Osong Public Health and Research Perspectives

"risk factors"

Original Articles

Identifying risk factors for COVID-19 cluster infections in schools in the Republic of Korea: a case-control study: Jihyun Choi, Seongju Choi, Baigu Lee, Young-Joon Park, Sang Eun Lee; Osong Public Health Res Perspect 2024;15(4):375-382. Published online July 11, 2024; DOI: https://doi.org/10.24171/j.phrp.2023.0351

Objectives No study has yet analyzed risk factors to determine whether students with confirmed coronavirus disease 2019 (COVID-19) infections may affect students at neighboring schools. Therefore, this study aimed to determine risk factors for COVID-19 transmission among schools within a community in the Republic of Korea. Methods An epidemiological investigation was conducted among 696 students and school staff members at 3 schools where COVID-19 clusters began on October 15, 2021. Interviews, visit history surveys, a facility risk assessment, and closed-circuit television were used to identify risk factors. The statistical significance of risk factors was also evaluated. Results We confirmed 129 cases (18.5%) among the individuals exposed to COVID-19 at the 3 schools, many of whom had a history of visiting the same multi-use facilities. The odds ratio of having visited multi-use facilities such as karaoke rooms was 1.90 (95% confidence interval, 1.03–3.50); the number of visits to a karaoke room and the visit durations were significantly higher among confirmed cases than non-confirmed cases (p=0.02 and p=0.03, respectively). Conclusion Having a history of visiting karaoke rooms often and spending a long time there were risk factors for COVID-19 infection and inter-school transmission. Thus, it is necessary to investigate the status of multi-use facilities frequently visited by adolescents and consider incorporating them into the scope of school quarantine to prevent infectious diseases at schools in a community.

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Household secondary attack rates and risk factors during periods of SARS-CoV-2 Delta and Omicron variant predominance in the Republic of Korea: Jin Lee, Mijeong Ko, Seontae Kim, Dosang Lim, Gemma Park, Sang-Eun Lee; Osong Public Health Res Perspect 2023;14(4):263-271. Published online August 11, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0133

Objectives The household secondary attack rate (SAR) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an important indicator for community transmission. This study aimed to characterize transmission by comparing household SARs and identifying risk factors during the periods of Delta and Omicron variant predominance in Republic of Korea. Methods We defined the period of Delta variant predominance (Delta period) as July 25, 2021 to January 15, 2022, and the period of Omicron variant predominance (Omicron period) as February 7 to September 3, 2022. The number of index cases included was 214,229 for the Delta period and 5,521,393 for the Omicron period. To identify the household SARs and risk factors for each period, logistic regression was performed to determine the adjusted odds ratio (aOR). Results The SAR was 35.2% for the Delta period and 43.1% for the Omicron period. The aOR of infection was higher in 2 groups, those aged 0 to 18 years and ≥75 years, compared to those aged 19 to 49 years. Unvaccinated individuals (vs. vaccinated individuals) and individuals experiencing initial infection (vs. individuals experiencing a second or third infection) had an increased risk of infection with SARS-CoV-2. Conclusion This study analyzed the household SARs and risk factors. We hope that the results can help develop age-specific immunization plans and responses to reduce the SAR in preparation for emerging infectious diseases or potential new variants of SARS-CoV-2.

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Lower Levels of Household Transmission of SARS-CoV-2 Omicron Variant of Concern vs Wild Type: An Interplay Between Transmissibility and Immune Status
Angelique M A M Winkel, Eva Kozanli, Mildred E Haverkort, Sjoerd M Euser, Judith G C Sluiter-Post, Rob Mariman, Afke Vogelzang, Jordy de Bakker, Coen R Lap, Marianne A van Houten, Dirk Eggink, Steven F L van Lelyveld
The Journal of Infectious Diseases.2025; 231(3): 653. CrossRef
Impact of disease severity, age, sex, comorbidity, and vaccination on secondary attack rates of SARS-CoV-2: a global systematic review and meta-analysis
Dewan Md. Sumsuzzman, Yang Ye, Zhen Wang, Abhishek Pandey, Joanne M. Langley, Alison P. Galvani, Seyed M. Moghadas
BMC Infectious Diseases.2025;[Epub] CrossRef

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Risk factors for transmission in a COVID-19 cluster infection in a high school in the Republic of Korea: Jin-Hwan Jeon, Su Jin Kang, Se-Jin Jeong, Hyeon-Cheol Jang, Young-Joon Park, Sang-Eun Lee; Osong Public Health Res Perspect 2023;14(4):252-262. Published online July 27, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0125

