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- 저자 : ( Hongjo Choi ) (검색결과 13 건)
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Mainstreaming of Health Equity in Infectious Disease Control Policy During the COVID-19 Pandemic Era
Choi, Hongjo,Kim, Seong-Yi,Kim, Jung-Woo,Park, Yukyung,Kim, Myoung-Hee The Korean Society for Preventive Medicine 2021 Journal of Preventive Medicine and Public Health Vol.54 No.1
The Korean government's strategy to combat coronavirus disease 2019 (COVID-19) has focused on non-pharmaceutical interventions, such as social distancing and wearing masks, along with testing, tracing, and treatment; overall, its performance has been relatively good compared to that of many other countries heavily affected by COVID-19. However, little attention has been paid to health equity in measures to control the COVID-19 pandemic. The study aimed to examine the unequal impacts of COVID-19 across socioeconomic groups and to suggest potential solutions to tackle these inequalities. The pathways linking social determinants and health could be entry points to tackle the unequal consequences of this public health emergency. It is crucial for infectious disease policy to consider social determinants of health including poor housing, precarious working conditions, disrupted healthcare services, and suspension of social services. Moreover, the high levels of uncertainty and complexity inherent in this public health emergency, as well as the health and socioeconomic inequalities caused by the pandemic, underscore the need for good governance other than top-down measures by the government. We emphasize that a people-centered perspective is a key approach during the pandemic era. Mutual trust between the state and civil society, strong accountability of the government, and civic participation are essential components of cooperative disaster governance.
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( Hongjo Choi ),( Myung Sun Lee ),( Young Ran Kim ),( Clifton E Barry Rd ),( Hae Joo Chung ) 대한결핵 및 호흡기학회 2013 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.116 No.-
Introduction: SES is a well-reported factor associated with tuberculosis morbidity. However, there were no studies to examine the association of SES with treatment adherence of tuberculosis in South Korea. The study aims to investigate an association between SES and treatment adherence. Method: To identify association between SES and treatment adherence, hierarchical logistic regression was performed (Model 1: adjusted for demographic factors; Model 2: Model 1 + individual behavioral factors; Model 3: Model 2 + clinical factors) and treatment regimen-stratified analysis was also conducted. Result: In hierarchical logistic model, poor housing status (adjusted OR: 2.80, 95% CI: 1.27-6.16) and service worker with low education (adjusted OR: 3.33, 95% CI: 1.06-10.43) and laborer group (adjusted OR: 4.39, 95% CI: 1.45-13.28) are significantly associated with the low treatment adherence in Model 3. However, low education is only significantly related to the low treatment adherence in Model 1 (adjusted OR: 1.71, 95% CI: 1.05-2.77). Discussion: The result on this study clearly showed associations of low SES with low treatment adherence in real practice. The study could explain what kind of barriers interferes for TB patients to complete their treatment successfully. This result may be a source to design policy intervention to support TB patients and develop National TB management plan.Introduction: SES is a well-reported factor associated with tuberculosis morbidity. However, there were no studies to examine the association of SES with treatment adherence of tuberculosis in South Korea. The study aims to investigate an association between SES and treatment adherence. Method: To identify association between SES and treatment adherence, hierarchical logistic regression was performed (Model 1: adjusted for demographic factors; Model 2: Model 1 + individual behavioral factors; Model 3: Model 2 + clinical factors) and treatment regimen-stratified analysis was also conducted. Result: In hierarchical logistic model, poor housing status (adjusted OR: 2.80, 95% CI: 1.27-6.16) and service worker with low education (adjusted OR: 3.33, 95% CI: 1.06-10.43) and laborer group (adjusted OR: 4.39, 95% CI: 1.45-13.28) are significantly associated with the low treatment adherence in Model 3. However, low education is only significantly related to the low treatment adherence in Model 1 (adjusted OR: 1.71, 95% CI: 1.05-2.77). Discussion: The result on this study clearly showed associations of low SES with low treatment adherence in real practice. The study could explain what kind of barriers interferes for TB patients to complete their treatment successfully. This result may be a source to design policy intervention to support TB patients and develop National TB management plan.
