Journal of Korean Medical Science最新文献

{"title":"Outcome of Ceftazidime/Avibactam Versus Alternative Antibiotics for Treatment of Carbapenem-Resistant <i>Enterobacterales</i> Bacteremia in Patients With Hematologic Malignancies.","authors":"Hyeon Mu Jang, Seunghee Baek, So Yun Lim, Seongman Bae, Hyunkyung Park, Han-Seung Park, Yunsuk Choi, Jung-Hee Lee, Je-Hwan Lee, Sung-Han Kim","doi":"10.3346/jkms.2026.41.e228","DOIUrl":"10.3346/jkms.2026.41.e228","url":null,"abstract":"<p><strong>Background: </strong>Until recent introduction of ceftazidime/avibactam (CAZ-AVI) to Korean hospitals in October 2023, alternative antibiotics had been used to treat carbapenem-resistant Enterobacterales (CRE) infection such as high-dose meropenem combination therapy with amikacin, tigecycline, and/or colistin. To compare the outcome of CRE bacteremia between CAZ-AVI (study group) and alternative antibiotics (comparator group) before/after the introduction of CAZ-AVI.</p><p><strong>Methods: </strong>We retrospectively reviewed the adult patients with hematologic malignancy who had CRE bacteremia between January 2020 and July 2024.</p><p><strong>Results: </strong>A total of 85 patients with CRE bacteremia were analyzed including 25 with CAZ-AVI and 60 with alternative antibiotics. In a time-dependent multivariable Cox model for negative conversion of bacteremia, CAZ-AVI (hazard ratio [HR], 2.475; 95% confidence interval [CI], 1.493-4.102; <i>P</i> < 0.001) and <i>Klebsiella pneumoniae</i> carbapenemase [KPC] (HR, 0.490; 95% CI, 0.296-0.810; <i>P</i> = 0.005) was independently associated with rapid negative conversion. CAZ-AVI was associated with rapid negative conversion of bacteremia in the inverse probability of treatment weighting (IPTW) analysis (HR, 3.030; 95% CI, 1.818-5.263; <i>P</i> < 0.001). In a time-dependent multivariable Cox model, CAZ-AVI was the only independent predictor for 30-day mortality (HR, 0.295; 95% CI, 0.087-0.996; <i>P</i> = 0.049), although CAZ-AVI did not reach any statistical significance for 30-day mortality (HR, 0.513; 95% CI, 0.146-1.804; <i>P</i> = 0.298) in IPTW analysis.</p><p><strong>Conclusion: </strong>CAZ-AVI showed higher rapid negative conversion for CRE bacteremia in patients with hematologic malignancy, compared to the alternative antibiotics.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 35","pages":"e228"},"PeriodicalIF":3.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global, Regional, and National Burden of Aortic Aneurysm, 1990-2021, and Projections to 2050.","authors":"Minwoo Jung, Jinyoung Jeong, Yeona Jo, Seohyun Hong, Sooji Lee, Tae Hyeon Kim, Seoyoung Park, Jaehyun Kong, Hyunjee Kim, Masoud Rahmati, Hanseul Cho, Dong Keon Yon","doi":"10.3346/jkms.2026.41.e237","DOIUrl":"10.3346/jkms.2026.41.e237","url":null,"abstract":"<p><strong>Background: </strong>Despite being a life-threatening condition that may rupture without prior symptoms-potentially resulting in sudden death-comprehensive research on its global burden remains limited. This study was conducted to estimate the global burden and associated risk factors of aortic aneurysms and to project future trends through to 2050.</p><p><strong>Methods: </strong>Data on aortic aneurysms were extracted from the Global Burden of Disease Study 2021, encompassing 204 countries and territories from 1990 to 2021. An aortic aneurysm was defined as a full-thickness dilation of the aorta, including both abdominal and thoracic types. The study stratified the burden by geographical region, age, year, sex, and Socio-demographic Index (SDI). Additionally, attributable risk factors were analyzed, and projections for the burden of aortic aneurysms in 2050 were generated using scenario modelling. These models evaluated the potential impact of eliminating smoking, dietary risks, and high body mass index among adults through improved behavioral and metabolic risk management.