Osong Public Health and Research Perspectives

Original Article

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 Abstract Abstract 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.

Short Communication

Epidemiological characteristics of carbapenemase-producing Enterobacteriaceae outbreaks in the Republic of Korea between 2017 and 2022: Hyoseon Jeong, Junghee Hyun, Yeon-Kyeng Lee; Osong Public Health Res Perspect. 2023;14(4):312-320. Published online August 21, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0069

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Graphical Abstract Abstract PDF

Objectives
We aimed to describe the epidemiological characteristics of carbapenemase-producing Enterobacteriaceae (CPE) outbreaks in healthcare settings in the Republic of Korea between 2017 and 2022.
Methods
Under the national notifiable disease surveillance system, we obtained annual descriptive statistics regarding the isolated species, carbapenemase genotype, healthcare facility type, outbreak location and duration, and number of patients affected and recommended interventions. We used epidemiological investigation reports on CPE outbreaks reported to Korea Disease Control and Prevention Agency from June 2017 to September 2022.
Results
Among the 168 reports analyzed, Klebsiella pneumoniae (85.1%) was the most frequently reported species, while K. pneumoniae carbapenemase (KPC, 82.7%) was the most common carbapenemase genotype. Both categories increased from 2017 to 2022 (p<0.01). General hospitals had the highest proportion (54.8%), while tertiary general hospitals demonstrated a decreasing trend (p<0.01). The largest proportion of outbreaks occurred exclusively in intensive care units (ICUs, 44.0%), and the frequency of concurrent outbreaks in ICUs and general wards increased over time (p<0.01). The median outbreak duration rose from 43.5 days before the coronavirus disease 2019 (COVID-19) pandemic (2017–2019) to 79.5 days during the pandemic (2020–2022) (p=0.01), and the median number of patients associated with each outbreak increased from 5.0 to 6.0 (p=0.03). Frequently recommended interventions included employee education (38.1%), and 3 or more measures were proposed for 45.2% of outbreaks.
Conclusion
In the Republic of Korea, CPE outbreaks have been consistently dominated by K. pneumoniae and KPC. The size of these outbreaks increased during the COVID-19 pandemic. Our findings highlight the need for continuing efforts to control CPE outbreaks using a multimodal approach, while considering their epidemiology.

Citations

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Comparison of clinical outcomes of patients with serial negative surveillance cultures according to a subsequent polymerase chain reaction test for carbapenemase-producing Enterobacterales
H. Seo, S. Kim, Y.W. Lee, H.S. Oh, H-S. Kim, Y.K. Kim
Journal of Hospital Infection.2024; 146: 93. CrossRef
Identifying Contact Time Required for Secondary Transmission of Clostridioides difficile Infections by Using Real-Time Locating System
Min Hyung Kim, Jaewoong Kim, Heejin Ra, Sooyeon Jeong, Yoon Soo Park, Dongju Won, Hyukmin Lee, Heejung Kim
Emerging Infectious Diseases.2024;[Epub] CrossRef
Antimicrobial activity of ceftazidime-avibactam against KPC-2-producing Enterobacterales: a cross-combination and dose-escalation titration study with relebactam and vaborbactam
Min Seo Kang, Jin Yang Baek, Jae-Hoon Ko, Sun Young Cho, Keon Young Lee, Young Ho Lee, Jinyoung Yang, Tae Yeul Kim, Hee Jae Huh, Nam Yong Lee, Kyungmin Huh, Cheol-In Kang, Doo Ryeon Chung, Kyong Ran Peck, Bobby G. Warren
Microbiology Spectrum.2024;[Epub] CrossRef
Performance comparison of BD Phoenix CPO detect panel with Cepheid Xpert Carba-R assay for the detection of carbapenemase-producing Klebsiella pneumoniae isolates
Nazmiye Ülkü Tüzemen, Uğur Önal, Osman Merdan, Bekir Akca, Beyza Ener, Halis Akalın, Cüneyt Özakın
BMC Microbiology.2024;[Epub] CrossRef

Review Article

Public health agencies’ use of social media for communication during pandemics: a scoping review of the literature: Babatunde Abiodun Balogun, Anne Hogden, Nenagh Kemp, Lin Yang, Maria Agaliotis; Osong Public Health Res Perspect. 2023;14(4):235-251. Published online August 9, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0095

