Search Results (146)

Background/Objectives: The two major subtypes of inflammatory bowel disease (IBD)—Crohn’s disease (CD) and ulcerative colitis (UC)—are known to increase the likelihood of developing colorectal cancer (CRC). While this relationship has been well studied in Western populations, evidence from East Asia remains limited and inconsistent. Using nationwide cohort data, this study explored the potential connection between IBD and CRC in a large Korean population. Methods: We conducted a retrospective cohort study using data from the Korean National Health Insurance Service–National Sample Cohort from 2005 to 2019. A total of 9920 CRC patients were matched 1:4 with 39,680 controls using propensity scores based on age, sex, income, and region. Overlap weighting and multivariable logistic regression were used to evaluate the association between IBD and CRC. Subgroup analyses were conducted to assess effect modification by demographic and clinical factors. Results: IBD markedly increased the likelihood of developing CRC (adjusted odds ratio (aOR) = 1.38; 95% confidence interval (CI): 1.20–1.58; p < 0.001), with the association primarily driven by UC (aOR = 1.52; 95% CI: 1.27–1.83). CD appeared unrelated to heightened CRC risk overall, though a significant association was observed among low-income CD patients (aOR = 1.58; 95% CI: 1.15–2.16). The UC–CRC association persisted across all subgroups, including patients without comorbidities. Conclusions: Our findings support an independent association between IBD—particularly UC—and increased CRC risk in Korea. These results underscore the need for personalized CRC surveillance strategies that account for disease subtype, comorbidity burden, and socioeconomic status, especially in vulnerable subpopulations. Full article

Emerging infectious diseases such as chytridiomycosis and ranavirosis, caused by Batrachochytrium dendrobatidis (Bd) and ranavirus (RV), respectively, are major contributors to global amphibian declines. Despite their significance, comprehensive data on the spatial epidemiology of these pathogens in South Korea remain limited. This study aimed to assess the nationwide co-occurrence and prevalence of Bd and RV across four anuran species in five administrative regions. Infection rates were analyzed in relation to host species, sex, and life history stage. Results indicated distinct prevalence patterns driven by ecological traits. Bd was predominantly detected in mountainous and coastal habitats, whereas RV was more common in flat inland areas. Both pathogens exhibited peak occurrence in central regions, likely reflecting seasonal transmission dynamics rather than stable endemic hotspots. The observed spatial heterogeneity appears to be influenced by pathogen-specific thermal tolerance and host ecology. These findings underscore the importance of understanding host–pathogen–environment interactions for effective disease surveillance and management. Continuous monitoring and integrative ecological approaches are essential to mitigate pathogen-induced biodiversity loss and to inform amphibian conservation strategies in East Asia. Full article

Background/Objectives: Initial cardiac rhythm is a known prognostic indicator in out-of-hospital cardiac arrest (OHCA). However, the impact of rhythm conversion during cardiopulmonary resuscitation (CPR) on outcomes in patients undergoing extracorporeal CPR (ECPR) remains unclear. This study evaluated the association between initial and converted cardiac rhythms and outcomes in patients with refractory OHCA treated with ECPR. Methods: This nationwide retrospective observational study analyzed data from the Out-of-Hospital Cardiac Arrest Surveillance registry in South Korea (2008–2022). Patients were categorized into three groups: initial shockable rhythm (SR), non-shockable rhythm (NSR) converted to SR, and refractory NSR. The primary outcome was survival to hospital discharge; the secondary outcome was favorable neurological status (CPC 1–2). Results: Among 681 patients, 161 had initial SR, 345 had converted SR, and 175 had refractory NSR. Before matching, survival and CPC 1–2 rates were highest in the initial SR group (21.1% and 15.5%), followed by the converted SR group (19.4% and 11.6%), and lowest in the refractory NSR group (9.7% and 4.0%) (p < 0.01). After matching, CPC 1–2 remained significantly higher in the initial SR group (14.4%) and in the converted SR group (9.3%) vs. the refractory NSR group (5.1%, p = 0.016; 3.7%, p = 0.042). Persistent NSR was independently associated with poor neurological outcomes compared to both initial SR (AOR 0.337, p = 0.037) and converted SR (AOR 0.283, p = 0.020). Conclusions: Rhythm conversion from NSR to SR before ECPR was associated with significantly improved neurological outcomes. Rhythm conversion may serve as a prognostic marker and resuscitation target to guide ECPR decisions. Full article

