Objectives:To systematically review and meta-analyze the prevalence and genetic diversity of rotavirus A (RVA) in humans, animals, and environmental water samples in West Africa and to describe its geographic distribution and circulation patterns. Methods:PubMed, Scopus, Web of Science, African Journals Online, ScienceDirect, SpringerLink, JSTOR, clinical trial registries, and global health libraries were searched for observational studies published from January 1, 2010, to December 20, 2025, reporting molecular RVA genotyping data from West Africa. Two reviewers independently screened studies, extracted data, assessed risk of bias using the Joanna Briggs Institute and SYRCLE tools, and summarized genotype distributions narratively. Random-effects meta-analyses were used to estimate pooled prevalence by source category. Results:Fifty-four studies were included, comprising 21,532 samples and 2,080 RVA-positive cases. The overall pooled prevalence was 12.6% (95% confidence interval [CI], 9.9%-15.6%). Prevalence was highest in animals (19.77%; 95% CI, 5.4%-40.1%), followed by environmental water samples (14.81%; 95% CI, 3.5%-31.1%) and humans (11.37%; 95% CI, 9.0%-14.0%). Overall heterogeneity was very high (I²=97.1%). In human studies, G1P[8], G9P[8], and G2P[4] were among the most frequently detected and geographically widespread genotype combinations. Conclusion:RVA circulates widely in humans, animals, and environmental water samples across West Africa, although evidence is characterized by substantial heterogeneity, uneven geographic representation, and limited animal and environmental water data. These findings support integrated One Health surveillance, monitoring for genotype shifts, and stronger water, sanitation, and hygiene interventions.
Objectives:Medication adherence remains a major challenge in the management of type 2 diabetes (T2D), especially in middle-income countries such as Morocco. With the rapid development of artificial intelligence, large language models, including ChatGPT, may offer new opportunities for clinical research through simulated patient profiles. This study examined the feasibility of using ChatGPT to generate culturally contextualized virtual profiles of Moroccan patients with T2D and to apply the validated Moroccan Arabic dialect version of the general medication adherence scale (GMAS). Methods:This exploratory pilot simulation study used ChatGPT-4 to generate 11 virtual profiles based on representative sociodemographic and clinical characteristics of Moroccan patients with T2D. Each profile was administered the validated Moroccan Arabic dialect version of the GMAS. Results:Four profiles (36.4%) showed high adherence, 6 (54.5%) displayed moderate adherence, and 1 (9.1%) exhibited low adherence. Expert evaluations were consistent, with all ratings ≥3 on a 4-point scale, supporting the credibility and cultural appropriateness of the profiles. The simulated patterns reflected real-world trends, with higher adherence among profiles treated with oral antidiabetic drugs, covered by health insurance, and having shorter disease duration, and lower adherence among profiles using insulin, lacking insurance, and having longer disease duration. Conclusion:ChatGPT generated credible, culturally adapted patient profiles that enabled application of a validated psychometric tool in a simulated environment. This rapid, low-cost approach may support exploratory research, healthcare training, and intervention design. Comparative studies using real patient data are needed to confirm validity.
Objectives:Chikungunya poses an increasing threat to people living in endemic areas and to travelers from non-endemic regions. This study descriptively characterized imported chikungunya cases in Japan and explored the relationship between local incidence in destination areas and infection risk among Japanese travelers. Methods:First, the descriptive features of imported chikungunya cases in Japan from 2011 to 2023 were examined. Second, monthly and yearly trends in the incidence of imported chikungunya cases among Japanese travelers were compared by destination with incidence in the corresponding destination country. Third, destination-specific incidence among Japanese travelers was compared between high- and low-transmission seasons in each destination country. Results:Of 155 imported chikungunya cases in Japan during 2011-2023, 112 (72.3%) were associated with travel to Myanmar, India, Indonesia, the Philippines, or Thailand. The yearly chikungunya importation rate among Japanese travelers returning from Indonesia and Thailand was correlated with the corresponding rate among local residents. The monthly incidence of imported cases during the high-transmission season was 12.3, 7.4, 12.0, and 4.0 times higher than that during the low-transmission season among travelers returning from Myanmar, India, Indonesia, and the Philippines, respectively. Conclusion:The risk of imported chikungunya infection among Japanese travelers reflected the local epidemiology of chikungunya in destination countries, including both seasonal and long-term patterns. Imported-case data may support risk assessment in destination countries and contribute to traveler-specific prevention, improved diagnosis, and a reduced risk of autochthonous outbreaks.
