Cook with Different Pots, but Similar Taste? Comparison of Phase Angle Using Bioelectrical Impedance Analysis According to Device Type and Examination Posture.

Bioelectrical impedance analysis (BIA) is gaining popularity as a tool for body composition assessment. Although BIA has been studied and validated in different populations, age groups, and clinical settings, including critically ill patients, there are concerns about BIA reproducibility and reliability for different device types and postures. This study aimed to evaluate the reliability of BIA using different devices, postures, and lead types. Cross-sectional observational data were collected from 74 healthy volunteers (32 women, 42 men). We used two types of devices, three types of postures (standing, sitting, and lying), and two lead types (clamp lead and adhesive lead) to measure the whole-body phase angle (phA) at a single frequency of 50 kHz. The measurements were validated using the intraclass correlation coefficient (ICC) and Bland-Altman plot analysis. All phA measurements recorded using the two types of devices, three different postures, and two types of leads were equivalent (mean ICC = 0.9932, 95% confidence interval (CI) 0.9905-0.0053, p < 0.001). The average mean difference in phA was 0.31 (95% CI 0.16-0.46). The largest phA value was measured using BWA with an adhesive-type lead in the supine position. There were no differences between the standing and sitting positions. We compared the consistency and reliability of phA using two devices, two lead types, and three postures. Seven different phA were interchangeable in healthy volunteers.

Preventive effect of on-farm biosecurity practices against highly pathogenic avian influenza (HPAI) H5N6 infection on commercial layer farms in the Republic of Korea during the 2016-17 epidemic: A case-control study.

Highly pathogenic avian influenza virus (HPAIv) H5N6 has destructive consequences on the global poultry production system. Recently, a growing number of layer farms have been heavily damaged from the HPAIv epidemic due to the increased virulence of the virus and the intensification of the production system. Therefore, stakeholders should implement effective preventive practices at the farm level that are aligned with contingency measures at the national level to minimize poultry losses. However, numerous biosecurity protocols for layer farm workers to follow have been developed, impeding efficient prevention and control. Furthermore, the effectiveness of biosecurity practices varies with the geographical condition and inter-farm contact structures. Hence, the objective of our study was to examine the preventive effect of five biosecurity actions commonly practiced at layer farms in the Republic of Korea against HPAIv H5N6: (i) fence installation around a farm, ii) rodent control inside a farm; iii) disinfection booth for visitors for disinfection protocols, iv) an anterior room in the sheds before entering the bird area and v) boots changes when moving between sheds in the same farm. We conducted a case-control study on 114 layer case farms and 129 layer control farms during the 2016-17 HPAI epidemic. The odds ratios for five on-farm biosecurity practices implemented in those study groups were estimated as a preventive effect on the HPAI infection with covariates, including seven geographical conditions and three network metrics using Bayesian hierarchical logistic regression and geographical location weighted logistic regression. The results showed that the use of a disinfection booth for personnel reduced the odds of HPAIv H5N6 infection (adjusted odds ratio [AOR] = 0.002, 95 % credible interval [CrI] = 0.00007 - 0.025) with relatively small spatial variation (minimum AOR - maximum AOR: 0.084-0.263). Changing boots between sheds on the same farm reduced the odds of HPAIv H5N6 infection (AOR = 0.160, 95 % CrI = 0.024-0.852) with relatively wide spatial variation (minimum AOR - maximum AOR = 0.270-0.688). Therefore, enhanced personnel biosecurity protocols at the farm of entry for layer farms is recommended to effectively prevent and respond to HPAIv H5N6 infection under different local condition. Our study provides an important message for layer farmers to effectively implement on-farm biosecurity actions against HPAIv H5N6 infection at their farms by setting priorities based on their spatial condition and network position.

Elucidating the Local Transmission Dynamics of Highly Pathogenic Avian Influenza H5N6 in the Republic of Korea by Integrating Phylogenetic Information.

