The study aims to examine the current status and differences in the burden of disease in Korea during 2008-2018. We calculated the burden of disease for Koreans from 2008 to 2018 using an incidence-based approach. Disability adjusted life years (DALYs) were expressed in units per 100 000 population by adding years of life lost (YLLs) and years lived with disability (YLDs). DALY calculation results were presented by gender, age group, disease, region, and income level. To explore differences in DALYs by region and income level, we used administrative district and insurance premium information from the National Health Insurance Service claims data. The burden of disease among Koreans showed an increasing trend from 2008 to 2018. By 2017, the burden of disease among men was higher than that among women. Diabetes mellitus, low back pain, and chronic lower respiratory disease were ranked high in the burden of disease; the sum of DALY rates for these diseases accounted for 18.4% of the total burden of disease among Koreans in 2018. The top leading causes associated with a high burden of disease differed slightly according to gender, age group, and income level. In this study, we measured the health status of Koreans and differences in the population health level according to gender, age group, region, and income level. This data can be used as an indicator of health equity, and the results derived from this study can be used to guide community-centered (or customized) health promotion policies and projects, and for setting national health policy goals.
Summary
Korean summary
이 논문에서는 장애보정생존년수라는 지표를 활용하여 2008-2018년 한국인의 질병부담 산출결과를 제시하였으며, 성별·연령군별·질환별 질병부담 수준의 차이 뿐만 아니라 지역 및 소득수준의 사회경제적 수준에 따른 질병부담의 격차도 함께 제시하였다.
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Objectives Despite its advantages, it is not yet common practice in Korea for researchers to investigate disease associations using spatio-temporal analyses. In this study, we aimed to review health-related epidemiological research using spatio-temporal analyses and to observe methodological trends.
Methods Health-related studies that applied spatial or spatio-temporal methods were identified using 2 international databases (PubMed and Embase) and 4 Korean academic databases (KoreaMed, NDSL, DBpia, and RISS). Two reviewers extracted data to review the included studies. A search for relevant keywords yielded 5919 studies.
Results Of the studies that were initially found, 150 were ultimately included based on the eligibility criteria. In terms of the research topic, 5 categories with 11 subcategories were identified: chronic diseases (n=31, 20.7%), infectious diseases (n=27, 18.0%), health-related topics (including service utilization, equity, and behavior) (n=47, 31.3%), mental health (n=15, 10.0%), and cancer (n=7, 4.7%). Compared to the period between 2000 and 2010, more studies published between 2011 and 2020 were found to use 2 or more spatial analysis techniques (35.6% of included studies), and the number of studies on mapping increased 6-fold.
Conclusions Further spatio-temporal analysis-related studies with point data are needed to provide insights and evidence to support policy decision-making for the prevention and control of infectious and chronic diseases using advances in spatial techniques.
Summary
Korean summary
본 연구는 국내 시공간 분석을 활용한 역학연구를 체계적 문헌고찰을 통해 검토하였다. 의료이용, 형평성, 건강행동 관련 주제가 가장 많았고, 두 가지 이상의 공간분석 기법을 적용한 사례가 늘었으며, 단순 지도화를 적용한 연구가 가장 많았다.
향후 시공간 분석 결과를 이용해 질병 예방과 관리 정책에 적극적으로 활용할 필요가 있다.
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Objectives This study examined stunting at birth and its associations with physical factors of parents and children in Indonesia.
Methods This study analyzed secondary data from the national cross-sectional Indonesian Basic Health Survey 2018, conducted across 34 provinces and 514 districts/cities. Birth length data were available for 756 newborns. Univariable, bivariable, and multivariable logistic regression analyses were performed to determine associations between the physical factors of parents and children and stunting at birth.
Results In total, 10.2% of children aged 0 months were stunted at birth (10.7% of males and 9.5% of females). Stunting at birth was associated with the mother’s age at first pregnancy, parity, parents’ heights, parents’ ages, and gestational age. Children from mothers with short statures (height <145.0 cm) and fathers with short statures (height <161.9 cm) had an almost 6 times higher likelihood of being stunted at birth (adjusted odds ratio, 5.93; 95% confidence interval, 5.53 to 6.36). A higher maternal age at first pregnancy had a protective effect against stunting. However, other variables (firstborn child, preterm birth, and both parents’ ages being <20 or >35 years) corresponded to a 2-fold higher likelihood of stunting at birth compared to the reference.
