Journal of Preventive Medicine and Public Health

Original Articles

SARS-CoV-2 Infection Risk Imposed by Fully-vaccinated Air Travelers Attending an Island-confined Quarantine System Enabling Tourism During the Pandemic: A Retrospective Cohort Study: Thunyaporn Sirijantradilok, Chanapong Rojanaworarit, Isabella Andrade, Worawaran Kallayanasit, Panunda Yodkhunnathum, Somruethai Khamsakhon, Supasit Suerungruang, Nuttawoot Photisan; J Prev Med Public Health. 2024;57(6):552-563. Published online September 23, 2024; DOI: https://doi.org/10.3961/jpmph.24.351

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Abstract Summary PDF: Objectives
This study aimed to identify the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among fully vaccinated air travelers participating in an island-confined quarantine system (Phuket Sandbox Program). It also compared the differential risk of SARS-CoV-2 infection across different coronavirus disease 2019 (COVID-19) vaccines and the difference in time-to-detection periods between asymptomatic and symptomatic cases.
Methods
This retrospective cohort study determined the cumulative incidence of SARS-CoV-2 infection among 63 052 air travelers who participated in a quarantine program from July 1, 2021 to October 31, 2021. Using Poisson regression with robust standard errors, we estimated the relative risk of SARS-CoV-2 infection across different brands and types of COVID-19 vaccines, adjusting for relevant covariates. We visualized the time-to-detection periods for SARS-CoV-2 infection using Kaplan-Meier failure curves and compared these curves for asymptomatic and symptomatic travelers using the log-rank test.
Results
The overall incidence of SARS-CoV-2 infection was 0.3%. Individuals vaccinated with Ad26.COV2.S, Gam-COVID-Vac, CoronaVac, and replicating viral vector vaccines faced a significantly higher risk of infection than those who received the BNT162b2 and mRNA vaccines. The time-to-detection periods for asymptomatic and symptomatic cases did not differ significantly.
Conclusions
Despite the relatively low risk of SARS-CoV-2 infection, a risk of breakthrough cases remained with certain vaccines. Given the high proportion of asymptomatic cases, quarantine and intermittent testing should be implemented. The mandatory quarantine system proved effective in managing positive cases without necessitating a complete shutdown of travel. Implementing an island quarantine could be a viable strategy for reintroducing travel and tourism during a future COVID-19 outbreak or a new pandemic.; Summary

Key Message
"This study evaluated the SARS-CoV-2 infection rate among 63,052 fully-vaccinated air travelers participating in the Phuket Sandbox Program in 2021. A breakthrough SARS-CoV-2 infection rate of 0.3% was identified. Travelers vaccinated with Ad26.COV2.S, Gam-COVID-Vac, CoronaVac, and replicating viral vector vaccines exhibited a higher risk of breakthrough infections than those vaccinated with BNT162b2 or other mRNA vaccines. The island-confined quarantine system combined with confirmatory COVID-19 testing effectively identified post-arrival infected travelers, demonstrating its potential as a model enabling safe tourism while preventing importation of cases into communities beyond the island during the pandemic."

Excess Deaths in Korea During the COVID-19 Pandemic: 2020-2022: So-Jin Im, Ji-Yeon Shin, Duk-Hee Lee; J Prev Med Public Health. 2024;57(5):480-489. Published online August 20, 2024; DOI: https://doi.org/10.3961/jpmph.24.254

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Abstract Summary PDF Supplementary Material: Objectives
Excess deaths, an indicator that compares total mortality rates before and during a pandemic, offer a comprehensive view of the pandemic’s impact. However, discrepancies may arise from variations in estimating expected deaths. This study aims to compare excess deaths in Korea during the coronavirus disease 2019 pandemic using 3 methods and to analyze patterns using the most appropriate method.
Methods
Expected deaths from 2020 to 2022 were estimated using mortality data from 2015-2019 as reference years. This estimation employed 3 approaches: (1) simple average, (2) age-adjusted average, and (3) age-adjusted linear regression. Excess deaths by age, gender, and cause of death were also presented.
Results
The number of excess deaths varied depending on the estimation method used, reaching its highest point with the simple average and its lowest with the age-adjusted average. Age-adjusted linear regression, which accounts for both the aging population and declining mortality rates, was considered most appropriate. Using this model, excess deaths were estimated at 0.3% for 2020, 4.0% for 2021, and 20.7% for 2022. Excess deaths surged among individuals in their 20s throughout the pandemic, largely attributed to a rise in self-harm and suicide. Additionally, the results indicated sharp increases in deaths associated with “endocrine, nutritional, and metabolic diseases” and “symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified.”
Conclusions
Substantial variations in excess deaths were evident based on estimation method, with a notable increase in 2022. The heightened excess deaths among young adults and specific causes underscore key considerations for future pandemic responses.; Summary

Korean summary
초과 사망은 팬데믹 영향을 종합적으로 평가하는 핵심 지표로 잘 알려져 있으나, 추정 방법에 따라 결과가 다양한 것으로 보고되고 있다. 코로나19 팬데믹동안 흔하게 사용된 3가지 방법 – 단순 평균, 연령보정 평균, 연령 보정 선형 회귀식-을 이용하여 초과사망을 추정하였을 때, 추정 방법에 따라서 초과사망에 큰 차이가 있었다. 3가지 방법 중 인구 고령화와 사망률 감소 추이를 고려한 연령 보정 선형 회귀식이 가장 적절한 것으로 판단되었으며, 이 방법을 이용한 한국의 초과 사망은 2020년 0.3%, 2021년 4.0%, 2022년 20.7%로 추정되었다. 또한 팬데믹 전 기간 동안 20대 초과 사망이 급증했는데 이는 주로 자해와 자살의 증가로 인한 것이었으며, '내분비, 영양 및 대사 질환' 및 ' 달리 분류되지 않은 증상, 징후와 임상 및 검사의 이상소견”으로 인한 초과사망도 급증하였다.

