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Original Article

Identification of Coronavirus Isolated from a Patient in Korea with COVID-19
Jeong-Min Kim, Yoon-Seok Chung, Hye Jun Jo, Nam-Joo Lee, Mi Seon Kim, Sang Hee Woo, Sehee Park, Jee Woong Kim, Heui Man Kim, Myung-Guk Han
Osong Public Health Res Perspect 2020;11(1):3-7.
Published online February 28, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.1.02
<sec> <title>Objectives</title> <p>Following reports of patients with unexplained pneumonia at the end of December 2019 in Wuhan, China, the causative agent was identified as coronavirus (SARS-CoV-2), and the 2019 novel coronavirus disease was named COVID-19 by the World Health Organization. Putative patients with COVID-19 have been identified in South Korea, and attempts have been made to isolate the pathogen from these patients.</p></sec> <sec> <title>Methods</title> <p>Upper and lower respiratory tract secretion samples from putative patients with COVID-19 were inoculated onto cells to isolate the virus. Full genome sequencing and electron microscopy were used to identify the virus.</p></sec> <sec> <title>Results</title> <p>The virus replicated in Vero cells and cytopathic effects were observed. Full genome sequencing showed that the virus genome exhibited sequence homology of more than 99.9% with SARS-CoV-2 which was isolated from patients from other countries, for instance China. Sequence homology of SARS-CoV-2 with SARS-CoV, and MERS-CoV was 77.5% and 50%, respectively. Coronavirus-specific morphology was observed by electron microscopy in virus-infected Vero cells.</p></sec> <sec> <title>Conclusion</title> <p>SARS-CoV-2 was isolated from putative patients with unexplained pneumonia and intermittent coughing and fever. The isolated virus was named BetaCoV/Korea/KCDC03/2020.</p></sec>

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Brief Report

Korea Community Health Survey Data Profiles
Yang Wha Kang, Yun Sil Ko, Yoo Jin Kim, Kyoung Mi Sung, Hyo Jin Kim, Hyung Yun Choi, Changhyun Sung, Eunkyeong Jeong
Osong Public Health Res Perspect 2015;6(3):211-217.
Published online June 30, 2015
DOI: https://doi.org/10.1016/j.phrp.2015.05.003
In 2008, Korea Centers for Disease Control and Prevention initiated the first nationwide survey, Korea Community Health Survey (KCHS), to provide data that could be used to plan, implement, monitor, and evaluate community health promotion and disease prevention programs. This community-based cross-sectional survey has been conducted by 253 community health centers, 35 community universities, and 1500 interviewers. The KCHS standardized questionnaire was developed jointly by the Korea Centers for Disease Control and Prevention staff, a working group of health indicators standardization subcommittee, and 16 metropolitan cities and provinces with 253 regional sites. The questionnaire covers a variety of topics related to health behaviors and prevention, which is used to assess the prevalence of personal health practices and behaviors related to the leading causes of disease, including smoking, alcohol use, drinking and driving, high blood pressure control, physical activity, weight control, quality of life (European Quality of Life-5 Dimensions, European Quality of Life-Visual Analogue Scale, Korean Instrumental Activities of Daily Living ), medical service, accident, injury, etc. The KCHS was administered by trained interviewers, and the quality control of the KCHS was improved by the introduction of a computer-assisted personal interview in 2010. The KCHS data allow a direct comparison of the differences of health issues among provinces. Furthermore, the provinces can use these data for their own cost-effective health interventions to improve health promotion and disease prevention. For users and researchers throughout the world, microdata (in the form of SAS files) and analytic guidelines can be downloaded from the KCHS website (<ext-link ext-link-type="uri" xlink:href="http://KCHS.cdc.go.kr/" id="intref0015-main">http://KCHS.cdc.go.kr/</ext-link>) in Korean.

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Original Articles

Middle East Respiratory Syndrome Coronavirus Outbreak in the Republic of Korea, 2015
Osong Public Health Res Perspect 2015;6(4):269-278.
Published online August 31, 2015
DOI: https://doi.org/10.1016/j.phrp.2015.08.006
Objectives
The outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the Republic of Korea started from the index case who developed fever after returning from the Middle East. He infected 26 cases in Hospital C, and consecutive nosocomial transmission proceeded throughout the nation. We provide an epidemiologic description of the outbreak, as of July 2015.
Methods
Epidemiological research was performed by direct interview of the confirmed patients and reviewing medical records. We also analyzed the incubation period, serial interval, the characteristics of superspreaders, and factors associated with mortality. Full genome sequence was obtained from sputum specimens of the index patient.
Results
A total of 186 confirmed patients with MERS-CoV infection across 16 hospitals were identified in the Republic of Korea. Some 44.1% of the cases were patients exposed in hospitals, 32.8% were caregivers, and 13.4% were healthcare personnel. The most common presenting symptom was fever and chills. The estimated incubation period was 6.83 days and the serial interval was 12.5 days. A total of 83.2% of the transmission events were epidemiologically linked to five superspreaders, all of whom had pneumonia at presentation and contacted hundreds of people. Older age [odds ratio (OR) = 4.86, 95% confidence interval (CI) 1.90–12.45] and underlying respiratory disease (OR = 4.90, 95% CI 1.64–14.65) were significantly associated with mortality. Phylogenetic analysis showed that the MERS-CoV of the index case clustered closest with a recent virus from Riyadh, Saudi Arabia.
Conclusion
A single imported MERS-CoV infection case imposed a huge threat to public health and safety. This highlights the importance of robust preparedness and optimal infection prevention control. The lessons learned from the current outbreak will contribute to more up-to-date guidelines and global health security.

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Assessment of Antioxidant Potential, Total Phenolics and Flavonoids of Different Solvent Fractions of Monotheca Buxifolia Fruit
Shumaila Jan, Muhammad Rashid Khan, Umbreen Rashid, Jasia Bokhari
Osong Public Health Res Perspect 2013;4(5):246-254.
Published online October 31, 2013
DOI: https://doi.org/10.1016/j.phrp.2013.09.003
Objectives
This study was conducted to investigate the antioxidant potential of methanol extract and its derived fractions (hexane, ethyl acetate, butanol, and aqueous) of fruits of <i>Monotheca buxifolia</i> (Falc.) Dc., a locally used fruit in Pakistan.
Methods
Dried powder of the fruit of <i>M. buxifolia</i> was extracted with methanol and the resultant was fractionated with solvents having escalating polarity; <i>n</i>-hexane, chloroform, ethyl acetate, <i>n</i>-butanol and the residual soluble aqueous fraction. Total phenolic and total flavonoid contents were estimated for the methanol and various fractions. These fractions were also subjected to various <i>in vitro</i> assays to estimate the scavenging activity for 2,2-diphenyl-1-picrylhydrazyl (DPPH), 2,2-azino-bis-(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS), superoxide, hydroxyl, hydrogen peroxide and reductive ability for ferric ions and phosphomolybdate assay.
Results
The <i>n</i>-butanol, aqueous and methanol fractions possessed high amount of phenolics and flavonoids compared with other fractions, and subsequently showed a pronounced scavenging activity on DPPH, ABTS, superoxide, hydroxyl and hydrogen peroxide radicals and had a potent reductive ability on ferric ion and phosphomolybdate assay. There was a found significant correlation between total phenolic and flavonoid contents and EC<sub>50</sub> of DPPH, superoxide, hydrogen peroxide radical and phosphomolybdate assays, whereas a nonsignificant correlation was found with the hydroxyl radical and ABTS radical assay.
Conclusion
<i>M. buxifolia</i> fruit can be used as natural antioxidant source to prevent damage associated with free radicals.

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  • Crossref
Cross-Country Comparison of Case Fatality Rates of COVID-19/SARS-COV-2
Morteza Abdullatif Khafaie, Fakher Rahim
Osong Public Health Res Perspect 2020;11(2):74-80.
Published online April 30, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.2.03
<sec> <title>Objectives</title> <p>Case fatality rates (CFR) and recovery rates are important readouts during epidemics and pandemics. In this article, an international analysis was performed on the ongoing coronavirus disease 2019 (COVID-19) pandemic.</p></sec> <sec> <title>Methods</title> <p>Data were retrieved from accurate databases according to the user’s guide of data sources for patient registries, CFR and recovery rates were calculated for each country. A comparison of CFR between countries with total cases ≥ 1,000 was observed for 12<sup>th</sup> and 23<sup>rd</sup> March.</p></sec> <sec> <title>Results</title> <p>Italy’s CFR was the highest of all countries studied for both time points (12<sup>th</sup> March, 6.22% versus 23<sup>rd</sup> March, 9.26%). The data showed that even though Italy was the only European country reported on 12<sup>rd</sup> March, Spain and France had the highest CFR of 6.16 and 4.21%, respectively, on 23<sup>rd</sup> March, which was strikingly higher than the overall CFR of 3.61%.</p></sec> <sec> <title>Conclusion</title> <p>Obtaining detailed and accurate medical history from COVID-19 patients, and analyzing CFR alongside the recovery rate, may enable the identification of the highest risk areas so that efficient medical care may be provided. This may lead to the development of point-of-care tools to help clinicians in stratifying patients based on possible requirements in the level of care, to increase the probabilities of survival from COVID-19 disease.</p></sec>

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Short Communication

Contact Transmission of COVID-19 in South Korea: Novel Investigation Techniques for Tracing Contacts
COVID-19 National Emergency Response Center, Epidemiology & Case Management Team, Korea Centers for Disease Control & Prevention
Osong Public Health Res Perspect 2020;11(1):60-63.
Published online February 28, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.1.09
<p>In the epidemiological investigation of an infectious disease, investigating, classifying, tracking, and managing contacts by identifying the patient’s route are important for preventing further transmission of the disease. However, omissions and errors in previous activities can occur when the investigation is performed through only a proxy interview with the patient. To overcome these limitations, methods that can objectively verify the patient’s claims (medical facility records, Global Positioning System, card transactions, and closed-circuit television) were used for the recent ongoing coronavirus disease 2019 contact investigations in South Korea.</p>

