Challenges and improvement opportunities in a telemedicine pilot project

A pilot project for telemedicine has been underway since June 2023. However, ongoing issues have persisted since its implementation. This study aimed to review the current status and challenges of this project and recommend necessary improvements.Current Concepts: The following challenges were observed. First, the primary and incidental effects of this pilot project were not presented. It is not a small-scale project as it targets the entire population without a strict predesign. Its evaluation must have a defined implementation period. Currently, an indefinite implementation period has been proposed until the medical law is revised. Second, safety measures were found to be inadequate. Lastly, from an industrial standpoint, the government unilaterally promoted telemedicine policies.Discussion and Conclusion: Enhancements should be implemented in this telemedicine pilot project to ensure safety. First, the project objectives were clearly defined. Clear policy effects and evaluation criteria should be presented, and the project should be implemented through a rigorous policy design to verify them. Second, policy measures should be established to ensure safety. Lastly, administrative and legal improvements related to telemedicine should be implemented simultaneously.

Strategies to enhance public health doctor system in South Korea

South Korea’s public health doctor system requires physicians to provide primary healthcare in medically underserved areas, such as rural regions, as an alternative to mandatory military service. Recently, concerns have arisen over the decline in the number of public health doctors available in these underserved areas. This study reviews issues related to the public health doctor system and proposes strategies for enhancing its management.Current Concepts: The annual number of public health doctors has steadily decreased by approximately 46.6%, from 1,962 in 2008 to 1,048 in 2022. According to the survey, the reasons behind this decline include the lengthy service period of 36 months compared to the 18-month military service, poor working conditions, low financial support, unreasonable manpower deployment, and uncertain social status.Discussion and Conclusion: Several recommendations can enhance the effectiveness of the public health doctor system. First, the mandatory service period of 36 months should be shortened, and a military training period of 1–2 months should be incorporated into the overall service duration. Second, ensuring appropriate working hours, including holidays, along with improved working conditions and reasonable financial support and compensation, is essential. Third, the role of public health doctors should shift from solely providing basic primary healthcare to acting as public health managers in local communities. Lastly, a long-term plan should be developed to establish various types of medical institutions in medically underserved regions.

Problems and improvements in the Medical Law’s excessive regulation of physicians in Korea

The Medical Service Act was implemented to protect the public’s health, but has come to excessively restrict the fundamental rights of medical professionals. Therefore, it is necessary to systematically organize the level of physicians’ obligations and the sanction provisions present under the Medical Law.Current Concepts: The Medical Law consists of 120 articles, 6 of which address physicians’ rights. However, the law also provides 72 reasons for physicians’ obligations and penalties, 40 reasons for the suspension of qualifications, 20 reasons for administrative fines, 30 reasons for corrective orders, and 17 reasons for the revocation of permission for establishment. Thus, the Medical Law provides medical professionals with approximately 150 reasons for obligations and sanctions.Discussion and Conclusion: We would like to suggest some measures to improve the excessive regulation of physicians under the Medical Law. First, statistics on the status of penalties and administrative dispositions must be accumulated and disclosed; second, obligations, penalties, and administrative dispositions must be stipulated in one consolidated article; third, penalties should be avoided for simple violations of duty; fourth, reasons for administrative dispositions–such as enforcement ordinances of the Medical Law–must be elevated to the Medical Law itself; fifth, the authority for administrative dispositions against medical institutions must be unified under the Minister of Health and Welfare, the subject of duties and responsibilities must be clarified as the ‘establisher of a medical institution,’ rather than a ‘medical institution,’ and the adequate time required for when two types of administrative dispositions are made must be unified; and sixth, detailed information on the administrative disposition procedures must be newly established in the Medical Law.

