Journal of Korean Medical Science最新文献

Background: Identifying the risks related to the complications of electrical cardioversion (ECV) can alert the determinaton of rhythm control in patients with atrial fibrillation (AF).

Methods: We retrospectively reviewed 1,058 patients who underwent ECV for persistent or long-standing persistent AF/atrial flutter (AFL) from multiple centers. Patients were classified into the no-complication (1,023 patients) and complication (35 patients) groups based on the following major complications: stroke and/or systemic embolism (SSE), myocardial infarction, major bleeding, implantation of cardiac implantable electronic devices, ventricular tachycardia/fibrillation, and death at 1 year follow-up after ECV.

Results: Compared with the no-complication group, the complication group exhibited a higher proportion of female patients (37% vs. 22%), as well as a higher proportion of patients with older age (67 ± 11 vs. 61 ± 10 years), diabetes mellitus (DM) (49% vs. 24%), heart failure (HF) (49% vs. 30%), SSE (23% vs. 9%), high CHA₂DS₂-VASc (CV) score (3.6 ± 1.8 vs. 2.2 ± 1.4), low left ventricular ejection fraction (LVEF) (50 ± 16% vs. 58 ± 21%), and high left atrial volume index (LAVI) (51 ± 26 vs. 40 ± 20 mL/m²). Class I and III antiarrhythmics were less prescribed in the complication group than in the no-complication group (57% vs. 76%). Univariate analysis for complications revealed age (≥ 65 years), female sex, DM, HF, SSE, LVEF (< 50%), LAVI (≥ 40 mL/m²), CV score (≥ 3), bradycardia on Holter (< 60/min), and no antiarrhythmics as risk factors. Among these, multivariate analysis revealed clinical significance of female sex and SSE.

Conclusion: Female sex and a history of SSE were the most important risk factors of complications in patients with persistent or long-standing persistent AF/AFL who underwent ECV.

Background: The management of sexually transmitted infections (STIs) at the national level is necessary for the health and well-being of individuals in society. The purpose of this study was to propose a redesign of the STI surveillance system by collecting opinions from experts.

Methods: After the major STIs were reviewed, 1) gonorrhea, 2) chancroid, 3) Mycoplasma genitalium infection, and 4) trichomoniasis were selected as diseases requiring a redesign of the surveillance system through the Delphi method, a technique for solving problems by collecting opinions from experts. The expert panel was selected from experts on STIs (n = 17) and included members of the Korean Association of Urogenital Tract Infection and Inflammation, the Korean Society of Infectious Diseases, and the 3rd advisory committee on STIs.

Results: The experts agreed upon the exclusion of surveillance for chancroid on the basis of the low incidence, with an agreement rate of 83%. The experts agreed upon the inclusion of M. genitalium in the surveillance system, with a high agreement rate of 88%. However, there was disagreement among the experts on whether to include trichomoniasis in the surveillance system and whether to switch to a mandatory surveillance system for gonorrhea.

Conclusion: Although a consensus was not reached in some of the surveys in this study, it involved the collection of various expert opinions. Therefore, policies should be promoted with a prioritized focus on items with high agreement, but items for which no consensus was reached need to be reviewed in greater depth through additional research and investigation.

Background: Korea's national suicide prevention strategies emphasize the role of local authorities. Evaluating local government performance helps determine whether suicide reduction goals are being met. This study assesses the performance of basic local government suicide prevention activities and explores their implications.

Methods: Data were drawn from the 2023 Survey on Suicide Prevention Activities. Seventeen indicators, covering both process and outcome measures, were used to evaluate performance. A composite score (0-100) was calculated by weighting and summing the indicators, with weights based on average scores for each indicator. The 229 local governments were grouped into four categories by urbanization and population size: large Si (≥ 300,000 population), small Si (< 300,000), Gun, and Gu. The maximum-minimum (max-min) value ratio was used to examine composite score variation.

