Journal of Preventive Medicine and Public Health

Volume 58(1); January 2025

Systematic Review

Effects of Physical and Mind-body Exercise on Sleep Quality in Individuals With Diabetes Mellitus: A Systematic Review and Meta‐analysis: Yohanes Andy Rias, Renny Wulan Apriliyasari, Made Satya Nugraha Gautama, Faizul Hasan, Margareta Teli, Hsiao-Yean Chiu, Ratsiri Thato; J Prev Med Public Health. 2025;58(1):1-10. Published online October 7, 2024; DOI: https://doi.org/10.3961/jpmph.24.354

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Objectives
Physical and mind-body exercises represent distinct intervention strategies that may improve sleep quality by influencing physiological and psychological factors. Nevertheless, their effectiveness in individuals with diabetes is not well-established. This systematic review and meta-analysis aimed to examine the impacts of physical and mind-body exercise interventions on sleep quality in patients with diabetes mellitus.
Methods
Six randomized controlled trials (RCTs) that met the inclusion criteria were identified from PubMed, CINAHL, Embase, Scopus, Web of Science, Cochrane, and Ovid-Medline Library. The effect size for sleep quality was calculated using the standardized mean difference (SMD) with a 95% confidence interval (CI), employing a random-effects model. Heterogeneity and publication bias were also examined, and subgroup, meta-regression, and sensitivity analyses were performed.
Results
Physical and mind-body exercise interventions significantly improved sleep quality, with an SMD of -1.040 (95% CI, -1.686 to -0.394). Subgroup analysis revealed significant differences with respect to the type of intervention (p=0.047), or its duration (p=0.282). Meta-regression analysis indicated that mean hemoglobin A1c level was the only factor to be significantly related to the effect size for sleep quality, demonstrating a negative association (p=0.033). The assessment of publication bias and the sensitivity analysis suggested that the findings were reliable and robust.
Conclusions
Physical and mind-body exercises may serve as effective interventions for patients with diabetes mellitus who experience poor sleep quality. However, to substantiate these findings, additional rigorous RCTs with larger sample sizes, longer follow-up periods, and standardized interventions are required.

Summary

Citations

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Acute and chronic effects of inspiratory muscle training in patients with type 2 diabetes mellitus: a systematic review of randomized controlled trials
Zoé Breuil-Marsal, Clémence Godek, Amandine Lotti, Patrick Feiereisen, Isabela Roque Marçal, Patricia Rehder-Santos, Juliana Cristina Milan-Mattos, Raphael Martins de Abreu
Frontiers in Sports and Active Living.2024;[Epub] CrossRef

Original Articles

The Effects of Subjective Socioeconomic Status and Social Capital on Self-rated Health and Perceived Quality of Life: A Cross-sectional Survey-based Study in a Minority Group in Iran: Rashid Ahmadifar, Nader Rajabi-Gilan, Shirzad Rostamizadeh, Nsrolah Nadimi, Parviz Sobhani, Adel Irankhah; J Prev Med Public Health. 2025;58(1):11-20. Published online October 5, 2024; DOI: https://doi.org/10.3961/jpmph.24.210

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Abstract PDF: Objectives
The purpose of this study is to examine the impact of subjective socioeconomic status and social capital on self-rated health and quality of life among a minority group in Iran.
Methods
This cross-sectional study involved 800 individuals from a minority group in Iran. The sampling method was clustering, and data collection was conducted using a questionnaire. Data analysis was performed using SPSS version 18 and Stata version 8.
Results
The results of logistic regression analysis revealed that subjective socioeconomic status (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.34 to 1.61), belonging and empathy (OR, 1.09; 95% CI, 1.03 to 1.15), and trust (OR, 1.06; 95% CI, 1.00 to 1.13) significantly impacted the quality of life. Additionally, the logistic regression analysis for factors influencing self–rated health demonstrated significant effects for the age group of 31-50 years (OR, 0.59; 95% CI, 0.38 to 0.91), gender (OR, 0.65; 95% CI, 0.46 to 0.92), academic education (OR, 2.00; 95% CI, 1.22 to 3.26), subjective socioeconomic status (OR, 1.27; 95% CI, 1.16 to 1.38), chronic disease (OR, 4.52; 95% CI, 2.49 to 8.19), belonging and empathy (OR, 1.06; 95% CI, 1.01 to 1.11), and participation (OR, 1.12; 95% CI, 1.00 to 1.24).
Conclusions
The findings indicate that bonding social capital significantly influences health levels and quality of life. Focusing on delegating local responsibilities to community members and striving to promote participation in health programs, along with increasing the socioeconomic status of minority groups, can effectively improve their health and quality of life.; Summary