Relationships of Peripheral Inflammatory Marker With Suicide Attempt History / 정신신체의학

objectives@#：The purpose of this study is to determine whether there is a significant difference in the neutro-phil-to-lymphocyte ratio and platelet-to-lymphocyte ratio according to the history of suicide attempt in patients with psychiatric diseases. @*Methods@#：A medical record review was conducted on patients who had been hospitalized in Konyang University Hospital since 2021-03-01 to 2023-02-28 to collect demographic and clinical characteristics. T-test for continuous variables and Chi-square test for categorical variables were performed to determine demographic differences according to the history of suicide attempt, and the ANCOVA test was performed to compare the average value of peripheral inflammatory marker according to the history of suicide attempt with gender and age as co-variates. One-way variance analysis was performed to determine whether the number of suicide attempt causes significant difference of the peripheral inflammatory marker. @*Results@#：The final analysis target of this study was 266 patients, 101 had history of suicide attempt, and 165 had no history of suicide attempt. The neutrophil-to-lymphocyte ratio (p<0.001) and platelet-to-lymphocyte ratio (p<0.001) were higher in patients with the history of suicide attempt than patients without the history of suicide attempt, but the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were not significantly in-creased depending on the serial increase of number of suicide attempts. @*Conclusions@#：This study suggests that peripheral inflammatory markers are meaningful and easily accessible indicators for predicting the risk of suicide attempt in psychiatric patients. We expect that prospective follow-up study will be conducted with more subjects and controlled potential confounding variables.

Measures to strengthen the political ability of the Korean Medical Association

The Korean Medical Association (KMA) must strengthen its political ability in order to respond appropriately to the changing medical environment. Further, this strengthening is necessary to establish the status of the KMA as an expert group for protecting members’ rights.Current Concepts: The KMA has been evaluated to have unsatisfactory performance because of a lack of internal and external political ability, negative social perception of medical associations, and insufficient regulations on the purpose and role of the organization.Discussion and Conclusion: The following are suggested to overcome this situation: First, as an expert group, the KMA must strengthen its ability to develop policy agendas that can lead to health and medical policy issues and establish action strategies. Second, it is necessary to pursue an appropriate balance between public interest and the association’s own interests. Third, efforts to secure the autonomy of the KMA should be continued. Fourth, active support is needed to produce doctors-turned-members of the National Assembly. Fifth, it is necessary to prepare a support system to strengthen political power. Sixth, internal solidarity must be strengthened so that the KMA can be positioned as an indispensable institution among its members. Seventh, it is necessary to induce a change in the social perception of the KMA by strengthening public activities. Eighth, the association’s solidarity with the media, civic groups, and health and medical organizations should be strengthened.

Screening for Atrial Fibrillation Using a Smartphone-Based Electrocardiogram in Korean Elderly / 전남의대학술지

Atrial fibrillation (AF) is responsible for 10–20% of cerebral infarctions. Several mobile devices have been developed to screen for AF and studies of AF screening have been conducted in several countries to evaluate the applicability of these mobile devices. In this tradition, we conducted a community-based AF screening using an automated single-lead electrocardiogram (SL-ECG). This survey examined 2,422 participants in a community dementia screening program who were aged 60 years or older in the preliminary study, and 5,366 participants at 9 Senior Welfare Centers aged 60 years or older in the expanded study. AF screening was conducted using an automated SL-ECG (Kardia Mobile, AliveCor, Mountain View, CA, USA). AF was confirmed with a 12-lead electrocardiogram in subjects classified as having AF on the SL-ECG. In the preliminary study, of the 2,422 subjects, 124 had AF on the SL-ECG. The prevalence of AF was 3.0% (95% confidence interval [CI]: 2.4–3.8). The positive predictive value (PPV) of SL-ECG was 58.9% (95% CI: 50.1–67.1). Of the subjects diagnosed with AF, 65.8% (95% CI: 54.3–75.6) were newly diagnosed. In an expanded study, of the 5,366 subjects, 289 had AF on SL-ECG. The prevalence was 2.6% (95% CI: 2.2–3.1) and PPV of SL-ECG was 48.8% (95% CI: 43.1–54.5). In this community-based AF screening, we found that AF is underdiagnosed and undertreated. These results suggest that the early detection of AF using mobile devices is needed in Korea.

Importance of lifestyle, stress, and chronic diseases in self-rated health of Korean doctors

The quality of medical services and the health of patients can be guaranteed when the doctors are healthy. In this study, we used the data from the 2016 Korean Physician Survey and analyzed the relationship of lifestyle, stress, and chronic diseases status with the self-rated health of Korean doctors. Among 7,631 doctors in Korea, 2,336 (30.6%) reported their self-rated health as ‘good’, 4,462 (58.5%) as ‘moderate’, and 833 (10.9%) as ‘bad’. The multinominal logistic regression analysis, showed that factors related to the self-rated health were age, type of healthcare facility, smoking, exercise, sleep duration, stress, and chronic diseases status. Since doctors’ lifestyle, stress, and chronic disease status were closely related to their self-rated health, it is imperative to prepare measures to protect doctors’ health in an intensive medical environment, where too many patients require treatment, due to the characteristics of the medical system in Korea.

