Clinical exam and electrovibratography detecting articular disk displacement: a comparative study.

The complete evaluation of the stomatognathic system is essential for orthodontic diagnosis and treatment planning. The evaluation should not only include the occlusal static aspects, but also the functional aspects. This is because the latter could be altered and one or more components of the stomatognathic system could be involved, including the temporomandibular joint (TMJ). The most usual alteration found is articular disk displacement, which can affect the prognosis, and eventually the result in the need for orthodontic treatment. In order to add to the literature on recognition of these alterations, the purpose of this study was to compare the findings of two calibrated examiners on disk displacement clinical diagnosis, and the possible matching between the clinical examination and the electrovibratography (EVG) as methods of disk displacement detection. The sample was composed of 60 patients, divided equally into four groups of 15 participants each, depending on the presence or absence of disk displacement determined by a clinical examination performed by two trained examiners and according to gender. One of the trained operators used EVG and SonoPAK (BioResearch, Inc., Brown Deer, WI) software. The results of the two examiners' findings, one using clinical examination and the other using EVG and SonoPak software. The results were analyzed by applying the kappa coefficient. The findings of the two examiners were very close, resulting in an excellent agreement, and the comparison between the clinical examination and EVG findings resulted in satisfactory agreement between the methods.

Association Between Economic Activity and Depressive Symptoms Among Women With Parenting Children

Background@#Balancing parenting and work life poses challenges for women with children, potentially making them vulnerable to depression owing to their dual responsibilities.Investigating working mothers’ mental health status is important on both the individual and societal levels. This study aimed to explore the relationship between economic activity participation and depressive symptoms among working mothers. @*Methods@#This study was a cross-sectional study and used data from the Korea National Health and Nutrition Examination Survey collected in 2014, 2016, 2018, and 2020. The participants in the study were women aged 19 to 50 who were residing with their children.In the total, 3,151 participants were used in the analysis. The independent variable was economic activity, categorized into two groups: 1) economically active and 2) economically inactive. The dependent variable was the depressive symptoms, categorized as present for a Patient Health Questionnaire-9 score of ≥ 10 and absent for a score < 10. Multiple logistic regression analysis was performed to assess the association between economic activity and depressive symptoms, and sensitivity analyses were performed based on the severity of depressive symptoms. @*Results@#Among women with children, economically active women had reduced odds ratio of depressive symptoms compared with economically inactive women (odds ratio [OR], 0.54;95% confidence interval [CI], 0.36–0.80). In additional analysis, women working as wage earners had the lowest odds of depressive symptoms (OR, 0.43; 95% CI, 0.28–0.66). Women working an average of 40 hours or less per week were least likely to have depressive symptoms (OR, 0.42; 95% CI, 0.25–0.69). @*Conclusion@#Economic activity is significantly associated with depressive symptoms among women with children. Environmental support and policy approaches are needed to ensure that women remain economically active after childbirth.

Management of Chyle Leakage after Thyroid Cancer Surgery

Chyle leakage is a rare but challenging complication that can occur after surgery for thyroid cancer involving lymph node dissection in the neck. The authors discuss preventive measures and surgical techniques to minimize the risk of chyle leakage. Postoperative chyle leakage diagnosis and conservative management strategies, such as fasting, nutrition support, and pharmacological treatment, are detailed for low output chyle leakage. For highoutput or refractory cases, surgical treatments, including local myofascial local flap, direct thoracic duct ligation, thoracic duct ligation via video-assisted thoracoscopy and radiologic interventions like thoracic duct embolization, are considered. Managing postoperative chyle leakage is crucial, and it should be tailored to the individual patient's condition and the volume of chyle leakage. Understanding the anatomy and having a comprehensive management strategy are essential for effectively addressing chyle leakage after thyroid cancer surgery.

Catastrophic Health Expenditure Rate and Trend in 2021 and before / 보건행정학회지

The term “catastrophic health expenditure” means assessing the extent to which medical costs cause financial hardship for households. The aim of this research is to analyze the percentage of households that faced severe financial strain due to medical expenses from 2006 to 2021. This was achieved by utilizing data obtained from the National Survey of Tax and Benefit (NaSTaB), Korea Health Panel (KHP), and Households Income and Expenditure Survey (HIES). A trend analysis was conducted to examine the percentage of households that experienced catastrophic healthcare expenses. The households that experienced the catastrophic health expenditure was 2.49% in 2021 using the NaSTaB data. The trend analysis yielded a statistically significant result, indicating a decreasing trend (annual percent change [APC], -4.79; p<0.0001) in the proportion of households facing catastrophic health expenditures. Also, the results of the 2019 KHP and the 2021 HIES showed 1.09% and 2.44% for the households that experienced catastrophic health expenditure. The trend was increased according to the KHP (APC, 0.55; p=0.0004) and the HIES (APC, 7.04;p<0.0001). As a result, this study proposes that sustained attention and further interventions are necessary to ease the economic pressure caused by catastrophic health expenses, particularly for low-income households.

