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Original Articles
Impact of long COVID-19 on posttraumatic stress disorder as modified by health literacy: an observational study in Vietnam
Han Thi Vo, Tien Duc Dao, Tuyen Van Duong, Tan Thanh Nguyen, Binh Nhu Do, Tinh Xuan Do, Khue Minh Pham, Vinh Hai Vu, Linh Van Pham, Lien Thi Hong Nguyen, Lan Thi Huong Le, Hoang Cong Nguyen, Nga Hoang Dang, Trung Huu Nguyen, Anh The Nguyen, Hoan Van Nguyen, Phuoc Ba Nguyen, Hoai Thi Thanh Nguyen, Thu Thi Minh Pham, Thuy Thi Le, Thao Thi Phuong Nguyen, Cuong Quoc Tran, Kien Trung Nguyen
Received September 15, 2023  Accepted January 12, 2024  Published online February 19, 2024  
DOI: https://doi.org/10.24171/j.phrp.2023.0261    [Epub ahead of print]
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AbstractAbstract PDF
Objectives
The incidence of posttraumatic stress disorder (PTSD) has increased, particularly among individuals who have recovered from coronavirus disease 2019 (COVID-19) infection. Health literacy is considered a “social vaccine” that helps people respond effectively to the pandemic. We aimed to investigate the association between long COVID-19 and PTSD, and to examine the modifying role of health literacy in this association.
Methods
A cross-sectional study was conducted at 18 hospitals and health centers in Vietnam from December 2021 to October 2022. We recruited 4,463 individuals who had recovered from COVID-19 infection for at least 4 weeks. Participants provided information about their sociodemographics, clinical parameters, health-related behaviors, health literacy (using the 12-item short-form health literacy scale), long COVID-19 symptoms and PTSD (Impact Event Scale-Revised score of 33 or higher). Logistic regression models were used to examine associations and interactions.
Results
Out of the study sample, 55.9% had long COVID-19 symptoms, and 49.6% had PTSD. Individuals with long COVID-19 symptoms had a higher likelihood of PTSD (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.63–2.12; p<0.001). Higher health literacy was associated with a lower likelihood of PTSD (OR, 0.98; 95% CI, 0.97–0.99; p=0.001). Compared to those with long COVID-19 symptoms and the lowest health literacy score, those with long COVID-19 symptoms and a 1-point health literacy increment had a 3% lower likelihood of PTSD (OR, 0.97; 95% CI, 0.96–0.99; p=0.001).
Conclusion
Health literacy was found to be a protective factor against PTSD and modified the negative impact of long COVID-19 symptoms on PTSD.
Prevalence, multidrug resistance, and biofilm formation of Vibrio parahaemolyticus isolated from fish mariculture environments in Cat Ba Island, Vietnam
Kim Cuc Thi Nguyen, Phuc Hung Truong, Hoa Truong Thi, Xuan Tuy Ho, Phu Van Nguyen
Received June 27, 2023  Accepted December 28, 2023  Published online February 19, 2024  
DOI: https://doi.org/10.24171/j.phrp.2023.0181    [Epub ahead of print]
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AbstractAbstract PDF
Objectives
Vibrio parahaemolyticus is a major foodborne pathogen in aquatic animals and a threat to human health worldwide. This study investigated the prevalence, antimicrobial resistance, antimicrobial resistance genes (ARGs), and biofilm formation of V. parahaemolyticus strains isolated from fish mariculture environments in Cat Ba Island, Vietnam.
Methods
In total, 150 rearing water samples were collected from 10 fish mariculture farms in winter and summer. A polymerase chain reaction assay was used to identify V. parahaemolyticus, its virulence factors, and ARGs. The antimicrobial resistance patterns and biofilm formation ability of V. parahaemolyticus strains were investigated using the disk diffusion test and a microtiter plate-based crystal violet method, respectively.