Objectives This study aimed to examine the scale, characteristics, risk factors, and modes of transmission in a coronavirus disease 2019 (COVID-19) outbreak at a high school in Seoul, Republic of Korea. Methods An epidemiological survey was conducted of 1,118 confirmed cases and close contacts from a COVID-19 outbreak at an educational facility starting on May 31, 2021. In-depth interviews, online questionnaires, flow evaluations, and CCTV analyses were used to devise infection prevention measures. Behavioral and spatial risk factors were identified, and statistical significance was tested. Results Among 3rd-year students, there were 33 confirmed COVID-19 cases (9.6%). Students who used a study room in the annex building showed a statistically significant 4.3-fold elevation in their relative risk for infection compared to those who did not use the study room. Moreover, CCTV facial recognition analysis confirmed that 17.8% of 3rd-year students did not wear masks and had the lowest percentage of mask-wearers by grade. The air epidemiological survey conducted in the study room in the annex, which met the 3 criteria for a closed space, confirmed that there was only 10% natural ventilation due to the poor ventilation system. Conclusion To prevent and manage the spread of COVID-19 in educational facilities, advance measures that consider the size, operation, and resources of each school are crucial. In addition, various survey methodologies should be used in future studies to quickly analyze a wider range of data that can inform an evidence-based quarantine response.

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Detection of a cluster of Omicron's BA.4 sublineage in Northern Senegal and identification of the first XAS recombinant variant in Senegal
Martin Faye, Modeste Name Faye, Babacar Ndiaye, Moussa Moïse Diagne, Safietou Sankhe, Ndeye Marième Top, Amadou Diallo, Cheikh Loucoubar, Ndongo Dia, Amadou Alpha Sall, Ousmane Faye
Virus Research.2024; 339: 199259. CrossRef

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Risk factors associated with death due to severe fever with thrombocytopenia syndrome in hospitalized Korean patients (2018–2022): Jia Kim, Hyo-jeong Hong, Ji-hye Hwang, Na-Ri Shin, Kyungwon Hwang; Osong Public Health Res Perspect 2023;14(3):151-163. Published online June 8, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0048

Objectives Severe fever with thrombocytopenia syndrome (SFTS) has no vaccine or treatment and an extremely high fatality rate. We aimed to analyze and evaluate the risk factors for death associated with SFTS. Methods Among reports from 2018 to 2022, we compared and analyzed 1,034 inpatients aged 18 years or older with laboratory-confirmed SFTS who underwent complete epidemiological investigations. Results Most of the inpatients with SFTS were aged 50 years or older (average age, 67.6 years). The median time from symptom onset to death was 9 days, and the average case fatality rate was 18.5%. Risk factors for death included age of 70 years or older (odds ratio [OR], 4.82); agriculture-related occupation (OR, 2.01); underlying disease (OR, 7.20); delayed diagnosis (OR, 1.28 per day); decreased level of consciousness (OR, 5.53); fever/chills (OR, 20.52); prolonged activated partial thromboplastin time (OR, 4.19); and elevated levels of aspartate aminotransferase (OR, 2.91), blood urea nitrogen (OR, 2.62), and creatine (OR, 3.21). Conclusion The risk factors for death in patients with SFTS were old age; agriculture-related occupation; underlying disease; delayed clinical suspicion; fever/chills; decreased level of consciousness; and elevated activated partial thromboplastin time, aspartate aminotransferase, blood urea nitrogen, and creatine levels.

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Identification of early prognostic biomarkers in Severe Fever with Thrombocytopenia Syndrome using machine learning algorithms
Jie Zhu, Jianmei Zhou, Chunhui Tao, Guomei Xia, Bingyan Liu, Xiaowei Zheng, Xu Li, Zhenhua Zhang
Annals of Medicine.2025;[Epub] CrossRef
The immunogenicity and protection efficacy evaluation of mRNA vaccine candidate for severe fever with thrombocytopenia syndrome in mice
Da-Eun Jeong, Jack Yoon, Baek Kim, Jun-Gu Kang, Abdallah M. Samy
PLOS Neglected Tropical Diseases.2025; 19(4): e0012999. CrossRef
Deciphering the evolutionary landscape of severe fever with thrombocytopenia syndrome virus across East Asia
Dongbin Park, Kwan Woo Kim, Young-Il Kim, Mark Anthony B Casel, Hyunwoo Jang, Woohyun Kwon, Kanghee Kim, Se-Mi Kim, Monford Paul Abishek N, Eun-Ha Kim, Hobin Jang, Suhee Hwang, Seok-Min Yun, Joo-Yeon Lee, Hye Won Jeong, Su-Jin Park, Young Ki Choi
Virus Evolution.2024;[Epub] CrossRef
Acute kidney injury as a prognostic marker in severe fever with thrombocytopenia syndrome
Jin Mi Lee, Hae Lee Kim, Myoung-nam Lim, Changhyup Kim, Yeon Ju La, Yong Duk Jeon, Won Sup Oh, Seongmin Son, Sunhwa Lee, Hyunjeong Baek, Daniel Duck-Jin Hwang, Ji In Park
Scientific Reports.2024;[Epub] CrossRef
Double-Stranded RNA-Based Method for Diagnosing Severe Fever with Thrombocytopenia
Jung Wan Park, Jaemin Jeon, Yoosik Kim, Min Hyok Jeon
Journal of Clinical Medicine.2024; 14(1): 105. CrossRef