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Original Article

Health-Related Quality of Life and its Associated Factors in COVID-19 Patients
Morteza Arab-Zozani, Fatemah Hashemi, Hossein Safari, Mahmood Yousefi, Hosein Ameri
Osong Public Health Res Perspect 2020;11(5):296-302.
Published online October 22, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.5.05
<sec> <title>Objectives</title> <p>Health-related quality of life (HRQoL) is one of the most important outcome measures for patients. The purpose of this study was to evaluate HRQoL and related factors in Coronavirus disease 2019 (COVID-19) patients.</p></sec> <sec> <title>Methods</title> <p>A total of 420 COVID-19 patients who had been discharged from hospital were selected using a systematic sampling. The EuroQol 5-dimensional-5 levels (EQ-5D-5L) questionnaire along with medical records of the patients were used to gather the data. The <italic>t</italic> test and analysis of variance were employed to test the difference between mean EQ-5D-5L scores, and the BetaMix model was used to investigate factors associated with EQ-5D-5L scores.</p></sec> <sec> <title>Results</title> <p>The mean score for the patients who completed the EQ-5D-5L questionnaire (<italic>n</italic> = 409) was 0.6125. The EQ-5D-5L scores were significantly higher in males, patients with younger age, those with a low level of education, the employed, patients who worked in uncrowded workplaces, patients without diabetes, and those who were not admitted to intensive care unit. The BetaMix model showed that gender, age, education, employment status, having diabetes, heart failure, and admission to the intensive care unit were significant independent predictors of the EQ-5D-5L index values.</p></sec> <sec> <title>Conclusion</title> <p>The mean score for EQ-5D-5L in COVID-19 patients was low in this study. Some of the factors, especially aging and having diabetes, should be considered in the aftercare of patients to improve their HRQoL.</p></sec>

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Review Article

COVID-19 Outbreak in Malaysia
Asita Elengoe
Osong Public Health Res Perspect 2020;11(3):93-100.
Published online June 1, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.3.08
<p>In 2020 a significant threat to public health emerged. The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic outbreak emerged in December 2019 from Wuhan City, Hubei Province, China and spread to the rest of the world. This disease was named COVID-19 by World Health Organization. To date (17<sup>th</sup> April 2020) a total of 2,230,439 cases of COVID-19; 150,810 cases of deaths and 564,210 recovered cases have been reported worldwide. In this review the SARS-CoV-2 morphology, pathogenic mechanism, similarities and differences between SARS-CoV and Middle East Respiratory Syndrome and severe acute respiratory syndrome, transmission mode, diagnosis, treatment, and preventive measures were investigated. The outbreak of COVID-19 from a Malaysian perspective was explored and mental health care during the COVID-19 outbreak was explored. To date, there is no vaccine or no specific treatment for COVID-19. Therefore, preventive measures are very important to prevent and control the rapid spread of the SARS-CoV-2 virus. Preparedness should be a priority for future pandemic outbreaks.</p>

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Original Articles

Detection and Isolation of SARS-CoV-2 in Serum, Urine, and Stool Specimens of COVID-19 Patients from the Republic of Korea
Jeong-Min Kim, Heui Man Kim, Eun Jung Lee, Hye Jun Jo, Youngsil Yoon, Nam-Joo Lee, Junseock Son, Ye-Ji Lee, Mi Seon Kim, Yong-Pyo Lee, Su-Jin Chae, Kye Ryeong Park, Seung-Rye Cho, Sehee Park, Su Jin Kim, Eunbyeol Wang, SangHee Woo, Aram Lim, Su-Jin Park, JunHyeong Jang, Yoon-Seok Chung, Bum Sik Chin, Jin-Soo Lee, Duko Lim, Myung-Guk Han, Cheon Kwon Yoo
Osong Public Health Res Perspect 2020;11(3):112-117.
Published online May 8, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.3.02
<sec><title>Objectives</title> <p>Coronavirus Disease-19 (COVID-19) is a respiratory infection characterized by the main symptoms of pneumonia and fever. It is caused by the novel coronavirus severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2), which is known to spread via respiratory droplets. We aimed to determine the rate and likelihood of SARS-CoV-2 transmission from COVID-19 patients through non-respiratory routes.</p></sec> <sec><title>Methods</title> <p>Serum, urine, and stool samples were collected from 74 hospitalized patients diagnosed with COVID-19 based on the detection of SARS-CoV-2 in respiratory samples. The SARS-CoV-2 RNA genome was extracted from each specimen and real-time reverse transcription polymerase chain reaction performed. CaCo-2 cells were inoculated with the specimens containing the SARS-COV-2 genome, and subcultured for virus isolation. After culturing, viral replication in the cell supernatant was assessed.</p></sec> <sec><title>Results</title> <p>Of the samples collected from 74 COVID-19 patients, SARS-CoV-2 was detected in 15 serum, urine, or stool samples. The virus detection rate in the serum, urine, and stool samples were 2.8% (9/323), 0.8% (2/247), and 10.1% (13/129), and the mean viral load was 1,210 ± 1,861, 79 ± 30, and 3,176 ± 7,208 copy/µL, respectively. However, the SARS-CoV-2 was not isolated by the culture method from the samples that tested positive for the SARS-CoV-2 gene.</p></sec> <sec><title>Conclusion</title> <p>While the virus remained detectable in the respiratory samples of COVID-19 patients for several days after hospitalization, its detection in the serum, urine, and stool samples was intermittent. Since the virus could not be isolated from the SARS-COV-2-positive samples, the risk of viral transmission via stool and urine is expected to be low.</p></sec>

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Factors that Correlate with Poor Glycemic Control in Type 2 Diabetes Mellitus Patients with Complications
Mohammad Haghighatpanah, Amir Sasan Mozaffari Nejad, Maryam Haghighatpanah, Girish Thunga, Surulivelrajan Mallayasamy
Osong Public Health Res Perspect 2018;9(4):167-174.
Published online August 31, 2018
DOI: https://doi.org/10.24171/j.phrp.2018.9.4.05
<sec> <title>Objectives</title> <p>Inadequate glycemic control amongst patients with Type 2 diabetes mellitus (T2DM) indicates a major public health problem and a significant risk factor for the progression and complications caused by diabetes. Glycemic control is the main therapeutic objective for the prevention of organ damage and other complications arising from diabetes.</p></sec> <sec> <title>Methods</title> <p>This was a retrospective observational study of T2DM patients with complications, who were aged 40 years and older. The study was conducted retrospectively on medical records (in-patient and out-patient) obtained from a South Indian teaching hospital, Manipal, India. The patients included in the study had fasting blood sugar, postprandial blood sugar and HbA1c measured at least twice during follow-ups the previous year. Patients’ HbA1c levels were categorized into good control ≤7% (≤53mmol/mol), and poor control >7% (>53mmol/mol), and patients’ characteristics were analyzed.</p></sec> <sec> <title>Results</title> <p>A total of 657 patients were included in the study. The mean age was 59.67 (SD = 9.617) years, with 152 (23.1%) females and 505 (76.9%) males, and 514 (78.2%) patients had poor glycemic control. Most of the patients were on insulin mono-therapy [<italic>n</italic> = 271 (42.1%)], about a third of the patients were on combination therapy that included an oral hypoglycemic agent and insulin [<italic>n</italic> = 236 (36.6%)]. Patients with a history of more than 10 years of diabetes [<italic>n</italic> = 293 (44.6%)], had a family history of diabetes [<italic>n</italic> = 256 (39%)] and obesity [<italic>n</italic> = 95 (14.5%)], all had poor glycemic control.</p></sec> <sec> <title>Conclusion</title> <p>This present study indicated a significant association of gender (female), age, high-density lipoprotein level, duration of diabetes and type of medication, with poor glycemic control in T2DM patients that had secondary medical complications.</p></sec>

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Factors associated with health services utilization between the years 2010 and 2012 in Korea: using Andersen's Behavioral model
Han-Kyoul Kim, Munjae Lee
Osong Public Health Res Perspect 2016;7(1):18-25.
Published online February 28, 2016
DOI: https://doi.org/10.1016/j.phrp.2015.11.007
Objectives
This study aimed to examine the factors associated with health services utilization using Andersen's behavioral model.
Methods
We collected Korea Health Panel data between the years 2010 and 2012 from the consortium of the National Health Insurance Service and the Korea Institute for Health and Social Affairs, and analyzed the data to determine the outpatients and inpatients of health services utilization.
Results
Health services utilization was more significantly explained by predisposing and need factors than enabling factors. The outpatients were examined more specifically; sex, age, and marital status as predisposing factors, and chronic illness as a need factor were the variables that had significant effects on health-services-utilization experience. The inpatients were examined more specifically: sex, age, and marital status in predisposing factors; education level, economic activities, and insurance type in enabling factors; and chronic illness and disability status in need factors were the significant variables having greater effects on health-services-utilization experience.
Conclusion
This study suggests the practical implications for providing health services for outpatients and inpatients. Moreover, verifying the general characteristics of outpatients and inpatients by focusing on their health services utilization provides the baseline data for establishing health service policies and programs with regard to the recently increasing interest in health services.

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Neck Pain in Adults with Forward Head Posture: Effects of Craniovertebral Angle and Cervical Range of Motion
Dae-Hyun Kim, Chang-Ju Kim, Sung-Min Son
Osong Public Health Res Perspect 2018;9(6):309-313.
Published online December 31, 2018
DOI: https://doi.org/10.24171/j.phrp.2018.9.6.04
<sec> <title>Objectives</title> <p>The purpose of this study was to determine whether the cranial vertebral angle (CVA) and the range of motion (ROM) was different between participants with a forward head posture (FHP), with or without pain.</p></sec> <sec> <title>Methods</title> <p>Forty-four participants who had FHP participated in this study. The FHP was assessed digitally by measuring a lateral view the CVA for each subject. A cervical ROM device measured the cervical ROM. The volunteers were allocated to either, with pain (<italic>n</italic> = 22), or without pain (<italic>n</italic> = 22) groups, and pain was evaluated using the Numeric Pain Rating Scale.</p></sec> <sec> <title>Results</title> <p>The FHP in the pain group showed a significant difference in the CVA, and the cervical ROM in both flexion and extension, compared with those in the FHP without pain group (<italic>p</italic> < 0.05). Logistic regression analysis indicated that the occurrence of cervical area pain was higher amongst subjects who had a decreased CVA and flexion motion.</p></sec> <sec> <title>Conclusion</title> <p>This study suggested that decreased CVA and cervical flexion range, were predictive factors for the occurrence of pain in the cervical region.</p></sec>

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Review Articles

The global prevalence of autism spectrum disorder in children: a systematic review and meta-analysis
Alwin Issac, Kurvatteppa Halemani, Asha Shetty, Latha Thimmappa, VR Vijay, Kiranmayi Koni, Prabhaker Mishra, Vishwas Kapoor
Osong Public Health Res Perspect 2025;16(1):3-27.
Published online February 10, 2025
DOI: https://doi.org/10.24171/j.phrp.2024.0286
The global prevalence of autism spectrum disorder in children: a systematic review and meta-analysis
Objectives
The objective of this review was to analyze quantitative data on autism spectrum disorder (ASD) and to increase the accuracy of estimates of the prevalence of ASD.
Methods
This review, which was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, included studies conducted from January 2008 to June 2024 on children aged 3 to 18 years that used standardized measurement tools and reported cut-off scores for ASD. The prevalence of ASD was the primary outcome analyzed in this review. The PubMed, Clinical Key, Scopus, Embase, CINAHL, and Web of Science databases were reviewed for relevant studies. The review protocol was registered with PROSPERO and followed the Cochrane collaboration guidelines.
Results
A total of 66 studies reported on the prevalence of ASD, screening 21,313,061 children worldwide. Among these, 25 studies were conducted in Europe, 22 in Asia, and 13 in America. Additionally, 3 studies each were reported from Africa and Australia. According to a meta-analysis, 0.77% of children globally are diagnosed with ASD, with boys comprising 1.14% of this group. Notably, Australia showed the highest prevalence rate, with an effect size of 2.18, highlighting it as a critical area for public health focus.
Conclusion
ASD represents a significant global health burden. Early detection, increased awareness among parents, and prompt intervention are crucial for mitigating developmental problems in children later in life. It is essential for health policymakers to acknowledge the prevalence and growing trends of ASD in order to implement effective interventions.