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( Hongjo Choi ),( Dawoon Jeong ),( Young Ae Kang ),( Doosoo Jeon ),( Hee-yeon Kang ),( Hee Jin Kim ),( Hee-sun Kim ),( Jeongha Mok ) 대한결핵 및 호흡기학회 2023 Tuberculosis and Respiratory Diseases Vol.86 No.3
Background: Effective treatment of fluoroquinolone-resistant multidrug-resistant tuberculosis (FQr-MDR-TB) is difficult because of the limited number of available core anti-TB drugs and high rates of resistance to anti-TB drugs other than FQs. However, few studies have examined anti-TB drugs that are effective in treating patients with FQr-MDR-TB in a real-world setting. Methods: The impact of anti-TB drug use on treatment outcomes in patients with pulmonary FQr-MDR-TB was retrospectively evaluated using a nationwide integrated TB database (Korean Tuberculosis and Post-Tuberculosis). Data from 2011 to 2017 were included. Results: The study population consisted of 1,082 patients with FQr-MDR-TB. The overall treatment outcomes were as follows: treatment success (69.7%), death (13.7%), lost to follow-up or not evaluated (12.8%), and treatment failure (3.9%). On a propensity- score-matched multivariate logistic regression analysis, the use of bedaquiline (BDQ), linezolid (LZD), levofloxacin (LFX), cycloserine (CS), ethambutol (EMB), pyrazinamide, kanamycin (KM), prothionamide (PTO), and para-aminosalicylic acid against susceptible strains increased the treatment success rate (vs. unfavorable outcomes). The use of LFX, CS, EMB, and PTO against susceptible strains decreased the mortality (vs. treatment success). Conclusion: A therapeutic regimen guided by drug-susceptibility testing can improve the treatment of patients with pulmonary FQr-MDR-TB. In addition to core anti-TB drugs, such as BDQ and LZD, treatment of susceptible strains with later-generation FQs and KM may be beneficial for FQr-MDR-TB patients with limited treatment options.
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( Nakwon Kwak ),( Hongjo Choi ),( Doosoo Jeon ),( Byung Woo Jhun ),( Kyung-wook Jo ),( Young Ae Kang ),( Yong-soo Kwon ),( Myungsun Lee ),( Jeongha Mok ),( Tae-sun Shim ),( Hong-joon Shin ),( Jake Wha 대한결핵 및 호흡기학회 2020 Tuberculosis and Respiratory Diseases Vol.83 No.2
Background: The burden of nontuberculous mycobacterial (NTM) pulmonary disease (PD) is increasing globally. To understand the treatment outcomes and prognosis of NTM-PD, a unified registry is needed. In this project, we aim to construct a multicenter prospective observational cohort with NTM-PD in South Korea (NTM-KOREA). Methods: The primary objective of this study is to analyze treatment outcomes according to the species. In addition, recurrence rate, adverse events, the impact of each drug on treatment outcomes as well as the impact of characteristics of mycobacteriology will be analyzed. The inclusion criteria for the study are as follows: fulfilling the criteria for NTM-PD having one of the following etiologic organisms: Mycobacterium avium complex, M. abscessus subspecies abscessus, M. abscessus subspecies massiliense, or M. kansasii ; receiving the first treatment for NTM-PD after enrollment; age >20 years; and consenting to participate in the study. Seven institutions will participate in patient enrollment and about 500 patients are expected to be enrolled. Participants will be recruited from 1 March 2020 until 19 March 2024 and will be observed through 19 March 2029. During the follow-up period, participants’ clinical course will be tracked and their clinical data as well as NTM isolates will be collected. Conclusion: NTM-KOREA will be the first nationwide observational cohort for NTM-PD in South Korea. It will provide the information to optimize treatment modalities and will contribute to deeper understanding of the treatment outcomes and long-term prognosis of patients with NTM-PD in South Korea.