Utilization of Acid Suppressants After Withdrawal of Ranitidine in Korea: An Interrupted Time Series Analysis: Jeong Pil Choi, Sangwan Kim, Jung Su Park, Mi-Sook Kim, Nam-Kyong Choi, Cheol Min Shin, Joongyub Lee; J Prev Med Public Health. 2025;58(1):21-30. Published online December 30, 2024; DOI: https://doi.org/10.3961/jpmph.24.357

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Abstract PDF: Objectives
This study was performed to evaluate the utilization patterns of acid suppressants following the withdrawal of ranitidine in Korea.
Methods
Health Insurance Review & Assessment Service (HIRA) data from January 2016 to May 2023 were utilized to assess the usage of histamine H2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) for acid-related diseases. Drug utilization was calculated for each agent based on the defined daily dose (DDD). To evaluate changes in utilization following the ranitidine recall, an interrupted time series analysis was conducted using segmented linear regression and an autoregressive integrated moving average model.
Results
Before the withdrawal of ranitidine, the DDD per 100 000 inhabitants per day was increasing by 6.9 (95% confidence interval [CI], 4.7 to 9.0) for H2RAs and by 19.3 (95% CI, 16.9 to 21.8) for PPIs each month. After the recall, H2RA utilization immediately declined by -1041.7 (95% CI, -1115.8 to -967.7), followed by a monthly increase of 6.6 (95% CI, 3.7 to 9.6) above the previous trend. PPI utilization temporarily surged by 235.2 (95% CI, 149.1 to 321.3), then displayed a monthly increase of 4.1 (95% CI, 0.7 to 7.6) on top of the pre-recall trend. Among PPIs, esomeprazole and rabeprazole demonstrated notable increases, representing the most commonly used acid suppressants in 2023.
Conclusions
PPI usage rose prominently following the withdrawal of ranitidine from the market. Considering the potential adverse effects of PPIs, further research is necessary to evaluate the public health implications of shifts in the utilization of acid suppressants.; Summary

The Development of an Assessment Instrument for Behavior Toward Hypoglycemia Risk Among Type 2 Diabetes Mellitus Outpatients in Jakarta, Indonesia: Putu Rika Veryanti, Rani Sauriasari, Ratu Ayu Dewi Sartika, Berna Elya, Muhammad Ikhsan Mokoagow; J Prev Med Public Health. 2025;58(1):31-43. Published online November 13, 2024; DOI: https://doi.org/10.3961/jpmph.24.313

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Abstract PDF: Objectives
The purpose of this study was to develop a valid and reliable instrument for assessing patients’ behavior toward the risk of hypoglycemia through self-assessment. Insufficient education and supervision of type 2 diabetes mellitus (DM) outpatients by healthcare providers is a significant concern, affecting their behavior during the treatment process. Additionally, inappropriate behavior typically increases the risk of hypoglycemia. To mitigate this risk, several studies have recommended evaluating patients’ behavior, necessitating the development of a new instrument.
Methods
The study procedures were conducted in 3 stages: instrument development (face and content validity, stage I), construct validity and reliability test (stage II), and criterion validity (stage III). Stage I involved 5 healthcare practitioners, including internal medicine doctors, nurses, dietitians, and pharmacists in hospitals and community health centers. Stage II included 20 respondents using a 1-shot test method. Stage III involved 237 type 2 DM outpatients at Central General Hospital (RSUP) in Jakarta, employing a cross-sectional design and consecutive sampling.
Results
The results indicated that the developed instrument was valid and reliable, comprising 9 domains (29 questions). These domains included behavior toward blood glucose monitoring, diet, physical activity, medication, assistance from healthcare providers, hypoglycemia management, self-care, family support, and insulin use. Furthermore, poor behavior was found to increase the risk of hypoglycemia by 2.36 times.
Conclusions
Based on these results, the developed instrument could be effectively used to evaluate behavior toward hypoglycemia among type 2 DM outpatients, confirming its validity and reliability.; Summary

