Journal Of Korean Medical Science[JOURNAL]
Sun
200 papers
Prescription Trends of Initial Antihypertensive Medications Among Presumed Treatment-Naïve Individuals in Korea: A Retrospective Analysis.
Je NK, Joo H, Chae SE … +2 more , Eom YR, Hwang AY
J Korean Med Sci · 2026 Jan · PMID 41527311 · Full text
BACKGROUND: Hypertension is a major global health concern, closely linked to cardiovascular disease risks. This study assesses prescribing trends for initial antihypertensive therapy in South Korea, with a particular foc...
BACKGROUND: Hypertension is a major global health concern, closely linked to cardiovascular disease risks. This study assesses prescribing trends for initial antihypertensive therapy in South Korea, with a particular focus on the shift towards combination therapies, including fixed-dose combinations, as advocated by recent guidelines. METHODS: We retrospectively analyzed data from 59,950 presumed treatment-naïve hypertension patients without significant comorbidities, sourced from the National Patient Sample of the Health Insurance Review and Assessment Service, spanning 2009 to 2020. The study examined the prevalence of monotherapy versus combination therapy and the preferred classes of antihypertensive drugs. RESULTS: The analysis revealed that 55.7% of patients received monotherapy, while 44.3% were initiated on combination therapy. Notably, 87.3% of the combination therapy cohort were prescribed fixed-dose combinations. The study observed a consistent increase in the use of fixed-dose combinations and a notable preference for angiotensin receptor blocker (ARB) and ARB/calcium channel blocker regimens over time. Factors such as age, sex, and specific comorbidities influenced the likelihood of receiving combination therapy. CONCLUSION: The findings highlight a progressive shift towards combination antihypertensive therapies, particularly fixed-dose combinations, among presumed treatment-naïve patients in South Korea. This trend reflects a broader move in clinical practice towards more aggressive treatment strategies recommended by current hypertension guidelines. The study underscores the importance of personalized treatment approaches, taking into consideration individual patient characteristics.
Erratum: Correction of Text in the Article "Complications of Nasopharyngeal Swabs and Safe Procedures for COVID-19 Testing Based on Anatomical Knowledge".
Kim DH, Kim D, Moon JW … +2 more , Chae SW, Rhyu IJ
J Korean Med Sci · 2026 Jan · PMID 41492838 · Full text
This corrects the article on p. e88 in vol. 37, PMID: 35315599.
This corrects the article on p. e88 in vol. 37, PMID: 35315599.
Establishing an Active Vaccine Safety Surveillance System Using Large Scale Databases in Korea: Lessons and Scalable Insights for Global Application.
Yoon JG, Nham E, Choi YJ … +11 more , Choi MJ, Choi WS, Yoon YK, Seo YB, Hyun H, Heo JY, Lee JS, Kim CJ, Noh JY, Song JY, Cheong HJ
J Korean Med Sci · 2026 Jan · PMID 41492837 · Full text
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,...
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.
Evaluating the Performance of Basic Local Government Initiatives in Suicide Prevention: Insights From Korea.
Kim KH, Choi M, Lee YH … +1 more , Lee SM
J Korean Med Sci · 2026 Jan · PMID 41492836 · Full text
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 assess...
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.
Suicidal Ideation Among Patients With Breast Cancer: A Comparison of Patient Health Questionnaire-9 Item 9 and Columbia-Suicide Severity Rating Scale.
Kim H, Park CHK
J Korean Med Sci · 2026 Jan · PMID 41492835 · Full text
BACKGROUND: The Columbia-Suicide Severity Rating Scale (C-SSRS) is the gold standard for assessing suicidal ideation, behavior, and risk. However, it is unclear whether the Patient Health Questionnaire-9 (PHQ-9) item 9 a...
