Microfluidic Bioreactor with Fibrous Micromixers for In Vitro mRNA Transcription.

A new type of microfluidic bioreactor with fibrous micromixers for the ingredient mixing and a long macrochannel for the in vitro transcription reaction was fabricated for the continuous production of mRNA. The diameter of the fibrous microchannels in the micromixers was tuned by using an electrospun microfibrous disc with different microfiber diameters. The micromixer with a larger diameter of fibrous microchannels exhibited a better mixing performance than the others. The mixing efficiency was increased to 0.95 while the mixture was passed through the micromixers, suggesting complete mixing. To demonstrate the continuous production of mRNA, the ingredients for in vitro transcription were introduced into the perfluoropolyether microfluidic bioreactor. The mRNA synthesized by the microfluidic bioreactor had the same sequence and in vitro/in vivo performances as those prepared by the bulk reaction. The continuous reaction in the microfluidic bioreactor with efficient mixing performance can be used as a powerful platform for various microfluidic reactions.

Analysis of the immunostimulatory effects of cytokine-expressing internal ribosome entry site-based RNA adjuvants and their applications.

Developing new adjuvants that can effectively induce both humoral and cellular immune responses while broadening the immune response is of great value. In this study, we aimed to develop GM-CSF- or IL-18-expressing single-stranded RNA (ssRNA) adjuvants based on the encephalomyocarditis virus (EMCV) internal ribosome entry site (IRES) and tested their efficacy in combination with ovalbumin (OVA) or inactivated influenza vaccines. Notably, cytokine-expressing RNA adjuvants increased the expression of antigen-presenting cell activation markers. Specifically, GM-CSF-expressing RNA adjuvants increased CD4+T cell responses, while IL-18-expressing RNA adjuvants increased CD8+T cell responses in mice when combined with OVA. In addition, cytokine-expressing RNA adjuvants increased the frequency of polyclonal T cells in combination with the influenza vaccine and reduced the clinical illness scores and weight loss of mice after viral challenge. Collectively, our results suggest that cytokine-expressing RNA adjuvants can be applied to protein-based or inactivated vaccines to increase their efficacy.

mRNA-HPV vaccine encoding E6 and E7 improves therapeutic potential for HPV-mediated cancers via subcutaneous immunization.

The E6 and E7 proteins of specific subtypes of human papillomavirus (HPV), including HPV 16 and 18, are highly associated with cervical cancer as they modulate cell cycle regulation. The aim of this study was to investigate the potential antitumor effects of a messenger RNA-HPV therapeutic vaccine (mHTV) containing nononcogenic E6 and E7 proteins. To achieve this, C57BL/6j mice were injected with the vaccine via both intramuscular and subcutaneous routes, and the resulting effects were evaluated. mHTV immunization markedly induced robust T cell-mediated immune responses and significantly suppressed tumor growth in both subcutaneous and orthotopic tumor-implanted mouse model, with a significant infiltration of immune cells into tumor tissues. Tumor retransplantation at day 62 postprimary vaccination completely halted progression in all mHTV-treated mice. Furthermore, tumor expansion was significantly reduced upon TC-1 transplantation 160 days after the last immunization. Immunization of rhesus monkeys with mHTV elicited promising immune responses. The immunogenicity of mHTV in nonhuman primates provides strong evidence for clinical application against HPV-related cancers in humans. All data suggest that mHTV can be used as both a therapeutic and prophylactic vaccine.

The Role of Media in Addressing Opioid Use Disorder: Examining Causal Attributions and Emotions as Mediators of Media Influence on Stigma and Policy Support.

This study examined the influence of media on stigma and public support for policy interventions that address opioid-related problems. Data from a survey of 997 U.S. adults indicate that media exposure to opioids and relevant topics significantly influenced stigma and support for punitive and public health-oriented policies, even after direct and indirect experiences with opioid misuse were controlled for. However, differences emerged in terms of what led people to endorse each type of policy intervention. When people attributed opioid misuse to individual-oriented causes after media exposure, they were more likely to support punitive policies. When people recognized pharmaceutical-oriented causes, they tended to support public health-related policies.In addition to causal attributions, emotions (fear, anger, and sympathy) served as mediators with different effects on stigma and policy support. Although exposure to opioid-related stories positively influenced all three emotions, media influence was most likely to elicit sympathy, which was negatively associated with social stigma. However, people who felt anger tended to stigmatize individuals with opioid use disorder and not to support either of the policy interventions. The overall findings suggest that communication efforts addressing the opioid situation should find frames that reduce social stigma and encourage support for public health-related policies.

