Osong Public Health and Research Perspectives

Articles in E-pub version are posted online ahead of regular printed publication.

Original Articles

Effectiveness of a cognitive behavioral therapy program in stroke patients in the Republic of Korea: a mixed-methods study: So-Eun Choi, Deok-Ju Kim; Received May 1, 2024 Accepted August 18, 2024 Published online September 30, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0116 [Epub ahead of print]

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Abstract PDF: Objectives
This study aimed to explore the effects of a cognitive behavioral therapy (CBT) program on stroke patients, as well as their experiences participating in the program.
Methods
This study employed a mixed-methods design, integrating qualitative case studies with quantitative analysis. We included 20 stroke patients, randomly divided into 2 groups of 10 each: an experimental group and a control group. The experimental group underwent a CBT program comprising 20 sessions, in addition to receiving general occupational therapy. Conversely, the control group participated in meditation relaxation sessions alongside their general occupational therapy. Both interventions were administered daily for 60 minutes, 5 days a week, over a 4-week period.
Results
After the intervention, the experimental group exhibited significant improvements in depression, anxiety, self-efficacy, and rehabilitation motivation (p<0.01, p<0.05). In contrast, the control group only demonstrated a significant reduction in anxiety (p<0.05). A comparison of the changes between the 2 groups showed significant differences in depression and anxiety (p<0.01), but no significant differences in self-efficacy and rehabilitation motivation (p>0.05). In-depth interviews with 10 participants from the experimental group were conducted and analyzed, revealing 4 core themes: “psychological stability,” “physical symptom relief,” “altered daily routines,” and “challenges and hopes for change.”
Conclusion
The findings of this study suggest that CBT programs may serve as a valuable intervention, offering psychological support and rehabilitation for stroke patients.

Molecular characteristics of drug-susceptible Mycobacterium tuberculosis clinical isolates based on treatment duration in the Republic of Korea: Eon-Min Ko, Jinsoo Min, Hyungjun Kim, Ji-A Jeong, Sungkyoung Lee, Seonghan Kim; Received April 11, 2024 Accepted August 18, 2024 Published online September 30, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0101 [Epub ahead of print]

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Abstract PDF: Objectives
In this study, we performed comparative genomic and transcriptomic analysis of clinical isolates of Mycobacterium tuberculosis collected from patients with drug-susceptible tuberculosis (DS-TB). The clinical isolates were categorized based on treatment duration: standard 6 months or >6 months.
Methods
Study participants were recruited from a 2016 to 2018 tuberculosis cohort, and clinical M. tuberculosis isolates were collected from the sputum of patients with tuberculosis. We analyzed the genome and transcriptome of the isolated M. tuberculosis.
Results
Genomic analysis revealed a specific non-synonymous single-nucleotide polymorphism in pe_pgrs9 and ppe34, exclusive to the group treated for >6 months. Transcriptomic analysis revealed increased expression of various virulence-associated protein family genes and decreased expression of ribosomal protein genes and ppe38 genes in the group treated for >6 months.
Conclusion
The identified genetic variation and gene expression patterns may influence treatment outcomes by modulating host immune responses, increasing virulence, and potentially contributing to persister cell formation in M. tuberculosis. This study provides insights into the genetic and transcriptomic factors associated with prolonged DS-TB treatment. However, our study identified molecular characteristics using a small sample size, and further detailed studies are warranted.

BCED-Net: Breast Cancer Ensemble Diagnosis Network using transfer learning and the XGBoost classifier with mammography images: Drishti Arora, Rakesh Garg, Farhan Asif; Received December 5, 2023 Accepted July 22, 2024 Published online September 10, 2024; DOI: https://doi.org/10.24171/j.phrp.2023.0361 [Epub ahead of print]

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Abstract PDF: Objectives
Breast cancer poses a significant global health challenge, characterized by complex origins and the potential for life-threatening metastasis. The critical need for early and accurate detection is underscored by the 685,000 lives claimed by the disease worldwide in 2020. Deep learning has made strides in advancing the prompt diagnosis of breast cancer. However, obstacles persist, such as dealing with high-dimensional data and the risk of overfitting, necessitating fresh approaches to improve accuracy and real-world applicability.
Methods
In response to these challenges, we propose BCED-Net, which stands for Breast Cancer Ensemble Diagnosis Network. This innovative framework leverages transfer learning and the extreme gradient boosting (XGBoost) classifier on the Breast Cancer RSNA dataset. Our methodology involved feature extraction using pre-trained models—namely, Resnet50, EfficientnetB3, VGG19, Densenet121, and ConvNeXtTiny—followed by the concatenation of the extracted features. Our most promising configuration combined features extracted from deep convolutional neural networks—namely Resnet50, EfficientnetB3, and ConvNeXtTiny—that were classified using the XGBoost classifier.
Results
The ensemble approach demonstrated strong overall performance with an accuracy of 0.89. The precision, recall, and F1-score values, which were all at 0.86, highlight a balanced trade-off between correctly identified positive instances and the ability to capture all actual positive samples.
Conclusion
BCED-Net represents a significant leap forward in addressing persistent issues such as the high dimensionality of features and the risk of overfitting.

