lee T, Jegal Y, Ra SW, Kim Y. Reduced Diffusing Capacity in Humidifier Disinfectant-Associated Asthma Versus Typical Asthma: A Retrospective Case Control Study. J Korean Med Sci 2022; 37:e319. [PMID: 36377294 PMCID: PMC9667013 DOI: 10.3346/jkms.2022.37.e319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 09/13/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Humidifier disinfectant-related lung injury (HDLI) is a severe form of toxic inhalational pulmonary parenchymal damage found in residents of South Korea previously exposed to specific guanidine-based compounds present in humidifier disinfectants (HD). HD-associated asthma (HDA), which is similar to irritant-induced asthma, has been recognized in victims with asthma-like symptoms and is probably caused by airway injury. In this study, diffusing capacity of the lung for carbon monoxide (DLCO) in individuals with HDA was compared to that in individuals with pre-existing asthma without HD exposure. METHODS We retrospectively compared data, including DLCO values, of 70 patients with HDA with that of 79 patients having pre-existing asthma without any known exposure to HD (controls). Multiple linear regression analysis and logistic regression analysis were performed to confirm the association between HD exposure and DLCO after controlling for confounding factors. The correlation between DLCO and several indicators related to HD exposure was evaluated in patients with HDA. RESULT The mean DLCO was significantly lower in the HDA group than in the control group (81.9% vs. 88.6%; P = 0.021). The mean DLCO of asthma patients with definite HD exposure was significantly lower than that of asthma patients with lesser exposure (P for trend = 0.002). In multivariable regression models, DLCO in the HDA group decreased by 5.8%, and patients with HDA were 2.1-fold more likely to have a lower DLCO than the controls. Pathway analysis showed that exposure to HD directly affected DLCO values and indirectly affected its measurement through a decrease in the forced vital capacity (FVC). Correlation analysis indicated a significant inverse correlation between DLCO% and cumulative HD exposure time. CONCLUSION DLCO was lower in patients with HDA than in asthma patients without HD exposure, and decreased FVC partially mediated this effect. Therefore, monitoring the DLCO may be useful for early diagnosis of HDA in patients with asthma symptoms and history of HD exposure.
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Affiliation(s)
- Chuiyong Pak
- Division of Pulmonology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Clayton T Cowl
- Divisions of Preventive, Occupational & Aerospace Medicine and Pulmonary & Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jin Hyoung Kim
- Division of Pulmonology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Byung Ju Kang
- Division of Pulmonology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Taehoon Lee
- Division of Pulmonology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Yangjin Jegal
- Division of Pulmonology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Seung Won Ra
- Division of Pulmonology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
| | - Yangho Kim
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
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Song JH, Ahn J, Park MY, Park J, Lee YM, Myong JP, Koo JW, Lee J. Health Effects Associated With Humidifier Disinfectant Use: A Systematic Review for Exploration. J Korean Med Sci 2022; 37:e257. [PMID: 35996934 PMCID: PMC9424740 DOI: 10.3346/jkms.2022.37.e257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/29/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND It has been 10 years since the outbreak of lung disease caused by humidifier disinfectants in Korea, but the health effects have not yet been summarized. Therefore, this study aims to systematically examine the health effects of humidifier disinfectants that have been discovered so far. METHODS All literature with humidifier disinfectants and their representative components as the main words were collected based on the web, including PubMed, Research Information Sharing Service, and government publication reports. A total of 902 studies were searched, of which 196 were selected. They were divided into four groups: published human studies (group 1), published animal and cytotoxicology studies (group 2), technical reports (group 3), and gray literature (group 4). RESULTS Out of the 196 studies, 97 (49.5%) were published in peer-reviewed journals as original research. Group 1 consisted of 49 articles (50.5%), while group 2 consisted of 48 articles (49.5%). Overall, respiratory diseases such as humidifier disinfectant associated lung injury, interstitial lung disease, and asthma have a clear correlation, but other effects such as liver, heart, thymus, thyroid, fetal growth, metabolic abnormalities, and eyes are observed in toxicological experimental studies, but have not yet been identified in epidemiologic studies. CONCLUSION The current level of evidence does not completely rule out the effects of humidifier disinfectants on extrapulmonary disease. Based on the toxicological evidence so far, it is required to monitor the population of humidifier disinfectant exposure continuously to see if similar damage occurs.
