Osong Public Health and Research Perspectives最新文献

Background: The co-occurrence of tuberculosis (TB) and diabetes mellitus presents a significant global health challenge, marked by a bidirectional relationship. This study aims to evaluate the effectiveness of the tuberculosis predictive index (TPI) score, developed by Isfandiari et al., in predicting TB occurrence among individuals living with type 2 diabetes mellitus.

Methods: A case-control study was conducted using primary data collected through questionnaires administered to individuals with type 2 diabetes mellitus, with and without pulmonary TB, at the internal medicine outpatient clinic of Fatmawati General Hospital from June to August 2024. The study compared TPI scores between those with type 2 diabetes mellitus who had TB and those who did not.

Results: TPI scores were significantly associated with TB risk. Individuals with both type 2 diabetes mellitus and TB had a 6.8-fold higher risk (95% confidence interval [CI], 2.6-17.6; p<0.001) than those without TB. Further chi-square analysis identified three significant risk factors: individuals with type 2 diabetes mellitus exhibiting TB-like symptoms had a 13.3-fold increased TB risk (95% CI, 5.1-34.3; p<0.001); those with a body mass index below 18.5 kg/m² had a 3.3-fold higher risk (95% CI, 1.0-11.0; p=0.039); and those living in poorly ventilated homes (ventilation ≤10%) had a 3.2-fold higher risk (95% CI, 1.0-9.8; p=0.035).

Conclusion: This study demonstrates that individuals with type 2 diabetes mellitus who developed TB had significantly higher TPI scores, corresponding to a 6.8-fold increased risk compared to their counterparts without TB. The TPI score may serve as a valuable tool for predicting TB risk among populations living with type 2 diabetes mellitus.

Background: This study aimed to (1) assess healthcare workers' (HCWs) knowledge and attitudes toward mpox across 3 Gulf countries, and (2) examine factors influencing their acceptance of the mpox vaccine using the health belief model (HBM). This model evaluated perceptions related to susceptibility, severity, benefits, barriers, cues to action, and self-efficacy. Additionally, the study explored the impact of prior coronavirus disease 2019 (COVID-19) vaccination history on mpox vaccine acceptance.

Methods: A cross-sectional study was conducted among 764 HCWs from the United Arab Emirates (UAE), Saudi Arabia, and Qatar. Data were collected through a structured online questionnaire based on HBM constructs. Logistic regression and structural equation modeling were employed to analyze predictors of vaccine acceptance.

Results: Knowledge levels varied across the countries, with the highest proportion of good knowledge reported in the UAE (59%). UAE HCWs also demonstrated higher perceived susceptibility, perceived benefits, and intention to vaccinate compared to those in Saudi Arabia and Qatar (p<0.001). Receiving 4 doses of the COVID-19 vaccine was associated with greater acceptance of the mpox vaccine. Among the HBM constructs, perceived benefits and self-efficacy were identified as the strongest predictors of vaccine acceptance. Perceived barriers, such as fear of side effects and concerns about vaccine safety, were more prominent among HCWs in Saudi Arabia and Qatar.

Conclusion: The HBM effectively explains the factors influencing mpox vaccine acceptance among Gulf HCWs. Targeted interventions that improve perceived benefits, reduce barriers, and improve self-efficacy may facilitate greater vaccine uptake and preparedness for emerging infectious diseases.

Background: The increasing prevalence of drug use in the Republic of Korea has emerged as a significant social concern. This study applied the extended theory of planned behavior to investigate the factors influencing intentions to use drugs among young adults (aged 20-30 years) in the Republic of Korea. The study integrated personal traits-specifically, impulsivity, sensation seeking, and self-efficacy-into 2 core theory of planned behavior constructs: attitudes and subjective norms. The principal aim was to improve the prediction of drug use intentions by incorporating these variables.

Methods: Data were obtained from the 2023 National Survey of Drug Harm Perception, which sampled 1,500 individuals aged 19 to 39 years. Hierarchical regression analysis was employed to assess the influence of psychological and social factors on intentions to use drugs.

