Journal of Preventive Medicine and Public Health

Volume 55(5); September 2022

Special Articles

The Primary Process and Key Concepts of Economic Evaluation in Healthcare: Younhee Kim, Yunjung Kim, Hyeon-Jeong Lee, Seulki Lee, Sun-Young Park, Sung-Hee Oh, Suhyun Jang, Taejin Lee, Jeonghoon Ahn, Sangjin Shin; J Prev Med Public Health. 2022;55(5):415-423. Published online August 24, 2022; DOI: https://doi.org/10.3961/jpmph.22.195

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Economic evaluations in the healthcare are used to assess economic efficiency of pharmaceuticals and medical interventions such as diagnoses and medical procedures. This study introduces the main concepts of economic evaluation across its key steps: planning, outcome and cost calculation, modeling, cost-effectiveness results, uncertainty analysis, and decision-making. When planning an economic evaluation, we determine the study population, intervention, comparators, perspectives, time horizon, discount rates, and type of economic evaluation. In healthcare economic evaluations, outcomes include changes in mortality, the survival rate, life years, and quality-adjusted life years, while costs include medical, non-medical, and productivity costs. Model-based economic evaluations, including decision tree and Markov models, are mainly used to calculate the total costs and total effects. In cost-effectiveness or costutility analyses, cost-effectiveness is evaluated using the incremental cost-effectiveness ratio, which is the additional cost per one additional unit of effectiveness gained by an intervention compared with a comparator. All outcomes have uncertainties owing to limited evidence, diverse methodologies, and unexplained variation. Thus, researchers should review these uncertainties and confirm their robustness. We hope to contribute to the establishment and dissemination of economic evaluation methodologies that reflect Korean clinical and research environment and ultimately improve the rationality of healthcare policies.

Summary

Korean summary
보건의료분야에서 경제성 평가는 의약품과 진단검사 및 치료법 등 의료기술에 대한 평가에서 널리 활용되고 있다. 본 연구에서는 경제성 평가절차를 경제성 평가 설계, 결과 산출, 비용산출, 모형 구축 및 분석, 비용-효과성 결과 제시 및 불확실성 평가와 의사 결정 단계로 나누어 주요 개념과 쟁점들을 소개하였다.

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Outbreak of carbapenem-resistant Enterobacterales at a long-term care facility in Seoul, Korea: surveillance and intervention mitigation strategies
Yoojin Park, Euncheol Son, Young June Choe, Cho Ryok Kang, Sangmi Roh, Young Ok Hwang, Sung-il Cho, Jihwan Bang
Epidemiology and Health.2023; 45: e2023057. CrossRef

Statin Intake and Gastric Cancer Risk: An Updated Subgroup Meta-analysis Considering Immortal Time Bias: Jong-Myon Bae; J Prev Med Public Health. 2022;55(5):424-427. Published online August 18, 2022; DOI: https://doi.org/10.3961/jpmph.22.209

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Abstract Summary PDF

A retrospective record-linkage study (RLS) based on medical records containing drug prescription histories involves immortal time bias (ITB). Thus, it is necessary to control for this bias in the research planning and analysis stages. Furthermore, a summary of a metaanalysis including RLSs that did not control for ITB showed that specific drugs had a preventive effect on the occurrence of the disease. Previous meta-analytic results of three systematic reviews evaluating the association between statin intake and gastric cancer risk showed that the summary hazard ratio (sHR) of the RLSs was lower than 1 and was statistically significant. We should consider the possibility of ITB in the sHR of RLSs and interpret the results carefully.

Summary

Korean summary
이차자료를 활용하여 구축한 코호트 추적연구는 immortal time bias가 개입될 개연성을 염두에 두어야 한다. 이들 연구결과들을 제외한 메타분석 결과 스타닌 복용에 따른 위암발생 위험 감소는 관련성이 없다는 결과를 도출하였다.

