Osong Public Health and Research Perspectives

Volume 15(3); June 2024

Editorial

Strengthening the health system, including innovative budget mobilization, is an urgent issue for the Expanded Programme on Immunization: Jong-Koo Lee; Osong Public Health Res Perspect. 2024;15(3):187-188. Published online June 27, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0181

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Review Article

Effectiveness of virtual reality-supported exercise therapy in improving upper extremity function and activities of daily living among patients after stroke: a systematic review of randomized control trials: Priyanshi Dixit, Uma Phalswal, Nipin Kalal, Saumya P. Srivastava; Osong Public Health Res Perspect. 2024;15(3):189-200. Published online May 24, 2024; DOI: https://doi.org/10.24171/j.phrp.2023.0148

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Graphical Abstract Abstract PDF

Objectives
This systematic review describes the effectiveness of virtual reality (VR)-supported exercise therapy on upper limb motor function and activities of daily living after stroke. Methods: Studies published through January 24, 2022, were identified using CINAHL, Cochrane Library, Embase, Medline, and Web of Science. Randomized control trials comparing VR treatment with conventional therapy (CT) for upper extremity rehabilitation after stroke were included. Methodological quality was assessed using the Cochrane risk-of-bias tool. Results: Of 9 included studies, 5 concluded that the VR group outperformed control participants, 1 indicated the superiority of VR-supported exercises alone over CT, and 3 found VR comparable to CT in promoting upper limb motor function. Five studies analyzed independence in daily living, with 4 reporting no significant difference between VR and CT groups. No strong evidence indicated long-term benefits of VR-assisted exercise. All included studies demonstrated low risk of bias concerning random sequence generation, allocation concealment, outcome assessment blinding, incomplete outcome data, and selective reporting bias. However, a high risk of bias was observed regarding participant blinding due to the nature of the intervention. Conclusion: Most studies suggested that VR, used alongside CT, can improve motor function following stroke. However, the evidence was insufficient to conclude that VR outperforms conventional approaches.

Citations

Citations to this article as recorded by

Efficacy of a Virtual Reality Rehabilitation Protocol Based on Art Therapy in Patients with Stroke: A Single-Blind Randomized Controlled Trial
Gaetano Tieri, Marco Iosa, Antonio Fortini, Federica Aghilarre, Federico Gentili, Cristiano Rubeca, Tommaso Mastropietro, Gabriella Antonucci, Roberto De Giorgi
Brain Sciences.2024; 14(9): 863. CrossRef
Elevating patient experience: Transformative strategies in hand therapy
Jean Paul Brutus, Bianieff Tchiloemba, Anna Galstyan, Tom Lattré, Aviva Wolff, Alison Taylor
Hand Surgery and Rehabilitation.2024; : 101764. CrossRef

Original Articles

Number of comorbidities and the risk of delay in seeking treatment for coronary heart disease: a longitudinal study in Bogor City, Indonesia: Sulistyowati Tuminah, Lely Indrawati, Woro Riyadina, Tri Wurisastuti, Alfons M. Letelay, Nikson Sitorus, Alifa S. Putri, Siti Isfandari, Irmansyah Irmansyah; Osong Public Health Res Perspect. 2024;15(3):201-211. Published online June 27, 2024; DOI: https://doi.org/10.24171/j.phrp.2023.0337

