Journal of Korean Medical Science最新文献

{"title":"Impact of the COVID-19 Pandemic on Treatment Outcomes and Healthcare Utilization Among People Living With HIV in Korea: A Multicenter Cohort Study.","authors":"EunKyung Nam, Jun Yong Choi, Jung Ho Kim, Young Keun Kim, Sang Il Kim, Dae Won Park, Won Suk Choi, Jin-Soo Lee, Joon Young Song, Boyoung Park, Sunghee Hong, Kyoung Hwan Ahn, Shin-Woo Kim","doi":"10.3346/jkms.2026.41.e337","DOIUrl":"10.3346/jkms.2026.41.e337","url":null,"abstract":"<p><strong>Background: </strong>The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare delivery worldwide, raising concerns about continuity of care for people living with HIV (PLWH). However, its long-term effect on HIV treatment outcomes in resource-rich settings with robust public health infrastructure remains unclear. Therefore, this study aims to evaluate the effects of the COVID-19 pandemic on virological outcomes, immunological status, healthcare utilization, medication adherence, and mortality among PLWH enrolled in the Korea HIV/AIDS Cohort.</p><p><strong>Methods: </strong>A retrospective longitudinal analysis was conducted using the Korea HIV/AIDS Cohort data collected between 2018 and 2023. Outcomes during the pre-pandemic (2018-2019) and pandemic (2020-2023) periods were compared. The primary outcome was virological failure, defined as an HIV RNA level ≥ 200 copies/mL. Secondary outcomes included CD4+ T-cell count, opportunistic infections, visit adherence (≥ 2 clinic visits/year), all-cause mortality, and visual analog scale-assessed self-reported medication adherence. Repeated-measures analyses were performed using generalized estimating equations with an exchangeable correlation structure, adjusted for age and sex. Mortality risk was evaluated using Cox proportional hazards models, with subgroup and sensitivity analyses also performed.</p><p><strong>Results: </strong>Overall, 1,674 patients contributed 9,721 visits. Virological failure decreased from 3.2% pre-pandemic to 1.2% during the pandemic (adjusted odds ratio [OR], 0.37; 95% confidence interval [CI], 0.27-0.50; <i>P</i> < 0.001). CD4+ T-cell counts were higher during the pandemic (β = +33.2 cells/mm³; 95% CI, 23.3-43.1; <i>P</i> < 0.001). Medication adherence improved from 85.3% to 90.2% (adjusted OR, 1.58; <i>P</i> < 0.001), despite reduced visit adherence (81.6% to 60.5%; adjusted OR, 0.49; 95% CI, 0.45-0.54; <i>P</i> < 0.001). All-cause mortality did not differ between periods (hazard ratio, 0.32; 95% CI, 0.07-1.51; <i>P</i> = 0.151), with consistent findings across subgroup and sensitivity analyses.</p><p><strong>Conclusion: </strong>Despite reduced clinic utilization during the COVID-19 pandemic, PLWH in Korea maintained or improved virological and immunological outcomes. These observational findings support the feasibility of less intensive monitoring for selected virologically stable individuals. However, given the potential for survivorship bias and unmeasured confounding, prospective studies are required before changes to monitoring practice can be recommended.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 38","pages":"e337"},"PeriodicalIF":3.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127841","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":"Insulin Resistance and Hepatocellular Carcinoma Development in Chronic Hepatitis B Patients Under Antiviral Therapy.","authors":"Dong Hyun Sinn, Kyung-Ah Kim, Jung Il Lee, Geum-Youn Gwak","doi":"10.3346/jkms.2026.41.e248","DOIUrl":"10.3346/jkms.2026.41.e248","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) remains a significant concern in patients with liver cirrhosis due to chronic hepatitis B virus (HBV) infection, even among those who achieve a virological response with antiviral therapy. This study aimed to evaluate whether insulin resistance (IR), assessed using the Homeostatic Model Assessment 2 for Insulin Resistance (HOMA2-IR) index, can serve as a surrogate marker for stratifying HCC risk in this population.</p><p><strong>Methods: </strong>In this multicenter prospective cohort study, 334 patients with HBV-related cirrhosis who achieved virological response to nucleos(t)ide analogue therapy were enrolled. The primary outcome was the incidence of HCC during follow-up. Baseline HOMA2-IR was calculated using serum C-peptide and fasting glucose levels.