Journal of Korean Medical Science最新文献

We retrospectively examined current trends in ordering for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) testing. All claims corresponding to ESR and CRP testing for hospital visits in 2022 were obtained from a platform operated by the Health Insurance and Review Agency. The annual (2018-2022) utilization and cost of ESR and CRP, total inpatient days, and patient encounters with outpatients were retrieved. The number of ESR and CRP tests gradually increased over 5 years, except a slight decrease in 2020. The proportion of claims with co-ordering of ESR and CRP tests was 46.64%. More than 60% co-ordering claims were observed in orthopedic surgery, neurosurgery, and plastic surgery departments. The proportion of co-orders was relatively high in inpatient setting and primary hospitals. This study indicated frequent co-ordering patterns of ESR and CRP tests, highlighting an urgent need for diagnostic stewardship programs on ESR and CRP testing in Korea.

Background: The association between happiness and suicide behaviour across different gender and age groups remains unclear, with few studies identifying potential confounding or mediating factors that explain this association. We aimed 1) to examine the association of happiness with suicide ideation/attempt and 2) to assess the relative contribution of potential factors in explaining the associations in South Korea.

Methods: We used data from the Korea Community Health Survey 2021, with 214,070 respondents aged over 20 years. Happiness was measured by using Cantril's ladder of life satisfaction. Suicide ideation and suicide attempt were each measured by a single question. A hierarchical logistic regression model was used to identify the association between happiness and suicide ideation/attempt and estimate the relative importance of each socio-environmental, psychological, and health-related factor.

Results: Unhappiness was associated with suicide ideation/attempt across gender and age groups. The associations appeared stronger in younger rather than older adults, particularly for women aged 20-39 and 40-59 years. Psychological factors contributed the most to explaining the association across all genders and age groups. Socio-environmental factors explained the associations more among individuals aged 40-59 years and health-related factors were more pronounced in explaining the association among those aged 60 years and above, compared to other age groups.

Conclusion: Unhappiness is associated with suicide ideation/attempt. Psychological factors could largely explain this association, suggesting that improving population mental health could play an important role in increasing happiness and preventing suicide behaviour.

Background: Polycystic ovary syndrome (PCOS) and endometriosis are widely recognized as significant risk factors affecting the reproductive health of women. The underlying mechanisms impacting fertility may vary, potentially leading to divergent outcomes. We aimed to examine and contrast the prevalence patterns of diseases coexisting with PCOS and endometriosis, using a large-scale nationwide insurance claims data from Asian women of reproductive age.

Methods: We analyzed health insurance and examination data of 157,662 Korean women aged 15-45 years, drawn from the Korea National Health Insurance Service-National Sample Cohort database. International Classification of Disease, Tenth Revision codes were mapped to phenome-wide association study codes (phecodes). Subsequently, multivariate logistic regression was performed to assess the comorbidity patterns among patients diagnosed with PCOS and endometriosis and healthy control groups.

Results: Our analysis revealed that PCOS was correlated with a wider range of metabolic disorders and symptoms, such as hyperlipidemia, type 2 diabetes, various gastrointestinal (GI) issues, and an array of pregnancy-related complications. Conversely, endometriosis was more prevalent among benign neoplasms of female reproductive and digestive organs, endometrial hyperplasia, and angina pectoris. Notably, infertility and glaucoma demonstrated significant associations with both conditions. Furthermore, a comparison of symptom-related codes in women with endometriosis revealed a predominance of pain-related symptoms, whereas those with PCOS exhibited a broader spectrum, encompassing pain, pruritus, GI problems, cough, fever, menstrual cycle disorders, edema, and dizziness.

Conclusion: PCOS and endometriosis, which are prevalent gynecological disorders affecting similar age groups of women, rarely co-occur and exhibit unique comorbidity profiles. Tailored healthcare strategies that take into account these distinct patterns have the potential to enhance long-term healthcare outcomes of affected patients. Further research is required to elucidate the underlying mechanisms and contrasting comorbidity profiles between PCOS and endometriosis.

Making correct decisions is of paramount importance in clinical medicine and health-related disciplines. Randomized clinical trials are considered the gold-standard type of study for the assessment of the efficacy of a treatment. However, conducting a randomized clinical trial is not always possible; observational studies should be conducted, instead. For lack of randomization in observational studies, there may be a priori differences in the distributions of certain variables (e.g., age, race, and quality of health care services) between the study groups that may result in a biased estimate of the outcome of interest. Risk adjustment methods are used to account for these a priori differences and find an unbiased measure of the treatment effect. The method involves several steps including defining the outcome of interest and identifying its potential outcome predictors. Then, we need to operationalize the selected risk factors and construct a statistical model or other methods of adjustment. This will result in a more accurate (less biased) estimate of the treatment effect.

Background: Suicide remains a significant global public health challenge, with hanging as the most prevalent suicide method in South Korea. This study aimed to determine diagnostic markers confirming suicidal hanging-associated deaths.

Methods: In this prospective study, hemorrhages at the periosteal-clavicular origin of the sternocleidomastoid (SCM) muscles were compared among suicidal hanging, manual strangulation, and ligature strangulation cases. This study included 211 cases of suicide by hanging, and a control group of 50 individuals who underwent cardiopulmonary resuscitation but died of other causes. Additionally, nine cases of ligature strangulation and six cases of manual strangulation were analyzed. Postmortem examinations were conducted, and clavicular hemorrhages were histologically evaluated. Statistical analyses were performed using the χ² test.