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Risk factors for deaths associated with COVID-19 according to the cause of death classification in Republic of Korea: Na-Young Kim, Seong-Sun Kim, Hyun Ju Lee, Dong Hwi Kim, Boyeong Ryu, Eunjeong Shin, Donghyok Kwon; Osong Public Health Res Perspect 2023;14(2):89-99. Published online April 18, 2023; DOI: https://doi.org/10.24171/j.phrp.2022.0312

Objectives This study aimed to classify coronavirus disease 2019 (COVID-19)-related deaths according to whether COVID-19 was listed as the cause of death, and to investigate the differences in demographic characteristics and risk factors for COVID-19 death classifications. Methods A total of 5,625 deaths in South Korea among patients with confirmed COVID-19 from January 20, 2020 to December 31, 2021 were selected. Excluding false reports and unnatural deaths, 5,597 deaths were analyzed. Based on death report data, deaths were classified according to whether the cause of death was listed as COVID-19 (CD) or not (NCD). The epidemiological characteristics and causes of deaths were investigated using descriptive, univariate, and multivariate statistical analyses. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to analyze the risk factors. Results The case fatality ratio was 0.89% and increased with age. Additionally, 96.4% of the subjects had an underlying disease, and 53.4% died in winter. The proportion of NCDs was 9.3%, of whom 19.1% died at home and 39.0% were confirmed to have COVID-19 after death. Malignant neoplasms (102/416 vs. 637/4,442; OR, 1.71; 95% CI, 1.36−2.16; p<0.001) were significantly associated with NCD. Conclusion This is the first study to analyze risk factors by cause of death using COVID-19 death report data in South Korea. These results are expected to be used as evidence for establishing a death monitoring system that can collect timely information in a new infectious disease pandemic.

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Analysis of risk factors affecting suicidal ideation in South Korea by life cycle stage: Ji-Young Hwang, Il-Su Park; Osong Public Health Res Perspect 2021;12(5):314-323. Published online October 26, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0208

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Objectives This study analyzed risk factors for suicidal ideation in South Koreans from a life cycle perspective. Methods A secondary analysis was conducted of data collected in 2015 as part of the 6th Korea National Health and Nutrition Examination Survey (KNHANES). The participants comprised 5,935 individuals aged 12 years or older. The statistical analysis reflected the complex sampling design of the KNHANES, and the Rao-Scott chi-square test and multiple logistic regression analysis were performed. Results The prevalence of suicidal ideation was 5.7% in adolescents, 3.7% in young adults, 5.4% in middle-aged adults, and 7.0% in older adults. Depression and stress were risk factors in every stage of the life cycle. In those aged 12 to 19 years, activity restrictions were significantly associated with suicidal ideation. Education and subjective health status were risk factors in adults aged 20 to 39 years, and education, activity restrictions, and quality of life were the major risk factors in those aged 40 to 64 years. For adults 65 years of age or older, the risk of suicidal ideation was higher among those with inappropriate sleep time. Conclusion The risk factors for suicidal ideation were found to be different across stages of the life cycle. This suggests a need for individualized suicide prevention plans and specific government policies that reflect the characteristics of each life cycle stage.