Key Message
● Excess deaths, a comprehensive indicator of the pandemic’s impact, varied by estimation method.
● Using an age-adjusted linear regression approach, which considers an aging population and declining mortality rates, excess deaths in Korea during the COVID-19 pandemic were estimated at 0.3% for 2020, 4.0% for 2021, and 20.7% for 2022.
● Excess deaths surged among individuals in their 20s throughout the pandemic, mainly due to increased self-harm and suicide, alongside a sharp rise in deaths related to ‘endocrine, nutritional, and metabolic diseases’, and ‘symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified’.

The Influence of Family Adversities on Longitudinal Changes in Physical Inactivity Among Korean Adolescents During the COVID-19 Pandemic: Tae Kyoung Lee, Jing Zhu, Young Mi Kim, Ze-Kai Jiang, Meilin Zhang, Won Ha Choi, Tae-Young Pak, Hana Song; J Prev Med Public Health. 2024;57(5):443-450. Published online August 4, 2024; DOI: https://doi.org/10.3961/jpmph.24.236

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Abstract Summary PDF Supplementary Material: Objectives
Lack of physical activity has a critical effect on the physical and mental health of adolescents. This study examined the influence of family adversities on the longitudinal changes in physical inactivity among adolescents during the coronavirus disease 2019 (COVID-19) pandemic.
Methods
The study used multi-wave data from the Korean Children and Youth Panel Survey, including 2590 Korean adolescents aged 12-14 years. The longitudinal trajectory of physical inactivity among adolescents and the effects of related factors were estimated using a latent growth modeling method.
Results
Our results revealed a significant increase in physical inactivity among adolescents over time. At the onset of the pandemic, approximately one-seventh of Korean middle schoolers reported a lack of physical activity. However, 3 years later, during the quarantine, nearly one-fifth of these adolescents reported a significant increase in their physical inactivity. Initially, low level parental education was predictive of adolescents’ physical inactivity, but this effect diminished over time, becoming statistically insignificant by the end of the 3-year period. Moreover, the increase in physical inactivity over the 3 years was significantly influenced by parental rejection.
Conclusions
These findings suggest that adolescents who experience parental rejection are more likely to report an increase in sedentary behaviors in contexts such as the COVID-19 pandemic.; Summary

Korean summary
본 연구는 팬데믹 기간 동안 청소년의 신체 활동 변화와 신체 활동 부족에 대한 부정적 가정 환경의 영향을 조사했다. 한국 청소년 2,590명을 대상으로 한 3년간의 종단 패널 데이터를 잠재 성장 모형으로 분석하여 신체 활동 부족의 변화를 추적하였다. 그 결과, 팬데믹 기간 동안 청소년들의 신체 활동 부족이 현저히 증가했으며, 부모의 거부가 이러한 증가에 유의한 영향을 미친 것으로 나타났다.

Key Message
This study examined the impact of family adversities on the longitudinal changes in physical inactivity among 2,590 Korean adolescents during the COVID-19 pandemic. Over the 3-year period, physical inactivity increased significantly, with parental rejection playing a key role in this rise. While low parental education initially predicted higher levels of inactivity, its influence diminished over time.

Assessing COVID-19 Vulnerability Among HIV-positive Men Who Have Sex With Men in Korea: The Role of Vaccination and Sexual Behaviors: Minsoo Jung; J Prev Med Public Health. 2024;57(4):370-378. Published online June 24, 2024; DOI: https://doi.org/10.3961/jpmph.24.196

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Abstract Summary PDF: Objectives
Comorbidities increase susceptibility to severe coronavirus disease 2019 (COVID-19) infections, but limited information has been published regarding human immunodeficiency virus (HIV) and COVID-19 co-infections. This study explored the relationships among socioeconomic characteristics, sexual behaviors, and COVID-19 infection rates among Korean men who have sex with men (MSM) who are also living with HIV.
Methods
Data were collected through a web survey aimed at members of the largest gay portal site in Korea, supported by the National Research Foundation of Korea (n=1005). The primary independent variables included COVID-19-related vaccinations and sexual behaviors. The dependent variable was the incidence of COVID-19 infection among respondents during the pandemic. For statistical analysis, hierarchical multiple logistic regression was performed, controlling for potential confounding variables.
Results
Model I indicated that older MSM were less likely to contract COVID-19 (adjusted odds ratio [aOR], 0.98; 95% confidence interval [CI], 0.96 to 0.99). Model II demonstrated that HIV-positive MSM were nearly twice as likely to be infected with COVID-19 compared to their HIV-negative counterparts (aOR, 1.97; 95% CI, 1.14 to 3.41). Furthermore, even after accounting for COVID-19 vaccination status in model III, HIV-positive MSM continued to show a higher risk of infection (aOR, 1.93; 95% CI, 1.12 to 3.35).
Conclusions
The findings of this study indicate that HIV-positive MSM are at an increased risk of contracting COVID-19, even when their vaccination status is considered. Therefore, it is essential to prioritize the prevention of COVID-19 infections in HIV-positive individuals by administering appropriate antiretroviral therapy and ensuring adherence to public health guidelines.; Summary

