Clinicians and healthcare decision-makers conduct their clinical practice based on the results of clinical trials. However, some health problems remain unresolved; in such cases, further research is required. To ensure reliable research results, it is important to understand the study design and conduct well-designed clinical trials. Many study designs can be chosen within the two broad categories of observational and interventional. Clinical studies have a variety of designs, including case series, case-control, cross-sectional, and prospective and retrospective cohort studies. Well-designed clinical studies can clarify important differences between treatment options and provide data on long-term drug efficacy and safety. Interpreting the results of clinical trials can be difficult because weaknesses in research design, data collection methods, analytic methods, and reporting can compromise their value and usefulness. However, although randomized controlled trials are limited owing to ethical and practical issues, they are optimal for investigating the effects of therapy and establishing causality. Here we present an overview of different clinical research designs and review their advantages and limitations.

PURPOSE: The purpose of this study was to identify parental coping strategies in the face of early infant and toddler injury, and to provide basic data for a parental education program and the most desirable directions it should take. METHODS: A Q-methodology to analyze the subjectivity of each item was used. Thirty-four Q-statements were derived from a literature review and interviews. Forty-seven parents were classified into a shape of normal distribution using a 9-point scale. Collected data were analyzed by the pc-QUANL program. RESULTS: Five types of parental coping in early infant and toddler injury were identified. Type I was “hospital treatment focused”, type II was “Improving the safety of the child's environment”, type III was “expression of negative emotion”, type IV was “taking the lead in problem solving”, and type V was “Interrogating the person in charge of the situation in which the injury occurred”. CONCLUSION: The results of this study indicate that different approaches to educational programs can be used for parents in early childhood injury.
Adaptation, Psychological ; Child ; Education ; Humans ; Infant* ; Parents* ; Wounds and Injuries

Background: This study aims to figure out the gaps in health status by estimating amenable mortality rate by region, reflecting the characteristics of Korea, and estimating the years of life lost (YLL) per capita by disease. Methods: People who died from amenable diseases between 2008 and 2018 were extracted from the cause of death statistics provided by Statistics Korea. The age-standardized amenable mortality rates were estimated to compare the health status of 229 regions. YLL per capita was calculated to compute the burden of diseases caused by treatable deaths by region. The YLL per capita by region was calculated to identify the burden of disease caused by amenable deaths. Results: First, while the annual amenable mortality rate in Korea is on a steady decline, but there is still a considerable gap between urban and rural areas when comparing the mortality rates of 229 areas. Second, YLL per capita due to the amenable deaths is approximately 14 person-years during the analysis period (2008–2018). Conclusion Although the health status of Koreans has continuously improved, there is still a gap in health status region by region in terms of amenable mortality rates. Amenable death accounts for a loss of life equivalent to 14 person-years per year. Since the amenable mortality rate is an indicator that can measure the performance of the health care system, efforts at each local area are required to lower it.

Background: This study aims to figure out the gaps in health status by estimating amenable mortality rate by region, reflecting the characteristics of Korea, and estimating the years of life lost (YLL) per capita by disease. Methods: People who died from amenable diseases between 2008 and 2018 were extracted from the cause of death statistics provided by Statistics Korea. The age-standardized amenable mortality rates were estimated to compare the health status of 229 regions. YLL per capita was calculated to compute the burden of diseases caused by treatable deaths by region. The YLL per capita by region was calculated to identify the burden of disease caused by amenable deaths. Results: First, while the annual amenable mortality rate in Korea is on a steady decline, but there is still a considerable gap between urban and rural areas when comparing the mortality rates of 229 areas. Second, YLL per capita due to the amenable deaths is approximately 14 person-years during the analysis period (2008–2018). Conclusion Although the health status of Koreans has continuously improved, there is still a gap in health status region by region in terms of amenable mortality rates. Amenable death accounts for a loss of life equivalent to 14 person-years per year. Since the amenable mortality rate is an indicator that can measure the performance of the health care system, efforts at each local area are required to lower it.

In this comprehensive review, we discuss recent updates on tinnitus evaluation and treatment. Tinnitus evaluation commences with comprehensive medical history taking and audiological evaluation, which can provide valuable insight into the nature and extent of auditory disturbances. Additionally, tinnitus evaluation includes investigation of psychosomatic comorbidities to determine the intricate interplay between psychological factors and tinnitus perception. Various therapeutic approaches are available to minimize the burden of tinnitus. Cognitive behavioral therapy reshapes negative thought patterns and behaviors that are closely associated with tinnitus-induced distress. Acceptance and commitment therapy fosters mindfulness and value-aligned actions to address emotional effects. Tinnitus retraining therapy combines counseling and sound therapy for habituation. Tailor-made notched music therapy offers customized auditory experiences for symptom relief. Hearing aids and cochlear implants compensate for hearing loss and associated stress. Both neuromodulation and neurofeedback may be potentially useful. The role of pharmacotherapy and dietary supplements remains uncertain. Physiotherapy and head-neck manipulation relieve tinnitus associated with orofacial factors. Virtual reality, smartphone applications, and photobiomodulation may serve as novel therapeutic avenues. Although promising interventions are available, further research is warranted to confirm their effectiveness and long-term effects.