</p><p><strong>Results: </strong>In 2021, there were an estimated 153.93 thousand (95% uncertainty interval [UI], 138.41-165.74) deaths globally due to aortic aneurysm. From 1990 to 2021, the global age-standardized mortality rate (ASMR) decreased from 2.54 (95% UI, 2.35-2.69) to 1.86 (1.67-2.00), and the age-standardized years of life lost rates declined from 48.79 (46.01-51.80) to 36.54 (33.52-39.46) per 100,000 population. While regions with higher SDI exhibited a sharp decline, the burden remained significant in both high (ASMR, 2.87 [95% UI, 2.51-3.06]) and high-middle (1.79 [1.66-1.92]) SDI areas. Conversely, regions with lower SDI demonstrated an increasing trend. Males consistently exhibited a higher burden than females, and burden increased with age. Tobacco use and high systolic blood pressure were identified as the predominant risk factors for aortic aneurysm-related mortality. Specifically, tobacco use was a more significant risk factor in males, while high systolic blood pressure was more prominent in females. Projections suggest that the global ASMR for aortic aneurysm will remain stable under the reference scenario in 2022 (1.87 [95% UI, 1.67-2.02]) and 2050 (1.44 [1.23-1.70]). However, improved behavioral and metabolic risk management could substantially reduce rates to 0.84 (0.71-0.99) by 2050.</p><p><strong>Conclusion: </strong>The findings demonstrate a global decline in the burden of aortic aneurysms, though pronounced regional differences persist. Effective management strategies must be tailored to account for healthcare infrastructure, socioeconomic status, and risk factors unique to each geographical region.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 35","pages":"e237"},"PeriodicalIF":3.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity of the T-MoCA for Screening MCI and Dementia and Its Equivalence to the K-MoCA-22.","authors":"Haeyoon Kim, Yujin Jeong, Hansol Ji, Jong-Sik Park, In-Uk Song, Jong-Hee Sohn, Juhee Chin, Yeonwook Kang","doi":"10.3346/jkms.2026.41.e238","DOIUrl":"10.3346/jkms.2026.41.e238","url":null,"abstract":"<p><strong>Background: </strong>With rapid population aging, the prevalence of cognitive impairment and dementia continues to rise, underscoring the need for accessible and reliable screening tools. The Telephone-Montreal Cognitive Assessment (T-MoCA) enables remote cognitive evaluation but has been rarely validated in non-Western populations or in patients with dementia. This study aimed to evaluate the diagnostic validity of the T-MoCA and its score equivalence to the corresponding face-to-face version, the Korean version of the MoCA (K-MoCA)-22, across the full cognitive spectrum in older Korean adults.</p><p><strong>Methods: </strong>The participants included 52 cognitively normal (CN) adults, 51 with mild cognitive impairment (MCI), and 50 with dementia. All participants completed the T-MoCA, the K-MoCA-30, and Korean-Mini Mental State Examination, 2nd Edition (K-MMSE-2). The K-MoCA-22 scores were derived from the K-MoCA-30 by excluding visuomotor items. The T-MoCA and K-MoCA-30 were administered approximately one month apart.</p><p><strong>Results: </strong>The T-MoCA showed moderate to strong correlations with the K-MoCA-30 and moderate correlations with the K-MMSE-2. T-MoCA scores declined progressively from CN to MCI to dementia, with significant between-group differences consistent with those observed for the K-MoCA-30. No significant differences in the areas under the curve were found between the T-MoCA and K-MoCA-30, or between the T-MoCA and K-MMSE-2, indicating comparable discriminability. Lin's concordance correlation coefficients showed good overall agreement, and Bradley-Blackwood tests revealed no significant differences in means or variances between the T-MoCA and K-MoCA-22. Bland-Altman plots showed no systematic bias, with differences symmetrically distributed around zero.</p><p><strong>Conclusion: </strong>These findings support the T-MoCA as a valid, reliable, and clinically equivalent alternative to in-person MoCA formats for older Korean adults, encompassing normal cognition, MCI and dementia. As a practical and accessible tool for remote cognitive screening, the T-MoCA is expected to facilitate early detection and longitudinal monitoring of cognitive decline, particularly in community and telehealth settings.