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

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

Recently, the Korean Medical Association (KMA) launched the KMA Policy system based upon the American Medical Association (AMA) Policy system. The KMA's official positions on health issues and medical ethics, as well as its constitution, bylaws, and directives, will be included in the KMA Policy system. The AMA's organizational structure and decision making process provided essential information for developing the KMA Policy system. Through the KMA Policy system, hereafter, the KMA should introduce a procedure not only to decide upon positions on various health issues but also a means to open them to the public. In addition, the KMA can expect the continuity and transparency of work, enhanced benefits to members, public credibility, and growth of its social reputation by means of KMA Policy. Furthermore, the system would be beneficial for both KMA members and the public, as they can easily access KMA Policy, and, in turn, access the healthcare systems of Korea and its medical knowledge. To achieve a successful KMA Policy system, the definite authority and responsibility should be granted to the organizational bodies of the KMA, for example, the House of Delegates and Board of Trustees, and the regional societies and other sections. These various groups must then efficiently divide up their work and cooperate systematically. Moreover, it is crucial that each individual member of the KMA pay much more attention to health issues and participate in the decision making process on KMA Policy.
American Medical Association ; Constitution and Bylaws ; Decision Making ; Delivery of Health Care ; Ethics, Medical ; Financing, Organized ; Humans ; Korea ; Power (Psychology)* ; Trustees

OBJECTIVES: Classification of the degree of postoperative nerve damage according to contact with the mandibular canal and buccal cortical bone has been studied, but there is a lack of research on the difference in postoperative courses according to contact with buccal cortical bone. In this study, we divided patients into groups according to contact between the mandibular canal and the buccal cortical bone, and we compared the position of the mandibular canal in the second and first molar areas. MATERIALS AND METHODS: Class III patients who visited the Dankook University Dental Hospital were included in this study. The following measurements were made at the second and first molar positions: (1) length between the outer margin of the mandibular canal and the buccal cortical margin (a); (2) mandibular thickness at the same level (b); (3) Buccolingual ratio=(a)/(b)×100; and (4) length between the inferior margin of the mandibular canal and the inferior cortical margin. RESULTS: The distances from the canal to the buccal bone and from the canal to the inferior bone and mandibular thickness were significantly larger in Group II than in Group I. The buccolingual ratio of the canal was larger in Group II in the second molar region. CONCLUSION: If mandibular canal is in contact with the buccal cortical bone, the canal will run closer to the buccal bone and the inferior border of the mandible in the second and first molar regions.
Classification ; Cone-Beam Computed Tomography ; Humans ; Mandible ; Mandibular Nerve ; Molar ; Osteotomy*

OBJECTIVES: This study explored socioeconomic disparities in Korea using health insurance type as a proxy during the ongoing coronavirus disease 2019 (COVID-19) pandemic. METHODS: We conducted a retrospective cohort study using Korea’s nationwide healthcare database, which contained all individuals who received a diagnostic test for COVID-19 (n=232,390) as of May 15, 2020. We classified our cohort by health insurance type into beneficiaries of the National Health Insurance (NHI) or Medicaid programs. Our study outcomes were infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19-related outcomes, a composite of all-cause death, intensive care unit admission, and mechanical ventilation use. We estimated age-, sex-, and Charlson comorbidity index score–adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using a multivariable logistic regression analysis. RESULTS: Of the 218,070 NHI and 14,320 Medicaid beneficiaries who received COVID-19 tests, 7,777 and 738 tested positive, respectively. The Medicaid beneficiaries were older (mean age, 57.5 vs. 47.8 years), more likely to be males (47.2 vs. 40.2%), and had a higher comorbidity burden (mean CCI, 2.0 vs. 1.7) than NHI beneficiaries. Compared to NHI beneficiaries, Medicaid beneficiaries had a 22% increased risk of SARS-CoV-2 infection (aOR, 1.22; 95% CI, 1.09 to 1.38), but had no significantly elevated risk of COVID-19-related outcomes (aOR 1.10, 95% CI 0.77 to 1.57); the individual events of the composite outcome yielded similar findings. CONCLUSIONS As socioeconomic factors, with health insurance as a proxy, could serve as determinants during the current pandemic, pre-emptive support is needed for high-risk groups to slow its spread.

