Protective behaviors against COVID-19 and their association with psychological factors in China and South Korea during the Omicron wave: a comparative study

OBJECTIVES

We aimed to explore the level of protective behaviors against COVID-19 and its association with psychological factors in China and South Korea during the Omicron wave.

STUDY DESIGN

Cross-sectional study.

METHODS

We conducted a population-based cross-sectional survey from March 15 to 30, 2023 in China and South Korea. Demographic characteristics, health status, protective behaviors, and psychological factors (including perceived risks, efficacy belief, attribution of disease, fear of COVID-19, trust and evaluation, fatalism, resilience, and pandemic fatigue) were investigated. After adjusting for sociodemographic and health-related factors, multivariable regression models were constructed to explore the psychological influencing factors of protective behavior.

RESULTS

A total of 3000 participants from China and 1000 participants from Korea were included in the final analysis. The mean performance score for protective behaviors among all respondents was 2.885 in China and 3.139 in Korea, with scores ranging from 1 to 4. In China, performance scores were higher in those who were female, aged 30-39, employed, married, living in urban areas, having the highest income level, having the best subjective health status, and having a history of chronic disease (P-value <0.05). In Korea, performance scores were higher for individuals who were female, over 50 years old, educated to high school or below, unemployed, married, had a history of chronic disease, and had never been infected with SARS-CoV-2 (P-value <0.05). In the multivariable regression model, perceived severity (β = 0.067), attribution of disease (β = 0.121), fear of COVID-19 (β = 0.128), trust and evaluation (β = 0.097), psychological resilience (β = 0.068), and efficacy belief (β = 0.216) were positively associated with the performance scores, pandemic fatigue (β = -0.089) was negatively associated with performance scores in China (P-value <0.05). However, in Korea, perceived susceptibility (β = 0.075), fear of COVID-19 (β = 0.107), and efficacy belief (β = 0.357) were positively associated with protective behaviors (P-value <0.05), trust and evaluation (β = -0.078) and pandemic fatigue (β = -0.063) were negatively associated with performance scores (P-value <0.05).

CONCLUSIONS

Populations in both China and Korea demonstrated great compliance with protective behaviors during the Omicron wave. Because of the sociocultural, economic, and political differences, there were differences in the association between psychological factors and protective behaviors in the two countries. This study, from the perspective of psychological factors in different cultural contexts, would provide references for increasing adherence to protective guidelines in future outbreaks of emerging infectious diseases.

Effect of information provision on parental intention toward COVID-19 vaccination for children: a nationwide survey experiment

The reluctance of parents to vaccinate their children against COVID-19 was prevalent particularly when uncertainty over vaccination outcomes prevailed. We conducted a nationwide randomized online survey experiment to assess the effect of information provision on parental intention for COVID-19 vaccination before the government started vaccination for children in South Korea. Parents of elementary school children were provided with either no information (Control), information on vaccine profile (vaccine informed group; VI), or COVID-19 (disease informed group; DI). Among 359,110 participants, parental intention for vaccination of children was significantly higher in both VI and DI groups compared with the Control group. In terms of effect size, information on COVID-19 vaccine increased likelihood to vaccinate by 1620 per 100,000 parents and reduced vaccine hesitancy by 1340 per 100,000 parents. Consistently with the positive effect on vaccination intention, both VI and DI interventions increased participants' perceptions on vaccination benefits being higher than its risks and vaccination risks being lower than health risks of COVID-19 infection, and self-reported trust in COVID-19 information. Our results lend strong support to the claim that the provision of targeted, tailored information on COVID-19 vaccine and infection increases parental intention to vaccinate children and reduces vaccine hesitancy.

Little Strokes Fell Big Oaks: How Repeated Recommendations for Suicide Reporting Drive the Quality of Suicide News in South Korea

This study investigates how far repeated releases of recommendations for responsible reporting on suicide (RRS) are associated with changes in the quality of suicide reporting. A content analysis was conducted on suicide news articles (N = 606) by the Korean newspapers Hankyoreh Sinmun and Chosun Ilbo in four six-month periods from 2004 to 2019, which covered the periods before and after the releases of three versions of suicide reporting guidelines. Elements for RRS served as a proxy for the reporting quality, which includes both avoiding negative elements and providing positive ones. Not only the number of suicide news stories reduced by half in the last two observation periods, overall RRS scores and most individual RRS elements increased in the third period, compared to the first or second period. The avoidance RRS for headline, however, was not significantly improved. Korean news media also tended to be sensationalistic in using photos.

Comparing the Effect of Declarative vs. Procedural Knowledge on Health Behavior Moderated by Outrage Factors

Knowledge's effect on behavioral responses in a health crisis has been a point of inquiry in many empirical studies that obtained significant findings. However, a variety of knowledge types has been considered in these studies rarely. This study compared the effect of declarative vs. procedural knowledge on behavioral responses to the COVID-19 pandemic. In addition, we examined whether outrage factors, which refer to perceived risk characteristics that are likely to elicit emotional responses, can moderate cognitive knowledge's effect. Data were collected with a survey conducted five months after the first COVID-19 case was confirmed in South Korea. A total of 1,000 respondents completed questions on the two types of knowledge, risk perception, and health behaviors in the pandemic crisis, and three different outrage factors. The results showed that procedural knowledge on how-to-do something was associated significantly with the health behaviors in the crisis, while the declarative knowledge that involves knowing that "something is the case" was not. Further, the outrage factors moderated knowledge's effect in such a way that procedural knowledge's influence on health behaviors diminished when the respondents perceived that the pandemic was uncontrollable. On the other hand, procedural knowledge's effect increased when the outrage factor of fairness was heightened. The implications are discussed in the context of studies of knowledge's effect and the outrage factors' moderation.

Implication of findings from a two-wave survey on embitterment in South Korea for strategies to promote mental health of the general public

OBJECTIVE

To examine the prevalence of embitterment by following individuals over time and to statistically evaluate how factors known as correlates of embitterment affect different groups with or without changes in embitterment over time.

METHOD

Responses for the posttraumatic embitterment disorder (PTED) self-rating Scale were collected from the same 1,153 adults who participated in a follow-up survey delivered 14 months apart. Suggested cutoff points were applied to identify changes in embitterment and four groups were identified. For each group, the relative impacts of factors that affect changes in or maintenance of embitterment, such as negative life events (NLEs), belief in a just world (BJW), social support, relative deprivation, and resilience, were statistically analyzed.

RESULTS

The average PTED scores were relatively high for both surveys (M = 1.73 and 1.58, respectively). "Persistent" or "increased" in embitterment was seen for 47.3% of the participants. In particular, 15.3% (Wave 1) and 12.1% (Wave 2) of participants experienced clinically relevant levels of embitterment. NLEs, BJW, relative deprivation, and resilience showed significant associations with the risk of persistence or deterioration of embitterment.

CONCLUSIONS

Our study highlights embitterment as a dynamic emotion that can either be aggravated or moderated over time. Embitterment can be elicited by joint effects of multiple social and interactional factors including known embitterment correlates, and relative deprivation is confirmed as a possible core elicitor of embitterment in the context of comparative justice. These findings imply that additional longitudinal research and development of practices for mental health prevention in general populations are needed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Outrage Effect of Personal Stake, Effect on Children, Dread, and Controllability on COVID-19 Risk Perception Moderated by Media Use

Public response to the COVID-19 pandemic provides a unique opportunity to study how lay people's risk perception involves their emotive responses. We investigated how outrage factors as emotional responses to risk influence levels of risk perception in the context of the pandemic disease. Furthermore, how media use influences the perception of outrage factors is also examined. A nationwide online survey (n = 1,000) was conducted in South Korea. The survey results indicated that pandemic risk perception was connected to the generic intensity of perceived outrage factors as measured by averaging the perception of multiple outrage factors. Individual outrage factors such as personal stake, effect on children, dread, and controllability directly influenced risk perception regarding COVID-19. When the intensity of media use was considered, individuals with heavy media use perceived outrage factors more intensely than those who used media less frequently. Media use also moderated the outrage effect of catastrophic potential and moral nature on the perception of risk associated with the pandemic disease. For heavy media users, the outrage effect of moral nature was increased, while that of catastrophic potential decreased. The implications of the outrage effect on the pandemic disease risk perception are addressed. Finally, we discuss the meaning of heavy media users' varying levels of vulnerability to outrage effect by moral nature and catastrophic potential.

