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The Importance Of Occupational Health Service In The Era Of Vuca And The Dissemination Of Related Research Results, Muchtaruddin Mansyur 2023 Community Medicine Department, Faculty of Medicine, Universitas Indonesia

The Importance Of Occupational Health Service In The Era Of Vuca And The Dissemination Of Related Research Results, Muchtaruddin Mansyur

Occupational and Environmental Medicine Journal of Indonesia

Worldwide have been facing the era of dynamic life with the rapidly changing global situation for decades. This era is colored by volatility, uncertainty, complexity, and ambiguity (VUCA) situation that is aggravated by the COVID-19 pandemic. We have all experienced the VUCA situation with the COVID-19 Pandemic that has lasted over 2 years. The United Nations Development Programme (UNDP)1 report should be a common reference for dealing with situations that are not just uncertain but also called “uncertainty complexes”. So-called because its dimensions take on a new form that has never been seen before in human history. The complexity of …


A Work-Related Thyrotoxic Periodic Paralysis In A Worker Exposed To Heat Stress: A Case Report, Shanti Puji Lestari, Muchtaruddin Mansyur 2023 Occupational Medicine Specialist Study Program, Department of Community Medicine, Faculty of Medicine, Universitas Indonesia.

A Work-Related Thyrotoxic Periodic Paralysis In A Worker Exposed To Heat Stress: A Case Report, Shanti Puji Lestari, Muchtaruddin Mansyur

Occupational and Environmental Medicine Journal of Indonesia

Thyrotoxic Periodic Paralysis (TPP) is an uncommon disorder, characterized by the triad of acute hypokalemia, muscle paralysis, and thyrotoxicosis. Attacks are typically transient, last hours to days, and may be triggered by many conditions, including exposure to heat stress in both indoor and outdoor activities. Indoor workers, especially those working around furnaces, ovens, smelters, and boilers, are at a higher heat stress risk, even higher risk if they have other individual factors such as obesity, dehydration, slower heat acclimation, consume certain medications and presence of underlying diseases. A 48-year-old man presented a sudden onset weakness in all four limbs, associated …


A Cohort Retrospective Study Of Framingham Score And Ecg Abnormality Among Coal Mining Workers, Faizal Ablansah Anandita, Isman Firdaus, Rino Alvani Gani, Retno Asti Werdhani, Muchtaruddin Mansyur 2023 Occupational Medicine Study Program, Universitas Indonesia, Jakarta, 10310, Indonesia.

A Cohort Retrospective Study Of Framingham Score And Ecg Abnormality Among Coal Mining Workers, Faizal Ablansah Anandita, Isman Firdaus, Rino Alvani Gani, Retno Asti Werdhani, Muchtaruddin Mansyur

Occupational and Environmental Medicine Journal of Indonesia

Introduction. ECG is widely used for detecting cardiovascular disease in coal mine worker’s medical check-up. As the study has proven, coal mine workers have a double cardiovascular risk from their workplace hazard and their own medical risks as individuals. An early detection and risk assessment method is needed to predict ECG abnormalities in the future. This study will analyze the relationship between ECG abnormality and Framingham Risk Score on coal mine workers’. Methods. We examine ECG result from medical check-up of male coal worker during 2018 and 2021. Using Minnesota Code, we determine ECG abnormality categories in the 2021 result, …


The Effect Of Physical Training Program For Fitness Improvement On Sickness Absence Of Workers At A Chemical Company In Indonesia, Anita Johan, Aria Kekalih, Nuri Purwito Adi, Ambar W. Roestam, Dewi S. Soemarko 2023 Perhimpunan Dokter Kesehatan Kerja Indonesia (IDKI)

The Effect Of Physical Training Program For Fitness Improvement On Sickness Absence Of Workers At A Chemical Company In Indonesia, Anita Johan, Aria Kekalih, Nuri Purwito Adi, Ambar W. Roestam, Dewi S. Soemarko

Occupational and Environmental Medicine Journal of Indonesia

Introduction. Sickness absence, which can be caused by an unhealthy lifestyle, is an important productivity parameter for the company. Therefore, there are many wellness programs developed in the workplace in an effort to improve workers’ health, fitness, and productivity. The aim of this study was to assess the effect of a physical training program for fitness improvement (VO2 max value) on sickness absence. Methods. This study was conducted by observing the results of the workers' physical training program in the chemical company during 2018, using a cohort retrospective design. SPSS Statistics version 22.0 was used for analysis, with the chi-square …


The Analysis Of Risk Factors Affecting The Proportion Of Standard Threshold Shift Among Manufacturing Workers, Firly Ratsmita, Muhammad Ilyas, Liem Jen Fuk, Dewi S. Soemarko, Levina Chandra 2023 Occupational Medicine Specialist Program, Faculty of Medicine, Universitas Indonesia, Jakarta 10310, Indonesia.

