Clinical Practice Guidelines for Managing Frailty in Community-Dwelling Korean Elderly Adults in Primary Care Settings / 가정의학회지

Aging has become a global problem, and the interest in healthy aging is growing. Healthy aging involves a focus on the maintenance of the function and well-being of elderly adults, rather than a specific disease. Thus, the management of frailty, which is an accumulated decline in function, is important for healthy aging. The adaptation method was used to develop clinical practice guidelines on frailty management that are applicable in primary care settings. The guidelines were developed in three phases: preparation (organization of committees and establishment of the scope of development), literature screening and evaluation (selection of the clinical practice guidelines to be adapted and evaluation of the guidelines using the Korean Appraisal of Guidelines for Research and Evaluation II tool), and confirmation of recommendations (three rounds of Delphi consensus and internal and external reviews). A total of 16 recommendations (five recommendations for diagnosis and assessment, 11 recommendations for intervention of frailty) were made through the guideline development process. These clinical practice guidelines provide overall guidance on the identification, evaluation, intervention, and monitoring of frailty, making them applicable in primary care settings. As aging and “healthy aging” become more and more important, these guidelines are also expected to increase in clinical usefulness.

Updates of adult immunization in Korea

An increase in the number of patients with infectious diseases in Korea, can be attributed to various factors, such as the prevalence of new infectious diseases of the 21st century, the re-emergence of past infectious diseases, an increase in the number of elderly individuals, patients with chronic diseases, immune deficiency, and globalization. In this context, vaccination becomes vital for the adult population. Although, the guidelines for adult immunization are currently being updated, the rate of adult vaccination remains lower than that of infant vaccination. At present, the major challenges for increasing the rate of adult immunization include negative views on the need for some immunizations and a lack of understanding of group immunity among the youth. Consequently, a successful immunization program will be required to direct efforts towards educating patients and spreading awareness. Based on the current guidelines and practical applications, varicella zoster; Japanese encephalitis; tetanus, diphtheria, and pertussis; pneumococcus; measles, mumps, and rubella; and hepatitis A vaccines could effectively be considered for adult vaccination.

Case of the Index Patient Who Caused Tertiary Transmission of COVID-19 Infection in Korea: the Application of Lopinavir/Ritonavir for the Treatment of COVID-19 Infected Pneumonia Monitored by Quantitative RT-PCR

Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.

Updates of adult immunization in Korea

An increase in the number of patients with infectious diseases in Korea, can be attributed to various factors, such as the prevalence of new infectious diseases of the 21st century, the re-emergence of past infectious diseases, an increase in the number of elderly individuals, patients with chronic diseases, immune deficiency, and globalization. In this context, vaccination becomes vital for the adult population. Although, the guidelines for adult immunization are currently being updated, the rate of adult vaccination remains lower than that of infant vaccination. At present, the major challenges for increasing the rate of adult immunization include negative views on the need for some immunizations and a lack of understanding of group immunity among the youth. Consequently, a successful immunization program will be required to direct efforts towards educating patients and spreading awareness. Based on the current guidelines and practical applications, varicella zoster; Japanese encephalitis; tetanus, diphtheria, and pertussis; pneumococcus; measles, mumps, and rubella; and hepatitis A vaccines could effectively be considered for adult vaccination.

Case of the Index Patient Who Caused Tertiary Transmission of COVID-19 Infection in Korea: the Application of Lopinavir/Ritonavir for the Treatment of COVID-19 Infected Pneumonia Monitored by Quantitative RT-PCR

Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.

Updates of adult immunization in Korea

An increase in the number of patients with infectious diseases in Korea, can be attributed to various factors, such as the prevalence of new infectious diseases of the 21st century, the re-emergence of past infectious diseases, an increase in the number of elderly individuals, patients with chronic diseases, immune deficiency, and globalization. In this context, vaccination becomes vital for the adult population. Although, the guidelines for adult immunization are currently being updated, the rate of adult vaccination remains lower than that of infant vaccination. At present, the major challenges for increasing the rate of adult immunization include negative views on the need for some immunizations and a lack of understanding of group immunity among the youth. Consequently, a successful immunization program will be required to direct efforts towards educating patients and spreading awareness. Based on the current guidelines and practical applications, varicella zoster; Japanese encephalitis; tetanus, diphtheria, and pertussis; pneumococcus; measles, mumps, and rubella; and hepatitis A vaccines could effectively be considered for adult vaccination.

Case of the Index Patient Who Caused Tertiary Transmission of COVID-19 Infection in Korea: the Application of Lopinavir/Ritonavir for the Treatment of COVID-19 Infected Pneumonia Monitored by Quantitative RT-PCR

Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.