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Affiliation(s)
- Ji-Hun Song
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joonho Ahn
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Young Park
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jaeyoung Park
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yu Min Lee
- Department of Occupational and Environmental Medicine, Severance Hospital, College of Medicine, Yonsei University, Seoul, Korea
| | - Jun-Pyo Myong
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung-Wan Koo
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jongin Lee
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Hong JS, Hyun SY, Lee JH, Sim M. Mental health effects of the Gangwon wildfires. BMC Public Health 2022; 22:1183. [PMID: 35701801 PMCID: PMC9195206 DOI: 10.1186/s12889-022-13560-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/20/2022] [Indexed: 11/21/2022] Open
Abstract
Background The April 2019 wildfires in Gangwon Province, South Korea forced the evacuation of 1500 individuals and cost more than $100 million in damages, making it the worst wildfire disaster in Korean history. The purpose of this paper was to investigate the mental health effects on survivors following the wildfires. Methods Between April and May 2019, outreach psychological support services were delivered to people impacted by the wildfires. Post-disaster psychological responses using a checklist and the Clinical Global Impression Scale-Severity (CGI-S) were evaluated for 206 wildfires survivors. The CGI-S was administered consequently at 1, 3, and 6 months after baseline measurement. Results Among four response categories, somatic responses (76.2%) were most frequently observed among the wildfire survivors. Specifically, insomnia (59.2%), anxiety (50%), chest tightness (34%), grief (33%), flashbacks (33%), and depression (32.5%) were reported by over 30% of the participants. The mean CGI-S scores were significantly decreased at 1 month (mean score = 1.94; SE = 0.09) compared to baseline (mean score = 2.94; SE = 0.08) and remained at the decreased level until 6 months (mean score = 1.66; SE = 0.11). However, participants with flashbacks showed significantly higher CGI-S scores compared to those without flashback at 6 months. Conclusions Wildfire survivors have various post-disaster responses, especially somatic responses. While most participants’ mental health improved over time, a few of them may have experienced prolonged psychological distress after 6 months. Flashbacks were particularly associated with continuing distress. These results suggest that the characteristics of responses should be considered in early phase intervention and in follow-up plans for disaster survivors.
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Affiliation(s)
- Ji Sun Hong
- Department of Psychiatry, Chung-Ang University Gwangmyeong Hospital, Gyeonggi-do, Korea
| | - So Yeon Hyun
- National Center for Disaster and Trauma, National Center for Mental Health, Seoul, Korea
| | - Jung Hyun Lee
- National Center for Disaster and Trauma, National Center for Mental Health, Seoul, Korea
| | - Minyoung Sim
- National Center for Disaster and Trauma, National Center for Mental Health, Seoul, Korea.
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Hwang Y, Lee DH, Prigerson HG. Psychometric properties, stability, and predictive validity of the Korean version of the Prolonged Grief Disorder Scale (PG-13-K): A longitudinal study among bereaved Koreans. DEATH STUDIES 2022; 47:410-420. [PMID: 35674060 DOI: 10.1080/07481187.2022.2081884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study aims to investigate the psychometric properties, stability, and predictive validity of the PG-13-K. Two subsamples were used: the first subsample (N = 153), participated at Time 1 only, and the second subsample (N = 184) participated at both Time 1 and Time 2. At each time point, reliability, test-retest reliability, and validity were adequate, and the hypothesized two-factor model indicated good to excellent fit. Moreover, the PG-13-K was able to predict the correlation between prolonged grief disorder (PGD) and negative psychological factors. The PG-13-K is a useful and valid instrument for measuring PGD symptoms in Korean settings.