Objectives:This study aimed to develop prevalence-informed post-release dengue control strategies for settings in which Wolbachia-carrying Aedes aegypti mosquitoes have become established through population replacement and to quantify how optimal supplementary intervention intensity and duration vary with adult Wolbachia prevalence, pW. Methods:A deterministic human-mosquito model was formulated that included Wolbachia-free and Wolbachia-carrying mosquitoes and incorporated cytoplasmic incompatibility, maternal transmission, and reduced vector competence. Two bounded supplementary controls were optimized over a 3-year horizon: reduction of effective human-mosquito contact and conventional adult mosquito suppression, represented by increased adult mortality. A quadratic-cost optimal-control problem was solved numerically using the Pontryagin maximum principle and a forward/backward sweep algorithm. Outcomes were compared across representative pW scenarios and prevalence scans. Results:The optimal policies applied high-intensity supplementary control early in the planning horizon and then relaxed control as infection pressure declined. Higher pW reduced the uncontrolled infection burden, decreased the incremental benefit of additional intervention, and shortened the duration of maximum control. In coarse scans with umax=0.30, the terminal dengue infection near-elimination indicator, defined as IH (T)≤10-4 at T=3 years, changed between pW=0.45 and pW=0.50 for all tested cost-weight combinations. A separate refined continuation example demonstrated non-monotonic mean control use and a sharp decrease in cumulative incidence. Conclusion:Adult Wolbachia prevalence measured through entomological surveillance may represent an actionable index for post-release dengue management. The identified transition band is a model-based planning indicator, not a universal field threshold or evidence of mosquito population elimination.
Objectives:This study investigated associations between building structure and managers' knowledge, attitudes, and practices (KAP) regarding indoor air quality in welfare facilities for persons with disabilities, comparing facilities with and without coronavirus disease 2019 (COVID-19) cluster outbreaks. Methods:A web-based survey was conducted among managers of 242 welfare facilities for persons with disabilities in the Republic of Korea. Facilities were recruited from a national sampling frame of approximately 3,000 facilities, yielding a response rate of 8.1%. The 80-item questionnaire assessed building characteristics and air quality-related KAP scores. Logistic regression was used to identify factors associated with cluster outbreaks. Results:Of the 242 facilities, 50.8% had experienced cluster outbreaks. Facilities in complex/multi-use buildings had higher odds of outbreaks than those in detached buildings did (adjusted odds ratio, 2.21; 95% confidence interval, 1.25-3.91; p=0.006). For managerial factors, facilities with outbreaks tended to have lower attitude scores (p=0.02); however, this association did not remain statistically significant after Bonferroni correction (adjusted α=0.0083). No significant differences were observed in knowledge or practice scores. Conclusion:Building structure, particularly complex/multi-use configuration, was associated with COVID-19 cluster outbreaks. Managerial KAP scores were not definitively associated with outbreaks under the conservative significance threshold, but the observed trends suggest that institutional support, ventilation guidance, and practical training for facility managers may help strengthen future infection-prevention efforts.
Objectives:This study assessed the economic value of 2 major initiatives within the national infectious disease response system of the Korea Disease Control and Prevention Agency (KDCA): the Training Programs for Public Health Workforce (TPPHW) and the Infectious Disease Information System (IDIS). Methods:We developed a structured estimation model to quantify the economic benefits of pandemic preparedness investments and applied it to the KDCA's TPPHW and IDIS. The model incorporated parameters elicited from 29 senior officials into a cost-benefit analysis (CBA) framework, from which we calculated the net present value (NPV) and benefit-cost ratio (BCR) over a 10-year period, with sensitivity analyses. Results:Both initiatives yielded positive net benefits under baseline assumptions, although the margin was substantially greater for workforce training than for the information system. At the assumed discount rate of 4.5%, the CBA yielded a BCR of 2.120 and an NPV of 27.2 billion Korean won (KRW) for TPPHW. For IDIS, the corresponding values were a BCR of 1.071 and an NPV of 2.7 billion KRW. Sensitivity analysis showed that workforce training remained economically justified across all scenarios, whereas the information system remained viable only under more favorable assumptions. Conclusion:This study contributes to the literature by systematically applying CBA to infectious disease preparedness in the Republic of Korea. The findings support continued investment in skilled workforce training and integrated information infrastructure for future pandemic preparedness. The study is limited by its reliance on expert-elicited parameters and its focus on monetary benefits, excluding health outcomes such as disability-adjusted life years and quality-of-life improvements.