The Analysis Of Risk Factors Affecting The Proportion Of Standard Threshold Shift Among Manufacturing Workers, Firly Ratsmita, Muhammad Ilyas, Liem Jen Fuk, Dewi S. Soemarko, Levina Chandra

Occupational and Environmental Medicine Journal of Indonesia

Introduction. About 82% of cases of hearing loss due to employment occur in workers in the manufacturing sector. The prevalence of hearing loss has a permanent impact that can be detected by standard threshold shift (STS). The aim of the study was to determine the relationship between individual and occupational risk factors on the proportion of STS. Methods. The research was a cross-sectional study on employees with noise exposure. The independent variables include individual factors such as age, history of hypertension, history of diabetes mellitus, smoking, body mass index, and occupational factors such as the history of chemical exposures, working …


Could Hypertension In Radiographers Associated With Low Ionizing Radiation Exposure? An Evidence-Based Case Report, Rita I. Wijaya, Levina C Khoe, Muchtaruddin Mansyur 2023 Occupational Medicine Specialist Study Program, Faculty of Medicine Universitas Indonesia, Jakarta.

Could Hypertension In Radiographers Associated With Low Ionizing Radiation Exposure? An Evidence-Based Case Report, Rita I. Wijaya, Levina C Khoe, Muchtaruddin Mansyur

Occupational and Environmental Medicine Journal of Indonesia

Low-dose ionizing radiation exposure (


Development Of Food-Based Recommendation And Nutrient-Dense Meal For Female Shift Workers In West Java, Indonesia, Shanti Puji Lestari, Nuri Purwito Adi, Umi Fahmida, Dian Kusuma Dewi, Muchtaruddin Mansyur 2023 Occupational Medicine Specialist Study Program, Department of Community Medicine, Faculty of Medicine, Universitas Indonesia

Development Of Food-Based Recommendation And Nutrient-Dense Meal For Female Shift Workers In West Java, Indonesia, Shanti Puji Lestari, Nuri Purwito Adi, Umi Fahmida, Dian Kusuma Dewi, Muchtaruddin Mansyur

Occupational and Environmental Medicine Journal of Indonesia

Introduction. Some manufacturing industries employ not only male workers but also female workers, who are required to undergo shift work. Given the altered eating habits as well as metabolic and endocrine profiles of shift workers, this will affect their nutritional needs. Considering that anemia that occurs in female workers is primarily nutritional anemia, this becomes a challenge in the field of occupational nutrition, especially in terms of preparing food for female workers in accordance with their nutritional needs. The aim of the study is to develop a set of FBR for female shift workers using the Linear Programming (LP) approach. …


Living Healthier: A Grounded Theory Of Older Adults With Prehypertension, Junjira Seesawang, Pulawit Thongtang 2023 Prachomklao College of Nursing, Phetchaburi Province, Faculty of Nursing, Praboromarajchanok Institute, Phetchaburi 76000, Thailand

Living Healthier: A Grounded Theory Of Older Adults With Prehypertension, Junjira Seesawang, Pulawit Thongtang

Journal of Health Research

Background: To prevent hypertension and long-term risk of cardiovascular events, older adults with prehypertension have to adhere to preventive behaviors. Little is known about the experience of adherence to preventive behavior among older adults with prehypertension.