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Affiliation(s)
- Yujin Hwang
- Department of Education, Traumatic Stress Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Dong Hun Lee
- Department of Education, Traumatic Stress Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Holly G Prigerson
- Cornell Center for Research on End-of-Live Care, Weill Cornell Medicine, New York City, New York, USA
- Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York City, New York, USA
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Need for individual-based evaluation to determine the association between humidifier disinfectants and health injuries. Ann Occup Environ Med 2021; 33:e21. [PMID: 34754482 PMCID: PMC8264121 DOI: 10.35371/aoem.2021.33.e21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 06/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background Injuries caused by humidifier disinfectants (HDs) can no longer be grouped under the concept of HD lung injury. Focusing on individual cases, we were able to evaluate the relevance not only of diseases for which epidemiological correlation is recognized but also all diseases and symptoms that the victims complain of. Methods In-depth interviews and reassessment of 113 HD-exposed patients who had not been acknowledged as victims by the government were conducted, and their medical records were reviewed. Based on these processes, an assessment questionnaire for the injuries related to HDs was completed and the involvement of HDs was assessed either as “strong association,” “association,” or “no association.” Results In this study, of the 113 patients included who claimed damages, 78 (69.0%) had HD-related injuries. Among the cases of 22 patients who applied for injury acknowledgment due to upper respiratory inflammation that was not included among the acknowledged diseases, 17 (77.3%) were judged to be HD-related injuries (strong association vs. association: 10 [45.5%] vs. 7 [31.8%]). When the cases of 12 rhinitis patients were reassessed, 9 were HD-related injuries (strong association vs. association: 4 [33.3%] vs. 5 [41.7%]). When the cases of 18 asthma patients unacknowledged as a victim were reassessed, 17 (94.4%) were humidifier-related injuries (strong association vs. association: 12 [66.6%] vs. 5 [27.8%]). Among 4 interstitial lung disease patients unacknowledged as a victim, 2 (50.0%) were HD-related injuries. Conclusions HD-related health injuries should be assessed through both individual interviews and detailed chart reviews for more accurate injury acknowledgment. In the future, efforts should go beyond existing methods based on the adherence to acknowledgment criteria to directly listen to the victims.
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Ju YJ, Lee S, Sheen S, Choi DW, Leem JH, Lee SY. A comprehensive study of deaths due to exposure to humidifier disinfectant in Korea: focusing on medical records, assessment of exposure to humidifier disinfectants, and causes of death. Epidemiol Health 2021; 43:e2021091. [PMID: 34727493 PMCID: PMC8920737 DOI: 10.4178/epih.e2021091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/08/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES We aimed to determine the characteristics of the deceased victims of deaths caused by exposure to humidifier disinfectants, and present the distribution of the victims’ data submitted for damage application, demographic characteristics, imaging findings, characteristics of humidifier disinfectant exposure, and distribution of the causes of death. METHODS An integrated database of victims was established using the medical records data of 1,413 victims submitted during the application for death damage caused by exposure to humidifier disinfectants, and the demographic characteristics, medical records, imaging findings, exposure characteristics, and cause of death were examined. RESULTS The average numbers of data submissions of each applicant for death damage were 3.0 medical use records. A total of 608 (43.0%) victims had more than one finding of acute, subacute, or chronic interstitial lung diseases. The average daily and cumulative use times of the victims were 14.40 and 24,645.81 hours, respectively, indicating greater exposure in this group than in the survivors. The humidifier disinfectants’ components comprised polyhexamethylene guanidine (72.8%), chloromethylisothiazolinone/methylisothiazolinone (10.5%), other components (15.0%), and oligo-[2-(2-ethoxy)-ethoxyethyl] guanidine chloride (1.5%). The components’ distribution was 67.8% for single-component use, which was higher than that in the survivors (59.8%). The distribution of the causes of death were: respiratory diseases (54.4%), neoplasms (16.8%), and circulatory diseases (6.3%). Other interstitial lung diseases (65.5%) were the most common cause of death among those who died due to respiratory diseases. CONCLUSIONS Careful discussions of appropriate remedies should be conducted based on a comprehensive understanding of the characteristics of the deceased victims, considering their specificities and limitations.
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Affiliation(s)
- Yeong Jun Ju
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea
| | - Seungho Lee
- Department of Occupational and Environmental Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Seungsoo Sheen
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Dong-Woo Choi
- Data Link and Operation Team, Cancer Data Center, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jong-Han Leem
- Department of Occupational and Environmental Medicine, Inha University Hospital, Incheon, Korea.,Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea
| | - Soon Young Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea
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Rodriguez-Arrastia M, García-Martín M, Villegas-Aguilar E, Ropero-Padilla C, Martin-Ibañez L, Roman P. Emotional and psychological implications for healthcare professionals in disasters or mass casualties: A systematic review. J Nurs Manag 2021; 30:298-309. [PMID: 34590385 DOI: 10.1111/jonm.13474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/18/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022]
Abstract
AIM To synthesize and describe the emotional and psychological implications for healthcare professionals who provided care in a mass casualty incident or disaster. BACKGROUND The experience of healthcare providers immersed in the actual uncertainty of an ongoing disaster is real, challenging, complex and strongly connected with emotions. Identifying these implications for healthcare professionals is essential for developing strategies to help these professionals deliver high-quality care. EVALUATION A systematic review was conducted in PubMed, CINAHL, Scopus, Nursing & Allied Health Database and PsycINFO using published data until February 2021 and following the PRISMA guidelines. KEY ISSUES Nineteen articles were included. Factors associated with negative psychological implications were identified and different strategies have been synthesized to prevent or reduce them when caring for the victims of a disaster. CONCLUSIONS Feelings of sadness, helplessness, fear and blockage, among others, were identified as common reactions among nurses and other healthcare professionals dealing in mass casualties or disasters. These reactions may lead to post-traumatic disorder, turning professionals into hidden victims. IMPLICATIONS FOR NURSING MANAGEMENT Organizations, senior charge nurses and other health service managers need to foster resilience and flexibility among their workforce to improve self-care during a disaster, as well as ensure policies to address a lack of emotional preparedness among their personnel. Some strategies to consider include cognitive behavioural therapy, psychoeducation or meditation.