[Analysis of clinical guidelines for oro-maxillofacial cone-beam CT]

Oro-maxillofacial cone-beam CT (CBCT) is the most widely used three-dimensional imaging method in the field of oral and maxillofacial radiology. It has been widely used in China, while radiation safety, examination indications and other issues still lack comprehensive regulations and standards. Over the years, clinical guidelines and position statements for the rational use of CBCT examinations have been issued in the world, providing standardized instructions for local practitioners. This paper reviewed these guidelines to provide reference for the formulation of relevant guidelines in China.

Factors Affecting the Public Intention to Repeat the COVID-19 Vaccination: Implications for Vaccine Communication

Although most of the pandemic-related mandatory restrictions have been lifted or eased, vaccination is still recommended as an effective measure to minimize the damage from COVID-19 infection. Since COVID-19 eradication is unlikely, it is necessary to understand the factors affecting the public's vaccination intention when COVID-19 vaccination is continuously recommended. This study aims to explore the factors that affect the intention to repeat the COVID-19 vaccination in South Korea. An online survey was conducted in January 2022 with adults living in Gyeonggi-do, South Korea. In a hierarchical logistic regression analysis, sociodemographic factors, COVID-19 infection-related factors, COVID-19 vaccination-related factors, sociocultural factors, and communication factors were taken into account. In this study, more than three-quarters (78.1%) of Koreans were willing to repeat the COVID-19 vaccination. People who had high-risk perceptions, had been vaccinated against COVID-19 at least once, had more authoritarian attitudes, regarded the vaccination as a social responsibility, and had positive attitudes toward health authorities' regular briefings were more likely to repeat the vaccination. In contrast, those who directly or indirectly experienced COVID-19 vaccine side effects and who showed psychological reactance against the government's vaccination recommendation were less likely to repeat the vaccination. Our research indicates that empathetic communication, promotion of the prosocial aspect of vaccination, and regular and transparent provision of vaccine information are essential for promoting the intention to repeat the COVID-19 vaccination.

The effect of resource loss on depression and peritraumatic distress during the early period of the COVID-19: considering the pandemic-situational and social context

BACKGROUND

The public experienced loss of resources, including their health and property during the COVID-19 pandemic. The Conservation of Resources (COR) theory is a useful tool to explain the effect of resource loss on mental health. This paper examines the effect of resource loss on depression and peritraumatic distress considering the situational and social context of the COVID-19 pandemic applying COR theory.

METHODS

An online survey was conducted for Gyeonggi residents when the second wave of COVID-19 in South Korea declined (5 October to 13 October 2020); 2,548 subjects were included in the hierarchical linear regression analysis.

RESULTS

COVID-19 infection-related experiences, resource losses (e.g., financial burden, deterioration of health, and decline of self-esteem), and fear of stigma were related to elevated levels of peritraumatic distress and depression. Risk perception was associated with peritraumatic distress. Reduced income or job loss were related to depression. Social support was a protective factor for mental health.

CONCLUSIONS

This study suggests that we need to focus on COVID-19 infection-related experiences and loss of daily resources in order to understand mental health deterioration during the COVID-19 pandemic. Moreover, it is important to monitor the mental health of medically and socially vulnerable groups and those who have lost resources due to the pandemic and to provide them with social support services.

Dentists' attitudes toward patient-centered care and its predictors: a cross-sectional study in South Korea

BACKGROUND

Patient-centered care (PCC) has been one of medical practice's most frequently discussed principles. However, attitudes toward PCC among dentists remain underexplored. This study focuses on examining dentists' patient-centered attitudes and investigating their predictors.

METHODS

The Patient-Practitioner Orientation Scale which consists of Sharing and Caring subscales was used to assess patient-centered attitudes. The statistical analysis included 217 dentists from South Korea. Hierarchical linear regression analysis was performed to examine the predictors such as sociodemographic aspects, academic factors, work-related factors, and empathy.

RESULTS

A patient-centered attitude of Caring subscale (M = 4.29, SD = 0.56) emerged, but the provider-centered attitude was higher in Sharing subscale (M = 3.40, SD = 0.48). Work year, academic track, and empathy were associated significantly with an overall caring aspect of patient-centered attitude, while the gender effect remained insignificant. Empathy had a critical and significant impact on the patient-centered attitude.

CONCLUSIONS

Efforts to enhance patient-centeredness in Sharing are needed; post-graduate education and transition to a more patient-centered health system are recommended. Moreover, empathy still matters as it was found to be a significant predictor of patient-centered attitudes. The findings of this study support the need for efforts to enhance patient-centered attitudes among dentists, which will help generate discussion on improving the curriculum of post-graduate education and health system reform.

[Research progress on moderate and deep sedation during wound dressing change in pediatric burn patients]

Moderate and deep sedation can effectively relieve or eliminate the pain and body discomfort during wound dressing change in pediatric burn patients, relieve anxiety, agitation, and even delirium of the children, reduce the metabolic rate of the children, make them in a quiet, comfortable, and cooperative state, which is conducive to the smooth completion of dressing change. This paper summarized the three aspects of moderate and deep sedation in pediatric burn patients, including the overview, main points of implementation, and effects, and further introduced the moderate and deep sedation medication regimens for different routes of administration, as well as the content of evaluation and monitoring. Suggestions on the prevention and management of related complications and the management of moderate and deep sedation implementation procedures were put forward, in order to provide references for the development of moderate and deep sedation for wound dressing change in pediatric burn patients in China.

Parental concerns on COVID-19 vaccine safety and hesitancy in Korea: Implications for vaccine communication

Objectives

Vaccination is one of the most important strategies to contain the spread of COVID-19. As vaccination in children is dependent on parents, it is important to understand parents' awareness and attitudes toward vaccines in order to devise strategies to raise vaccination rates in children.

Methods

A web-based nationwide survey was conducted among Korean parents of 7-18- year-old children in August 2021 to estimate parents' intention to vaccinate their children against COVID-19 and identify key factors affecting parental acceptance and hesitancy using regression analysis.

Results

Approximately 56.4% (575/1,019) were willing to vaccinate their children against COVID-19. Contributing factors to COVID-19 vaccine hesitancy were mothers (aOR 0.36, 95% CI 0.25-0.52), parents with lower education (aOR 0.83, 95% CI 0.70-0.97), hesitancy to other childhood vaccines (aOR 0.78, 95% CI 0.64-0.96), and refusal to vaccinate themselves (aOR 0.08, 95% CI 0.02-0.20). Children of older age (aOR 1.2, 95% CI 1.13-1.28), trust to child's doctor (aOR 1.19, 95% CI 1.07-1.32),parents who showed positive perception about the effectiveness of the COVID-19 (aOR 2.6, 95% CI 1.9-3.57), and those who reported low risk of COVID-19 vaccine (aOR 1.68, 95% CI 1.27-2.24) were associated with COVID-19 vaccine acceptance. The most common cause of hesitancy was a concern about experiencing adverse reactions.

Conclusion

Providing parents with accurate and reliable information on vaccine effectiveness and safety is important to increase uptake of COVID-19 vaccine in children. Differential or targeted approaches to parents according to gender, age and age of children are necessary for effective communication on the vaccination in children.

Parental Acceptance of COVID-19 Vaccination for Children and Its Association With Information Sufficiency and Credibility in South Korea

IMPORTANCE

Vaccination against COVID-19 is an effective method for individuals to reduce negative health outcomes. However, widespread COVID-19 vaccination among children has been challenging owing to parental hesitancy.

OBJECTIVE

To examine parental decision-making in favor of the COVID-19 vaccine for their children and its association with the sufficiency and credibility of the information about the vaccine.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional survey study was conducted in South Korea from February 7 to 10, 2022, 7 weeks before initiation of the COVID-19 vaccine for children aged 5 to 11 years. Parents were included if they spoke Korean and had at least 1 child in elementary school (grades 1-6). Parents and children were included in a 1:1 ratio; a total of 113 450 parents and 113 450 children were included in the analysis. Statistical analysis was performed between March and April 2022.