Objectives:We examined national temporal trends, laboratory-confirmation performance, and climate associations in Lassa fever surveillance in Nigeria from 2020 to 2025, and assessed the impact of the coronavirus disease 2019 (COVID-19) pandemic on surveillance metrics. Methods:We analyzed 307 consecutive weeks of national Lassa fever surveillance data using an ecological study design. Primary outcomes included confirmed-case counts, case fatality rate (CFR), and laboratory-confirmation rate (LCR). Temporal trends were evaluated using regression models, climate associations using correlation and negative binomial regression analyses, and the impact of COVID-19 using interrupted time-series analysis. Results:Overall, 47,029 suspected cases, 6,288 confirmed cases, and 975 deaths were reported. The mean LCR was 11.2% (standard deviation, 7.2%), declining from 18.4% in 2020 to 9.9% in 2025 (p <0.001). The overall CFR was 15.5%, with no significant downward trend over time. Confirmed cases were inversely associated with weekly rainfall (rs=-0.589, p <0.0001) and positively associated with mean temperature (rs=0.462, p<0.0001). Peak season incidence was 5.3-fold higher than that during off-peak periods. The COVID-19 lockdown period was associated with an immediate reduction in confirmed cases without a corresponding reduction in suspected cases. Conclusion:Lassa fever surveillance in Nigeria from 2020 to 2025 was characterized by a declining LCR, persistently elevated CFR, and a climate-linked seasonal pattern of increasing intensity, findings that are consistent with, but do not definitively establish, systemic underascertainment. CFR trends may partly reflect case-mix variation and detection bias. Because of the ecological study design, causal inferences cannot be drawn. These findings underscore the need for resilient, climate-informed, One Health surveillance systems.
Objectives:This study evaluated the epidemiological burden and temporal trends of mental disorders in Vietnam from 1990 to 2023 and projected the future burden through 2040. Methods:Global Burden of Disease Study 2023 data were used to analyze the age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), and age-standardized disability-adjusted life-year rate (ASDAR) by age, sex, and diagnostic subtype. Temporal trends were quantified using the estimated annual percentage change (EAPC), and Pearson correlation analysis examined associations with Vietnam's human development index (HDI). Bayesian structural time series (BSTS) models were used to forecast the burden through 2040. Results:In 2023, approximately 9.1 million individuals in Vietnam had mental disorders, with 2.94 million annual incident cases and 1.41 million disability-adjusted life-years. Depressive disorders ranked highest across all metrics, and females consistently had higher age-standardized rates than males. Age-standardized rates increased significantly from 1990 to 2023: ASIR, 1.10% EAPC (95% confidence interval [CI], 0.87%-1.33%); ASPR, 0.27% EAPC (95% CI, 0.21%-0.33%); and ASDAR, 0.52% EAPC (95% CI, 0.46%-0.58%). Mental disorder burden was strongly positively correlated with HDI (r=0.773-0.909, all p<0.001). BSTS models projected continued increases through 2040 (ASPR, 9,003.75; ASIR, 3,307.11; ASDAR, 1,408.05 per 100,000 population). Conclusion:Mental disorders constitute an escalating public health challenge in Vietnam, with the burden increasing steadily over 3 decades and projected to continue rising through 2040. Reorientation toward an integrated, community-based care model, alongside targeted workforce expansion and systematic integration of mental health services into primary care, is essential to mitigate this growing burden.
Objectives:This study examined the association between lifestyle inflammation score (LIS) and health-related quality of life, assessed using the EuroQol-5 Dimensions (EQ-5D) index, among adults in the Republic of Korea. It also evaluated whether depressive symptoms moderated this association. Methods:Data from the 2024 Community Health Survey were analyzed, and 231,386 adults were included. LIS was calculated by integrating smoking, alcohol consumption, physical activity, and body mass index. The dependent variable, quality of life, was assessed using the EQ-5D index. Depressive symptoms, the moderator variable, were assessed using the Patient Health Questionnaire-9, with a score of ≥10 indicating depressive symptoms. Data were analyzed using complex-sample multivariable linear regression to examine interaction effects according to depressive symptom status, followed by simple-slope analyses. Results:After adjustment for demographic and health-related variables, LIS was significantly and negatively associated with the EQ-5D index (β=-0.0069, p<0.001), indicating that higher levels of inflammation-related lifestyle behaviors were associated with poorer quality of life. Depressive symptoms significantly moderated the association between LIS and the EQ-5D index (β=-0.01727, p<0.001). Simple-slope analyses showed that the adverse association between LIS and quality of life was stronger among individuals with depressive symptoms (β=-0.02349) than among those without depressive symptoms (β=-0.00621). Conclusion:Inflammation-related lifestyle behaviors were associated with reduced quality of life, and this negative association was stronger among individuals with depressive symptoms. These findings suggest that considering both lifestyle-related inflammatory burden and depressive symptoms may help explain population-level differences in quality of life.