Results: Hemorrhages at the periosteal-clavicular origin of the SCM were observed in 178 of the 211 hanging cases (84.4%). The highest frequency of clavicular hemorrhage was found in typical hanging cases with complete suspension. Among the 50 control cases, only three showed hemorrhages in the clavicular region, but these were extravasations in the adjoining soft tissue, not in the periosteum. In cases of manual and ligature strangulation, SCM hemorrhages were found within the muscle tissue and were not of periosteal-clavicular origin.

Conclusion: Hemorrhage at the periosteal-clavicular origin of the SCM is a significant finding in suicidal hanging and serves as a potential pathognomonic marker for confirming cases of suicidal hanging. The study revealed a statistically significant association between the type of hanging, completeness of body suspension, and the occurrence of these hemorrhages. Cardiopulmonary resuscitation does not cause a hemorrhage at this location.

Background: Respiratory syncytial virus (RSV) prophylaxis using palivizumab effectively reduces RSV-associated morbidity in preterm infants. In Korea, national insurance coverage for palivizumab was implemented in October 2016 for moderate-to-late preterm (MLPT) infants born during the RSV season (October-March) who have older siblings. However, no large-scale studies have investigated the changes in the incidence and risk of severe acute lower respiratory infections (ALRIs) after insurance coverage implementation for MLPT infants.

Methods: This large-scale retrospective cohort study used data from the Korean National Health Insurance Service between October 2013 and December 2019. MLPT infants (32 0/7-35 6/7 weeks of gestation) with older siblings were stratified into pre-insurance period (PIP; October 2013-September 2016) and insurance period (IP; October 2016-March 2019) groups based on the date of birth with respect to initial insurance palivizumab implementation. Severe ALRI outcomes (hospitalization, respiratory support, and intensive care unit admission) were evaluated up to 1 year of age using multivariable logistic regression models.

Results: Of the 11,722 MLPT infants included in the study, 6,716 and 5,006 infants were included in the IP and PIP groups, respectively. The incidences of ALRI-hospitalization and ALRI-respiratory support were significantly lower in the IP group than that in PIP group (24.0% vs. 26.0% and 3.1% vs. 4.0%, respectively). Additionally, ALRI-respiratory support risk was significantly lower in the IP group (adjusted odds ratio 0.771, 95% confidence interval 0.626-0.949, P = 0.014) than that in the PIP group. Among infants born during the RSV season, the risk of ALRI-hospitalization and ALRI-respiratory support were significantly lower in the IP group than that in the PIP group. However, no significant differences were observed between the IP and PIP groups for infants born during the non-RSV season.

Conclusion: The risks of severe ALRI outcomes decreased in Korea following the 2016 insurance implementation of palivizumab prophylaxis for MLPT infants born during the RSV season with older siblings.

The emergence of the omicron variant and its sub-lineages has necessitated vaccine updates for coronavirus disease 2019. In September 2023, the U.S. Food and Drug Administration approved an updated BNT162b2 vaccine targeting the omicron XBB.1.5 variant, which was initiated in Korea in October 2024. This study demonstrates the adverse events reported through active nationwide surveillance after XBB.1.5 vaccination in Korea. Since October 19, 2023, the Korea Disease Control and Prevention Agency has conducted daily Short Message Service surveys to collect data on health issues, fever, vaccination site reactions, systemic symptoms, impact on daily life, and healthcare visits. Among 20,180 respondents, 27.9% reported health issues. Adverse reactions peaked on day 1 (28.7%), including pain at the vaccination site, muscle pain, fatigue, and fever. These findings elucidate the short-term safety of the XBB.1.5 vaccine and support its co-administration with the influenza vaccine, reducing vaccine hesitancy and achieving herd immunity.

Background: Renal replacement therapy (RRT) is an important treatment option for sepsis-associated acute kidney injury (AKI); however, the optimal timing for its initiation remains controversial. Herein, we investigated the clinical outcomes of early continuous kidney replacement therapy (CKRT), defined as CKRT initiation within 6 hours of sepsis-associated AKI onset, which was earlier than the initiation time defined in previous studies.

Methods: We used clinical data sourced from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. This study included patients aged ≥ 18 years who met the sepsis diagnostic criteria and received CKRT because of stage 2 or 3 AKI. Early and late CKRTs were defined as CKRT initiation within 6 hours and after 6 hours of the development of sepsis-associated AKI, respectively.

Results: Of the 33,236 patients diagnosed with sepsis, 553 underwent CKRT for sepsis-associated AKI. After excluding cases of early mortality and patients with a dialysis history, 45 and 334 patients were included in the early and late CKRT groups, respectively. After propensity score matching, the 28-day mortality rate was significantly lower in the early CKRT group than in the late CKRT group (26.7% vs. 43.9%, P = 0.035). The early CKRT group also had a significantly greater number of days free of mechanical ventilation (median, 19; interquartile range [IQR], 3-25) and vasopressor administration (median, 21; IQR, 5-26) than the late CKRT group did (median, 10.5; IQR, 0-23; P = 0.037 and median, 13.5; IQR, 0-25; P = 0.028, respectively). The Kaplan-Meier curve also showed that early CKRT initiation was associated with an improved 28-day mortality rate (log-rank test, P = 0.040). In contrast, there was no significant difference in the 28-day mortality between patients who started CKRT within 12 hours and those who did not (log-rank test, P = 0.237).

Conclusion: Early CKRT initiation improved the survival of patients with sepsis-associated AKI. Initiation of CKRT should be considered as early as possible after sepsis-associated AKI onset, preferably within 6 hours.