Association between Serum 25-hydroxyvitamin D Levels and Type 2 Diabetes in Korean Adults / 전남의대학술지

Previous studies have suggested that a vitamin D deficiency increases the risk of type 2 diabetes. This study evaluated the association between serum vitamin D levels and type 2 diabetes in Korean adults. This study included 9,014 subjects (3,600 males and 5,414 females) aged ≥50 years who participated in the Dong-gu Study. The subjects were divided into groups in whom the serum vitamin D level was severely deficient (<10 ng/mL), deficient (10 to <20 ng/mL), insufficient (20 to <30 ng/mL) and sufficient (≥30 ng/mL). Type 2 diabetes was defined by a fasting blood glucose level of ≥126 mg/dL and/or an HbA1c proportion of ≥6.5% and/or self-reported current use of diabetes medication. Multiple logistic regression was performed to evaluate the association between vitamin D status and type 2 diabetes. The age- and sex-adjusted prevalence of type 2 diabetes was 22.6%, 22.5% and 18.4% and 12.7% for severely deficient, deficient, insufficient, and sufficient, respectively. Multivariate modeling revealed that subjects with insufficient or sufficient vitamin D levels were at a lower risk of type 2 diabetes than were subjects with deficient vitamin D levels [odds ratio (OR), 0.82; 95% confidence interval (CI), 0.71–0.94 and OR, 0.51; 95% CI, 0.35–0.74, respectively]. Higher serum vitamin D levels were associated with a reduced risk of diabetes in Korean adults, suggesting that vitamin D may play a role in the pathogenesis of diabetes.

Association between Serum 25-hydroxyvitamin D Levels and Type 2 Diabetes in Korean Adults / 전남의대학술지

Previous studies have suggested that a vitamin D deficiency increases the risk of type 2 diabetes. This study evaluated the association between serum vitamin D levels and type 2 diabetes in Korean adults. This study included 9,014 subjects (3,600 males and 5,414 females) aged ≥50 years who participated in the Dong-gu Study. The subjects were divided into groups in whom the serum vitamin D level was severely deficient (<10 ng/mL), deficient (10 to <20 ng/mL), insufficient (20 to <30 ng/mL) and sufficient (≥30 ng/mL). Type 2 diabetes was defined by a fasting blood glucose level of ≥126 mg/dL and/or an HbA1c proportion of ≥6.5% and/or self-reported current use of diabetes medication. Multiple logistic regression was performed to evaluate the association between vitamin D status and type 2 diabetes. The age- and sex-adjusted prevalence of type 2 diabetes was 22.6%, 22.5% and 18.4% and 12.7% for severely deficient, deficient, insufficient, and sufficient, respectively. Multivariate modeling revealed that subjects with insufficient or sufficient vitamin D levels were at a lower risk of type 2 diabetes than were subjects with deficient vitamin D levels [odds ratio (OR), 0.82; 95% confidence interval (CI), 0.71–0.94 and OR, 0.51; 95% CI, 0.35–0.74, respectively]. Higher serum vitamin D levels were associated with a reduced risk of diabetes in Korean adults, suggesting that vitamin D may play a role in the pathogenesis of diabetes.

A Gender-Specific Association between Self-Reported Snoring and Hemoglobin A1c Levels in a General Population without Type 2 Diabetes Mellitus

