Journal of Korean Medical Science最新文献

{"title":"Global Cost of Silencing Science: Editors and Publishers Have a Duty to Resist.","authors":"Frank Frizelle, Kamran Abbasi, Vivienne Bachelet, Christopher Baethge, Sabine Kleinbert, Jin-Hong Yoo, Lilia Zakhama","doi":"10.3346/jkms.2025.40.e216","DOIUrl":"10.3346/jkms.2025.40.e216","url":null,"abstract":"","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 29","pages":"e216"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12303664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Preventable Trauma Death Rates in Korea: A Follow-up Study of the Trauma System's Performance.","authors":"Byung Hee Kang, Kyoungwon Jung, Jonghwan Moon, Junsik Kwon, Yo Huh, Seoyoung Song, Sora Kim, Yo Han Lee, Eun Hae Lee, Won Pyo Hong, Borami Lim, Seunghyeon Yoo, Chan Yong Park, Byungchul Yu, Hangjoo Cho, Younghwan Kim, Young Sun Ro, Jeong Ho Park, Tae Seok Jeong","doi":"10.3346/jkms.2025.40.e165","DOIUrl":"10.3346/jkms.2025.40.e165","url":null,"abstract":"<p><strong>Background: </strong>The preventable trauma death rate (PTDR) is a key measure of trauma system performance. This study, the fourth follow-up since the implementation of trauma centers in South Korea, aimed to evaluate trends in PTDR and assess the mid-term performance of the trauma system. The study utilized consistent methods with previous analyses to ensure comparability and continuity.</p><p><strong>Methods: </strong>A total of 8,490 trauma deaths occurred in 2021, and 1,688 patients from 265 medical institutions were included in the study. A multidisciplinary panel review was conducted to assess the preventability of mortality and identify opportunities for improvement. The results were compared with those from previous studies on the PTDR.</p><p><strong>Results: </strong>Of the 1,688 sampled patients, the PTDR was calculated for 929. The overall PTDR was estimated at 13.9%, with a definitive preventable death rate of 2.9% and a potentially preventable death rate of 12.7%. The reduction in PTDR was not statistically significant compared to the 2019 study, which reported a rate of 15.7% (<i>P</i> = 0.261). Significant differences were observed between the preventable and non-preventable groups in terms of age, timing of death, level of medical institution, inter-hospital transfer, means of hospital admission, and time from accident to death.</p><p><strong>Conclusion: </strong>In 2021, the PTDR was 13.9%, showing a slight reduction compared to the 2019 study. This study primarily evaluated the performance of Korea's trauma system, with findings highlighting both progress and persistent challenges. Although the study was conducted during the coronavirus disease 2019 pandemic, its potential indirect impact on trauma care is acknowledged as an area for further research. Addressing systemic limitations remains essential for further reducing preventable trauma deaths.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 29","pages":"e165"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12303663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpersonal Constructs in the Mediation of Early Maladaptive Schemas and Suicidal Ideation Among Outpatients With Major Depressive Disorder.","authors":"Jong Yoon Ko, C Hyung Keun Park","doi":"10.3346/jkms.2025.40.e173","DOIUrl":"10.3346/jkms.2025.40.e173","url":null,"abstract":"<p><strong>Background: </strong>Four early maladaptive schemas (EMSs) are known to increase suicidal ideation: defectiveness/shame, social isolation/alienation, failure, and dependence/incompetence. However, no mechanisms through which EMSs may increase suicidal ideation have been studied. We aimed to examine important mechanisms that may underlie the association between specific EMSs related to heightened suicidal ideation (defectiveness/shame, social isolation/alienation, failure, and dependence/incompetence) and present suicidal ideation in outpatients with major depressive disorder (MDD) through 2 interpersonal constructs: perceived burdensomeness and thwarted belongingness.</p><p><strong>Methods: </strong>We conducted parallel mediation analysis for 247 outpatients with MDD to test the hypothesis that each of the four EMSs would exhibit positive correlations with suicidal ideation, while perceived burdensomeness and thwarted belongingness would concurrently mediate these associations.</p><p><strong>Results: </strong>Perceived burdensomeness and thwarted belongingness fully mediated the associations between early maladaptive schemas and suicidal ideation, with significant total indirect effects for defectiveness/shame schema (95% confidence interval [CI], 0.28-0.47; B = 0.38), social isolation schema (95% CI, 0.27-0.48; B = 0.37), failure schema (95% CI, 0.25-0.41; B = 0.33), and dependence/incompetence schema (95% CI, 0.23-0.40; B = 0.31), after controlling for age and sex.