MAIN OUTCOMES AND MEASURES

The main outcomes of interest were (1) parental acceptance of COVID-19 vaccination for their children and (2) its association with self-reported sufficiency and credibility of information about the vaccine. A multivariable logistic regression was used to evaluate factors associated with parental decision-making in favor of COVID-19 vaccination; path analysis was used to examine indirect effects of information sufficiency and credibility.

RESULTS

Of the 113 450 children, 58 342 (51.4%) were boys, and the mean (SD) age was 10.1 (1.5) years. Of the 113 450 parents who responded, 7379 (6.5%) were accepting vaccination for their children; 15 731 (13.9%) reported the vaccine-related information they received was sufficient, and 23 021 (20.3%) reported the information was credible. Parents who reported that the information was sufficient were 3.08 times (95% CI, 2.85-3.33; P < .001) more likely to report being willing to vaccinate their children than those who believed the information was insufficient, and those who reported that the information was credible were 7.55 times (95% CI, 6.46-8.87; P < .001) more likely to report being willing to vaccinate their children than those who believed the information was not credible. Higher levels of information sufficiency and credibility were associated with perceptions of increased vaccine safety (sufficiency: β = 0.08; P < .001; credibility: β = 0.59; P < .001) and effectiveness (sufficiency: β = 0.05; P < .001; credibility: β = 0.60; P < .001).

CONCLUSIONS AND RELEVANCE

In this study, a significant association was found between self-reported sufficiency and credibility of vaccine-related information and parental decision-making regarding COVID-19 vaccination for their children, suggesting that communications and policies that provide sound information are essential to improve vaccination rates.

Perceived barriers to the process of COVID-19 control among frontline healthcare workers in South Korea: a qualitative study

OBJECTIVE

This study aimed to explore barriers to disease control perceived by frontline healthcare workers (HCWs) working in community settings during the COVID-19 pandemic in South Korea.

DESIGN

A qualitative study was conducted using semistructured focus group interviews. All interviews were conducted in Korean on Zoom between October and November 2020, audio-recorded and transcribed for reflexive thematic analysis.

SETTING

All participants were working in Gyeonggi-do, the most populous province in South Korea. The province had the second-highest COVID-19 infection rates at the time of the interview.

PARTICIPANTS

Participants serving as HCWs in Gyeonggi Province were eligible to participate in the study. A total of 20 HCWs comprised of public health doctors and professional epidemiologists agreed to participate in the study.

RESULTS

Four themes were generated. Each theme described how these barriers affected a disease control process: (1) 'uncooperative public and unprepared community health centre' delayed the investigation of newly diagnosed COVID-19 cases; (2) 'uncoordinated disease control system' impeded the collection and analysis of digital data; (3) 'the gap between responsibilities and capabilities' hindered the classification of close and casual contacts; and (4) 'conflicts with persons who have different interests and priorities' hampered epidemiological decision-making.

CONCLUSIONS

Our study found that frontline HCWs experienced various challenges disrupting their work performance to control COVID-19. We provide several recommendations, such as providing HCWs with systematic interview skill training, strengthening patient information security systems, providing sufficient resources, securing a regular workforce, collecting the field experiences of HCWs, implementing task-shifting, and having regular stakeholder meetings. These strategies may promote work capacity among the frontline HCWs and subsequently strengthen emergency preparedness.

Attitude and Acceptance of COVID-19 Vaccine in Parents and Adolescents: A Nationwide Survey

PURPOSE

Coronavirus disease 2019 (COVID-19) vaccines are currently authorized for emergency use in adolescents aged 12-17 years; however, there is concern and uncertainty regarding the safety and necessity of COVID-19 vaccination. A survey was carried out to assess the attitudes and acceptance towards vaccination in adolescents.

METHODS

A nationwide web-based survey was conducted among adolescents aged 12-17 years and their parents between June 29 and July 8, 2021 on a platform provided by the Ministry of Education.

RESULTS

A total of 341,326 parents and 272,914 adolescents participated in this study. Intention for vaccination was 69.1% for adolescents, and 72.2% of parents reported they would recommend vaccination for their child. Among adolescents, perception of safety (odds ratio [OR] 4.09, 95% confidence interval [CI] 3.95-4.22), effectiveness (OR 2.24, 95% CI 2.17-2.32), and risk-benefit (OR 1.75, 95% CI 1.72-1.78) had the highest impact on intention for vaccination. Also, perceived risk (OR 1.14, 95% CI 1.12-1.17), severity (OR 1.12, 95% CI 1.10-1.13) for COVID-19 infection, self-health perception (OR 1.12, 95%, CI 1.10-1.14) and recent vaccination of childhood vaccines (OR 1.25, 95% CI 1.19-1.32) were related to intention for COVID-19 vaccination. On the other hand, self-perceived knowledge (OR 0.96, 95% 0.95-0.98) was related to vaccine hesitancy. Gender or school district did not influence intention for COVID-19 vaccination in adolescents.

DISCUSSION

Decisions on COVID-19 vaccination for adolescents should be a shared process between adolescents, parents, and physicians based on updated information on safety and effectiveness.

Effects of a Medical Aid program on medical utilization patterns for low-income patients with affective disorder in Seoul

Mental illness has been increasing globally and its global burden of disease has reached a significant level, and urban dwellers have more chances of having worse mental health status due to high population density, isolated social networks. In Korea's medical security system, Medical Aid (MA) program and National Health Insurance (NHI), patients covered by MA pay much smaller out-of-pocket payments for outpatient services because of exempt from hospitalization fees. However, as a result of focusing on improving access to medical services for the urban poor due to lower out-of-pocket payment, their healthcare costs have greatly increased, while their health management has thus far been inadequate. In light of the background, this study investigated the differences in patterns of medical utilization among affective disordered patients covered by the MA program and the NHI system respectively.Data used for this study were extracted from customized health information data from the National Health Insurance Service (NHIS). The data source used in this study, customized claims data from the NHIS, is census data, which strengthens the representativeness and reliability of the study results. A total of 6754 inpatients (MA: 3327 and NHI 20%: 3327) diagnosed with the affective disorder were retrieved by Propensity Scores Matching (PSM).The length of stay of MA beneficiaries was found to be longer than that of NHI enrollees. However, the rate of hospital emergency room visits by NHI enrollees was higher than that of MA beneficiaries.Overall, community-based interventions are required to prevent and treat mental health by providing primary medical care in the community, and linking with mental health centers. Such policies will ultimately improve the financial sustainability of medical security systems.

Embitterment among the unemployed: A multiple mediation model of belief in a just world

BACKGROUND: The negative consequences of job loss on financial and psychological quality of life have been well documented. OBJECTIVE: This study evaluated the level of unemployed individuals’ embitterment and the mechanism by which negative life experiences increase embitterment by lowering the belief in a just world (BJW). METHODS: A survey was administered to 1,074 unemployed Korean adults who visited a regional Center for Employment and Welfare. Question items included the Korean version of posttraumatic embitterment disorder (PTED) self-rating scale, the BJW (personal and general) scale, negative life events, and sociodemographic characteristics. RESULTS: Only 45.9% of the participants were categorized as being in a ‘normal state,’ indicating that many of the unemployed were emotionally embittered. There was a positive direct effect of an increase in negative life events on embitterment. Negative life events also significantly and indirectly affected embitterment through personal BJW. CONCLUSIONS: Embitterment was prevalent among the unemployed participants and embitterment was a reactive emotion following personal downgrading, not so much related to conditions in the world at large. Thus, we recommend developing a screening program to detect extreme embitterment and an interventional program to help people better cope with emotional stress due to job loss. Efforts should be made to restore their violated expectation and trust that they would be treated in a just and fair way.

The Correlation Function of Communication in an Emotional Domain Observed in the Effect of Media on Embitterment

The media correlation function has mainly been evaluated in cognitive domains from theoretical perspectives, such as agenda-setting, framing, or priming. Here we examined the correlation function in an emotional domain by investigating the association between media use and the degree of embitterment, which is a psychological symptom that originates from the accumulation of negative life experiences. A survey of 1,720 South Koreans revealed that those who had higher frequencies of media use felt a greater degree of embitterment. When different media types were examined, frequent use of print newspapers was associated with a level of embitterment from personal experiences, whereas heavy consumption of the internet and TV news was associated with embitterment from mediated reality. The implications of these findings are addressed in the context of both communication function and social epidemiology.

