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Volume 11(5); October 2020
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Editorial
Challenging Issues Caused by COVID-19 – A Window of Opportunity to Make Our Health System Healthier
Jong-Koo Lee
Osong Public Health Res Perspect. 2020;11(5):267-268.   Published online October 22, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.5.01
  • 3,101 View
  • 65 Download
PDF
Review Article
COVID-19 Patients: A Systematic Review and Meta-Analysis of Laboratory Findings, Comorbidities, and Clinical Outcomes Comparing Medical Staff versus the General Population
Mina Ebrahimi, Amal Saki Malehi, Fakher Rahim
Osong Public Health Res Perspect. 2020;11(5):269-279.   Published online October 22, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.5.02
  • 5,044 View
  • 105 Download
  • 8 Citations
AbstractAbstract PDFSupplementary Material

This review compared coronavirus disease 2019 (COVID-19) laboratory findings, comorbidities, and clinical outcomes in patients from the general population versus medical staff to aid diagnosis of COVID-19 in a more timely, efficient, and accurate way. Electronic databases were searched up to 23rd March, 2020. The initial search yielded 6,527 studies. Following screening, 24 studies were included [18 studies (11,564 cases) of confirmed COVID-19 cases in the general public, and 6 studies (394 cases) in medical staff] in this review. Significant differences were observed in white blood cell counts (p < 0.001), lymphocyte counts (p < 0.001), platelet counts (p = 0.04), procalcitonin levels (p < 0.001), lactate dehydrogenase levels (p < 0.001), and creatinine levels (p = 0.03) when comparing infected medical staff with the general public. The mortality rate was higher in the general population than in medical staff (8% versus 2%). This review showed that during the early stages of COVID-19, laboratory findings alone may not be significant predictors of infection and may just accompany increasing C-reactive protein levels, erythrocyte sedimentation rates, and lactate dehydrogenase levels. In the symptomatic stage, the lymphocyte and platelet counts tended to decrease. Elevated D-dimer fibrin degradation product was associated with poor prognosis.

Original Articles
2019 Tabletop Exercise for Laboratory Diagnosis and Analyses of Unknown Disease Outbreaks by the Korea Centers for Disease Control and Prevention
Il-Hwan Kim, Jun Hyeong Jang, Su-Kyoung Jo, Jin Sun No, Seung-Hee Seo, Jun-Young Kim, Sang-Oun Jung, Jeong-Min Kim, Sang-Eun Lee, Hye-Kyung Park, Eun-Jin Kim, Jun Ho Jeon, Myung-Min Choi, Boyeong Ryu, Yoon Suk Jang, Hwami Kim, Jin Lee, Seung-Hwan Shin, Hee Kyoung Kim, Eun-Kyoung Kim, Ye Eun Park, Cheon-Kwon Yoo, Sang-Won Lee, Myung-Guk Han, Gi-Eun Rhie, Byung Hak Kang
Osong Public Health Res Perspect. 2020;11(5):280-285.   Published online October 22, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.5.03
  • 3,057 View
  • 84 Download
AbstractAbstract PDF
Objectives

The Korea Centers for Disease Control and Prevention has published “A Guideline for Unknown Disease Outbreaks (UDO).” The aim of this report was to introduce tabletop exercises (TTX) to prepare for UDO in the future.

Methods

The UDO Laboratory Analyses Task Force in Korea Centers for Disease Control and Prevention in April 2018, assigned unknown diseases into 5 syndromes, designed an algorithm for diagnosis, and made a panel list for diagnosis by exclusion. Using the guidelines and laboratory analyses for UDO, TTX were introduced.

Results

Since September 9th, 2018, the UDO Laboratory Analyses Task Force has been preparing TTX based on a scenario of an outbreak caused by a novel coronavirus. In December 2019, through TTX, individual missions, epidemiological investigations, sample treatments, diagnosis by exclusions, and next generation sequencing analysis were discussed, and a novel coronavirus was identified as the causal pathogen.

Conclusion

Guideline and laboratory analyses for UDO successfully applied in TTX. Conclusions drawn from TTX could be applied effectively in the analyses for the initial response to COVID-19, an ongoing epidemic of 2019 – 2020. Therefore, TTX should continuously be conducted for the response and preparation against UDO.