Monkeypox disease, now commonly referred to as mpox, was once considered a geographically restricted zoonotic disease but has emerged as a global public health concern. The 2022 multinational outbreak marked a turning point, with notable shifts in transmission dynamics, affected populations, and clinical manifestations. Classical cases typically involve fever, lymphadenopathy, and a centrifugal vesiculopustular rash; however, recent outbreaks have revealed atypical presentations, including genital and perianal lesions, minimal or absent prodromal symptoms, and asynchronous rash evolution. These variations have complicated early clinical recognition and may contribute to delayed diagnosis and onward transmission. This review synthesizes current evidence on the evolving epidemiology of mpox, highlights differences between endemic and non-endemic outbreaks, and describes the full spectrum of typical and atypical clinical features. It also assesses diagnostic approaches, including molecular and point-of-care techniques, and evaluates the efficacy and limitations of current and emerging vaccines, such as JYNNEOS and ACAM2000. Future priorities include improving global surveillance, refining case definitions, expanding diagnostic access, and ensuring equitable vaccine distribution. Understanding the expanding clinical and epidemiological profile of mpox is essential for timely diagnosis, containment, and preparedness against future outbreaks.
Objectives:This study examined the predictive role of child health problems and social determinants in postpartum depression (PPD), with the aim of supporting early screening strategies and more comprehensive maternal health policies. Methods:This cross-sectional study used secondary data from the 2023 Indonesia Health Survey, conducted by the Indonesian Ministry of Health. The analysis included 26,656 postpartum women aged at least 15 years who had given birth within the previous 24 months. PPD was assessed using the Mini International Neuropsychiatric Interview. Multiple logistic regression was used to analyze the data. Results:Child health problems were among the strongest factors associated with PPD in Indonesia. Having had an unplanned pregnancy was associated with higher odds of PPD (adjusted odds ratio [aOR], 3.90; 95% confidence interval [CI], 2.90-5.25; p<0.001), as was having a child with chronic illness (aOR, 2.30; 95% CI, 1.01-5.26; p=0.048). Social risk factors, including younger maternal age, divorce or separation from a partner, unemployment, and lack of social support, were also associated with PPD in Indonesia. Conclusion:Child health problems and adverse social conditions were significantly associated with postpartum mental health in Indonesia. Integrating early screening into maternal and child health services and strengthening maternal support systems may help reduce the burden of PPD.
Objectives: This systematic review aimed to identify perinatal risk factors associated with obesity in children aged ≤5 years.Methods: This studyfollowed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline (via PubMed), Embase, and Cochrane CENTRAL were searched from inception, without language or date restrictions. In addition, gray literature sources, including LILACS and CNKI, were screened for comprehensive evidence synthesis. Meta-analyses were conducted to estimate pooled risk ratios. Study quality was independently assessed by 2 reviewers using the Joanna Briggs Institute critical appraisal tool.Results: A total of 24,643 articles were screened, and 39 cohort studies were included in the final analysis. Sample sizes ranged from 169 to 333,353 participants. Meta-analysis results indicated that high gestational weight gain (adjusted risk ratio [aRR], 1.46; 95% confidence interval [CI], 1.17–1.82), history of cesarean section (aRR, 1.25; 95% CI, 1.17–1.33), macrosomia (aRR, 1.88; 95% CI, 1.55–2.27), antibiotic use (aRR, 1.31; 95% CI, 1.14–1.51), pre-pregnancy obesity (aRR, 1.82; 95% CI, 1.21–2.73), and female sex (aRR, 1.46; 95% CI, 1.32–1.61) were associated with an increased risk of obesity in children aged ≤5 years. Exclusive breastfeeding (aRR, 0.74; 95% CI, 0.64–0.85) was identified as a protective factor..Conclusion: Perinatal factors and pre-pregnancy obesity played important roles in increasing the risk of obesity in children aged ≤5 years. Breastfeeding was associated with a protective effect against childhood obesity. Therefore, obesity prevention efforts should begin during pregnancy, and maintaining appropriate maternal weight before conception is equally essential.