BACKGROUND: The Columbia-Suicide Severity Rating Scale (C-SSRS) is the gold standard for assessing suicidal ideation, behavior, and risk. However, it is unclear whether the Patient Health Questionnaire-9 (PHQ-9) item 9 alone is sufficient for detecting suicidal ideation among patients with breast cancer. This study aimed to assess the validity of PHQ-9 item 9 compared to C-SSRS in female breast cancer patients undergoing psychiatric treatment. METHODS: In this study, we evaluated the validity of PHQ-9 item 9 compared to C-SSRS for identifying suicidal ideation among 176 female patients with breast cancer receiving psychiatric treatment, using self-reported questionnaires and leveraging demographic, clinical data, and statistical analyses to refine suicide risk assessment methods. RESULTS: Among 176 patients, 35.2% showed a positive response to PHQ-9 item 9, 41.0% and 17.0% of them showed a response indicating and based on C-SSRS, respectively. The areas under the ROC curves for and were 0.840 and 0.842, respectively, indicating good discriminatory power with an optimal cut-off of 1/3 for both criteria. CONCLUSION: Although PHQ-9 item 9 may have limited utility in detecting among patients with breast cancer, it may serve as a valuable screening tool for identifying those at risk of having thoughts of suicide accompanied by .
Beneficial Effects and Factors Associated With Provision of Breast Milk at Neonatal Intensive Care Unit Discharge to Very Low Birth Weight Infants: A Nationwide Cohort Study in Korea.
Shin SH, Kim HS, Choi DM … +2 more , Hwang SY, Choi EK
J Korean Med Sci · 2026 Jan · PMID 41492834 · Full text
BACKGROUND: The incidence of preterm birth in Korea increased from 6.5% in 2013 to 9.7% in 2020. Very low birth weight (VLBW) infants, defined as those weighing < 1,500 g, are particularly vulnerable to numerous health r...
BACKGROUND: The incidence of preterm birth in Korea increased from 6.5% in 2013 to 9.7% in 2020. Very low birth weight (VLBW) infants, defined as those weighing < 1,500 g, are particularly vulnerable to numerous health risks. Breast milk provision reduces the incidence of complications in this vulnerable population. The objective of this study was to examine the rate and factors associated with breast milk provision at neonatal intensive care unit (NICU) discharge and to investigate its potential effects on growth and developmental outcomes at 18-24 months corrected age (CA). METHODS: We conducted this cohort study using data from over 70 NICUs participating in the Korean Neonatal Network. VLBW infants born between January 2019 and December 2020 at a gestational age of 23 to 31 weeks were included. Discharge feeding types were analyzed of 2,490 infants, while follow-up assessments of growth and neurodevelopmental outcomes at 18-24 months of CA were available for 1,426 infants. Propensity score matching was used for comparative analysis. RESULTS: The rate of breast milk provision at discharge among VLBW infants was 55.9% in 2019 and 56.5% in 2020. Factors that were positively associated with breast milk feeding included higher maternal education level and antenatal steroid use. In contrast, maternal hypertensive disorders, cesarean section, and severe neonatal morbidities (e.g., necrotizing enterocolitis) were correlated with lower breast milk feeding rates at the time of discharge. The provision of breast milk at discharge was not associated with a higher risk of suboptimal growth (below two standard deviations) compared to control infants at 18-24 months of CA. Neurodevelopmental assessments indicated that breast milk was associated with a reduced risk of developmental delay (adjusted odds ratio, 0.72; 95% confidence interval, 0.56-0.94) at follow-up. CONCLUSION: Breast milk provision to VLBW infants at NICU discharge in Korea was comparable to that in other countries. This nationwide study highlights the critical role of breast milk in promoting the neurodevelopment of VLBW infants. Future efforts should focus on identifying the barriers to breast milk provision to improve health outcomes in vulnerable populations.
Risk Factors of Complications in Patients With Persistent or Long-Standing Persistent Atrial Fibrillation/Atrial Flutter Who Underwent Electrical Cardioversion: A Multicenter Cardioversion Registry.
Kim KH, Park J, Ku D … +12 more , Park J, Kim S, Kim DK, Kim DI, Choi SG, Yang PS, Kim JY, Shim J, Ahn J, Lee SH, Im SI, Lim HE
J Korean Med Sci · 2026 Jan · PMID 41492833 · Full text
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 reviewe...