Korean summary
이 연구는 한국의 HIV 양성인 남성 동성애자(MSM)가 코로나-19 백신접종을 했어도 HIV 음성인 MSM에 비하여 COVID-19에 감염될 위험이 더 높다는 것을 보여주었다. 이러한 결과는 항레트로바이러스 요법의 준수나 촉진과 더불어 이들 취약 계층을 위한 COVID-19 예방조치 강화와 맞춤형 공중보건 전략의 필요성을 강조한다.

Key Message
This study found that HIV-positive men who have sex with men (MSM) in Korea are at a heightened risk of contracting COVID-19 compared to HIV-negative individuals, even when vaccination status is accounted for. This finding underscore the necessity of targeted public health strategies, including the promotion of adherence to antiretroviral therapy and the reinforcement of COVID-19 prevention measures for this vulnerable population.

The Impact of COVID-19 on Healthcare Services in Bangladesh: A Qualitative Study on Healthcare Providers’ Perspectives: Sharmin Parveen, Md. Shahriar Mahbub, Nasreen Nahar, K. A. M. Morshed, Nourin Rahman, Ezzat Tanzila Evana, Nazia Islam, Abu Said Md. Juel Miah; J Prev Med Public Health. 2024;57(4):356-369. Published online June 9, 2024; DOI: https://doi.org/10.3961/jpmph.24.081

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Abstract Summary PDF: Objectives
The objective of this study was to explore healthcare providers’ experiences in managing the coronavirus disease 2019 (COVID-19) pandemic and its impact on healthcare services.
Methods
A qualitative study was conducted with 34 healthcare professionals across 15 districts in Bangladesh. Among the participants, 24 were health managers or administrators stationed at the district or upazila (sub-district) level, and 10 were clinicians providing care to patients with COVID-19. The telephone interviews were conducted in Bangla, audio-recorded, transcribed, and then translated into English. Data were analyzed thematically.
Results
Most interviewees identified a range of issues within the health system. These included unpreparedness, challenges in segregating COVID-19 patients, maintaining isolation and home quarantine, a scarcity of intensive care unit beds, and ensuring continuity of service for non-COVID-19 patients. The limited availability of personal protective equipment, a shortage of human resources, and logistical challenges, such as obtaining COVID-19 tests, were frequently cited as barriers to managing the pandemic. Additionally, changes in the behavior of health service seekers, particularly increased aggression, were reported. The primary motivating factor for healthcare providers was the willingness to continue providing health services, rather than financial incentives.
Conclusions
The COVID-19 pandemic presented a unique set of challenges for health systems, while also providing valuable lessons in managing a public health crisis. To effectively address future health crises, it is crucial to resolve a myriad of issues within the health system, including the inequitable distribution of human resources and logistical challenges.; Summary

Key Message
This qualitative study explored healthcare providers' perspectives on the impact of the COVID-19 pandemic on healthcare services. Issues within the health system, such as a lack of skilled human resources, insufficient critical care facilities, low coverage of COVID-19 tests, inadequate logistical support, poor health behaviors and practices among health service seekers posed barriers to managing the pandemic at different healthcare levels. Ensuring personal protection for health professionals in the face of a novel disease presented a significant challenge. Increasing resource allocation and developing the capacity of healthcare providers were identified as potential solutions.

Mental Health of Medical Students After Combating the COVID-19 Epidemic: A Cross-sectional Study in Vietnam: Duc Minh Cap, Anh Quang Nguyen, Tham Thi Nguyen; J Prev Med Public Health. 2024;57(4):347-355. Published online May 22, 2024; DOI: https://doi.org/10.3961/jpmph.24.108

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Abstract Summary PDF: Objectives
This study was conducted to investigate the prevalence of mental health (MH) symptoms and associated factors among medical students who were engaged in combating the coronavirus disease 2019 (COVID-19) epidemic in 4 provinces/cities of Vietnam.
Methods
A cross-sectional study with 580 participants was conducted at a medical university in Northern Vietnam. MH was assessed using the 21-item Depression, Anxiety, and Stress Scale, which was previously standardized in Vietnam. Data were collected through a structured self-administered questionnaire. Multivariate logistic regression was employed to examine the association between MH symptoms and relevant factors.
Results
Out of a total of 2703 medical students, 21.5% responded to the questionnaire. Among the 580 respondents, the prevalence rates of depression, anxiety, and stress were 43.3%, 44.0%, and 24.7%, respectively. Factors significantly associated with self-reported depression included being female and having a COVID-19 infection. Similarly, being female and having a COVID-19 infection were significantly associated with self-reported anxiety. Factors associated with self-reported stress included being female, having a personal or family history of MH symptoms, working more than 8 hr/day, and having a COVID-19 infection.
Conclusions
COVID-19 has adversely impacted the MH of medical students. Our findings are valuable in their potential to motivate universities, MH professionals, and authorities to offer mental healthcare services to this group. Furthermore, there is a pressing need for training courses designed to equip future healthcare workers with the skills to manage crises effectively.; Summary