Highly pathogenic avian influenza (HPAI) virus is one of the most virulent and infectious pathogens of poultry. As a response to HPAI epidemics, veterinary authorities implement preemptive depopulation as a controlling strategy. However, mass culling within a uniform radius of the infection site can result in unnecessary depopulation. Therefore, it is useful to quantify the transmission distance from infected premises (IPs) before determining the optimal area for preemptive depopulation. Accordingly, we analyzed the transmission risk within spatiotemporal clusters of IPs using transmission kernel estimates derived from phylogenetic clustering information on 311 HPAI H5N6 IPs identified during the 2016-2017 epidemic, Republic of Korea. Subsequently, we explored the impact of varying the culling radius on the local transmission of HPAI given the transmission risk estimates. The domestic duck farm density was positively associated with higher transmissibility. Ring culling over a radius of 3 km may be effective for areas with high dense duck holdings, but this approach does not appear to significantly reduce the risk for local transmission in areas with chicken farms. This study provides the first estimation of the local transmission dynamics of HPAI in the Republic of Korea as well as insight into determining an effective ring culling radius.

Prioritization of the introduction of new vaccines to the national immunization program in the Republic of Korea.

BACKGROUND: This study was performed to determine the priority of vaccine introduction for five vaccine-preventable diseases (VPDs) caused by Haemophilus influenzae type b (Hib), pneumococcus (Spn), hepatitis A virus (HepA), rotavirus (RV), and human papillomavirus (HPV) to the future Korean National Immunization Program (NIP) and to suggest framework programs to assist decision makers on implementation of the NIP. METHODS: Following analysis of the disease burden and economics of the five VPDs by the core team and Korean Advisory Committee on Immunization Practices sub-committee members, a Delphi survey was administered to 94 Korean experts using structured questionnaires that provided the reference data. The two evaluation frameworks for NIP prioritization were (1) a disease-related framework and (2) a vaccine-related framework. After analyzing the responses, a meeting of experts was held to build a consensus for determining how to prioritize NIP implementation. RESULTS: The average scores for relative importance were 63.29 for the disease-related framework and 36.71 for the vaccine-related framework. Within the disease-related framework, the mortality and case fatality rate was the highest scored factor (8.97), whereas within the vaccine-related framework, efficacy of the vaccine was considered the most important factor (9.56). On average, Spn, Hib, and HepA had the highest priority scores. CONCLUSION: The Korean experts suggested that the main factors influencing the decision to adopt new vaccines in the Korean NIP should be disease mortality, case fatality, and the efficacy and effectiveness of the vaccine. Among the five selected VPDs, Spn, Hib, and HepA were considered to be of higher priority than RV and HPV.

Outbreak of febrile respiratory illness caused by adenovirus at a South Korean military training facility: clinical and radiological characteristics of adenovirus pneumonia.

Adenovirus often causes respiratory disease outbreaks in military training soldiers. Compared with adenovirus pneumonia in young military adults, symptoms arising from febrile respiratory illness (FRI) caused by adenovirus have not been previously evaluated in Korean soldiers. We conducted an event-based outbreak investigation involving 712 male soldiers aged 19 to 21 years from March 14 to 30, 2012 to evaluate the epidemiological and clinical characteristics of patients with pneumonia and FRI caused by adenovirus. We described the laboratory and radiological characteristics of patients with adenovirus pneumonia. Among these, 407 cases of FRI and 15 cases of pneumonia were identified through active surveillance (attack rate of FRI, 57.16%; attack rate of pneumonia, 2.11%). Fire training and march training may present environmental risk factors for adenovirus-associated outbreaks. Most symptoms were mild. The most frequent symptom in patients with pneumonia and FRI was cough. Patients with pneumonia were associated with an increased incidence of dizziness (crude odds ratio [cOR], 9.65; 95% confidence interval [CI], 2.38-37.15) and a decreased incidence of rhinorrhea (cOR, 0.15; 95% CI, 0.04-0.53) during adenovirus-associated outbreaks. Differential leukocyte count revealed high monocytes, low lymphocytes, and low eosinophils, and chest computed tomography revealed a consolidation pattern and right lobar pneumonia. These findings warrant a high level of suspicion for adenovirus pneumonia.

Red blood cell transfusions are associated with lower mortality in patients with severe sepsis and septic shock: a propensity-matched analysis*.