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.
Expert Consensus Study on the Redesign of the Sexually Transmitted Infection Surveillance System in Korea.
Choi JB, Kim DS, Shin CE … +3 more , Yu SY, Lee KW, Lee SJ
J Korean Med Sci · 2026 Jan · PMID 41492832 · Full text
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...
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) 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 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.
Sequential Mediation by Maternal Weight Gain and Late Blood Metal Concentration in the Association Between Heavy Metal Exposure in Early Pregnancy and Fetal Growth.
Choe SA, Lee JS, Kang C … +5 more , Jo J, Yoon W, Song DJ, Yoo Y, Ko-CHENS Study Group
J Korean Med Sci · 2026 Jan · PMID 41492831 · Full text
BACKGROUND: To assess the mediation effect of gestational weight gain (GWG) and blood heavy metal levels in the late pregnancy affecting the association between early pregnancy metal exposure and fetal growth. METHODS: W...
BACKGROUND: To assess the mediation effect of gestational weight gain (GWG) and blood heavy metal levels in the late pregnancy affecting the association between early pregnancy metal exposure and fetal growth. METHODS: We analyzed data from Korean Children's Environmental Health Study cohort comprising 4,712 full-term births. Blood levels of lead (Pb), mercury (Hg), and cadmium (Cd) during pregnancy, and newborn birthweights were retrieved. We applied single-exposure model to assess the association between heavy metal levels and newborn anthropometric measures and conducted path analyses to examine the direct and indirect effects of heavy metal levels in early pregnancy on newborn measures. RESULTS: Exposure to Pb (β = -15.470, = 0.036) and Cd (β = -24.150, = 0.004) during late pregnancy were associated with lower birthweight. Early exposure to Pb was not directly associated with lower birthweight, however, mediation of late exposure to Pb (β = -7.417, = 0.049) resulted in lower birthweight (β = -14.787, = 0.036). Early exposure to Hg was associated with higher birthweight, however, indirect paths via GWG (β = 3.626, = 0.048) and late Hg levels (β = -12.929, = 0.111) countered each other, resulting in the nullification of the total effect (β = -8.519, = 0.301). CONCLUSION: The effect of Pb exposure in early pregnancy on birthweight was mediated by GWG and Pb exposures during late pregnancy. When assessing the impact of heavy metal exposure on birthweight, it is important to note that GWG and late heavy metal levels act as mediators, rather than confounders.
Validation of Diagnostic Code Definitions for Identifying Patient in Korean Health Insurance Claims Data: A Scoping Review.
Kim KH
J Korean Med Sci · 2025 Dec · PMID 41468919 · Full text
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 operation...
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.
Analysis of Multi-Domain Factors Influencing Mental Health and Suicide: A Comparative Study of Urban and Rural Areas at City, County, and District Levels in Korea.
Kim C, Kim Y, Lee A … +5 more , Lee W, Choi Y, Kim H, Lee M, Yang JH
J Korean Med Sci · 2025 Dec · PMID 41468918 · Full text
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 characteris...
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 ( < 0.001). However, the relationship between stress and suicide showed contrasting patterns: a negative correlation in urban areas ( = 0.007) and a positive correlation in rural areas ( = 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.
Outcomes of Acute Ischemic Stroke Patients Undergoing Air Versus Ground Interhospital Transport in a Rural Area: A Retrospective Comparative Study.
Park E, Cha YS, Lee KH … +4 more , Kim SJ, Kang CY, Son YJ, Kim OH
J Korean Med Sci · 2025 Dec · PMID 41468917 · Full text
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 medi...
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; = 0.005) and interfacility transport time (39 vs. 51 minutes; < 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%; < 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.
Comparative Study of the Clinical Characteristics of Patients With Sexually Transmitted Infections Diagnosed by Nucleic Acid Amplification Tests.