</p><p><strong>Conclusion: </strong>Through greater perceived burdensomeness and thwarted belongingness, outpatients with MDD with higher levels of the schemas previously known to be associated with elevated suicidal ideation were likely to exhibit a more severe level of current suicidal ideation. These findings highlight the potential benefits of including components that can reduce the severity of both interpersonal constructs in antisuicidal strategies.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 29","pages":"e173"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12303658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Incidences, Treatments and Outcomes of Spontaneous Subarachnoid Hemorrhage in Korea Between 2002 and 2022.","authors":"Jinju Park, Ji Yoon Baek, Sung Ho Lee, Keun-Hwa Jung, Hae-Young Lee, Aesun Shin, Won-Sang Cho","doi":"10.3346/jkms.2025.40.e171","DOIUrl":"10.3346/jkms.2025.40.e171","url":null,"abstract":"<p><strong>Background: </strong>Access to equitable care for severely emergent diseases serves as a key indicator for evaluating the performance of a country's health care system. The aim of this study was to examine trends in the incidence, treatment and outcomes of patients with spontaneous subarachnoid hemorrhage (SAH) using Korean national claims data.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on a cohort of inpatients with spontaneous SAH from 2002 to 2022, utilizing data from the Korean National Health Insurance Service. The primary outcomes assessed were fatalities within 30 and 90 days from the index date of hospitalization.</p><p><strong>Results: </strong>While the crude incidence rate has remained constant, the age-standardized incidence rate (ASR) has decreased from 22.0 per 100,000 in 2002 to 12.5 per 100,000 in 2022. The regions with the highest incidence rates were Gyeonggi (29,833 cases, 21.0%) and Seoul (26,484, 18.7%). In 2002, 59.6% of all patients received major treatments within 48 hours of admission, with a distribution of 68.4% in tertiary hospitals and 30.7% in secondary hospitals. By 2022, the proportion of patients receiving major treatment had increased to 71.9%, with 42.3% in tertiary hospitals and 57.5% in secondary hospitals. Endovascular coiling surpassed surgical clipping as the predominant treatment modality between 2013 and 2014. On average, 70.1% of treated patients received care within their area of residence, with the highest rates in Daegu (92.9%), Gwangju (91.4%) and Busan (90.1%) and the lowest in Jeonnam (14.2%). From 2002 to 2019, the 30-day and 90-day fatality rates declined from 21.2% to 19.2% and from 24.4% to 21.3%, respectively, whereas these rates gradually increased after 2020.</p><p><strong>Conclusion: </strong>The total number of patients with spontaneous SAH remained relatively constant, whereas both the ASR and overall crude fatality rate declined. A national shift in treatment modalities was observed, with coiling surpassing clipping and admissions to secondary hospitals exceeding those to tertiary hospitals. Regional disparities in health care utilization were identified, highlighting the need for a locally accountable health care system in health care policy.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 29","pages":"e171"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12303661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Difference in Lymphocyte Subset Counts According to Disease Severity and SARS-CoV-2 Variants of Hospitalized COVID-19 Patients in Korea.","authors":"Heayeon Lee, Bora Lee, Sei Won Kim, Chang Dong Yeo, Sang Haak Lee, Jihyang Lim","doi":"10.3346/jkms.2025.40.e172","DOIUrl":"10.3346/jkms.2025.40.e172","url":null,"abstract":"<p><strong>Background: </strong>The studies about the characteristics of immune systems and lymphocyte subset counts regarding coronavirus disease 2019 (COVID-19) have been conducted in a number of ways, however studies on the difference of lymphocyte subset counts according to each severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant are rare. As each country has a different quarantine system, it is necessary to investigate the characteristics in places such as South Korea where the vaccination rate is high and a thorough national quarantine system is being operated. The aim of this study was to investigate the difference in peripheral blood lymphocyte subset counts in COVID-19 patients in South Korea according to their disease severity and SARS-CoV-2 variants.