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Sodium-glucose cotransporter-2 inhibitors use and the risk of gout: a systematic review and meta-analysis
Shih-Wei Lai, Bing-Fang Hwang, Yu-Hung Kuo, Chiu-Shong Liu, Kuan-Fu Liao
Frontiers in Endocrinology.2023;[Epub] CrossRef

Original Articles

Knowledge and Attitudes of Indonesian General Practitioners Towards the Isoniazid Preventive Therapy Program in Indonesia: Wira Winardi, Widhy Yudistira Nalapraya, Sarifuddin Sarifuddin, Samsul Anwar, Amanda Yufika, Adityo Wibowo, Iziddin Fadhil, Hendra Wahyuni MS, Yunita Arliny, Dewi Behtri Yanifitri, Teuku Zulfikar, Harapan Harapan; J Prev Med Public Health. 2022;55(5):428-435. Published online August 5, 2022; DOI: https://doi.org/10.3961/jpmph.22.248

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Abstract PDF: Objectives
The Indonesian Ministry of Health launched isoniazid preventive therapy (IPT) in 2016, with general practitioners (GPs) at the frontline of this program. However, the extent to which GPs have internalized this program remains uncertain. The aim of this study was to identify the knowledge and attitudes of GPs towards the IPT program in Indonesia.
Methods
This study used an online, self-administered questionnaire distributed via e-mail and social messaging services. A logistic regression model was employed to identify the explanatory variables influencing the level of knowledge and attitudes toward IPT among GPs in Indonesia. An empirical analysis was conducted separately for each response variable (knowledge and attitudes).
Results
Of the 418 respondents, 128 (30.6%) had a good knowledge of IPT. Working at a public hospital was the only variable associated with good knowledge, with an adjusted odds ratio (aOR) of 1.69 (95% confidence interval [CI], 1.02 to 2.81). Furthermore, 279 respondents (66.7%) had favorable attitudes toward IPT. In the adjusted logistic regression analysis, good knowledge (aOR, 0.55; 95% CI, 0.34 to 0.89), 1-5 years of work experience (aOR, 2.09; 95% CI, 1.21 to 3.60), and having experienced IPT training (aOR, 0.48; 95% CI, 0.25 to 0.93), were significantly associated with favorable attitudes.
Conclusions
In general, GPs in Indonesia had favorable attitudes toward IPT. However, their knowledge of IPT was limited. GPs are an essential element of the IPT program in the country, and therefore, adequate information dissemination to improve their understanding is critical for the long-term viability and quality of the IPT program in Indonesia.; Summary

The Moderating Effect of Gender on the Relationship Between Self-neglect and Suicidal Ideation in Older Adults of Korea: Kyuhyoung Jeong, Daeyeon Jang, Boyoung Nam, Soyoung Kwon, Eunsol Seo; J Prev Med Public Health. 2022;55(5):436-443. Published online August 3, 2022; DOI: https://doi.org/10.3961/jpmph.22.083

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Abstract Summary PDF

Objectives
Previous studies have reported that self-neglect, which may be a sign of elder abuse, can result in suicide among older adults. The signs of self-neglect and its impact on the risk of suicide may differ by gender. Thus, this study explored the association between self-neglect and suicide risk in older Korean adults and examined the potential moderating effect of gender on this relationship.
Methods
Data were collected from 356 Korean adults aged 65 or older through an online survey. Multiple regression analysis was used to test the research hypothesis. First, the associations between 4 sub-dimensions of self-neglect (i.e., daily life management issues, personal hygiene issues, financial management issues, and relational issues) and suicidal ideation were examined. Then, the moderating effect of gender on these relationships was investigated by including interaction terms.
Results
Self-neglect was significantly associated with suicidal ideation in older adults. Aspects of self-neglect related to daily life management and relational factors were key predictors of suicidal ideation. Gender significantly moderated the effect of the relational dimension of self-neglect on suicidal ideation. The relational dimension of self-neglect was more strongly associated with suicidal ideation in older women than in older men.
Conclusions
The findings suggest the importance of screening older adults with signs of self-neglect for suicide risk. Special attention should be paid to older women who experience relational issues as a high-risk group for suicidal ideation. Public programs and support systems should be established to improve daily life management and promote social relationships among older adults.

Summary

Korean summary
본 연구는 노인의 자기방임과 자살생각의 관계에서 성별의 조절효과를 검증하는 데에 목적이 있다. 연구결과를 토대로 성별에 따른 노인의 자살위험 영향요인을 고려한 정책 개입의 필요성과 사회적 고립 완화를 위한 프로그램 도입 등을 제안하였다.