Son JS, Kim N, Oh HS … +2 more , Park SW, Shin DH
J Korean Med Sci · 2025 Dec · PMID 41468916 · Full text
BACKGROUND: Sexually transmitted infections (STIs) caused by (CT), (MG), and (NG) are major public health concerns. While nucleic acid amplification tests (NAATs) are the primary diagnostic tool for these pathogens, r...
BACKGROUND: Sexually transmitted infections (STIs) caused by (CT), (MG), and (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; < 0.001) and symptomatic presentation (aOR, 2.542; 95% CI, 1.103-5.861; = 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.
Potential Risk Factors for Lonely Death: A Nationwide Case-Control Study in Korea.
Koo HY, Bai H, Lee JR … +6 more , Kang MJ, Jun YH, Yun J, Sohn JH, Lee JY, Lee H
J Korean Med Sci · 2025 Dec · PMID 41468915 · Full text
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...
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.
Global Prevalence of Combustible Cigarettes and Noncombustible Nicotine or Tobacco Products Use Among Adolescents, 2014-2021.
Hong S, Son Y, Kim S … +13 more , Kim S, Kim HJ, Jo H, Park J, Lee K, Lee H, Kang J, Pizzol D, Woo S, Smith L, Hwang J, Rhee SY, Yon DK
J Korean Med Sci · 2025 Dec · PMID 41468914 · Full text
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 i...
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.
Clinical Outcomes of Robot-Assisted "Asleep" Deep Brain Stimulation With Microelectrode Recording in Parkinson's Disease.
Chang KW, Youn J, Jeong JS … +4 more , Jo I, Choi Y, Cho JW, Lee JI
J Korean Med Sci · 2025 Dec · PMID 41468913 · Full text
BACKGROUND: Deep brain stimulation (DBS) is a well-established treatment for movement disorders, particularly Parkinson's disease (PD), where precise electrode placement is critical for optimal outcomes. With advances in...
BACKGROUND: Deep brain stimulation (DBS) is a well-established treatment for movement disorders, particularly Parkinson's disease (PD), where precise electrode placement is critical for optimal outcomes. With advances in robotic systems and imaging technologies, robot-assisted asleep DBS combined with microelectrode recording (MER) has emerged as a promising technique. This study aimed to evaluate the surgical accuracy and clinical outcomes of robot-assisted asleep DBS with MER in PD patients. METHODS: We conducted a retrospective review of PD patients who underwent either robot-assisted asleep DBS or conventional manual frame-based DBS at a single center between August 2021 and August 2024. Targeting accuracy was assessed using radial error measured on intraoperative computed tomography. Clinical outcomes were evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS), levodopa equivalent daily dose (LEDD), and the Parkinson's Disease Questionnaire-39 (PDQ-39) at baseline, 6 months, and 1 year postoperatively. RESULTS: A total of 51 patients underwent robot-assisted asleep DBS. This group demonstrated significantly higher targeting accuracy than the manual frame-based group ( = 0.001). Both surgical methods resulted in significant improvements in UPDRS, LEDD, and PDQ-39 scores over time, with no significant differences between groups. MER was successfully performed under general anesthesia using remimazolam, maintaining high-quality recordings and patient safety. CONCLUSION: Robot-assisted asleep DBS significantly improves targeting accuracy while maintaining comparable clinical outcomes to manual frame-based DBS. Asleep DBS with MER is a safe and effective approach, enhancing patient comfort without compromising efficacy. These findings support the broader adoption of robotic techniques in DBS for PD.
Artificial Intelligence in Detecting Statistical Errors: Implications for Authors, Reviewers, and Editors.
Alnaimat F, AlSamhori ARF, El Sharu H … +3 more , Othman L, Oralbek A, Zimba O
J Korean Med Sci · 2025 Dec · PMID 41430754 · Full text
Choosing the right statistical tests is essential for reliable results, but errors, like picking the wrong test or misinterpreting data, can easily lead to incorrect conclusions. Research integrity implies presenting res...
