1.Gastrointestinal Surgery Status and the Risks of Ischemic Stroke and Safety Outcomes With Direct Oral Anticoagulants Versus Warfarin in Atrial Fibrillation: A Nationwide Population-Based Cohort Study
Jiyeon HA ; Wookjin YANG ; Mi-Sook KIM ; Eung-Joon LEE ; Matthew CHUNG ; Boyeon YANG ; Hyemin JANG ; Jeong-Min KIM ; Keun-Hwa JUNG ; Seung-Hoon LEE
Journal of Stroke 2026;28(2):228-239
Background:
and Purpose Although gastrointestinal (GI) surgery can affect drug efficacy, its impact on oral anticoagulants (OACs) remains unclear. This study investigated the impact of GI surgery on the comparative effectiveness and safety of direct oral anticoagulants (DOACs) versus warfarin in atrial fibrillation (AF).
Methods:
Using a nationwide South Korean claims database, AF patients prescribed OACs between 2015 and 2021 were analyzed. The primary outcome was ischemic stroke, and secondary outcomes were major bleeding, all-cause death, and composite outcome (ischemic stroke, major bleeding, all-cause death). Outcomes were compared by OAC type (DOAC vs. warfarin) and GI surgery status using inverse probability of treatment weighting and a Fine–Gray subdistribution hazard model with time-varying covariates.
Results:
Among 388,214 AF patients (mean age, 71.9 yr; 42.7% male), 6,907 (1.8%) underwent GI surgery. The effect of GI surgery differed between warfarin and DOACs for ischemic stroke (Pint= 0.018), with increased risk for warfarin (adjusted HR [aHR]: 2.32; 95% confidence interval [CI] 1.17–4.62), but not for DOACs (aHR: 0.97 [95% CI 0.77–1.22]) after surgery. Effects of surgery on major bleeding, all-cause death, and composite outcome did not differ. In post–GI surgery setting, DOACs demonstrated lower ischemic stroke risk (aHR: 0.35 [95% CI 0.17–0.72]) and comparable risks for other outcomes. Exploratory analyses by surgery location suggested a more favorable profile of DOACs after upper GI surgery.
Conclusions
In AF patients, GI surgery significantly increased ischemic stroke risk among warfarin users, but not among DOAC users. DOACs showed generally favorable profiles after GI surgery and may remain a reasonable anticoagulant, with potentially more favorable profile after upper GI surgery.
2.Occupational disease monitoring by the Korea Occupational Disease Surveillance Center: a narrative review
Dong-Wook LEE ; Inah KIM ; Jungho HWANG ; Sunhaeng CHOI ; Tae-Won JANG ; Insung CHUNG ; Hwan-Cheol KIM ; Jaebum PARK ; Jungwon KIM ; Kyoung Sook JEONG ; Youngki KIM ; Eun-Soo LEE ; Yangwoo KIM ; Inchul JEONG ; Hyunjeong OH ; Hyeoncheol OH ; Jea Chul HA ; Jeehee MIN ; Chul Gab LEE ; Heon KIM ; Jaechul SONG
The Ewha Medical Journal 2025;48(1):e9-
This review examines the challenges associated with occupational disease surveillance in Korea, particularly emphasizing the limitations of current data sources such as the Industrial Accident Compensation Insurance (IACI) statistics and special health examinations. The IACI system undercounts cases due to its emphasis on severe diseases and restrictions on approvals. Special health examinations, although they cover a broad workforce, are constrained by their annual scheduling, which leads to missed acute illnesses and subclinical conditions. The paper also explores the history of occupational disease surveillance in Korea, highlighting the fragmented and disease-specific approach of earlier systems. The authors introduce the newly established Korea Occupational Disease Surveillance Center (KODSC), a comprehensive nationwide system designed to gather, analyze, and interpret data on occupational diseases through a network of regional centers. By incorporating hospital-based surveillance and focusing on acute poisonings and other sentinel events, the KODSC aims to overcome the limitations of previous systems and promote collaboration with various agencies. Although it is still in the early stages of implementation, the KODSC demonstrates potential for improving data accuracy and contributing valuable insights for public health policy.