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( Eunjeong Son ),( Hongjo Choi ),( Jeongha Mok ),( Young Ae Kang ),( Dawoon Jeong ),( Doosoo Jeon ) 대한내과학회 2024 The Korean Journal of Internal Medicine Vol.39 No.4
Background/Aims: This study aimed to investigate the timing and predictors of death during treatment among patients with multidrug/rifampin-resistant tuberculosis (MDR/RR-TB) in South Korea. Methods: This was a retrospective cohort study that included MDR/RR-TB cases notified between 2011 and 2017 in South Korea. Results: Among 7,226 MDR/RR-TB cases, 699 (9.7%) died at a median of 167 days (IQR 51-358 d) from the initiation of MDR-TB treatment. The cumulative proportion of all-cause death was 35.5% at 90 days and 52.8% at 180 days from treatment initiation. TB-related deaths occurred at a median of 133 days (IQR 32-366 d), which was significantly earlier than the median of 184 days (IQR 68-356 d) for non-TB-related deaths (p = 0.002). In a multivariate analysis, older age was the factor most strongly associated with death, with those aged ≥ 75 years being 68 times more likely to die (aHR 68.11, 95% CI 21.75-213.26), compared those aged ≤ 24 years. In addition, male sex, comorbidities (cancer, human immunodeficiency virus, and end stage renal disease), the lowest household income class, and TB-specific factors (previous history of TB treatment, smear positivity, and fluoroquinolone resistance) were identified as independent predictors of all-cause death. Conclusions: This nationwide study highlights increased deaths during the intensive phase and identifies high-risk groups including older people and those with comorbidities or socioeconomic vulnerabilities. An integrated and comprehensive strategy is required to reduce mortality in patients with MDR/RR-TB, particularly focusing on the early stages of treatment and target populations.
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Honghyok Kim,Sarah Yu,Hongjo Choi 한국역학회 2020 Epidemiology and Health Vol.42 No.-
OBJECTIVES: Epidemiological evidence of associations between ambient particulate matter (PM) and tuberculosis (TB) risk is accumulating. Two previous studies in Korea found associations between air pollution—especially sulfur dioxide (SO2)—and TB. In this study, we conducted an annual time-series cross-sectional study to assess the effect of PM with an aerodynamic diameter less than 10 μm (PM10) on TB risk in seven major cities of Korea from 2010 to 2016, taking into account time lag and long-term cumulative exposure. METHODS: Age-standardized TB notification rates were derived using the Korea National TB Surveillance System. Annual average PM10 concentrations were obtained from annual Korean air quality reports. We applied a generalized linear mixed model with unconstrained distributed lags of exposure to PM10. We adjusted for potential confounders such as age, health behaviors, and area-level characteristics. RESULTS: Both average annual PM10 concentrations and age-standardized TB notification rates decreased over time. The association between cumulative exposure to PM10 and TB incidence became stronger as a longer exposure duration was considered. An increase of one standard deviation (5.63 μg/m3) in PM10 exposure for six years was associated with a 1.20 (95% confidence interval, 1.17 to 1.22) times higher TB notification rate. The marginal association of exposure duration with the TB notification rate was highest at four and five years prior to TB notification. This association remained consistent even after adjusting it for exposure to SO2. CONCLUSIONS: The findings of this study suggest that cumulative exposure to PM10 may affect TB risk, with a potential lag effect.
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A Pilot Project of Systematic Tuberculosis Screening in the Elderly in a South Korean Province
( Hyunwoo Kim ),( Hee-jin Kim ),( Kyung-hyun Oh ),( Hwan-wook Oh ),( Hongjo Choi ) 대한결핵 및 호흡기학회 2019 Tuberculosis and Respiratory Diseases Vol.82 No.3
Background: Tuberculosis (TB) is a major infectious disease in South Korea causing substantial disease burden, particularly in the elderly. This study aimed to identify the case detection rate of mobile TB screening for the elderly conducted in the Jeollanam-do region and to analyze risk factors of active TB. Methods: We screened the elderly population (≥65 years old) in Jeollanam-do from August to December 2017. Chest radiography was performed for all participants. Participants with TB presumptive signs were asked to submit sputum specimen(s). Sputum smear, culture, and polymerase chain reaction analyses were performed. Cascade analysis, chisquared tests, and Fisher exact tests were used to evaluate screening performance. Results: In total, 12,402 participants were screened, and 211 (1.7%) were suspected to have active TB; 181 of the suspected patients (85.8%) underwent sputum smear test, and 16 (8.8%) patients were confirmed to have TB. The TB prevalence among the elderly was bacteriologically confirmed to be 129 per 100,000 individuals, which was similar to national TB notification data for the same age groups. The proportion of active TB cases increased with age, and differed based on sex and past TB history. However, TB-related symptoms, comorbidity status, and TB screening history within 12 months were not predictive of active TB. Conclusion: This study identified that the prevalence rate was similar to national TB notification data from the same age groups. Periodic, community-based, systematic TB screening among the elderly population is recommended.
