1.Performance Evaluation of the 2020 European Society of Cardiology 0-hour/1-hour Algorithm Using High-sensitivity Cardiac Troponin I for Non-ST-segment Elevation Acute Coronary Syndrome and Mortality Assessment Based on 1-year Real-world Data
Changhee HA ; Yeon Jae LEE ; Jong Do SEO ; Hanah KIM ; Hee-Won MOON ; Mina HUR ; Young Hwan LEE ; Sang O PARK ; Kyeong Ryong LEE ; Hyun-Joong KIM ; Yeo-Min YUN
Annals of Laboratory Medicine 2026;46(1):52-61
Background:
The 2020 European Society of Cardiology (ESC) 0-hr/1-hr algorithm using high-sensitivity cardiac troponin I (hs-cTnI) for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) aims at early diagnosis and shorter emergency department (ED) stays. While this algorithm has been well-established in controlled studies, real-world implementation remains challenging. We evaluated the algorithm’s clinical performance and risk stratification capability in patients with chest pain or discomfort.
Methods:
We measured hs-cTnI in 4,678 patients suspected of NSTE-ACS between August 2022 and July 2023, using an Atellica IM Analyzer (Siemens Healthineers, Erlangen, Germany). We categorized patients into rule-in, observe, or rule-out groups according to the algorithm and assessed its diagnostic performance for NSTE-ACS. The final diagnosis of NSTE-ACS was adjudicated by two independent physicians. Additionally, we evaluated 30-day all-cause mortality, hazard risk, and ED length of stay across the three groups.
Results:
The algorithm categorized 3,408 (72.9%), 573 (12.2%), and 697 (14.9%) patients into the rule-out, observe, and rule-in groups, respectively. Among 90 patients diagnosed as having NSTE-ACS, none were falsely categorized into the rule-out group. Survival analysis revealed significant differences (P < 0.001), with Cox hazard ratios of 2.38 (95% confidence interval: 1.20–4.71) and 6.39 (3.45–11.86) in the observe and rule-in groups, respectively. ED stays shortened in the order of rule-out, observe, and rule-in groups (P < 0.001).
Conclusions
The 2020 ESC 0-hr/1-hr algorithm demonstrates excellent diagnostic accuracy without false rule-outs and effective risk stratification, and contributes to efficient ED throughput, supporting its clinical utility in real-world emergency settings.
2.Risk of non-cancer respiratory diseases attributed to humidifier disinfectant exposure in Koreans: age-period-cohort and differences-in-difference analyses
Jaiyong KIM ; Kyoung Sook JEONG ; Seungyeon HEO ; Younghee KIM ; Jungyun LIM ; Sol YU ; Suejin KIM ; Sun-Kyoung SHIN ; Hae-Kwan CHEONG ; Mina HA ;
Epidemiology and Health 2025;47(1):e2025006-
OBJECTIVES:
Humidifier disinfectants (HDs) were sold in Korea from 1994 until their recall in 2011. We examined the incidence patterns of 8 respiratory diseases before and after the HD recall and estimated the attributable risk in the Korean population.
METHODS:
Using National Health Insurance data from 2002 to 2019, we performed age–cohort–period and differences-in-diffference analyses (comparing periods before vs. after the recall) to estimate the population-attributable fraction and the excess number of episodes. The database comprised 51 million individuals (99% of the Korean population). The incidence of 8 diseases—acute upper respiratory infection (AURI), acute lower respiratory infection (ALRI), asthma, pneumonia, chronic sinusitis (CS), interstitial lung disease (ILD), bronchiectasis, and chronic obstructive pulmonary disease (COPD)—was defined by constructing episodes of care based on patterns of medical care and the clinical characteristics of each disease.
RESULTS:
The relative risks (RRs) for AURI, ALRI, asthma, pneumonia, CS, and ILD were elevated among younger individuals (with an RR as high as 82.18 for AURI in males), whereas chronic conditions such as bronchiectasis, COPD, and ILD showed higher RRs in older individuals. During the HD exposure period, the population-attributable risk percentage ranged from 4.6% for bronchiectasis to 25.1% for pneumonia, with the excess number of episodes ranging from 6,218 for ILD to 3,058,861 for CS. Notably, females of reproductive age (19-44 years) experienced 1.1-9.2 times more excess episodes than males.
CONCLUSIONS
This study provides epidemiological evidence that inhalation exposure to HDs affects the entire respiratory tract and identifies vulnerable groups.