3.Occupational disease monitoring by the Korea Occupational Disease Surveillance Center: a narrative review
Dong-Wook LEE ; Inah KIM ; Jungho HWANG ; Sunhaeng CHOI ; Tae-Won JANG ; Insung CHUNG ; Hwan-Cheol KIM ; Jaebum PARK ; Jungwon KIM ; Kyoung Sook JEONG ; Youngki KIM ; Eun-Soo LEE ; Yangwoo KIM ; Inchul JEONG ; Hyunjeong OH ; Hyeoncheol OH ; Jea Chul HA ; Jeehee MIN ; Chul Gab LEE ; Heon KIM ; Jaechul SONG
The Ewha Medical Journal 2025;48(1):e9-
This review examines the challenges associated with occupational disease surveillance in Korea, particularly emphasizing the limitations of current data sources such as the Industrial Accident Compensation Insurance (IACI) statistics and special health examinations. The IACI system undercounts cases due to its emphasis on severe diseases and restrictions on approvals. Special health examinations, although they cover a broad workforce, are constrained by their annual scheduling, which leads to missed acute illnesses and subclinical conditions. The paper also explores the history of occupational disease surveillance in Korea, highlighting the fragmented and disease-specific approach of earlier systems. The authors introduce the newly established Korea Occupational Disease Surveillance Center (KODSC), a comprehensive nationwide system designed to gather, analyze, and interpret data on occupational diseases through a network of regional centers. By incorporating hospital-based surveillance and focusing on acute poisonings and other sentinel events, the KODSC aims to overcome the limitations of previous systems and promote collaboration with various agencies. Although it is still in the early stages of implementation, the KODSC demonstrates potential for improving data accuracy and contributing valuable insights for public health policy.
4.Occupational disease monitoring by the Korea Occupational Disease Surveillance Center: a narrative review
Dong-Wook LEE ; Inah KIM ; Jungho HWANG ; Sunhaeng CHOI ; Tae-Won JANG ; Insung CHUNG ; Hwan-Cheol KIM ; Jaebum PARK ; Jungwon KIM ; Kyoung Sook JEONG ; Youngki KIM ; Eun-Soo LEE ; Yangwoo KIM ; Inchul JEONG ; Hyunjeong OH ; Hyeoncheol OH ; Jea Chul HA ; Jeehee MIN ; Chul Gab LEE ; Heon KIM ; Jaechul SONG
The Ewha Medical Journal 2025;48(1):e9-
This review examines the challenges associated with occupational disease surveillance in Korea, particularly emphasizing the limitations of current data sources such as the Industrial Accident Compensation Insurance (IACI) statistics and special health examinations. The IACI system undercounts cases due to its emphasis on severe diseases and restrictions on approvals. Special health examinations, although they cover a broad workforce, are constrained by their annual scheduling, which leads to missed acute illnesses and subclinical conditions. The paper also explores the history of occupational disease surveillance in Korea, highlighting the fragmented and disease-specific approach of earlier systems. The authors introduce the newly established Korea Occupational Disease Surveillance Center (KODSC), a comprehensive nationwide system designed to gather, analyze, and interpret data on occupational diseases through a network of regional centers. By incorporating hospital-based surveillance and focusing on acute poisonings and other sentinel events, the KODSC aims to overcome the limitations of previous systems and promote collaboration with various agencies. Although it is still in the early stages of implementation, the KODSC demonstrates potential for improving data accuracy and contributing valuable insights for public health policy.