Results: Among the 229 local governments, 29 were large Si areas, 49 small Si, 82 Gun, and 69 Gu. Significant disparities were found across several indicators, such as the operation of community suicide prevention centers, availability of mental health professionals, and allocated budgets. Composite scores were highest in large Si areas (59.8), followed by small Si (59.3), and Gu (57.9). The greatest variation was in Gun areas (max-min ratio: 2.6), suggesting inconsistent performance.

Conclusion: There are notable disparities in suicide prevention performance among Korea's basic local governments. Customized strategies that reflect local capacities and contexts are essential to reduce these gaps and improve overall effectiveness.

Vaccines are highly effective, but rare or delayed adverse events following immunization (AEFIs) require post-licensure surveillance beyond clinical trials. Korea lacks a comprehensive, active, database-based framework, yet key assets exist: nationwide claims databases (National Health Insurance Service/Health Insurance Review and Assessment Service), the national immunization registry (Korea Disease Control and Prevention Agency's Immunization Registry Information System) for National Immunization Program (NIP) and non-NIP vaccines, and increasingly standardized hospital electronic health records. We propose a federated, code to data architecture with data linkages between these data. Implementation should adopt a common data model (CDM), standardized case definitions, latency accounting, and transparent public reporting under strong privacy governance. Major challenges include multi step administrative approvals for data linkage, incomplete capture of adult non-NIP vaccinations, heterogeneous hospital data structures, and strict data protection constraints. Strategic priorities are to streamline statutory and administrative processes for public health use, mandate or enable claims-based capture of adult vaccinations, enhance CDM based interoperability, and develop secure hubs for aggregated outputs. With these measures, Korea will be well positioned to establish a scalable active surveillance system capable of detecting rare AEFIs, supporting transparent and evidence-based communication, and ensuring equitable injury compensation grounded in domestic data.

Background: This study assessed social determinants in urban and rural nationalities to identify regional factors associated with mental health and suicide.

Methods: Data on 32 variables representing regional characteristics (sociodemographic, health and welfare, environmental, economic, and mental health status including suicide mortality) were collected at the municipal level (si/gun/gu) between 2017 and 2021. For the purpose of analysis, regions were categorized as urban (comprising "si" and "gu") and rural (comprising "gun"); and correlations were examined between stress perception rate, depressive mood experience rate, prevalence of depressive symptoms, and suicide rates. Simple linear regression analysis and multiple linear regression analysis were done.

Results: Stress perception, depressive mood experience, and depressive symptom prevalence were higher in urban areas whereas suicide rates were higher in rural areas. Positive correlations were observed between stress, depressive mood, and depressive symptoms in both urban and rural areas (P < 0.001). However, the relationship between stress and suicide showed contrasting patterns: a negative correlation in urban areas (P = 0.007) and a positive correlation in rural areas (P = 0.016). In urban areas, sociodemographic and health and welfare factors were primary correlates. Conversely, rural areas showed correlations with certain health and welfare, environmental, and economic factors.

Conclusion: The findings reveal distinct patterns in the relationships between stress, depression, and suicide between urban and rural areas. These results underscore the need for tailored suicide prevention policies and mental health interventions that address the unique characteristics of each region.

Background: Sexually transmitted infections (STIs) caused by Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), and Neisseria gonorrhoeae (NG) are major public health concerns. While nucleic acid amplification tests (NAATs) are the primary diagnostic tool for these pathogens, research on pathogen-specific characteristics and risk factors for NAAT clearance failure remain limited in Korea. This study analyzed clinical features of STIs and post-treatment NAAT changes.

Methods: This retrospective cohort study included adult, non-pregnant patients diagnosed with CT, MG, or NG via NAAT at a secondary care hospital between 2012 and 2024. Clinical characteristics were compared using the Kruskal-Wallis test, and multivariate logistic regression identified risk factors for NAAT clearance failure in patients with follow-up NAAT within three months.

