Background
Modifiable risk factors account for a substantial proportion of dementia cases and represent important targets for prevention. However, previous studies have often focused on a limited range of risk factors and have rarely examined whether their associations with dementia differ according to sex and age at onset. Objectives: To investigate sex- and age-specific associations between modifiable risk factors and incident Alzheimer's disease dementia using a nationwide population-based cohort in South Korea.
Methods
We conducted a retrospective cohort study using the National Health Information Database of the Korean National Health Insurance Service. Among individuals who participated in the National Cancer Screening Program in 2006 and underwent general health examinations in 2004, 2006, and 2008, 599,306 adults aged 40–79 years were included. Participants were followed from 2010 to 2019 after applying pre- and post-screening washout periods. Incident Alzheimer's disease dementia was defined using ICD-10 codes F00 or G30. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Analyses were stratified by sex and age group to distinguish early-onset Alzheimer's disease dementia (EOAD) and late-onset Alzheimer's disease dementia (LOAD). During the 10-year follow-up period, dementia risk profiles differed substantially according to sex and age at onset. Lower educational attainment was consistently associated with increased dementia risk across all groups. Current smoking and physical inactivity were significant risk factors for dementia in both sexes, whereas underweight status was associated with an increased risk of LOAD. Among chronic conditions, diabetes, hypertension, and depression elevated dementia risk, with depression demonstrating the strongest association, particularly for EOAD (males: HR = 3.61, 95% CI: 2.63–4.96; females: HR = 1.83, 95% CI: 1.46–2.29). Sensory and functional impairments, including hearing loss, visual loss, physical disability, and traumatic brain injury, were also associated with increased dementia risk, although the magnitude and significance of these associations varied by sex and age group. The predictive performance of the models was acceptable, with C-statistics ranging from 0.6784 to 0.7803.
Conclusions
The associations between modifiable risk factors and incident Alzheimer's disease dementia exhibited distinct sex- and age-specific patterns. These findings highlight the importance of tailored dementia prevention strategies that account for differences in demographic characteristics and risk factor profiles. Targeted interventions addressing modifiable risk factors may contribute to reducing the future burden of dementia at both individual and population levels.

Background
Evidence-based medicine (EBM) is an important element of medical education. However, nationwide data on EBM education in Korean medical schools are limited. This study aimed to describe the organizational structure, content, methods, and assessment of EBM education, together with barriers and support needs, and to explore factors associated with variation across schools.
Methods
A 26-item questionnaire was administered to EBM education leaders or course directors at 21 Korean medical schools. Data were analyzed descriptively, and differences by structural and exogenous characteristics were explored using cross-tabulation.
Results
Twenty-one of 40 medical schools responded. All responding institutions offered EBM as a mandatory subject, but 42.9% had no dedicated organizing unit. Coverage of classic EBM steps was high (formulating clinical questions: 95.2%; literature searching: 95.2%; critical appraisal: 76.2%), whereas AI-assisted evidence summarization was included in only 19.0%. Only 19.0% reported systematic theory–clinical integration, and 57.1% left bedside EBM to preceptor discretion. Demand for a standardized curriculum guide (90.5%) and faculty development (76.2%) was high, and 100% were willing to use externally developed materials. Variation in key outcomes was associated with organizational governance but was not explained by exogenous structural characteristics such as class size, clinical infrastructure, establishment type, or region.
Conclusions
EBM education in Korean medical schools is universally mandatory but uneven in organization, theory–clinical integration, faculty capacity, assessment, and AI integration. These differences appeared to reflect governance more than resource size, suggesting that society-level support should include organizational models alongside standardized curricula, assessment tools, and faculty development.

Background
Large language model (LLM)–based tools are increasingly used to automate risk-of-bias assessment of randomized controlled trials with the revised Cochrane tool (RoB 2.0). However, their reproducibility, their accuracy, and their fidelity to the deterministic algorithm mapping signalling-question responses to domain judgments remain unclear.
Methods
In a conference workshop, participants used an identical prompt and tool versions to assess one RCT with three configurations and entered each tool’s output verbatim (13, 15, and 10 runs). One experienced reviewer’s assessment served as the reference. For each run we computed run-to-run reproducibility, agreement with the expert, and conformance between the tool’s stated domain judgment and the judgment implied by applying the RoB 2.0 algorithm to that run’s own signalling answers.
Results
All configurations showed substantial run-to-run variability under identical conditions, greatest in the conditionally complex domain 2 (Gemini pairwise agreement 0.34). Expert agreement varied widely across configurations (mean 5–60%), and one configuration systematically under-rated risk. Even in domains with a fully specified algorithm, stated judgments frequently diverged from the value implied by the tool’s own signalling answers (domain 2, mean 42%). Skip-logic violations occurred in 69%, 80%, and 100% of runs. Recomputing domain judgments from the signalling answers improved expert agreement for the general-purpose configurations.
Conclusion
LLM-based RoB 2.0 assessments exhibited variability and errors. Whatever tool is adopted, its characteristics and variability must be recognized. Having the tool perform only atomic (single) judgments while delegating aggregation to the algorithm, together with human review, may improve accuracy.

