Evidence of the ethical appropriateness and clinical benefits of shared decision-making (SDM) are accumulating. This study aimed to not only identify physicians’ perspectives on SDM, and practices related to end-of-life care in particular, but also to gauge the effect of SDM education on physicians in Korea. Methods: A 14-item questionnaire survey using a modified Delphi process was delivered to nephrologists and internal medicine trainees at 17 university hospitals. Results: A total of 309 physicians completed the survey. Although respondents reported that 69.9% of their practical decisions were made using SDM, 59.9% reported that it is not being applied appropriately. Only 12.3% of respondents had received education on SDM as part of their training. The main obstacles to appropriate SDM were identified as lack of time (46.0%), educational materials and tools (29.4%), and education on SDM (24.3%). Although only a few respondents had received training on SDM, the proportion of those who thought they were using SDM appropriately in actual practice was high; the proportion of those who chose lack of time and education as factors that hindered the proper application of SDM was low. Conclusion: The majority of respondents believed that SDM was not being implemented properly in Korea, despite its use in actual practice. To improve the effectiveness of SDM in the Korean medical system, appropriate training programs and supplemental policies that guarantee sufficient application time are required.

Purpose: The purpose of this study was to identify how women who were adult children of alcoholics and spouses of alcoholics had grown up in difficult situations and found the meaning of life. Methods: This study used a life history research method and data were collected from three participants who are adult children of alcoholics and spouses of alcoholics. In-depth interviews with each participant were conducted three times from September to October 2020. Results: In this study, ‘realm of life’ includes taking care of the family like a young hero, difficulty in express one’s feelings and desire, facing the problems of the family at stake. ‘Turning point’ meeting a role model overcoming addiction problems, sharing one’s story in the Therapeutic Community, self-awareness to live independently not as a victim. ‘Adaptation’ includes recognizing and expressing one’s thoughts and feelings, trying to separate from the family psychologically and spatially, reinterpretation of one’s life and discovery of the meaning of life. Conclusion Their meaning of life was to love and respect themselves, make responsible choices in their circumstances, break the inheritance of addiction and had a healthy family life. Therefore, it is necessary to provide an existential meaning therapy program that helps them find the meaning of life and recover to their original self.

Purpose: The purpose of this study was to identify how women who were adult children of alcoholics and spouses of alcoholics had grown up in difficult situations and found the meaning of life. Methods: This study used a life history research method and data were collected from three participants who are adult children of alcoholics and spouses of alcoholics. In-depth interviews with each participant were conducted three times from September to October 2020. Results: In this study, ‘realm of life’ includes taking care of the family like a young hero, difficulty in express one’s feelings and desire, facing the problems of the family at stake. ‘Turning point’ meeting a role model overcoming addiction problems, sharing one’s story in the Therapeutic Community, self-awareness to live independently not as a victim. ‘Adaptation’ includes recognizing and expressing one’s thoughts and feelings, trying to separate from the family psychologically and spatially, reinterpretation of one’s life and discovery of the meaning of life. Conclusion Their meaning of life was to love and respect themselves, make responsible choices in their circumstances, break the inheritance of addiction and had a healthy family life. Therefore, it is necessary to provide an existential meaning therapy program that helps them find the meaning of life and recover to their original self.

Background/Aims: Inhibitors of the renin-angiotensin system, angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), reportedly have anti-inflammatory effects. This study assessed the association of prior use of ACE inhibitors and ARBs with sepsis-related clinical outcomes. Methods: A population-based observational study was conducted using the Health Insurance Review and Assessment Service claims data. Among the adult patients hospitalized with new onset of sepsis in 2012, patients who took ARBs or ACE inhibitors at least 30 days prior to hospitalization were analyzed. Generalized linear models and logistic regression were used to examine the relation between the prior use of medication and clinical outcomes, such as in-hospital mortality, mechanical ventilation, and length of stay. Results: Of a total of 27,628 patients who were hospitalized for sepsis, the ACE inhibitor, ARB, and non-user groups included 1,214 (4.4%), 3,951 (14.4%), and 22,463 (82.1%) patients, respectively. As the patients in the ACE inhibitor and ARB groups had several comorbid conditions, higher rates of intensive care unit admission, hemodialysis, and mechanical ventilation were observed. However, after covariate adjustment, the use of ACE inhibitor (odds ratio [OR], 0.752; 95% confidence interval [CI], 0.661 to 0.855) or ARB (OR, 0.575; 95% CI, 0.532 to 0.621) was significantly associated with a lower rate of in-hospital mortality. Conclusions Pre-hospitalization use of ACE inhibitors or ARBs for sepsis was an independent factor for a lower rate of in-hospital mortality.