Method: A constructivist grounded theory approach was used to develop a model explaining the process of adherence to preventive behavior among older adults with prehypertension living in Thailand. Participants were recruited using purposive and theoretical samplings from two primary health care units in Western Thailand. Semi-structured interviews were conducted with 26 participants. All interview data collection was recorded, transcribed, and analyzed simultaneously. Initial and …


Hand Hygiene Behaviors Associated With Peritoneal Dialysis-Related Infection, Piyaporn Towannang, Aurawamon Sriyuktasuth, Doungrut Wattanakitkrileart, Talerngsak Kanjanabuch 2023 Faculty of Nursing, Mahidol University, Bangkok, Thailand

Hand Hygiene Behaviors Associated With Peritoneal Dialysis-Related Infection, Piyaporn Towannang, Aurawamon Sriyuktasuth, Doungrut Wattanakitkrileart, Talerngsak Kanjanabuch

Journal of Health Research

Background: Hand hygiene (HH) is an effective strategy to prevent infections. This study aimed to explore the association between HH behavior among peritoneal dialysis (PD) patients or caregivers and PD-related infection.

Method: A single-center, cross-sectional study was conducted among PD patients and primary caregivers of totally-dependent PD patients. Data were collected through a participant information form and three different questionnaires about knowledge of HH, facilities for HH, and HH behavior. Documentation of PD-related infections were obtained from patients’ medical records during the last 12 months. Descriptive statistics and binary logistic regression were used to analyze the data.

Results: A total …


Effect Of The Culturally Tailored Diabetes Prevention Program For At-Risk Thai Muslim People In Semi-Urban Areas, Yuparat Odglun, Kitti Sranacharoenpong, Nattvara Nirdnoy 2023 Graduate Student in Doctor of Philosophy Program in Nutrition, Faculty of Medicine Ramathibodi Hospital and Institute of Nutrition, Mahidol University, Nakhon Pathom, Thailand

Effect Of The Culturally Tailored Diabetes Prevention Program For At-Risk Thai Muslim People In Semi-Urban Areas, Yuparat Odglun, Kitti Sranacharoenpong, Nattvara Nirdnoy

Journal of Health Research

Background: Lifestyle intervention is effective in preventing type 2 diabetes mellitus (T2DM). The efficacy of intervention components across different sociocultural settings is relevant for real world implementation. Thus, this study aimed to evaluate the effectiveness of a culturally tailored diabetes prevention program (CTDPP) for at-risk Muslim people in Thailand.

Method: The CTDPP was developed and culturally adapted based on formative research. Participants at risk for diabetes were recruited and randomly assigned to either the intervention group (n=60) or the control group (n=59). Study group subjects participated in the CTDPP for 3 months. Control group subjects received only routine self-care recommendations …


Association Of Omega 3 Polyunsaturated Fatty Acids With Incident Chronic Kidney Disease: Pooled Analysis Of 19 Cohorts, Kwok Leung Ong, Matti Marklund, Liping Huang, Kerry-Anne Rye, Nicholas Hui, Xiong-Fei Pan, Casey M Rebholz, Hyunju Kim, Lyn M Steffen, Anniek C van Westing, Johanna M Geleijnse, Ellen K Hoogeveen, Yun-Yu Chen, Kuo-Liong Chien, Amanda M Fretts, Rozenn N Lemaitre, Fumiaki Imamura, Nita G Forouhi, Nicholas J Wareham, Anna Birukov, Susanne Jäger, Olga Kuxhaus, Matthias B Schulze, Vanessa Derenji de Mello, Jaakko Tuomilehto, Matti Uusitupa, Jaana Lindström, Nathan Tintle, William S Harris, Keisuke Yamasaki, Yoichiro Hirakawa, Toshiharu Ninomiya, Toshiko Tanaka, Luigi Ferrucci, Stefania Bandinelli, Jyrki K Virtanen, Ari Voutilainen, Tharusha Jayasena, Anbupalam Thalamuthu, Anne Poljak, Sonia Bustamante, Perminder S Sachdev, Mackenzie K Senn, Stephen S Rich, Michael Y Tsai, Alexis C Wood, Markku Laakso, Maria Lankinen, Xiaowei Yang, Liang Sun, Huaixing Li, Xu Lin, Christoph Nowak, Johan Ärnlöv, Ulf Risérus, Lars Lind, Mélanie Le Goff, Cécilia Samieri, Catherine Helmer, Frank Qian, Renata Micha, Adrienne Tin, Anna Köttgen, Ian H de Boer, David S Siscovick, Dariush Mozaffarian, Jason Hy Wu 2023 The Texas Medical Center Library

