Korean Journal of Family Medicine最新文献

Background: Good glucose control is an indicator of treatment adherence and insulin therapy. However, insulin rejection has become an increasingly concerning phenomenon and is underdiscussed in health modules. The effects of incomplete exploration and suboptimal analysis requirements have led to the problem of insulin rejection, which needs to be identified by considering the broader perceptions of informal caregivers and patients with type 2 diabetes mellitus. Photo-elicitation, a technique that combines images and interviews, has gained traction for in-depth exploration. This study aimed to explore insulin rejection using photo-elicitation in this population.

Methods: This study employed a qualitative phenomenological design. The photo-elicitation interview involved ten photographs, which were taken and discussed narratively. This involved 10 families of informal caregivers and patients with type 2 diabetes mellitus between 20 and 60 years of age as purposive sampling at the Hospital Sultanah Nur Zahirah, Kuala Terengganu. Glycated hemoglobin levels (%) were between 6.3% and 14.8% in patients with type 2 diabetes mellitus. Atlas.ti version 25 and an Excel spreadsheet were used to analyze qualitative data through thematic analysis based on Maslow's hierarchy of needs.

Results: Four main themes were revealed: (1) financial challenges, (2) public stigma related to insulin therapy, (3) improving self-efficacy for self-action, and (4) improving glycemic levels for quality of life.

Conclusion: Photo-elicitation successfully explored trends in the management of type 2 diabetes mellitus in this population. This study provides insights into the use of needs analyses to create more engaging experiences when designing comprehensive evidence- and need-based interventions.

Background: This study aimed to evaluate the effectiveness and engagement of an interactive simulation-based online smoking prevention program compared to a traditional offline program for Korean adolescents.

Methods: A total of 1,008 adolescents from elementary, middle, high, and alternative schools in Chungcheongnam-do Province, South Korea participated in this study from October 1 to 31, 2021. The offline program consisted of 2-hour lectures by teachers, whereas the online program included six interactive peer-oriented video modules. The evaluation compared and analyzed the survey results measuring changes in smoking-related knowledge and attitudes before and after each program, as well as the level of interest in and satisfaction with education.

Results: When comparing the pre- and post-intervention scores between the two groups, no statistically significant differences were found except for a decreased belief that smoking helps relieve stress (F=12.125, P=0.001). However, withingroup comparisons revealed that the online smoking prevention program led to positive changes in most smokingrelated knowledge and attitude items, including reduced beliefs about smoking as a stress reliever (P<0.001) and lower misconceptions about the harm of e-cigarettes (P<0.001). In terms of engagement and satisfaction, the online program received significantly higher scores for interest (P<0.001), knowledge improvement (P<0.001), and program recommendations (P=0.021).

Conclusion: The online smoking prevention program was as effective as the traditional offline approach in enhancing smoking-related knowledge and attitudes. Moreover, its superior engagement and time efficiency highlight its strong potential as an effective alternative or complementary strategy to conventional school-based programs.

Artificial intelligence (AI) technologies are increasingly being integrated into clinical practice, offering potential enhancements in diagnostic accuracy and clinical efficiency. In this case report, a diagnostic attempt assisted by ChatGPT-4o in a 51-year-old female patient presenting with hand arthralgia is described. The AI-generated interpretation demonstrated hallucination-namely, the fabrication of unsupported or inaccurate information-in the analysis of radiologic and laboratory findings, as well as in treatment recommendations. This case underscores the importance of exercising caution when applying AI tools in clinical contexts. To ensure diagnostic accuracy, patient safety, and ethical responsibility, expert oversight and multi-step verification processes are essential in the deployment of AI-generated clinical outputs.

Background: This study aimed to evaluate the effects of sedentary behavior types and physical activity on well-being.

Methods: A cross-sectional study was conducted with 428 university students. The study data were collected through online forms between March and April 2021: the Sociodemographic Characteristics and Activities Form, Sedentary Behaviour Questionnaire, Health Assessment Form, and World Health Organization-5 Well-Being Index. Data were evaluated using descriptive statistics and decision tree analysis.

Results: The average time spent sedentary in a day was 11.231±4.358 hours. The mean sedentary time spent mentally passive was 4.660±2.240 hours, and the time spent mentally active was 6.571±3.335 hours. A low positive correlation was observed between well-being score and weekly moderate and total moderate-to-high physical activity time, and a low negative correlation was observed with mentally passive sedentary time. According to decision tree analysis, students who rated their health status as worse than in the previous year and those who did not engage in any physical activity were more likely to be classified as individuals at risk in terms of well-being. In contrast, among those who reported no change in their health status, students who engaged in physical activity and had mentally passive sedentary time below 5.25 hours were less likely to be assigned to the risk group.