Child injury death statistics from 2006 to 2016 in the Republic of Korea

This study aimed to analyze changing trends in child injury deaths from 2006 to 2016 and to provide basic data for initiatives to help prevent child injury deaths through improvements in social systems and education. Specific causes of death were analyzed using micro-data of the death statistics of Korea from 2006 to 2016, which were made available by Statistics Korea. Types and place of death were classified according to the KCD-7 (Korean Standard Classification of Diseases and Causes of Death). The data were compared to those of other Organization for Economic Cooperation and Development countries. Changing trends were presented. The number of child deaths by injury was 270 in 2016. The death rate was 8.1 per 100,000 population in 2006, while it was 3.9 in 2016. The death rate of boys was 1.7 times greater than that of girls. Unintentional injury deaths comprised 72.6% of all child injury deaths in 2016, while intentional injury deaths comprised 27.4%. The first leading cause of unintentional injury deaths in infants (less than 1-year-old) was suffocation, while that of children aged 1 to 14 years was transport accidents. The second leading cause of death in infants was transport accidents, that of children aged 1 to 4 was falling, and that of children aged 5 to 14 was drowning. Pedestrian accidents comprised 43.7% of the transport accidents from 2014 to 2016. To prevent child injury deaths by both unintentional and intentional causes, nation-wide policy measures and more specific interventions according to cause are required.

Associations of Breastfeeding Duration and Reproductive Factors with Sarcopenia in Elderly Korean Women: A Cross-Sectional Study from the Korea National Health and Nutrition Examination Survey 2010–2011 / 가정의학회지

BACKGROUND: Several studies have suggested that breastfeeding has a positive effect on long-term obesity, diabetes, hypertension, and hyperlipidemia. This study aimed to examine maternal bone health, muscle mass, and obesity based on breastfeeding duration. METHODS: This study was based on the Korea National Health and Nutrition Examination Survey 2010–2011. We selected 2,027 elderly women by screening survey participants with a history of delivery. Multivariate logistic regression analyses were performed to estimate the odds ratios (ORs) of sarcopenia, osteoporosis, and obesity among four breastfeeding groups. RESULTS: The OR of sarcopenia significantly decreased with increasing breastfeeding duration (OR, 0.27; 95% confidence interval [CI], 0.11–0.65; P for trend <0.001), whereas the OR of obesity significantly increased with increasing breastfeeding duration (OR, 2.56; 95% CI, 1.43–4.60; P for trend=0.009) after adjusting for potential confounding variables. We also found a positive correlation between the duration since last delivery and sarcopenia. CONCLUSION: Our results suggest a negative correlation between prolonged breastfeeding and the prevalence of sarcopenia, and a positive correlation between prolonged breastfeeding and the prevalence of obesity. Further studies are needed to clarify the relationship between breastfeeding and sarcopenia in the future.

Use of hypnotics and the risk of or mortality from heart disease: a meta-analysis of observational studies

BACKGROUND/AIMS: Some observational epidemiologic studies have reported conflicting results on the relationship between hypnotics use and the risk of developing and/or dying from heart disease. We investigated these associations using a meta-analysis of available literatures. METHODS: We searched the databases PubMed and EMBASE, along with the bibliographies of relevant articles to find additional publications in February 2016. RESULTS: Of 495 articles satisfying our initial criteria, two case-control studies and six cohort studies met our inclusion criteria and were included in the final analyses. Compared with never having used any kind of hypnotics, the odds ratio for overall use was 0.84 for risk of or mortality from heart disease (95% confidence interval, 0.79 to 0.89) in a random-effects meta-analysis of all eight studies. With respect to the geographical region, use of hypnotics was associated with a decreased risk or mortality of heart disease in Asia but not in Western countries. Among various types of sleep medications, zolpidem showed a decreased risk (–29%) of developing or dying from heart disease, but benzodiazepines were related with an increased risk (80%) of or mortality from heart disease. CONCLUSIONS: The current meta-analysis of observational epidemiological studies suggested an evidence of association between hypnotics use and a decreased risk of heart disease.

Efforts to reflect on and resolve sexual violence in the medical field in Korea

Some coercive aspects of culture in the medical field that have traditionally been regarded as routine practice are now gradually changing in the aftermath of the MeToo movement that has come to Korea, due to improved awareness of sexual violence. It is important for the medical community to endeavor to eradicate sexual violence by implementing the measures against sexual violence proposed by medical organizations, including the Korean Medical Women's Association. The medical field should undergo a self-purification process, so that medical personnel can change themselves and their own behavior in the context of the medical profession, which is a noble occupation that deals with life-and-death matters. As such, essential elements of the training system of doctors should be maintained. Developing action plans to properly deal with sexual violence incidents in medical institutions can be considered the first step in this process.