Conclusions These findings provide evidence that interventions to reduce stunting aimed at pregnant females should also consider the parents’ stature, age, and parity, particularly if it is the first pregnancy and if the parents are short in stature or young. Robust programs to support pregnant females and monitor children’s heights from birth will help prevent intergenerational stunting.
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Objectives The aim of this study was to identify the association between cohabitation status and sleep quality in family members of people with dementia (PwDs).
Methods Data of 190 365 participants aged ≥19 years from the 2018 Korea Community Health Survey were analyzed. Participants were categorized according to their cohabitation status with PwDs. Multiple logistic regression and ordinal logistic regression analyses were performed to evaluate the relationship between the cohabitation status of PwDs’ relatives and sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI) and PSQI subscales.
Results Compared to participants without PwDs in their families, both cohabitation and non-cohabitation with PwDs were associated with poor sleep quality (cohabitation, male: odds ratio [OR],1.28; 95% confidence interval [CI], 1.08 to 1.52; female: OR, 1.40; 95% CI, 1.20 to 1.64; non-cohabitation, male: OR, 1.14; 95% CI, 1.05 to 1.24; female: OR, 1.23; 95% CI, 1.14 to 1.33). In a subgroup analysis, non-cohabiting family members showed the highest odds of experiencing poor sleep quality when the PwD lived alone (male: OR, 1.48; 95% CI, 1.14 to 1.91; female: OR, 1.58; 95% CI, 1.24 to 2.01). Cohabiting male and female participants had higher odds of poor subjective sleep quality and use of sleeping medications than non-cohabiting male and female participants, respectively.
Conclusions The residence of PwDs and cohabitation status may contribute to poor sleep quality among PwDs’ family members. The circumstances faced by cohabiting and non-cohabiting family members should be considered when evaluating sleep quality in family members of PwDs, and appropriate interventions may be needed to improve sleep quality in both cohabiting and non-cohabiting family members.
Summary
Korean summary
2018년 지역사회건강조사를 이용하여 190 365명을 대상으로 가족 중 치매환자 유무 및 치매환자와의 동거여부와 수면의 질 사이의 연관성을 분석하였다. 치매환자와의 동거여부와 상관없이 가족 중 치매환자가 존재하는 것은 낮은 수면의 질과 유의한 연관성이 있었다. 가족 중 치매환자가 있지만 동거하지 않는 가족 구성원의 경우 치매환자가 혼자 살 때 낮은 수면의 질과의 연관성이 가장 높게 나타났다.
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Objectives Tobacco control in Indonesia is very lenient compared to international standards. This study explored the perspectives of tobacco control stakeholders (TCSs) on the likelihood of advancing tobacco marketing regulation in Indonesia.
Methods Data were collected from TCSs who were members of the Indonesia Tobacco Control Network group in a modified Delphi study. We collected the data in 2 waves using a questionnaire that comprised a set of closed and open-ended questions. For this paper, we analysed 2 of the 3 sections of the questionnaire: (1) tobacco advertising, promotions, and sponsorship (TAPS) bans, and (2) marketing and retailing regulations. We conducted a descriptive analysis of the scores using Stata/IC.13 and summarised the comments for each item.
Results The TCSs viewed the measures/strategies across all aspects of TAPS and tobacco marketing regulation as highly desirable, but provided varied responses on their feasibility. They rated political feasibility lower than technical feasibility for most measures. Advancing TAPS measures and prohibition of selling to minors were considered more attainable by sub-national governments, while prohibition of tobacco corporate social responsibility was considered as the least feasible measure in the next 5 years.
Conclusions Despite little optimism for substantial national-level change, there is a positive expectation that sub-national governments will strengthen their tobacco control regulation. It is paramount that the government reduce tobacco industry leverage by implementing Article 5.3 of the World Health Organization Framework Convention on Tobacco Control. Extending advocacy networks beyond tobacco control groups and framing tobacco control more effectively are necessary steps.
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Objectives To develop and investigate the effectiveness of an integrative counseling intervention for enhancing social intelligence and reducing bullying behaviors among lower secondary school students in Bangkok, Thailand.
