OBJECTIVES: Estimating influenza-associated mortality is important since seasonal influenza affects persons of all ages, causing severe illness or death. This study aimed to estimate influenza-associated mortality, considering both periodic changes and age-specific mortality by influenza subtypes. METHODS: Using the Microdata Integrated Service from Statistics Korea, we collected weekly mortality data including cause of death. Laboratory surveillance data of respiratory viruses from 2009 to 2016 were obtained from the Korea Centers for Disease Control and Prevention. After adjusting for the annual age-specific population size, we used a negative binomial regression model by age group and influenza subtype. RESULTS: Overall, 1 859 890 deaths were observed and the average rate of influenza virus positivity was 14.7% (standard deviation [SD], 5.8), with the following subtype distribution: A(H1N1), 5.0% (SD, 5.8); A(H3N2), 4.4% (SD, 3.4); and B, 5.3% (SD, 3.7). As a result, among individuals under 65 years old, 6774 (0.51%) all-cause deaths, 2521 (3.05%) respiratory or circulatory deaths, and 1048 (18.23%) influenza or pneumonia deaths were estimated. Among those 65 years of age or older, 30 414 (2.27%) all-cause deaths, 16 411 (3.42%) respiratory or circulatory deaths, and 4906 (6.87%) influenza or pneumonia deaths were estimated. Influenza A(H3N2) virus was the major contributor to influenza-associated all-cause and respiratory or circulatory deaths in both age groups. However, influenza A(H1N1) virus–associated influenza or pneumonia deaths were more common in those under 65 years old. CONCLUSIONS: Influenza-associated mortality was substantial during this period, especially in the elderly. By subtype, influenza A(H3N2) virus made the largest contribution to influenza-associated mortality.
Aged ; Cause of Death ; Centers for Disease Control and Prevention (U.S.) ; Cost of Illness ; Humans ; Influenza, Human ; Korea ; Mortality ; Orthomyxoviridae ; Pneumonia ; Population Density ; Seasons

Objective: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide and is both unpredictable and inevitable. While uterotonic drugs are routinely recommended, there is ongoing debate on the ideal intervention to control uterine bleeding. This review aims to compare the use of non-pharmacologic treatments with peripartum hysterectomy in cases of life-threatening uncontrolled obstetric hemorrhage. The review’s objective is to use a network meta-analysis to help prevent maternal deaths and rank the treatments according to success rates. Methods: We searched MEDLINE (PubMed), Embase, and the Cochrane Library, from January 2014 until December 2018. A second search was carried out in April 2019 before the final data analysis. Network meta-analysis allows for the calculation of the effect size between treatment groups through indirect treatment comparison. Results: We confirmed that balloon-assisted management is the best intervention for uncontrolled postpartum bleeding with pharmacologic treatment. This is followed by uterine artery embolization and surgical procedures, which can help avoid the need for a hysterectomy. The balloon tamponade demonstrated lower failure rate than the surgical procedure with odds ratio (OR) of 0.44 and 95% confidence intervals (CIs) 0.50–30.54. Uterine artery embolization had a lower risk for hysterectomy than the surgical procedure group (OR, 0.74; 95% CI, 0.22–2.50). Conclusion For the quick treatment of postpartum bleeding, balloon tamponade is the best method for uncontrolled postpartum bleeding with pharmacologic treatment, followed by uterine artery embolization and surgical procedures.

