Journal of Korean Medical Science最新文献

Background: Complex post-traumatic stress disorder (CPTSD) is characterized by the presence of post-traumatic stress disorder symptoms combined with disturbances in self-organization. However, treatment strategies for this newly defined condition remain lacking.

Methods: In this systematic review of international studies exploring psychological interventions for CPTSD in children, adolescents, and adults, we screened PubMed and Google Scholar for relevant literature while adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: In total, 6 studies met our inclusion criteria. The psychological interventions explored in these studies encompassed a range of therapeutic modalities, including trauma-focused cognitive behavioral therapy, prolonged exposure therapy, skill training in affect and interpersonal regulation narrative therapy, mindfulness-based practices, and group therapies with a focus on somatic or body-oriented techniques. For children and adolescents with CPTSD, interventions were typically concise and followed a structured, phase-based approach, whereas adults often benefited from longer intervention durations that facilitated a more gradual and profound therapeutic process.

Conclusion: This review highlights the effectiveness of psychological interventions in addressing CPTSD symptoms. However, treatments specifically targeting CPTSD's unique symptom clusters, especially disturbances in self-organization, remain limited. Future research should prioritize the development of interventions tailored to address these distinct features.

Background: This study investigated the patterns and determinants of smart device usage among children over a period of six years, utilizing latent trajectory class analysis with a growth mixture model (GMM) to identify risk groups based on their screen time trajectories.

Methods: The Kids Cohort for Understanding of internet addiction Risk factors in Early childhood provided data from six waves of surveys conducted from 2018 to 2023, with a final sample size of 313 participants (mostly mothers) who completed all assessments. We used a GMM to analyze six-year patterns of children's smart device usage. Subgroups were identified based on screen time trajectories using GMM, and the impact of sex, age, parental education, family income, and child behavior checklist (CBCL) scores on group membership was assessed with multinomial logistic regression.

Results: Three distinct risk groups were identified: a low-risk group (69.86%) with minimal and stable screen time, a mid-risk group (21.92%) with moderate and occasionally increased screen time, and a high-risk group (8.22%) with consistently high and increasing screen time. Factors such as older age of the child, higher early CBCL scores, lower maternal educational levels, and lower economic status were significantly associated with a higher risk of excessive screen time.

Conclusion: This study highlights the significant variations in children's smart device usage patterns influenced by behavioral and socioeconomic factors. The findings suggest the need for targeted interventions that address the specific needs and risks associated with different screen-time trajectories. Effective strategies should consider both individual and familial factors to promote healthier digital habits among children.

Background: During the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic, healthcare workers (HCWs) faced significant challenges related to their exposure to the virus and the prevention of its transmission. HCWs were advised to use personal protective equipment (PPE) when treating patients diagnosed with or suspected of having coronavirus disease 2019. However, the effectiveness of PPE in preventing SARS-CoV-2 infection remains unclear. This study aims to investigate the protective effect of PPE against SARS-CoV-2 infection.

Methods: HCWs without a history of SARS-CoV-2 infection or vaccination were enrolled. Blood samples were collected at two-time points: the first between February and April 2020, before any patient contact, and the second between February and March 2021. Anti-SARS-CoV-2 immunoglobulin G antibodies were measured to assess SARS-CoV-2 infection.

Results: Among the 181 participants, only one developed SARS-CoV-2 antibodies. However, an epidemiological investigation suggested that this infection was more likely acquired outside the hospital than during clinical duties.

Conclusion: Our findings suggest that PPE is effective in preventing SARS-CoV-2 infection among HCWs.

Background: Despite high approval for euthanasia and physician-assisted suicide (PAS) reported recently in South Korea, confusion from varying term interpretations must be addressed. This study assesses public understanding of end-of-life terminology and preferred decisions among Koreans.