Background/Objectives: Mobile healthcare units (MHUs) comprise flexible, ambulatory healthcare teams that deliver community care services, particularly in underserved or remote areas. In Greece, MHUs were pivotal in epidemiological surveillance during the COVID-19 pandemic and are now evolving into a sustainable and integrated service for much-needed community-based healthcare. To support this expanded role, targeted, competency-based training is essential; however, this can pose challenges, especially in coordinating synchronous learning across geographically dispersed teams and in ensuring engagement using an online format. Methods: A nationwide, online training program was developed to improve the knowledge of the personnel members of the Hellenic National Public Health Organization’s MHUs. This program was structured focusing on four core themes: (i) prevention–health promotion; (ii) provision of care; (iii) social welfare and solidarity initiatives; and (iv) digital health skill enhancement. The program was implemented by the University of Crete’s Center for Training and Lifelong Learning from 16 January to 24 February 2025. A multidisciplinary team of 64 experts delivered 250 h of live and on-demand educational content, including health screenings, vaccination protocols, biomarker monitoring, chronic disease management, treatment adherence, organ donation awareness, counseling on social violence, and eHealth applications. Knowledge acquisition was assessed through a pre- and post-training multiple-choice test related to the core themes. Trainees’ and trainers’ qualitative feedback was evaluated using a 0–10 numerical rating scale (Likert-type). Results: A total of 873 MHU members participated in the study, including both healthcare professionals and administrative staff. The attendance rate was consistently above 90% on a daily basis. The average assessment score increased from 52.8% (pre-training) to 69.8% (post-training), indicating 17% knowledge acquisition. The paired t-test analysis demonstrated that this improvement was statistically significant (t = −8.52, p < 0.001), confirming the program’s effectiveness in enhancing knowledge. As part of the evaluation of qualitative feedback, the program was positively evaluated, with 75–80% of trainees rating key components such as content, structure, and trainer effectiveness as “Very Good” or “Excellent.” In addition, using a 0–10 scale, trainers rated the program relative to organization (9.4/10), content (8.8), and trainee engagement (8.9), confirming the program’s strength and scalability in primary care education. Conclusions: This initiative highlights the effectiveness of a structured, online training program in enhancing MHU knowledge, ensuring standardized, high-quality education that supports current primary healthcare needs. Future studies evaluating whether the increase in knowledge acquisition may also result in an improvement in the personnel’s competencies, and clinical practice will further contribute to assessing whether additional training programs may be helpful. Full article

Bovine leukemia virus (BLV) remains a major concern for cattle industries worldwide due to its persistent nature, economic impact, and challenges in control. In this study, we conducted a comprehensive nationwide survey of BLV in Kazakhstan between 2014 and 2024, utilizing serological diagnostics to assess prevalence and characterize viral genotypes (2024). A total of 433,537 serum samples were screened by agar gel immunodiffusion (AGID), revealing an overall seroprevalence of 5.87%, with the highest rates observed in the North Kazakhstan, Kostanay, and East Kazakhstan regions. In 2024, a targeted analysis of 3736 serum and 536 whole blood samples across 17 regions was performed using AGID, ELISA, real-time PCR, and nested PCR. ELISA demonstrated higher sensitivity than AGID (10.4% vs. 8.2%), confirmed by statistical correlation (r = 0.97, p < 0.001) and a Wilcoxon signed-rank test (p = 0.026). Real-time PCR detected BLV DNA in 4.7% of samples, with the highest positivity in the East Kazakhstan and Abai regions, confirming active viral circulation. Validation of a domestically developed AGID diagnostic kit showed full concordance with commercial assays (IDEXX, IDvet), supporting its use in national surveillance programs. These findings highlight the endemic status of BLV in Kazakhstan. Molecular analysis of sequenced isolates revealed the presence of genotype G-7, consistent with strains circulating in neighboring countries. Together, these results underscore the importance of integrated serological and molecular approaches for effective monitoring and control. Full article

Dengue has been a serious public health concern in Nepal since the past few years, with concurrent big outbreaks occurring in 2022–2024. This cross-sectional study was conducted among febrile patients visiting hospitals in Mahottari district in southern Nepal. A total of 2141 dengue-suspected patients were investigated by routine laboratory assays and serological and molecular techniques, including real-time quantitative polymerase chain reaction (RT-qPCR). Among them, 455 (21.3%) were confirmed as dengue cases. The majority of dengue cases (435, 95.6%) had a primary dengue infection. The total bilirubin level was significantly higher in secondary dengue infection than in primary (p = 0.032). The major dengue virus (DENV) serotypes responsible for this outbreak were DENV-1 (45.5%) and DENV-2 (40.9%), while 13.6% patients had DENV-3 infection. DENV-3 infection showed a significantly higher viral load (median: 7.71 Log₁₀ copies/mL; range: 6.48–7.94) compared to DENV-1 (6.72 Log₁₀ copies/mL; 5.49–7.17) and DENV-2 (4.76 Log₁₀ copies/mL; 2.32–6.96). Adult patients exhibited a significantly higher viral load than children (p = 0.035). NS1- and IgM-positive as well as admitted patients had a higher viral load (p < 0.05). Co-circulation of multiple serotypes (DENV-1, -2, -3) was confirmed with the first introduction of DENV-1 and DENV-3 in Mahottari and surrounding areas in the 2023 outbreak. Identification of the circulating DENV serotypes is crucial to understanding the epidemiological trend and dynamics of population immunity. These findings underscore the need of nation-wide integrated surveillance, including genomic data generation, in Nepal for disease control, prevention, and potential vaccine implication. Full article