Historical footsteps of Korean women doctors during modernization in Korea

Women doctors played an exceptional role during the period of modernization in Korea, making tremendous contributions toward the development of Korean society. The first woman doctor, Esther Park, started a community service program for women in adverse circumstances, but later, expanded it to serve both men and women equally. Esther Park's spirit of service earned her tremendous respect and inspired later generations of women doctors, whose contributions and competences have been acknowledged, and who made steps toward establishing and demanding sexual equality between men and women. In addition, women doctors have contributed to informing people on about important health issues, administering treatment, and preventing of disease. All these considerations demonstrate that during the modernization of Korea, women doctors played a crucial role in the national liberation movement. The most important aspect of this period was that women became role models in many parts of society and pioneered the path toward sexual equality. They became a symbol of responsibility and collective leadership for the following generations, and women doctors, in particular, were notable examples of the spirit of leadership.

Global reach of Korean women doctors

Korean women doctors have expanded their activities globally in various fields within the international community. This study conducted face-to-face interviews or e-mail surveys of representatives among internationally active women doctors with experience in working with the Medical Women's International Association and the World Health Organization. Conveying the activities of these senior women doctors will be valuable to the younger generation of doctors who are interested in international health and who aspire to become potential leaders in the international health care scene in the future.

A qualitative study on leadership experiences of women doctors in Korea

This study was designed to explore women doctors' leadership experiences and to identify mechanisms of leadership development based on their experiences. Between November 1 and December 18, 2017, in-depth interviews were conducted with 12 women doctors whose professional roles included being the dean of a college of medicine, director of a university hospital system, director of a government institution, and member of the National Assembly. Twelve meaningful experiences were discovered, and 10 mechanisms and several action steps for developing women doctors' leadership were drawn from the interviews. Firstly, women doctors' leadership experiences can be divided into 4 periods: experiences before entering medical school, time during medical school, the training process, and experiences after completing board certification as a clinical specialist or PhD candidate. These periods were respectively designated as an unaffected leap, temporary break, involuntary interruption, and voluntary leap forward. Secondly, based on these results, 10 mechanisms for leadership development were identified. These included an intimate relationship with one's father, curiosity and concerns about various themes, accepting opportunities that arise, work-life balance from an individual perspective, promotion of social concerns regarding the under-representation of medical leaders, removal of traditional stereotypes about women doctors, remedies for invisible discrimination (glass ceiling) from a social perspective, as well as the provision of equal leadership experience and opportunities, the promotion of active mentoring, and the extension of formal and informal networks from an educational perspective. Currently, 25% of doctors are women, and they are not a token group any more. In order to resolve women's under-representation in medical leadership, practical and concrete efforts in individual, social, and educational domains, which are appropriate and adaptable to Korean culture, are needed.

How to write a death certificate: from a statistical point of view

Although the enclosed rate of death certificates has steadily improved when domestic death notification to the government, the percent of well-certified causes of death is still 29th among the 35 Organization for Economic Cooperation and Development countries. The death certificate is a medical diagnosis how the deceased died, however, it is difficult to identify the causes of death such as cardiopulmonary arrest, unknown, and death due to old age were up to about 11%. The Statistics Korea selects the final cause of death by linking administrative records such as national health insurance records and national cancer registry data. The World Health Organization's the international statistical classification of diseases and related health problems, 10th revision, volume 2 manual, provides standard forms of death certificate and guidelines for how to write death certificates. It is necessary to provide the education materials or programs to the clinical doctors such as how differentiate the concepts of the underlying cause of death which is the basis of the death cause statistics, originating antecedent cause, main condition and the direct diagnosis of the death. Statistics on the causes of death are continuously needed to improve for the people's perception of death and to upgrade the quality of health care research and policy development.

The Association between Socioeconomic Status and Adherence to Health Check-up in Korean Adults, Based on the 2010–2012 Korean National Health and Nutrition Examination Survey / 가정의학회지

BACKGROUND: We investigated the association between socioeconomic status and adherence to health check-ups in a Korean population aged 40 years or older. METHODS: This cross-sectional study included 12,311 participants who participated in the 2010–2012 Korean National Health and Nutrition Examination Survey. Self-reported questionnaires were used to assess each participant's socioeconomic status (household income, occupation, and education) and adherence to health check-ups. RESULTS: Men with a higher income (highest vs. lowest: odds ratio [OR], 1.799; 95% confidence interval [CI], 1.296–2.497) and men with a higher education level (≥12 vs. < 6 years: OR, 1.488; 95% CI, 1.078–2.054) and office workers compared with manual workers (men: OR, 1.431; 95% CI, 1.077–1.902; women: OR, 1.783; 95% CI, 1.256–2.532) appeared to undergo more health check-ups. In particular, men and women with a higher income and education appeared more likely to undergo opportunistic health check-ups (men: highest vs. lowest income: OR, 2.380; 95% CI, 1.218–4.653; ≥12 vs. < 6 years education: OR, 2.121; 95% CI, 1.142–3.936; women: highest vs. lowest income: OR, 4.042; 95% CI, 2.239–7.297; ≥12 vs. < 6 years education: OR, 2.475; 95% CI, 1.283–4.775). CONCLUSION: A higher socioeconomic status was associated with a higher rate of participation in health check-ups. More efforts are needed to identify the factors associated with disparity in adherence to health check-ups.

