Global health & medicine最新文献

The Korea Centers for Disease Control and Prevention (KCDC) was established in 2004 after the SARS epidemic. As a national disease control agency, KCDC strengthened its capacities for global health security based on experiences from some important issues such as the Influenza A/H1N1 pandemic (2009), the Middle East Respiratory Syndrome outbreak in Korea (2015), the Zika epidemic (2016), and COVID-19 pandemic (2020-2024). KCDC can make or revise infectious disease prevention and control related law, and collect, manage and analyze disease data from all the local public health centers and medical institutions in Korea. Based on the indicator-based surveillance, event-based surveillance and laboratory-based surveillance, KCDC conducts risk assessment for public health threats and has full responsibility as a competing authority in responding to outbreaks on a legal basis, which is specified in the national disaster framework. All quarantine stations in airports and sea ports belong to KCDC, and individual international travel history data at point of entries are linked to the National Health Insurance Services Database and medical doctors can access the database when the symptomatic individual visits the clinics/hospitals to check his/her travel history in the affected countries. This is a backbone to identify and notify imported infectious diseases from local clinic/hospitals to KCDC. Based on risk assessment in KCDC, KCDC triggers the Emergency Operations Center to respond. This KCDC-centered public health governance with centralized, comprehensive surveillance and response is one of the model cases from the health security perspective to consider for countries that are to establish new national public health institutes in the post-COVID-19 era.

Urban centers face a complex and multifaceted array of public health threats from infectious disease outbreaks and incidents of foodborne pathogens to health crises due to disasters, posing grave risks to people's health and societal stability. As the operational backbone of emergency response systems, public health rapid response teams are mission-critical in performing disease surveillance, outbreak containment, and clinical case management across all phases of emergencies. Nevertheless, persistent structural barriers including workforce deficits and competency mismatches constrain operational effectiveness during large-scale health emergencies. To address these challenges, this study proposes a resilience-building framework for public health rapid response teams that takes into account multi-hazard scenario planning and the evolving nature of events. Key interventions including institutional capacity building, strategic foresight initiatives, cross-sector policy integration, and tiered resource allocation systems have been implemented in order to enhance the core resilience dimensions of withstanding shocks, agile adaptability, and restoration of functioning.

The COVID-19 pandemic has highlighted the importance of pandemic prevention, preparedness, and response (PPPR) in global health. This review first examined global health governance (GHG) for PPPR, identifying its core-satellite structure. Key GHG functions include rule-setting, resource mobilization, medical countermeasures (MCMs) supply, surveillance and data/pathogen sharing with rapid response, and One Health. Major gaps exist in global collaboration, enforcement of the International Health Regulations (IHR), and the World Health Organization's (WHO) capacity. The most urgent issue is pathogen access and benefit-sharing (PABS). Second, the PPPR capacity across world regions were assessed using two public datasets: eSPAR and GHS Index. Sub-Saharan Africa requires urgent support to strengthen most PPPR aspects, while epidemiological and laboratory surveillance, infection prevention and control (IPC), and regulatory functions need improvement in low- and middle-income countries (LMICs) in various regions outside Europe. Japan, with its strong PPPR capacity, is well-positioned to assist. Lastly, the review explored the link between PPPR and health systems strengthening (HSS). PPPR must be firmly integrated into HSS to ensure resilience, equity, inclusiveness, continuity of care, and sustainability. Core health system components - service delivery, workforce, health information systems, MCMs access, and governance - along with communication and trust-building, effectively contribute to PPPR. However, pandemic exceptionalism and the over-securitization of PPPR and health security may hinder coordination. The enhanced GHG for PPPR, led by the empowered WHO, should effectively facilitate and coordinate technical assistance to LMICs to strengthen their PPPR capacities and promote PPPR-HSS integration by bringing together the often-divided health security and HSS communities.