3.Risk of non-cancer respiratory diseases attributed to humidifier disinfectant exposure in Koreans: age-period-cohort and differences-in-difference analyses
Jaiyong KIM ; Kyoung Sook JEONG ; Seungyeon HEO ; Younghee KIM ; Jungyun LIM ; Sol YU ; Suejin KIM ; Sun-Kyoung SHIN ; Hae-Kwan CHEONG ; Mina HA ;
Epidemiology and Health 2025;47(1):e2025006-
OBJECTIVES:
Humidifier disinfectants (HDs) were sold in Korea from 1994 until their recall in 2011. We examined the incidence patterns of 8 respiratory diseases before and after the HD recall and estimated the attributable risk in the Korean population.
METHODS:
Using National Health Insurance data from 2002 to 2019, we performed age–cohort–period and differences-in-diffference analyses (comparing periods before vs. after the recall) to estimate the population-attributable fraction and the excess number of episodes. The database comprised 51 million individuals (99% of the Korean population). The incidence of 8 diseases—acute upper respiratory infection (AURI), acute lower respiratory infection (ALRI), asthma, pneumonia, chronic sinusitis (CS), interstitial lung disease (ILD), bronchiectasis, and chronic obstructive pulmonary disease (COPD)—was defined by constructing episodes of care based on patterns of medical care and the clinical characteristics of each disease.
RESULTS:
The relative risks (RRs) for AURI, ALRI, asthma, pneumonia, CS, and ILD were elevated among younger individuals (with an RR as high as 82.18 for AURI in males), whereas chronic conditions such as bronchiectasis, COPD, and ILD showed higher RRs in older individuals. During the HD exposure period, the population-attributable risk percentage ranged from 4.6% for bronchiectasis to 25.1% for pneumonia, with the excess number of episodes ranging from 6,218 for ILD to 3,058,861 for CS. Notably, females of reproductive age (19-44 years) experienced 1.1-9.2 times more excess episodes than males.
CONCLUSIONS
This study provides epidemiological evidence that inhalation exposure to HDs affects the entire respiratory tract and identifies vulnerable groups.
4.Risk of non-cancer respiratory diseases attributed to humidifier disinfectant exposure in Koreans: age-period-cohort and differences-in-difference analyses
Jaiyong KIM ; Kyoung Sook JEONG ; Seungyeon HEO ; Younghee KIM ; Jungyun LIM ; Sol YU ; Suejin KIM ; Sun-Kyoung SHIN ; Hae-Kwan CHEONG ; Mina HA ;
Epidemiology and Health 2025;47(1):e2025006-
OBJECTIVES:
Humidifier disinfectants (HDs) were sold in Korea from 1994 until their recall in 2011. We examined the incidence patterns of 8 respiratory diseases before and after the HD recall and estimated the attributable risk in the Korean population.
METHODS:
Using National Health Insurance data from 2002 to 2019, we performed age–cohort–period and differences-in-diffference analyses (comparing periods before vs. after the recall) to estimate the population-attributable fraction and the excess number of episodes. The database comprised 51 million individuals (99% of the Korean population). The incidence of 8 diseases—acute upper respiratory infection (AURI), acute lower respiratory infection (ALRI), asthma, pneumonia, chronic sinusitis (CS), interstitial lung disease (ILD), bronchiectasis, and chronic obstructive pulmonary disease (COPD)—was defined by constructing episodes of care based on patterns of medical care and the clinical characteristics of each disease.
RESULTS:
The relative risks (RRs) for AURI, ALRI, asthma, pneumonia, CS, and ILD were elevated among younger individuals (with an RR as high as 82.18 for AURI in males), whereas chronic conditions such as bronchiectasis, COPD, and ILD showed higher RRs in older individuals. During the HD exposure period, the population-attributable risk percentage ranged from 4.6% for bronchiectasis to 25.1% for pneumonia, with the excess number of episodes ranging from 6,218 for ILD to 3,058,861 for CS. Notably, females of reproductive age (19-44 years) experienced 1.1-9.2 times more excess episodes than males.
CONCLUSIONS
This study provides epidemiological evidence that inhalation exposure to HDs affects the entire respiratory tract and identifies vulnerable groups.
5.Incidence and mortality of upper tract urothelial carcinoma in Korea: A nationwide population-based study conducted from 2002 to 2020
Seongmin MOON ; Yun-Sok HA ; Mina KIM ; Hoseob KIM ; Won Tae KIM ; Yong-June KIM ; Seok-Joong YUN ; Sang-Cheol LEE ; Ho Won KANG
Investigative and Clinical Urology 2025;66(1):11-17
Purpose:
To describe the incidence and mortality of upper tract urothelial carcinoma (UTUC) from 2002–2020 using data from the Korean National Health Insurance Service, which contains data from the entire Korean population.
Materials and Methods:
Reimbursement records for 43,255 patients diagnosed with primary UTUC (according to the International Classification of Disease 10th revision code C65 and C66) between 2002–2020 were retrieved. The study period was split into four: period I (2002–2005), period II (2006–2010), period III (2011–2015), and period IV (2016–2020). Trends were quantified by calculating the annual percentage change (APC). Mortality data were obtained from the Statistics Korea.