Key Message
This study investigated mental health symptoms among medical students after being involved in combating COVID-19 in Vietnam. Out of 580 participants, depression, anxiety, and stress rates were 43.3%, 44.0%, and 24.7%, respectively. Factors significantly associated with self-reported depression and anxiety were being female and having a COVID-19 infection. Factors associated with self-reported stress included being female, having a personal or family history of mental health symptoms, working more than 8 hours per day, and having a COVID-19 infection. The study emphasizes the importance of providing psychological support for medical students and the necessity for training programs to enhance crisis management skills.

Symptoms, Mental Health, and Quality of Life Among Patients After COVID-19 Infection: A Cross-sectional Study in Vietnam: Hai Nguyen Thanh, Duc Cap Minh, Hien Hoang Thu, Duc Nguyen Quang; J Prev Med Public Health. 2024;57(2):128-137. Published online February 27, 2024; DOI: https://doi.org/10.3961/jpmph.23.511

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Abstract Summary PDF

Objectives
This study was conducted to characterize the symptoms, mental health, quality of life (QoL), and associated factors following the coronavirus disease 2019 (COVID-19) infection.
Methods
This cross-sectional study included 394 participants previously infected with COVID-19 in Ho Chi Minh City, Vietnam. Mental health was assessed using the 21-item Depression, Anxiety, and Stress Scale (DASS-21). Participants self-reported health-related QoL was measured with the EuroQol 5-Dimension 5-Level (EQ-5D-5L) scale.
Results
Among the participants, 76.4% reported experiencing at least one symptom following COVID-19 infection. The most common symptoms were fatigue (42.1%), cognitive dysfunction (42.9%), and hair loss (27.9%). According to the DASS-21 results, the proportions of depression, anxiety, and stress were 28.7%, 26.4%, and 20.6%, respectively. The mean scores on the EQ-5D-5L and the EuroQol Visual Analog Scale were 0.94±0.11 and 84.20±13.11, respectively. Regarding QoL issues, the highest proportion of participants (32.7%) reported experiencing anxiety or depression, followed by pain or discomfort (25.4%). Multivariable logistic regression analysis revealed that factors associated with the presence of symptoms following COVID-19 infection included female (odds ratio [OR], 2.84; 95% confidence interval [CI], 1.65 to 4.91) and having QoL issues (OR, 3.25; 95% CI, 1.71 to 6.19).
Conclusions
The study investigated the prevalence rates of various symptoms following COVID-19 infection. These findings underscore the need to prioritize comprehensive care for individuals recovering from COVID-19 and to implement strategies to mitigate the long-term impact of the disease on mental health and QoL.

Summary

Key Message
This cross-sectional study in Vietnam investigated symptoms, mental health, and quality of life among patients recovering from COVID-19. The study found that most participants experienced post-infection symptoms, with fatigue, cognitive dysfunction, and hair loss being the most common. Mental health issues were prevalent, and participants reported varying levels of quality of life. The findings highlight the importance of comprehensive care and strategies to address the long-term impact of COVID-19 on mental health and quality of life.

Citations

Citations to this article as recorded by

Quality of sleep after COVID-19 infection: a cross-sectional study in the Southern Italy
Vincenza Sansone, Silvia Angelillo, Giovanna Paduano, Claudia Pileggi, Carmelo Giuseppe Angelo Nobile, Gabriella Di Giuseppe
Frontiers in Psychiatry.2024;[Epub] CrossRef

Excess Deaths During the COVID-19 Pandemic in Southern Iran: Estimating the Absolute Count and Relative Risk Using Ecological Data: Mohammadreza Zakeri, Alireza Mirahmadizadeh, Habibollah Azarbakhsh, Seyed Sina Dehghani, Maryam Janfada, Mohammad Javad Moradian, Leila Moftakhar, Mehdi Sharafi, Alireza Heiran; J Prev Med Public Health. 2024;57(2):120-127. Published online February 7, 2024; DOI: https://doi.org/10.3961/jpmph.23.198

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Abstract Summary PDF Supplementary Material: Objectives
The coronavirus disease 2019 (COVID-19) pandemic led to increased mortality rates. To assess this impact, this ecological study aimed to estimate the excess death counts in southern Iran.
Methods
The study obtained weekly death counts by linking the National Death Registry and Medical Care Monitoring Center repositories. The P-score was initially estimated using a simple method that involved calculating the difference between the observed and expected death counts. The interrupted time series analysis was then used to calculate the mean relative risk (RR) of death during the first year of the pandemic.
Results
Our study found that there were 5571 excess deaths from all causes (P-score=33.29%) during the first year of the COVID-19 pandemic, with 48.03% of these deaths directly related to COVID-19. The pandemic was found to increase the risk of death from all causes (RR, 1.26; 95% confidence interval [CI], 1.19 to 1.33), as well as in specific age groups such as those aged 35-49 (RR, 1.21; 95% CI, 1.12 to 1.32), 50-64 (RR, 1.38; 95% CI, 1.28 to 1.49), and ≥65 (RR, 1.29; 95% CI, 1.12 to 1.32) years old. Furthermore, there was an increased risk of death from cardiovascular diseases (RR, 1.17; 95% CI, 1.11 to 1.22).
Conclusions
There was a 26% increase in the death count in southern Iran during the COVID-19 pandemic. More than half of these excess deaths were not directly related to COVID-19, but rather other causes, with cardiovascular diseases being a major contributor.; Summary