PURPOSE: Childhood asthma has a considerable social impact and economic burden, especially in severe asthma. This study aimed to identify the proportion of childhood asthma severity and to evaluate associated factors for greater asthma severity. METHODS: This study was performed on 667 children aged 5–15 years with asthma from the nationwide 19 hospitals in the Korean childhood Asthma Study (KAS). Asthma was classified as mild intermittent, mild persistent, and moderate/severe persistent groups according to the National Asthma Education and Prevention Program recommendations. Multinomial logistic regression models were used to identify the associated factors for greater asthma severity. RESULTS: Mild persistent asthma was most prevalent (39.0%), followed by mild intermittent (37.6%), moderate persistent (22.8%), and severe persistent asthma (0.6%). Onset later than 6 years of age (adjusted odds ratio [aOR], 1.69 for mild persistent asthma; aOR, 1.92 for moderate/severe persistent asthma) tended to increase asthma severity. Exposure to environmental tobacco smoke (aOR, 1.53 for mild persistent asthma; aOR, 1.85 for moderate/severe persistent asthma), and current dog ownership with sensitization to dog dander (aOR, 5.86 for mild persistent asthma; aOR, 6.90 for moderate/severe persistent asthma) showed increasing trends with greater asthma severity. Lower maternal education levels (aOR, 2.32) and no usage of an air purifier in exposure to high levels of outdoor air pollution (aOR, 1.76) were associated with moderate/severe persistent asthma. CONCLUSIONS: Modification of identified environmental factors associated with greater asthma severity might help better control childhood asthma, thereby reducing the disease burden due to childhood asthma.
Air Filters ; Air Pollution ; Animals ; Asthma ; Child ; Dander ; Dogs ; Education ; Environmental Exposure ; Humans ; Logistic Models ; Odds Ratio ; Ownership ; Risk Factors ; Smoke ; Social Change ; Tobacco

OBJECTIVES: Open and supportive communication between parents and children is known to reduce adolescents' delinquent behavior. Recently, the risk of Internet gaming disorder (IGD) has been increasing in adolescents. The purpose of this study was to investigate the mediating effects of parent-child communication styles on the relationship between adolescent aggressiveness and risk of IGD. METHODS: Participants in this study were 402 first-year students from 4 middle schools in Seoul who enrolled in the Internet user Cohort for Unbiased Recognition of gaming disorder in Early adolescence (iCURE) and completed baseline assessment in 2016. The structural equation model was constructed based on an aggression questionnaire, the Internet game use-elicited symptom screen, a mother-child communication inventory, and a father-child communication inventory. RESULTS: Adolescents' aggressiveness was found to be related to their risk of IGD. The father-child communication style mediated the relationship between aggression and risk of IGD. However, the mother-child communication style had no mediating effect. CONCLUSIONS Our findings suggest that fathers should make an effort to improve open and positive communication skills with their children, because the father-child communication style plays an important role in the relationship between adolescent aggressiveness and risk of IGD.

OBJECTIVES: Open and supportive communication between parents and children is known to reduce adolescents' delinquent behavior. Recently, the risk of Internet gaming disorder (IGD) has been increasing in adolescents. The purpose of this study was to investigate the mediating effects of parent-child communication styles on the relationship between adolescent aggressiveness and risk of IGD.METHODS: Participants in this study were 402 first-year students from 4 middle schools in Seoul who enrolled in the Internet user Cohort for Unbiased Recognition of gaming disorder in Early adolescence (iCURE) and completed baseline assessment in 2016. The structural equation model was constructed based on an aggression questionnaire, the Internet game use-elicited symptom screen, a mother-child communication inventory, and a father-child communication inventory.RESULTS: Adolescents' aggressiveness was found to be related to their risk of IGD. The father-child communication style mediated the relationship between aggression and risk of IGD. However, the mother-child communication style had no mediating effect.CONCLUSIONS: Our findings suggest that fathers should make an effort to improve open and positive communication skills with their children, because the father-child communication style plays an important role in the relationship between adolescent aggressiveness and risk of IGD.
Adolescent ; Aggression ; Behavior, Addictive ; Child ; Cohort Studies ; Fathers ; Humans ; Immunoglobulin D ; Internet ; Negotiating ; Parents ; Seoul