Primary Healthcare Under Transformation in 3 Eastern European Countries: Quality Satisfaction as Rated by Students
Sviatlana Ahiyevets, Andrei Shpakou, Joanna Baj-Korpak, Ewa Kleszczewska, Katarzyna Rzatkiewicz, Krzysztof Mancewicz, Valentina Stetsenko, Semen Stetsenko
Osong Public Health Res Perspect. 2020;11(5):286-295.   Published online October 22, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.5.04
  • 3,086 View
  • 131 Download
AbstractAbstract PDF
Objectives

This study aimed to determine the reasons for student dissatisfaction with the quality of primary healthcare (PHC) in countries under healthcare system transformation (Belarus, Poland, and Ukraine) to identify reserves and make improvements.

Methods

A comparative multipopulation survey was translated, verified, and completed during face-to-face interviews during March 2019 to May 2019. There were 700 Humanities students included in this study to determine satisfaction with the quality of PHC provided by the family doctor. Satisfaction was assessed according to the availability of the doctor, the level of organization of the institution, the service process, the quality of the interaction with the doctor, adherence to the rights of patients, and any additional financial expense incurred by the patient.

Results

Politeness and attentiveness of doctors were rated highly. Dissatisfaction was associated with the negative attitude of medical personnel towards the patient. One in 10 respondents replied that medical confidentiality was not observed. More than 65% of students had paid for diagnostic tests/or treatments, and some respondents from Poland and Ukraine were asked by the doctor to pay for services without a receipt.

Conclusion

Dissatisfaction with the quality of PHC in countries under transformation of the health system was largely due to ethical aspects of the doctor-patient relationship. Therefore, ethical standards need to be upheld and patients need to be aware of these standards using medical education materials covering the moral aspects of the relationship between medical personnel and patient.

Health-Related Quality of Life and its Associated Factors in COVID-19 Patients
Morteza Arab-Zozani, Fatemah Hashemi, Hossein Safari, Mahmood Yousefi, Hosein Ameri
Osong Public Health Res Perspect. 2020;11(5):296-302.   Published online October 22, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.5.05
  • 7,583 View
  • 398 Download
  • 28 Citations
AbstractAbstract PDF
Objectives

Health-related quality of life (HRQoL) is one of the most important outcome measures for patients. The purpose of this study was to evaluate HRQoL and related factors in Coronavirus disease 2019 (COVID-19) patients.

Methods

A total of 420 COVID-19 patients who had been discharged from hospital were selected using a systematic sampling. The EuroQol 5-dimensional-5 levels (EQ-5D-5L) questionnaire along with medical records of the patients were used to gather the data. The t test and analysis of variance were employed to test the difference between mean EQ-5D-5L scores, and the BetaMix model was used to investigate factors associated with EQ-5D-5L scores.

Results

The mean score for the patients who completed the EQ-5D-5L questionnaire (n = 409) was 0.6125. The EQ-5D-5L scores were significantly higher in males, patients with younger age, those with a low level of education, the employed, patients who worked in uncrowded workplaces, patients without diabetes, and those who were not admitted to intensive care unit. The BetaMix model showed that gender, age, education, employment status, having diabetes, heart failure, and admission to the intensive care unit were significant independent predictors of the EQ-5D-5L index values.

Conclusion

The mean score for EQ-5D-5L in COVID-19 patients was low in this study. Some of the factors, especially aging and having diabetes, should be considered in the aftercare of patients to improve their HRQoL.

Prevalence of Internet Addiction, Poor Sleep Quality, and Depressive Symptoms Among Medical Students: A Cross-Sectional Study
Aanchal Anant Awasthi, Neha Taneja, Sonam Maheshwari, Trisha Gupta, Bhavika
Osong Public Health Res Perspect. 2020;11(5):303-308.   Published online October 22, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.5.06
  • 4,770 View
  • 130 Download
  • 3 Citations
AbstractAbstract PDF
Objectives

This objective of the study was to report the prevalence of internet addiction, sleep quality, depression, anxiety, and stress in undergraduate medical students.

Methods

A cross-sectional, questionnaire-based study was conducted among 221 undergraduate medical students at Government Doon Medical College, Dehradun, Uttarakhand. Data pertaining to internet addiction, sleep quality, and depressive symptoms were also collected using validated and reliable questionnaires (Young Internet Addiction Test, Pittsburgh Sleep Quality Index, and Depression Anxiety Stress Scale 21).