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Subgroups of self-neglect and effects on suicidal ideation among the older adults
Hyun Lee, Eunjin Lee
Development and Psychopathology.2023; : 1. CrossRef

Associations of Socioeconomic Status With Depression and Quality of Life in Patients With Hypertension: An Analysis of Data From the 2019 Community Health Survey in Korea: Hye Ri Kim, Mia Son; J Prev Med Public Health. 2022;55(5):444-454. Published online August 24, 2022; DOI: https://doi.org/10.3961/jpmph.22.214

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Abstract Summary PDF: Objectives
We aimed to identify the factors related to depression and quality of life in patients with hypertension by using multilevel regression analysis.
Methods
In 2019, 229 043 participants in the Korean Community Health Survey were selected as the study group. Individual factors were identified using data from the 2019 Community Health Survey. Regional factors were identified using data from the National Statistical Office of Korea. Multilevel regression analysis was conducted to find individual and local factors affecting depression and quality of life in patients with hypertension and to determine any associated interactions.
Results
As individual factors in patients with hypertension, women, those with lower education-levels, recipients of basic livelihood benefits, and those with poor dietary conditions showed stronger associations with depression and quality of life. As regional factors and individual-level variables in patients with hypertension, lower gross regional personal income, fewer doctors at medical institutions, and lower rates of participation in volunteer activities presented stronger associations with depression and quality of life. In addition, the associations of depression with gross regional personal income, the number of doctors at medical institutions, and dietary conditions were significantly stronger in patients with hypertension than in patients without hypertension. The associations of gender and employment status with quality of life were also significantly greater.
Conclusions
Policy interventions are needed to adjust health behaviors, prevent depression, and improve quality of life for patients with hypertension, especially for those with the risk factors identified in this study.; Summary

Korean summary
2019년 지역사회건강조사, 대한민국 통계청 자료를 통해, 다수준 회귀분석을 이용하여 고혈압 환자의 우울 및 삶의 질과 관련된 요인을 파악한 결과, 비고혈압 집단 대비 고혈압 환자의 지역총소득, 의료기관 종사 의사수, 식생활 형편이 우울과 연관성이 유의미하게 컸고, 성별, 직업수준이 삶의 질과 연관성이 유의미하게 컸다.

The Impact of Household Economic Deterioration Caused by the COVID-19 Pandemic and Socioeconomic Status on Suicidal Behaviors in Adolescents: A Cross-sectional Study Using 2020 Korea Youth Risk Behavior Web-based Survey Data: Sanggu Kang, Yeri Jeong, Eun Hye Park, Seung-sik Hwang; J Prev Med Public Health. 2022;55(5):455-463. Published online September 12, 2022; DOI: https://doi.org/10.3961/jpmph.22.241

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Abstract Summary PDF Supplementary Material

Objectives
Economic hardship has a serious impact on adolescents’ mental health. The financial impact of the coronavirus disease 2019 (COVID-19) pandemic was more severe for low-income families, and this also impacted adolescents. This study aimed to examine the associations of economic deterioration (ED) caused by the COVID-19 pandemic and low socioeconomic status (SES) with adolescents’ suicidal behaviors.
Methods
This study analyzed data from the 2020 Korea Youth Risk Behavior Web-based Survey, which included 54 948 middle and high school students. Odds ratios (ORs) of suicidal ideation, suicidal planning, and suicide attempts related to ED and SES were calculated using multivariable logistic regression. We calculated relative excess risks due to interaction to assess additive interactions.
Results
The ORs for suicidal ideation, suicidal planning, and suicide attempts related to combined severe ED and low SES were 3.64 (95% confidence interval [CI], 3.13 to 4.23), 3.88 (95% CI, 3.09 to 4.88), and 4.27 (95% CI, 3.21 to 5.69), respectively.
Conclusions
ED and low SES were significantly associated with suicidal behaviors in adolescents. Although no significant additive interaction was found, the ORs related to suicidal ideation, suicidal planning, and suicide attempts were highest among adolescents from low-income families with severe ED. Special attention is needed for this group, considering the increased impact of economic inequality due to the COVID-19 pandemic.