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Graphical Abstract Abstract PDF: Objectives
The aim of this study was to investigate the relationship between the number of patient comorbidities and the delays in seeking treatment for coronary heart disease (CHD). Methods: This longitudinal study utilized secondary data from the Non-Communicable Disease Risk Factor (NCDRF) cohort study conducted in Bogor City. Individuals who participated in the NCDRF cohort study and were diagnosed with CHD within the 6-year study period met the inclusion criteria. Respondents who were not continuously monitored up to the 6th year were excluded. The final sample included data from respondents with CHD who participated in the NCDRF cohort study and were monitored for the full 6-year duration. The final logistic regression analysis was conducted on data collected from 812 participants. Results: Among the participants with CHD, 702 out of 812 exhibited a delay in seeking treatment. The risk of a delay in seeking treatment was significantly higher among individuals without comorbidities, with an odds ratio (OR) of 3.5 (95% confidence interval [CI], 1.735–7.036; p<0.001). Among those with a single comorbidity, the risk of delay in seeking treatment was still notable (OR, 2.6; 95% CI, 1.259–5.418; p=0.010) when compared to those with 2 or more comorbidities. These odds were adjusted for age, sex, education level, and health insurance status. Conclusion: The proportion of patients with CHD who delayed seeking treatment was high, particularly among individuals with no comorbidities. Low levels of comorbidity also appeared to correlate with a greater tendency to delay in seeking treatment.

Periodontitis and non-communicable diseases in a Brazilian population, a cross-sectional study, Vila Velha-ES, Brazil: Gustavo Vital de Mendonça, Crispim Cerutti Junior, Alfredo Carlos Rodrigues Feitosa, Brígida Franco Sampaio de Mendonça, Lucia Helena Sagrillo Pimassoni; Osong Public Health Res Perspect. 2024;15(3):212-220. Published online June 27, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0021

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Graphical Abstract Abstract PDF: Objectives
The objective of this study was to examine the hypothesis that periodontal disease is associated with chronic non-communicable diseases. Methods: In this cross-sectional study, we evaluated the periodontal health condition of the population, based on the community periodontal index, as well as the number of missing teeth and the presence of systemic health conditions. We quantified the association between oral health and the presence of chronic diseases using simple logistic regression, adjusting for confounding factors including age, smoking, and overweight. Results: The study population consisted of 334 volunteers, aged between 19 and 81 years. In patients over 45 years old, periodontal disease was found to be significantly associated with hypertension and diabetes. Furthermore, in female patients, periodontal disease was significantly associated with hypertension, diabetes, and cancer. Conclusion: Our findings indicate that periodontal disease is positively and significantly associated with both arterial hypertension and diabetes, independent of potential confounding factors.

The association between living arrangements and health-related quality of life in Korean older people: a nationwide repeated cross-sectional study: Eunok Park, Philip Larkin, Zee-A Han; Osong Public Health Res Perspect. 2024;15(3):221-228. Published online May 23, 2024; DOI: https://doi.org/10.24171/j.phrp.2023.0273

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Graphical Abstract Abstract PDF: Objectives
This study investigated the association between living arrangements and healthrelated quality of life (HRQoL) in older people. Methods: A secondary analysis was conducted of 6,153 participants (aged ≥60 years) from the seventh Korean National Health and Nutrition Examination Survey (2016 to 2018). HRQoL was measured using the 3-level version of the EuroQol 5-dimensional questionnaire. The chi-square test, t-test, and multiple regression were used, applying sampling weights for the analysis. Results: The proportion of respondents living alone was 18.0%, with a higher prevalence among women and older age groups (p<0.001). The overall HRQoL was lower in groups living alone than in groups living with others (p<0.001). Older people living alone showed higher impairments in all dimensions of the 3-level version of the European Quality of Life 5-Dimensional Questionnaire (EQ-5D-3L) than those living with others, including mobility (p<0.001), self-care (p<0.001), usual activities (p<0.001), pain/discomfort (p<0.001), and depression/anxiety (p<0.001). Problems with mobility were most prevalent (42.8%), followed by pain/ discomfort (41.9%) in respondents living alone. Living alone was significantly associated with a lower HRQoL index score (b=–0.048, p<0.001) after adjusting for age, gender, education, exercise, perceived stress, and perceived health status. Conclusion: Living alone was negatively associated with HRQoL. Based on this study, future care planning for older people should consider their living arrangements. The need to strengthen and expand care programs targeting those living alone should also be addressed.