Methods An interventional mixed-method design was employed in 2 phases. Phase 1 involved the development of a qualitative method-based integrative counseling program from key informants using the eclecticism technique. In phase 2, a randomized controlled trial with a wait-list control was conducted and qualitative research was performed with students who demonstrated bullying behaviors. Demographic data, Social Intelligence Scale (SIS) scores, and Bullying-Behavior Scale (BBS) scores were collected at baseline. Changes in SIS scores and qualitative findings obtained from in-depth interviews were examined after counseling ended, and BBS scores were collected again 1 month later.
Results The developed social intelligence counseling program included eight 1-hour weekly sessions consisting of 3 components: (1) social awareness, (2) social information processing, and (3) social skills. After receiving this intervention, scores for the SIS overall (p<0.001) and all of its components (p<0.05) were significantly enhanced in the experimental group compared to the control group. Moreover, the mean BBS scores in the experimental group significantly decreased 1 month after counseling (p=0.001). With regard to the qualitative research results, the experimental students demonstrated improvements in all components of social intelligence.
Conclusions The results indicated that a preventive counseling program may enhance social intelligence, decrease bullying behaviors among lower secondary school students, and prevent further incidents of school violence. However, further studies in various population subgroups should also be performed.
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Objectives The aim of this study was to examine the geographic distribution of diabetes mortality in Japan and identify socioeconomic factors affecting differences in municipality-specific diabetes mortality.
Methods Diabetes mortality data by year and municipality from 2013 to 2017 were extracted from Japanese Vital Statistics, and the socioeconomic characteristics of municipalities were obtained from government statistics. We calculated the standardized mortality ratio (SMR) of diabetes for each municipality using the empirical Bayes method and represented geographic differences in SMRs in a map of Japan. Multiple linear regression was conducted to identify the socioeconomic factors affecting differences in SMR. Statistically significant socioeconomic factors were further assessed by calculating the relative risk of mortality of quintiles of municipalities classified according to the degree of each socioeconomic factor using Poisson regression analysis.
Results The geographic distribution of diabetes mortality differed by gender. Of the municipality-specific socioeconomic factors, high rates of single-person households and unemployment and a high number of hospital beds were associated with a high SMR for men. High rates of fatherless households and blue-collar workers were associated with a high SMR for women, while high taxable income per-capita income and total population were associated with low SMR for women. Quintile analysis revealed a complex relationship between taxable income and mortality for women. The mortality risk of quintiles with the highest and lowest taxable per-capita income was significantly lower than that of the middle-income quintile.
Conclusions Socioeconomic factors of municipalities in Japan were found to affect geographic differences in diabetes mortality.
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Objectives The purpose of this study was to investigate public preferences regarding allocation principles for scarce medical resources in the coronavirus disease 2019 (COVID-19) pandemic, particularly in comparison with the recommendations of ethicists.
Methods An online survey was conducted with a nationally representative sample of 1509 adults residing in Korea, from November 2 to 5, 2020. The degree of agreement with resource allocation principles in the context of the medical resource constraints precipitated by the COVID-19 pandemic was examined. The results were then compared with ethicists’ recommendations. We also examined whether the perceived severity of COVID-19 explained differences in individual preferences, and by doing so, whether perceived severity helps explain discrepancies between public preferences and ethicists’ recommendations.
Results Overall, the public of Korea agreed strongly with the principles of “save the most lives,” “Koreans first,” and “sickest first,” but less with “random selection,” in contrast to the recommendations of ethicists. “Save the most lives” was given the highest priority by both the public and ethicists. Higher perceived severity of the pandemic was associated with a greater likelihood of agreeing with allocation principles based on utilitarianism, as well as those promoting and rewarding social usefulness, in line with the opinions of expert ethicists.
Conclusions The general public of Korea preferred rationing scarce medical resources in the COVID-19 pandemic predominantly based on utilitarianism, identity and prioritarianism, rather than egalitarianism. Further research is needed to explore the reasons for discrepancies between public preferences and ethicists’ recommendations.
