Journal of Korean Medical Science最新文献

Background: Trends in mental health-related emergency department (ED) use among adolescents and young adults in South Korea are largely unexplored. This study evaluated recent trends and characteristics of these ED visits.

Methods: This nationwide epidemiologic study used data from the National Emergency Department Information System in Korea, including patients who visited the ED to receive psychiatric consultation between 2017 and 2021. Adolescents and young adults were defined as 10-24 years old, and their characteristics and trends were compared with those of adult (≥ 25 years) patients.

Results: Among 117,997 patients, adolescents and young adults comprised 28.0% of the population. There was a significant increasing trend in ED visits between 2017 and 2021 among adolescents and young adults (4,737 to 8,787, P < 0.001), whereas the adult patient visits were stationary (16,798 to 16,313, P = 0.497). In the adolescents and young adults group, there was a greater predominance of females (67.1%), transfer from other facilities (10.8%), discharge to home after treatment (71.7%), and visits due to intentional self-harm (26.9%) than in the older age group. The most common diagnostic codes were F30-F39 (mood [affective] disorder; 43.2%), and the most common diagnosis was F32 (depressive episode), accounting for 17.7%. Diagnoses in the F30-39 category, especially F32, significantly increased each year (P < 0.001).

Conclusion: The study revealed that from 2017 to 2021, mental health-related ED visits for adolescents and young adults nearly doubled, especially for depression and mood disorders, with a significant increase among female patients. This highlights the need for tailored strategies and more psychiatric expertise in the ED.

Background: Isoniazid resistance is the most common type of ant-tuberculosis drug resistance, which is often neglected in clinical practice. This study aimed to evaluate the impact of isoniazid mono-resistant tuberculosis (Hr-TB) on the treatment outcomes of people with pulmonary tuberculosis.

Methods: People with pulmonary tuberculosis were enrolled from the Korea Tuberculosis Cohort (KTBC) registry and the multicenter prospective cohort study of pulmonary tuberculosis (COSMOTB). Isoniazid resistance was confirmed using drug susceptibility test results. The primary outcome was an unfavorable outcome, which defined as comprising death, failure, loss-to-follow-up, still-on-treatment, and not-evaluated. Logistic regression analysis was conducted to evaluate effect of isoniazid resistance on treatment outcomes. We also compared 2-month sputum negative culture conversion rate and incidence of adverse events between Hr-TB and drug-susceptible tuberculosis.

Results: From the KTBC and COSMOTB databases, 10,482 and 758 participants were included, respectively. Compared to drug-susceptible tuberculosis, Hr-TB had higher rates of unfavorable outcome in the KTBC (45.8% vs. 37.0%, P < 0.001) and COSMOTB (31.5% vs. 17.9%, P = 0.014). Multivariable logistic regression analysis showed significant association between isoniazid resistance and unfavorable outcome in the KTBC (adjusted odds ratio [aOR], 1.43; 95% confidence interval [CI], 1.24-1.65) and in the COSMOTB (aOR, 1.98; 95% CI, 1.02-3.85). Additional analyses on COSMOTB data showed that Hr-TB had more serious adverse drug reactions, while 2-month sputum culture conversion rates did not differ significantly.

Conclusion: Isoniazid resistance is significantly associated with unfavorable clinical outcomes.

Background: This study aimed to investigate the long-term clinical outcomes of ABO-incompatible kidney transplantation (ABO icKT) in patients with high baseline anti-A/B antibody titers.

Methods: This study included 271 cases of ABO icKT. Of these, 42 patients with a baseline antibody titer of ≥ 1:256 were assigned to the high-titer group, while the remaining 229 patients were categorized into the low-titer group. We compared the groups regarding the number of required pre-transplant plasmapheresis (PP) and intravenous immunoglobulin (IVIG) sessions. Clinical outcomes included post-operative bleeding, biopsy-proven acute rejection (BPAR), infectious complications, changes in allograft function, and long-term allograft and patient survival.