</p><p><strong>Results: </strong>During a median follow-up of 7.45 years (range, 0.5-8.9 years), 62 patients (18.6%) developed HCC. In a fully adjusted Cox proportional hazards model, each unit increase in HOMA2-IR was associated with a higher risk of HCC (hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.16-2.04). Patients with HOMA2-IR ≥ 2.3 had a significantly higher 5-year cumulative incidence of HCC compared to those with HOMA2-IR < 2.3 (30.6% vs. 12.3%; adjusted HR, 2.62; 95% CI, 1.40-4.91). The association between HOMA2-IR and HCC risk was consistent across subgroups, including those with and without metabolic comorbidities such as obesity, diabetes, hypertension, or dyslipidemia.</p><p><strong>Conclusion: </strong>IR, as measured by HOMA2-IR, independently predicted HCC development in cirrhotic patients with chronic HBV infection. HOMA2-IR may serve as a useful surrogate marker for identifying high-risk individuals. Intervention trials are warranted to determine whether reducing HOMA2-IR can lower HCC risk in this population.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 38","pages":"e248"},"PeriodicalIF":3.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127874","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 of Electronic-Cigarette and Heated Tobacco Product Use Among Korean Adults From 2013 to 2023: A Cross-Sectional Study.","authors":"Jong Geol Jang, Sun-Kyung Lee, Sung Jun Chung, Yoomi Yeo, Kyung Soo Hong, Bumhee Yang, Sang Hyuk Kim, Ahn June Hong, Hyung Koo Kang, Tai Sun Park, Kyung Hoon Min, Tae-Hyung Kim, Jang Won Sohn, Ho Joo Yoon, Sang-Heon Kim, Hyun Lee","doi":"10.3346/jkms.2026.41.e259","DOIUrl":"10.3346/jkms.2026.41.e259","url":null,"abstract":"<p><strong>Background: </strong>While awareness and use of electronic cigarettes and heated tobacco products (EC/HTP) have increased in Korea over the past decade, studies on the yearly prevalence of such use are limited, as are those identifying factors associated with their use.</p><p><strong>Methods: </strong>In this study, we analyzed the prevalence, trends, and factors associated with EC/HTP use over a 10-year period (2013-2023) using the Korea National Health and Nutrition Examination Survey. The yearly prevalence of EC/HTP use was assessed, and factors related to EC/HTP use were identified.</p><p><strong>Results: </strong>Over the study period, EC/HTP use increased, especially use by males and younger study subjects, to 7.3% in 2023. While conventional cigarette use declined consistently from 24.1% in 2013 to 18.7% in 2023, EC/HTP use fluctuated; however, the overall trend was increasing, particularly among individuals in their 20s and 30s. Groups associated with EC/HTP use as identified on multivariable analyses were former smoking (adjusted odds ratio [aOR], 66.01; <i>P</i> < 0.001), current smoking (aOR, 152.43), younger age (aOR, 7.34 for ages 20-29 years; <i>P</i> < 0.001 and aOR, 7.42 for ages 30-39 years; <i>P</i> < 0.01; the reference group was those 60 years or older), higher body mass index (aOR, 1.30; <i>P</i> < 0.001), unmarried (aOR, 1.53; <i>P</i> < 0.001), and employed in managerial/professional and service/sales positions (aOR, 2.66 and 2.63, respectively; <i>P</i> < 0.001 for both).</p><p><strong>Conclusion: </strong>EC/HTP use in Korea has risen significantly, particularly among younger males, and conventional cigarette use has declined. Key factors include ever-smoking status, younger age, male, elevated BMI, unmarried, and specific occupational roles. These trends highlight the need for targeted interventions and public health strategies to address shifting modes of tobacco use.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 38","pages":"e259"},"PeriodicalIF":3.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127362","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":"Evaluation of Vaccine Cold Chain Practices in Healthcare Facilities of the Republic of Korea: A Multi-Site Cross-Sectional Study.","authors":"Cho Ryok Kang, Sumyeong Choe, Young Hwa Lee, Young June Choe, Won Suk Choi, Ji Yun Noh, Nam-Kyong Choi, Heehyun Won, Suyeon Jeong, Jong-Koo Lee","doi":"10.3346/jkms.2026.41.e240","DOIUrl":"10.3346/jkms.2026.41.e240","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated vaccine cold chain management and storage practices in Korean healthcare facilities to identify strengths and gaps, with a focus on private healthcare facilities and public health centers. We aimed to assess compliance with national guidelines and World Health Organization (WHO) recommendations on vaccine storage, handling, and emergency preparedness.</p><p><strong>Methods: </strong>A cross-sectional nationwide survey was conducted in 53 immunization service providers (43 private healthcare facilities and 10 public health centers). A structured checklist and questionnaire were used to audit equipment, temperature monitoring, inventory management, and emergency preparedness practices at each site. Key indicators were recorded.