1.Comparative Analysis of Risk Assessment Tools for Infectious Diseases
Eunmi CHOI ; Darae WOO ; YoungJune CHOE ; Jungyong YEH ; Sangshin PARK
Health Policy and Management 2022;32(4):380-388
Background:
Emerging infectious diseases, such as Middle East respiratory syndrome or coronavirus disease 2019, pose a continuous threat to public health, making a risk assessment necessary for infectious disease control and prevention. Therefore, we aimed to investigate the risk assessment methods for infectious diseases used by major foreign countries and organizations.
Methods:
We conducted an investigation and comparative analysis of risk assessment and risk determination methods for infectious diseases. The risk assessment tools included the strategic toolkit for assessing risks, influenza risk assessment tool, pandemic severity assessment framework, and rapid risk assessment methodology.
Results:
The most frequently reported risk elements were disease severity, antiviral treatment, attack rate, population immunity, and basic productive ratio. The risk evaluation method was evaluated quantitatively and qualitatively by the stakeholders at each institution. Additionally, the final risk level was visualized in a matrix, framework, and x and y-axis.
Conclusion
Considering the risk assessment tools, the risk element was classified based on the duplicate of each indicator, and risk evaluation and level of risk assessment were analyzed.
2.Development of a Risk Assessment Tool for Emerging Infectious Diseases
Darae WOO ; Eunmi CHOI ; Young June CHOE ; Jungyong YEH ; Sangshin PARK
Health Policy and Management 2022;32(4):356-367
Background:
The emergence of new infectious diseases threatens public health, increasing socioeconomic damage, and national risks. This study aimed to develop an evidence-based risk assessment tool to quickly respond to new infectious diseases.
Methods:
The risk elements were extracted by reviewing the risk assessment methods of the World Health Organization, United States, Europe, United Kingdom, and Germany, and the validity and priority of elements were determined through expert meetings and Delphi surveys. Then, the scale and level for each risk element were defined and a final score calculation method according to the risk evaluation result was derived. The developed risk assessment tool was verified using data at the time of domestic transmission of an emerging infectious disease.
Results:
In case of spread of actual infectious diseases, priority is determined based on the criticality of the elements in each area of transmissibility and severity, from which the weighted score of the risk assessment is derived. Then, the risk score for each element was calculated by multiplying the average value of the risk evaluation by its weight and the evaluation risk assessment score for the two areas was calculated. At last, the final score is plotted in a matrix where the x-axis indicates the transmissibility and the y-axis the severity and plotted on the coordinate plane for time series use.
Conclusion
With respect to transmissibility and severity, this risk assessment method to respond to new and re-emerging infectious diseases enables rapid and evidence-based evaluation by quantitatively and qualitatively assessing various risk elements.
3.Determinants of Exercise Capacity in Patients With Hypertrophic Cardiomyopathy
Ji-won HWANG ; Sang-Chol LEE ; Darae KIM ; Jihoon KIM ; Eun Kyoung KIM ; Sung-A CHANG ; Sung-Ji PARK ; Sung Mok KIM ; Yeon Hyeon CHOE ; Joong Hyun AHN ; Seung Woo PARK
Journal of Korean Medical Science 2022;37(8):e62-
Background:
Reduced exercise capacity reflects symptom severity and clinical outcomes in patients with hypertrophic cardiomyopathy (HCM). The present study aimed to identify factors that may affect exercise capacity in patients with HCM.
Methods:
In 294 patients with HCM and preserved left ventricular (LV) ejection fraction, we compared peak oxygen consumption (peak VO2 ) evaluated by cardiopulmonary exercise testing as a representative parameter of exercise tolerance with clinical and laboratory data, including N-terminal pro-hormone of brain natriuretic peptide (NT-proBNP), diastolic parameters on echocardiography, and the grade of myocardial fibrosis on cardiac magnetic resonance imaging (CMR).
Results:
Median peak VO2 , was 29.0 mL/kg/min (interquartile range [IQR], 25.0–34.0). Age (estimated β = −0.140, P < 0.001), female sex (β = −5.362, P < 0.001), NT-proBNP (β = −1.256, P < 0.001), and E/e′ ratio on echocardiography (β = −0.209, P = 0.019) were significantly associated with exercise capacity. Peak VO2 was not associated with the amount of myocardial fibrosis on CMR (mean of late gadolinium enhancement 12.25 ± 9.67%LV).
Conclusion
Decreased exercise capacity was associated with age, female sex, increased NTproBNP level, and E/e′ ratio on echocardiography. Hemodynamic changes and increased filling pressure on echocardiography should be monitored in this population for improved outcomes.
4.Diagnostic Pitfall and Clinical Characteristics of Variant Versus Wild-Type Transthyretin Amyloid Cardiomyopathy in Asian Population: The Korean Nationwide Cohort Study
Darae KIM ; Jong-Chan YOUN ; Hye Won LEE ; Jaewon OH ; Jung-Woo SON ; Hyun-Jai CHO ; Seul LEE ; Nishant R. SHAH ; Michelle M. KITTLESON ; Eun-Seok JEON
Journal of Korean Medical Science 2024;39(19):e163-
Background:
Transthyretin amyloidosis cardiomyopathy (ATTR-CM) is an under-recognized cause of heart failure (HF) with clinical phenotypes that vary across regions and genotypes.We sought to characterize the clinical characteristics of ATTR-CM in Asia.
Methods:
Data from a nationwide cohort of patients with ATTR-CM from six major tertiary centres in South Korea were analysed between 2010 and 2021. All patients underwent clinical evaluation, biochemical laboratory tests, echocardiography, and transthyretin (TTR) genotyping at the time of diagnosis. The study population comprised 105 Asian ATTR-CM patients (mean age: 69 years; male: 65.7%, wild-type ATTR-CM: 41.9%).
Results:
Among our cohort, 18% of the patients had a mean left ventricular (LV) wall thickness < 12 mm. The diagnosis of ATTR-CM increased notably during the study period (8 [7.6%] during 2010–2013 vs. 22 [21.0%] during 2014–2017 vs. 75 [71.4%] during 2018–2021).Although the duration between symptom onset and diagnosis did not differ, the proportion of patients with HF presenting mild symptoms increased during the study period (25% NYHA class I/II between 2010–2013 to 77% between 2018–2021). In contrast to other international registry data, male predominance was less prominent in wild-type ATTR-CM (68.2%). The distribution of TTR variants was also different from Western countries and from Japan.Asp38Ala was the most common mutation.
Conclusion
A nationwide cohort of ATTR-CM exhibited less male predominance, a proportion of patients without increased LV wall thickness, and distinct characteristics of genetic mutations, compared to cohorts in other parts of the world. Our results highlight the ethnic variation in ATTR-CM and may contribute to improving the screening process for ATTR-CM in the Asian population.