Results: Among 500 STI cases, 80.8% were female, with a median age of 27.0 years. CT was the most common pathogen (53.8%), followed by MG (37.2%) and NG (9.0%). CT infections had the highest complication rate (28.6%), while NG infections were more frequently symptomatic (77.8%) and associated with pyuria (46.4%). Of 221 patients with follow-up NAAT, 14.9% failed clearance. MG infection (adjusted odds ratio [aOR], 6.100; 95% confidence interval [CI], 2.711-13.725; P < 0.001) and symptomatic presentation (aOR, 2.542; 95% CI, 1.103-5.861; P = 0.029) were independent risk factors for clearance failure.

Conclusion: CT showed the highest complication rate and NG was the most symptomatic. MG was a key predictor of NAAT clearance failure, underscoring the need for antimicrobial resistance monitoring and optimized retreatment strategies.

Background: Lonely death, referred to the death of an individual at home alone and found after some time has elapsed, has emerged as a significant social issue in many countries. This study aimed to distinguish high-risk groups by comparing the characteristics of individuals who died of loneliness with those of the control group.

Methods: This case-control study was conducted using data from the Korea Crime Scene Investigation and National Health Insurance Service (NHIS) databases. We identified all lonely deaths that occurred in 2021 in Korea and sex- and age-matched controls were randomly selected from the NHIS database in a 1:3 ratio. Data on demographics, health conditions, and healthcare utilisation were analysed. Associations between lonely deaths and various factors were assessed using logistic regression.

Results: This study included 3,122 lonely death cases and 9,493 controls. Individuals who experienced lonely death were more likely to be covered by medical aid, in the lowest income group, and have high (≥ 3) Charlson comorbidity index scores than the controls (30.8% vs. 4.0%, 54.5% vs. 19.2%, 14.5% vs. 8.6%, respectively). Furthermore, they exhibited a higher prevalence of chronic diseases (including diabetes and heart failure), mental health disorders (including schizophrenia and bipolar disorder), and alcohol-related diseases, along with more frequent healthcare utilisation. Most of these factors exhibited statistical or borderline significance in adjusted logistic regression analyses.

Conclusion: Lonely death is associated with low income, multi-morbidity, underlying diseases, and frequent healthcare utilisation. Targeted intervention strategies that focus on these potentially high-risk populations may help prevent lonely deaths.

Background: Timely reperfusion therapy is critical in acute ischemic stroke, yet prolonged transport remains a major barrier. This study compared the clinical outcomes and time intervals between helicopter emergency medical services (HEMS) and ground emergency medical services (GEMS) in patients transferred for suspected stroke to a rural tertiary center in South Korea.

Methods: We retrospectively analyzed adult patients (≥ 18 years) with acute ischemic stroke (International Classification of Diseases, 10th Revision, code I63) transferred from referral hospitals at least 30 km away, between July 2013 and June 2021. Patients arriving over 24 hours from onset, transient ischemic attack cases, or those with incomplete records were excluded. After propensity score matching by age, sex, and referral hospital, data on demographics, National Institutes of Health Stroke Severity (NIHSS), modified Rankin Scale (mRS), transport times, and treatments (tissue plasminogen activator [tPA] or mechanical thrombectomy) were examined. Primary outcomes included rates of thrombolytic therapy and neurological outcomes at discharge (mRS ≤ 2).

Results: A total of 182 matched patients (91 HEMS, 91 GEMS) were analyzed. Baseline comorbidities were similar, although current smoking was more frequent in the HEMS group (29.7% vs. 15.4%). HEMS resulted in significantly shorter door-in-door-out time (60 vs. 83 minutes; P = 0.005) and interfacility transport time (39 vs. 51 minutes; P < 0.001), leading to a shorter onset-to-receiving-hospital interval. Despite these time advantages, no statistically significant differences were observed in overall tPA administration, mechanical thrombectomy rates, or discharge NIHSS and mRS scores. The most common reason for non-administration of tPA in both groups was arriving beyond the 4.5-hour window, reported more often in the GEMS group (72.8% vs. 42.9%; P < 0.001).

