Osong Public Health and Research Perspectives

Original Articles

Factors associated with malaria infection in under-5 children in Papua Province, Indonesia: an observational study: Betty Roosihermiatie, Gurendro Putro, Arga Setyo Adji, Windy Tri Yuana, Selma Arsit Selto Siahaan, Rukmini Rukmini, Rustika Rustika; Received May 24, 2024 Accepted October 23, 2024 Published online November 28, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0152 [Epub ahead of print]

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Abstract PDF: Objectives
Malaria remains a serious public health challenge in tropical and subtropical regions, including Indonesia. Children under 5 years old face particular risk of contracting malaria due to low immunity. We examined potential factors associated with malaria infection among under-5 children in Papua Province, Indonesia.
Methods
The study utilized secondary data from Indonesia Basic Health Research 2018. Multistage random sampling was employed, from the province level to census blocks (CBs). In Papua Province, interviews were conducted in 928 CBs. All 2,745 under-5 children were selected. The dependent variable was laboratory-confirmed malaria positivity; independent factors included residential area, socioeconomic characteristics, and behaviors such as sleeping under an insecticide net impregnated ≤3 years ago and the use of ventilation barriers. We also examined the conditions of the bedroom, kitchen, and living room according to the frequency of window-opening, proportion of ventilation area to the floor, and radiance.
Results
Not sleeping under an insecticide net impregnated within the last 3 years (adjusted odds ratio [aOR], 0.518; 95% confidence interval [CI], 0.391–0.685; p<0.001); having a kitchen without windows (aOR, 0.491; 95% CI, 0.285–0.844; p=0.01); rarely opening the living room window (aOR, 2.804; 95% CI, 1.232–6.383; p=0.01), and having a windowless living room (aOR, 3.027; 95% CI, 1.369–6.696; p=0.01) displayed significant relationships with malaria infection among under-5 children.
Conclusion
Not using an insecticide-treated net impregnated ≤3 years ago, along with opening the living room window daily and having a kitchen without windows, appear preventive of malaria infection among under-5 children.

Factors influencing intentional self-harm in Chungcheongbuk Province relative to the Seoul region in the Republic of Korea: a retrospective study: Hyun-Ju Lee; Received April 23, 2024 Accepted October 23, 2024 Published online November 27, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0112 [Epub ahead of print]

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Abstract PDF: Objectives
This study investigated factors influencing intentional self-harm in Chungcheongbuk Province (hereinafter, Chungbuk) compared to Seoul in the Republic of Korea. Methods: Raw data from the Discharge In-depth Injury Survey conducted by the Korea Disease Control and Prevention Agency were utilized. From 2,329,149 cases recorded over 9 years (2013–2021), 911 were identified as intentional self-harm cases (248 from Chungbuk and 633 from Seoul). We analyzed the differences in and influencing factors of intentional self-harm in Chungbuk relative to Seoul using the independent sample t-test, chi-square test, and binomial logistic regression analysis. Results: Intentional self-harm was found to be 1.232 times more prevalent among females than males (p<0.05); 2.327 times more prevalent among middle-aged and older adults, ages 50 to 64, compared to those under 50 years old (p<0.01); 8.603 times more prevalent among those using hospitals with fewer than 500 beds compared to those with 500 beds or more (p<0.001); 2.412 times more prevalent among individuals using hospitals in different regions compared to those within the same region (p<0.01); 2.217 times more prevalent among those attempting intentional self-harm during daily activities compared to other specified activities (p<0.01); and 6.987 times more prevalent among those using pesticides or herbicides compared to other poisons (p<0.001) in Chungbuk relative to Seoul. Conclusion: In the Chungbuk region, intentional self-harm prevention programs should be implemented, specifically targeting women, particularly those aged 50 to 64. Additionally, due to the high incidence of intentional self-harm involving pesticides or herbicides in Chungbuk, these substances should be stringently monitored to restrict access.

