Osong Public Health and Research Perspectives

Original Articles

Seroprevalence of immunoglobulin G antibodies against SARS-CoV-2 in children and adolescents in Delhi, India, from January to October 2021: a repeated cross-sectional analysis: Pragya Sharma, Saurav Basu, Suruchi Mishra, Mongjam Meghachandra Singh; Osong Public Health Res Perspect. 2022;13(3):184-190. Published online June 10, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0014; Funded: ATE Chandra Foundation and ACT grants

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Abstract PDF: Objectives
The aim of this study was to assess changes in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) seroprevalence among children and adolescents in Delhi, India from January 2021 to October 2021
Methods
This was a repeated cross-sectional analysis of participants aged 5 to 17 years from 2 SARS-CoV-2 seroprevalence surveys conducted in Delhi, India during January 2021 and September to October 2021. Anti-SARS-CoV-2 IgG antibodies were detected by using the VITROS assay (90% sensitivity, 100% specificity).
Results
The seroprevalence among 5- to 17-year-old school-age children and adolescents increased from 52.8% (95% confidence interval [CI], 51.3%−54.3%) in January 2021 to 81.8% (95% CI, 80.9%−82.6%) in September to October 2021. The assay-adjusted seroprevalence was 90.8% (95% CI, 89.8%−91.7%). Seropositivity positively correlated with participants’ age (p<0.001), but not sex (p=0.388). A signal to cut-off ratio ≥4.00, correlating with the presence of neutralization antibodies, was observed in 4,814 (57.9%) participants.
Conclusion
The high percentage of seroconversion among children and adolescents indicates the presence of natural infection-induced immunity from past exposure to the SARS-CoV-2 virus. However, the lack of hybrid immunity and the concomitant likelihood of lower levels of neutralization antibodies than in adults due to the absence of vaccination warrants careful monitoring and surveillance of infection risk and disease severity from newer and emergent variants.

Transmission parameters of coronavirus disease 2019 in South Asian countries: Mridul Sannyal, Abul Mukid Mohammad Mukaddes; Osong Public Health Res Perspect. 2022;13(3):191-202. Published online June 23, 2022; DOI: https://doi.org/10.24171/j.phrp.2021.0234; Funded: Shahjalal University of Science and Technology, Sylhet

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Abstract PDF: Objectives
This study aimed to estimate the transmission parameters, effective reproduction number, epidemic peak, and future exposure of coronavirus disease 2019 (COVID-19) in South Asian countries.
Methods
A susceptible-exposed-infected-recovered-death (SEIRD) model programmed with MATLAB was developed for this purpose. Data were collected (till June 28, 2021) from the official webpage of World Health Organization, along with the Center for Systems Science and Engineering at Johns Hopkins University. The model was simulated to measure the primary transmission parameters. The reproduction number was measured using the next-generating matrix method.
Results
The primary transmission rate followed an exponential Gaussian process regression. India showed the highest transmission rate (0.037) and Bhutan the lowest (0.023). The simulated epidemic peaks matched the reported peaks, thereby validating the SEIRD model. The simulation was carried out up to December 31, 2020 using the reported data till June 9, 2020.
Conclusion
The information gathered in this research will be helpful for authorities to prevent the transmission of COVID-19 in the subsequent wave or in the future.

Sex differences in factors associated with prediabetes in Korean adults: Jin Suk Ra; Osong Public Health Res Perspect. 2022;13(2):142-152. Published online April 22, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0053; Funded: National Research Foundation of Korea

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Abstract PDF: Objectives
Identifying the factors associated with prediabetes is necessary for the early detection and management of high-risk individuals with prediabetes. The purpose of this study was to identify the factors associated with prediabetes according to sex in Korean adults. Methods: Using the Korean National Health and Nutrition Examination Survey from 2015 to 2019, a total of 13,595 adults (5,565 males and 8,030 females) aged ≥20 years were included in the data analysis. Logistic regression analysis was performed to identify the factors associated with prediabetes according to sex in Korean adults. Results: In both males and females, age and a family history of type 2 diabetes were associated with prediabetes. In males, current and past smoking habits were associated with increased prediabetes. In addition, low-intensity physical activity and prolonged sedentary behavior were associated with a higher prevalence of prediabetes. Females with a lower education level (less than middle school graduation) showed a higher risk of prediabetes. Conclusion: Sex-specific prevention strategies for prediabetes should be developed. In addition, older individuals and those with a family history of type 2 diabetes should be screened for prediabetes.