Results
Thirty-seven V. parahaemolyticus isolates were recovered from 150 samples. The frequencies of the tdh and trh genes among V. parahaemolyticus isolates were 8.1% and 21.6%, respectively. More than 90% of isolates were susceptible to ceftazidime, cefotaxime, and chloramphenicol, but over 72% were resistant to ampicillin, tetracycline, and erythromycin. Furthermore, 67.57% of isolates exhibited multidrug resistance. The presence of ARGs related to gentamicin (aac(3)-IV), tetracycline (tetA) and ciprofloxacin (qnrA) in V. parahaemolyticus isolates was identified. Conversely, no ARGs related to ampicillin or erythromycin resistance were detected. Biofilm formation capacity was detected in significantly more multidrug-resistant isolates (64.9%) than non-multidrug-resistant isolates (18.9%).
Conclusion
Mariculture environments are a potential source of antibiotic-resistant V. parahaemolyticus and a hotspot for virulence genes and ARGs diffusing to aquatic environments. Thus, the prevention of antibiotic-resistant foodborne vibriosis in aquatic animals and humans requires continuous monitoring.
Commentary
Activities of the Republic of Korea in the Global Health Security Agenda
Gang Lip Kim, Sookhyun Lee, So Yoon Kim
Received June 14, 2023  Accepted December 28, 2023  Published online February 19, 2024  
DOI: https://doi.org/10.24171/j.phrp.2023.0157    [Epub ahead of print]
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AbstractAbstract PDF
The government of the Republic of Korea has been an active participant in the Global Health Security Agenda (GHSA) since its inception in 2014. The country’s experiences with Middle East respiratory syndrome (MERS) in 2015 and coronavirus disease 2019 (COVID-19) from 2018 to 2023 underscored the critical importance of capacities for prevention, detection, and response in health security. During the transition from the first phase (2014–2018) to the second phase (2018–2023) of the GHSA, the Republic of Korea hosted 2 Ministerial Meetings, resulting in the Seoul Declaration and the subsequent New Seoul Declaration. The nation has also played a pivotal role in the Steering Group and Action Packages. Specifically, at the Seventh Ministerial Meeting in 2022, the Republic of Korea spearheaded the Immunization Action Package Expert Forum. Additionally, within the Legal Preparedness Action Package, the Republic of Korea shared examples of how its revised legal framework, updated in response to MERS, was applied during the COVID-19 pandemic. Moreover, with the announcement of the establishment of the Global Health Security Coordinating Office, the Republic of Korea aims to facilitate coordination and create a platform for communication and cooperation among GHSA Action Package members at various levels.
Original Article
Epidemiological analysis and prevention strategies in response to a shigellosis cluster outbreak: a retrospective case series in an alternative school in the Republic of Korea, 2023
Yeongseo Ahn, Sunmi Jin, Gemma Park, Hye Young Lee, Hyungyong Lee, Eunkyung Shin, Junyoung Kim, Jaeil Yoo, Yuna Kim
Received October 14, 2023  Accepted December 7, 2023  Published online February 7, 2024  
DOI: https://doi.org/10.24171/j.phrp.2023.0298    [Epub ahead of print]
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AbstractAbstract PDF
Objectives
In March 2023, an alternative school in the Republic of Korea reported 12 cases of shigellosis. This study aims to analyze the epidemiological characteristics in order to determine the cause of the cluster outbreak of shigellosis and to develop prevention strategies.
Methods
This study focused on 12 patients with confirmed Shigella infection and investigated their demographics, clinical features, epidemiology, diagnostics, and antimicrobial susceptibility. Following the identification of Shigella, we conducted follow-up rectal smear cultures to manage patients, implementing isolation and control measures.