Effects of green coffee supplementation on paraoxonase-1 activity and malondialdehyde levels in Iranian women with polycystic ovary syndrome: a randomized clinical trial: Azam Ildarabadi, Marzieh Vahid-Dastjerdi, Mina Ghorbanpour, Ahmad Mousavi, Mehrnoush Meshkani, Mirsaeed Yekaninejad, Ahmad Saedisomeolia; Received July 8, 2024 Accepted October 23, 2024 Published online November 20, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0187 [Epub ahead of print]

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Abstract PDF: Objectives
Polycystic ovary syndrome (PCOS) is a common, heterogeneous clinical syndrome affecting women. Investigating oxidative stress in women is crucial, as it is linked to insulin resistance and endothelial dysfunction. Chlorogenic acid, a bioactive component found in green coffee, has numerous documented health benefits. This study aimed to assess the beneficial effects of green coffee consumption on paraoxonase-1 (PON-1) activity and malondialdehyde (MDA) levels in women with PCOS.
Methods
This study was a double-blind randomized clinical trial that included 44 patients with PCOS. Participants were randomly assigned to either the intervention or control group. For 6 weeks, the intervention group (n=22) received 400 mg of green coffee supplements, while the control group (n=22) received 400 mg of a starch-based placebo. Anthropometric indices, dietary assessments, and physical activity levels were evaluated before and after the 6-week intervention period. Additionally, blood samples were collected for laboratory analysis.
Results
Supplementation with green coffee increased PON-1 levels by 3.5 units, a significant finding (p=0.038). Additionally, the intake of green coffee supplements significantly reduced blood cholesterol levels by 18.8 units (p=0.013) and triglyceride levels by 6.1 units (p=0.053). However, no significant differences were observed in the levels of MDA, high-density lipoprotein, low-density lipoprotein, fasting blood sugar, insulin, or homeostatic model assessment of insulin resistance as a result of the intervention.
Conclusion
Supplementation with green coffee alters PON-1 activity and cholesterol levels in women with PCOS. However, it has no significant impact on MDA levels or glycemic status.

Assessment of brucellosis-causing pathogens with an emphasis on the prevalence of Brucella melitensis in the Republic of Korea: insights from a decade of pathogen surveillance (2014–2023), a retrospective study: In-Sook Shin, Su-Gwon Roh, Byoung-Chul Gill, Young-Suk Kim, Kyung-Won Hwang; Received May 10, 2024 Accepted September 23, 2024 Published online November 19, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0134 [Epub ahead of print]

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Abstract PDF: Objectives
The main Brucella species causing human infections in the Republic of Korea is Brucella abortus, which uses cattle as its host. However, since 2014, Brucella melitensis, which uses sheep and goats as hosts, has also been identified. This study investigated whether a shift has occurred in the predominant species of Brucella pathogens. Methods: Brucellosis is a class 3 infectious disease requiring mandatory reporting and registration in the Korea Disease Control and Prevention Agency’s infectious disease surveillance system (http://is.kdca.go.kr). Cases from 2014 to 2023 were studied, and whole-genome sequencing analysis was conducted using BruMLSA21. Results: Out of 51 patients, males (45 patients, 88.2%) were predominantly affected. Twentyfive patients (49%) came from the livestock industry, and within the livestock sector group, the route of infection occurred exclusively through contact (25/25, 100%), whereas in other occupations, it was split between contact (9/26 patients, 34.6%) and ingestion (8/26 patients, 30.8%). Among the 31 patients who underwent Brucella culture tests, B. melitensis was found to be more prevalent than B. abortus (14 patients, 45.2% vs. 11 patients, 35.5%). In all cases where B. melitensis was isolated, the infections were of foreign origin, consistent with the results of BruMLSA21. Conclusion: Regular monitoring of the causative agent of brucellosis is necessary due to its varying host preferences and antibiotic resistance. Furthermore, given the increasing prevalence of B. melitensis worldwide, changes in dietary habits (e.g., increased lamb consumption), and the increase in foreign workers and Chinese immigrants, a multi-ministerial One Health response will be required.

Review Article

Comparison and consideration of vaccine injury compensation programs in the Republic of Korea, Japan, and Taiwan: Cho Ryok Kang, Young June Choe, Jihyun Moon, Dooyoung Kim, Taemi Kim, Jong-Koo Lee; Received May 7, 2024 Accepted September 24, 2024 Published online November 12, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0129 [Epub ahead of print]

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Abstract PDF: This study aimed to establish a foundation for future collaborations aimed at preparing for and responding to infectious diseases by examining the vaccine injury compensation programs (VICPs) of East Asian countries. We reviewed the current status of VICPs in the Republic of Korea, Japan, and Taiwan by searching national government websites and reviewing relevant literature. Additionally, we conducted email inquiries targeting experts from Japan and Taiwan. Through the comprehensive analysis of VICPs in these 3 countries covered various aspects, we identified several similarities and differences in the VICPs across these countries. While the governments of the Republic of Korea, Japan, and Taiwan play a central role in supporting investigations into vaccine injuries and managing compensation procedures based on legal statutes, they differ in terms of financial resources for compensation, the range of vaccines covered, and the criteria for assessing causality. In the Republic of Korea, Japan, and Taiwan, compensation is typically paid in a lump sum, although the specific benefits available vary by country. This study on VICPs in the Republic of Korea, Japan, and Taiwan provides valuable insights for the further development and management of domestic systems.