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The Effect of Global Warming on Infectious Diseases
Ichiro Kurane
Osong Public Health Res Perspect 2010;1(1):4-9.
Published online December 31, 2010
DOI: https://doi.org/10.1016/j.phrp.2010.12.004
Global warming has various effects on human health. The main indirect effects are on infectious diseases. Although the effects on infectious diseases will be detected worldwide, the degree and types of the effect are different, depending on the location of the respective countries and socioeconomical situations.Among infectious diseases, water- and foodborne infectious diseases and vector-borne infectious diseases are two main categories that are forecasted to be most affected. The effect on vector-borne infectious diseases such as malaria and dengue fever is mainly because of the expansion of the infested areas of vector mosquitoes and increase in the number and feeding activity of infected mosquitoes. There will be increase in the number of cases with water- and foodborne diarrhoeal diseases.Even with the strongest mitigation procedures, global warming cannot be avoided for decades. Therefore, implementation of adaptation measures to the effect of global warming is the most practical action we can take. It is generally accepted that the impacts of global warming on infectious diseases have not been apparent at this point yet in East Asia. However, these impacts will appear in one form or another if global warming continues to progress in future. Further research on the impacts of global warming on infectious diseases and on future prospects should be conducted.

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Short Communication

Coronavirus Disease-19: The First 7,755 Cases in the Republic of Korea
COVID-19 National Emergency Response Center, Epidemiology and Case Management Team, Korea Centers for Disease Control and Prevention
Osong Public Health Res Perspect 2020;11(2):85-90.
Published online April 30, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.2.05
<p>We report the first 7,755 patients with confirmed COVID-19 in Korea as of March 12<sup>th</sup>, 2020. A total of 66 deaths have been recorded, giving a case fatality proportion of 0.9%. Older people, and those with comorbidities were at a higher risk of a fatal outcome. The highest number of cases of COVID-19 were in Daegu, followed by Gyeongbuk. This summary may help to understand the disease dynamics in the early phase of the COVID-19 outbreaks, and may therefore, guide future public health measures.</p>

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Original Article

Early Epidemiological and Clinical Characteristics of 28 Cases of Coronavirus Disease in South Korea
COVID-19 National Emergency Response Center, Epidemiology & Case Management Team, Korea Centers for Disease Control & Prevention
Osong Public Health Res Perspect 2020;11(1):8-14.
Published online February 28, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.1.03
<sec> <title>Objectives</title> <p>The first confirmed case of coronavirus disease 2019 (COVID-19) in South Korea was reported in January 2020, with 28 confirmed cases reported as of February 14<sup>th</sup>, 2020. The epidemiological and clinical characteristics of all 28 cases were analyzed in response to this disease.</p></sec> <sec> <title>Methods</title> <p>The epidemiological characteristics and early clinical features of the 28 patients from Korea with confirmed COVID-19 were analyzed using COVID-19 reporting and surveillance data and the epidemiological investigation reports prepared by the rapid response team.</p></sec> <sec> <title>Results</title> <p>There were 16 patients that entered Korea from foreign countries: Wuhan, China (11 patients), Zhuhai, China, (1 patient), Singapore (2 patients), Japan (1 patient), and Thailand (1 patient). The early symptoms were fever, sore throat, cough or sputum production, chills, and muscle ache. Three patients were asymptomatic, however, 18 developed pneumonia. Of the 28 cases, 16 were index cases imported from abroad, with 10 cases of secondary infection originating in Korea, and the route of transmission still under investigation for 2 patients. The 10 patients with secondary infection were infected from contact with family members or acquaintances of primary patients, and the suspected sites of transmission were mostly at home.</p></sec> <sec> <title>Conclusion</title> <p>COVID-19 in Korea was spread by 16 infected individuals traveling from other countries, leading to second-generation cases. The initial symptoms were mostly minor, but the disease was infectious at this stage, resulting from close contact, particularly at home. Establishing an early detection strategy for COVID-19 is crucial for managing the transmission of the disease.</p></sec>

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Review Article

Traditional and Modern Cell Culture in Virus Diagnosis
Ali Hematian, Nourkhoda Sadeghifard, Reza Mohebi, Morovat Taherikalani, Abbas Nasrolahi, Mansour Amraei, Sobhan Ghafourian
Osong Public Health Res Perspect 2016;7(2):77-82.
Published online April 30, 2016
DOI: https://doi.org/10.1016/j.phrp.2015.11.011
Cell cultures are developed from tissue samples and then disaggregated by mechanical, chemical, and enzymatic methods to extract cells suitable for isolation of viruses. With the recent advances in technology, cell culture is considered a gold standard for virus isolation. This paper reviews the evolution of cell culture methods and demonstrates why cell culture is a preferred method for identification of viruses. In addition, the advantages and disadvantages of both traditional and modern cell culture methods for diagnosis of each type of virus are discussed. Detection of viruses by the novel cell culture methods is considered more accurate and sensitive. However, there is a need to include some more accurate methods such as molecular methods in cell culture for precise identification of viruses.

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Original Articles

The Characteristics of Middle Eastern Respiratory Syndrome Coronavirus Transmission Dynamics in South Korea
Yunhwan Kim, Sunmi Lee, Chaeshin Chu, Seoyun Choe, Saeme Hong, Youngseo Shin
Osong Public Health Res Perspect 2016;7(1):49-55.
Published online February 28, 2016
DOI: https://doi.org/10.1016/j.phrp.2016.01.001
Objectives
The outbreak of Middle Eastern respiratory syndrome coronavirus (MERS-CoV) was one of the major events in South Korea in 2015. In particular, this study pays attention to formulating a mathematical model for MERS transmission dynamics and estimating transmission rates.
Methods
Incidence data of MERS-CoV from the government authority was analyzed for the first aim and a mathematical model was built and analyzed for the second aim of the study. A mathematical model for MERS-CoV transmission dynamics is used to estimate the transmission rates in two periods due to the implementation of intensive interventions.
Results
Using the estimates of the transmission rates, the basic reproduction number was estimated in two periods. Due to the superspreader, the basic reproduction number was very large in the first period; however, the basic reproduction number of the second period has reduced significantly after intensive interventions.
Conclusion
It turned out to be the intensive isolation and quarantine interventions that were the most critical factors that prevented the spread of the MERS outbreak. The results are expected to be useful to devise more efficient intervention strategies in the future.

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Genome-Wide Identification and Characterization of Point Mutations in the SARS-CoV-2 Genome
Jun-Sub Kim, Jun-Hyeong Jang, Jeong-Min Kim, Yoon-Seok Chung, Cheon-Kwon Yoo, Myung-Guk Han
Osong Public Health Res Perspect 2020;11(3):101-111.
Published online May 14, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.3.05
<sec><title>Objectives</title> <p>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, in December 2019 and has been rapidly spreading worldwide. Although the causal relationship among mutations and the features of SARS-CoV-2 such as rapid transmission, pathogenicity, and tropism, remains unclear, our results of genomic mutations in SARS-CoV-2 may help to interpret the interaction between genomic characterization in SARS-CoV-2 and infectivity with the host.</p></sec> <sec><title>Methods</title> <p>A total of 4,254 genomic sequences of SARS-CoV-2 were collected from the Global Initiative on Sharing all Influenza Data (GISAID). Multiple sequence alignment for phylogenetic analysis and comparative genomic approach for mutation analysis were conducted using Molecular Evolutionary Genetics Analysis (MEGA), and an in-house program based on Perl language, respectively.</p></sec> <sec><title>Results</title> <p>Phylogenetic analysis of SARS-CoV-2 strains indicated that there were 3 major clades including S, V, and G, and 2 subclades (G.1 and G.2). There were 767 types of synonymous and 1,352 types of non-synonymous mutation. ORF1a, ORF1b, S, and N genes were detected at high frequency, whereas ORF7b and E genes exhibited low frequency. In the receptor-binding domain (RBD) of the S gene, 11 non-synonymous mutations were observed in the region adjacent to the angiotensin converting enzyme 2 (ACE2) binding site.</p></sec> <sec><title>Conclusion</title> <p>It has been reported that the rapid infectivity and transmission of SARS-CoV-2 associated with host receptor affinity are derived from several mutations in its genes. Without these genetic mutations to enhance evolutionary adaptation, species recognition, host receptor affinity, and pathogenicity, it would not survive. It is expected that our results could provide an important clue in understanding the genomic characteristics of SARS-CoV-2.</p></sec>

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Phenotypic Assays to Determine Virulence Factors of Uropathogenic Escherichia coli (UPEC) Isolates and their Correlation with Antibiotic Resistance Pattern
Mohsen Tabasi, Mohammad Reza Asadi Karam, Mehri Habibi, Mir Saeed Yekaninejad, Saeid Bouzari
Osong Public Health Res Perspect 2015;6(4):261-268.
Published online August 31, 2015
DOI: https://doi.org/10.1016/j.phrp.2015.08.002
Objectives
Urinary tract infection caused by uropathogenic <i>Escherichia coli</i> (UPEC) strains is one of the most important infections in the world. UPEC encode widespread virulence factors closely related with pathogenesis of the bacteria. The purpose of this study was to evaluate the presence of different phenotypic virulence markers in UPEC isolates and determine their correlation with antibiotic resistance pattern.
Methods
UPEC isolates from patients with different clinical symptoms of UTI were collected and screened for biofilm and hemolysin production, mannose resistant, and mannose sensitive hemagglutination (MRHA and MSHA, respectively). In addition, antimicrobial resistance pattern and ESBL-producing isolates were recorded.
Results
Of the 156 UPEC isolates, biofilm and hemolysin formation was seen in 133 (85.3%) and 53 (34%) isolates, respectively. Moreover, 98 (62.8%) and 58 (37.2%) isolates showed the presence of Types 1 fimbriae (MSHA) and P fimbriae (MRHA), respectively. Our results also showed a relationship between biofilm formation in UPEC isolated from acute cystitis patients and recurrent UTI cases. Occurrence of UTI was dramatically correlated with the patients' profiles. We observed that the difference in antimicrobial susceptibilities of the biofilm and nonbiofilm former isolates was statistically significant. The UPEC isolates showed the highest resistance to ampicillin, tetracycline, amoxicillin, and cotrimoxazole. Moreover, 26.9% of isolates were ESBL producers.
Conclusion
This study indicated that there is a relationship between the phenotypic virulence traits of the UPEC isolates, patients' profiles, and antibiotic resistance. Detection of the phenotypic virulence factors could help to improve understanding of pathogenesis of UPEC isolates and better medical intervention.

