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.
As the health impacts of climate change become increasingly evident, research on climate-related exposures and health outcomes has grown. However, a disproportionate focus on certain exposures and health outcomes persists, and substantial inconsistencies remain in the definitions and measurement methods used across studies, hindering the integration of findings and the development of comprehensive public health strategies. To address this gap, we assessed epidemiological literature, identifying uneven research distribution and highlighting areas requiring further investigation. We conducted a literature search in PubMed, the Cochrane Library, and Embase using key terms related to climate change and health. A total of 611 original studies on human populations, published in English from January 2000 to June 2024, were included. Significant heterogeneity was evident in the definitions of climate-related exposure metrics. The focus areas of climate-related exposure were narrow, primarily limited to temperature and temperature-related hazards (n = 526), precipitation (n = 88), and air pollution (n = 39), while research on extreme weather events was scarce. Similarly, the scope of health outcomes studied was largely confined to all-cause mortality (n = 249), cardiovascular disease (n = 159), and communicable diseases (n = 148). In contrast, relatively few studies have addressed the impacts of climate change on neurodegenerative diseases (n = 8), endocrine disorders (n = 4), or hematologic diseases (n = 3), indicating a critical need for broader investigation into these underrepresented health outcomes. Future research should prioritize the transparent reporting of both context-specific and standardized exposure definitions to improve cross-study comparability and broaden its scope to encompass more diverse climate-related exposures and health outcomes.
BACKGROUND:ABVD chemotherapy (consisting of doxorubicin, bleomycin, vinblastine, and dacarbazine) and positron emission tomography (PET)-guided risk-adapted treatment have improved outcomes in classic Hodgkin lymphoma (cHL), but real-world evidence from Asian populations remains limited. METHODS:We retrospectively analyzed 270 patients with classical Hodgkin lymphoma treated with ABVD at two Korean tertiary centers (2015-2024). Survival analyses were performed on an intention-to-treat basis including all 270 patients. RESULTS:Among end-of-treatment (EOT) evaluable patients (n = 266), the complete response (CR) rate and overall response rate were 89.1% and 95.5%, respectively. With a median follow-up of 58.3 months, the estimated 5-year progression-free survival (PFS) and overall survival (OS) were 81.6% (95% confidence interval [CI], 75.8-86.2%) and 88.8% (95% CI, 83.6-92.4%), respectively. In the interim PET-CR subgroup (n = 200), bleomycin omission (ABVD→AVD) did not impact survival (PFS: P = 0.904; OS: P = 0.290). In multivariate analysis, male sex, an Eastern Cooperative Oncology Group (ECOG) performance status score of ≥ 2 points, and failure to achieve EOT CR were independent predictors of poor PFS, while age ≥ 65 years, extranodal involvement, and non-CR at EOT were associated with inferior OS. CONCLUSION:ABVD with PET-guided modification remains an effective and pragmatic first-line approach for cHL in Korean clinical practice. Real-world outcomes align with clinical trial data, even with limited use of novel agents. These findings support risk-adapted therapy tailored to patient response and regional treatment availability.
BACKGROUND:The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the healthcare workforce. This study aimed to compare needlestick and sharp injuries (NSIs) incidence between the pre-pandemic period and the pandemic period and to assess how hospital responses influenced NSI incidence among healthcare workers. METHODS:This retrospective study was conducted at a tertiary care hospital designated for COVID-19 management. We compared the incidence of NSIs before (2017-2019) and after (2020-2022) the pandemic onset. The incidence, expressed as cases per 100 full-time equivalents (FTEs) per year, was analyzed using generalized linear regression with interrupted time series analysis based on the Prais-Winsten model. RESULTS:Hospital admissions (7.63%) and surgeries (7.01%) declined in the first pandemic year and continued to decrease, whereas the workforce steadily increased. A total of 844 NSIs were reported, with 475 (56.3%) before the pandemic and 369 (43.7%) during the pandemic. The overall NSI incidence (per 100 FTEs/year) declined both immediately after the outbreak (from 5.78 in 2019 to 4.58 in 2020, P = 0.530) and throughout the pandemic (from 4.58 in 2020 to 3.89 in 2022, P = 0.756). By occupation, incidence among nurses significantly decreased immediately after the outbreak (from 7.6 in 2019 to 5.2 in 2020, P = 0.035). Of the 369 NSIs during the pandemic, most occurred in non-COVID-19 care areas, with only 9 cases (2.4%) in COVID-19 care areas. CONCLUSION:Our study observed a declining trend in NSI incidence during the COVID-19 pandemic, likely related to reduced hospitalizations, adequate staffing, optimized patient contact and infection control measures.