Objectives: Artificial intelligence (AI) is reshaping healthcare by improving diagnosis and treatment planning, increasing operational efficiency, and streamlining administrative workflows. This paper integrates findings from an extensive PubMed search (2015–2025) with bibliometric analysis using RStudio and VOSviewer to investigate the comparative applications of AI methods in healthcare, collaborative networks, and emerging trends.Methods: A total of 1,243 records were identified through the PubMed search, and after removal of 143 duplicates, 1,100 records were screened. Following full-text assessment and exclusion of ineligible studies, 986 articles were included in the final bibliometric analysis.Results: The main research areas included robotic-assisted surgery, predictive analytics, diagnostic imaging, and precision medicine, with particular emphasis on the prevalence of machine learning and deep learning in imaging and the increasing application of natural language processing to unstructured medical information.Conclusion: The review emphasizes the need for greater budgetary allocation to scalable and pragmatic AI technologies and for interdisciplinary cooperation among researchers, industry, and healthcare providers. Despite this growth, challenges such as algorithmic bias, data integration, and ethical concerns persist. The paper also highlights the importance of equitable collaboration, accountable AI, and multinational partnerships in ensuring that AI can be used ethically and efficiently in healthcare over the long term to improve patient care and biomedical innovation. It does so by mapping international and regional trends, identifying the most influential authors, institutions, and funding sources, and evaluating methodological approaches.
Objectives: Patients receiving hemodialysis (HD) are at increased risk of acquiring hepatitis B virus (HBV) and hepatitis C virus (HCV) due to repeated blood exposure, vascular access procedures, and blood transfusions. The study aimed to determine the seroconversion rates of HBV and HCV among patients undergoing dialysis and to identify associated risk factors.Methods: A total of 220 adult patients receiving dialysis who were seronegative for hepatitis B surface antigen (HBsAg) and anti-HCV antibodies at baseline were enrolled. Serologic testing was repeated at 6 months.Results: Sixteen patients (7.3%) seroconverted to HBsAg positivity, and 23 (10.5%) seroconverted to anti-HCV positivity. HBV seroconversion was significantly associated with multiple dialysis center visits. HCV seroconversion was significantly associated with dialyzer reuse, multiple dialysis center visits, and dialysis duration ≥2 years. Elevated liver enzyme levels were strongly correlated with seroconversion for both viruses.Conclusion: HBV and HCV seroconversion remain concerns in HD units. Standardized infection control practices, minimization of patient transfers, and strict adherence to national guidelines are essential to reducing risk.
Objectives: This study investigated a cluster of secondary human-to-human transmission of severe fever with thrombocytopenia syndrome (SFTS) in a hospital setting, focusing on infection risk factors and the role of personal protective equipment (PPE).Methods: A descriptive epidemiological investigation was conducted following the death of an index patient with laboratory-confirmed SFTS. A total of 27 close contacts, including healthcare workers and a funeral director, were monitored for symptoms. Suspected cases underwent real-time reverse transcription polymerase chain reaction testing. Clinical features, PPE use, and exposure histories were analyzed. The Fisher exact test was used to assess associations between PPE use and infection. Viral genotyping and sequence analyses were performed to evaluate transmission routes.Results: The index patient deteriorated rapidly and died after repeated cardiopulmonary resuscitation (CPR), during which 8 secondary cases occurred. Most infections were identified among individuals involved in CPR or postmortem care without adequate PPE. Although not statistically significant, infection rates were higher among those who did not wear masks or who used low-filtration masks. Proper use of gloves, gowns, and goggles was associated with lower infection rates. Cycle threshold values in secondary cases (range, 34–39) were higher than in the index case (14.07), suggesting lower viral loads. Sequence analysis demonstrated 99.6%–100% homology between the index and secondary cases; all isolates were genotype B, indicating direct transmission.Conclusion: This study provides molecular and epidemiological evidence of nosocomial SFTS transmission. Inadequate PPE use during aerosol-generating procedures likely facilitated infection, underscoring the importance of strict adherence to PPE protocols and reinforced infection control practices.
Objectives: In alignment with the World Health Organization's goal of eliminating hepatitis C, this study assessed the current treatment status and reasons for non-treatment among patients with hepatitis C in Jeonbuk State, Republic of Korea, to inform strategies for improving care engagement. Methods: Among 311 individuals diagnosed with hepatitis C and reported through the National Notifiable Infectious Disease Surveillance system between January 2023 and June 2024, 208 patients were surveyed after excluding those who had died or could not be contacted. Statistical analyses included the chi-square test, the Cochran-Armitage test for trend, and logistic regression. Results: Overall, 116 participants (55.8%) reported having received antiviral therapy. Among the 92 untreated individuals, the most common reason for non-treatment was the absence of symptoms (n = 23; 25.0%), followed by the burden of drug costs (n = 21; 22.8%). Conclusion: These findings highlight suboptimal treatment uptake and key barriers that may hinder progress toward hepatitis C elimination. Expanding screening and strengthening linkage-to-care strategies, while addressing financial barriers, will be essential to achieving national elimination targets.
