Maternal perceptions of vaccinating boys against human papillomavirus (HPV) in Seoul, South Korea: A descriptive exploratory qualitative study.

Human Papillomavirus (HPV) vaccination is of paramount importance to reduce HPV-associated cancers in both genders. In South Korea, the prophylactic vaccine is recognized as prevention of cervical cancer with little attention given to male HPV vaccination. The purpose of this study was to explore perceptions of male HPV vaccination and underlying factors for vaccine hesitancy among mothers of unvaccinated boys in Seoul, Korea using a qualitative method. We used a purposive sampling strategy to recruit mothers of unvaccinated middle school-aged boys living in one of the 25 districts in Seoul, supplemented by a snowball sampling approach. We conducted one-on-one telephone interviews with ten mothers using a semi-structured interview guide. Questions probed mothers' views on vaccinating boys against HPV and the reasons for not vaccinating their sons. We found that mothers were hesitant to vaccinate their sons against HPV due to high out-of-pocket costs, fear of side effects concerning the young age of their sons, and low awareness of HPV and HPV vaccine, all of which stemmed from the exclusion of male HPV vaccination in the national immunization program. Sociocultural factors, including vaccination norms, lack of HPV education, and values associated with sexually transmitted infections were also likely to negatively impact mothers' vaccination decision-making. Despite the barriers, mothers were willing to accept HPV vaccination when it was framed as cancer prevention for not only the sons but also their future spouses. In conclusion, reasons for Korean mothers' hesitancy for their sons' HPV vaccine uptake were multifaceted. Healthcare providers' role in emphasizing and conveying the importance of gender-neutral HPV vaccination will be essential to alleviate negative sentiments around the vaccine for boys and reduce their risk of compromised sexual health. As an effective public health strategy, tailored cancer prevention messages should be delivered heightening significant benefits of the HPV vaccine beyond the prevention of cervical cancer.

Sustainability assessment of retrofitting alternatives for large and old wastewater treatment plants in Seoul.

Old wastewater treatment plants (WWTPs) must be upgraded to alleviate the problems associated with aging and reduce their total environmental impacts. To enhance the environmental sustainability in retrofitting large and old WWTPs, the decision-making process for selecting the most appropriate alternative is complicated. In this study, evaluation criteria were proposed to select the most sustainable alternatives for mid- to long-term retrofitting plans for a large WWTP with the treatment capacity of 1.6 M m3/d, which is initially built in 1987. An analytic hierarchy process was applied to estimate the weights of each criterion. Fourteen experts evaluated the relative importance of criteria through pairwise comparisons. In order to assess the current retrofitting opinions, three retrofitting alternatives were constructed: A focused on energy sufficiency; B expanded the bioreactor capacity and enhancement of the facility for incinerating the sludge leaving the anaerobic digestor; C emphasized the treatment of contaminants of emerging concerns (CECs). A achieved the highest score (0.623) owing to the environmental benefits associated with recycling and first flush stormwater treatment. C exhibited the second highest score (0.612) as the focus on CECs removal. B corresponded to the lowest sustainability (0.426), with the lowest scores pertaining to effective land use and first flush stormwater treatment.

Reliability and Validity of the Korean Version of the Ask Suicide-Screening Questions (ASQ).

BACKGROUND: The Ask Suicide-Screening Questions (ASQ) tool is a simple suicide screening tool developed to screen patient suicide risk (SR). The purpose of this study was to verify the reliability and validity of the ASQ tool in hospitalized patients. METHODS: The internal consistency and test-retest reliability of the South Korean version of the ASQ tool were verified in 99 hospitalized patients admitted to a tertiary medical institution in Seoul. To verify the correlations and validity of each convergence with other scales, the Mini-International Neuropsychiatric Interview (MINI), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Satisfaction with Life Scale (SWLS) were also conducted to determine convergent and discriminant validity. Then, the receiver operating characteristic (ROC) curve diagnosis values for suicide and depression levels with the highest correlations were analyzed. RESULTS: As a result, Cronbach's alpha was 0.826, and when each item was removed sequentially, Cronbach's alpha ranged from 0.736-0.840, showing stable internal consistency. Most of the corrected item-total correlation were over 0.500; however, a relatively low correlation was shown for the fourth and fifth questions, which had values of 0.429 and 0.410, respectively. The test-retest reliability was 0.830, and the MINI and PHQ-9 showed high values of 0.872 and 0.672, respectively. The area under the curve (AUC) according to the ASQ diagnosis value was also the highest for the MINI (0.936). CONCLUSION: The validity and reliability of the South Korean version of the ASQ tool were demonstrated. Through this validation, the ASQ tool can be used for simple suicide risk screening (SRS) in hospitalized patients.