OBJECTIVES: Open and supportive communication between parents and children is known to reduce adolescents' delinquent behavior. Recently, the risk of Internet gaming disorder (IGD) has been increasing in adolescents. The purpose of this study was to investigate the mediating effects of parent-child communication styles on the relationship between adolescent aggressiveness and risk of IGD. METHODS: Participants in this study were 402 first-year students from 4 middle schools in Seoul who enrolled in the Internet user Cohort for Unbiased Recognition of gaming disorder in Early adolescence (iCURE) and completed baseline assessment in 2016. The structural equation model was constructed based on an aggression questionnaire, the Internet game use-elicited symptom screen, a mother-child communication inventory, and a father-child communication inventory. RESULTS: Adolescents' aggressiveness was found to be related to their risk of IGD. The father-child communication style mediated the relationship between aggression and risk of IGD. However, the mother-child communication style had no mediating effect. CONCLUSIONS: Our findings suggest that fathers should make an effort to improve open and positive communication skills with their children, because the father-child communication style plays an important role in the relationship between adolescent aggressiveness and risk of IGD.
Adolescent* ; Aggression* ; Behavior, Addictive ; Child ; Cohort Studies ; Fathers ; Humans ; Immunoglobulin D ; Internet* ; Negotiating* ; Parents ; Seoul

OBJECTIVE: To explore the structure of Internet gaming disorder (IGD) criteria and their distribution according to the different severity level of IGD. The associations of psychiatric comorbidities to each IGD symptom and to the IGD severity were also investigated. METHODS: Consecutively recruited 330 Korean middle school students underwent face-to-face diagnostic interviews to assess their gaming problems by clinicians. The psychiatric comorbidities were also evaluated with a semi-structured instrument. The data was analyzed using principal components analysis and the distribution of criteria among different severity groups was visualized by plotting univariate curves. RESULTS: Two principal components of ‘Compulsivity’ and ‘Tolerance’ were extracted. ‘Decrease in other activities’ and ‘Jeopardizing relationship/career’ may indicate a higher severity of IGD. While ‘Craving’ deserved more recognition in clinical utility, ‘Tolerance’ did not demonstrate much difference in distribution by the IGD severity. Internalizing and externalizing psychiatric disorders differed in distribution by the IGD severity. CONCLUSION: A hierarchic presentation of IGD criteria was revealed. ‘Decrease in other activities’ and ‘Jeopardizing relationship/career’ may represent a higher severity, thus indicating more clinical attention to such symptoms. However, ‘Tolerance’ was not found to be a valid diagnostic criterion.
Comorbidity ; Humans ; Immunoglobulin D ; Internet* ; Pathology*

Traditional morphometrics uses ratios between measured values such as the cranial index and the upper facial index. However, with these ratios alone, it is impossible to represent the shape of the entire cranium in a three-dimensional space because ratio does not express coordinate data. This methodological limitation of traditional morphometrics makes it difficult to evaluate relations between cranial parts. However, it is important to assess relations between cranial parts because cranial parts change their shapes in an integrated way. Therefore, this study adopted geometric morphometrics to overcome the limitations of traditional morphometrics and provide a more enhanced visual analysis of the cranial shape. Using geometric morphometrics, this study focused on variations of cranial shapes in a population from Joseon Dynasty to obtain their specific characteristics. This study investigated variations of cranial shapes in 57 individuals from Seoul Gyeonggi province who lived in the 15th to the early 20th centuries. The coordinates of the crania were collected by MicroScribe G2X (Immersion Corporation, USA) and statistically analyzed using principal component analysis. The results showed that the variations in cranial shapes of females were reflected mostly in width, length of cranium, position of bregma, shape of posterior part of cranium, and length of facial bone. The cranial shapes of the males varied mostly in length, width, height of cranium, size of mastoid process, and length of facial bones. The cranial length became shorter when the cranial width became broader in both sexes. However, cranial height and facial length showed different variations between the two sexes. In addition, the variation in females only showed evidence of static allometry. The results of this research provide basic information about cranial shapes in a population from Joseon Dynasty and will be useful in future studies such as analysis on between-group differences. By identifying within-group variations first, researchers focusing on between-group differences will likely avoid erroneous conclusions.
Facial Bones ; Female ; Gyeonggi-do ; Humans ; Male ; Mastoid ; Principal Component Analysis ; Seoul ; Skull