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Kang, Minji,Yang, Jeong Seong,Kim, Yoojeong,Kim, Kyungjong,Choi, Hongjo,Lee, Seung Heon Elsevier 2018 Journal of microbiological methods Vol.152 No.-
<P><B>Abstract</B></P> <P>Tuberculosis (TB), caused by infections of the <I>Mycobacterium tuberculosis</I> (MTB) complex, is the ninth leading cause of death worldwide, and several molecular approaches for MTB species identification and the detection of mutations associated with drug resistance have been developed to date. We previously developed a diagnostic assay for drug susceptibility testing that can detect mutations conferring resistance to anti-TB drugs using allele-specific primer extension on a microsphere-based platform for multiplex polymerase chain reaction. The aim of the present study was to optimize this diagnostic assay based on the evaluation of three methods for extracting mycobacterial DNA from clinical samples. Mycobacterial DNA of 81 samples was digested and decontaminated by <I>N</I>-acetyl-<SMALL>L</SMALL>-cysteine-2% NaOH and then extracted using three methods: “in-house” 5% Chelex-100 chelating resin, InstaGene Matrix, and MagPurix TB DNA Extraction Kit. The former two methods are manual extraction methods, whereas the MagPurix TB DNA Extraction Kit is an automated extraction method used with the MagPurix 12 s automated nucleic acid purification system. The extracted DNA was then subjected to our diagnostic assay, and the results were compared among methods. The magnetic bead method exhibited a higher extraction efficiency and resulted in greater diagnostic efficacy than the two resin-based methods with respect to both target gene detection and acid-fast bacilli smear grades. Therefore, the MagPurix TB DNA Extraction Kit is the optimal MTB DNA extraction method for our diagnostic assay of TB drug susceptibility testing.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Magnetic beads extract DNA of greater purity than that extracted by resin. </LI> <LI> Magnetic bead DNA extraction had higher efficiency in detection of TB genes. </LI> <LI> The automated extraction system is technically simple and completely closed. </LI> <LI> Magnetic bead extraction is optimal for anti-TB drug susceptibility gene testing. </LI> </UL> </P>
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A Pilot Project of Systematic Tuberculosis Screening in the Elderly in a South Korean Province
Kim, Hyunwoo,Kim, Hee-Jin,Oh, Kyung-Hyun,Oh, Hwan-Wook,Choi, Hongjo The Korean Academy of Tuberculosis and Respiratory 2019 Tuberculosis and Respiratory Diseases Vol.82 No.3
Background: Tuberculosis (TB) is a major infectious disease in South Korea causing substantial disease burden, particularly in the elderly. This study aimed to identify the case detection rate of mobile TB screening for the elderly conducted in the Jeollanam-do region and to analyze risk factors of active TB. Methods: We screened the elderly population (${\geq}65$ years old) in Jeollanam-do from August to December 2017. Chest radiography was performed for all participants. Participants with TB presumptive signs were asked to submit sputum specimen(s). Sputum smear, culture, and polymerase chain reaction analyses were performed. Cascade analysis, chi-squared tests, and Fisher exact tests were used to evaluate screening performance. Results: In total, 12,402 participants were screened, and 211 (1.7%) were suspected to have active TB; 181 of the suspected patients (85.8%) underwent sputum smear test, and 16 (8.8%) patients were confirmed to have TB. The TB prevalence among the elderly was bacteriologically confirmed to be 129 per 100,000 individuals, which was similar to national TB notification data for the same age groups. The proportion of active TB cases increased with age, and differed based on sex and past TB history. However, TB-related symptoms, comorbidity status, and TB screening history within 12 months were not predictive of active TB. Conclusion: This study identified that the prevalence rate was similar to national TB notification data from the same age groups. Periodic, community-based, systematic TB screening among the elderly population is recommended.
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