Summary

Korean summary
청소년의 정신건강은 가정의 경제상황에 크게 영향을 받는다. 청소년건강행태조사(KYRBS)(2020)에 참여한 54948명의 중고등학생을 대상으로 가정의 기존 경제적 형편과 코로나19로 인한 가정경제 악화가 자살위험에 미치는 영향을 분석하였다. 그 결과 자살사고, 자살계획, 자살시도 모두 코로나19로 인한 경제상황 악화 정도가 심한 저소득층 가정 청소년에서 위험이 제일 높은 것으로 확인되었다. 코로나19(COVID-19)로 인해 심화된 경제적 불평등이 청소년 정신건강 불평등으로 이어지지 않게 하기 위한 개입이 필요하다.

Citations

Citations to this article as recorded by

Latent class analysis of health behaviors, anxiety, and suicidal behaviors among Korean adolescents
Mi-Sun Lee, Hooyeon Lee
Journal of Affective Disorders.2024; 354: 339. CrossRef
Letter to the Editor: Addressing Children’s Mental Health Issues Related to Economic Changes Caused by the COVID-19 Pandemic
Dalmacito A. Cordero
Journal of Preventive Medicine and Public Health.2023; 56(1): 95. CrossRef
Effects of COVID-19 outbreak on Korean adolescents: Impact of altered economic perception on physical activity, sedentary behavior, and stress levels in an age-, gender-, and BMI-matched study
Jisu Kim, In-Whi Hwang, Jeong-Hui Park, Youngdeok Kim, Jung-Min Lee, Sandra Celina Fernandes Fonseca
PLOS ONE.2023; 18(11): e0294270. CrossRef

The Korea Cohort Consortium: The Future of Pooling Cohort Studies: Sangjun Lee, Kwang-Pil Ko, Jung Eun Lee, Inah Kim, Sun Ha Jee, Aesun Shin, Sun-Seog Kweon, Min-Ho Shin, Sangmin Park, Seungho Ryu, Sun Young Yang, Seung Ho Choi, Jeongseon Kim, Sang-Wook Yi, Daehee Kang, Keun-Young Yoo, Sue K. Park; J Prev Med Public Health. 2022;55(5):464-474. Published online September 12, 2022; DOI: https://doi.org/10.3961/jpmph.22.299

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Abstract Summary PDF Supplementary Material

Objectives
We introduced the cohort studies included in the Korea Cohort Consortium (KCC), focusing on large-scale cohort studies established in Korea with a prolonged follow-up period. Moreover, we also provided projections of the follow-up and estimates of the sample size that would be necessary for big-data analyses based on pooling established cohort studies, including population-based genomic studies.
Methods
We mainly focused on the characteristics of individual cohort studies from the KCC. We developed “PROFAN”, a Shiny application for projecting the follow-up period to achieve a certain number of cases when pooling established cohort studies. As examples, we projected the follow-up periods for 5000 cases of gastric cancer, 2500 cases of prostate and breast cancer, and 500 cases of non-Hodgkin lymphoma. The sample sizes for sequencing-based analyses based on a 1:1 case-control study were also calculated.
Results
The KCC consisted of 8 individual cohort studies, of which 3 were community-based and 5 were health screening-based cohorts. The population-based cohort studies were mainly organized by Korean government agencies and research institutes. The projected follow-up period was at least 10 years to achieve 5000 cases based on a cohort of 0.5 million participants. The mean of the minimum to maximum sample sizes for performing sequencing analyses was 5917-72 102.
Conclusions
We propose an approach to establish a large-scale consortium based on the standardization and harmonization of existing cohort studies to obtain adequate statistical power with a sufficient sample size to analyze high-risk groups or rare cancer subtypes.