OBJECTIVES: To evaluate the effects of transfusions in patients with severe sepsis and septic shock on mortality. DESIGN: Propensity-matched analysis of a prospective observational database (April 2005 to February 2009). SETTING: Twenty-two medical and surgical intensive care units in 12 teaching hospitals in Korea. PATIENTS: One thousand fifty-four patients with community-acquired severe sepsis and septic shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 1,054 patients, 407 (38.6%) received a blood transfusion. The mean pretransfusion hemoglobin level was 7.7 ± 1.2 g/dL. Transfused patients had higher 28-day and in-hospital mortality rates (32.7% vs. 17.3%; p < .001, 41.3% vs. 20.3%; p < .001, respectively) and a longer duration of hospital stay (21 [interquartile range, 10-35] vs. 13 [interquartile range, 8-24] days; p < .001), but were more severely ill at admission (lower systolic blood pressure, higher Acute Physiology and Chronic Health Evaluation II score, and Sequential Organ Failure Assessment score at admission). In 152 pairs matched according to the propensity score depending on patient transfusion status, transfused patients had a lower risk of 7-day (9.2% vs. 27.0%; p < .001), 28-day (24.3% vs. 38.8%; p = .007), and in-hospital mortality rates (31.6% vs. 42.8%; p = .044). After adjusting for blood transfusion as a time-dependent variable in multivariable analysis, blood transfusion was independently associated with lower risk of 7-day (hazard ratio 0.42, 95% confidence interval 0.19-0.50, p = .026), 28-day (hazard ratio 0.43, 95% confidence interval 0.29-0.62, p < .001), and in-hospital mortality (hazard ratio 0.51, 95% confidence interval 0.39-0.69, p < .001). CONCLUSIONS: In this observational study of patients with community-acquired severe sepsis and septic shock, red blood cell transfusions were associated with lower risk of mortality.

Comparison of the adverse events associated with MF59-adjuvanted and non-adjuvanted H1N1 vaccines in healthy young male Korean soldiers.

The first large-scale outbreaks of respiratory disease in the 21st century were caused by the influenza A (H1N1) virus in 2009, which affected mostly young adults. The M59 vaccine was developed to control pandemic influenza A (H1N1). However, the complications arising from the use of the non-adjuvanted and adjuvanted vaccines in young male Korean soldiers have not previously been evaluated and compared. We conducted a prospective multicenter study of 2,864 healthy male soldiers aged 19 to 25 years to evaluate the adverse events associated with both the MF59-adjuvanted and non-adjuvanted forms of the influenza A/California/2009 (H1N1) surface-antigen vaccine. In most cases, the adverse-event symptoms were mild, and the most frequent adverse events were swelling at the injection site and myalgia, which were noted in 4.8% and 10.7% of participants, respectively. Administration of the MF59-adjuvanted vaccine was associated with an increased incidence of local (crude odds ratio [cOR], 1.56; 95% confidence interval [CI], 1.11-2.29) and systemic adverse events (cOR, 1.64; 95% CI, 1.29-2.07) after vaccination. Atopic dermatitis (adjusted OR [aOR], 2.32; 95% CI, 0.99-5.46) might be the choice risk factor for local adverse events, and adjuvant use (aOR, 1.35; 95% CI, 1.03-1.78) was a significant predictor of systemic adverse events in healthy young male Korean soldiers.

The adverse events of influenza A (H1N1) vaccination and its risk factors in healthcare personnel in 18 military healthcare units in Korea.

In this study, we characterized adverse events related to influenza A (H1N1) vaccination and studied the factors that influence the occurrence of these events. A total of 4,302 personnel in 18 military healthcare units in Korea received 0.5 ml of inactivated H1N1 vaccine. The study questionnaires were answered by 3,939 (91.6%) personnel, at both 2 weeks and 4 weeks after vaccination. Among these subjects, 3,531 (82.1%) who responded to all questions in the questionnaire were studied. After immunization, military doctors were ordered to report the occurrence of any adverse event related to the vaccine for 2 months. According to the responses of the subjects, the most prevalent events were fatigue (11.3%), pain at the injection site (8.38%), and myalgia (6.97%). Female gender, being in the age range of 20-49 years, obesity, regular alcohol consumption, and comorbidity, but not smoking status or pregnancy, were related to a high incidence of local or systemic adverse events after H1N1 vaccination. A total of 14 cases of adverse events were reported by the military doctors. In most reported cases, the subjects had fever in addition to the primary adverse event, and one patient was diagnosed with pneumonia. In conclusion, the overall burden of adverse events related to influenza A (H1N1) vaccination was not inconsequential, but most symptoms were mild. Female gender, middle-age range of 20-49 years, obesity, regular alcohol consumption, and comorbidity were risk factors for the occurrence of adverse events after H1N1 vaccination.