PURPOSE: We explored whether a gender difference was evident in terms of the associations of snoring with hemoglobin A1c (HbA1c) and homeostatic model assessment-insulin resistance (HOMA-IR) levels in a healthy population without type 2 diabetes mellitus (DM). MATERIALS AND METHODS: We analyzed 2706 males and 4080 females who participated in the baseline survey of the Namwon Study. In terms of self-reported snoring frequency, participants were classified as non-snorers or occasional (1–3 days/week), frequent (4–6 days/week), or constant (7 days/week) snorers. Participants with DM, defined as a fasting blood glucose level ≥126 mg/dL and/or use of insulin or hypoglycemic medication, were excluded from the analysis. RESULTS: In females, the fully adjusted mean (95% confidence interval) HbA1c levels in non-snorers and in occasional, frequent, and constant snorers were 5.53% (5.47–5.59%), 5.53% (5.47–5.59%), 5.57% (5.49–5.64%), and 5.57% (5.51–5.64%), respectively, reflecting a dose-response relationship (p trend=0.004). Compared with female non-snorers, the risk of an elevated HbA1c level (top quintile, ≥5.9%) in constant snorers remained significant (odds ratio 1.30, 95% confidence interval 1.02–1.66) after full adjustment. In addition, in females, a significant linear trend in HbA1c level odds ratio by increased snoring frequency was apparent (p trend=0.019 in model 3). In contrast, no significant association between snoring frequency and HbA1c level was identified in males. No significant association between snoring frequency and HOMA-IR was detected in either gender. CONCLUSION: We discovered a gender-specific association between snoring and HbA1c level in a healthy, community-dwelling population free of DM.

Association between Vitamin D Status and Risk of Peripheral Arterial Disease: The Dong-gu Study / 전남의대학술지

Low levels of vitamin D have been associated with increased cardiovascular disease risk. However, few studies have evaluated the association between vitamin D status and peripheral arterial disease (PAD). We therefore aimed to investigate whether low 25-hydroxyvitamin D (25(OH)D) levels were associated with increased risk of PAD in the Korean population. This cross-sectional study was conducted among 8,960 subjects aged 50 years or older without known myocardial infarction or stroke. PAD was defined by an ankle brachial blood pressure index <0.9. Multivariate logistic regression was used to evaluate the association between serum 25(OH)D levels and risk of PAD. Of the 8,960 subjects, 3.0% had PAD and the age and sex adjusted prevalence of PAD decreased with the increasing 25(OH)D quartile. After adjusting for potential confounders and parathyroid hormones, serum 25(OH)D levels were associated with a significantly decreased risk of PAD (OR for one SD increase, 0.98; 95% CI, 0.95-1.0, P for trend=0.040). Compared with the first 25(OH)D quartile, the odds of PAD were 0.86 (95% CI, 0.62-1.21), 0.67 (95% CI, 0.46-0.97), and 0.71 (95% CI, 0.49-1.04) for the second, third, and fourth quartiles, respectively. In this cross-sectional study, we found that low serum 25(OH)D levels were associated with an increased risk of PAD, independent of traditional cardiovascular risk factors and parathyroid hormone. Our findings suggest that low vitamin D levels may contribute to PAD in the Korean population.

Association of APOE Genotype with Bone Mineral Density in Men and Women: The Dong-gu and Namwon Studies / 전남의대학술지

Many studies have investigated relationships between APOE genotype and bone mineral density (BMD). However, the results of these studies have been inconsistent. Few studies have been carried out in Asian populations. We studied the relationship of the APOE gene polymorphism and BMD in two large population-based studies. The datasets included the Dong-gu Study (3575 men and 5335 women) and the Namwon Study (2310 men, 3512 women). Lumbar spine and femoral neck BMD were measured by dual-energy X-ray absorptiometry. APOE genotypes were analyzed by polymerase chain reaction-restriction fragment length polymorphism. The APOE genotypes were classified into APOE E2 (E2/E2 and E2/E3), APOE E3 (E3/E3), and APOE E4 (E3/E4 and E4/E4). The genotype distribution of the study population was in Hardy-Weinberg equilibrium. There were no significant differences among APOE genotype groups in lumbar and femoral neck BMD in either cohort. Our data do not support the hypothesis that the APOE genotype is associated with BMD.