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Association between long working hours and the development of suicidal ideation among female workers: An 8-year population-based study using the Korean Longitudinal Survey of Women & Family (2012–2020)
Seong-Uk Baek, Yu-Min Lee, Jin-Ha Yoon
Psychiatry Research.2024; 333: 115731. CrossRef
Prevalence and incidence of suicide, suicidal ideation and self-harm in caregivers of cancer patients: A systematic review and meta-analysis
Chen Ee Low, Sean Loke, Sounak Rana, Ben Sim, Cyrus Su Hui Ho
General Hospital Psychiatry.2024; 90: 35. CrossRef
Psychological resilience and suicidality in the general population: A cross-sectional study based on data from the National Mental Health Survey of Korea 2021
Seung-Hoon Lee, Junhyung Kim, Changsu Han
Journal of Affective Disorders.2024; 363: 15. CrossRef
Risk factors of passive suicidal ideation among outpatients in traditional medicine clinics: The case of Korean medicine in South Korea
Ilsu Park, Tae-Hyeon Lee, Chan-Young Kwon
Heliyon.2024; 10(17): e37181. CrossRef
Development of a Clinical Guideline for Suicide Prevention in Psychiatric Patients Based on the ADAPTE Methodology
Jeong Hun Yang, Jieun Yoo, Dae Hun Kang, C. Hyung Keun Park, Sang Jin Rhee, Min Ji Kim, Sang Yeol Lee, Se-Hoon Shim, Jung-Joon Moon, Seong-Jin Cho, Shin Gyeom Kim, Min-Hyuk Kim, Jinhee Lee, Won Sub Kang, Weon-Young Lee, Yong Min Ahn
Psychiatry Investigation.2024; 21(10): 1149. CrossRef
Hwa-byung (anger syndrome) as a risk factor for suicidal ideation in MZ generation: a survey study in South Korea
Chan-Young Kwon
Frontiers in Psychology.2024;[Epub] CrossRef
Alcohol Consumption and Quality of Life in Middle-aged Men
Jeong-Sook Lee
International Journal of High Risk Behaviors and A.2023;[Epub] CrossRef
Factors Related to Suicidal Ideation by Gender and Age Group in Korean Adults
Eun Young Kim, Yong Whi Jeong, Jihye Lim, Dae Ryong Kang
Journal of Korean Medical Science.2023;[Epub] CrossRef
Association between Sleep Duration and Symptoms of Depression Aged between 18 and 49: The Korea National Health and Nutrition Examination Survey (KNHANES Ⅶ) from 2016 to 2018
Sung-Yong Choi, Ji-Eun Han, Jiae Choi, Minjung Park, Soo-Hyun Sung, Angela Dong-Min Sung
Healthcare.2022; 10(11): 2324. CrossRef

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Risk Factors in Early Life for Preschool Children in Korea that are Associated with Being Overweight or Obese: Jin Suk Ra, Hyun Jung Yun; Osong Public Health Res Perspect 2020;11(1):15-26. Published online February 28, 2020; DOI: https://doi.org/10.24171/j.phrp.2020.11.1.04

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<sec> Objectives The present study addressed the risk factors in early life for Korean preschool children that are associated with being overweight or obese.</sec> <sec> Methods A descriptive cross-sectional design was used to conduct this study, which included 507 mothers with preschool children aged 3–5 years, who attended daycare centers. Data were acquired via a self-administered questionnaire completed by the mothers. Of the 650 questionnaires that were distributed, 507 (78%) were completed and sent back. Multivariate logistic regression analyses were used to identify risk factors in early life, which may contribute to being overweight or obese in preschool children.</sec> <sec> Results Fifty-eight (11.4%) preschool children were overweight and 41 (8.1%) were obese. Multivariate logistic regression analysis with adjustment for covariates, revealed a significant association with the introduction of solid foods before 4 months of age [adjusted odds ratio (aOR) = 9.49, <italic>p</italic> = 0.029] and a nonresponsive feeding style (aOR = 2.80, <italic>p</italic> = 0.043) with being overweight or obese in preschool children.</sec> <sec> Conclusion The findings of this study highlighted the need for parenting education programs on feeding practices to increase their understanding of hunger and satiety cues in infants, and appropriate timing for the introduction of solid foods.</sec>

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Trajectory of Obesity and the Impact of Eating Behaviors on Obesity in Preschool Children: A Nationwide Population-Based Cohort Study in Korea
Kyeong Hun Lee, Baek Seung Kim, Gitae Seo, Hyeon-Jong Yang, Kyunghoon Kim, Eun-Ae Yang
Children.2024; 11(11): 1297. CrossRef
Systematic review and meta‐analysis of breastfeeding and later overweight or obesity expands on previous study for World Health Organization
Bernardo Lessa Horta, Nigel Rollins, Mariane S. Dias, Valquiria Garcez, Rafael Pérez‐Escamilla
Acta Paediatrica.2023; 112(1): 34. CrossRef

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Enteroparasitism and Risk Factors Associated with Clinical Manifestations in Children and Adults of Jalisco State in Western Mexico: María de la Luz Galván-Ramírez, Ana Luisa Madriz-Elisondo, Cynthia Guadalupe Temores Ramírez, Jorge de Jesús Romero Rameño, Dania Araceli de la O Carrasco, Marco Antonio Cardona López; Osong Public Health Res Perspect 2019;10(1):39-48. Published online February 28, 2019; DOI: https://doi.org/10.24171/j.phrp.2019.10.1.08

