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Original Articles
- Analysis of influenza-like illness trends in Saudi Arabia: a comparative study of statistical and deep learning techniques
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Fathelrhman EL Guma
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Received March 11, 2025 Accepted April 25, 2025 Published online June 12, 2025
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DOI: https://doi.org/10.24171/j.phrp.2025.0080
[Epub ahead of print]
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Abstract
- Objectives
To develop and evaluate forecasting models using the Holt-Winters statistical approach and the long short-term memory (LSTM) deep learning method for weekly seasonal influenza-like illness (ILI) incidences in Saudi Arabia. The study compares model performance and assesses the predictive value added by incorporating region-specific exogenous variables within Middle Eastern epidemiological modeling.
Methods
This study compared the performance of Holt-Winters and LSTM models in forecasting weekly ILI cases in Saudi Arabia, using data collected from 2017 to 2022. Time series analysis integrated exogenous variables including climatic conditions and population mobility trends. The Holt-Winters model employed both additive and multiplicative seasonal components. Model performance was evaluated using root mean squared error (RMSE), mean absolute percentage error, and R2.
Results
The best-performing model, LSTM with exogenous variables, achieved an RMSE of 28.55, mean absolute error (MAE) of 0.14, R2 of 0.96, and percent bias (PBIAS) of +2.1%, indicating negligible systematic error. The LSTM model without exogenous variables demonstrated slightly lower accuracy (RMSE of 34.07, MAE of 0.18, R2 of 0.93, PBIAS of +5.8%), indicating strong predictive capability but less precision in determining peak ILI cases. The Holt-Winters model effectively captured seasonal and long-term trends, but showed a moderate performance with an RMSE of 82.57, MAE of 0.38, R2 of 0.58, and a high PBIAS of +14.2%, revealing significant unexplained variability during periods of high incidence fluctuation.
Conclusion
This study highlights the respective strengths and limitations of statistical and machine learning approaches for ILI forecasting.
- Genetic diversity and spatiotemporal population structure of Anopheles sinensis in the Republic of Korea based on the mitochondrial cytochrome c oxidase subunit I (COI) marker
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Haneul Jung, Bo Gyeong Han, Hyun-Il Shin, Myoung-Ro Lee, Jung-Won Ju, Hee-Il Lee
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Received February 18, 2025 Accepted May 6, 2025 Published online June 11, 2025
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DOI: https://doi.org/10.24171/j.phrp.2025.0052
[Epub ahead of print]
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Abstract
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- Objectives
Anopheles sinensis is a predominant malaria vector found throughout the Republic of Korea (ROK). Population genetic analysis can provide insights into the origins and migration patterns of malaria vectors by assessing genetic variation and distribution among populations.
Methods
In this study, we examined the population genetic structure of An. sinensis in the ROK using mitochondrial cytochrome c oxidase subunit I (COI) marker.
Results
A total of 903 specimens of An. sinensis were collected from 9 sampling regions, including malaria-endemic and non-endemic areas. All populations displayed characteristics typical of migrant populations, with high haplotype diversity (Hd) and low nucleotide diversity (Pi). Network analysis identified 124 haplotypes grouped into 2 clusters. Both clusters included haplotypes from malaria-endemic and non-endemic areas. Cluster I shared its most recent common ancestry with Chinese reference sequences, while cluster II had related with Japanese reference sequences. Pairwise genetic distance (FST) analysis indicated generally low genetic differentiation among populations. Furthermore, FST values tended to increase proportionally with geographical distance between regions. Analysis of molecular variance confirmed that individual mosquitoes within the population had a large effect on the overall variation. Neutrality tests using 4 methods (Tajima’s D, Fu’s Fs, Fu and Li’s D, and Fu and Li’s F) yielded negative values, suggesting that An. sinensis populations are expanding in all studied regions.
Conclusion
This study characterizes the genetic attributes of An. sinensis in the ROK, providing valuable insights into the biology of this important malaria vector and contributing useful data for malaria control strategies.