</p><p><strong>Results: </strong>All facilities had functional refrigeration for vaccines, with 53 (100.0%) having a dedicated vaccine refrigerator and 4 (7.5%) had a dedicated vaccine freezer. However, 39 facilities (73.6%) had continuous temperature monitoring devices in installed on all of their refrigeration units, and alarm systems were present in 44 (83.0%) of sites. Proper vaccine placement (center shelf, away from vents) was observed in 52 (98.1%) of facilities, and 51 facilities (96.2%) appropriately stored live vaccines to shield them from sunlight. 52 sites (98.1%) maintained up-to-date vaccine inventory records and all sites adhered to recommended procedures for disposing expired doses. Notably, 28 (52.8%) had documented emergency plans, such as a backup system, though fewer, 27 (40.9%), tested their backup power regularly.</p><p><strong>Conclusion: </strong>This nationwide audit reveals generally sound cold chain infrastructure in Korean healthcare facilities, alongside specific deficiencies. While most facilities meet basic standards for equipment and record-keeping, improvements are needed in continuous temperature monitoring, alarm systems, and emergency backup provisions. Strengthening training and oversight in these areas will help ensure vaccine potency and supply security throughout the immunization delivery system.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 37","pages":"e240"},"PeriodicalIF":3.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025166","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":"Risk of Dementia After Cholecystectomy in Older Adults: A Nationwide Retrospective Study.","authors":"Won Jae Kim, So Hyeon Gwon, Eun Lee, Hyung Soon Lee, Nak-Hoon Son, Woo Jung Kim","doi":"10.3346/jkms.2026.41.e246","DOIUrl":"10.3346/jkms.2026.41.e246","url":null,"abstract":"<p><strong>Background: </strong>Identification of factors that increase the hazard of dementia is critical for early intervention and management. Cholecystectomy, which affects the metabolism and storage of bile acid, is a potential risk factor for dementia. We aimed to determine whether cholecystectomy increases the hazard of dementia onset in older adults, regardless of subtype.</p><p><strong>Methods: </strong>This retrospective observational study used data from the Korean Health Insurance Review and Assessment Service database for patients who underwent cholecystectomy or appendectomy from 2013 to 2022. Patients aged 60 years or older who had a cholecystectomy (Q7380) were included in the study group (294,008 eligible participants; 66,021 excluded), and those who had an appendectomy (Q2861, Q2862, Q2863) were included in the control group (125,961 eligible participants; 14,963 excluded). Incidence of dementia, regardless of subtype, was defined using International Classification of Diseases 10^th Revision codes (F00, F01, F02, F03, G23.1, G30, G31.0, G31.1, G31.8). Propensity score matching and inverse probability of treatment weighting were performed for all independent variables (age, sex, hypertension, diabetes, dyslipidemia, depressive disorder, Charlson Comorbidity Index). Cox proportional hazard regression analyses were performed to assess the hazard ratio of dementia.</p><p><strong>Results: </strong>A total of 227,987 individuals (mean age 70.36 years; 51.1% male) were included in the cholecystectomy group, and 110,998 individuals (mean age 69.31 years, 45.8% male) were included in the control group. In an unadjusted Cox proportional hazards model, the hazard ratio for dementia in the cholecystectomy group was 1.148 (95% confidence interval [CI], 1.123-1.172; <i>P</i> < 0.001). This modest but statistically significant increase in the hazard of dementia in the cholecystectomy group remained consistent after model adjustment (1.071; 95% CI, 1.048-1.095; <i>P</i> < 0.001), propensity score matching (1.086; 95% CI, 1.060-1.114; <i>P</i> < 0.001), and inverse probability of treatment weighting (1.081; 95% CI, 1.066-1.096; <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Our findings indicate that cholecystectomy is associated with a modestly increased hazard of dementia after adjustment for relevant covariates. This association should be interpreted as a population-level signal rather than a clinically actionable risk factor, and may inform future research on links between cognitive decline and biliary function.