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<sec> Objectives To determine the prevalence and risk factors associated with intestinal parasites in the population of San Juan Cosala, Jalisco, Mexico.</sec> <sec> Methods A total of 277 samples from 104 participants were analysed using direct smear, flotation, formaldehyde/ethyl acetate, and modified Kinyoun’s acid-fast stain methods. The Graham method was applied only for samples from children under 12 years of age for the diagnosis of<italic> Enterobius vermicularis.</italic></sec> <sec> Results The prevalence of parasite infections in the study population was 77.9% including:<italic> Entamoeba histolytica/E. dispar/E. moshkovskii/E. bangladeshi</italic> (37.5%),<italic> Giardia intestinalis</italic> (11.5%);<italic> commensals: Endolimax nana</italic> (44.2%),<italic> Entamoeba coli</italic> (27.9%),<italic> Chilomastix mesnili</italic> (6.7%) and<italic> Iodamoeba bütschlii</italic>, (2.9%); emerging intestinal protozoans:<italic> Blastocystis</italic> spp. (49%),<italic> Cryptosporidium</italic> spp. (7.7%) and <italic>Cyclospora cayetanensis</italic> (2.9%); and helminths:<italic> Enterobius vermicularis</italic> (18.3%) and <italic>Ascaris lumbricoides</italic> (5.8%). The results also showed that 58.64% of the studied population presented polyparasitism. A significant association was found between protozoan infections and housewives, and houses that were not built with concrete ceilings, brick walls and cement floors (<italic>p</italic> < 0.05).</sec> <sec> Conclusion Polyparasitism was observed in over half the study population. The most prevalent parasite was <italic>Blastocystis</italic> spp, whilst the prevalence of helminths was less than that of protozoans. The risk factors for infection to intestinal parasites were being a housewife and not having solid brick, cement and concrete materials for house construction.</sec>

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Enterobius vermicularis Infection in a Child Population with Evidence of Vulvovaginitis and Bacterial Coinfection in Girls in Oaxaca, México
Jaime Vargas-Arzola, Aristeo Segura-Salvador, Luis Alberto Hernández-Osorio, Nancy G. Santos-Hernández, Dolores G. Vidal-López, Adriana Moreno-Rodríguez, José A. De Fuentes-Vicente, Ranjan Kumar Mohapatra
Advances in Public Health.2024;[Epub] CrossRef
Intestinal parasite infections associated with sociodemographic and seasonal factors in the Western Amazon
Gustavo Henrique Sinhorin, Ana Carolina Gomes Carneiro, Beatrice Emeli Silva Farias, Patrícia de Almeida, Antônio Ralph Medeiros-Sousa, Leonardo Augusto Kohara Melchior, Andreia Fernandes Brilhante
Parasitology Research.2023; 122(2): 419. CrossRef
Prevalence of Enterobius vermicularis among children in Iran: A comprehensive systematic review and meta-analysis
Elnaz Moussavi, Mohammad Houssaini, Nader Salari, Mahvan Hemmati, Ahmad Abdullahi, Ali Asghar Khaleghi, Shamarina Shohaimi, Masoud Mohammadi
Parasite Epidemiology and Control.2023; 22: e00315. CrossRef
Improved household flooring is associated with lower odds of enteric and parasitic infections in low- and middle-income countries: A systematic review and meta-analysis
Hugo Legge, Rachel L. Pullan, Benn Sartorius, Srinivasa Rao Mutheneni
PLOS Global Public Health.2023; 3(12): e0002631. CrossRef
Enterobiasis among Yemeni children: a cross-sectional study
Abdulelah H. Al-Adhroey, Yahya A. Al-Ansi, Mohammed A. Al-Kholani, Abdulrahman H. Amer, Marwan M. Al-Khyat, Fadia H. Al Hubaishi, Radhwan H. Aziz, Ebrahim S. Al-Khateeb, Souad A. Al-Gabri, Tawfik M. Al-Gabri
Journal of Parasitic Diseases.2022; 46(3): 722. CrossRef
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Higor Wilson Jann, Mauro Jorge Cabral-Castro, João Victor Barreto Costa, Alba Cristina Miranda de Barros Alencar, José Mauro Peralta, Regina Helena Saramago Peralta
Revista do Instituto de Medicina Tropical de São P.2022;[Epub] CrossRef
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Vanessa Oceguera-Segovia, Gabriel Obed Martínez-Rodríguez, Janet Michelle Villafuerte-Ordaz, Xóchitl Magnolia Alanís-Reyes, Angel Alberto Puig-Lagunes
Revista Mexicana de Pediatría.2022; 89(4): 146. CrossRef
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Abdurakhim Toychiev, Behzod Navruzov, Dinora Pazylova, Nikolay Davis, Najiya Badalova, Svetlana Osipova
Acta Tropica.2021; 213: 105755. CrossRef
Contamination of fresh produce sold on the Italian market with Cyclospora cayetanensis and Echinococcus multilocularis
Alessandra Barlaam, Tamirat T. Temesgen, Kristoffer R. Tysnes, Laura Rinaldi, Nicola Ferrari, Anna R. Sannella, Giovanni Normanno, Simone M. Cacciò, Lucy J. Robertson, Annunziata Giangaspero
Food Microbiology.2021; 98: 103792. CrossRef
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Anton A. Martsev
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Emine YURDAKUL ERTÜRK, Ülkü KARAMAN, Yeliz KAŞKO ARICI, Cemil ÇOLAK, Gamze YOLALAN, Şermin TOP
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Molecular genotyping of Blastocystis spp. in wild mammals from Mexico
Fernando Martinez-Hernandez, Jose Alejandro Martinez-Ibarra, Eduardo Lopez-Escamilla, Claudia Villanueva-Garcia, Claudia Irais Muñoz-Garcia, Emilio Rendon-Franco, Pablo Maravilla, Guiehdani Villalobos
Parasitology Research.2020; 119(1): 97. CrossRef
The association between the lack of safe drinking water and sanitation facilities with intestinal Entamoeba spp infection risk: A systematic review and meta-analysis
Hamid Atabati, Hamid Kassiri, Ehsan Shamloo, Mitra Akbari, Ali Atamaleki, Fatemeh Sahlabadi, Nguyen Thi Thuy Linh, Ali Rostami, Yadolah Fakhri, Amin Mousavi Khaneghah, Chia Kwung Fan
PLOS ONE.2020; 15(11): e0237102. CrossRef
Cyclospora cayetanensis and Cyclosporiasis: An Update
Sonia Almeria, Hediye N. Cinar, Jitender P. Dubey
Microorganisms.2019; 7(9): 317. CrossRef