Results: The high-titer group required significantly more sessions of PP and IVIG than the low-titer group (8.74 ± 2.68 vs. 3.85 ± 1.64; P < 0.001). Following transplantation, anti-A/B antibody titers remained elevated in the high-titer group. There was no significant difference in post-operative bleeding between the two groups. However, the incidence of bacterial infection was higher in the high-titer group compared with the low-titer group (47.62% vs. 30.57%; P = 0.031), although this association was not significant in multivariable analysis. The incidence of total BPAR did not differ significantly; however, chronic active antibody-mediated rejection was more frequently observed in the high-titer group (7.14% vs. 0.87%; P = 0.028). Overall allograft and patient survival did not differ significantly between the two groups.

Conclusion: Patients with high baseline anti-A/B titers demonstrated comparable short-term and long-term patient and allograft outcomes to those in the low-titer group.

Background: The widespread use of polluting fuels for indoor heating in the Demographic People's Republic of Korea (DPRK, North Korea) poses a significant risk for unintentional carbon monoxide (CO) poisoning. Despite its public health impact, reliable national-level data on the burden of CO poisoning in the DPRK remain scarce. This study addresses the need for more accurate estimates by analyzing fatality rates among hospitalized patients.

Methods: A meta-analysis was conducted to estimate the fatality rate of hospitalized patients with unintentional CO poisoning in the DPRK and to compare it with historical data from the Republic of Korea (ROK, South Korea). In the DPRK, relevant publications were identified through a keyword search of the North Korean Materials Center, and studies reporting both hospital admissions and fatality outcomes were selected for analysis. In the ROK, seven hospital-based studies conducted between the 1960s and 1970s were analyzed and stratified by the use of hyperbaric oxygen therapy (HBOT).

Results: The fatality rate in hospitalized patients with unintentional CO poisoning in the DPRK was estimated at 6.49% (95% confidence interval [CI], 4.23-9.83%) using a random-effects model. This rate was 2.48 times higher (95% CI, 1.16-5.29) than that observed among ROK patients who received HBOT (2.62%; 95% CI, 1.38-4.91%). When compared to ROK patients who did not receive HBOT (6.26%; 95% CI, 4.10-9.42%), the DPRK fatality rate was 1.04 times higher (95% CI, 0.57-1.88), indicating comparable clinical outcomes in settings where advanced therapeutic interventions such as HBOT were not available.

Conclusion: Accurate estimation of fatality rates among hospitalized patients with CO poisoning is essential to understanding its disease burden in the DPRK. The continued use of low-quality solid fuels for residential heating contributes substantially to the risk of unintentional CO poisoning. These findings highlight the urgent need for evidence-based public health interventions and international collaboration to improve heating practices and reduce preventable morbidity and mortality.

Background: Scientific medical research has progressed tremendously during the last 50 years, but concerns about research integrity, publishing ethics, and retraction trends have grown. Retractions are essential for revising the scientific record and maintaining credibility, yet an extensive long-term assessment of retracted medical publications is limited.

Methods: We performed a descriptive analysis of 50 years of retracted medical publications from the Retraction Watch Database. Data were refined to encompass solely medicine-related retractions, omitting corrections, expressions of concern, and reinstatements. We classified retraction reasons into 68 categories, emphasizing the top 10 most frequently encountered reasons. Temporal trends were evaluated employing semi-logarithmic linear regression models. The geographical distribution and journal-specific retractions were also examined.

Results: An analysis was conducted on 16,041 retracted medical documents from 1975 to 2024. The leading reasons for retraction included data concerns (31.47%), fraud (11.37%), peer review issues (11.21%), referencing issues (7.54%), and ethical violations (7.09%). The highest number of retractions was noted in Computational and Mathematical Methods in Medicine (5.91%), Journal of Healthcare Engineering (5.85%), and Evidence-Based Complementary and Alternative Medicine (4.36%). Approximately 45.28% of retracted papers included at least one author from China, followed by the United States and India. The medical subfields most impacted were oncology (19.87%), cardiovascular medicine (15.62%), and pharmacology (14.49%). Temporal analysis indicated a steady rise in retractions, with data concerns and fraud doubling typically every 5.5 and 5.2 years.

Conclusion: The rising amount of retractions underscores heightened scrutiny and enhanced detection techniques while highlighting ongoing research integrity issues. Data integrity, fraudulent activities, and compromised peer review are significant issues. Fortifying editorial policies, augmenting transparency, and bolstering research ethics education are essential for reducing misconduct and maintaining the integrity of medical papers.