Prevalence of plasmid-mediated AmpC β-lactamases among uropathogenic Escherichia coli isolates in southwestern Iran: Nabi Jomehzadeh, Khadijeh Ahmadi, Zahra Rahmani; Osong Public Health Res Perspect. 2021;12(6):390-395. Published online December 1, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0272; Funded: Research of Abadan University of Medical Sciences

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Abstract PDF: Objectives
This study was undertaken to evaluate AmpC β-lactamase-producing Escherichia coli urine isolates and to characterize the frequency of plasmid-mediated AmpC (pAmpC)-encoding genes.
Methods
Antimicrobial susceptibility tests were performed using the disk diffusion technique. AmpC β-lactamase production was assessed with a phenotypic inhibitor-based method. The presence of 6 pAmpC-encoding cluster genes was detected by multiplex polymerase chain reaction (PCR).
Results
The proportion of antibiotic resistance of E. coli isolates ranged from 7.4% to 90.5%, and more than half (51.6%) of the total isolates were multidrug-resistant (MDR). Among the 95 E. coli isolates, 60 (63.2%) were found to be cefoxitin-resistant, but only 14 (14.7%) isolates were confirmed as AmpC β-lactamase-producers. In the PCR assay, pAmpC-encoding genes were found in 15 (15.8%) isolates, and blaDHA was the most prevalent type. However, blaFOX, blaMOX, and blaACC genes were not detected in the isolates.
Conclusion
Our findings contributed valuable information concerning antibiotic resistance, confirmatory phenotypic testing for AmpC production, and pAmpC β-lactamase gene content in E. coli isolates in southwestern Iran. The level of MDR recorded in AmpC-producing strains of this study was worrying; therefore, implementing strong infection control approaches to reduce the MDR burden is recommended.

Yes-associated protein 1 as a prognostic biomarker and its correlation with telomerase in various cancers: Hye-Ran Kim, Choong-Won Seo, Keunje Yoo, Sang Jun Han, Jongwan Kim; Osong Public Health Res Perspect. 2021;12(5):324-332. Published online September 17, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0207; Funded: National Research Foundation of Korea

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Abstract PDF Supplementary Material: Objectives
The aims of this study were to investigate the expression of Yes-associated protein 1 (YAP1), its prognostic significance, and the correlation between YAP1 and telomerase in various cancers.
Methods
The Gene Expression Profiling Interactive Analysis database was used to analyze RNA sequencing data and the survival rate of patients with various cancers in The Cancer Genome Atlas (TCGA) database. PrognoScan was used to analyze the prognostic value of YAP1 expression in various cancers. Tumor Immune Estimation Resource was used to determine the correlation between YAP1 expression and telomerase in various cancer types based on TCGA data.
Results
The analysis suggested that YAP1 was differentially expressed between tissues of various cancers and non-tumor tissues. High YAP1 expression was also related to a poor prognosis in adrenocortical carcinoma, bladder urothelial carcinoma, and pancreatic adenocarcinoma. Moreover, YAP1 expression was correlated with the expression of telomerase reverse transcriptase and telomerase RNA component in various cancer types.
Conclusion
These results suggest that YAP1 is a potential biomarker with prognostic significance and relevance for oncogene research in various cancer types. The correlation between the expression of YAP1 and telomere-associated genes will help to understand their cancer-promoting mechanisms and interactions.