Results:
From 2002–2020, the incidence of UTUC in Korea increased gradually from 9.34 to 11.40 per 100,000 person-years. Although there was a male predominance, the male to female ratio did not change significantly over time; however, age at the time of diagnosis, the comorbidity index, and the proportion of patients undergoing open/laparoscopic surgery increased significantly over time. There was a modest improvement in 5-year survival (both all cause- and cancer-specific) over the study period. Multivariate analysis identified age at diagnosis, sex, the comorbidity index, and open/laparoscopic surgery as being associated with survival.
Conclusions
Between 2002 and 2020, the incidence of UTUC in Korea showed a general upward trend; however, survival outcomes have improved. These representative datasets from the Korean population might provide crucial information that enables clinicians to better understand of the epidemiology of UTUC in Korea.
6.Risk of non-cancer respiratory diseases attributed to humidifier disinfectant exposure in Koreans: age-period-cohort and differences-in-difference analyses
Jaiyong KIM ; Kyoung Sook JEONG ; Seungyeon HEO ; Younghee KIM ; Jungyun LIM ; Sol YU ; Suejin KIM ; Sun-Kyoung SHIN ; Hae-Kwan CHEONG ; Mina HA ;
Epidemiology and Health 2025;47(1):e2025006-
OBJECTIVES:
Humidifier disinfectants (HDs) were sold in Korea from 1994 until their recall in 2011. We examined the incidence patterns of 8 respiratory diseases before and after the HD recall and estimated the attributable risk in the Korean population.
METHODS:
Using National Health Insurance data from 2002 to 2019, we performed age–cohort–period and differences-in-diffference analyses (comparing periods before vs. after the recall) to estimate the population-attributable fraction and the excess number of episodes. The database comprised 51 million individuals (99% of the Korean population). The incidence of 8 diseases—acute upper respiratory infection (AURI), acute lower respiratory infection (ALRI), asthma, pneumonia, chronic sinusitis (CS), interstitial lung disease (ILD), bronchiectasis, and chronic obstructive pulmonary disease (COPD)—was defined by constructing episodes of care based on patterns of medical care and the clinical characteristics of each disease.
RESULTS:
The relative risks (RRs) for AURI, ALRI, asthma, pneumonia, CS, and ILD were elevated among younger individuals (with an RR as high as 82.18 for AURI in males), whereas chronic conditions such as bronchiectasis, COPD, and ILD showed higher RRs in older individuals. During the HD exposure period, the population-attributable risk percentage ranged from 4.6% for bronchiectasis to 25.1% for pneumonia, with the excess number of episodes ranging from 6,218 for ILD to 3,058,861 for CS. Notably, females of reproductive age (19-44 years) experienced 1.1-9.2 times more excess episodes than males.
CONCLUSIONS
This study provides epidemiological evidence that inhalation exposure to HDs affects the entire respiratory tract and identifies vulnerable groups.
7.Establishing the Guidelines for Recommendation Reporting (G-RECO): a study protocol for developing reporting guidelines for disease prevention recommendations
Wonyoung JUNG ; Sukhyun RYU ; So Yeon RYU ; Mina HA ; Bo Youl CHOI ; Soo Young KIM
The Ewha Medical Journal 2024;47(3):e43-
Objectives:
The objective of this study was to develop the Guidelines for Recommendation Reporting (G-RECO) for use in the Public Health Weekly Report (PHWR) in Korea, aiming to improve the standardization, scientific accuracy, and practical applicability of recommendation reports in clinical practice guidelines.
Methods:
The methodology of this study aligned with the EQUATOR Network standards. A multidisciplinary research committee was formed, comprising experts in various relevant fields. The development process included a comprehensive literature review, analysis of existing guidelines, and formulation of a structured G-RECO framework with 21 key items. This was supplemented with Explanation & Elaboration documents for each item. The draft underwent rigorous revisions and evaluations by both internal and external experts.
Results:
By November 2023, significant progress had been made in developing a detailed G-RECO checklist and accompanying E&E documents. These tools are designed to guide authors in clear and consistent reporting of recommendation reports. The team is poised to finalize and publish the checklist and E&E documents by December 2024.
Conclusion
The G-RECO guidelines represent a significant advancement in the formalization and standardization of recommendation reports for the PHWR. They are expected to improve the quality of research and publications in clinical practice guidelines, contributing to the evolution of the field and enriching public health discourse. The guidelines, with their comprehensive nature and user-friendly design, will become an invaluable resource for researchers, editors, and peer reviewers in public health and epidemiology.