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Graphical Abstract Abstract PDF: Public health agencies (PHAs) have increasingly incorporated social media into their communication mix during successive pandemics in the 21st century. However, the quality, timing, and accuracy of their health messages have varied significantly, resulting in mixed outcomes for communication, audience engagement, and pandemic management. This study aimed to identify factors influencing the effectiveness of pandemic-related health messages shared by PHAs on social media and to report their impact on public engagement as documented in the literature. A scoping literature review was conducted following a predefined protocol. An electronic search of 7 relevant databases and 5 grey literature repositories yielded 9,714 papers published between January 2003 and November 2022. Seventy-three papers were deemed eligible and selected for review. The results underscored the insufficiency of social media guidance policies for PHAs. Six themes were identified: message source, message topic, message style, message timing, content credibility and reliability, and message recipient profile. These themes encompassed 20 variables that could inform PHAs’ social media public health communication during pandemics. Additionally, the findings revealed potential interconnectedness among the variables, and this study concluded by proposing a conceptual model that expands upon existing theoretical foundations for developing and evaluating pandemic-related health messaging.

Original Articles

Neck circumference and incidence of cerebrovascular disease over 12 years among Korean adults: Jae-Seon Han, Yun-Hee Kim; Osong Public Health Res Perspect. 2022;13(1):71-79. Published online February 8, 2022; DOI: https://doi.org/10.24171/j.phrp.2021.0277

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Abstract PDF

Objectives
Neck circumference is associated with a distinctive fat storage process that confers additional metabolic risk. Hence, this study aimed to investigate the correlation between baseline neck circumference and the incidence of cerebrovascular disease using a prospective community-based sample of Korean adults over 12 years of follow-up, after controlling for selected covariates. Methods: Participants with non-cerebrovascular disease were divided into 4 groups (Q1–Q4) based on their baseline neck circumference. Cox proportional hazards analysis was used to calculate hazard ratios and 95% confidence intervals (CIs) to evaluate the relationship between neck circumference and cerebrovascular disease incidence over a 12-year period. Results: Among this study’s 3,662 participants, 128 (3.50%) developed cerebrovascular disease. The incidence of cerebrovascular disease increased from 2.2% in Q1 to 4.3% in Q2, 2.5% in Q3, and 5.0% in Q4. When compared to Q1, the relative risks of cerebrovascular disease development were 0.57 (95% CI, 0.25–1.31), 0.86 (95% CI, 0.38–1.96), and 0.79 (95% CI, 0.30–2.07) in man and 1.86 (95% CI, 0.66–5.20), 3.50 (95% CI, 1.25–9.86), and 4.71 (95% CI, 1.50–14.77) in woman in Q2, Q3, and Q4, respectively, after adjusting for most risk factors related to cerebrovascular disease. Conclusion: The relationship between neck circumference and cerebrovascular disease was stronger in woman than in man, indicating potential differences between the sexes. These results are meaningful for evaluating and surveilling neck circumference as a promising tool for identifying subgroups of vulnerable and at-risk populations.

Citations

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Neck circumference as a predictor of all-cause mortality in middle-aged and older adults in rural Ecuador
Oscar H Del Brutto, Denisse A Rumbea, Maitri Patel, Robertino M Mera
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Xiaolong Liu, Mengxiao He, Yi Li
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The association of Carbohydrate Quality Index with cardiovascular disease risk factors among women with overweight and obesity: A cross-sectional study
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Global variation of COVID-19 mortality rates in the initial phase: Saman Hasan Siddiqui, Azza Sarfraz, Arjumand Rizvi, Fariha Shaheen, Mohammad Tahir Yousafzai, Syed Asad Ali; Osong Public Health Res Perspect. 2021;12(2):64-72. Published online April 29, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.12.2.03

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Abstract PDF Supplementary Material

Objectives
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused devastation in over 200 countries. Italy, Spain, and the United States (US) were most severely affected by the first wave of the pandemic. The reasons why some countries were more strongly affected than others remain unknown. We identified the most-affected and less-affected countries and states and explored environmental, host, and infrastructure risk factors that may explain differences in the SARS-CoV-2 mortality burden.
Methods
We identified the top 10 countries/US states with the highest deaths per population until May 2020. For each of these 10 case countries/states, we identified 6 control countries/states with a similar population size and at least 3 times fewer deaths per population. We extracted data for 30 risk factors from publicly available, trusted sources. We compared case and control countries/states using the non-parametric Wilcoxon rank-sum test, and conducted a secondary cluster analysis to explore the relationship between the number of cases per population and the number of deaths per population using a scalable EM (expectation–maximization) clustering algorithm.
Results
Statistically significant differences were found in 16 of 30 investigated risk factors, the most important of which were temperature, neonatal and under-5 mortality rates, the percentage of under-5 deaths due to acute respiratory infections (ARIs) and diarrhea, and tuberculosis incidence (p<0.05)
Conclusion
Countries with a higher burden of baseline pediatric mortality rates, higher pediatric mortality from preventable diseases like diarrhea and ARI, and higher tuberculosis incidence had lower rates of coronavirus disease 2019-associated mortality, supporting the hygiene hypothesis.