</p><p><strong>Methods: </strong>A total of 148 hospitalized COVID-19 patients enrolled in this study at Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea. SARS-CoV-2 infection was confirmed using real-time quantitative polymerase chain reaction and COVID-19 severity was divided into three groups (mild, moderate, and severe) at the time of admission, according to the treatment types of oxygen support. Laboratory tests were performed for evaluation of inflammatory status. The peripheral lymphocyte subset counts were analyzed using flow cytometry at the time of admission in all 148 patients and after treatment in 65 patients with moderate or severe severity. We analyzed the changes of peripheral lymphocyte subset counts according to three COVID-19 severity groups and three SARS-CoV-2 variants (wild and alpha, delta and omicron variants).</p><p><strong>Results: </strong>At admission, total T, CD4+ T, CD8+ T, natural killer (NK), and NKT cell counts decreased, but B cells did not change significantly depending on severity. There were markedly decreased in total T, CD4+ T, CD8+ T, and NK cells in the delta and omicron variants and not in the wild and alpha variant. After treatment in patients with moderate or severe severity, most lymphocyte subset counts were increased except the NK cells. Lower total lymphocyte counts, especially total T lymphocyte counts were associated with a higher occurrence of severe COVID-19.</p><p><strong>Conclusion: </strong>The peripheral lymphocyte subset counts decreased according to disease severity and the types of SARS-CoV-2 variants in hospitalized COVID-19 patients. Despite the efficient operation of the national quarantine system and high vaccination rates in South Korea, it suggests that viral mutations evolve in a direction that further weakens the immune system. This is the only study on the difference in peripheral lymphocyte subset counts according to COVID-19 severity and SARS-CoV-2 variants conducted in South Korea, and therefore our data could be used as an important reference for another pandemic situation in the future.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 29","pages":"e172"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12303659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Voxel-Based Morphometric Analysis of the Mini-Mental State Examination and the Mini-Mental State Examination-2 in Patients With Mild Cognitive Impairment and Alzheimer's Disease in Korea.","authors":"Min Jae Baek, Jae-Won Jang, Young Ho Park, SangYun Kim","doi":"10.3346/jkms.2025.40.e167","DOIUrl":"10.3346/jkms.2025.40.e167","url":null,"abstract":"<p><strong>Background: </strong>This study investigated the association between the Mini-Mental State Examination-2 (MMSE-2) and the Korean version of the Mini-Mental State Examination (K-MMSE) scores with global cortical gray matter volume changes in healthy older adults, patients with mild cognitive impairment (MCI), and Alzheimer's Disease (AD) in Korea. Using voxel-based morphometry analysis of structural magnetic resonance imaging (MRI), we explored how these correlations evolve with the progression of cognitive impairment. Additionally, we identified brain regions linked to the newly added components of MMSE-2, such as story memory and processing speed.</p><p><strong>Methods: </strong>A total of 22 patients with MCI, 11 patients with AD, and 10 healthy controls were enrolled based on a comprehensive neuropsychological assessment. All participants underwent brain MRI within six months of completing both the MMSE-2 and K-MMSE. MRI data were acquired using T1-weighted three-dimensional spoiled gradient echo sequences on a Philips Intera Achieva 3.0T scanner. Image preprocessing and analysis were conducted using MATLAB and Statistical Parametric Mapping (SPM5). Multiple regression analysis was performed to compare gray matter volumes across groups, with adjustments for age and education. Statistical significance was set at <i>P</i> = 0.005 with a voxel threshold of 100, and brain atrophy regions were identified using Talairach Client 2.4.2.</p><p><strong>Results: </strong>MMSE-2 scores demonstrated stronger and more extensive correlations with gray matter volume than K-MMSE scores. Specifically, MMSE-2: Brief Version was associated with the left fusiform gyrus and left inferior temporal gyri, while MMSE-2: Standard Version extended its correlations to include regions such as the hippocampus. Notably, MMSE-2: Expanded Version (EV) exhibited the most robust and widespread associations, involving frontal, temporal, and occipital regions. In contrast, K-MMSE scores showed more limited regional correlations, primarily focusing on the fusiform gyrus, hippocampus, and cuneus.