Review Article

Severe acute respiratory syndrome coronavirus 2 and respiratory syncytial virus coinfection in children: Milad Zandi, Saber Soltani, Mona Fani, Samaneh Abbasi, Saeedeh Ebrahimi, Ali Ramezani; Osong Public Health Res Perspect. 2021;12(5):286-292. Published online October 1, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0140; Funded: Abadan University of Medical Sciences

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Abstract PDF: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has infected many people around the world. Children are considered an important target group for SARS-CoV-2, as well as other viral infections such as respiratory syncytial virus infection. Both SARS-CoV-2 and respiratory syncytial virus can affect the respiratory tract. Coinfection of SARS-CoV-2 and respiratory syncytial virus can pose significant challenges in terms of diagnosis and treatment in children. This review compares the symptoms, diagnostic methods, and treatment of COVID-19 and respiratory syncytial virus infection in children.

Original Article

Behavioral therapy and pharmacotherapy for relapse prevention in abstinent smokers: a rapid review and meta-analysis for the Korea Preventive Service Task Force: Naae Lee, Eon Sook Lee, Jae Moon Yun, Cheol Min Lee, Seung-Won Oh, Younglee Choi, Belong Cho; Osong Public Health Res Perspect. 2021;12(4):244-253. Published online July 6, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0017; Funded: Korea Disease Control and Prevention Agency

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Abstract PDF Supplementary Material: Objectives
This study aimed to assess the effectiveness of relapse prevention interventions involving behavioral and pharmacological treatment among abstinent smokers.
Methods
This rapid review was conducted using MEDLINE, Cochrane CENTRAL, CINAHL, Embase, KMbase, and KoreaMed to identify studies published until June 20, 2020. The participants were abstinent smokers who quit smoking on their own, due to pregnancy, hospitalization, or by participating in a smoking cessation program. We found a systematic review that fit the objective of this study and included 81 randomized controlled trials (RCTs). Studies that did not present information on smoking cessation status, had no control group, or used reward-based interventions were excluded. Random effect and fixed effect meta-analyses were used to estimate the relative risk (RR) and 95% confidence interval (CI). In subgroup analyses, differences between subgroups were verified based on the participant setting, characteristics, intervention type, and intensity.
Results
Following screening, 44 RCTs were included in the meta-analysis. The review reported no differences in the success rate of relapse prevention between the behavioral interventions. Pharmacotherapy interventions showed higher success rates (RR, 1.15; 95% CI, 1.05−1.26; I²=40.71%), depending on prior abstinence duration and the drug type. Conclusions: The results indicated that pharmacotherapy has a significant effect on preventing relapse among abstinent smokers.

Brief Report

The laboratory test procedure to confirm rotavirus vaccine infection in severe complex immunodeficiency patients: Su-Jin Chae, Seung-Rye Cho, Wooyoung Choi, Myung-Guk Han, Deog-Yong Lee; Osong Public Health Res Perspect. 2021;12(4):269-273. Published online August 13, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0079; Funded: Acute Diarrheal Laboratory Surveillance

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Abstract PDF: The rotavirus vaccine is a live vaccine, and there is a possibility of infection by the virus strain used in the vaccine. We investigated the process of determining whether an infection was caused by the vaccine strain in a severe complex immunodeficiency (SCID) patient with rotavirus infection. The patient was vaccinated with RotaTeq prior to being diagnosed with SCID. The testing process was conducted in the following order: confirming rotavirus infection, determining its genotype, and confirming the vaccine strain. Rotavirus infection was confirmed through enzyme immunoassay and VP6 gene detection. G1 and P[8] were identified by multiplex polymerase chain reaction for the genotype, and G3 was further identified using a single primer. By detecting the fingerprint gene (WC3) of RotaTeq, it was confirmed that the detected virus was the vaccine strain. Genotypes G1 and P[8] were identified, and the infection was suspected of having been caused by rotavirus G1P[8]. G1P[8] is the most commonly detected genotype worldwide and is not included in the recombinant strains used in vaccines. Therefore, the infection was confirmed to have been caused by the vaccine strain by analyzing the genetic relationship between VP4 and VP7. Rotavirus infection by the vaccine strain can be identified through genotyping and fingerprint gene detection. However, genetic linkage analysis will also help to identify vaccine strains.