- Risk of tuberculosis in individuals with type 2 diabetes mellitus based on the tuberculosis predictive index score: a case-control study in Indonesia
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Dea P. Audina, Rachel S. Aritonang, Muhammad I. Mokoagow
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Received November 5, 2024 Accepted May 11, 2025 Published online June 11, 2025
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DOI: https://doi.org/10.24171/j.phrp.2024.0310
[Epub ahead of print]
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Abstract
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- Objectives
The co-occurrence of tuberculosis (TB) and diabetes mellitus presents a significant global health challenge, marked by a bidirectional relationship. This study aims to evaluate the effectiveness of the tuberculosis predictive index (TPI) score, developed by Isfandiari et al., in predicting TB occurrence among individuals living with type 2 diabetes mellitus.
Methods
A case-control study was conducted using primary data collected through questionnaires administered to individuals with type 2 diabetes mellitus, with and without pulmonary TB, at the internal medicine outpatient clinic of Fatmawati General Hospital from June to August 2024. The study compared TPI scores between those with type 2 diabetes mellitus who had TB and those who did not.
Results
TPI scores were significantly associated with TB risk. Individuals with both type 2 diabetes mellitus and TB had a 6.8-fold higher risk (95% confidence interval [CI], 2.6–17.6; p<0.001) than those without TB. Further chi-square analysis identified three significant risk factors: individuals with type 2 diabetes mellitus exhibiting TB-like symptoms had a 13.3-fold increased TB risk (95% CI, 5.1–34.3; p<0.001); those with a body mass index below 18.5 kg/m² had a 3.3-fold higher risk (95% CI, 1.0–11.0; p=0.039); and those living in poorly ventilated homes (ventilation ≤10%) had a 3.2-fold higher risk (95% CI, 1.0–9.8; p=0.035).
Conclusion
This study demonstrates that individuals with type 2 diabetes mellitus who developed TB had significantly higher TPI scores, corresponding to a 6.8-fold increased risk compared to their counterparts without TB. The TPI score may serve as a valuable tool for predicting TB risk among populations living with type 2 diabetes mellitus.
Short Communication
- Subacute sclerosing panencephalitis incidence following measles elimination efforts in the Republic of Korea
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Young Hwa Lee, Jung Hye Byeon, Cho Ryok Kang, Young June Choe, Jong-Koo Lee
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Received March 3, 2025 Accepted April 28, 2025 Published online June 9, 2025
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DOI: https://doi.org/10.24171/j.phrp.2025.0067
[Epub ahead of print]
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Abstract
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- Objectives
Subacute sclerosing panencephalitis (SSPE) is a rare but fatal neurodegenerative disease caused by persistent measles virus infection. After a significant measles outbreak in 2000–2001, the Republic of Korea implemented a nationwide measles elimination program, which led to a dramatic reduction in measles incidence. This study aimed to evaluate the impact of these measles elimination efforts on the incidence of SSPE in the Republic of Korea.
Methods
This nationwide, population-based retrospective cohort study identified patients newly diagnosed with measles and SSPE between 2007 and 2022, registered in the Health Insurance Review and Assessment Service (HIRA) and Korea Disease Control and Prevention Agency (KDCA) databases. Population-based incidence rates of measles and SSPE were calculated and compared annually.
Results
A total of 236 measles cases (HIRA data) and 1,168 measles cases (KDCA data), along with 2,736 SSPE cases, were diagnosed during the study period. Measles incidence significantly declined, reaching zero cases in 2021, while SSPE incidence displayed an upward trend, peaking in 2014. The mean age at SSPE onset was 21.2 years, with a marked male-to-female ratio of 13.0:1.
Conclusion
SSPE incidence was remarkably low in the post-outbreak period, likely attributable to successful measles control. This study underscores the critical importance of maintaining low measles incidence through sustained vaccination efforts, preventing SSPE and other measles-related complications.
Review Article
- Effect of cognitive behavior therapy on abstinence among healthy smokers: a systematic review and meta-analysis of randomized controlled trials
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Rajesh Kumar, Priyanka Malhotra, Vishwas AS, Kalpana Beniwal, Gopal Singh Charan
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Received January 22, 2025 Accepted April 24, 2025 Published online June 9, 2025
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DOI: https://doi.org/10.24171/j.phrp.2025.0019
[Epub ahead of print]
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Abstract
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Supplementary Material
- Objectives
The objectives of this review and meta-analysis were twofold: first, to critically evaluate the effectiveness of cognitive behavioral therapy (CBT)-based interventions relative to standard care or control conditions in promoting smoking abstinence at the end of treatment, and second, to determine abstinence rates at 3 and 6 months of follow-up.