</p><p><strong>Conclusion: </strong>The MMSE-2 demonstrated broader and stronger associations with cortical gray matter volume compared to the K-MMSE. In particular, MMSE-2:EV emerged as a more effective cognitive screening tool in clinical settings due to its widespread correlations across key brain regions, including the frontal lobe-a region inadequately assessed by the K-MMSE. These findings highlight the enhanced sensitivity of MMSE-2 in detecting structural brain changes associated with cognitive decline.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 29","pages":"e167"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12303662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Strategies to Improve Outcomes in Patients With Giant Cell Myocarditis: A Case Series of Five Biopsy-Proven Cases.","authors":"Minjung Bak, Jinyoung Lee, Minseok Hong, Darae Kim, Jin-Oh Choi, Jung-Sun Kim, Jeong Hoon Yang","doi":"10.3346/jkms.2025.40.e221","DOIUrl":"10.3346/jkms.2025.40.e221","url":null,"abstract":"<p><p>Giant cell myocarditis (GCM) is a rare but severe disease with high morbidity and mortality, often requiring heart transplantation (HT). While immunosuppressive therapy has improved outcomes, recurrence after HT remains high, and long-term survival without transplantation is also limited. This case series presents five biopsy-confirmed GCM cases, highlighting clinical characteristics and strategies to improve prognosis. A retrospective analysis was conducted on five GCM patients at Samsung Medical Center (2004-2024). The median age was 57.8 years, and 40% had underlying autoimmune diseases. All patients presented with fulminant heart failure, requiring vasopressor support or mechanical circulatory support (MCS). Early diagnosis facilitated targeted therapy, improving outcomes in select cases. Two patients achieved long-term survival without recurrence. One patient recovered cardiac function and avoided in-hospital mortality but was later readmitted due to infection and subsequently died. The remaining two patients underwent HT but died during hospitalization due to post HT complications. Timely histologic confirmation, early immunosuppressive therapy, and appropriate MCS bridging are critical in GCM management. Larger studies are needed to validate these findings.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 29","pages":"e221"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12303660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Patch-Type Electrocardiography Is Superior to Holter Monitoring for Detecting Paroxysmal Cardiac Arrhythmias.","authors":"Yun Gi Kim, Jong-Il Choi, Il-Young Oh, Joo Hee Jeong, Hyoung Seok Lee, Yun Young Choi, Ji Hyun Lee, Youngjin Cho, Jaemin Shim, Ho Sung Son, Young-Hoon Kim","doi":"10.3346/jkms.2025.40.e168","DOIUrl":"10.3346/jkms.2025.40.e168","url":null,"abstract":"<p><strong>Background: </strong>Patch-electrocardiography (ECG) enables prolonged ECG monitoring beyond 24 hours. However, diagnostic yield between patch-ECG and Holter monitoring needs further validation. We aimed to compare diagnostic capabilities of 14-day patch-ECG and one day Holter monitoring to detect cardiac arrhythmias.</p><p><strong>Methods: </strong>Patients with suspected cardiac arrhythmias but could not be diagnosed by 12-lead ECG were enrolled from two tertiary centers. Patch-ECG and Holter monitoring was attached simultaneously in enrolled patients. Primary endpoint was detection of major arrhythmias which was defined as atrial fibrillation (AF), atrial tachycardia, atrial flutter, paroxysmal supraventricular tachycardia (PSVT), ventricular tachycardia, 2nd or 3rd degree atrioventricular block, sick pause (> 2 seconds of pause), sick sinus syndrome, tachycardia-bradycardia syndrome, and Wolff-Parkinson-White syndrome.</p><p><strong>Results: </strong>A total of 147 patients were analyzed. Major arrhythmias were detected in 75.5% and 48.3% in patch-ECG and Holter monitoring, respectively (<i>P</i> < 0.001). Detection rate between the first day of patch-ECG and Holter monitoring was identical. Detection rate for AF was significantly higher in patch-ECG (23.8% vs. 11.6%; <i>P</i> < 0.001). Substantial proportion of AF events were detected in the first day of monitoring (42.9%) but diagnosis rate increased steadily between day 2-14 of monitoring. Detection rate of supraventricular tachycardia (atrial tachycardia or PSVT), ventricular tachycardia, and brady-arrhythmias was higher in the patch-ECG. Four patients had to detach their patch-ECG due to skin side effects.