[Education of bioterrorism preparedness and response in healthcare-associated colleges--current status and learning objectives development].

OBJECTIVES: Bioterrorism (BT) preparedness and response plans are particularly important among healthcare workers who will be among the first involved in the outbreak situations. This study was conducted to evaluate the current status of education for BT preparedness and response in healthcare-related colleges/junior colleges and to develop learning objectives for use in their regular curricula. METHODS: We surveyed all medical colleges/schools, colleges/junior colleges that train nurses, emergency medical technicians or clinical pathologists, and 10% (randomly selected) of them that train general hygienists in Korea. The survey was conducted via mail from March to July of 2007. We surveyed 35 experts to determine if there was a consensus of learning objectives among healthcare workers. RESULTS: Only 31.3% of medical colleges/schools and 13.3% of nursing colleges/junior colleges had education programs that included BT preparedness and responses in their curricula. The most common reason given for the lack of BT educational programs was 'There is not much need for education regarding BT preparedness and response in Korea'. None of the colleges/junior colleges that train clinical pathologists, or general hygienists had an education program for BT response. After evaluating the expert opinions, we developed individual learning objectives designed specifically for educational institutions. CONCLUSIONS: There were only a few colleges/junior colleges that enforce the requirement to provide education for BT preparedness and response in curricula. It is necessary to raise the perception of BT preparedness and response to induce the schools to provide such programs.

[Curriculum of health promotion and disease prevention for the 21st century--the 5th revision of preventive medicine learning objectives--].

The preventive medicine learning objectives, first developed in 1977 and subsequently supplemented, underwent necessary revision of the contents for the fourth time to create the fifth revision. However, the required educational contents of health promotion and disease prevention have been changed by the new trends of medical education such as PBL and integrated curriculum, the rapid change of the health and medical environment and the globalization of medicine. The Korean Society of Preventive Medicine formed a task force, led by the Undergraduate Education Committee in 2003, which surveyed all the medical colleges to describe the state of preventive medicine education in Korea, analyzed the changing education demand according to the change of health environment and quantitatively measured the validity and usefulness of each learning objective in the previous curriculum. Based on these data, some temporary objectives were formed and promulgated to all the medical schools. After multiple revisions, an almost completely new series of learning objectives for preventive medicine was created. The objectives comprised 4 classifications and 1 supplement: 1) health and disease, 2) epidemiology and its application, 3) environment and health, 4) patient-doctor-society, and supplementary clinical occupational health. The total number of learning objectives, contained within 13 sub-classifications, was 221 (including 35 of supplementary clinical occupational health). Future studies of the learning process and ongoing development of teaching materials according to the new learning objectives should be undertaken with persistence in order to ensure the progress of preventive medicine education.

[Modelling the impact of pandemic influenza].

The impact of the next influenza pandemic is difficult to predict. It is dependent on how virulent the virus is, how rapidly it spreads from population to population, and the effectiveness of prevention and response efforts. Despite the uncertainty about the magnitude of the next pandemic, estimates of the health and economic impact remain important to aid public health policy decisions and guide pandemic planning for health and emergency sectors. Planning ahead in preparation for an influenza pandemic, with its potentially very high morbidity and mortality rates, is essential for hospital administrators and public health officials. The estimation of pandemic impact is based on the previous pandemics--we had experienced at least 3 pandemics in 20th century. But the epidemiological characteristics--ie, start season, the impact of 1st wave, pathogenicity and virulence of the viruses and the primary victims of population were quite different from one another. I reviewed methodology for estimation and modelling of pandemic impact and described some nations's results using them in their national preparedness plans. And then I showed the estimates of pandemic influenza impact in Korea with FluSurge and FluAid. And, I described the results of pandemic modelling with parameters of 1918 pandemic for the sake of education and training of the first-line responder health officials to the epidemics. In preparing influenza pandemics, the simulation and modelling are the keys to reduce the uncertainty of the future and to make proper policies to manage and control the pandemics.