Key Message
During the first year of the COVID-19 pandemic in southern Iran, there was a notable increase in excess deaths, representing a 33.29% rise compared to expected figures. Approximately half of these excess deaths were directly attributed to COVID-19. Moreover, the pandemic heightened the risk of death across all causes by 26%, with specific age groups, notably those aged 50-64, experiencing heightened vulnerability. Notably, cardiovascular diseases emerged as a significant contributor to excess mortality during this period, while decreases were observed in deaths related to chronic respiratory diseases and cancers.

Alleviation of PM_2.5-associated Risk of Daily Influenza Hospitalization by COVID-19 Lockdown Measures: A Time-series Study in Northeastern Thailand: Benjawan Roudreo, Sitthichok Puangthongthub; J Prev Med Public Health. 2024;57(2):108-119. Published online January 19, 2024; DOI: https://doi.org/10.3961/jpmph.23.349

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Abstract Summary PDF Supplementary Material

Objectives
Abrupt changes in air pollution levels associated with the coronavirus disease 2019 (COVID-19) outbreak present a unique opportunity to evaluate the effects of air pollution on influenza risk, at a time when emission sources were less active and personal hygiene practices were more rigorous.
Methods
This time-series study examined the relationship between influenza cases (n=22 874) and air pollutant concentrations from 2018 to 2021, comparing the timeframes before and during the COVID-19 pandemic in and around Thailand’s Khon Kaen province. Poisson generalized additive modeling was employed to estimate the relative risk of hospitalization for influenza associated with air pollutant levels.
Results
Before the COVID-19 outbreak, both the average daily number of influenza hospitalizations and particulate matter with an aerodynamic diameter of 2.5 μm or less (PM_2.5) concentration exceeded those later observed during the pandemic (p<0.001). In single-pollutant models, a 10 μg/m³ increase in PM_2.5 before COVID-19 was significantly associated with increased influenza risk upon exposure to cumulative-day lags, specifically lags 0-5 and 0-6 (p<0.01). After adjustment for co-pollutants, PM_2.5 demonstrated the strongest effects at lags 0 and 4, with elevated risk found across all cumulative-day lags (0-1, 0-2, 0-3, 0-4, 0-5, and 0-6) and significantly greater risk in the winter and summer at lag 0-5 (p<0.01). However, the PM_2.5 level was not significantly associated with influenza risk during the COVID-19 outbreak.
Conclusions
Lockdown measures implemented during the COVID-19 pandemic could mitigate the risk of PM_2.5-induced influenza. Effective regulatory actions in the context of COVID-19 may decrease PM_2.5 emissions and improve hygiene practices, thereby reducing influenza hospitalizations.

Summary

Key Message
In the present research, both single- and multi-pollutant models indicated that the level of PM2.5 was significantly related to the daily number of influenza cases in Khon Kaen, Thailand, prior to the COVID-19 outbreak. Additionally, a significant risk difference was observed between the pre-outbreak and the pandemic periods due to the reduction in air pollutant concentrations because of lockdown measures to control the spread of COVID-19. These findings could be useful for developing environmental policies and strategies accordingly to mitigate respiratory health issues.

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Environmental Impact by Particulate Material and Meteorological Parameters on the Incidence of Positive Cases of COVID-19 During the First Year of the Pandemic in a High Andean City
Ivan Cesar Miranda Hankgo, Bruce Stephen Warthon Olarte, Ariatna Isabel Zamalloa Ponce de Leon, Julio Lucas Warthon Ascarza, Amanda Olarte Perez, Greg Lucas Warthon Olarte, Victor Fernando Ramos Salcedo
Earth Systems and Environment.2024; 8(4): 1267. CrossRef

Trends in Research on Patients With COVID-19 in Korean Medical Journals: Heejeong Choi, Seunggwan Song, Heesang Ahn, Hyobean Yang, Hyeonseong Lim, Yohan Park, Juhyun Kim, Hongju Yong, Minseok Yoon, Mi Ah Han; J Prev Med Public Health. 2024;57(1):47-54. Published online January 17, 2024; DOI: https://doi.org/10.3961/jpmph.23.254