Summary

Korean summary
한국 코호트 컨소시엄(KCC)은 “2015년 한국의 생활 습관 및 환경 요인에 따른 암 기여분율” 프로젝트의 3단계 과업으로써, 본 프로젝트에 참여한 기존의 구축된 개인 코호트 연구의 연구자들을 주도로 다수의 대규모 한국 코호트 연구를 기반으로 구성되었다. 따라서 본 연구는 KCC에 포함된 한국 코호트 연구를 소개하는 것을 목표로 하였다. 또한 여러 기 확립된 국제 컨소시엄을 기반으로 빅데이터 기반 코호트 풀링 연구의 중요성을 제시하였다.

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The relationship between regional inequalities in the provision of emergency health services and other health services
Erkan Boğa
Medicine.2023; 102(45): e35930. CrossRef

The Association Between Metabolic Syndrome and Colorectal Cancer Risk by Obesity Status in Korean Women: A Nationwide Cohort Study: Seong-geun Moon, Boyoung Park; J Prev Med Public Health. 2022;55(5):475-484. Published online September 21, 2022; DOI: https://doi.org/10.3961/jpmph.22.286

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Abstract Summary PDF Supplementary Material

Objectives
This study aimed to determine the association between metabolic syndrome (MetS) and the incidence of colorectal cancer (CRC) in Korean women with obesity.
Methods
Cancer-free women (n=6 142 486) aged 40-79 years, who underwent National Health Insurance Service health examinations in 2009 and 2010 were included. The incidence of CRC was followed until 2018. The hazard ratio (HR) of MetS for the incidence of colon and rectal cancer was analyzed according to body mass index (BMI) categories, adjusting for confounders such as women’s reproductive factors. In addition, the heterogeneity of associations across BMI categories was assessed.
Results
Women with MetS were at increased risk of colon and rectal cancer compared to women without MetS (HR, 1.20; 95% confidence interval [CI], 1.16 to 1.23 and HR,1.15; 95% CI, 1.11 to 1.20), respectively. The HR of MetS for colon cancer across BMI categories was 1.12 (95% CI, 1.06 to 1.19), 1.14 (95% CI, 1.08 to 1.20), and 1.16 (95% CI, 1.12 to 1.21) in women with BMIs <23.0 kg/m², 23.0-24.9 kg/m², and ≥25.0 kg/m², respectively. The HR of MetS for rectal cancer across corresponding BMI categories was 1.16 (95% CI, 1.06 to 1.26), 1.14 (95% CI, 1.05 to 1.23), and 1.13 (95% CI, 1.06 to 1.20). The heterogeneity of associations across BMI categories was not significant in either colon or rectal cancer (p=0.587 for colon cancer and p=0.927 for rectal cancer).
Conclusions
Women with MetS were at increased risk of colon and rectal cancer. Clinical and public health strategies should be considered for primary CRC prevention with an emphasis on improving women’s metabolic health across all BMI groups.

Summary

Korean summary
한국 여성에서 대사증후군은 대장암 발생과 직장암 발생에 유의한 위험요인으로 보인다. 이는 체질량지수를 층화하고 여성력과 관련된 요인들을 보정하더라도 유의했다. 한국 여성의 대장암 및 직장암 예방을 위해 비만도에 관계 없이 대사증후군 요소를 관리하는 것이 필요하다.

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Increased risk of cancer and cancer-related mortality in middle-aged Korean women with prediabetes and diabetes: a population-based study
Thi Xuan Mai Tran, Soyeoun Kim, Huiyeon Song, Boyoung Park
Epidemiology and Health.2023; 45: e2023080. CrossRef

Social Contact Patterns Associated With Tuberculosis: A Case-control Study in Southwest Iran: Neda Amoori, Bahman Cheraghian, Payam Amini, Seyed Mohammad Alavi; J Prev Med Public Health. 2022;55(5):485-491. Published online September 30, 2022; DOI: https://doi.org/10.3961/jpmph.22.335

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Abstract PDF Supplementary Material