Results
This study investigated the emergence of multidrug-resistant Shigella following missionary activities in Cambodia, documenting a cluster infection within an alternative school in Daejeon, the Republic of Korea. The outbreak affected 56 participants, resulting in the confirmation of 12 cases. The incidence rates varied by gender and occupation, with higher rates among males and teachers. All 12 cases demonstrated multidrug resistance. Challenges included delayed pathogen confirmation and suboptimal adherence to isolation criteria. The incident prompted revisions in the criteria for isolation release, focusing on symptom resolution. The study underscores the necessity for strengthened surveillance, educational initiatives focusing on prevention in endemic areas, and improved oversight of unlicensed educational establishments.
Conclusion
Successful response strategies included swift situation assessment, collaborative efforts, effective infection control measures, and modified criteria for isolation release. Continued surveillance of multidrug-resistant strains is recommended, especially in regions with a high prevalence.
Review Article
Predictors of outcomes 3 to 12 months after traumatic brain injury: a systematic review and meta-analysis
Younes Iderdar, Maryem Arraji, Nadia Al Wachami, Morad Guennouni, Karima Boumendil, Yassmine Mourajid, Noureddine Elkhoudri, Elmadani Saad, Mohamed Chahboune
Received October 8, 2023  Accepted December 28, 2023  Published online February 5, 2024  
DOI: https://doi.org/10.24171/j.phrp.2023.0288    [Epub ahead of print]
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AbstractAbstract PDF
The exact factors predicting outcomes following traumatic brain injury (TBI) remain elusive. In this systematic review and meta-analysis, we examined factors influencing outcomes in adult patients with TBI, from 3 months to 1 year after injury. A search of four electronic databases—PubMed, Scopus, Web of Science, and ScienceDirect—yielded 29 studies for review and 16 for meta-analysis, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. In patients with TBI of any severity, mean differences were observed in age (8.72 years; 95% confidence interval [CI], 4.77–12.66 years), lymphocyte count (−0.15 109/L; 95% CI, −0.18 to −0.11), glucose levels (1.20 mmol/L; 95% CI, 0.73–1.68), and haemoglobin levels (−0.91 g/dL; 95% CI, −1.49 to −0.33) between those with favourable and unfavourable outcomes. The prevalence rates of unfavourable outcomes were as follows: abnormal cisterns, 65.7%; intracranial pressure above 20 mmHg, 52.9%; midline shift of 5 mm or more, 63%; hypotension, 71%; hypoxia, 86.8%; blood transfusion, 70.3%; and mechanical ventilation, 90%. Several predictors were strongly associated with outcome. Specifically, age, lymphocyte count, glucose level, haemoglobin level, severity of TBI, pupillary reaction, and type of injury were identified as potential predictors of long-term outcomes.
Short Communication
Characteristics of a large outbreak arising from a school field trip after COVID-19 restrictions were eased in 2022
Sueng-Jin Kim, Eun-Young Kim, Jeonghee Yu
Received September 19, 2023  Accepted November 27, 2023  Published online February 5, 2024  
DOI: https://doi.org/10.24171/j.phrp.2023.0264    [Epub ahead of print]
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AbstractAbstract PDF
Objectives
This study analyzed a large outbreak of coronavirus disease 2019 (COVID-19) that occurred during a high school field trip in the Jeonbuk region and aimed to identify risk factors for COVID-19 infection, with the goal of preventing such outbreaks in the future.
Methods
A retrospective cohort study of 737 participants, including 668 students and 69 staff at High School A, was designed to describe the epidemiological characteristics of this large COVID-19 outbreak. Logistic regression analysis was performed to calculate relative risks (odds ratios [ORs]) and 95% confidence intervals (CIs).
Results
There were 190 confirmed cases (174 students, 16 staff), with an attack rate of 25.8%. Small outbreaks were decreasing before the field trip, but this trend reversed after the trip, leading to larger outbreaks. Logistic regression showed an OR of 2.39 (95% CI, 1.66–3.43; p<0.05) for COVID-19 infection among field trip participants. Among them, 11th graders had an OR of 2.32 (95% CI, 1.53–3.52; p<0.05) compared to 10th graders, while no significant risk difference was found within same-grade teams.