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Abstract Summary PDF Supplementary Material: Objectives
This study was conducted to systematically summarize trends in research concerning patients with coronavirus disease 2019 (COVID-19) as reported in Korean medical journals.
Methods
We performed a literature search of KoreaMed from January 2020 to September 2022. We included only primary studies of patients with COVID-19. Two reviewers screened titles and abstracts, then performed full-text screening, both independently and in duplicate. We first identified the 5 journals with the greatest numbers of eligible publications, then extracted data pertaining to the general characteristics, study population attributes, and research features of papers published in these journals.
Results
Our analysis encompassed 142 primary studies. Of these, approximately 41.0% reported a funding source, while 3.5% disclosed a conflict of interest. In 2020, 42.9% of studies included fewer than 10 participants; however, by 2022, the proportion of studies with over 200 participants had increased to 40.6%. The most common design was the cohort study (48.6%), followed by case reports/series (35.2%). Only 3 randomized controlled trials were identified. Studies most frequently focused on prognosis (58.5%), followed by therapy/intervention (20.4%). Regarding the type of intervention/exposure, therapeutic clinical interventions comprised 26.1%, while studies of morbidity accounted for 13.4%. As for the outcomes measured, 50.7% of studies assessed symptoms/clinical status/improvement, and 14.1% evaluated mortality.
Conclusions
Employing a systematic approach, we examined the characteristics of research involving patients with COVID-19 that was published in Korean medical journals from 2020 onward. Subsequent research should assess not only publication trends over a longer timeframe but also the quality of evidence provided.; Summary

Korean summary
본 연구는 2020년 이후 국내 의학저널에 보고된 코로나19 환자를 대상으로 진행된 연구의 특성을 체계적 방법론을 통해 살펴보았다. 142개 연구 중 5개는 국제 연구자들과 협력했으며 약 50%가 자금 지원에 관해 보고하였으며, 2022년에는 2020년에 비해 대규모 환자 코호트를 포함하는 연구 수가 증가하였다. 연구의 약 20%는 약물 치료와 같은 개입의 영향을 평가하였으며, 향후 연구에서는 장기간에 걸친 연구 경향 뿐만 아니라 연구의 질도 평가해야 할 것이다.

Key Message
This study employed a systematic approach to examine the characteristics of research conducted among patients with COVID-19, as reported in Korean medical journals from 2020 onward. Of 142 studies, 5 involved collaborations with international researchers, and approximately 50% made any declaration regarding funding, and By 2022, an increase was evident in the number of studies that included a large patient cohort relative to the year 2020. Roughly 20% of the studies assessed the impact of interventions, such as pharmaceutical treatments, and further research should assess not only publication trends over a longer timeframe but also the quality of evidence provided.

Mental Health Among Healthcare Workers During the COVID-19 Pandemic in Vietnam: Nhan Phuc Thanh Nguyen, Ha Phan Ai Nguyen, Cao Khoa Dang, Minh Tri Phan, Huynh Ho Ngoc Quynh, Van Tuan Le, Chinh Van Dang, Tinh Huu Ho, Van Trong Phan, Thang Van Dinh, Thang Phan, Thi Anh Thu Dang; J Prev Med Public Health. 2024;57(1):37-46. Published online December 11, 2023; DOI: https://doi.org/10.3961/jpmph.23.327

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Abstract Summary PDF: Objectives
The objective of this study was to characterize mental health issues among Vietnamese healthcare workers (HCWs) and to identify related factors.
Methods
A cross-sectional study was conducted with 990 HCWs in 2021. Their mental health status was measured using the Depression, Anxiety, and Stress Scale.
Results
In total, 49.9%, 52.3%, and 29.8% of respondents were found to have depression, anxiety, and stress, respectively. The multivariable linear regression model revealed that factors associated with increased anxiety scores included depression scores (β, 0.45; 95% confidence interval [CI], 0.39 to 0.51) and stress scores (β, 0.46; 95% CI, 0.41 to 0.52). Factors associated with increased depression scores included being frontline HCWs (β, 0.57; 95% CI, 0.10 to 1.10), stress scores (β, 0.50; 95% CI, 0.45 to 0.56), and anxiety scores (β, 0.41; 95% CI, 0.36 to 0.47), while working experience was associated with reduced depression scores (β, -0.08; 95% CI, -0.16 to -0.01). Factors associated with increased stress scores included working experience (β, 0.08; 95% CI, 0.00 to 0.16), personal protective equipment interference with daily activities (β, 0.55; 95% CI, 0.07 to 1.00), depression scores (β, 0.54; 95% CI, 0.48 to 0.59), and anxiety scores (β, 0.45; 95% CI, 0.39 to 0.50), while age was associated with reduced stress scores (β, -0.12; 95% CI, -0.20 to -0.05).
Conclusions
Specific interventions are necessary to enhance and promote the mental health of HCWs so they can successfully cope with the circumstances of the pandemic.; Summary

Key Message
A cross-sectional study of 990 Vietnamese healthcare workers in Vietnam, 2021 revealed significant mental health issues: 49.9 % suffered from depression, 52.3 % from anxiety, and 29.8 % from stress. The study found a correlation between these conditions, with frontline workers being particularly vulnerable to depression. These findings highlight the critical need for targeted mental health interventions for healthcare workers, particularly those new to the field and working on the front lines, in order to better manage pandemic-related stressors.