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KCDC Risk Assessments on the Initial Phase of the COVID-19 Outbreak in Korea: Inho Kim, Jia Lee, Jihee Lee, Eensuk Shin, Chaeshin Chu, Seon Kui Lee; Osong Public Health Res Perspect. 2020;11(2):67-73. Published online April 30, 2020; DOI: https://doi.org/10.24171/j.phrp.2020.11.2.02

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Abstract PDF

Objectives

This study aims to evaluate the risk assessments of coronavirus 2019 (COVID-19) in the Korea Centers for Disease Control and Prevention (KCDC), from the point of detection to the provision of basic information to the relevant public health authorities.

Methods

To estimate the overall risk of specific public health events, probability, and impact at the country-level were evaluated using available information. To determine the probability of particular public health events, the risk of importation and risk of transmission were taken into consideration. KCDC used 5 levels (“very low,” “low,” “moderate,” “high,” and “very high”) for each category and overall risk was eventually decided.

Results

A total of 8 risk assessments were performed on 8 separate occasions between January 8^th to February 28^th, 2020, depending on the detection and report of COVID-19 cases in other countries. The overall risk of the situation in each assessment increased in severity over this period: “low” (first), “moderate” (second), “high” (third), “high” (fourth), “high” (fifth), “high” (sixth), “high” (seventh), and “very high” (eighth).

Conclusion

The KCDC’s 8 risk assessments were utilized to activate national emergency response mechanisms and eventually prepare for the pandemic to ensure the containment and mitigation of COVID-19 with non-pharmaceutical public health measures.

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Brief Report

Enhancing ‘Whole-of-Government’ Response to Biological Events in Korea: Able Response 2014: Sangwoo Tak, Anton Jareb, Suon Choi, Marvin Sikes, Yeon Hwa Choi, Hyeong-wook Boo; Osong Public Health Res Perspect. 2018;9(1):32-35. Published online December 31, 2017; DOI: https://doi.org/10.24171/j.phrp.2018.9.1.06

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Abstract PDF

Since 2011, the Republic of Korea (ROK) and United States (U.S.) have been collaborating to conduct inter- and intra-governmental exercises to jointly respond to biological events in Korea. These exercises highlight U.S. interest in increasing its global biosurveillance capability and the ROK’s interest in improving cooperation among ministries to respond to crises. With Able Response (AR) exercises, the ROK and U.S. have improved coordination among US and ROK government and defense agencies responding to potential bio-threats and identified additional areas on which to apply refinements in policies and practices. In 2014, the AR exercise employed a Biosurveillance Portal (BSP) to facilitate more effective communication among participating agencies and countries including Australia. In the present paper, we seek to provide a comprehensive assessment of the AR 2014 (AR14) exercise and make recommendations for future improvements. Incorporating a more realistic response in future scenarios by integrating a tactical response episode in the exercise is recommended.

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Original Articles

Cost of Tuberculosis Treatment: Evidence from Iran’s Health System: Vahid Bay, Payam Tabarsi, Aziz Rezapour, Sima Marzban, Ehsan Zarei; Osong Public Health Res Perspect. 2017;8(5):351-357. Published online October 31, 2017; DOI: https://doi.org/10.24171/j.phrp.2017.8.5.09

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Abstract PDF

Objectives

This study aimed to estimate the cost of smear-positive drug-susceptible pulmonary tuberculosis (TB) treatment of the patients in the Azadshahr district, Golestan Province, Iran.

Methods

In this retrospective study, all new smear positive pulmonary TB patients who had been registered at the district’s health network between April, 2013 and December, 2015 and had successfully completed their treatment were entered into the study (45 patients). Treatment costs were estimated from the provider’s perspective using an activity-based costing (ABC) method.

Results

The cost of treating a new smear-positive pulmonary TB patient was US dollar (USD) 1,409.00 (Iranian Rial, 39,438,260), which can be divided into direct and indirect costs (USD 1,226.00 [87%] and USD 183.00 [13%], respectively). The highest cost (58.1%) was related to care and management of TB patients (including 46.1% human resources costs and 12% directly-observed treatment, short course implementation) and then respectively related to hospitalization (12.1%), supportive activity centers (11.4%), transportation (6.5%), medicines (5.3%), and laboratory tests and radiography (3.2%).