Conclusion
There was a high risk for COVID-19 transmission during extracurricular activities with a large number of participants, such as field trips, even after the nationwide Omicron variant epidemic subsided. Even when students are separated into teams and follow different routes, it is challenging to design routes that entirely prevent contact between teams. Thus, programs should be designed carefully, and students with symptoms should be identified before and during the program to isolate them promptly.
Original Articles
Risk factors for SARS-CoV-2 transmission during a movie theater outbreak in Incheon in the Republic of Korea, November 2021: a retrospective study
Hye Young Lee, Young-Joon Park, Sang-Eun Lee, Han-Na Yoo, Il-Hwan Kim, Jin Sun No, Eun-Jin Kim, Jungyeon Yu, Sanghwan Bae, Mi Yu
Received September 20, 2023  Accepted November 26, 2023  Published online January 31, 2024  
DOI: https://doi.org/10.24171/j.phrp.2023.0269    [Epub ahead of print]
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AbstractAbstract PDF
Objectives
We examined factors contributing to the transmission of an acute respiratory virus within multi-use facilities, focusing on an outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a movie theater in the Republic of Korea.
Methods
This retrospective cohort study involved a descriptive analysis of 48 confirmed cases. Logistic regression was applied to a cohort of 80 theater attendees to identify risk factors for infection. The infection source and transmission route were determined through gene sequencing data analysis.
Results
Of the 48 confirmed cases, 35 were theater attendees (72.9%), 10 were family members of attendees (20.8%), 2 were friends (4.2%), and 1 was an employee (2.1%). Among the 80 individuals who attended the 3rd to 5th screenings of the day, 35 became infected, representing a 45.0% attack rate. Specifically, 28 of the 33 third-screening attendees developed confirmed SARS-CoV-2, constituting an 84.8% attack rate. Furthermore, 11 of the 12 cases epidemiologically linked to the theater outbreak were clustered monophyletically within the AY.69 lineage. At the time of the screening, 35 individuals (72.9%) had received 2 vaccine doses. However, vaccination status did not significantly influence infection risk. Multivariate analysis revealed that close contacts had a 15.9-fold higher risk of infection (95% confidence interval, 4.37–78.39) than casual contacts.
Conclusion
SARS-CoV-2 transmission occurred within the theater, and extended into the community, via a moviegoer who attended the 3rd screening during the viral incubation period after contracting the virus from a family member. This study emphasizes the importance of adequate ventilation in theaters.
Developing a national surveillance system for stroke and acute myocardial infarction using claims data in the Republic of Korea: a retrospective study
Tae Jung Kim, Hak Seung Lee, Seong-Eun Kim, Jinju Park, Jun Yup Kim, Jiyoon Lee, Ji Eun Song, Jin-Hyuk Hong, Joongyub Lee, Joong-Hwa Chung, Hyeon Chang Kim, Dong-Ho Shin, Hae-Young Lee, Bum Joon Kim, Woo-Keun Seo, Jong-Moo Park, Soo Joo Lee, Keun-Hwa Jung, Sun U. Kwon, Yun-Chul Hong, Hyo-Soo Kim, Hyun-Jae Kang, Juneyoung Lee, Hee-Joon Bae
Received September 3, 2023  Accepted December 3, 2023  Published online January 31, 2024  
DOI: https://doi.org/10.24171/j.phrp.2023.0248    [Epub ahead of print]
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AbstractAbstract PDF
Objectives
Limited information is available concerning the epidemiology of stroke and acute myocardial infarction (AMI) in the Republic of Korea. This study aimed to develop a national surveillance system to monitor the incidence of stroke and AMI using national claims data.
Methods
We developed and validated identification algorithms for stroke and AMI using claims data. This validation involved a 2-stage stratified sampling method with a review of medical records for sampled cases. The weighted positive predictive value (PPV) and negative predictive value (NPV) were calculated based on the sampling structure and the corresponding sampling rates. Incident cases and the incidence rates of stroke and AMI in the Republic of Korea were estimated by applying the algorithms and weighted PPV and NPV to the 2018 National Health Insurance Service claims data.