Child and adolescent health plays a critical role in shaping future public health and intergenerational outcomes. In China, rising rates of myopia, obesity, mental health issues, and other common conditions highlight the need for continuous monitoring. Since 2016, the Chinese National Surveillance on Students’ Common Diseases and Risk Factors (CNSSCDRF) has provided comprehensive, nationwide data on student health. By 2022, the system had expanded to nearly all counties, tracking key indicators such as vision problems, overweight/obesity, dental caries, and health-risk behaviors across multiple administrative levels. This review outlines the surveillance methodology, including sampling, data collection, and analysis. Findings have directly informed school health policies and technical guidelines, supporting national goals such as those in the Healthy China 2030 Plan. Full article

Antimicrobial resistance (AMR) is a critical public health issue in Bangladesh, where antibiotic use is widespread but often unregulated. This nationwide cross-sectional study (2017–2020) analyzed data from 26 public and private laboratories across all divisions of the country. Standardized data on antimicrobial susceptibility testing (AST) were collected, curated, and analyzed using WHONET, QAAPT, and R software to assess resistance patterns in 232,329 bacterial isolates from various clinical specimens. Escherichia coli was the most common pathogen (32.5%), followed by Klebsiella sp. (15.5%) and Pseudomonas sp. (10.6%). Urine specimens comprised 50.3% of the tested samples, while blood and soft tissue/body fluids accounted for 12.1% and 24.8%, respectively. Patients aged 55 years and older represented the largest group (36.3%), highlighting their vulnerability to drug-resistant infections. Resistance to third-generation cephalosporins was alarmingly high in Escherichia coli (62.9% resistant to ceftriaxone), whereas carbapenem resistance remained relatively low (5.3% and 6.8% to imipenem and meropenem, respectively). Klebsiella sp. showed widespread resistance, though carbapenems remained relatively effective (imipenem resistance 20.3%, meropenem 21.7%). In contrast, Salmonella sp. remained largely sensitive to third-generation cephalosporins. However, 42% of Staphylococcus aureus isolates were methicillin-resistant (MRSA). This study underscores the urgent need for improved antibiotic stewardship, enhanced diagnostic capacity, and strengthened AMR surveillance to preserve treatment options in Bangladesh. Full article

Purpose: Organ preservation (OP) is an increasingly recognized treatment for locally advanced rectal cancer. However, variability in patient selection, treatment regimens, and surveillance can hinder widespread adoption. We conducted a national, cross-sectional survey evaluating how OP is implemented across Canada. Methods: Between June and July 2023, surgeons, radiation oncologists, and medical oncologists with expertise in OP from all 44 Canadian radiation centers completed an electronic survey about the implementation of OP at their centers. Primary OP was defined as administering neoadjuvant therapy with the explicit goal of avoiding surgery. Secondary OP was defined as deferring planned surgery only when there was an unexpected yet sufficient clinical response. Results: Responses from 40 radiation centers (response rate 90.9%) identified that 20 (50.0%) offered primary and secondary OP, 11 (27.8%) offered only secondary, and 8 (20.0%) offered neither. The most common treatment in primary OP was chemoradiation with consolidation chemotherapy (17/20, 89.5%). When assessing the response in primary OP, endoscopic biopsies were more commonly performed with a near-complete response (10/20, 50.0%) than a complete response (4/20, 20.0%). Watch-and-wait surveillance was more frequently offered for a complete response (17/31, 54.8%) than a near-complete response (4/31, 12.9%). Challenges included limited MRI (21/40, 52.5%), clinic time (18/40, 45.0%), timely surgery if required (16/40, 40.0%), and limited familiarity with the protocols and evidence (15/40, 37.5%). Conclusion: OP is recognized nationwide but is inconsistently implemented. Challenges raise concerns about the current feasibility of OP in Canada and highlight the need for less resource-intensive, complex OP protocols. Full article