Conclusion

Using disease-specific cost studies can help the healthcare system management to have correct insight into the financial burden created by the disease. This can subsequently be used in prioritization, planning, operational budgeting, economic evaluation of programs, interventions, and ultimately in disease management.

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Changes in incidence and clinical features of tuberculosis with regard to the COVID-19 outbreak in Southern Iran
Mohammad Javad Fallahi, Mohammad Nazemi, Ali Zeighami, Reza Shahriarirad
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Costs of services and funding gap of the Bangladesh National Tuberculosis Control Programme 2016–2022: An ingredient based approach
Md. Zahid Hasan, Sayem Ahmed, Zeenat Islam, Farzana Dorin, Md. Golam Rabbani, Gazi Golam Mehdi, Mohammad Wahid Ahmed, Tazeen Tahsina, Shehrin Shaila Mahmood, Ziaul Islam, Kevin Schwartzman
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Distribution incidence, mortality of tuberculosis and human development index in Iran: estimates from the global burden of disease study 2019
Hossien Fallahzadeh, Zaher Khazaei, Moslem Lari Najafi, Sajjad Rahimi Pordanjani, Elham Goodarzi
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Spatio-temporal epidemiology of the tuberculosis incidence rate in Iran 2008 to 2018
Behzad Kiani, Amene Raouf Rahmati, Robert Bergquist, Soheil Hashtarkhani, Neda Firouraghi, Nasser Bagheri, Elham Moghaddas, Alireza Mohammadi
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Vahid Bay, Aziz Rezapour, Mehdi Jafari, Mohammad Reza Maleki, Irvan Masoudi Asl
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Mohammad Hossein Dehghan, Seyyed Mohammad Hashemi Shahri, Mojgan Salari
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Extent and determinants of catastrophic health expenditure for tuberculosis care in Chongqing municipality, China: a cross-sectional study
Weixia Duan, Wen Zhang, Chengguo Wu, Qingya Wang, Ya Yu, Hui Lin, Ying Liu, Daiyu Hu
BMJ Open.2019; 9(4): e026638. CrossRef
Demographic, socio-economic and behavior as risk factors of tuberculosis in Malaysia: a systematic review of the literature
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Trends and Characteristics of HIV Infection among Suspected Tuberculosis Cases in Public Health Centers in Korea: 2001–2013: Meekyung Kee, Kyoung-Ho Lee, Sae-Young Lee, Chun Kang, Chaeshin Chu; Osong Public Health Res Perspect. 2014;5(Suppl):S37-S42. Published online December 31, 2014; DOI: https://doi.org/10.1016/j.phrp.2014.11.002

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Abstract PDF

Objectives
The Republic of Korea reports approximately 35,000 new tuberculosis (TB) patients each year, and the number of HIV-infected individuals is steadily increasing. Public health centers (PHCs) conduct TB diagnosis and treatment for risk groups in communities. This study aimed to identify possible trends and characteristics of HIV infection among suspected TB cases in PHCs.
Methods
Study subjects were suspected TB cases in PHCs who agreed to be tested for HIV from 2001 to 2013. Trends in HIV seroprevalence were assessed through a series of annual cross-sectional analyses. We analyzed suspected TB cases, and HIV-infected individuals among suspected TB cases, by gender, age, nationality, and region.
Results
The number of suspected tuberculosis cases who took an HIV test in PHCs was approximately 6,000 each year from 2001 to 2013. Among the suspected TB cases who took an HIV test, the number of those aged 20–39 is gradually decreasing, while the number of those aged 50–69 is increasing. During this period, 32 HIV-infected individuals were identified; the majority were men (94%), aged 30–49 (68%), Korean (94%), and residents in a metropolitan area (53%). HIV seroprevalence decreased from 8.2 per 10,000 persons in 2001 to 1.9 per 10,000 persons in 2013.
Conclusion
This study has identified trends and characteristics of HIV infection among suspected tuberculosis cases in PHCs. This national data provides a basis for public health policy for HIV and tuberculosis infections.