Bacterial degradation kinetics of poly(Ɛ-caprolactone) (PCL) film by Aquabacterium sp. CY2-9 isolated from plastic-contaminated landfill.

Despite the identification of numerous bioplastic-degrading bacteria, the inconsistent rate of bioplastic degradation under differing cultivation conditions limits the intercomparison of results on biodegradation kinetics. In this study, we isolated a poly (Ɛ-caprolactone) (PCL)-degrading bacterium from a plastic-contaminated landfill and determined the principle-based biodegradation kinetics in a confined model system of varying cultivation conditions. Bacterial degradation of PCL films synthesized by different polymer number average molecular weights (Mn) and concentrations (% w/v) was investigated using both solid and liquid media at various temperatures. As a result, the most active gram-negative bacterial strain at ambient temperature (28 °C), designated CY2-9, was identified as Aquabacterium sp. Based on 16 S rRNA gene analysis. A clear zone around the bacterial colony was apparently exhibited during solid cultivation, and the diameter sizes increased with incubation time. During biodegradation processes in the PCL film, the thermal stability declined (determined by TGA; weight changes at critical temperature), whereas the crystalline proportion increased (determined by DSC; phase transition with temperature increment), implying preferential degradation of the amorphous region in the polymer structure. The surface morphologies (determined by SEM; electron optical system) were gradually hydrolyzed, creating destruction patterns as well as alterations in functional groups on film surfaces (determined by FT-IR; infrared spectrum of absorption or emission). In the kinetic study based on the weight loss of the PCL film (4.5 × 104 Da, 1% w/v), ∼1.5 (>±0.1) × 10-1 day-1 was obtained from linear regression for both solid and liquid media cultivation at 28 °C. The biodegradation efficiencies increased proportionally by a factor of 2.6-7.9, depending on the lower polymer number average molecular weight and lower concentration. Overall, our results are useful for measuring and/or predicting the degradation rates of PCL films by microorganisms in natural environments.

The Effects of Auricular Acupressure on Physiological Index, Depression, Anxiety, and Stress for Elders With Hypertension.

The purpose of the study was to examine the effects of auricular acupressure (AA) on physiological index, depression, anxiety, and stress in elderly people with hypertension. The verum group received verum AA therapy for 8 weeks. Five different acupressure sites were applied in each group. There was a significant difference in systolic blood pressure between the 2 groups after 8 weeks of AA, whereas a significant difference in pulse pressure was found between the 2 groups after 6 weeks of AA. This study is meaningful in comparing intervention and sham groups, verifying the effects by using physiological and psychological variables, and confirming the effects of repetitive measurement. AA therapy is expected to be a practical and efficient health care intervention for elderly people with hypertension.

Benefits of a Single-Session, In-Hospital Preoperative Education Program for Patients Undergoing Ostomy Surgery: A Randomized Controlled Trial.

PURPOSE: The purpose of this study was to compare the effects of a 45-minute session of video-based preoperative ostomy education on self-care knowledge, self-care proficiency, anxiety, depression, length of hospital stay, and ostomy-related complications to a control group who received 3 postoperative educational sessions. DESIGN: This was a randomized controlled trial. SAMPLE AND SETTING: The sample comprised 47 patients scheduled to undergo ostomy surgery for colon or rectal cancer surgery at a tertiary referral hospital in Seoul, South Korea, from November 2018 to May 2019. However, 2 participants in the intervention group and 4 in the control group withdrew from the study and data analysis is based on 41 participants who completed study procedures. METHODS: Participants were randomly allocated to an intervention group (n = 21) or a control group (n = 20). The intervention group received a single 45-minute session of video-based preoperative ostomy education along with stoma site marking and postoperative education. The control group underwent stoma site marking and 3 postoperative education sessions Self-care knowledge, anxiety, and depression were assessed by validated instruments. Self-care proficiency was assessed via direct observation using a checklist. Ostomy-related complications were evaluated by a WOC nurse. Length of hospital stay and disease-related characteristics were collected from medical records. RESULTS: Compared with the control group, the intervention group showed significant improvements in self-care knowledge (P = .001) and self-care proficiency scores (P = .001). Intervention group participants also had lower anxiety scores (P = .025), depression scores (P = .014), shorter hospital stays (P = .008), and fewer ostomy-related complications (P = .001). CONCLUSIONS: In patients undergoing ostomy surgery, a single 45-minute session of preoperative video-based ostomy education improved self-care knowledge and proficiency. This intervention also reduced depression, anxiety, and ostomy-related complications.