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Affiliation(s)
- Miguel Rodriguez-Arrastia
- Faculty of Health Sciences, Pre-Department of Nursing, Jaume I University, Castellon de la Plana, Spain.,Research Group CYS, Faculty of Health Sciences, Jaume I University, Castellon de la Plana, Spain
| | - Manuel García-Martín
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain.,IMA S0082 Group, Hospital de Poniente, Almeria, Spain
| | | | - Carmen Ropero-Padilla
- Faculty of Health Sciences, Pre-Department of Nursing, Jaume I University, Castellon de la Plana, Spain.,Research Group CYS, Faculty of Health Sciences, Jaume I University, Castellon de la Plana, Spain
| | - Luis Martin-Ibañez
- Field Artillery Group, Light Infantry Brigade "King Alfonso XIII" II of the Legion, Almeria, Spain
| | - Pablo Roman
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain.,Research Group CTS-451 Health Sciences, University of Almeria, Almeria, Spain.,Health Research Centre, University of Almeria, Almeria, Spain
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Psychological Responses Among Korean Middle East Respiratory Syndrome Survivors and Bereaved Families. Disaster Med Public Health Prep 2021; 16:1077-1082. [PMID: 33977892 DOI: 10.1017/dmp.2021.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In 2015, the outbreak of Middle East Respiratory Syndrome (MERS) in South Korea affected 186 patients and led to 38 bereaved families. This study aimed at investigating the nature and related factors of the psychological responses of MERS victims during the acute phase of disaster. METHODS The MERS Psychological Support Team under the Korean Ministry of Health and Welfare provided counseling services to MERS survivors and bereaved families for 4 weeks, based on crisis intervention. In this study, we reviewed the counseling records of 109 survivors and 80 bereaved family members, and analyzed their epidemiological and MERS-related information along with psychological responses. RESULTS Somatic symptoms and anxiety related to social stigmatization or disease transmission were common in MERS survivors, whereas grief reactions such as sadness, and anger were frequently observed in bereaved families. Bereaved MERS survivors showed more avoidance/isolation than non-bereaved MERS survivors. Females, those with an underlying physical or psychiatric health condition, and those having experienced longer duration of hospitalization and non-healthcare workers were more at risk of suffering from psychological problems. CONCLUSIONS Survivors and bereaved families of epidemics can experience various psychological distresses depending on individual characteristics and the inherent features of the epidemic. Therefore, mental health in epidemics should be approached and considered more seriously.
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Mental health impact on a humidifier disinfectant disaster victim: a case report. Ann Occup Environ Med 2020; 32:e15. [PMID: 32676193 PMCID: PMC7332353 DOI: 10.35371/aoem.2020.32.e15] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/20/2020] [Indexed: 12/21/2022] Open
Abstract
In Korea, the cause of lung disease of unknown origin was identified as humidifier disinfectants in November 2011. In February 2017, the ‘Special Act on Remedy for Damage Caused by Humidifier Disinfectants’ was promulgated. Even though emotional and mental injuries caused by humidifier disinfectants have been reported, the focus of the special act has been on physical injury only, and criteria for recognizing mental health impact have not been considered. This case considers emotional and mental injury caused by humidifier disinfectants. After a humidifier disinfectant was used from January 2005 to April 2006, the patient's son aged 20 months was hospitalized with respiratory symptoms, and he died within two weeks. Also, the patient was hospitalized for a month with the same symptoms, and then she led a normal life with no symptoms. After both mother and son were diagnosed with definite (level 1) humidifier disinfectant lung injury (HDLI) in 2017, she took to drinking alcohol because of extreme guilt over her son's death. In March 2018 she died from acute liver failure due to alcohol use disorder. The patient's death was caused by continuous alcoholism, due to emotional and mental trauma caused by her son's death after HDLI was revealed as the cause. The government did not acknowledge her death was due to humidifier disinfectants, but the company that sold the humidifier disinfectants recognized her as a victim and compensated the family of the victim. There are still lots of psychological responses among humidifier disinfectant disaster victims. Mental health impact on humidifier disinfectant victims should be considered more carefully, and institutional improvements should be made into establish psychological interventions and measures.