OBJECTIVES: This study explored socioeconomic disparities in Korea using health insurance type as a proxy during the ongoing coronavirus disease 2019 (COVID-19) pandemic. METHODS: We conducted a retrospective cohort study using Korea’s nationwide healthcare database, which contained all individuals who received a diagnostic test for COVID-19 (n=232,390) as of May 15, 2020. We classified our cohort by health insurance type into beneficiaries of the National Health Insurance (NHI) or Medicaid programs. Our study outcomes were infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19-related outcomes, a composite of all-cause death, intensive care unit admission, and mechanical ventilation use. We estimated age-, sex-, and Charlson comorbidity index score–adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using a multivariable logistic regression analysis. RESULTS: Of the 218,070 NHI and 14,320 Medicaid beneficiaries who received COVID-19 tests, 7,777 and 738 tested positive, respectively. The Medicaid beneficiaries were older (mean age, 57.5 vs. 47.8 years), more likely to be males (47.2 vs. 40.2%), and had a higher comorbidity burden (mean CCI, 2.0 vs. 1.7) than NHI beneficiaries. Compared to NHI beneficiaries, Medicaid beneficiaries had a 22% increased risk of SARS-CoV-2 infection (aOR, 1.22; 95% CI, 1.09 to 1.38), but had no significantly elevated risk of COVID-19-related outcomes (aOR 1.10, 95% CI 0.77 to 1.57); the individual events of the composite outcome yielded similar findings. CONCLUSIONS As socioeconomic factors, with health insurance as a proxy, could serve as determinants during the current pandemic, pre-emptive support is needed for high-risk groups to slow its spread.

BACKGROUND AND OBJECTIVES: With the currently available diagnostic procedure, hearing impaired children are diagnosed at an early age and hearing aids are fitted soon thereafter. Thus, appropriateness of using available correction methods for adult ears and ear models for determining and predicting hearing aid characteristics for these children need to be examined. The objectives of this study are to create a database of resonance frequency and length of external auditory canal (EAC) in all age groups and to adjust the peak frequency response of hearing aid system to take account of the changing resonance peak frequency as child gets older. MATERIALS AND METHOD: We studied 437 ears with no age limitation. We measured rear ear unaided response (REUR) with Rastronics frequency response analyzer and external ear canal length using silastic tube under microscopic or otoscopic finding. Statistical analyses were performed to determine age differences. RESULTS: Ear canal length increased with age, and an adult value was achieved by the age of 14 years. Resonance frequency decreased with age, and reached to an adult value by the age of 9 years. There was significant relationship between ear canal length and resonance frequency. CONCLUSION: Alteration in resonance frequency with age may have practical implications by affecting the insertion gain of hearing aid system in children. The data may be used as useful adjustment factors to correct the current hearing aid system in children.
Adult ; Child ; Ear ; Ear Canal* ; Hearing ; Hearing Aids ; Humans