Methods
A comprehensive search of electronic databases, including PubMed, Cochrane Library, PsycINFO, Embase, and ClinicalTrials.gov, was conducted for randomized controlled trials published from 2001 to September 2024. Studies evaluating the effect of CBT on abstinence rates among healthy smokers (aged ≥12 years) were included and analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Results
Out of 1,514 study records screened, 7 studies (comprising 17 arms and 1,438 participants) met eligibility criteria for inclusion in the final analysis. The pooled analysis revealed that CBT significantly improved smoking abstinence rates, demonstrating a fourfold increase in effectiveness compared to controls (odds ratio [OR], 4.04; 95% confidence interval [CI], 2.73–5.99; I2=19%; p<0.00001). Additionally, CBT significantly impacted smoking cessation at 3-month follow-up (OR, 1.62; 95% CI, 1.11–2.38; I2=0%; p=0.01) and 6-month follow-up (OR, 2.19; 95% CI, 1.59–3.00; I2=0%; p<0.00001).
Conclusion
CBT has demonstrated efficacy in facilitating smoking abstinence, particularly immediately after treatment, with sustained but diminished effects over time. However, robust conclusions on the efficacy of CBT require further studies involving larger sample sizes, diverse geographical regions, and longer follow-up periods.
Original Articles
- The level of household food insecurity is associated with the risk of infectious diseases among toddlers in Indonesia: a cross-sectional study
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Siti Masitoh, Tri Wurisastuti, Woro Riyadina, Sudarto Ronoatmodjo
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Received January 16, 2025 Accepted April 24, 2025 Published online June 4, 2025
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DOI: https://doi.org/10.24171/j.phrp.2025.0009
[Epub ahead of print]
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Abstract
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- Objectives
This study investigated the correlation between food insecurity and infectious diseases among toddlers in Indonesia.
Methods
This research employed a cross-sectional study design using data from the 2021 Indonesian Nutrition Status Survey, which included a sample of 84,115 toddlers. Food insecurity levels were assessed using the food insecurity experience scale, developed by the Food and Agriculture Organization. The dependent variable, infectious disease, was defined as a toddler experiencing 1 or more of the following conditions: acute respiratory infections, diarrhea, pneumonia, measles, or worms. Multivariate analysis was conducted using multiple logistic regression to determine adjusted odds ratios (ORs).
Results
The findings indicate that 23.78% of toddlers experienced at least 1 infectious disease. While more than half of the respondents were food secure, 26.5% faced mild food insecurity, 13.6% moderate food insecurity, and 6.5% severe food insecurity. Toddlers from households experiencing mild, moderate, and severe food insecurity had higher risks of infectious diseases compared to those from food-secure households, with adjusted ORs of 1.367 (95% confidence interval [CI], 1.308–1.428), 1.490 (95% CI, 1.399–1.588), and 1.500 (95% CI, 1.374–1.638), respectively.
Conclusion
In conclusion, more severe food insecurity is correlated with an increased risk of toddlers suffering infectious diseases.
- Metabolic and systemic inflammation status in rheumatoid arthritis—fasting blood glucose as a primary predictor of rheumatoid arthritis risk: a cross-sectional study in Iran
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Sorayya Kheirouri, Mohammad Alizadeh, Arash Tandorost
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Received February 9, 2025 Accepted April 21, 2025 Published online May 23, 2025
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DOI: https://doi.org/10.24171/j.phrp.2025.0036
[Epub ahead of print]
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Abstract
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- Objectives
This study investigated the relationship between metabolic factors (blood lipids and glucose) and inflammatory indicators (tumor necrosis factor-alpha [TNF-α] and high-sensitivity C-reactive protein [hs-CRP]), disease activity, and the rheumatoid arthritis (RA) risk.
Methods
Serum fasting blood glucose (FBG) and lipid profiles—including total cholesterol (Chol), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein—were measured in 100 RA patients and 100 healthy individuals. Disease severity was assessed using the disease activity score 28. Inflammatory indicators (TNF-α and hs-CRP) were measured using the enzyme-linked immunosorbent assay method.