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 35","pages":"e238"},"PeriodicalIF":3.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Ropeginterferon Alfa-2b in Pregnant Women With Myeloproliferative Neoplasms: Case Series of Three Subtypes and Review.","authors":"Hangyeol Kim, Sung-Eun Lee, Young Rok Do, Sung-Yong Kim, Junshik Hong","doi":"10.3346/jkms.2026.41.e327","DOIUrl":"10.3346/jkms.2026.41.e327","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 34","pages":"e327"},"PeriodicalIF":3.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-Pregnancy Physical Activity Lowers Risk of Diet-Controlled but Not Insulin-Treated Gestational Diabetes Mellitus: A Korean Prospective Cohort Study.","authors":"Hye-Ji Han, Hyun Jung Lee, Tae Ho Kim, MinJeong Kwak, Jin Woo Kim, Su Ji Yang, Ju Yeon Kim, Yong Jun Choi, Nari Kim, Ji Hyon Jang, You Jung Han, Jin Hoon Chung, Dong Wook Kwak, Ji Hyae Lim, Hyun Mee Ryu","doi":"10.3346/jkms.2026.41.e226","DOIUrl":"10.3346/jkms.2026.41.e226","url":null,"abstract":"<p><strong>Background: </strong>Gestational diabetes mellitus (GDM) presents clinically as either diet-controlled (diet-controlled gestational diabetes mellitus, A1GDM) or medication-controlled (insulin-requiring gestational diabetes mellitus, A2GDM) subtypes. Pre-pregnancy physical activity represents a significant modifiable factor in GDM prevention and management. Therefore, this study aimed to investigate the differential effects of physical activity on these two clinical GDM subtypes.</p><p><strong>Methods: </strong>This secondary analysis utilized data from the Korean Pregnancy Outcome Study, a longitudinal multicenter cohort. From 3,457 singleton pregnant participants, physical activity was assessed at five time points from pre-pregnancy to postpartum using the International Physical Activity Questionnaire Short Form. Logistic regression models were used to estimate adjusted odds ratios (aORs) for GDM subtypes according to physical activity. Firth's penalized logistic regression was used for A2GDM analysis.</p><p><strong>Results: </strong>Of the participants, 231 developed GDM (overall prevalence 6.7%). Among these cases, 198 (85.7%) were diagnosed with A1GDM, and 33 (14.3%) with A2GDM. No significant differences in moderate-to-vigorous physical activity or muscle-strengthening activity were observed across three groups in baseline characteristics. However, Women who performed muscle-strengthening activity before pregnancy had a significantly lower risk of A1GDM (aOR, 0.492; 95% confidence interval, 0.262-0.923), with risk decreasing as activity frequency increased (<i>P</i> for trend = 0.014).</p><p><strong>Conclusion: </strong>Pre-pregnancy muscle-strengthening activity is associated with significantly reduced risk of A1GDM. These findings highlight the importance of muscle-strengthening activity before conception as a potential strategy for GDM prevention.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 34","pages":"e226"},"PeriodicalIF":3.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comorbidity Trajectories Before and After Hip Fracture in Elderly Patients: A Korean Nationwide Database Cohort Study.","authors":"Seung Hoon Kim, Eunjeong Choi, Yonghan Cha, Jaewoo Hong, Seoyeong Choi, Suk-Yong Jang","doi":"10.3346/jkms.2026.41.e218","DOIUrl":"10.3346/jkms.2026.41.e218","url":null,"abstract":"<p><strong>Background: </strong>Hip fractures in older adults often signal frailty and are associated with poor outcomes, including mortality and disability. Although a high burden of comorbidities is common, little is known about how these conditions evolve before and after the fracture event. Understanding comorbidity trajectories can inform preventive and rehabilitative strategies.