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During the coronavirus disease 2019 (COVID-19) pandemic, conclusively evaluating possible associations between COVID-19 vaccines and potential adverse events was of critical importance. The National Academy of Medicine of Korea established the COVID-19 Vaccine Safety Research Center (CoVaSC) with support from the Korea Disease Control and Prevention Agency to investigate the scientific relationship between COVID-19 vaccines and suspected adverse events. Although determining whether the COVID-19 vaccine was responsible for any suspected adverse event necessitated a systematic approach, traditional causal inference theories, such as Hill's criteria, encountered certain limitations and criticisms. To facilitate a systematic and evidence-based evaluation, the United States Institute of Medicine, at the request of the Centers for Disease Control and Prevention, offered a detailed causality assessment framework in 2012, which was updated in the recent report by the National Academies of Sciences, Engineering, and Medicine (NASEM) in 2024. This framework, based on a weight-of-evidence approach, allows the independent evaluation of both epidemiological and mechanistic evidence, culminating in a comprehensive conclusion about causality. Epidemiological evidence derived from population studies is categorized into four levels-high, moderate, limited, or insufficient-while mechanistic evidence, primarily from biological and clinical studies in animals and individuals, is classified as strong, intermediate, weak, or lacking. The committee then synthesizes these two types of evidence to draw a conclusion about the causal relationship, which can be described as "convincingly supports" ("evidence established" in the 2024 NASEM report), "favors acceptance," "favors rejection," or "inadequate to accept or reject." The CoVaSC has established an independent committee to conduct causality assessments using the weight-of-evidence framework, specifically for evaluating the causality of adverse events associated with COVID-19 vaccines. The aim of this study is to provide an overview of the weight-of-evidence framework and to detail the considerations involved in its practical application in the CoVaSC.
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Vacinas contra COVID-19 , COVID-19 , SARS-CoV-2 , Humanos , Vacinas contra COVID-19/efeitos adversos , COVID-19/prevenção & controle , COVID-19/epidemiologia , SARS-CoV-2/imunologia , República da Coreia/epidemiologia , Causalidade , Estados UnidosRESUMO
Four species of dominant wild animals, namely, Prionailurus bengalensis euptilurus, Nyctereutes procyonoides koreensis, Hydropotes inermis argyropus, and Sus scrofa coreanus, are hosts of potential infectious agents, including helminths and protozoa. Therefore, it is necessary to analyze the infectious agents present in these wild animals to monitor and control the spread of pathogens. In the present study, fecal samples from 51 wild animals were collected from the mountains of Yangpyeong, Hoengseong, and Cheongyang in South Korea and metabarcoding of the V9 region of the 18S rRNA gene was performed to identify various parasite species that infect these wild animals. Genes from nematodes, such as Metastrongylus sp., Strongyloides spp., Ancylostoma sp., and Toxocara sp., were detected in the fecal samples from wild animals. In addition, platyhelminthes, including Spirometra sp., Echinostomatidae gen. sp., Alaria sp., Neodiplostomum sp., and Clonorchis sp., and protozoa, including Entamoeba sp., Blastocystis sp., Isospora sp., Tritrichomonas sp., Pentatrichomonas sp., and Cryptosporidium sp., were detected. In the present study, various parasites infecting wild animals were successfully identified using metabarcoding. Our technique may play a crucial role in monitoring parasites within wild animals, especially those causing zoonoses.
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The COVID-19 Vaccine Safety Research Committee (CoVaSC) was established in November 2021 to address the growing need for independent, in-depth scientific evidence on adverse events (AEs) following coronavirus disease 2019 (COVID-19) vaccination. This initiative was requested by the Korea Disease Control and Prevention Agency and led by the National Academy of Medicine of Korea. In September 2022, the COVID-19 Vaccine Safety Research Center was established, strengthening CoVaSC's initiatives. The center has conducted various studies on the safety of COVID-19 vaccines. During CoVaSC's second research year, from September 29, 2022 to July 19, 2023, the center was restructured into 4 departments: Epidemiological Research, Clinical Research, Communication & Education, and International Cooperation & Policy Research. Its main activities include (1) managing CoVaSC and the COVID-19 Vaccine Safety Research Center, (2) surveying domestic and international trends in AE causality investigation, (3) assessing AEs following COVID-19 vaccination, (4) fostering international collaboration and policy research, and (5) organizing regular fora and training sessions for the public and clinicians. Causality assessments have been conducted for 27 diseases, and independent research has been conducted after organizing ad hoc committees comprising both epidemiologists and clinical experts on each AE of interest. The research process included protocol development, data analysis, interpretation of results, and causality assessment. These research outcomes have been shared transparently with the public and healthcare experts through various fora. The COVID-19 Vaccine Safety Research Center plans to continue strengthening and expanding its research activities to provide reliable, high-quality safety information to the public.