Results

The prevalence of poor sleep quality, severe anxiety, and severe depression was 33.9%, 7.3% and 3.6%, respectively. The place of residence was significantly associated (p = 0.006) with internet addiction. The mean Young Internet Addiction Test score was higher in students residing in hostels compared with students staying with families. Stress was associated with age. The mean stress score was higher in the age group 17–20 compared with the 21–24 age group. Stress and depression were independent predictors of sleep quality.

Conclusion

Quality sleep is the key for good health. Based on limited samples, this study showed that poor sleep quality was associated with stress and depression. Hence, continuous counselling is suggested for supporting students managing their stress and depression.

Alarm Thresholds for Pertussis Outbreaks in Iran: National Data Analysis
Yousef Alimohamadi, Seyed Mohsen Zahraei, Manoochehr Karami, Mehdi Yaseri, Mojtaba Lotfizad, Kourosh Holakouie-Naieni
Osong Public Health Res Perspect. 2020;11(5):309-318.   Published online October 22, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.5.07
  • 2,740 View
  • 40 Download
  • 1 Citations
AbstractAbstract PDF
Objectives

The purpose of the current study was to determine the upper threshold number of cases for which pertussis infection would reach an outbreak level nationally in Iran.

Methods

Data on suspected cases of pertussis from the 25th February 2012 to the 23rd March 2018 from the Center for Disease Control and Prevention in Iran was used. The national upper threshold level was estimated using the exponentially weighted moving average (EWMA) method and the Poisson regression method.

Results

In total, 2,577 (33.6%) and 1,714 (22.3%) cases were reported in the Spring and Summer respectively. There were 1,417 (18.5%) and 1,971 (25.6%) cases reported in the Autumn and Winter, respectively. The overall upper threshold using the EWMA and the Poisson regression methods, was estimated as a daily occurrence of 8 (7.55) and 7.50 (4.48–11.06) suspected cases per 10,000,000 people, respectively. The daily seasonal thresholds estimated by the EWMA and the Poisson regression methods were 10, 7, 6, 8 cases and 10, 7, 7, 9 cases for the Spring, Summer, Autumn, and Winter, respectively.

Conclusion

The overall and seasonal estimated thresholds by the 2 methods were similar. Therefore, the estimated thresholds of 6–10 cases in a day, per 10,000,000 people could be used to detect pertussis outbreaks and epidemics by health policymakers.

Immunological Profile and Bacterial Drug Resistance in Pregnant Women: A Cross Sectional Study
Ornella JT Ngalani, Wiliane JT Marbou, Armelle Tsafack Mbaveng, Victor Kuete
Osong Public Health Res Perspect. 2020;11(5):319-326.   Published online October 22, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.5.08
  • 3,312 View
  • 66 Download
  • 2 Citations
AbstractAbstract PDFSupplementary Material
Objectives

This study aimed to investigate the immunological and bacterial profiles in pregnant women of Bafang-Cameroon.

Methods

Stool and midstream urine were cultured using specific culture media. The disk diffusion method was used for the antimicrobial susceptibility test. T-cell lymphocyte counts (CD3, CD4 and CD8), white blood cell counts, sensitive C-reactive protein, and interleukin-6, were measured by flow cytometry, optical detection, and the enzyme-linked immunosorbent assay solid phase direct sandwich method.

Results

Out of 700 participants, 71.43% were pregnant, and 28.57% were non-pregnant women. The mean age was 29.40 ± 8.27 and 27.41 ± 6.55 years in non-pregnant and pregnant women, respectively. CD4 T-cells were not significantly lower in pregnant women compared with non-pregnant women. There were 43.65% and 56.35% bacteria isolates obtained from urine and stool samples, respectively. Bacteria were mostly isolated in patients with a CD4 T-cell count between 461 and 806 cells/μL. Isolates of Klebsiella pneumoniae and Enterobacter aerogenes showed 100% resistance in non-pregnant women, however all isolated bacteria were shown to be multidrug resistant in pregnant women. Salmonella sp. (24.3%) and Escherichia coli (21.51%) showed an increase in multidrug resistant phenotypes in pregnant women.

Conclusion

This study demonstrated that routine bacteriological analysis during pregnancy is necessary for their follow-up care.