Institutional Delivery in the Philippines: Does a Minimum of 8 Antenatal Care Visits Matter?: Felly Philipus Senewe, Agung Dwi Laksono, Roy Glenn Albert Massie, Leny Latifah, Syarifah Nuraini, Rozana Ika Agustiya, Jane Kartika Propiana, Wahyu Pudji Nugraheni; J Prev Med Public Health. 2025;58(1):44-51. Published online October 22, 2024; DOI: https://doi.org/10.3961/jpmph.24.245

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Abstract PDF: Objectives
This cross-sectional study investigated the association between the utilization of 8 antenatal care (ANC) visits and delivery in a healthcare institution in the Philippines, using data from the 2022 National Demographic and Health Survey.
Methods
A sample of women who had given birth within the past 3 years was selected for analysis (n=4452). The association between ANC utilization and institutional delivery was assessed using logistic regression models, covariates by relevant socio-demographic factors, and childbirth history.
Results
We found that 97.2% of respondents who completed ANC opted for institutional delivery. A higher proportion of rural residents did not undergo institutional delivery than urban residents (12.9 vs. 6.9%). The group aged 20-24 years had the highest coverage (92.8%), and the group aged 40-44 years had the lowest. Higher education levels, employment, and greater wealth were associated with higher institutional delivery rates. Divorced or widowed mothers (85.1%) and grand multiparous mothers had lower rates than other groups. Multivariable logistic regression analysis showed a significant positive association between ANC utilization and institutional deliveries after adjusting for covariates (adjusted odds ratio, 2.486; 95% confidence interval, 2.485 to 2.487; p<0.001).
Conclusions
ANC visits were associated with deliveries in institutions in the Philippines. Policymakers should promote ANC by ensuring 8 World Health Organization-recommended visits, strengthening programs, conducting community outreach, addressing access barriers, and integrating maternal health services to increase institutional births and improve maternal and infant health.; Summary

Development and Validation of an Instrument to Assess the Safe Use of Antidiabetic Medication to Prevent Hypoglycemia Requiring Hospitalization Among Ambulatory Patients With Type 2 Diabetes Mellitus in Bali, Indonesia: Made Krisna Adi Jaya, Fita Rahmawati, Nanang Munif Yasin, Zullies Ikawati; J Prev Med Public Health. 2025;58(1):52-59. Published online October 24, 2024; DOI: https://doi.org/10.3961/jpmph.24.424

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Abstract PDF: Objectives
Ambulatory patients with type 2 diabetes mellitus (T2DM) require special attention when being discharged from the hospital with anti-diabetes medication. This necessity stems primarily from the risk of adverse drug reactions, particularly hypoglycemia. However, this risk is significantly influenced by the patients’ knowledge and behavior regarding their medication use. This study aimed to develop instrument to assess the risk of medication-related hypoglycemia in ambulatory T2DM patients by clinical pharmacists.
Methods
The study was conducted using an observational design that included multiple stages. These stages involved item development through focus group discussions (FGDs), content validation by clinical pharmacists, and criterion and construct validation by ambulatory T2DM patients using a cross-sectional approach.
Results
A total of 10 question items were developed for assessment by clinical pharmacists following FGDs and content validation. Criterion and construct validation identified 8 valid question items through multivariate analysis (p<0.05). The scoring system developed demonstrated a linear relationship between the score and the number of items at risk in the instrument (p<0.05, R²=0.988). Additionally, the instrument was named “Medication-related Hypoglycemia Risk Score Assessment Tools (HYPOGLYRISK).”
Conclusions
The findings of this study suggest that HYPOGLYRISK may serve as a useful tool for clinical pharmacists to evaluate the risk of medication-related hypoglycemia in ambulatory T2DM patients. Additionally, this instrument could assist clinical pharmacists in identifying priority patients and tailoring educational services to meet their specific goals and needs.; Summary

The Impact of COVID-19 on Admissions and In-hospital Mortality of Patients With Stroke in Korea: An Interrupted Time Series Analysis: Youngs Chang, Soo-Hee Hwang, Haibin Bai, Seowoo Park, Eunbyul Cho, Dohoung Kim, Hyejin Lee, Jin Yong Lee; J Prev Med Public Health. 2025;58(1):60-71. Published online October 28, 2024; DOI: https://doi.org/10.3961/jpmph.24.432