Results
In RA patients, serum FBG, TG, Chol/HDL, and TG/HDL were significantly elevated, whereas HDL levels reduced compared to healthy individuals. Multivariate analysis indicated that each unit increase in serum FBG, HDL, Chol/HDL, and TG/HDL was associated with a 64% increase (p<0.001), a 7% reduction (p=0.001), a 52% increase (p=0.007), and a 54% increase (p=0.001) in the odds of RA, respectively. Disease activity showed no correlation with metabolic factors (p>0.05). Among all metabolic factors studied, FBG had the largest area under the curve (0.981) (p<0.0001) for predicting RA. Across the total participant group, FBG, TG, and TG/HDL were positively associated with hs-CRP and TNF-α (p<0.05). HDL showed an inverse association with hs-CRP (p=0.008). Among RA patients specifically, TNF-α positively correlated with TG and TG/HDL, while hs-CRP correlated only with TG/HDL.
Conclusion
These findings indicate that increased FBG and Chol/HDL and decreased HDL may elevate RA risk by promoting systemic inflammation. Among these, elevated FBG may serve as the strongest predictor of RA risk.
Review Article
- Effectiveness of non-pharmacological school-based therapies for cigarette smoking cessation among adolescents in South and Southeast Asian countries: a systematic review and meta-analysis
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Fahad Ali Mangrio, Penpaktr Uthis, Suwimon Rojnawee, Alicia K Matthews
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Received November 22, 2024 Accepted March 6, 2025 Published online April 30, 2025
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DOI: https://doi.org/10.24171/j.phrp.2024.0320
[Epub ahead of print]
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Abstract
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Supplementary Material
- Objectives
This review and meta-analysis examined the effectiveness of non-pharmacological therapies delivered through school-based interventions for smoking cessation among adolescents in South and Southeast Asian countries.
Methods
A systematic search was conducted across PubMed, Scopus, Science Direct, BioMed Central, the Cochrane Library, and ProQuest Dissertations & Theses Global from inception to October 2024. Eligible studies comprised randomized controlled trials and quasi-experimental studies that compared non-pharmacological smoking cessation interventions delivered in schools or other educational institutions. Data on smoking abstinence outcomes were extracted from published studies, and odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model via the Mantel-Haenszel estimator.
Results
Seven studies involving 1,260 participants were included. The meta-analysis demonstrated that non-pharmacological school-based therapies significantly increased smoking abstinence compared to controls (OR, 2.83; 95% CI, 1.83–4.40; p<0.001. Subgroup analyzes revealed benefits across both randomized controlled trials and quasi-experimental studies with varying abstinence rates. Studies utilizing biochemical verification showed significant positive effects despite substantial heterogeneity, and short-term (<3 months) abstinence was significantly higher in intervention groups compared to controls. Overall, no differences were found between subgroups regarding intervention effectiveness.
Conclusion
This meta-analysis indicates that non-pharmacological school-based interventions positively impact smoking abstinence rates, although effectiveness may vary based on study design, follow-up duration, and use of biochemical verification. The findings underscore the need for further research with larger sample sizes, extended follow-up periods, and improved methodological rigor in these regions.
Editorial
Review Article
- The role of vitamin D and the VDR gene polymorphism in sepsis risk and mortality: a systematic review and meta-analysis
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Wiwi Jaya, Sumarno Reto Prawiro, Hani Susianti, Aswoco Andyk Asmoro
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Received January 14, 2025 Accepted March 17, 2025 Published online April 29, 2025
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DOI: https://doi.org/10.24171/j.phrp.2025.0006
[Epub ahead of print]
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Abstract
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Supplementary Material
- Objectives
Vitamin D regulates immune function, cell proliferation, and differentiation. Its deficiency is linked to sepsis, although the causal relationship remains unclear. Studies suggest a strong correlation between FokI polymorphism and sepsis in the context of vitamin D deficiency. This study examined the association between vitamin D levels, the VDR FokI polymorphism, and sepsis risk through a systematic review and meta-analysis. Methods: Relevant articles from 2014–2024 were identified from various databases, including PubMed, Scopus, and Cochrane. A meta-analysis was conducted to assess the difference in vitamin D levels between the sepsis and control groups, as well as the relationship between VDR FokI genotypes (TT, CT, CC) and sepsis risk.