Fungal Catastrophe of a Specimen Room: Just One Week is Enough to Eradicate Traces of Thousands of Animals.

Indoor fungi obtain carbon sources from natural sources and even recalcitrant biodegradable materials, such as plastics and synthetic dye. Their vigorous activity may have negative consequences, such as structural damage to building materials or the destruction of precious cultural materials. The animal specimen room of the Seoul National University stocked 36,000 animal resources that had been well-maintained for over 80 years. Due to abandonment without the management of temperature and humidity during the rainy summer season, many stuffed animal specimens had been heavily colonized by fungi. To investigate the fungal species responsible for the destruction of the historical specimens, we isolated fungi from the stuffed animal specimens and identified them at the species level based on morphology and molecular analysis of the ß-tubulin (BenA) gene. A total of 365 strains were isolated and identified as 26 species in Aspergillus (10 spp.), Penicillium (14 spp.), and Talaromyces (2 spp.). Penicillium brocae and Aspergillus sydowii were isolated from most sections of the animal specimens and have damaged the feathers and beaks of valuable specimens. Our findings indicate that within a week of mismanagement, it takes only a few fungal species to wipe out the decades of history of animal diversity. The important lesson here is to prevent this catastrophe from occurring again through a continued interest, not to put all previous efforts to waste.

Analysis of time-dependent effects of ambient temperatures on health by vulnerable groups in Korea in 1999-2018.

This study compared the relative risks of heat days on mortalities by vulnerable groups (elderly, single-person households, less-educated) in the past decade (1999-2008) and the recent decade (2009-2018) in four cities, Seoul, Incheon, Daegu, and Gwangju, in Korea. It has been known that the health impacts of heatwaves have gradually decreased over time due to socio-economic development, climate adaptation, and acclimatization. Contrary to general perception, we found that the recent relative risk of mortality caused by heat days has increased among vulnerable groups. It may associate with recent increasing trends of severe heat days due to climate change. The increasing relative risk was more significant in single-person households and less-educated groups than in the elderly. It implies that the impacts of climate change-induced severe heat days have been and will be concentrated on vulnerable groups. It suggests that social polarization and social isolation should be addressed to reduce heatwave impacts. Furthermore, this study shows the necessity of customized heatwave policies, which consider the characteristics of vulnerable groups.

Role of Seaports and Imported Rats in Seoul Hantavirus Circulation, Africa.

Seoul orthohantavirus (SEOV) is not considered a major public health threat on the continent of Africa. However, Africa is exposed to rodentborne SEOV introduction events through maritime traffic after exponential growth of trade with the rest of the world. Serologic studies have already detected hantavirus antibodies in human populations, and recent investigations have confirmed circulation of hantavirus, including SEOV, in rat populations. Thus, SEOV is a possible emerging zoonotic risk in Africa. Moreover, the range of SEOV could rapidly expand, and transmission to humans could increase because of host switching from the usual brown rat (Rattus norvegicus) species, which is currently invading Africa, to the more widely installed black rat (R. rattus) species. Because of rapid economic development, environmental and climatic changes, and increased international trade, strengthened surveillance is urgently needed to prevent SEOV dissemination among humans in Africa.

Modified susceptible-exposed-infectious-recovered model for assessing the effectiveness of non-pharmaceutical interventions during the COVID-19 pandemic in Seoul.

Susceptible-exposed-infectious-recovered (SEIR) models were applied to assess the effectiveness of non-pharmaceutical interventions (NPIs) and to study the dynamic behavior of the COVID-19 pandemic. Recently, SEIR models have evolved to address the change of human mobility by some NPIs for predicting the new confirmed cases. However, the models have serious limitations when applied to Seoul. Seoul has two representative quarantine policies, i.e. social distancing and the ban on gatherings. Effects of the two policies need to be reflected in different functional forms in the model because changes in human mobility do not fully reflect the ban on gatherings. Thus we propose a modified SEIR model to assess the effectiveness of social distancing, ban on gatherings and vaccination strategies. The application of the modified SEIR model was illustrated by comparing the model output with real data.

Experience of suffering in patients with hypertension: a qualitative analysis of in-depth interview of patients in a university hospital in Seoul, Republic of Korea.