Original Article

The relationship between obstructive sleep apnea, dyspnea, and health-related quality of life in lung cancer survivors: a cross-sectional study in the Republic of Korea: Hyeong-pyo Kim, Duck-won Oh, Dong-kyu Kim; Received May 21, 2024 Accepted September 24, 2024 Published online November 7, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0146 [Epub ahead of print]

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Abstract PDF: Objectives
The purpose of this study was to explore the relationships among obstructive sleep apnea (OSA), dyspnea, and health-related quality of life (HRQOL), as well as the factors influencing HRQOL. Methods: A total of 129 lung cancer survivors (mean age, 53.4 years; 77 men and 52 women; mean time since diagnosis, 1.6 years; and cancer stage [1/2/3/4/relapse], 43/31/19/34/2, respectively) completed a questionnaire that included demographic and clinical information, as well as questions about the severity of sleep apnea, dyspnea, and HRQOL. The severity of OSA, dyspnea, and HRQOL were assessed using the Berlin questionnaire, the Dyspnea-10 item (FACIT-Dyspnea), and the European Organization for Research and Treatment of Cancer QLQ-C30, respectively. Results: The severity of OSA and dyspnea exhibited negative correlations with HRQOL (p<0.05). Multiple regression analysis revealed that several factors significantly impacted the HRQOL of lung cancer survivors. These included the extent of dyspnea (β=–0.369, p<0.01), weight loss (β =0.192, p<0.01), OSA score (β =−0.215, p<0.01), stage 2 cancer (β =−0.181, p<0.01), and poor perceived health status (β=−0.179, p<0.05). Conclusion: These findings suggest that breathing difficulties, including OSA and dyspnea, contribute to decreased HRQOL. This study offers valuable insights for researchers and clinicians, aiding in the development of effective strategies to manage these issues in daily life.

Editorial

Which infectious diseases are currently posing problems in the Republic of Korea? One out of every two tuberculosis patients is over 65 years old: Jong-Koo Lee; Osong Public Health Res Perspect. 2024;15(5):383-384. Published online October 31, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0301

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Original Article

Performance of indicators used in regular risk assessments for COVID-19 in association with contextual factors: Sujin Hong, Jiyoung Oh, Jia Lee, Yongmoon Kim, Bryan Inho Kim, Min Jei Lee, Hyunjung Kim, Sangwoo Tak; Osong Public Health Res Perspect. 2024;15(5):420-428. Published online October 31, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0141

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Graphical Abstract Abstract PDF: Objectives
This study aimed to summarize the results of coronavirus disease 2019 (COVID-19) risk assessments and to examine the associations between risk levels and various indicators, including COVID-19 incidence, risk perception, community mobility, and government policy.
Methods
The results of the risk assessment and the indicators utilized were summarized. From November 2021 to May 2022, the COVID-19 risk level was evaluated on a weekly basis, and its correlation with these indicators was analyzed. Data were obtained from press releases by the Korea Disease Control and Prevention Agency, regular surveys conducted by Hankook Research, and information available on the Google and Oxford websites.
Results
Weekly risk assessments were conducted for 30 weeks, using different indices depending on the phases. Correlation analysis revealed the strongest positive correlation between risk level and risk perception (r=0.841). The risk level from “1-week lead” demonstrated a strong positive correlation with the time-varying reproduction number (Rt). Similarly, the risk level from “week lagged value” showed a strong positive correlation with the number of severe cases in the hospital.
Conclusion
At the time of risk assessment, the Rt precedes the risk level, while severe cases in hospitals follow. Therefore, the assessed risk level functioned as an early warning system. Risk perception demonstrated the strongest correlation with the risk level, suggesting consistency throughout the assessment period. Contextual indicators (e.g., risk perception) that consider time lags and implementation scales, could improve the evaluation of future risk assessment results, particularly when there are challenges in reflecting specific situations in coordinated emergency response.