OBJECTIVES: Estimating influenza-associated mortality is important since seasonal influenza affects persons of all ages, causing severe illness or death. This study aimed to estimate influenza-associated mortality, considering both periodic changes and age-specific mortality by influenza subtypes. METHODS: Using the Microdata Integrated Service from Statistics Korea, we collected weekly mortality data including cause of death. Laboratory surveillance data of respiratory viruses from 2009 to 2016 were obtained from the Korea Centers for Disease Control and Prevention. After adjusting for the annual age-specific population size, we used a negative binomial regression model by age group and influenza subtype. RESULTS: Overall, 1 859 890 deaths were observed and the average rate of influenza virus positivity was 14.7% (standard deviation [SD], 5.8), with the following subtype distribution: A(H1N1), 5.0% (SD, 5.8); A(H3N2), 4.4% (SD, 3.4); and B, 5.3% (SD, 3.7). As a result, among individuals under 65 years old, 6774 (0.51%) all-cause deaths, 2521 (3.05%) respiratory or circulatory deaths, and 1048 (18.23%) influenza or pneumonia deaths were estimated. Among those 65 years of age or older, 30 414 (2.27%) all-cause deaths, 16 411 (3.42%) respiratory or circulatory deaths, and 4906 (6.87%) influenza or pneumonia deaths were estimated. Influenza A(H3N2) virus was the major contributor to influenza-associated all-cause and respiratory or circulatory deaths in both age groups. However, influenza A(H1N1) virus–associated influenza or pneumonia deaths were more common in those under 65 years old. CONCLUSIONS Influenza-associated mortality was substantial during this period, especially in the elderly. By subtype, influenza A(H3N2) virus made the largest contribution to influenza-associated mortality.

Objective: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide and is both unpredictable and inevitable. While uterotonic drugs are routinely recommended, there is ongoing debate on the ideal intervention to control uterine bleeding. This review aims to compare the use of non-pharmacologic treatments with peripartum hysterectomy in cases of life-threatening uncontrolled obstetric hemorrhage. The review’s objective is to use a network meta-analysis to help prevent maternal deaths and rank the treatments according to success rates. Methods: We searched MEDLINE (PubMed), Embase, and the Cochrane Library, from January 2014 until December 2018. A second search was carried out in April 2019 before the final data analysis. Network meta-analysis allows for the calculation of the effect size between treatment groups through indirect treatment comparison. Results: We confirmed that balloon-assisted management is the best intervention for uncontrolled postpartum bleeding with pharmacologic treatment. This is followed by uterine artery embolization and surgical procedures, which can help avoid the need for a hysterectomy. The balloon tamponade demonstrated lower failure rate than the surgical procedure with odds ratio (OR) of 0.44 and 95% confidence intervals (CIs) 0.50–30.54. Uterine artery embolization had a lower risk for hysterectomy than the surgical procedure group (OR, 0.74; 95% CI, 0.22–2.50). Conclusion For the quick treatment of postpartum bleeding, balloon tamponade is the best method for uncontrolled postpartum bleeding with pharmacologic treatment, followed by uterine artery embolization and surgical procedures.

German cockroaches are major household allergens that can trigger allergic airway inflammatory diseases with sensitive T-cell responses. Although the use of immune modulatory biologics, such as antibodies, to mediate allergic responses has recently been examined, only systemic administration is available because of the size limitations on intranasal administration. Here we utilized a cell-permeable peptide, dNP2, to deliver the cytoplasmic domain of cytotoxic T-lymphocyte antigen-4 (ctCTLA-4) through the airway epithelium to modulate Th2 responses in a German cockroach extract (GCE)-induced allergic airway inflammation model. The intranasal delivery efficiency of the dNP2-dTomato protein to the lungs was higher in GCE-induced asthmatic lung parenchymal cells compared to the sham cells. Intranasal administration of the dNP2-ctCTLA-4 protein inhibited airway hyper-responsiveness and reduced airway inflammation and remodeling, including goblet cell metaplasia and collagen deposition around the bronchi. The number of infiltrated cells, including eosinophils, and the levels of IL-4, IL-5, IL-13 and IFN-γ in the lungs were significantly reduced, presumably owing to inhibition of Th2 differentiation. However, intranasal administration of CTLA4-Ig did not inhibit airway inflammation. These results collectively suggest that dNP2-ctCTLA-4 is an efficient intranasally applicable candidate biologic for treating allergic asthma.
Abatacept ; Administration, Intranasal ; Allergens ; Antibodies ; Asthma ; Biological Products ; Blattellidae* ; Bronchi ; Collagen ; Cytoplasm ; Eosinophils ; Epithelium ; Family Characteristics ; Goblet Cells ; Inflammation* ; Interleukin-13 ; Interleukin-4 ; Interleukin-5 ; Lung ; Metaplasia ; Respiratory Hypersensitivity ; T-Lymphocytes ; T-Lymphocytes, Cytotoxic