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 37","pages":"e246"},"PeriodicalIF":3.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025147","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":"Income Volatility and Risk of All-Cause Mortality and Cause-Specific Hospitalization Among Adults With Depression: A Nationwide Cohort Study.","authors":"Hanseul Cho, Yerin Hwang, Hayeon Lee, Ann K Shinn, Alexander C Tsai, André Hajek, Lee Smith, Ho Geol Woo, Selin Woo, Dong Keon Yon","doi":"10.3346/jkms.2026.41.e254","DOIUrl":"10.3346/jkms.2026.41.e254","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Depression and personal income volatility are associated with adverse health outcomes through both shared and distinct pathways. However, their combined impact on long-term health outcomes remains poorly understood.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This nationwide cohort study used the National Health Insurance Service claims database of South Korea, including 735,922 adults aged 19-80 years newly diagnosed with depression in the pre-observation period (2008-2012). Depression was identified using International Classification of Diseases, Tenth Revision codes F32, F33, and F34.1. Personal income volatility was measured using the intraindividual standard deviation of annual percent income change from the same period and categorized into tertiles (low, medium, and high). Individuals were followed from the index date (January 1, 2013) through December 31, 2023 for all-cause mortality and hospitalizations across 15 major disease categories and 80 specific conditions. We estimated mortality using Cox proportional hazards regression and hospitalization using negative binomial regression, using overlap propensity score weighting across tertiles in a 1:1:1 ratio.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 735,922 adults with a recorded diagnosis of depression (mean age 46.08 years; 499,404 [67.9%] women), a total of 1,770,856 hospitalizations and 90,087 deaths were observed over 7,622,456 person-years of follow-up (mean duration, 10.3 years). Higher income volatility was associated with increased risk of all-cause mortality (high vs. low tertile: hazard ratio [HR], 1.18 [95% confidence interval, 1.16-1.19]) and hospitalization (incidence rate ratio [IRR], 1.07 [1.06-1.08]). The associations between high income volatility and all-cause mortality were more pronounced among men (HR, 1.26 [1.24-1.28]) than women (HR, 1.12 [1.10-1.14]), and among adults aged 30-49 years (HR, 1.17 [1.14-1.21]). The associations with hospitalization were also more pronounced among men (IRR, 1.08 [1.07-1.10]) than women (IRR, 1.07 [1.06-1.08]), and among those aged 50-80 years (IRR, 1.09 [1.08-1.10]). Among the 15 disease categories, hospitalization risks associated with high income volatility were greatest for blood disorders (IRR, 1.47 [1.36-1.59]), endocrine diseases (IRR, 1.40 [1.34-1.46]), respiratory diseases (IRR, 1.35 [1.27-1.43]), and mental disorders (IRR, 1.26 [1.23-1.30]), and lowest for cancer and neoplasms (IRR, 0.96 [0.92-0.99]). Among the 80 conditions, hospitalization risks associated with high income volatility were greatest for hypertensive heart disease (IRR, 1.74 [1.50-2.02]), epilepsy/seizures (IRR, 1.58 [1.46-1.71]), malnutrition (IRR, 2.08 [1.34-3.22]), and nutritional anemia (IRR, 1.85 [1.60-2.13]), among others.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Income volatility is a risk factor for increased mortality and hospitalization among individuals with depression, separable from baseline income. These findings underscore income volati","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 37","pages":"e254"},"PeriodicalIF":3.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025154","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":"Invasive Pulmonary Aspergillosis-Mimicking <i>Pseudomonas aeruginosa</i> Pneumonia in Immunocompromised Patients: Radiologic Differentiation.","authors":"Yeonjoo Choi, Yura Ahn, Choseok Yoon, Hyeon Mu Jang, Mi Young Kim, Sung-Han Kim","doi":"10.3346/jkms.2026.41.e241","DOIUrl":"10.3346/jkms.2026.41.e241","url":null,"abstract":"<p><strong>Background: </strong><i>Pseudomonas aeruginosa</i> (PA) pneumonia is occasionally misdiagnosed as invasive pulmonary aspergillosis (IPA) in immunocompromised patients because of shared risk factors and overlapping radiologic manifestations. However, this topic has not been systematically investigated.