RoBANS 2: A Revised Risk of Bias Assessment Tool for Nonrandomized Studies of Interventions / 가정의학회지

Assessment of the risk of bias is an essential component of any systematic review. This is true for both nonrandomized studies and randomized trials, which are the main study designs of systematic reviews. The Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS) was developed in 2013 and has gained wide usage as a risk-of-bias assessment tool for nonrandomized studies. Four risk-of-bias assessment experts revised it by reviewing existing assessment tools and user surveys. The main modifications included additional domains of selection and detection bias susceptible to nonrandomized studies of interventions, a more detailed consideration of the comparability of participants, and more reliable and valid outcome measurements. A psychometric assessment of the revised RoBANS (RoBANS 2) revealed acceptable inter-rater reliability (weighted kappa, 0.25 to 0.49) and construct validity in which intervention effects of studies with an unclear or high risk of bias were overestimated. The RoBANS 2 has acceptable feasibility, fair-to-moderate reliability, and construct validity. It provides a comprehensive framework for allowing authors to assess and understand the plausible risk of bias in nonrandomized studies of interventions.

Evaluation of public’s perception of scar cosmesis after thyroidectomy: results of a survey of Turkish versus South Korean individuals

Purpose@#Visible scars on the neck caused by thyroid surgery give rise to significant aesthetic, functional, and psychosocial problems. The objective of this study is to comparatively investigate the public perception of neck scar cosmesis in Turkish and South Korean populations. @*Methods@#This survey was prepared to collect participants’ demographic and socioeconomic data and determine their perception of scar cosmesis on the neck and consisted of 15 questions. One thousand thirty-nine individuals who did not undergo thyroid surgery completed the survey. The P-values of <0.05 were deemed to indicate statistical significance. @*Results@#There were 1,039 respondents, of whom 525 (50.5%) were Turkish and 514 (49.5%) were South Korean. South Korean respondents stated that they would be significantly more uncomfortable with the thought of having a scar due to thyroid surgery, compared to the Turkish respondents (P < 0.001). The South Korean respondents stated that they would be significantly more concerned about the scar’s length, thickness, and darkening color, compared to the Turkish respondents (P < 0.001 for all cases). @*Conclusion@#Patients’ expectations, which are affected by various sociodemographic factors and cultural characteristics, are as important as the medical condition when deciding on the type of thyroid surgery. The study findings clearly indicated that the South Korean population would be significantly more uncomfortable with having a scar on the neck, compared to the Turkish population. Therefore, in selected cases, a scarless thyroidectomy approach, such as transoral endoscopic thyroidectomy, vestibular approach may be preferable for societies like South Korea.

2022 Clinical practice guidelines for central precocious puberty of Korean children and adolescents

The Committee of Central Precocious Puberty of Korean Pediatrics and Adolescents of the Korean Society of Pediatric Endocrinology has newly developed evidence-based 2022 clinical practice guidelines for central precocious puberty in Korean children and adolescents. These guidelines provide the grade of recommendations, which includes both the strength of recommendations and the level of evidence. In the absence of sufficient evidence, recommendations are based on expert opinion. These guidelines have been revised and supplement the previous guidelines "Clinical Guidelines for Precocious Puberty 2011," and are drawn from a comprehensive review of the latest domestic and international research and the grade of recommendation appropriate to the domestic situation. This review summarizes the newly revised guidelines into 8 key questions and 27 recommendations and consists of 4 sections: screening, diagnosis, treatment, and long-term outcome of central precocious puberty.