Choosing the right statistical tests is essential for reliable results, but errors, like picking the wrong test or misinterpreting data, can easily lead to incorrect conclusions. Research integrity implies presenting research that is honest, clear, and uses correct statistics. By identifying statistical errors, artificial intelligence (AI) systems such as Statcheck and GRIM-Test increase the reliability of research and assist reviewers. AI helps non-experts analyze data, but it can be unpredictable for experts dealing with complex data analysis. Still, its ease of use and growing abilities show promise. Recent studies show that AI is increasingly helpful in research, assisting in spotting errors in methodology, citations, and statistical analyses. Tools like LLMs, Black Spatula, YesNoError, and GRIM-Test improve accuracy, but they need good data and human checks. AI has moderate accuracy overall but performs better in controlled settings. The Statcheck and GRIM-Test are especially good at spotting statistical errors. As more studies are retracted, AI offers helpful, albeit imperfect, support. It can speed up peer review and reduce reviewer workload, but it still has limits, such as bias and a lack of expert judgment. AI also brings risks like misreading results, ethical issues, and privacy concerns, so editors must make final decisions. To use AI safely and effectively, large, well-labeled datasets, teamwork across fields, and secure systems are required. Human oversight is always necessary to review research processes and ensure their reliability; humans must make the final decision and utilize AI responsibly.
Salivary Varicella Zoster Virus DNA Detection in Patients With Acute Abdominal Pain: Frequency, Diagnostic Value, and Implications for Enteric Zoster.
Son HJ, Kim SB, Kwon JS … +3 more , Jung KH, Lee SO, Kim SH
J Korean Med Sci · 2025 Dec · PMID 41430753 · Full text
BACKGROUND: Enteric zoster, a rare herpes zoster manifestation, occurs when varicella-zoster virus (VZV) reactivates enteric nervous system neurons, leading to abdominal pain and gastrointestinal symptoms without a cutan...
BACKGROUND: Enteric zoster, a rare herpes zoster manifestation, occurs when varicella-zoster virus (VZV) reactivates enteric nervous system neurons, leading to abdominal pain and gastrointestinal symptoms without a cutaneous rash. Due to absence of the skin lesion, diagnosis is challenging. Recently, salivary VZV DNA polymerase chain reaction (PCR) has been suggested as a diagnostic test for herpes zoster. This investigation aimed to assess the prevalence of salivary VZV DNA positivity among patients with acute abdominal pain and to evaluate its diagnostic value by comparing PCR results in patients undergoing intra-abdominal surgery. METHODS: We prospectively enrolled adult patients presenting to the emergency department with acute abdominal pain between June 2023 and April 2024 at a community-based university hospital. The patients underwent detailed history reviews, blood tests, and abdominal computed tomography (CT). Salivary VZV DNA PCR was performed. Additionally, to investigate subclinical VZV reactivation under acute gastrointestinal stress, salivary VZV DNA PCR was conducted within 48 hour post-abdominal surgery as a control. Enteric zoster was inferred in individuals exhibiting positive salivary VZV DNA, identified through real-time PCR. RESULTS: In total, 101 patients with abdominal pain were enrolled. Positive salivary VZV DNA PCR results were found in 5 (5.0%) patients. Two patients had acute cholecystitis, one had acute appendicitis, one had acute pancreatitis, and the remaining patient had no identifiable cause of abdominal pain on CT. All 19 patients tested negative for salivary VZV DNA PCR post-abdominal surgery within 48 hours. CONCLUSION: About 5% of patients experiencing acute abdominal pain exhibited positive salivary VZV DNA PCR findings, indicating that enteric zoster may be a potential factor in both recognized and unidentified causes of acute abdominal pain. Further research is needed to determine if antiviral therapy guided by salivary VZV DNA PCR results can alleviate abdominal pain in this patient population.
Development of Evaluation Criteria for Occupational Health Management Systems: Delphi Study.
Song H, Lee J, Sim B … +2 more , Lee YM, Kim HR
J Korean Med Sci · 2025 Dec · PMID 41430752 · Full text
BACKGROUND: This study aimed to develop evaluation criteria for assessing a large-scale enterprise's occupational health management system (OHMS). METHODS: A literature review was conducted, and the OHMS evaluation crite...