</p><p><strong>Methods: </strong>We retrospectively reviewed immunocompromised patients diagnosed with PA pneumonia between 2014 and 2023. Patients with confirmed or probable PA pneumonia were analyzed. For comparison, control patients with proven or probable IPA diagnosed between 2018 and 2023 were randomly selected. First, we tested whether two thoracic radiologists could differentiate PA pneumonia from IPA based on computed tomography (CT) findings. Second, we identified clinical and radiologic features that could help differentiation.</p><p><strong>Results: </strong>Thirty-three PA patients (15 confirmed and 18 probable) and 75 IPA control patients (15 proven and 60 probable) were analysed. Two radiologists blindly scored 33 PA and 25 IPA cases which were randomly selected from control patients. Among PA pneumonia cases, 36% (12/33) were unanimously misclassified as IPA by the two radiologists. The sensitivities of radiologist A and B for PA were 61% and 33%, respectively (fair agreement, kappa value = 0.38). We then compared the clinical features and CT findings of the 33 PA and 75 IPA patients. Clinical factors such as solid organ transplantation beyond 6 months and an acute clinical course favored PA diagnosis. PA pneumonia frequently exhibited IPA-like features, including macronodules (39%), mass-shaped consolidation (49%), and cavitation (24%). However, ill-defined centrilobular nodules and peribronchial consolidation were significantly more common in PA pneumonia (67% vs. 21% and 58% vs. 21%, respectively, <i>P</i> < 0.001). In multivariate analysis, solid organ transplantation, peribronchial consolidation, and ill-defined centrilobular nodules were independent predictors of PA pneumonia.</p><p><strong>Conclusion: </strong>Approximately one-third of patients with PA pneumonia exhibited CT findings resembling IPA. Integration of clinical contexts, especially transplant history and detailed interpretation of radiologic signs, may improve differential diagnosis between PA pneumonia and IPA.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 37","pages":"e241"},"PeriodicalIF":3.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025085","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":"Smoking Habit Change and Atrial Fibrillation Risk in Patients With Diabetes Mellitus: A Nationwide Observational Cohort Study in Korea.","authors":"Kyung-Yeon Lee, So-Ryoung Lee, JungMin Choi, Hyo-Jeong Ahn, Soonil Kwon, Bongseong Kim, Kyung-Do Han, Seil Oh, Gregory Y H Lip, Eue-Keun Choi","doi":"10.3346/jkms.2026.41.e243","DOIUrl":"10.3346/jkms.2026.41.e243","url":null,"abstract":"<p><strong>Background: </strong>Smoking and diabetes mellitus (DM) are known risk factors for atrial fibrillation (AF), but the impact of smoking habit changes on AF risk in patients with DM remains unclear. We aimed to evaluate the association between smoking habit changes and incident AF in patients with DM.</p><p><strong>Methods: </strong>Using the Korean nationwide claims database, we identified patients with DM, defined as fasting glucose ≥ 126 mg/dL or use of antidiabetic medications. Smoking habits were assessed by self-reported questionnaires from two health assessments within a two-year interval, and patients were categorized as never smokers, ex-smokers, quitters, or current smokers. The primary outcome was incident AF.</p><p><strong>Results: </strong>Among 1,354,907 patients with DM (median follow-up 5.93 years, interquartile range 5.30-6.33; mean age 60.0 years [SD 11.8], 51.0% male), current smokers had a 20% higher risk of AF than never smokers (adjusted hazard ratio [95% confidence interval], 1.20 [1.16-1.24]). While ex-smokers and quitters had lower risks than current smokers, their risk remained elevated relative to never smokers, by 8.5% (1.09 [1.04-1.13]) and 10% (1.10 [1.06-1.15]), respectively. Among patients with new-onset DM or DM duration < 5 years, quitters showed comparable AF risk to that of never smokers (1.06 [0.97-1.15] and 1.04 [0.95-1.13], respectively).</p><p><strong>Conclusion: </strong>Smoking cessation in patients with DM was associated with a lower risk of AF than continued smoking. Especially in new-onset DM, AF risk in quitters approached that of never smokers. Encouraging smoking cessation may be beneficial for preventing new-onset AF in patients with DM.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 37","pages":"e243"},"PeriodicalIF":3.