Adjuvant effect of IRES-based single-stranded RNA on melanoma immunotherapy.

BACKGROUND: Adjuvant therapies such as radiation therapy, chemotherapy, and immunotherapy are usually given after cancer surgery to improve the survival of cancer patients. However, despite advances in several adjuvant therapies, they are still limited in the prevention of recurrences. METHODS: We evaluated the immunological effects of RNA-based adjuvants in a murine melanoma model. Single-stranded RNA (ssRNA) were constructed based on the cricket paralysis virus (CrPV) internal ribosome entry site (IRES). Populations of immune cells in bone marrow cells and lymph node cells following immunization with CrPVIRES-ssRNA were determined using flow cytometry. Activated cytokine levels were measured using ELISA and ELISpot. The tumor protection efficacy of CrPVIRES-ssRNA was analyzed based on any reduction in tumor size or weight, and overall survival. RESULTS: CrPVIRES-ssRNA treatment stimulated antigen-presenting cells in the drain lymph nodes associated with activated antigen-specific dendritic cells. Next, we evaluated the expression of CD40, CD86, and XCR1, showing that immunization with CrPVIRES-ssRNA enhanced antigen presentation by CD8a+ conventional dendritic cell 1 (cDC1), as well as activated antigen-specific CD8 T cells. In addition, CrPVIRES-ssRNA treatment markedly increased the frequency of antigen-specific CD8 T cells and interferon-gamma (IFN-γ) producing cells, which promoted immune responses and reduced tumor burden in melanoma-bearing mice. CONCLUSIONS: This study provides evidence that the CrPVIRES-ssRNA adjuvant has potential for use in therapeutic cancer vaccines. Moreover, CrPVIRES-ssRNA possesses protective effects on various cancer cell models.

Single-stranded RNA adjuvant enhances the efficacy of 10-valent human papilloma virus-like particle vaccine.

Following the development of various types of vaccines, the use of adjuvants to boost vaccine efficacy has become a focus of research. Aluminum hydroxide (alum), the most commonly used adjuvant, induces a certain immune response and ensures safety in human trials. However, alum mainly induces only a Th2 response; its Th1 response is weak. Thus, we previously developed a single-stranded ribose nucleic acid (ssRNA) adjuvant that induces a Th1 response through toll-like receptors. Here, we explored whether 10-valent human papilloma virus (HPV)-like particle (VLP) vaccine formulated with ssRNA adjuvant and alum helped to enhance immune response and maintained memory response. The mice were immunized intramuscularly twice at 2 week intervals and were inoculated 4 days after the second boost (after about 1 year). The antibody response and T cell activation were measured by Elispot, ELISA using harvested serum and splenocytes. The 10-valent HPV VLP vaccine formulated with ssRNA adjuvant and alum increased the antigen-specific immune response more than alum used alone. It increased each type-specific IgG1/IgG2a titer, and antigen-specific IFN-γ cells. Furthermore, the ssRNA adjuvant with alum induced memory response. In memory response, each type-specific IgG1/IgG2c, IFN-γ, and IL-6 cytokine, and neutralizing antibodies were increased by the ssRNA adjuvant with alum. Overall, the ssRNA adjuvant with alum induced memory responses and balanced Th1/Th2 responses. The ssRNA adjuvant and alum may help to enhance prophylactic vaccine efficacy.

Clinical characteristics, treatment outcomes, and occurrence of diabetes mellitus after pancreatic resection of solid pseudopapillary tumor in children and adolescents: A single institution experience with 51 cases.

BACKGROUND: Solid pseudopapillary tumors (SPTs) are rare, but they comprise the majority of pediatric pancreatic neoplasms. However, studies on these conditions in pediatric patients are lacking. The aim of this study was to investigate the clinical characteristics and treatment outcomes in children and adolescents with SPTs. METHODS: This retrospective study included 51 patients with SPTs who had undergone pancreatic tumor resection before the age of 19 years at Samsung Medical Center in Korea (from November 1994 to August 2020). We investigated the postoperative outcomes. RESULTS: Of the 51 patients with SPTs (female, 88.2%), the median age at diagnosis was 14 years (range, 8-19). The most common symptom was abdominal pain (60.8%), and 14 patients (27.5%) were asymptomatic. The median maximal tumor diameter was 7 cm (range, 1.4-14), and the pancreatic body and/or tail were involved in 68.6% of patients. The short-term complication rate was 21.5%, and the recurrence rate was 5.9%. New-onset diabetes mellitus (NODM) occurred in four patients. CONCLUSIONS: The ideal treatment for SPTs is complete resection of the tumor; however, long-term postoperative complications including NODM should be monitored carefully, particularly in children and adolescents.