Conclusion: To protect physical and mental health, measures should be taken to reduce sedentary time, especially mentally passive sedentary time, and to increase physical activity time.

Background: Polypharmacy poses a growing challenge to healthcare systems because of its association with adverse effects and the misuse of medication. This study aimed to identify the sociodemographic factors and comorbidities associated with polypharmacy.

Methods: We selected patients aged ≥30 years registered in the National Health Information Database in 2018 who were prescribed at least one medication for ≥180 days. Multivariate logistic regression analyses were performed to evaluate the associations between polypharmacy, sociodemographic characteristics, and comorbidities.

Results: Polypharmacy was significantly associated with increasing age, with the strongest association observed in adults aged ≥65 years. Compared with medical aid recipients, higher-income groups had a weaker association with polypharmacy. After adjusting for covariates, significant associations with polypharmacy were found for specific comorbidities, such as Parkinson disease (odds ratio [OR], 3.804; 95% confidence interval [CI], 3.733-3.876; P<0.001) and chronic ischemic heart disease (OR, 3.199; 95% CI, 3.178-3.221; P<0.001).

Conclusion: These findings may help reduce the burden of polypharmacy by facilitating the development of targeted strategies tailored to patients.

Background: This study examined the impact of the COVID-19 pandemic on adult vaccination uptake, specifically recombinant zoster vaccine (RZV), influenza (FLU), and pneumococcal vaccines (PnV), and explored factors influencing COVID-19 vaccine receipt in US adults.

Methods: We conducted a retrospective analysis of nationally representative cross-sectional data from the 2019 and 2022 Behavioral Risk Factor Surveillance Systems (n=777,807). Multivariable regression models assessed vaccination status for COVID-19, RZV, FLU, and PnV, adjusting for sociodemographic factors, geography, and healthcare coverage.

Results: Among insured adults, RZV vaccination increased from 31.9% in 2019 to 41.5% in 2022, and FLU vaccination increased from 42.7% to 45.0%. Among uninsured individuals, FLU vaccination rates declined 3.2%, while RZV remained unchanged. PnV rates remained stable among the insured but decreased by 15.4% among the uninsured. Individuals with healthcare coverage were 2.9 times more likely (95% confidence interval, 2.6-3.2) to have received ≥1 dose of the COVID- 19 vaccine. Minorities reported higher uptake for 1 to 2 doses of the COVID-19 vaccine but lower uptake for FLU, RZV, and PnV than non-Hispanic Whites, who had higher rates of >4 doses of COVID-19 vaccine.

Conclusion: Despite free access to the COVID-19 vaccine, healthcare coverage significantly influenced its uptake. Increases in RZV and FLU vaccination among the insured, in contrast to minimal changes or decreases among the uninsured, highlight the critical role of healthcare access. While RZV and FLU uptake improved post-pandemic, PnV uptake remained stable. We found no evidence that COVID-19 vaccine safety affected RZV, FLU, and PnV vaccination rates.

Background: Treatment of hand osteoarthritis (OA) often includes corticosteroid and hyaluronic acid (HA) injections. Some studies have reported better pain relief and improved function, whereas others have reported minimal long-term benefits. This study aimed to evaluate the effects of corticosteroids and HA injections on the management of hand OA.

Methods: PubMed, Embase, CENTRAL, and EBSCO Open Disk were searched from their inception to May 2024. Randomized controlled trials (RCTs) comparing intra-articular corticosteroid and HA injections in adults with hand OA were included. Data on demographics, interventions, and outcomes were extracted and the risk of bias was assessed using the Cochrane Risk of Bias 2. We performed a pairwise meta-analysis using a random-effects model to estimate the pooled effects of the included trials, that is, standardized mean differences (SMDs) with their corresponding 95% confidence intervals (CIs).

Results: Of 189 articles, three RCTs involving 180 participants (mean age, 62-62.9 years) were included. One RCT was identified through a database search, and two RCTs were identified through other searching techniques. The risk of bias was considered low in two trials and high in one trial. No significant difference in pain relief was found between the corticosteroid and HA treatments (SMD, 0.06; 95% CI, -0.23 to 0.35; I2=0.0%).