Prevalence and patterns of post-COVID-19 symptoms in recovered patients of Delhi, India: a population-based study: Nidhi Bhatnagar, Mongjam Meghachandra Singh, Hitakshi Sharma, Suruchi Mishra, Gurmeet Singh, Shivani Rao, Amod Borle, Tanu Anand, Naresh Kumar, Binita Goswami, Sarika Singh, Mahima Kapoor, Sumeet Singla, Bembem Khuraijam, Nita Khurana, Urvi Sharma, Suneela Garg; Osong Public Health Res Perspect. 2024;15(3):229-237. Published online May 17, 2024; DOI: https://doi.org/10.24171/j.phrp.2023.0251

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Graphical Abstract Abstract PDF: Objectives
Post-coronavirus disease 2019 (COVID-19) symptoms were widely reported. However, data on post-COVID-19 conditions following infection with the Omicron variant remained scarce. This prospective study was conducted to understand the prevalence, patterns, and duration of symptoms in patients who had recovered from COVID-19. Methods: A prospective study was conducted across 11 districts of Delhi, India, among individuals who had recovered from COVID-19. Study participants were enrolled, and then returned for post-recovery follow-up at 3 months and 6 months interval. Results: The mean age of study participants was 42.07 years, with a standard deviation of 14.89 years. The majority of the participants (79.7%) reported experiencing post-COVID-19 symptoms. The most common symptoms included joint pain (36.0%), persistent dry cough (35.7%), anxiety (28.4%), and shortness of breath (27.1%). Other symptoms were persistent fatigue (21.6%), persistent headache (20.0%), forgetfulness (19.7%), and limb weakness (18.6%). The longest duration of symptom was observed to be anxiety (138.75±54.14 days), followed by fatigue (137.57±48.33 days), shortness of breath (131.89±60.21 days), and joint pain/swelling (131.59±58.76 days). At the first follow-up visit, 2.2% of participants presented with abnormal electrocardiogram readings, but no abnormalities were noticed during the second follow-up. Additionally, 4.06% of participants exhibited abnormal chest X-ray findings at the first followup, which decreased to 2.16% by the second visit. Conclusion: The most frequently reported post-COVID-19 symptoms were joint pain, dry cough, anxiety and shortness of breath. These clinical symptoms persisted for up to 6 months, with evidence of multi-system involvement. Consequently, findings highlighted the need for long-term follow-up during the post-COVID-19 period.

Effects of aquatic versus land-based exercise on irisin and fibroblast growth factor 21 expression and triiodothyronine and free fatty acid levels in elderly women: Du-Wang Kang, Su-Han Koh, Min-Kyo Kim, Do-Yeon Kim; Osong Public Health Res Perspect. 2024;15(3):238-247. Published online May 17, 2024; DOI: https://doi.org/10.24171/j.phrp.2023.0394

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Graphical Abstract Abstract PDF: Objectives
This study investigated the impacts of exercise on irisin and fibroblast growth factor 21 (FGF-21) expression, as well as triiodothyronine (T3 ) and free fatty acid (FFA) levels in elderly women. Methods: Thirty women aged 65 to 70 years (10 per group) were randomly assigned to aquatic exercise, land exercise, and control groups. The aquatic and land groups engaged in 3 exercise sessions per week (60 min/session) for 16 weeks. The intensity was progressively increased every 4 weeks. Results: Irisin and FGF-21 levels significantly increased in the aquatic exercise group. In the posttest, the aquatic exercise group had the highest irisin levels. Significant findings were observed for irisin and FGF-21 for the main effect between aquatic and band exercise groups (p<0.05 for both), the main effect between measurement times (p<0.01 and p<0.001, respectively), and the interaction effect (p<0.05 and p<0.001, respectively). The irisin level was significantly higher in the aquatic than in the land group 30 minutes after the last session (p<0.05). In both exercise groups, T3 levels were significantly higher 30 minutes after the final session (p<0.05) than before the program. The FFA level was significantly higher in the aquatic exercise group than the others. In the aquatic group, FFA levels were significantly higher 30 minutes after both the first (p<0.01) and the last (p<0.001) session compared to pre-program values. Conclusion: Differences in exercise type and environment can promote fat metabolism by stimulating hormonal changes that induce brown fat activity and browning.