Conclusion: HEMS significantly reduced transport intervals and in-hospital time metrics for patients with acute ischemic stroke. However, faster arrival did not translate into a statistically significant improvement in thrombolysis or neurological outcomes compared to GEMS. Future research should refine patient selection for HEMS and optimize in-hospital workflows to fully leverage potential time savings and improve clinical outcomes.

Background: Understanding global patterns of adolescent noncombustible nicotine or tobacco product (NNTP) and combustible cigarette (CC) use is vital due to rising prevalence and long-term health risks, but comparative international analyses are lacking. Thus, we aimed to assess smoking prevalence and trends among adolescents in 57 countries and territories and to identify factors associated with NNTP and CC use.

Methods: We utilized World Health Organization (WHO) Global Youth Tobacco Survey data to investigate adolescent NNTP and CC use prevalence and trends globally from 2014 to 2021. We conducted a meta-analysis using random-effects models to identify the summary effect of smoking prevalence in each country. Weighted linear regression was used to calculate weighted β coefficients with 95% confidence intervals (CIs). Each analysis was stratified by sex, World Bank income category, e-cigarette regulatory policy status, and WHO Framework Convention on Tobacco Control ratification status. Finally, a hierarchical Bayesian statistical model was employed to precisely predict the prevalence rates of both CC and NNTP use up to 2045.

Results: Among the 57 countries with 173,658 adolescents, NNTP use exhibited a higher prevalence than CC use in 31 countries. Demographic groups exhibiting higher smoking prevalence included male adolescents (NNTP use: 10.78% [95% CI, 9.38 to 12.18]; CC use: 10.36% [9.03 to 11.69]), adolescents in high-income countries (NNTP use: 11.29% [8.62 to 13.95]; CC use: 10.48% [7.27 to 13.68]), and those in countries with less restrictive policies (NNTP use: 11.18% [7.32 to 15.04]; CC use: 11.44% [7.75 to 15.13]). Global NNTP use showed an overall increase from 2014 to 2021 (β, 0.73 [0.16 to 1.30]), with a particularly notable rise among male adolescents (β, 0.81 [0.05 to 1.57]). In 2044-2045, NNTP use is expected to remain relatively stable (10.61%), while CC use is projected to show a downward trend (1.05%).

Conclusion: Over half of the countries exhibited a higher prevalence of NNTP use than CC use. Global smoking prevalence varied across diverse factors. NNTP use among adolescents has increased, especially among male adolescents.

Background: Health administrative data are widely used in health services research, but diagnostic codes may be subject to misclassification. This scoping review examined the validity and reporting practices of operational definitions using the Korean National Health Insurance Claim Database (KHICD), focusing on compliance with the REporting of studies Conducted using Observational Routinely collected health Data (RECORD) statement.

Methods: PubMed was searched for studies validating operational definitions or using the KHICD for population identification, published between 2020 and 2024. After screening 29 validation studies and 239 KHICD-based studies, 12 validation studies and 157 KHICD-based studies were included. Data on operational definitions, validation methods, and adherence to RECORD guidelines were extracted.

Results: Among 12 validation studies, most focused on cancer, and algorithms combining diagnostic codes with rare intractable disease program codes, prescription, or procedure codes demonstrated higher positive predictive values than diagnostic codes alone. Among the 157 KHICD-based studies, 131 (83.4%) used diagnosis codes to identify patients, of which 71 (45.2%) combined them with supplementary codes. However, 60 (38.2%) studies relied solely on diagnosis codes, often without specifying diagnosis scope or acknowledging misclassification risks. Only three studies conducted validation, and overall compliance with the RECORD statement was limited.

Conclusion: While operational definitions using combined codes improve patient identification in the KHICD, methodological rigor and reporting transparency remain suboptimal. Systematic validation studies and strict adherence to reporting guidelines are needed to enhance reproducibility and comparability of KHICD-based research.