Porcine reproductive and respiratory syndrome virus (PRRSV) poses a significant economic challenge to Japan’s swine industry. This review synthesizes the epidemiological evolution of PRRSV in Japan by examining the available scientific literature from its initial Type 2 isolation in 1993 to recent events. Endemic Type 2 strains, initially dominated by Cluster III (Lineage 4), have diversified significantly. This diversification was marked by key events including the emergence of vaccine-associated Cluster II (Lineage 5) and incursions of virulent Cluster IV/Lineage 1F (MN184A-like) strains and Type 1 virus around 2008. By 2018–2020, Clusters II and IV predominated nationwide, a trend strongly linked to widespread modified live virus (MLV) vaccination. The recent detection of the globally significant NADC34-like (Lineage 1A) strain underscores ongoing foreign incursion risks. Current MLV vaccines face challenges, including safety concerns and limited cross-protection against diverse field strains. Consequently, effective control requires integrated strategies, comprising optimized vaccination, stringent biosecurity, advanced molecular surveillance, improved diagnostics, and coordinated regional control programs guided by systematic herd classification and stakeholder partnerships. The development of next-generation vaccines and sustained multi-stakeholder collaboration are critical for mitigating the impact of PRRSV in Japan. Full article

Objectives: Linezolid resistance among Enterococcus species poses a growing clinical and public health concern, especially due to the dissemination of transferable resistance genes, such as optrA. This study aimed to evaluate the prevalence of linezolid resistance and to characterize the molecular epidemiology and genetic contexts of optrA-positive linezolid-resistant Enterococcus (LRE) isolates from clinical and animal sources in South Korea. Methods: A total of 2156 Enterococcus isolates, collected through nationwide surveillance from hospitalized patients and healthy livestock (pigs, cattle, and chickens) between 2017 and 2019, were retrospectively analyzed. Phenotypic susceptibility testing, optrA gene screening, and whole-genome sequencing were performed to investigate genetic environments and phylogenetic relationships. Results: The prevalence of linezolid resistance was 0.2% in clinical isolates, 3.3% in pigs, 4.3% in cattle, and 1.4% in chickens. optrA-positive linezolid-resistant isolates were less frequent, with rates of 0.1%, 1.4%, 0.9%, and 1.0%, respectively. Multilocus sequence typing identified sequence types (STs) 330 and ST476 in E. faecalis from humans, with no shared STs between human and livestock isolates. The optrA gene was located either chromosomally, frequently associated with transposon Tn6674, or on multidrug resistance plasmids. Notably, optrA variants exhibited host-specific distribution patterns. Phylogenetic analysis demonstrated considerable genomic diversity, and Korean ST476 isolates were genetically related to international strains reported from livestock, poultry products, and wild birds, suggesting potential global dissemination. Conclusions: This study provides a comprehensive, nationally representative assessment of linezolid resistance in South Korea. The findings highlight the zoonotic potential and possible international dissemination of optrA-carrying ST476 lineages, underscoring the need for integrated One Health surveillance to monitor and control the spread of transferable resistance genes. Full article

The pressing ecological challenges of the twenty-first century underscore the need for biodiversity protection. The “One Health” approach, which integrates human, animal, and environmental health, has become increasingly vital. This study investigates the relationship between bird species richness, an important indicator of biodiversity, and both all-cause and cause-specific mortality rates in China. This nationwide county-level ecological study combined citizen science bird data from the China Bird Report Center, all-cause and cause-specific mortality rates of 2021 from the National Mortality Surveillance System, and county-level statistics of population characteristics, socio-economics, education, and healthcare services. We employed univariate and multivariate linear regressions to explore the association between bird diversity and mortality rates. Overall, data from 421 counties revealed a negative association between bird species richness and all-cause mortality rates, with a regression coefficient (95% confidence interval) of −0.197 (−0.376, −0.017). This study also found significant negative associations between bird species richness and cause-specific mortality rates for several diseases, such as cardiovascular diseases (including cerebrovascular and ischemic heart diseases) and cancers (including lung cancer). The effects of associations were similar between both genders. Our findings underscore the significance of biodiversity conservation for public health and highlight the importance of integrated environmental and health policies. Full article