BACKGROUND/AIMS: GC7101, an extract of Lonicera Flos, is a novel developing drug for reflux esophagitis and functional dyspepsia. However, the drug's exact pharmacological mechanism of action remains unclear. This study assessed the effects of GC7101 on gastrointestinal (GI) motor function. METHODS: We used male guinea pigs to evaluate the effects of GC7101 on GI motility. The contraction of antral circular muscle in the presence of different doses of GC7101 was measured in a tissue bath. The prokinetic effects of GC7101 were tested using the charcoal transit assay from the pylorus to the most distal point of migration of charcoal mixture. To clarify the mechanism of action of GC7101, atropine, dopamine and the selective 5-hydroxytryptamine 4 receptor antagonist, GR113808 were used. RESULTS: The maximal amplitude of circular muscle contraction was induced by 5 mg mL(-1) GC7101. The area under the curve of contraction was significantly increased at 5 mg mL(-1) GC7101. Addition of 10(-6) M atropine, 10(-8) M dopamine or 10(-7) M GR 113808 to GC7101 5 mg mL(-1) decreased the amplitude and area under curve compared to GC7101 5 mg mL(-1) alone. GC7101 accelerated GI transit in a dose dependent manner except 100 mg kg(-1). Delayed GI transit caused by atropine, dopamine and GR 113808 was restored by GC7101 50 mg kg(-1). CONCLUSIONS: GC7101, an extract of Lonicera Flos, exerts a gastric prokinetic effect in guinea pig through cholinergic, antidopaminergic and serotonergic mechanisms. Therefore, GC7101 might be a novel drug for the treatment of functional dyspepsia.
Animals ; Area Under Curve ; Atropine ; Baths ; Charcoal ; Dopamine ; Dyspepsia ; Esophagitis, Peptic ; Gastrointestinal Motility ; Guinea Pigs ; Humans ; Lonicera ; Male ; Muscle Contraction ; Pylorus ; Serotonin

Metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) are differentiated by the presence of cardiometabolic risk factors (CMRFs) and insulin resistance (IR). This study aimed to evaluate the prevalence and clinical characteristics of MHO in Korean children and adolescents and to investigate the anthropometric, laboratory, and lifestyle predictors of MHO. This study included data from 530 obese subjects, aged 10–19 years, obtained from the Fourth Korea National Health and Nutrition Examination Survey. Subjects were classified into MHO and MUO groups according to the presence of CMRF (MHO(CMRF)/MUO(CMRF)) and degree of IR (MHO(IR)/MUO(IR)). Demographic, anthropometric, cardiometabolic, and lifestyle factors were compared between the groups. Logistic regression analysis and receiver operating characteristic curve analysis were performed to identify factors that predicted MHO. The prevalence of MHO(CMRF) and MHO(IR) in obese Korean youth was 36.8% (n = 197) and 68.8% (n = 356), respectively. CMRF profiles were significantly less favorable in MUO children. Longer and more vigorous physical activity and less protein intake were associated with MHO(CMRF) phenotype. The best predictors of MHO(CMRF) and MHO(IR) were waist circumference (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.77–0.88; P < 0.001) and body mass index (BMI) standard deviation score (OR, 0.24; 95% CI, 0.15–0.39; P < 0.001), respectively. The prevalence of MHO differed depending on how it was defined. To adequately manage obesity in youth, the approach to individuals with MHO and MUO should be personalized due to variation in clinical characteristics. Longitudinal studies are needed to evaluate long-term consequences of MHO.
Adolescent* ; Body Mass Index ; Child* ; Humans ; Insulin Resistance ; Korea* ; Life Style ; Logistic Models ; Longitudinal Studies ; Motor Activity ; Nutrition Surveys* ; Obesity ; Obesity, Metabolically Benign* ; Phenotype ; Prevalence* ; Risk Factors ; ROC Curve ; Waist Circumference