OBJECTIVES: Many studies have explored the relationship between short-term weather and its health effects (including pneumonia) based on mortality, although both morbidity and mortality pose a substantial burden. In this study, the authors aimed to describe the influence of meteorological factors on the number of emergency room (ER) visits due to pneumonia in Seoul, Korea. METHODS: Daily records of ER visits for pneumonia over a 6-year period (2009-2014) were collected from the National Emergency Department Information System. Corresponding meteorological data were obtained from the National Climate Data Service System. A generalized additive model was used to analyze the effects. The percent change in the relative risk of certain meteorological variables, including pneumonia temperature (defined as the change in average temperature from one day to the next), were estimated for specific age groups. RESULTS: A total of 217 776 ER visits for pneumonia were identified. The additional risk associated with a 1°C increase in pneumonia temperature above the threshold of 6°C was 1.89 (95% confidence interval [CI], 1.37 to 2.61). Average temperature and diurnal temperature range, representing within-day temperature variance, showed protective effects of 0.07 (95% CI, 0.92 to 0.93) and 0.04 (95% CI, 0.94 to 0.98), respectively. However, in the elderly (65+ years), the effect of pneumonia temperature was inconclusive, and the directionality of the effects of average temperature and diurnal temperature range differed. CONCLUSIONS: The term ‘pneumonia temperature’ is valid. Pneumonia temperature was associated with an increased risk of ER visits for pneumonia, while warm average temperatures and large diurnal temperature ranges showed protective effects.
Aged ; Climate ; Emergencies ; Emergency Service, Hospital ; Humans ; Information Systems ; Korea ; Meteorological Concepts ; Mortality ; Pneumonia ; Public Health ; Seoul ; Weather

Purpose: In 2015, the South Korean government legislated the Act for the Improvement of Training Conditions and Status of Medical Residents (Medical Resident Act). This study investigated changes in the working and learning environment pre- and post-implementation of the Medical Resident Act in 2017, as well as changes in training conditions by year post-implementation. Methods: An annual cross-sectional voluntary survey was conducted by the Korean Intern Resident Association (KIRA) between 2016 and 2019. The learning and working environment, including extended shift length, rest time, learning goals, and job satisfaction, were compared by institution type, training year, and specialty. Results: Of the 55,727 enrollees in the KIRA, 15,029 trainees took the survey, and the number of survey participants increased year by year (from 2,984 in 2016 to 4,700 in 2019). Overall working hours tended to decrease; however, interns worked the most (114 hours in 2016, 88 hours in 2019; P<0.001). Having 10 hours or more of break time has gradually become more common (P<0.001). Lunch breaks per week decreased from 5 in 2017 to 4 in 2019 (P<0.001). Trainees’ sense of educational deprivation due to physician assistants increased from 17.5% in 2016 to 25.6% in 2018 (P<0.001). Awareness of tasks and program/work achievement goals increased from 29.2% in 2016 to 58.3% in 2018 (P<0.001). Satisfaction with the learning environment increased over time, whereas satisfaction with working conditions varied. Conclusion The Medical Resident Act has brought promising changes to the training of medical residents in Korea, as well as their satisfaction with the training environment.