OBJECTIVE: To describe the suffering experienced by patients with hypertension, not only regarding symptoms, but also suffering in a social context. DESIGN: A qualitative analysis of semi-structured interview data. Interviews were audio-recorded and transcribed verbatim. A descriptive approach was taken by exploring patient accounts and presenting their experiences and perspectives. SETTING: Cardiology clinic in a university hospital (Samsung Medical Center, Seoul, Republic of Korea). PARTICIPANTS: Patients with hypertension and without serious comorbidities who had been followed-up at a cardiology clinic of a training university hospital. RESULTS: Nineteen men and women (male:female=12:7) were interviewed. The mean age was 44 years, and the average hypertension duration was 4 years. All 19 patients reported symptoms allegedly to be associated with hypertension. Anxiety about blood pressure fluctuation and hypertension complications, dislike of antihypertensive medication and associated labelling effect, family stress and refusal to be enrolled in life insurance were commonly found among patients' interviews. Relatively younger (≤50 years of age), actively working patients experienced stigmatisation and discrimination in the workplace. CONCLUSION: The illness experience of patients with hypertension consists of suffering associated with threatened or damaged self-identity at the individual and social level. Medical professionals should have more awareness of the suffering of these patients to improve the quality of care. An education programme with proper focus on the elements of patients' suffering may help to alleviate it.

Examining the Relationship between Land Use/Land Cover (LULC) and Land Surface Temperature (LST) Using Explainable Artificial Intelligence (XAI) Models: A Case Study of Seoul, South Korea.

Understanding the relationship between land use/land cover (LULC) and land surface temperature (LST) has long been an area of interest in urban and environmental study fields. To examine this, existing studies have utilized both white-box and black-box approaches, including regression, decision tree, and artificial intelligence models. To overcome the limitations of previous models, this study adopted the explainable artificial intelligence (XAI) approach in examining the relationships between LULC and LST. By integrating the XGBoost and SHAP model, we developed the LST prediction model in Seoul and estimated the LST reduction effects after specific LULC changes. Results showed that the prediction accuracy of LST was maximized when landscape, topographic, and LULC features within a 150 m buffer radius were adopted as independent variables. Specifically, the existence of surrounding built-up and vegetation areas were found to be the most influencing factors in explaining LST. In this study, after the LULC changes from expressway to green areas, approximately 1.5 °C of decreasing LST was predicted. The findings of our study can be utilized for assessing and monitoring the thermal environmental impact of urban planning and projects. Also, this study can contribute to determining the priorities of different policy measures for improving the thermal environment.

The Factors and Relationships Influencing Forest Hiking Exercise Characteristics after COVID-19 Occurrence: At Seoul Metropolitan Area and in Hikers' 20s and 30s.

The growing interest and usage of green space during the pandemic relates to why greenery increases enjoyment of daily life and alleviates troubles arising from infectious periods. However, it is necessary to understand what reactions to the degree of COVID-19's spread were expressed in hiking exercise characteristics (hiking frequency, actual movement distance, average speed, total exercise time). To understand the progress of forest usage behavior during the pandemic, we analyzed factors influencing hiking exercise characteristics and relationships between those factors and hiking exercise characteristics. Hiking record data were obtained (2019-2020) from the workout app "Tranggle" pertaining to hikers in their 20s and 30s who visited the 13 mountains in the Seoul Metropolitan Area most frequently. The differences in hiking exercise characteristics (2019 data subtracted from 2020) were linked with factor data that could be related to them, including the degree of COVID-19's spread (Rt). To explore relationships between hiking exercise characteristics and factors, we developed four models with a linear mixed model. We found that Rt, week, weekdays/weekends, and PM10 contributed to explaining the hiking exercise characteristics' differences. As a result of this analysis, the degree of COVID-19's spread (Rt) affected hiking frequency; the week affected hiking frequency and actual movement distance; weekdays or weekends affected hiking frequency, actual movement distance, average speed, and total exercise time; and PM10 affected hiking frequency. These findings indicate that hiking was an alternative way for those looking for a new strategy to replace lost opportunities for physical activity. Therefore, we conclude that it is necessary to induce the usage of green space so that many people can take advantage of the functions and benefits of greenery, which stood out during the pandemic era.

Reduction in COVID-19 Vaccine Effectiveness against SARS-CoV-2 Variants in Seoul according to Age, Sex, and Symptoms: A Test-Negative Case-Control Study.