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Abstract PDF: Objectives
This study aimed to investigate the impact of coronavirus disease 2019 (COVID-19) on admission rates and in-hospital mortality among patients with ischemic and hemorrhagic stroke.
Methods
We constructed a dataset detailing the monthly hospitalizations and mortality rates of inpatients with stroke from January 2017 to December 2021. Employing an interrupted time series analysis, we explored the impact of COVID-19 on hospitalizations and 30-day in-hospital mortality among stroke patients.
Results
The number of ischemic stroke admissions decreased by 18.5%, from 5335 to 4348, immediately following the COVID-19 outbreak (p<0.001). The in-hospital mortality rate for ischemic stroke increased slightly from 3.3% to 3.4% immediately after the outbreak, although it showed a decreasing trend over time. The number of hemorrhagic stroke admissions fell by 7.5%, from 2014 to 1864, immediately following the COVID-19 outbreak. The 30-day in-hospital mortality rate for hemorrhagic stroke initially decreased from 12.9% to 12.7%, but subsequently showed an increasing trend.
Conclusions
We confirmed that COVID-19 impacted both the admission and death rates of stroke patients. The admission rate for both ischemic and hemorrhagic strokes decreased, while in-hospital mortality increased. Specifically, in-hospital mortality from ischemic stroke rose initially after the outbreak before stabilizing. Additionally, our findings indicate variable effects based on sex, age, and socioeconomic status, suggesting that certain groups may be more susceptible. This underscores the need to identify and support vulnerable populations to mitigate adverse health outcomes.; Summary

Air Passengers’ Risk of SARS-CoV-2 Infection With a 14-Day Quarantine and Accuracy Assessment of a Symptom-based Screening System at an Airport: Toonlaya Direkwutthikun, Chanapong Rojanaworarit, Isabella Andrade, Bhanasut Hunsajarupan, Nuttawoot Photisan, Pattarasuda Sookchom, Thawabhorn Jannok, Rome Buathong; J Prev Med Public Health. 2025;58(1):72-82. Published online November 3, 2024; DOI: https://doi.org/10.3961/jpmph.24.517

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Abstract PDF: Objectives
This study aimed to validate the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, identify infection risk factors among air passengers subject to a 14-day mandatory quarantine, and evaluate the accuracy of mass symptom-based screening criteria at an airport.
Methods
This retrospective cohort study analyzed data from 116 004 air passengers who entered Thailand through Suvarnabhumi Airport in Bangkok from April 2020 to September 2020. The incidence of SARS-CoV-2 infection, risk characteristics, and accuracy indices of symptom-based screening were calculated.
Results
The overall incidence of SARS-CoV-2 was 0.5%, or 540 infections per 100 000 air passengers. Identified risk factors included sex, nationality, continent of departure, on-arrival screening results, and month of travel. Positive screening results indicated a higher risk and positive likelihood ratio for SARS-CoV-2 infection. However, the on-arrival screening criteria demonstrated low sensitivity and area under the receiver operating characteristic curve.
Conclusions
The current study confirms previous findings that the risk of SARS-CoV-2 infection during air travel is low. However, this might result from strict pre-departure screening and the SARS-CoV-2 test requirement for arriving passengers. The symptom-based screening criteria used upon arrival showed a low probability of identifying positive cases, suggesting that incorporating additional criteria could help detect asymptomatic infections. The integrated screening and quarantine model proved effective in preventing the spread of the virus into local communities.; Summary

Necessity of Analyzing the Korea Community Health Survey Using 7 Local Government Types: Seowoo Park, Haibin Bai, Jae-ryun Lee, Soomin Kim, Hyemin Jung, Jin Yong Lee; J Prev Med Public Health. 2025;58(1):83-91. Published online November 5, 2024; DOI: https://doi.org/10.3961/jpmph.24.388