Results
In total, 2,200 cases (1,086 stroke cases and 1,114 AMI cases) were sampled from the 2018 claims database. The sensitivity and specificity of the algorithms were 94.3% and 88.6% for stroke and 97.9% and 90.1% for AMI, respectively. The estimated number of cases, including recurrent events, was 150,837 for stroke and 40,529 for AMI in 2018. The age- and sex-standardized incidence rate for stroke and AMI was 180.2 and 46.1 cases per 100,000 person-years, respectively, in 2018.
Conclusion
This study demonstrates the feasibility of developing a national surveillance system based on claims data and identification algorithms for stroke and AMI to monitor their incidence rates.
Editorial
How to transform the medical care system after the COVID-19 pandemic
Jong-Koo Lee
Osong Public Health Res Perspect. 2023;14(6):439-440.   Published online December 28, 2023
DOI: https://doi.org/10.24171/j.phrp.2023.0382
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PDF
Review Article
Global prevalence of enterobiasis in young children over the past 20 years: a systematic review and meta-analysis
Elham Kia Lashaki, Azadeh Mizani, Seyed Abdollah Hosseini, Bentolhoda Habibi, Khadijeh Taherkhani, Amir Javadi, AliReza Taremiha, Samira Dodangeh
Osong Public Health Res Perspect. 2023;14(6):441-450.   Published online December 28, 2023
DOI: https://doi.org/10.24171/j.phrp.2023.0204
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Graphical AbstractGraphical Abstract AbstractAbstract PDF
Parasitic infections are the most common diseases worldwide, and enterobiasis is a common parasitic infection in children. Various studies have reported on the prevalence of Enterobius vermicularis in different regions of the world. However, no study has gathered and analyzed this data systematically. Our systematic review and meta-analysis investigated the overall prevalence of E. vermicularis among children globally. Data were extracted from 4 available databases for studies published from January 2002 to April 2022. The quality of the included studies was scored based on the standard Strengthening the Reporting of Observational Studies in Epidemiology. A random-effect model was chosen to calculate the pooled prevalence and corresponding 95% confidence interval (CI) according to the degree of heterogeneity in the included studies. Thus, 40 publications (42 data sets) that included 3,279 children with enterobiasis met all criteria and were included in the analysis. The meta-analysis showed that heterogeneity among the included studies was high (Q=4,399.35, I2=99.96%; df=41; p<0.001). The pooled global prevalence of enterobiasis among the studied children was 12.9% (95% CI, 8.2%–17.7%). Our systematic review and meta-analysis estimated that, for the past 20 years, 12.9% of children around the world have been infected with E. vermicularis.