Background: Body composition disorders such as sarcopenia, obesity, and osteoporosis are common; however, the body composition of patients with dizziness and vestibular dysfunction (VD) has not been thoroughly assessed.

Methods: This cross-sectional study included 9,682 participants aged over 40. Based on the results of a dizziness questionnaire and modified Romberg test, they were classified into three groups: dizziness associated with VD, dizziness without VD, and controls. A body composition analysis focused on muscles, bones, and fats.

Results: Multivariate regression analysis revealed that sarcopenia was associated with a higher risk of dizziness with VD when compared to dizziness without VD (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.09-2.49; P = 0.017) and the control group (OR, 1.92; 95% CI, 1.28-2.88; P = 0.002). The proportions of bone mineral and fat were comparable among the groups.

Conclusion: Sarcopenia was found to be significantly associated with dizziness in the group with VD but not in those without it. While this study does not establish a causal relationship, maintaining muscle mass through proper diet and physical activity may be beneficial for individuals with VD. Such efforts could help manage overall health, potentially reducing risks associated with sarcopenia and improving balance. Further longitudinal studies are necessary to explore the potential causal pathways between VD and sarcopenia.

Background: We aimed to explore whether the dysfunctional pandemic grief of nursing professionals who experienced a patient's death may be related with their suicidal ideation and examine whether their interpersonal problems and dysfunctional self-focus mediate this association.

Methods: An anonymous online survey was conducted on November 16-18, 2023 among nurses in a tertiary hospital who witnessed people's death. Their psychological states were assessed using the Pandemic Grief Scale (PGS) for healthcare workers, Dysfunctional Self-focus Attributes Scale (DSAS), Interpersonal Needs Questionnaire (INQ), and Depressive Symptom Inventory-Suicidality Subscale (DSI-SS). Linear regression analysis was conducted to explore the expecting variables for the DSI-SS. Mediation analysis was performed to examine the mediating effects of self-focus and interpersonal problems between grief reaction and suicidal ideation.

Results: The PGS (β = 0.18, P = 0.005), INQ-Perceived Burdensomeness (INQ-PB; β = 0.51, P < 0.001), and DSAS-Negatively Biased Focus (DSAS-NBF; β = 0.17, P = 0.021) were significantly associated with the DSI-SS. Mediation analysis using these variables showed that the PGS directly influenced the DSI-SS, and the INQ-PB and DSAS-NBF partially mediated the influence of the PGS on DSI-SS.

Conclusion: Dysfunctional grief experienced by nurses following the loss of patients during the pandemic exacerbated suicidal ideation by fostering a greater focus on negative outcomes and heightened feelings of being a burden. These findings underscore the need for targeted interventions to address these specific cognitive and emotional vulnerabilities to mitigate the risk of suicidal ideation.

Background: Pre-pregnancy blood pressure (BP) has gained attention as a potential predictor of adverse pregnancy outcomes. However, data on the impact of mildly elevated BP, particularly in women without overt hypertension, remain limited. In this study, we aimed to examine the association between pre-pregnancy BP and adverse pregnancy outcomes in women without a history of hypertension.

Methods: In this retrospective nationwide study, we included pregnant women with pre-pregnancy BP below 140/90 mmHg and no prior diagnosis of hypertension. Participants were categorized based on their pre-pregnancy BP into the normal BP (< 120/80 mmHg), elevated BP (120-129 and < 80 mmHg), and stage 1 hypertension (130-139 or 80-89 mmHg) groups. The following adverse pregnancy outcomes were recorded: preeclampsia, gestational diabetes, placental abruption, postpartum hemorrhage, preterm birth, and small or large for gestational age. Multivariable logistic regression was used to evaluate the associations between pre-pregnancy BP categories and adverse pregnancy outcomes.

Results: Among 298,433 women, 76.9% had normal BP, 8.7% had elevated BP, and 14.3% had stage 1 hypertension. The incidence of adverse outcomes significantly increased in groups with higher BP (normal BP, 24.8%; elevated BP, 27.1%, and stage 1 hypertension, 29.9%; P < 0.001). Compared to the normal BP group, adjusted odds ratios for adverse outcomes were 1.11 (95% confidence interval [CI], 1.07-1.14) for the elevated BP group and 1.24 (95% CI, 1.21-1.27) for the stage 1 hypertension group. A curvilinear relationship was observed between pre-pregnancy BP and the risk of adverse pregnancy outcomes.