Methods: An online survey was conducted with 1,000 adult Koreans from June 10 to 14, 2024. To assess their understanding of end-of-life decision terms, participants were presented with scenarios on euthanasia, PAS, and decisions on forgoing life-sustaining treatment (DLST) and asked to select appropriate terms from each of the conventional (natural death, death with dignity, euthanasia) and objective (euthanasia, PAS, DLST) categories. To examine whether agreement levels differed between questions on terms alone and those with scenarios, initial agreement on euthanasia, PAS, death with dignity, natural death, and DLST was measured using a 5-point Likert scale, followed by case-specific agreement for euthanasia, PAS, and DLST. Finally, participants selected their preferred end-of-life decision, assuming terminal cancer.

Results: 1) When scenarios involving euthanasia, PAS, and DLST were presented, respondents correctly identified each medical practice using objective terminology at rates of 37.4%, 53.8%, and 85.9%, respectively. 2) When the same medical practices were presented and respondents were asked to choose conventional terminology, the perception of these practices as "death with dignity" was 27.3% for euthanasia, 34.3% for PAS, and 57.2% for DLST. This result indicates that the subjective term "death with dignity" does not effectively differentiate between the three medical practices. 3) The initial agreement rates with the terms alone were 66.6% for euthanasia, 47.8% for death with dignity, 72.1% for PAS, 72.0% for natural death, and 75.5% for DLST. However, after presenting scenarios explaining each medical practice, some changes in agreement rates were observed. 4) When asked what decision they would personally choose in an end-of-life situation, 35.5% accepted euthanasia, 15.4% accepted PAS, and 41.3% accepted DLST.

Conclusion: There is considerable confusion regarding end-of-life decision terminology among Koreans, particularly with "death with dignity," which significantly confounds opinions on euthanasia and PAS. Therefore, objective terms should be used in end-of-life decisions discussions. Finally, DLST was the most preferred end-of-life decision among Koreans.

Mycoplasma pneumoniae is a unique, wall-less bacterium and a leading cause of community-acquired pneumonia in school-aged children. Epidemiologically, M. pneumoniae causes endemic and epidemic infections every 3-5 years, with recent surges noted globally since mid-2023. Diagnostic challenges persist; although polymerase chain reaction and serology are widely used, both carry risks of false positives or negatives owing to prolonged shedding or delayed antibody responses, respectively. Novel approaches such as ELISpot assays for antibody-secreting cells may improve diagnostic accuracy. Macrolides remain the first-line treatment in children because of the toxicity of tetracyclines and fluoroquinolones. However, macrolide-resistant M. pneumoniae (MRMP) has emerged as a major concern, especially in the Western Pacific Region (South Korea, China, and Japan), where resistance rates have exceeded 80% in recent years. Resistance is developed by 23S rRNA mutations (notably A2063G) and driven primarily by macrolide over usage and clonal expansion-particularly in sequence type 3 strains. Despite high resistance rates, many M. pneumoniae pneumonia cases remain self-limiting, and clinical outcomes are not substantially different between macrolide-sensitive and macrolide-resistant infections. Clinical studies show that while MRMP is associated with longer fever and hospital stays, it rarely increases severity. Tetracyclines and quinolones have been shown to lead to faster fever resolution in MRMP patients, and treatment guidelines now recommend switching to second-line agents when macrolide-refractory disease is suspected. Nevertheless, a considerable proportion of patients recover spontaneously, regardless of antibiotic choice, likely owing to the self-limiting nature of the pathogen, misdiagnosis of viral infections, or the immunomodulatory effects of macrolides. Amid rising MRMP, this review highlights the complex interplay between bacterial resistance, diagnostic limitations, and host factors in shaping M. pneumoniae disease outcomes.

Background: In this study, we aimed to evaluate the relationship between the body mass index (BMI) of participants in their 20s (20s_BMI) and the risk of developing various chronic metabolic diseases when they were over the age of 65 years. We also investigated how quickly these values worsened after 65 years of age.

Methods: This 8-year prospective cohort study targeted elderly people aged 65 years or older with three healthcare visits at 3-4 to year intervals. Participants were divided into four groups according to their 20s_BMI and the occurrence and changes in body weight and fatty liver were observed for approximately 8 years.