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Abstract PDF: Objectives
This study examined the potential of a new analytical framework for the Korea Community Health Survey (KCHS) with classification criteria for the sub-national governmental level, the degree of urbanization including an urban-rural multimodal category, and population size as a more effective tool to address local health problems and deduce practical implications.
Methods
Retrospective survey data from 2023 KCHS were obtained. Frequency analyses were performed for self-rated good health status, current smoking status, and unmet medical needs as proxies for health status, as well as health behavior and healthcare utilization, utilizing individual weights to represent national community residents.
Results
We established a new classification of local governments into 7 types to facilitate regional comparisons. These local government types are presumably composed of populations showing statistically significant differences in demographic characteristics. There were evident differences in health status, health behavior, and healthcare utilization in comparisons of groups categorized by local government types.
Conclusions
This study suggests that regional disparities can be analyzed using a new typology of local governments. This practically effective approach could be used in decision-making for community-centered health projects in terms of community health planning. Future research should conduct analyses of KCHS data that use these 7 local government types to comprehensively reflect regional characteristics.; Summary

The Diabetogenic Effect of Statin Use May Interact With Polygenic Risk Scores for Type 2 Diabetes: Evidence From the UK Biobank: Jong Hyun Park, Kyu-Taek Lim, Jooyeon Lee, Yongjin Gil, Joohon Sung; J Prev Med Public Health. 2025;58(1):92-102. Published online December 11, 2024; DOI: https://doi.org/10.3961/jpmph.24.671

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Abstract PDF: Objectives
Statins are essential in the prevention of cardiovascular disease; however, their association with type 2 diabetes mellitus (T2DM) risk is concerning. We examined whether genetic susceptibility to T2DM modifies the association between regular statin use and T2DM risk.
Methods
This study included 447 176 individuals from the UK Biobank without baseline diabetes or major cardiovascular disease. Statin use was recorded at baseline, and T2DM incidence was determined using clinical records. Polygenic risk scores (PRS) for T2DM risk were provided by the UK Biobank. Using propensity scores adjusted for age, sex, body mass index, and comorbidities, 14 831 statin users were matched with 37 060 non-users. Cox proportional hazards models were used to estimate the interaction effect of statin use and PRS on T2DM incidence, adjusting for key confounders.
Results
In the propensity-matched cohort, 3675 of 51 891 participants developed T2DM over a mean follow-up period of 13.7 years. Within the top 5% of the PRS distribution, per 1000 person-years, the incidence of T2DM was 15.42 for statin users versus 12.18 for non-users. Among the lowest 5%, the incidence was 1.90 for statin users and 1.65 for non-users. Based on the Cox proportional hazards model, regular statin use was associated with a 1.24-fold increased T2DM risk (95% confidence interval [CI], 1.15 to 1.33). Furthermore, PRS exhibited a significant multiplicative interaction with regular statin use (odds ratio, 1.10; 95% CI, 1.02 to 1.19).
Conclusions
PRS may help identify individuals particularly susceptible to the diabetogenic effects of statins, providing a potential path for personalized cardiovascular disease management.; Summary

Association Between Geriatric Oral Health Assessment Index and Cardiovascular Disease in Korean Older Adults: Kyu-Taek Lim, Ji-won Choe, Seung-sik Hwang; J Prev Med Public Health. 2025;58(1):103-112. Published online January 14, 2025; DOI: https://doi.org/10.3961/jpmph.24.569

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Abstract PDF: Objectives
This study examined the association between oral health-related quality of life (OHRQoL), as assessed by the Geriatric Oral Health Assessment Index (GOHAI), and cardiovascular disease (CVD) outcomes among Korean older adults.
Methods
Data from 5413 participants in the Korean Longitudinal Study of Aging were analyzed. GOHAI scores were categorized as either “poor” (<40) or “not poor” (≥40). Generalized estimating equation models were used to assess the relationship between GOHAI scores and CVD prevalence, with analyses stratified by sex.
Results
Poor GOHAI score was significantly associated with elevated odds of CVD (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.07 to 1.19; p<0.001). This association was stronger in female (OR, 1.36) compared to male (OR, 1.12). Poor oral health is indicative of systemic inflammation and age-related vulnerabilities, underscoring the utility of the GOHAI as an instrument for early identification of CVD risk.
Conclusions
Poor oral health, as measured by the GOHAI, is associated with an increased risk of CVD among older adults, especially female. These findings support the use of the GOHAI as a cost-effective screening tool for the early assessment of CVD risk. Further research is warranted to explore inflammatory biomarkers and sex-specific mechanisms that could inform targeted interventions.; Summary

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