Explanatory Power and Prognostic Implications of Factors Associated with Troponin Elevation in Acute Ischemic Stroke / 대한뇌졸중학회지

Background@#and Purpose We investigated the impact of comorbidity burden on troponin elevation, with separate consideration of neurological conditions, in patients with acute ischemic stroke (AIS). @*Methods@#This prospective, observational cohort study consecutively enrolled patients with AIS for 2 years. Serum cardiac troponin I was repeatedly measured, and disease-related biomarkers were collected for diagnosis of preassigned comorbidities, including atrial fibrillation (AF), ischemic heart disease (IHD), myocardial hypertrophy (MH), heart failure (HF), renal insufficiency (RI), and active cancer. The severity of neurological deficits and insular cortical ischemic lesions were assessed as neurological conditions. Adjusted associations between these factors and troponin elevation were determined using a multivariate ordinal logistic regression model and area under the receiver operating characteristic curve (AUC). Cox proportional hazards model was used to determine the prognostic significance of comorbidity beyond neurological conditions. @*Results@#Among 1,092 patients (66.5±12.4 years, 63.3% male), 145 (13.3%) and 335 (30.7%) had elevated (≥0.040 ng/mL) and minimally-elevated (0.040–0.010 ng/mL) troponin, respectively. In the adjusted analysis, AF, MH, HF, RI, active cancer, and neurological deficits were associated with troponin elevation. The multivariate model with six comorbidities and two neurological conditions exhibited an AUC of 0.729 (95% confidence interval [CI], 0.698–0.759). In Cox regression, AF, IHD, and HF were associated with adverse cardio-cerebrovascular events, whereas HF and active cancer were associated with mortality. @*Conclusion@#Troponin elevation in patients with AIS can be explained by the burden of comorbidities in combination with neurological status, which explains the prognostic significance of troponin assay.

Korean guidelines for the management of gout

Gout is the most common form of arthritis, with the prevalence increasing worldwide. The present treatment guidelines provide recommendations for the appropriate treatment of acute gout, management during the inter-critical period, and prevention of chronic complications. The guidelines were developed based on evidence-based medicine and draft recommendations finalized after expert consensus. These guidelines are designed to provide clinicians with clinical evidence to enable efficient treatment of gout.

Korean guidelines for the management of gout

Gout is the most common form of arthritis, with the prevalence increasing worldwide. The present treatment guidelines provide recommendations for the appropriate treatment of acute gout, management during the inter-critical period, and prevention of chronic complications. The guidelines were developed based on evidence-based medicine and draft recommendations finalized after expert consensus. These guidelines are designed to provide clinicians with clinical evidence to enable efficient treatment of gout.

Recent Advance in Clinical Practice Guideline Development Methodology / 가정의학회지

Clinical practice guidelines (CPG) can be defined as systematically developed recommendations and related content obtained by reviewing scientific evidence, which help healthcare providers make decisions. CPG is one of the most powerful tools that helps clinicians make evidence-based decisions in practice. Methodologies in areas essential for CPG development, such as for systematic review, risk of bias (ROB) assessment, adaptation, and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations, are rapidly developing. Therefore, they must be well-understood and applied to evidence-based CPG development. In this regard, it is necessary to learn about the updates and changed in the methodologies for CPG development. This manuscript covers the following CPG development methodologies: (1) main principles of CPG, (2) managing conflict of interest, (3) considering patient value and preference, (4) determination of key questions, (5) ROB assessment, (6) adaptation, (7) rapid guideline development, (8) living guideline development, and (9) GIN-McMaster Guideline Development Checklist.

Current status of health promotion in Korea

Health promotion can be defined as a process that allows individuals to control and improve their health. However, the term health promotion is used narrowly, it focuses on healthy lifestyle changes and behavioral risk factors such as nutrition, exercise, and stress management. Health promotion involves not only medicine and health but also a wide range of related areas such as policies, finances, and climate change measures. Nonetheless the medical field continues to play a/the leading role in health promotion.Current Concepts: The Korean government’s comprehensive national health promotion plan has implemented mid-to long-term health promotion policies under the National Health Promotion Act. From 2002, this project establishes a new goal every 10 years and prepares a supplementary plan every five years. Another initiative is the community health survey by the Korea Disease Control and Prevention Agency, which has been conducted since 2007. This survey provides data on basic health behavior and status, including physical measurement, smoking, obesity, drinking, diet, medicine use, disease, vaccination, health knowledge, accidents, and visits to medical institutions. Research on health promotion in Korea is available from the KoreaMed database.Discussion and Conclusion: While Korea’s health promotion status has seen rapid improvement in the past, the degree of improvement has recently been marginal and risks stagnating, the degree of improvement has recently been marginal and risks stagnating and the role of medical professionals is an essential.