This commentary aims to reflect on the clinical implications of past pandemics and discuss Japans preparedness for future pandemics, with a specific focus on enhancing national countermeasures through clinical, infrastructural, and systemic reforms. By analyzing pandemics including the Spanish flu (1918), Asian flu (1957), Hong Kong flu (1968), H1N1 influenza (2009), and COVID-19 (2019- ), the article discusses their clinical features, societal impacts, and the factors that drive the spread of infectious diseases. With Japans clinical context as a case study, this commentary emphasizes the importance of enhancing healthcare systems to accommodate sudden surges in cases, with a focus on expanding infrastructure and ensuring rapid access to diagnostics, treatments, and vaccines. The commentary also advocates for improved early detection systems, effective global sharing of information, and the training of healthcare professionals to respond to emerging threats. This article argue that pandemic preparedness should go beyond lessons from COVID-19, promoting a comprehensive and flexible approach that can be adapted to a range of potential future scenarios. Such measures will help ensure that healthcare systems remain resilient and capable of mitigating the impact of future pandemics.

The duration of antimicrobial therapy required to treat community-acquired pneumonia is often longer than expected, likely because of the high number of such inpatients in developed countries with aging populations. In this study, we evaluated the effects of short-term treatments for both pneumonia and aspiration pneumonia in older Japanese adults using the nation's inpatient database. Inpatients aged ≥ 65 years who were admitted to the hospital for pneumonia or aspiration pneumonia between April 1, 2018, and October 31, 2018, were included. We compared patients treated via intravenous antibiotics for 3-7 days to control patients treated with a similar regimen for 8-28 days, using inverse probability of treatment-weighted Cox regression. The primary outcome was relapse or readmission for pneumonia and death within 30 days after completing antimicrobial therapy. The secondary outcomes were average treatment effect for Clostridioides difficile infection (CDI), chest drainage, and length of hospital stay. The total number of eligible patients was 72,294. The hazard ratio for the primary outcome was 1.04 (95% confidence interval: 0.99-1.10). The mean length of hospital stay was shortened to 9.74 days (range, 9.34-10.1) in the short-term treatment group. The prevalence rates of CDI and chest drainage did not differ significantly between the short- and long-term treatment groups. We observed no statistically significant difference in clinical outcomes between the older adults with pneumonia including aspiration pneumonia who received short- vs long-term antimicrobial therapy.

Human monkeypox (Mpox) is an emerging zoonotic disease. Its clinical features are similar to but less severe than those of smallpox. The etiology of this disease is the monkeypox virus. This virus is a double-stranded DNA virus that is classified into the genus Orthopoxvirus and the family Poxviridae. Human monkeypox was first identified in 1970 and mainly occurred in Central and Western Africa. In 2022, outbreaks of Mpox virus infection occurred in several non-endemic countries and caused a potential threat to humans. It is urgent to take immediate action to control and prevent the outbreak of the Mpox virus infection. This paper summarizes the current status of Mpox and generated strategies for managing the Mpox epidemic. Although progress in the diagnostic methods and treatment of Mpox produces better knowledge, we argue that the sensitive surveillance for animal and human Mpox virus infection and evidence-based response and management of Mpox outbreaks is critical. This study highlights the need for further research on preventive and control strategies for Mpox disease approached through the One Health concept.

In recent years, the prevalence of diabetes in the elderly has risen sharply, and diabetes and its related complications seriously affect the physical and mental health of patients. Health promotion behaviors are extremely important in preventing the onset and development of diabetes. Ego depletion is a common negative psychological experience among most patients with chronic disease, which affects their performance of health-promoting behaviors. However, the relationship between ego depletion and health-promoting behaviors in elderly patients with diabetes is unclear. We assessed the relationship between ego depletion and health-promoting behaviors in older people with diabetes, and the factors influencing health-promoting behaviors. The 751 participants had an ego depletion score of 44.55 ± 6.62 and a health-promoting behavior score of 77.61 ± 18.72, with a significant negative correlation between ego depletion and health-promoting behavior (r = -0.320, p < 0.001). The level of health promotion behaviors was higher in patients with a high school level of education and above (p < 0.001), living with a spouse and children (p = 0.010) and having received diabetes-related health education (p < 0.001), and the cognitive (p < 0.001), emotional (p < 0.001) and behavioral control dimensions of ego depletion (p = 0.016) were significant predictors of health promotion behaviors. Nursing staff should provide personalized care for patients with a low level education, who are living alone, and who have not received health education to prevent or respond to patient ego depletion and to improve patients' health promotion behaviors.