An application of the extended parallel process model to protective behaviors against COVID-19 in South Korea

This study applied the extended parallel process model (EPPM) to investigate the factors affecting people's preventive behaviors against COVID-19, and thereby, draw relevant policy implications for current and future other epidemics. The EPPM was used to examine the danger control and fear control responses, along with the separate effects of their sub-factors (perceived susceptibility, perceived severity, response efficacy, and self-efficacy) on personal hygiene behaviors, social distancing measures, and fatalism. In total, data from an online survey of 813 adults were analyzed. The results of multiple regression analysis showed a strong effect of self-efficacy on danger control (ß = 0.23 for personal hygiene behaviors, β = 0.26 for social distancing) and fear control responses (ß = -0.13 for fatalism). However, based on the type of control response, the effect of perceived susceptibility and perceived severity, which were the main factors in threat appraisal, was insignificant or marginally significant. Further, a higher perceived severity was associated with higher fatalism in the fear control response (ß = 0.09). Those who were currently employed performed fewer social distancing measures compared to those who did not (ß = -0.11), whereas there was no difference in personal hygiene behaviors. These results suggest that risk communication in emerging infectious disease crises should provide customized information on people who are hard to comply with social distancing. Besides delivering the message of self-efficacy, policies should be implemented to create a social environment in which individuals can practice social distancing without constraints.

It's Politics, Isn't It? Investigating Direct and Indirect Influences of Political Orientation on Risk Perception of COVID-19

Public response to the COVID-19 pandemic provides a unique opportunity to study risk perception in relation to political orientation. We tested a risk perception model of how political orientation influences risk perception of an emerging infectious disease and how it moderates other influences. Two nationwide online surveys in South Korea (N = 2,000) revealed that conservatives showed a higher risk perception regarding an emerging infectious disease, and political orientation can even moderate the influence of perceived risk characteristics on risk perception such as how a liberal orientation exhibited a greater outrage effect of perceived unfairness on COVID-19 risk perception. Also, the frequency of media use is positively related to higher risk perception. The implications of the direct and moderating effects of political orientation are discussed in the context of the studies of political orientation as well as risk perception.

CRISPR/Cas9-based functional characterization of the pigmentation gene ebony in Plutella xylostella

Body pigmentation is an important character of insects in adapting to biotic and abiotic environmental challenges. Additionally, based on the relative ease of screening, several genes involved in insect melanization have been used in classic genetic studies or as visual markers in constructing transgenic insects. Here, a homologue of the Bombyx mori melanization-inhibiting gene ebony, associated with the conversion of dopamine to N-β-alanyl dopamine, was identified in a global pest, Plutella xylostella. The CRISPR/Cas9 system was applied to generate multiple Pxebony knockout alleles which were crossed to produce a Pxebony knockout strain, showing darker pigmentation in larvae, pupae and adults, compared with wildtype. Interestingly, we observed that Pxebony heterozygotes displayed an intermediate darkened phenotype, indicating partial dominance between the knockout and wildtype alleles. The fitness costs of Pxebony deficiency were also assessed in the mutant strain, indicating that embryo hatchability and larval survival were significantly reduced, while the eclosion rate was not obviously affected. Our work provides a potential target for exploring CRISPR-based genetics-control systems in this economically important pest lepidopteran.

Direct and Indirect Associations of Media Use with COVID-19 Vaccine Hesitancy: Cross-sectional Web-Based Survey in South Korea

BACKGROUND

Background: The battle against the 2019 novel coronavirus (COVID-19) has not concluded. Although vaccines are available, the high prevalence of vaccine hesitancy represents a significant challenge to public health and raising vaccine acceptance among the public is critical. While media has become an increasingly popular source of COVID-19 vaccine-related information, the question of whether and how media use is related to the public's vaccine hesitancy warrants exploration.

OBJECTIVE

This study aimed to (1) examine the level of COVID-19 vaccine hesitancy, (2) identify factors associated with COVID-19 vaccine hesitancy, and (3) explore the direct and indirect relationship between media use and vaccine hesitancy through psychological factors.

METHODS

A cross-sectional online survey took place over six days (January 20-25, 2021), a month ago before COVID-19 vaccination was initiated in South Korea. This study included 1016 subjects, and a logit model for regression analyzed associations between socio-demographic factors, health-related factors, psychological factors, and media use toward one's COVID-19 vaccine hesitancy. Additionally, path analysis to examine the indirect effects of media use on vaccine hesitancy via psychological factors (i.e., perceived risk of COVID-19 infection, perceived benefits, and perceived barriers of COVID-19 vaccination) were conducted.

RESULTS

Among the respondents (n=1,016), 53.3% hesitated COVID-19 vaccination, while 46.7% of the respondents would accept the vaccine. Out of the socio-demographic factors, female (OR, 1.967; 95% CI, 1.36-2.86; P < .001), age in 50s (OR, .47; 95% CI, .23-.96; P= .004), and over 60s (OR, .49; 95% CI, .24 - 0.99; P= .04) were significant individual predictors of COVID-19 vaccine hesitancy. Perceived susceptibility of infection (OR, .69; 95% CI, .52 - .91; P= .01) and perceived benefits of vaccination (OR, .69; 95% CI, .52 - .91; P= .01) were associated with lower vaccine hesitancy. Perceived barriers of vaccination (OR, 1.63; 95% CI, 1.29 - 2.07; P < .001) and lower trust in government (OR, .72; 95% CI, .53 - 0.98; P= .04) were related to vaccine hesitancy. The use of offline and online media was associated with vaccine hesitancy through perceived benefits of vaccination, resulting in a lower vaccine hesitancy. Moreover, perceived susceptibility of the disease and perceived barriers of vaccination mediated the association between social media use and vaccine hesitancy.

CONCLUSIONS

Findings revealed a considerable level of COVID-19 vaccine hesitancy in South Korea. Gender-based and generation-based public health policies and communication are recommended. Efforts to lower the perceived risk of vaccine side effects and heighten perceived benefits of the vaccine are required. While the use of media has a positive or negative effect on the population's vaccine hesitancy, efforts should be made to disseminate reliable and timely information on media while confront misinformation or disinformation for successive implementation of vaccine programs during pandemics.

CLINICALTRIAL

Burnout and peritraumatic distress of healthcare workers in the COVID-19 pandemic

BACKGROUND

To evaluate the current status of emotional exhaustion and peritraumatic distress of healthcare workers (HCWs) in the COVID-19 pandemic, and identify factors associated with their mental health status.

METHODS

An online survey involving 1068 of consented HCWs that included nurses, physicians, and public health officers was conducted in May 2020. Descriptive statistics and multivariate regression analyses were performed on the collected data.

RESULTS

Although no significant difference in peritraumatic distress was observed among the surveyed HCWs, the workers' experience of emotional exhaustion varied according to work characteristics. Respondents who were female, older, living with a spouse, and/or full-time workers reported higher levels of emotional exhaustion. Public health officers and other medical personnel who did not have direct contact with confirmed patients and full-time workers had a higher level of peritraumatic distress. Forced involvement in work related to COVID-19, worry about stigma, worry about becoming infected, and perceived sufficiency of organizational support negatively predict emotional exhaustion and peritraumatic distress.

CONCLUSIONS

Job-related and emotional stress of HCWs should not be neglected. Evidence-based interventions and supports are required to protect HCWs from mental illness and to promote mental health of those involved in the response to the COVID-19 pandemic.

First snapshot on behavioral characteristics and related factors of patients with chronic kidney disease in South Korea during the COVID-19 pandemic (June to October 2020)

Background

The recent novel coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented changes in behavior. We evaluated the current status of precautionary behavior and physical activity in chronic kidney disease (CKD) patients during the COVID-19 pandemic.