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Effect of Repeated Freezing and Thawing on Biomarker Stability in Plasma and Serum Samples
Jae-Eun Lee, Shine Young Kim, So-Youn Shin
Osong Public Health Res Perspect 2015;6(6):357-362.
Published online December 31, 2015
DOI: https://doi.org/10.1016/j.phrp.2015.11.005
Objectives
The stability of circulating proteins can be affected by repeated freezing and thawing. The aim of our study was to identify the effect of repeated freezing and thawing on the plasma and serum concentrations of eight proteins [interferon-γ, interleukin (IL)-8, IL-15, IL-17A, matrix metalloproteinase (MMP)-7, tumor necrosis factor-α, vascular endothelial growth factor (VEGF), and VEGF receptor 2 (VEGF-R2)].
Methods
We assessed the concentration changes of these proteins in 30 plasma and serum samples subjected to three, four, or five freeze–thaw cycles, and compared these with the concentration changes in the samples that were subjected to two freeze–thaw cycles before analysis.
Results
Repeated freezing and thawing by up to five cycles did not modify the plasma and serum concentrations of interferon-γ, IL-8, and VEGF-R2, while levels of MMP-7, tumor necrosis factor-α, and VEGF were significantly changed in both plasma and serum samples. Moreover, MMP-7 and VEGF concentrations tended to increase with freeze–thaw cycles. They were more elevated in plasma samples (up to about 15%) than in serum samples (up to about 7%), suggesting that serum is the preferred sample type for the analysis of circulating proteins.
Conclusion
This is the first report on the effect of repeated freezing and thawing on plasma concentrations of MMP-7 and VEGF-R2. Our findings propose that researchers should consider the number of freeze–thaw cycles to select plasma or serum samples, depending on the type of analyte.

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Factors Affecting Sarcopenia in Korean Adults by Age Groups
Eun-Jung Bae, Yun-Hee Kim
Osong Public Health Res Perspect 2017;8(3):169-178.
Published online June 30, 2017
DOI: https://doi.org/10.24171/j.phrp.2017.8.3.03
<sec><title>Objectives</title><p>This study aimed to investigate factors affecting sarcopenia in different age groups among Korean adults aged 20 years or older.</p></sec><sec><title>Methods</title><p>In this secondary analysis, data were collected from records for 17,968, participants who participated in the Korea National Health and Nutrition Examination Survey during 2008–2011. Data were analyzed using multiple logistic regression to determine the associated factors of sarcopenia by age groups.</p></sec><sec><title>Results</title><p>The prevalence of sarcopenia increased significantly with age. Physical activity, blood pressure, waist circumference, triglycerides, vitamin D level were found to be factors significantly associated with sarcopenia in all age groups. Total energy intake was found to be a factor that is significantly associated with sarcopenia among the adults aged 20–39 years. Fasting glucose, suicidal ideation, perceived health status, mobility problem, pain/discomfort, total energy intake were found to be factors associated with sarcopenia in the adults aged 40–64 years. Sex, residential area, smoking, drinking, fasting glucose, osteoarthritis, fall experience, usual activity problem, protein intake were factors associated with sarcopenia in the adults over 65 years of age.</p></sec><sec><title>Conclusion</title><p>The findings show that sarcopenia in adults and the associated factors were different by age groups. Thus, these factors should be considered in the development of intervention programs for the care and prevention of sarcopenia, and such programs should be modified according to different age groups.</p></sec>

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Investigation of Biofilm Formation and its Association with the Molecular and Clinical Characteristics of Methicillin-resistant Staphylococcus aureus
Jeong-Ok Cha, Jae Il Yoo, Jung Sik Yoo, Hae-Sun Chung, Sun-Hee Park, Hwa Su Kim, Yeong Seon Lee, Gyung Tae Chung
Osong Public Health Res Perspect 2013;4(5):225-232.
Published online October 31, 2013
DOI: https://doi.org/10.1016/j.phrp.2013.09.001
Objectives
To investigate the biofilm-forming related factors against MRSA bloodstream isolates and evaluates their clinical features and treatment outcomes by biofilm production.
Methods
We collected 126 consecutive methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) causing blood stream infections (BSIs) at 10 tertiary hospitals from 2007 to 2009. We investigated biofilm-forming ability using a microtiter plate assay, and molecular characteristics including multilocus sequence typing, staphylococcal cassette chromosome mec and accessory gene regulator types. We compared the clinical characteristics and outcomes of patients infected with biofilm-forming and non-biofilm-forming MRSA isolates.
Results
Of the 126 samples, 86 (68.3%), including 5 strong level (OD<sub>570</sub> ≥ 1.0) and 81 weak level (0.2 ≤ OD<sub>570</sub> < 1.0), had biofilm-forming capacity. Detection of fibronectinbinding protein in biofilm-forming strains was significantly higher than biofilm non-forming ones (<i>p</i> = 0.001) and three enterotoxin genes (sec-seg-sei) islands had a high frequency regardless of biofilm production. However, biofilm-forming strains were more likely to be multidrug resistant (three or more non-β-lactam antibiotics) than biofilm non-forming ones [79.2% vs. 59.2%, <i>p</i> = 0.015, odds ratio (OR) 2.629, 95% confidence interval (CI) 1.92–5.81]. Clinical features of patients with BSIs caused by biofilm-forming MRSA strains were more likely to be hospital onset [77.9% vs. 60.0%, <i>p</i> = 0.024, OR 2.434, 95% CI 1.11–5.33) and more frequently occurred in patients with use of invasive devices [85.7% vs. 61.2%, <i>p</i> = 0.002, OR 3.879, 95% CI 1.61–8.97]. The other clinical features were compared with the clinical outcomes of the two groups and were not significant (<i>p</i> > 0.05).
Conclusion
Biofilm-forming MRSA strains showed higher frequency of <i>fnbB</i> gene than biofilm non-forming ones and more incidence rates on particular genotypes. And, their patient's features were not significantly different between two groups in this study, except for several clinical factors.

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Epidemiology and Inequality in the Incidence and Mortality of Nasopharynx Cancer in Asia
Neda Mahdavifar, Mahshid Ghoncheh, Abdollah Mohammadian-Hafshejani, Bahman Khosravi, Hamid Salehiniya
Osong Public Health Res Perspect 2016;7(6):360-372.
Published online December 31, 2016
DOI: https://doi.org/10.1016/j.phrp.2016.11.002
Objectives
One of the most common head and neck cancers is nasopharynx cancer. Knowledge about the incidence and mortality of this disease and its distribution in terms of geographical areas is necessary for further study and better planning. Therefore, this study was conducted with the aim of determining the incidence and mortality rates of nasopharynx cancer and its relationship with the Human Development Index (HDI) in Asia in 2012.
Methods
The aim of this ecologic study was to assess the correlation between age-specific incidence rate (ASIR) and age-specific mortality rate (ASMR) with HDI and its components, which include the following: life expectancy at birth, mean years of schooling, and gross national income per capita. Data about SIR and SMR for every Asian country for 2012 were obtained from the global cancer project. We used the correlation bivariate method for the assessment. Statistical significance was assumed if <i>p</i> < 0.05. All reported <i>p</i> values are two-sided. Statistical analyses were performed using SPSS (Version 15.0, SPSS Inc.).
Results
A total of 68,272 cases (males, 71.02%; females, 28.97%; sex ratio, 2.45) and 40,530 mortalities (males, 71.63%; females, 28.36%; sex ratio, 2.52) were recorded in Asian countries in 2012. The five countries with the highest ASIR of nasopharynx cancer were Malaysia, Singapore, Indonesia, Vietnam, and Brunei, and the five countries with the highest ASMR were Indonesia, Vietnam, Singapore, Malaysia, and Brunei. The correlation between HDI and ASIR was 0.097 (<i>p</i> = 0.520) [0.105 in men (<i>p</i> = 0.488) and 0.119 in women (<i>p</i> = 0.901)]. The correlation between HDI and ASMR was –0.102 (<i>p</i> = 0.502) [–0.072 in men (<i>p</i> = 0.633) and –0.224 in women (<i>p</i> = 0.134)].
Conclusion
Nasopharynx cancer is native to Southeast Asia. The highest incidence and mortality rates are found in Malaysia, Singapore, Indonesia, Vietnam, and Brunei. No significant relation was found between the standardized incidence and mortality rates of nasopharynx cancer and the HDI components. Further studies are recommended in Southeast Asian countries in order to find the etiology of cancer, as well as its diagnosis and treatment.

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Evaluating Service Quality from Patients' Perceptions: Application of Importance–performance Analysis Method
Rafat Mohebifar, Hana Hasani, Ameneh Barikani, Sima Rafiei
Osong Public Health Res Perspect 2016;7(4):233-238.
Published online August 31, 2016
DOI: https://doi.org/10.1016/j.phrp.2016.05.002
Objectives
Providing high service quality is one of the main functions of health systems. Measuring service quality is the basic prerequisite for improving quality. The aim of this study was to evaluate the quality of service in teaching hospitals using importance–performance analysis matrix.
Methods
A descriptive–analytic study was conducted through a cross-sectional method in six academic hospitals of Qazvin, Iran, in 2012. A total of 360 patients contributed to the study. The sampling technique was stratified random sampling. Required data were collected based on a standard questionnaire (SERVQUAL). Data analysis was done through SPSS version 18 statistical software and importance–performance analysis matrix.
Results
The results showed a significant gap between importance and performance in all five dimensions of service quality (<i>p</i> < 0.05). In reviewing the gap, “reliability” (2.36) and “assurance” (2.24) dimensions had the highest quality gap and “responsiveness” had the lowest gap (1.97). Also, according to findings, reliability and assurance were in Quadrant (I), empathy was in Quadrant (II), and tangibles and responsiveness were in Quadrant (IV) of the importance–performance matrix.
Conclusion
The negative gap in all dimensions of quality shows that quality improvement is necessary in all dimensions. Using quality and diagnosis measurement instruments such as importance–performance analysis will help hospital managers with planning of service quality improvement and achieving long-term goals.

