Managing myeloproliferative neoplasms (MPNs) during pregnancy is challenging due to increased thrombotic risk and limited cytoreductive options. Ropeginterferon alfa-2b (ropeginterferon), a long-acting mono-pegylated interferon, has limited data in this setting. We report a Korean multicenter case series of four pregnancies across MPN subtypes, including prefibrotic/early primary myelofibrosis, essential thrombocythemia, and polycythemia vera. Ropeginterferon was used during pregnancy or prior to conception (250-500 μg every 2-12 weeks) with aspirin and/or low-molecular-weight heparin. Hematologic responses were sustained throughout pregnancy without treatment-limiting adverse events. All pregnancies resulted in live births without major maternal or neonatal complications. Within the limits of a small retrospective series, ropeginterferon appeared to be a feasible cytoreductive option in these MPN pregnancies, including pre-conception and intra-pregnancy use; these preliminary observations warrant confirmation in larger prospective studies.
BACKGROUND:We examined long-term trends in age-specific and cause-specific maternal mortality and assessed shifts in the relative contributions of direct versus indirect obstetric causes from 1983 to 2023 in Korea. METHODS:In this population-based observational study, we analyzed all registered maternal deaths (International Classification of Diseases-10 O00-O99) among women aged 15-49 years and corresponding live births in Republic of Korea (= South Korea) from 1983 through 2023. Annual age-specific maternal mortality ratios (MMRs) per 100,000 live births were calculated using data from the Korean Statistical Information Service and the Causes of Death Statistics microdata of Statistics Korea. We classified deaths as direct or indirect obstetric causes and further disaggregated direct causes for the period 2009-2023. Proportions of direct versus indirect deaths were evaluated across five intervals (1997-2004, 2005-2009, 2010-2014, 2015-2019, and 2020-2023). Linear or segmented regression analyzed trends in overall MMRs and changes in the share of direct obstetric deaths. RESULTS:All age groups showed marked declines in MMRs; women aged ≥ 40 years exhibited the greatest absolute reduction (from 249 to 38 per 100,000). The overall MMR ranged from 10.3 to 13.7 per 100,000 since the early 2000s. The proportion of direct obstetric deaths fell by 2.1 percentage points per year before 2011, then rose by 0.9 points annually afterward. From 2009 to 2023, other direct causes accounted for 24.1% of deaths, embolism 21.5%, hemorrhage 21.3%, and indirect causes 19.9%; hypertensive disorders (5.9%), sepsis (4.2%), and abortion complications (3.1%) comprised smaller shares. Indirect causes predominated in maternal deaths among younger women, whereas direct obstetric causes were more common in those aged ≥ 35 years. CONCLUSION:Although age-specific MMRs in Korea have steadily declined, the stagnation of the overall rate and continued burden of direct obstetric causes underscore vulnerabilities in the country's emergency obstetric care infrastructure.
BACKGROUND:Children with complex chronic conditions (CCCs) require timely, resource-intensive emergency care, yet how they access emergency departments (EDs) across South Korea-and how access relates to outcomes-remains unclear. METHODS:We analyzed nationwide ED visits (ages 0-19) in the National Emergency Department Information System, 2016-2022. CCCs were identified using the Pediatric Complex Chronic Conditions Classification System v3. Travel distance was the Euclidean distance from the centroid of the residential area to the ED. For regional analyses, 29 emergency medical services (EMS) regions were consolidated into eight broader zones. The primary outcome was intensive care unit (ICU) admission or ED death. We estimated adjusted associations using multilevel logistic regression with a hospital random intercept and applied inverse probability of treatment weighting to balance EMS transport. RESULTS:Of 7.76 million pediatric ED visits, 149,306 (1.9%) involved CCCs. Compared with non-CCC visits, CCC visits had higher acuity (the Korean Triage Acuity Scale 1-2: 16.5% vs. 3.1%), longer travel (median 11.2 vs. 6.2 km), and higher rates of ICU admission (4.4% vs. 0.3%) and ED death (0.2% vs. 0.04%); EMS arrival was also more frequent (11.8% vs. 8.0%) (all P < 0.001). Access was highly concentrated: 47.9% of CCC ED visits occurred in Seoul, and 40.7% were seen at five high-volume Seoul EDs. In weighted multilevel models, longer travel was independently associated with adverse outcomes: adjusted odds ratios were 1.3 (95% confidence interval, 1.2-1.3) for 15-59.9 km, 1.6 (1.4-1.8) for 60-99.9 km, and 1.3 (1.1-1.5) for ≥ 100 km (all P < 0.001). Findings were robust to additional adjustment for individual CCC categories and domains. CONCLUSION:CCC-related ED visits are characterized by higher acuity, longer travel, and worse outcomes, with marked centralization in a few hospitals in the capital region. Travel burden is independently associated with ICU admission or ED death, underscoring the need to strengthen regional pediatric emergency capacity and coordination so medically complex children can receive timely, high-quality emergency care closer to home.
BACKGROUND:Despite resulting in significant mortality and long-term disability, research on the burden of intracerebral hemorrhage (ICH) remains insufficient. Therefore, this study estimated the global burden of ICH and projected changes in the disease burden through 2050 under scenarios of improved risk factor profiles. METHODS:The burden of ICH was estimated using data from the Global Burden of Disease Study 2021, based on incidence, mortality, and disability-adjusted life years (DALYs), and was stratified by region, age, year, sex, and Socio-demographic Index (SDI) level. In addition, we conducted an attribution analysis of the ICH burden, focusing on behavioral (including dietary risks and tobacco) and metabolic risk factors, and developed scenario-based projections through 2050 to estimate the potential impact of improved risk management. RESULTS:In 2021, a total of 3,444.34 thousand incident cases (95% uncertainty interval [UI], 3,053.01-3,812.04) of ICH were reported worldwide, along with 3,308.37 thousand deaths (3,021.08-3,594.72) attributable to ICH. Males exhibited a higher disease burden, with an age-standardized incidence rate (ASIR) per 100,000 population of 48.71 (95% UI, 43.07-54.27), compared to 33.61 (29.47-37.22) in females. The burden progressively increased with age, with notably higher mortality observed among individuals aged ≥ 65 years. There were substantial disparities in the ASIR by SDI level, with high SDI countries showing the lowest rates at 16.30 per 100,000 population (95% UI, 14.51-18.02), compared to 57.83 (51.95-63.27) in low SDI countries. Among behavioral and metabolic risk factors, high systolic blood pressure and smoking were identified as the leading modifiable risk factors for ICH. Forecasts based on the improved behavioral and metabolic risk scenario project a reduction in the age-standardized DALY rate to 166.13 per 100,000 population (95% UI, 132.31-209.64) by 2050, compared to 599.04 (482.89-744.16) projected under the baseline scenario. CONCLUSION:Although the global burden of ICH has declined, it remains a major concern in several regions. Projections through 2050 suggest that improvements in the behavioral and metabolic risk profiles could substantially reduce the future burden of ICH, emphasizing the importance of targeted strategies to support evidence-based public health policy.