</p><p><strong>Methods: </strong>We analyzed data from the Korean National Health Insurance Service-Senior cohort between 2005 and 2016. A total of 8,319 patients aged ≥ 65 years with surgically treated hip fractures were matched 1:2 with 16,638 controls by age, sex, and year. Comorbidity data were extracted from claims using the International Classification of Diseases, Tenth Revision (ICD-10) codes. We evaluated changes in comorbidity prevalence over a 7-year window (3 years pre- and post-fracture). Difference-in-differences (DIDs) analysis using generalized estimating equations was performed to compare temporal trends between groups.</p><p><strong>Results: </strong>At the time of fracture, the most prevalent comorbidities were hypertension, osteoarthritis, vertebral disease, osteoporosis, and diabetes. Comorbidity burden increased more steeply in hip fracture patients compared to controls, especially after the fracture event. Notable post-fracture increases were observed in osteoporosis (DID ratio: 1.19), dementia (1.17), congestive heart failure (1.09), Parkinson's disease (1.11), and chronic obstructive pulmonary disease (1.04). In contrast, diabetes (0.96), asthma (0.96), and vertebral disease (0.97) showed relative decreases.</p><p><strong>Conclusion: </strong>Hip fracture signals not only existing multimorbidity but also accelerates its progression, particularly for neurodegenerative and cardiovascular diseases. Integrated care strategies should proactively address chronic disease burden before and after hip fracture.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 34","pages":"e218"},"PeriodicalIF":3.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Menopausal Hormone Therapy and the Risk of Urologic Cancer: A National Population-Based Retrospective Cohort Study in Korea.","authors":"Jin-Sung Yuk, Sang-Hee Yoon, Dae Yeon Cho, Nuri Oh, Jae Yoon Kim","doi":"10.3346/jkms.2026.41.e225","DOIUrl":"10.3346/jkms.2026.41.e225","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the relationship between menopausal hormone therapy (MHT) and the risk of urologic cancer in women using the Health Insurance Database in Korea.</p><p><strong>Method: </strong>We collected Health insurance data from the Health Insurance Review and Assessment Service in Korea between January 1, 2002 and December 31, 2019. Postmenopausal women aged > 40 years were grouped based on MHT exposure status, forming an exposed (MHT users) and an unexposed (non-users) cohort. Types of MHT included tibolone, combined oestrogen plus progestin by the manufacturer (CEPM) or physician (CEPP), and oral and topical oestrogen. Patient characteristics, including age, body mass index (BMI), Charlson comorbidity index, socioeconomic status, residency region, smoking status, alcohol history, physical exercise pattern, reproductive factors such as age at menarche and at menopause, parity, and the period from menopause to inclusion in the study, were reviewed. We performed a Cox proportional hazard analysis to clarify the risk of urologic cancer associated with MHT.</p><p><strong>Results: </strong>Among 2,506,271 participants who had a national health check, 557,031 did not receive MHT and 204,130 received MHT. The median age and BMI of patients were 56 (52-62) and 23.8 (21.9-25.9) kg/m², respectively. According to MHT types, 104,089 patients were treated with tibolone, 65,597 with CEPM, 29,357 with oral oestrogen, 3,913 with CEPP, and 1,174 with topical oestrogen. Among women on MHT, the incidence of kidney cancer was significantly associated with oral (hazard ratio [HR], 1.36; 95% confidence interval [CI], 1.062-1.735) and topical oestrogen (HR, 2.84; 95% CI, 1.270-6.344); other formulations were not associated with kidney cancer. Meanwhile, tibolone was significantly associated with a decreased incidence of bladder cancer (HR, 0.69; 95% CI, 0.548-0.858); other formulations were not associated with bladder cancer.</p><p><strong>Conclusion: </strong>MHT in postmenopausal women is significantly associated with the incidence of kidney and bladder cancers.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 34","pages":"e225"},"PeriodicalIF":3.