BACKGROUND AND OBJECTIVES: Although it is widely accepted that nasal obstruction leads to snoring and sleep apnea, the relationship between these variable factors is not clear. Moreover, while nasal blockage in human is known to produce sleep- disordered breathing, it is controversial whether nasal obstruction itself produces obstructive apnea and whether it causes changes in the sleep stages. The purpose of this study is to measure changes in sleep physiology by nasal blockage alone and to evaluate whether the nasal blockage itself ca>i produce the sleep apnea syndrorm or not. MATERIAL AND METHOD: Normal thirty subjects, 15 males and 15 females, who had sleep apnea episodes <2 by polysomnography during sleep, were evaluated using Alice III polysomnography after both nostrils opened, unilateral nostril blockage, and bilateral nostril blockage. The parameters of measurement were hypopnea and apnea episodes and apnea type, apnea index (AI), respiratory disturbance index (RDI), SO and sleep stages. A statistical analysis was performed using a wicoxon signed rank test. RESULTS: Bilateral nasal blockage induces significantly increased apnea and hypopnea episodes, AI, and RDI but induces significantly decreased mean and lowest O. saturation. Also, bilateral nasal blockage significantly prolonged S,-NREM sleep and decreased REM sleep (p(0.05). However, these changes did not correspond with the criteria of the sleep apnea syndrome. CONCLUSION: Unilateral nasal obstruction does not cause any significant changes in the measured parameters compared to the normal nose of unblocked state. Bilateral nasal obstruction does not induce the obstructive sleep apnea syndrome by itself. However, it causes changes in the sleep stages and increases sleep apnea episodes significantly.
Apnea ; Female ; Humans ; Male ; Nasal Obstruction* ; Nose ; Physiology ; Polysomnography ; Respiration ; Sleep Apnea Syndromes* ; Sleep Apnea, Obstructive ; Sleep Stages ; Sleep, REM ; Snoring

Purpose: To investigate the effect of regular monitoring of pulmonary function and ventilatory status on the initiation of non-invasive ventilation (NIV) between patients who were routinely monitored before receiving NIV and those who were not. Materials and Methods: This retrospective cohort study included subjects with Duchenne muscular dystrophy (DMD) who first received NIV between 2010 and 2019. The subjects were assigned to either the regular-follow-up (REG) group or the non-REG group, according to their follow-up status, before initiating NIV. We compared the number of emergent cases, the results of nocturnal ventilatory monitoring, and the pulmonary function of each group at initial ventilatory support. Results: In total, 73 subjects were enrolled in the REG group and 47 subjects in the non-REG group. There were significantly more emergency cases due to respiratory insufficiency in the non-REG group (12/47, 25.5%) than in the REG group (3/73, 4.1%). At the time of initial ventilatory support, hypoventilatory symptoms were more common and relatively severe in the non-REG group (37/47, 78.7%) than in the REG group (18/73, 24.7%). The average age at initial ventilatory support of the non-REG group was 2.15 years older than that of the subjects in the REG group. Moreover, subjects who were not regularly monitored exhibited greater deterioration in pulmonary function compared to those who were regularly followed up. Conclusion Regular evaluation of pulmonary function and ventilatory status before the onset of ventilatory insufficiency is crucial to reduce the risk of patients with DMD requiring emergency care due to ventilatory insufficiency.

Objectives: This research delves into the application of texture analysis in spine computed tomography (CT) scans and its correlation with bone mineral density (BMD), as determined by dual-energy X-ray absorptiometry (DXA).It specifically addresses the discordance between the 2 measurements, suggesting that certain spinal-specific factors may contribute to this discrepancy. Methods: The study involved 405 cases from a single institution collected between May 6, 2012 and June 30, 2021. Each case underwent a spinal CT scan and a DXA scan. BMD values at the lumbar region (T12 to S1) and total hip were recorded. Texture features from axial cuts of T12 to S1 vertebrae were extracted using gray-level co-occurrence matrices, and a regression model was constructed to predict the BMD values. Results: The correlation between CT texture analysis results and BMD from DXA was moderate, with a correlation coefficient ranging between 0.4 and 0.5. This discordance was examined in light of factors unique to the spine region, such as abdominal obesity, aortic calcification, and lumbar degenerative changes, which could poten tially affect BMD measurements. Conclusions Emerging from this study is a novel insight into the discordance between spinal CT texture analysis and DXA-derived BMD measurements, highlighting the unique influence of spinal attributes. This revelation calls into question the exclusive reliance on DXA scans for BMD assessment, particularly in scenarios where DXA scanning may not be feasible or accurate.