Association Of Omega 3 Polyunsaturated Fatty Acids With Incident Chronic Kidney Disease: Pooled Analysis Of 19 Cohorts, Kwok Leung Ong, Matti Marklund, Liping Huang, Kerry-Anne Rye, Nicholas Hui, Xiong-Fei Pan, Casey M Rebholz, Hyunju Kim, Lyn M Steffen, Anniek C Van Westing, Johanna M Geleijnse, Ellen K Hoogeveen, Yun-Yu Chen, Kuo-Liong Chien, Amanda M Fretts, Rozenn N Lemaitre, Fumiaki Imamura, Nita G Forouhi, Nicholas J Wareham, Anna Birukov, Susanne Jäger, Olga Kuxhaus, Matthias B Schulze, Vanessa Derenji De Mello, Jaakko Tuomilehto, Matti Uusitupa, Jaana Lindström, Nathan Tintle, William S Harris, Keisuke Yamasaki, Yoichiro Hirakawa, Toshiharu Ninomiya, Toshiko Tanaka, Luigi Ferrucci, Stefania Bandinelli, Jyrki K Virtanen, Ari Voutilainen, Tharusha Jayasena, Anbupalam Thalamuthu, Anne Poljak, Sonia Bustamante, Perminder S Sachdev, Mackenzie K Senn, Stephen S Rich, Michael Y Tsai, Alexis C Wood, Markku Laakso, Maria Lankinen, Xiaowei Yang, Liang Sun, Huaixing Li, Xu Lin, Christoph Nowak, Johan Ärnlöv, Ulf Risérus, Lars Lind, Mélanie Le Goff, Cécilia Samieri, Catherine Helmer, Frank Qian, Renata Micha, Adrienne Tin, Anna Köttgen, Ian H De Boer, David S Siscovick, Dariush Mozaffarian, Jason Hy Wu

Faculty, Staff and Students Publications

OBJECTIVE: To assess the prospective associations of circulating levels of omega 3 polyunsaturated fatty acid (n-3 PUFA) biomarkers (including plant derived α linolenic acid and seafood derived eicosapentaenoic acid, docosapentaenoic acid, and docosahexaenoic acid) with incident chronic kidney disease (CKD).

DESIGN: Pooled analysis.

DATA SOURCES: A consortium of 19 studies from 12 countries identified up to May 2020.

STUDY SELECTION: Prospective studies with measured n-3 PUFA biomarker data and incident CKD based on estimated glomerular filtration rate.

DATA EXTRACTION AND SYNTHESIS: Each participating cohort conducted de novo analysis with prespecified and consistent exposures, outcomes, covariates, and models. The results were …


Review Of Alcohol And Drug Treatment For Aboriginal And Torres Strait Islander Peoples, Marguerite Tracy, Bradley Freeburn, Kylie Lee, Julie Woods, Kate Conigrave 2023 The University of Sydney

Review Of Alcohol And Drug Treatment For Aboriginal And Torres Strait Islander Peoples, Marguerite Tracy, Bradley Freeburn, Kylie Lee, Julie Woods, Kate Conigrave

Journal of the Australian Indigenous HealthInfoNet

This review provides an overview of treatments for problem alcohol and other drug (AOD) use for Aboriginal and Torres Strait Islander people. It includes information on the available research and discusses core principles for providing treatment. The review outlines how effective mainstream treatment approaches can be adapted to be more suitable for Aboriginal and Torres Strait Islander ways of being or worldview. It also highlights that services, such as those offered by Aboriginal community controlled health organisations are in a unique position to offer culturally secure treatment approaches. The barriers to accessing treatment are discussed as well as recommendations for …


Identification Of Cancer Related Risk And Protective Factors For American Indian Youth: A Mixed Studies Review, Melanie Nadeau, Kathryn Wise, Vianca Farfan Cuela, Devon Olson, Karan Saravana 2023 University of North Dakota

Identification Of Cancer Related Risk And Protective Factors For American Indian Youth: A Mixed Studies Review, Melanie Nadeau, Kathryn Wise, Vianca Farfan Cuela, Devon Olson, Karan Saravana

Indigenous Health Faculty Publications

Introduction: Many causes of cancer related morbidity and mortality can be traced back to childhood behaviors. The culmination of cancer related risk and protective factors impacting the health and wellbeing of American Indian youth is unknown. The aim of this Mixed Studies Review was to identify cancer related risk and protective factors among American Indian youth. Results will be shared with Tribal communities to inform surveillance efforts.