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025115","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":"Changes in the Distribution of General Physicians in Korea During the 2024-2025 Medical Crisis: A Descriptive Analysis Using Nationwide HIRA Data.","authors":"Jun Young Park, Sang Gyu Lee","doi":"10.3346/jkms.2026.41.e332","DOIUrl":"10.3346/jkms.2026.41.e332","url":null,"abstract":"<p><p>In February 2024, approximately 90% of resident physicians in Republic of Korea (= South Korea) collectively resigned from training hospitals in protest of the government's plan to reform healthcare system, creating an abrupt and nationwide supply shock in the physician workforce. Using publicly available Health Insurance Review and Assessment Service data across eight timepoints (December 2022-March 2026), we describe how this shock reshaped the distribution of general physicians-licensed physicians without specialty board certification-across institution types, regions, urban-rural areas, and clinic specialties. Between December 2023 and December 2024, trainees at training hospitals declined from 13,001 to 1,208 (-90.7%), while general physicians at non-training institutions rose from 5,557 to 9,157 (+64.8%). The increase was concentrated in urban areas, capital-area clinics, and a small set of specialties dominated by dermatology, internal medicine, and aesthetic-related fields; per-population rates confirmed that Gangwon showed the smallest reallocation. Trainee numbers partially recovered by March 2026. Approximately 8,200 (≈ 69%) of the displaced trainees were not accounted for by the concurrent rise in general physicians at non-training institutions. This study is descriptive and does not itself perform causal inference; rather, it documents how a sudden physician supply expansion was absorbed by the existing healthcare market and provides an empirical foundation for future causal analyses treating this shock as a natural experiment.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 37","pages":"e332"},"PeriodicalIF":3.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025026","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":"Sex-Specific Cut-off Values for Respiratory Muscle Strength in Older Women: Screening Implications for Respiratory Sarcopenia.","authors":"Tae-Sung Park, Yunkyung Jeon, Sa-Eun Park, Ki-Hun Kim, Jae Hyun Lee, Myunghun Jang, Sang-Hun Kim, Byeong-Ju Lee, Jin A Yoon, Yong Beom Shin, Myung-Jun Shin","doi":"10.3346/jkms.2026.41.e244","DOIUrl":"10.3346/jkms.2026.41.e244","url":null,"abstract":"<p><strong>Background: </strong>To establish sex-specific cut-off values for maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) in elderly women, aiming to improve the screening of sarcopenia and to explore their implications for respiratory sarcopenia by accounting for physiological differences in muscle strength and mass.</p><p><strong>Methods: </strong>Eighty-eight older women were assessed for respiratory muscle strength (MIP, MEP), hand grip strength (HGS), and skeletal muscle mass index (SMI). Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia consensus criteria (HGS < 18 kg; SMI < 5.7 kg/m²). Pearson correlation coefficients were calculated between respiratory muscle strength and conventional sarcopenia indicators. Receiver operating characteristic (ROC) analysis was conducted to derive optimal cut-off values for MIP and MEP. Sarcopenia prevalence was compared using three threshold strategies: -1 standard deviation (SD) and -2SD from healthy young women, and the 20th percentile from age-matched older adults.</p><p><strong>Results: </strong>MIP and MEP were significantly correlated with HGS (<i>r</i> = 0.318 and 0.323, respectively) and SMI (<i>r</i> = 0.291 and 0.255, respectively). The ROC-derived cut-off values were 28.50 cmH₂O for MIP (area under the receiver operating characteristic curve [AUC] = 0.81, 95% confidence interval [CI], 0.70-0.93) and 49.50 cmH₂O for MEP (AUC = 0.78, 95% CI, 0.64-0.92), demonstrating acceptable diagnostic performance. These values identified a meaningful proportion of sarcopenic individuals and offered a favorable balance of sensitivity and specificity compared to traditional reference thresholds.</p><p><strong>Conclusion: </strong>MIP and MEP may serve as accessible and complementary indicators that support the screening of sarcopenia and provide implications for respiratory sarcopenia in elderly women. The use of sex- and age-specific cut-off values could enhance diagnostic precision and facilitate early intervention strategies for respiratory muscle decline in aging populations.</p><p><strong>Trial registration: </strong>Clinical Research Information Service Identifier: KCT0009413.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 37","pages":"e244"},"PeriodicalIF":3.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025145","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}