BACKGROUND: We evaluated vaccine effectiveness (VE) against infections with SARS-CoV-2 variants of concern in Seoul, the capital of the Republic of Korea, having the highest population density in the country, under real-world conditions. METHODS: We evaluated the reduction in the effectiveness of mRNA and viral-vector COVID-19 vaccines against infection by the SARS-CoV-2 delta variant in a subpopulation from April 2021 to July 2021 who visited screening clinics in Seoul using a test-negative case-control study design. Moreover, we conducted a case-control study matching the ten-year-old age group, sex, healthcare workers, and five districts of Seoul, which are considered confounding factors. RESULTS: The full VE in the pre-delta-dominant period was 95.0% (95% confidence interval [CI]: 91.2-97.2); however, it decreased to 61.1% (95% CI: 53.2-67.6) during the delta-dominant period. Notably, we found that COVID-19 VE was significantly decreased in individuals aged ≥80 years (52.9%, 95% CI: -9.9-79.8), men (50.6 %, 95% CI: 39.4-59.8), and asymptomatic individuals (49.8%, 95% CI: 36.5-60.3) during the widespread SARS-CoV-2 delta variant circulation. CONCLUSIONS: Vaccine-mediated protection drastically declined during the delta-dominant period and in vulnerable groups. This study suggests the requirement for additional countermeasures, such as the administration of a booster vaccine, in vulnerable groups based on age, sex, and symptomatic manifestation.

A Study on the Preliminary Plan for Environmental Health in Seoul, Korea.

In the Republic of Korea, the Environmental Health Act was amended in January 2021, making it mandatory for each local government to establish a plan for environmental health. Accordingly, the Seoul Metropolitan Government (SMG) must establish the Local Plan for Environmental Health (LPEH) to protect citizens' health from environmental hazards. The plan would support existing environmental health policies in Seoul to improve population health and achieve their goals. As a proof-of-concept to establish the LPEH, we developed a preliminary plan for environmental health in Seoul. We analyzed environmental health conditions of Seoul, identified driving conditions for execution of environmental health policies, set basic policy directions, and identified tasks needed to establish the preliminary plan. As a result, we established the vision and the goals of the preliminary plan. The vision is "a safe Seoul environment, healthy citizens". The strategies are "active monitoring of environmental health issues", "minimization of health damage and meticulous and systematic response", and "building a foundation for environmental health". To achieve the vision and the goals, we developed three strategies, eight tasks, and 25 sub-tasks. Under the preliminary plan we developed, we expect that SMG is able to protect citizens' health from threats of environmental hazards; improve environmental health conditions, especially in susceptible populations such as infants; and promote environmental justice.

Identification of Health Characteristics of People with Physical Disability by Applying the PRECEDE Model.

This study aimed to diagnose the health characteristics of people with grade 1-4 physical disability (but without intellectual disability) by analyzing factors affecting their health through social, epidemiological, behavioral, and ecological diagnoses by partially applying the PRECEDE model. Those registered with physical disability in 2022 and attending a welfare center were selected, with samples extracted from Seoul, Gyeonggi-do, Chungcheong-do, Jeolla-do, and Gyeongsang-do. A total of 1200 people were selected, and the data of 1000 people were finally analyzed. A frequency analysis was performed to identify the participants' characteristics. An independent t-test and one-way analysis of variance were performed to verify the hypotheses. To clarify the relationship between each variable, normality verification, confirmatory factor analysis, and structural equation model analysis were performed. First, the differences in factors influencing health promotion according to personal background variables (gender, age, and income level), including quality of life, showed partial differences according to age and income level. Second, according to disability-related variables (time of onset and disability grade), quality of life and health status showed partial differences. These results can be used as basic data or indicators to build a health promotion system that considers the health characteristics of individuals with a physical disability.

Forecasting the Reduction in Urban Air Pollution by Expansion of Market Shares of Eco-Friendly Vehicles: A Focus on Seoul, Korea.

Due to global climate change, various countries have agreed upon the use of conventions. In this study, the eco-friendly vehicular policy on carbon neutrality implemented in Seoul, Korea, was examined. To this end, various policy-based scenarios were set, and the changes in automotive exhaust gas emissions were evaluated and compared. The evaluation method combined macroscopic and microscopic emission models as its analysis framework. Micro-traffic data available in Korea were used for analyses, and the results for all autonomous districts were derived to cover the entire area of Seoul. The findings confirmed that the most effective measure is the initial replacement of old, mid-size, or large diesel passenger cars with eco-friendly vehicles (Middle-sized: Scenario 2-1 5.52%, Scenario 2-2 6.86%, Scenario 3-1 80.93%, and Scenario 3-2 83.98%). The replacement of old vehicles exhibited the highest effect in all tested scenarios, while the initial replacement of diesel vehicles was more effective than the replacement of gasoline and liquified petroleum gas vehicles (Diesel: Scenario2-1 6.64%, Scenario 2-2 8.21%, Scenario3-1 86.23%, and Scenario 3-2 90.51%). Among the autonomous districts of Seoul, the Gangnam-gu area exhibited the largest emission-reduced effect among all the tested scenarios (Gangnam-gu: Scenario 2-1 5.80%, Scenario 2-2 6.74%, Scenario 3-1 80.44%, and Scenario 3-2 82.62%). Overall, it was demonstrated that the findings of this study may have significant policy implications in terms of urban emission changes pertaining to transportation.