Results: In the primary model, age emerged as a significant predictor of drug use intentions (R2 =0.01). The secondary model showed that positive attitudes toward drugs, subjective norms, and lower self-efficacy significantly increased drug use intentions (R2 =0.23). In the final tertiary model, the addition of sensation seeking and impulsivity further amplified these intentions (R2 =0.25).

Conclusion: The findings underscore the pivotal roles of attitudes, subjective norms, and selfefficacy in shaping intentions to use drugs. Sensation seeking and impulsivity were found to further elevate vulnerability. Effective prevention efforts must address both psychological traits and social influences. Future research should examine the long-term behavioral outcomes associated with these factors.

Background: This study developed deep neural network (DNN) models capable of accurately classifying major adverse cardiac events (MACE) in patients with acute myocardial infarction (AMI) after hospital discharge, across 3 follow-up intervals: 1, 6, and 12 months.

Methods: DNN models were constructed to predict post-discharge MACE across 4 categories. Multiple traditional machine learning models were implemented as controls to benchmark the performance of our DNN approach. All models were evaluated based on their ability to predict MACE occurrence during the specified follow-up periods.

Results: The DNN models demonstrated superior predictive performance over conventional machine learning methods, achieving high accuracies of 0.922, 0.884, and 0.913 for the 1-month, 6-month, and 12-month follow-up periods, respectively.

Conclusion: The high accuracy of our DNN models highlights their practical advantages for AMI diagnosis and guidance of follow-up treatment. These models can serve as valuable decision support tools, enabling clinicians to optimize the overall management of AMI patients and potentially enhance their hospitalization experience.

Background: Incorporating CD40 ligand (CD40L) into vaccine strategies has shown considerable potential for enhancing immune responses. In this study, we designed and formulated a CD40Lbased multi-epitope vaccine construct using immunoinformatics approaches, and compared it to a full-length CD40L-based vaccine construct.

Methods: The study commenced with the identification and screening of potential T-cell and B-cell epitopes derived from the CD40L protein, followed by the construction of a multi-epitope vaccine from these selected epitopes. We analyzed and validated the physicochemical and structural properties of the vaccine constructs. Further, we predicted disulfide bonds, performed protein-protein docking, and conducted molecular dynamics simulations to evaluate the constructs. Comparative analyses of the ligand-binding site localization were conducted using LigPlot. Additionally, simulation trajectories were analyzed using multiple descriptors, including root mean square deviations, radius of gyration, and root mean square fluctuations.

Results: Our findings indicated that the CD40L multi-epitope vaccine construct possessed favorable physicochemical properties and a validated structural profile. Immune simulation studies showed a stronger affinity of the multi-epitope construct for the CD40 receptor compared to the full-length CD40L construct.

Conclusion: Overall, the CD40L multi-epitope vaccine construct demonstrated greater potency in eliciting an effective immune response than the full-length CD40L construct. These results highlight a promising approach to vaccine design for the prevention or treatment of infections and cancers.

Background: Anopheles sinensis is a predominant malaria vector found throughout the Republic of Korea (ROK). Population genetic analysis can provide insights into the origins and migration patterns of malaria vectors by assessing genetic variation and distribution among populations.

Methods: In this study, we examined the population genetic structure of An. sinensis in the ROK using mitochondrial cytochrome c oxidase subunit I (COI) marker.

Results: A total of 903 specimens of An. sinensis were collected from 9 sampling regions, including malaria-endemic and non-endemic areas. All populations displayed characteristics typical of migrant populations, with high haplotype diversity (Hd) and low nucleotide diversity (Pi). Network analysis identified 124 haplotypes grouped into 2 clusters. Both clusters included haplotypes from malaria-endemic and non-endemic areas. Cluster I shared its most recent common ancestry with Chinese reference sequences, while cluster II had related with Japanese reference sequences. Pairwise genetic distance (FST) analysis indicated generally low genetic differentiation among populations. Furthermore, FST values tended to increase proportionally with geographical distance between regions. Analysis of molecular variance confirmed that individual mosquitoes within the population had a large effect on the overall variation. Neutrality tests using 4 methods (Tajima's D, Fu's Fs, Fu and Li's D, and Fu and Li's F) yielded negative values, suggesting that An. sinensis populations are expanding in all studied regions.