Korean Clinical Practice Guidelines: Current Status of Adherence to the RIGHT Checklist

Background@#The Korean Academy of Medical Sciences (KAMS) has been utilizing AGREE II to audit the quality of clinical practice guidelines (CPGs) developed in Korea. Monitoring the RIGHT Checklist adherence could help monitor the quality status and discover areas for improvement of CPG development. @*Methods@#We included 129 CPGs from the past 5 years and assessed each item of the RIGHT Checklist. STATA version 15.0 was used for statistical analysis. @*Results@#Among the seven sections of the RIGHT checklist, sections with a full compliance rate over 60% were ‘basic information’ (65%) and ‘background’ (66%). The other sections’ mean full compliance rates were ‘Evidence’ 52%, ‘Recommendation’ 35%, ‘Review and quality assurance’ 25% and ‘Funding, declaration and management of interest’ 17%. Sections with a partial compliance rate over 60% were ‘Recommendation’ (60%) and ‘Funding, declaration and management of interest’ (70%). Non-compliance was highest in the ‘Review and quality assurance’ (17%) domain. In comparison between groups 1 (under median group) and 2 (over median group), group 2 showed a tendency to have multi-stakeholder involvement and present sufficient information on financial resources and conflict of interest declarations. For the CPGs developmental methodology aspect, group 2 provided more pertinent information than group 1 about supporting evidence-making and the process from evidence to recommendation. @*Conclusion@#This study evaluated adherence to the RIGHT Checklist of CPGs developed in Korea. It can provide helpful information to develop strategic plans for enhancing the capabilities of developing CPGs in Korea.

Survey for Government Policies Regarding Strategies for the Commercialization and Globalization of Digital Therapeutics

Purpose@#This study was conducted to build a direction for government policies regarding strategies for the commercialization of digital therapeutics in Korea, as well as its globalization. @*Materials and Methods@#The study included 37 participants from the Korea Digital Health Industry Association (KODHIA). The data was based on a survey conducted in 2020 targeting employees of companies engaged in the digital health industry in Korea.Participants were asked about their involvement in product development of digital therapeutics and their opinion about the growing motivator for digital therapeutics in Korea and the global market. @*Results@#According to our data, among subjects not involved in making digital therapeutics products, the main reason for not being involved was the lack of experts (73.9%) and difficulty in licensing (73.9%). Responses concerning the priority area in need of national support were R&D funding (43.2%), and the next was licensing guidance and simplifying regulations (24.3%). Possible difficulties of overseas market expansion were the unfamiliarity in digital therapeutics technology verification and licensing structures of foreign countries (73%), and concerns regarding the level of recognition of clinical trials and technology in Korea from overseas (70.3%). Overall, respondents were hesitant in starting a related business due to the lack of government support and the complexity of the regulation process. Moreover, concerns about global market entry were similar. Being unfamiliar with the novel process and worrying about the achievement despite existing challenges were the biggest drawback. @*Conclusion@#For the digital therapeutics industry to evolve domestically and internationally, government support and guidance are essential.

Phentermine and Phendimetrazine-Induced Psychotic Disorder and Bipolar Disorder: A Case Series

Objectives@#Recently, weight loss has emerged as a national concern in South Korea, and this has resulted in an increase in the frequency of use of central nervous system (CNS)-stimulating appetite suppressants. This study aimed to collect cases of psychotic disorders and bipolar disorders triggered by phentermine and phendimetrazine and explore the clinical features and courses. @*Methods@#In this retrospective study, we analyzed the electronic medical records of patients and selected eight patients who developed psychotic symptoms and manic symptoms for the first time after taking phentermine and phendimetrazine. All cases were reviewed, and their clinical features and course were summarized. @*Results@#All eight patients developed psychotic symptoms, and one had accompanying manic symptoms. The final diagnosis was appetite-suppressant-induced psychotic disorder in four patients, schizophrenia in three, and appetite-suppressant-induced bipolar disorder in one. In addition, three patients were diagnosed as having substance-use disorder. The key psychotic symptoms of these patients were hallucinations and paranoia. @*Conclusions@#These case findings suggest that phentermine and phendimetrazine can cause psychotic disorder, bipolar disorder, or substance use disorder and that medical professionals and the public should practice caution when prescribing and using these drugs.