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Antibiotic Resistance of Acinetobacter baumannii in Iran: A Systemic Review of the Published Literature
Jale Moradi, Farhad B. Hashemi, Abbas Bahador
Osong Public Health Res Perspect 2015;6(2):79-86.
Published online April 30, 2015
DOI: https://doi.org/10.1016/j.phrp.2014.12.006
Objectives
<i>Acinetobacter baumannii</i> is a bacterium responsible for health care-associated infections, and it frequently develops multiple drug resistance (MDR). The prevalence of antibiotic-resistant <i>A. baumannii</i> in Iran has increased, and this may cause significant clinical problems. Therefore, in order to elucidate the development of antibiotic resistance, we performed a systematic review of the literature published on antibiotic-resistant <i>A. baumannii</i> reported in Iran.
Methods
Thirty-six publications that met the criteria for inclusion were reviewed from an initial 87 papers. Selected papers published between 2008 and September 2014, were categorized on the basis of the sample collecting year been between 2001 and 2013.
Results
Analysis of data revealed that, in general, there was an increase in antimicrobial resistance. During the initial time point of these studies (2001–2007) there was a high rate of resistance to all antibiotics, with the exception of carbapenems, lipopeptides, and aminoglycosides that had a low resistance rate in comparison with the others. Also, the resistance rate was increased in one group of these three antimicrobial groups from 2010 to 2013. In particular, there was an increase in resistance to carbapenems (imipenem and meropenem) from 2010–2011 and 2012–2013, whereas no significant change in the resistance rate of the other two antimicrobial groups (lipopeptides and aminoglycosides) during the study time was observed, although we did observe certain trends in amikacin (aminoglycoside group antibiotic) between 2011–2012 and 2012–2013.
Conclusion
These findings indicate that antimicrobial resistance of <i>A. baumannii</i> in Iran has increased, which may very well affect the antimicrobial resistance of this organism worldwide. Based on these results, novel prevention and treatment strategies against <i>A. baumannii</i> infections are warranted. Furthermore, these data may assist in revising treatment guidelines and regional policies in care units to slow the emergence of antimicrobial resistance.

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Rapid DNA Extraction from Dried Blood Spots on Filter Paper: Potential Applications in Biobanking
Eun-Hye Choi, Sang Kwang Lee, Chunhwa Ihm, Young-Hak Sohn
Osong Public Health Res Perspect 2014;5(6):351-357.
Published online December 31, 2014
DOI: https://doi.org/10.1016/j.phrp.2014.09.005
Objectives
Dried blood spot (DBS) technology is a microsampling alternative to traditional plasma or serum sampling for pharmaco- or toxicokinetic evaluation. DBS technology has been applied to diagnostic screening in drug discovery, nonclinical, and clinical settings. We have developed an improved elution protocol involving boiling of blood spots dried on Whatman filter paper.
Methods
The purpose of this study was to compare the quality, purity, and quantity of DNA isolated from frozen blood samples and DBSs. We optimized a method for extraction and estimation of DNA from blood spots dried on filter paper (3-mm FTA card). A single DBS containing 40 μL blood was used.
Results
DNA was efficiently extracted in phosphate-buffered saline (PBS) or Tris-EDTA (TE) buffer by incubation at 37°C overnight. DNA was stable in DBSs that were stored at room temperature or frozen. The housekeeping genes GAPDH and beta-actin were used as positive standards for polymerase chain reaction (PCR) validation of general diagnostic screening.
Conclusion
Our simple and convenient DBS storage and extraction methods are suitable for diagnostic screening by using very small volumes of blood collected on filter paper, and can be used in biobanks for blood sample storage.

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Accuracy of Self-reported Hypertension, Diabetes, and Hypercholesterolemia: Analysis of a Representative Sample of Korean Older Adults
Heeran Chun, Il-Ho Kim, Kyung-Duk Min
Osong Public Health Res Perspect 2016;7(2):108-115.
Published online April 30, 2016
DOI: https://doi.org/10.1016/j.phrp.2015.12.002
Objectives
This study will assess the accuracy of self-reported hypertension, diabetes, and hypercholesterolemia among Korean older adults.
Methods
Using data from the fourth Korean National Health Examination and Nutrition Survey (KNHANES IV, 2007–2009), we selected 7,270 individuals aged 50 years and older who participated in both a health examination and a health interview survey. Self-reported prevalence of hypertension (HTN), diabetes mellitus (DM), and hypercholesterolemia was compared with measured data (arterial systolic/diastolic blood pressure, fasting glucose, and total cholesterol).
Results
An agreement between self-reported and measured data was only moderate for hypercholesterolemia (κ, 0.48), even though it was high for HTN (κ, 0.72) and DM (κ, 0. 82). Sensitivity was low in hypercholesterolemia (46.7%), but high in HTN and DM (73% and 79.3%, respectively). Multiple analysis shows that predictors for sensitivity differed by disease. People with less education were more likely to exhibit lower sensitivity to HTN and hypercholesterolemia, and people living in rural areas were less sensitive to DM and hypercholesterolemia.
Conclusion
Caution is needed in interpreting the results of community studies using self-reported data on chronic diseases, especially hypercholesterolemia, among adults aged 50 years and older.

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High Prevalence of Class 1 to 3 Integrons Among Multidrug-Resistant Diarrheagenic Escherichia coli in Southwest of Iran
Mohammad Kargar, Zahra Mohammadalipour, Abbas Doosti, Shahrokh Lorzadeh, Alireza Japoni-Nejad
Osong Public Health Res Perspect 2014;5(4):193-198.
Published online August 31, 2014
DOI: https://doi.org/10.1016/j.phrp.2014.06.003
Objectives
Horizontal transfer of integrons is one of the important factors that can contribute to the occurrence of multidrug-resistant (MDR) bacteria. This study aimed to determine the prevalence of integrons among MDR <i>Escherichia coli</i> strains isolated from stool specimens and investigate the associations between the existence of integrons and MDR properties in the southwest of Iran.
Methods
There were 164 <i>E. coli</i> strains isolated from January 2012 to June 2012. Fecal specimens identified as <i>E. coli</i> by the conventional methods. Subsequently the antibiotic resistance was assessed using Clinical and Laboratory Standard Institute criteria. The presence of class 1–3 integrons and embedded gene cassettes was verified using specific primers by multiplex polymerase chain reaction assay.
Results
Among a total of 164 studied samples, 69 (42.07%) isolates were multidrug resistant. Class 1 and class 2 integrons were present in 78.26% and 76.81% MDR isolates, respectively. For the first time in Iran, class 3 integron was observed in 26.09% MDR isolates. Significant correlations were identified between: class 1 integron and resistance to amikacin, gentamicin, chloramphenicol, ampicillin, tetracycline, nalidixic acid, and co-trimoxazole; class 2 integron and resistance to aminoglycosides, co-trimoxazole, cefalexin, ampicillin, and chloramphenicol; and class 3 integron and resistance to gentamicin, kanamycin, and streptomycin.
Conclusion
Our results indicate that integrons are common among MDR isolates and they can be used as a marker for the identification of MDR isolates. Therefore, due to the possibility of a widespread outbreak of MDR isolates, molecular surveillance and sequencing of the integrons in other parts of the country is recommended.

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Alterations of gyrA, gyrB, and parC and Activity of Efflux Pump in Fluoroquinolone-resistant Acinetobacter baumannii
Sunok Park, Kyeong Min Lee, Yong Sun Yoo, Jung Sik Yoo, Jae Il Yoo, Hwa Su Kim, Yeong Seon Lee, Gyung Tae Chung
Osong Public Health Res Perspect 2011;2(3):164-170.
Published online December 31, 2011
DOI: https://doi.org/10.1016/j.phrp.2011.11.040
Objectives
This study investigated the fluoroquinolone-resistant mechanism of 56 clinical cases of <i>A baumannii</i> infection from 23 non-tertiary hospitals, collected between 2004 and 2006.
Methods
Susceptibility testing was performed by broth microdilution and Epsilometer test. Analyses of quinolone resistance-determining region (QRDR) were done by sequencing. The activity of the efflux pump was measured using inhibitors.
Results
The sequences from selected 56 isolates were divided into seven groups (I-VII) on the basis of mutations in <i>gyrA</i> (S83L), <i>parC</i> (S80L, S80W and S84K) and <i>gyrB</i> (containing the novel mutations E679D, D644Y and A677V). The 27 isolates with triple mutations in <i>gyrA, gyrB</i> and <i>parC</i> (groups IV-VII) showed higher levels of resistance to ciprofloxacin (minimal inhibitory concentration [MIC] of 16-256 μg/mL) than the 26 isolates with double mutations in <i>gyrA</i> and <i>parC</i> (groups II and III, MIC of 8-64 μ g/mL; <i>p</i> < 0.05). Alterations in the efflux pump were observed in four isolates with the <i>parC</i> S80L mutation (group II) or E84K mutation (group VII), but no effect was observed in an isolate with the <i>parC</i> S80 W mutation (group III).
Conclusion
These results suggest that triple mutations in clinical isolates of <i>A baumannii</i> contribute to the development of high levels of resistance to fluoroquinolones and that mutations in <i>parC</i> S80L or E84K (groups II and VII) may contribute to alterations in efflux pump activity in <i>A baumannii</i>.