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Cardiovascular Disease Risk Factors and Obesity Levels in Korean Adults: Results from the Korea National Health and Nutrition Examination Survey, 2007–2015: Kwanjun Park, Sunmi Lim, Yoonhyung Park, Woong Ju, Yoonhee Shin, Hansol Yeom; Osong Public Health Res Perspect 2018;9(4):150-159. Published online August 31, 2018; DOI: https://doi.org/10.24171/j.phrp.2018.9.4.03

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<sec> Objectives The increase in the obesity rate in adult males in Korea is higher than countries in the Organization for Economic Co-operation and Development and other Asian countries. We examined the trends and prevalence of major risk factors for cardiovascular disease by evaluating the weight status amongst adults from 2007 to 2015.</sec> <sec> Methods The study included 37,402 adults, who participated in the Korea National Health and Nutrition Examination Survey. The prevalence trends of cardiovascular disease risk factors were estimated for each body mass index group.</sec> <sec> Results From 2007 to 2015, significant increases in the prevalence of hypertension, diabetes, and hypercholesterolemia were observed in normal weight adults (0.03 percentage point (%p), 0.06%p, and 0.13%p, respectively). Amongst the overweight and obese adults, a significant increase in the prevalence of hypercholesterolemia was observed, During this period, the prevalence of smoking decreased amongst obese adults and no significant changes in drinking habits and physical activity were noted across all body mass index groups.</sec> <sec> Conclusion The prevalence of obesity in Korean adults is increasing, and it is necessary to implement interventions to prevent further weight gain and obesity-associated cardiovascular disease.</sec>

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Age-differentiated Risk Factors of Suicidal Ideation among Young and Middle-aged Korean Adults: Ahra Jo, Minho Jeon, Heeyoung Oh; Osong Public Health Res Perspect 2017;8(3):201-210. Published online June 30, 2017; DOI: https://doi.org/10.24171/j.phrp.2017.8.3.07

<sec>ObjectivesThis study aimed to determine the prevalence of suicidal ideation among young and middle-aged adults, and explore the risk factors that affect suicidal ideation.</sec><sec>MethodsA descriptive study design was used for secondary data analysis. A total sample of 5,214 was drawn from two waves (2012–2013) of the 7th Korea Health Panel (KHP) survey. The KHP data were collected by a well-trained interviewer using the face-to-face method during home visits as well as self-report method. Descriptive statistics of frequency, percentage, chi-square test, and logistic regression analysis were performed using SPSS 22.0.</sec><sec>ResultsThe prevalence of suicidal ideation in young and middle-aged adults was 4.4% and 5.6%, respectively. For young adults, suicidal ideation risk was higher among those with low income or heavy drinking habits. In middle-aged adults, low income, poor perceived health status, negative perception of peer-compared health status, and negative social perspective were the major risk factors.</sec><sec>ConclusionThere is considerable risk of suicidal ideation in adulthood. Opportunities for increased income, avoidance of heavy drinking, and the construction of positive subjective health status and social perspective should be considered in suicide prevention interventions for Korean young and middle-aged adults.</sec>