5.Occupational disease monitoring by the Korea Occupational Disease Surveillance Center: a narrative review
Dong-Wook LEE ; Inah KIM ; Jungho HWANG ; Sunhaeng CHOI ; Tae-Won JANG ; Insung CHUNG ; Hwan-Cheol KIM ; Jaebum PARK ; Jungwon KIM ; Kyoung Sook JEONG ; Youngki KIM ; Eun-Soo LEE ; Yangwoo KIM ; Inchul JEONG ; Hyunjeong OH ; Hyeoncheol OH ; Jea Chul HA ; Jeehee MIN ; Chul Gab LEE ; Heon KIM ; Jaechul SONG
The Ewha Medical Journal 2025;48(1):e9-
This review examines the challenges associated with occupational disease surveillance in Korea, particularly emphasizing the limitations of current data sources such as the Industrial Accident Compensation Insurance (IACI) statistics and special health examinations. The IACI system undercounts cases due to its emphasis on severe diseases and restrictions on approvals. Special health examinations, although they cover a broad workforce, are constrained by their annual scheduling, which leads to missed acute illnesses and subclinical conditions. The paper also explores the history of occupational disease surveillance in Korea, highlighting the fragmented and disease-specific approach of earlier systems. The authors introduce the newly established Korea Occupational Disease Surveillance Center (KODSC), a comprehensive nationwide system designed to gather, analyze, and interpret data on occupational diseases through a network of regional centers. By incorporating hospital-based surveillance and focusing on acute poisonings and other sentinel events, the KODSC aims to overcome the limitations of previous systems and promote collaboration with various agencies. Although it is still in the early stages of implementation, the KODSC demonstrates potential for improving data accuracy and contributing valuable insights for public health policy.
6.Occupational disease monitoring by the Korea Occupational Disease Surveillance Center: a narrative review
Dong-Wook LEE ; Inah KIM ; Jungho HWANG ; Sunhaeng CHOI ; Tae-Won JANG ; Insung CHUNG ; Hwan-Cheol KIM ; Jaebum PARK ; Jungwon KIM ; Kyoung Sook JEONG ; Youngki KIM ; Eun-Soo LEE ; Yangwoo KIM ; Inchul JEONG ; Hyunjeong OH ; Hyeoncheol OH ; Jea Chul HA ; Jeehee MIN ; Chul Gab LEE ; Heon KIM ; Jaechul SONG
The Ewha Medical Journal 2025;48(1):e9-
This review examines the challenges associated with occupational disease surveillance in Korea, particularly emphasizing the limitations of current data sources such as the Industrial Accident Compensation Insurance (IACI) statistics and special health examinations. The IACI system undercounts cases due to its emphasis on severe diseases and restrictions on approvals. Special health examinations, although they cover a broad workforce, are constrained by their annual scheduling, which leads to missed acute illnesses and subclinical conditions. The paper also explores the history of occupational disease surveillance in Korea, highlighting the fragmented and disease-specific approach of earlier systems. The authors introduce the newly established Korea Occupational Disease Surveillance Center (KODSC), a comprehensive nationwide system designed to gather, analyze, and interpret data on occupational diseases through a network of regional centers. By incorporating hospital-based surveillance and focusing on acute poisonings and other sentinel events, the KODSC aims to overcome the limitations of previous systems and promote collaboration with various agencies. Although it is still in the early stages of implementation, the KODSC demonstrates potential for improving data accuracy and contributing valuable insights for public health policy.
7.Contemporary diagnosis and treatment of valvular heart disease in Korea: a nationwide hospital‑based registry study
Hyung Yoon KIM ; Hee Jeong LEE ; In‑Cheol KIM ; Jung‑Woo SON ; Jun‑Bean PARK ; Sahmin LEE ; Eun Kyoung KIM ; Seong‑Mi PARK ; Woo‑Baek CHUNG ; Jung Sun CHO ; Jin‑Sun PARK ; Jeong‑Sook SEO ; Sun Hwa LEE ; Byung Joo SUN ; Chi Young SHIM ; Hyungseop KIM ; Kye Hun KIM ; Duk‑Hyun KANG ; Jong‑Won HA ;
Journal of Cardiovascular Imaging 2024;32(1):37-
Background:
This study was designed to determine the current status of diagnosis and treatment of valvular heart disease (VHD) in Korea.