Pharmacists who provide medication to patients immediately before they overdose should intervene appropriately; however, little information exists on the types and amounts of over-the-counter (OTC) drugs that are dangerous. This study investigated the toxicity and characteristics of overdosing on a single package of commercially available OTC drugs in humans. We researched 14,107 OTC drugs. The number of products that could contain a lethal dose if taken as a single package was 1,223 (8.7%) and a toxic dose was 2,982 (21.1%). A single product containing a lethal dose to humans by therapeutic category included skin drugs (n = 672, 25.0%), psychotropic drugs (n = 288, 17.9%), and public health drugs (n = 92, 26.1%) in descending order. Comparing before and after April 2023, the number of OTC pharmaceuticals that contained ingredients that may be abused, significantly increased: psychotropic drugs (44.9% increase), respiratory drugs (8.2% increase), and urogenital and anal organs drugs (3.5% increase) (p < 0.05). These products had not been previously designated as hazardous despite their potential for abuse. The registrants in the "Drug Database for Overdose Prevention" that made these public included 199 pharmacists, registered sellers, and doctors as of July 31, 2024. The city with the most users was Osaka (377 users) and an average engagement time of 41.8 seconds, followed by Sapporo, Fukuoka, and Nagoya. These areas were consistent with urban centers and high numbers of emergency transports due to overdose. Our findings provide important pharmaceutical information that pharmacists can use for their gatekeeper activities.

Family members caring for individuals with Alzheimers disease (AD) often experience significant psychological distress, which can lead to mental health issues such as severe depression, post-traumatic stress disorder, and anxiety. We conducted a study to explore the experiences of 18 primary caregivers of AD patients through semi-structured in-depth interviews. The study identified four key stages of post-traumatic growth (PTG): i) the pain period, ii) the struggle period, iii) the recovery period, and iv) the period of positive growth. Additionally, factors that contribute to PTG among caregivers include i) strong social support, ii) active coping strategies, iii) reflection on and understanding of their caregiving experience, and iv) future planning. Healthcare professionals should incorporate strategies to promote PTG in clinical practice to effectively support caregivers.

SAG-524 is a novel, oral HBV RNA destabilizer developed to address the limitations of treatment with nucleos(t)ide analogues (NAs), which are effective against HBV DNA but show limited efficacy in reducing hepatitis B surface antigen (HBsAg) levels. SAG-524 exerts its effect by destabilizing HBV RNA by shortening the poly(A) tail, which leads to a significant reduction of both pgRNA and PreS/S mRNA. This destabilization seems to be specific for HBV RNA molecules. The mechanism involves the recruitment of PAPD5/7 by ZCCHC14 to the HBV RNA, where guanine is incorporated into the poly(A) tail to protect against degradation. SAG-524 disrupts this process by directly targeting PAPD5, thus destabilizing HBV RNA. In preclinical trials, oral administration of SAG-524 reduced serum HBsAg levels in HBV-infected PXB mice. When combined with NAs or capsid assembly modulators (CAMs), significant reductions in HBsAg, HBV DNA, and intrahepatic covalently closed circular DNA were observed. Safety studies conducted over 13 weeks in mice and monkeys revealed no significant toxicity, demonstrating the drug demonstrated a favorable safety profile. In conclusion, the novel mechanism of action, high oral bioavailability, and strong suppression of HBsAg make SAG-524 a promising candidate for future therapeutic use. The potential for combination therapy with NAs or CAMs underscores its capacity to contribute to achieving a functional cure for chronic HBV infection.