</p><p><strong>Conclusion: </strong>Patch-ECG has higher diagnostic capabilities compared to Holter monitoring for diagnosis of various cardiac arrhythmias.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 28","pages":"e168"},"PeriodicalIF":2.3,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12284308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Epidemiology of Cardiovascular Autonomic Neuropathy in Peoples With Long-Standing Diabetes.","authors":"Sook Jung Lee, Chong Hwa Kim, Su Jin Jeong, Jae-Seung Yun, Jong Chul Won, Jae Hyuk Lee, Ie Byung Park, Chang Won Lee, Hyuk-Sang Kwon, Tae Sun Park","doi":"10.3346/jkms.2025.40.e154","DOIUrl":"10.3346/jkms.2025.40.e154","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular autonomic neuropathy (CAN) is a frequently underdiagnosed complication of diabetes mellitus that contributes to increased mortality and morbidity rates. This multicenter study investigated the epidemiology and clinical characteristics of CAN in patients with long-term diabetes.</p><p><strong>Methods: </strong>Retrospective data were collected from 884 individuals with diabetes who were assessed for CAN across eight hospitals in Korea. CAN was diagnosed using electrocardiography and cardiovascular autonomic function tests, including the heart rate-corrected QT interval and Ewing's method. This study evaluated the clinical characteristics, cardiovascular autonomic nerve function test results, and risk factors associated with CAN.</p><p><strong>Results: </strong>Among the 884 patients, 778 (88%) were diagnosed with CAN (DCAN), while 106 (12%) were not (non-DCAN). Individuals with DCAN were older, had a longer duration of diabetes, and had higher creatinine levels. The DCAN group showed decreased time and frequency parameters of heart rate variability (HRV). A multiple logistic regression analysis revealed that a longer diabetes duration, older age, and higher creatinine level were significant risk factors for CAN.</p><p><strong>Conclusion: </strong>CAN was associated with advanced age, a longer duration of diabetes, higher creatinine levels, and lower time and frequency HRV parameters.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 28","pages":"e154"},"PeriodicalIF":2.3,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12284305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outbreak of Severe Obesity and Metabolic Complications in Children and Adolescents Using the Korea National School Health Examination (KNSHE) From 2017 to 2021.","authors":"Kyung Hee Kim, Hye Ah Lee, Jung Eun Choi, Eunji Mun, Rosie Lee, Hyesook Park, Hae Soon Kim","doi":"10.3346/jkms.2025.40.e160","DOIUrl":"10.3346/jkms.2025.40.e160","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to estimate the prevalence of obesity in school children by severity and to assess the coronavirus disease 2019 (COVID-19) pandemic's impact on changes in the prevalence of obesity. In addition, the prevalence of obesity-related metabolic complications was calculated.</p><p><strong>Methods: </strong>We used data from 390,580 school-aged children in the 2017-2021 Korea National School Health Examination to estimate the prevalence of obesity and assess secular trends in prevalence. We estimated the prevalence of metabolic complications in overweight and obese students with serological data and assessed their association with the degree of obesity, which was classified as overweight, obesity, and severe obesity per the criteria of the American Academy of Pediatrics.</p><p><strong>Results: </strong>In 2021, the prevalence of overweight, obesity, and severe obesity among school children was 12.5%, 17.6%, and 4.9%, respectively, for boys and 10.8%, 11.9%, and 2.9%, respectively, for girls, and these values have been increasing significantly since 2017. Compared with the pre-COVID-19 period, the increase in the prevalence of obesity and severe obesity was remarkable, especially in elementary school students. The linear relationship between the prevalence of metabolic complications and the degree of obesity was evident in high school students. In elementary school students, similar relationships were found with nonalcoholic fatty liver disease and high blood pressure.</p><p><strong>Conclusion: </strong>The severity of obesity in school-age children (especially younger children) is worsening, and this may predict an increase in the prevalence of related metabolic complications. To prevent long-term complications, it is essential to expand health screening programs.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"40 28","pages":"e160"},"PeriodicalIF":2.3,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12284304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}