Personalized medicine, including targeted and immunotherapy, has substantially changed the landscape of non-small cell lung cancer (NSCLC). About 30% of NSCLC tumors have targetable mutations, like EGFR, and 28% of tumors will have a PD-L1 score or tumor mutation burden high enough to warrant immunotherapy; a molecular test prior to therapy assesses eligibility. However, the congruence between testing and treatment, and the effect of treatment without testing on outcomes, is understudied. We extracted a cohort of NSCLC patients from the Surveillance, Epidemiology and End Results (SEER)-Medicare-linked data. The primary outcome was survival. Demographic and clinical characteristics of those receiving vs. not receiving a molecular test were compared, and a Kaplan–Meier curve along with a multivariable Cox proportional hazards regression assessed the association of survival with the receipt of molecular diagnostic testing, adjusting for sex, race, age, income tract, metro/urban/rural region, histology, and stage. There were 911 NSCLC patients treated with personalized therapy, of which 513 (56.3%) had received prior molecular testing. Black patients were less likely than White patients to receive testing (36.4% vs. 59.9%; p < 0.001). Testing was significantly more frequent in patients with fewer comorbidities (p < 0.001), adenocarcinoma (p = 0.004), tumors in the lower lobe (p = 0.037), or diagnosed at a later stage (p = 0.026). Only 39.9% of patients receiving EGFR inhibitors were initially tested for an EGFR mutation. Among NSCLC patients treated with personalized therapy, untested patients were at increased mortality risk compared to tested patients (median survival 8.22 vs. 12.79 months, p = 0.024). After adjustment, treated patients not tested beforehand had a significantly higher mortality risk (HRadj: 1.20; 95% CI: 1.04–1.40). Substantial incongruence between receipt of molecular testing and personalized therapies exists according to nationwide claims data, with only about half of treated patients having had an appropriate molecular diagnostic workup. This could explain, in part, the higher mortality among treated patients who did not undergo testing. Before expanding personalized therapies, further addressing these issues through standardized, reflexive testing protocols and improved clinician education is critical to optimizing the integration of molecular diagnostics into treatment planning. Full article

To investigate the real-world effectiveness of COVID-19 vaccines in a large cohort of patients with diabetes mellitus (DM), we analyzed all >18-year-old patients with COVID-19 registered in a Brazilian nationwide surveillance database between February 2020 and February 2023. The primary outcome of interest was vaccine effectiveness against death, evaluated using multivariate logistic regression models. Among the 2,131,089 patients registered in the SIVEP-Gripe, 482,677 (22.6%) had DM. After adjusting for covariates, patients with DM had a higher risk of death than those without comorbidities (adjusted odds ratio [aOR] = 1.43, 95% CI, 1.39–1.47). For patients without comorbidities (72.7%, 95% CI, 70.5–74.7) and those with DM (73.4%, 95% CI, 68.2–76.7), vaccine effectiveness was similar after the booster dose. However, it was reduced in patients with DM associated with other comorbidities (60.5%; 95% CI, 57.5–63.2). The strongest factor associated with booster failure was the omicron variant (aOR = 27.8, 95% CI, 19.9–40.1). Our study revealed that COVID-19 vaccines provided robust protection against death in individuals with DM. However, our findings underscore the need to update vaccines and develop tailored strategies for individuals with diabetes, especially those with additional underlying conditions. Full article

Background/Objectives: Salmonella is a major cause of foodborne illnesses, with multidrug-resistant (MDR) strains posing significant threats to public health worldwide. This study investigated the prevalence and antimicrobial resistance (AMR) of Salmonella, focusing on extended-spectrum β-lactamase (ESBL)-producing Salmonella in retail poultry meat in Korea. Methods: A total of 300 poultry meat samples were collected nationwide from retail markets. Multi-locus sequence typing, serotyping, and antimicrobial susceptibility testing were performed. Whole-genome sequencing (WGS) analysis was conducted against 28 representative ESBL-producing S. Infantis isolates to identify the genetic characteristics and phylogenetic relationship. Results: Salmonella was detected in 81.3% of raw poultry meat samples, with S. Infantis ST32 being the dominant serotype in chicken (53.0%) and S. Typhimurium ST19 predominant in duck (39.0%). MDR was identified in 58.2% of samples, with a significantly higher rate in chicken isolates than in duck isolates (p < 0.001). Notably, 75.3% of chicken MDR isolates were ESBL-producing S. Infantis carrying bla_CTX-M-65. WGS of 28 geographically and phenotypically representative ESBL-producing S. Infantis revealed five clonal clusters, suggesting the widespread dissemination of ESBL-producing S. Infantis across Korea’s poultry supply chain. All 28 ESBL-producing S. Infantis isolates contained a pESI-like megaplasmid, carrying multiple resistance and virulence genes, with sequences highly identical to plasmids reported in the United States, indicating potential international transmission. Conclusions: This study emphasizes the urgent need for continuous surveillance and responsible antibiotic use in livestock under a One Health framework. WGS can provide an effective tool for tracking AMR evolution and clonal spread within and across regions. Full article