Objectives
Tuberculosis (TB) is a major public health concern worldwide. Social contact patterns can affect the epidemiology and risk of airborne diseases such as TB. This study was designed to investigate the social contact patterns associated with TB.
Methods
In this case-control study, groups of participants with and without TB were matched by age and sex. Participants reported the nature, location, frequency, and average duration of social contacts over 1 month. The duration and number of social and spatial contacts were compared between groups using the chi-square test and the t-test. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to quantify the relationship between social contact time and TB status. Data were analyzed using Stata version 11 statistical software. A p-value of <0.05 was considered to indicate statistical significance.
Results
In this study, 80 patients with TB and 172 control participants were included, and a total of 3545 social contacts were registered. Social contact with family members (OR, 1.72; 95% CI, 1.10 to 2.40), contact with a person with TB (OR, 1.53; 95% CI, 1.16 to 2.01), and contact at the participant’s home (OR, 1.42; 95% CI, 1.19 to 1.82) were significantly associated with TB status.
Conclusions
The duration of long-term social contact, rather than the number of contacts, may be the main contact-related factor associated with TB transmission in this population. The focus of contact-tracing efforts should be on finding and treating both family members and long-term contacts in non-household settings.

Summary

Citations

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Collaboration and involvement of village heads, public health officer, and village midwives in improving adherence of tuberculosis patients
Nixson Manurung, R. Hamdani Harahap, Fazidah A. Siregar, Lita Sri Andayani
Clinical Epidemiology and Global Health.2024; 26: 101528. CrossRef
Investigating the intensity of social contacts associated with tuberculosis: a weighted networks model
Neda Amoori, Payam Amini, Bahman Cheraghian, Seyed Mohammad Alavi
BMC Pulmonary Medicine.2023;[Epub] CrossRef

Brief Report

Effects of Forest Therapy on Psychological Improvement in Middle-aged Women in Korea: Bum-Jin Park, Won-Sop Shin, Chang-Seob Shin, Poung-Sik Yeon, Chung-Yeub Chung, Si-Hyung Lee, Dong-Jun Kim, Youn-Hee Kim, Chang-Eun Park; J Prev Med Public Health. 2022;55(5):492-497. Published online September 20, 2022; DOI: https://doi.org/10.3961/jpmph.22.086

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Abstract Summary PDF Supplementary Material

Objectives
Women experience more stress in middle age than in other periods of their lives. Therefore, health management programs that enable middle-aged women to cope with and manage stress are needed. This study investigated the psychological effects of a meditation-focused forest therapy program among 53 middle-aged women living in urban areas in Korea.
Methods
Participants were divided into 2 groups: one group underwent the program for 3 days in a forest, followed by 3 days in an urban environment, and the other group underwent the program for 3 days in the urban environment, followed by 3 days in the forest. The psychological effects of the forest therapy program were evaluated using the Profile of Mood States-Brief (POMS-B). Differences in mood state before and after the program conducted in the forest (experimental group) and in the urban environment (control group) were evaluated using the paired-samples t-test.
Results
The program in the forest significantly reduced tension, depression, anger, fatigue, and confusion among the domains of the POMS-B. The program in the urban area significantly reduced tension, but not depression, anger, fatigue, or confusion.
Conclusions
Meditation-focused forest therapy programs are expected to contribute to promoting psychological health and enhancing the quality of life of middle-aged women.

Summary

Korean summary
중년 여성이 건강을 관리할 수 있는 프로그램이 필요하다. 이 연구는 명상 중심의 산림치유 프로그램이 중년 여성의 심리적 건강 증진에 효과적인지 검증하기 위해 프로그램 시행 전후에 참가자의 기분상태(POMS-B)를 측정하여 비교하였다. 결과에 의하면 긴장, 우울, 분노, 피곤, 혼돈이 통계적으로 유의하게 감소하였다.

Citations

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Effect of Anti-Aging Standard Forest Healing Program With Multiple Visits to a Forest Facility on Cognition in Older Age Patients
Jinseok Park, Sheng-Min Wang, Dong Woo Kang, Beom Lee, Hojin Choi
Dementia and Neurocognitive Disorders.2024; 23(1): 44. CrossRef
Supporting Wellness, Resilience, and Community With Forest Therapy
Susan A Abookire, Sujata G Ayala, Nancy A Shadick
Global Advances in Integrative Medicine and Health.2024;[Epub] CrossRef
The Impact of Forest Therapy Programs on Stress Reduction: A Systematic Review
Yawei Zhang, Lu Feng, Wenjie Duan
Forests.2023; 14(9): 1851. CrossRef

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