Changes in Adolescent Health Behavior and the Exacerbation of Economic Hardship During the COVID-19 Pandemic: A Cross-sectional Study From the Korea Youth Risk Behavior Survey: Chaeeun Kim, Haeun Lee, Kyunghee Jung-Choi, Hyesook Park; J Prev Med Public Health. 2024;57(1):18-27. Published online November 11, 2023; DOI: https://doi.org/10.3961/jpmph.23.306

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Abstract Summary PDF Supplementary Material

Objectives
This study investigated the association between exacerbated economic hardship during the coronavirus disease 2019 (COVID-19) pandemic and changes in the health behaviors of Korean adolescents.
Methods
We analyzed data from the 2021 Korea Youth Risk Behavior Survey and included 44 908 students (22 823 boys and 22 085 girls) as study subjects. The dependent variables included changes in health behaviors (breakfast habits, physical activity, and alcohol use) that occurred during the COVID-19 pandemic. The aggravation of economic hardship by COVID-19 and the subjective economic status of the family were used as exposure variables. Multiple logistic regression analysis was utilized to calculate the prevalence odds ratios (PORs).
Results
Severe exacerbation of a family’s economic hardship due to COVID-19 was negatively associated with the health behaviors of adolescents, including increased breakfast skipping (POR, 1.85; 95% confidence interval [CI], 1.55 to 2.21 for boys and POR, 1.56; 95% CI, 1.27 to 1.92 for girls) and decreased physical activity (POR, 1.37; 95% CI, 1.19 to 1.57 for boys and POR, 1.38; 95% CI, 1.19 to 1.60 for girls). These negative changes in health behaviors were further amplified when combined with a low subjective family economic status.
Conclusions
The experience of worsening household hardship can lead to negative changes in health behavior among adolescents. It is crucial to implement measures that address the economic challenges that arise from stressful events such as COVID-19 and to strive to improve the lifestyles of adolescents under such circumstances.

Summary

Korean summary
이 연구는 코로나바이러스감염증-19 (COVID-19) 대유행 기간 악화된 가구의 경제적 상황과 청소년의 건강 행태 변화의 관련성을 청소년건강행태조사를 이용하여 분석하였다. 가구의 경제적 상황이 COVID-19로 인해 심각하게 악화된 경우, 청소년 건강 행태의 부정적인 변화와 연관성이 관찰되었다. 가구의 경제적 상황이 악화되는 경험은 청소년들의 건강 행태에 부정적인 변화를 초래할 수 있다. COVID-19와 같은 사회적 사건으로 인해 발생하는 경제적 어려움에 대응하는 조치를 마련하고, 이러한 상황에서 청소년들의 건강 행태를 개선하기 위한 개입이 필요하다.

Key Message
This study investigated the association between exacerbated economic hardship during the coronavirus disease 2019 (COVID-19) pandemic and changes in the health behaviors of Korean adolescents using the 2021 Korea Youth Risk Behavior Survey. Severe exacerbation of a family’s economic hardship due to COVID-19 was negatively associated with the health behaviors of adolescents. The experience of worsening household hardship can lead to negative changes in health behavior among adolescents. It is crucial to implement measures that address the economic challenges that arise from stressful events such as COVID-19 and to strive to improve the lifestyles of adolescents under such circumstances.

Citations

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Family Dynamics, Socioeconomic Hardships, and Health Risk Behaviours of Bulgarian Adolescents during the COVID-19 Pandemic
Elitsa Dimitrova, Anna Alexandrova-Karamanova
Children.2024; 11(8): 1016. CrossRef

An Important Strategy to Improve Adolescent Health Literacy: COVID-19 Modules in High School in Indonesia: Nurina Hasanatuludhhiyah, Visuddho Visuddho, Abdul Khairul Rizki Purba, Annette d’ Arqom, Ancah Caesarina Novi Marchianti; J Prev Med Public Health. 2023;56(6):523-532. Published online November 1, 2023; DOI: https://doi.org/10.3961/jpmph.23.113

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Abstract Summary PDF

Objectives
During the second coronavirus disease 2019 (COVID-19) surge, cases increased sharply due to low awareness and compliance with measures to limit disease spread. Health literacy (HL) is an important component of public health initiatives, and schools are potential sources of health education to increase HL via the presentation of COVID-19 educational modules.
Methods
This cross-sectional study involved an online questionnaire administered to students from 5 high schools in Surabaya and Sidoarjo, Indonesia, 6-7 weeks after the start of government-issued directives restricting public gatherings. We collected data on each respondent’s age, gender, parental education, and socioeconomic variables. HL was determined by the Health Literacy Measure for Adolescents. We additionally measured their attitudes and behaviors related to preventing the spread of COVID-19. The students were asked if they watched the COVID-19 module at school, their feelings about vaccination, and preferred online sources of COVID-19-related information.
Results
Most of the 432 respondents had viewed COVID-19 modules at school. Module exposure was associated with significantly higher total and domain-specific HL and more positive attitudes toward government-issued COVID-19 restrictions on travel and public gatherings (p<0.05). However, behaviors to prevent COVID-19 spread and vaccine acceptance were not associated with module exposure. Most students chose social media as their source of COVID-19-related information.
Conclusions
Schools can provide information to increase adolescents’ HL and the public’s support for health initiatives to prevent or limit the spread of COVID-19.