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Health-Related Quality of Life Based on Comorbidities Among Patients with End-Stage Renal Disease
Jieun Cha, Dallong Han
Osong Public Health Res Perspect 2020;11(4):194-200.
Published online August 31, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.4.08
<sec> <title>Objectives</title> <p>The aim of this study was to investigate comorbidities in patients with end-stage renal disease, and to compare health-related quality of life (HRQOL) according to the type, and number of comorbidities.</p></sec> <sec> <title>Methods</title> <p>A total of 250 adults undergoing hemodialysis were recruited at local clinics. HRQOL was measured using the 12-item Medical Outcomes Study Short Form questionnaire. Data were analyzed using descriptive statistics, analysis of variance, and <italic>t</italic> test.</p></sec> <sec> <title>Results</title> <p>Around 70.8% of patients with end stage renal disease had 1 or more comorbidities, and the most common comorbidities were hypertension, diabetes, and cardiovascular disease. HRQOL was significantly different based on the number of comorbidities (F = 9.83, <italic>p</italic> < 0.001). The effect of comorbidities on the scores for mental health domains of the HRQOL questionnaire was not conclusive compared with the scores for the physical domain which were conclusive. Among the comorbidities, diabetes was associated with a lower quality of life.</p></sec> <sec> <title>Conclusion</title> <p>The customized management of diabetic and hypertensive patients is necessary for the early detection and prevention of chronic kidney disease, and slowing the progression of renal disease and managing cardiovascular risk factors is essential.</p></sec>

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The Mediating Role of Organizational Learning in the Relationship of Organizational Intelligence and Organizational Agility
Mohammad Amin Bahrami, Mohammad Mehdi Kiani, Raziye Montazeralfaraj, Hossein Fallah Zadeh, Morteza Mohammad Zadeh
Osong Public Health Res Perspect 2016;7(3):190-196.
Published online June 30, 2016
DOI: https://doi.org/10.1016/j.phrp.2016.04.007
Objectives
Organizational learning is defined as creating, absorbing, retaining, transferring, and application of knowledge within an organization. This article aims to examine the mediating role of organizational learning in the relationship of organizational intelligence and organizational agility.
Methods
This analytical and cross-sectional study was conducted in 2015 at four teaching hospitals of Yazd city, Iran. A total of 370 administrative and medical staff contributed to the study. We used stratified-random method for sampling. Required data were gathered using three valid questionnaires including Alberkht (2003) organizational intelligence, Neefe (2001) organizational learning, and Sharifi and Zhang (1999) organizational agility questionnaires. Data analysis was done through R and SPSS 18 statistical software.
Results
The results showed that organizational learning acts as a mediator in the relationship of organizational intelligence and organizational agility (path coefficient = 0.943). Also, organizational learning has a statistical relationship with organizational agility (path coefficient = 0.382).
Conclusion
Our findings suggest that the improvement of organizational learning abilities can affect an organization's agility which is crucial for its survival.

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Prevalence of Head Lice Infestation and Its Associated Factors among Primary School Students in Iran: A Systematic Review and Meta-analysis
Mahmood Moosazadeh, Mahdi Afshari, Hormoz Keianian, Asghar Nezammahalleh, Ahmad Ali Enayati
Osong Public Health Res Perspect 2015;6(6):346-356.
Published online December 31, 2015
DOI: https://doi.org/10.1016/j.phrp.2015.10.011
Objectives
Head lice infestation is one of the most important health problems, generally involving children aged 5–13 years. This study aims to estimate the prevalence of head lice infestation and its associated factors among primary school children using systematic review and meta-analysis methods.
Methods
Different national and international databases were searched for selecting the relevant studies using appropriate keywords, Medical Subject Heading terms, and references. Relevant studies with acceptable quality for meta-analysis were selected having excluded duplicate and irrelevant articles, quality assessment, and application of inclusion/exclusion criteria. With calculating standard errors according to binomial distribution and also considering the Cochrane's Q test as well as I-squared index for heterogeneity, pediculosis prevalence rate was estimated using Stata SE V.11 software.
Results
Forty studies met the inclusion criteria of this review and entered into the meta-analysis including 200,306 individuals. Using a random effect model, the prevalence (95% confidence interval) of head lice infestation among primary school children was estimated as 1.6% (1.2–2.05), 8.8% (7.6–9.9), and 7.4% (6.6–8.2) for boys, girls, and all the students, respectively. The infestation rate was found to be associated with low educational level of parents, long hair, family size, mother's job (housewife), father's job (worker/unemployed), using a common comb, lack of bathrooms in the house, and a low frequency of bathing.
Conclusion
This meta-analysis revealed that the prevalence of head lice infestation among Iranian primary school children is relatively high with more prevalence among girls. We also found that economic, social, cultural, behavioral, and hygienic factors are associated with this infestation.

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Perceptions of the COVID-19 vaccine and willingness to receive vaccination among health workers in Nigeria
Oluseyi Ademola Adejumo, Olorunfemi Akinbode Ogundele, Cynthia Roli Madubuko, Rosena Olubanke Oluwafemi, Ogochukwu Chinedum Okoye, Kenechukwu Chukwuemeka Okonkwo, Sunday Samson Owolade, Oladimeji Adedeji Junaid, Olutoyin Morenike Lawal, Adenike Christianah Enikuomehin, Maureen Iru Ntaji, Aisha Sokunbi, Aina Omodele Timothy, Olatunji Sunday Abolarin, Emmanuel Olalekan Ali, John Oghenevwirhe Ohaju-Obodo
Osong Public Health Res Perspect 2021;12(4):236-243.
Published online July 19, 2021
DOI: https://doi.org/10.24171/j.phrp.2021.0023
Perceptions of the COVID-19 vaccine and willingness to receive vaccination among health workers in Nigeria
Objectives
The study aimed to examine health workers’ perceptions of the coronavirus disease 2019 (COVID-19) vaccine in Nigeria and their willingness to receive the vaccine when it becomes available.
Methods
This multi-center cross-sectional study used non-probability convenience sampling to enroll 1,470 hospital workers aged 18 and above from 4 specialized hospitals. A structured and validated self-administered questionnaire was used for data collection. Data entry and analysis were conducted using IBM SPSS ver. 22.0.
Results
The mean age of respondents was 40±6 years. Only 53.5% of the health workers had positive perceptions of the COVID-19 vaccine, and only slightly more than half (55.5%) were willing to receive vaccination. Predictors of willingness to receive the COVID-19 vaccine included having a positive perception of the vaccine (adjusted odds ratio [AOR], 4.55; 95% confidence interval [CI], 3.50−5.69), perceiving a risk of contracting COVID-19 (AOR, 1.50; 95% CI, 1.25–3.98), having received tertiary education (AOR, 3.50; 95% CI, 1.40−6.86), and being a clinical health worker (AOR, 1.25; 95% CI, 1.01−1.68).
Conclusion
Perceptions of the COVID-19 vaccine and willingness to receive the vaccine were sub-optimal among this group. Educational interventions to improve health workers' perceptions and attitudes toward the COVID-19 vaccine are needed.

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Short Communication

Coronavirus Disease-19: Summary of 2,370 Contact Investigations of the First 30 Cases in the Republic of Korea
COVID-19 National Emergency Response Center, Epidemiology and Case Management Team, Korea Centers for Disease Control and Prevention
Osong Public Health Res Perspect 2020;11(2):81-84.
Published online April 30, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.2.04
<p>Between January 24<sup>th</sup> and March 10<sup>th</sup>, a total of 2,370 individuals had contact with the first 30 cases of COVID-19. There were 13 individuals who contracted COVID-19 resulting in a secondary attack rate of 0.55% (95% CI 0.31–0.96). There were 119 household contacts, of which 9 individuals developed COVID-19 resulting in a secondary attack rate of 7.56% (95% CI 3.7–14.26).</p>

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Original Articles
Incubation Period of Ebola Hemorrhagic Virus Subtype Zaire
Martin Eichner, Scott F. Dowell, Nina Firese
Osong Public Health Res Perspect 2011;2(1):3-7.
Published online June 30, 2011
DOI: https://doi.org/10.1016/j.phrp.2011.04.001
Objectives
Ebola hemorrhagic fever has killed over 1300 people, mostly in equatorial Africa. There is still uncertainty about the natural reservoir of the virus and about some of the factors involved in disease transmission. Until now, a maximum incubation period of 21 days has been assumed.
Methods
We analyzed data collected during the Ebola outbreak (subtype Zaire) in Kikwit, Democratic Republic of the Congo, in 1995 using maximum likelihood inference and assuming a log-normally distributed incubation period.
Results
The mean incubation period was estimated to be 12.7 days (standard deviation 4.31 days), indicating that about 4.1% of patients may have incubation periods longer than 21 days.
Conclusion
If the risk of new cases is to be reduced to 1% then 25 days should be used when investigating the source of an outbreak, when determining the duration of surveillance for contacts, and when declaring the end of an outbreak.

Citations

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Under-reporting of Energy Intake from 24-hour Dietary Recalls in the Korean National Health and Nutrition Examination Survey
Seunghee Kye, Sung-Ok Kwon, Soon-Young Lee, Jiyoon Lee, Bok Hee Kim, Hee-Jae Suh, Hyun-Kyung Moon
Osong Public Health Res Perspect 2014;5(2):85-91.
Published online April 30, 2014
DOI: https://doi.org/10.1016/j.phrp.2014.02.002
Objectives
Chronic degenerative diseases are closely related to daily eating habits, nutritional status, and, in particular, energy intake. In clarifying these relationships it is very important for dietary surveys to report accurate information about energy intake. This study attempted to identify the prevalence of the under-reporting of energy intake and its related characteristics based on the Korean National Health and Nutrition Examination Survey conducted in the years 2007–2009.
Methods
The present study analyzed dietary intake data from 15,133 adults aged ≥19 years using 24-hour dietary recalls. Basal metabolic rates were calculated from the age- and gender-specific equations of Schofield and under-reporting was defined as an energy intake <0.9, represented by the ratio of energy intake to estimated basal metabolic rate.
Results
Under-reporters (URs) accounted for 14.4% of men and 23.0% of women and the under-reporting rate was higher in the age group 30–49 years for both men and women. The results from an analysis of the age-specific socioeconomic characteristics of participants classified as URs showed that under-reporting was high in women living alone and in women with only elementary school education or no education. The results from an analysis of the health-specific characteristics of URs showed that a large proportion of URs had poor self-rated health or were obese, or both, compared with non-URs. The proportion of participants who consumed less than the estimated average requirements for nutrients was significantly higher in URs compared with non-URs.
Conclusion
The under-reporting of energy intake was associated with age, gender, education level, income level, household status (single-person or multi-person), self-rated health, physical activity, and obesity.