Methods: A Mixed Studies Review process was deemed most appropriate for the search process and data collection. 7 databases were included in the search along with 3 databases that were hand searched. Google …


Neighborhood Condition Prevalence Rates Correlate With Covid-19 Mortality In Milwaukee County, Wisconsin, George L. Morris III 2023 Ascension Columbia St. Mary’s Hospital; Imperial College of London

Neighborhood Condition Prevalence Rates Correlate With Covid-19 Mortality In Milwaukee County, Wisconsin, George L. Morris Iii

Journal of Patient-Centered Research and Reviews

Purpose: We sought to determine if census tract-level (ie, neighborhood) COVID-19 death rates in Milwaukee County correlated with the census tract-level condition prevalence rates (CPRs) for individual COVID-19 mortality risk.

Methods: This study used Milwaukee County-reported COVID-19 death rates per 100,000 lives for the 296 census tracts within the county to perform a linear regression with individual COVID-19 mortality risk CPR, mean age, racial composition of census tract (by percentage of non-White residents), and poverty (by percentage within census tract), followed by multiple regression with all 7 CPRs as well as the 7 CPRs combined with the additional demographic variables. …


Antibody-Dependent Enhancement Activity Of A Plant-Made Vaccine Against West Nile Virus, Amber M. Paul, Haiyan Sun, Dhiraj Acharya, Huafang Lai, Junyun He, Fengwei Bai, Qiang Chen 2023 University of Southern Mississippi

Antibody-Dependent Enhancement Activity Of A Plant-Made Vaccine Against West Nile Virus, Amber M. Paul, Haiyan Sun, Dhiraj Acharya, Huafang Lai, Junyun He, Fengwei Bai, Qiang Chen

Publications

West Nile virus (WNV) causes annual outbreaks globally and is the leading cause of mosquito-borne disease in Unite States. In the absence of licensed therapeutics, there is an urgent need to develop effective and safe human vaccines against WNV. One of the major safety concerns for WNV vaccine development is the risk of increasing infection by related flaviviruses in vaccinated subjects via antibody-dependent enhancement of infection (ADE). Herein, we report the development of a plant-based vaccine candidate that provides protective immunity against a lethal WNV challenge mice, while minimizes the risk of ADE for infection by Zika (ZIKV) and dengue …


I Don't Believe A Person Has To Die When Trying To Get High: Overdose Prevention And Response Strategies In Rural Illinois, Suzan M. Walters, Marisa Felsher, David Frank, Jessica Jaiswal, Tarlise Townsend, Brandon Muncan, Alex S. Bennett, Samuel R. Friedman, Wiley Jenkins, Mai T. Pho, Scott Fletcher, Danielle C. Ompad 2023 New York University

I Don't Believe A Person Has To Die When Trying To Get High: Overdose Prevention And Response Strategies In Rural Illinois, Suzan M. Walters, Marisa Felsher, David Frank, Jessica Jaiswal, Tarlise Townsend, Brandon Muncan, Alex S. Bennett, Samuel R. Friedman, Wiley Jenkins, Mai T. Pho, Scott Fletcher, Danielle C. Ompad

College of Population Health Faculty Papers

BACKGROUND: Overdose is a leading cause of morbidity and mortality among people who inject drugs. Illicitly manufactured fentanyl is now a major driver of opioid overdose deaths.

METHODS: Semi-structured interviews were conducted with 23 participants (19 persons who inject drugs and 4 service providers) from rural southern Illinois. Data were analyzed using constant comparison and theoretical sampling methods.

RESULTS: Participants were concerned about the growing presence of fentanyl in both opioids and stimulants, and many disclosed overdose experiences. Strategies participants reported using to lower overdose risk included purchasing drugs from trusted sellers and modifying drug use practices by partially injecting …


Providers’ Stigmas And The Effects On Patients With Opioid Use Disorder: A Scoping Review, Peyton Mashni, Sarah Beth Bell, F. Douglas Scutchfield MD, Lauren E. Robinson 2023 University of Kentucky

Providers’ Stigmas And The Effects On Patients With Opioid Use Disorder: A Scoping Review, Peyton Mashni, Sarah Beth Bell, F. Douglas Scutchfield Md, Lauren E. Robinson

Journal of Appalachian Health

Introduction: One of the most prevalent, dangerous stigmas in health care is the complex bias toward patients with opioid use disorder (OUD). This stigma damages the vital patient–provider relationship, further perpetuating the opioid epidemic.