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Brief Reports

Public Health Crisis Preparedness and Response in Korea: Hye-Young Lee, Mi-Na Oh, Yong-Shik Park, Chaeshin Chu, Tae-Jong Son; Osong Public Health Res Perspect. 2013;4(5):278-284. Published online October 31, 2013; DOI: https://doi.org/10.1016/j.phrp.2013.09.008

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Since the 2006 Pandemic Influenza Preparedness and Response Plan according to the World Health Organization’s recommendation, the Republic of Korea has prepared and periodically evaluated the plan to respond to various public health crises including pandemic influenza. Korea has stockpiled 13,000,000 doses of antiviral drugs covering 26% of the Korean population and runs 519 isolated beds in 16 medical institutions. The division of public health crisis response in Korea Centers for Disease Control and Prevention are in charge of responding to public health crises caused by emerging infectious diseases including severe acute respiratory syndrome, avian influenza human infection, and pandemic influenza. Its job description includes preparing for emerging infectious diseases, securing medical resources during a crisis, activating the emergency response during the crisis, and fortification of capabilities of public health personnel. It could evolve into a comprehensive national agency to deal with public health crisis based on the experience of previous national emerging infectious diseases.

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Epidemic Intelligence Service Officers and Field Epidemiology Training Program in Korea: Geun-Yong Kwon, Shinje Moon, Wooseok Kwak, Jin Gwack, Chaeshin Chu, Seung-Ki Youn; Osong Public Health Res Perspect. 2013;4(4):215-221. Published online August 31, 2013; DOI: https://doi.org/10.1016/j.phrp.2013.07.001

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Korea has adopted Epidemic Intelligence Service (EIS) officers through the Field Epidemiology Training Program (FETP) since 1999 for systematic control of emerging and re-emerging infectious diseases. Graduates of medical schools in Korea are selected and serve as public health doctors (PHDs) for their mandatory military service. The duration of service is 3 years and PHDs comprise general practitioners and specialists. Some PHDs are selected as EIS officers with 3 weeks basic FETP training and work for central and provincial public health authorities to conduct epidemiological investigations. The total number of EIS officers is 31 as of 2012. The Korea Centers for Disease Control and Prevention (KCDC) has 12 specialists, whereas specialists and each province has one or two EIS officers to administer local epidemiological investigations in 253 public health centers. The Korean EIS officers have successfully responded and prevented infectious diseases, but there is a unique limitation: the number of PHDs in Korea is decreasing and PHDs are not allowed to stay outside Korea, which makes it difficult to cope with overseas infectious diseases. Furthermore, after 3 years service, they quit and their experiences are not accumulated. KCDC has hired full-time EIS officers since 2012 to overcome this limitation.

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Original Article

The Effects of Religious Attendance and Obesity on Health by Race/Ethnicity: Sanggon Nam; Osong Public Health Res Perspect. 2013;4(2):81-88. Published online April 30, 2013; DOI: https://doi.org/10.1016/j.phrp.2013.03.002

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Abstract PDF

Objectives
The objectives of this paper are to examine the effects of religion and obesity on health and determine how the relationship varies by racial/ethnic groups with data from the Panel Study of American Race and Ethnicity (PS-ARE).
Methods
Using ordinal logistic regression, the effects of religion and obesity on self-rated health and how the relationship varies by racial/ethnic groups are investigated. Additionally, to determine whether certain ethnic groups are more impacted by the frequency of religious attendance and obesity, whites, blacks, and Hispanics are analyzed separately with ordinal logistic regression.
Results
When obesity was added in focal relationship between religious services attendance and self-rated health strengthened this focal relationship which is a suppression effect between religious services attending and self-rated health adding obesity. For BMI is also significantly associated with decreased odds of reporting better health–normal weight (OR = 2.99; 95% CI = 2.43–3.67) and overweight (OR = 2.19; 95% CI = 1.79–2.68) compared to obese. Subjects who attend religious services 1–2 time a year (OR = 1.30; 95% CI = 1.04–1.62) and 1–3 times a month (OR = 1.28; 95% CI = 1.05–1.57) are associated with increased odds of reporting better health. In whites, attending religious services 1–2 times a year are associated with increased odds of reporting better health (OR = 1.48; 95% CI = 1.09–2.00) and 1–3 times a month are also associated with increased odds of reporting health (OR = 1.34; 95% CI = 1.02–1.78) compared to never attending religious attendance. The frequency of religious services attendance of blacks and Hispanics are not associated with self-rated health. For BMI, being white is more positively associated with increased odds of reporting better health than black and Hispanic subjects. Although white subjects are less likely to attend religious services more frequently than black and Hispanic subjects, the influence on self-rated health in white subjects is more evidenced than other racial/ethnic groups.
Conclusions
Although it was not proven that the association between participation in religious services and self-rated health is mediated by obesity, the research shows the suppression effect of obesity between participation in religious services and self-rated health.

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