Methods

A population of CKD patients (n = 306) registered in the Study on Kidney Disease and Environmental Chemicals (SKETCH, Clinical Trial No. NCT04679168) cohort recruited from June 2020 to October 2020 was included in the study. We conducted a questionnaire survey related to risk perception of COVID-19, precautionary behavior, and physical activity.

Results

There were 187 patients (61.1%) with estimated glomerular filtration rate of <45 mL/min/1.73 m². This population showed a higher degree of risk perception for COVID-19 than the general population. Age was the most significant determinant of risk perception among CKD patients. During the pandemic, social distancing and hygiene-related behavior were significantly increased (p < 0.001). The frequency of exercise was decreased only in those who took regular exercise, without diabetes, or with a lower Charlson comorbidity index (CCI) (p < 0.001), with no change among the other groups. Socioeconomic status and comorbidities significantly affected behavioral characteristics regardless of the category. Education and income were significantly associated with precautionary behaviors such as staying at home and hand sanitizer use. Patients with higher CCI status significantly increased frequency of exercise (adjusted odds ratio, 2.10; 95% confidence interval, 1.01–4.38).

Conclusion

CKD patients showed higher risk perception with active precautionary behavioral changes than the general population. Healthcare providers should be aware of the characteristics to comprise precautionary behavior without reducing physical activity.

Perceived sources of occupational burn-out and embitterment among front-line health workers for COVID-19 control in Gyeonggi province, South Korea: a qualitative study

Objectives

Front-line health workers (FHWs) for COVID-19 control in South Korea have implemented a labour-intensive contact tracing programme, which places them at high risk for mental health problems. However, a few studies have examined mental health conditions in this population. We employed a qualitative approach to understand the factors perceived as causes of burn-out and embitterment among temporary FHWs to provide recommendations for supporting the workforce.

Methods

We recruited 20 FHWs to participate in semistructured focus group interviews through purposive sampling. The sample size was determined on the basis of data saturation. We collected data from October to November 2020, audiorecording and transcribing the interviews. Data analysis was conducted manually, applying the principles of grounded theory.

Results

Five levels of perceived sources of occupational burn-out and embitterment emerged. FHWs showed considerable mistrust of patients and faced ethical dilemmas in accessing and disclosing personal information. Poor collaboration with community health centre workers and interested parties as well as inadequate organisational support aggravated their conditions. Lack of social recognition and employment instability also presented challenges for FHWs’ mental health.

Conclusions

The current pandemic response system imposes great moral and emotional burdens on the workforce, prompting the need for initiatives to safeguard the values and needs of those who represent the backbone of the system. This study suggests that multilevel strategies, including providing organisational support and establishing contingency plans for workforce management and resource distribution, may improve FHWs’ mental health outcomes as well as the health system for emergency preparedness.

Impact of the COVID-19 pandemic on unmet healthcare needs in Seoul, South Korea: a cross-sectional study

OBJECTIVES

This study investigated the factors influencing unmet healthcare needs of people during the early stage of the COVID-19 pandemic in Seoul, South Korea. The findings help to identify people who have difficulty accessing healthcare services during a pandemic situation.

DESIGN

We conducted a cross-sectional study using a proportionate quota sampling method according to five major districts, sex and age, using an online survey. We analysed the key characteristics of influencing factors of unmet healthcare needs based on the Andersen behavioural model of healthcare utilisation: predisposing factors (eg, sex, age), need factors (eg, health status, illness) and enabling factors (eg, income, efficacy belief).

SETTING

The questionnaire was sent via email and mobile text messages from the end of April to the beginning of May 2020 during the first wave of the COVID-19 pandemic.

PARTICIPANTS

A sample of 813 respondents was used, and the respondent information was anonymised in the analysis process.

RESULTS

For the predisposing factors, sex, age, education level and occupational cluster were associated with unmet needs for healthcare. Chronic diseases and mental health were the influencing factors as an enabling factor that exerted an influence on the unmet need for healthcare in South Korea. Women, younger persons, those with lower education and persons with white-collar jobs were more likely to experience unmet healthcare needs. In addition, the more chronic diseases people had, the more COVID-19 negatively affected them mentally; and the more people felt fear of COVID-19, the higher chances they experienced unmet healthcare needs.

CONCLUSION

Government and policymakers are guided to draw out measures such as health communication and telemedicine to reduce the unmet healthcare needs during the pandemic and to recognise the different influencing factors.

The Spread of COVID-19 in Athletes

Background/objectives

According to the reported cases, more than 100 athletes were infected with severe acute respiratory syndrome coronavirus 2 in March 2020 alone, and this has created an increased interest in the effect of coronavirus disease (COVID-19) on athletes. This promoted us to study the spread of COVID-19 in athletes and formulate prevention strategies.

Methodology

We collected and analyzed the demographic information, such as nationality, sex, age, name, sport played, sport level, source and cause of infection, date of symptoms onset or confirmation of positive status, date of recovery, location of infection contraction, symptoms, and the people infected by the contracted athletes, of 521 infected athletes worldwide, as of the end of July, 2020.

Results

The cohort comprised 95.49% male athletes; 57.2% were aged 19–35 years, with the average age 23 years. Most of these cases emerged in March 2020 (27.3%) and June 2020 (30.1%), 90.8% of cases were active athletes and 74.2% were professional players, 45.2% of infected athletes exhibited mild symptoms and 30.6% of them were asymptomatic; however, 23.1% of the cases died, including cases aged less than 40 years. Most infected athletes represented soccer (46.6%), football (15.9%), and basketball (10.9%). Most of the infected athletes were from the United States, Western Europe, and Eastern Asia. The athletes primarily contracted the infection in the United States, Western Europe, and Japan. The spread of COVID-19 in these athletes primarily occurred during training- and game-related activities. More than 60% of the infected athletes were unaware of their source of infection.

Conclusion

It found that the halting of training and matches, isolation of athletes at home, and timely testing can effectively control the spread of COVID-19 among athletes, and it is recommended that athletes discontinue international travel, especially to countries with a high epidemic risk.

How to Mitigate the Negative Effect of Emotional Exhaustion among Healthcare Workers: The Role of Safety Climate and Compensation

This study examines the relationship between emotional exhaustion and job satisfaction. We further propose a safety climate and compensation as contextual variables that weaken the effect of emotional exhaustion. Survey data collected from 694 employees of a public hospital provided support for the hypothesized research model. The hierarchical multiple regression results reveal that high emotional exhaustion is negatively related to job satisfaction. In addition, the results suggest that compensation and a safety climate are moderating variables that mitigate the negative effects of emotional exhaustion. The theoretical implications and future directions are discussed.

Precautionary Behavior Practices and Psychological Characteristics of COVID-19 Patients and Quarantined Persons

Background: since the coronavirus disease (COVID-19) was first reported in 2019, South Korea has enforced isolation of patients with confirmed cases of COVID-19, as well as quarantine for close contacts of individuals diagnosed with COVID-19 and persons traveling from abroad, in order to contain its spread. Precautionary behavior practices and psychological characteristics of confirmed and quarantined persons were investigated for planning pandemic recovery and preparedness. Methods: this study was conducted with 1716 confirmed patients and quarantined persons in Daegu and Busan, regions where a high number of cases were confirmed during the early stage of the COVID-19 outbreak in South Korea. We collected online survey data from 23 April to 20 May 2020, in Daegu, and 28 April to 27 May 2020, in Busan, in cooperation with Daegu and Busan Infectious Disease Control Centers and public health centers in the regions. COVID-19 symptoms, pre-cautionary behavior practices, psychological states, and the need for improvement in isolation/quarantine environments were examined using an online survey. Results: compared to patients infected with coronavirus, quarantined persons engaged in more hygiene-related behaviors (e.g., hand washing, cough etiquette, and proper mask-wearing) and social distancing. COVID-19 patients had a strong fear of stigma, while quarantined persons had a strong fear of contracting COVID-19. Study participants responded that it was necessary to provide financial support and adequate information during isolation/quarantine. Conclusions: the study highlights the importance of precautionary behavior to prevent COVID-19 infection and the need to provide support (both psychological and financial) to patients and quarantined persons, to reinforce effective communication, social solidarity, and public health emergency preparedness (PHEP) in a pandemic situation.