Methods:
A nationwide registry study was conducted in 45 hospitals in Korea involving adult patients with at least moderate VHD as determined by echocardiography carried out between September and October of 2019. Of a total of 4,094 patients with at least moderate VHD, 1,482 had severe VHD (age, 71.3 ± 13.5 years; 49.1% male). Echocar‑ diographic data used for the diagnosis of each case of VHD were analyzed. Experts from each center determined the diagnosis and treatment strategy for VHD based on current guidelines and institutional policy. The clinical out‑ come was in-hospital mortality.
Results:
Each valve underwent surgical or transcatheter intervention in 19.3% cases of severe mitral stenosis, 31.4% cases of severe primary mitral regurgitation (MR), 7.5% cases of severe secondary MR, 43.7% cases of severe aortic stenosis, 27.5% cases of severe aortic regurgitation, and 7.2% cases of severe tricuspid regurgitation. The overall inhospital mortality rate for patients with severe VHD was 5.4%, and for secondary severe MR and severe tricuspid regur‑ gitation, the rates were 9.0% and 7.5%, respectively, indicating a poor prognosis. In-hospital mortality occurred in 73 of the 1,244 patients (5.9%) who received conservative treatment and in 18 of the 455 patients (4.0%) who received a surgical or transcatheter intervention, which was significantly lower in the intervention group (P = 0.037).
Conclusions
This study provides important information about the current status of VHD diagnosis and treatment through a nationwide registry in Korea and helps to define future changes.
8.Contemporary diagnosis and treatment of valvular heart disease in Korea: a nationwide hospital‑based registry study
Hyung Yoon KIM ; Hee Jeong LEE ; In‑Cheol KIM ; Jung‑Woo SON ; Jun‑Bean PARK ; Sahmin LEE ; Eun Kyoung KIM ; Seong‑Mi PARK ; Woo‑Baek CHUNG ; Jung Sun CHO ; Jin‑Sun PARK ; Jeong‑Sook SEO ; Sun Hwa LEE ; Byung Joo SUN ; Chi Young SHIM ; Hyungseop KIM ; Kye Hun KIM ; Duk‑Hyun KANG ; Jong‑Won HA ;
Journal of Cardiovascular Imaging 2024;32(1):37-
Background:
This study was designed to determine the current status of diagnosis and treatment of valvular heart disease (VHD) in Korea.
Methods:
A nationwide registry study was conducted in 45 hospitals in Korea involving adult patients with at least moderate VHD as determined by echocardiography carried out between September and October of 2019. Of a total of 4,094 patients with at least moderate VHD, 1,482 had severe VHD (age, 71.3 ± 13.5 years; 49.1% male). Echocar‑ diographic data used for the diagnosis of each case of VHD were analyzed. Experts from each center determined the diagnosis and treatment strategy for VHD based on current guidelines and institutional policy. The clinical out‑ come was in-hospital mortality.
Results:
Each valve underwent surgical or transcatheter intervention in 19.3% cases of severe mitral stenosis, 31.4% cases of severe primary mitral regurgitation (MR), 7.5% cases of severe secondary MR, 43.7% cases of severe aortic stenosis, 27.5% cases of severe aortic regurgitation, and 7.2% cases of severe tricuspid regurgitation. The overall inhospital mortality rate for patients with severe VHD was 5.4%, and for secondary severe MR and severe tricuspid regur‑ gitation, the rates were 9.0% and 7.5%, respectively, indicating a poor prognosis. In-hospital mortality occurred in 73 of the 1,244 patients (5.9%) who received conservative treatment and in 18 of the 455 patients (4.0%) who received a surgical or transcatheter intervention, which was significantly lower in the intervention group (P = 0.037).
Conclusions
This study provides important information about the current status of VHD diagnosis and treatment through a nationwide registry in Korea and helps to define future changes.