The Effects of Particulate Matter Alert on Urban Park Visitation in Seoul, Korea: Using Segmented Regression.

To reduce the health burden from particulate matter (PM), the Korean government implemented a nationwide PM10 (particles less than 10 µg/m3 in diameter) alert system in 2015. The policy was intended to reduce PM exposure by advising people to refrain from outdoor activities on highly polluted days. The present study aimed to estimate the effect of the PM10 alert system on people's daily outdoor activity patterns using urban park (specifically, Children's Grand Park) visitation data from Seoul, South Korea, from 2014-2019. Segmented regression was fitted to estimate whether the number of visitors to the park decreased on the days with PM10 alerts. PM10 concentration of 80 µg/m3, the cut-off point for a "Bad" alert, was set as a threshold, and discontinuity at the threshold and change in the relative risk after the threshold was tested. Time series regression was used to estimate the dose-response line between the ambient PM10 concentration and the daily number of park visitors. The number of park visitors decreased by 11.8% (relative risk: 0.881, 95% confidence interval: 0.808, 0.960) when a "Bad" alert was issued (PM10 level above 80 µg/m3) compared to when the alert level was "Normal" (PM10 level less than 80 µg/m3). The present study found evidence that the PM10 alert influenced people's daily outdoor activities in Seoul, Korea. As the main purpose of the PM alert is to encourage people to refrain from outdoor activities, evaluating the relationship between PM alerts and behavior patterns can help to grasp the effectiveness of the policy. Further efforts should be made to investigate whether the observed behavioral change leads to reductions in health outcomes caused by PM.

Seasonal variations of the airborne microbial assemblages of the Seoul subway, South Korea from 16S and ITS gene profiles with chemical analysis.

In this study, we determined the seasonal airborne microbial diversity profiles at SMRT stations by sequencing the 16S rRNA and ITS. Particulate matter samples were collected from air purifiers installed in the platform area of the SMRT subway stations. Three stations that included the most crowded one were selected for the sampling. The sampling was done at each season during 2019. After extracting the total DNA from all seasonal samples, PCR was performed with Illumina overhang adapter primers for the V3-V4 region of the 16S rRNA gene and ITS2 region of the ITS gene. The amplified products were further purified, and sequencing libraries were made. Sequencing was carried with the Illumina Miseq Sequencing system (Illumina, USA) followed by in-depth diversity analyses. The elemental composition of the particulate matter samples collected from the different subway stations were obtained using a WD-XRF spectrometer. The SMRT microbiome showed extensive taxonomic diversity with the most common bacterial genera at the subway stations associated with the skin. Overall, the stations included in this study harbored different phylogenetic communities based on α- and ß-diversity comparisons. Microbial assemblages also varied depending upon the season in which the samples were taken and the station. Major elements present at the subway stations were from aerosols generated between wheels and brake cushions and between the catenaries and the pantographs. This study shows that the microbial composition of the SMRT subway stations comes from a diverse combination of environmental and human sources, the season and the lifestyle of commuters.

Severe Pneumonia Caused by Corynebacterium striatum in Adults, Seoul, South Korea, 2014-2019.

We investigated the proportion and characteristics of severe Corynebacterium striatum pneumonia in South Korea during 2014-2019. As part of an ongoing observational study of severe pneumonia among adult patients, we identified 27 severe C. striatum pneumonia cases. Most (70.4%) cases were hospital-acquired, and 51.9% of patients were immunocompromised. C. striatum cases among patients with severe hospital-acquired pneumonia (HAP) increased from 1.0% (2/200) during 2014-2015 to 5.4% (10/185) during 2018-2019, but methicillin-resistant Staphylococcus aureus (MRSA) infections among severe HAP cases decreased from 12.0% to 2.7% during the same timeframe. During 2018-2019, C. striatum was responsible for 13.3% of severe HAP cases from which bacterial pathogens were identified. The 90-day mortality rates were similarly high in the C. striatum and MRSA groups. C. striatum was a major cause of severe HAP and had high mortality rates. This pathogen is emerging as a possible cause for severe pneumonia, especially among immunocompromised patients.