Results
Vitamin D levels in sepsis patients were consistently lower than in the control group, with a mean difference of –4.17 ng/mL (95% confidence interval, –7.87 to –0.47; p=0.03). However, the relationship between VDR FokI genotype and sepsis risk was not statistically significant (p>0.05), although several individual studies showed a positive correlation. High heterogeneity was found in the analysis of vitamin D levels (I²=100%) and FokI genotypes (I²=91%), which affected the interpretation of the results.
Conclusion
Vitamin D deficiency is a potential risk factor for sepsis, while the relationship between the VDR FokI polymorphism and sepsis risk requires further investigation. These findings highlight the importance of early detection of vitamin D deficiency as a preventive strategy in at-risk populations, although additional studies with more standardized designs are needed to definitively confirm this relationship.
Original Article
- Design and evaluation of a multi-epitope subunit vaccine against human norovirus using an immunoinformatics approach
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Zxcy L. Nonog, Edward C. Banico, Ma. Easter V. Sajo, Pablo V. Serrano, Fredmoore L. Orosco
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Received December 16, 2024 Accepted March 18, 2025 Published online April 25, 2025
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DOI: https://doi.org/10.24171/j.phrp.2024.0349
[Epub ahead of print]
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Abstract
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Supplementary Material
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This study aimed to identify safe, conserved, and highly immunogenic epitopes from all proteins of human-infecting norovirus (NoV) and to design a multi-epitope subunit vaccine construct from these epitopes using an immunoinformatics approach. Additionally, the vaccine construct was evaluated using both sequence- and structure-based assessments.
Methods
Conserved fragments were identified from all proteins of human-infecting NoV, and B and T lymphocyte epitopes were subsequently predicted using multiple epitope prediction tools. The selected epitopes were linked to form a multi-epitope construct, incorporating various adjuvants in the design. Vaccine constructs with different adjuvants were analyzed for their physicochemical properties and immune simulation profiles, and the optimal combination was selected as the final vaccine candidate for further study. Finally, molecular docking and dynamics simulations were performed to visualize the interaction between the construct and a host immune receptor.
Results
Twenty-two safe, conserved, and highly immunogenic epitopes were identified from all human-infecting NoV proteins. The construct adjuvanted with 50S ribosomal protein L7/L12 (50SrpL7/L12) was chosen as the final vaccine candidate due to its optimal physicochemical properties and favorable immune simulation profile. Furthermore, the construct exhibited high binding affinity and a stable interaction with toll-like receptor 4).
Conclusion
The multi-epitope subunit vaccine designed in this study shows promise as a potential NoV vaccine candidate for human immunization. Further in vitro and in vivo experiments are warranted to validate these findings.
Data Profile
- Synthetic data production for biomedical research
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Yun Gyeong Lee, Mi-Sook Kwak, Jeong Eun Kim, Min Sun Kim, Dong Un No, Hee Youl Chai
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Osong Public Health Res Perspect. 2025;16(2):94-99. Published online April 22, 2025
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DOI: https://doi.org/10.24171/j.phrp.2024.0335
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Graphical Abstract
Abstract
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Supplementary Material

- Synthetic data, generated using advanced artificial intelligence (AI) techniques, replicates the statistical properties of real-world datasets while excluding identifiable information. Although synthetic data does not consist of actual data points, it is derived from original datasets, thereby enabling analyses that yield results comparable to those obtained with real data. Synthetic datasets are evaluated based on their utility—a measure of how effectively they mirror real data for analytical purposes. This paper presents the generation of synthetic datasets through the Healthcare Big Data Showcase Project (2019–2023). The original dataset comprises comprehensive multi-omics data from 400 individuals, including cancer survivors, chronic disease patients, and healthy participants. Synthetic data facilitates efficient access and robust analyses, serving as a practical tool for research and education. It addresses privacy concerns, supports AI research, and provides a foundation for innovative applications across diverse fields, such as public health and precision medicine.