9.Contemporary diagnosis and treatment of valvular heart disease in Korea: a nationwide hospital‑based registry study
Hyung Yoon KIM ; Hee Jeong LEE ; In‑Cheol KIM ; Jung‑Woo SON ; Jun‑Bean PARK ; Sahmin LEE ; Eun Kyoung KIM ; Seong‑Mi PARK ; Woo‑Baek CHUNG ; Jung Sun CHO ; Jin‑Sun PARK ; Jeong‑Sook SEO ; Sun Hwa LEE ; Byung Joo SUN ; Chi Young SHIM ; Hyungseop KIM ; Kye Hun KIM ; Duk‑Hyun KANG ; Jong‑Won HA ;
Journal of Cardiovascular Imaging 2024;32(1):37-
Background:
This study was designed to determine the current status of diagnosis and treatment of valvular heart disease (VHD) in Korea.
Methods:
A nationwide registry study was conducted in 45 hospitals in Korea involving adult patients with at least moderate VHD as determined by echocardiography carried out between September and October of 2019. Of a total of 4,094 patients with at least moderate VHD, 1,482 had severe VHD (age, 71.3 ± 13.5 years; 49.1% male). Echocar‑ diographic data used for the diagnosis of each case of VHD were analyzed. Experts from each center determined the diagnosis and treatment strategy for VHD based on current guidelines and institutional policy. The clinical out‑ come was in-hospital mortality.
Results:
Each valve underwent surgical or transcatheter intervention in 19.3% cases of severe mitral stenosis, 31.4% cases of severe primary mitral regurgitation (MR), 7.5% cases of severe secondary MR, 43.7% cases of severe aortic stenosis, 27.5% cases of severe aortic regurgitation, and 7.2% cases of severe tricuspid regurgitation. The overall inhospital mortality rate for patients with severe VHD was 5.4%, and for secondary severe MR and severe tricuspid regur‑ gitation, the rates were 9.0% and 7.5%, respectively, indicating a poor prognosis. In-hospital mortality occurred in 73 of the 1,244 patients (5.9%) who received conservative treatment and in 18 of the 455 patients (4.0%) who received a surgical or transcatheter intervention, which was significantly lower in the intervention group (P = 0.037).
Conclusions
This study provides important information about the current status of VHD diagnosis and treatment through a nationwide registry in Korea and helps to define future changes.
10.Effectiveness of the COVID-19 vaccine in the Honam region of the Republic of Korea
In-Sook SHIN ; Yong-Pyo LEE ; Seung-Hoon LEE ; Jae-Young LEE ; Jong-Ha PARK ; Yoon-Seok CHUNG
Osong Public Health and Research Perspectives 2023;14(3):197-206
Objectives:
In 2021, the effectiveness of the COVID-19 vaccine was analyzed among people living in the Honam region (Gwangju, Jeollanam-do, Jeollabuk-do, and Jeju) of the Republic of Korea. And we investigated changes in the dominant virus strain.
Methods:
This study used the data provided by the Korean Ministry of the Interior and Safety for individuals ≥12 years old in the Honam region, and the Integrated Disease and Health Management System of the Korea Centers for Disease Control and Prevention for COVID-19-vaccinated individuals as of December 31, 2021. Statistical analyzes were performed using IBM SPSS ver. 23.0. The occurrence of confirmed cases by vaccination status, the relative risk, and vaccine effectiveness by vaccine type were calculated.
Results:
In 2021, the COVID-19 vaccination rate in Honam was 88.6%. The overall vaccine effectiveness (after 2 and 3 doses) was 98.7% (p<0.001). and the breakthrough infection rate was 0.16%. From week 21 to week 27 of 2021 (June 27 to July 3), the genome sequencing results were mostly alpha variants. The Delta variant emerged as the dominant variant after 27 weeks and the Omicron variant was found at 50 weeks (December 5–11).
Conclusion
Vaccine effectiveness changed with the outbreak of new variants of the virus as well as over time as antibody levels decreased. that the prevention effectiveness of vaccination in Honam was >98%, and the effect among persons who received 2 doses was >90% regardless of the vaccine type. Although vaccine effectiveness decreased because of reduced antibody levels over time (as observed in breakthrough infections), receiving a booster dose restored the neutralizing antibody levels.

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