Current Status of Clinical Practice Guidelines in Korea

Background@#The development process of clinical practice guidelines (CPGs) must adhere to development standards and must be supported and steered by a representative and consistent governing body. We aimed to investigate the current status of the most recent CPGs published in Korea through surveys of medical professional societies and literature searches. @*Methods@#We collected CPGs developed in Korea in the past 5 years through several electronic database searches (MEDLINE, Embase, and KoreaMed), hand searches, and surveys of medical society memberships from the Korean Academy Medical Societies. Three authors selected Korean CPGs according to our inclusion/exclusion criteria and extracted data from selected CPGs about general characteristics, characteristics of CPGs for setup, evidence evaluation, and the finalization phase. @*Results@#Out of 2,337 articles searched from various sources and 66 documents collected by survey, 129 guidelines (122 by database searching and 7 by survey) were selected. During the recent 5 years, the yearly numbers of CPGs developed were around 25. A single organization was the most frequent CPG development body (42, 32.6%). The most common development methodologies described in the CPGs included were de novo (53, 41.1%) followed by adaptation (48, 37.2%) and hybrid (4, 3.1%). Systematic literature searching was performed in most of the guidelines (79.8%). The evidence level was reported in 104 guidelines (80.6%).There were 77 guidelines (59.7%) that reported an update plan. Fifty guidelines were published in Korean (41.0%), and 46 guidelines were published in English only (37.7%). @*Conclusion@#Among CPGs developed in Korea in the last 5 years, the proportion adhering to CPG development standards has increased, but there is still room for improvement.

Current Status of Clinical Practice Guidelines in Korea

Background@#The development process of clinical practice guidelines (CPGs) must adhere to development standards and must be supported and steered by a representative and consistent governing body. We aimed to investigate the current status of the most recent CPGs published in Korea through surveys of medical professional societies and literature searches. @*Methods@#We collected CPGs developed in Korea in the past 5 years through several electronic database searches (MEDLINE, Embase, and KoreaMed), hand searches, and surveys of medical society memberships from the Korean Academy Medical Societies. Three authors selected Korean CPGs according to our inclusion/exclusion criteria and extracted data from selected CPGs about general characteristics, characteristics of CPGs for setup, evidence evaluation, and the finalization phase. @*Results@#Out of 2,337 articles searched from various sources and 66 documents collected by survey, 129 guidelines (122 by database searching and 7 by survey) were selected. During the recent 5 years, the yearly numbers of CPGs developed were around 25. A single organization was the most frequent CPG development body (42, 32.6%). The most common development methodologies described in the CPGs included were de novo (53, 41.1%) followed by adaptation (48, 37.2%) and hybrid (4, 3.1%). Systematic literature searching was performed in most of the guidelines (79.8%). The evidence level was reported in 104 guidelines (80.6%).There were 77 guidelines (59.7%) that reported an update plan. Fifty guidelines were published in Korean (41.0%), and 46 guidelines were published in English only (37.7%). @*Conclusion@#Among CPGs developed in Korea in the last 5 years, the proportion adhering to CPG development standards has increased, but there is still room for improvement.

Vasomotor Symptoms: More Than Temporary Menopausal Symptoms

Vasomotor symptoms (VMS), such as hot flashes and night sweating, are classic menopausal symptoms experienced by a majority of perimenopausal and postmenopausal women. VMS have received a great deal of attention due to their relationship with cardiometabolic risk. Further, accumulating evidence indicates that VMS are associated with an increased risk of several chronic diseases, including metabolic syndrome, type 2 diabetes mellitus, nonalcoholic fatty liver diseases, and osteoporosis in perimenopausal and postmenopausal women. These findings suggest VMS as biomarkers of impaired cardiometabolic conditions rather than just temporary symptoms in menopausal women, warranting further studies to confirm the casual relationship of VMS with these diseases and the exact underlying mechanism in this context.

Vasomotor Symptoms: More Than Temporary Menopausal Symptoms

Vasomotor symptoms (VMS), such as hot flashes and night sweating, are classic menopausal symptoms experienced by a majority of perimenopausal and postmenopausal women. VMS have received a great deal of attention due to their relationship with cardiometabolic risk. Further, accumulating evidence indicates that VMS are associated with an increased risk of several chronic diseases, including metabolic syndrome, type 2 diabetes mellitus, nonalcoholic fatty liver diseases, and osteoporosis in perimenopausal and postmenopausal women. These findings suggest VMS as biomarkers of impaired cardiometabolic conditions rather than just temporary symptoms in menopausal women, warranting further studies to confirm the casual relationship of VMS with these diseases and the exact underlying mechanism in this context.

Irritable Bowel Syndrome and Synbiotics / 가정의학회지

No abstract available.