Cause-of-death statistics in 2016 in the Republic of Korea

This study aimed to analyze changes in the causes of death in the Korean population in 2016 and to provide some insights regarding how to cope with related issues of public health and welfare. The causes of death made available by Statistics Korea were classified according to the International Statistical Classification of Diseases and Related Health Problems, 10th revision as well as the KCD-7 (Korean Standard Classification of Diseases and Causes of Death), which has been modified to fit circumstances in Korea. The total number of deaths was 280,827, which was an increase of 4,932 (1.8%) from 2015. The crude death rate was 549.4 per 100,000 population, which was an increase of 7.9 (1.5%) from 2015. The 10 leading causes of death, in order, were malignant neoplasms, heart diseases, cerebrovascular diseases, pneumonia, intentional self-harm, diabetes mellitus, chronic lower respiratory diseases, liver diseases, hypertensive diseases, and transport accidents. The rank of hypertensive diseases rose from 10th in 2015 to 9th in 2016, while that of transfer accidents dropped from 9th in 2015 to 10th in 2016. The proportion of the number of deaths caused by cancer was 27.8%. The death rate due to cancer was 153.0 per 100,000 population, which was an increase of 1.4% from 2015; 16.5 deaths per 100,000 population were due to colon cancer, and 16.2 were due to stomach cancer. The above trends in causes of death reflect aspects of the population structure, disease patterns, lifestyle, and medical care in present-day Korean society.

Efforts to reflect on and resolve sexual violence in the medical field in Korea

Some coercive aspects of culture in the medical field that have traditionally been regarded as routine practice are now gradually changing in the aftermath of the MeToo movement that has come to Korea, due to improved awareness of sexual violence. It is important for the medical community to endeavor to eradicate sexual violence by implementing the measures against sexual violence proposed by medical organizations, including the Korean Medical Women's Association. The medical field should undergo a self-purification process, so that medical personnel can change themselves and their own behavior in the context of the medical profession, which is a noble occupation that deals with life-and-death matters. As such, essential elements of the training system of doctors should be maintained. Developing action plans to properly deal with sexual violence incidents in medical institutions can be considered the first step in this process.

How to write a death certificate: from a statistical point of view

Although the enclosed rate of death certificates has steadily improved when domestic death notification to the government, the percent of well-certified causes of death is still 29th among the 35 Organization for Economic Cooperation and Development countries. The death certificate is a medical diagnosis how the deceased died, however, it is difficult to identify the causes of death such as cardiopulmonary arrest, unknown, and death due to old age were up to about 11%. The Statistics Korea selects the final cause of death by linking administrative records such as national health insurance records and national cancer registry data. The World Health Organization's the international statistical classification of diseases and related health problems, 10th revision, volume 2 manual, provides standard forms of death certificate and guidelines for how to write death certificates. It is necessary to provide the education materials or programs to the clinical doctors such as how differentiate the concepts of the underlying cause of death which is the basis of the death cause statistics, originating antecedent cause, main condition and the direct diagnosis of the death. Statistics on the causes of death are continuously needed to improve for the people's perception of death and to upgrade the quality of health care research and policy development.

Historical footsteps of Korean women doctors during modernization in Korea

Women doctors played an exceptional role during the period of modernization in Korea, making tremendous contributions toward the development of Korean society. The first woman doctor, Esther Park, started a community service program for women in adverse circumstances, but later, expanded it to serve both men and women equally. Esther Park's spirit of service earned her tremendous respect and inspired later generations of women doctors, whose contributions and competences have been acknowledged, and who made steps toward establishing and demanding sexual equality between men and women. In addition, women doctors have contributed to informing people on about important health issues, administering treatment, and preventing of disease. All these considerations demonstrate that during the modernization of Korea, women doctors played a crucial role in the national liberation movement. The most important aspect of this period was that women became role models in many parts of society and pioneered the path toward sexual equality. They became a symbol of responsibility and collective leadership for the following generations, and women doctors, in particular, were notable examples of the spirit of leadership.