Characterization of Antimicrobial Susceptibility, Extended-Spectrum β-Lactamase Genes and Phylogenetic Groups of Enteropathogenic Escherichia coli Isolated from Patients with Diarrhea
Erfaneh Jafari, Saeid Mostaan, Saeid Bouzari
Osong Public Health Res Perspect. 2020;11(5):327-333.   Published online October 22, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.5.09
  • 4,422 View
  • 74 Download
  • 3 Citations
AbstractAbstract PDF
Objectives

Infectious diarrhea is one of the most common causes of pediatric death worldwide and enteropathogenic Escherichia coli (EPEC) is one of the main causes. There are 2 subgroups of EPEC, typical and atypical, based on the presence or absence of bundle forming pili (bfp), of which atypical EPEC is considered less virulent, but not less pathogenic. Antimicrobial resistance towards atypical EPEC among children is growing and is considered a major problem. In this study the pattern of antibiotic resistance in clinical isolates was determined.

Methods

Using 130 isolates, antibiotic resistance patterns and phenotypes were assessed, and genotypic profiles of extended spectrum β-lactamase (ESBL) production using disc diffusion and PCR was carried out. Phylogenetic groups were analyzed using quadruplex PCR.

Results

There were 65 E. coli isolates identified as atypical EPEC by PCR, among which the highest antibiotic resistance was towards ampicillin, followed by trimethoprim-sulfamethoxazole, and tetracycline. Multidrug resistance was detected in 44.6% of atypical EPEC isolates. Around 33% of isolates were determined to be extended spectrum β-lactamase producers, and in 90% of isolates, genes responsible for ESBL production could be detected. Moreover, the majority of atypical EPEC strains belonged to Group E, followed by Groups B1, B2 and C.

Conclusion

High rates of multidrug resistance and ESBL production among atypical EPEC isolates warrant periodical surveillance studies to select effective antibiotic treatment for patients. It is considered a critical step to manage antibiotic resistance by avoiding unnecessary prescriptions for antibiotics.

Brief Reports
Air Evacuation of Passengers with Potential SARS-CoV-2 Infection Under the Guidelines for Appropriate Infection Control and Prevention
Jeong-Gil Kim, Seung Hak Lee, Hansuk Kim, Hong Sang Oh, Jacob Lee
Osong Public Health Res Perspect. 2020;11(5):334-338.   Published online October 22, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.5.10
  • 3,110 View
  • 66 Download
  • 1 Citations
AbstractAbstract PDF

This report describes the air evacuation of 80 Koreans from Iran to Korea on March 19th, 2020, with a direct transfer of passengers between airplanes in Dubai. The passengers were potentially infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) so, strict precautions were taken for the duration of the flight, and the passengers were screened before embarking from Dubai and disembarking at Incheon International Airport in Korea. Passengers with fever or symptoms of SARS-CoV-2 were assessed by a quarantine doctor, and if they were suspected of being infected with SARS-CoV-2, they were categorized as a “patient under investigation (PUI)”. There was 1 passenger designated as a PUI before the departure from Dubai and another designated as a PUI upon arrival into Korea. The first PUI tested negative, but the second PUI tested positive for SARS-CoV-2. All those aboard the flight (passengers, aircrew, and medical staff) were screened for SARS-CoV-2 upon arrival into Korea and completed a mandatory 14-day medical quarantine. There were no additional cases of infection.

A Public-Private Partnership Model to Build a Triage System in Response to a COVID-19 Outbreak in Hanam City, South Korea
Seong Su Ku, Young June Choe
Osong Public Health Res Perspect. 2020;11(5):339-342.   Published online October 22, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.5.11
  • 3,448 View
  • 78 Download
  • 3 Citations
AbstractAbstract PDF

A substantial, immediate healthcare burden for screening of Coronavirus disease 2019 (COVID-19) is created when large-scale outbreaks occur. There have been a series of measures to strengthen the screening process through robust public-private partnerships between Hanam City Public Health Center (PHC), the local medical association, and central/provincial government. A partnership between PHC and the local physician’s group in Hanam City established the Respiratory Clinic. The PHC provided the infrastructure for the Respiratory Clinic including medical facilities, supplies (i.e. personal protective equipment), and administrative support. A total of 11 registered physicians from the local physicians group agreed to participate in clinical service provided at the Respiratory Clinic. Any citizens with COVID-19 suspected respiratory symptoms call the COVID-19 hotline and visit the Respiratory Clinic if required. Responding to COVID-19 outbreaks will be a continual process, and the screening system is essential support to public health interventions, and crucial in the response to a surge in COVID-19 cases.


PHRP : Osong Public Health and Research Perspectives