8.Reporting Guidelines for Survey Reporting (G-SURE):protocol for guideline development
Wonyoung JUNG ; Soo Young KIM ; Sukhyun RYU ; So Yeon RYU ; Mina HA ; Bo Youl CHOI
The Ewha Medical Journal 2024;47(3):e44-
Objectives:
The objective of this study was to develop a reporting guideline for epidemiological survey reports, referred to as “Guidelines for Survey Reporting (G-SURE).”
Methods:
To develop G-SURE, we adopted a systematic approach, starting with a detailed review of recent survey reports in Public Health Weekly Report, Eurosurveillance, and Morbidity and Mortality Weekly Report and an analysis of current reporting standards. After drafting the guidelines, our team conducted an in-depth internal evaluation to assess their effectiveness and applicability. We then refined the guidelines based on insights from external experts and potential users, particularly those with significant experience in survey reporting. The plan also includes ongoing efforts to widely share the guidelines and update them periodically, incorporating new findings and user feedback.
Results:
G-SURE will provide a structured framework for reporting outbreak investigations, comprising a detailed checklist and Explanation & Elaboration documents. These will improve the transparency, consistency, and quality of public health documentation.
Conclusion
In this protocol article, we introduce G-SURE, a guideline developed to improve epidemiological survey research. G-SURE addresses the critical need for uniform reporting standards in epidemiological surveys, aiming to improve the quality and relevance of research outcomes in this area. This guideline is also designed to be a key resource for peer reviewers and editors, aiding them in efficiently assessing the thoroughness and accuracy of survey reports. By providing consistent reporting criteria, G-SURE seeks to minimize confusion and irregularities, which are often encountered in the process of scientific publication.
9.Developing Guidelines for Surveillance Reporting (G-SIRE): protocol for guideline development
Wonyoung JUNG ; Sukhyun RYU ; So Yeon RYU ; Mina HA ; Bo Youl CHOI ; Soo Young KIM
The Ewha Medical Journal 2024;47(3):e42-
Objectives:
Surveillance reporting, which is integral to public health and safety, involves the systematic collection, analysis, and dissemination of data crucial for various health and security scenarios. Despite its importance, standardized Guidelines for Surveillance Reporting (G-SIRE) are lacking, leading to inconsistencies and affecting data reliability and comparability. To address this gap, this study aimed to develop the G-SIRE, tailored to improve the clarity, transparency, and consistency of surveillance reports, thereby increasing the accuracy and usability of surveillance data for better public health outcomes.
Methods:
The methodology adhered to the EQUATOR Network standards, employing a multidimensional approach with a diverse expert team. The process included forming a research committee of multidisciplinary experts, conducting a thorough literature review of recent surveillance report publications, reviewing existing reporting guidelines, and developing a new set of guidelines.Continuous updates and revisions are planned to keep the guidelines relevant and effective.
Results:
Significant progress has been made as of November 2023 in developing comprehensive reporting guidelines for surveillance reports. A detailed checklist and Explanation & Elaboration documents have been formulated, which are anticipated to be finalized and published by December 2023.
Conclusion
The G-SIRE guidelines signify a major advancement in standardizing surveillance.They provide a structured approach that increases scientific accuracy, transparency, and practical applicability in this domain. The guidelines are expected to improve the quality of surveillance reporting significantly, contributing to the advancement of public health research and discourse.
10.Reporting Guidelines for Community Outbreak Investigation Reporting (G-CORE): protocol for guideline development
Wonyoung JUNG ; Sukhyun RYU ; So Yeon RYU ; Mina HA ; Bo Youl CHOI ; Soo Young KIM
The Ewha Medical Journal 2024;47(3):e41-
Objectives:
Outbreak reports are essential for documenting the spread of and responses to disease outbreaks. However, there is a lack of standardized reporting guidelines that encompass broader perspectives on outbreaks. We aimed to develop a universal reporting guideline applicable to diverse outbreak reports and community epidemic interventions, the “Guidelines for Community Outbreak Investigation Reporting (G-CORE).”
Methods:
G-CORE is designed to address the challenges in documenting various outbreak scenarios, including infectious diseases and non-infectious environmental hazards. The development of G-CORE involved a structured process, including a comprehensive literature review of recent outbreak reports from leading journals and an analysis of existing reporting guidelines. The process also involved project registration with the EQUATOR Network and collaboration with experts in various fields. Following the initial drafting, an internal (team) review was conducted to evaluate the guidelines' robustness and relevance. Subsequently, the guidelines underwent revision based on feedback from external experts and potential users, including authors with experience in outbreak reporting. The project also includes plans for widespread dissemination and periodic revisions to adapt to developments and user feedback.
Results:
G-CORE will provide a structured framework for reporting outbreak investigations, comprising a detailed checklist and Explanation & Elaboration documents.
Conclusion
G-CORE establishes a new standard in outbreak reporting, facilitating comprehensive, clear, and actionable public health communications. Its development marks a significant advance in the documentation and management of public health outbreaks.

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