Conclusion: This study characterizes the genetic attributes of An. sinensis in the ROK, providing valuable insights into the biology of this important malaria vector and contributing useful data for malaria control strategies.

Background: This study was performed to evaluate the prevalence of medication adherence and its determinants among Moroccan patients with type 2 diabetes mellitus.

Methods: A multicenter cross-sectional survey was conducted from February to June 2024, involving 584 patients from the Casablanca-Settat and Rabat-Sale-Kenitra regions of Morocco. Medication adherence was assessed using the general medication adherence scale. Associations between independent variables and adherence were analyzed using chi-square tests and multivariate logistic regression.

Results: Medication adherence was observed in 96.2% of participants. Multivariate analysis revealed significantly lower medication adherence among patients using 2 or more oral antidiabetic drugs (adjusted odds ratio [aOR], 0.026; 95% confidence interval [CI], 0.001-0.642; p=0.026) and those with a diabetes duration of 11 to 15 years (aOR, 0.037; 95% CI, 0.001-0.956; p=0.047).

Conclusion: Despite a high overall adherence rate, patients on dual or polytherapy and those with longer disease duration exhibited lower adherence in multivariate analysis. Targeted interventions are needed to improve adherence in these high-risk groups.

Background: Severe trauma remains a leading cause of death in the Republic of Korea. In response, regional trauma centers were established in 2012. This study evaluated the impact of direct prehospital transport to trauma centers on in-hospital mortality among patients with severe trauma using the national trauma registry.

Methods: This nationwide observational study utilized data from the Korean community-based trauma registry between 2016 and 2020. Patients with an injury severity score >15 who were directly transported from the prehospital setting were included. Variables analyzed encompassed demographics, injury mechanism, transport time, hospital level, and outcomes. The primary outcome was in-hospital mortality. Both logistic regression and decision tree models were employed.

Results: A total of 24,567 patients were included. Overall mortality decreased by 5.2% during the study period. Patients transported to level 1 or 2 trauma centers had a lower mortality rate (23.6%) compared to those transported to level 3 or 4 hospitals (28.0%). The proportion of direct transports to high-level centers increased from 46.7% to 64.1% between 2016 and 2020. Despite longer transport times, patients transported to high-level institutions exhibited improved survival, particularly when transport exceeded 30 minutes, suggesting that hospital selection may be more critical than minimizing transport time.

Conclusion: Direct transport to high-level trauma centers improves survival among patients with severe trauma, even when transport times are prolonged. These findings support the importance of a well-organized trauma system that emphasizes hospital capability in prehospital triage decisions.

Background: In the Republic of Korea, the previous surveillance system for zoonotic tuberculosis (TB) involved the X-ray testing of humans in contact with Mycobacterium bovis-infected livestock. In contrast, the updated surveillance system incorporates the genotyping of cultured Mycobacterium isolates for high-risk occupational groups. This study aimed to systematically document the detection, diagnosis, assessment, and response in the epidemic investigation of zoonotic TB in a laboratory worker in the Republic of Korea.

Methods: M. bovis was confirmed using spoligotyping and whole genome sequencing. Clinical characteristics were reviewed through epidemiological investigation and interviews with the affected individual. Transmission routes and secondary spread were assessed via field epidemiological investigations and contact evaluations using chest X-ray and interferon gamma release assay for latent TB infection.

Results: A 56-year-old laboratory worker presented with chest X-ray findings compatible with TB and subsequently tested positive for M. bovis. She had no clinical or family history of TB and remained asymptomatic. She completed a 6 month treatment regimen of isoniazid, rifampin, ethambutol, and pyrazinamide without hospitalization. Although no direct transmission pathways for zoonotic TB were identified, her work in a laboratory, processing specimens for zoonotic TB, indicated potential laboratory related exposure.

Conclusion: This case underscores the importance of stringent use of personal protective equipment among high-risk occupational groups and the implementation of an enhanced surveillance system to report zoonotic TB. These findings highlight the need for a One Health approach and proactive surveillance, emphasizing the necessity of refining and strengthening surveillance systems for precise monitoring and an effective response.