Short Communication
- First report of human Mycobacterium bovis infection in a veterinary laboratory worker in the Republic of Korea
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Ji-Yeon Lee, Seong Wook Pyo, Jieun Kim, Young-Joon Park
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Received December 24, 2024 Accepted March 9, 2025 Published online April 16, 2025
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DOI: https://doi.org/10.24171/j.phrp.2024.0343
[Epub ahead of print]
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Abstract
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In the Republic of Korea, the previous surveillance system for zoonotic tuberculosis (TB) involved the X-ray testing of humans in contact with Mycobacterium bovis-infected livestock. In contrast, the updated surveillance system incorporates the genotyping of cultured Mycobacterium isolates for high-risk occupational groups. This study aimed to systematically document the detection, diagnosis, assessment, and response in the epidemic investigation of zoonotic TB in a laboratory worker in the Republic of Korea.
Methods
M. bovis was confirmed using spoligotyping and whole genome sequencing. Clinical characteristics were reviewed through epidemiological investigation and interviews with the affected individual. Transmission routes and secondary spread were assessed via field epidemiological investigations and contact evaluations using chest X-ray and interferon gamma release assay for latent TB infection.
Results
A 56-year-old laboratory worker presented with chest X-ray findings compatible with TB and subsequently tested positive for M. bovis. She had no clinical or family history of TB and remained asymptomatic. She completed a 6 month treatment regimen of isoniazid, rifampin, ethambutol, and pyrazinamide without hospitalization. Although no direct transmission pathways for zoonotic TB were identified, her work in a laboratory, processing specimens for zoonotic TB, indicated potential laboratory related exposure.
Conclusion
This case underscores the importance of stringent use of personal protective equipment among high-risk occupational groups and the implementation of an enhanced surveillance system to report zoonotic TB. These findings highlight the need for a One Health approach and proactive surveillance, emphasizing the necessity of refining and strengthening surveillance systems for precise monitoring and an effective response.
Brief Report
- Standardizing the approach to clinical-based human microbiome research: from clinical information collection to microbiome profiling and human resource utilization
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Jung Wook Kim, Eun Chae Choi, Kwang Jun Lee
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Received November 14, 2024 Accepted March 6, 2025 Published online April 11, 2025
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DOI: https://doi.org/10.24171/j.phrp.2024.0319
[Epub ahead of print]
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Abstract
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This study presents the standardized protocols developed by the Clinical-Based Human Microbiome Research and Development Project (cHMP) in the Republic of Korea.
Methods
It addresses clinical metadata collection, specimen handling, DNA extraction, sequencing methods, and quality control measures for microbiome research.
Results
The cHMP involves collecting samples from healthy individuals and patients across various body sites, including the gastrointestinal tract, oral cavity, respiratory system, urogenital tract, and skin. These standardized procedures ensure consistent data quality through controlled specimen collection, storage, transportation, DNA extraction, and sequencing. Sequencing encompasses both amplicon and whole metagenome methods, followed by stringent quality checks. The protocols conform to international guidelines, ensuring that the data generated are both reliable and comparable across microbiome studies.
Conclusion
The cHMP underscores the importance of methodological standardization in enhancing data integrity, reproducibility, and advancing microbiome-based research with potential applications for improving human health outcomes.
Review Article
- Global health security in the post-COVID-19 era: threats, preparation, and response
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Chaeshin Chu
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Osong Public Health Res Perspect. 2025;16(2):116-125. Published online April 4, 2025
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DOI: https://doi.org/10.24171/j.phrp.2025.0037
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Graphical Abstract
Abstract
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- Global health security threats in the post-coronavirus disease 2019 era include dense urban populations, increased human–animal proximity, migration driven by political or economic instability, climate change, humanitarian crises, antimicrobial resistance (AMR), and the misuse of biological research—including the accidental or intentional release of high-risk pathogens. The foundational preparation for these threats is to establish a robust, resilient public health system based on universal health coverage. The World Health Organization’s International Health Regulations must continue to promote global solidarity by maintaining core capacities such as surveillance, national laboratories, and epidemiological investigations of emerging infectious diseases, with timely reporting and information sharing within the global health security community. A One Health approach is essential for addressing AMR. Infection prevention and control must be enhanced to reduce healthcare-associated infections in medical facilities. Additionally, regulations concerning biosafety and biosecurity should address dual-use research of concern as well as the accidental or intentional release of highrisk pathogens from laboratories. Global health security is a collective responsibility because these threats know no borders and require coordinated action.
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