The Outrage Effect of Personal Stake, Dread, and Moral Nature on Fine Dust Risk Perception Moderated by Media Use

Outrage factors are perceived characteristics of risk that provoke emotional responses and influence risk perception by individuals. We investigated outrage factors that are associated with risk perception regarding fine dust. A nationwide online survey (N = 1,000) measured the magnitude of 14 perceived outrage factors and media use in a South Korean population. As a result, the hypothetical three outrage factors of personal stake, dread, and moral nature were found to be influential. The risk perception increased when people perceived that the environmental hazard has personal implications or is associated with fearful images and irresponsible government/corporate actions. The risk perception was also heightened when fine dust was thought to cause large-scale damage to many people simultaneously. Those using news media frequently showed higher risk perception than those using it less frequently. However, heavy media users were affected to a lesser degree by the outrage effects voluntariness and effects on children. The implications of the direct and indirect outrage effect are discussed in light of risk perception studies.

Peritraumatic Distress during the COVID-19 Pandemic in Seoul, South Korea

The coronavirus disease (COVID-19) pandemic is traumatic and causes a substantial psychological burden on the general public. The aim of the present study is to examine the severity and prevalence of peritraumatic distress among the citizens of Seoul, which conducted preemptive and aggressive social distancing policy before the central government during the early stage of COVID-19. Furthermore, this study aims to explore the associated risk factors for peritraumatic distress, including risk perception, fear, and COVID-19-related experiences. We conducted an online survey to 813 participants at the end of the first wave of COVID-19 in South Korea. Peritraumatic distress inventory (PDI) was used to measure the level of pandemic-related distress. One-third of participants were at risk for the development of clinically elevated peritraumatic distress. The perception of risk, fear of COVID-19, and stigma were significantly associated with elevated levels of distress. Individuals who had poor health, or who spent more than 1 h per day using the media, also expressed a higher level of distress. Moreover, the level of disruption of daily life and financial difficulties due to the COVID-19 pandemic is significantly associated with a higher level of peritraumatic distress. The results of this study highlight the urgent need to develop evidence-based and tailored public mental health interventions, along with various measures to help recovery to daily life.

A social network analysis of the spread of COVID-19 in South Korea and policy implications

This study estimates the COVID-19 infection network from actual data and draws on implications for policy and research. Using contact tracing information of 3283 confirmed patients in Seoul metropolitan areas from January 20, 2020 to July 19, 2020, this study created an infection network and analyzed its structural characteristics. The main results are as follows: (i) out-degrees follow an extremely positively skewed distribution; (ii) removing the top nodes on the out-degree significantly decreases the size of the infection network, and (iii) the indicators that express the infectious power of the network change according to governmental measures. Efforts to collect network data and analyze network structures are urgently required for the efficiency of governmental responses to COVID-19. Implications for better use of a metric such as R0 to estimate infection spread are also discussed.

Correction: Effects of COVID-19 Emergency Alert Text Messages on Practicing Preventive Behaviors: Cross-sectional Web-Based Survey in South Korea

[This corrects the article DOI: 10.2196/24165.].

Effects of COVID-19 Emergency Alert Text Messages on Practicing Preventive Behaviors: Cross-sectional Web-Based Survey in South Korea

BACKGROUND

Sending emergency messages via mobile phone text messaging can be a promising communication tool to rapidly disseminate information and promote preventive behavior among the public during epidemic outbreaks. The battle to overcome COVID-19 is not yet over; thus, it is essential that the public practices preventive measures to prevent the spread of COVID-19.

OBJECTIVE

This study aimed to investigate the effectiveness of reading and obtaining information via emergency alert SMS text messages and their effects on the individual's practice of preventive behaviors during the early stages of the COVID-19 outbreak in South Korea.

METHODS

A cross-sectional web-based survey comprising 990 participants was conducted over 3 days (March 25-27, 2020). A multivariable logistic regression analysis revealed the sociodemographic factors that might influence the behavior of reading emergency alert text messages. A hierarchical linear regression model estimated the associations between reading emergency alert text messages for each precautionary behavior practiced against COVID-19. Additionally, the indirect effects of reading the text messages on each precautionary behavior via psychological factors (ie, perceived risk and response efficacy) were calculated. All data were weighted according to the 2019 Korea census data.

RESULTS

Overall, 49.2% (487/990) of the participants reported that they always read emergency alert text messages and visited the linked website to obtain more information. Factors such as female sex (odds ratio [OR] 1.68, 95% CI 1.28-2.21) and older age (30-39 years: OR 2.02, 95% CI 1.25-3.28; 40-49 years: OR 2.84, 95% CI 1.80-4.47; 50-59 years: OR 3.19, 95% CI 2.01-5.06; 60 years and above: OR 3.12, 95% CI 2.00-4.86 versus 18-29 years) were identified to be associated with a higher frequency of reading the text messages. Participants who always read the text messages practiced wearing facial masks (β=.074, P=.01) more frequently than those who did not. In terms of social distancing, participants who reported they always read the text messages avoided crowded places (β=.078, P=.01) and canceled or postponed social gatherings (β=.103, P<.001) more frequently than those who did not read the text messages. Furthermore, reading text messages directly and indirectly affected practicing precautionary behaviors, as the mediation effect of response efficacy between reading text messages and practicing preventive behaviors was significant.

CONCLUSIONS

Our findings suggest that emergency alert text messages sent to individuals' mobile phones are timely and effective strategies for encouraging preventive behavior in public. Sending emergency alert text messages to provide the public with accurate and reliable information could be positively considered by the health authorities, which might reduce the negative impact of infodemics.

Knowledge, attitudes, and practices (KAP) toward COVID-19: a cross-sectional study in South Korea

BACKGROUND

The public must routinely practice precautionary behaviors to control the spread of COVID-19, as no vaccines and antiviral treatments are currently available. This paper examines the public's knowledge, attitudes, and practices (KAP) related to COVID-19 and their relationships and identified the pandemic's vulnerable populations to provide recommendations for behavioral interventions and policies.

METHODS

Data collection took place over 3 days (June 26-29) via an online survey 5 months after the Korea Centers for Disease Control and Prevention (KCDC) confirmed the first COVID case in South Korea; 970 subjects were included in the statistical data analysis.

RESULTS

Knowledge directly affected both attitudes (e.g., perceived risk and efficacy belief) and practices (e.g., personal hygiene practices and social distancing). Among the influencing factors of COVID-19 preventive behaviors, efficacy belief was the most influential and significant practice factor. It mediated the relationship between knowledge and all three preventive behaviors (wearing facial masks, practicing hand hygiene, and avoiding crowded places). The level of knowledge varied by sociodemographic characteristics. Females (β = 0.06, p <  0.05) and individuals with higher levels of education (β = 0.06, p <  0.05) demonstrated higher levels of knowledge.

CONCLUSION

To increase precautionary behaviors among the public, health officials and policymakers must promote knowledge and efficacy belief. Future interventions and policies should also be developed in a 'person-centered' approach, targeting vulnerable subgroups, embracing them, and closing the gap of KAP toward COVID-19.

Exploring News Media Epidemiology of "Embitterment": A Content Analysis of Korean News Coverage between 1990 and 2018

Embitterment is a newly emerging mental problem that requires a social epidemiological approach. As this emotional state is varied in its manifestation and is pervasive in South Korea, we examined the embittered, those embittering, and causes of embitterment covered in news media in the nation. All news stories appearing between January 1, 1990 and August 31, 2018 in seven major daily newspapers in South Korea were searched for headlines containing "embitterment". A total of 321 news stories were identified for content analysis, which was conducted by two trained coders who examined each article to determine the identity of the embittered and embitters and the causes of and reponses from the embitterment. An inductive method was used to establish major levels for each variable. As a result, victims of disaster and accidents (and their families) were the most frequently embittered group, followed by politicians, laborers, persons of interest and the general public without specification. The three major causes of embitterment were: deprivation of basic life needs and rights, defamation/insult and abuse of power. Liberal newspapers published more "embitterment" stories, especially during conservative regimes. Since the periods of conservative regimes were longer than liberal regimes during the time under investigation, liberal newspapers published more "embitterment" stories than conservative newspapers. The patterns of coverage for the embittered, those embittering, and causes of embitterment also differed according to the political orientation of the newspaper. The implications of the findings from a social epidemiological approach and points requiring further study are discussed.