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Chemical Constituents of Essential Oils Possessing Anti-Influenza A/WS/33 Virus Activity
Hwa-Jung Choi
Osong Public Health Res Perspect 2018;9(6):348-353.
Published online December 31, 2018
DOI: https://doi.org/10.24171/j.phrp.2018.9.6.09
<sec> <title>Objectives</title> <p>This study was conducted to determine whether essential oils had anti-influenza A/WS/33 virus activity and whether there were specific compounds associated with this activity.</p></sec> <sec> <title>Methods</title> <p>There were 63 essential oils evaluated for anti-influenza (A/WS/33 virus) activity using a cytopathic effect reduction method. The chemical composition of the anti-influenza essential oils was phytochemically analyzed by gas chromatography-mass spectrometry.</p></sec> <sec> <title>Results</title> <p>The antiviral assays demonstrated that 11 of the 62 essential oils (100 μg/mL) possessed anti-influenza activity, reducing visible cytopathic effects of influenza A/WS/33 virus activity by > 30%. Furthermore, marjoram, clary sage and anise oils exhibited anti-influenza A/WS/33 virus activity of > 52.8%. However, oseltamivir (the anti-influenza A and B drug), showed cytotoxicity at the same concentration (100 μg/mL) as the essential oils. The chemical composition detected by GC–MS analysis, differed amongst the 3 most potent anti-viral essential oils (marjoram, clary sage and anise oils) except for linalool, which was detected in all 3 essential oils.</p></sec> <sec> <title>Conclusion</title> <p>This study demonstrated anti-influenza activity in 11 essential oils tested, with marjoram, clary sage and anise essential oils being the most effective at reducing visible cytopathic effects of the A/WS/33 virus. All 3 oils contained linalool, suggesting that this may have anti-influenza activity. Further investigation is needed to characterize the antiviral activity of linalool against influenza A/WS/33 virus.</p></sec>

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Nurse-Perceived Patient Adverse Events depend on Nursing Workload
Jeong-Hee Kang, Chul-Woung Kim, Sang-Yi Lee
Osong Public Health Res Perspect 2016;7(1):56-62.
Published online February 28, 2016
DOI: https://doi.org/10.1016/j.phrp.2015.10.015
Objectives
The purpose of this study was to investigate the correlation between nursing workload and nurse-perceived patient adverse events.
Methods
A total of 1,816 nurses working in general inpatient units of 23 tertiary general hospitals in South Korea were surveyed, and collected data were analyzed through multilevel logistic regression analysis.
Results
Among variables related to nursing workload, the non-nursing task experience had an influence on all four types of patient adverse events. Nurses with non-nursing tasks experienced patient adverse events—falls [odds ratio (OR) = 1.31], nosocomial infections (OR = 1.23), pressure sores (OR = 1.16), and medication errors (OR = 1.23)—more often than <i>occasionally</i>. In addition, when the bed to nurse ratio was higher, nurses experienced cases of pressure sores more often (OR = 1.35). By contrast, nurses who said the nursing workforce is sufficient were less likely than others to experience cases of pressure sores (OR = 0.78). Hospitals with a relatively high proportion of nurses who perceived the nursing workforce to be sufficient showed a low rate of medication error (OR = 0.28).
Conclusion
The study suggested that the high level of nursing workload in South Korea increases the possibility of patient adverse events.

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Ovicidal and Oviposition Deterrent Activities of Medicinal Plant Extracts Against Aedes aegypti L. and Culex quinquefasciatus Say Mosquitoes (Diptera: Culicidae)
Appadurai Daniel Reegan, Munusamy Rajiv Gandhi, Micheal Gabriel Paulraj, Savarimuthu Ignacimuthu
Osong Public Health Res Perspect 2015;6(1):64-69.
Published online February 28, 2015
DOI: https://doi.org/10.1016/j.phrp.2014.08.009
Objectives
To evaluate the ovicidal and oviposition deterrent activities of five medicinal plant extracts namely <i>Aegle marmelos</i> (Linn.), <i>Limonia acidissima</i> (Linn.), <i>Sphaeranthus indicus</i> (Linn.), <i>Sphaeranthus amaranthoides</i> (burm.f), and <i>Chromolaena odorata</i> (Linn.) against <i>Culex quinquefasciatus</i> and <i>Aedes aegypti</i> mosquitoes. Three solvents, namely hexane, ethyl acetate, and methanol, were used for the preparation of extracts from each plant.
Methods
Four different concentrations—62.5 parts per million (ppm), 125 ppm, 250 ppm, and 500 ppm—were prepared using acetone and tested for ovicidal and oviposition deterrent activities. One-way analysis of variance (ANOVA) was used to determine the significance of the treatments and means were separated by Tukey's test of comparison.
Results
Among the different extracts of the five plants screened, the hexane extract of <i>L. acidissima</i> recorded the highest ovicidal activity of 79.2% and 60% at 500 ppm concentration against the eggs of <i>Cx. quinquefasciatus</i> and <i>Ae. aegypti</i>, respectively. Similarly, the same hexane extract of <i>L. acidissima</i> showed 100% oviposition deterrent activity at all the tested concentrations against <i>Cx. quinquefasciatus</i> and <i>Ae. aegypti</i> adult females.
Conclusion
It is concluded that the hexane extract of <i>L. acidissima</i> could be used in an integrated mosquito management program.

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Osong Public Health Res Perspect 2012;3(3):177-184.
DOI: https://doi.org/10.1016/j.phrp.2012.07.004
On April 26, 2012, the Korea National Institute of Health officially held the opening ceremony of newly dedicated biobank building, ‘National Biobank of Korea’. The stocked biospecimens and related information have been distributed for medical and public health researches. The Korea Biobank Project, which was initiated in 2008, constructed the Korea Biobank Network consisting of the National Biobank of Korea (NBK) with 17 regional biobanks in Korea. As of December 2011, a total of 525,416 biospecimens with related information have been secured: 325,952 biospecimens from the general population obtained through cohort studies and 199,464 biospecimens of patients from regional biobanks. A large scale genomic study, Korea Association Resource (KARE) and many researches utilized the biospecimens secured through Korea Genome Epidemiology Study (KoGES) and Korea Biobank Project (KBP). Construction of ‘National Biobank of Korea’, a dedicated biobank building at Osong means that NBK can manage and check quality of the biospecimens with promising distribution of 26 million vials of biospecimen, which provide the infrastructure for the development of health technology in Korea. The NBK and the National Library of Medicine (to be constructed in 2014) will play a central role in future biomedical research in Korea.

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Influence of Obesity on Postural Stability in Young Adults
Sung Min Son
Osong Public Health Res Perspect 2016;7(6):378-381.
Published online December 31, 2016
DOI: https://doi.org/10.1016/j.phrp.2016.10.001
Objectives
The purpose of this study was to determine whether obesity is associated with less postural stability in young adults, and whether it is influenced by anterior pelvic tilt angle and sensory dysfunction.
Methods
Center of gravity (COG) velocity and total sway distance with eyes open or eyes closed on firm or foam floors were determined in 12 obese individuals and 12 individuals with normal weight.
Results
On firm and foam floors with eyes closed, center of gravity velocity and total sway distance were significantly greater in the obese group than in the normal-weight group. However, on firm and foam floors with eyes open, center of gravity velocity and total sway distance were not significantly different in the two groups.
Conclusion
The clinical implication of our findings is that obese young adults exhibit poor postural stability. Our findings also suggested that postural instability in obese individuals is associated with increased lordosis due to abdominal fat and poor integration of plantar somatosensory input.

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Factors Affecting Hospital Employees' Knowledge Sharing Intention and Behavior, and Innovation Behavior
Hyun Sook Lee, Seong Ae Hong
Osong Public Health Res Perspect 2014;5(3):148-155.
Published online June 30, 2014
DOI: https://doi.org/10.1016/j.phrp.2014.04.006
Objectives
To investigate the factors affecting employees' knowledge sharing intention, knowledge sharing behavior, and innovation behavior of the four top-ranked university hospitals in South Korea.
Methods
Data were collected from employees at three university hospitals in Seoul, Korea and one university hospital in Gyeonggi-Do, Korea through self-administered questionnaires. The survey was conducted from May 29, 2013 to July 17, 2013. A total of 779 questionnaires were analyzed by SPSS version 18.0 and AMOS version 18.0.
Results
Factors affecting hospital employees' knowledge sharing intention, knowledge sharing behavior, and innovation behavior are reciprocity, behavioral control, and trust.
Conclusion
It is important to select employees who have a propensity for innovation and continuously educate them about knowledge management based on trust.

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Relationships between Virulence Factors and Antimicrobial Resistance among Escherichia coli Isolated from Urinary Tract Infections and Commensal Isolates in Tehran, Iran
Mohammad Reza Asadi Karam, Mehri Habibi, Saeid Bouzari
Osong Public Health Res Perspect 2018;9(5):217-224.
Published online October 31, 2018
DOI: https://doi.org/10.24171/j.phrp.2018.9.5.02
<sec> <title>Objectives</title> <p>Uropathogenic <italic>Escherichia coli</italic> (UPEC) are the major cause of urinary tract infections (UTIs). Here, we determined whether sensitivity to antibiotics was related to the prevalence of iron scavenging genes, or to biofilm and hemolysis formation.</p></sec> <sec> <title>Methods</title> <p>A total of 110 UPEC and 30 <italic>E coli</italic> isolates were collected from the urine of UTI patients and feces of healthy individuals without UTI, respectively. The presence of iron receptor genes and phenotypic properties were evaluated by polymerase chain reaction and phenotypic methods, respectively. Susceptibility to routine antibiotics was evaluated using the disc diffusion method.</p></sec> <sec> <title>Results</title> <p>The prevalence of iron scavenging genes ranged from 21.8% (<italic>ireA</italic>) to 84.5% (<italic>chuA</italic>) in the UPEC. Resistance to ceftazidime and cefotaxime was significantly correlated with the presence of <italic>fyuA</italic> and <italic>iutA</italic> iron genes. Biofilm production was significantly associated with the prevalence of <italic>fyuA</italic> and <italic>hma</italic> iron genes. A higher degree of antibiotic resistance was exhibited by isolates that produced biofilms than by their non-biofilm producing counterparts.</p></sec> <sec> <title>Conclusion</title> <p>Our study clearly indicates that biofilm production is associated with antibiotic resistance, and that iron receptors and hemolysin production also contribute to reduced antibiotic sensitivity. These results further our understanding of the role that these virulence factors play during UPEC pathogenesis, which in turn may be valuable for the development of novel treatment strategies against UTIs.</p></sec>

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The Determinants of Participation in Physical Activity in Malaysia
Yong Kang Cheah, Bee Koon Poh
Osong Public Health Res Perspect 2014;5(1):20-27.
Published online February 28, 2014
DOI: https://doi.org/10.1016/j.phrp.2013.12.002
Objectives
In light of the importance of physical activity, the aim of the present study is to examine the factors affecting participation in physical activity among adults in Malaysia.
Methods
A logistic regression model and the Third National Health and Morbidity Survey consisting of 30,992 respondents were used.
Results
Age, income, gender, education, marital status, region, house locality, job characteristics, and medical conditions are significantly associated with participation in physical activity. In particular, old individuals, high income earners, females, the well-educated, widowed or divorced individuals, East Malaysians, urban dwellers, the unemployed, and individuals who are not diagnosed with hypercholesterolemia are less likely to be physically active than others.
Conclusion
Because sociodemographic and health factors play an important role in determining physical activity, the government should take them into account when formulating policy.