Conclusion: Corticosteroid and HA injections offered similar pain relief in patients with hand OA. Further long-term studies are necessary to evaluate the functional outcomes and potential side effects. However, this conclusion should be interpreted with caution due to the small sample size of the studies (PROSPERO registration number: CRD42024511411).

Background: Physical inactivity and sedentary behavior influence the prevalence of anxiety disorders. However, there is a lack of research on how these factors affect Korean adults. Therefore, we conducted a large-scale cohort study to investigate the association of physical activity and sedentary behavior with the development of anxiety disorders.

Methods: This cross-sectional study included 5,615 Korean adults aged 19 years and over. This study analyzed data from the Korea National Health and Nutrition Examination Survey VIII (2021). Participants were divided into three groups based on sedentary time (minute per day), and anxiety levels were compared using the Generalized Anxiety Disorder Scale.

Results: The odds ratio (OR) for severe generalized anxiety disorder was higher in the longer sedentary time group (≥480 & <660 minutes and ≥660 minutes) than in the lowest sedentary time group (<480 minutes) (≥480 & <660 minutes: OR, 1.004; 95% confidence interval [CI], 0.463-2.178; ≥660 minutes: OR, 2.233; 95% CI, 1.385-3.599; P=0.001). After adjusting for confounding factors, these correlations remained consistent and statistically significant. Furthermore, subgroup analysis revealed that middle-aged adults, women, high school graduates, individuals living with housemates, and employed individuals had a stronger association with severe anxiety as sitting time increased.

Conclusion: Sitting for more than 11 hours a day is a significant risk factor for the development of severe anxiety. Incorporating regular walking into daily routines and reducing sedentary behaviors could alleviate anxiety in Korean adults.

Background: Although the association between smoking and health-related quality of life (HRQoL) has been established, the effects of tobacco products, including combustible cigarettes (CCs) and non-combustible nicotine or tobacco products (NNTPs), on HRQoL remain unclear. This study examined the association between tobacco use and HRQoL in Korean men.

Methods: Data from the Korea National Health and Nutrition Examination Survey conducted between 2013 and 2020 were analyzed. A total of 16,429 male participants aged ≥19 years completed the European Quality of Life-5 Dimensions (EQ-5D). Impaired HRQoL was defined as scoring in the lowest 20% of the EQ-5D index and having some or extreme problems in the following five domains of the EQ-5D: mobility, self-care, usual activities, pain/ discomfort, and anxiety/depression. Multiple logistic regression was conducted to evaluate the risk of impaired HRQoL in current tobacco users.

Results: Current tobacco users exhibited a significantly higher risk of impaired HRQoL compared with never users (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.05-1.92). Compared to never users, current tobacco users reported more problems with mobility and pain/discomfort (all P<0.05). Moreover, compared with former tobacco users, current tobacco users had a higher risk of impaired HRQoL (OR, 1.60; 95% CI, 1.18-2.17). Compared to former tobacco users, current tobacco users reported more problems with mobility and pain/discomfort (all P<0.05).

Conclusion: Use of CCs and NNTPs is associated with impaired HRQoL in Korean men. Therefore, further interventions for lifestyle modification and smoking cessation treatments are required to reduce the risk of impaired HRQoL among current tobacco users.

Background: The liver plays an important role in gonadal steroid hormone metabolism, which can affect reproductive health, including the menstrual cycle. However, evidence from large population-based studies is limited. Therefore, this study aimed to investigate the association between liver function markers and menstrual cycle irregularities in premenopausal Korean women using nationwide data.

Methods: This study analyzed Data from the Korea National Health and Nutrition Examination Survey 2010-2011. We investigated 3,045 premenopausal women aged 19-59 years. Liver function markers including serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase, and fatty liver index were analyzed. Multivariable logistic regression analysis was performed to investigate the association between liver function markers and menstrual cycle irregularity while adjusting for confounding factors. Values were presented as odds ratios (ORs) with 95% confidence intervals (CIs). Subgroup analysis was also performed.

Results: Baseline characteristic analysis showed that approximately 14.4% of the study population experienced menstrual cycle irregularity. The mean age was 34.5±0.7 years. The highest quartile of serum ALT and AST levels showed significantly higher ORs for menstrual cycle irregularity (adjusted OR, 1.83; 95% CI, 1.26-2.64 and adjusted OR, 1.67; 95% CI, 1.17-2.39, respectively). A similar result was observed in the subgroup analysis.

Conclusion: Liver function markers were positively associated with menstrual cycle irregularities. In clinical settings, women of reproductive age with relatively decreased liver function should be considered for regular followup of their reproductive health status.