Summary

Key Message
A cross-sectional study carried out on high school students during the second surge of COVID-19 in Indonesia revealed that they benefitted from the COVID-19 module. Students who viewed the module had higher scores on health literacy measures of adolescents (HELMA), had a more favorable attitude toward government-issued restrictive policies, and were more likely to have adequate health literacy, in regard to the ability to use health information. These imply schools as part of the public health response by providing education to increase adolescents’ health literacy and the public’s support for health initiatives to prevent and limit the spread of COVID-19.

Citations

Citations to this article as recorded by

TikTok and digital health literacy: A systematic review
Margaret Kristin Merga
IFLA Journal.2024;[Epub] CrossRef

Vaccination Status and In-hospital Mortality Among Adults With COVID-19 in Jakarta, Indonesia: A Retrospective Hospital-based Cohort Study: Hotma Martogi Lorensi Hutapea, Pandji Wibawa Dhewantara, Anton Suryatma, Raras Anasi, Harimat Hendarwan, Mondastri Korib Sudaryo, Dwi Gayatri; J Prev Med Public Health. 2023;56(6):542-551. Published online October 30, 2023; DOI: https://doi.org/10.3961/jpmph.23.360

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Abstract Summary PDF Supplementary Material: Objectives
Prospective studies on vaccination status and mortality related to coronavirus disease 2019 (COVID-19) in low-resource settings are still limited. We assessed the association between vaccination status (full, partial, or none) and in-hospital mortality among COVID-19 patients at most hospitals in Jakarta, Indonesia during the Delta predomination wave.
Methods
We conducted a retrospective cohort study among hospitalized COVID-19 patients who met the study criteria (>18 years old and admitted for inpatient treatment because of laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection). We linked individual-level data in the hospital admission database with vaccination records. Several socio-demographic and clinical characteristics were also analyzed. A Cox proportional hazards regression model was used to explore the association between vaccination status and in-hospital mortality in this patient group.
Results
In total, 40 827 patients were included in this study. Of these, 70% were unvaccinated (n=28 543) and 19.3% (n=7882) died during hospitalization. The mean age of the patients was 49 years (range, 35-59), 53.2% were female, 22.0% had hypertension, and 14.2% were treated in the intensive care unit, and the median hospital length of stay across the group was 9 days. Our study showed that the risk of in-hospital mortality among fully and partially vaccinated patients was lower than among unvaccinated adults (adjusted hazard ratio [aHR], 0.43; 95% confidence interval [CI], 0.40 to 0.47 and aHR, 0.70; 95% CI, 0.64 to 0.77, respectively).
Conclusions
Vaccinated patients had fewer severe outcomes among hospitalized adults during the Delta wave in Jakarta. These features should be carefully considered by healthcare professionals in treating adults within this patient group.; Summary

Key Message
During the COVID-19 pandemic the Delta variant of SARS-CoV-2 was dominating and challenging. Vaccination is one of many approaches to control the pandemic. We assessed the association between vaccination status and in-hospitalized mortality in COVID-19 patients. We found that vaccination status was associated with lower mortality, and fully vaccinated patients experienced lower risk of in-hospitalized mortality compared to partially vaccinated ones.

Healthcare Systems and COVID-19 Mortality in Selected OECD Countries: A Panel Quantile Regression Analysis: Jalil Safaei, Andisheh Saliminezhad; J Prev Med Public Health. 2023;56(6):515-522. Published online October 15, 2023; DOI: https://doi.org/10.3961/jpmph.23.162

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Abstract Summary PDF: Objectives
The pandemic caused by coronavirus disease 2019 (COVID-19) has exerted an unprecedented impact on the health of populations worldwide. However, the adverse health consequences of the pandemic in terms of infection and mortality rates have varied across countries. In this study, we investigate whether COVID-19 mortality rates across a group of developed nations are associated with characteristics of their healthcare systems, beyond the differential policy responses in those countries.
Methods
To achieve the study objective, we distinguished healthcare systems based on the extent of healthcare decommodification. Using available daily data from 2020, 2021, and 2022, we applied quantile regression with non-additive fixed effects to estimate mortality rates across quantiles. Our analysis began prior to vaccine development (in 2020) and continued after the vaccines were introduced (throughout 2021 and part of 2022).
Results
The findings indicate that higher testing rates, coupled with more stringent containment and public health measures, had a significant negative impact on the death rate in both pre-vaccination and post-vaccination models. The data from the post-vaccination model demonstrate that higher vaccination rates were associated with significant decreases in fatalities. Additionally, our research indicates that countries with healthcare systems characterized by high and medium levels of decommodification experienced lower mortality rates than those with healthcare systems involving low decommodification.
Conclusions
The results of this study indicate that stronger public health infrastructure and more inclusive social protections have mitigated the severity of the pandemic’s adverse health impacts, more so than emergency containment measures and social restrictions.; Summary

Key Message
This study investigates whether COVID-19 mortality rates across a group of developed nations are associated with characteristics of their healthcare systems, beyond the differential policy responses in those countries. To this aim, a quantile regression with non-additive fixed effects is applied to estimate mortality rates across quantiles. The results of this study indicate that stronger public health infrastructure and more inclusive social protections have mitigated the severity of the pandemic’s adverse health impacts, more so than emergency containment measures and social restrictions.

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