Original Articles

Validity and reliability of the Health-Related Quality of Life Instrument with 8 Items (HINT-8) in Korean breast cancer patients: Juyoung Kim, Min-Woo Jo, Hyeon-Jeong Lee, Sei-Hyun Ahn, Byung Ho Son, Jong Won Lee, Sae Byul Lee; Osong Public Health Res Perspect. 2021;12(4):254-263. Published online August 5, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0005; Funded: Asan Institute for Life Sciences, Asan Medical Center

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Abstract PDF Supplementary Material: Objectives
This study evaluated the validity and reliability of the Health-Related Quality of Life Instrument with 8 Items (HINT-8) in postoperative breast cancer patients in South Korea.
Methods
The study included 300 breast cancer patients visiting a tertiary hospital. We measured health-related quality of life (HRQoL) using the HINT-8, the 5-level EQ-5D version (EQ-5D-5L), and the Functional Assessment of Cancer Therapy-Breast (FACT-B). Discriminatory ability, known-group validity, and convergent validity were assessed. Reliability was evaluated with the Cohen kappa, weighted kappa, and intraclass correlation coefficient (ICC).
Results
The EQ-5D-5L indexes (p<0.001) and EQ visual analogue scale (VAS) scores (p<0.001) were significantly higher in subjects with no problems in each item of the HINT-8 than in those with problems. The FACT-B total scores were also higher in subjects without problems on the HINT-8. Older age, lower education level, and comorbidities were associated with a lower HINT-8 index. The HINT-8 index was correlated with the EQ-5D-5L index and the EQ VAS, with correlation coefficients of 0.671 (p<0.001) and 0.577 (p<0.001), respectively. The correlation coefficients between the HINT-8 and the FACT-B ranged from 0.390 to 0.714. The ICC was 0.690 (95% confidence interval, 0.580–0.780).
Conclusion
The HINT-8 showed appropriate validity for capturing HRQoL in postoperative breast cancer patients.

Behavioral interventions for smoking cessation among adolescents: a rapid review and meta-analysis for the Korea Preventive Services Task Force: Younglee Choi, Cheol Min Lee, Belong Cho, Eon Sook Lee, Seung-Won Oh, Naae Lee, Jae Moon Yun; Osong Public Health Res Perspect. 2021;12(3):177-186. Published online June 2, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0018; Funded: Korea Disease Control and Prevention Agency

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Abstract PDF Supplementary Material: Objectives
The aim of this study was to evaluate the effectiveness of behavioral smoking cessation interventions among adolescents.
Methods
MEDLINE, CENTRAL, Embase, CINAHL, KoreaMed, and KMbase were searched from inception to June 2020. Systematic reviews (SRs) or meta-analyses of randomized controlled trials (RCTs) were initially searched to perform a rapid SR. After selecting the final SR, RCTs after the publication year of the selected SR were searched. The primary outcome was smoking status after at least 6 months of follow-up, and the secondary outcome was smoking status at 4 weeks. Two reviewers independently assessed the selected studies’ quality using the Cochrane risk of bias tool. The meta-analysis utilized a Mantel-Haenszel fixed-effect model reporting the relative risk (RR) and 95% confidence interval (CI). The subgroup analysis utilized Cochrane’s Q.
Results
Thirty-two RCTs (11,637 participants) from a single SR were meta-analyzed. After 6 months of follow-up, the intervention group had significantly higher abstinence rates (RR, 1.30; 95% CI, 1.20−1.41; I2=26.46%). At 4 weeks of follow-up, the intervention group also had significantly higher abstinence rates (RR, 1.92; 95% CI, 1.49–2.47; I2=0.00%). The subgroup analysis indicated a significant difference in the abstinence rate according to the study setting and the period between intervention completion and follow-up.
Conclusion
This review showed that adolescent behavioral smoking cessation intervention programs significantly increased abstinence rates compared to the usual care.