Results: A total of 1,130 people aged 65 years or older were included. In the 65-69 years age group, as the 20s_BMI increased, weight, BMI, waist circumference, and hip circumference all significantly increased (all P < 0.001); furthermore, the incidence of metabolic syndrome also significantly increased (P < 0.05). In particular, the rates of deterioration in weight, BMI, waist circumference, and waist-to-hip ratio were high in people aged 75 years and older (all P < 0.001). The Framingham Steatosis Index and Hepatic Steatosis Index tended to increase as the 20s_BMI increased; moreover, they all showed a worsening trend toward the second and third visit.

Conclusion: We found that a high 20s_BMI continued to be high even after the age of 65 years and had a negative impact on the occurrence and worsening of metabolic dysfunction-associated steatotic liver disease. This suggests that weight management starting in the 20s is important to prevent the progression of chronic diseases after the age of 65 years.

Background: Neonatal herpes simplex virus (HSV) infection is rare but can cause severe disease, even death. However, data on neonatal HSV infection is limited in Asia. Thus, this study estimated the incidence of neonatal HSV infections and evaluated the characteristics in hospitalized patients in Korea, where seroprevalence of HSV infection in child-bearing age women is not well known.

Methods: This is the first multicenter retrospective study in 12 university hospitals in Korea. Neonates aged ≤ 28 days with confirmed HSV infection were identified from January 2008 to December 2017, and a chart review was performed.

Results: Among 12 medical centers, 16 patients were identified in 6 centers. The estimated incidence rate was 1/7,888 in hospitalized neonates. Eight (50%) patients were males, and the median age at diagnosis was 11 days (range, 4-28 days). Ten (62.5%) patients were HSV-1-positive, and 6 (37.5%) patients were HSV-2-positive. Four (25%) patients had disseminated infection, 11 (68.8%) patients had central nervous system disease, and 1 (6.2%) patient had skin, eye, and/or mouth disease. All the patients received intravenous acyclovir, with a median treatment duration of 19 days (range, 3-68 days). Four (25%) patients received additional oral acyclovir suppressive therapy, with the median treatment duration of 5 months (3-6 months). Four patients (25%) developed seizures (one case with disseminated disease and 3 cases with central nervous system disease), and 2 of them recovered without neurologic complications. Two (12.5%) patients with disseminated disease died within 30 days from the diagnosis, and one of them had a maternal history of previous genital herpetic lesions. Medical records of maternal genital herpes were not available in 10 (62.5%) patients with neonatal HSV infections.

Conclusion: Although uncommon, neonatal HSV infection occurs in Korean babies with a high 30-day mortality of 12.5%. Increased awareness is warranted among Korean pediatricians for the early diagnosis and treatment of neonatal HSV infection.

Background: Lung cancer remains a significant public health concern, with external environmental factors, such as particulate matter 2.5 (PM2.5), playing a crucial role in its development. This study aimed to assess the interaction between cumulative exposure to PM2.5 and lung function impairment, focusing on the risk of lung cancer in a large Korean population.

Methods: Data from the Korea National Health and Nutrition Examination Survey from 2007 to 2020 were analyzed with linkage of the national cancer registry. A total of 43,973 participants, including 386 lung cancer cases, were included, with spirometry data available to classify lung function into categories. PM2.5 exposure was quantified using geocoded address information. Logistic regression models with interaction terms were used to evaluate lung cancer risk according to PM2.5 exposure levels and in interaction of lung function categories.

Results: A significant increase in lung cancer risk was observed with higher PM2.5 exposure levels, with odds ratios (ORs) of 1.41, 1.59, and 1.68 for the 2nd, 3rd, and 4th quartiles, respectively in multivariable models. Stratified analysis showed that the interaction between PM2.5 exposure and obstructive lung function significantly increased lung cancer risk, with ORs of 2.74 for spirometric obstruction and 3.43 for preserved ratio impaired spirometry in the highest PM2.5 quartile.

Conclusion: This study suggests the carcinogenic risk of PM2.5 exposure, particularly in individuals with obstructive lung function impairments.