Purpose: Unfortunately, research on the relationship between OUD and provider stigma is greatly lacking. To fill this gap, the present in-depth study undertakes a scoping review of research on providers’ stigma toward OUD in order to determine how enacted stigma affects treatment plans.

Methods: Four databases were used to identify articles published from 1999 to 2021. A comprehensive search strategy was developed through a collaborative process …


The Relationship Between Psychosocial Factors, Self-Care, And Blood Sugar In An Appalachian Population, Brittany L. Smalls, Md. Tofial Azam, Madeline Dunfee, Philip M. Westgate, Susan C. Westneat, Nancy Schoenberg 2023 University of Kentucky

The Relationship Between Psychosocial Factors, Self-Care, And Blood Sugar In An Appalachian Population, Brittany L. Smalls, Md. Tofial Azam, Madeline Dunfee, Philip M. Westgate, Susan C. Westneat, Nancy Schoenberg

Journal of Appalachian Health

Introduction: Appalachian residents are more likely than other populations to have Type 2 Diabetes Mellitus (T2DM) and to experience more severe complications from the disease, including excess and premature mortality.

Methods: This study examines health alongside sociodemographic factors, psychosocial factors (including knowledge, empowerment, social support/function, religiosity, distress), and perceived problems in diabetes management that may influence self-care and HbA1c among vulnerable rural residents. A survey of a community–based sample of 356 adults with diagnosed diabetes or HbA1c > 6.5 was conducted in six counties in Appalachian Kentucky.

Results: Findings suggest that neither religiosity nor social support/function mediate/moderate the relationship between psychosocial …


Racial Differences In Perceived Risk And Sunscreen Usage, Rebecca Fliorent, Alicia Podwojniak, Lianne Adolphe, Katharine Milani 2023 Rowan University

Racial Differences In Perceived Risk And Sunscreen Usage, Rebecca Fliorent, Alicia Podwojniak, Lianne Adolphe, Katharine Milani

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Background Although White individuals have higher incidence of melanoma, clinical outcomes are worse among patients with skin of color. This disparity arises from delayed diagnoses and treatment that are largely due to clinical and sociodemographic factors. Investigating this discrepancy is crucial to decrease melanoma-related mortality rates in minority communities. A survey was used to investigate the presence of racial disparities in perceived sun exposure risks and behaviors. Methods A survey consisting of 16 questions was deployed via social media to assess skin health knowledge. Over 350 responses were recorded, and the extracted data were analyzed using statistical software. Results Of …


Impact Of Enteropathogens On Faltering Growth In A Resource-Limited Setting, Furqan Kabir, Junaid Iqbal, Zehra Jamil, Najeeha Talat Iqbal, Fatima Aziz, Adil Kalam, Sahrish Muneer, Aneeta Hotwani, Sheraz Ahmed, Fayyaz Umrani, Sana Syed, Kamran Sadiq, Syed Asad Ali 2023 Aga Khan University

Impact Of Enteropathogens On Faltering Growth In A Resource-Limited Setting, Furqan Kabir, Junaid Iqbal, Zehra Jamil, Najeeha Talat Iqbal, Fatima Aziz, Adil Kalam, Sahrish Muneer, Aneeta Hotwani, Sheraz Ahmed, Fayyaz Umrani, Sana Syed, Kamran Sadiq, Syed Asad Ali

Department of Paediatrics and Child Health

Introduction: Environmental enteropathy is an important contributor to childhood malnutrition in the developing world. Chronic exposure to fecal pathogens leads to alteration in intestinal structure and function, resulting in impaired gut immune function, malabsorption, and growth faltering leading to environmental enteropathy.
Methods: A community-based intervention study was carried out on children till 24 months of age in Matiari district, Pakistan. Blood and fecal specimens were collected from the enrolled children aged 3-6 and 9 months. A real-time PCR-based TaqMan array card (TAC) was used to detect enteropathogens.
Results: Giardia, Campylobacter spp., enteroaggregative Escherichia coli (EAEC), Enteropathogenic Escherichia coli (EPEC), …


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