Limitations of immunization registers at community health centers for measuring immunization coverage: a case study of the Japanese encephalitis mass immunization program in Bali Province, Indonesia: Anak A. S. Sawitri, Putu C. D. Yuliyatni, Made D. Ariawan, Komang A. Kartika Sari, Raka Susanti, I Nyoman Sutarsa; Osong Public Health Res Perspect. 2021;12(3):158-168. Published online June 2, 2021; DOI: https://doi.org/10.24171/j.phrp.2020.0241; Funded: WHO Geneva

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Graphical Abstract Abstract PDF: Objectives
The aim of this study was to compare the coverage of Japanese encephalitis (JE) immunization obtained from a recall survey and immunization registers at community health centers (CHCs) in Bali Province, Indonesia.
Methods
A population-based survey was conducted, and random 2-staged selection of clusters of sub-villages was performed. The sample consisted of households with children aged 9 months to 15 years old. Interviews were carried out with carers to recall JE immunization status. The recall immunization status was considered valid when name, date, and confirmation of immunization were available in an immunization register at a CHC. Descriptive analysis was performed. The completeness of the information within immunization registers at CHCs was assessed.
Results
The coverage of JE immunization obtained from the recall survey was 93.8% (95% confidence interval [CI], 92.8–94.9). It decreased to 74.9% (95% CI, 72.8–77.2) after being validated against immunization registers. The recall coverage of JE immunization was significantly higher than immunization register data suggested. This discrepancy varied from 6.5% to 36.4% across 6 districts; however, none of these districts achieved the recommended target coverage of 95%. The quality of immunization registers varied across CHCs.
Conclusion
The use of an immunization register may result in underestimating the true coverage of vaccination programs, and its utilization for measuring immunization coverage requires further consideration.

Epidemiological, imaging, laboratory, and clinical characteristics and factors related to mortality in patients with COVID-19: a single-center study: Zohreh Azarkar, Hamid Salehiniya, Toba Kazemi, Hamid Abbaszadeh; Osong Public Health Res Perspect. 2021;12(3):169-176. Published online May 26, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0012; Funded: Birjand University of Medical Sciences

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Abstract PDF: Objectives
Coronavirus disease 2019 (COVID-19) is a novel pandemic. Considerable differences in disease severity and the mortality rate have been observed in different parts of the world. The present study investigated the characteristics and outcomes of patients hospitalized with COVID-19 in Iran.
Methods
We established a retrospective cohort to study hospitalized COVID-19 patients in Iran. Epidemiological, imaging, laboratory, and clinical characteristics and outcomes were recorded from medical documents. The chi-square test, t-test, and logistic regression models were used to analyze the data. A p<0.05 was considered to indicate statistical significance.
Results
In total, 364 cases (207 males and 157 females) were analyzed. The most common symptoms were cough, fever, and dyspnea. Multifocal bilateral ground-glass opacities with peripheral distribution were the predominant imaging finding. The mean age of patients was 54.28±18.81 years. The mean age of patients who died was 71.50±14.60 years. The mortality rate was 17.6%. The total proportion of patients with a comorbidity was 47.5%, and 84.4% of patients who died had a comorbidity. Sex, history of diabetes mellitus, and dyslipidemia were not significantly associated with mortality (p>0.05). However, mortality showed significant relationships with body mass index; age; history of hypertension, chronic kidney disease (CKD), ischemic heart disease, cerebrovascular accident (CVA), pulmonary disease, and cancer; and abnormal high-resolution computed tomography (HRCT) findings (p<0.05 for all). Cancer had the highest odds ratio.
Conclusion
Comorbidities (especially cancer, CKD, and CVA), severe obesity, old age, and abnormal HRCT findings affected the health outcomes of patients hospitalized with COVID-19.

Characteristics of hand-to-environment contact during indoor activities in daily life among Korean adults using a video-based observation method: Hyang Soon Oh, Mikyung Ryu, Youngran Yang; Osong Public Health Res Perspect. 2021;12(3):187-195. Published online June 8, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0006; Funded: Korea Centers for Disease Control and Prevention