Predicting Public Support for Government Actions in a Public Health Crisis: Testing Fear, Organization-Public Relationship, and Behavioral Intention in the Framework of the Situational Theory of Problem Solving.

This study aimed to examine a theoretical model to predict publics' communicative actions to take and transmit information from the Centers for Disease Control and Prevention (CDC), as well as their behavioral intentions to follow the CDC's instructions in the context of infectious disease outbreaks. Using the framework of the situational theory of problem-solving (STOPS), this study tested the roles of fear and positive organization-public relationship (OPR), linking STOPS and behavioral intentions to follow CDC instructions. The results of this study suggest that fear and positive OPR variables play vital roles in predicting individuals' information acquisition, information transmission, and willingness to follow the CDC's instructions to cope with infectious diseases.

Innate Type 2 Response to Aspergillus fumigatus in a Murine Model of Atopic Dermatitis-like Skin Inflammation.

BACKGROUND: Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease mediated by T helper type 2 (Th2) cells in acute phase. Group 2 innate lymphoid cells (ILCs) play a role in the initiation of the Th2 response. Although mold exposure is associated with the development of AD, studies on the underlying mechanisms are lacking. This study investigated whether group 2 ILCs are involved in inflammation in AD-like skin induced by Aspergillus fumigatus (Af). METHODS: We investigated changes of group 2 ILCs population in Af-induced AD-like skin lesions. To induce AD-like skin lesions, Af extracts were applied to the dorsal skin of BALB/c and Rag1-/- mice five times per week, with repeat exposures at 2-week intervals. RESULTS: The clinical parameters were higher in the Af-treated group than in the control group. Histologic findings revealed epiderrmal and dermal thickening as well as eosinophil and mast cell infiltration into the skin of Af-treated mice. Populations of group 2 ILCs in the skin were also significantly higher in the Af-treated group. In addition, interleukin-33 mRNA expression was significantly higher in the skin lesions of the Af-treated mice. In the Rag1-/- mice lacking mature lymphocytes, AD-like skin lesions were still induced by Af and ILCs depletion using an anti-CD90.2 mAb lowered the Af-induced inflammatory response. CONCLUSIONS: Group 2 ILCs may play a role in a murine model of Af-induced AD-like skin lesions.

The Effect of Auricular Acupressure for Chronic Low Back Pain in Elders: A Randomized Controlled Study.

Chronic low back pain (CLBP) is a major problem throughout the world and getting worse because of population increase and aging. The cost of treatment increases as the population of people with CLBP increases. This study aimed to examine the effect of auricular acupressure (AA) on pain and disability in elders with chronic low back pain. The randomized, single-blinded, and placebo-controlled study was conducted on 51 elders with CLBP in South Korea from June 2019 to August 2019. The experimental group (n = 26) received AA on low back pain-related points, whereas the placebo control group (n = 25) received AA on points unrelated to low back pain. Participants received 6 weeks of AA in weekly cycles. Collected data were analyzed using IBM SPSS Statistics, version 25. Statistically significant differences between the 2 groups emerged in the visual analog scale (P < .001), pain threshold (P < .001), and Oswestry Disability Index (P < .001). This study showed that 6 weeks of AA improved CLBP and pain-related disability. Therefore, AA can be used as a noninvasive and self-managed alternative intervention for CLBP in older adults.

The Effect of Electrical Stimulation Therapy With Pelvic Floor Muscle Exercise on Stress Urinary Incontinence in Middle-Aged Women: A Nonequivalent Comparison Cohort Study.