Brief Report

Safety of the bivalent COVID-19 mRNA booster vaccination among persons aged over 18 years in the Republic of Korea: Seok-Kyoung Choi, Seontae Kim, Mijeong Ko, Yeseul Heo, Tae Eun Kim, Yeonkyeong Lee, Juyeon Jang, Eunok Bahng; Received July 8, 2024 Accepted September 5, 2024 Published online October 29, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0194 [Epub ahead of print]

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Abstract PDF: Objectives
The aim of this study was to disseminate information about the safety of bivalent coronavirus disease 2019 (COVID-19) mRNA booster vaccines administered to adults in the Republic of Korea. Methods: Two databases were used to assess the safety of COVID-19 booster doses of Pfizer BA.1, Pfizer BA.4/5, Moderna BA.1, and Moderna BA.4/5 vaccines for adults aged 18 years and older. Adverse events (AEs) were analyzed using data reported to the web-based COVID-19 vaccination management system (CVMS) and a self-reported text-message survey. Results: Between October 11, 2022 and March 30, 2023, the CVMS received reports of 2,369 (93.7%) non-serious AEs from vaccinated adults, along with 158 (6.3%) serious AEs, which included 5 cases of anaphylaxis and 33 deaths. From October 11, 2022 to January 27, 2023, 40,022 people aged 18 and older responded to a survey conducted via text message. The booster doses were associated with fewer local and systemic AEs compared to the original vaccines. After receiving the bivalent vaccine, the most commonly reported AEs were pain at the injection site, headache, fatigue, and myalgia. Conclusion: Overall, bivalent vaccines exhibited fewer AEs compared to the original vaccines. The majority of AEs were non-serious, and serious AEs were rare among adults aged 18 years and older following vaccination with the Pfizer and Moderna bivalent vaccines.

Original Articles

Methodology of comparative studies on the relative effectiveness of COVID-19 vaccines: a systematic review: Erdenetuya Bolormaa, Jiae Shim, Young-Sook Choi, Donghyok Kwon, Young June Choe, Seung-Ah Choe; Osong Public Health Res Perspect. 2024;15(5):395-408. Published online October 15, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0063

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Graphical Abstract Abstract PDF: Objectives
This study aimed to comprehensively outline the methodological approaches used in published research comparing the vaccine effectiveness (VE) of coronavirus disease 2019 (COVID-19) vaccines.
Methods
A systematic search was conducted on June 13, 2024, to identify comparative studies evaluating the effectiveness of mRNA versus non-mRNA and monovalent versus bivalent COVID-19 vaccines. We screened titles, abstracts, and full texts, collecting data on publication year, country, sample size, study population composition, study design, VE estimates, outcomes, and covariates. Studies that reported relative VE (rVE) were analyzed separately from those that did not.
Results
We identified 25 articles comparing rVE between mRNA and non-mRNA COVID-19 vaccines, as well as between monovalent and bivalent formulations. Among the studies assessing VE by vaccine type, 126 did not provide rVE estimates. Comparative VE studies frequently employed retrospective cohort designs. Among the definitions of rVE used, the most common were hazard ratio and absolute VE, calculated as (1−odds ratio)×100. Studies were most frequently conducted in the United Kingdom and the United States, and the most common outcome was infection. Most targeted the general population and assessed the VE of mRNA vaccines using the AstraZeneca vaccine as a reference. A small proportion, 7.3% (n=11), did not adjust for any variables. Only 3 studies (2.0%) adjusted for all core confounding variables recommended by the World Health Organization.
Conclusion
Few comparative studies of COVID-19 vaccines have incorporated rVE methodologies. Reporting rVE and employing a consistent set of covariates can broaden our understanding of COVID-19 vaccines.

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; Osong Public Health Res Perspect. 2024;15(5):461-475. Published online September 30, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0116

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Graphical Abstract 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: Eon-Min Ko, Jinsoo Min, Hyungjun Kim, Ji-A Jeong, Sungkyoung Lee, Seonghan Kim; Osong Public Health Res Perspect. 2024;15(5):385-394. Published online September 30, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0101

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Graphical Abstract 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; Osong Public Health Res Perspect. 2024;15(5):409-419. Published online September 10, 2024; DOI: https://doi.org/10.24171/j.phrp.2023.0361

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Graphical Abstract 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.

Editorial

Preparedness for the recent increase in COVID-19 cases: Jong-Koo Lee; Osong Public Health Res Perspect. 2024;15(4):265-266. Published online August 29, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0236

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Original Article

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; Osong Public Health Res Perspect. 2024;15(5):429-439. Published online August 21, 2024; DOI: https://doi.org/10.24171/j.phrp.2024.0156

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Graphical Abstract 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, fine particulate matter less than 2.5 μm (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.

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