Corrigendum
Correction to “The risk associated with psychiatric disturbances in patients with diabetes in Indonesia (2018): a cross-sectional observational study” [Osong Public Health Res Perspect 2023;14(5):368–78]
Siti Isfandari, Betty Roosihermiatie, Sulistyowati Tuminah, Laurentia Konadi Mihardja
Osong Public Health Res Perspect. 2023;14(6):530-531.   Published online December 28, 2023
DOI: https://doi.org/10.24171/j.phrp.2023.0144.e1
Corrects: Osong Public Health Res Perspect 2023;14(5):368
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Original Articles
The value of CDC42 effector protein 2 as a novel prognostic biomarker in liver hepatocellular carcinoma: a comprehensive data analysis
Hye-Ran Kim, Choong Won Seo, Jongwan Kim
Osong Public Health Res Perspect. 2023;14(6):451-467.   Published online December 15, 2023
DOI: https://doi.org/10.24171/j.phrp.2023.0229
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Graphical AbstractGraphical Abstract AbstractAbstract PDF
Objectives
The prognostic significance of CDC42 effector protein 2 (CDC42EP2) and its association with tumor-infiltrating immune cells (TIICs) have not been explored in liver hepatocellular carcinoma (LIHC). This study aims to assess the potential prognostic value of CDC42EP2 by conducting a comprehensive analysis of online databases pertaining to LIHC. Methods: We evaluated the potential of CDC42EP2 as a prognostic biomarker by utilizing online databases such as TIMER, GEPIA2, KM, OSlihc, HPA, and LinkedOmics. Results: In LIHC, we observed that the mRNA and protein expression of CDC42EP2 were upregulated compared to normal tissues. Upregulated CDC42EP2 expression was associated with a worse prognosis based on the clinicopathological characteristics of patients with LIHC. Furthermore, CDC42EP2 was positively associated with TIICs. In the co-expression and functional enrichment analyses of CDC42EP2, 11,416 genes showed positive associations with CDC42EP2 while 8,008 genes showed negative associations. CDC42EP2-related co-expression genes were involved in protein localization to the endoplasmic reticulum, translational initiation, and RNA catabolic processes in gene set enrichment analysis-Gene Ontology (GSEAGO), and regulated the ribosome, spliceosome, and primary immune deficiency in the GSEAKyoto Encyclopedia of Genes and Genomes (KEGG) pathway. In a survival map, 23 and 17 genes that exhibited positive associations with CDC42EP2 showed a significant hazard ratio (HR) for overall survival and disease-free survival, respectively. Conclusion: Our findings demonstrated that CDC42EP2 is a novel prognostic biomarker and a potential tumor immune therapeutic target in patients with LIHC.
Characteristics and related factors of waterborne and foodborne infectious disease outbreaks before and after the onset of the COVID-19 pandemic (2017–2021) in the Republic of Korea: a descriptive study
Eunkyoung Kim, Bryan Inho Kim
Osong Public Health Res Perspect. 2023;14(6):483-493.   Published online December 14, 2023
DOI: https://doi.org/10.24171/j.phrp.2023.0221
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Graphical AbstractGraphical Abstract AbstractAbstract PDF
Objectives
The incidence of waterborne and foodborne infectious diseases (WFIDs) continues to increase annually, attracting significant global attention. This study examined trends in WFID outbreaks in the Republic of Korea over the 5-year period before and during the coronavirus disease 2019 (COVID-19) pandemic and provided foundational data to establish measures for the prevention and control of WFID outbreaks. Methods: We analyzed 2,541 WFID outbreaks from 2017 to 2021 (42,805 cases) that were reported through the Integrated Disease Surveillance System of the Korea Disease Control and Prevention Agency. Outbreaks were defined as the occurrence of gastrointestinal symptoms in ≥2 individuals within a group with temporal and regional epidemiological associations. The related factors associated with WFID outbreaks during the observation period were statistically analyzed. Results: The total number of WFID outbreaks significantly decreased in 2020 during the COVID-19 pandemic and increased to the pre-pandemic level in 2021. Different patterns were observed for each pathogen. The incidence of Salmonella outbreaks more than doubled, while norovirus outbreaks decreased significantly. Conclusion: WFID outbreaks in the Republic of Korea showed different patterns before and during the COVID-19 pandemic, influenced by infection control measures and changes in dietary consumption patterns. Outbreaks of some diseases increased, but the infection control measures applied during the pandemic resulted in a significant decrease in the overall number of WFID outbreaks. This highlights the importance of strengthening the management strategies for outbreak prevention through hygiene inspections, long-term monitoring, education, and promotion by conducting multidimensional analyses to understand the complex related factors.