Expression, purification and characterization of three odorant binding proteins from the diamondback moth, Plutella xylostella

Odorant binding proteins (OBPs) are critical components in insect olfactory systems where they bind, solubilize and transport odorant molecules to receptors. Here, we cloned three OBPs (PxylGOBP1, PxylGOBP2 and PxylOBP24) from the diamondback moth, Plutella xylostella, one of the most destructive pests of cruciferous crops. These three OBPs were expressed in Escherichia coli as recombinant proteins, purified and characterized by fluorescence binding assays with 39 ligands including sex pheromone and plant-derived chemical compounds. PxylGOBP1 and PxylGOBP2 showed significantly different binding affinities to theses ligands, suggesting distinct binding preferences of these two general odorant binding proteins. PxylOBP24 showed no or extremely low binding activities to selected ligands, suggesting it may be involved in non-olfactory functions. Circular dichroism spectral results demonstrated that PxylGOBP1 and PxylGOBP2 shared similar secondary structures while PxylOBP24 was significantly different. This study improves our knowledge of insect OBPs, which will assist in a better understanding of insect olfactory system and developing more environmentally friendly pest control strategies for P. xylostella.

Comparing Outrage Effect on the Risk Perception of Climate Change versus Fine Dust

Public evaluation of risk is influenced by the emotive response to perceived risk characteristics, namely outrage factors. We evaluated which outrage factors contribute to the public perception of two different environmental risks, climate change and fine dust. In particular, the outrage factors of controllability, familiarity, and delayed effect were assessed to determine if they are more salient and influential for climate change than fine dust. A nationwide online survey (N = 1,000) was conducted to measure nine outrage factors and risk perception for both risks in a South Korean population. Although both environmental risks were associated with a similar level of risk perception, catastrophic potential and personal stake were the highest scoring outrage factors for climate change and fine dust, respectively, and were also the strongest influence for the level of each risk perception. Familiarity was more salient for climate change than fine dust, and was influential only for climate change. Delayed effect was more salient for climate change, but was not influential for the perception of both risks. Controllability was more salient for fine dust but had no significant influence on both risk perceptions. Catastrophic potential, dread, personal stake, and trust were common influential outrage factors for both risks. We discuss the significance of an individualistic approach to evaluating outrage effects. In addition, the practical implications of comparing salient and influential outrage factors for both risks were addressed in terms of risk communication.

A cross-sectional survey of knowledge, attitude, and willingness to engage in spontaneous reporting of adverse drug reactions by Korean consumers

BACKGROUND

Spontaneous reporting (SR) of adverse drug reactions (ADRs) from patients can be considered as a valuable activity providing both objective and subjective data. However, improving the rate of under-reporting has been a major challenge to ensure successful operation of the SR system. This study aimed to assess knowledge, attitude, and intent to report ADRs and explore the factors contributing to consumers' reporting intent in South Korea.

METHODS

Self-administered questionnaire was collected from a sex-, age-, and regionally stratified nationwide convenience sample of consumers using a commercial panel in December 2018. Univariate and multivariate logistic regression analyses were used to explore the factors contributing to the intent to report ADRs by consumers.

RESULTS

A total of 1000 respondents were enrolled in the survey; 50.9% were males and the mean age was 44.4 (standard deviation, 13.3) years. While less than 15% of the respondents were aware of the SR system and even fewer (3.4%) had actual experience of SR, however, 59.2% expressed their intent to report ADRs. The positive attitude (adjusted odds ratio [aOR] 3.972, p < 0.001), awareness of the SR system (aOR 2.102, p < 0.01), self-efficacy for SR (aOR 1.956, p < 0.001), and experiences related to ADR counselling with healthcare professionals (OR 2.318, p < 0.001) are the significant factors contributing to reporting intent.

CONCLUSIONS

Findings of this study highlight the need for increasing the awareness of the SR system among consumers and empowering them to report ADRs by themselves, which would ultimately improve the drug-safety environment.

The Effects of Social Determinants on Public Health Emergency Preparedness Mediated by Health Communication: The 2015 MERS Outbreak in South Korea

The influence of social determinants and health communication on Public health emergency preparedness (PHEP) as well as the mediating effect of health communication were investigated with respect to the 2015 Middle East Respiratory Syndrome (MERS) outbreak in South Korea. Data were collected through a survey six months after the de facto end of the outbreak and a total of 855 subjects completed the surveys and were included in the analysis. The results suggested that the public's preventive (hand hygiene) and avoidance (avoiding hospitals even when sick) behaviors that were frequently practiced during the pandemic were influenced by their social determinants both direct and indirect pathways. Health communication such as information seeking and processing mediated the effect of social determinants on the behaviors and information seeking was found to have the most significant mediating effect on the relationship between the practice of both preventive and avoidance behaviors and social determinants such as education and age. The results of the present study will deepen our understanding of PHEP by identifying key factors that influence the public's behavioral responses as well as providing information to public health emergency management and health risk communication officials to implement strategies necessary in improving PHEP.

The Outrage Effect of Personal Stake, Familiarity, Effects on Children, and Fairness on Climate Change Risk Perception Moderated by Political Orientation

Outrage factors are perceived characteristics of risk that provoke emotional responses and influence risk perception. Although several studies examined how multiple influences affect climate change risk perception, outrage factors have not been comprehensively assessed in the context of climate change risk perception. Using an online survey in South Korea (n = 592), we investigated outrage factors associated with climate change risk perception and whether political orientation moderates these outrage effects. We considered 11 of 20 outrage factors: voluntariness, controllability, familiarity, fairness, uncertainty, delayed effects, effects on children, trust, reversibility, personal stake, and human vs. natural origin. Factors that overlapped with the selected outrage factors or those that were not relevant to climate change were excluded. The survey revealed that the climate change risk perception of an individual increased when they perceived climate change to be relevant to their personal lives, when they felt unfamiliar with climate change, when they thought climate change would have a severe impact on children, or when they thought climate change would have unequal consequences. Moreover, respondents who identified as political conservatives were subject to a greater outrage effect of personal stake for climate change. The implications of the outrage effect on climate change risk perception and the greater vulnerability of conservatives to outrage effect are discussed.

Modeling embitterment dynamics: The influence of negative life events and social support mediated by belief in a just world

BACKGROUND

Embitterment is an emotional state as a reaction to negative life events and is characterized as a nagging and burning feeling of being let down, insulted, or being a loser, and of being revengeful but helpless. There have been few studies concerning embitterment dynamics. This study aims to test a structural equation model for embitterment dynamics by examining likely factors that could have contributed to feelings of embitterment.

METHODS

A total of 2024 South Koreans completed Post-Traumatic Embitterment Disorder Self-Rating Scale and Bern Embitterment Inventory, as well as the scales of belief in a just world (BJW), negative life events, and social support.

RESULTS

Experiencing more negative life events was connected to a higher level of embitterment, whereas having more social supports decreased embitterment. As an indirect effect, BJW showed the most powerful influence on embitterment and BJW itself was reduced or increased either by negative life events or social support, respectively.

LIMITATIONS

Although some significant influences on embitterment were examined, other aspects that include individual characteristics (self-efficacy, trust, political orientation, and media use) await examination.

CONCLUSIONS

The level of embitterment was affected by BJW, social support, and negative life events, which suggests points of possible intervention.

Sexual dimorphism of physical activity on cognitive aging: Role of immune functioning

OBJECTIVE

Exercise is one of the most potent strategies available to support cognitive health with age, yet substantial variability exists. Sexual dimorphism is evident for brain and immune functioning, the latter being implicated as important pathway for exercise. We examined the moderating role of sex on the relationship between physical activity and systemic inflammatory and brain health outcomes in support of more personalized approaches to behavioral interventions.