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PURPOSE: Neoadjuvant chemotherapy (NACT) followed by total mastectomy and immediate reconstruction has become an important strategy in the treatment of breast cancer. Although the safety of subpectoral implant-based breast reconstruction with NACT has been extensively evaluated, the safety in prepectoral reconstruction has not been clearly elucidated. We aimed to evaluate the association of NACT with immediate prepectoral breast reconstruction outcomes. METHODS: A retrospective review of patients who underwent total mastectomy and immediate implant-based prepectoral breast reconstruction between May and December 2021 was conducted. Patients were categorized into 2 groups: those receiving NACT and those not receiving it. Postoperative complication rates were compared between the 2 groups. The independent association between NACT and the complication profiles was evaluated. Propensity score matching was also conducted. RESULTS: We analyzed 343 cases, including 85 who received NACT treatment and 258 who did not. Compared with the non-NACT group, the NACT group was younger, had a higher body mass index, and a higher rate of adjuvant radiotherapy. There were no differences in the rates of overall complications or type of complication between the 2 groups. In the multivariable logistic analyses, NACT did not show a significant association with the development of adverse outcomes. Similar results were observed in propensity score matching analyses. CONCLUSIONS: Our results suggest that receiving NACT may not have a significant detrimental effect on the postoperative outcomes of immediate prepectoral prosthetic reconstructions. Conducting prepectoral implant-based reconstruction in the setting of NACT might be safe and provide acceptable outcomes.
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Neoplasias da Mama , Terapia Neoadjuvante , Complicações Pós-Operatórias , Humanos , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Neoplasias da Mama/cirurgia , Adulto , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Implante Mamário/métodos , Pontuação de Propensão , Quimioterapia Adjuvante , Mamoplastia/métodos , Resultado do Tratamento , Mastectomia Simples , Implantes de MamaRESUMO
Coxiella burnetii is a Gram-negative bacterium that causes the zoonotic disease Q fever. Wild boars serve as reservoirs for C. burnetii. This study aimed to identify the risk factors associated with C. burnetii infection in wild boars. We analyzed the data from 975 wild boar samples collected from June to November 2021 in South Korea. We utilized the indirect ELISA to detect antibodies against C. burnetii. A sample optical density to positive-control optical density value exceeding 50% was classified as positive. We gathered data on the forestation, terrain, weather, agriculture, and animal density of the region where the samples were collected. Continuous variables were categorized into tertiles. We performed a univariate logistic regression analysis and included variables with a p-value < 0.2 in the final multivariable logistic regression model. In our multivariable logistic regression analysis to identify risk factors for C. burnetii infection in wild boars, we used a forward selection method to enter variables based on the order of their significance. We performed the final multivariable logistic regression analyses using either continuous variables or variables categorized into tertiles. The prevalence of C. burnetii was 14.6% (n=142). Locations with the highest maximum wind speeds (3.92-8.24â¯m/s) showed a 59% increase in infection odds compared to locations with the lowest speeds (1.45-3.25â¯m/s)(p=0.044). For each 1â¯m/s increase in maximum wind speed, infection odds increased by 24.1% (p=0.037). Regions with the highest percentage of paddy fields per area (8.3-45%) showed a 76% increase in infection odds compared to regions with the lowest percentage (0-1.5%)(p=0.011). For each 1% increase in the proportion of paddy fields per area, infection odds increased by 3.3% (p=0.003). High maximum wind speed and a high percentage of paddy field were identified as significant risk factors for C. burnetii infection in wild boars.
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Coxiella burnetii , Febre Q , Animais , Estudos Soroepidemiológicos , Febre Q/epidemiologia , Febre Q/veterinária , Febre Q/microbiologia , Fatores de Risco , República da Coreia/epidemiologia , PrevalênciaRESUMO
This study was conducted as an effort to examine the association between mammalian species richness and environmental, anthropogenic, and bioclimate factors in the Province of Chungnam, Korea, using a stacked species distribution model (SSDM) approach. An SSDM model was constructed using an extensive dataset collected from 1357 mammal sampling points and their corresponding forest, geographical, anthropogenic, and bioclimatic information. Distance to forest edge, elevation, slope, population density, and distance to water channels were identified as important variables for determining species richness, whereas the impact of bioclimate variables was less important. The endemism map showed a strong correlation with species richness, suggesting the important role of endemic species. Overestimation was observed in areas with lower species richness. However, the findings of the study still demonstrated that valuable insights can be obtained through the use of the SSDM, which may be helpful to land managers, aiding in the effective management of wildlife habitats, particularly in regions with an abundance of species richness and endemism.