A Mycobacterium bovis outbreak among exhibition animals at a zoo in the Republic of Korea: the first contact investigation of zoonotic tuberculosis: Hye Young Lee, Yunhyung Kwon, Sang-Eun Lee, Jieun Kim, Hoyong Choi; Osong Public Health Res Perspect. 2024;15(3):248-259. Published online May 17, 2024; DOI: https://doi.org/10.24171/j.phrp.2023.0228

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Graphical Abstract Abstract PDF: Objectives
Between July 2, 2021, and September 20, 2022, a Mycobacterium bovis outbreak occurred among exhibition animals at a zoo in the Republic of Korea. This study was conducted to assess the likelihood of M. bovis transmission to human contacts through a contact investigation and to implement preventive treatment for latent tuberculosis infection (LTBI). Methods: In this descriptive study, the Korea Disease Control and Prevention Agency conducted a contact investigation, which included interviews, interferon-gamma release assay (IGRA) tests, and chest X-rays. Contacts underwent IGRA testing on 2 occasions: initial testing of 29 contacts (15 in the first cluster of infection and 14 in the second cluster) and follow-up testing of the 15 contacts in the first cluster. Results: The study included 29 participants, 18 of whom were male (62.1%) and 11 female (37.9%). The mean participant age was 37.3 years (standard deviation, 9.6 years). In the initial IGRA tests, 6 of the 29 participants tested positive, indicating a prevalence of 20.7%. Following prolonged exposure, 1 additional positive case was detected in follow-up testing, raising the prevalence of LTBI to 24.1%. None of the contacts had active tuberculosis. Among the 7 individuals with positive results, 2 (28.6%) underwent treatment for LTBI. Conclusion: This study faced challenges in confirming the transmission of M. bovis infection from infected animals to humans in the Republic of Korea. Nevertheless, adopting a One Health approach necessitates the implementation of surveillance systems and infection control protocols, particularly for occupational groups at high risk of exposure.

Brief Report

Replication kinetics and infectivity of SARS-CoV-2 Omicron variant sublineages recovered in the Republic of Korea: Jeong-Min Kim, Dongju Kim, Jee Eun Rhee, Cheon Kwon Yoo, Eun-Jin Kim; Osong Public Health Res Perspect. 2024;15(3):260-264. Published online June 27, 2024; DOI: https://doi.org/10.24171/j.phrp.2023.0216

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Graphical Abstract Abstract PDF Supplementary Material: Objectives
We analyzed the correlation between the infectivity and transmissibility of the severe acute respiratory syndrome coronavirus 2 Omicron sublineages BA.1, BA. 2, BA.4, and BA.5. Methods: We assessed viral replication kinetics and infectivity at the cellular level. Nasopharyngeal and oropharyngeal specimens were obtained from patients with coronavirus disease 2019, confirmed using whole-genome sequencing to be caused by the Omicron sublineages BA.1, BA.2, BA.4, or BA.5. These specimens were used to infect Vero E6 cells, derived from monkey kidneys, for the purpose of viral isolation. Viral stocks were then passaged in Vero E6 cells at a multiplicity of infection of 0.01, and culture supernatants were harvested at 12-hour intervals for 72 hours. To evaluate viral replication kinetics, we determined the cycle threshold values of the supernatants using real-time reverse transcription polymerase chain reaction and converted these values to genome copy numbers. Results: The viral load was comparable between BA.2, BA.4, and BA.5, whereas BA.1 exhibited a lower value. The peak infectious load of BA.4 was approximately 3 times lower than that of BA.2 and BA.5, while the peak load of BA.2 and BA.5 was about 7 times higher than that of BA.1. Notably, BA.1 demonstrated the lowest infectivity over the entire study period. Conclusion: Our results suggest that the global BA.5 wave may have been amplified by the higher viral replication and infectivity of BA.5 compared to other Omicron sublineages. These analyses could support the rapid assessment of the impact of novel variants on case incidence.

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