BACKGROUND: This study aimed to develop evaluation criteria for assessing a large-scale enterprise's occupational health management system (OHMS). METHODS: A literature review was conducted, and the OHMS evaluation criteria were selected. A two-round Delphi survey was conducted with 20 panelists in the fields of occupational and environmental medicine and industrial hygiene. The evaluation items were formulated based on the results of the first-round Delphi survey, written opinions submitted by experts, and focus group interviews with company health management managers. If the content validity ratio (CVR) of each evaluation item was less than 0.42, the item was rejected. RESULTS: The first Delphi survey questionnaire consisted of 36 evaluation criteria in 5 areas according to the Plan-Do-Check-Act cycle based on the literature review. These areas included 5 plan items, 6 do items, 4 check items, 3 action items, and 12 occupational health service items. From the first Delphi survey, out of the 36 evaluation items, 10 exhibited excellent content validity with a score of 0.7 or higher, and 25 demonstrated good content validity with a score lower than 0.7, but higher than 0.474. The evaluation items underwent significant revisions by incorporating written opinions from experts and feedback obtained from focus group interviews with health managers. The second Delphi survey questionnaire presented 31 evaluation criteria across four domains. Three criteria did not meet the CVR standards, and 28 items in four domains were finally selected. CONCLUSION: Using this evaluation tool, the company's health management director will be able to continuously monitor and improve the system by evaluating the system that produces performance rather than evaluating performance.
Analysis of Treatment Pattern of Antiplatelet in First-Ever Ischemic Stroke Without Previous Antiplatelet Use: A Real-World Distributed Network Analysis of 11 Observational Korean Databases Using a Common Data Model.
Park SH, Lee KJ, Kim J … +16 more , Seo SI, Lee DY, Park RW, Rhee SY, Cha JM, Yang HJ, Jang JW, Jung S, Lee J, Lee M, Lee SH, Kim C, Bae JS, Kim YJ, Lee JH, Kim Y
J Korean Med Sci · 2025 Dec · PMID 41430751 · Full text
BACKGROUND: Antiplatelet agents are widely prescribed to prevent cardiovascular events, with cardiovascular disease being the leading global cause of death and the second most common in Korea. As the demand for antiplate...
BACKGROUND: Antiplatelet agents are widely prescribed to prevent cardiovascular events, with cardiovascular disease being the leading global cause of death and the second most common in Korea. As the demand for antiplatelets increases, understanding real-world prescribing patterns is essential. METHODS: This study analyzed antiplatelet prescription trends for patients with first-ever ischemic stroke (IS) using 11 Korean observational databases transformed to a Common Data Model, spanning 1995-2023. Prescription shifts were assessed in relation to the 2013 CHANCE trial. RESULTS: The analysis included 162,361 patients with first-ever IS who had no prior antiplatelet therapy. Aspirin was the most commonly prescribed initial medication (39.4%), followed by aspirin-clopidogrel combination (28.2%), clopidogrel alone (13.7%), and cilostazol (5.0%). Initial medication were typically maintained: however, some patients initially on aspirin or clopidogrel switched to dual antiplatelet therapy (DAPT; aspirin and clopidogrel), while those on initial DAPT primarily transitioned to clopidogrel, then to aspirin. Following the CHANCE trial, a marked shift in prescription patterns was observed. Before CHANCE, aspirin was predominant (45.7%), followed by aspirin-clopidogrel (19.2%), and clopidogrel (15.5%). Post-CHANCE, aspirin-clopidogrel became the leading therapy (40.6%), with aspirin (30.3%) and clopidogrel (11.3%) monotherapy. CONCLUSION: While aspirin remains the mainstay for secondary prevention of IS, the CHANCE trial significantly influenced increased use of DAPT. As evidence continues to grow for P2Y12 inhibitors in the IS context, analyzing antiplatelet prescription patterns is vital for evaluating the implementation of guidelines in clinical practice.
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