Conclusion: Even modest increases in pre-pregnancy BP below the clinical threshold for hypertension were associated with a higher risk of adverse pregnancy outcomes. These findings highlight the need for early BP monitoring and management before pregnancy.

Background: Hepatic stellate cells (HSCs) activation is the principal event in the development of liver fibrosis in which succinate-G-protein coupled receptor 91 signaling has recently been shown to be a contributor. Moreover, endoplasmic reticulum (ER) stress has been reported to involve in HSC activation, but its association with succinate in pathogenesis of liver fibrosis remains scarce. In this study, we investigated the role of gemigliptin, an antidiabetic dipeptidyl peptidase-4 inhibitor, in the succinate-induced ER stress and activation of HSCs.

Methods: LX-2 cells, the immortalized human HSCs, were treated with succinate and gemigliptin. For animal experiments, C57BL/6N mice were divided into 3 groups: control diet, high-fat high-cholesterol (HFHC) diet, and HFHC diet mixed with gemigliptin.

Results: Succinate significantly induced HSC activation and increased expression of inflammatory markers and the increase in the migration of HSCs. The treatment of succinate also caused ER dilation and activated the unfolded protein response signaling as protein kinase RNA-like ER kinase, eIF2alpha, binding immunoglobulin protein, suggesting increasing ER stress in HSCs. All responses of HSCs to succinate were attenuated with the co-treatment of gemigliptin. Moreover, the exposure of HSCs to tunicamycin, an inducer of ER stress, promoted the expression of α-smooth muscle actin, proliferation and migration of HSCs. In vivo, the level of fibrotic and ER stress markers was increased in mice fed with HFHC diet and the administration of gemigliptin improved these changes in HFHC-induced mice.

Conclusion: This study showed the involvement of ER stress in the activation of succinate-induced LX-2 HSCs and gemigliptin significantly reduced ER stress in HSC activation. Therefore, gemigliptin may become an anti-fibrotic agent and targeting to succinate and ER stress may be a promising therapeutic in the management of liver fibrosis.

Background: The aim of this study is to review data on infants who received hearing aid support through the Infantile Hearing Aid Support Program after the settlement of universal newborn hearing screening (NHS) in the country over the past five years in Korea. This study seeks to identify the characteristics of infants with bilateral moderate hearing loss and to explore effective strategies for auditory rehabilitation by analyzing the timing of hearing aid interventions and regional disparities.

Methods: We analyzed the National Health Insurance Service (NHIS) records and the Infantile Hearing Aid Support Program database between January 2019 and December 2023. Our analysis included the NHS performance rate, NHS results, diagnostic hearing test outcomes, types of hearing loss, and the relationship between NHS results and hearing loss risk factors. Additionally, we examined the submission dates for the program, hearing aid purchase dates, types of hearing aids, and whether the residential area, prescription area, and hearing aid purchase areas matched.

Results: In this period, a total of 1,318,551 neonates were born and 540 bilateral moderate hearing loss infants registered for the Infantile Hearing Aid Support Program. The NHS performance rate increased to 95.4% by 2023, while the proportion of infants receiving diagnostic hearing tests within three months was 46.2%. The rate of infants receiving hearing aids within six months for auditory rehabilitation was 22.4%. Although no correlation was found between risk factors for hearing loss and NHS results, it was observed that infants admitted to the neonatal intensive care unit or with other syndromes had a higher likelihood of being diagnosed with moderate hearing loss, even if they passed the NHS. Finally, there were regional disparities in access to hearing aid prescriptions and rehabilitation.

Conclusion: Our findings suggest that auditory rehabilitation achieves greater focus following the implementation of NHS. This study also provides valuable insights into the hearing status and rehabilitation outcomes of infants with moderate hearing loss. Furthermore, we anticipate that these results will contribute to informing policies aimed at reducing regional disparities in access to auditory rehabilitation services.