PURPOSE: The purpose of this study was to evaluate the effects of combined pelvic floor muscle exercises (PFMEs) and a novel electrical stimulation (ES) device versus PFMEs alone on lower urinary tract symptoms, urinary incontinence-related quality of life, and pelvic floor muscle contractions (PFMCs). DESIGN: Nonrandomized comparison cohort study. SUBJECTS AND SETTING: The sample comprised 54 community-dwelling middle-aged women with stress urinary incontinence recruited from churches and cultural centers in Gyeonggi Province, South Korea. Comparisons of demographic and pertinent clinical characteristics revealed no significant differences between the experimental and comparison groups. METHODS: Participants allocated to the combined intervention group (n = 27) performed self-exercises of the pelvic floor muscles 3 times a day under weekly telephone coaching, and they used the ES device twice daily for 8 weeks. Participants in the comparison group (n = 27) received the PFMEs alone without telephone coaching. The 3 main outcomes including lower urinary tract symptoms, urinary incontinence-related quality of life, and PFMCs were measured using the Bristol Female Lower Urinary Tract Symptom instrument (BFLUTS), King's Health Questionnaire (KHQ), and a perineometer, respectively. Study outcomes were measured at baseline and at the end of the 8-week period. RESULTS: Participants in the experimental group achieved significantly greater reductions in lower urinary tract symptoms (t = -4.07, P < .001) and improvement in urinary incontinence-related quality of life (P = .006), peak PFMC pressure (P = .004), mean pelvic muscle contraction (PMC) pressure (P < .001), and duration of PFMCs (P < .001) when compared to participants undergoing PFMEs alone. CONCLUSIONS: Combined ES and pelvic floor exercise was more effective in reducing severity of lower urinary tract symptoms, enhancing health-related quality of life, and increasing PMC pressure in middle-aged women with stress urinary incontinence than PFMEs alone.

Effects of Auricular Acupressure on Korean Children Who are Obese.

PURPOSE: This study aimed to examine the effects of auricular acupresure on reducing obesity in children who are obese. DESIGN AND METHODS: The study design was a randomized controlled trial design. Participants aged between 9 and 11 years were 65 children who are obese, divided into the experimental group (n = 31) and control group (n = 34). The sessions continued for 8 weeks. The participants in the experimental and control groups received auricular acupressure using ear pellets (seeds) on 5 acupoints known to be either effective in obesity treatment or ineffective. Outcome measures included body image score, children's depression inventory, Rosenberg self-esteem scale, and anthropometric indices (waist circumference, hip circumference, BMI, etc.). RESULTS: Children in the experimental group showed significant improvement in waist circumference and hip circumference after 8 weeks compared with those in the control group (p < .001). But no statistically significant difference in body image score, depression score, or self-esteem score emerged before or after auricular acupressure in the experimental and control groups. CONCLUSIONS: Auricular acupressure using ear pellets for eight weeks was effective in decreasing waist and hip circumferences in children who are obese. PRACTICE IMPLICATIONS: Auricular acupressure can be used as an intervention method for children to control obesity.

Effects of auricular acupressure on the quality of sleep and anxiety in patients undergoing cardiac surgery: A single-blind, randomized controlled trial.

AIM: This study aimed to evaluate the effects of auricular acupressure (AA), a non-invasive type of reflexotherapy, on sleep quality and anxiety in patients after cardiac surgery. BACKGROUND: Sleep disturbances and anxiety hinder the recovery of patients after cardiac surgery; thus, appropriate and adequate nursing interventions must be pursued. AA is a complementary therapy suitable for patients with limited pharmacological therapy options. METHOD: A single-blind, randomized controlled trial with a pretest-posttest control group design was applied. The study consisted of 42 patients, comprising an experimental group (n = 21) and a control group (n = 21). AA was applied for six days per trial for a total of 2 trials, while sleep (sleep score, sleep satisfaction) and anxiety (state, trait) were measured at three time points (pre-op, 7 days post-op, and 14 days post-op). RESULTS: The sleep and sleep satisfaction scores of the experimental group were significantly higher than those of the control group. No significant difference was found in anxiety state/trait between the two groups. CONCLUSIONS: We conclude that AA is a safe, effective, noninvasive, and low-risk nursing intervention that can improve sleep quality in patients after cardiac surgery.

Effects of Auricular Acupressure on Women With Irritable Bowel Syndrome.

The purpose of this study was to examine the effect of auricular acupressure on bowel symptoms, stress, mental health, and heart rate variability in women with irritable bowel syndrome (IBS). A quasi-experimental study design with a nonequivalent control group assessed a total sample of 56 women diagnosed with IBS according to Rome III criteria. There were 29 women in the experimental group who received auricular acupressure; 27 women were in the control group. Semen sinapis albae seeds were used to administer acupressure to four auricular points: endocrine, large intestine, lung, and Shenmen for 5 days/week for 4 weeks; the control group received no treatment. Bowel symptoms, stress, mental health, and heart rate variability were measured twice, once before and once after the intervention. Chi-square tests, t tests, and paired t tests were used for analysis. The experimental group had decreased loose stools, abdominal pain, diarrhea, abdominal discomfort, stress, and heart rate variability compared with the control group (p < .05). Auricular acupressure was effective for symptom improvement in patients with IBS.