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Analysis of Resistance to Macrolide–Lincosamide–Streptogramin B Among mecA-Positive Staphylococcus Aureus Isolates
Mahmoud Khodabandeh, Mohsen Mohammadi, Mohammad Reza Abdolsalehi, Azadeh Alvandimanesh, Mehrdad Gholami, Meysam Hasannejad Bibalan, Abazar Pournajaf, Ramin Kafshgari, Ramazan Rajabnia
Osong Public Health Res Perspect 2019;10(1):25-31.
Published online February 28, 2019
DOI: https://doi.org/10.24171/j.phrp.2019.10.1.06
<sec> <title>Objectives</title> <p>Genetic determinants conferring resistance to macrolide, lincosamide, and streptogramin B (MLS<sub>B</sub>) via ribosomal modification such as, <italic>erm</italic>, <italic>msrA/B</italic> and <italic>ereA/B</italic> genes are distributed in bacteria. The main goals of this work were to evaluate the dissemination of MLS<sub>B</sub> resistance phenotypes and genotypes in methicillin-resistant <italic>Staphylococcus aureus</italic> (MRSA) isolates collected from clinical samples.</p></sec> <sec> <title>Methods</title> <p>A total of 106 MRSA isolates were studied. Isolates were recovered from 3 hospitals in Tehran between May 2016 to July 2017. The prevalence of MLS<sub>B</sub>-resistant strains were determined by D-test, and then M-PCR was performed to identify genes encoding resistance to macrolides, lincosamides, and streptogramins in the tested isolates.</p></sec> <sec> <title>Results</title> <p>The frequency of constitutive resistance MLS<sub>B</sub>, inducible resistance MLS<sub>B</sub> and MS<sub>B</sub> resistance were 56.2%, 22.9%, and 16.6%, respectively. Of 11 isolates with the inducible resistance MLS<sub>B</sub> phenotype, <italic>ermC</italic>, <italic>ermB</italic>, <italic>ermA</italic> and <italic>ereA</italic> were positive in 81.8%, 63.6%, 54.5% and 18.2% of these isolates, respectively. In isolates with the constitutive resistance MLS<sub>B</sub> phenotype, the prevalence of <italic>ermA</italic>, <italic>ermB</italic>, <italic>ermC</italic>, <italic>msrA</italic>, <italic>msrB</italic>, <italic>ereA</italic> and <italic>ereB</italic> were 25.9%, 18.5%, 44.4%, 0.0%, 0.0%, 11.1% and 0.0%, respectively.</p></sec> <sec> <title>Conclusion</title> <p>Clindamycin is commonly administered in severe MRSA infections depending upon the antimicrobial susceptibility findings. This study showed that the D-test should be used as an obligatory method in routine disk diffusion assay to detect inducible clindamycin resistance in MRSA so that effective antibiotic treatment can be provided.</p></sec>

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Dentofacial and Cranial Changes in Down Syndrome
Deepika Shukla, Deepika Bablani, Aman Chowdhry, Raveena Thapar, Puneet Gupta, Shashwat Mishra
Osong Public Health Res Perspect 2014;5(6):339-344.
Published online December 31, 2014
DOI: https://doi.org/10.1016/j.phrp.2014.09.004
Objectives
This study aimed to determine the prevalence of certain oral characteristics usually associated with Down syndrome and to determine the oral health status of these patients.
Methods
The cross-sectional study was conducted among patients attending a special education program at Faculty of Dentistry, Jamia Millia Islamia, Delhi, India. The study design consisted of closed-ended questions on demographic characteristics (age, sex, and education and income of parents), dietary habits, and oral hygiene habits. Clinical examination included assessment of oral hygiene according to Simplified Oral Hygiene Index (OHI-S), dental caries according to decayed, missing, and filled teeth (DMFT) index, periodontal status according to the Community Periodontal Index of Treatment Needs (CPITN), and malocclusion according to Angles classification of malocclusion. Examinations were carried out using a using a CPI probe and a mouth mirror in accordance with World Health Organization criteria and methods. Craniometric measurements, including maximum head length and head breadth were measured for each participant using Martin spreading calipers centered on standard anthropological methods.
Results
The majority of the patients were males (<i>n</i> = 63; 82%) with age ranging from 6–40 years. The Intelligence Quotient (IQ) score of the patients indicated that 31% had moderate mental disability and 52% had mild mental disability. 22% exhibited hearing and speech problems.12% had missing teeth and 15% had retained deciduous teeth in adult population. The overall prevalence of dental caries in the study population was 78%. DMFT, CPITN and OHI scores of the study group were 3.8 ± 2.52, 2.10 ± 1.14 and 1.92 ± 0.63 respectively. The vast majority of patients required treatment (90%), primarily of scaling, root planing, and oral hygiene education. 16% of patients reported CPITN scores of 4 (deep pockets) requiring complex periodontal care. The prevalence of malocclusion was 97% predominantly of Class III malocclusions. Further 14% presented with fractured anterior teeth primarily central incisor. The percentage means of cephalic index was 84.6% in the study population. The brachycephalic and hyperbrachycephalic type of head shape was dominant in the Down syndrome individuals (90%).
Conclusion
The most common dentofacial anomaly seen in these individuals was fissured tongue followed by macroglossia.

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Assessment of Service Quality in Teaching Hospitals of Yazd University of Medical Sciences: Using Multi-criteria Decision Making Techniques
Milad Shafii, Sima Rafiei, Fatemeh Abooee, Mohammad Amin Bahrami, Mojtaba Nouhi, Farhad Lotfi, Khatere Khanjankhani
Osong Public Health Res Perspect 2016;7(4):239-247.
Published online August 31, 2016
DOI: https://doi.org/10.1016/j.phrp.2016.05.001
Objectives
Hospitals as integrated parts of the wide-ranging health care systems have dominant focus on health care provision to meet, maintain and promote people's health needs of a community. This study aimed to assess the service quality of teaching hospitals of Yazd University of Medical Sciences using Fuzzy Analytical Hierarchy Process (FAHP) and Technique for Order Preference by Similarity to Ideal Solution (TOPSIS).
Methods
A literature review and a qualitative method were used to obtain experts' viewpoints about the quality dimensions of hospital services to design a questionnaire. Then, using a self-made questionnaire, perceptions of 300 patients about the quality of delivered services were gathered. Finally, FAHP was applied to weigh each quality dimension and TOPSIS method to rank hospital wards.
Results
Six dimensions including responsiveness, assurance, security, tangibles, health communication and Patient orientation were identified as affecting aspects of hospital services quality among which, security and tangibles got the highest and lowest importance respectively (0.25406, 0.06883). Findings also revealed that in hospital A, orthopedics and ophthalmology wards obtained the highest score in terms of quality while cardiology department got the lowest ranking (0.954, 0.323). In hospital B, the highest and the lowest ranking was belonged to cardiology and surgical wards (0.895, 0.00) while in hospital C, surgical units were rated higher than internal wards (0.959, 0.851).
Conclusion
Findings emphasized that the security dimension got the lowest ranking among SERVQUAL facets in studied hospitals. This requires hospital executives to pay special attention to the issue of patients’ security and plan effectively for its promotion.

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Plasmid-Mediated Quinolone-Resistance (qnr) Genes in Clinical Isolates of Escherichia coli Collected from Several Hospitals of Qazvin and Zanjan Provinces, Iran
Maryam Rezazadeh, Hamid Baghchesaraei, Amir Peymani
Osong Public Health Res Perspect 2016;7(5):307-312.
Published online October 31, 2016
DOI: https://doi.org/10.1016/j.phrp.2016.08.003
Objectives
<i>Escherichia coli</i> is regarded as the most important etiological agent of urinary tract infections. Fluoroquinolones are routinely used in the treatment of these infections; however, in recent years, a growing rate of resistance to these drugs has been reported globally. The aims of this study were to detect plasmid-mediated <i>qnrA</i>, <i>qnrB</i>, and <i>qnrS</i> genes among the quinolone-nonsusceptible <i>E. coli</i> isolates and to investigate their clonal relatedness in Qazvin and Zanjan Provinces, Iran.
Methods
A total of 200 clinical isolates of <i>E. coli</i> were collected from hospitalized patients. The bacterial isolates were identified through standard laboratory protocols and further confirmed using API 20E test strips. Antimicrobial susceptibility was determined by the standard disk diffusion method. Polymerase chain reaction (PCR) and sequencing were used for detecting <i>qnrA</i>, <i>qnrB</i>, and <i>qnrS</i> genes and the clonal relatedness of <i>qnr</i>-positive isolates was evaluated by enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR) method.
Results
In total, 136 (68%) isolates were nonsusceptible to quinolone compounds, among which 45 (33.1%) and 71 (52.2%) isolates showed high- and low-level quinolone resistance, respectively. Of the 136 isolates, four (2.9%) isolates were positive for the <i>qnrS1</i> gene. The results from ERIC-PCR revealed that two (50%) cases of <i>qnr</i>-positive isolates were related genetically.
Conclusion
Our study results were indicative of the presence of low frequency of <i>qnr</i> genes among the clinical isolates of <i>E. coli</i> in Qazvin and Zanjan Provinces, which emphasizes the need for establishing tactful policies associated with infection-control measures in our hospital settings.

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Mediating and Moderating Effects in Ageism and Depression among the Korean Elderly: The Roles of Emotional Reactions and Coping Reponses
Il-Ho Kim, Samuel Noh, Heeran Chun
Osong Public Health Res Perspect 2016;7(1):3-11.
Published online February 28, 2016
DOI: https://doi.org/10.1016/j.phrp.2015.11.012
Objectives
This study evaluated the relationship between ageism and depression, exploring the stress-mediating and stress-moderating roles of emotional reactions and coping behaviors.
Methods
Data were from the 2013 Ageism and Health Study (<i>n</i> = 816), a cross-sectional survey of urban and rural community-dwelling seniors aged 60–89 years in South Korea. Participants with at least one experience of ageism reported on their emotional reactions and coping responses. The measure yielded two types of coping: problem-focused (taking formal action, confrontation, seeking social support) and emotion-focused (passive acceptance, emotional discharge).
Results
Although ageism was significantly associated with depressive symptoms (B = 0.27, <i>p</i> < 0.0001), the association was entirely mediated by emotional reactions such as anger, sadness, and powerlessness. Problem-focused coping, especially confrontation and social support, seemingly reduced the impact of emotional reactions on depression, whereas emotion-focused coping exacerbated the adverse effects.
Conclusion
These findings support the cultural characterization explanation of ageism and related coping processes among Korean elderly and suggest that regulating emotional reactions may determine the efficacy of coping with ageism.

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