Association between Vitamin D Status and Risk of Peripheral Arterial Disease: The Dong-gu Study / 전남의대학술지

Low levels of vitamin D have been associated with increased cardiovascular disease risk. However, few studies have evaluated the association between vitamin D status and peripheral arterial disease (PAD). We therefore aimed to investigate whether low 25-hydroxyvitamin D (25(OH)D) levels were associated with increased risk of PAD in the Korean population. This cross-sectional study was conducted among 8,960 subjects aged 50 years or older without known myocardial infarction or stroke. PAD was defined by an ankle brachial blood pressure index <0.9. Multivariate logistic regression was used to evaluate the association between serum 25(OH)D levels and risk of PAD. Of the 8,960 subjects, 3.0% had PAD and the age and sex adjusted prevalence of PAD decreased with the increasing 25(OH)D quartile. After adjusting for potential confounders and parathyroid hormones, serum 25(OH)D levels were associated with a significantly decreased risk of PAD (OR for one SD increase, 0.98; 95% CI, 0.95-1.0, P for trend=0.040). Compared with the first 25(OH)D quartile, the odds of PAD were 0.86 (95% CI, 0.62-1.21), 0.67 (95% CI, 0.46-0.97), and 0.71 (95% CI, 0.49-1.04) for the second, third, and fourth quartiles, respectively. In this cross-sectional study, we found that low serum 25(OH)D levels were associated with an increased risk of PAD, independent of traditional cardiovascular risk factors and parathyroid hormone. Our findings suggest that low vitamin D levels may contribute to PAD in the Korean population.

Association of APOE Genotype with Bone Mineral Density in Men and Women: The Dong-gu and Namwon Studies / 전남의대학술지

Many studies have investigated relationships between APOE genotype and bone mineral density (BMD). However, the results of these studies have been inconsistent. Few studies have been carried out in Asian populations. We studied the relationship of the APOE gene polymorphism and BMD in two large population-based studies. The datasets included the Dong-gu Study (3575 men and 5335 women) and the Namwon Study (2310 men, 3512 women). Lumbar spine and femoral neck BMD were measured by dual-energy X-ray absorptiometry. APOE genotypes were analyzed by polymerase chain reaction-restriction fragment length polymorphism. The APOE genotypes were classified into APOE E2 (E2/E2 and E2/E3), APOE E3 (E3/E3), and APOE E4 (E3/E4 and E4/E4). The genotype distribution of the study population was in Hardy-Weinberg equilibrium. There were no significant differences among APOE genotype groups in lumbar and femoral neck BMD in either cohort. Our data do not support the hypothesis that the APOE genotype is associated with BMD.

Current status of state telemedicine policy in the United States and policy implications for Korea

The main objective of this study to propose an implementation about telemedicine policy in Korea through analyzing current status of state telemedicine policy in the United States. To achieve the result, three types of data sets were used to draw conclusions; 1) status of insured service of telemedicine in each state, 2) physician practice standards related to telemedicine, and 3) licensure. Analyzed results indicated differentiation in insured status of telemedicine service among private insurance parity law, medicaid coverage parity law, and state employee health plan parity in each states. Only two states provide insured service of telemedicine without any limits or certain conditions. Other states have a strict regulation or coverage condition about providing insurance. Each states also apply rigorous standards to telemedicine providers about physician practice standards and licensure. Some states restrict telemedicine itself or provide strict regulation process of telemedicine in Physician-patient encounter. Also, the most strict type 'full state license' and 'consulting exemptions (applied in certain condition)' are applied in most of states. On the basis of study result, environmental and conditional requirement implementation in application of telemedicine policy in Korea is provided in conclusion.

A survey on training and working conditions of residents in 2015

The objectives of this study are (1) to examine the training and working conditions of residents after revision of the 'Regulations on Specialist Training and Accreditation,' (2) to determine the causes of problems with these training and working conditions, and (3) to seek improvement in these conditions. A questionnaire survey was conducted over two weeks. A total of 10,768 respondents and 1,793 valid responses were analyzed. Although revised regulations had been implemented, training conditions did not appear to have undergone any improvements. 52.9% of residents work over 80 hours per week and 27.1% respondents exceeded 100 hours per week. 76.9% of respondents indicated that they exceed the maximum continuous training time of 36 hours. 64.5% of respondents said their emergency room training time was over 12 hours. 25.4% of respondents' duty days exceeded three days a week. 34.7% of respondents said that they had less than three days off per month. The proportion of those with annual leave under 14 days is 70.2%. For substantive improvements in training and working conditions, new plans must consider practical factors in the implementation of improvements. This requires a governance structure based on participation, and an independent, objective training evaluation organization should be established to perform a reliable assessment. Above all, the government financial compensation plan must prepare for improving the training environment.