OBJECTIVES: "Internet-addiction" came into common use not only in clinical setting but also in everyday life. But, pathophysiology and diagnostic criteria of the internet addiction remain unknown. Because adolescents are in developing period, they might be vulnerable to the internet addiction, depression and sleep-related problem. The objectives of this study were to investigate the characteristics of internet addiction and its association with sleep pattern and depression in Korean adolescence. METHODS: Subjects were 799 middle and high school students in Seoul, Korea. We administered a self-reported questionnaire including socio-demographic data, Korean versions of Young's Internet Addiction Scale (YIAS), Pittsburgh Sleep Quality Index (PSQI), the Center for Epidemiologic Studies for Depression Scale (CES-D) and questions about internet using patterns. Data of 696 subjects were included in analysis. Chi-square tests were used to analyze proportional differences, and ANOVA with post-hoc tests were used to analyze differences among groups. Partial correlation analyses were performed to analyze the correlation of internet addiction with other variables (two-tailed, p<0.05). RESULTS: Of the 696 participants (grade 2 of middle school;M2 135 vs. grade 1 of high school;H1 238 vs. grade 2 of high school;H2 323), 2.0% (n=14) were internet-addicted (IA), 27.7% (n=193) were over-using (OU) and 70.3% (n=489) were not-addicted (NA). The mean scores of YIAS, PSQI and CES-D scores were 35.24+/-12.78, 5.53+/-3.04 and 16.72+/-8.69, respectively. In higher grade students, average total sleep time was shorter (M2 426.20+/-67.68 min. vs. H1 380.47+/-62.57 min. vs. H2 354.67+/-73.37 min., F=51.909, p<0.001), and PSQI (4.69+/-3.14 vs. 5.42+/-3.15 vs. 5.97+/-2.83, F=8.871, p<0.001) CES-D (13.53+/-8.37 vs. 16.96+/-8.24 vs. 17.87+/-8.84, F=12.373, p<0.001) scores were higher than those of lower grade students. Comparing variables among IA, OU and NA groups, computer using time not for study (96.36+/-63.31 min. vs. 134.92+/-86.79 min. vs. 213.57+/-136.87 min., F=34.287, p<0.001) and portable device using time not for study (84.22+/-79.11 min. vs. 96.97+/-91.89 min. vs. 152.31+/- 93.64 min., F=5.400, p=0.005) were different among groups. PSQI (5.26+/-2.97 vs. 6.08+/-2.97 vs. 7.50+/-4.41, F=8.218, p<0.001) and CES-D scores (15.40+/-8.08 vs. 19.05+/-8.42 vs. 30.43+/-13.69, F=32.692, p<0.001) were also different among groups. YIAS score were correlated with computer using time not for study (r=0.356, p<0.001) and portable device using time not for study (r=0.136, p<0.001). PSQI score (r=0.237, p<0.001) and CES-D score (r=0.332, p<0.001). YIAS score and PSQI score (r=0.131, p=0.001), YIAS and CES-D score (r=0.265, p<0.001), PSQI score and CES-D score (r=0.357, p<0.001) were correlated each other. CONCLUSION: These results suggested that adolescents' internet-addiction was correlated with not only computer and portable device using time not for study but also depression and sleep-related problems. We should pay attention to depression and sleep-related problems, when evaluating internet-addiction in adolescents.
Adolescent ; Depression ; Epidemiologic Studies ; Humans ; Internet ; Korea ; Porphyrins ; Surveys and Questionnaires

Familial isolated primary hyperparathyroidism(FIPH) is associated with multiple endocrine neoplasia type 1 (MEN1) syndrome, primary hyperparathyroidism accompanied by jaw-tumor syndrome, and familial hypocalciuric hypercalcemia. FIPH may be an early stage of MEN1 or an allelic variant of MEN1. Thymic carcinoid tumor is a rare tumor in MEN1 syndrome. Here, the authors report the case of a 40-year-old man diagnosed with recurrent thymic carcinoid tumor and FIPH. Both the patient and his elder sister had been previously diagnosed to have FIPH with a novel frameshift mutation in the MEN1 gene. Initially, the patient underwent thymectomy because of an incidental finding of a mediastinal mass in his chest X-ray, and had remained asymptomatic over the following 4 years. Pancreas computed tomography conducted to evaluate MEN1 syndrome revealed anterior and middle mediastinal masses, and resultantly, massive mass excision was performed. Histological findings disclosed atypical carcinoids with infiltrative margins. In view of the thymic carcinoid tumor relapse that occurred in this patient, the authors recommend that regular pancreas and pituitary imaging studies be conducted for FIPH associated with a MEN1 gene mutation.
Adult ; Carcinoid Tumor* ; Frameshift Mutation ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary* ; Incidental Findings ; Multiple Endocrine Neoplasia Type 1 ; Pancreas ; Recurrence ; Siblings ; Thorax ; Thymectomy

BACKGROUND AND OBJECTIVES: It is well established that cochlear implantation provides significant benefits for prelingually profound deaf children. However, there are few studies that examined the long-term outcome of cochlear implantation beyond 10 years in prelingually deaf children. The purpose of this study was to examine the long-term benefit of cochlear implantation for children with more than 10 years of experience of using cochlear implantation, regarding auditory performance and academic status. We then determined the age effect of cochlear implantation on auditory performance for prelingually deaf children. SUBJECTS AND METHOD: The longitudinal development of auditory performance of 119 deaf children was analyzed after cochlear implantation. Among the 119 children, 58 were included for analysis. RESULTS: The children who received cochlear implanst at younger age showed significantly better auditory performance. Age at which implantation had been performed had a significant effect on the development of auditory performance before 4 years of age. Many children continued to demonstrate improvements of auditory performance upto five years of implant use. Some showed development of auditory performance upto 10 years cochlear implantation. CONCLUSION: The present result indicates that speech perception and performance for children continue to improve over time from 5 upto 10 years while using cochlear implant. The use of earlier cochlear implantation was demonstrated to provide better auditory performance. The age at which implantation was performed was one of the important factors influencing the long-term outcome of cochlear implantation.
Child* ; Cochlear Implantation* ; Cochlear Implants* ; Humans ; Language Development* ; Methods ; Speech Perception