Objective: To provide updates on maternal, infant, and perinatal mortality using the national population data of South Korea between 2009 and 2017 and describe the mortality rate by target groups, timing, or causes of events to provide a basis for detecting vulnerable populations and ensuring timely medical and political interventions. Methods: Pregnancy-related mortality in women, as well as deaths of infants, in South Korea was identified using population data from Statistics Korea. Records from death certificates, cremation reports on infant and fetal deaths, and the complementary cause-of-death investigation system were reviewed for the 2009–2017 period. Results: A total of 461 maternal deaths, 11,717 infant deaths, and 12,249 perinatal deaths, including fetal deaths over 28 gestational weeks, were identified from 3,945,159 live births between 2009 and 2017. The maternal mortality ratio was 13.5 deaths per 100,000 live births in 2009 and decreased to 7.8 in 2017. Only the rate of deaths related to hypertensive disorders showed an increasing tendency. Both the infant and perinatal mortality rates improved (from 3.2 deaths per 1,000 live births in 2009 to 2.8 in 2017 and from 3.5 to 2.7, respectively). Among the external causes of infant mortality, assaults including homicides accounted for 25% (n=150), and this proportion was constant throughout the study period. Conclusion Overall improvements were observed in all maternal, infant, and perinatal mortality measures. In-depth analysis and interventions with respect to certain causes, such as hypertensive disorders in mothers or assaults in infants, should be considered priority issues.

PURPOSE: The flipped classroom has been suggested as a method for efficient teaching in medical education. However, its feasibility and effectiveness in the educational environment are often overlooked. The authors redesigned an epidemiology course applying the flipped classroom method under a traditional curriculum consisting of heavily scheduled classroom hours and explored its feasibility and effectiveness. METHODS: In the fall semester of 2017, we flipped the ‘practice of epidemiology’ course for third-year medical students at Korea University College of Medicine. We provided online lectures and assigned readings as pre-class materials, and substituted group discussions and communicative activities for traditional lectures. We conducted pre- and post-course surveys to review students' perceptions. We also analyzed the pre-test results and final exam scores for quantitative comparison. RESULTS: Ninety-seven students out of 120 completed the course. Most students made use of the online lectures, but not the reading materials. Lack of time was the most frequently cited reason for under-preparedness. We observed improvements in preparedness, participation, and effectiveness at the end of the course, while changes in satisfaction were unclear. Students' perceptions of course relevance and difficulty were predictive of pre-test outcomes, but the effects of preparedness and length of materials were insignificant. The authors found no evidence of differing test scores before and after the course. CONCLUSION: This study supports the feasibility of the flipped classroom model even under a traditional, heavily scheduled medical curriculum. To encourage self-directed learning and achieve better learning outcomes, restructuring pre-existing curricular components should also be considered in parallel with new instructional methods.
Curriculum ; Education, Medical ; Epidemiology ; Humans ; Korea ; Learning ; Lectures ; Methods ; Preventive Medicine ; Reading ; Students, Medical

Purpose: In 2015, the South Korean government legislated the Act for the Improvement of Training Conditions and Status of Medical Residents (Medical Resident Act). This study investigated changes in the working and learning environment pre- and post-implementation of the Medical Resident Act in 2017, as well as changes in training conditions by year post-implementation. Methods: An annual cross-sectional voluntary survey was conducted by the Korean Intern Resident Association (KIRA) between 2016 and 2019. The learning and working environment, including extended shift length, rest time, learning goals, and job satisfaction, were compared by institution type, training year, and specialty. Results: Of the 55,727 enrollees in the KIRA, 15,029 trainees took the survey, and the number of survey participants increased year by year (from 2,984 in 2016 to 4,700 in 2019). Overall working hours tended to decrease; however, interns worked the most (114 hours in 2016, 88 hours in 2019; P<0.001). Having 10 hours or more of break time has gradually become more common (P<0.001). Lunch breaks per week decreased from 5 in 2017 to 4 in 2019 (P<0.001). Trainees’ sense of educational deprivation due to physician assistants increased from 17.5% in 2016 to 25.6% in 2018 (P<0.001). Awareness of tasks and program/work achievement goals increased from 29.2% in 2016 to 58.3% in 2018 (P<0.001). Satisfaction with the learning environment increased over time, whereas satisfaction with working conditions varied. Conclusion The Medical Resident Act has brought promising changes to the training of medical residents in Korea, as well as their satisfaction with the training environment.