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Low Levels of Extensively Drug-resistant Tuberculosis among Multidrug Resistant Tuberculosis Isolates and Their Relationship to Risk Factors: Surveillance in Tehran, Iran; 2006 to 2014: Alireza Hadizadeh Tasbiti, Shamsi Yari, Mostafa Ghanei, Mohammad Ali Shokrgozar, Abolfazl Fateh, Ahmadreza Bahrmand; Osong Public Health Res Perspect 2017;8(2):116-123. Published online April 30, 2017; DOI: https://doi.org/10.24171/j.phrp.2017.8.2.03

<sec>ObjectivesExtensively drug-resistant tuberculosis (XDR-TB) is more expensive and difficult to treat than multidrug-resistant tuberculosis (MDR-TB), and outcomes for patients are much worse; therefore, it is important that clinicians understand the magnitude and distribution of XDR-TB. We conducted a retrospective study to compare the estimated incidence of and risk factors for M/XDR-TB with those of susceptible TB controls.</sec><sec>MethodsSputum culture and drug susceptibility testing (DST) were performed in patients with known or suspected TB. Strains that were identified as MDR were subjected to DST for second-line drugs using the proportion method.</sec><sec>ResultsAmong 1,442 TB patients (mean age, 46.48 ± 21.24 years) who were culture-positive for <italic>Mycobacterium tuberculosis</italic>, 1,126 (78.1%) yielded isolates that were resistant to at least one first-line drug; there were 33 isolates (2.3%) of MDR-TB, of which three (0.2%) were classified as XDR-TB. Ofloxacin resistance was found in 10 (0.7%) isolates. Women were 15% more likely than men to yield M/XDR-TB isolates, but this difference was not significant. In a multivariate analysis comparing susceptible TB with X/MDR-TB, only one variable—the number of previous treatment regimens—was associated with MDR (odds ratio, 1.06; 95% confidence interval, 1.14–21.2).</sec><sec>ConclusionThe burden of M/XDR-TB cases is not sizeable in Iran. Nonetheless, strategies must be implemented to identify and cure patients with pre-XDR-TB before they develop XDR-TB. Our results provide a greater understanding of the evolution and spread of M/XDR-TB in an environment where drug-resistant TB has a low incidence.</sec>

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Intake Trends of Red Meat, Alcohol, and Fruits and Vegetables as Cancer-Related Dietary Factors from 1998 to 2009: Min Kyung Park, Hee Young Paik, Yeonsook Lee; Osong Public Health Res Perspect 2016;7(3):180-189. Published online June 30, 2016; DOI: https://doi.org/10.1016/j.phrp.2016.04.005

Objectives Cancer is the leading cause of death worldwide, and cancer incidence and mortality have been increasing steadily in South Korea. This study aimed to examine the change in consumption of three cancer-related dietary factors—red meat, alcohol, and fruits/vegetables, and to evaluate consumption of these dietary factors among Koreans according to the criteria from the recommendations of the World Cancer Research Fund/American Institute of Cancer Research. Methods Consumption of red meat, alcoholic beverages, and fruits and vegetables was calculated from the 24-hour recall data of 36,486 individuals older than 20 years who were selected from the Korea National Health and Nutrition Examination Survey 1998–2009. The intake adequacy of these three factors was evaluated by the recommended criteria of the World Cancer Research Fund/American Institute of Cancer Research report. Results The mean red meat intake in the men in their 20s increased sharply (from 91.6 g to 111.3 g, p < 0.05). The mean alcohol intake increased continuously in men (from 10.3 g to 20.0 g, p < 0.05) and women (from 1.5 g to 3.5 g, p < 0.05). The mean fruit/vegetable intake decreased in the 21–29–year age group (from 349.4 g to 306.7 g in men; from 393.3 g to 292.5 g in women; p < 0.05). The percentage of individuals who did not meet the intake criteria for the three cancer-related dietary factors was especially high, and the percentage increased over 10 years in those in their 20s (p < 0.05). Conclusion We confirmed that intakes of red meat, alcoholic drink, and fruits and vegetables have moved toward a negative direction in both men and women in their 20s.