METHODS

Our discovery cohort included 45 typically aging women matched on age (±5y) and education (±2y) to 45 men (mean age = 72.5; Clinical Dementia Rating = 0) who completed self-reported current physical activity (Physical Activity Scale for Elderly), blood draw, neuropsychological evaluation, and brain MRI. An independent sample of 45 typically aging women and 36 men who completed the same measures comprised a replication cohort. Plasma was analyzed for 11 proinflammatory cytokine and chemokine markers via MesoScale Discovery.

RESULTS

Discovery cohort: Reported physical activity did not differ between sexes (150 vs. 157, p = 0.72). There was a significant interaction between sex and physical activity on chemokine markers MDC, MIP-1b, MCP-4, and eotaxin-3 (ps < 0.03), with a similar trend for MCP-1 and INFγ (ps < 0.09). Men who reported greater activity demonstrated lower inflammatory markers, an effect attenuated-to-absent in women. An interaction between sex and physical activity was also observed for parahippocampal volumes (p = 0.02) and cognition (processing speed and visual memory; ps < 0.04). Again, the beneficial effect of physical activity on outcomes was present in men, but not women. Replication cohort analyses conferred a consistent effect of sex on the relationship between physical activity and immune markers; models examining neurobehavioral outcomes did not strongly replicate. Across cohorts, post-hoc models demonstrated an interaction between sex and activity-related inflammatory markers on total gray matter volume and visual memory. Men with higher inflammatory markers demonstrated poorer brain structure and function, whereas inflammatory markers did not strongly relate to neurobehavioral outcomes in women.

CONCLUSIONS

Greater physical activity was associated with lower markers of inflammation in clinically normal older men, but not women - an effect consistently replicated across cohorts. Additionally, men appeared disproportionately vulnerable to the adverse effects of peripheral inflammatory markers on brain structure and function compared to women. Immune activation may be a male-specific pathway through which exercise confers neurobehavioral benefit.

Inoculation of exogenous lactic acid bacteria exerted a limited influence on the silage fermentation and bacterial community compositions of reed canary grass straw on the Qinghai-Tibetan Plateau

AIMS

This study evaluated the effects of exogenous lactic acid bacteria (LAB) on silage fermentation and bacterial community of reed canary grass (RCG) straw.

METHODS AND RESULTS

The leaf, stem and whole crop of RCG straw were separately ensiled in small bag silos, without (control) or with inoculation of two exogenous LAB (LP, Lactobacillus plantarum; LB, Lactobacillus buchneri), and stored at ambient temperature of <20°C. Inoculation of exogenous LAB decreased (P < 0·05) bacterial alpha diversity and shifted (P < 0·05) bacterial community compositions, but did not change (P> 0·05) the relative abundance of Lactobacillus. Particularly, inoculation of LB increased (P < 0·05) acetic acid and propionic acid contents, decreased (P < 0·05) butyric acid (BA) and ammonia-N contents, separated (P < 0·05) the bacterial community in silage. However, the exogenous LAB inoculated silages were characterized by main distribution of yeasts, presence of undesirable bacterial genera such as Clostridium and high levels of BA and ammonia-N.

CONCLUSION

Inoculation of exogenous LAB exerted a limited influence on the silage fermentation and bacterial community compositions of RCG straw on the Qinghai-Tibetan Plateau.

SIGNIFICANCE AND IMPACT OF THE STUDY

Commercial LAB inoculants are not always efficient on enhancing silage quality and stability. Thus, an alternative additive for inhibiting undesirable microbes during storage is important to improve RCG silage quality on the Qinghai-Tibetan Plateau.

Psychological and Behavioral Responses in South Korea During the Early Stages of Coronavirus Disease 2019 (COVID-19)

Background: The psychological and behavioral responses during the early stage of Coronavirus disease 2019 (COVID-19) in South Korea were investigated to guide the public as full and active participants of public health emergency preparedness (PHEP), which is essential to improving resilience and reducing the population's fundamental vulnerability. Methods: Data were collected through an online survey four weeks after the Korea Centers for Disease Control and Prevention (KCDC) confirmed the first case in South Korea; 973 subjects were included in the analysis. Results: Respondents' perceived risk of COVID-19 infection; the majority of respondents reported that their perceived chance of infection was "neither high nor low" (51.3%). The average perceived severity score was higher than perceived susceptibility; 48.6 % reported that the severity would be "high," while 19.9% reported "very high." Many respondents reported taking precautions, 67.8% reported always practicing hand hygiene, and 63.2% reported always wearing a facial mask when outside. Approximately 50% reported postponing or canceling social events, and 41.5% were avoiding crowded places. Practicing precautionary behaviors associated strongly with perceived risk and response efficacy of the behavior. Conclusions: Our study confirmed the significance of the psychological responses, which associated with behavioral responses and significantly influenced the public's level of public health emergency preparedness regarding the COVID-19 pandemic. This result has consequences not only for implementing public health strategies for the pandemic but also for understanding future emerging infectious diseases.

Safety Behaviors to Reduce Risk of Using Chemical Household Products: An Application of the Risk Perception Attitude Framework

Various chemical household products (CHPs) can make life more convenient; however, CHP users have higher rates of chemical exposure and are faced with the risk of accidents associated with using these products. Safe use of CHPs requires that individuals perform safety-related behaviors such as reading and following CHP risk information. As such, it may be worthwhile to apply the Risk Recognition Attitude (RPA) framework to classify groups of CHP users and investigate whether there is a difference in the safety behaviors between them. Therefore, the objectives of this study are to (a) examine social determinants of each group in the RPA framework, (b) identify different policies that would be effective for each group, and (c) provide evidence to inform the development of effective policies and risk communication strategies that encourage safety behaviors. The study included 1537 subjects and used an ANOVA with a post-hoc Tukey test to examine practices of the four groups in terms of two safety behaviors. A multinomial logistic regression was performed to identify factors that influence the classification of the group types. The results confirmed that safety behaviors associated with using CHPs differed according to weak levels of efficacy beliefs. Two groups of particular concern for low rates of safety behaviors were those with lower education and income levels. Recommendations include (a) customized safety policies and risk communications based on RPA characteristics, (b) distinctive messaging for different groups, (c) policy support for vulnerable populations, and (d) implementing ‘user-centered’ rather than ‘substance-centered’ policies and communications for the public.

News media's framing of health policy and its implications for government communication: A text mining analysis of news coverage on a policy to expand health insurance coverage in South Korea

On August 9, 2017, South Korea announced a new measure to expand National Health Insurance (NHI) coverage, which was nicknamed "Mooncare." At the early stage of its implementation, the interpretation of a policy by social actors influences its success and the formation of social conflicts around it. This study sought to identify the strategies for interpreting Mooncare in newspapers and government documents and examine the conflicts between them. Therefore, this study used text mining methods that are well-suited to processing large amounts of natural language data. Findings revealed that, while the conservative newspaper The Chosun Ilbo tended to highlight the financial feasibility of Mooncare, the liberal newspaper The Hankyoreh emphasized the change in rationality of government from the previous administration implied by Mooncare. Additionally, medical newspapers tended to adopt the perspective of healthcare providers and to focus on the changes in the medical system that may threaten them. In contrast, general newspapers tended to adopt the perspective of Mooncare's beneficiaries. Finally, government documents were found to focus on simply introducing the benefits of Mooncare, not responding to the framings of various media. This study identified how various social actors interpreted Mooncare. The results suggest that the government should assume a more active role in the meaning making of the policy.

A puzzling pregnancy epulis with aggressive bone loss mimicking malignant neoplasm: A case report

Epulis is a benign tumor, rarely involves aggressive alveolar bone resorption. This study reported a rare case of rapid growth of pregnancy epulis with extensive alveolar bone destruction and the management of this case. A 24-year old pregnant woman at 35 weeks and 1 day of gestation presented a large asymptomatic nodular mass with severe teeth loosening at the anterior mandibular region for 4 weeks. Radiographic examination showed extensive alveolar bone resorption around the affected teeth to the apical area. After delivery, the patient received an extended resection under general anesthesia. The final histopathological analysis revealed the diagnosis of epulis. In conclusion, the rapid growth of epulis during pregnancy mimicking malignant neoplasm with aggressive alveolar bone destruction was rare and puzzling. In such cases, the histopathological and immunohistochemical examinations are the only effective method to reach the correct diagnosis and clinician should proceed with high precaution.