Nanoformulated Single-Stranded RNA-Based Adjuvant with a Coordinative Amphiphile as an Effective Stabilizer: Inducing Humoral Immune Response by Activation of Antigen-Presenting Cells.

As agonists of TLR7/8, single-stranded RNAs (ssRNAs) are safe and promising adjuvants that do not cause off-target effects or innate immune overactivation. However, low stability prevents them from mounting sufficient immune responses. This study evaluates the adjuvant effects of ssRNA derived from the cricket paralysis virus intergenic region internal ribosome entry site, formulated as nanoparticles with a coordinative amphiphile, containing a zinc/dipicolylamine complex moiety as a coordinative phosphate binder, as a stabilizer for RNA-based adjuvants. The nanoformulated ssRNA adjuvant was resistant to enzymatic degradation in vitro and in vivo, and that with a coordinative amphiphile bearing an oleyl group (CA-O) was approximately 100 nm, promoted effective recognition, and improved activation of antigen-presenting cells, leading to better induction of neutralizing antibodies following single immunization. Hence, CA-O may increase the efficacy of ssRNA-based adjuvants, proving useful to meet the urgent need for vaccines during pathogen outbreaks.

Effects of auricular acupressure on pain and disability in adults with chronic neck pain.

AIM: The aim of this study was to examine the effect of auricular acupressure (AA) on pain, pain threshold (PT), disability, and cervical range of motion in adults with chronic neck pain. BACKGROUND: About 30-50% of the world's population suffers from chronic neck pain, and the cost of treatment is increasing. MATERIALS AND METHODS: This single-blind, randomized sham-controlled study was conducted on 48 adults with chronic neck pain in South Korea. The experimental group (n = 25) received AA on specific acupoints for neck pain, whereas the control group (n = 23) received AA on unspecific acupoints. Participants received 4 weeks of auricular-acupressure intervention. Outcomes were assessed by the visual analog scale (VAS), PT, neck-disability index (NDI), and cervical range of motion. Measurements were taken 3 times: before intervention, 2 weeks into the intervention, and after the intervention. RESULTS: Statistical differences between the two groups emerged in PT (p = .003), the NDI (p = .033), cervical flexion (p = .004), and left rotation (p = .004), but not on the VAS. CONCLUSIONS: This study showed that AA leads to improvements on PT, neck disability, and cervical range of motion. Therefore, AA can be used as an alternative nursing intervention for chronic neck pain.

Collaborative accountability for sustainable public health: A Korean perspective on the effective use of ICT-based health risk communication.

The sustainability of public health practices requires collaboration between the government and its citizens. On the government's side, social media can provide a conduit for communicating health risk information in an effective and timely fashion, while also engaging citizens in informed decision-making. On the citizen's side, information communication technology (ICT)-based practices cannot function unless citizens recognize and act on their responsibility to actively engage with government social media platforms. Despite an increasing interest in understanding the adoption of ICT practices and e-government services for health risk communication, there remains a crucial need for a comprehensive framework to explain which factors determine citizen use of digital government resources. The purpose of this study is to investigate how to increase government accountability for motivating citizens to engage in ICT-based health risk communication, thereby attaining sustainable public health practices through collaborative governance. By integrating trust and health risk information into the e-government adoption model (GAM), this research examines factors that influence citizens' likelihood of using government social media resources. Survey data from 700 Korean citizens were analyzed using structural equation modeling. The results indicated that individuals with higher social media competency are more likely to (a) seek risk information through social media and (b) perceive the government's social media sites as easy to use. Consistent with the GAM, intentions to use the government's social media sites for information and interactions appear to increase as citizens perceive more value in using them regarding information quality, ease of use, functional benefit, and security. Furthermore, perceived trust in the government's social media resources appears to function as a mediator of this process. Initial trust in the government is an important determinant of perceptions of its digital resources. Citizens who trust the government tend to evaluate new initiatives positively and are more likely to accept and make use of them. The results of this study can inform policy design and implementation by elucidating the mechanisms that determine citizens' adoption and usage of digital government services. Theoretically, this work expands the GAM to include health risk communication and adds empirical evidence to the small yet growing body of knowledge of e-government initiatives. These findings also highlight the importance of public trust in the government, as this encourages citizens to seek health risk information and assistance from the government. Overall, the data and model generated in this investigation represent an important step toward the successful and sustainable modernization of public services.