Background
Patient values and preferences are important in clinical practice guideline development, but responses indicating reliance on physician judgment may be difficult to interpret. We examined whether such reliance can coexist with explicit preferences about treatment outcomes and trade-offs.
Methods
We conducted an exploratory secondary analysis of a 22-item cross-sectional survey completed by 14 adults with anal cancer recruited from four hospitals during guideline development. The survey assessed decision-making participation, responses to specific clinical scenarios, rankings of six treatment goals, and treatment-acceptance thresholds. Ten scenario items included the option “I would follow my treating physician’s judgment.” Analyses were descriptive and emphasized within-participant response patterns.
Results
Ten participants (71.4%) generally preferred shared decision-making, yet 11 selected physician judgment in at least one scenario. All 11 completed a full ranking of treatment goals, and 9 completed both trade-off threshold items. Among seven participants who relied on physician judgment for salvage treatment, all completed the ranking and six completed both thresholds; five required at least a 20% survival improvement to accept surgery resulting in a permanent stoma. Although permanent stoma ranked fourth among six goals overall, 11 of 13 respondents required at least a 20% survival improvement to accept such surgery.
Conclusions
Reliance on physician judgment did not necessarily indicate an absence of patient preferences. Guideline-related preference studies should distinguish preferences for the decision process, general priorities among outcomes, and context-specific benefit-risk trade-offs. Responses indicating reliance on physician judgment should not automatically be treated as “no preference” or missing information.

Background
In the case of clinical practice guideline (CPG), the need for the prospective registration of protocols has been proposed several times. However, the registration of CPG protocols is not yet active. The objective of this study was to summarize the experience of the CPG protocol registration program in Korea.
Methods
This study was performed in the following order: 1) formation of a methodological expert group; 2) CPG protocol template development; 3) CPG protocol preparation and expert review; 4) exploration of the knowledge and attitude of the guideline developers toward CPG protocol.
Results
The final version of the CPG protocol templates consists of four parts (planning, development, finalization, and timetable). The protocols for 18 cancers were submitted by 14 medical societies. conflicts of interest (n = 14, 77.8%), guideline development group (GDG; n = 9, 50%), scope of CPG (n = 9, 50%), and key questions (n = 8, 44.4%) were the under-reported areas in the submitted protocols. The GDGs (n = 13, 72.7%) was the most misreported areas of the protocol. CPG developers generally agreed on the advantages of protocol registration but responded that it was difficult to understand the concepts in the protocol and fill them with appropriate content. The areas where CPG developers responded that they felt difficulty were were recommendation grade (n = 9, 75.0%), GDG composition (n = 7, 58.3%), and determining key questions (n = 7, 58.3%).
Conclusions
The CPG protocol registration program was planned and piloted in Korea, and it could be said that it is feasible. It is necessary to evaluate the developed CPG later and determine whether protocol registration affects the quality of CPG through indices such as transparency and clarity of CPG.

Although there is a genetic component to primary open-angle glaucoma (POAG) susceptibility, few studies have investigated interactions between genetic and environmental factors. We aimed to quantify the familial risk of POAG and estimate disease risk among individuals with a positive family history and either hypertension or hyperglycemia, as well as assess their interactions. Using the National Health Insurance database, which includes information on familial relationships and lifestyle risk factors, we identified 6,217,057 individuals with first-degree relatives (FDRs) from 2002-2018. We calculated familial risk using hazard ratios (HRs) with 95% confidence intervals (CIs) which compare the risk of individuals with and without affected FDRs. Disease risk was estimated among individuals with both a positive family history and hypertension or hyperglycemia, and interactions were assessed on an additive scale. Individuals with an affected parent had a 3.13-fold (95% CI 2.74 –3.58) increased risk of disease compared to those with unaffected parents. Individuals with affected father, mother, or both affected parents showed HRs (95% CI) of 3.50 (2.86 –4.30), 2.87 (2.41 –3.44) and 4.88 (1.83 –12.98), respectively. Familial risk adjusted for lifestyle factors decreased slightly (HR 3.14), suggesting that genetic component is the predominant driver in the familial aggregation. Individuals with a positive family history and either hypertension or hyperglycemia had a markedly elevated risk of disease, with HRs of 3.42 (95% CI 2.49 –4.69) and 3.27 (95% CI 2.15 –4.97), respectively. Hypertensive or hyperglycemic individuals with a positive family history may be considered a high-risk group and glaucoma screening may be considered.