Individual and contextual factors associated with measles infection in Malaysia: a multilevel analysis: Mohd Rujhan Hadfi Mat Daud, Nor Azwany Yaacob, Wan Nor Arifin, Jamiatul Aida Md Sani, Wan Abdul Hannan Wan Ibadullah; Received June 4, 2024 Accepted July 9, 2024 Published online August 21, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0156 [Epub ahead of print]

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Abstract PDF: Objectives
Despite effective vaccination strategies, measles remains a global public health challenge. The study explored individual and contextual factors associated with measles infection in Malaysia from 2018 to 2022, informing the development of targeted public health interventions.
Methods
This cross-sectional study utilised data from the Ministry of Health, the Department of Statistics, and the Department of Environment Malaysia. Multilevel logistic regression analysis was employed to examine individual-level factors, including age, sex, ethnicity, nationality, contact history, travel history, and vaccination status. Concurrently, contextual factors were assessed, encompassing district-level determinants such as population density, median household income, urbanisation, the number of health and rural clinics, vaccination rates, PM2.5 levels, relative humidity, and temperature, to determine their impact on measles infection risk.
Results
Measles infection was significantly associated with various individual factors. These included age (adjusted odds ratio [aOR], 1.02; 95% confidence interval [CI], 1.02–1.03), ethnicity, non-Malaysian nationality (aOR, 34.53; 95% CI, 8.42–141.51), prior contact with a measles case (aOR, 2.36; 95% CI, 2.07–2.69), travel history (aOR, 2.30; 95% CI, 1.13–4.70), and vaccination status (aOR, 0.76; 95% CI, 0.72–0.79). Among contextual factors, urbanisation (aOR, 1.56; 95% CI, 1.16–2.10) and the number of clinics (aOR, 0.98; 95% CI, 0.97–0.99) were significant determinants.
Conclusion
This multilevel logistic regression analysis illuminates the complexities of measles transmission, advocating public health interventions tailored to individual and contextual vulnerabilities. The findings highlight the need for a synergistic approach that combines vaccination campaigns, healthcare accessibility improvements, and socioeconomic interventions to effectively combat measles.

Associations of type and intensity of social participation with depression, self-rated health, and life satisfaction among community-dwelling older adults in the Republic of Korea: a nationwide cross-sectional study: Myo-Gyeong Kim, Sookja Choi; Received February 6, 2024 Accepted June 11, 2024 Published online August 21, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0039 [Epub ahead of print]

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Abstract PDF: Objectives
Social activities are important and influential factors for healthy aging. However, limited information is available regarding the associations of the type and intensity of social participation with health and well-being. This study aimed to investigate how various types of social activities are associated with several dimensions of health outcomes.
Methods
This cross-sectional study utilized data from the Seventh Korean Longitudinal Study of Aging, which included 5,526 adults aged 60 years and older. Multivariate linear regression analysis was employed to analyze the associations of social activities with depression, self-rated health, and life satisfaction. Additionally, subgroup analyses by sex and age were performed.
Results
Among the participants, 73.5% reported involvement in at least 1 of the 4 types of social engagement. After adjustment for all covariates, individuals who participated in any social activity reported better self-rated health and higher life satisfaction compared to those who did not participate. However, the intensity of engagement in different social activities had varying impacts on subjective health outcomes. An increased level of participation was associated with a lower rate of depression and improved self-rated health. However, no significant differences were observed in the relationship between the intensity of participation in activities (with the exception of alumni societies or family councils) and life satisfaction.
Conclusion
This study suggests that to improve their health, older adults in the Republic of Korea should not only engage in social activities but also do so actively and regularly.

Rural-urban differences in common mental disorders among Indonesian youth: a cross-sectional national survey: Marizka Khairunnisa, Diah Yunitawati, Leny Latifah, Diyan Ermawan Effendi, Yunita Fitrianti, Sri Handayani, Hastin Dyah Kusumawardani; Received December 21, 2023 Accepted June 14, 2024 Published online August 21, 2024; DOI: https://doi.org/10.24171/j.phrp.2023.0385 [Epub ahead of print]

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Abstract PDF: Objectives
The onset of common mental disorders (CMDs) is most prevalent among youth; thus, mental health management is crucial. We examined differences in risk and risk factor determinants regarding CMDs prevalence among youth in rural and urban Indonesia.
Methods
This cross-sectional study utilized data from the 2018 Indonesia National Health Survey. The population comprised 122,114 respondents, aged 15 to 24 years, who had completed the 20-item Self-Report Questionnaire along with providing demographic and health behavior data. Chi-square testing and logistic regression were employed for analysis.
Results
The CMDs risk was higher among urban than rural youth. Risk factors impacting both populations included being female, having a lower education level, consuming fewer than 7 portions of vegetables weekly, smoking, and drinking alcohol (p<0.05). Consuming under 7 portions of fruit weekly and being in the highest or lowest wealth quintile were significant risk factors only in urban youth, while unemployment and divorce were significant only among rural respondents (p<0.05). Marriage was protective against CMDs among rural participants.
Conclusion
Being male, possessing a college degree, consuming at least 7 portions of vegetables weekly, not smoking, and not consuming alcohol were associated with reduced CMDs risk in urban and rural youth. Among rural youth, marriage and employment were linked to decreased risk, whereas divorce displayed the opposite relationship. In urban populations, consuming at least 7 portions of fruit weekly and belonging to neither the highest nor the lowest economic quintile were protective factors. Management strategies for CMDs in young people must address these considerations.

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