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Lee E, Lee SY, Hong SJ. The past, present, and future of humidifier disinfectant-associated interstitial lung diseases in children. Clin Exp Pediatr 2020; 63:251-258. [PMID: 32024320 PMCID: PMC7374007 DOI: 10.3345/cep.2019.01326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/03/2019] [Indexed: 12/19/2022] Open
Abstract
Exposure to environmental factors can cause interstitial lung diseases (ILDs); however, such types of ILDs are rare. From 2007 to 2011, an ILD epidemic occurred in South Korea owing to inhalational exposure to toxic chemicals in humidifier disinfectants (HDs). HD-associated ILDs (HD-ILDs) are characterized by rapidly progressing respiratory failure with pulmonary fibrosis and a high mortality rate of 43.8%-58.0%. Although 18.1%-31.1% of the general population used HDs, only a small proportion of HD users were diagnosed with HD-ILDs. This finding suggests that investigation of the pathophysiologies underlying HD-ILDs is needed in addition to the identification of susceptibility to HD-ILDs. Further, there have been several concerns regarding the diverse health effects of exposure to toxic chemicals in HDs, including those that have not been identified, and long-term prognoses in terms of pulmonary function and residual pulmonary lesions observed on follow-up chest images. In this review, we summarize the clinical features, pathologic findings, and changes in radiologic findings over time in patients with HD-ILDs and the results of previous experimental research on the mechanisms underlying the effects of toxic chemicals in HDs. Studies are currently underway to identify the pathophysiologies of HD-ILDs and possible health effects of exposure to HDs along with the development of targeted therapeutic strategies. The experience of identification of HD-ILDs has encouraged stricter control of safe chemicals in everyday life.
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Affiliation(s)
- Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - So-Yeon Lee
- Department of Pediatrics, Childhood Asthma Atopy Center, Humidifier Disinfectant Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Humidifier Disinfectant Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Lancel M, Stroebe M, Eisma MC. Sleep disturbances in bereavement: A systematic review. Sleep Med Rev 2020; 53:101331. [PMID: 32505968 DOI: 10.1016/j.smrv.2020.101331] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 12/16/2022]
Abstract
Severe, persistent and disabling grief occurs among a sizable minority experiencing bereavement, with diagnostic manuals newly including complicated grief (CG) disorders. Sleep disturbances/disorders have been established as worsening affective and stress-related conditions. However, the role of sleep difficulties in bereavement and CG has not received similar scientific attention. We therefore conducted a systematic review with narrative syntheses on this topic to clarify the role of sleep in bereavement (PROSPERO: CRD42018093145). We searched PubMed, Web of Science and PsychInfo for peer-reviewed English-language articles including (at least one) bereaved sample and sleep disturbance measure. We identified 85 articles on 12.294 participants. We answered seven pre-defined research questions demonstrating: high prevalence of sleep disturbances in bereavement; positive associations of grief intensity with sleep difficulties; preliminary indications of risk factors of post-loss sleep disturbance; higher prevalence of sleep disturbances in CG, enhanced by psychiatric comorbidity (i.e., depression); and initial evidence of causal relationships between (complicated) grief and sleep. Grief therapy partly improves sleep difficulties, yet no intervention studies have specifically targeted sleep problems in bereaved persons. Causal relationships between sleep and grief require further examination in intensive longitudinal investigations, including randomized trials, thereby clarifying whether treating sleep problems enhances CG treatment effects.
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Affiliation(s)
- Marike Lancel
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands; Psychiatric Sleep Center Assen, Mental Health Services Drenthe, the Netherlands.
| | - Margaret Stroebe
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Maarten C Eisma
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
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