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We found that barn swallow (Hirundo rustica) breeding occurs within close proximity to humans. An evaluation of barn swallow breeding frequency and the breeding success rate of swallows at research sites, which were buildings inhabited by humans and buildings where humans had previously resided, was conducted in order to establish a relationship between the location of barn swallow nests and human habitation and activity frequency. The results demonstrated that barn swallows often breed in human-inhabited buildings. No significant relationship was observed between the wall material and the direction of the wall and the type of building, whereas a much higher proportion of the nests were located near doors with a high level of human movement. In addition, no significant correlation was observed between the location of the nest and the distance from potential resources (food, water etc.), however, a statistically significant relationship was observed between the frequency of human activity measured through the video camera and the number of nests located at a certain distance. The average number of offspring and the reproductive success rate were higher in nests located within close proximity to human activity compared to nests not located within close proximity to human activity, suggesting that the presence of humans had a positive effect on reproduction. This study show that barn swallow nesting occurs in locations where there is a human influence and humans provide implicit protection of swallows from predation, which has a significant impact on breeding.
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Andorinhas , Animais , Humanos , Reprodução , Atividades HumanasRESUMO
OBJECTIVES: The purpose of this study was to explore the association between adherence to 2 cancer prevention recommendations and cancer risk. METHODS: In total, 104,386 individuals aged 40-69 years old who were recruited between 2004 and 2013 in the Health Examinees-Gem study were included. Adherence scores were constructed based on 8 items from the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations, including body weight, physical activity, diet, alcohol consumption and breastfeeding, and on 6 items from the Korean cancer prevention guidelines (smoking status, eating vegetables and fruits, salty foods, alcohol intake, physical activity, and body weight). A Cox proportional hazards model was used to estimate the associations between adherence scores and the risk of total and 5 major cancers. RESULTS: The multivariable hazard ratio (HR) for total cancer with the high adherence score versus the lowest score (4.25-7.00 vs. 0.00-3.25) for the WCRF/AICR guidelines was 0.91 (95% confidence interval [CI], 0.82 to 1.00) in men. A reduced breast cancer risk was observed among women with the highest score. Men within the highest category of the Korean cancer prevention guideline score (3.25-6.00) had an HR of 0.80 (95% CI, 0.73 to 0.88) for developing total cancer compared to men within the lowest score (0.00-2.50). The higher adherence group among men showed lower risks of developing stomach, colorectal, and lung cancers. CONCLUSIONS: Adhering to guidelines for cancer prevention can help to reduce the risk of developing cancer in Korean men. The association might differ by cancer type and gender.
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Neoplasias da Mama , Dieta , Masculino , Humanos , Feminino , Estados Unidos , Adulto , Pessoa de Meia-Idade , Idoso , Fatores de Risco , Estudos Prospectivos , Peso Corporal , República da Coreia/epidemiologiaRESUMO
BACKGROUND: Donor site defects following the radial forearm flap (RFF) harvest have been usually covered with skin grafting, which often lead to suboptimal outcomes and donor morbidities, including delayed healing and scar contractures. The present report aimed to evaluate the outcomes of using another free flap, the domino flap, for coverage of donor site defects following RFFF harvest. METHODS: Five patients (two males and three females) who underwent coverage of donor defects of RFFF using another free flap between 2019 and 2021 were reviewed. Their mean age was 74 years and the mean dimension of the defect of the RFF donor site was 8.7 × 5.6 cm. Four patients used an anterolateral thigh flap and one used a superficial circumflex iliac artery perforator flap. RESULTS: The mean size of the domino flaps were 12.2 × 5.8 cm. Distal stumps of radial vessels adopting retrograde flow were used as recipients in four cases, and proximal ones adopting anterograde in one. The donor site of the domino flaps was primarily closed. All patients recovered well without any postoperative complications. Aesthetically pleasing outcomes with no functional impairment related to scar contractures were observed in the donor site of RFF during the mean follow-up of 15.7 months. CONCLUSIONS: Use of another free flap for coverage of RFFF donor defects may provide rapid wound healing and satisfactory outcomes, and may be considered an alternative option in cases with large-sized defects that are expected to take a long time to achieve complete healing with skin grafting.