Genetic diversity and evolutionary patterns of SARS-CoV-2 among the Bhutanese population during the pandemic
Tshering Dorji, Kunzang Dorji, Tandin Wangchuk, Tshering Pelki, Sonam Gyeltshen
Osong Public Health Res Perspect. 2023;14(6):494-507.   Published online December 14, 2023
DOI: https://doi.org/10.24171/j.phrp.2023.0209
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Graphical AbstractGraphical Abstract AbstractAbstract PDF
Objectives
The coronavirus disease 2019 (COVID-19) pandemic, caused by a dynamic virus, has had a profound global impact. Despite declining global COVID-19 cases and mortality rates, the emergence of new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants remains a major concern. This study provides a comprehensive analysis of the genomic sequences of SARS-CoV-2 within the Bhutanese population during the pandemic. The primary aim was to elucidate the molecular epidemiology and evolutionary patterns of SARS-CoV-2 in Bhutan, with a particular focus on genetic variations and lineage dynamics. Methods: Whole-genome sequences of SARS-CoV-2 collected from Bhutan between May 2020 and February 2023 (n=135) were retrieved from the Global Initiative on Sharing All Influenza Database. Results: The SARS-CoV-2 variants in Bhutan were predominantly classified within the Nextstrain clade 20A (31.1%), followed by clade 21L (20%) and clade 22D (15.6%). We identified 26 Pangolin lineages with variations in their spatial and temporal distribution. Bayesian time-scaled phylogenetic analysis estimated the time to the most recent common ancestor as February 15, 2020, with a substitution rate of 0.97×10–3 substitutions per site per year. Notably, the spike glycoprotein displayed the highest mutation frequency among major viral proteins, with 116 distinct mutations, including D614G. The Bhutanese isolates also featured mutations such as E484K, K417N, and S477N in the spike protein, which have implications for altered viral properties. Conclusion: This is the first study to describe the genetic diversity of SARS-CoV-2 circulating in Bhutan during the pandemic, and this data can inform public health policies and strategies for preventing future outbreaks in Bhutan.
The effect of the COVID-19 pandemic on the trends and characteristics of natural and unnatural deaths in an urban Sri Lankan cohort viewed through retrospective analysis of forensic death investigations from 2019 to 2022
Sameera Anuruddha Gunawardena, Nishani Dassanayake, Buddhika Indeewarie Keerawelle, Shivasankarie Kanthasamy, Hasini Ranganatha, Jayani Wathsala Gunawardana
Osong Public Health Res Perspect. 2023;14(6):468-482.   Published online November 23, 2023
DOI: https://doi.org/10.24171/j.phrp.2023.0175
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Graphical AbstractGraphical Abstract AbstractAbstract PDF
Objectives
The coronavirus disease 2019 (COVID-19) pandemic has had a severe impact on global health. Apart from the disease itself, the strict restrictions and lockdowns enforced to minimize its spread have also substantially disrupted personal and public health. Methods: An analysis of forensic autopsy investigations was conducted between 2019 and 2022 on a selected urban population in Colombo, Sri Lanka, assessing the effects of the COVID-19 pandemic on mortality within these communities. Results: During the COVID-19 restrictions, there was a 2.5-fold increase in the total number of deaths, with a significantly higher percentage of female deaths than before. The majority of these deaths were due to cardiovascular causes, while COVID-19-related deaths ranked third overall. The highest proportion of COVID-19 deaths occurred among unvaccinated females. The monthly frequency of deaths from traffic accidents, poisoning, and asphyxiation decreased, while deaths from blunt trauma, sharp trauma, burns, and immersion increased. There was also a rise in blunt homicides and a greater number of femicides during the COVID-19 restrictions than in the pre-pandemic period. A significantly higher percentage of males who received the COVID-19 vaccine died from cardiovascular causes compared to those in the unvaccinated group. Conclusion: The significant changes in mortality demographics and causes of death within this community during the COVID-19 restrictions underscore the disruption in healthcare, healthseeking behavior, and social interactions during this period. The vulnerability of individuals residing in highly urbanized areas with lower socioeconomic status, particularly women, is brought into sharp focus.

PHRP : Osong Public Health and Research Perspectives