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Abstract PDF: Objectives
The aim of this study was to describe the characteristics of hand-to-environmental contact (HEC) and to identify the factors influencing HEC behavior in Korean adults’ indoor daily life.
Methods
Thirty participants were enrolled from January 14 to February 12, 2018 after providing informed consent for being videotaped. Data were collected by recording their indoor daily lives for 2 hours, resulting in 4,732 HEC cases. To ensure the accuracy and reliability of the HEC readings, 3 training sessions were conducted for the videotape readers. Rereading and verifying randomly selected data ensured the validity of intra- and inter-reader readings.
Results
The most frequent contact items were phones, papers, computer accessories, and furniture surfaces. The contact density (frequency-duration/min) was highest for category II (items occasionally shared by others, 56.8), followed in descending order by category I (items for individual use, 35.9), and category III (public use items, 3.4). Significant differences in contact density were found according to participants’ demographic characteristics.
Conclusion
As mobile phones were the most frequent contact item, regular and strict mobile phone cleansing or disinfection strategies are needed, in addition to preventative measures taken for category II and III items. Avoiding sharing personal items with others, refraining from unnecessary HEC, and maintaining strict hand hygiene are recommended.

The 100 top-cited articles on scrub typhus: a bibliometric analysis: Taha Hussein Musa, Wei Li, Joseph Kawuki, Pingmin Wei; Osong Public Health Res Perspect. 2021;12(2):126-135. Published online April 29, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.12.2.10; Funded: Jiangsu Provincial Social Science Foundation Grant

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Abstract PDF Supplementary Material: Objectives
The aims of this study were to analyze the characteristics of the 100 top-cited articles on scrub typhus (ST), and to assess the present research landscape and future research directions using bibliometric analysis.
Methods
Web of Science was used to conduct a bibliometric analysis of the 100 top-cited articles on ST. The articles were analyzed by publication year, number of citations, document type, journals, keywords, institutions, country of origin, and authorship.
Results
The top 100 articles on ST were published between 1945 to 2017. The number of citations ranges from 39 to 227 and the interquartile range was 35.5. The United States published the highest number (n=21) of articles. Mahidol University was the most prolific institution in terms of articles (n=14). The American Journal of Tropical Medicine and Hygiene was the journal with the most articles (n=14), and Paris DH was the most productive author in terms of the Hirsh-index, which was 10 for that author. The study revealed a significant correlation between the total number of citations and the number of authors (r=0.668, p<0.001), number of institutions (r=0.692, p<0.001), number of years since publication (r=0.869, p<0.001), and number of countries involved (r=0.963, p<0.001).
Conclusion
The findings of this study provide landmarks in the publication and citation frequency of the most influential articles on ST. In addition, this study provides useful information for readers and health policy-makers in evaluating the literature on ST.

Psychological outcomes of the COVID-19 pandemic among pregnant women in Indonesia: a cross-sectional study: Rahmah Hida Nurrizka, Yuri Nurdiantami, Feda Anisah Makkiyah; Osong Public Health Res Perspect. 2021;12(2):80-87. Published online April 29, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.12.2.05; Funded: Research and Community Service Institution of Universitas Pembangunan Nasional (UPN) Veteran Jakarta

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Abstract PDF: Objectives
The objective of this study was to analyze the psychological outcomes of pregnant women during the coronavirus disease 2019 (COVID-19) pandemic in several areas that are epicenters for the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Indonesia.
Methods
This cross-sectional study used data obtained from an online survey administered to 120 women who were pregnant and gave birth during the COVID-19 pandemic in Indonesia. The psychological condition of pregnant women was measured using the Depression, Anxiety, and Stress Scale-21 questionnaire which was modified for conditions experienced during the COVID-19 pandemic. We classified pregnant women into 2 groups according to their psychological condition: pregnant women who experienced anxiety and pregnant women who did not experience anxiety or felt normal. Receiver operating characteristic (ROC) analysis was undertaken for the 2 groups. This study also used univariate analysis and bivariate analysis.
Results
The results of the ROC analysis resulted in a cutoff score of 3.56. The proportion of respondents who felt anxious was 53.3% and the proportion of respondents who did not feel anxious or felt normal was 46.7%. Anxiety was most common among pregnant women with high education levels, gestational age <19 weeks, and working pregnant women.
Conclusion
Maternal health services need to be performed with strict health protocols, complemented by pregnancy counseling services. This will provide a feeling of comfort and safety as pregnant women receive health services and give birth.

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