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Contratura , Retalhos de Tecido Biológico , Retalho Perfurante , Procedimentos de Cirurgia Plástica , Lesões dos Tecidos Moles , Masculino , Feminino , Humanos , Idoso , Retalhos de Tecido Biológico/cirurgia , Antebraço/cirurgia , Cicatriz/etiologia , Cicatriz/cirurgia , Transplante de Pele , Retalho Perfurante/irrigação sanguínea , Coxa da Perna/cirurgia , Contratura/cirurgia , Lesões dos Tecidos Moles/cirurgiaRESUMO
BACKGROUND: Physical activity (PA) is recommended to improve the survival of cancer patients. However, the prognostic impact of specific PAs is not well understood. Therefore, we investigated the associations of the duration, type, intensity, and number of PAs one participates in pre- and post-diagnosis with mortality in Korean patients with cancer. METHODS: Among the participants aged 40-69 years recruited from the Health Examines study, those diagnosed with cancer after baseline (n = 7749) and within 10 years before baseline (n = 3008) were included in the analyses for pre- and post-diagnosis PA, respectively. Duration, intensity, type, and number of leisure-time physical activities participated in were assessed using questionnaires. The Cox proportional hazard model was used to characterize the association between PA and cancer-specific mortality, adjusting for demographics, behaviors, comorbidities, and cancer stage based on the Surveillance, Epidemiology, and End Results program. RESULTS: Pre-diagnosis, patients participating in vigorous-intensity activities (hazard ratio [HR]: 0.70, 95% confidence interval [CI]: 0.61-0.82), walking (HR: 0.85, 95% CI: 0.74-0.97), climbing (HR: 0.65, 95% CI: 0.55-0.77), sports (HR: 0.39, 95% CI: 0.25-0.61), and more than two activities (HR: 0.73, 95% CI: 0.63-0.86) had significantly lower all-cause mortality. Importantly, these associations were only found in patients with colorectal cancer participating in vigorous-intensity activities (HR: 0.40, 95% CI: 0.23-0.70). Post-diagnosis, only patients who performed more than two activities (HR: 0.65, 95% CI: 0.44-0.95) had significantly lower all-cause mortality. Similar associations were found for cancer mortality, both pre- and post-diagnosis. CONCLUSION: Specific characteristics of PA pre- and post-diagnosis may influence the survival of cancer patients.
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Exercício Físico , Neoplasias , Humanos , Estudos de Coortes , Atividade Motora , Neoplasias/diagnóstico , Neoplasias/epidemiologia , República da Coreia/epidemiologiaRESUMO
The brood reduction hypothesis, which explains asynchronous hatching in birds, as an adaptation that enables selective survival of older nestlings when availability of food is unpredictable. This study was conducted in order to determine whether the brood reduction hypothesis can explain asynchronous hatching in passerines. Infrared cameras were installed inside nest boxes where great tits (Parus major) were attempting to reproduce in order to determine whether the parents practiced selective feeding of older nestlings. According to the results of the study, no significant difference was observed between the hatching order and the average number of feedings per nestling. In addition, when examining the distribution of food according to hatching order over time, every 30 min, beginning at 9 a.m., selective distribution of food to older nestlings was not observed. In conclusion, use of the brood reduction hypothesis, which supports selective provision of beneficial feeding of older and larger nestlings, to explain the asynchronous hatching of passerines is problematic, thus conduct of future studies focusing on other hypotheses in order to explain the asynchronous hatching of this passerine bird will be necessary.
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BACKGROUND: Previous studies suggested that metabolic syndrome (MetS) might create a pro-cancer environment and increase cancer incidence. However, evidence on the risk of gastric cancer (GC) was limited. This study aimed to evaluate the association between MetS and its components and GC in the Korean population. METHODS: Included were 108,397 individuals who participated in the large-scale prospective cohort study, the Health Examinees-Gem study during 2004-2017. The multivariable Cox proportional was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) on the association between MetS and its components with GC risk. Age was used as the time scale in the analyses. The stratified analysis was performed to determine the joint effect of lifestyle factors and MetS on GC risk in different groups. RESULTS: During the mean follow-up of 9.1 years, 759 cases of newly diagnosed cancer (408 men and 351 women) were identified. Overall, participants with MetS had a 26% increased risk of GC than those without MetS (HR 1.26; 95% CI 1.07-1.47); the risk increased with the number of MetS components (p for trend 0.01). Hypertriglyceridemia, low HDL-cholesterol, and hyperglycemia were independently associated with the risk of GC. The potential joint effect of MetS and current smokers (p for interaction 0.02) and obesity (BMI ≥ 25.0) (p for interaction 0.03) in GC. CONCLUSIONS: In this prospective cohort study, we found that MetS were associated with an increased risk of GC in the Korean population. Our findings suggest that MetS may be a potentially modifiable risk factor for GC risk.