Summary
Korean summary
코로나19 대유행으로 가시화된 의료자원의 부족 상황에서 서로 다른 의료자원 배분 원칙에 대한 일반 대중의 선호를 조사한 연구이다. 제시된 여러 원칙 중에서, 공리주의, 한국인 아이덴티티, 약자우선주의에 기초한 배분 원칙이 가장 높은 선호를 보였다. 이러한 결과는, 일반 상황과 달리 감염병 대유행 상황에서는 공리주의에 기초한 배분 원칙을 강화하되 사회적 유용성도 자원 배분의 주요 원칙으로 받아들일 수 있다는 윤리학자들의 견해와는 차이를 보인다.
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Health Professional vs Layperson Values and Preferences on Scarce Resource Allocation Russell G. Buhr, Ashley Huynh, Connie Lee, Vishnu P. Nair, Ruby Romero, Lauren E. Wisk JAMA Network Open.2024; 7(3): e241958. CrossRef
What are the views of Quebec and Ontario citizens on the tiebreaker criteria for prioritizing access to adult critical care in the extreme context of a COVID-19 pandemic? Claudia Calderon Ramirez, Yanick Farmer, Andrea Frolic, Gina Bravo, Nathalie Orr Gaucher, Antoine Payot, Lucie Opatrny, Diane Poirier, Joseph Dahine, Audrey L’Espérance, James Downar, Peter Tanuseputro, Louis-Martin Rousseau, Vincent Dumez, Annie Descôtea BMC Medical Ethics.2024;[Epub] CrossRef
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Objectives The number of cases of hepatitis A virus (HAV) infections has sharply increased in Korea, especially among young adults. In this study, an HAV outbreak in a facility for disabled people was investigated, and we found epidemiological differences both between 2 different generations and between generally abled and disabled groups.
Methods We analyzed the incubation period and attack rate of an HAV outbreak and investigated the prevalence of HAV antibodies among the staff and residents of a facility for the disabled. We performed a retrospective cohort study during the HAV outbreak, which lasted from February 8 to 25, 2019, including examinations of HAV antibody tests and post-exposure HAV vaccination for the staff or residents of the facility.
Results There were 9 confirmed cases in 2 staff members and 7 residents. Among 53 people (30 staff and 23 residents), except for the 9 confirmed cases and 1 staff member with a known history of HAV infection, HAV seroprevalence was seen in 16.7% of the staff under 40 years of age and 95.2% of those over 40 years of age, while the corresponding rates in the residents were 0.0% and 58.8%, respectively.
Conclusions This result implies that it is necessary to prioritize HAV vaccination for vulnerable groups and workers of residential care facilities.
Summary
Korean summary
본 연구는 장애인 거주시설에서 발생한 A형간염 유행 사례를 다루고 있다. 그 결과 거주시설 소속의 장애인들은 종사자들보다 높은 발병률(attack rate)을 나타냈을 뿐만 아니라, 비슷한 연령의 일반 인구집단보다 낮은 항체유병률을 나타내는 것으로 확인되었다. 거주시설 소속의 장애인들과 같이 취약한 인구집단은 예방접종 이력을 확인하기 어려울 뿐만 아니라 병원체에 자연스럽게 노출 기회가 적을 수밖에 없기 때문에, 예방접종 정책 수립 시 우선 접종의 대상으로 고려될 필요가 있다.
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Elemental mercury exposure can result in significant toxicity. Source decontamination and remediation are often required after larger elemental mercury exposures, but the details of these processes are infrequently reported. In the case described herein, a 64-year-old woman and her husband were exposed to elemental mercury in their home after the husband purchased it online for the purpose of recreational barometer calibration. After the mercury reportedly spilled during the calibration process, a vacuum cleaner was used to decontaminate the affected surface; this led to extensive mercury contamination of the home. The couple was relocated from the home while remediation occurred over the course of several weeks. Vacuum cleaning of an elemental mercury spill can lead to extensive volatilization and recirculation of mercury vapor. For smaller mercury spills, careful removal of visible mercury beads by using an eyedropper, cardboard, and masking tape is recommended. Larger spills require professional decontamination and remediation and may necessitate involvement of governmental resources. Vacuum cleaning should not be used as an initial method of decontamination after elemental mercury exposure. Careful attention to source decontamination can reduce the emotional and financial costs associated with extensive remediation after elemental mercury exposure.
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