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Department Utilization Patterns and Regional Disparities in Access to Care for Children With Complex Chronic Conditions in Korea: A Nationwide Analysis.","authors":"Youn Young Choi, You Sun Kim, Ye Kyung Kim, Kyung-Shin Lee, Ho Kyung Sung","doi":"10.3346/jkms.2026.41.e143","DOIUrl":"10.3346/jkms.2026.41.e143","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 <i>P</i> < 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 <i>P</i> < 0.001). Findings were robust to additional adjustment for individual CCC categories and domains.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 34","pages":"e143"},"PeriodicalIF":3.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consistency in North Korean Medical Academic Research Topics During the COVID-19 Pandemic: A Text Mining Analysis.","authors":"Eun Hae Lee, Minjae Choi, Hanul Park, Joon Hee Han, Sujeong Yu, Joshua Kirabo Sempungu, Yo Han Lee","doi":"10.3346/jkms.2026.41.e227","DOIUrl":"10.3346/jkms.2026.41.e227","url":null,"abstract":"<p><strong>Background: </strong>The coronavirus disease 2019 (COVID-19) pandemic triggered a global shift in medical research priorities, with increased emphasis on infectious disease response and public health. However, little is known about whether similar changes occurred in the People's Republic of Korea (North Korea), a country with limited transparency and access to health data. This study aimed to assess thematic changes in North Korean medical academic research before and during the COVID-19 pandemic by analyzing article titles using text mining techniques.</p><p><strong>Methods: </strong>We extracted 8,818 paper titles from six major North Korean medical academic journals published between 2017 and 2022 and categorized them into two periods: pre-pandemic (2017-2019) and pandemic (2020-2022). Morpheme analysis was performed to break down text data into meaningful units, frequency analysis and word cloud visualization were applied to identify and intuitively describe the most frequently occurring terms, and latent dirichlet allocation (LDA) topic modeling was performed to identify latent topics formed by words that frequently occur simultaneously within the article's title. In addition, the framework of the analysis was divided into two categories: disease and health care service, and the subject-specific changes in each area were analyzed.</p><p><strong>Results: </strong>During the pandemic, as expected, an increasing proportion of topics related to new infectious diseases was observed. However, the core structure of the research topic remained essentially unchanged over the two periods. In particular, as before the pandemic, surgical treatment-related words accounted for the largest proportion. In LDA thematic modeling, treatment-oriented topics such as drug prescription formed a key group. The majority of COVID-19-related articles tended to focus on clinical management and quarantine rather than basic science or vaccine development.</p><p><strong>Conclusion: </strong>While the world is focusing on vaccine and quarantine research, the medical research in North Korea maintained a strong focus on solving immediate problems, such as surgical and drug treatment, rather than shifting significantly toward pandemic-specific research. This means that medical academic research in North Korea tends to adhere to the existing research system rather than responding to external crises. In conclusion, identifying this pattern provides essential insights for predicting North Korea's capacity to respond and its limitations in the event of another health crisis in the future.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 34","pages":"e227"},"PeriodicalIF":3.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transition in the Composition of Maternal Mortality in Korea: Implications for Extremely Low Fertility Societies.","authors":"Bo Ryoung Han, Jeong-Won Oh, Seok-Jun Yoon, Jiwoo Seo, Hye Sook Min, Ki Hoon Ahn, Seung-Ah Choe","doi":"10.3346/jkms.2026.41.e267","DOIUrl":"10.3346/jkms.2026.41.e267","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"41 34","pages":"e267"},"PeriodicalIF":3.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}