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Accuracy of Self-reported Hypertension, Diabetes, and Hypercholesterolemia: Analysis of a Representative Sample of Korean Older Adults: Heeran Chun, Il-Ho Kim, Kyung-Duk Min; Osong Public Health Res Perspect 2016;7(2):108-115. Published online April 30, 2016; DOI: https://doi.org/10.1016/j.phrp.2015.12.002

Objectives This study will assess the accuracy of self-reported hypertension, diabetes, and hypercholesterolemia among Korean older adults. Methods Using data from the fourth Korean National Health Examination and Nutrition Survey (KNHANES IV, 2007–2009), we selected 7,270 individuals aged 50 years and older who participated in both a health examination and a health interview survey. Self-reported prevalence of hypertension (HTN), diabetes mellitus (DM), and hypercholesterolemia was compared with measured data (arterial systolic/diastolic blood pressure, fasting glucose, and total cholesterol). Results An agreement between self-reported and measured data was only moderate for hypercholesterolemia (κ, 0.48), even though it was high for HTN (κ, 0.72) and DM (κ, 0. 82). Sensitivity was low in hypercholesterolemia (46.7%), but high in HTN and DM (73% and 79.3%, respectively). Multiple analysis shows that predictors for sensitivity differed by disease. People with less education were more likely to exhibit lower sensitivity to HTN and hypercholesterolemia, and people living in rural areas were less sensitive to DM and hypercholesterolemia. Conclusion Caution is needed in interpreting the results of community studies using self-reported data on chronic diseases, especially hypercholesterolemia, among adults aged 50 years and older.

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Composition of Metabolic Syndrome Among Korean Adults in a Lifestyle Modification Intervention: Nan-He Yoon, Seunghyun Yoo, Hyekyeong Kim; Osong Public Health Res Perspect 2014;5(6):370-377. Published online December 31, 2014; DOI: https://doi.org/10.1016/j.phrp.2014.10.005

Objectives The aim of this study was to examine the composition of metabolic syndrome (MetS) components among middle-aged and older Koreans. Methods A total of 263 participants (age 40 + years) in a lifestyle modification intervention program who met the MetS definition of National Cholesterol Education Program (NCEP) – Adult Treatment Panel (ATP) III criteria were included in the study. The frequent patterns and clustering of MetS components were investigated. Clustering of changes in individual components, through a lifestyle modification intervention, was also identified. All characteristics were stratified by and compared between sexes. Results Approximately 80% of the participants had three of five MetS risk factors at baseline. The prevalence of each risk differed by sex. MetS composition patterns that do not include low high-density lipoprotein (HDL) cholesterol were more noticeable in men because of the low prevalence of low HDL cholesterol. In women, with higher prevalence of low HDL cholesterol, more patterns that include low HDL cholesterol were observed. The most common combination was “elevated blood pressure + abdominal obesity + impaired fasting glucose” in both sexes. Clustering of MetS risks was also found with most of the frequent combinations of MetS components. Through the lifestyle intervention, the greatest change was observed in HDL cholesterol among men and blood pressure among women. Triglycerides and HDL cholesterol were likely to be improved with blood pressure in men and abdominal obesity in women. Conclusion Differences in the prevalent patterns of MetS compositions were observed prior to and after the intervention, along with during-intervention changes. It is recommended that intervention strategies and guidelines for MetS management consider the MetS composition patterns for effectiveness.

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Evidence Gap on the Prevalence of Non-conventional Risk Factors for Type 2 Diabetes in Iran: Abdolreza Shaghaghi, Ali Ahmadi; Osong Public Health Res Perspect 2014;5(5):292-297. Published online October 31, 2014; DOI: https://doi.org/10.1016/j.phrp.2014.08.002

Objectives Robust scientific evidence exists about the role of non-conventional risk factors in type 2 diabetes worldwide. The current epidemiological pattern of the disease in Iran suggests a precipitating role for these non-conventional risk factors. This review was performed to examine the research evidence suggesting a higher prevalence of non-conventional type 2 diabetes risk factors in Iran. Methods MeSH keywords were applied to search several databases, including PUBMED, MEDLINE, AMED, EMBASE, Iran DOC, and the Scientific Information Database without a time limit from inception to September 2011. The quality of the non-interventional and population-based studies on Iranians included in these databases was assessed by the authors and any disagreement was resolved with consensus. Results The literature search yielded 1847 publications, of which 62 were included in this study after eliminating non-relevant and overlapping papers. No study was found that verified a higher prevalence of the non-conventional type 2 diabetes risk factors in the Iranian population. Conclusion The identified evidence gap about the role of prominent non-conventional risk factors of type 2 diabetes in the Iranian population could be a major caveat in the application of an evidence-based approach to endorse or reject existing hypothesis about these risk factors. Studies on the prevalence of non-conventional biomarkers of type 2 diabetes among Iranians could be a promising area of research.

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